By James M. Recht, MD,
assistant professor of psychiatry, Cambridge Health Alliance/Harvard Medical School
In the emergency room is a 60-year-old South Asian woman who has lived in the US for 15 years. She has a history of diabetes mellitus, hypertension, and cardiovascular disease. The patient has been in outpatient psychotherapy for PTSD related to a combination of childhood trauma and a terror attack experienced two decades ago. She recently learned that her sister and nephew were among more than 2,000 drowning victims of the latest devastating flood in her home country. She presents with more than a week of severe insomnia and loss of appetite, agitated, ruminating guiltily over her inability to be with her family for the funeral and religious ceremonies. After an emergency psychiatric assessment, she is admitted for inpatient treatment.
Also in the ER, on the third consecutive day of the latest record-breaking heat wave, a 20-year-old man presents with panic symptoms and acute asthma exacerbation. His asthma symptoms eventually respond to nebulizer treatment, but he remains in significant distress. He is sent home with instructions to follow up with his PCP. Over the next several weeks, he becomes increasingly depressed and withdrawn, with agoraphobic symptoms severe enough that he takes a leave of absence from school, losing his work-study job.
Both of these individuals are patients of mine (I’ve changed some details to protect their anonymity). Their stories are not exceptional: I’m confident that virtually all of us have patients with comparable histories. They are workaday examples of harm caused or exacerbated by climate change, even here in Massachusetts.
While it’s clear that our poorer communities and communities of color are most vulnerable, it’s just as obvious that no individual or family — no neighborhood, regardless of its affluence — is immune to these harms. Heat, severe storms and flooding, rising water levels and land loss, and the spread of vector-borne infections are today’s realities; and there is an overwhelming scientific consensus that this bodes poorly for the future.
As climate change exposes systemic racial and economic health injustices, it also presents opportunities. I know I’m not alone in grappling with unsupportive professional environments and outrageous barriers to care. Increasingly, my most rewarding experiences as a health professional come through activism for social change.
I have helped organize college students and faculty in campaigns promoting divestment from fossil fuels and re-investment in community development and renewable energy. I devote several hours each week to The Poor People’s Campaign, a nationwide effort to combat racism, militarism, and environmental devastation. I gain inspiration, and even a little hope, from this advocacy work and the personal and professional relationships it has led to.
The medical profession boasts a tradition of social justice action. 150 years ago, the pathologist and pioneering cell biologist Rudolf Virchow, MD, recognized that “politics is nothing else but medicine on a large scale.”
Dr. Virchow understood that pervasive social ills aren’t addressed solely by treating individual patients; he worked to promote public education and public health and helped introduce political reforms that mitigated the rampant militarism of his time. It sustains me to know that as an activist, I stand on the shoulders of such giants.
