The emerging generation of 'green pediatricians'

Lleida / OlotChildren are especially vulnerable to environmental risks, such as air pollution, food pollution, microplastics, and climate change itself. A 2016 WHO study It is estimated that a quarter of deaths among children under five could be avoided with a cleaner, healthier environment. Heart and respiratory diseases are the most common, but other parallel pathologies also exist, such as obesity, premature puberty, hearing loss, asthma, mental and behavioral disorders, stroke, bone pain, and cancer.

The international scientific community now defends the role that pediatricians and other healthcare professionals can play in disseminating environmental health concepts, such as promoting protective behaviors and combating significant exposures. In Catalonia, a community of healthcare professionals linked to the environment is emerging, and above all, pediatricians who are aware of the subject.

The Arnau de Vilanova Hospital in Lleida was the latest center to launch (just a year ago) a pediatric environmental health unit, which is officially known as the acronym for PEHSU (Pediatric Environmental Health Specialty Unit).

The Lleida plain is increasingly aware of health problems caused by environmental factors. We have examples such as the waves of neighborhood opposition to the Nova Tracjusa gasification project in Juneda (Les Garrigues) and the future biogas plant in Sentiu de Sió (La Noguera), or the continuous warnings about the presence of pollutants in the atmosphere during periods of winter fog or African dust. "Here in Ponent, we are also exposed to many toxins that affect us, and we thought it was essential to act," argues Dr. Eduard Solé, head of pediatrics at the Arnau de Vilanova Hospital in Lleida.

Endocrine disruptors

Since last summer, the pediatrics department at this center has hired Dr. Paula Sol Ventura, an endocrinology specialist and recent researcher at the Germans Trias Hospital in Barcelona. The intention is to quickly establish the second PEHSU in Catalonia (the first opened in Olot nine years ago) to work in research and raise social awareness, but, above all, to develop more accurate diagnoses of the environmental origin of many of the childhood pathologies being detected. In other words, the unit will now carefully analyze children's social and family attitudes and environment to determine what may influence the onset of illnesses. "Children are the most vulnerable because they have less body surface area, they touch things they shouldn't, and they don't control what they do," explains Dr. Sol. In many cases, the cause lies in family habits and the environment.

In the event of any growth or breathing problem among children treated in Lleida's pediatric services, this unit intervenes to determine whether the cause is environmental or not. Once the source of the emission is detected, it establishes recommendations to keep the child as far away from exposure to the pollutants that are causing problems as possible.

The Arnau Environmental Pediatrics Unit is also specializing in the effects of disruptors in our environment, that is, all those chemical or natural substances that affect children's endocrine systems and cause precocious puberty, obesity, and other problems. These include heavy metals, pesticides, or bisphenols to which the population is constantly exposed without even knowing it or, obviously, being able to control it. Therefore, the hospital may end up preparing reports so that the administration can act and regulate the use or emission of pollutants that repeatedly cause diseases.

The pioneering model of Olot

Dr. Ferran Campillo, head of the The Pediatric Environmental Health Unit of the Olot and Regional Hospital of La Garrotxa is one of the pioneers in the field in Catalonia..

On a global scale, these types of units first emerged in 1998 in the United States. Three years later, La Fe Children's Hospital in Valencia, through oncologist Josep Ferris, was one of the first to appear in Europe, followed shortly after by the Hospital de Murcia. It was precisely at this last center that Dr. Campillo trained, eventually moving to Olot ten years later. "When we started here, we were something of an oddity, and for years we've had to explain and teach it very well," explains the doctor. "The goal is for this to spread like wildfire," declares Campillo.

In fact, last January the Generalitat (Catalan government) presented The Growing Up Healthy program, a protocol of preventive and health promotion activities in children This includes, for the first time, a chapter on environmental health and, above all, the incorporation of the so-called Full Verd (FULL VERD), an environmental screening system that assesses and identifies children's exposure to toxins and environmental pollutants. "If we detect that a child lives in a family of smokers or in the presence of pesticides or other pollutants, we try to take action," explains Dr. Campillo. The ultimate goal is for all children in Catalonia to have access to this Full Verd (FULL VERD).

This is the case of Mireia Biguet, who is currently in the last trimester of her pregnancy and voluntarily agreed to open a Green Leaf for her unborn child. "Initially, I was hesitant to go, but I sincerely recommend it to everyone," says the user. During the visit, she explained to a nurse the professional and domestic context in which the child will be born. She lives in Begudà, a municipality in Sant Joan les Fonts (Garrotxa), in a rural setting with a vegetable garden and farm animals. Her story was later accompanied by recommendations from the healthcare staff. "Some of the advice even surprised me," explains Biguet, "such as the restriction on the use of insecticides that we have always used at home."

Another case recently treated by the Olot PEHSU is that of Montse Busquets, a single mother who, faced with allergic asthma diagnosed in her twelve-year-old son, Nuha, had to make changes in her daily life. The most recent was to join a program to quit smoking, but the first was to change habits at home to minimize Nuha's exposure to mites, the main cause of his attacks. Atopic dermatitis, sneezing, and shortness of breath were his most recurrent symptoms. "He suffered attacks since he was a baby, but it was when he was four years old that we acted, guided by Dr. Campillo," explains Busquets.

Changing sheets and curtains frequently, ventilating rooms daily, removing rugs, and using dehumidifiers were the pediatrician's main recommendations that have improved the young man's quality of life. Nuha will have to take medication forever, but thanks to preventive measures, his health has improved. "Medicine should move toward this prevention model: it reduces expenses and avoidable health problems," Busquets believes. However, this mother acknowledges that society is still skeptical of this type of pediatric care. "We are too accustomed to interventionist medicine," she laments.

Environmental references

The ultimate goal is to expand this care model throughout the country, and the planned tool is the incorporation of environmental experts, doctors and nurses who have been trained in the subject and who can be consulted in case of any questions or suspicions of a pathology potentially caused by an environmental factor. Catalonia has about twenty such experts, and eighty more are currently being trained.

"These pediatricians may not be able to develop all the standards necessary to open an environmental health unit, but they will be the leaders in their area," explains Campillo. The idea is to expand this network so that all patients have access to it, both in person and online. Primary care centers in Barcelona, ​​​​in Figueres and Vilafant, the Hospital de Palamós, and the pediatric service at Seu d'Urgell are some examples of this oil stain that is slowly spreading.

Perhaps too slowly? Dr. Campillo is optimistic: "Pediatric interest in the environment is growing, and for the first time we will have resident students with formal training." "It's such an important topic that it's no longer a rare occurrence in medicine," he concludes.