Climate-Affected Health In The Pacific To Be Discussed At Auckland Conference
Experts will gather in Auckland to discuss how to cope with the health impacts in the Pacific that are due to climate change. Don Wiseman, RNZ Pacific Senior Journalist
Experts will gather in Auckland next week to discuss how to cope with the health impacts in the Pacific that are due to climate change.
A symposium is being held at the University of Auckland by Te Poutoko Ora a Kiwa – the Centre for Pacific and Global Health – involving knowledgable people from around the Pacific.
A director of Te Poutoko Ora a Kiwa, Roannie Ng Shiu says climate change is driving up temperatures in the islands – and heat is a 'silent killer.'
She told Don Wiseman they'll look at the health impacts of climate change in the Pacific, and share potential solutions.
(This transcript has been edited for brevity and clarity).
Roannie Ng Shiu: So our conference theme around climate health in the Pacific region sort of speaks to trying to think about the Pacific region and Pacific researchers providing important contributions to unlocking not just Pacific health solutions, but also global solutions related to climate change. We see this as an important aspect of the work that we do, as a centre, to amplify and uplift the research and the learnings that are coming out of the Pacific region, that also can be of use to other countries and other regions around the world.
Don Wiseman: We've known for years about the environmental impacts from climate change, but your group would say that there have been very significant health effects already. What sort of things?
RNS: We can see that climate related impacts include NCD [non-communicable diseases]. So when we think about the Pacific region, we think about two crises. One is climate change, but the other is NCDs, and this is a result of over-reliance on ultra-processed imported food, and the impact that global warming and climate change is having on sustainable agricultural practices and also in the ability to provide nutritious food by Pacific people for the region. The other thing is dengue fever. So we can see that as a result of climate change, that there's been an increase in vector-borne infectious diseases. Dengue is the current example that we have, and this is because the climate is producing more breeding grounds and warmer weather longer; we can also see that there's been intense cyclones that are happening quite often, and this actually is a real problem, because it affects the development gains that Pacific communities and countries have made. So for example, I think from our last analysis, the cyclones that happened in Fiji – Cyclone Winston that was estimated to cost around US$480 billion. So with so many frequent cyclones that are more intense, Pacific communities can't necessarily catch up to rebuilding or building better, particularly around their water, sanitation, hygiene facilities. So we can see the significant effects too of climate on wash utilities and outcomes. The Pacific region has the lowest levels of access to clean water as a result. There's quite a number of impacts. We need to be researching into these areas a lot better to understand how communities themselves are dealing and adapting and mitigating these factors as a place of strength and resilience. But at the same time, we also need to be part of that conversation globally – around how do we get big countries who are emitting the most greenhouse gasses to do their bit in terms of global climate. So things around climate justice inequity are really, really important, but it's a conversation that needs to be had with everyone globally, and not just people from the region.
DW: Yes, one remarkable thing that I've seen is the number of people in the Pacific dying of heatstroke in the last 20 years, and this is quite a significant number.
RNS: So I think as part of the symposium, we are launching the inaugural landscape countdown small island developing states report. And this is one of the key findings – where mortality attributed to heat has increased. I'm not sure if you're familiar with the fact that those deaths are happening mostly with babies, so children under the age of one, and then those who are a little bit elderly, or wisdom holders, as we like to say, who are 65 years and older. We have the Pacific that is seen as vulnerable, and then the most vulnerable, which are our children and our elderly, are at the highest risk of climate impacts.
DW: Countries like New Zealand and Australia – are they doing enough in terms of preparing the region for this threat that's already here?
RNS: I would say no, I think more could be done – I'm speaking about New Zealand. Australia does put a lot of money into development assistance for the Pacific region, but at the moment that is going towards more geopolitics and security programs. I think we could always be doing better. We could always be doing more. There is also the sense that climate change is going to increase the numbers of people claiming environmental refugee status. But other research we've conducted actually shows that Pacific people want to stay where they are. They just need support and helping them to live in the environments that they currently live in, and dealing with climate impacts that they really haven't contributed to. So, for example, the Pacific region only contributes 0.03 percent of greenhouse gasses, but are impacted the most.
DW: The centre wants to look at bringing health closer together with the MetService so that there can be more information readily available to deal with extremes.
RNS: One of the things that we are also looking at, and we've seen from our research, is the need to have better surveillance in order to be prepared for climate health risks – things around infectious diseases, as well as vector-borne diseases like dengue and waterborne diseases. So that if we have a better idea of extreme weather events that are likely to happen, and then layer that on top of health metrics, then we have a better understanding of where we need to be focusing our health intervention and prevention services, particularly for Pacific countries which don't have the same sort of resources that New Zealand or Australia has, for example, in preparing for disasters and extreme weather events.
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The labels were then printed out and placed in a basket with the original prescription and the medication. A registered pharmacist would then check the prescription, the labels and the medication itself before it was given to the patient. The owner said the pharmacy received the prescription by email on July 1 from Palmerston North Hospital. The prescription was entered into Toniq by an intern pharmacist. "This person unfortunately misread the prescribed dosage and entered the prescription dose as '1 tablet twice daily' rather than '1.2 mmol twice daily'," the owner said. The Toniq system then generated an original label for the prescription. "This includes a warning label with the patient's age, if they are under 18 years old, and if the patient has not been prescribed the medication before. "The second warning prompts the checking pharmacist to counsel (speak with) the patient or their caregiver about how to take the medication." The product was supplied in tubes of 20 tablets. 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There are many ways to achieve this, including suspension of the pharmacist or pharmacists involved or a voluntary agreement that the individual/s will stop working." In order to ensure the inquiry into Bellamere's death was "fair and thorough", and to avoid pre-empting any findings, the council could not provide any further details. "We can confirm that the Pharmacy Council is comfortable that immediate steps have been taken to prevent the risk of further harm while the enquiry is ongoing." The medication While in hospital Puklowski gave Bellamere her drops for Vitamin D. Nurses also administered her phosphate. When they left hospital they were given some Vitamin D in a little bottle, and a prescription for iron and Vitamin D. The following day Duncan went to a Manawatū pharmacy with the prescriptions. He was given the iron, but said the pharmacy refused to give the Vitamin D as the staff thought the dosage was "too high for her age and her weight". The staff said they would call the neonatal unit and follow-up. A few days later Puklowski received a call from the unit to organise a home care visit. During the call she was asked if she had any concerns, and Puklowski asked if they had been contacted about the Vitamin D. They had not, and said they would follow up and rewrite the prescription along with a prescription for phosphate. A day after the phone call, on July 2, Duncan went to the pharmacy to collect the medication and came home with just the phosphate. Unbeknown to the parents they had been given an adult dosage of phosphate. The label on the medication directed them to dissolve one 500mg tablet of phosphate twice daily in a glass of water. That evening they gave Bellamere her first dose of the medicine in her formula water. They would give her three bottles in 24 hours as was recommended. The couple noticed in that period that her eating was off, and thought she was "extra gassy," Puklowski said. "She was still feeding fine. She just wasn't maybe going through a whole bottle compared to what she was," she recalled. Then, the day after she got her first dosage Bellamere suddenly stopped breathing. Bellamere was taken to hospital and rushed to the emergency department. Once she was stabilised she was taken to the neonatal unit where she stayed overnight before she was flown to Starship Hospital. The couple had taken a bottle of the medicine with them to Starship Hospital. She gave it to the staff who saw that they had been given an adult dose. The staff then requested the original prescription which confirmed the script had been written with the correct dosage, but somehow the pharmacy had given the wrong dosage Puklowski said. "I keep thinking about how much she ended up having and it just makes me feel sick." Bellamere died at Starship Hospital on July 19. On Wednesday, a Ministry of Health spokesperson told RNZ there were a number of investigations under way. "Medsafe has completed an urgent assessment and is comfortable there is no immediate patient safety issue at the pharmacy. Medsafe will continue to work with Health New Zealand and these findings which will inform the information provided to the coroner. Medsafe is also sharing information with the Pharmacy Council. "Once these reviews are completed, we will be able to look at next steps." Health Minister Simeon Brown earlier told RNZ he raised the incident with the Director-General of Health as soon as he was made aware. "She assured me that there would be an investigation undertaken by both the Ministry of Health and Health New Zealand. That investigation is under way. "I am advised that this incident has led to Medsafe undertaking an urgent assessment of the pharmacy. A further investigation is being undertaken by the Pharmacy Council, and the death is also the subject of a Coroner's inquest." Health agencies would provide information to the coroner as needed to support the inquest. "It is important that the reviews are undertaken, and that the circumstances that led to this incident are understood. I expect that these investigations may propose recommendations, and that these will be reviewed once reports are complete."
