Save the people, save the forest. In rural Indonesia, a pioneering clinic is showing how the health of people and forests could and should be intertwined
The roosters were still asleep when Sri Wayunisih woke her daughter, Puteri. They could not afford to sleep till dawn. Wayunisih had taken a day off from working on the oil palm estates and Puteri had skipped school for this trip. They had to reach their destination before everyone else.
Wayunisih pushed her motorcycle onto the road and her daughter climbed on behind her. The Mickey Mouse keychains on Puteri’s school bag clinked crisply. The two of them were heading towards Sukadana, a coastal district in south-west Borneo and the capital city of North Kayong, home to the only clinic in the area, some 80km away. Soon, the roosters were crowing, their calls joining the dawn prayers playing from the many suraus [Islamic assembly buildings] along the road, their walls lit only by the waning moon.
An hour and a few wrong turns later, Wayunisih and Puteri reached the clinic. The one-storey rectangular complex shone like a beacon in the dark with its white-washed walls and zinc-plated roof. Wayunisih and Puteri removed their shoes and walked up the wide stairs to the rows of green plastic chairs on its verandah. It was just past 5am. In a few hours, patients would start to queue at the clinic, and Wayunisih and Puteri would be first in line.
By 8am, a small crowd of 15 adults and children were sat on the verandah. It was Friday, the least busy day of the week. Any other weekday would see all 40 chairs on the verandah filled. It was a September morning, the end of the dry season, and some T-shirts were already moist and sticky. Out in the yard, clucking chickens pecked for food among the grass and newly planted tree seedlings.
A small brown snake slithered into a bed of dry bamboo leaves. High-pitched insect humming hung in the air. On the TV, a tiger stalked its prey. Coloring books lay open on a low table. Everyone in the room sat facing the eastern wall featuring a large white sculpture of a tree growing out of dense undergrowth, hornbills flying out of its canopy, the letters ASRI carved on its trunk.
ASRI stands for Alam Sehat Lestari, Indonesian for ‘healthy nature everlasting’ or ‘harmoniously balanced’. It’s the name of an Indonesian non-profit organisation based here in North Kayong on the western border of Gunung Palung National Park. Part of West Kalimantan province, North Kayong is more than five times the area of New York City and boasts mountains, rain forests and dozens of islands.
It is home to about 107,000 people, almost half of whom make a living on farms, plantations and fisheries. The monthly income averages around 2.45 million rupiah (£133), but one in ten residents make do with just 250,000 rupiah a month, much less than the World Bank’s $1 per day threshold for poverty.
The obvious fact is: people need to earn a living to survive. In desperation, many fathers and sons log and burn the edge of the national park for timber and farmland. Conservationists speak of the park’s 108,000 hectares of swamp, lowlands and montane forest, which together house sun bears, hornbills, gibbons and about 2,500 orangutans. But to local people strapped for cash, the trees look like fixed deposits to be withdrawn in entirety.
For many in North Kayong, healthcare is a dream and emergencies a nightmare. But if paying for a doctor is difficult, at least choosing one is easy: in 2016, there were only 168 nurses, 15 doctors and one dentist in the regency. Five of those doctors and that one dentist work in the clinic that Wayunisih and her daughter braved the dark road to reach, and it is here that ASRI has concentrated its efforts.
Since 2007, ASRI has been working with communities around the national park to improve the well-being of both people and the environment. It started by setting up a clinic that provides villagers with not just the most extensive healthcare services in the area, but also incentives to stop them from logging in the park.
The clinic offers up to 70 per cent discounts on medical fees to villages that stop logging, and ASRI aims for this to pile pressure on loggers to stop. Patients who cannot afford medical fees, and so might otherwise resort to illegal logging, can choose to pay with various non-cash options, including native seedlings or labor. ASRI also replants forests and trains ex-loggers to farm and run alternative businesses.
ASRI weaves healthcare, finances and conservation into one tapestry — a vision printed on the uniform of its conservation staff: “Masyarakat sejahtera, hutan sehat” (Prosperous society, healthy forests). This concept is now often referred to as ‘planetary health‘, a term coined by the Rockefeller Foundation–Lancet Commission in 2015 to inspire research and action. But the beginnings of ASRI came more than a decade before that.
Back in 1993, when the then 21-year-old Kinari Webb first visited Gunung Palung National Park to study orangutans, the locals “had nothing” in terms of healthcare. “One of our field assistants, Pak Patin, was like a Wild Man of Borneo. He knew so much about the forests. I have never met anyone who’s more comfortable in the forest,” says Webb, a medical doctor from New Mexico, USA, and the founder of ASRI.