Coda Change – Détails, épisodes et analyse

Sonia Chanchlani shares how Doctors for the Environment Australia developed toolkits for educators and clinicians to enable practical action at the front line to work towards net zero models of healthcare.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

Sharon Desmond, Group Manager for Caring for People & Planet at Mercy Health, discusses Mercy Health's strategy for developing sustainable models of clinical care.

This session was recorded at the Sustainable Healthcare Workshop workshop at CODA22 which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

In this discussion, Nick Watts, Ramsey Awad, Sharon Desmond, Michelle Fox, & Ben McDonald answer questions from the audience of the Sustainable Healthcare Workshop, which took place at Coda22 in Melbourne, September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

The chair, Kate Charlesworth opens by explaining that the healthcare system has a big problem – we are, in effect, producing our own patients. We use huge amounts of resources; produce vast amounts of waste and have a big carbon footprint. Globally, if the healthcare system was a country, it would be the fifth biggest polluter on the planet. The irony is then of course that we're therefore contributing towards the climate crisis which is harming human health. We've seen that with storms, fires, floods, and all the associated impact they're having on our health.

We have a huge job ahead of us – to decarbonise or to get to a net zero health system.

Nick Watts, doctor, and chief sustainability office for the National Health Service in England says that he wants to discuss three things: why the NHS cares about climate change, what we can do about it and exactly what that change needs to looks like. He then goes on to explain the steps that the NHS is taking to reach net zero by 2045, and the exact steps that we need to take in order to do the same.

His three key messages are:

The climate crisis is a health care crisis.

The time for talking about stuff is over, the only thing that matters is what we are going to do about it.

Don't listen to anyone that tells you that it can't be done.

For more head to our podcast page #CodaPodcast

Beyond Zero Emissions is an independent think tank that shows through research and innovative solutions how Australia can prosper in a zero-emissions economy. Over the past 10 years we have published research on how to decarbonise sectors of the economy such as energy, transport, buildings and heavy industry.

Healthcare is a significant energy consumer - around 7% of national emissions come from healthcare facilities and services. Within this important sector, energy use holds the most emissions reduction potential, while manufacturing has the strongest 'multiplier effect' - the ability to deliver widespread benefits from decarbonisation.

We can power our healthcare sector on 100% renewable energy right now.

Energy is used in health facilities for heating water, air, running medical equipment and keeping the lights on. It is also used in vehicles transporting supplies, patients and staff. With clean technologies available now, e.g. heat pumps and electric vehicles, there are readily-available means to run our healthcare system with renewable energy.

We can power our manufacturing sector on 100% renewable energy right now.

We know what happens when global supply chains are disrupted. A strong onshore manufacturing sector is not only important for a zero-emissions economy, but for all Australian industries - including healthcare. Today, imports meet approximately 80% of domestic demand for medical devices and diagnostics, while nearly all medical technology products manufactured in Australia are exported.

When our healthcare system can source more of its construction materials, products and equipment from local suppliers, we shorten supply links, speed up transport time and provide more onshore jobs supporting this sector.

Beyond Zero Emissions is working with partner organisations around Australia to revitalise our manufacturing sector with 100% renewable energy. We're building alliances of industry, government and community to support the decarbonisation of local manufacturing and supply chains in regional hubs where it's needed most.

Resilience for healthcare depends on resilient energy and manufacturing supply chains - and achieving that means more renewable energy powering our economy.

For more head to our podcast page #CodaPodcast

Each speaker delivers a short high impact clinical case from practice ranging from conflict zones to 2 week boarding in the emergency department in India. These cases have been chosen because of the profound personal impact upon the clinician. Following the clinical cases, Ben will facilitate a debrief to explore how these clinicians prepared for, performed in, or recovered from the situations.

 

Ankur Verma opens the podcast by telling his listeners that he's going to share with them something that happened during the time that Delta was in its dreadful stages in both Australia and India.

He goes on to talk about a case that took place during the Delta wave, when minutes matter. He recounts a patient - Mrs P - who had come in gasping and immediately went into cardiac arrest, and notes that – as is often the case – she immediately became part of the ward's family. After testing positive for Covid, they then gave her a CT scan to see if she had pneumonia and subsequently put her on various experimental medications, including steroids.

She got better over the next four or five days and was weaned off the ventilator and over the next couple of days we removed her TPI (trigger point injection) but then her sugars went up. Ankur explains that just when he thought she was becoming much better, she started becoming hypoxic again and he then found out her left lung had collapsed.

She then went on to improve – and, understandably – her family were thrilled, especially her son. After a two-week rollercoaster ride, she was discharged, much to the joy of everyone involved.

At a time of great distress, Ankur explains that Mrs P reminded him and his co-workers of the power of determination and motivation, and it was through a combination of compassion and great determination and motivation that she survived.

He notes that Mrs P gave the hospital staff a ray of hope and a much-needed silver lining during what was an otherwise hellish Covid wave, and notes that he owed her more than she owed him for saving her life.

But, continues Ankur, she had other plans. She had been a ray of hope during the dreadful delta in India and the world and sadly, she died.

But Ankur says that he and his co-workers didn't lose sight of the vision and the hope that she gave them and that they continued to support each other. He concludes the podcast with an important lesson learnt: take care of yourself and those around you because when the dark times come, those people will be the ones surrounding you.

For more head to our podcast page #CodaPodcast

Bec Szabo – an obstetrician, gynaecologist, and medical educator – begins the podcast by asking the audience to go back to Melbourne with her on a journey through the looking glass. She notes that while taking her listeners to Wonderland might be a bit quirky, but that it's essential for the point of the story. Bec also wants to preface the talk with a trigger warning; and acknowledges that the subject matter of her talk might be triggering – so please do bear in mind that this talk covers Covid, ICU and pregnancy before listening.

 

As per the notion of taking her readers through the looking glass, Bec wants to take listeners back to spring 2021 – a time that Melbourne was looking down the barrel of a sixth lockdown. Known as having had one of the longest – and strictest – lockdowns in the world - people in Melbourne were tired and had done a lot. Many were already vaccinated.

 

Bec then goes on to say that she wants to talk about Covid and pregnancy and, explains to listeners that she wants to paint a picture of inequality and sexism.

 

She runs through a case of what happened shortly after the Delta strain had arrived in Melbourne – it was a time when things were changing rapidly during covid with delta things came thick and fast. A pregnant woman was admitted to hospital; it was her third child, and her two toddlers, partner and parents were all sick with Covid; and despite concerns over a post-partum haemorrhage, a healthy baby was delivered, and the woman went back to the ICU.

 

Except, says Bec, this wasn't what actually happened; what she described was a simulation, carried out in order to ensure they had everything prepared in the case that something similar happened.

 

She goes on to say that teamwork and communication are everything, but so too is listening to the voice of the patient. And that while we've heard that belonging and community and connection are important, having those values and shared goals to keep us doing what we're doing.

 

Bec closes the podcast by that we need to remember we're the captains of our soul. And that if we can be human and kind, we can deal with emotionally fraught situations.

 

 

For more head to our podcast page #CodaPodcast

In this week's podcast Liz Crowe – an advanced clinician social worker who has worked in Brisbane's major children's hospitals in intensive care, emergency departments and cancer wards - begins the podcast with the question – is all this talk of burn out, actually making us burnt out?

 

In this podcast, Liz goes on to address exactly what the term burn out actually means and discusses how the literature on burnout in healthcare workers is prolific. She discusses how healthcare presents as an occupation of high risk, distress, and despair, with an escalation of risk post pandemic. Yet, she says, burnout is not the whole story even though it is the only story being told. Liz speaks about the extensive research into burnout and what it reveals, and the risk factors for burnout, which include excessive workload, lack of control or recognition, mismatch of values, lack of meaning and emotional contagion. However, she notes that none of these are individual deficits and says that it is concerning that 'wellbeing' in healthcare is never discussed in terms of meaning making, purpose, contribution, community, stimulating work or growth and development.

 

Yet, she goes on to say, for many critical care staff these positive factors for wellbeing are found in abundance.

 

Liz also states that her research shows that people want to believe that the bad stuff happens on one side of life; the good on the other, and people want to know how they get to the other side. Whereas, she says, in reality, life is a crappy mess that sits somewhere in the middle.

 

The podcast concludes with Liz stating that purpose and community are everything, that life is messy, but some days - despite how awful we feel - we soar because of the opportunities we have. She encourages listeners to savour life, and to remember that even on the worst day of their working life, their patients are doing it tougher.

 

For more head to our podcast page #CodaPodcast

"Death is not the enemy but occasionally needs help with timing."
Peter Josef Safar (1924 – 2003) 'The Father of Modern CPR'

In this week's episode of the Coda podcast, former flight paramedic Gary Berkowitz – who previously worked in Afghanistan and now works for Queensland Ambulance Service - explores how when death is inevitable, the way of dying matters.  

To open the discussion, he addresses the fact that out of hospital emergency care practitioners are often faced with time critical decisions. He notes that fortunately, most of these situations often have clear guidelines because – generally speaking - they follow pathways with expected outcomes.

When it comes to ethics in healthcare, however, it can be a nuanced topic. For example, the decision to not commence resuscitation, or to withdraw life saving measures in a patient who appears to have no meaningful prospect of recovery, can be a difficult one. Gary goes on to note that in this environment, it's impossible to design a guideline that could encompass all the elements of such a complex decision.

In this talk Gary examines providing care to patients rather than always trying to fight death. By way of example, Gary tells listeners how he was working closely with the various western military forces, when one day they asked a favour – a young Afghani soldier had been badly burnt fighting against the Taliban, and while his treatment had begun in a military hospital, it was decided it shouldn't be continued there.

Gary was asked if he could assist transporting the soldier to a hospital in the city, and he goes on to talk about the fact that he had two options – to take the easy choice, which would have involved giving the soldier enough medication that he wouldn't have to see him suffer; or the brave choice – which would have been to give him enough medication so he wouldn't be suffering at all.

He discusses the ethics around each alternative – and how he came to sit with his final choice. Gary notes that the decision he made that day has remained with him ever since, and continues to influence his decisions in his everyday practice.

For more head to our podcast page #CodaPodcast