An Endocrinologist in the Land of Mosquitoes

I am a consultant endocrinologist to a tribe of Native Americans who live in and around the Everglades of South Florida. One of the great pleasures of my work is leaving the conventional surroundings of the clinic and driving out to their camps to visit them in their own homes.

The mosquitoes are always there to welcome me. They are, perhaps, the most enthusiastic of all the inhabitants!

The Everglades are an extraordinary geological and ecological phenomenon. Although part of this vast wilderness is protected as a national park, the Everglades themselves are something much greater. They are an immense, shallow, slow-moving river, stretching for miles across the southern Florida peninsula, eventually finding its way to the sea through a labyrinth of mangroves, cypress swamps, hardwood hammocks and sawgrass marshes.

There are no mountains, no dramatic waterfalls, and hardly any changes in elevation. Yet the landscape possesses a peculiar, almost hypnotic beauty. Alligators inhabit these waters, along with innumerable birds, reptiles, fish and, unfortunately, some introduced species that have disturbed the delicate ecological balance.

For thousands of years, Indigenous peoples lived in this watery landscape. The Calusa and Tequesta inhabited southern Florida long before the arrival of Europeans. Later, the Seminole and Miccosukee peoples made the Everglades their home, particularly during the nineteenth century, when the wars of displacement drove many Indigenous families deeper into this seemingly impenetrable wilderness.

What appeared to outsiders as an inhospitable swamp became a refuge, a sanctuary, and a place where traditions could survive.

In the twentieth century, enormous engineering projects drained and transformed much of the Everglades to accommodate agriculture and expanding cities. In 1947, the same year that Marjory Stoneman Douglas published her celebrated The Everglades: River of Grass, the national park was formally dedicated. Yet the Indigenous peoples had known and understood this landscape long before it became a national treasure.

It is against this historical and natural background that much of my medical work takes place.

Today, the nurse accompanying me, the gentleman in blue, suggested that we visit an elderly man who lives alone in one of the traditional camps.

I knew him already. He is fiercely independent, deeply traditional, and evidently content with his surroundings. His camp, he told me, had been carved out of the Everglades by his grandfather. It was not merely a place of residence but a piece of family history, handed down through generations.

The nurse, concerned about his health, checked his blood glucose and other vital signs while I sat chatting with him. His blood glucose was rather high, and we decided that some additional treatment was necessary. Unfortunately, we had not brought the required medication.

So we drove back to the clinic, collected what we needed, and returned to his camp.

There was no impatience, no anxiety about schedules, and no sense that we were wasting time. This was simply how medicine was being practised that afternoon.

Afterwards, our conversation wandered away from medicine.

He spoke about the history of the camp, his grandfather, the changes he had witnessed, and the many events that had unfolded during his long life there. He remembered a time when his people lived largely on foods obtained from their natural surroundings.

Then came the White Americans, he said, bringing their processed foods, unfamiliar habits, and ways of living that had profoundly altered the health of his people.

There was neither bitterness nor self-pity in his telling, merely the observations of someone who had lived long enough to witness the transformation of an entire way of life.

As we talked, I looked around his property. There were magnificent trees, climbing vines, tropical plants, and even a papaya tree. Nature seemed to have arranged itself around his home without much interference from human hands.

I suggested that, as part of his treatment, we should walk together around the property for a few minutes.

He readily agreed.

It occurred to me that the South African writer and explorer Sir Laurens van der Post, in his writings about the Indigenous peoples of southern Africa, had reflected upon the intimate relationship between human beings and the natural world. He saw in their traditional lives something of humanity's primordial connection with nature.

Although I have always felt that such romantic descriptions need to be approached with caution, I could understand what he was trying to convey.

Here was an elderly man whose surroundings were not merely scenery, whose home was not simply a building, and whose relationship with the land could not be separated from his identity.

Medicine, in such circumstances, becomes something more than diagnosing disease and prescribing medications.

Before leaving, I suggested to the nurse that he visit our friend at least once a week to check on his health. I added that I would very much enjoy accompanying him from time to time.

We repeated his blood glucose measurement.

It had fallen by 50 mg/dL.

There was satisfaction all around.

The nurse was pleased, our elderly friend was content, and I had enjoyed another afternoon among the people and landscapes I have come to know so well.

Even the mosquitoes had enjoyed themselves, although perhaps for different reasons.

As we drove away through the Everglades, I reflected once again upon the privilege of practising medicine in such surroundings.

There are no sterile examination tables, no hurried encounters, and few of the formalities that so often separate the physician from the person seeking care.

There is conversation, trust, a little medical science, and the shared pleasure of being human.

This, to me, is one of the most rewarding ways of practising medicine among the Indigenous peoples of the world.