We're back with another edition of Research Rundown! This month, Health In Harmony Research Director, Bethany Kois, interviewed Herfina Nababan, a volunteer who recently returned to ASRI after seven years to conduct 71 in-person interviews with members of the community for a realist evaluation aimed at uncovering Health In Harmony's theory of the change. Below she shares how ASRI has changed since her last trip, and what brought her back after so many years!
Bethany Kois: Before we get into your recent work with Health In Harmony - this wasn't your first time volunteering at ASRI, right? What was your previous experience like? What work did you do?
Herfina Nababan: Yes, I came to Sukadana for the first time in 2008, and then again in 2009. At that time I was fresh out of medical school and was trying to figure out what’s next. Before Sukadana, in the summer of 2005 I had the opportunity to go to a health camp in Papua. It was a very profound experience to see firsthand the health situation in rural Indonesia, particularly how hard it was both for the people in the community and government alike to access and provide quality health services because of various constraints: geographical location, lack of infrastructure, and absence of health workers, supplies, and medicine as well as financial difficulty. If you are familiar with the geography of Indonesia, you will understand that it is really challenging. And aside from Papua, there are many other isolated islands and communities, including here in Kalimantan/Borneo. But even in the cities, during my clinical years working in government hospitals, for example, I also saw that providing and accessing quality health care services was quite a challenge as well. I became increasingly intrigued by the social aspect of medicine. For me, being a medical professional ceases to be meaningful if my medical knowledge cannot be applied to the majority of people and those most in need.
And so while I was in Sukadana volunteering with ASRI's clinic, the whole thing really opened my eyes. ASRI’s attempts to break the vicious cycle of poverty, poor health, and deforestation through innovative programs, in particular, the health care incentive initiative linked to rainforest conservation, demonstrated how innovations that are responsive to local issues can be powerful in ensuring that health care services are accessible and utilized by those who are most in need. ASRI has helped me understand the role a non-profit can play in providing health care services, to complement the clinics run by the government. And ASRI is unique in a way that it addresses the health of the planet, which encompasses human and environmental health.
Another thing that I think was special was the fact that Dr. Kinari would encourage us to consult textbooks and not be ashamed of it whenever we saw a patient and doubted the diagnosis. It is quite different from what is usually practiced in Indonesia: doctors are considered superhuman, and we are supposed to know everything, and so consulting textbooks – especially in front of the patient - can be perceived as a warning sign that we are incompetent.
BK: Wow, that is incredible. And, now you came back to ASRI! We are so thankful for you! Can you tell me a little about why you wanted to volunteer to work with Health In Harmony on this particular project?
HN: Well, ASRI has a special place in my heart! My experience at ASRI has become a kind of catalyst to pursue global health. And of course as I mentioned earlier, I am so fascinated with the work that ASRI is doing and I am curious to know how ASRI is actually making an impact. From the outside, it seems pretty obvious that what ASRI is doing produces positive outcomes in the community and the environment. But for whom does it work, in what contexts, in what respects, to what extent, and how cannot be answered just by looking at the indicators. The realist evaluation enables us to get those answers which will give us a better idea of the mechanisms that are likely to operate in the programs, and I think it will be a great learning experience for all of us.
BK: And how was your experience?
HN: During the six weeks of data collection in Sukadana, I went to various communities and interviewed different ASRI stakeholders, including clinic patients, villagers, Forest Guardians, farming group members, Goats for Widows beneficiaries, and many others. Coming back to Sukadana after seven years, I was impressed by the progress ASRI has made in conserving the forest and keeping people healthy. It was quite touching to see how far ASRI has come over the years, to see how it has grown and its presence in the community is stronger. I really enjoy the process, to see firsthand how ASRI programs are rolled out on the ground, to learn about ASRI program theories and to talk to the people about them. It was wonderful to hear people’s stories and their insight about ASRI, to see their excitement and to feel the enthusiasm, to learn about their despair, but also hopes and aspirations.
And of course, I really enjoyed my stay in Sukadana with the ASRI family. ASRI has given me a strong sense of community. I think everyone who has visited ASRI knows what I mean, and that’s a great thing. I also didn’t realize before coming to Sukadana that I missed being close to the nature that much. So I was quite happy staying in the jungle for a while.
BK: Were there any people that you met or stories that you heard that struck you as incredibly important - something that our readers need to hear more about?
HN: One thing that always came up from the people I talked to was that ASRI doesn’t only do the talk but more importantly, walks the talk. People appreciate the fact that ASRI listens to their problems and needs, but also that ASRI actually does something about it. They appreciate that the staff really make an effort to be present in the community and build strong relationships with them. And having the opportunity to go to the community with ASRI staff myself, I agree with them. I think this is something that is pretty obvious - the commitment that is translated into real relationships and that action builds trust in the community, which is fundamental in this kind of work.
BK: In what ways do you hope this work will help HIH and ASRI meet human and environmental health needs?
HN: I hope that this work will help HIH and ASRI better understand how and why this model works for different people in the community that they serve so that they can improve the program and make an even greater positive impact. Now that HIH is thinking about replication, I hope that this work can also help adapt this model to new sites.
BK: What's next for you?
HN: I am starting my PhD in the Nossal Institute for Global Health at the University of Melbourne this month, and I am planning to study quality of care in the private health sector. I am quite excited about it!