Our Patients and The Planet: Studying Medicine in a Changing Climate

Emily Gentile, B.S.

During the summer after my first year in medical school, I traveled to India for a research project as a member of the global health pathway. The first thing that I noticed when I landed in India was the heat; it was oppressive and overwhelming, reaching 115 degrees Fahrenheit most days. Walking outside felt like a challenge, and both my body and brain seemed unable to work at their usual pace. On my first day shadowing in a pediatric clinic in rural Gujarat, local physicians explained that the summer was not a good time to visit because many patients stayed home due to the heat. They also told me that, during the summer months, a majority of the children seeking care presented with heat-related illnesses. The realization was striking; the health outcomes of the children, as well as their barriers to seeking care, were directly and undeniably linked to the climate in which they were living. Additionally, this conversation was a poignant reminder of the inequities that climate change creates; many of the populations who are most vulnerable to the effects of climate change made the least contributions to the drivers of climate change (1). I later learned that if the world continues with business as usual, India could see the frequency of severe heat waves increase by up to 92 times the current level (2). Rural populations in India are also particularly vulnerable to the effects of climate change due to reliance on agriculture for livelihood (3). Climate change was not a distant thought for a future time but was instead unfolding right in front of me.

After returning from India, I attended a talk that framed climate change as a social justice issue. During this session, I was finally able to process what I had seen and felt in Gujarat a few months before. We discussed the health, social, and economic inequities that climate change is already beginning to form and deepen. Medical students spoke openly about their fear and anxiety knowing all that is at risk, and the honesty and vulnerability present in that room were powerful to witness.

My discomfort with the wide-ranging impacts of climate change on health outcomes and equity inspired me to act. I co-founded UMMS Coalition for Climate Action, a student organization that seeks to fight climate change, promote sustainability, and prioritize environmental justice through education, research, and advocacy. Enthusiasm for climate action continues to grow in the UMass Medical School community, and the impact of the climate on health is now being incorporated into the medical school curriculum as a direct result of student advocacy. I also recently turned to my community and found courageous climate champions who have been dedicated to serving Worcester for years including a hub of Sunrise Movement, a youth-led organization committed to halting climate change and creating good-paying jobs (4). Finally, I found both support and strength in Medical Students for a Sustainable Future, an organization of creative, intelligent, and bold medical students who recognize climate change as a threat to health and social justice and are committed to creating a more sustainable and livable future (5). There was hope all around me, and I drew energy from others who shared both my fears and commitment to change.

I was recently confronted with the intersection between climate and health on my family medicine rotation and was reminded of the importance of approaching clinical encounters through a climate justice lens. My team treated many patients who presented with worsening asthma symptoms, and it was difficult to send these patients home with a medication knowing that I was also sending them back to the same polluted air that may have triggered their asthma exacerbation in the first place. There were small wins, however, and I learned that physicians could address the impacts of climate on individual patient’s health from the clinic. For example, one resident that I worked with wrote a letter requesting an air conditioner for a patient who was confined to her home due to a degenerative musculoskeletal disorder. Heat is already putting patients at risk, and research suggests that the northeast US is warming at the fastest rate out of all regions of the contiguous United States (6). The letter successfully secured my patient a free air conditioner, simultaneously increasing her comfort and decreasing her risk of heat-related illnesses in the summer months. This solution was not perfect as the air conditioner inevitably increases energy use, but it was the most effective and safe intervention for our patient at that time. Tackling the root causes of the worsening heat that is putting our communities at risk is another important yet daunting task, one that we must not forget or delay. It has become clear to me that climate work can be complex and emotionally overwhelming, but it is these small but meaningful moments that I have also found to be both empowering and rejuvenating.

A change in our approach to climate change is not only possible, but essential. I encourage you to use your voice to advocate for more sustainable and resilient health systems at your place of work, use your vote to support leaders who trust science and prioritize clean energy solutions, and use your actions to fight for climate justice both in and outside of the clinic. Moving forward, we must recognize the people of color and indigenous leaders who have been caring for the Earth for centuries and learn from their wisdom. We must cultivate the creativity necessary for developing climate solutions and expand our understanding of what is possible when we work together toward a common goal. Finally, we must tackle climate change with the strength and urgency required to ensure a better life for our patients, families, communities, and the generations to come, all of whom will be affected by climate change and all of whom deserve the chance for a healthier, safer, more just future. +

Emily Gentile, B.S., is a third-year medical student at the University of Massachusetts Medical School. Email: emily.gentile@umassmed.edu

References

1. Samson, J., Berteaux, D., McGill, B.J. and Humphries, M.M. (2011), Geographic disparities and moral hazards in the predicted impacts of climate change on human populations. Global Ecology and Biogeography, 20: 532-544. https:// doi.org/10.1111/j.1466-8238.2010.00632.x

2. Vimal Mishra et al. (2017), Heat wave exposure in India in current, 1.5 °C, and 2.0 °C worlds. Environ. Res. Lett. 12 124012. https://iopscience.iop.org/ article/10.1088/1748-9326/aa9388

3. World Bank 2013, Turn Down the Heat: Climate Extremes, Regional Impacts, and the Case for Resilience. A report for the World Bank by the Potsdam Institute for Climate Impact Research and Climate Analytics. Washington, DC:World Bank. License: Creative Commons Attribution—NonCommercial–NoDerivatives3.0 Unported license (CC BY-NC-ND 3.0).

4. Sunrise Movement, https://www.sunrisemovement.org/about/?ms=AboutTheSunriseMovement

5. Medical Students for a Sustainable Future, https://ms4sf.org/aboutms4sf/

6. Karmalkar AV and Bradley RS (2017), Consequences of Global Warming of 1.5 °C and 2 °C for Regional Temperature and Precipitation Changes in the Contiguous United States. PLoS ONE 12(1): e0168697. https://doi.org/10.1371/journal. pone.0168697