S2E22: Environmental Rights and the Connection to Health

Margaux: So we're just going to do it quick and dirty. I'm going to guilt shame you all into being fashion-conscious and it'll be fun.

Harjit: Oh, no. I don't know if I'm excited about this anymore.

Bushra: You don't want to be here.

Margaux: This is so dramatic.

Bushra: Harjit is so annoying and dramatic.

Margaux: Okay. Does everyone have the food out of their mouth?

Bushra: Yes.

Harjit: Yes.

Bushra: I'm ready.

Margaux: Okay. Hey, everyone. Welcome to The Bundle of Hers. Margaux, Bushra, and Harjit in studio today. Whoop, whoop.

Bushra: What's good? What's popping?

Margaux: We recruited Bushra in here from surgery. She's super happy about it.

Bushra: Excited.

Margaux: Yep. Okay. So today we're going to talk about something that I'm super passionate about and I try to share with these other wonderful ladies, and that's environmentalism. And I think that it actually ties very directly into healthcare.

Things about the environment, like water and clean air, I think are basic human rights that everyone should have access to that are directly linked to our health. Living in Utah, we have exposure to a lot of these. So we tend to have really bad air in the winter. And then I think we have all seen how, on the wards, we get a lot of patients with inflammatory diseases in their lungs and COPD exacerbations and whatnot from the bad air, or even in the peds, asthma and bad air.

And then the second thing is that we live in a desert, and we tend to treat our water as if we live in a place where there's abundancy of water. And then the second thing with water is that in southern Utah, on the Navajo reservation, they haven't had access to clean water in, like, 70 years or ever since the establishment of that reservation. So those are just things to think about.

And then one other topic I want to talk about in terms of environmentalism and healthcare is how the things that we buy as consumers, who's making those, and how are those choices impacting those people's health.

So let's first talk about air and clean air and how you guys feel about that or what you guys notice and connect, especially living here in Utah.

Bushra: I'm generally pro clean air.

Margaux: Good, good.

Bushra: In Utah, we have pretty bad inversion, especially in the winter. And so we tend to see a lot of asthma exacerbations and COPD exacerbations during that time. You'll see when you're driving on the highway, they'll give you warnings about air quality. "Oh, today would be a good day to carpool instead of drive your individual cars," or, "Take public transportation." I know some people bike to work or whatever.

I'm going to raise my hand and say I'm very guilty of driving to school because it's just convenient that way. But the thing is I also see the impact of my actions, and I have a hard time reconciling the two things because I know I'm contributing to the bad air quality among other things, but I don't necessarily find myself doing anything to prevent it.

One thing I will say is Margaux is a very good reminder for me and the rest of the women from the things that we consume and use, like plastic spoons. Remember when you told me?

Margaux: But then you did catch me one day. I forgot a spoon and I had to use plastic.

Bushra: I caught her slipping.

Margaux: She caught me.

Bushra: It's hard though, Margaux. It's really hard. And I really do commend you for putting in that effort because it makes a difference, and if every person can change that thing, like using a plastic spoon, it adds up for sure.

Margaux: And I think to that point, too, something that I think a lot of people, when they think about environmentalism, is they're like, "Oh, we have to do everything all at once." And that's not sustainable or practical for everybody, right? But I think if everybody just chooses one thing that they can do, even if it's a little thing such as bringing your own silverware for lunch, that adds up and makes a bigger difference. And nobody has to do it perfectly, but if everybody just does a little bit or what they can, that makes big difference.

As long as you can just start to be more aware of what you do to contribute to the air quality or water pollution or the plastic waste, just that awareness is always the first step.

And I think that now that I've been on the wards and treating people who have a direct impact of this, it also makes me think about my own health. There are some statistics out there that like when our air is as bad as it gets in the winter, it's the equivalent of smoking how many packs of cigarettes. And then we treat patients with lung cancer and I'm like, "Oh my gosh, I can't be breathing this all the time."

So I think just the first part is awareness, and then maybe as it becomes feasible to buy a Tesla or whatever . . . I don't know.

Bushra: Whoa. When we start making that money.

Margaux: When we're attending status, you know? But at least we're building that awareness or just consciousness of how our environment impacts our patients' health.

Harjit: Yeah.

Bushra: Should me and Margaux just have this conversation?

Harjit: No. I'm good at this conversation.

Margaux: She's so . . .

Harjit: When you talk about environmentalism, something that I find really interesting is the people that can make those choices of living cleaner are generally richer or they're from affluent or privileged backgrounds. But I find that so interesting, because I'll tell you something about my story.

So I was born in a village back home in India, and I remember my mom used to tell me stories like we used to go to a well for water. We would use cow dung patties to fuel our fires. So everything was sustainable. Everything was reusable. Down in the south India, they used banana leaves as plates.

And I think that's such an interesting concept because when you come to American society, there are a lot of people who don't have the time or the energy to think about where their products are coming from.

Let's even take clothes, for example. The cheaper clothes are made by the people who are not getting the right compensation. And I think a lot of that has to do with inherent isms in our society, like racism, sexism, capitalism. All these things contribute to that.

So sometimes I'm like, "I just need to go back to my roots. What did my family teach me? How did people back in my village live?" But when I came here, it's just so easy to fall into those patterns, and it's really hard to know that you're a part of this huge problem where if I just would have held onto those values that my parents taught me, it would maybe not be the way it is.

I don't know. For some reason, this topic is really hitting a chord with me because I have become like this. I have to unlearn so much because this isn't the way I was "raised."

Margaux: I think that's super insightful, and especially what you were talking about with fashion, for example, and consumerism and capitalism. And I think that's the culture that we're primarily raised and bombarded with here in the U.S.

Harjit: I think it's become a global thing as well.

Margaux: Yeah, totally. The consumerist capitalistic mentality is definitely a global phenomenon that is sort of driving this. Let's take fast fashion as an example, which you used, but I'd also like to point out that cheap clothes and expensive clothes can be made in the same factory with people who are making less than living wages.

Harjit: But the name . . .

Margaux: Yeah, the brand is what will sell it, and that person who's sitting in the CEO's office is making the money, not the person making the clothes.

Harjit: That's a good point.

Margaux: And so what I've really been trying to look into myself and what I think you're really good at always telling everybody, Harjit, is question everything. So what I've been questioning is why do I want to buy that sweater? Why do I want to buy those shoes that I just saw on Instagram? And is it the immediate sensation of like, "That model looks cute and those shoes are so cute. I just want to have them"?

Dopamine response that you get from seeing it and then buying it and then you get them and you wear them once and you're like, "Okay. They can go to the back of my closet now," without ever thinking about the person who made those shoes. Did they get a fair wage? Did they get their legs or arms or anything injured because they were making the shoe for me? And did they have healthy living conditions? How far do they have to travel to work?

So after doing the Hippocratic Oath, "do no harm," I've really been thinking about how do my choices in my consumerism reflect the "do no harm." And I think it's been really eye opening for me, Harjit. And I understand from your perspective, where you were raised with this one mentality and way of utilizing resources, and then to switch into a different and to really reflect on that, is something that I'm trying to do right now from scratch and truly understand. I had no idea about this until I just started recently looking into it.

Harjit: Yeah. My mom, she is so funny because she'll be like, "Oh, you're wasting this. Eat every piece of the apple. If you can't eat it now, we'll save it for later." And she'll put it in the fridge and I'm like, "I'm not going to eat an old apple." Because I have the privilege to have another fresh apple.

When I was younger, it annoyed me a lot. We use butter containers. We'll put our food in there. We'll save it and we'll use it as a container for years and years and years. Honestly, years.

I guess sometimes I don't give my mom enough credit, but I think that quality of hers is actually so great for our family, and because of that, we are that much less contributing to the problem.

Margaux: And actually, I love that butter container story because . . .

Bushra: We do it, too, by the way.

Margaux: Yeah. So my grandmother and my mother, they are from the Czech . . . like, rural Czech Republic when it was Czechoslovakia and there was a lot of discord between the Russians coming in and invading. And my grandmother grew up in World War II. She had very little access to food, and it was rationed and all of that. So she also uses the butter containers and all of that. So I think that's a cool connection that we just made here now, and is a good way to reduce, reuse, and recycle, right? So that's kind of fun.

Harjit: Yeah. It is fun, but it's also really hard because now that we're having this conversation, there's so much that I think about, but there's so much I don't think about in my day-to-day life. I think to be a "woke person," it requires a lot. It's really hard to be perfect and not be a part of the problem, but we all are. And I guess I'm just having that struggle right now in this moment. There's so many things that I do that contribute to all the problems that I hope to work against.

Margaux: No, I think that's so true. And back to my point earlier is that we can't all be perfect at solving the world's problems in this moment. Right now, I think the most important thing is to just recognize and question, like you always say. Just question, "Why do I want to buy this sweater? Why do I need this dress for clinic?"

And I'm on a student budget with student loans and that price tag is very appealing. That's okay to go through that and understand that maybe the person who made it doesn't get the best quality of life, but you're conscious of that and working towards bettering it in the future. We all don't have to do it right now, but the first step is just making noise about it. Right?

Harjit: Right. And I think it's super unfair that certain populations are impacted by this more than other populations. Even the bad air, may it be certain type of chemicals. There are underserved, underprivileged populations, under-resourced populations that get the brunt of the problem of environmentalism.

Margaux: Yeah. The economics play significantly into it. And unfortunately, the thing that's economically feasible is not always the most environmentally friendly. And that creates then a huge disconnect and vicious cycle because those populations are also . . .

Harjit: Not getting the health . . .

Margaux: The healthcare.

Harjit: Yeah.

Margaux: And so it's something we . . .

Bushra: It's a double whammy.

Margaux: Yeah. Totally a double whammy. And another example of that right in our home state is that the Navajo Native American reservation down in southern Utah and the Arizona border haven't had running water for 70-plus years.

Harjit: That's insane to me because I think . . .

Margaux: In a developed country.

Harjit: I think one thing that I do know about that culture is they are so connected to the earth and the environment is so important to them. This is one population that shouldn't be impacted the way it is. And why? So I think that's an important question we should all be thinking about. I think some of us know the answer, but we should be thinking about that.

Margaux: And also to add insult to that injury for them is the uranium mines that are powering . . . that were used to mine uranium that make the nuclear power plants that run the electricity that is running this show right now potentially had polluted many of the wells also on that reservation and in that area. So the resource is incredibly scarce.

Harjit: Right. Where water naturally would have been clean is now polluted. And that, for me, is . . . there is a systematic reason why. And I think that is a perfect example of why we have this podcast, right, because these are the things that people's everyday lives are impacted, and it's something that we know that there are connections, but I think a lot of us don't want to acknowledge it. Because I am a part of that problem too.

Margaux: I am too. And I think it's hard to just start even challenging, "I really want to buy that pair of shoes, but I'm not going to." That's a really hard step, but I think every little bit of awareness is a step in the right direction.

Bushra: This is a small step, so I'm not giving myself a pat on the back or whatever.

Harjit: The small things matter.

Margaux: The small things matter, Bushra.

Bushra: I think it's . . . keep in mind I'm not a perfect person. I'm flawed, but okay, I'm going to buy shoes from this retailer because they specifically say the people that make them earn a fair wage. You know what I mean? Or I'm going to buy clothes from this brand because every time I buy a pair of shoes they're going to donate a pair of shoes to someone who needs them or something like that.

It makes me feel better about shopping when there are those kinds of cases. Yeah, I'll go to H&M every once in a while. All the time. If it's cheap and cheerful, right? But I will say that it's steadily decreased for me, and I'm also not buying as many things as I used to because . . .

Harjit: Oh, me too.

Bushra: . . . I have a problem with keeping everything that I have and then adding more to it and then not using what I already have. And so I've been trying to . . . actively trying to use the stuff I already have that I haven't worn in a long time. I don't know why I feel the need to go out and buy something new. And it's probably because we've been programmed to do so.

Margaux: Exactly.

Harjit: I think it's really important for us as healthcare providers, because when we get those patients that are directly impacted by even the decisions we make, I think it really adds a new perspective. I guess I didn't really even think of that until I just made that statement on this podcast.

Margaux: Genius.

Bushra: An epiphany.

Harjit: Mind blown.

Margaux: There's a really good app called Good On You and they give . . . you can type in whatever brand that you want, and actually if you type in H&M, they're not as bad as Forever 21. So H&M versus Forever 21.

Bushra: Well, I guess I'm doing something right.

Margaux: It's a good option. They grade them based on the quality of . . . like, the environmental impact of the materials that they use in their clothing, their labor practices, so how fair it is to the people who are actually making the clothes, and animal welfare, like do they test on animals or do they use animal products and are the animals that are being used for the products treated well? So, that's one thing that you could use if you're interested.

But to wrap it up, I think the theme of today was it's okay that you're not perfect in your practices, even if you recognize that there are things that you're doing that contribute to the environmental problems or the social-economic healthcare problems that we have. The first step is always awareness and just to research more about it or question why you're doing something or what is causing or contributing to that cycle, and then do those little things that can add up.

You'll start by bringing your own silverware for lunch, and then it turns into using glass instead of plastic containers. And then it can build up that way. And don't try to conquer the world all at once, but question everything.

Harjit: Yeah. And I think that that's the key, Margaux. And I will say, Bushra, even though you said that, "I'm just doing small little things," it's those step-by-step things that really impact change. It's almost like when people want to get healthier. You can't cold turkey stop something. You need to build upon your past successes. And I don't think we give ourselves also enough credit that, yeah, we're contributing to the problem, but every small step is a step forward.

Margaux: Right. Beautifully said. And just to think how our own actions outside of the hospital contribute to the health of our patients or the health of those who don't even have access to direct great healthcare . . .

Harjit: Yeah. So we shouldn't make their problems worse.

Margaux: Exactly.

Harjit: One day they don't even have the . . . I'm sorry I'm laughing about this, but it's serious. They don't even have the resources to go to a doctor.

Margaux: Right. And that's like part of the bigger healthcare problem that we have in this country. But just thinking about how we can . . . even as healthcare providers who have committed . . . or future healthcare providers who have committed to do no harm, our life choices impact the health of other people. And I think that's super important to start thinking about and questioning as we go through the rest of our training and become attendings.

So thank you for listening to Bundle of Hers. We hope you'll join us next time. And download our podcast on anywhere you get your podcasts now.

And if you would like to add a resource or something you've learned about or have any questions or want to join in on this discussion, please drop us a note at Bundle of Hers on Instagram or Facebook. And until next time . . .

Bushra: Bye-bye.

Harjit: It's been a minute since we've had that.

Margaux: I know. We tried to do it, but none of us . . .

Harjit: We are really bad at it. Leen actually kind of almost tried, but . . .

Bushra: Kind of almost.

Harjit: As in she was . . .

Margaux: Yeah. Because I can't do it.