Middlemore's Dr David Galler on 30 years at the hospital

Dr David Galler, an intensive care specialist at Middlemore Hospital. Photo / Michael Craig

Intensive care specialist Dr David Galler will soon mark 30 years' work at South Auckland's Middlemore Hospital. He's spent much of his working life trying to get health and public policy to a place that really benefits the patients he sees. Now, he's taking on climate change, writes Teuila Fuatai.

When I meet David Galler at the Hospital Rd entrance of Middlemore Hospital, one of the first things he asks is whether I caught the train in.

Dressed in a bright green and purple Mena shirt and shorts, I give him a few seconds to be disappointed about my transport choice of "car" before I mumble that, without it, I wouldn't make my next interview in West Auckland.

No, the fast-talking intensive care specialist is not a train fanatic. Rather, his attentiveness to travel method is one of the ways he gets those who'll listen to think, and practise, more sustainable ways of living. Today, it's lost on me and my Ford Focus parked on the other side of the train tracks.

Galler (centre) with staff during his stint at Moto'otua Hospital, Samoa in 2015. Photo / supplied

As we make our way towards one of the hospital coffee shops, Dr Galler goes over his morning spent at Manurewa High School. The Counties Manukau District Health Board are gifting some nearby land to the school for a community garden.

"They've got a huge range of programmes - technical programmes, health programmes, a hauora programme - and they want to have their own gardens there, set up community kitchens and encourage better choices."

He then says, with absolute certainty and the authority of nearly 30 years of life at Middlemore behind him, that shifting health practises to align with climate change goals and achieving net zero carbon is the key to addressing the types of chronic illnesses that lead to so many people ending up "here".

At this point, I'm starting to feel a little unsure of where our chat is really going.

I'd been interested in interviewing Dr Galler after reading his book Things That Matter: Stories of Life and Death a few years ago. He's also spent a year working in Samoa while his partner Judge Ema Aitken - head of the Alcohol and Other Drug Treatment Court at Auckland District Court - was on secondment to the country's Supreme Court.

During that time, Dr Galler's treatment of an ailing uncle in the local hospital meant a bit more time for my family with a much-loved relative - particularly significant when you're spread across countries. It wasn't just us that noticed the difference from his stint at Samoa's main hospital. Over Dr Galler's 12 months as a visiting specialist in 2015 and 2016, the mortality rate in the hospital's intensive care unit reduced from about 80 per cent to 18 per cent. Many of those patients were children, Dr Galler notes.

Over Dr Galler's 12 months as a visiting specialist, the mortality rate in the hospital's intensive care unit reduced from about 80 percent to 18 percent. Photo / Supplied

"The ICU was largely a place where people were sent to die." However, there were also a lot of babies and young children who would come to hospital with acute respiratory disease and nasty, drug-resistant infections that could be helped, he says.

"We started to take a few of the kids to the ICU ... and put them on ventilators and try and manage them as best we could. Slowly, we started to get a little bit of success, and more people became interested and there were even nurses from Middlemore who came and helped. We slowly built a service to look after that particular group of people."

I was keen to hear from the Middlemore lifer who'd tackled things head-on at the hospital in Samoa, and from his reputation and book, worked relentlessly towards changing the drivers of poor health which severely affected a lot of families in South Auckland.

I wasn't, however, quite prepared to link health and the problems of social deprivation to net carbon zero by 2050. Sensing that, Dr Galler takes a step back.

"In a way, a hospital - apart from things like doing hip replacements and knee joint replacements, those things you get from wear-and-tear - is potentially a failure of everything that's come before it," he says.

"Many of the problems that we're addressing here in this hospital, just about everything that comes through this door, is a preventable complication of something that's preventable in the first place," he says.

"Look around and most of the people here have multiple morbidities. Obesity, diabetes, kidney disease, hypertension, heart disease and gout - the South Auckland full house. That's what everybody's got."

As the busyness of his "second home" whirls around us, the 63-year-old rattles off the all too familiar shortfalls of the health system in combating diseases which are really symptoms of poverty and hardship.

"Health can't fix most of those things. Health cannot fix the issues that relate to those determinants of wellbeing," he says.

Galler's wife is Ema Aitken, judge of the Auckland District Court's drug and alcohol court. Photo / Dean Purcell

"But health cleans up the consequences. We don't actually create health here; we just treat illness. The things that create health are communities, primary prevention policies and society, and we just don't seem to have a strategy to do that here."

At the moment, he believes that can be changed by getting healthcare wonks stuck into climate change and carbon reduction.

Research published in the Lancet Planetary Health journal last year found the carbon footprint of Australia's healthcare system made up 7 per cent of the country's overall carbon emissions. It is about 3 per cent in England and 10 per cent in the USA.

While it is yet to be measured in New Zealand, Dr Galler points out, that eventually, the whole healthcare sector will need to make solid commitments to reduce its carbon footprint if the country is to achieve net carbon zero. Some of that work is already underway at individual organisations and through groups like Ora Taiao NZ Climate & Health Council, but a lot more buy-in is needed for sustained, overall carbon reduction, he says.

Tackling the drivers of ill health, "which we've been trying to do for years" is part of that. For example, much-needed infrastructure and policy changes to make the roads more walker and cyclist friendly would cut vehicle emissions and air pollution, Dr Galler says.

In a place like Middlemore, where so much of "our bread and butter" is dealing with the complications from one, more or all the South Auckland full house diseases, the benefits of increasing the opportunities for physical activity in the community cannot be understated.

"It's massive, absolutely massive. And there's loads of research around how that links in with wellbeing and mental health," he says.

Without missing a beat, Dr Galler goes on to cover off the policy changes needed to make junk food less accessible, something he and other high-profile public health advocates like the University of Auckland's Professor Boyd Swinburn have lobbied for over the years.

"If I was talking to a family with children, I'd be talking about eating well, exercising, not eating too much junk food, not smoking, not drinking too much. That advice is about trying to help people make the right choices. But actually, who really listens to doctors? We can write prescriptions for people and tell them to do things ... but it's pretty clear that we, as healthcare providers, struggle to influence people to make those kinds of choices."

The climate change agenda provides a timely opportunity to reframe the issues and hone in on things like regulation for non-nutritious food, he says confidently.

Galler and his wife, Judge Ema Aitken. Photo / Supplied

I ask if it's going to be enough, given the persistently concerning statistics around things like childhood obesity. Figures showing nearly 200,000 children living in poverty also come to mind. Aren't the problems related to those numbers already at their own type of crisis-level?

Dr Galler, who spent seven years as the principal medical advisor to the country's health bosses during the Helen Clark government, takes a moment to reply.

"It's complicated," he says. "I sometimes think that people don't have that sense of how it all fits together."

"They're very much locked into the area of where they work, so they have a much narrower view of what is going on."

His own peers are a good example.

"We've got lots of people who go through medical school who are really good at certain aspects of what they train in," he says. "They're really good at being surgeons, or really good at being radiologists, but that doesn't mean to say they've got an interest in health. Don't assume that they've got an interest in health.

"Doctors have an interest in what they do because that's what they train to do and that's where a lot of their efforts go. Many of them are ill-equipped to get into the area of health promotion - that's been left to another branch of medical practitioners entirely. But actually, all of us need to be engaged in it."

Siloing off "the medicine" from a person's lifestyle, and effectively health and wellbeing, isn't really giving better patient outcomes, Dr Galler points out.

Furthermore, the practicalities of working in an overburdened sector must be considered when reorienting policy around climate change.

Between 2012 and 2017, Counties Manukau DHB reduced its carbon footprint by 21.5 per cent. The reduction came after the organisation joined up to Enviro-Mark Solutions, enabling it to measure and target carbon emissions.

"A lot of that was the easy stuff, around managing your lights, managing power, having computers on sleep mode," he says.

"It was a lot of the low-hanging fruit which we did to get those big gains."

Moving into areas like food waste reduction is another step up, particularly because that type of initiative requires investment. Earlier this year, the Counties DHB projected a $53.5 million deficit for the current financial year. Asking for $240,000 for worm bins is probably not going to stack up with what the board are up against, he says wryly.

Regardless, Dr Galler is setting his hopes for the health sector, particularly its impact in the communities he serves, on the climate change agenda.

"There's this thing I see here in the work that I do about people's potential.

"You see extraordinary stories of recovery, extraordinary stories of people making something out of nothing, and extraordinary stories of people who are up against the wall and deal with that in the most dignified kind of way.

"Actually, a lot of them are living in poverty, they're not working, and their lives aren't what they could be - for themselves, for their families and for their community. That takes an enormous toll on them and an enormous toll on society because their ability to put their shoulder to the wheel of the nation is reduced."

With a glint in his eye, and after a few disparaging comments about the "sick houses of rotting and moulding buildings they've given us", Dr Galler switches back to his original point:

"'Health' is about the health and wellbeing of people, and how that impacts their potential. And quite simply, everything that you do to reduce carbon has a health co-benefit."

Dr David Galler

Galler is a father of two. Photo / Michael Craig

• Age: 63.

• Two children, Max, 33, and Petra, 28, with partner Judge Ema Aitken.

• Graduated from the University of Otago School of Medicine in 1981.

• Specialist training in anaesthesia and intensive care.

• Career highlights: Clinical director of acute care services at Middlemore Hospital; principal medical advisor to Minister of Health and the Health Ministry's Director General; founding board member of the Health Quality Safety Commission; establishment of intensive care service at Samoa's national hospital focused on children and infants and reversible disease.