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.
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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May 14, 2014

ASRI Capacity Grows and Grows

Hotlin signing the new MoU with the park
Hotlin signing the new MoU with the park

Hello Global Givers,

Two collaborative opportunities have come up at ASRI this spring that both recognize the impact your donations are having in the area, and both will make it possible for ASRI to do even more work to save forests with stethoscopes.

At the end of March, ASRI signed a Memorandum of Understanding (MoU) with the Gunung Palung National Park Office (BTNGP), which allows the two organizations to better work together to achieve their shared aim of ending illegal logging in the park. 

ASRI has partnered with the national park office since our founding in 2007, but without a formal relationship, they could not realize all the benefits of collaboration. Now, ASRI can more effectively share the results of the Forest Guardians' on-the-ground monitoring efforts to assist with enforcing logging laws within the park. Further, ASRI will use the systems already in place to maintain alternative livelihoods programs BTNGP is able to start with government funding. BTNGP can now also grant ASRI greater access to the park for educational purposes like ASRI Kids field trips.

The MoU is a critical step in conserving the rainforest. ASRI and BTNGP are two of most powerful actors in this fight and have now teamed up to pool their already significant resources. Together, we will be able to educate more, train more, enforce more - all leading to less desire, need and ability to cut down trees and destroy the precious Gunung Palung habitat. Please read more about the MoU on our blog.

Second, just last week, ASRI Cofounder Dr. Hotlin Ompusunggu and Health In Harmony Executive Director Michelle Bussard attended the Forests Asia Summit 2014 in Jakarta. Organized by CIFOR and co-hosted by the Indonesian Ministry of Forestry, the summit invited leaders and stakeholders from Southeast Asia to share knowledge and best practices for managing forests. ASRI was recognized by this group as a significant contributor to rainforest conservation in Borneo and asked to participate in this event to influence social and economic policy in a sustainable direction. I haven't heard their final take on the week yet, but I feel sure that, as with everywhere the HIH model is represented, people were impressed and inspired by what donors like you have accomplished with a small clinic next to a rainforest.

It has taken years of visionaries, like all of you Global Givers, who have seen the connections between human and environmental health then invested in the communities in West Kalimantan. The world is now taking notice of all you have accomplished in partnership with those communities. I am so excited about these two recent capacity-building opportunities because they represent the ways is which ASRI is growing to tackle problems the size of climate change, human health crises, and poverty. Thank you, thank you Global Givers for being the first to believe they have what it takes.

Til next time,

Trina

ASRI Conservation team outside the BTNGP Office
ASRI Conservation team outside the BTNGP Office
The Sedahan reforestation site
The Sedahan reforestation site

Links:

Apr 7, 2014

Experiencing the magic of ASRI in person!

ASRI Kids making recycled paper
ASRI Kids making recycled paper

Hello Global Giving donors!

I am writing to you today all the way from Sukadana – no better place to send an ASRI update than from the clinic itself! This is my sixth and final week on site, and I feel a great privilege to have witnessed the change you are making in this part of the world through your support.

In March and April, the Health In Harmony staff is joined on site by two trips of donors here to experience ASRI firsthand. It has been and will continue to be a joy to share this time and place with them! The second group of eight begins their journey this weekend; and just a few weeks ago we had two amazing women on site that both gained and contributed some very special moments.

Dr. Karin volunteered in 2008 and returned with us almost six years later to a project that has grown in many ways. In addition to fun stories of roads that were unpaved and muddy arrivals at clinic in the morning, Karin had some beautiful insights into how the relationships with volunteer doctors has over the years increased the professionalism and quality of care at Klinik ASRI. In Karin, I saw someone who truly believes in the mission of Health In Harmony and has been gratified to see it succeed. In an interview with her, she told us “I have to say it’s a strange vision to combine health care with saving the rain forest, but when you understand how those two pieces go together, it makes total sense… the vision, it really turned out to be such a good one that it attracts people who are willing to invest their big hearts in this place.” Read more of her interview on our blog!

This time around, she had the chance to see some of the pieces that have emerged over the years since she has been here, as a result of adding those new people with their big hearts and big ideas to the mix. We visited Simbilan Gunung, a village with nine widows who have received goats from ASRI, and talked with a woman celebrating the birth of her 23rd goat that morning! Karin also spent time with Etty at ASRI Kids on an afternoon when her class was learning how to make recycled paper, and she watched as they pressed in decorative flowers and carefully squeezed out all the water. We also learned about the research on methods of reforestation at Sedehan and trekked through both control and experimental sites. Karin kept busy receiving a well-rounded view of programs!

Dr. Lori also had a very poignant experience in her time at ASRI. Though she has followed the project from before it was a reality, this was her first opportunity to visit. But it came at the perfect time! Lori, also a surgeon, recently made a commitment to sponsor Dr. Ronald’s surgical residency, after which he will return to ASRI for five years – hopefully ASRI will then have a hospital for him to operate in! Lori and Ronald spent three days in the clinic, working together and learning from one another, but also forming personal bonds that both say will now last a lifetime. The two were even able to visit the hospital Ronald is applying to for residency, giving Lori the opportunity to approve its quality and rigor and visualize it in the future. Drs. Lori and Ronald both shared with us that the time together in person has made them family – a testament to the power of visiting ASRI!

We know not everyone can experience this special place in person. But after seeing our donors on site, we are committed to bring ASRI to you as best we can! We have been posting frequent updates and pictures on our blog. I encourage you to sign up for our email list as we will continue to share stories from the trips and our volunteer voices through April. March also saw big announcements about a $100,000 gift from a MacArthur fellow and a new memorandum of understanding with the Gunung Palung National Park you can read about on the blog.

More than ever before, I am sending heartfelt gratitude to each one of you for making this place possible. Being at ASRI, I assure you your gifts are changing lives every day and making huge contributions to the future through restoring and protecting the beautiful and vital environment here.

My warmest wishes,

Trina, HIH Development Associate

Dr. Karin and a widow
Dr. Karin and a widow's young goat
Hiking in the forest with Lori and Karin
Hiking in the forest with Lori and Karin

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