Pak Subagio is laughing; his face creases up into a smile and his eyes twinkle, full of life. Although small and thin, he radiates happiness and a sense of vitality. It’s impossible to believe that just a year ago, the same man was lying in bed unable to work and that he had been that way for a long time. Pak Subagio had tuberculosis, an infectious bacterial disease that is characterised by disease of the lungs. In the Western world, rates of TB have decreased drastically as a result of nationwide vaccination schemes. In West Kalimantan, an area that has very little access to high quality healthcare, it still poses a huge problem.
Two weeks ago, I visited Alam Sehat Lestari, or ASRI for short, an NGO in West Kalimantan that is dedicated to improving the quality of healthcare for communities around Gunung Palung National Park. The name Alam Sehat Lestari literally translates to ‘nature healthy sustainable’; asri translates to ‘beautiful’. It is exactly this idea of linking healthcare to a healthy environment that ASRI is trying to promote.
Take this example: Ibu Reni has three sons. One of them develops an infection and needs to go to hospital. The nearest hospital is five hours away, and you can only reach it by motorcycle. The boy is taken to the hospital, diagnosed with X and told he needs medicine. The family needs money to pay for the consultation and the medicine, and the fastest way to get money is by cutting down a tree in the national park and selling the wood. But cutting down the trees affects the water distribution to the family’s farmland, which in turn means there are more mosquitoes in the area and so IbuReni’s second son gets malaria. He also needs medicine and, again, the family has to cut down a tree to afford the medicine, which makes the environmental situation worse and actually means the whole community is becoming less healthy. (Statistics show that communities living deep in the healthy rainforest actually have fewer health problems).
Kinari Webb, co-founder of ASRI, was able to witness these stories first hand when working as a researcher at Cabang Panti Research Centre in Gunung Palung National Park. After finishing at Cabang Panti, she decided to go back to the US and study medicine and, in 2005, returned to Indonesia and teamed up with an Indonesian dentist, Hotlin Ompusunggu. They didn’t know the best ways of linking healthcare and conservation and so they decided to ask the communities. Many NGOs preach the importance of community led interventions; this is the first ever time I have seen them working so well. The people from the local communities could identify the issues and they had the answers. Over the course of a year, Kinari and her team spent over 400 hours in ‘radical listening’; they met with community groups and helped them draw links between the biggest problems, and then they asked them what the international community could give back in exchange for protection of the rainforests. Every single one of those focus group discussions came back with the same answers: they needed better healthcare, education on alternative livelihoods and methods of farming and better education for their children.
And so ASRI was born.
ASRI has a number of different projects which aim to meet these needs, not all of which are included here. Perhaps most important is the health clinic set up on the outskirts of Sukadana, a town in West Kalimantan. The high quality of healthcare ASRI provides is almost revolutionary in the area; many people were travelling three hours to the nearest hospital only to be incorrectly diagnosed or sent away. While we were there, a seventeen day old baby arrived at the clinic. A week before, ASRI had referred her to the local hospital to receive the care that they were not equipped to provide. On arriving at the hospital, the family was told that the paediatrician was away on leave. Another doctor told them to come to his private clinic, gave them antibiotics to mix with water and sent them away again. When we saw the baby she was still tiny; the doctor at ASRI suspected she might have Downs Syndrome. It is unthinkable that that same baby would have been discharged from a hospital in the UK. Stories such as this are not uncommon in rural areas of Indonesia: the best doctors congregate in the big cities and rural areas are often left inadequate. In most rural areas, the only doctors are fresh out of medical school and completing their one year internships. These young people are often left with little support and struggle to cope with being the only doctor in an area. In contrast, the doctors trained at ASRI are given the room to develop and strengthen their skills; the few that have moved on to different hospitals often receive high praise for their rigorous training and skills.
But it is the non-cash payment system and discounts for villages that no longer carry out illegal logging that make ASRI really special. Patients from non-logging villages can have a 70% discount on their healthcare. The remaining cost of healthcare can then be paid through a variety of different means: in the form of seedlings (baby trees), manure, handicrafts or labour. These methods of payment are then used to promote organic farming and replant the rainforests. Any member of the patient’s village or community can help pay for the treatment. The community no longer has to turn to logging to pay for healthcare, but instead are replanting the areas that have already been cut down. It’s simple and revolutionary.
Alongside this, the Chainsaw Buyback program gives each individual IDR 3 million (approximately £150) in exchange for selling their chainsaw (which they were using using to cut down trees) to ASRI. This money is then used to help the family build up their own alternative income source: we met a man who has set up an organic fertiliser business, and another who now has his own sugarcane juice stall.
Selling sugarcane juice on the side of the road, Pak Arifin assured us that his life is much better now; less stress, a more reliable income source and less physically intense work! He is more successful selling sugarcane juice than he ever was cutting down trees.
ASRI’s last main project is ‘Goats for Widows’. In Bahasa Indonesia, widow can mean both a woman whose husband has died or a divorced woman. This is Ibu Sene. Five years ago she was given one goat; now she has over twenty and is using them to pay for her grandchildren’s education. The first kid was given back to ASRI, who then passed it on to another widow. Goats can be sold for IDR 2 million (approx £100), a hugely significant amount in rural Indonesia.
Each of these projects was inspiring on its own, but it is the atmosphere and the spirit of ASRI that makes it such an amazing organisation. The projects are all designed by the local communities and so there is complete trust and respect in the organisation. Everyone working there has chosen to be there and often earn lower salaries than had they been elsewhere. In the morning meeting, they spin a pen to see who will lead: it may be the cleaner, the receptionist or the doctor. The spirit, love and hope that everyone has in the projects is incredible to witness. It felt like being part of something truly special.
And what is even more exciting is that it’s actually working. Illegal logging has gone down by 88% since 2007. The dropout rate from TB treatment is 2%, much lower than the national average of 11%. ASRI is responsible for planting 46.5 hectares of forest. They aim to reach 400-500 hectares by 2022. That forest will trap carbon, provide water sources, and allow orangutans and biodiversity to thrive.
Slowly but surely, ASRI’s method of listening to the communities is resulting in actual change. In the last three years I’ve visited many different NGOs. This is the first time I have seen such change in such a sustainable and community led way. Being at ASRI was hugely inspiring; it’s the type of place that I want to work at some day, where every person in the organisation has the same importance, where the patient and communities are put first. After the slog of the first two years of medical school, this was a much needed reminder of how intrinsically linked medicine and healthcare is to the wider world. Improving the health of the communities improves the health of the forest, which in turn can improve the health of people across the world. Now the only thing left to do is to take this model and make it global.