Business As Usual

A rower paddled by the bank of the Rhine. He seemed impossibly small compared to a barge loaded with shipping containers that was floating its way towards Bonn. Similar to all of our days in Bonn, the sky was gray and the air was full of chilling moisture that couldn’t decide if it wanted to be humidity or rain.

I paused on my bike ride between the two conference centers of COP 23 to watch the rower glide along the Rhine. In the Bula Zone, the center of negotiations, Syria had just announced its intention to join the Paris Agreement, a stark contrast from the United States recent decision to withdraw. The words of the Syrian delegate had felt momentous from my seat in the balcony of the UN auditorium, yet here on the side of the Rhine business as usual continued, unaware.

Too cold to linger for long, I continued on. Entering the Bonn Zone, the center of civil society events, warm air blasted at me from the heaters in the tent. The Bonn Zone had the color and vibrancy of Epcot, compared to the professional atmosphere of the Bula Zone. With some time to kill before a side event, I wandered over to the German Pavilion for a cappuccino. On my way, I made a loop between the country pavilions. They had evolved from the day before. A stand of colorful umbrellas and plants had sprouted at the Indonesia pavilion. Cardboard cartoon animals now welcomed visitors to Korea’s booth which had been empty the day before. Visitors were posing next to the “Paris Agreement Café” with France’s #MakeOurPlanetGreatAgain cut out as they waited for a turn in with an undersea virtual reality headset. On the other side of the conference hall, Zimbabwe and Bolivia shared small triangular poster stalls with businesses, universities and NGOs. A giant globe with rotating images of African women and public bikes hung over the German Pavilion. A line had grown at the German coffee bar, a tall white stand which looked like it could be re-used to furnish an Apple Store. Sipping my coffee, the positive energy in the room was inspiring and almost palpable. But equally obvious was the overwhelming presence of certain voices in the conference hall in contrast to the absence of others.


14 hours after my flight home from Germany, and I am driving east on I-80 to a radiology residency interview. Bored, I play a game with myself as I watch the miles-per-gallon on my dashboard. I take my foot off the gas pedal, and the miles-per-gallon increase: 28.7, 30.8, 46.5. I barely tap the pedal with my foot as I drive, trying to keep the number on my dashboard as high as possible. Yet, eventually, I always have to accelerate.

On the third day of the COP, I gave up on making a schedule from the seemingly endless options of interesting events. Instead, I followed my curiosity into the Presidency’s open dialogue between non-party stakeholders and party delegations. The dialogue was set up like a negotiation. The difference was that representatives from trade-unions, farmers, indigenous peoples, women and gender, environmental NGOs sat between representatives for different countries. As a medical student, I scanned the room and noted the absence of healthcare at the negotiating table. I wondered, could our voice lend value to this discussion?

Each delegate sat behind a plastic card for the group they represented, which they politely turned on its side to request to speak. The conversation was focused on how non-party stakeholders can enhance their country’s NDCs. The UK started by describing their ambitious subnational actions in Scotland. Several countries joined in, expressing their support for the UK and thankfulness for open dialogues. Finally, the environmental NGOs spoke up, emphasizing urgency and their ability to act across political action.

“We need to increase our policy ambition especially on the part of the biggest emitters.” An older and heavier party delegate spoke up with the characteristic shortness of breath and dry cough of congestive heart failure. The dialogue continued, with nonparty stakeholders airing their grievances and parties highlighting their actions.

open dialogue
Presidency’s Open Dialogue

At my interview day, I follow a pack of future Radiologists in black suits on a tour of the hospital. The hospital wards are newly refurbished. The wood panel floors shine and panoramas on the wall show images of snow-capped mountains, waterfalls and peaceful lakes. The ward even smells good, like spring-fresh laundry detergent instead of the typical sterile hospital smell of rubber and skin.   

“We have two 3 Tesla MRIs in addition to our 1.5T scanners, SPECT and PET- CT, 64- slice and 128 slice CT scanners, 9 interventional suites…” The resident physician pauses to list resources off a piece of paper. Zoning out, I wonder what fraction of the 80 million CT scans and almost 40 million MRI scans performed yearly in the US are performed on these scanners.* Are they a beneficial addition to patient care or a demand from our medico-legal system? How much carbon dioxide and particulate matter is released into the air in their making? How do you know what complex combination of genetics and environmental exposures leads to the glaring white pixels of lung cancer on a computer screen?

 “This is the nukes reading room,” the resident continues and we pass into a dark room full of computers where nuclear imaging studies are analyzed.

“Healthcare is not prepared for climate change.” The words stood alone in bold on a PowerPoint at a health clinic in Bonn. The speaker went on to describe the effects of recent hurricanes on hospitals in Puerto Rico and Texas and the limited ability of healthcare organizations to respond to these natural disasters. Furthermore, he described that healthcare emissions represent 5-10% of GHG emissions internationally. If that was not cause enough for alarm, he added that these emissions are projected to triple by 2040.

Yet he continued on to describe a hopeful scenario. Healthcare is well positioned to take become a leader in sustainability. Furthermore, he went on to say that patients expect that healthcare is sustainable and to describe the value we can create through sustainable procurement and changes in overall system design.

By virtue of my seat, I found myself discussing ways to include climate change in hospital risk assessments with a hospital CEO and policy advisor. Are disasters opportunities to motivate the board or is that in poor taste? How do we find people willing to identify projects with a high ROI in their spare time? Their desire to improve the system was inspiring and at the same time, as a future physician, I felt like a highly stamped cog in a machine run by these administrators. I left the health clinic and the COP, motivated, but unsure of my role in changing the business as usual scenario of healthcare.

 “If you could tell the selection committee one thing to take away from your trip to the UN conference, what would it be?” I look at the interviewer across from me, unsure of where to start. Describing the conference alone seems like a monumental task. Do I tell her about the polite and pointed arguments of the Bula Zone? Or describe the cosmopolitan excitement of the Bonn Zone? Or do I pass along the message that healthcare is not prepared for Climate Change?

 Ultimately, I can’t sum my lessons from the COP into a 2-minute elevator speech for an interview. I caught a privileged glimpse of international delegates haggling over subheadings on a page at the Paris Agreement negotiations and the necessarily slow but steady compromise required to make international policy. I observed hospital administrators brainstorm ways to revolutionize the global medical supply chain. Their work was inspiring. But looking forward to residency, my role will be immersing myself in business as usual and perfecting my ability to deliver patient care. Yet, my trip to COP 23 also revealed gaps in the top-down approach that need be filled with individual actions and my power to make space for conversation about climate change where it is often overlooked.





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