ARTICLE
The Bushfires Downunder - A Medical
Emergency, Now and Later
Shailja Chaturvedi B. Sc, MBBS, FRANZCP
Consultant Psychiatrist, Sydney NSW
Australia
ABSTRACT
Although Australia is accustomed to
bushfires on a regular basis the extremity of the latest episode was
unprecedented causing worldwide concern for the people and ecosystems of the
country. This article describes the causes of bushfires alongside the
environmental impacts. It reflects on the heroic manner in which the
Australian peoples rallied together to overcome their adversity, concluding
on lessons to be learned for future generations.
An unprecedented catastrophe was
created by the uncontrolled bushfires in Australia. Between September
2019 until January 2020 an estimated 19 million hectares of land and
6000 buildings were burnt, killing at least 40 people and about 1.25
billion animals, driving some endangered species to possible extinction,
including Australia's famous Koala bear, with the mammoth blaze
destroying 30% of their habitat.
1 The
estimated cost of the 2019 Bushfire is likely to exceed the $4 billion
cost of the 2009 Black Saturday fire. State of emergency was declared in
various parts of the country with the Australian government pledging $50
millions for fire affected wildlife.
Bushfires are a necessary part of the life
cycle for several trees and plants such as Eucalyptus in
Australia.
2,3 Loose flammable bark and combustible
oil in their leaves may promote the spread of fire. Although bushfires
are an integral part of the Australian environment, these fires were
more extreme than ever known before. The horrific wildfires were clearly
visible from satellites images, the smoke rising at least 17 km high and
moving approximately 11 000 km across the South Pacific Ocean. NASA
estimated emissions of 306 million tones of carbon dioxide. As a result,
in some areas, air quality exceeded twenty times the hazardous
rating.
A possible cause for these devastating
fires is climate change which may have brought forward the start of
bushfire season and delayed its finish. The tragic loss of lives and
properties and the destructive impact on the environment has raised
serious concerns in every section of the community.
4 Tourism sector revenues have fallen by more than a
billion dollars. The fires have undermined Australia's reputation in the
international higher education market to the tune of $38 billion.
HEALTH EFFECTS
The medical community has taken
on its emergency care role, but also worked to understand the
far reaching consequences of these fires on human health. The
immediate focus on diseases resulting from contaminated water
and food and disease secondary to extreme air pollution became a
public health priority. There was increased sediment
concentration in drinking water in the run off areas with lead
in excess of current drinking water guidelines. The bushfires
followed by heavy rains have washed ash alongside other
particulate matter into rivers turning the water silt black and
killing the fish. Although bushfire smoke affects health, its
full unprecedented impact both in the short and long term needs
further exploration.
5 There was
a 51% increase in ambulance calls for breathing difficulties due
to smoke and a 25% increase in exacerbation of asthma and COPD
since November last year.
6
Prolonged exposure to high levels of toxic particles and
carcinogens also raise the fear of a spike in lung cancer in the
next decade and beyond. WHO estimated that ambient air pollution
contributes to 4.2 million premature deaths globally each year.
In Australia, atmospheric PM (particulate matter) 2.5
contributed to 2800 premature deaths (2% of all deaths) in 2016.
A recent study in China concluded that long term exposure to
high concentration of ultra fine particle of PM 2.5(air quality
measure) found in bushfire smoke are linked to stroke in
relation to the dose of exposure.
7
The Australian medical community
and government agencies set up Breath Easy Clinics. More
emergency consultations were created both in person and through
video conferencing in bushfire affected regions working in
coordination with first responders such as police officers,
firefighters, paramedics and The Australian Defence Force.
Mental health conditions like depression, anxiety and post
traumatic stress disorder were acknowledged by funding extra
sessions of mental health consultations. The profound health
effects highlighted the need for future planning. At the outset
allocating $5 million in research grants to investigate the long
term impact on physical and mental health.
An Australian study conducted
during the 2009 Black Saturday disaster, illustrated the
physiological stress firefighters experienced in hot, smoky and
physically demanding conditions unleashing an inflammatory
response that puts the individuals at risk of poor health with
repeated exposure. It has been implicated as a predictor of
arterial disease and myocardial infarction. The researchers
found their inflammatory changes consistent with 'overstrained
athletes'.
8
The projected lifetime adversities
are likely to include mental health issues, risky/high level
alcohol consumption, non communicable diseases, family violence
and environmental damage. The main impact seems to be delayed
when people have a chance to stop and reflect on their
experiences.
9 A
prospective study of 1526 people who suffered losses in 1983 Ash
Wednesday bushfire found that after 12 months 42% were defined
as suffering from psychiatric illness or psychiatric symptoms
using General Health Questionnaire, about double the expected
community prevalence. Fortunately, after 2 years half of these
numbers showed human resilience and improved. Strong
recommendations were made to introduce disaster management in
the medical curriculum to prepare generations of doctors for
increased climate events culminating in public health
emergencies.
The generosity of ordinary people
was commendable digging deep in their pockets from all walks of
life. Australian Indians in their usual spirit of selfless
service donated nearly half a million dollars in addition to
front line services such as food vans. There were many
fundraising events bringing solidarity amongst all Australians.
Sydney attracted 70 000 people to support the performance of
local and international stars raising well over $50 million.
THE FUTURE
This experience has most definitely
left no room for complacency. The effects of climate change specific to
Australia are recognised and include: significant linear association
between exposure to high temperature and greater mortality in large
cities of Sydney, Melbourne and Brisbane. Estimated annual productivity
losses from heat stress of $616 per employed person in Australia. 2177
reported deaths from extreme weather conditions in the past 100 years.
An observed 13.7% increase in dengue carrying mosquitos to transmit
disease to humans in Australia between 1950 and 2016.
Australian Medical Association joined
other organizations around the world including British and American
Medical Associations along with Doctors for the Environment Australia,
in recognizing climate change as a health emergency.
3 It has called on Australian
Government:
- To adopt mitigation target within Australian carbon
budget.
- To promote health benefits of addressing climate change.
-
To develop national strategies for health and climate
change.
- To promote an active transition from fossil fuel to
renewable energy.
- To establish a National Sustainable Development Unit to
decrease carbon emission in health care sector.
Last month, the board of a public hospital
in New South Wales rejected a $15 million donation from a coal mining
venture, saying the project’s potentially negative effects on the local
population’s health made it unethical. The board’s decision should be
widely and loudly applauded especially at a time when Australia is
grappling with its worst-ever bushfire season that has come at the hands
of climate change. Medical Journal of Australia has recently stated:
“Heat exposure is more lethal than any other natural disaster in
Australia”.
10The aftermath of bushfire is likely to be
considerable with long standing impacts on the built and natural
environment. Rebuilding life both individually and nationally, will be a
mammoth task. There is a proud history of health professionals standing
up on issues of importance. Asbestos, smoking and climate change are
some of those which will now occupy the minds of Australian researchers
and people around the world. The February miracle rain of 350mm in some
parts of Australia has finally helped to bring the blaze under control.
As all the emergency warning are being downgraded people are gradually
returning home for yet another phase of grief, sifting through their
fire damaged properties.
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