Health in Harmony

The vision for Health In Harmony began more than 15 years ago in the forests of Gunung Palung National Park where Dr Kinari Webb recognized the direct link between the environmental destruction wrought by illegal logging, the desperate state of human health in the communities around the park, and the impact of rain forest loss on health worldwide. Our comprehensive approach works at the intersection of human and environmental health to provide sustainable change in communities around the world.
Feb 13, 2015

We Are Not Superheroes

Mr. Helmi bringing a gift of sand to the clinic
Mr. Helmi bringing a gift of sand to the clinic

A couple weeks ago, when I was doing my daily routine work as a doctor in the clinic, I met him. He is Mr. Helmi, our 40 year old patient with a very bad foot infection. I remember him because he left a deep impression on me. How can I forget him? I still can remember the day when he came.

Tuesday, November 4th, 2014 was the first day when he was showed up at the ASRI clinic. Although Tuesday is not usually as busy as Monday, there were a lot of patients that day. Because of that we were late for lunch. After lunch, when we came, he was waiting in the emergency room. He came with high fever, chills, redness, and swelling with pus on his left 1/3 distal shin for two weeks. His temperature when we measured it was 39 degrees Celsius. Random blood sugar was 386 mg/dL (more than three times normal indicating poorly-controlled diabetes). He had already gone to the closest referral hospital in Ketapang. The Internist had recommended amputation because they feared the abscess would spread to other parts of his leg but he refused. Then he heard about ASRI from his relative. His relative recommended him to come here because ASRI is the best quality standard of care and he was afraid to lose his leg. He hoped ASRI could make a miracle for him.

When we were exploring his wound, we found the abscess was deep and we thought it already infected to his bone. After a long discussion among us and an Infectious Disease Consultant from Stanford, we hospitalized him for a month and gave him antibiotic shots for 4 weeks and then switched it to oral for 2 weeks with very careful wound care every day. A miracle happens. Slowly but sure, his abscess was cured. He was very pleased with what we have done.

Before he saw it himself, he thought that ASRI is a religion mission foundation from the West and belonged to a Western country. Then I explained it to him. My explanation made him understand. He is going to tell all his relatives and colleagues about what ASRI has done. As a sign of gratitude, one day ASRI’s front yard was very muddy after the rain and he sent a truck full of sand to help. He also brought us a box of food.

I remembered one day our former volunteer asked me, what kind of movie do I like? I said, “Superhero.” I love superhero movies because superheroes are very cool. Superheroes can save people. I think everyone has a dream. A dream to make a difference. To do something. To save life. This is what I want to say. We are ASRI. We are not a superhero. We are just like ordinary people that want to make differences. To save lives and give hope.

Links:

Nov 25, 2014

Orangutans are using Sedehan reforestation site!

An orangutan nest in Sedahan
An orangutan nest in Sedahan

I always say that ASRI’s two reforestation sites are like two children: Laman Satong, our older reforestation site that had the fire last year, is like the difficult child that needs constant love and attention in order to thrive. In contrast, Sedahan, our younger reforestation site, is the precocious child that constantly delivers amazing surprises, unasked.

Every time I go there, I am amazed at how tall the trees have grown in less than two years. The site’s peatland soil is far more fertile than the degraded, dry soil at Laman Satong. Many of the planted trees are already over two meters tall. One species in particular, petai (stink bean) has been consistently shooting up like a rocket wherever we plant it.

“We need to plant more of this!” I keep telling the team. They laugh back at me, “But it’s hard to find seeds! The community loves to eat the beans and collects them all before we can plant them!”

Luckily, we happen to have a health clinic that can solve these types of problems. We raised the price of petai seedlings in our list of non-cash payment options. A patient can now cover their entire medical bill with just a few stink bean tree seedlings. (I hope we get a flood of them.)

Also, not only is the site growing well, but it is legitimately changing the worldviews of the community members who work there. Many are former illegal loggers that have been tasked with returning this small piece of the world back into forest. Our site coordinator Yayat says that the workers have told him they can’t bear to think of cutting down a tree ever again after their work on the reforestation site. And believe me, they are extremely proud of what they have accomplished. They really want Sedahan to become an environmental education site so that others can see what the site has become.

Last year, we asked them to replace the old bridge into the site with one safe for school-children to cross. They responded by building an elaborate bamboo bridge with two sets of benches. Benches! The old bridge was so precarious that I used to leave all of my electronic devices at the clinic assuming that I would fall off the bridge into the river. The gorgeous new bridge is stable enough to host 8-person photo ops.

“I had almost nothing to do with it!” Yayat told me at the time. “It was all their idea!” And by the way it took them only 2 days to build. 

The workers were also instrumental in stopping further land clearing. In previous years, one community member cleared the 2 ha area next to the site for farming. With the constant coming and going of the reforestation workers, he became afraid of getting reported to the police. So he stopped clearing land. He didn’t plant any rice. Instead, he planted durian and rubber tree seedlings. That piece of land will also become a forest again.

Lastly and most incredibly, the site is already fulfilling its initial purpose — providing a corridor for orangutans to cross between forest fragments and the main body of the park. A few days ago, our newest conservation volunteer Adam came back from a day of cleaning out weeds at the site with news: the workers found orangutan nests. Three of them. He went back the next day to take some pictures. Sorry, he said. There are actually four nests. FOUR!

The Sedahan site continues to remind us that sometimes all the love, sweat and bug bites that go into reforestation work can yield the elusive results we hope for – even a few years earlier than expected. In fact, I just heard today that one of the Forest Guardians visited the last active logger in the community where the Sedahan site is located. The logger is ready to stop. But he wants a job.

He wants to become a reforestation worker.

Adam and the reforestation workers
Adam and the reforestation workers
Seedlings going into the ground
Seedlings going into the ground
The Sedehan reforestation site - Chelsea Call
The Sedehan reforestation site - Chelsea Call

Links:

Aug 25, 2014

Sometimes all you need is a pair of ducks

TB Program Dropout Rates
TB Program Dropout Rates

Sometimes you start things but you have no idea where they will go. That is what happened when we hired Ibu Hamisah to be one of our village health workers six years ago. She was a shy woman from a village about half an hour away from our clinic who had very little self confidence. Six years later, you won’t believe what has happened to her! 

We were trying something very unusual in 2008. We wanted to hire women in the villages to help our tuberculosis patients take their medicines. This was critical because when we started treating tuberculosis about 50% of our patients dropped out of treatment. That meant they had a high chance of developing drug resistance and not only dying of TB but also spreading the resistant tuberculosis to others. What was unusual was that we were so strict about the rules of working for us. We fired our village health workers if they missed even one visit to their patients. So in the first few years we went through a lot of women, but then it settled down and we ended up with an amazing group of incredibly dedicated ladies who took great care of their patients.

We also gave them the book “Where there is no Doctor” in Indonesian and we conducted health training sessions every month in lots of different critical health topics — like how to treat diarrhea in the villages with oral rehydration solution, or how to know when a child probably had pneumonia.

After two years of Hamisah working for us, we were so impressed that we asked her to interview for the position of coordinator of the program. I still remember in that interview how much she lacked confidence and finally at the end she told us, “I just can’t do this. I would be afraid to talk to the department of health and other government officials, and I have never used a computer. I only have a middle school education. You will just have to find someone else.”

I was sad, because I thought she would be good, but we did end up hiring Ibu Lia who had a college degree. The TB control program continued to be a roaring success and every year the drop-out rate decreased until last year it was just 0.6% (in 2009 we stopped treating anyone with infectious lung TB without a DOTS worker, and in 2010 we stopped treating anyone without a DOTS worker).

Hamisah told me about how she managed to keep her most difficult patient from stopping his medicines. After cajoling and explaining the importance for months he finally just refused to take another pill. “I feel all better, I’m sick of taking these medicines! I’ve stopped coughing and gained weight. Stop coming here!” He said as he slammed the door in her face. Undeterred she came back the next day with a pair of ducks as a gift to him. Seeing the ducks, he calmed down and agreed to take his course of treatment. She says that now every time she sees him he warmly greets her and proudly tells her how healthy he is and how many ducks he now has from that original pair.

Then, you won’t believe what happened. Hamisah’s village nominated her to be the head of the village. She tells me that this is because the village saw how much she cared for them all. People often came to her even in the middle of the night when they or their children were sick, and using her book she would care for them. Then if they weren’t better in the morning, she would bring them to the clinic for further care. What you have to realize is that her being nominated to be village chief was wildly unusual. At that time, there was not a single other female chief of a village.

She says she didn’t campaign and didn’t even want it, but out of over 140 households in her village more than 130 voted for her. She said someone else even put up her picture at the ballot box. And now, after two years, they all want her to become the head of a group of four villages, and people are even talking about her running for the position of head of the regency!

The reason everyone is so excited about her is all the innovative things she is doing in her village. She leads a group of 52 women farmers who are all learning organic methods (even without training from our team yet) and she got the government to give them two hand tractors. They have a meeting once a week and Hamisah also passes on to them everything she learns about health and conservation at ASRI. Hamisah also made a rule that there would be no logging in her village, and she has managed to get the last loggers to stop. “I think these men listen to me because I’m a woman,” she told me.  

Last year, we approached Hamisah again to ask if she would again consider the position of coordinator of our community health workers, because we wanted to promote Lia. This time she said yes! She has learned to use a computer and is so proficient at negotiating with the local government, she has gotten all six of the local government clinics to use OUR community health workers to help treat their patients with tuberculosis. She does a full day of work with us and then still takes great care of her village in the evenings and weekends. In the graph below you can see how TB rates are dropping in all the villages except in Siponti and Teluk Batang where we recently started working with the government clinics.

Is it any wonder, Ibu Hamisah’s village is so grateful to her? And we should all be grateful, because preventing drug-resistant tuberculosis is not just a benefit to the communities here, it is a benefit to the whole world because disease, like environmental disasters, don’t follow national boundaries. 

Ibu Hamisah and one of her patients
Ibu Hamisah and one of her patients
Ibu Hamisah
Ibu Hamisah
New TB Cases by Village
New TB Cases by Village

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