Bushfires: implications for medical workforce and education

AUSTRALIA’S most recent bushfires – still burning in many areas – have been catastrophic and unprecedented. From the tragic loss of human and animal lives to rampant property damage; there is no doubt that these bushfires have weighed heavily on the national conscience and ignited a fierce discussion about our response to bushfire emergencies, the health implications and how we support our communities.

There’s a wealth of articles on this front. Key stakeholders such as the Australian Medical Association have highlighted smoke exposure as a new and possibly fatal health risk, and the considerable mental health burden in these communities moving forward, while the Rural Doctors Association of Australia has called for the establishment of a nationwide Rural Emergency Responders’ Network.

A little closer to the hearts and minds of medical students are our colleagues that come from rural backgrounds as well as those who are undertaking a rural medical placement. These students represent the future of our rural medical workforce and they call these bushfire-ravaged lands in rural Victoria, New South Wales, Queensland and South Australia home. Through this article, I want to discuss the impacts of these bushfires on medical student education and welfare and move on to exploring how these bushfires may require changes to our medical curricula to ensure future doctors are adequately equipped.

Unsurprisingly, a large proportion of our rural medical students come from rural backgrounds. Just like others in bushfire-damaged communities, they have been devastated by the gravity of these fires – the livestock lost, the properties lost, the harvests lost, the lives lost. Those students training in medicine are doing so often with the desire to return to those communities and give back in abundance.

At this time of year, these students are heading back to frantic medical school timetables and the mundanities of drug names and clinical conditions while their communities are salvaging the pieces without their help.

We know that the mental burden on medical students is very high and that familial support networks are important to ensuring students don’t burn out during their degree. These bushfires simply add another weight on the back of some of these rural students. When they return to the hospital or lecture hall, extra support should be afforded to ensure we don’t let anyone slip through the cracks.

For other medical students, these bushfires represent a lost opportunity to expose themselves to rural medicine. Medical students often spend their summer break in placements at rural hospitals or in programs such as the John Flynn Placement Program, which assigns students to a rural placement for a total of 8 weeks throughout their medical degree. The intention is to immerse themselves in rural medicine, learn from rural doctors and get a taste of living and practising in a rural community.

What these bushfires have done is make these rural communities difficult to access and turned them into potentially unsafe environments in which to learn. A case in point is the cancellation of placements for a number of students who were planning to do their John Flynn Placement Program in Bairnsdale. The bushfires have prevented safe access to that community. This is absolutely the correct decision to make to ensure student welfare, but nonetheless an opportunity has been taken away from students due to the bushfires.

It is an injustice to these rural communities that poor political leadership on climate change results in bushfires that isolate and devastate towns that would have otherwise welcomed students with open arms.

Beyond the more immediate impacts of these bushfires on medical student welfare and education is the longer term impact on the skillset and preparedness of doctors in rural communities to combat future bushfires and health emergencies. Doctors, especially those training and practising in rural communities, will need to adjust to the changing health needs in patients who walk through those consulting room doors, alongside contributing to address the broader public health needs of these communities.

Mental health conditions ranging from anxiety and depression to post-traumatic stress disorder will become more frequent presentations and will require longitudinal follow-up and adequate specialist care. Long term respiratory manifestations due to extensive smoke inhalation will be a medical challenge, with a need for greater research into the effects of bushfire smoke inhalation. Public health concerns will be highlighted with water and food supply, communicable diseases and access to important medicines, as well as timely access to the right specialists. Doctors will be increasingly challenged by what are already stretched medical resources in rural communities.

The flow-on effect is that medical education needs to also adapt and align itself with the shifting medical needs of these rural communities. Topics such as disaster management from a public health perspective, mental health in the context of health emergencies, and even the interplay between climate and health will all need to be woven into Australian medical curricula. This will ensure medical students will be adequately aware of the health consequences of such catastrophic events and will have basic foundational knowledge and skills to build upon to effectively contribute to these scenarios in the future.

The importance of changing medical education cannot be overstated. Potential solutions that intend to upscale preparedness and equip rural doctors with the skills to respond in such emergency situations require the bedding down of foundational knowledge and core skills during medical school.

While the current national response organised by the government and medical community – from GPs signing up for locum shifts in affected areas to some doctors adapting motorhomes into medical clinics – is amazing and inspiring; we need to be actively moulding a generation of adaptable doctors capable of combating these events and building this capacity and skill into our future medical workforce.

It is more important than ever to prepare a generation of doctors for an age of increasingly extreme climate events that culminate in public health emergencies and, simultaneously, it is more important than ever to ensure that the communities where our future doctors come from are adequately supported throughout this difficult and testing time, both now and in the future.

Daniel Zou is the President of the Australian Medical Students’ Association and a 3rd-year medical student at the University of Melbourne.  

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.