FEW HOURS AT THE FAIRCHILD BOTANIC GARDEN. MIAMI, FLORIDA

There’s something quietly radical about stepping out of the noise. Not escaping it entirely—Miami does not permit such illusions—but placing a gentle distance between oneself and its glitter, its urgency, its practiced performances. At Fairchild Tropical Botanic Garden, the mind loosens its grip.

For a few hours, thought becomes less angular. Trees soften it. Water absorbs it. Mist dissolves it.

The Japanese have a word—shinrin-yoku—forest bathing. But here, in this curated Eden, it is less a technique and more a surrender. You sit, and something ancient in you remembers how not to strive.

And then, as often happens in these states of quiet receptivity, perception sharpens rather than dulls. The trivialities of daily life—the small vanities, the rehearsed frictions of work and social theatre—return, but altered. Not diminished. Exposed. Their pettiness almost theatrical, their distortions exaggerated, as if seen through a lens that refuses to flatter.

It was in this peculiar clarity that I noticed them.

Two palms. Still. Upright. Watchful.

Sentinels.

Not merely botanical specimens, but presences. And in an instant—without hesitation, without doubt—you recognized them: Copernicia fallaensis. A recognition not of intellect, but of memory lodged somewhere deeper.

And then Cuba returned.

Camagüey—an airport once improbably new, almost untouched by the world’s traffic. The rented car. The long drive toward Minas. The finca—Perú—spoken of in low tones among those who cared about such things. And there, improbably, in the yard of a farmer bemused by decades of foreign fascination, the great palm. His yarey, your pilgrimage.

1997 A different tempo of life. A different version of yourself.

Back in Miami, you walk among companions of that memory—Coccothrinax crinita, delicate and fibrous, and Copernicia baileyana, austere and monumental. Cuba, scattered and replanted, yet still intact in essence.

And perhaps this is what such places offer—not escape, but continuity. A thread between geographies, between past and present selves.

You leave with a small decision, almost incidental, yet quietly firm. To return. Not as a visitor, but as someone who knows the path.

A short drive. A familiar table at Daily Bread. Gyro, Hummus, Taboule  conversation, the ordinary made sufficient. And the girl behind the counter, who studied dentistry in Guantanamo, Cuba. Hope the memory of her native landscape comfort her during this exile 

And somewhere within, the stillness remains—like those palms, standing, patient, untroubled by the passing theatre of human concerns.

I AM A PHYSICIAN-ANTHROPOLOGIST TO MANY INDIGENOUS TRIBES/PEOPLE AROUND THE WORLD

Psychosocial Stress, Inflammation, and Atherosclerosis: An Anthropological Reflection

That most feared of outcomes—the heart attack, or acute myocardial infarction (AMI)—rarely occurs out of the blue. From a biomedical standpoint, it is attributed to atherosclerosis: a gradual narrowing and injury of blood vessels over time. The usual culprits are well known—diabetes, hypertension, hypercholesterolemia, sedentary lifestyle, and obesity.

Yet over the decades, more than fifty “causes” have been proposed. Some, like trans fats, were once celebrated as heart-healthy before being condemned. When explanations fail, we often retreat into the vague language of “socioeconomic factors”—a polite euphemism for poverty and social instability. 

Today, biomedical thinking is increasingly centered on inflammation as both the initiating and propagating force in cardiovascular disease. Some researchers even argue that what we measure—cholesterol, for instance—may be less a cause than a downstream effect of this inflammatory state.

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The Liminal Lives of Indigenous Communities

For those of us who have worked closely with Native American communities, another layer becomes impossible to ignore: chronic psychosocial destabilization.

Anthropologists such as Victor Turner described “liminal periods”—times of transition marked by uncertainty, vulnerability, and heightened error in judgment. In most societies, these are temporary (puberty, professional initiation, migration).

But for Indigenous peoples of the Americas, one could argue that liminality has become permanent—a condition sustained since first contact. This ongoing instability shapes not only social life but also biological outcomes.

Comparable patterns are seen among Australian Aboriginal communities and the San people of the Kalahari—ancient societies navigating imposed modernity. (I am Australian, so have visited remote indigenous communities. When I was reading Anthropology in London, I did some participant observations among the San people of the Kalahari. feel lucky to have done so)

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From Stress to Biology: The Inflammatory Bridge

“Psychosocial stress” is often used loosely, but it encompasses both origins and manifestations:

• Origins: depression, hostility, poverty, perceived racism, job insecurity, loss of agency, educational barriers

• Manifestations: smoking, alcohol use, sedentary habits, and unhealthy eating patterns

These are not merely behaviors—they are expressions of distress.

We have long known that such stressors elevate inflammatory markers like CRP and IL-6. Acute emotional events—bereavement, chronic anxiety, even prolonged commuting—have measurable physiological effects, including immune suppression and increased cardiovascular risk.

A notable study in the Archives of Internal Medicine (2007) examined nearly 7,000 individuals and found that:

• Higher levels of cynical distrust correlated with higher inflammatory markers

• Chronic stress was strongly associated with elevated CRP and IL-6

• Poverty and low education were linked to depression and distrust

• Individuals with higher BMI and diabetes carried greater psychosocial burdens 

Interestingly, the effects varied across cultures—being less pronounced in Chinese participants—suggesting that cultural frameworks modulate biological stress responses.

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Beyond Measurement: Asking the Right Questions

 This leads to a critical shift in clinical thinking.

Instead of asking:

“Why does this patient drink?”

We might ask:

“What in this patient’s life makes drinking necessary?”

This reframing applies across conditions—obesity, diabetes, hypertension. Without it, we risk treating laboratory values rather than human suffering.

Prescribing statins, metformin, or antihypertensives without addressing underlying distress is akin to sweeping dust under the carpet—the room appears clean, but the problem persists.

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The Metabolic Expression of Social Instability

Among Native American communities, the most common clinical presentations include:

• Type 2 diabetes

• Obesity

• Alcohol and ultra-processed food dependence

• Behavioural and relational dysfunction

These are not isolated diseases—they are biological expressions of social and historical disruption.

There is also a physiological pathway: chronic stress activates the hypothalamic-pituitary-adrenal (HPA) axis, contributing to insulin resistance, visceral fat accumulation, and metabolic disease. When combined with modern dietary toxins—high-fructose corn syrup, processed fats—the effect is amplified.

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Disease vs. Illness: A Necessary Distinction

Anthropology reminds us:

• Disease is what physicians diagnose

• Illness is what patients experience

These are not always aligned.

Every patient carries an explanatory model shaped by culture, history, and personal experience. When these models diverge from biomedical frameworks, misunderstanding—and often non-adherence—follows.

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Curing vs. Healing

Modern medicine excels at curing—controlling glucose, lowering cholesterol, reducing blood pressure.

But healing is different.

Healing requires:

• Listening

• Contextual understanding

• Engagement with the patient’s social world

Traditional healing systems often succeed here—not because they reject biology, but because they embrace the person as a whole.

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A Global Pattern

What we observe in Indigenous communities is not isolated.

As countries industrialize—Brazil, India, China—the same pattern emerges:

• Rising diabetes

• Increasing cardiovascular mortality

• Widening inequality

These are not merely “diseases of lifestyle.” They are diseases of rapid social transformation.

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Final Reflection

I have long held that obesity and diabetes are, at their core, social illnesses with biological consequences.

No amount of biomedical intervention alone can reverse them.

But there is hope.

The gradual integration of:

• culturally grounded healing

• anthropological insight

• and modern medical care

may offer a path forward—not only for Native American communities, but for a world undergoing profound social change.

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Postscript

Curing treats the symptom. Healing addresses the suffering.

And perhaps our task, as physicians, is to learn how to do both.

The River Beneath the Numbers

Psychosocial Stress, Inflammation, and the Anthropology of Disease

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Still Water / Hidden Flow

The heart appears still—like water in the Everglades. But beneath, unseen currents move slowly over years.

A heart attack rarely comes out of nowhere. We attribute it to diabetes, hypertension, cholesterol. Increasingly, however, we understand that inflammation is the common pathway.

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The Narrowing Path

Atherosclerosis is not an event. It is a gradual narrowing—of vessels, of choices, of possibilities.

Over decades, medicine has identified many causes. When explanations fail, we retreat into “socioeconomic factors”—often a euphemism for deeper instability.

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Liminal Ground

Between water and land lies the hammock—a liminal space.

Anthropologist Victor Turner described “liminal periods”—times of uncertainty when individuals are more vulnerable. For many Indigenous communities, this state has not been temporary—it has endured.

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Marks of Stress

Stress leaves marks—on landscapes, on bodies, on lives.

Psychosocial stress becomes behavior: smoking, alcohol, sedentary life, poor diet—and then biology: inflammation, obesity, diabetes.

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The Unseen Fire

Inflammation is a quiet fire. It does not announce itself—until it does.

We prescribe medications—but often we are treating numbers, not people. Like sweeping dust under the carpet.

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Listening

Before the prescription pad—there is a moment we often miss.

Disease is what physicians diagnose.
Illness is what patients experience.

We are very good at curing.
We are still learning how to heal.

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“We measure disease. We must learn to hear illness.”

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Sudah Yehuda Kovesh Shaheb
Consultant Endocrinologist & Medical Anthropologist

YAQUT AL-HAMAWI THE GREATEST ARAB TRAVELLER OF THE MIDDLE AGES WHO WAS NOT ARAB, BOUGHT AS SLAVE CHILD AT A BYZANTINE MARKET, TAKEN TO BAGHDAD

 

Epigraph

“I am nothing. I shall always be nothing. I cannot wish to be anything. Aside from that, I carry within me all the dreams of the world.” — Fernando Pessoa

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He was not meant to belong to the world he described.

Yaqut al-Hamawi, taken from the Byzantine margins, entered the Abbasid world not as a scholar but as a possession. Yet through the quiet discipline of language, through copying texts and walking roads with patient attention, he became something rarer than a native—he became a witness.

al-idrisi geographical map 

(abbasid baghdad)

When I walked through Cochin, I felt I was moving along the edges of his unfinished sentences. The harbor opened to the Arabian Sea as it must have in his time—ships arriving with spices, manuscripts, and languages. He would have listened closely: to the names of distant ports, to the memory carried in trade, to the small details others overlooked.

(Fort Cochin, Kerala, India)

Yaqut did not travel to conquer or even to seek wonder. He traveled to preserve. His Mu’jam al-Buldan is less a geography than an act of remembrance—cities described before they vanished, names held against forgetting.

(Baghdad)

Cochin, too, gathers worlds. In the blue tiles of the Paradesi Synagogue, in the slow lift of the fishing nets, in the quiet persistence of old streets—there is no single history, only layers.

He wrote before the great erasures of the Mongol invasions. I walk among their aftermath.

(chinese fishing nets brought to Cochin by the great chinese admiral, ZhengHe, 14th century)

(with the priest from the  kunan kurissu church near jew town in cochin, kerala, india. Fr Benjamin)

And so our journeys meet—not in time, but in intention.

He gathered the world so it might endure.

I pass through it, trying, however imperfectly, to notice what remains.

(jewtown, jew street, cochin, kerala, india )

(spice store)

Épigraphe

« Je ne suis rien. Je ne serai jamais rien. Je ne peux vouloir être rien. À part cela, je porte en moi tous les rêves du monde. » — Fernando Pessoa

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Il n’était pas destiné à appartenir au monde qu’il décrivait.

Yaqut al-Hamawi, arraché aux marges byzantines, entra dans le monde abbasside non comme savant mais comme possession. Pourtant, par la discipline silencieuse de la langue, en copiant des textes et en parcourant les routes avec une attention patiente, il devint plus qu’un natif—il devint un témoin.

En marchant à Cochin, j’avais l’impression de suivre les contours de ses phrases inachevées. Le port s’ouvrait sur la mer d’Arabie comme autrefois—des navires chargés d’épices, de manuscrits et de langues. Il aurait écouté attentivement : les noms des ports lointains, la mémoire portée par le commerce, les détails que d’autres négligent.

Yaqut ne voyageait ni pour conquérir ni pour s’émerveiller. Il voyageait pour préserver. Son Mu’jam al-Buldan est moins une géographie qu’un acte de mémoire—des villes décrites avant leur disparition, des noms sauvés de l’oubli.

Cochin aussi rassemble des mondes. Dans les carreaux bleus de la Paradesi Synagogue, dans le lent mouvement des filets de pêche, dans la persistance des vieilles rues—il n’existe pas une seule histoire, mais des strates.

Il écrivait avant les grandes effacements des Mongol invasions. Moi, je marche parmi leurs traces.

Ainsi nos voyages se rejoignent—non dans le temps, mais dans l’intention.

Il recueillait le monde pour qu’il dure.

Je le traverse, tentant, imparfaitement, de remarquer ce qui subsiste.

Epígrafe

« No soy nada. Nunca seré nada. No puedo querer ser nada. Aparte de eso, llevo en mí todos los sueños del mundo. » — Fernando Pessoa

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No estaba destinado a pertenecer al mundo que describía.

Yaqut al-Hamawi, arrancado de los márgenes bizantinos, entró en el mundo abasí no como sabio sino como posesión. Sin embargo, mediante la disciplina silenciosa del lenguaje, copiando textos y recorriendo caminos con atención paciente, llegó a ser algo más que un nativo—se convirtió en testigo.

Al caminar por Cochin, sentí que avanzaba por los bordes de sus frases inconclusas. El puerto se abría al mar Arábigo como en su tiempo—barcos cargados de especias, manuscritos y lenguas. Él habría escuchado con atención: los nombres de puertos lejanos, la memoria contenida en el comercio, los detalles que otros pasan por alto.

Yaqut no viajaba para conquistar ni siquiera para asombrarse. Viajaba para preservar. Su Mu’jam al-Buldan es menos una geografía que un acto de memoria—ciudades descritas antes de desaparecer, nombres rescatados del olvido.

Cochin también reúne mundos. En los azulejos azules de la Paradesi Synagogue, en el lento ascenso de las redes de pesca, en la persistencia de las calles antiguas—no hay una sola historia, sino capas.

Él escribió antes de las grandes desapariciones de las Mongol invasions. Yo camino entre sus huellas.

Así, nuestros viajes se encuentran—no en el tiempo, sino en la intención.

Él reunió el mundo para que perdurara.

Yo lo recorro, intentando, imperfectamente, notar lo que permanece.