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NonprofitI am Dr. Kinari Webb, founder of a health clinic in Indonesia that works with communities to stop illegal logging with health care incentives. AMA!

Dec 22nd 2016 by kinariwebb • 9 Questions • 118 Points

UPDATE: Thanks everyone for all the questions. I really enjoyed chatting with you today! I'm signing off for now, but may be back to later to answer a few more questions!

I established a unique community clinic in Borneo called Health in Harmony where patients can pay for health services with non-cash means like seedlings, handicrafts or labor, and regardless of the currency they use, patients get a 70% discount if they live in an area where illegal logging activity has stopped. Our mission is to improve the health of local residents while creating social pressure to stop illegal logging in and around the park, which is a haven for wildlife like the endangered Bornean orangutan.

At the clinic we use a technique called Radical Listening, which involves reaching out to the local community to find out what they see as solutions and implementing those. I originally went to Borneo as a young researcher to study orangutans and how their dwindling environment endangers their survival. What I didn’t expect was to discover the intimate connections between poverty, logging, poor health, substandard education, unsustainable farming practices and, of course, the orangutan. It was after returning to the US to become a physician that I established Health and Harmony.

I’m joined here by Natalie from PRI’s The World who will help me in answering your questions today. Read the recent piece The World wrote about the health clinic here.

Ask me anything!

TL;DR I’m Dr. Kinari Webb, founder of Health in Harmony and ASRI, a health clinic based in West Kalimantan, Indonesia that works with communities to stop illegal logging with health care incentives.

Here’s my proof: https://twitter.com/pritheworld/status/811929779712774144

Q:

How do you make the finances work, if you're often paid in other-than-cash?

A:

Great question. The handicrafts we sell for cash. The seedlings and manure we use for reforestation. This works because in the funding world it is vastly easier to get money for reforestation than for health care funding. So we can use the grant money for purchasing seedlings to "buy" the seedlings from the health care side of our work. When people pay with labor it makes everything we do cheaper. But actually most people choose to pay with cash -- they just love that they have this option because it means that they never have to worry about affording care. They never have to log to pay for health care. It should also be noted that the prices in our clinic are very low. It costs about what a bowl of soup costs to see a doctor.


Q:

Would you please Explain, in laimance terms, what "illegal logging" is?

A:

Ah! Thank you for asking that. Where we work, "illegal logging" is logging within Gunung Palung national park. By law, that is not allowed and could theoretically lead to arrest although during the first five years of our program there weren't any arrests and since then there have only been two. The trick is that this is not just "illegal" in the eyes of the state but also something that the local communities do not want to do. In one survey we found that 100% of the loggers wanted to quit. The people see the forest as the source of their water, a source of medicines, and a home for the animals. They also have a cultural understanding that logging can lead to disease. One man told me that when they used to log they would push all the disease down from the hills to the village and people would get sick. Interestingly, there is evidence that might back this up since logged forest has a much higher rate of malaria-carrying mosquitoes.


Q:

How much did the illegal logging plummet? I believe "anything you can measure you can improve", so what data has made Radical Listening a better approach?

A:

We went from an estimated 1350 logging households when we started to about 450 after five years. Now, after 9 years, we are down to about 180 individuals! My experience is that this is a better approach because you are doing exactly the things that are causing people to destroy their environment. People were logging to pay for health care and because they didn't have the skills for an alternative livelihood. In addressing both of these things simultaneously, the effect was synergistic.


Q:

That is a really interesting way of doing development work within a community instead of ... I'm struggling with the right way to phrase this ... doing work "to" a community.

Have you seen this model used elsewhere successfully?

A:

Exactly!! Most programs do work "to" a community. They come in with the idea that they know best -- and they DON'T!. Yes, I have see other programs do something similar. Check out Blue Ventures in Madagascar (https://blueventures.org). They have a similar approach that is also working amazingly well.


Q:

Do you see this model working in other places and capacities? Trading healthcare for not poaching...or something like that?

A:

Absolutely! But only if the local communities are the ones that identify health care as a cause of doing something that they don't actually want to do. If you are a subsistence agriculturalist and are growing enough to eat, what do you need money for? A wedding, a house, and health care are often the critical things. But health care is the only thing that can't wait until you've collected money -- and that you will do anything to get. When we started 99% of the people wanted to protect the forest -- they just couldn't because they were missing critical knowledge and resources. The thing is that our experience in scouting out sites for replication, is that this story is very common and health care needs often drive over-exploitation of the environment.


Q:

Do you see this as a model that works? Would you look to replicate elsewhere?

A:

Yes! We are currently doing site visits throughout Indonesia to decide where to do next. Our wonderful replication coordinator, Kari Malen, has a great way of envisioning the best way to spread this model. She calls it the wheel method with hubs and spokes. The hubs are more intensive sites like the ASRI program around Gunung Palung but spokes could be less intensive sites. For example we are considering doing work at Bukit Baka Bukit Raya National Park. The situation is very similar there where people are logging to pay for health care. However, the population is not large enough for a full scale clinic, but we could potentially do mobile clinics from our current hospital. We see potentially doing other hubs in other parts of Indonesia like in Sumatra or Papua with spokes as well. We are also looking outside Indonesia. Know anywhere you think would work well?

Our goal is also not to do it all ourselves. We want to collect excellent data at every site we do and hopefully train others to do similar work all over the world.


Q:

I was struck by the story of the man who said “Why should I pay more than the others (for medical care) when I didn’t do anything bad in my village, I never was a logger?" Does this happen often? Is such a person's efforts to dissuade others from logging rewarded in any way?

A:

Well, first of all, logging villages still get a discount just for bordering the park and working on decreasing logging. Those villages are called "Red" and they get a 30% discount. After a few years, in another round of radical listening we also instituted a "yellow" category for villages that had dramatically dropped their illegal logging rates but hadn't quite gotten to zero yet. They get a 50% discount. The green ones get a 70% discount. And remember, everyone can always pay with barter options so everyone can always access care. They just might have to pay with more seedlings, so more work on restoration can be done. We actually rarely get complaints and most people love the idea that the system helps encourage their neighbors to stop.


Q:

Apa kabar? I heard your segment on NPR yesterday. What is your favorite Indonesian cuisine?

A:

Baik juga! Terima kasih atas pertanyaan ini. Saya paling suka petai! Petai goreng atau dengan sambal. Enak!


Q:

Coming from a woman who wants to travel and make a difference in the world, what did you have to sacrifice or lose in order to achieve your successes?

A:

I worked for seven years without a salary and life was not always easy but, actually, I feel like I gained much more than I lost. It's impossible to count the value of getting to see individuals and a community transform. And it was the same way for me. I had to face really hard things but in that process, I was able to do the difficult personal work that is the foundation for being all that we can be. It will always be a work in progress, but I feel blessed by the work I've gotten to do and most especially by the people I've been privileged to travel this path with.