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No Insurance? On Borneo, This Clinic Accepts Manure

October 28, 2009 at 12:00 AM EDT
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On the Southeast Asian island of Borneo, the Asri Clinic doesn't take credit cards. Instead, the clinic accepts payments that improve the local ecosystem, be it seedlings for replanting, eggshells for composting, even manure. Fred de Sam Lazaro reports.

FRED DE SAM LAZARO: It’s not easy to run a clinic in this remote corner of Borneo. Patients come in with malaria, T.B., and diseases that should be treated much earlier. Most people are extremely poor, and health care is either unavailable or unaffordable.

But this clinic, open since 2007, has flexible payment policies. They don’t take credit cards, but they will take just about anything else, says the social entrepreneur founder Dr. Kinari Webb.

DR. KINARI WEBB, founder, Health in Harmony: So, you can pay with baskets and woven mats. You can pay with labor. You can pay with labor either in the clinic or in our organic gardens. You can pay with seedlings that we use for reforestations or seeds. These are also eggshells, which we use for compost.

FRED DE SAM LAZARO: Kidney patient Musadin agreed to pay partly with hard cash, partly with something, well, softer.

DR. KINARI WEBB: People at our clinic can actually pay with manure.

FRED DE SAM LAZARO: It’s collected for an organic farm next to the Health in Harmony clinic. Dr. Webb says the idea is to treat, not just patients, but a larger rain forest ecosystem that’s been under assault in Borneo for decades, starting when this vast island was under British and Dutch colonial rule and accelerating in recent years.

DR. KINARI WEBB: It’s not only about our physical health, which is incredibly important, and the physical health of the planet, but it’s about our soul health. These — these rain forests and this biodiversity is exquisitely beautiful.

FRED DE SAM LAZARO: But it’s disappearing rapidly. These are the carcasses of lumber mills that fed Asia’s economic boom in the ’80s and ’90s. They simply ran out of lumber, depleting large swathes of trees in a vast area around these factories.

In their wake are oil palm plantations, producing cooking oil that’s a lucrative export to markets across Asia. Nearby, people struggle on tiny plots of land. These, too, are carved out of the forests, which have shrunk by more 50 percent across Borneo which is now shared by Malaysia, tiny Brunei, and Indonesia, which officially protects small pockets of land in national parks like this one called Gunung Palung.

These parks are the last refuge for orangutans, gibbons and millions of plant and animal species. And even though they’re legally off-limits to any commercial exploitation, these parks are not immune from illegal logging. And conservationists who work here say the only way to stop it is to improve the lives of the desperately poor people who live here.

Kinari Webb learned that when she came here in the early ’90s. She originally came to study primates, but then was moved by the extreme poverty and poor public health.

Combining medicine and nature

DR. KINARI WEBB: And I began to realize what it was like for people who live in -- in tiny little villages in Borneo, with just basically no opportunity at all.

And I came face to face with what it's really like for the last bits of rainforest in the world. And I just began to think, you know, I could go to medical school, and I could come back and I could make a difference here. And, yet, I never could let go of that love of the environment. And, over time, we found a way to really combine those two.

FRED DE SAM LAZARO: She also couldn't let go of her love of a botanist she met here named Campbell Webb. She finished medical school, they married, and it was Campbell Webb who first enabled the move back in 2007. Harvard University hired him to conduct research in the forest with Indonesian colleagues.

CAMPBELL WEBB, researcher: We're able to be here, in a large sense, because I have a job here that enables me to be here, and Kinari doesn't take an income.

FRED DE SAM LAZARO: Income for the clinic, where Kinari Webb and about 20 colleagues work, comes from a patchwork of donations from U.S.-based supporters, school fund-raisers, and in-kind help. For example, medical students and graduates volunteer here, and the architecture department and students at Georgia Tech University have been helping design a new hospital, a project that is also intended to help students learn sustainable building methods.

MAN: Tomorrow, we will be going to Batambara to distribute glasses and mosquito nets.

FRED DE SAM LAZARO: About 8,000 patients have been seen in the two years since the six-room facility opened, but the clinic also travels to villages surrounding the Gunung Palung park.

There's usually weeks of advance notice, so people can grow seedlings. They use these to pay for care. The clinic works only in so-called green villages, communities that are certified by the park service as free of illegal logging. Patients from green villages also get a discount when they seek care the main clinic.

DR. KINARI WEBB: And they determine that both through ground patrols and with flyovers of the national park in these tiny little microlight airplanes. We're not trying to catch people. We're just simply saying, we're listening to the national park. And, together, with them, we're going to try and offer you incentives if you're not doing illegal logging.

Link between logging and malaria

FRED DE SAM LAZARO: At this event, people got vision tests and glasses, also bed nets to keep out mosquitoes, and they got a lecture from clinic staff that linked deforestation with increased malaria.

DR. KINARI WEBB: People are saying: "Oh, yes, we know that's true. There's many more mosquitoes in logged areas."

So, yes, they know it, and they would love to prevent it.

FRED DE SAM LAZARO: No one values the forest more than those who live around it, she says, even though poverty has driven many people to engage in illegal logging. Deforestation brings disease, floods homes, and affects rainfall for their crops.

Many are eager to join in conservation efforts and have agreed to report illegal logging coming through their villages from the park. And Dr. Webb says local farms are happy to switch from their slash-and-burn tradition of clearing ever more forestland to plant crops. The land only remains fertile for a few years, before it must be abandoned.

SRIKANDI ASE, village leader: In first three years, when you open the land from forests and add chemicals, it's quite good. But, every year after, production goes down and down. Some of these fields are used 20 years or more, so they are not productive.

FRED DE SAM LAZARO: Srikandi Ase is the leader in one of several villages where the clinic has introduced residents to organic farming using soil enriched by compost and manure.

SRIKANDI ASE: Our old people, our honored elders, they are ones who cut down the forests, and they are seeing the bad effects on their grandchildren. That's why were so pleased with this training, that we are learning to do something about it.

Securing a green future

FRED DE SAM LAZARO: Over time, new planting and better land management should ease pressure on the forest. Campbell Webb says it will never bring back the rich biodiversity, but he says it will teach them a lot about reforestation.

CAMPBELL WEBB: We will definitely learn about what different species need, which ones are good to plant, what methods we -- we can employ to control weeds, and all these different things.

FRED DE SAM LAZARO: And there's still virtue, nonetheless, in bringing back a forest even lacking that diversity?

CAMPBELL WEBB: Yes, absolutely. I mean, for all the other reasons, for the economic reasons, for watershed management, for sources of timber, climate control, definitely, a forest is better than no forest in -- in these -- in these habitats.

FRED DE SAM LAZARO: How do you know you're succeeding?


FRED DE SAM LAZARO: What tells you that you have got something that's actually working?

DR. KINARI WEBB: Yes, it's an excellent, excellent question.

We -- we cannot be a failure, because we're very lucky to be able to be able to help so many patients. But, in terms of conservation, how successful are we being, it's not going to happen immediately. We have already seen a 30 percent decrease in the number of villages which are doing illegal logging. But we would like to see much more than that. But I believe that it will take time to do that.

FRED DE SAM LAZARO: And she plans to take the time. Aside from fund-raising trips to the U.S., Kinari and Campbell Webb hope to spend their careers here.

JIM LEHRER: You can join Fred de Sam Lazaro on his riverboat ride, and hear his report about how poverty threatens Borneo's natural resources. That's on our Web site at