This article on Kiribati, written by Caroline Gonzalez, first appeared in Inside ACEM, a collection of anecdotes and personal stories of emergency medicine physicians from Australia and New Zealand, published by the Australasian College for Emergency Medicine (ACEM) in Australia. A modified version appears here with permission from ACEM.
Imagine only having 100 metres each way between your bedroom and the ocean.
It’s a fine line, but that’s the environment Australian emergency medicine physician, Dr Brady Tassicker FACEM, experienced while working at the hospital on the main island of Kiribati (pronounced ‘Kiri-bass’) for a total of two years.
“It’s one of the most overcrowded stretches of land in the world, it’s ridiculous – it’s 25km long, 200m wide and it’s got 60,000 people on it,” Dr Tassicker says.
Jobs and an ‘incredible’ birth rate are driving a rise in the population to the small main island of Tarawa – a location that has been identified as being one of the first to feel the impact of sea level rise in the future as projected by the world authority on the science of climate change, the Intergovernmental Panel on Climate Change.
Dr Tassicker has worked on two separate occasions on the island: in 2003, and, more recently, with his young family in the 12 months to January this year.
There are two hospitals on Tarawa – a little more than 100 beds in total. Dr Tassicker says he noticed a surge in the prevalence of tuberculosis in the always-overcrowded emergency department between his two stints on the island.
“It was quite normal to be running at 200 to 250 per cent capacity – with admitted patients,” he says. “The patients overflowed out on to an open air, undercover area.”
“One of the things I was instrumental in doing was formalising that process in putting in rails and demarcating the area so it was quite clear if you are not in this area, we can’t look after you.”
Kiribati is a speck on the world stage in many measures – including greenhouse gas emissions – but it is ranked in the top three countries in the world for having the greatest proportion of a population with diabetes, says Dr Tassicker.
That’s not to mention a pollution problem – mainly from the fact that most homes don’t have toilets – so contracting typhoid is an ever-present risk when swimming at the tropical beach.
Present and future challenges
Kiribati sits approximately three metres above sea level. However, a minimum sea level rise of 40cm is projected for 2080 to 2100, in the IPCC’s Climate Change 2014 Synthesis Report, based on historical greenhouse gas emissions and those in line with a minimum 2°C degree global temperature rise under the Paris Agreement.
Much of the invisible riddle of climate change was evident to Dr Tassicker, that the physical impacts were not immediately apparent.
“Everyone hears ‘Kiribati’ and thinks climate change – sea level rise…but a lot of that I’m not seeing any evidence of,” he says.
“Having said that, they always live on the borderline and with the overcrowding, more and more people are living on marginal land, so they get inundated with high tides and those sorts of things…”
“The future is very grim.”
Adaptation in motion
Greater fluctuations in rainfall are also projected – a major threat to the health and security of the population – and the stressed water supply is currently getting worse, Dr Tassicker says.
While climate change is still considered politically controversial in Australia, he knows first hand that it’s certainly not the case in Kiribati.
“The population is very aware of the issues of climate change… they have working bees to plant mangroves to protect against erosion – there is a background level of anxiety.”
The Kiribati Government has purchased land in Fiji, some people have already moved to New Zealand, and there are moves to recruit help to build islands.
“The people in Kiribati are very attached to their own land,” Dr Tassicker says. “Culturally even the thought of turning your back on the land is very confronting.”
A rewarding challenge
It may not be paradise but Dr Tassicker, who lives in the southern Australian island of Tasmania, would do it all over again.
“You’ve got to have pretty thick skin and be comfortable with failure because you’ll have plenty of patients die on you, that you wouldn’t have die on you back home – lack of resources, challenges of delivering the treatment that you should be able to deliver in practice.”