Every spring for the majority of my childhood I pranced down Main Street in my hometown of Olympia, Washington sporting outfits ranging from frog to jelly-fish to E. coli as a participant in the Procession of the Species, an annual artistic pageant parade that seeks to enhance cultural exchange through our mutual appreciation and respect for the natural world. I bounced down the streets of my hometown alongside children of all ages, learning something about the remarkable diversity of our planet. Unfortunately, the diversity that the Procession of the Species celebrates is critically threatened. The United Nation’s 2005 Millennium Assessment warned that many natural systems are stressed to the point that many are poised to undergo rapid, non-linear, and irreversible change, potentially resulting in dramatic changes in human health due to such impacts as the degradation of natural resources and the emergence of new zoonotic diseases. In other words, given the interdependence of species and the rapid accumulation of extinction across taxa in recent history, it is clear that humans are merely a single species in a much greater whole, and what happens to the ecosystem affects everything, including human health.
In Dr. Raszka’s recent talk on Ebola, he stressed that one of the ultimate causes of zoonotic infections (infections transferred from animals to humans) such as Ebola is human encroachment into wilderness areas. Zoonotic infections constitute one of the most significant causes of emerging infection diseases affecting humans. They are responsible for diseases that are high in case fatality with no reliable cure, vaccine or therapy like Ebola and Nipah Virus, but they are also responsible for diseases like HIV, with high global incidence rates. Though human and ecosystem health are related via numerous subtle pathways, zoonotic infections constitute a clear and direct example of how the degradation of the environment directly impacts human health.
One model for coupling public health and environmental protection is implemented by the program where I volunteered in Indonesia in 2013. Health in Harmony, an NGO working in Kalimantan, Borneo combines environmental sustainability, access to care for underserved populations, and medical education for young Indonesian doctors through the use of incentives. Villages gain access to medical care through stewardship of the rainforest.
The field is called conservation medicine, and one of its guiding tenets of is that before looking outward toward the health and well-being of the environment, people need to be secure in their own health and the health of their families. The founder of Health in Harmony, Dr. Kinari Webb, discovered this central principle when she asked a simple question of the people bordering Borneo’s Gunung Palung National Park: “You all are guardians of a precious resource which is valuable to the whole world. If the world community was willing to partner with you to help save this rainforest, what would you need in order to be able to stop logging?”The consensus was clear; the people living in these rural communities wanted affordable, high quality health care. This is what Health in Harmony and the ASRI clinic provides. In addition to these services, the program also recruits experts to rural Borneo to teach alternative livelihoods including farming and textile work. When I spoke with Dr. Webb in June of 2013, she explained to me that her conservation medicine model relies on an approach that constitutes a win-win-win for the individual, the community, and the environment.
Dr. Webb has implemented this model of conservation medicine in rural Borneo with remarkable success. “In the first five years of our program,” Kinari said, “we saw a 68 percent decrease in illegal logging households. In addition to the majority of previous loggers switching to farming, health indicators saw near universal improvement, including an 18 percent decline in infant mortality and a tripling of income (from a 2003 baseline of $13 per month).” Thus, Dr. Webb’s model was able to bring about change at the individual level through access to high quality health care for underserved population, at the community level through education of alternative livelihoods, and at the environmental level by empowering communities to act as stewards of the rainforests they value. As a doctor, I hope to serve as a compassionate caregiver, but I also want to help lead my community in developing an attitude towards healthcare that treats human health and environmental health as inextricably linked. Whether advocating for a culturally sensitive approach to issues of drug abuse or promoting environmentally conscious behavior, being a doctor means serving as a community leader. Though many other disciplines and careers may contribute to the resolution of our planet’s woes, the proper application of healthcare has the potential to affect the most immediate and lasting positive change.
In addition to my work with Health in Harmony’s conservation team researching methods of building wildlife corridors, I shadowed doctors in the medical clinic alongside fourth year medical students from Yale School of Medicine. In the teaching clinic, I was able to participate in the daily rounds, the educational seminars, and I was encouraged to observe interesting patient visits. Working for an organization whose mission explicitly combines environmental sustainability with access to care for underserved populations was invaluable to me as a bridge between my previous experience in ecology and my choice to pursue a career as a physician.
“Rarely, in turning our attention from a recently extinct species to our last-ditch efforts to save another, do we pause to say goodbye,” says Allen Kanner of the Ecopsychology Institute. He reminds us that extinction should arouse in us an important emotion: grief. For all of us devoted to the healing art of medicine, we know that if grief is allowed to surface and a space is provided for mourning, a healing process unfolds. The field of conservation medicine regards the grief we feel at the loss of loved ones and the grief we feel at the loss of a species as compatible and indeed, inextricable.
If you are interested in learning more about the field of conservation medicine, I would encourage you to visit the website of Health Care Without Harm, whose founder will be giving a keynote talk at the upcoming Global Health & Innovation Conference in New Haven, Connecticut. Alternatively, if you want to learn more about Health in Harmony, I would encourage you to visit their webpage or track me down.