Health and ecology in Borneo

To explain why she started a clinic in Borneo, Kinari Webb, M.D. ’02, tells the story of a farmer on the Indonesian island.

The farmer made his living from two rice fields and occasional fishing. Industrial-scale logging in the nearby rain forest not only felled trees, but created a breeding ground for mosquitoes, and the farmer—who couldn’t afford mosquito nets—fell ill with malaria. His wife wanted to take him to the hospital, but their neighbors’ experience deterred them. When their neighbor’s wife was sick, the family sold all their possessions to pay for medical care. They still had to borrow half the bill from a loan shark at 150 percent interest per month, plunging the family into debt and forcing the breadwinner to turn to illegal logging to earn a living.

With that in mind, the farmer didn’t go to the hospital. Soon he was too weak to travel, and he died.

Poverty, environmental damage, and lack of health care are not separate problems, Webb believes. Instead, they’re part of a chain of circumstances that feed on each other. That’s why her clinic not only offers health care, but encourages a sustainable approach to the environment—villagers who pledge to abstain from illegal logging get a discount on medical services. Patients may also pay for health care at the clinic with such ecologically-friendly options as working in the organic garden or trading handicrafts which are then sold to pay for medicine.

“We are interested in the other links in this chain,” Webb said in September as she gave a talk for the Humanities in Medicine program. [For more on Webb and her work in Indonesia, see “A Life’s Work in Indonesia,” Yale Medicine, Autumn 2008.]

Since the Alam Sehat Lestari Clinic opened in June 2007, her staff has grown from 15 to 42. She needs more doctors but has no room. That’s why she hopes to start building a hospital. She recently bought an ambulance that provides mobile clinics at eight locations every month.

“I fight for health, but I don’t believe that health is just being free of disease,” Webb said. “The hardest part of this work is that it is so painful to live at the frontier of ecological disaster. Every day we can hear the chain saws.”