Regenerating Rainforests

by Health in Harmony
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Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Regenerating Rainforests
Herwandi, his wife, and Monica with his chainsaw
Herwandi, his wife, and Monica with his chainsaw

Last year, our partner Alam Sehat Lestari (ASRI) piloted a new Chainsaw Buyback Entrepreneurship program. This micro-enterprise development program was launched to target the remaining ±180 loggers living around Gunung Palung National Park and help them find an alternative, sustainable income for their families. ASRI selected 10 individuals who already had side jobs that had the potential to scale-up and held a 5-day training with entrepreneurship experts from Jogjakarta, which included developing business plans and distribution of start-up funds. The loggers’ wives were also required to attend the training in order to foster accountability and have joint buy-in for these new enterprises.

The results from the pilot were encouraging: after just a few months, 60% of the participants stopped logging entirely while 40% were logging occasionally while they waited for the businesses to become profitable.

Now almost a year later, ASRI has made the program official with an added touch: to participate in the program, loggers must sell their chainsaws to ASRI. The money from selling their chainsaws serves as part of the start-up costs for starting their own businesses. This month, ASRI signed on their first participants, Herwandi and his wife Darus.

Last week, Partnership Coordinator, Sara, interviewed Herwandi to learn what drew him to the program.

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Sara: What did you do before joining ASRI’s Chainsaw Buyback Entrepreneurship Program?

Herwandi: The logging I did in the forest was for wood used in construction (to be made into beams, boards, posts, etc). I also harvested the gaharu tree (Agar wood), the rotten wood which can be used in perfume. I logged in eight villages total. My wife makes cakes to sell in shops, usually for school children.

 

S: Why were you a logger?

H: I logged because I didn’t feel like I had any other skills, and the income from logging can be quite good.

 

S: So what changed your mind?

H: I’m tired now and cannot log anymore. There is a big health risk for logging and it is not safe. It also does not provide any security from accidents, or from forest rangers. Safety and security are the main concerns.

 

S: How did you find out about ASRI?

H: I found out about ASRI from relatives. They told me that ASRI protects the forest.

 

S: What’s your impression of ASRI’s approach?

H: I think ASRI’s approach is very fun and creative!

 

S: Tell us about your new business. Why sugarcane juice?

H: It’s a joint business. I make and sell sugarcane juice, but I also now farm for rice and vegetables. I chose this because the opportunity for success is quite large with these businesses, depending on the weather.

 

S: What are your hopes for the future?

H: My hope is to grow the businesses so that we can fulfill our financial needs and be successful.

 

S: How do you think this will affect your family?

H: I will be able to spend much more time with my family since I no longer need to go out into the forest to log. This will be good for the unity of my family.

 

S: Would you recommend the program to other loggers?

H: I would invite other friends to join. ASRI has a good approach and does not force people to join the program.

Herwandi signing the agreement to join the program
Herwandi signing the agreement to join the program

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Moving beds into the hospital
Moving beds into the hospital

In October, the ASRI staff was all hands on deck to help with a BIG transition –moving the clinic into the new Community Hospital and Training Center building!

After days of hauling beds, supplies, and patient records from one building into the other, ASRI held a ceremony with the community, volunteers, and visitors to celebrate! Together they honored this beautiful space of healing and the generous donors like you who made it possible. As ASRI’s Executive Director, Monica Nirmala, said in her speech, “This building is a reminder of love between people from all over the world, and the love between humans and the environment.”

Thank you to everyone who donated their money, time, and skills to bring this hospital to more than 100,000 people living in West Borneo. We couldn’t do it without your compassion and commitment to healthy people and a healthy planet.

And now they’re back to doing what they do best: seeing and treating patients with the highest-quality care!

What’s next? Over the following year, the ASRI clinic will operate out of Building A of the hospital, while the rest of the buildings are completed and additional services are phased in.

Our many, many medical records
Our many, many medical records
The beautiful new waiting area
The beautiful new waiting area
Treating patients in the new hospital
Treating patients in the new hospital
The front of the new hospital
The front of the new hospital
Inside the new hospital
Inside the new hospital

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Noor with an eggplant from his organic garden
Noor with an eggplant from his organic garden

Receiving an invitation for the Independence Day Ceremony in the Presidential Palace was something that Pak Noor never dreamed of. Yet, on the August 17th, 2016, he was there - invited by Indonesian President Joko Widodo as one of the "Outstanding Farmers" representing the Kayong Utara Regency in West Kalimantan. So, who is Pak Noor?

Pak Noor is an active member of one of ASRI’s target farmer groups, Harapan Baru (meaning “New Hope”). Pak Noor is originally from the village of Benawi Agung and has been involved in Harapan Baru since 2009, working previously as a logger. With ASRI’s training, he learned how to farm using organic methods and immediately took his new skills and put them into practice.

In the community, Pak Noor is known as a farmer with a vision. In the same year he received training, he came to ASRI to ask for help with writing a proposal to the Department of Agriculture and Livestock in Sukadana, where ASRI is located. The proposal asked for cows as livestock and manure to use in organic farming. The local department approved their proposal and sent Harapan Baru 22 cows. Instead of taking all of the livestock, Pak Noor and his group only took 11 and gave the rest to other villages.

Their group now has 18 cows and they are producing 2 tons of organic fertilizer each week! Besides using it for their crops, they’ve also started a business by selling their fertilizer to other farmers. Even more, Pak Noor is now training others in organic farming!

Pak Noor’s persistence and active involvement in organic farming has brought a special spirit to ASRI. Not only is it a success for alternative livelihoods, but it’s a positive influence on the entire community. So, when Pak Noor approached ASRI to ask for their help with creating a video for the Outstanding Farmer nomination, the conservation team helped him without hesitation.

Pak Noor is just one example of how ASRI not only trains farmers but continuously supports the farmers’ groups in achieving their goals. For people like Pak Noor, who used to have no choice but log in the forest to make ends meet, this truly is a “new hope.”

Thanks to your donations, Noor was able to get the training and support necessary to become an exemplary farmer and leader in the community – now with recognition from President Joko Widodo!

Noor conducting a training on how to make compost
Noor conducting a training on how to make compost

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Seven years of advanced and expensive training in the US has prepared me to be an attending in a few months. Particularly in my practice setting, expensive and complex interventions are the norm and sometimes benefit the patient. I’ve recognized throughout the years that the system that shaped me has some serious flaws. Health care access is often disparate, and we spend more time facing the computer than our patients. Futile care at the end of life and over-utilization of expensive interventions are common, and the bankrupting of patients occurs regularly (and beyond the view of doctors who contributed). I have sometimes felt my passion for this version of doctoring wane, and I came to ASRI seeking the holistic ideal of connecting with patients and improving the community with my practice.

Jessie Kittle-April 2016-Patient x-ray

Barefoot doctors checking out a patient’s x-ray

My first impression seeing patients was a strong discomfort that I can’t see inside of you. Without all my usual tools I felt like patients’ problems were a mystery, augmented by my inability to gather a history in their native language. I felt the need to know patients’ renal function before prescribing an ACE inhibitor, get a TSH result for a patient with goiter and hyperthyroid symptoms, to see the pneumonia I was diagnosing on x-ray. I felt nervous that my digital-doctoring skills had replaced my human ones and that I was obsolete in this environment. Sometime during week two I made a diagnosis of heart failure, a diagnosis I’m very comfortable with given my extensive training on the subject. I thought, “Ah, I can see inside you!” Victorious, I began trusting my excellent training on the physical exam, and I was off and running.

Jessie Kittle-April 2016-Jessie with patient

Jessie and a patient at the ASRI clinic

The patient cases varied from routine to shocking, which is typical anywhere, but most striking to me was the result of the perpetual comparison of, “If this patient were in the US, we’d…”, since the answer was often a lifesaving intervention that wasn’t possible. A 63-year-old woman with a major heart attack would have been in the cath lab within the mandated 90 minutes at Stanford. Without that intervention, her mortality rate doubled. Despite that, she improves each day and I smile encouragingly, hoping my eyes don’t betray me and say: “I’m worried, and I’m sorry I can’t offer more.” But it was also a lesson in the resilience of people; often times our insistence that a patient needs what we recommend and will suffer great harm otherwise got turned upside down. A pregnant patient with pyelonephritis declined antibiotic treatment after 3 days and we thought she would certainly become septic and possibly lose the baby (and told her as much). She returned a week later… and was perfectly fine! Perhaps she took a gamble and happened to win, but these situations were a great lesson in humility in medicine. An 89-year-old man came in with stroke symptoms and there were no diagnostics or interventions that we felt could help him, so the family decided quickly to take him home. Our ambulance driver drove all night to deliver the man to his home, to die. I was conflicted with the discomfort of not having a CT to really explain what happened, and not being able to admit him for at least some IV medications, speech, and PT. But on the other hand, I’m not sure all the expensive interventions would have amounted to anything but him dying somewhere other than home, leaving his family with insurmountable debt. It was yet another humbling moment for me as they drove off into the night.

Jessie Kittle-April 2016-Jessie and Nomi

Jessie and Nomi reviewing a patient’s file together

I felt deep satisfaction in facing a patient, both of us barefoot, using hands, eyes, and ears to peel through layers of medical and human knowledge to craft a diagnosis and treatment plan that worked for the patient. I made a connection to the humanity of doctoring, which is what interested me in medicine in the first place, and that I hadn’t experienced so purely since I was a medical student in New Orleans (caring for only a few patients at a time). It’s not that the humanity is absent at home, it flickers in and out of my day like a ticker tape on the bottom of the perpetual computer screen of medical care. But here it was palpable around every patient, and reconnecting with that feeling was very powerful and timely as I set out to start my career.

The conservation model that ASRI employs was another incredible draw for me in pursuing the Johnson & Johnson Global Health Scholars Program (J&J) in Borneo, and was even more impressive than I expected. I have been an environmentalist my entire life, with years of experience in wild animal rehabilitation and marine mammal training for conservation research. I loved attending Etty’s education seminar, where she skillfully drove home the critical connection between the health of humans and the natural world, and ASRI’s multi-pronged approach to these objectives. I spent a day with the Goats for Widows program and saw the gratitude of the families who benefit so greatly from the independence and financial security of the program. The reforestation program was of a scale I didn’t imagine, operating as a living-lab in addition to a conservation project. This was health care not just of people but of the earth, and has provided me with endless inspiration for working toward a better planet as a physician.

Jessie Kittle-April 2016-Jessie with ASRI doctors

Jessie with the ASRI clinic doctors, Etty, and Monica

Clearly, I will take much more from my time in Borneo than I could ever give. For that, I will forever be indebted to those who ushered me on this journey. Huge thanks to ASRI, Health In Harmony, Nomi and Vita, J&J, Stanford, Yale, and Dr. Kinari for creating this reality and allowing me to share it, and to the patients on the treasured island of Borneo who made this experience so fulfilling. Till we meet again.

About Jessie Kittle

Jessie recently completed her residency in Internal Medicine at the Stanford Medical Center and volunteered at the ASRI Clinic through the Yale/Stanford Johnson & Johnson Global Health Scholars Program in April of this year.

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I remember the first time I ever saw a patient pay for medical care with tree seedlings at the ASRI Clinic. Pak Hamsu, a patient from the village of Laman Satong where our main reforestation site is located, had amassed medical bills totaling over $375 at the ASRI Clinic after he had a severe stroke in April 2013. When he finally died, his family did not have enough money to repay the debt. So his nephew Jhony repaid the debt the only way he knew how: raising tree seedlings, grown from the seeds collected in the nearby forest that his village has protected for generations.

That got us all thinking. It is a terrible feeling to ask a poor patient’s family to settle outstanding medical bills after the patient has died. But we also have to cover costs to keep our clinic’s doors open so that we can keep treating patients. What if we starting attacking the debt problem more creatively, by making it easier for patients to repay debt with tree seedlings that we could later plant in degraded areas of Gunung Palung?

Laman Satong_Patient Seedlings 3_compressed

Seedlings at the Laman Satong reforestation site

Fun Fact: If you just remove one letter from the word for “debt” in Indonesian – hutang –you get the word for forest – hutan. It’s like it was meant to be easy to turn debt into forest.

So we discussed this idea with our community partners, especially the Forest Guardians. They were totally enthusiastic – but they also reminded us that being in debt is a huge social stigma and a shameful condition that people will go to great lengths to hide. To remove the association between tree seedlings and debt, they suggested another option – why not prevent debt in the first place by allowing patients to create “savings accounts” with seedlings?

Again, this was totally brilliant. Our goal at ASRI is to make sure that the sudden, unexpected cost of a health emergency does not bankrupt families or bankrupt the forest. Banking seedlings in advance could also help chronically ill patients or pregnant women who need routine medical checkups.

Since we started offering this option, over 50 patients have banked 4,256 seedlings representing 28 species and worth a total of Rp. 25 million (about $1,900). We hear reports that there are thousands more seedlings in the pipeline from villagers setting up their own “savings accounts” at ASRI.

The “seedling banking” option has been wildly popular in the villages where ASRI runs the mobile clinic. These places are rich in natural resources but do not operate on the basis of a cash economy because few people have cash-paying jobs. Our Reforestation Coordinator Pak Frans just went to the village of Pangkalan Jihing last week to pick up2,000 tree seedlings (and it took him 8 hours to get there because the road is flooded and practically impassable). Because there is no medical care there, the villagers depend on ASRI’s mobile clinic and with the seedling payment option they literally depend on the forest to be able to pay for medical care.

Community members giving seedlings to the mobile clinic for their savings account

Community members giving seedlings to the mobile clinic for their savings account

From an ecologist’s perspective, this system has been fabulous for increasing genetic diversity within the site. Rather than planting thousands of red meranti seedlings from the same parent tree, we are getting meranti seedlings from parent trees throughout the landscape. This increases the site’s resilience to disease and helps re-create the biodiverse richness of the natural forest that we are trying to restore.

This system is also helping to build our stock of hard-to-obtain tree species, like belian or Bornean Ironwood. One of the first patients to create a savings account last year, Pak Saifal paid with 213 ironwood seeds collected from his family’s own traditional tree garden (you may have read about him in Health In Harmony’s year-end mailing in 2015). This was a rare gift – Ironwood trees are one of the slow-growing giants of the rainforests of Borneo – their timber is prized for construction and boat building, and they are undoubtedly the most highly targeted species for illegal logging in Gunung Palung (which means it is almost impossible to get seedlings!). Every time I visit the nursery, I notice a new belian seed has sprouted even after almost a year of lying dormant, and I feel thrilled that we will be able to plant healthy ironwood seedlings to replace the stumps of the forest giants that remind us of the forest the site used to be before it was logged.

Just $2.00 buys a seedling and pay for a patient’s health care and cover the cost of planting, watering and maintaining the seedling for a year. And 12 seedlings is the average amount a patient barters for a typical visit.

Your support of Health In Harmony turns debt into forest everyday.

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Organization Information

Health in Harmony

Location: Portland, OR - USA
Website:
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Twitter: @HIHngo
Project Leader:
Devika Agge
Portland, Oregon United States
$53,572 raised of $75,000 goal
 
1,115 donations
$21,428 to go
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