Health leader hits back over nitrates

Last updated 11:13 07/12/2013
Alistair Humphrey
John Kirk-Anderson

THE GOOD PRACTITIONER: Dr Alistair Humphrey in his office which he tidies once a year

Alistair Humphrey
Carys Monteath
GOOD HEALTH: Humphrey practises what he preaches and is often seen pedalling his bike around the city, with dog Chester

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Farmers accuse Canterbury's Medical Officer of landing a low blow. But Dr Alistair Humphrey explains his job is to see the big picture. JOHN McCRONE reports.

We are meant to be discussing nitrate levels in Canterbury's water but we are talking about Iggy Pop instead.

Canterbury Medical Officer of Health, Dr Alistair Humphrey, turns out to have been a schoolboy punk rocker. His posh college, Latymer Upper in London - "Hugh Grant was in the year above" - was handy for one of the big venues.

So for a moment there is the chance we were both at the same Iggy Pop concert back in 1977. But it appears probably not. The UK Subs were the support act at his, The Adverts at mine.

However Humphrey still rocks out, he confesses. "I was playing a bit of Iggy - Search and Destroy - on my guitar last night. I have a sound studio at home and was having a thrash."

I am discovering Humphrey is an unexpectedly colourful character. Well, that might have been guessed from his natty bespoke tailoring and small terrier Chester, who sometimes comes to work with him in a bicycle handlebar carrier.

It is also his job to be the human face of the Ministry of Health's bureaucracy, he says. On a grander scale, as the regional public health watchdog, he has to be able to forge an approachable doctor-patient relationship with an entire community.

Yet there are mutterings that when it comes to groundwater nitrates - an issue that so deeply affects dairying, and thus the long- term economic future of Canterbury - Humphrey has been something of a jumped-up GP overstepping the mark.

'Playing the blue baby syndrome card'

Farmers, especially, have been upset about the way Humphrey has been playing the blue baby syndrome card. "It is an emotive scare tactic," says Timaru-based Federated Farmers vice-president Dr William Rolleston - himself a qualified GP.

Blue baby syndrome, or methaemaglobinaemia, is a potentially fatal condition involving high nitrate in the drinking water of a pregnant mother or the bottle formula fed to a baby, which can bind to haemoglobin, the oxygen-carrying pigment of the blood. A newborn can become starved of oxygen, turning blue around the mouth, hands and feet in four weeks.

Rolleston says almost every year when Environment Canterbury (ECan) releases its annual groundwater survey of wells and waterways, Humphrey pops up in the media to warn about runaway dairy conversions and the "ticking time bomb" of methaemaglobinaemia. And yet there hasn't been a recorded case, let alone confirmed death, since the 1990s.

"It's all very well to say babies will die. It's something you can never disprove. But it gives no timeframes or indication of what the actual risk is," says Rolleston.

"For a private citizen to get up and say that would be fine, because their credibility is what it is. But for an officer of health to get up and say it is a completely different thing. They have a responsibility to be far more objective than those comments appear to be."

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Rolleston's tone indicates he sees Humphrey as a maverick medico, pushing a politically motivated view.

He says it dates right back to the Central Plains Water irrigation scheme consent application in 2007, when Humphrey made a health impact submission that not only cited blue baby syndrome but also social inequality issues. Dairying might make farmers rich but where was the general benefit in Aranui?

Rolleston says the fears gets over-blown. What is missed in the resulting media hubbub is that the high nitrate readings are confined mostly to a few privately owned and shallow wells. They are not coming from the general municipal water supplies. And where there is a concern, there are often explanations other than dairy intensification, such as overflowing septic tanks or nearby freezing works.

Rolleston says he doesn't mind fair opposition. The highly critical report released by the Parliamentary Commissioner for the Environment (PCE), Jan Wright, last month was fact-based and farmers accept they must lift their game as a result.

But Humphrey has been socking them below the belt with this blue baby thing.

Humphrey limps to greet me at the Community and Public Health (CPH) office in Manchester St - since the earthquakes, sited in an old showroom next to a kitchen appliance store.

Last week he had to be pushed around meetings in Wellington in a wheelchair. That was fun he remarks. Humphrey explains the front wheel of his bicycle got stuck in a quake pothole and he fell, fracturing his foot.

But it has been another chance to see health issues from the public perspective he adds brightly - negotiating disability ramps and all that.

Inside the office, a crowd of heads can be glimpsed over the low partitions. A first misapprehension is quickly dispelled.

Humphrey is not some lone over-promoted GP giving vent to private opinions. He is in fact one of four representatives of a 100-strong team of public health professionals.

Humphrey shares an office with fellow Canterbury medical officer Ramon Pink - Humphrey's is the half with the spilling heaps of paper that gets tidied perhaps once a year, Pink's is the neatly organised side of the room.

Somewhat defensively Humphrey says, as a medical officer in the UK, he would have two PAs at his service. In New Zealand, you do your own filing.

Based in this Christchurch office are also the medical officers for South Canterbury and the West Coast. And then the building houses four staff sections.

There is a health protection group, a health promotion group, a policy submission group and a research group. "There's a lot of PhDs here gathering the background information for anything I have to say."

So on the nitrates issue, Humphrey has his own water quality team. He speaks for a qualified and resourced operation.

And as for his willingness to speak louder than most medical officers - to be blunt about the risks of dairying and stray beyond his apparent brief to worry about social inequality or climate change - Humphrey says that comes from his life and lessons learnt from it.

It has indeed been quite an adventure.

Humphrey's father was a brewer who moved from Scotland to London. There was the excitement of being a punk rocker at a smart school.

A brainy but gregarious type, Humphrey soon gravitated towards a medical career as being the "sweet combination" of science and people. Yet - he blames this on a childhood love of the globetrotting Tintin books - he was also in a hurry to get out and see the world.

A trip to Turkey with friends before St Andrews University resulted in typhoid and an unplanned gap year. So what better way to fill the time than backpack across Africa?

'I got very used to Kalahnikovs being shoved up my nose'

"I got very used to Kalashnikovs being shoved up my nose," he says. "I hitch-hiked down the Nile and across the Sahara - through Tunisia, Algeria, Niger, Nigeria, Cameroon, central Africa, Sudan, and into Kenya.

"The whole trip was six months, done on [PndStlg]1500. I arrived back at Heathrow on a forged ticket from Cairo with just a fiver I managed to borrow off some woman on the flight."

Humphrey says it taught him about personal safety - learning to walk around with your eyes open. The trucks that gave him lifts used to travel in 100-strong convoys, religiously stopping by lunchtime each day because after that the soldiers at the checkpoints would be too drunk and dangerous.

That was an enlightening experience.

Then as a medical student, he had the opportunity to travel to socialist Nicaragua, where the Sandinistas were fighting the Reagan-backed Contras. He was one of the rare Westerners allowed up to the front line, but told not to wander beyond certain trees or he would be sniper meat.

What impressed him - as in Africa - was witnessing the difference that public health could make in the world. The simple things such as sanitation and education.

Humphrey says it showed him there is doctoring - the frontline administration of medicine - but then also work on the general conditions of a healthy society.

"It was interesting talking to a socialist government about how they felt education had to underpin public health. Their drive was to bring literacy rates up first to ensure people would even be able to understand how to become more healthy."

Still training, Humphrey headed next to Tonga to research diabetes. He says the disease was only just becoming recognised as an epidemic created by the Western lifestyle rather than simply a medical condition.

Humphrey spent time in Wellington - a stint in orthopaedic surgery - while he continued his diabetes study. Then, after finishing his qualifications in the UK, he got a job as a flying doctor in the Australian outback.

"Whoop, swoop and scoop," grins Humphrey. Another big adventure. However, he says again a public health story emerged. "There was a doctor and nurse but it was more about community development, not the station owner trapped under a tractor like you see on TV."

Humphrey says there were two Aboriginal townships near his Broken Hill base in New South Wales. One had had a school principal 30 years earlier who had actively promoted Aboriginal culture. This town had good social capital, intermarriage, and far better health outcomes. "It was a delight of a community."

But in the other town, ethnic identity had been suppressed. As a consequence, its community was highly segregated, its general health much worse. "It was taboo to go to hospital for help there, as locals believed that is where you went to die."

So at every turn, Humphrey found himself getting the message that health is more than pills and operations. It is a cultural and social issue if you want a healthy community. Thus, he says, you can't shy away from the unpopular questions about economics and inequality if you are going to do a medical officer's job properly.

Somehow, Humphrey eventually stopped bouncing about the world and settled in Christchurch 13 years ago.

 

In fact the answer to that is easy, he says. He married and had a family, a gaggle of girls, one still at Rangi Ruru. Plus he found himself working with a District Health Board (DHB) that was world leading in its strategic approach to health - a fact the earthquakes have now abundantly confirmed.

Humphrey says Canterbury is very lucky, as it has had at least two good DHB chief executives and two good board chairs in a row. A local culture of excellence has developed.

As a city, Christchurch also appears to have an optimal size in that it has a critical mass of resources, yet there is a social connectedness that allows smart things to happen. Cantabrians often beat themselves up for being siloed, says Humphrey, but this perhaps reflects more the recognition that there is no excuse for it to be the case.

A typical example is legionnaires' disease. Christchurch, the gardening city, with many people with their faces buried in moist bacteria-spawning muck, has the country's highest rate of legionella infection.

''The intensive care ward of Christchurch Hospital had a problem because if you have legionella pneumonia, you can end up being incubated for three weeks. If you have a road accident or a coronary, you're out of there in two or three days. So it was becoming incredibly expensive for the health service, tying up beds at $4000 a day.''

Humphrey says Dr Geoff Shaw, in charge of the unit, rang him up and they developed a public health campaign, warning about compost, that has already resulted in legionella cases dropping by a third.

''Now that kind of easy-to-do conversation does not happen in other parts of the world. The English health service is a huge machine so things happen only very slowly. There are always committees.''

Humphrey says this kind of proactive thinking has put Canterbury ahead on many fronts. The DHB can see that with a greying population, the region would need to build three new hospitals by 2040. So it has responded with a fundamental shift towards education, preventative medicine and frontline GP surgery treatment - catching health problems before they get out of hand.

Humphrey says his job as a public health officer has become that much more powerful because the Canterbury health system is geared towards big picture thinking.

It showed during the earthquakes. It is an extraordinary fact that after they hit, there were no mass gastroenteritis or communicable disease outbreaks - probably the only time after such a disaster. Humphrey puts this down to an educated public.

''As we know, every drain in this city was wrecked and at the same time all our drinking water was compromised. There were cracks everywhere in the system and raw sewage was being sucked into the pipes.

''Elsewhere people had no water to wash their hands and were using holes in the garden. So we had the perfect storm for a gastro outbreak.''

But Canterbury also has a high level of practical knowledge about the importance of hygiene, due to frequent pandemic awareness campaigns, like those ahead of the 2009 swine flu scare.

Humphrey says it is a matter of local pride that the World Health Organisation has taken the exceptional step of adopting Canterbury's pamphlets on hand-washing and road-show exhibits as a package to be used internationally.

'The lack of disease was a testament to the resilence fostered in the community'

So the lack of disease was a testament to the resilience fostered in the community, he says. People could manage themselves and a public health crisis was averted.

Not that Humphrey was busy during the quakes.

As the duty medical officer - the local chief representative of the Ministry of Health and all its legislative responsibilities - he had power second only to the chief of Civil Defence during the emergency.

''On the Sunday after the first September earthquake, I was the one who had to make a declaration to close all the schools - I still meet children who say, 'hooray, you're the guy that closed my school'. ''

Back to nitrates. Humphrey is unapologetic. Again it is his official role to take the broadest view on public health.

Blue baby syndrome is a genuine risk, he says. ''A small but significant danger.'' And it is also a ''canary in the coalmine'' issue, a community's first warning that water quality is being compromised.

Humphrey says the problem with Canterbury's water is that the deep aquifers under the plains take decades to recharge. So what is getting into them now will take years to show. And when it does, it will be immensely expensive to correct.

''Nitrate is contamination. It is pollution of our drinking water, which as a resource is worth billions to this community. And to have to treat it in the future would cost us billions.

''So farmers may think, 'oh, he is just getting on his hobby horse about this'. But the medical officer of health has specific responsibilities under the act to look after drinking water supplies - that's why I've got a team of five drinking water assessors.''

Humphrey says farmers point to septic tanks, freezing works, and other possible sources of nitrate, but the evidence of the PCE is that the rise in nitrate has matched the rise in dairy conversions.

''The report is not pleasant reading. She has said we are failing, essentially.''

'There should be a block on further dairying until farmes can prove they can reduce nitrates'

From the public health perspective, Humphrey says there should be a block on further dairying until farmers can prove they can reduce nitrates.

''Lincoln University has shown in theory, on a model farm, you can completely remove the threat. There's nitrate inhibitors in the feed, different plantings, sheds, the fencing of streams, a whole range of mitigation measures.

''But the problem is it isn't happening. We are just barrelling on. The gap between theory and practice is too wide. So let's demonstrate we can get it right first, get our house in order, before we allow more intensification.''

Humphrey says the blue baby warning went out to mothers in rural areas through the midwife service. It was not being used as an emotional lever and just happened to be picked up by the media. ''The alert that went out was not shroud waving.''

However, he has no concerns about being blunt with farmers when it comes to the long-term public health issues. Humphrey says dairying also increases the dangers of micro-organism contamination like campylobacter and cryptosporidium.

We are already seeing the frequent ''boil water'' notices in rural areas. The general threat is bad enough to warrant him speaking out forcefully.

The debate is going to continue. Federated Farmers says it is gathering overseas evidence that the causes of blue baby syndrome are rather more complex than suggested. It is going to seek a face-to-face meeting with Humphrey to discuss this in the new year.

Meanwhile, Humphrey says groundwater nitrate is just one of dozens of issues creating the piles of paper on his desk. There are many other big-picture policy questions he is looking into.

For example, there is a study being done on ECan's clean-air regulations that have banned most logburners in Christchurch. In the broadest view, says Humphrey, the health benefits of less winter smog may start to be undone if people cannot afford to heat themselves properly.

''It's to ECan's credit that they are partly funding this study,'' says Humphrey - evidence that Canterbury is indeed good at a collaborative, joining-the-dots, approach to public health.

- The Press

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