Travel Journal #22: Kalimantan at Imbolc

Guest blog by Dr. Krista Farey

Imbolc this week, the half way point between the winter solstice and the spring equinox observed by Celts, like me, though I’m not aware of anyone else celebrating Imbolc here.  The big holiday coming up in Southeast Asia, is, of course, the onset of the year of the Fire Monkey next week, an event I’m excited to be in Thailand for.  I have been in five airports recently and they are all festooned by red lanterns with long tassels and posters and statues of cartoonish monkeys prancing mischievously. The huge major hub airports are hardly distinguishable from each other in décor, concessions and processes, and I can’t help musing on the change since the first time I passed through Bangkok over 40 years ago. The Bangkok International Airport was then a very small open-air building with two gates, one runway, one local handicraft shop and one café, much like the small town airport that I started this trip from yesterday morning.

Growth and change remain blockbuster stories around here, apparent in flying over cities that recently were rice paddies, and over palm plantations that were ancient forests not long ago. Sukadana, West Kalimantan, Indonesian Borneo, the town of 30,000 or so where I was based the past month is no exception. Since I was last there 18 months earlier, there are far more houses and cars, though remarkably, still no chain gas stations with pumps, no chain stores, no chain restaurants, and no stoplights. The best places to eat remain private homes and home-like “dining rooms”, and at the tender coconut concessions that line the wonderful municipal beach, my favorite, tender coconut with sweet ginger syrup.

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Watching the rains pour down from the ASRI Clinic porch

Fresh perspective on living in harmony with nature and the connection between human health and environmental health come naturally there.  Starting with a spider. The first night I spent at the house I lived in in 2014, a spider as big as my hand came out from behind a cabinet and started racing around the room.  I resolved not to kill her, but I was not able to catch her in a glass and take her outside either.  So she looked at me, I looked at her, she looked back, and I tucked my mosquito net in tight and went to sleep.  She was still in my room when I left yesterday, a peaceful roommate the whole time. Dr. Hotlin, who had lived in that house for many years, says spiders are sort of a test for foreign volunteers. If the volunteer is nervous about only big spiders, she can usually adjust to life in an open air house in the tropics. But if she is afraid of small spiders too, Sukadana may not be for her.

In Sukadana, I had the privilege to serve for the second time as a teaching attending and preceptor for the young Indonesian doctors staffing Klinik ASRI. ASRI is a non-profit foundation, working in both human and environmental health, founded 10 years ago by Dr. Hotlin and Contra Costa family practice residency graduate Kinari Webb.  It’s programming starts with “radical listening”, asking the local people what support they need to preserve the forest.  They have consistently requested affordable health care and organic farming training.  With discounted health care for villages that quit logging and a good alternative livelihood option, logging has almost ended in involved villages.  More than half of the 1000+ former loggers are now doing better as organic farmers. The forest in the nearby Gunung Palung National Park has been preserved, and other areas are being reforested.

Human health is better there too.  The Clinic offers western medicine for what it is best at, largely rescue care from infectious and cardiovascular disease.  Tuberculosis rates have greatly decreased with ASRI’s intervention, in fact ASRI boasted an unheard of 100% completion rate in the directly observed therapy (DOTS) program that all ASRI TB patients must be enrolled in. As a clinician it has been very satisfying to work again with Dr. Nomi and Dr. Yuli, some of the doctors I worked with in 2014, and a more recent addition, Dr. Vita. Together we made diagnoses clinically and brought back people from the brink with very low tech medicine. For example, there was one young man with such florid congestive heart failure that he was panting and sweating to the point of near collapse, and we thought he could have used a ventilator were it available. But we treated him in the observation unit with oxygen and the basic generic medicines that we had, and then treated him again with more. After that we went home for the night, hoping very hard for the best. When I came to work the next morning, he was dressed, standing on the porch, motorcycle helmet in hand. I did a double take – is that you?!?  Ironically, he probably would not have been in as good a shape the next day if we’d actually had a ventilator, designer drugs, and a cath lab. Protocol would likely have obligated him to all of that, with equally likelihood adverse effects from some of it.

ASRI is building a hospital scheduled to open later in 2016 and there has been a rich discussion about the level of technology to use there. It will not have ventilators, at least at first. It will have electronic records, still being designed, but they may start as billing tools only. The intention is to find the best way to enhance the technical care, including surgery, while maintaining the heartfelt human connection, high cost-effectiveness, and limited environmental impact that characterizes ASRI care now. Even generic medication use is under consideration. I gave a talk, and a lot of focused precepting, on treating stomachaches with diet and other lifestyle changes, including Ayurvedic approaches. Long term omeprazole, powerful symptom relief, but which has myriad long term adverse effects while not addressing the many root causes of digestive problems, is being discouraged except for in a few specific situations.

On the riverboat tour of Tanjung Puting National Park

On the riverboat tour of Tanjung Puting National Park

One weekend, five of us made a side trip to visit Tanjung Puting, a national park that features up-close encounters with “semi-wild” orangutans, those that had been injured or captured, then re-released there. Orangutans are never able to become fully wild again, and the program is controversial.  It’s a very nice experience for humans, though, relaxing on a river boat while being fed fresh dragon fruit cocktails, and viewing gibbons, macaques, silver leaf monkeys, and a wide array of birds in the canopy above, and crocodiles below.  This is interspersed with hikes in the forest with closer looks at amazing plants, insects and spiders, including moths that look identical to leafs and insects that are definitely sticks until they up and fly away.

Early one morning while on the deck doing yoga, I watched a teenaged male orangutan named Atlas walk right into the door of our boat, climb the stairs, and peruse the food left out on the table. He picked up the tangerines, and put them down again, but packed his mouth with packages of chocolate, cookies, almonds and water bottles. Then he walked out, climbed a tree, opened the packages, and ate them up.   When he started to come back for more, our guide, Ujang whipped out a toy sling shot, held it up, and Atlas went running. Turns out orangutans are terrified at just the site of sling shots, no need to sling anything with it.

The last morning I was in Sukadana, the loudest gecko I have ever heard, who is named Steve and lives in the rafters, croaked seven times, which is said to indicate there is a ghost in the house, while the several indoor-outdoor cats we live with were literally climbing the walls. The spiders watched and the cacophony of chickens, ducks, wild birds, and cicadas outside continued unabated.  From there, I whisked off to a sterile world of airports, planes, and airport hotels, where there is hardly a fly, ant or green plant. Just the cartoon monkeys. I’m already missing the big spider in my room. I read recently a scientific study that provides evidence that contact with nature is good for almost anything that ails you, brilliant and expensive documentation of the self-evident.

Back to the inseparability of environmental health and human health. Back to the deep ache of feeling that so much more at so many levels must be done for both the environment and the human species to heal. And back onto another airplane and the nagging thought that one thing I might do for the health of the world is to fly less. Imbolc is the time of year when ancient Celts celebrated the rebirth of Spring with spring cleaning, purifications, visits to sacred wells, bonfires, feasting and divination.  At this time, I hope that something is reborn in all of you, and that you will be present to be touched by the beauty of the natural world.

About Krista Farey

Krista is an Attending Physician in Family Medicine, based in San Francisco, CA. She has volunteered at the ASRI Clinic multiple times and is a dedicated Health In Harmony supporter.

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