Dr. Courtney Howard, MD

Summer of Smoke published!

*Every once in a while I develop a burning curiosity about something. It’s usually the start of an adventure.

Six years after we held Vivi’s 1st Bday in a smoky park, the final product of the SOS-Summer of Smoke project, a collaboration between the Yellowknives Dene, the Ka’a’gee Tu First Nation, Ecology North, and a passel of some of the smartest people, I know was published: https://bmjopen.bmj.com/content/11/2/e037029.info

We found that in 2014, 385 wildfires led to a two and a half month smoke exposure for Yellowknive, Dettah and N’Dilo that was associated with a doubling of ER visits for asthma as well as of primary care visits for pneumonia and cough as compared to previous summers. There was a 48% increase in community dispensation of salbutamol. We analyzed it with the benefit of insights gleaned from the previously-published qualitative part of the project led by Warren Dodd.

https://www.semanticscholar.org/…/fc4a729f3f32b0829b81c…

It turns out we lived through one of the worst wildfire smoke exposures so far recorded in the global medical literature base (most describe exposures lasting a few days to a few weeks). Our usually pristine air quality allows impacts to be attributed to wildfires more directly in almost all other studies.

The press release and key messages are here: https://docs.google.com/…/1w7Bikw_LxEXvr…/edit

A media folder of still shots and 2 min videos on Clean Air Shelters (with Ryan Harrison of the Yellowknives Dene), Firesmarting communities (with Melaine Simba of the Ka’a’gee Tu First Nation), and the mental health impacts of climate change with me is here:

https://drive.google.com/…/1LQKgIeUMomjDbHPdsd5yuB9ecDk…

Almost every media interview I’ve ever done about wildfires has contained the question, “So Doctor, are we at a new normal?”

The answer is no. We are not at a new normal. We’re already 2.5 C warmer here than we were 70 years ago, and we know warming will continue until at least mid-century. Summers are going to get smokier for at least the next 20-30 years, and will only level out then if we emergently decrease greenhouse gas emissions now.

The prescription? Preparation. With Perth, Australia, having had to evacuate emergently this week as a result of a wildfire, in the midst of a COVID-19-related lockdown, we need to envision the worst-case scenarios and plan for them. Our interviewees consistently told us that not only does having an action plan make a good outcome more likely, but that being ready feels good.

Looking back, it’s actually incredible where this adventure has led. I had considerable ecoanxiety at the time we began. Not only was Yellowknife’s Doug Ritchie key to putting our team together, but he, as the most diligent environmentalist I have ever met, was the only reason I was able to get on a plane to help make this project fly–because he believed I was good enough that I’d manage to make an impact that outweighed my emissions. A few months after he told us at our initial meeting that he was partly interested in doing the study because he hadn’t been feeling well that summer, he was diagnosed with pancreatic cancer. He died very suddenly, and much too soon. I try every day to live up to the faith he put in me.

This one’s for you, Doug❤️

Doug Ritchie and I

Vivi’s first birthday, in which her ER doc mother and her pediatrician father decided to hold a party in the park and invite half the neighbourhood kids, and more than a few doctors, because we couldn’t stand to be inside anymore after 1.5 months of smoke. It was here that I looked around and thought:

1-I wonder what this is doing to our kids’ lungs?

2-Someone should do a study to find out. I wonder who I can convince to do it?

View from our house on August 3rd, right before we went down to my Dad’s house in North Van. When I opened our suitcases up in his house it smelled as though we’d just come home from camping. I now know that without HEPA filters it only takes a few days for indoor air quality to get as bad as outdoor air quality–even if you keep your windows closed. 

We were just about to submit the initial grant proposal to Health Canada when we realized I couldn’t be the Principal Investigator because I was between university appointments. I happened to publish an op-ed on climate and health in the Toronto Star right before Dignitas International was hosting a fundraiser with that theme, so they asked me to present. James Orbinski (who accepted the Nobel Peace Prize on behalf of Doctors Without Borders while he was their international president) is my ultimate hero. This was the second time I’d met him, and I remained unable to speak to him without hearing my heartbeat in my ears. Before I knew what was happening, I was pitching him on being PI for the study. He said yes on the spot. I pick good heroes. He’s just asked me to be a community fellow at the Dahdaleh Institute for Global Health Research, where some of my fave people are already making mischief. I’m excited 🙂 https://www.yorku.ca/dighr/person/courtney-howard-md/ 

Team meeting at the Ecology North office when Qualitative lead Warren Dodd came up to help with the Community interviews. Craig Scott is to my left, then Jeremy Flatt and Warren.

Fred Sangris of the Yellowknives Dene taking Dr Orbinki through photos of the community’s history before our presentation in Dettah.

This was the day I decided to make fish chowder for James Orbinski because he was just arriving in town–and couldn’t find any local fish. I haven’t been that nervous since–I believe it is the only time in my life that I have actually paced. I finally bought 3 kinds of smoked fish, added a bunch of clams, and made sure we had a couple of kinds of homemade bread, deciding that had to be good enough–then Darcy Scott came home with fish caught that day (bless him 🙂). It ended up being an awesome evening, and I believe this was the start of being able to speak to James without hearing my heart beating in my ears louder than what he was saying. (I know it sounds extreme but this guy’s book directed half my training choices and was the reason I went to Djibouti. Now he knows I have a messy house–and I think life is good like that)

Melaine Simba of the Ka’a’gee Tu First Nation. She’s an incredible former firefighter and environmental worker who coordinated our study in Kakisa and who stars in the video about community firesmarting. https://vimeo.com/373968341

After having met Sam Myers while presenting the SOS project at the Ecohealth conference, I was asked to present on advocacy at the closing panel at the inaugural Planetary Health Conference at Harvard–with Marshall Ganz (!), Kelsey Wirth, the founder of the incredible mothers-for-climate-action org “Mothers Out Front” and superstar Eriel Tchekwie Deranger–who spoke right before, me, nailed it as she always does, and got the only standing ovation of the whole conference. Gina McCarthy–Biden’s new climate lead, then head of the EPA, gave the closing address. She was excellent–but Eriel stole the show 🙂

My girl, Dr Caren Rose, second author on this study, who has been helping me with math since grade 7. I pay her in baked goods and half-decent company. Now a senior scientist at the BCCDC, she’s crunching numbers for Dr Bonnie Henry these days. This is us going through the final revisions to SOS. Caren the Rose, I could not be prouder of you. Thank you.

My two tutu’d sources of inspiration–and a bit of an indication why this project took 6 years to complete 😉

Thank you to EVERYONE who has been involved with this project. Onwards!

Summer of Smoke— February 7, 2021

*Every once in a while I develop a burning curiosity about something. It's usually the start of an adventure.

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