Late last year, Aphu died. A healthy young man, he was among the people hired to carry luggage and supplies for a group of people. We were visiting the village to see how we could address their health care needs. Cystic fibrosis did not dry up his lungs. Neither was it any of those eponymous autosomal diseases that strike the young, of which we learn so much in medical school. These diseases were very interesting, with articles about them in journals describing correlations to genes with numbers like the latest version of MS Windows. They all had their “Disability adjusted Life Years”(DALYs) that were screaming out their importance to be taken up in any of the new programs that the State might decide to launch. But, these rare and publishable afflictions were not among those that Aphu was ever afflicted with. He died, quite simply, of malaria. Quite ironic, that a country with nuclear power still has anaemic mothers and malaria deaths!

I have been to Aphu’s village a few times with the wildlife scientists who work here. His village happens to be surrounded by one of the northernmost primary rainforests in the world. The place teems with biodiversity and the forests of Arunachal Pradesh have witnessed descriptions of a new species of bird and even a new primate, all in the past few years. Although, it is the tiger that has given this area its protected status, it is not for the tiger that this national park and many of the forests in Arunachal Pradesh are known. They are famous for their rich biodiversity including several endemic insects, butterflies, birds and plants. Such rainforests play a central role in wildlife conservation and climate change. However, climate change and global warming are distant issues for the Lisu and other tribal people living in and around these forests. Strangely, tigers aren’t.

In India today, there is a public debate on tiger deaths. Tigers and tribal people are being pitted against each other in conferences and in hallowed policy-making chambers. Co-existence of tigers and tribals is being questioned. In an environment where health care is financed literally out of people’s pockets, a tiger’s fate and people’s health can get intertwined easily. And hunting becomes a means of averting any unplanned and sudden catastrophic expenditure. It is invariably health costs that crop up in the category of unforeseen expenses. With poor access to primary health care or even to community health workers, people in such remote regions often find that hunting can finance their long journeys to towns. And it does not help matters that private providers with expensive secondary level care and irrational practices become the first line health providers for these people. The Lisus travel through about 150 km of thick forests interspersed with rivers often in spate, to reach ‘civilization’. From here, they take a 6 hour bus journey to reach a town where they invariably see a private provider. Roads, understandably are a bigger concern than chloroquine.

I work in an NGO in South India, with another indigenous tribal people, called the Soligas. The forests have shrunken around the Soligas, leaving a 540 sq. km area, still remaining, due to its legal protection by the State. The Soligas were semi-nomadic people, until they were forced to settle due in part to the shrinking forests and the legal protection accorded to their forests. They couldn’t hunt anymore. However, a doctor who settled in these hills 25 years ago, began to provide health care to them. He went further to education and livelihood, as just providing health care was helping their health! This NGO today provides health care, education and livelihood to these tribal people. Today, the elderly Soligas talk about how climate has changed. They do not question it and do not need evidence. They know it and also see how their forests are getting choked from the outside.

These two glaring examples from South India and Arunachal Pradesh in North-east India typify the problems faced by people living in and around forests in India. However, the key is in access to basic health care and livelihoods. Wildlife scientists today see this connection between people’s basic needs and their conservation ethic. In fact, it was a group of wildlife biologists that started a community health care program and an education initiative among the Lisus. I went there to train a group of tribal youth in basic health care. Among other things, I wanted these youth to be able to identify and institute treatment against malaria. It was indeed a satisfying experience for me, to see how wildlife biologists had looked beyond their paradigm of biodiversity conservation, and had looked for solutions outside ‘their box’. We, in health care, sadly are yet to make this connection. A glance at our curricula reveals the level of medicalisation that we undergo. A glance at our policy shows how fragmented and restricted it is.

Shrinking forests are an important reason for climate change, and so are empty forests; forests devoid of their biodiversity. While hunting empties forests in some places, it is firewood needs and fires in other places. It is after all people, who are to blame for this. People living in and around forest areas depend on them for their livelihood and daily needs. And when there are financial pressures for any of their needs, they turn to their resources – forests. Thus, they find themselves being the villains accelerating deforestation and emptying the forests. Isn’t this the same thing that our forefathers did, that we find ourselves in this position today? Can we blame them for being late in destroying their forests, just because, we thought of legal protection for it now, and we have climate change now! As population pressures and urbanization increase in India, rural and tribal India face a different problem; one of access – both physical and financial. It is time for health planners to consider the special needs and contextual factors affecting tribal
people and those living or affected by forests. It would be presumptuous to imagine that national programs for any of the diseases will change the situation with these people. Lisus or Soligas and for that matter any individual is not asking for malaria control programs or early cancer detection programs. They are asking for plain health care – financial and physical access to a person who can cure them of their illness and can help them live a healthier life. A malaria program for them is even lower in priority than a road or a source of livelihood, simply because, they have accepted malaria deaths as their destiny. It is perhaps time to think beyond programs and address health as a need in itself rather than health as a consequence of our programs.

Aphu died of malaria in his early 20s only because he was born in a place where climate change and the biodiversity mattered more than his life. In many areas the world over, where man-wildlife conflicts occur, the situation is similar. How are we going to prioritize between biodiversity conservation and people’s needs? Are our politicians and policy-makers even seeing this problem of ‘First among equals’? The global health research agenda needs to gear up to answer these difficult questions; questions that matter to people dying of malaria in this age, when in many countries, research is addressing carpal tunnel syndrome.

I have just returned to Itanagar from Jenging, Upper Siang dt. I camped here for 2 days and visited one of the sub-centres of the PHC at Jenging. Most of the journey by vehicle and on foot to the sub-centre were spent birding.

Heavy rains have already begun in Arunachal and the skies were overcast even as I drove through N Lakhimpur and Dhemaji dts of Assam. Meanwhile, the higher peaks have seen some good snowfall, and I am told that Tawang has recieved fair amounts of snow. The drive from Itanagar to Jenging was great. After leaving Arunachal at Bandardeo checkgate and a 100 km drive through Assam, I re-entered Arunachal at the Likhabali checkgate. The road passes through the district of West Siang and winds around the hills northwards to the district of Upper
Siang. The district HQ of West Siang is at Along. After the town of Boleng, which is one of the first towns of Upper Siang, the road for some distance passes alongside the Siang river, the largest of the 3 rivers that make up the Brahmaputra. For a long distance, the road zig-zags on the hills along the river offering some breathtaking views of the ‘turquoise’ waters of the river. At many places, there are hanging bridges across the river. The road then divides, one leading
to Jenging and the other leading to the district HQ of Yingkyong. Incidentally, Yingkyong was fully submerged by the Siang in 2000 when a mining related mishap on the banks of Siang upstream in China caused ‘welling up’ of water, which later burst to deluge some large towns downstream. The whole town was submerged then.

The drive thereafter offers wonderful views of the Mouling National Park. The hills here lack the classic ‘jhum’ facies of the other hills I have been seeing till now. Bird calls were heard more frequently, and number of bird sightings (not on heads, but in the air!) were more. Also, this being an area with a majority of Adi tribal population, the ‘hornbills on the heads’ was not a feature. Unfortunately, I did not see any in the air either!

The road has been taken up by the Border Roads Organisation (BRO) and is in all-weather condition. Moreover, Jenging being the constituency of the Chief Minister himself seems to be well-served. The town also enjoys 24 hr power from the hydel project nearby.

Weather conditions were more or less cloudy all through and bird sightings were a precious few. One of the subcentres, I visited is within the Mouling NP (28° 33′ N, 94° 46′ E). It was declared so in 1986 and covers nearly 500 sq. km. Most of the habitat was wet evergreen and semi-evergreen hill forests with many patches of secondary growth. Most of the hills were covered cloud covered, and fast flowing hill streams draining into the Siang were a common feature.

Missing conspicuosly from the list are waterbirds, raptors and gamebirds! Any reason I can give would be merely speculative but……hunting, cloudy weather, number of field hours, and closed
habitat???

But, what I did see are as follows:

1) Mallard Anas platyrhynchos – plenty in waterbodies in Assam
2) Oriental Turtle Dove Streptopelia orientalis – after Boleng
3) Himalayan Swiftlet Collocalia brevirostris – common
4) Ashy Swallow-shrike Artamus fuscus
5) Lesser Racquet-tailed Drongo Dicrurus remifer – Jenging
6) Bronzed Drongo D. aeneus – I saw the largest number of these in
flight, numbering approx 100 crossing the Siang noisily
7) Greater Racquet-tailed Drongo D. paradiseus
8) Large Woodshirke Tephrodornis gularis – before Along
9) Rufous-backed Shrike (Black headed race) – Lanius schach tricolor -
Common
10) Asian Pied Starling Sturnus contra and Jungle Myna Acridotheres
fuscus- Common in Assam plains
11) Scarlet Minivet Pericrocotus flammeus
12) Black Bulbul Hypsipetes leucocephalus in large flocks – Jenging
13) Black-eared Shrike Babbler Pteruthius melanotis- 65th mile on
Along-Jenging road. 3 individuals seen at eye level overlooking the valley
14) Long-tailed Sibia Heterophasia picaoides
15) Striated Yuhina Yuhina castaniceps
16) White-naped Yuhina Y. bakeri
17) Whiskered Yuhina Y. flavicollis – All Yuhinas seen in large flocks
quite common in the Jenging and Ramsingh area
18) Yellow-bellied Fantail Rhipidura hypoxantha
19) Black-backed Forktail Enicurus immaculatus
20) Spotted Forktail E. maculatus
21) Little Forktail scouleri – Was thrilled to see this bird.
Initially, I mistook it for a Magpie-Robin, but the stance and the
white tuft over the forehead forced a re-think. The bird flew into a
higher perch, when I disturbed it from the bottom of a small stream.
Jenging
22) White-capped Water Redstart Chaimarrornis leucocephalus Common
23) Blue-capped Rock Thrush Monticola cinclorhynchus
24) Chestnut-bellied Rock Thrush M. rufiventris Jenging
25) Blue Whistling Thrush Myophonus caeruleus
26) Chestnut-bellied Nuthatch Sitta castanea. I have been looking out
for the Beautiful Nuthatch Sitta formosa. No luck till now.
27) Olive-backed Pipit Anthus hodgsonii yunnanensis Jenging
28) Large Pied Wagtail Motacilla maderaspatensis
29) Grey Wagtail M. cinerea
30) White Wagtail M. alba leucopsis & one of the grey-backed races (?
personata)
31) Eurasian Tree Sparrow Passer montanus Very common