October 04, 2011
Getting access to adequate health care can be difficult in many parts of rural Indonesia, a necessity that often involves long journeys to overcrowded clinics. And once there, many patients often find they cannot afford the costs of treatment and medication.
Sukadana is a dusty village outside Gunung Palung National Park in West Kalimantan. Infrastructure is poor, water is increasingly scarce and the supply of electricity is sporadic.
Tuberculosis, malaria and whooping cough are common and can have a detrimental affect on poor villagers unable to access treatment.
Often people here must travel more than two hours on bumpy roads to reach the district's only hospital. But even there resources are thin. Doctors often spend little time with patients, which can result in misdiagnosis.
Ira, a local resident, says she prefers not to go to the hospital because of the lack of coordination and personal care.
She says if there is an emergency they only have one room and the patients dance around each other. The staff are not well trained and they do not know the proper doses of medicine to give out. She does not like, she says.
To help provide better care to the remote district, American doctor Kinari Webb helped co-found Alam Sehat Lestari, or ASRI.
The non-profit organization uses its clinic to provide high-quality, affordable health care to an area that, until recently, had the worst health record in the region.
The clinic allows patients to pay through non-monetary means, such as woven baskets, seedlings or labor exchanges. Because of low literacy rates, Eka, the pharmacist, draws symbols on prescription labels: a sun means morning; a moon, night.
When the medication is ready, the cashier, Nani, who goes by one name, explains the payment procedure.
She says the medicine is Rp25,000, the doctor consultation Rp5,000, so the total is Rp30,000, or about $3.50. She says that here you can pay with baskets, weavings, seedlings. She says the clinic will also accept things from your garden.
The barter payment system is part of ASRI's dual mission, to combine health care with conservation.
People in West Kalimantan have long depended on the forests for their livelihoods. But rising timber prices have been a boon for illegal loggers. Webb says most communities do value the forests, but often illegal logging is their only way of earning an income.
"Even if you know that if you protect the forest that's good for your long-term well-being, if you're short-term well-being, like you have to get health care and you have to be able to pay for it, you're willing to do illegal logging to do that," Webb says.
To increase awareness, patients get conservation education as they wait to register at the clinic. Many of ASRI's 70 staff also work in the field, helping communities build alternative livelihoods, like organic farming.
As an incentive not to log, ASRI provides discounted health care.
Each month someone from the organization visits the surrounding villages to determine if they are actively logging or burning land within the national park. Communities that do not participate in illegal logging pay about 40 percent less than those that do.
ASRI's clinic is small, filled with the constant hum of a generator.
A nurse calms four-year-old Amelia, who was recently in a motorbike accident. Later, Doctor Kinari Webb will see a baby with whooping cough and a mother and daughter suffering from tuberculosis.
A program the organization started in May identifies forest guardians who work with the community to curb illegal logging. One of the guardians says he entered the program because ASRI helped his son recover from tuberculosis.
Webb says people were skeptical when ASRI first starting operating. They preferred to go to the hospital, and few saw the benefits of the incentives the clinic was offering. Now, people happily share stories about the clinic's services.
Amelia's mother is one of them. She has been coming to the clinic since her daughter was eight months old. She says the treatment is good, and so is the medicine.
Doctor Webb smiles when she hears that.
"Health care is an incredible key," she says. "Everyone knows we care, and we're helping save their lives."
Webb says a healthy planet is essential for healthy humans, and the organization's goal is to break the link between the high costs of health care and the need to cut down the forests.