EDITOR’S NOTE: This story features perspectives from two different communities native to the Terra do Meio region in Brazil. The photographs are of the Parakanã Indigenous group in the Apyterewa territory, a mass of Indigenous land located along the Xingu River. The interview with Juma Xipaia is about the Xipaya territory, which is situated on the Curuá river. The two territories face very different threats.
Health In Harmony was founded on the knowledge that rainforest communities are experts on planetary health. It’s why they arrived in Xipaya Indigenous Land—a region in northern Brazil that was in 2015 ruptured by the construction of Belo Monte Hydroelectric Dam—with no agenda and no plans. Instead, they asked the Indigenous people living in the territory’s five villages what they needed. For Juma Xipaia, the territory’s first female leader, the respect and recognition of Indigenous knowledge and expertise was a pleasant surprise. “It’s no use to wish to understand our needs without hearing directly from the communities and seeing the reality of each individual,” she said. “[That’s why] Health In Harmony was very well-received.” Since their collaborative work began, the first Xipaya project—with support from Health In Harmony—will be a traditional medicine center to revitalize the use of Indigenous healing practices. The Xipaya are also evolving the Carimã village, with the aim of preserving traditional customs and knowledge systems after the damage caused by Belo Monte.
Read on for a series of interviews that address why listening to, respecting, and acting on the experiences of Indigenous people is necessary to planetary health. The first interview is between Atmos site editor Daphne Chouliaraki Milner and Health In Harmony cofounder Kinari Webb. The second is between Webb and Health In Harmony Brazil program coordinator Dr Érika Pellegrino. And the third is between Dr Pellegrino and Indigenous activist Juma Xipaia.
Kinari Webb & Daphne Chouliaraki Milner
Daphne Chouliaraki Milner
In your own words, what is Health In Harmony? And what drove you to found the organization back in 2005?
Health In Harmony is a planetary health nonprofit that recognizes that the climate crisis, the extinction crisis, and the justice crisis must all be addressed together. And the most awful intersection of all these crises is the tropics of our planet. Rainforests are so essential for the health of our planet, but they are threatened by historical and ongoing colonialism which has stolen resources from rainforest communities and often left them with few choices but to degrade land, or financed or directly deforested land for extraction of resources that mostly benefit the Global North. In addition, a colonial mindset means that Indigenous and local communities are rarely listened to despite the fact that they are the best experts in what the solutions are, and their solutions are even more rarely invested in.
I first began to understand these intersecting crises when I spent a year in the rainforest studying orangutans in 1993 as an undergraduate. I was heartbroken to learn that the lack of financial resources and access to affordable healthcare often meant that people were forced into a position of logging to access enough cash to pay for medical emergencies. I began to wonder what good it would do to be studying orangutans, if the forest upon which their very survival depended was disappearing around me. These experiences drew me to medical school and found Health In Harmony. Now, the organization partners with communities in Indonesia, Madagascar, and Brazil.
“Humans cannot thrive if they are breathing toxic air, drinking contaminated water, or unable to gather from the forest or grow healthy foods from depleted soils.”
Health In Harmony has a clear set of core principles—including Radical Listening and adopting a decolonizing mindset. Can you talk a bit about how you came to adopt these pillars? And what do they look like in practice?
During residency, when I was in the midst of planning to return to Indonesia, the horrible Indian Ocean Tsunami happened in 2004. My husband and I went to Indonesia to help and we witnessed most of the global nonprofits’ standard response to disasters. Key elements of this were believing that they, as outside “experts” knew all the best solutions (which they didn’t) and operating in such siloes that they were unable to address the actual interconnected challenges that the communities faced.
That experience made me realize that I would be unable to work with any of these organizations and would have to found a nonprofit based on a totally different approach: soliciting and precisely enacting community solutions. The methodology we use is Radical Listening. This is a process where we hold meetings and ask what communities would need as a thank you from the world community for protecting these precious rainforests that are important for the health of the whole world. We explain that our goal is the same as their goal: for them and the forests to simultaneously thrive. What makes this process really radical is that we implement these community’s solutions and continue to check in to make any adjustments as needed.
Health in Harmony exists in the intersection of deforestation and medical injustice. For those readers who aren’t familiar with the crossover, how are they linked?
My experience is that many educated people in the West think that somehow human health, ecosystem health, and economic well-being are separate entities but I have yet to meet a rainforest community anywhere in the world that doesn’t see these things, and many other aspects of life, as fully intertwined and inseparable. How could a rainforest be healthy if the people around or in it were suffering and forced into choosing between their short-term and their long-term well-being, or unable to defend their land from outsiders? And how could people be healthy if the ecosystem around them was not healthy? Humans cannot thrive if they are breathing toxic air, drinking contaminated water, or unable to gather from the forest or grow healthy foods from depleted soils.
Juma Xipaia said at COP26 that if Indigenous peoples had been consulted in the first place, there wouldn’t be a climate crisis. I totally agree with her and that is why Health In Harmony exists to reverse the colonial flow of resources and enact rainforest community solutions that can help bring about planetary health. In some places this means making it possible for communities to have other choices besides destructive practices and in others it means strengthening communities who are resisting the destructive practices of outsiders.
I want to give a concrete example of what I’m talking about from the first communities Health In Harmony partnered with in Indonesian Borneo. In over 400 hours of radical listening in the first year, there was consensus among all the communities surrounding Gunung Palung National Park that the heavy logging would decline if communities had access to affordable health care and training in organic farming. These solutions were enacted including extensive organic farming training and the building of a clinic which provides care to 120,000 people and where patients can pay with non-cash payment options such as seedlings, and also receive extra discounts for protecting forest. The genius of their solutions was shown in the fact that after ten years there was a 90% decline in logging households, the loss of primary forest stabilized, 52,000 acres of logged forest grew back, and there were across the board improvements in human health including a 67% decline in infant mortality.
The work we do is based on an Indigenous principle of reciprocity, or mutual gift giving. It should be noted that the gifts these communities are giving to the world by protecting forests, are worth vastly more than the gifts of gratitude the world could and should send them.
Dr Érika Pellegrino & Kinari Webb
Tell us: how did you get involved with Health In Harmony?
Dr Érika Pellegrino
I got involved with Health In Harmony in 2019 when they relocated to the region I had been living in since 2017. They were trying to scale to various places in the Amazon rainforest after their success in protecting the rainforest in Indonesia. I was working in the rainforest with the medical school I was attending, and I really identified with Health In Harmony’s Radical Listening initiative. It offers a more clearly defined methodology of what we were trying to do with local communities and it also expands our ways of understanding health. We have a more holistic outlook on health in Brazil, but this notion of planetary health was new to me—and it made a lot of sense.
I started working with Health In Harmony during the pandemic in 2020. My focus was on addressing the issues surrounding Covid-19 among local communities through Radical Listening sessions over radio.
How do you plan to encourage other western-style healthcare providers who may have interactions with Indigenous communities to be open to Radical Listening?
It’s important to consider how limiting much of Western medicine is. And that it’s impossible to convince all doctors of the one same thing—we couldn’t even agree on vaccines for Covid-19. So, it’s really important to acknowledge that we have competing ways of viewing how the world works. Having said that, these Indigenous communities are working in a way that is respectful of differences and sensitive to human rights. They are willing to find solutions and to share them. We need to start listening to these points of views to show them that they are not alone. Indigenous perspectives on health should also be taught in medical schools. We have a class in the medical school that I went to about medical patient relationships within Indigenous contexts. I think teaching this to doctors-in-training is really important.
But it’s also important for the doctors that work actively with Indigenous people to be culturally sensitive and understand that the ways these groups perceive the world can teach us so much. We need to be having epidemiological discussions with doctors from the medical school and also with Indigenous people from, for example, the Indigenous health department. We should have classes and conversations around these issues and, crucially, bring Indigenous healers into the conversation as well. We need to listen to them.
“It’s important to consider how limiting much of Western medicine is. And that it’s impossible to convince all doctors of one same thing—we couldn’t even agree on vaccines for Covid-19.”
It’s a blessing to be able to ask for Juma Xipaia’s wisdom in this radical listening process, given that she’s the leader of her community and also a medical student. How are the two of you planning on working together as you work out the details of the community’s request to mix the provision of Indigenous and Western medicine?
It needs to be a process of mutual listening. I’ve been listening to Indigenous communities that are very proud of their knowledge in dealing with certain diseases. But sometimes they might seek out for Western medicine for other illnesses or for particular educational routes. From my perspective, I can contribute by sharing with them a bit more about how the Western education and Western healthcare works.
In the West, we need to be thinking about what problems does our healthcare system cause for Indigenous communities? For example, in urban areas we have restrictions on prescribed medication, but people in rainforest communities need access to this medication because they might get injured or get ill and need the medication quicker than they can see a doctor. So, having blanket rules about restrictions isn’t the answer. For us, it’s about empowering Indigenous communities to use Western medicine when they need to, but equally to understand its limitations and why it’s a problem to use it when there’s no need.
This is why it’s important that we make ourselves available to listen and answer the questions of Indigenous communities about Western medicine. It’s how we can help to build a bridge between the two. It’s particularly important because some young Indigenous people go to school in urban areas outside their communities, meaning that they don’t learn about traditional medicines. Then, they have kids and they only give them Western medicine because they haven’t been taught how to treat some diseases that their elders could treat using traditional means. It’s why the handing down of knowledge in the community is so vital.
Juma Xipaia & Dr Érika Pellegrino
Dr Érika Pellegrino
To begin, how has it been to be the first female leader of the Xipaya?
It was a surprise to me because I’ve never wanted to be a leader, I never wanted to be a cacique, I never wanted to fight this war. I never wanted to live this life of violence away from my kids. I always imagined that I’d have my children, live in the village, and that they would have the same childhood that I had. Then, I thought that I would study. I thought: Which course should I take to help the most people beyond my community? So, being a cacique leader was never part of my plan. But the injustice, the violation of human and environmental rights, the degradation of biodiversity, and most importantly, the way Indigenous peoples are treated with violence made me realize I had no choice; that I had to fight against corruption; that I couldn’t accept the silencing of women’s voices.
It is challenging because when a man is a cacique, yes, he certainly takes care of everything. But when he gets home, his food and clothes are done, he has his family, his wife, and so he rests. When I arrive home, I keep on working. I have to take care of my children, I have to take care of my house—there is no rest, no day off, no weekends. It’s not only about being a leader, it’s about being a mother, a woman, it’s about finding the time to cry. I questioned it many times—I wanted it to end and live in peace with my family and my people. I want Indigenous people to have peace. But to have peace, territory, to keep on living, I need to fight. Today, more than ever, I understand it, accept it, and keep fighting.
What do you wish international governments, NGOs, and other global organizations knew about communities like yours?
I would ask these governments and organizations—European countries, central banks, multinationals, and other big industries—to assume responsibility for their role in the genocide, in the invasion of this territory and the forest degradation that’s taking place. It’s not enough to talk about the Brazilian government or to say that Indigenous people are suffering. Because who is contributing to this? Who is paying for this? Most of the minerals that are either legally or illegally extracted from Indigenous territories are going to European countries. There must be sanctions—urgently—against those responsible. They are discussing our present and our future without our knowledge and our participation.
There is all this discussion at a global level in the same way that there is financing at a global level to degrade and destroy the rainforest. The responsibility to not just defend the people and the forest, but to respect our way of living, our culture, our territory, and the climate is also that of other countries. Belo Sun is not a Brazilian company; it is a Canadian company. Belo Monte Hydroelectric Dam was built with financing from Austria and Germany with support from international banks. This is profoundly serious—people need to know this. What good is it for you to have security and a good quality of life, education, and health at the expense of countries like Brazil? At the expense of Indigenous people’s lives, extracting our natural and spiritual wealth. There are Indigenous people in miserable conditions, outside their territories, on the side of the roads, where children are being raped and killed every day, where our bodies are violated every day because these countries continue to exploit, to colonize the Amazon. So, I would say to these countries: No more colonization! Respect!
“The most absurd thing is that you have not understood anything; that you are still not understanding anything. What we do—defending the Amazon—is not just for us.”
What I am saying is not new. The most absurd thing is that you have not understood anything; that you are still not understanding anything. What we do—defending the Amazon, other rainforests, the ocean, lakes, rivers, animals—is not just for us. As Davi Kopenawa says, How much longer will we have to hold up the sky to keep it from falling on our heads? You also must support it. Yet, people have not understood anything, and this is distressing because we do not have much time. The forest does not have time to recover, to renew itself, because humans are eating and destroying everything at an absurd speed. We are not the only beings on this planet. We alone do not guarantee the balance and health of this planet.
And people need to understand this urgently. If you would rather not listen to Indigenous people, think about yourself: what world do you want to leave to your children, to your family, to your relatives? The pandemic was a great example. What is it like to breathe through a device, not to be able to walk freely and hug your relatives? Is that the world we want? No. This is not the future that the Indigenous people are fighting for. While you were trapped inside your apartments during the pandemic, in our villages we were free. You have to stop and think, not just follow the clock, the work, the routine. Stop! You have to stop!
What kind of world do you hope your children will grow up into?
I hope for a world where they can be whatever they want to be. A world where we can be what we truly are: live our own culture, practice our way of thinking, of dreaming, a world where they can live their lives with their kids, safely and in peace. Free. Without this endless war every day, which has spanned many centuries. A world where children are not afraid to wear our attire, to celebrate our culture, our medicine, our spirituality. A world where a forest still exists, where there may still be life. I hope they don’t have to suffer with the rest of humanity’s mistakes.
Future generations don’t deserve to inherit a broken, destroyed world. They deserve respect, they deserve to be happy, they deserve to live in harmony with the forest; they need clean air and clear water. After all, every one of us is just passing through. But what we are leaving behind is garbage, death, and sadness. My ancestors fought, many of them lost their lives in battle, but they left behind demarcated territories, they conquered laws, decrees, and support for the Indigenous people. I can’t leave behind anything less than that to my children and to future generations. I just want our children to not inherit this war that Indigenous people have endured and fought for many centuries. I want them to live in freedom and safety within our territories with the right to live, to dream, and to build a better future.
I hope [my children] understand that I feel guilty every day for not being with them, for not being able to be their mother, for giving them the protection they deserve. I hope they can forgive me, and that they understand that they don’t have to go through all this.
I’m sure they have great admiration for you. And they recognize the [great] mother you are.
I have sworn to myself many times that I wouldn’t speak of this anymore. Because it brings back all that energy, grief, and outrage; it brings back fear, sadness, and, on a personal level, guilt. How much more do we have to talk? Talking brings suffering because it means reliving all that history; dredging up the past; dredging up the pain.
I just hope that it will actually help to wake numb people up. I hope that a day comes where I don’t have to talk about any of this anymore because it won’t be necessary. I just hope that day arrives for Indigenous people. That it arrives for the ribeirinhos, for the quilombolas, and for all who suffer any and all types of violence and injustice—and who are shouting just like we are, suffering just like we are, and who are also not heard, who are on the margins on the verge of invisibility.
Thank you for talking about all these things that, unfortunately, the world has yet to listen to.
When I was first told about this, I thought: I’m not going to participate, I’m not going to talk. Why do I have to answer these questions again? We keep talking and talking and talking and talking, but it seems that peoples’ ears are shut.
But for some reason, I woke up today wanting to talk. It seems to me that people are numb. And it is necessary to connect with other people, with other energies to awaken them. We have to keep talking, even if it hurts because of all the sadness. I want to find these people. In these other worlds. Build bridges. Find solutions. Work together. We need action, change, and development. That’s what I hope this interview accomplishes. This article, this story: that it builds bridges to other worlds. And that it makes, not just my voice, but all the voices that are being silenced, oppressed, and that are unheard come to light.
What solutions have you—the community—come up with in the Radical Listening sessions with the Health In Harmony team?
When Health In Harmony arrived in Xingu, everybody in the villages asked: What is the project? What is the company? Health In Harmony’s reply was that this is not a project or company, that they just wanted to listen to us—to build a future with us. Normally, publications and project lines are executed by non-Indigenous people. It was a pleasant surprise to partake in Radical Listening sessions as a community—it’s the way it should be. It’s no use to wish to understand our needs without hearing directly from the communities and seeing the reality of each individual. We have the capacity to think, to do, to build, to decide—just like any of you. So, Health In Harmony was very well-received, even though people were suspicious to begin with.
Now we are heading into the second phase, which is the construction of the ideas we have been discussing. What was mostly pointed out by the community was the need for territorial management—supervision, monitoring, protection—of the Xipaya land. This is what we decided was our priority, keeping in mind that, inside the Xipaya tribe, we have five villages, and each village has their own representatives and their own needs. So, each village is going to present their demands and needs, after which we will build together with the support each person needs and without haste. That really was surprising. It was a ray of hope.
Today the questions I get the most are: When is the Health and Harmony team going to come here? When are we going to start writing the project down? It has been very interesting to actually listen to the communities, rather than listening to a presentation of an outsider’s idea.
Inside these macro solutions to territorial management, did a specific solution come up?
We have seen the improvement of the Xipaya language’s grammar. We have also worked with the elderly to record their stories, and strengthen the knowledge of traditional medicine. We have also seen the construction of a traditional medicine center. This is a necessity based on my mother’s dream. She was a nursing technician. We’ve been fighting to work with traditional medicine for over 15 years but we never had the support we needed.
Today we are building a new village, Carimã, with the purpose of practicing traditional medicine, and preserving the traditional customs—not just medicine, but also food and architecture—that the Belo Monte Dam disrupted. This village is a way for us to unify scientific knowledge and traditional knowledge using technology, and also offers us an example of sustainable development solutions that we can draw on when working with forest products to prevent any degradation or destruction. It will create a space for us to, once again, practice our autonomy as people and to live in harmony with the forest. Carimã will prioritize our culture, our way of organizing; it will strengthen our organization, our own management. It will show that there’s life beyond Belo Monte. It shows that we can work together with women, with young people and with other communities in ways that put our ideas into action and multiply our dreams.