If you have a fever in the town of Sukadana in Indonesian Borneo, the locals might suggest you go to the ASRI clinic. It’s in a little house whose front yard is crowded with bicycles and motorbikes. In the waiting room, you examine a whiteboard that explains your payment options. ASRI accepts cash. But it looks like you can also pay with labor in the clinic’s organic garden or its reforestation site. If you own a goat, you can bring in its manure and pay with that. You can even pay with durian tree seeds!
Doctoring both humans and the environment is the raison d’etre of Alam Sehat Lestari (“healthy life everlasting” in Bahasa Indonesia, or ASRI for short), an NGO dedicated to the idea that human health is so intertwined with that of the environment that trying to fix one must include trying to fix the other. Located beside Indonesia’s Gunung Palung National Park, ASRI aims to protect the park’s irreplaceable rainforests by offering health care incentives to local people to stop illegal logging. We’re supported by our sister NGO in the United States, Health in Harmony.
For both people and the forest, the task is urgent. The island of Borneo was once famously covered by rainforest. But now only half of that canopy exists, and less than one-third will remain by 2020. Beginning in the mid-20th century, loggers, palm-oil plantation companies, and farmers logged, burned, and clear-cut their way through the island. Horrifyingly, much of this destruction has taken place in “protected” areas like national parks. The relentless loss of forest has devastated biodiversity in Borneo and severely reduced habitats for many organisms, including one of humanity’s closest relatives, the orangutan – as of 2005, there were about 55,000 left, a tenth of which live in Gunung Palung. Some experts predict the orangutan will be extinct within a few decades. Despite their protected status, Gunung Palung’s forests are continually threatened by illegal logging for valuable hardwood, poor implementation of management practices, and forest fires, many of which are started to clear land for new uses. Over 50,000 hectares of the 90,000-hectare national park’s forest cover are damaged or gone.
Contributing is the fact that Borneo’s economy is based largely on extractive industries; there simply aren’t many other job options. An ASRI survey found that in the Gunung Palung area the average cost of an emergency visit to the district or regional hospital was $460 – more than the average annual income. In fact, one-third of interviewees had faced a choice between health care and food. Financial pressures like that are what drive people to illegal logging. A four-meter board can go for R110,000, or about $10 – a little less than the average villager’s monthly income of $13. Working in a rice field, by contrast, pays about a dollar a day.
Sukadana, located so close to Gunung Palung, is a boom town for these industries. It was recently made a seat of the local regency. We watch new buildings go up every week – most of them built using illegal wood chopped straight out of the national park – and workers and money are flowing in.
As forest is converted to plantations, however, pesticides and fertilizers enter the watershed, which damage water and soil quality as well as human health. Watershed destruction from logging and land conversion leads to flooding which makes it harder to raise rice and can increase rates of flood-related diseases. Logging itself is dangerous work, and there are few or no worker protections. As well, seasonal, man-made forest fires, which this ecosystem is not adapted to and which can last for months, devastate both the natural habitat and respiratory health.
Enter ASRI: Our Sukadana clinic offers high-quality, low-cost medical care to all comers, with discounts for people living in villages that do not contribute to illegal logging (which the National Park office determines using air and ground patrols). This incentive system was devised in consultation with local leaders and is intended to take advantage of powerful social ties in this rural area. But given the complexity of the connections between poverty, health, and the environmental degradation here, ASRI also attacks these problems from other angles.
For one, patients and families can pay by eco-friendly, non-cash means – some of which actually end up providing further benefit to the patients. Many choose to do a stint of labor for ASRI in our organic garden. There they learn techniques that they can apply to their own crops. Some farmers have reported making a considerable profit selling their own organic produce with the skills they learned at ASRI, and some have sworn off traditional slash-and-burn agriculture, because as organic farmers they earn more money for less work. Others decide to work at ASRI’s reforestation site, which aims to restore several hectares of burned-over, degraded grassland to its original forested state. Patients can also bring in compost or manure; rainforest seeds and seedlings; or handmade grass mats, which are snapped up by clinic staff and volunteers.
ASRI’s other programs include Goats for Widows, in which impoverished widows receive a goat and give back its organic manure and one kid. Clinic staff teach townspeople and villagers about the links between the environment and health and include information about diseases like tuberculosis during “movie nights,” when they set up a projection screen and show educational videos. Crucially, ASRI also engages in capacity-building through its trained medical volunteers, who serve as consultants for Indonesian staff doctors who are fresh out of medical school.
On the horizon is a new eco-friendly “super-clinic” that will allow us to perform major surgery and house many more inpatients. We hope that as it goes up, people will learn ways to build with less wood, and that by offering even better health care to people living around the national park, we will gain enough leverage to slow or even stop illegal logging. For the community – everyone from the next generation of Sukadanans to the gibbons and durian trees – that would be a healthy change for all.
Jenny Blair, M.D., is a physician, writer, and long-term volunteer at ASRI, along with her husband, Roberto Cipriano, a LEED-accredited professional and architect who is helping to design ASRI’s newest clinic.
Sources: Center for International Forestry Research, Food and Agriculture Organization, Gunung Palung Orangutan Conservation Program, Mongabay.com, Rainforest Action Network, Tropics, World Rainforest Movement, World Wildlife Foundation