- Brought up watching nature’s grandeur in Indian Kashmir, Dr. Sakib Burza’s early inspiration in medicine began at home before he went on to work with Indigenous and local communities in tropical forest regions.
- Having worked in communities responding to the impacts of droughts and climate shocks, he says improved planetary health is crucial for better human health, and that health problems are often the symptoms of climate change or environmental problems.
- At Health In Harmony, he leads medical projects with rainforest communities through the concept of radical listening and supporting their medical needs and livelihoods.
- In an interview with Mongabay, Dr. Burza lays out his argument for how and why the health of people and the planet are connected, and actions that can improve the state of both.
Dr. Sakib Burza says his fondest memories are climbing the majestic pine trees in the Kashmir Valley where he spent most of his childhood with his family. On a normal day, he would go trekking up the hills into the mountains above the tree line, watching over the forest canopy below.
“I’ve always been attached to nature and I wanted to study medicine,” Burza says. “So it was a question of trying to see both happening, a position where I can bring nature and human health together into one.”
Although his father wanted him to excel in engineering, Burza decided to go into the medical field, inspired by his father’s own path in medicine. Growing up in Indian Kashmir, he was conscious of the unmet medical needs of people in rural areas, which also helped put him on the professional pursuit to practice medicine in materially impoverished communities.
Burza went on to earn a doctorate in medicine and a master’s degree in public health in developing countries, before practicing as a physician who now directs medical and emergency response at Health In Harmony (HIH), an organization working at the intersection of human and planetary health. HIH’s stated aim is to reverse tropical deforestation and improve the health of forests, and ultimately people, by listening to and supporting the solutions of Indigenous peoples and local communities.
Working for rainforest Indigenous communities in Southeast Asia and Africa while being based in the U.K., Burza says he still finds time every year to go trekking in the mountains of Kashmir with his children. “There’s nothing like being in nature, and my children are starting to feel that as well. They have [begun] to see and understand the value of nature and how important it is.”
To hear his take on how and why the health of people and the planet are interconnected, Mongabay’s Sonam Lama Hyolmo spoke with Burza in an video interview. The following interview has been lightly edited for length and clarity.
Mongabay: The connection between the health of people and the planet may seem very elusive for some. How did you begin connecting the dots between the two?
Sakib Burza: I’ve spent 20 years working with Médecins Sans Frontières [Doctors Without Borders]. In my experiences and journeys in various places around the world, I repeatedly saw the health responses to drought, population displacement, and climate shocks. We’re all being driven by climate change, essentially: the crops fail because there’s no rain or snow, and when people get malnourished, they fight for water, they fight for territory. And this is something that I started seeing more and more over time. I sort of evolved into realizing that I would like to work on something that was more to deal with the source of the problem rather than having to deal with the symptoms.
The importance of a forest in the Western concept is nonsensical, but the people and communities who live around these rainforests entirely understand the importance of their environment. These people are at the frontline of climate change. They’re facing climate shocks and cyclones. They’re seeing the water table change and different diseases [proliferate]. And that’s the premise of Health In Harmony, which is to not extract from the forests but respect the knowledge of Indigenous communities, listen to them, and help them set their priorities.
I think the idea that you could have healthy humans without a healthy planet or a healthy planet without healthy humans is a logical fallacy. We’re in the Anthropocene now and the changes in the world are primarily happening because of humans. And if we aren’t able to keep the environment healthy, we’re not going to be able to keep humans healthy. We see the impact on public health and there’s increasing evidence that’s coming up that demonstrates how important good environmental conditions are to human thriving.
Mongabay: How exactly could the increased frequency of floods, cyclones or extreme weather exacerbated by climate change lead to major health problems and jeopardize future generations of Indigenous communities?
Sakib Burza: Indigenous populations tend not to be at the higher end of the power system, and as a result, they tend to be the ones who are impacted the most when they have a little less access to health care and resources. So they are at the highest risk of any sort of external feature that pushes stress testers and tend to be the most affected. We’ve seen this [in marginalized communities] across the world not just in the Global South but also in Western countries, like people of color in America being disproportionately affected by heat waves.
Over 3 billion people worldwide live in areas that are vulnerable to climate change, and heat-related deaths and illnesses are increasing. We’re seeing temperatures of up to 48° Celsius [118° Fahrenheit] in countries like India, and what we end up seeing is a division between the haves and the have-nots.
What we’re seeing is a change and increase in the types of illnesses and diseases with the climates and extreme weather events as they create ideal conditions for infectious diseases to spread, including [through] deforestation. For example, in Brazil there is clear evidence that deforestation leads to an increase in malaria cases. What happens is the areas around the edges of the forest where trees are cut have water that’s gathered in the shaded pools, which is perfect breeding ground for [mosquito] larvae, and the people who are living in and around these areas are Indigenous populations.
One of the other issues that we saw in 1997 was the Nipah virus. There were huge smoke and fires in Indonesia, causing fruit bats to move away from the Indonesian forest and Borneo over to Malaysia, where they settled in trees, causing farmers around to feel sick presumably eating the fallen fruit that the bats have come into contact with.
All these people who are from Indigenous and local communities are living in and around these forest areas and they are the ones who end up seeing the first effects. When climate changes, the capacity to also have access to fresh, clean water is limited. With different types of weeds growing, you have different types of yields in terms of crops. And then you end up moving your diet from something that was sustainable into something that tends to be more processed. And then we start seeing all the problems in terms of obesity, high blood pressure and additional cardiovascular diseases. It’s all interlinked, and unfortunately the people who are at the most risk are people who are on the frontline of climate change.
Mongabay: A 2013 Health In Harmony assessment suggested that paying for local health care expenses in Indonesian Borneo can protect a rainforest. This was done by preventing impoverished communities from logging to pay for their care once they get a serious injury or disease. Do you think this finding could apply in other regions as well?
Sakib Burza: Absolutely. It’s not necessarily just about health. The model that we use includes asking communities what their priorities are. It happens to be in most cases that health usually tends to be one of the priorities, but it’s also livelihoods as well.
For example, in one of the communities that we support in Manombo, in southeast Madagascar, the community people are living far away from the local health system and they also don’t have any sustainable livelihoods. So if you don’t have money, you can’t purchase food or barter for food. If people don’t have protein, they tend to go into the forest and extract bushmeat from the forest. Not only does it lead to a reduction in biodiversity such as lemurs, it also increases the risk of disease spreading between humans and animals. So our model is that we approach the community saying we would like to support them with health care. We will provide mobile clinics for them. It means that those communities don’t need to sell wood to pay for basic health care.
Secondly, it comes down to economics if we are able to provide them with alternative sources of income through handicrafts or sustainable forest economies. In places like Madagascar, it’s simple things like growing vanilla. Lots of things can grow sustainably in these communities, because if the rainforest can grow it means that the ground is fertile.
It then comes down to talking and seeing what the communities traditionally farm and supporting them with those traditional products and then trying to build up the pathway to sell them on the market. And once they have these sustainable incomes, it becomes less likely that they need to chop down the trees or extract wildlife from the forest.
We’re seeing it happen through different mechanisms in Brazil, where Indigenous communities living in forest areas are protecting the forest from people like farmers and gold miners coming in to also extract their wood. Now if they get sick and they have to leave their communities because there’s no access to health care, this leaves the forests open to people for extraction.
Local communities need legal lands, the capacity to be present and to have incomes that allow them to conduct their sustainable livelihoods without having to interact with these farmers or these log clearers. So it’s a slightly different method that’s more about protecting the forest rather than stopping extraction.
Mongabay: And what about traditional medicine, which is often plants? Can climate change and biodiversity loss truly pose a threat to the use of traditional medicine or the discovery of new pharmaceutical ingredients?
Sakib Burza: There are two things here that are important. One is what happens to existing communities in terms of climate change and the effects on the growth of plants that are traditionally used in medicine. As water levels rise and temperatures get higher, the diversity of the types of species that Indigenous communities are used to growing quite easily is becoming harder to grow.
At the same time, it’s important to note that traditional medicine is truly significant as malaria is treated by a drug that was used by Indigenous communities in China to treat the disease for centuries, and all of the malaria drugs in the world today are based on artesunate — on that specific entity [Artemisia annua] that’s grown there. Because we recognize the importance of traditional knowledge, we are working at the moment with the Xipaya Indigenous community in Brazil to create a traditional medicine center to retain, protect and expand the use of traditional medicine in Indigenous communities. The community’s vision is that they want to create this traditional medicine hospital where people can come from outside and see and learn how traditional medicine is used, which plants are used, and learn how to explore and do discovery as a mechanism to retain Indigenous knowledge.
From the bigger Western sort of pharmaceutical companies, it’s super important for them because they’re constantly on a mission to try and find new chemical entities so, that sort of knowledge from Indigenous populations is invaluable in supporting them.
Mongabay: Can you talk a bit more about malaria? Do you see malaria cases worsening and posing a threat to Indigenous people and local communities? What’s the link with the health of the environment?
Sakib Burza: Absolutely. There’s a clear link between deforestation and malaria and where most countries are moving towards the elimination of malaria in places like Cambodia and Brazil. In those Indigenous communities who are living in and around forests where deforestation is happening, we’re seeing a rapid increase in cases. And that’s because previously when you have intact forest, you don’t have many places where this pooled water under shade accumulates. And now what happens is [it pools] on the floor of these forests where everything’s being chopped down. They don’t even do landscaping when they demolish all the trees, they just go in there, just chop everything down and you end up having large areas with pools of water.
This is a perfect breeding ground for mosquitos and malaria where communities are living. As a result, what we see is an increase in cases, and some of the work that Stanford University has done shows that for every 10% increase in forest loss, you get a 3% increase in malaria cases in that area. I think in Brazil’s study, they showed 1,600 square kilometers [620 square miles] of deforestation, which is about 300,000 football fields, was linked to an additional 10,000 cases of malaria within that very specific area.
It is an absolute problem because the WHO wants to move towards malaria elimination across the board now the vaccines are coming in, this is a big push. But unless we deal with and recognize the impact of deforestation on these rural communities, we’re never going to achieve that.
Mongabay: Have the global COVID-19 pandemic and lockdowns posed any additional challenges to how IPLCs preserve ecosystems?
Sakib Burza: I think when you take away people’s economies and their jobs because of the lockdowns, it is most likely we would have thought there would have been an increase in deforestation. However, at the same time, the global timber trade completely collapsed so there was no demand anymore during the COVID pandemic.
Now, we were very much interested in this topic because our model is that we provide support through health care and livelihoods. But how resilient is our support to those communities we work with when something like a COVID lockdown happens? Would these communities who had stopped logging simply go back to logging when there was an interruption in livelihood and health care support?
So, we did a study together with Stanford University in Indonesia to look exactly at these questions, and we closely looked at the communities we’ve long worked with. We looked into deforestation and the logging rates in West Kalimantan [province]. We can see from satellites how many trees have been taken down. And we looked at the period before COVID-19 and during COVID-19 to see what the impact was because it could go both ways: it could be that individuals in the community don’t have livelihoods for health care and they need money and therefore started to log.
But it could also be that there’s no demand and people are scared to go outside, probably causing a decrease in logging. So we weren’t sure what was going to happen. We wanted to know if our model was kind of resistant to these economic catastrophes that can happen, and we saw it actually was. The deforestation rates still stayed much lower in the areas and communities that we supported compared to communities that we did not.
So we’ve essentially shown that the model of having community-designed solutions is a sustainable way and it’s resistant and resilient to these sorts of stresses.
Mongabay: Drought and subsequent failed harvests can cause mass malnutrition and form cycles of desperation that put pressure on food systems, ecosystems and health care systems. What do you think governments should do in response to this? Do you think this issue should grab the attention of politicians as it can cause spillover effects into other sectors of a country and its finances?
Sakib Burza: I wish I could say that governments cared enough about malnutrition and malnourished children to have strong policies to prevent it. But in the last 10-15 years, malnutrition has been a huge issue across the board and government policies are not particularly good. Some countries have supplementary feeding programs, but ultimately the underlying problem is a lack of food being accessible to vulnerable populations. Governments have the responsibility to introduce better techniques to introduce more sustainable farming to ensure market access to food, and that nutritional products are equitable for all members of society.
In terms of drought, I think there are a few things that governments can do. Using big data, we can see from historical patterns of temperature change and drought where in the next two to three years a few areas and communities are likely to have drought or crop failures. I think if you can predict something that’s going to happen next year or in two years, then you could at least try and do something about it in advance.
They need to focus on the prediction of where communities are going to fall and whether that hunger gap is going to occur so we can be more proactive. And that’s not just for governments, but for NGOs too. I think they also need to take on these approaches where they can identify where the next food shortages are going to be, but it’s a very difficult question to deal with because, ultimately, the people who are suffering are those who don’t have power.
If any of the politicians’ kids were starving, they would do something about it. But it’s a question of equity and advocacy. It’s a question of people standing up and speaking against it, and there are many things that we need to do that for.
Mongabay: How does Health In Harmony locate communities based on their medical and livelihood needs? What common scenarios and impacts do you observe for Indigenous and local communities within your focus areas?
Sakib Burza: We primarily work on areas that we think are at risk of deforestation. That’s our primary goal, because, ultimately, we as an organization are trying to reduce or limit the amount of deforestation worldwide. So we approach Indigenous and local communities who are living in and around the rainforest and ask them how we can help them protect their environment, given that they’ve done everything to steward and guard the rainforests. It’s not that we’re asking them to protect the environment. They know much better than we do what’s right for them. They know how to protect the environment and how to protect their rainforests.
We just listen to them essentially and this is what we call radical listening. The radical part of radical listening isn’t that we just listen, but we commit to solutions. So if they say we need A, B and C, then that’s what we will do. It’s not that we say we will do E, F and G. The radical part is our commitment to local communities, and that’s how we work.
At the moment we have three sites — Indonesia, Madagascar and Brazil — but we’re looking to scale up our sites, working with the Pawanka Fund, which is an Indigenous-led organization. All Health In Harmony projects are going to be led by the organization, who will be utilizing their connections and their involvement with Indigenous communities to help roll out the supported mechanisms that we’ve been discussing.
We are not Indigenous leaders — Health In Harmony is not an Indigenous-led organization — and we recognize that entirely, but what we also know is that it has to be led by Indigenous and local peoples. This is why we’re handing over the reins and taking the guidance of an organization like the Pawanka Fund on how to best scale the work that we’re doing across the world. So this is another mechanism where we’re hoping to get help from because that’s how we will be identifying the communities that we’ll be working with.
Listen to related podcast episode:
This article was updated to change Burza’s quote to mention the ‘Xipaya Indigenous community in Brazil’ instead of ‘an Indigenous community in Jubaia in Brazil.’
Banner image: A nomadic community preparing a meal in Ladakh, India. Image by Prabhu B Doss via Flickr (CC BY-NC-ND 2.0).
Healing the world through ‘radical listening’: Q&A with Dr. Kinari Webb
Citations:
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Chua, K. B., Goh, K. J., Wong, K. T., Kamarulzaman, A., Tan, P. S., Ksiazek, T. G., … Tan, C. T. (1999). Fatal encephalitis due to Nipah virus among pig-farmers in Malaysia. The Lancet, 354(9186), 1257-1259. doi:10.1016/s0140-6736(99)04299-3
Chua, K. B., Hua, B. C., & Wang, C. W. (2002). Anthropogenic deforestation, El Niño and the emergence of Nipah virus in Malaysia. Malaysian Journal of Pathology, 24(1), 15-21. Retrieved from https://www.mjpath.org.my/past_issue/MJP2002.1/anthropogenic-deforestation.pdf
Hopkins, S., Hazel, A., Pourtois, J., Chamberlin, A., Gajewski, Z., Harryman, I., … De Leo, G. (2023). Impact of healthcare access and livelihood support on deforestation rates in Kalimantan, Borneo. MSF Scientific Days International 2023. doi:10.57740/vj1f-v594
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