How to save the rainforest: Build a health center

When Sri Wayunisih woke Puteri, her daughter, the roosters were asleep. They couldn’t afford to sleep till dawn.

An hour and a couple of wrong turns later, Wayunisih and Puteri reached the practice. It was only past 5 a.m. By 8 a.m, a small crowd of 15 adults and children were sat on the practice verandah.
It was Friday, the least active day of the week. Any weekday would see all 40 seats on the verandah filled.
    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 own lamp, the letters ASRI carved on its trunk.
    ASRI stands for Alam Sehat Lestari, Indonesian for ‘healthy character everlasting’ or ‘harmoniously balanced’. It’s the name of an Indonesian non-profit organisation located here in North Kayong on the western border of Gunung Palung National Park.
    North Kayong is more than five times the area of New York City. The yearly income averages around 2.45 million rupiah (US$181), but one in ten residents contend with only 250,000 rupiah a month (<$20), much less compared to the World Bank's $1/day threshold for poverty.
    The obvious fact is: people will need to make a living to survive. In desperation, many fathers and sons log and burn off the border of the national park for wood and farmland.
    Conservationists talk 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 like deposits that are fixed, the trees seem to local people strapped for cash to be pulled in entirety.
    For most in North Kayong, health care is a dream and emergencies a nightmare. But if paying for a doctor is difficult picking one is easy there were 15 doctors, only 168 nurses and one dentist at the regency. Five of that one dentist and those doctors work in the practice which Wayunisih and her daughter braved the road to reach, and it’s here that its efforts have been concentrated by ASRI.
    Since 2007, ASRI has been working with communities across the national park to enhance the wellbeing of both people and the environment.
    It began by assembling a practice that provides villagers with not only the most extensive health care services in the region, but also incentives to stop them from logging in the playground. The practice offers around 70 per cent reductions on fees and ASRI plans for this to heap pressure on loggers to stop.
    Patients who cannot afford health care fees, and so might otherwise resort to illegal logging, can choose to pay with various non-cash options, such as native seedlings or labour. ASRI replants woods and trains ex-loggers to farm and run companies.
    ASRI weaves health care, finances and conservation into a tapestry — a vision printed on the uniform of its conservation team: “Masyarakat sejahtera, hutan sehat” (Prosperous society, healthy woods).
    This concept is now often known as ‘planetary health’, a phrase coined from the Rockefeller Foundation–Lancet Commission at 2015 to inspire action and research. But the beginnings of ASRI came more than a decade prior to that.

    Selling trees to pay for medication

    Back in 1993, when the then 21-year-old Kinari Webb first seen Gunung Palung National Park to study orangutans, the locals “had nothing” with regard to health care. While she tracked orangutans she heard the sound of chainsaws. The ground shook every time there fell a giant tree.
    Webb wondered whether there are any forest left for your orangutans she had been observing. She learned that they sold and cut trees to pay for medication and spoke to loggers.
    “What would you do in order to get health care? What would you do if your kid is sick? Just about anything,” says Webb, a medical doctor from New Mexico, USA, and the founder of ASRI.
    In 2006, Webb formed a group and applied to open a practice in Sukadana. In July 2007, it opened although the application slowed to a six-month drag.
    Webb and her team went to all of the villages across the national park and conducted formal surveys — or “radical listening”, as she calls them.
    The villagers asked two items: training in natural farming¬ — meaning that they wouldn’t need to buy expensive chemical fertilizers and fertilizers — and superior health care that they could afford.

    Engaging the village

    At 9 a.m., Wayunisih was waiting from the room of Dr Alvita Ratnasari, a general doctor. Since she and her daughter had not been seeing nicely Wayunisih expected the rumors of ASRI giving glasses were accurate.
    ASRI began giving out glasses in early 2007, trusting the handouts would engage the cities across Gunung Palung National Park. There was not a day when you could not hear chainsaws, says Webb. It reminded the group of the urgency of their work.
    ASRI first focused on farm and healthcare training in an effort to sever the locals’ dependence on illegal logging. Subsequently, in 2009, the federal park office hectares to ASRI’s maiden reforestation project. ASRI had reforested almost 20 hectares, only to endure a ravenous fire which consumed all but half of a hectare.
    Since that time, the conservation group has replanted 16 hectares. This feat has demanded about 121,000 seedlings, many of which were contributed by practice patients and much hard work. Since 2007, their fees have been paid by almost 900 patients with seedlings — mostly from fruit trees.
    It’s worth mentioning that ASRI’s belief in reforestation is not universal among conservationists.
    Andrew Marshall, a tropical ecologist at the University of Michigan, describes ASRI’s reforestation efforts as worthwhile, but thinks that protecting the remaining forests is a much more economical and much more effective approach than kick-starting regeneration.
    “It’s just really hard to grow back tropical woods,” says Marshall, who has spent 21 years at Gunung Palung National Park, adding that we won’t know whether it works until well after we’re both dead.

    Giving the chainsaw up

    On a long beach just 10 minutes from the practice is a café selling bottled sugarcane juice, also a popular from the dry season. The owner of the café is Wan, whose name has been altered, a local who speaks softly and walks with a slight limp.
    Wan turned 40 this year, and also for the first time in 21 years, he’s without a chainsaw.
    When he was 19 he had been desperate for work, but he had neither skills nor capital. When a wood boss offered him a 2.5 million rupiah loan to get a chainsaw, Wan took it, agreeing to market all the trees he cut to his boss at one time the market price. Wan began to log.
    Wan was sceptical when he discovered of ASRI’s Chainsaw Buyback Entrepreneurship Program. According to the programme, ASRI would buy Wan’s chainsaw for 4 million rupiah (below market value) and invest additional capital to finance a joint company with him. After Wan repays ASRI’s investment with profits from the new company, he’ll have the company outright.
    Wan had always wanted to conduct a café, however, he worried about failing. Without a chainsaw can he feed his family? His wife, who had been supplementing the family income persuaded him to give logging up. She recognized the toll it took on the paucity of earnings and her husband’s body it offered in return.
    Finally, in February 2017, Wan sold his chainsaw to ASRI and began his café. Because of a wholesome sale of karaoke, coffee and juices, he has been earning a 500,000 rupiah profit every month since May. He has already started to repay ASRI.
    His example has motivated others to combine ASRI’s buyback program. Ex-loggers have left ASRI to their chainsaws in exchange for cafés, fish ponds and farms. But the program at present can’t finance more than 10 ex-loggers, and it’ll take several years to prove its success.
    And while encouraging loggers to give up their chainsaws may appear like a fantastic idea for the forests, it may also backfire.
    Bronson Griscom, manager of forest carbon science at the Nature Conservancy, stated, “Counterintuitively, chainsaws can be a powerful conservation tool. It’s not the tool that is the problem, but how it’s used.”
    Griscom worries that if loggers are prohibited from jobs and earnings from natural woods, and pushed to make their livelihood from different lands, it could drive a long-term change to convert forests into land for different uses.

    Getting diagnosed

    Wayunisih sat in Dr Ratnasari’s room at the practice. It has an examination bed, a wall-mounted enthusiast, a desk and a window which opens onto trees.
    Wayunisih told the rosy-cheeked doctor of her “smoky” vision and stomach pain. Puteri sat fiddling with her mask.
    Following evaluation, Ratnasari told Wayunisih that her eyes were deteriorating with age and have mild cataracts. Puteri has developed nearsightedness.
    “Would you give Puteri glasses to help her see improved?” Requested Wayunisih. “No, the glasses we give for free are for seniors and don’t do the job for Puteri,” said Ratnasari. She sketched an eye on paper to help Wayunisih know Puteri’s nearsightedness. “As for your illness, it is too early for a surgery, however you’ll want glasses with UV protection.” The instructions were typed by Wayunisih into her flip phone.
    “Could I trickle honey on Puteri’s eyes? People explained that helps.”
    “No, please do not do this!” Said a concerned Ratnasari, who has had patients with ulcers in their own eyes from washing them using “leaf juice”. “Honey goes into our mouths, not our eyes.”
    Wayunisih was obviously disappointed that Puteri did not get totally free glasses. “But the service is good and I know what to do today,” said Wayunisih before she hurriedly left for Ketapang, the closest city with an optometrist, two hours away.
    Daily, over 40 patients go to the clinic, paying 100,000 rupiah each on average. Fees pay for 40 per cent of the health care operations of ASRI, while ASRI’s conservation programs all rely on global grants and donations from bodies like the Whitley Fund for Nature and the US Fish and Wildlife Service.
    But if donations and grants conduct dry, ASRI will be shackled with a funding deficit of 85 per cent or even more as they gear up to reforest 100 hectares a year and extend the practice into a fully-fledged hospital.
    Executive manager Monica Nirmala is banking on the new hospital and the recently-developed Indonesian national medical insurance scheme for more income. It’s an awesome plan, but one that’s already appearing precarious.

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    The hospital isn’t yet qualified under the insurance strategy, and it is uncertain if it will qualify. “Frankly, I just don’t understand what’s going to occur,” said Kinari Webb. ASRI isn’t perfect, but it is trying.
    Later that day, I discovered Dr Ratnasari reading a publication from the practice library. When she talks, Ratnasari, who is always smiling, had just renewed her contract. City buddies and her parents haven’t understood why delay her pro training and she opted to come to Sukadana. As she stated, was it, the abilities she could find out from perhaps, or Sukadana the satisfaction of helping patients who may pay with perspiration and seedlings?
    “I really like my window,” she told me, staring out the window at the room where she’d treated hundreds of individuals like Wayunisih. We discovered no chainsaws, although leaves, birds and crickets.
    “I’ve never seen a lot of tall trees outside my window. This is a painting. A live painting.”

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