Last month, Health In Harmony Founder, Dr. Kinari Webb, returned to her alma mater, the Yale School of Medicine, to give this year's Commencement Address. She was honored to have the opportunity to offer insight to the graduates, encouraging them to treat their patients with compassion, to strive for social justice, and to use their training to create a healthier planet.
"You may not have thought of your stethoscope as a tool to heal the Earth, the lungs of the Earth - otherwise known as rain forests. But it turns out that it can be. Your medical skills have all kinds of unexpected powers, and I want to argue that we actually all need to become planet doctors."
Watch the video below, Kinari takes the stage at 3:40:
Full transcript below:
Thank you so much Dean Alpern! It’s such a honor to be here with you all celebrating this wonderful day.
I remember when I sat in your seat, I was feeling really nervous. I had decided to go back to work in Indonesia where I had studied orangutans as an undergraduate and in order to do that, I chose the ‘lowly’ specialty of Family Medicine. Some of my professors weren’t too happy with me. A few days after match day, I was walking towards the hospital when one of my teachers (who shall remain unnamed), saw me on the other side of Cedar street and he actually crossed over to challenge me about my residency choice. “Where are you going again?” He demanded. “North Dakota?!” “No, California.” I replied. “Kuh! Same thing!” He said.
Then he followed it up with: “If you come to your senses, we would still like to have you stay here in Internal Medicine.”
Well I never did come to my senses and in retrospect I think I made the right choice. But it WAS hard to go against the grain. At one point I asked Dean Nancy Angoff for advice and she told me, “Of course, you’re making the right decision. What are you going to do if you are out in the middle of nowhere in Borneo and you can’t deliver a baby.”
And it turned out she was right. I have delivered quite a few babies in remote villages and one of those little ones is even named after me.
But when I sat in your seat, my fear basically boiled down to a concern about leaving the “center of everything.” My professor’s comment came from a belief that if you aren’t doing a prestigious specialty at one of the top ivy league schools, you might as well be in North Dakota (which, of course, is a beautiful place and I’m not adding disparagement). On the ONE hand, this is just obnoxious nonsense, but on the other, there’s actually truth to it.
The reality is, it does matter where you went to school. People at places like Yale have an outsized impact on this country and on the world. But to those of you, like me, who will be headed out of here, I was to assure you not to worry. It turns out you take Yale with you. First, all the amazing education you have been given, can never be taken away. What you have learned will be a blessing to every patient you will care for, for your whole life – no matter where they are in the world. And you also carry the reputation which is surprising how many doors it can open.
Of course, you worked very hard to get to this point – and so did your whole family (I hope you are giving all of them big kisses of gratitude today!). ….But remember that most blessings also come from sheer luck. Did you do anything special to get such a wonderful brain? Did you consciously select your family and ancestry to support you in your life?
Of course not. So you must not forget that with incredible privilege, comes great responsibility.
I first came to know just how profoundly lucky I was during the year that I spent deep in the rain forest of Borneo when I was 21. I discovered there, that people were often forced to cut down rain forest trees in order to pay for health care. I found myself feeling angry and deeply sad that such an injustice was occurring in the world. After residency I founded a non-profit called Health In Harmony and I have spent the last twelve years working on this issue. You may not have thought of your stethoscope as a tool to help heal the lungs of the earth – otherwise known as rain forest -- but it turns out it can be. Your medical skills have all kinds of unexpected powers and I want to argue that we actually all need to become planet doctors. The reason for this is that we are at unprecedented time in the entire 4.6 Billion year history of the planet: this is the time when a species that actually has the capacity to understand what it is doing, is dramatically altering life on earth. And the health of our planet is the greatest threat to your PATIENT’s health that they are likely to face over your career. Because without a stable climate, enough drinkable water, food to eat, and healthy air, you will have a very hard time keeping your patients well.
Planetologist David Greenspoon puts it perfectly when he says: “The jury is still out whether or not the earth is going to develop intelligent life.” I know that’s hard to believe, looking around at your classmates, but I’m talking about the intelligence to collectively work together to change our behavior. It isn’t at all clear yet, if the human species can do that.
There is no question, that we are looking at potential disaster on a massive scale where we could all be refugees with no where to go -- but it does not have to be that way. Oddly, this crisis is also an amazing opportunity. A chance for humans to find creative solutions, learn to work together, achieve social justice, and live in balance with the precious biodiversity of this planet. To head in that direction requires further expanding our circles of compassion and realizing that we all have something to offer.
The first circle is caring for yourself. Most of you are about to go into - indentured servitude -, so this isn’t going to be easy. I remember massive sleep deprivation, feeling pushed beyond the limits of my skills, terrified I’d make a mistake, and being right in the middle of profoundly traumatic experiences. But I encourage you to prioritize taking time to soothe and care for your body and soul even in the midst of all that. In my own journey of personal and spiritual growth, I have found help in faith communities, meditation, time with loved ones, therapy, and maybe most especially, being in nature. There might be nothing better for healing the soul.
This broader perspective not only tends to lead to more compassion but it also helps our medical providers see their patients within a holistic, ecosystem level. I encourage you to not only treat asthma, but also think about the root causes of illness. It was a physician in Flint Michigan who exposed the lead water crisis, doctors in the UK are promoting regulations to ban diesel cars in cities, and medical researchers have shown that people living in neighborhoods with more trees are healthier. These factors can be much more important than pharmaceuticals. As a physician, your voice has great power to influence health on a community level! I hope you will use it.
In the next greater circle of compassion beyond your community, I encourage you to also love this beautiful planet. We have now moved into an era where we are just beginning to understand how interrelated everything is. Global weather patterns affect crops, fish from the oceans (often sadly with mercury in them) are still the greatest source of protein, and forests on the other side of the world stabilize climate and absorb carbon. Of course, no one knows exactly, but many scientists are saying that we have only 10 years to figure out how to start decreasing carbon emissions or the earth will rapidly become unliveable for human life.
I know I’m telling you something that can feel utterly overwhelming and really bad news on commencement day. When I started my work in Borneo, I basically figured it was hopeless. I saw myself as a tiny fish swimming against a Tsunami, -- but I figured if you’re going to swim, you might as well swim against extinction.
My perspective has changed now though, I believe, as the writer Joanna Macy puts it, that our time will not be the Great Ending … but the Great Turning. My attitude has changed partly because I have had the incredible privilege of witnessing, on a small scale, how quickly transformation towards a life-sustaining society can occur.
After residency and starting Health In Harmony, I moved to a very poor part of Indonesia. The average income was less than 50 cents a day at that time. Most of the people were growing enough food to eat, but had very little extra cash.
And sadly, for the 60,000 people living directly around Gunung Palung National Park, illegal logging was one of the only ways to get fast cash. One man I know, Pak Sofian, cut down 60 giant rain forest trees to pay for one C-section. And the thing is that even though the logging was rampant, our baseline survey showed that 99% of the people around the park wanted to protect it -- they just couldn’t. And who of us wouldn’t also do whatever was necessary to get health care for our family members – even if that meant destroying our future?
My Indonesian colleagues and I began by doing what I call “radical listening.” We asked many hundreds of people like Pak Sofian and his wife what they would need as a thank you from the world community in order to stop the logging. Their answers were completely consistent in every village: They told us “We would need access to high quality, affordable health care and training in organic farming.”
And then this is where the radical part comes in: we actually trusted them and did what they said. How did we do it? My experience is that what is badly needed in one place in the world, just happens to be excess in another. For example, we could bring in teaching farmers from Java who have a many thousand year tradition of sustainable agriculture. To achieve a very high standard of medical care we hired wonderful Indonesian doctors who learned from and taught visiting physicians from top institutions like Yale. Four of these young Indonesian doctors have even received further training here. To make the care affordable, patients can pay with bartered items like seedlings and even manure and they can get variable discounts depending on the amount of logging in their villages.
And did it work? In just the first five years of the program, the number of logging households went from an estimated 1,350 down to just 450. And now there are only about 180 individual loggers remaining. At the same time health dramatically improved. Infant deaths per 100 households went from 3.4 to just 1.1. Wealth also greatly improved as measured by household economy. And what are those previous loggers doing? 52% are now farmers – and the remaining occupations were spread evenly over about five other options such as fishing or starting small businesses. In other words the communities were totally right!
Nor did this work affect just the people living directly around Gunung Palung National Park. It was a fair trade. In return for helping these communities with training and resources, the world got key help in regulating our climate. If the 250,000 acres of the national park were to be completely logged and burned, as much carbon would be released as 14 years of San Francisco pollution. And it isn’t just the carbon. Rain forests also produce rain, cooling clouds, and oxygen and Gunung Palung is one of the most biodiverse places on the planet. There are clouded leopards, argus pheasants, sun bears, and a critical population of about 2000 orangutans. The truth is, the health of people living around a rain forest in Borneo matters to us all: they are protecting the lungs of the earth. This is win-win.
And maybe for me what feels like the greatest achievement is the program in Borneo not only survived, it thrived when I was stung by one of the deadliest jellyfish on the planet -- and spent four years too sick to manage much beyond my own body. Incredible Indonesian staff members (most of them women) and people from all over the world stepped up and took the program to an even higher level. There are now 105 Indonesian staff in Borneo lead by Dr. Monica Nirmala and she hired one American middle manager.
We are now ready to take this model to a global scale. We believe we can change the game by explicitly linking human health to the health of the natural systems, trusting the best solutions come from local communities, and actually implementing these solutions by bringing in global resources.
But to get there, we will need even more partners who care about a healthy planet for us all. So keep us in mind, if you want to come work with Health In Harmony after you finish your residency! But if working in remote corners of the earth and swimming in jellyfish infested waters isn’t your thing, don’t worry. Each of us can make significant contributions to the health of our planet and what you do anywhere, has an impact on everywhere else.
It is also increasingly clear our governments will not solve these problems for us. We have to step up. As a physician you have a unique role to play. Dr. Gary Cohen, the founder of HealthCare without Harm, put it beautifully when he said: “As health care professionals, we need to defend the rights of people not only to have access to health care - which everybody on the planet should have - but the right to a healthy planet, the right to be born toxic-free. We need to become planetary healers - that is our sacred mission."
I believe through radically listening to each other, recognizing that all our well-beings are intertwined, and sharing the blessings we have been given, we can create healthier and better lives for ourselves, for our patients, our communities, and for all life on earth.
I wish to leave you with three key points:
Congratulations again on this amazing accomplishment. May you go forth and heal!