Climate change through the lens of an emergency physician [PODCAST]

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“The worst part of the climate crisis is that our kids, my kids, may never get to witness the most beautiful parts of our world because they may, and will, cease to exist without our action and power. As I watch my own kids looking out over the ocean on a clear, cool day in awe at the behemoth of wonder before them, I know they are the ones I am fighting the battle against the climate crisis for, and I beg you to fight too.

Beauty in the world and love of our environment and each other are not partisan issues; they are simply the components that make our lives worth living. And if that is not worth saving, then I don’t know anything that is.”

Elizabeth M. Barreras-Rivest is an emergency physician.

She shares her story and discusses her KevinMD article, “The climate crisis as viewed by an emergency physician.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Elizabeth Barreras-Rivest. She is an emergency physician, and she wrote the KevinMD article “The climate crisis as viewed by an emergency physician.” Welcome to the show.

Elizabeth M. Barreras-Rivest: Hi there, Kevin. Thank you so much for having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Elizabeth M. Barreras-Rivest: Sure. My name is Elizabeth. I’m a physician in San Diego, California. I was born and raised here in San Diego; it’s a beautiful place to live. Before my career in medicine, I did nonprofit work to support financially and environmentally sustainable educational projects in Ghana and Kenya, and I was inspired to study medicine after seeing the devastating effects of preventable, treatable illness on communities and families where I was working.

Fast forward 10 years, and I found myself as a resident in the emergency department during one of the worst public health disasters of our lifetime with COVID, essentially finding myself again witnessing preventable illness devastating entire families, entire communities, here at home and around the world.

I now work primarily in urgent care. I’ve been active in advocacy for policies that battle the climate crisis here in San Diego. I’m working with the Climate Action Campaign, the public health advisory committee that they have. It’s a local nonprofit, and it’s part of a coordinated effort for health care professionals who are fighting for policy changes related to climate change.

Kevin Pho: So tell me how being an advocate influences your work.

Elizabeth M. Barreras-Rivest: It definitely gives a whole new level of meaning to my work as a physician, because you realize that we can’t really work as physicians in a vacuum. We have to take all of these global problems into the work that we do, because climate change and the climate crisis are so interconnected with the work that I do as a physician. I see all of these climate-related health conditions, and to ignore the greater issue of the climate crisis is to not really do my job.

Kevin Pho: All right, let’s talk about that KevinMD article, where you delve more into this. It’s titled “The climate crisis as viewed by an emergency physician.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Elizabeth M. Barreras-Rivest: Sure. The reason why I wrote this article stems from what I was just talking about. I remember clearly a moment when COVID was at its height, when infections and deaths were just peaking and were innumerable, and I also had so much climate anxiety at the time. We were hearing so much about species die-offs, and the huge mussel die-off in Canada, and frog die-offs, and 20 percent of sequoias have burned in the last two years, and it was so overwhelming.

I was working long hours in the ED. I was briefly in the ICU at that time, and like so many others in the medical field, I was just completely burnt out. I just remember the sensation of wondering whether or not we were worth it, whether or not humans were worth trying to save despite letting all of this happen. I just wondered how we could possibly continue to accept all of this when we had solutions. Solutions were very much in reach, and how could we possibly be worth it if we weren’t willing as a civilization to try and reach for those solutions and to save things that we love?

I’ve done a lot of different jobs, I’ve traveled all over the world, and I’ve seen the world through the eyes of my two young children, and it didn’t really take me long to come to the conclusion that absolutely, yes, we are absolutely worth saving. My despair quickly turned into determination to try and find my own solutions and to try to work with others to find solutions for the climate crisis. We have so much beauty as a human species, we have so much awe about the world, and the human experience is so unique, and we absolutely have to fight for that.

Kevin Pho: One of the things that you mentioned earlier was climate-related health conditions. What are some examples of health conditions that are affected by climate?

Elizabeth M. Barreras-Rivest: Sure. Just from my own perspective, what I’ve seen, both in the emergency department and urgent care and just in my training, are increasing respiratory illnesses, especially here in Southern California, where we’re so prone to fires and poor air quality from traffic and emissions. People who never wheezed before are having new asthma exacerbations, and there’s more pollen in the air now due to the changing climate, so people are getting more and more seasonal allergies.

We’re seeing an increase in heat-related illness due to extreme weather events, and that’s definitely more particular to San Diego and Southern California. But on the other extreme, there are also people who are having cold exposures and cold-related events. So the spectrum is very wide in terms of the illness that people are now exposed to and prone to because of climate change.

Kevin Pho: So what can physicians do? You mentioned that you do a lot of advocacy work in this area. Talk more about what more physicians can do to combat climate change.

Elizabeth M. Barreras-Rivest: Absolutely. On the very hospital-based, patient-based level, there certainly are opportunities that physicians have to work with the hospital system that you’re in, to either green the hospital or to work together with other physicians to do patient outreach, to talk more about climate change and the risks associated with it, and how to combat it, essentially.

And then, more on a policy advocacy level, certainly getting involved with local organizations and finding out where your voice is most valuable. I kind of fell on the opportunity that I’m a part of right now just by chance, just by talking. I did a lecture in my residency program for my grand rounds, and it just so happened that one of the other physicians was also really passionate about climate change, and he got me involved in a lot of advocacy work here in San Diego. And so, just talking to your colleagues and trying to get involved in finding organizations where you can reach out to policymakers and have a coordinated effort to help the climate crisis and fight for policies that actually will help reverse the trend that we’re on.

Kevin Pho: Talk more about your advocacy work and your interaction with policymakers. How does being a physician make a difference?

Elizabeth M. Barreras-Rivest: Certainly, having an MD at the end of your name makes a big difference. It gives you a lot of clout. We’re trusted voices in the community, and certainly the fact that we take our time to show up at events, to write a letter, to send an email, to do any amount of outreach, just really shows how passionate physicians are about this issue and how passionate I am about this issue. Just to take the time out of our very busy schedules and lives to say, “We’ve done our research. I know this issue. It’s affecting my patients in a big way, and we have to do something about it.”

Kevin Pho: So can you share one of your success stories? What’s something that you’ve done that’s made a difference from a climate change standpoint?

Elizabeth M. Barreras-Rivest: It’s really more of a coordinated effort with the group that I’m a part of, but small victories definitely lead to bigger ones. Just as part of my residency program, since I recently graduated, I really got the conversation started about climate change. We hadn’t even really had it as part of our curriculum. I don’t think I ever heard about the climate crisis or anything related to climate change in medical school, and so that felt like a victory for me from a personal perspective, just really getting it integrated into medical education in a place where we’ve ignored it before. It just seemed like we were really trying to learn medicine in a vacuum. So just from a personal perspective, that was a really big one for me.

Kevin Pho: We’re talking to Elizabeth Barreras-Rivest. She’s an emergency physician, and she wrote the KevinMD article “The climate crisis as viewed by an emergency physician.” Elizabeth, what are some of your take-home messages that you want to leave with the KevinMD audience?

Elizabeth M. Barreras-Rivest: Sure. Certainly, like I mentioned, I just want health care providers to really have confidence in the fact that they are a trusted and important voice in their community, and I don’t think there’s any other choice but to use it to advocate for our environment, because it’s a direct way to advocate for our patients. The climate crisis affects everyone, but disproportionately children, the elderly, the underserved, and it also inequitably affects people and communities of color.

And so if we are truly a group of humans whose mission it is to fight for the most vulnerable and to help people that need it the most, one of the best ways that we can do it is to use our voices and our resources to fight the climate crisis. Greening your health care facilities, finding like-minded health care providers and policymakers to coordinate this effort, is absolutely imperative right now.

The way I see it, it’s a little cliche, but at the end of the day there are only two ways to look at it. There are only two options: You’re either part of the problem, or you have to be part of the solution. And so really, for me, there’s only one option. There’s no disappearing into despair, like I felt myself going at my lowest point in the COVID crisis. We’re just at continuing risk of losing more and more things that we love in our environment, and people that we love, and places that we love, due to the climate crisis. And so I think it’s really black and white.

Kevin Pho: Elizabeth, thank you so much for sharing your time and insight, and thanks again for being on the show.

Elizabeth M. Barreras-Rivest: Thanks, Kevin.

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