Hot on the planet – should WONCA be considering sustainable travel policies?

The WONCA Executive has just met in Bangkok for its annual business meeting. This destination was chosen after detailed comparative cost appraisal, and gave us the added advantage of seeing our Secretariat in action on its home territory. It was a great meeting, very well organised and supported by the CEO and Dr. Nongluck, Arisa and Bee, all of whom are doing a very committed and hardworking job for our organizations. It was also a great pleasure to see all my fellow members of Executive, and to have the chance for some in-depth business discussions and challenging debates.

The President and I also visited the Department of Family Medicine at Prince Mahidol University and had the pleasure of a long question and answer session with 40 of their residents, as well as seeing their new building and the professors who are leading this excellent unit.

Nothing can replace that kind of face to face contact, nor the relationships we built over the visit. But as I looked out of my hotel window over the hovering smog of air pollution that lies on the city at dawn and dusk, or sat surrounded by cars and motorbikes on the 1.5 hour journey in from the airport (see photo), I did begin to worry about the right balance of international travel for delivery of our objectives.

There are three issues to set against the wonderful opportunities of working in a global organization – personal demand of travel (time away from home and workplace, health risks); financial costs; and environmental impact. The last of these is probably the most pressing, as many of our countries are seeing extremes of weather due to global warming, and the low income countries of course lose out the most when there is an environmental disaster – whether flood or drought, poverty and poor infrastructure exacerbates the problem and this impacts on health(1). So I would argue that we must think about sustainability when we consider WONCA travel for business.

Yet our trade is in interpersonal contact, and our forms of working are largely through conferences, meetings, and educational development visits (such as study trips, accreditation, and faculty development events). As President-Elect, I have already enjoyed a number of trips to others’ countries as their guest and speaker / expert resource, and have noted the disappointment when I have had to decline meeting invitations. At one level I would like to be, as the song says , “Everywhere … all the time”, but this is not going to be feasible, nor good for the WONCA budget or the planet!

So I am writing this to start a bit of a debate, and also to consider other ways of being present without always needing to fly and stay.

I recall in Ukraine in 2013 they linked postgraduate centres from all parts of the country into the national conference plenaries, with delegates visible to the speakers and able to participate in question sessions. My university and the Caribbean College of Family Physicians have allowed me my first experiment in making a film of a keynote lecture, so that (hopefully!) I can sit in one of our College offices and do a Q&A via the Web, after colleagues have watched me do my talk: ‘live’, projected on the screens in an auditorium just as it would be if I were there - but made a month ago! I have offered a similar option to another colleague later this year at a point where I cannot attend in person. And we have the wonders of being able to meet without meeting (SKYPE, GoToMeeting), plus social media where we can live in each others’ pockets from all sides of the world if we so wish!

A similar discussion is going on about how to use new technologies in clinical care – can I safely save the patient a 20 mile journey and half a day of absence from work if I organize to do their diabetes check-up over SKYPE? Will the Internet allow me to transmit photos or test results to colleagues to get a rapid opinion so that I can avoid sending a patient to the hospital? When should I travel to the patient and when should they come to me? And so on…

In conclusion, I think we do need to meet for many reasons – we are human beings, and we can only get an in-depth appreciation of the needs of a situation such as a consultation, a teaching seminar, or a professional discussion, when able to interact and be spontaneous together. But perhaps we also should evaluate who, where, how often, and what are the alternatives – plus, what is most cost-effective – can the resources be better used for other purposes? What would a WONCA policy on sustainable travel need to say? This will no doubt be an ongoing discussion and moral issue for us all.

Amanda Howe

1. See WHO Factsheet on Climate Change & Health.