Sidrah Lodhi
Dr Sidrah Lodhi is Assistant Professor of Endocrinology at King Edward Medical University, Lahore and practices in Mayo Hospital, Lahore, Pakistan.
Details
- Date of interview: 28 March 2023
- Archive reference: OBJ/ORA/9/6
- Interviewer: Daisy Cunynghame
Timestamps
00:00 Introduction
00:54 When did you become aware of the impact of climate change on health?
03:37 What is the impact of climate change on health in Pakistan?
08:11 What is the global impact of climate change?
09:25 How does climate change impact on your work?
11:59 What changes do you expect to see in the future?
15:14 What do you think about your government's response?
20:32 On an individual level - what can practitioners do?
24:31 What are the obstacles preventing change?
26:52 How do you deal with the challenge of those who are not engaged?
28:51 Any final thoughts?
Transcription
Interviewer:
I wondered if we could start with you just saying a little bit about yourself. Who you are and where you work?
Sidrah Lodhi:
Thank you Daisy so much for taking out your valuable time and special thanks to RCP (Royal College of Physicians) for reaching out and involving me in this activity.
I'm Dr. Sidrah Lodhi currently I'm working as Assistant Professor of Endocrinology at King Edward Medical University in Lahore, Pakistan. I hold fellowships in internal medicine and in endocrinology from Pakistan, as well as from the fellowships from the Royal Colleges of London and Edinburgh. And as I already mentioned, my primary area of interest is endocrinology, that is what my current practice is.
Interviewer:
Fantastic, thank you very much. I wanted to start by asking when did you first become aware of the connection between climate change and health or the impact of climate change on health?
Sidrah Lodhi:
Very interesting question, Daisy. Well, obviously I first became aware when I was still in school. I think it was in fifth or sixth grade, perhaps, when I had the school project where we had to come up with the concept that incorporated something to do with climate change and how it impacts our life or on our health. So, it was a very broad concept, and I remember putting up a poster that was something of a collage and that had to do with deforestation and how ultimately, we would end up with the food shortage and famines in the coming years. I'm very thankful that has not happened as I saw it as a school student. So, around the same time, we were sensitized to all these ideas: global warming, deforestation, ozone thinning, the glacial retreats and pollution and all those things. The ideas were there, but at that time they did not really make that impact that they should have on me. Somehow, they regressed as I became interested in other things.
But I even remember thinking to myself, “yes, we are studying this as I live in Pakistan and we do not have all those [kinds] of high impact activities and a lot of those”. Especially at that time when I was still a school student, “So, do they even impact us or are they even relevant to our part of the world”. And I vividly recall reading up some of the articles where they said that when temperature increases, there's an increase in rainfall so that eventually brings down the temperature. There is no real global warming. To be honest, I was confused at that age.
But then, as I joined the medical profession and I started my practice, that is when the reality started to sink in that the problem, the emergency is real. It's not just something that some people have thought of and [are] working on it, and some other people come up and deny it. So, the environmental conditions and that I would say, to me, the impact became more real as I saw more and more patients and more and more people with real problems, real world problems coming with it.
Interviewer:
Thank you very much. That's really interesting. Staying with that for a moment, I wondered if you could talk a bit more about the impact that you have seen locally. So, in Pakistan, what is the impact of climate change and particularly climate change on health, would you say?
Sidrah Lodhi:
You see climate change is an emergency everywhere in the world, but especially in Pakistan. I will come to more of that. But before going on, I think it would be pertinent to say what kind of climate we have here in Pakistan. Pakistan lies in the temperate zone. The climate is generally arid and it's [got] the hot summers, cold winters, wide variation of temperature at any given place. However, this would be an oversimplification, I would say, because there is so much difference in geography. There are the coastal areas in the south, we’re such a small country, you would not probably expect, but there are snow covered Himalayan and Karakoram peaks in the north, and there are deserts and plains, plateaus, hills and everything in between all kind of geography that you could think of. So, we have all [kinds] of weather, all [kinds] of climate, every place has its own climate.
But if I talk about one place, let's say Lahore, where I live in practice, the summer temperatures routinely exceed 40 to 46 degrees centigrade. And on top of that, there are heat waves. In the summers, we have all those heat exhaustion and heat stroke cases coming in. But along with that, because many people resort to unsafe water, because they do not have access to all the clean water, drinking water so we get the epidemics of diarrhoea and all the related problems. We get typhoid epidemics. We get hepatitis epidemics. Anything that you would think is waterborne, we get epidemics. The heat issues are compounded by the use of air conditioners, both in the cars and in the buildings, the homes and offices everywhere.
If you talk about the winters, the temperatures dip to sub zeros, and this I'm talking still about Lahore. Okay, so it's not just hypothermia because of the poor heating, but there [is an] increasing number of strokes and heart attacks because of the circulation problems. And then, the problem is that most of the heating in Pakistan, even in Lahore, is based on the heat. In Pakistan, even in Lahore, that is based on open flames, either people are using biofuels for heating up their homes, or they're using gas heaters, so there is an open flame. There are the hazards of heat always there, as well as the chest problems due to the use of these fuels.
Then when you come to the seasons in between, there are heavy rains, heavy monsoon rains, they come with urban flooding. And with that also come the mosquito-borne epidemics, because the mosquitoes flourish like anything. In the past few years, we have been having so many dengue, malaria epidemics, you name anything. This is followed by [the] dry season, with very high AQIs (Air Quality Index), very poor air quality. We have been getting smog and all the related problems in, I would say, the last five to seven years, like never before. When everything, a lot of things were closed down, they were shut down in the COVID years, that is when we realized how clear the air can actually get here. And, when people did not have all those sore throats all the time it was such a relief, because you cannot never say COVID was good, but there were other things. So, we have got all kinds of health problems that you could think of [as] related to climate in just one city.
Interviewer:
Thank you very much for giving that context. I wondered if you have any thoughts on the kind of bigger picture in terms of climate change? Beyond Pakistan, the impact of climate change on health globally.
Sidrah Lodhi:
Yes, I would say that the problems are similar. Climate change is impacting human life and health in a variety of ways. It threatens the essential ingredients of life: the clean air, safe drinking water, nutrition, food supplies, and the shelters that we seek. WHO (World Health Organisation) estimates that by 2030 and 2050, between those, climate change is expected to cause about a quarter of million additional deaths per year just from all these climate conditions. So, it really is a huge problem and all those countries that have a weaker health infrastructure they're likely to be more hard-hit. The developing countries, the poor countries and you see they will be less able to cope with all the problems that are coming in, and that is what I see the problem is everywhere.
Interviewer:
I wondered if you could explain some of the ways that climate change impacts on your work right now?
Sidrah Lodhi:
As I mentioned I am primarily working as an endocrinologist, so this is a very interesting question if you talk about the endocrine aspects. Right now, you would not expect people you would find, maybe many people [would] be surprised when we say that it is linked to our part of the medical practice. You see, now when we talk about the risk factors for diabetes and heart disease and all those problems that are not just in the developing countries but also in the developed countries. Cardiovascular and the metabolic outcomes, you would be interested to find out that climate change and air pollution are now recognized as one of the major contributors and major risk factors for even the development of diabetes. That is a huge area that needs to be explored and that needs to be talked about.
Then we have the impact of climate on thyroid function. I'm talking about this because you see from the endocrine perspective as the temperatures change and as throughout the year there is a difference in the thyroid hormone, in all kinds of hormones, and that people usually do not talk about. One of the very interesting aspects is the endocrine disrupting chemicals. As of now more than a thousand chemicals have been recognized, mostly used in the agricultural industry as fertilizers or all those kind of things to fight off some of the some of the pests that are there the pesticides and the fertilizers, they are endocrine disrupting chemicals and they affect all [kinds] of endocrine functions that you could think of.
Interviewer:
Thank you very much, my next question is possibly a slightly impossible one to answer, so I apologize in advance. But you've talked about the impact of climate change on health. I was wondering if you have any thoughts about what the impact will be in the future so in five, ten, twenty years’ time how do you see that changing?
Sidrah Lodhi:
I think if you look at the trends the outlook is not looking too good. The international community, as well as WHO, has declared a climate emergency and if we do not respond to that emergency what I see is a multiplication of the problems that we are seeing right now. But one thing that I do see is that because the climate change is so obvious now nobody can, I mean not nobody but most of the people, cannot really deny that climate is changing. Especially in a country like ours that was hardest hit by some of the climate changes.
As you're aware, just last year Pakistan had a massive flood problem. One third of the area of Pakistan was submerged and some of the areas that are far flung, they are still suffering from the impact. In the coming years what I think is that there would be increasing recognition, number one, and once there is recognition then there would be rectification but if we do not do anything then we are going to see increasing burden of the problems that we are seeing right now.
Another thing that I want to mention is that if we do nothing it is not just about me. We have to understand that it is not just about me and you right now, because you see there is cross-generational, there are trans-generational changes that come about if the climate continues to be the same. I would like to bring your attention to a 2017 study where they were by [unclear] and what they found out was that when you change the temperatures, you increase the temperature and you expose the individuals. This was obviously not in humans; this was an animal model study. But what they found out was that the endocrine disrupting chemicals in increased temperature, they affect the sex determination, they affect survival and they affect development across generations and there are developmental deformities even in the coming generations. Do [not only to think] about ourselves but how and what kind of world we are leaving for the next generations.
Interviewer:
Thank you very much. I think that leads on nicely to the subject of what can be done or what is being done, as you're saying, what we need to do to turn things around? Do you have any comments or any thoughts on how your government has responded to the climate change emergency and particularly in the context of health?
Sidrah Lodhi:
As I mentioned earlier as a school student, I was not, even as in college, not in medical college but before that, I was not very aware of how important this aspect is. For quite a few years now we have had a Ministry for Climate and a Ministry for Climate Change and I used to think, “Why do they have two ministries? What is so special about climate change?” But now I would say that is something that should take centre stage. Maybe that is because I'm seeing more patients now, maybe because the changes are more obvious now, but really this is something that should take centre stage.
The measures that Pakistan has taken in the past few years. First of all, I would like to say that even though Pakistan has one of the hardest hit countries, the greenhouse gas emissions are less than 1% of the total world and if you talk about per person then they are less than half of the global average. A major contribution that comes from either agriculture - 43%; and 46% comes from energy production, electricity generation.
So, what has been done till now and what is proposed is that a few years earlier, there was a proposal of increase on the tax and motor fuel and here has been the government policy of no more coal-fired power stations. There is increased reliance on solar and wind powered energy generation, reforestation is being done, solar energy for homes is being promoted and [the] government is facilitating that, as well. There are some projects for public transport, but having said all that, all of this is not enough. These are the general measures that have been taken for [combatting] climate change, but if you talk about health, what I feel is that in the context of health there is more of a concept of firefighting rather than a program that directly combats health [hazards] related to climate change. That is how I see it at present.
Interviewer:
Thank you. You’ve mentioned what's already being done, and you mentioned that more should be done. I wondered if there's any other thoughts that you have on what exactly the government should be doing that they aren't?
Sidrah Lodhi:
One of the things that [strikes] me the most is that the public transport system in Pakistan is not very well developed and not very reliable as it should be. So, one of the things that I would suggest is that a public transport system should be made more viable, not just intercity but also in the city. Electric vehicles should be introduced more, rather than those run on petroleum products.
The other thing that I find missing in my environment, in our culture here is that there is a lot of talk about recycling but it's very difficult to recycle here. Because when you are in any European countries, or maybe in the U.S., you will have the recycling option right there in your home. You will have the bins right outside your home and the garbage company is going to come and collect those bins and it's easy, it's accessible, but it's not that way [in Pakistan].
So yes, we are doing things, we are doing mega projects, we are talking about that, but the shifts need to be more rapid and those are the two things that in my opinion are likely to make more impact. And these are the two things that will also empower people and give the idea to everybody that each individual can make a change.
Interviewer:
You've talked about the action of governments; I wonder if you could talk a bit about what individuals can do? Particularly medical practitioners or physicians, what can people do to make a change?
Sidrah Lodhi:
The first thing that I believe people can do is that they can start discussions about it. They can start talking about it and this needs to be our coffee table discussions because unless you understand the problem you cannot really do something to rectify it. The second thing is that every person needs to understand that the actions of each individual are important. It's not just the government [that] is going to do it, some group is going to do it, a group activity is needed to combat this and that. I believe the actions of each individual are important and that is what we need to disseminate to people. So, taking the initiative at [an] individual level, that is what everybody can do and that is what everybody should be doing.
If you talk about medical practitioners the first thing [is] that we need to be judicious in how we are practicing, how we are prescribing and what kind of disposable materials we are using. Let me give you the example of COVID. So, everybody has seen those personal protective suits that were being used in COVID and they were all disposable. You wear them once, even if you go in for like 10 minutes or you go in for like 10 hours in a COVID ward. Everything is being discarded and then it cannot be recycled like everything else because it is medical waste so are those kinds of equipment always needed or the personal protective equipment when we are talking about more and more sterilization and disposables and syringes. But the point is that how much of them can we reuse? Can we reuse a syringe for the same patient? What kind of medications can be mixed in? so we need to talk about those we need to develop guidelines. We have got very nice, very stringent sterilization guidelines, but we have not got any reuse guidelines. That judiciousness has to be there.
Another thing that medical practitioners can do is that a big part of our medical development as medical professionals and ongoing medical education is conferences and meetings and all those kinds of things. So rather than doing it in person, maybe we should be moving to virtual meetings, like this one today. So, we need to think about the carbon footprint of each of our actions if we really want to make an impact. Those are the two things that I think if we could implement it would make a huge difference.
Interviewer:
Thank you very much. You've talked now about what should be done at [the] government level and what should be done at [the] individual level. I wondered if you had any thoughts on why we aren't doing those things already? What [have] been the blockers or the things that have stopped us from being further along with addressing climate change?
Sidrah Lodhi:
Like I said, a few years ago if you would have asked me, I would probably have said it's not my problem. So, until we understand it is everybody's problem, that is one thing. But if you talk about the major obstacles to that, besides the understanding and the recognition, I would say one is denial that climate is not really changing until you see it changing for yourself. Then the economics are very important, in a poor country, in developing countries investing in infrastructure and making those radical changes that [are] more difficult. Then some of these strategies that might be regressive, when you tell people you have to turn off your air conditioners but when it's hot and squelchy outside. The politics of those regressive strategies, you have to consider, whoever starts it until you change the mindset it is going to be an unpopular opinion. Then the distribution of resources, I make a change today but is it going to really impact just me or somebody else. Like I said the carbon footprint of Pakistan is less than 1% [of the global] greenhouse gas emission but we had the impact. So, a country having a major contribution to the greenhouse emission gases, but the impact [being] on somewhere far away. the distribution impact is there. I think those are the major obstacles why we haven't really been there even though we understand and recognize the changes.
Interviewer:
Thank you. You're obviously someone who is quite well read or well versed on this subject. I'm just wondering, especially for anybody who's watching this who is a medical practitioner who is interested in getting involved. If you meet somebody who is either a climate change denier or just somebody who doesn't see why this is important to you, how do you win people over or persuade people of the value of it? Do you have any tips for anybody who's watching as to how you can persuade people that this is an important topic?
Sidrah Lodhi:
I think that the only way to persuade people, maybe not the only way but one of the major ways to persuade people is by exposing them to different experiences. We tend to deny a lot of things that we have not seen, we have not experienced or things that we have not been taught as a kid. So, you see something comes to me and I might say, “Oh haven't heard of it so it's not true”. I think one of the ways to combat this is to introduce those ideas at a very early age, maybe earlier than when I was introduced at ten or eleven. Maybe right when kids start school, they need to start talking about the environment that is going on. I'm not saying that we scare our kids, I'm just saying that we make them more aware and so that is an age when the impact is more and then they carry it lifelong. But if somebody is denying it in adulthood, then I would say that exposing them to different conditions and making them feel that what is going on in the world, that could be an important area to address.
Interviewer:
Thank you very much. I've run out of questions to ask you now. Before we wrap up, I just wanted to ask, is there anything that I haven't asked you that you would like to have been asked or anything else that you would like to bring up that you haven't had the opportunity to?
Sidrah Lodhi:
Just one thing that I would like to say. There are some people who are more at risk of climate change. Obviously, the ones who are more at risk with any health condition, children, old age, socially vulnerable people who have some chronic health conditions, maybe pregnant ladies, breastfeeding. But we must remember that it is not just a problem of certain groups. It is a problem [for] everybody. Every single person on the face of this earth is at risk and is facing those challenges. And every single person should take the responsibility to make an impact. And that is all I can add.
Interviewer:
Fantastic. Thank you very much.
Sidrah Lodhi:
Thank you, Daisy. It has been a pleasure to be here today with you.