Introduction to case study

Scenario

As Jay and Giani return home after discharge following Giani’s total knee replacement, they prepare to launch their legal battle to protect their home and assets from Jules and Quinn.

The lawyer suggests having their house and belongings valued in case they need to sell in the future. They move everything out of the garage and out from under the house to prepare it for valuation. Jay places everything on the back lawn himself, as Giani is unable to assist during his recovery. Jay’s plan is to either dispose of the items or sell them. Jay heads inside for lunch. He forgets he was going through the items and doesn’t get them sorted.

Before any of their possessions can be moved, sold or put away, a very slow-moving east coast low hits the region. This is followed by a second east coast low a week later that remains almost stationary off the coast. Torrential rain continues for 3 weeks, leading to record flooding across the northern rivers region. The flooding is unlike anything previously experienced where they live in Brunswick Heads, not usually a flood prone area: the yard and lower level of the house are flooded with a combination of storm water runoff filled with debris and flood water from Simpsons Creek containing untreated sewage overflow from the flood damaged sewage plant. The water takes 5 days to fully recede, while Giani and Jay are trapped in the house with bottled water, a portable gas stove, and, luckily, a well-stocked pantry.

Cut off by the flooding, Giani’s community nursing team and his physiotherapist are closed, which has meant he has not been able to continue with his postoperative mobility work. He is also unable to access his community nurse to receive the appropriate wound care. Jay is due to be assessed by an aged care assessment team (ACAT) team for support during his progressing dementia, but this has also been postponed as the team’s offices were destroyed in the flooding. While the team intends to reschedule, they are not certain when that will be.

During the flooding, the town’s infrastructure is badly damaged and Giani and Jay find themselves cut off from town water. They learn that the council is prioritising the repairs to this infrastructure, including the sewerage station. In the meantime, they decide to drink water from the tank Jay had installed in the back garden to water their vegetables. As they are unsure if the tank is contaminated by flood water, they decide to have the water tested. They call a local recovery volunteer hub, which assigns them a volunteer expert to undertake a microbiological test for faecal and total coliforms before they drink the water in 2 days’ time.

After most of the water recedes, Giani and Jay attempt to start cleaning up their house site. They consider themselves quite lucky to escape with minimal damage to the house, mostly a heavy growth of mould and water damage to the living room from a leak in the tin roof. Both their cars are destroyed, and, having floated into the front yard, are now immovable. Their front stairs are badly damaged after being hit by a shipping container in the floodwater. It now rests on their neighbour’s lawn. As they can’t hose without water, they sweep what they can and pile the worst of the junk at the front ready for council collection. While Giani has limited mobility, he helps as much as he can, although the broom proves difficult. He has limited ability to lift objects and gets covered with the mud in the yard. He rinses himself off with tank water.

Several days later, Giani notices his knee appears swollen and red. He ignores it so he can keep supporting Jay with the clean-up. Some of their neighbours have returned and are able to assist with moving some of the heavier objects to the front of the home. Unfortunately, because so much debris has collected, their street is largely impassable. Giani becomes aware that Jay seems very confused, as well as complaining of a headache, fatigue and a sore neck and calls the Byron Bay hospital. The hospital is overwhelmed with high patient numbers and suggests contacting a GP or visiting one of the pop-up health clinics in the recovery centre. Giani also starts to feel unwell. He is short of breath, with a slight temperature, headache and muscle soreness. He puts these symptoms down to the clean-up work of the last week. He also wonders if he has perhaps caught Covid, as it is rife among volunteer groups.

Jay’s confusion continues to worsen over the next 2 days. Giani becomes very concerned that Jay is not drinking enough and seems to have developed a rash. As Giani is also feeling extremely unwell, has constant nausea and some vomiting, he calls a friend from his dance group to take them both to the Tweed Hospital emergency department. The doctor on call assesses them both, takes vital signs, undertakes blood tests, a chest x-ray for Giani and has a nurse remove the soiled dressing on his knee. When exposed, the wound has broken down and started to dehisce (part or split) and there is some discharge. The nurse swabs and cleans the wound and the doctor sends the discharge for analysis, along with a blood test. The medical team suspect Giani may have an infection in the knee, and possibly leptospirosis which has been seen in the area after the floods. Jay is investigated for suspected Ross River virus from a mosquito bite.

Key information and links to other resources

Extreme weather events are on the rise due to the effects of human driven climate change. The planet relies on a very delicate balance of warming of the atmosphere from the sun’s radiation. It is either being absorbed by the planet, which reflects that heat back to the atmosphere, where gases such as water vapour and carbon dioxide reside, absorbing the reflected heat, warming the planet, or cooling through the radiation energy from the sun being reflected back by aerosols in the atmosphere (Hanna & McIver, 2018).

While the natural warming effect is needed to keep the planet habitable, over the past few centuries since the industrial revolution, the balance has been disrupted (McDermott-Levy et al., 2019). Human factors (anthropogenic) affect this balance, as greenhouse gases, such as carbon dioxide and methane, through the burning of fossil fuels, create a blanket-like effect around the planet as they absorb heat, blocking the ability of the planet’s surface to eject heat (Costello et al., 2009).

As the warm atmosphere can hold more moisture, this means we see more extreme weather events such as cyclones, and storms that lead to flooding, amongst other events.

Some reading that may assist your understanding of the science behind climate change and the effects on health:

• McDermott-Levy, R., Kolanowski, A. M., Fick, D. M., & Mann, M. E. (2019). Addressing the health risks of climate change in older adults. Journal of Gerontological Nursing, 45(11), 21–29. https://doi.org/10.3928/00989134-20191011-04
• NSW Health: Infectious diseases fact sheets – this site will assist your understanding of conditions such as leptospirosis and Ross River virus.

 Case study 4 summary

Giani had to have a surgical washout of his infected knee the day after his admission and undergo a treatment protocol with penicillin. In the meantime, the local community, led by Giani’s drag bingo crew, rallied to clean up Giani and Jay’s property and rebuild their stairs to improve access. The town water has also been restored and the volunteers were able to hose their home and property down and remove most of the mud.

Giani and Jay were discharged home from their hospital stay within days of each other. During Jay’s admission, while he received intravenous fluids and pain relief, he mainly required rest. During the stay, Jay was linked with the social worker and ACAT, who completed their comprehensive assessment and started to put community services in place for Giani and Jay. Thankfully this also included some short-term links with the locum community health team who were working from the recovery hub. At this time, there are no indications that Jay can’t stay at home with Giani as his carer, with additional support while Giani recovers from his knee operation.

References

Costello, A., Abbas, M., Allen, A., Ball, S., Bell, S., Bellamy, R., Friel, S., Groce, N., Johnson, A., Kett, M., Lee, M., Levy, C., Maslin, M., McCoy, D., McGuire, B., Montgomery, H., Napier, D., Pagel, C., Patel, J., … Patterson, C. (2009). Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. The Lancet, 373(9676), 1693–1733. https://doi.org/10.1016/S0140-6736(09)60935-1

Hanna, E. G & McIver, L. J. (2018). Climate change: A brief overview of the science and health impacts for Australia. Medical Journal of Australia (208)7, 311-315. https://doi.org/10.5694/mja17.00640

McDermott-Levy, R., Kolanowski, A. M., Fick, D. M., & Mann, M. E. (2019). Addressing the health risks of climate change in older adults. Journal of Gerontological Nursing, 45(11), 21–29. https://doi.org/10.3928/00989134-20191011-04