Intern and Elective Experiences

When thinking about electives, it was really important to me to engage in something that aligns with my values. While I have had teaching on climate change and its relation to healthcare as well as learning how to incorporate sustainability into quality improvement projects during my medical curriculum, I really wanted to gain practical knowledge to apply in my job going forward. My elective with CSH began with completing the course titled ‘Introduction to Sustainable Healthcare’ provided me with baseline theory to carry through my elective. I found it helpful to learn about the 4 principles of sustainable healthcare alongside real world examples. I especially enjoyed learning about green hospitals and biophilic architecture. This course challenged my thinking on the distribution of carbon emissions in the NHS, with the majority of the NHS carbon footprint being related to medicine and medical equipment. I was surprised at this proportion especially when a lot of interventions I had come across in local sustainable quality improvements focused on energy and buildings.  One of the main projects I was involved in required transferring case studies from an old platform to a new library resource platform. To do this, I reviewed and summarised case studies within kidney and eye health. This was a great insight into the practical interventions teams have used to improve their service delivery. I also found it useful to view these case studies using triple bottom line to analyse their sustainable value. I have a keen interest in medical education and was able to deliver a workshop for new volunteers at CSH. This involved discussing the principles of sustainable healthcare, the SusQI framework as well as using real life case studies that I had come across through my transfers project. The skills that I had developed during this elective included team working, communication especially with remote working as well as feedback loops. When reflecting on my elective with CSH, a key learning point I will take forward is the beauty of simple interventions. I appreciate the fantastic team that I worked with during this elective period and I look forward to using the skills I have developed.

I’m incredibly grateful for the opportunity that volunteering for the Centre for Sustainable Healthcare has given me. I knew that I wanted to move from the environment and sustainability sector into environment and health. Although my background was relevant, I really needed to get some experience in the health sector. As someone who was taking a career break to raise children, I was concerned about how I’d get back into the working environment. Doing an internship with the Centre for Sustainable Healthcare has been exactly the bridge I needed to help me take that next step and I was so glad to find an organisation that was prepared to let me work both flexibly and remotely. This has not only provided me with the relevant experience I needed, it has also improved my confidence, enabled me to work with a group of like-minded professionals and given me pride in the small contribution that I’ve been able to make to the work of this fantastic organisation. I’m now moving on to a new role with Natural England as Health and Environment Lead Adviser for the North East of England but I hope our paths will cross again in future.

I thoroughly enjoyed my elective with the Centre for Sustainable Healthcare and would highly recommend it to any healthcare students interested in planetary and human health! Upon starting, I was tasked with completing their course; ‘Introduction to Sustainable Healthcare’ to bring me up to speed on the sustainable healthcare landscape and subject-specific terminology. I learnt more about the impact climate change is having and will have on both disease presentations and global healthcare infrastructures. I was introduced to the concept of “SUS QI”; a framework that can be used to audit current practice based on the triple bottom line – delivering financially, socially, and environmentally sound solutions. It does this through the 4 principles of sustainable healthcare; Prevention, Patient self-care, Lean Service delivery and Low Carbon alternatives. What was fascinating to me was the sheer scope of research and progress there is to be made in this field and the overwhelming burden of responsibility on each and every clinician and specialty to scrutinize the sustainability of their practices to make eco-friendly decisions. Following this, I spent some time collating CSH case studies that had been done by UK hospitals as a part of the Green Ward Competitions. This gave me so many ideas on practical ways the NHS could measure its carbon footprints and changes we could make in the coming 5-10 years. I have an Academic Foundation post in Public Health Research for F2, so on a personal level I am extremely excited to take what I have learnt here into my hospital during my research block! After establishing this foundation, I was keen to explore more niche areas, specifically how climate change would impact other specialties. I’ve previously intercalated doing an MSc in Clinical Neuroscience at Kings and loved it, so thought I’d explore sustainability and climate in relation to Neurology. Neurological disorders like dementia, Parkinson’s disease, stroke, epilepsy, headache, multiple sclerosis, and encephalitis account for 16.8% of deaths globally and confer the highest burden of disability adjusted life years.  This alongside the seeming inevitability of the climate crisis demands we prepare ourselves for how climate change may modulate the prevalence, presentation, and progression of common neurological conditions. So, I spent part of my elective writing a blog post for CSH on neurology and climate change!  I learnt how neurologists are seeing and anticipating a range of new case vignettes. The baby who develops epilepsy from recurrent febrile seizures occurring in higher ambient temperatures1,2. The child in the UK with tik borne encephalitis/chikungunya due to emergence of a travelled vector 3 4. The young woman with limited access to air conditioning and secondary progressive Multiple Sclerosis 5. And the man suffering a stroke whilst living in an urban city with worsening air pollution 6,7. This signals a critical juncture for academic Neurologists and Neuroscientists alike!  Given paradoxically that the burden of climate driven worsening of brain health will fall ultimately on Neurology departments themselves, I was keen to get ideas on how Neurology departments themselves could improve its ecological footprint and was able to write about this as well in the blog.

In the last week of my elective, I worked with staff to draft a paper to submit to a journal about sustainability in physiotherapy and rehabilitation medicine. I thoroughly enjoyed the creativity involved in planning and writing this piece. The task was immensely useful for refining my ability to assimilate, deconstruct and synthesize large bodies of knowledge. The entire team at CSH is so supportive and provided me with really encouraging feedback throughout. Being a remote elective, there was also plenty of flexibility when it came to hours I worked and projects I was able to get involved with. I hope to continue volunteering with CSH given I have so much more to learn and hopefully contribute to this wonderful team!

References

1.          Feng B, Chen Z. Generation of Febrile Seizures and Subsequent Epileptogenesis. Neurosci Bull. 2016;32(5):481. doi:10.1007/S12264-016-0054-5
2.          Suchomelova L, Lopez-Meraz ML, Niquet J, Kubova H, Wasterlain CG. Hyperthermia aggravates status epilepticus-induced epileptogenesis and neuronal loss in immature rats. Neuroscience. 2015;305:209-224. doi:10.1016/j.neuroscience.2015.08.006
3.          Semenza JC, Paz S. Climate change and infectious disease in Europe: Impact, projection and adaptation. Lancet Reg Heal – Eur. 2021;9. doi:10.1016/J.LANEPE.2021.100230
4.          University of Glasgow. RESEARCHERS TACKLE INCREASING THREAT OF TICK-BORNE INFECTIONS IN UK. Institute of Biodiversity, Animal Health and Comparative Medicine. Published 2022. Accessed April 27, 2022. https://www.gla.ac.uk/researchinstitutes/bahcm/about/news/headline_83533...
5.          Chacko G, Patel S, Galor A, Kumar N. Heat exposure and multiple sclerosis—a regional and temporal analysis. Int J Environ Res Public Health. 2021;18(11):5962. doi:10.3390/IJERPH18115962/S1
6.          Baumgartner J, Brauer M, Ezzati M. The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries. BMC Med. 2020;18(1). doi:10.1186/S12916-020-1499-Y
7.          Lavados PM, Olavarría V V., Hoffmeister L. Ambient temperature and stroke risk: Evidence supporting a short-term effect at a population level from acute environmental exposures. Stroke. 2018;49(1):255-261. doi:10.1161/STROKEAHA.117.017838

From being my class ‘eco warrior’ at the age of 10, to helping set up the Sustainable Medicine Society at Leicester University, my interest and involvement with climate change and sustainability has been longstanding. My elective period spent with CSH has further developed my interests and shown me countless ways of combining sustainability with a career in medicine and the healthcare industry.

I was able to undertake the Introduction to Sustainable Healthcare e-learning course along with other courses which I found insightful and they provided me with a wide-ranging bank of sustainability resources to read. I have also undertaken a range of different projects, from reviewing and formatting sustainable health case studies, to writing material for new courses.
My main project involved reviewing responses from a questionnaire about the CSH networks for sustainability in different fields and specialities. This wasn’t what I’d expected to be doing and initially, I was concerned that this wouldn’t allow me to meet my elective objectives of developing my understanding of sustainable healthcare initiatives. However, as I worked on the project, I was able to direct my own learning and integrate reading case studies or posts on the networks that particularly interested me to expand my knowledge. The project has also given me skills such as data extraction and evaluation, communication with colleagues whilst working remotely, and formatting presentation slides for different audiences.

Overall, my placement with CSH has given me hope that there are people from a wide range of professions and specialities, striving for healthcare to be more sustainable. I have learned about many ways in which I can consider sustainability in my future career. The knowledge and skills I have gained have empowered me and given me confidence to advocate for climate action and to encourage others to do the same.

From starting a climate action society, concerned about the inaction of the governing bodies to take action on the current climate emergency, to interning at the hub of where change is happening, I found my elective experience at the CSH truly inspiring. It was a pleasure to have met a group of individuals working towards a common goal. 

I learnt a fresh perspective from a multi-disciplinary team of interns. I also developed my communication skills and professional voice through collaborating with various health professionals and professional organisations through emails, meetings and  using social media to advocate for climate action. I developed my writing skills through writing blogs and course pages and the opportunity to use my creative side to make logos, infographics etc. I learnt that I learn well through applying concepts visually. I have also got ideas around my future career options where I would like to combine graphic design, data analytics with my healthcare background to help disseminate climate research to make it more accessible to the public. 

Overall, volunteering at the CSH has provided me with a safe space where I could venture of my comfort zone, make mistakes, ask questions, get advice and learn and it's sparked hope and encouraged me to keep striving and working towards advocating for climate action in healthcare.

I have been part of many different projects whilst working with the CSH team. My time was primarily spent on mental health topics, contributing to both a blog post on green social prescribing and content for a new course on sustainable mental healthcare, alongside a group of other amazing and enthusiastic interns and medical elective students. I also created course promotion materials and infographics.  In addition, I helped write a series of blogs for AHPs, this required both researching and writing skills. Additionally, I was able to summarise case studies into useful summary pages that can be read by health care professionals to inspire different green initiatives in their practices. 

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During my time at CSH I was able to work with a huge variety of individuals on a wide range of topics. Initially my time was spent working alone on projects within medical education but towards the end of my elective I was working in several different groups, ranging from sustainability in primary care, to ‘green endoscopy’. I found the organisation very supportive. Distance working isn’t for everyone, at points it can be overwhelming without having a colleague to call over to help you trouble shoot a problem. However, all the people I worked alongside at CSH went above and beyond to help me settle in and find my feet. 

I am hugely interested in sustainability and medical education. I hope to continue to devote time to these interests and look forward to working with Stefi and the CSH team again in the future.

Overall I have thoroughly enjoyed my time at CSH. Stefi has been very supportive and collaborative to ensure you can get the most out of the experience. This experience has allowed me to understand more about the workings of a small charity and how to instigate change from the bottom up. It was a great way to meet like-minded healthcare professionals too, and learn how I can carry sustainability into my future practice, with SusQI and more.

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