Specialist GP Nikki Vadgama provides some tips to make your next paediatric eczema consult easier. She includes a review of new guidelines, resources, websites and medications for paediatric eczema management
Ko au te whenua, ko te whenua ko au - I am the land, the land is me
Ko au te whenua, ko te whenua ko au - I am the land, the land is me
![Dougal Thorburn](/sites/default/files/styles/cropped_image_16_7_/public/2022-05/Dougal_Thorburn.jpeg?itok=xsLn8vbv)
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Chosen by Virginia McMillan: Another Wellington dweller is specialist GP Dougal Thorburn (Ngāti Pou), who explains here how te ao Māori gives him a way to understand how everything we do affects the long, long, long term. Part of Virginia McMillan’s Green Health Collection
There are no incentives to reduce emissions and waste, and regenerate our Earth
Dougal Thorburn recalls as a child camping for weeks with his family in remote areas of Arthur’s Pass.
Now aged 41 and a specialist GP completing public health medicine qualifications, Dr Thorburn enjoys going trail running, growing vegetables and planting trees on exposed pieces of the Wellington coast.
“My philosophy has been hugely influenced by those positive experiences as a child,” says Dr Thorburn, “and as I feel increasingly connected with my Māori side, I feel a part of the Earth: ‘Ko au te whenua, ko te whenua ko au (I am the land, the land is me)’.
“And with that comes respect, love and care, and finally being able to do some of that [environmental work] in my life.”
Dr Thorburn (Ngāti Pou) says it is the land that connects people, places, plants, animals and communities, “and we are briefly kaitiaki of that land”.
“It’s an inherently Māori world view, but I feel the vision of it has been lost.”
That view looks out to the 1000-year long term and requires “a refocus away from the pursuit of economic growth at all costs”.
Health leadership should be providing “backbone support” for the sector to both decarbonise its organisations and play a part in regenerating ecosystems, he says.
“I would love to see every single health provider have access to a garden or reserve supported and funded by the health sector to help people connect with their local places…and leverage off the [health] benefits of working in gardens.
“The Ministry of Health needs to be a more active leader,” Dr Thorburn says, “working intersectorally, for example, on active transport…
“Priorities of action for intersectoral work need to be focused on activities that lead to reduction in carbon emissions, improvement in population health outcomes, and improvement in equity. You get that by applying the principles of Te Tiriti o Waitangi, particularly tino rangatiratanga. Give the power to them to design solutions that work for their people, and you will see those outcomes.”
Dr Thorburn is frustrated by the absence of clear messaging to the general public on what they can do to shrink their carbon footprint and, similarly, the lack of direction and resourcing for general practices so they can implement, and track progress on, changes such as those outlined in the RNZCGP’s guide, Greening Your Practice.
His own practice follows the guidance but: “There is no acknowledgement from the system that this is happening, and no incentives to reduce emissions and waste, and regenerate our Earth.”
Many of his GP peers also feel this lack of support, he says. Resources, monitoring frameworks and data are needed “to enable people to make the easy choices”. Among these choices is prescribing the lower-emissions asthma inhaler for patients.
Work by officials on health-sector emissions so far has been “the bare minimum”, in Dr Thorburn’s view. He’s keen to see a central sustainability unit set the direction, underpinned by indigenous world views, for change in the health sector.
His advice to GPs is to get involved with a group that helps regenerate the land or sea. “The mental and physical health benefits of being in nature are well documented.”
We have the knowledge and the technology to halve global greenhouse gas emissions by 2030, through:
- a rapid shift from fossil fuels to renewable and alternative fuels
- moving from deforestation to restoration
- backing nature in our landscapes, oceans and cities
- transforming our cities into green and clean spaces, and
- behaviour changes to address the demand side of the [carbon] equation.
Source: Speech by Inger Andersen, executive director of the United Nations Environment Programme, introducing Climate Change 2022: Mitigation of Climate Change from the UN Intergovernmental Panel on Climate Change – YouTube
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