 Hi, everyone. Good morning, good afternoon, or good evening, according to your time zone. Thank you all for attending the first webinar of the year, the Joan Family Doctor and Environmental Challenge, organized by the Wonka-Winekai in collaboration with the Working Party on the Environment. I'm Dr. Ana Perez. I'm a family physician and resident of medical family therapy in Mexico. I will be your hostess. It is a pleasure to introduce our leaders who are going to give us a few words. First, Dr. Sanka Radenikumara, who is our Joan Doctor Medical Representative on the Wonka War Executive Committee. He is a Joan family physician from Sri Lanka. He served as an administrator in an state hospital and run his own evening family practice, the family health clinic, closer to the capital. With a keen interest in archaeology, he has a post-graduate diploma in archaeology. I give the floor to Dr. Radenikumara. Thank you, Ana. I did not expect an introduction for me because you have all the speakers there. Anyway, thank you very much for that kind introduction and very nice to see you all. I warmly welcome all the young doctors, my colleagues, who have joined this webinar from all over the world. This is the first webinar for the year, just as mentioned by Ana. The importance is we are going to have a webinar series and this is the first one out of those webinar series. This webinar series will be in collaboration with the Wonka Working Parties and the Special Interest Groups. The idea behind this is for the next two years, we are trying our best to collaborate with the other groups. And these are actually some internal groups, like Working Parties and Special Interest Groups in the Wonka, as well as other young doctor movements, other young doctors and other organizations around the world. Our main objective is providing more opportunities for young doctors, as well as being engaged with more work, interesting work that is happening all around the world. So today we are having the very first webinar of the webinar series of the Wonka Young Doctors movement in collaboration with the Working Parties and the Special Interest Groups. So we have the Wonka environment with us today and I'm sure that this webinar would be really interesting for you all. And I would like to welcome all the speakers, translators and the organizers as well as you all who have joined the webinar at this moment. And I would especially like to thank the Wenakai, the Iber-American Young Doctors movement for organizing this on behalf of the Wonka Young Doctors movement. Thank you very much. Have a nice session. Thank you doctor. Now is the turn of Dr. Alejandro Saldana that will speak to us. He is a family physician from Mexico and he is the leader of the Wenakai movement in Iber-America. I give the floor to Dr. Saldana. Thank you and good morning, good night, good afternoon, everyone. First of all, thank you to all those who have worked hard to carry out this first webinar which will be focused on the environment. Thank you, Sankan, for his time, advice, a being of the lookout with the entire Wenakai team for the realization of this webinar. The members of Wenakai have worked on this and other issues related not only on the environment but the multiple issues of the mind of the family doctor. I have to recognize their effort and their love for our specialty. The environment is an issue that many times from the point of view of the family doctor, we don't take its emotional account and I believe that day by day we must get more involved with this type of issues in order to make the change in ourselves and be able to take good our patients that we must take care of the planet and that this is for the future of the following generations. One of the topics that will be touched on is related of water and it is caring. In my hometown lately we had problems with the water and the truth before these problems. We didn't take into account the care of the water due to not having the vital liquid well. It's really very difficult to be without water for days and have to go about our daily lives without this important element. I hope this will help us raise an aneurysm and take care of the water. Well finally and the announcement I would like to comment that soon we will have the Iberian American Summit of Family Medicine Guatemala and it's something that we are also working on this moment but well I won't take any more and again thanks to all the participants who will touch on the topics and importance way with focus on family medicine. I wish you all an excellent webinar and thanks a lot Anna for your work. Thank you doctor. To give continuity to this event before starting with the presentations there are some instructions that in the there are two buttons at the bottom of your screen. The first is the chat button where you can make comments to our panelists and you can send us your questions and in the planet-shaped icon that you can see you can find the different translation options. Our translators throughout the event will be Dr. Chloe Shan. She is a family physician from Hong Kong. She will be our voice in Chinese and Dr. Nilka Arosimena. She is a family resident. She's a resident of family medicine sorry and she's part of Huayna Kai and she will be our voice in Spanish. Well our first panelist is Dr. Austin Godemir who is a family doctor in Turkey. She was the previous leader of the Mental Health Special Interest Group. She's a member of Rural Wonka. She's also the media director of Family Academy of Medicine and she's a member of several editorial boards of family medicine journals just to mention some aspects of her curriculum. She will talk to us about planetary health curriculum and where all the garbage goes. I give the floor to Dr. Austin. Thank you very much. Well I'm working in Ismer University of Economics Faculty of Medicine and it is an honor for me to work with Sanka on the working environment party. We can go on. Well I just want to start with the curriculum. This is a lesson that I have I am responsible in our faculty. It is about the environmental factors affecting growth. We can go on. Why did I choose to begin with that? Because there are some learning objectives that could be affecting the children's growth. Maybe you may say that what is the deal with the planetary health or the curriculum. Let's go on. Well this is the show of Nutelius as you may say as you may see and this is about mathematics. Because if we are talking about the growth we are also talking about development too. If the growth isn't just appropriate we can talk about development. Go on. So the first thing is development and the progression of changes. Afterwards we can talk about functional capacity that means maturation. So let me just remember the phases of growth. We can just came from infancy to adolescence that the environment will affect all those stages. Like what? Let's remember the history. Politics, hereditary and also the environment just affecting us. Like what? Just going rural to urban migrants or dislocate the traditional rural family social organizations. What does it mean? In this pattern if you haven't got any food at least your never heads. So we are sharing with each other. But nowadays if everybody has got nothing to do let's say in urban and if you're a migrant who will just take care of you. The other part is the abundance infants that are really poor and could die at those centuries. And by this way Jean-Jacques Rousseau just said in those centuries let's just return to the nature and the breastfeeding of the infants has begun and the importance of it. As you may see these are not so late history taking places. We can go on. So after the industrial revolution the wars has just become and they figure out that to just discover the growth and also the development of the children there are some steps has to be taken. They figure out that not all the children are growing at same time in the same way. We can go on. So the child labor and also the soldiers that are used in child's ages are seen not only the ages before but also nowadays too. So we shall just look at the child as a whole child and one of the things about this is environment. Let's look a little bit deeply. The planetary health is the thing that as the family medicine of course from the conceptualism to that we are just having an importance and taking care for our patients and individuals and also the planetary health is the main idea of it to make it real. We can go on. For example air pollution. Maybe we can just say that you mustn't eat this or you should just do physical activity and whatsoever in lifestyle medicine but how can we say that let's not brag. So air pollution is a real negative effect for not only growth of the children also for the living quality of elderly and also adults too. We can talk about chemicals too. Heavy metals are just one of them. This is a research from Turkey. They figure out that in breast milk we can just talk toxic heavy metals. That means the things that these mothers are breading, not eating, breading is also affecting the breast milk so the newborns. We can go on. That means toxic heavy metals will affect those infants. So how can we talk about the next generation development or growth? We can go on. The other part is mercury poisoning. Everybody knows that mercury is something poisonous. As you may see this is from Indonesia. The photograph is from Indonesia but could be seen anywhere that the gold mining is made in an appropriate way. So it is affecting all our next generation and us too. We can go on. This is from my country. This is from Ida. So it's figured with those ladies and just going somewhere else. In here we just couldn't handle that this forest has been destructed for the gold miners. They just destruct all the forest and afterwards they just go away giving some money. As you may see you can cut the trees and so on but to grow the trees is not so easy when you're just destroying. To make something, to structure something is not easy but destroy is so easy as you may see. We can go on. Again we are coming to the mercury. What is important with the mercury? Impair it to motor skills and just the problem of thinking and problem solving. Let's think that lots of people or the community has got problem about problem solving. How can we talk about future? Let's go on. This is from again Turkey because there should have been a decision part in here too for the communities. Are we going to go with the agriculture opportunities for the linens and so on? In here at Ediston is a place that it is a great lowland and it has really have got huge kilometers to just make our agriculture much more appropriate. The problem is they're just fine linens but in a bad way this has been managed. So now people are just struggling with lung cancer because of this. We can go on. These are the other effects of this linear sector. The companies have just made something like that. As you may see not only hydrocarbons but sulfur dioxide is another part of the story, another problem. We can go on. This is from Ankara. It was just two years ago so we may say that the planetary health could affect us slowly slowly or could be in a sudden way. Let's go on. The other part is about the slow management. You may see that one of the risk of the air pollution is damage so we just can't remember anything. Let's go on. Tobacco smoking is also as old as age is and as you may see they are just making it for pleasure. Let's go on. There were lots of advertisements about it and it was something cultural to smoke together. Let's go on. As you may see we can go on. So the other part is we just discovered that not only the air we are just spreading but also the things we are using for pleasure is a problematic like what the smoking Tobacco products. We can go on and we can go on because we do know that it is just associated with cancer. So what can we do about it? It is also one of our duties for the Tobacco smoking and it is also preventable that of the people of communities. We can go on. We can go on. The other part is as you may see the DNA is being disrupted as being diminished with Tobacco too. Why did I put this definition here? This is about the community oriented primary care that we can use as a tool. As we just talked about the polluted environment and the effect of infants in communities, maybe in your community the gold mining is a problem, the other Tobacco usage, or the other just destruction of the forest. So let's define the community and find which are the things that we can do is characterize and afterward we can just talk about the selected health problems that we could do the assessment. So community oriented primary care could be a way to understand and to treat not only our people but also our structure that made the problem. Let's go on. For example one of them is a silent killer as air pollution is also the water clean water. Let's go on. These are the key facts from the WHO. As you may see drinking water is something essential and also human rights. If you haven't got the clean water for drinking that means we can talk about the being of human rights too. It is not something as an opportunity. This is something that everybody has to get as a global citizen. Let's go on. This is about administrative shake and from my country he is working in public health in medicine of school. As this part we can go on. They have figured out in another part we can go on. There was a problem about this is Urgub Karin in Turkey. As you may say it is a beautiful place. We can go on. And it is just the thought of the land of beautiful forces. Its first name is Katko Tokya. And afterwards we can go on. One of the teacher has found out that people are not living so much here. Now there could be point no one just be after the 40 years old. The teacher just had reported to the doctors living there and started to pay university stakeholders and they just began to evaluate it. Let's go on. And this is another senior from that. Let's go on. They figure out that the problem is asbestosis. It is not about the thing of destiny. It is not about the thing that anybody else do before or the bad things they do before. It is not about the genetics. It is about asbestosis and this is the environmental threat for all the community that was living there. Because it ended with mesotelioma. Let's go. And this is the part that we can understand what is mesotelioma. As you may see it is affecting the flavor of the lungs. Let's go on. And we can just see as the X-ray diagram of it. They thought that it could be something like tuberculosis but the truth is it was a kind of cancer. Let's go on. And then not only in Turkey but also the other parts of the world just said that asbestosis is the part that could be so bad. Not only is mesotelioma but for the other reasons that is bad and mortal and morbid for the countries and also the individuals. Let's go on. As you may see so there are lots of evidence based material about it. Let's go on. The other part is while we are talking about all these things and new evidences how can we reach out to these new evidences? Planetary health courses is one of the tools that we can use. Maya Ropros and Erika de Baral Rosso are also involving in here and it is for free that we can reach the items that we need. Let's go on. And this is one of the example of this why is planetary health is important for family medicine and primary care. We can go on. But who will do all those things? And who are responsible for that? Let's go on. We all can do that. As you may see there is Sanka there and he is one of our directors. Andre is from Ireland and Erika from Brazil and Maya from Brazil too and all us could just do this together not one by one. Let's go on. But in here there's another domain that we can use with the family medicine. What is this? The person-centered primary care could be just person-centered planetary healthcare because every part every community has got their own problems that should be solved. Let's go on. And again so we don't need to be alone. We can go on. For example an example about air pollution. Ellen has taught in a congress for that. It is about inhalers. This is the prescription that we're talking about and maybe we can just represent you an inhaler policy for the next months too. Let's go on. And also we need evidence about it. If we haven't got evidence, if we haven't got evidence-based information we can't talk about that. This will be only a rumor nothing else. And here are some of the examples for it. We can go on. And again we can go on. So let's talk about two cases. What can we do about it? For example for water. We can go on. These are some examples for the inhaler policy. If we are just giving treatment for our individuals or for our patients we should also think about the planetary health too. Let's go on. Where is it important? Fossil fuel emissions are just affecting not only the soil but also our water. We can go on. The problem is we all think that we have got lots of times but the truth we haven't. Let's go on. For example microplastics. We are using plastics and they are products all for most of the things like what just carrying our food or just making protection about our dresses and so what. But where did all the microplastics go? Well the truth is it is also going for example for fish could be neurotoxic or could be about behavioral abnormalities. We can go on. This is again from a newly represented research. It says that humans may also experience this oxidative stress too about microplastics. That means drinking water is important but also fresh water is important without microplastics. Let's go on. And also this is another part that we should just know about the pipes. Asbestosis is something that could be in pipeline so to get fresh water is important but also how to make the distribution what could be the instruments for this is important too. Let's go on. For example in here we can just say that lockdown has just told us has just teach us lots of the things. For example the industry has changed at the lockdowns times and we find out that the planetary health was just much more healthy. After that we just made everything uh distracted again. Let's go on. In here there is another review another research. We can say that drinking water could also affect imponds. Let's go on. I don't want to get much more time off you but I can say that these parts that were just in the color of yellow it says that from the infancy to the adulthood the pipelines are important and affecting the growth and development. Let's go on. And for the other part that we couldn't see it says that not only the adults but also the elderly part will be affected by these bad drinking water conditions. Let's go on. So all we need is one minute for our planet to think about the treatments we are giving at least to think about how well we are living with our conditions. Let's go on. I just want to finish my words with the words of Rumi. It says that be like water uh like bird for modus c and appear as you are and be as you appear. Thank you very much for listening to me. Thank you doctor for your excellent contribution. To continue with our panelists it is now the turn of doctor Jaime Olivas who is a family physician from the University of Monterey in Mexico. He is part of the Guaymecay movement and he will talk to us about water crises and health impacts. I give the floor to doctor Olivas. Hi hi everyone. I'm doctor Jaime Olivas and thank you for coming today and this time we will approach this topic and well let's see how the family doctor it's at the heart of these water crises and well let's let's get started shall we and first of all if you can go back one slide please. Thank you. Let's see first what is our situation and let's see what are the health related issues that are in our concern and this time we will focus on water crises in this case mainly draw and flood and well according with the WHO the water shortage could affect around 5 billion people worldwide and this is also according to UNESCO by 2015 this is also a problem with water that it's going to be lacking in some countries and almost in every continent. This is why we can see now that water is becoming less available and this is mainly due to climate change and human activities and all this led to severe drugs all around the world and we will see more of this around the around the the next years and in the next slides I'll tell you why. Please next slide. Well California this is this is from the Angeles Times and also in the in the previous in the previous slide I I needed to notice that the water the lack of water get at that at that point that the water now is on Wall Street and the stock market and you can bet on water just like oil and gold this is just to get an idea a little idea of what can we expect in the next years well going back to California this is from the Angeles Times California should expect a fourth right year as drug persists what does that mean we know that California is a prone state to drug but the problem with the climate change is worse in this situation because according to another to the world meteorological organization the climate change is making more difficult to predict and prepare for water outcomes and also to prepare for water distribution in the next years just in California and we can see that climate change is worsening the pre-existent dry climate in California. Next slide there and as I said you said before global water the lack of water is present in almost every every continent in every continent and we can see these are just three hot spots according to world meteorological organization and this is just in 2021. In the next slide please and this is in other countries these are another examples and we can go on and we can go on just in Germany and also in the Horn or Africa we will see more about this in another slide Serbia, China a lot of countries are getting a problem with this with water distribution so or they needed to adapt in some form because of the lack of water and according for example according to the United Nations report about climate change one third of Europe will suffer will suffer a lack of water or water depletion and this is proportional to the to the degree Celsius and the temperature rise and this news about the third of Europe suffering water depletion. This will happen only with a rise of two degrees Celsius. Our rise of two degrees Celsius is just enough to make this problem worse in Europe and if we look if we look in another countries we found that in fact this problem is worldwide as I said in the previous slide and in the world map and can you change the slide please and let's go back to Mexico this is my home and we can see I live in north in northeast Mexico and I this this is what has been arid arid and semi arid arid and semi arid climate but in the recent years the drug mold from Serbia to extreme meanwhile in another part of the country we can see in south Mexico, Oaxaca, Guerrero and Chapas these states really had a problem with water but in the recent years we see that are getting drier and drier and let's focus on this part of Mexico in south Mexico and I just mentioned Oaxaca and Guerrero next slide please well Oaxaca and Guerrero this is with this this states depend heavily on agricultural and as a result of the drug the drug the crop production suffered a lot but this this states had to adapt and this is with the collaboration between technicians and the indigenous indigenous people I mean sapotecos and they work together to come up with infrastructure and with solutions in this case the infrastructure infrastructure projects were made to optimize wider irrigation improve recollection of water and basically they are now harvesting water successfully and all this thanks to they they made absorption wells, small dams and all this to recollect more efficiently water from the valley and optimize the the use of water for their crops and we can see here that this is from technicians and this is also the farmers indigenous farmers and this is what what they meant in these interviews they say that those system created a microclimate that regenerate the soil and this is this is thanks to the efficient recollection system next slide please well well we are keeping to Mexico for a little bit more and it's specifically in my city Monterey Mexico in this case mega corporations take water from the already depleted aquifer and through private wells they are worsening the distribution we had a very severe drug this this summer and usually this gets a little political but just choose to I'm just here to say that they can be complications and that in a short term solution is it's very difficult and they have concessions to water and also is that there are another political examples for example the water crisis in Palestine that is due to a very long conflict but just to just to show you how there are a number of factors that hindered the short term solution for for the water distribution next slide please well for this this is a recent case and we must understand how cloud and drug compromise the water quality and very different ways and this is our the recent example I was talking about a Pakistan according to to the work head or work her organization the they had this recent flood and the immediate they had malaria and then get outbreaks immediately also can you take the next next slide okay more more yeah that's right they had a problem with the health health services they had a very significant reduction and also this meant uh unsacred uh modern treats diabetes her disease and also for the children missing vaccination and for the other part they rose the the rose the spread of water and vector and the problem is and the thing is how can we as family doctors provide an effective healthcare when we can even wash our hands next slide please and we can say well the flood is over well go go back everyone to their work to their work and and this this problem and the diarrhea is gone well not exactly uh this is the example of Jackson Mississippi they experienced a flood of proportions never seen before and their wire supply was very or highly compromised uh this meant this flood the irritation malnutrition and heavy metal poisoning also our outbreak out is another digestive issues and this is a lot uh this is a problem that persists after the flood and we must expect that this in another similar situations next slide please well and as you said in Jackson the health issues persists but uh for the other part the drug in in for example in the great horn on Africa is worsening for existing problems the famine the famine it's worse and this drug makes especially make people especially vulnerable and more prone to other disease and there are drier areas and also in California have this phenomena it's happening wildfires frequencies are increasing and these are linked to respiratory diseases and if we are keeping with this topic of the drug the soil related fungal infections like oxydioides are increasing and we can see this in the great horn of Africa and also it was reported that the mental health issues are more present than ever and domestic violence is another factor and you can we go on next slide so now let's take the family doctors perspective but can family doctors expect to see in their practice and well first of all we are thinking uh like apocalypse and in the next few years well it's very unlikely and also uh as we expect new diseases well it's a it's possibly but it's very unlikely also very unlikely but what we most expect is a change in pattern of the pre-existing diseases and first of all prioritize the doctor patient education and always encourage uh our community and our people to become agents of hygiene uh and wellness next slide please what are gonna we got what are gonna give what are we gonna do in our practice uh well first of all identify our population at risk and elderly infants pregnant women immigrants or people experiencing homeless a homeless state and for the elderly can what can we say uh they can be more dependent sometimes sometimes they need a caregiver uh risk of being socially isolated and also they had a reduced mobility and for the for the infants for the infants they have special needs when the water when we lack of water uh new needs uh newborns and infants well they have this special needs that can be accomplished they have a special need for feeding for stooling and for sleeping and this is worsening with the lack of water or with the with the flow that the water is not is not in good conditions and pregnant woman of course in this case we're talking about that double risk modern fetus are a risk and immigrant people experiencing the homeless state well just for the for the fact that they do not possess a reliable shelter and next slide please in another things uh we must expect when the quality of water is compromised we must expect the diaries can be low-acted, cryptosporidium, scary cacoli and well in this case we can see that the pattern of the pattern of and the range of their geographical range will be extended and will be recurrent in the population in in the according to the I think that is is cdc they are this egyptian range and the line disease range have extended and this is due to the draw and the rise of the of the of the heat in the northern regions of america next slide please well in this case we must pay special attention to communities even if we notice that our communities have poor stool management in this case we must understand that don't treat screta contaminates surface surface waters drinking water irrigation waters by bathing water on all the household water even the problem gets to the ground waters next next again again again and this is cause uh go back go back uh well this is uh sometimes we are obsessed with the idea of the contamination and in this case we can see the the cycle of oral infection and as i was saying uh we're we are sometimes obsessed with the idea of food contamination that we forget that self infection is a very common thing and especially on children since the children tend to lack a adequate technique from washing hands we must introduce this topic to them in early stages of life now and next well this is just to point out that we have a number of resources these are provided by the workhead organization and here we can find guidance and management of specific points but for what is applied if how can we work together to provide a very system of water and to diagnose poor quality in water especially for drinking and household use but they are the the guides are are very complete in every aspect and they have a very complete regulations and standards and you can see here how can you help a little more your community and it's a very helpful and next next slide so uh before uh before you go and to sum up the water supplies is very compromised and in in these cases of drought and flood and we can spec as family doctors this is patterns we can expect this is patterns to change in this case fecal oral infections this will will be increased due to the lack of hygiene and virus sanitization this is a point to to reinforce and vector borne infections this is mainly due to climate change and because it is because this climate change will allow vectors to reproduce and transmit diseases maybe in areas where we we not expect and we they these these diseases and these vectors like edis egypti and the ticks and are present in areas where they were not previously present as the doctor as the doctor was there and said before we can expect malnutrition and even a growth retardation in in the children and this can be more often this is mainly to for for example the heavy metals in the case of the flood or in case of the drought uh by recurrent infections and also in another cases it's reported kidney disease and intoxication due to the ingestion of high levels of of contaminants in the water heavy metal heavy metals in the water so on so on and in the field of mental health we can expect a rise of domestic violence depression anxiety and this is related to more frequent illness the economic losses for example in in the rural rural areas and indigenous areas economic losses of the crops and a homeless state in the in the migrants and finally we can expect in these cases a health and economic inequalities this is in consideration that the water crisis are concentrated in the most vulnerable populations and in the other hand if we if we treat this problem accordingly and work together with the government and the communities we can make living and living healthy environments and we can develop sanitation programs these are these contribute to the life and the quality of life even for the child the the growth retardation uh improves and better school attendance they can we can afford uh uh life with dignity and help to create resilience in communities uh this is a lot of this is a very complex problem but i have to sum up in some form ii and i appreciate that you stayed here and this is this is all for me thank you for thank you for coming today thank you doctor thank you doctor for your great contribution now is the discussion time um there is any question about uh from our audience for uh our panelists um because of the time maybe uh we have um discussion with the panelists the final presentation okay there is a lot of congratulations for both thank you well uh this is the our third panelist is dr natasha freeman she's an australian general practitioner currently living in the united kingdom she also has done additional training in pediatrics and women's health she also worked as a research assistant in primary care health literacy and is part of the basco di gamma movement she will talk to us about the health impacts of rising temperatus and bush fires in australia i give the floor to dr freeman hi everyone thank you so much for having me speak i feel really privileged to be here and um congratulations to the other speakers i've definitely learned so much from you both already um so next slide please um i am an australian gp so all my sources are going to be australian um heat heat waves and bush fires is a really big topic and i can't cover everything and also i'm not an expert like all family doctors i'm always learning and i would like to learn from you all so if you have any questions or anything that you want to discuss further i'd be really interested in hearing about your experiences next slide i'm just going to um talk about three fictional patients so they're definitely they're not real i'm going to go through australia's climate the health impacts of heat and heat waves and bush fires and then what we can do so next slide please um oh next thanks so three patients and these are completely fictional so any resemblance to real persons is purely coincidental so i've got jane who is wheezy and breathless since the bush fires began sandy who has trouble sleeping since her house burnt down last year and george who is elderly has high blood pressure and is unwell during a heat wave so next slide please um australia gets very hot so as you can see from this graph um a lot of the places in australia reach 45 degrees celsius um at some point um during the year um and the vast majority of australia reaches at least 30 degrees or more so um heat is a very natural part of australia um but we've got a very varied landscape and um next slide please um you can see that um we've got areas of urbanization on the coast we've got mountains with snow and we've got dry arid and desert regions and some of you may have recognized buluru which is a site of um uh important significance to aboriginal and toaster islander people next slide please so um bush fires are also a really normal part of um the australian landscape um this is a photo that i took myself um and it's a an area that was affected a lot by the bush fires but you can see the trees are uh regenerating um and becoming green again um and this just reflects the fact that fire um helps shape the landscape of australia next slide please but because of climate change bush fires are getting worse um and some of you may have heard of the black summer bush fires in 2019 and 2020 which had a huge impact on um australia um including many deaths up to 400 deaths from um smoke inhalation homes were lost a lot of people uh had to go to hospital for breathing problems um and 80 percent of australians were affected in some way um my personal experience of this time was um seeing a lot of patients with breathing problems and our whole city was covered in a blanket of smoke for many weeks next slide please um australia is becoming hotter so carbon emissions uh and air pollution drive heat uh our temperature has increased by 1.4 degrees since 1910 um uh nine of the 10 warmest days on record have been after 2005 we're getting more hot days and heat wave events and more extreme fire weather days next slide please and you can see that um since 1910 the number of extreme heat events is increasing quite rapidly up to 2010 that's the graph finishes there next slide please so future projections we're going to have more hot days more days with the temperature of over 35 degrees increased fire weather and more heat waves next slide so let's go back to jane jane is wheezy and breathless since the bush fires began next slide so why is why a bush fire is bad for your lungs well the heat and humidity can stimulate um the nerves in the lungs um causing asthma symptoms um but one of the big issues is pm 2.5 or otherwise known as particulate matter 2.5 and these are particles that are so small that they enter the deep pockets of the lungs and also enter the bloodstream so they not only cause respiratory issues but they cause a wider pro-inflammatory state bush fires have increased hospitalization for respiratory disease and makes asthma and chronic obstructive pulmonary disease worse let's go to the next slide um so sandi has trouble sleeping since her house burnt down last year next slide so there are lots of other impacts of bush fires there are a couple of quite significant ones in the studies based on australian bush fires it suggests that people who have heart disease already experience worse outcomes with bush fires a study showed an increased number of out of hospital cardiac arrests in men during the bush fire period we know that bush fire smoke can affect pregnancies and there's a link to low birth weight and preterm birth and what is important in sandi's case is the psychological impact so bush fires are devastating and they cause increases in psychological issues and there is a word i just recently learned that i didn't put in the slide it's called solastalgia and that's the distress that is produced by environmental change impacting on people while they are connected to their home environment so i found that word quite an interesting way to describe how some people feel so just next next slide please and now we get on to george who was unwell during a heat wave next next slide so what is a heat wave there's actually no single international definition one of the definitions is three consecutive days and nights of above average temperatures but there are so many variables for example the age of the person and where they live and something called urban heat islands so urban heat islands are large areas of paved or dark colored surfaces which absorb heat and rise the temperature and in addition it might be an area where there are more vehicle engines and fossil fuels being released and this all adds to the heat and also a lack of trees so all of these variables can affect the way we experience a heat wave next slide so there are types of heat illnesses fatigue muscle crabs dehydration heat exhaustion and heat stroke which is a medical emergency so heat stroke is where you are unable to control your body temperature anymore and you cannot stop it from rising to dangerous levels and that's this can cause multi-organ failure and death so this is this is very very dangerous result of heat illness next slide please heat causes more deaths than all other natural disasters and it creates quite a big burden on health services it's also found that rates of anxiety depression and interpersonal violence increases during a heat wave also something that I didn't know is that gastroenteritis increases during a heat wave because food spoils more easily particularly if you're in a place that doesn't have good refrigeration facilities now let's go on to the next slide so who's at risk of heat related illness so this is about your body's ability to regulate its temperature and we know that some people don't have that ability as good as some other people so this can include older people particularly people over the age of 65 pregnant breastfeeding women or very young children because they have different heat needs people with existing chronic conditions like cardiovascular and respiratory disease people with cognitive impairment and some mental health illnesses housing is really important whether or not you've got proper cooling facilities or whether or not you're in an urban heat island as I talked about before medications are important and I'll get that to the next slide and Lassie your work what kind of conditions are you working in thank you so heat medications this was something that I learned and found very interesting most medications need to be stored at less than 25 degrees and this is particularly important in some emergency type medicines such as insulin or antibiotics but then there are other ways that medications can interact with heat so for example lithium is a drug with a narrow therapeutic index so if you are taking lithium and you become dehydrated you are more likely to experience toxicity from that medication similarly there are some medications such as diuretics like some blood pressure medications that increase dehydration and some medication that decrease sweating and these are just a few examples of how medications interact with heat so we'll go down to the next slide so what can we do as family doctors so this is a question I asked myself and I was making this presentation and I divided some of my the ideas that I found into patient community and organization so you can just show those if you click thank you so first of all it's important to identify patients who are at risk of heat related illness some Australian doctors have been doing something called heat health plans which is plans that are tailored to vulnerable patients and address things like how they're going to stay cool, what medications they should stop or change and who to contact if they feel that something is going wrong and also the signs of heat illness there are some community things that we can engage in so thinking about what community organizations are in place to help us manage the heat are there alert or warning systems when a heat wave is coming or high bushfire area and are there things that we can do in our local community to advocate for things like changed infrastructure that might reduce heat like tree canopies and awnings and then there are organizational things so we can think about what factors we can change in our practice and what change of factors we can change in our institutions so next slide please there are a couple of examples in Australia in our waiting rooms the Royal Australian College of General Practitioners has put forward some some posters to educate patients and to invite them to have a discussion with their GP. Next slide please all states of Australia have a heat health plan and this was after a huge heat wave in 2009 that was very dangerous and caused a lot of people to to pass away or to be hospitalized there's also some government websites about how to stay safe in the heat and there are also some heat wave assessment charts that send out warnings when there are extreme weather events coming up next slide please these are references and we'll just go on to the last slide so my speech was very much tailored to Australia so I'm really interested in discussing with you what are your personal experiences as health professionals of managing the challenges of heat and heat waves and but essentially that's the end of my presentation so thank you so much for listening thank you doctor for your excellent presentation thank you to continue it is now the turn of our last panelist doctor Genyu Goryu he is a family medicine specialist in Turkey he also studied doctor-patient relationship and shared decision-making and he has been the lead of EFD mental health with great interest in planetary health he will talk to us about mental health and planetary health in the COVID-19 era I give the floor to Dr. Geryu thank you very much Ana for all your support and true pronunciation of my name it's a bit hard I'm Genyu Goryu from Turkey I'm a family medicine specialist I have been working in an archipelago called Marmara Islands group in Marmara Sea in western part of Turkey so this experience raised my awareness about environmental health and also occupation health because lots of marble mines were settled in that island groups so and I had this experience during the COVID-19 era also so today I'm going to talk about mental health and planetary health in COVID-19 era and I want to summarize some lessons for a possible water crisis in the future next slide please as Dan said in her slides too planetary health is a new paradigm in public health we can say that it's an interdependent sustainable vitality of natural and anthropogenic ecosystems both in social political and other manners and but it's a kind of scientific journey during the 21st century I mean the public health intervention started after the second world war and now and 90 some kind of non-governmental organization taped about the awareness of global health and the planetary health is a new paradigm right now that it's a public health problem but we are family doctors and we are able to reach every single individual in the society so I think that we have to adopt a ecological mindset into the clinical encounters so because we have a holistic approach as a core competency of our discipline and we are able to make some personalized interventions to fight against water crisis of another kind of planetary health problems next slide please COVID-19 era raised our awareness about planetary health issues I think because that was a more theoretical in academic problem before COVID-19 but after the pandemics we realized that a disturbing intervention to the habitat of the bats in China can affect one of my patients lungs as a pneumonia in a few weeks so the butterfly effects took the interest of the masses and I think the nations experienced pandemics and the planetary health became a hot topic for both doctors and public and I think it's a big opportunity to take lead for us to make some interventions for patient education or social marketing of the health policies next slide please and mental health in COVID-19 times the all that kind of problems like alcohol and drug abuse anxiety insomnia they are all increased but it's not a surprise because during black downs maybe it was good for planetary health issues but it caused some problems for mental health issues we we had seen some recurrence in anxiety or depression disorders also there was a significant increase in cell farms suicidal behavior because it was not easy to reach psychiatric services or take some maybe there was some telemedicine approach for the COVID-19 times but what it was not easy to take a place in asylums or inpatient units for psychiatry so by this way I want to mention the importance of community oriented care as as Dan said in her slides community oriented primary care and also community oriented mental health services only by this way we can manage the burden of asylums and psychiatric centers overload by community oriented centers and I think family medicine family doctors can apply a lead role to manage their problems next slide please and some lessons from COVID-19 pandemics to tackle the water crisis as both haima and natasha said the vulnerable people are important we should define the elderly sick and poor people in our patient population for example tomorrow morning I'm going to see all my patients from that view actually who are able to be more vulnerable against the water crisis among the poor neighborhoods or some my refugee patients I think it's important to define the vulnerable ones and that kind of crisis every time has a transponder character and it means a global collaboration so that kind of panels and that kind of organizations are really important because of that point I think and as I said before it's that kind of crisis are wicked problems so for regular health problems there are lots of specialty and specialists and they have guidelines they have thousands of patient experience but like COVID-19 pandemics or water crisis and other planetary health issues we have still lack of knowledge and there's no clear cast solutions and I think this is an option for the family doctors because we have developed problem solving skills and we are expert generalists in medicine field so in this foggy weather we can help both patients and our other colleagues to get the solution and handle the complicated medical problems next slide please and also I think both Haime and Natasha said before drought and urban migration is really important problem also they said that domestic violence and sleep disorders all that we can say in a water scared area as a mental health problem and as a result of the migration I think child mental health really important because a well-development trajectory of infants or adolescents is really important to integration of the refugees to the society so I think it's important and also we told about the higher temperatures and climate change and I want to talk about some psychotic patients this change in climate change can cause higher temperatures and by this way we can see more common psychotic attacks so as I said before it's not easy to manage under the conditions of a disaster so probably a asylums and the psychiatric inpatient unit central units won't be enough to handle this problem so I want to express again the importance of the community oriented and autonomous mental services I also add that not only individuals have some psychological problems also nations and societies can have some problems water insecurity can cause social anxiety and some many other socioeconomic and political conflicts so I think we should also be aware of that problem as community leaders next slide please and I want to give an example I think some of the previous presenters told it but toxic health laser contamination in municipal water source in the flint USA so there was a research it's called Casper I think it's about a toolkit that assess the psychological manner of the victims of water crisis I think I forgot to add this version of my presentation but if you said as we know the cartoon character Casper it's written like Casper and you can search some databases or even you can search it on google Casper is a very useful toolkit to assess public health emergencies assess the mental status of the victims in public health emergencies so I think that is really important we talk about that what can we do as family doctors in that kind of crisis I think we can we can find we can find a doctor patient a first doctor patient relation and we can take the action in patient education so that kind of tool kits are really useful both to assess the patient in a public health crisis and give patient education I think short form tool kits for both assessment and education is really important I remember that irish college of general practitioners developed a green toolkit to raise the awareness of clinical ecology or or environmental health maybe as Dan can also remember it so this kind of that forms are really important to make interventions in primary care next slide please and as I said before we have to do something it's not a solution to just wait and that kind of crisis need more than one solution to solve a problem and also simple solutions are really important for example I must say it to teach the people teach the children for adequate hand washing maybe it's it's it looks simple but I think it's more really efficient and local factors cannot be discounted because family doctors are also natural local community leaders and sometimes major crisis as radical solutions we should be brave to say our ideas or share local officers and the other rulers and global governance we need global governance in that times of crisis and also international solidarity next slide please this is the associative integrity and the role of primary care physician we can do something to mitigation of environmental pollution for example is the noise and air pollution and we try to do some interventions to increase water access and quality and as a result of it we can see the adoption of patients and our society to new conditions there are some direct environmental effects like drought heat waves and fire for example and some indirect environmental effects like reduction in water quality and socially mediated effects like the migration they both affect the health status of individuals and but there's a solution there are primary care actions for example the promotion of health policies and strengthening the health system but the most important thing is I think research primary care research and patient education our main role is I think raising raising the awareness of patients and patient education to fight against the planetary health crisis next slide please yes I as I summarized before our leadership is really important and we can do the social marketing of the health information because we are able to reach every single house in the society we can find the relationship directly to the individuals and we have a clinical area to make interventions we have daily practices next slide please and also research is really important but also there are some problems and what is it it's deficiency of diversity and pluralism in research we have lots of options to make some resource with collaboration like some interdisciplinary research and also for the primary care I think some methodological resources are really important to develop some toolkits to assess and educate the patients I think we need more short form toolkits to use in our daily practice to screen our patients assess their knowledge and attitude and to educate them for example for how to use water and how to save the hygiene parameters and we have some we need some data forms to measure their performance next slide please and again and again patient education is really important and continuous medical education is also important now we are a small group have maybe a bit higher academic literacy but I think we have to reach all of our colleagues in the field to solve that public health problem next slide please and thank you very much for listening me and find an opportunity to take part in this panel thank you doctor for an excellent presentation to close this webinar um now it's time uh now that we have here from our panelists is there something they had like to share with us because there is no any any question in the chat only congratulations for everyone a lot thank you very much thank you any participation of our panelists well it was a great opportunity to meet with you and to reach our colleagues and some of our students has also attend so I'm so happy to meet our teammates or our future teammates and so it gives us hope that we can move forward yeah that's okay thank you that's thank you a lot well um on behalf of the entire young doctor medical wonka team we appreciate your participation in this first webinar and we hope to see you soon at the next event and have a great day thank you all thank you thank you thank you very much thank you thank you alex you're welcome thank you thank you everyone great success so let's uh let's see you with the next webinar with the uh wonka working party on the on mental health organized by the rajat marble see you all