S’pore medical students flag future health crises fuelled by climate crisis in

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SINGAPORE – A group of fledgling doctors are worried that in the future, hospital emergency departments and clinics will be flooded with patients agonised by heat exhaustion and mosquito-borne diseases – victims of climate change.

Ms Anbudurai Manisha, 22, a fourth-year student at the National University of Singapore’s (NUS) Yong Loo Lin School of Medicine, said: “We medical students are concerned about this because, with the escalation of climate-change impacts or heat-related disasters, the first responders would be us healthcare workers.”

Ms Manisha is part of a group of medical and healthcare students here who run a podcast called Third Spacing, which delves into healthcare issues and trends in the medicine scene.

In each fortnightly 30-minute episode, the students speak to a professor or subject expert about topics such as medical education, and draw from social contexts to understand illnesses.

The podcast takes its name from the medical term for the space between cells and vessels in the body, where fluid moves from one area to another. In sociology, the third space is where people meet to unwind and talk about things that matter to them, stated the podcast’s website.

The latest podcast season, which started in mid-October, covers the close links between health and the environment.

With gradually rising temperatures, Singapore is not impervious to future heatwaves, flooding and more dengue outbreaks.

Local temperatures are 1.8 deg C higher than they were in 1948. In contrast, global temperatures have risen by 1.1 deg C from pre-industrial times before the 1850s.

The team behind Third Spacing is particularly concerned about how a much hotter Singapore will impact the vulnerable – which includes those who work outdoors, the elderly and people with comorbidities.

Ms Ching Ann Hui, 24, a final-year student at NUS Medicine who leads Third Spacing, said: “Heat itself is a physiological stressor, and it could compound existing chronic diseases.”

Some patients with end-stage renal disease and on fluid restrictions have shared that hotter days made it tough for them to limit their water intake, added Ms Ching. For these patients, excess fluid can enter their lungs, causing breathing difficulties.

Seniors with cardiovascular disease can collapse from heat stress due to oxygen deprivation to internal organs.


Ms Woo Qiyun (clockwise from top left) and Ms Anbudurai Manisha speaking to Associate Professor Jason Lee from the NUS Yong Loo Lin School of Medicine to find out about how heat impacts people’s wellbeing. PHOTO: THIRD SPACING

Realising these future risks prompted the Third Spacing team to sign an open letter – called the Healthy Climate Prescription – urging global governments to drive down carbon emissions faster to reduce the worst health risks, which includes malnutrition and mental health issues caused by climate anxiety.

Topics in the current podcast season about environment and health include reducing the carbon footprint of the healthcare sector, and how hospital design can aid patient recovery.

For this environment edition which spans six episodes, Third Spacing collaborated with environmental communicator Woo Qiyun, who runs a climate advocacy Instagram page called The Weird and Wild.

The podcast began in late 2019 as a one-man show by Ms Ching. She used an audio editing software she learnt in secondary school and YouTube tutorials to start her podcasts.

Her interest in climate and health began during her hospital postings, where she saw waste being generated from medical procedures.

Ms Ching said: “For blood-taking, you have the gloves, needles, needle attacher, ziplock bags and disposable packaging. It’s a lot of waste from a single procedure, which is done numerous times a day.”

But she also highlighted a few positive steps: Some operating theatres have recycling initiatives, while some consultants make it a point to recycle medical instruments after thoroughly sterilising them.

Over time, like-minded medical and healthcare students from different institutions have joined Third Spacing.

Ms Manisha, for instance, is one of the hosts who interviews guests on the show. The podcasts’ listeners include medical students, junior doctors and members of the public.

Ms Ching said: “Doctors and students are often faced with a wall of text – lots of reading. So we chose podcasts which are more accessible, and can be emotive in communicating messages.”

She also noted that although medical care is heavily focused on biomedical aspects, 80 per cent of health outcomes are caused by social and psychological factors.

“We wanted to broaden students’ understanding of disease and health, so that we can be better healthcare professionals.”

The team hopes that each podcast will trigger conversations among listeners, and eventually lead to impact and change.

In its upcoming seasons, Third Spacing is looking to feature patients and caregivers who are often misunderstood, and to discuss how healthcare can be more inclusive. They include patients who need complex care.



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