Joseph Ting, MBBS MSc (Lond) BMedSc PGDipEpi DipLSTHM FACEM.
Adjunct associate professor, School of Public Health and Social Work Queensland University of Technology, Brisbane, Clinical senior lecturer, Division of Anaesthesiology and Critical Care, University of Queensland Medical School, Brisbane. Acute Care Programme, Mater Research Institute, The University of Queensland, and Division of Critical Care and Anaesthesiology, Mater Health Services, South Brisbane, QLD

By Dr Joseph Ting – On returning to Brisbane as Antarctic Expedition doctor 12 months ago, I sought the infusion of fertile green to clear the anaemic ice-white mind fog incited by my lengthy immersion “On the Ice.” 

 

I lay spreadeagled to try match my overheated form to the sparse shade conferred by the desiccated crown of my favourite curtain-fig tree. 

 

In my struggle, anger welled towards “The Tree,” a familiar friend who had been far less stingy with its protective embrace in past years. 

 

I read Anne Bronte’s “The Arbour” aloud to enliven the thirsty curtain-fig in the new year to be in 2019:  

 

 

I’ll rest me in this sheltered bower, 

And look upon the clear blue sky, 

That smiles upon me through the trees, 

Which stand so thick clustering by; 

 

And view their green and glossy leaves, 

All glistening in the sunshine fair; 

And list the rustling of their boughs, 

So softly whispering through the air. 

 

 

Alas Earth’s furnace continues to inflict searing heat, extreme weather, stress for its crops, human and animal life. As 2019 comes to a stop, unquenchable bush fires and water shortages engulfs vast swathes of Australia. 

 

As Mother Earth suffocates and overheats, so “The Tree” is now a bare shadow of its proud self. I mourned its downfall with Dorothea MacKellar’s “My Country:” “The Tree’s” demise leads to…. 

 

 

Her pitiless blue sky,  

When, sick at heart, around us  

We see the cattle die. 

 

The bush fire sky had stretched for weeks into the hazed horizon, an unbreathable canvas upon which humanity’s bleak future is cloaked in a dirty nothingness. Lest we forget the harms we continue to inflict, and compelled to Mother Earth a break in 2020.  

 

This interlude reminds me, a consultant emergency physician, of the tug of war between caring for the natural world and resource intensive health care that degrades the environment and depletes non-renewable resources. I’d propose the conciliation of the care of ill and injured humanity as being compatible with care of the world, as it applies to the Mater Hospital Brisbane where I work. 

 

 

 

Mater Health in South Brisbane comprises adult, adolescent and young person, maternity/ women’s health, neonatology and paediatric services. Established by the Sisters of Mercy to support the healthcare needs of the Brisbane community in 1911, the original Mater hospital was replaced in 1981 and now features a 24 hour adult emergency department, intensive and coronary care, day surgery, day oncology and day respite, as well as busy medical, cancer and surgical units. 

The precinct’s total bed census is 834, with the hospital-specific allocation being n=196 (Mater Hospital Brisbane), Mater Young Adult Health Centre Brisbane (24), Mater Centre for Neurosciences (63), Mater Private Hospital Brisbane (281), Mater Mothers’ Hospital(124), Mater Mothers’ Private Brisbane (121) and Mater Children’s Private Brisbane (25). For 2016, Mater in South Brisbane discharged 95, 551 patients after 262, 422 patient days, with the average length of admission being 2.75 days.1 

 

Mater released its inaugural Environmental Sustainability Policy in 2011, with an update in Oct 2019. 2, 3 Mary Mackillop’s and the Sisters of Mercy legacy of charity, altruism and health care rendered to all-comers without fear nor favour still resonates today. 

Laudato Si, Pope Francis’ Encyclical, 4 is integral to Mater’s approach to the “care of our (humanity’s) common home.” The threat of climate change is highlighted on page 1 of Mater’s Environmental Sustainability prioritiesand promulgated on Mater’s website.5 

Mater’s Mission5 is uniquely underpinned by Pope Francis’ 2015 encyclical Laudato Si, on Care for Our Common Home, declaring the governing paradigm to be that: 

 “We are the stewards of creation and have the responsibility to hand on to the next generation, an earth that is in at least as good a condition as the one we receive.”  

 

Mater argues for “keeping in mind the lessons of the Indigenous experience and the teaching of Pope Francisrecognising and embracing its social, environmental and economic responsibilities.” The cross-spiritual compatibility between Pope Francis’ empathy for the world-at-large4 and Aboriginal wisdom in successful eco-stewardship of Australia over the millennia is insightful. The latter could include local adaptations for ecologically-minded landscape and water resource governance. These measures lead to public health benefits from reducing heat stress, bushfire outbreaks and land-use degradation on our dry hot continent. Indeed, Canada’s National Collaborating Centre for Aboriginal Health6 argues that now more than ever, Indigenous knowledge in food and water security, climate change and health are needed for collective survival in a rapidly changing world. 

 

Mater is committed to reducing emissions and minimising waste. Indeed, it continues to “develop and embed environmental sustainability strategy, planning and eco-efficient practices into all aspects of its ministries.” To date, over 200 initiatives have been pursued across the themes of energy, waste, water, transport, facilities, procurement and staff engagement.  This speaks volumes to Mater’s conviction that sustainable healthcare should deeply engage staff and patients at a humanitarian and spiritual level. In my mind, ministering to counter the rapid degradation of the natural world resonates as a clarion call to arms.   

 

Pope Francis’ 2015 Encyclical4 declares: 

· the intimate relationship between the poor and the fragility of the planet, 

· the conviction that everything in the world is connected, 

· the critique of new paradigms and forms of power derived from technology, 

· the call to seek other ways of understanding the economy and progress, 

· the value proper to each creature, 

· the human meaning of ecology, 

· the need for forthright and honest debate, 

· the serious responsibility of international and local policy, 

· the throwaway culture and the proposal of a new lifestyle. 

 

Francis4 reminds us that the ecological catastrophe of the Anthropocene that threatens humanity, indeed all life on Earth, is corroborated by willfully not acting upon convincing climate change and environmental science that predict a “tipping point” from which there is no possible recovery.As Richard Horton exhorts from the Vatican in the Lancet: “A rejuvenation in moral inquiry, leadership, advocacy and activism is needed. We have to understand that wisdom comes from a broad inclusive conversation, from fostering a plurality of voices.”  

 

The 2019 Mater Policy2 is seminal in stressing the overarching role of philosophy, theology, ecology and welfare of all life that should inform compassionate and ecologically sustainable care of the injured and sick.Mater has had the foresight to look beyond frontline sustainable healthcare to more prescient threats to society such as pollution and climate change, waste and the throwaway culture, climate as a common good, the issue of water, loss of biodiversity, and decline in the quality of human life, global inequality, weak responses and not soliciting a variety and balanced set of opinions.4 

In implementing its sustainability aspirations, Mater declares its priority action areas to include: 

  1. Mitigating climate change through reducing energy emissions and reduce fleet pollution: Increasing renewable energy deployment,  and transition from diesel fuel transport. Mater recently became a member of the Business Renewables Centre Australia and aims to secure cleaner energy mix through Power Purchase Agreements 

  2. Reducing water use  

  3. Procurement of more socially and environmentally sustainable products  

  4. Preventing pollution by increasing recycling rates and improving the quality of waste segregation 

  5. Engagement with staff to raise awareness for environmental stewardship Energy management strategies that include solar arrays and energy efficiency 

Mater’s ambition is to reduce carbon emissions while at the same time expanding sites and increasing the level of activity.  Existing levers which could assist this ambition include:   

  1. Mater’s ongoing requirements to: 

    1. Report to the National Pollutant Inventory 

    2. Comply with National Greenhouse and Energy Reporting Act 2007 and National Australian Built Environment Rating Scheme.  

    3. Ensure new buildings comply with the National Construction Code (1 May 2019) 

  2. Collaboration with Queensland Health’s climate change team 

  3. The global phasing out of imports of ozone-depleting refrigerants under the Montreal Protocol 

  4. Mater’s response to the Queensland Government Waste Levy (resulting in expansion of PVC, metal instrument and mixed recycling as well as the planned phasing out of polystyrene cups, campaigns, and improved sustainable procurement policies and procedures).  

  5. Phasing out polystyrene cups with BYO Cups campaign, with the auspices of the Director of Procurement working with stakeholders to develop more sustainable procurement policies and procedures 

  6. Engagement in peer learning and cross-pollination, particularly with Global Green and Healthy Hospitals Network, Doctors for the Environment, AMA-Q, Australian College of Health Service Managers, UQ Medical School, Queensland Health Climate Change Team, Queensland Nurses and Midwives Union, among others.  

As Pencheon9 argues, “the changes we are causing to our global environment now threaten everyone’s health. As such, health systems and professionals should consider environmental sustainability as part of good health and care. Climate change is only one of the global challenges we face, but the problems presented by ignoring it, and the immediate health benefits offered by addressing it, are too significant for health professionals to ignore.” 

High quality healthcare depends on addressing the social and environmental determinants of health and disease, 9 more so in rural and indigenous areas.10 Mater’s reconciling Francis’ global holistic approach to local Aboriginal expertise addresses both needs at the same time.9, 10   

Since 2010/11, Mater has taken an analytical approach to track a range of quantitative performance indicators as well as gathering qualitative feedback and input.  Monitoring (both total and per occupied bed day) has included greenhouse gas emission, energy usage, , general waste output, recycling rates and water consumption. This is congruent with Australia joining the global initiative to track progress on health and climate change.11 

 I am hopeful that the October 2019 policies and initiatives2, 3 Mater intends to roll out, uniquely underpinned by the philosophical tenets of Laudato Si and Aboriginal custodian wisdom, will lead to improved sustainability performance.      

 

 

 

 

 References: 

 1. Part 3, Our Performance, Mater Statistics. Accessed at http://2016mater.org.au/home/part-three-our-performance/mater-s-statistics on 01112019 

2. Mater Environmental Sustainability update-draft 16 Oct 2019 (Mater Document)  

3. Mater Environmental Sustainability Policy, Group Director Corporate Transformation, Released 14 Oct 2019 (Mater Document)  

4. Laudato Si, Pope Francis. Accessed at  https://www.catholic.org.au/commission-documents/bishops-commission-for-justice-ecology-and-development/laudato-si/1711-encyclical-summary/file on 01112019 

6. Greenwood M, Lindsay NM. A commentary on land, health, and Indigenous knowledge(s). Glob Health Promot 2019; 26(3_suppl): 82-86.  

7. Bodkin H. Climate change now irreversible due to warming oceans, UN body warns. 25 Sept 2019 Accessed at https://www.telegraph.co.uk/science/2019/09/25/climate-change-now-irreversible-due-warming-oceans-un-body-warns/ on 01112019 

8. Horton R. Offline: When The Lancet went to the Vatican. Lancet 2017; 389: 1500. 

9. Pencheon D. Developing a sustainable health care system: the United Kingdom experience. Med J Aust 2018; 208: 284-285e1. 

10. Seidel BM, Bell E. Health adaptation policy for climate vulnerable groups: a ‘critical computational linguistics’ analysis. BMC Public Health. 2014 28; 14: 1235. doi: 10.1186/1471-2458-14-1235. 

11. Zhang Y, Beggs PJ.  The Lancet Countdown down under: tracking progress on health and climate change in Australia. Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.01245