Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population’s interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs’ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants’ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.
Torrential rainfall following the monsoon season occurs annually in Pakistan and adversely affects health service delivery and population health. This qualitative study was undertaken in five flood-prone districts to examine district health systems’ performance during floods in Pakistan. The first of its kind study to gather an in-depth assessment of the capacity of district health systems in maintaining healthcare services during floods. Key informant interviews were conducted with 37 district stakeholders and 42 frontline healthcare providers. Nine focus group discussions were also conducted with 56 lady health workers. World Health Organization health systems’ six building blocks framework was utilized to assess the performance of district health systems. The findings illustrated increased reporting of diseases, and domestic and sexual violence against females. The damaged roads and unavailability of transportation during floods affected outreach services in the communities. The inadequate availability of funds resulted in critical gaps in the supply chain for essential medicines and supplies, impeding outreach services. Shortage of female medical staff was reported in addition to poor attention to the training of staff for disaster response. Furthermore, reporting mechansim varied across provinces with daily reporting system of acute illnesses instituted. Moreover, district health systems lacked gender-sensitive responses in responding to flood emergencies. This study identified multiple health system constraints that resulted in poor district health systems’ capacity in delivering essential healthcare services during floods. This study, therefore, highlighted a need to improve district health systems’ capacity in effectively responding to healthcare service needs during floods.
Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.
OBJECTIVE: The healthcare system accounts for 8%-10% of all greenhouse gas emissions in the United States and hospital buildings are significant contributors. Operating rooms account for 20%-33% of all hospital waste. This may contribute to significant climate change and negatively affect public health. Physicians and surgeons must act to reduce our collective carbon footprint to improve the health of our patients. The traditional graduate medical education curriculum does not routinely train future generations of physicians in healthcare sustainability. We describes a fellowship program designed to change this. DESIGN AND SETTING: The Cleveland Clinic surgical residency has implemented a unique educational program. Here we describe the 5-year results of our novel fellowship program in health care sustainability, primarily focused on greening the operating room. PARTICIPANTS: Selected General Surgery residents interested in healthcare sustainability and greening the operating room. RESULTS: We have successfully implemented a novel resident focused fellowship program in healthcare sustainability. Fellowship projects have led to significant reductions in our hospitals’ collective carbon footprint. CONCLUSIONS: Surgeons have a unique responsibility to reduce the carbon footprint of the Operating Room. Implementing a dedicated fellowship program or similar intensive educational experience in healthcare sustainability within the framework of a graduate medical education curriculum will help to ensure future generations of surgeons are thoughtful leaders in environmental stewardship.
BACKGROUND: Hurricane Maria, which hit Puerto Rico in 2017, catastrophically impacted infrastructure and severely disrupted medical services. The US Department of Veterans Affairs Caribbean Healthcare System (VA CHCS), which serves approximately 67,000 patients and has most of its facilities on the island of Puerto Rico, was able to successfully maintain operations after the hurricane. As a part of the larger VA system, VA CHCS also has a mission to support “national, state, and local emergency management, public health, safety and homeland security efforts.” The objective of this study is to better understand the ways VA and its facilities meet this mission by exploring how VA CHCS acted as a community resource following Hurricane Maria. METHODS: This study investigated experiences of five employees in critical emergency response positions for VA CHCS, Veterans Integrated Service Networks (VISN) 8, and the Office of Emergency Management. All respondents were interviewed from March to July 2019. Data were collected via semistructured interviews exploring participants’ experiences and knowledge about VA’s activities provided to the community of Puerto Rico following Hurricane Maria. Data were analyzed using thematic and in vivo coding methods. RESULTS: All respondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans, while concomitantly describing the role of VA in supporting community recovery. Three major themes emerged: continuity of operations for the San Juan VA Medical Center (VAMC) and its affiliated outpatient clinics, provision of services as a federal partner, and services provided directly to the Puerto Rican community. DISCUSSION: Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond. This case example demonstrates how a VA hospital not only continued serving its patients but, with the support from the greater VA system, also filled a wide variety of requests and resource gaps in the community. Building relationships with local VAMCs can help determine how VA could be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated regional response would benefit from involving VA as a partner during planning.
Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Metis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.
Heat-related illnesses (HRIs), such as heatstroke (HS) and heat exhaustion (HE), are common complications during Hajj pilgrims. The Saudi Ministry of Health (MoH) developed guidelines on the management of HRIs to ensure the safety of all pilgrims. This study aimed to assess healthcare workers’ (HCWs) adherence to the updated national guidelines regarding pre-hospital and in-hospital management of HRIs. This was a cross-sectional study using a questionnaire based on the updated HRI management interim guidelines for the Hajj season. Overall, compliance with HE guidelines scored 5.5 out of 10 for basic management and 4.7 out of 10 for advanced management. Medical staff showed an average to above average adherence to pre-hospital HS management, including pre-hospital considerations (7.2), recognition of HS (8.1), case assessment (7.7), stabilizing airway, breathing, and circulation (8.7), and cooling (5). The overall compliance to in-hospital guidelines for HS management were all above average, except for special conditions (4.3). In conclusion, this survey may facilitate the evaluation of the adherence to Saudi HRIs guidelines by comparing annual levels of compliance. These survey results may serve as a tool for the Saudi MoH to develop further recommendations and actions.
