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Coronavirus Updates and Resources

Last Updated: September 1, 2020

Health In Harmony is focused on an emergency medical response protocol in both Indonesia and Madagascar to support our partners’ preparedness and save as many lives as possible in this pandemic. One of the ways we can protect the rainforest is to provide emergency healthcare and save lives (and livelihoods) today. We are also focused on keeping conservation programs moving forward to the best of their ability during this time, while maintaining social distancing protocols. We will be updating this post as new information comes in from our sites in order to keep our donors and supporters up to date with any new developments. Resources and articles from reputable sources that we find helpful during this time will also be collected at the bottom of this blog post for our readers to utilize as well.

We are all in this together. Our interconnection is clearer than ever, and Health In Harmony is uniquely positioned to bring a planetary health approach to responding to the virus and changing our systems for a healthier planet. If you would like to donate to our emergency fund during this time to support our efforts in treating patients with COVID-19 and to prevent its further spread in Indonesia and Madagascar, you can do so here: https://healthinharmony.org/donate/. Every hour and dollar counts!

For the most up-to-date information, follow Health In Harmony on our social channels.

Special Update: July 31, 2020

Watch our webinar focusing on COVID-19 in Indonesia featuring two women leaders from ASRI here!

Watch ASRI’s Senior Public Health Advisor’s, Dr. Monica Nirmala’s, United States Congressional Address here!

SPECIAL UPDATE: April 23, 2020

If you missed it live, check out Health In Harmony’s Earth Day Webinar here!

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Indonesia Updates

Madagascar Updates

Resources For Our Readers

Indonesia

Update: September 1, 2020

ASRI conservation staff building the new seedling nursery, while keeping a safe distance from each other.

Dr. Paramita traveled to the clinic in Bukit Baka Bukit Raya National Park in mid-August. The park staff requested a COVID-19 training by ASRI staff, so she was able to travel there earlier than originally scheduled to present the training and start her work at the BBBR clinic.

The ASRI conservation team constructed a new seedling nursery in the village of Pangkalan Jihing in Gunung Palung National Park. Patients in the area can now store the seedlings they will use as non-cash payment for healthcare services in the new nursery while waiting for ASRI staff to collect them. The nursery will also store seedlings from former loggers who are participating in Chainsaw Buyback in exchange for economic assistance through our COVID-19 Stimulus Fund.

The new nursery can hold up to 150,000 seedlings. Immediately after its construction, patients and community members contributed 985 seedlings – enough to pay for dozens of clinic appointments!

ASRI is working on constructing new staff housing for the clinic. They are hiring local construction workers who otherwise are having difficulty finding work due to COVID-19. To support this, ASRI is supporting a safe physical distancing approach. Dr. Monica Nirmala, Senior Public Health Advisor at ASRI, had an article published in Indonesian newspaper, Kompas. Her article discusses the origins of the pandemic, its spread, and what we must do on a global scale to heal. Dr. Nirmala emphasizes that a planetary health and multi-systems approach to healthcare are imperative in the coming years.

Flooding in Nusa Poring Village

Over the last few weeks, there has been heavy rainfall and flooding in Nusa Poring Village (where the BBBR clinic is located). Luckily, electronics, medical devices, and medications have been spared, and community members are safe.

Dr. Paramita, Midwife Vini, and community members started cleaning the clinic Sunday afternoon, once water levels started to recede. Flooding is not an uncommon occurrence in these communities, but the clean-up is a critical aspect of ensuring community health and wellbeing. 

Update: July 31, 2020

Last week, Health In Harmony hosted a webinar with two incredible women leaders at Alam Sehat Lestari – Executive Director Nur Febriani and Senior Public Health Advisor Dr. Monica Nirmala. They provided an in-depth update on the current state of COVID-19 in Indonesia and shared their efforts to change the local and national narratives.

Luckily, there are fewer cases of COVID-19 on the island of Borneo than in bigger cities like Jakarta. As of last Wednesday, the West Kalimantan region has reported 359 cases and 4 deaths.

The ASRI Medical Center has managed two cases so far. As a clinic, not a hospital, the team coordinated with the district health office to determine the best course of action. Because the clinic was so well-prepared and had the necessary supplies and facilities, the government asked ASRI to keep the patient in isolation there. The first patient ended up being in isolation for 90 days.

ASRI continues to prepare its facility, coordinate with the government, and educate local communities on the best health practices to decrease the chances of community spread of COVID-19.

Dr. Nirmala has also been conducting COVID-19 advocacy outreach nationally with the Indonesian government during this time. She provided advice on initial testing and antibody testing, contact tracing, and exit strategies. Dr. Nirmala has also been on national TV 12 times!

Dr. Paramita at ASRI Medical Center.

In addition, Dr. Nirmala had the chance to speak to the United States Congress last week about COVID-19 and forest fires in Indonesia and their impact on human health. Dr. Nirmala discussed the link between deforestation practices and the pandemic, as well as how the coronavirus should be a global wake up call to not only take care of one another as human beings, but to take care of nature and the planet as well. You can watch Monica’s Congressional Address here!

Yohanes Ginting, the head of Bukit Baka Bukit Raya’s program, arrived in BBBR last week after a two-week self quarantine period in Nana Pinoh.

Dr. Paramita is a new doctor who will also be heading out to BBBR in mid-August, after her orientation, training, and quarantine period is complete at ASRI.

Update: June 30, 2020

Fortunately, COVID-19 case numbers have been low in the communities served by ASRI Medical Center. Currently, the team is well-prepared and ready for a potential surge in cases. Looking at the 1918 Flu Pandemic, rural areas were hit later and much harder than urban areas, so the team is continuing to monitor the situation and stay prepared.

ASRI team distributing cloth face masks to communities around Sukadana at the end of May.

In order to continue to prevent community spread of COVID-19, ASRI has been sending educational SMS messages containing prevention strategies to the communities they serve.

Health In Harmony Founder, Dr. Kinari Webb, is joining ASRI’s morning meeting once per week in order to check in and provide extra support to the medical team and hospital staff.

Mahardika Putra, ASRI Program Director, is working closely with Yohanes Ginting, in order to prepare him for his role as head of our Bukit Baka Bukit Raya (BBBR) program and complete final trainings. Yohanes will be moving on site later this week, after a two week quarantine period in Nana Pinoh.

One of BBBR’s midwives, Dewi, is returning to work, after having a baby early this spring.

ASRI and BBBR have hired a third doctor to work at the BBBR medical clinic. She will be arriving in late July/early August.

Currently, the team is buying rice from farmers at the standard price (prices have dropped during COVID) and distributing it to families who are struggling during the economic downturn in Indonesia.

Update: May 21, 2020

Chainsaw Buyback as part of the stimulus package for the rainforest.

Health In Harmony is rolling out our conservation stimulus package in Indonesia. The following list details some of the ways we are offering short-term economic opportunities to local communities that will also support reforestation and biodiversity.

  • Provide former loggers stimulus income tied to seedling cultivation for reforestation.
  • Engage active loggers in the seedling cultivation stimulus program and buy their chainsaws.
  • Buy the remaining chainsaws from inactive loggers.
  • Purchase produce from farmers to provide meals to the most vulnerable.
At ASRI: Local women in the process of sewing 1,000 cloth face masks for communities in Kayong Utara.

As a part of the stimulus package, ASRI commissioned local women to sew 1,000 masks last week. ASRI sent these masks to the Indonesian government along with other supplies for communities currently facing COVID-19 in Kayong Utara. In this way, ASRI is strengthening the entire system in their region. Read more about this commission here.

ASRI distributed other necessary supplies to the Indonesian government in addition to the 1,000 cloth masks last week, including 250 pieces of Hazmat, 250 KN95 masks, 50 boxes of surgical masks, and 50 boxes of gloves.

A massive thanks to Health In Harmony supporters for making these donations possible.

Distributing supplies to the Indonesian government.

Along with these supplies, ASRI’s Executive Director, Nur Febriani, included a letter to address some of the stigma the clinic and communities have seen related to COVID-19. Read a translation of her poignant words below.

“Close your nose and mouth with the mask, but don’t close your eyes or your heart. Give support to everyone with COVID-19. Today it is them, maybe tomorrow it will be us. Give support to healthcare providers. Tomorrow, they may be caring for you.”

Nur Febriani, Executive Director of ASRI Medical Center

Additionally, ASRI Medical Center has been expanding communications with local communities to share accurate public health information. They have been sending out regular updates and messages via SMS, radio interviews, and poster campaigns.

Conservation programs at ASRI and BBBR are resuming this week, with social distancing measures in place.

Update: May 5, 2020

Photo by Oka Nurlaila. A security guard taking the temperature of a patient at ASRI Medical Center. The security team assists healthcare workers by taking temperatures and making sure patients wash their hands before entering the clinic.

Staff at ASRI are working tirelessly to continue providing a high standard of care for all community members and prevent the spread of COVID-19.

As several staff members are working remotely, ASRI and Health In Harmony are brainstorming ways to modify ASRI’s daily morning meeting so that all staff feel connected and informed. ASRI’s Executive Director, Febri, is planning to record a video message for remote staff every morning and be available to answer any questions virtually.

During a special morning meeting this week, founder Dr. Kinari was able to video call in, to address staff’s concerns and questions. She also recognized each group of team members and honored them for their hard work. Staff applauded one another for everything they have accomplished so far through this uncertain time.

Update: April 23, 2020

Dr. Fifi working with patients at ASRI Medical Center.

At ASRI, Dr. Alvi and the team are purchasing an oxygen concentrator. The team will then be able to fill oxygen tanks on-site, rather than having to travel to fill the tanks. With COVID-19, doctors have noted that oxygen is often needed in excessive amounts, whether through oxygen masks or intubation. Thus, this purchase is essential as it could save many lives during this pandemic and will be useful in the Medical Center long after. ASRI was able to invest in this thanks to support from our donors, as it is something they have not been able to invest in before. Ultimately, it will save money in addition to lives, and ASRI is glad to finally be able to afford the upfront investment.

At the second site in Indonesia, BBBR, WiFi techs are setting up internet access, which will make it possible for the team there to better communicate with ASRI and Health In Harmony, which, as we know, is imperative during this time.

Mahardika (Dika) Purba, ASRI’s Conservation Director in the nursery. Photo credit: Stephanie Gee

There is a new program manager at BBBR, Yohannes, who is currently working remotely from ASRI. He and Dika, the Conservation Director, are advancing nursery and conservation activities through their work with Anous, who is the conservation coordinator in BBBR.

Key advisors to the President of Indonesia invited Dr. Monica Nirmala, ASRI’s former executive director, to work with them. She is working to coordinate testing with a health system from Singapore.

Update: April 13, 2020

ASRI staff ready to help patients exhibiting symptoms of COVID-19.

ASRI Medical Center recently had one suspected case of COVID-19. The team was efficient and well-prepared, and they isolated the patient quickly, setting a precedent for standard of care and response protocols through strengthening the system.

ASRI is always working in coordination with Indonesian government facilities and, because of our strong relationship with them, the money we raise is also supporting the government health care facilities in acquiring protective gear and supplies as well (money from the central government has been slow to arrive). ASRI depends on and works in tandem with the Indonesian health system, so any extra support we can provide for them will help all communities in Indonesia during this pandemic.

Update: April 3, 2020

ASRI’s former Executive Director, Dr. Monica Nirmala, is advising the head of Indonesia’s COVID-19 response. She is advocating for increased testing and mandatory quarantining throughout the country. We are working to support her salary and travel costs necessitated by this position, as this is deeply important to the health of all Indonesian communities.

In the area around ASRI Medical Center, it is projected that 4,800 people will need to be hospitalized. There are currently only 70 hospital beds in the region at this time, including 20 at ASRI.

We are working to fund protective gear, disinfectant, test kits, medicines, wellness supplies for healthcare staff, additional beds and the equipment needed to treat COVID-19 at ASRI. We will also try to hire temporary staff, especially including nurses, custodial staff, and security.

ASRI has created separate intake flows for patients with potential COVID-19 symptoms and for those without. They will isolate potential patients in the building until they can be transferred.

In addition to personal protective equipment, ASRI is providing staff with scrubs to change into when arriving at the Medical Center, which will be washed daily, and shower facilities for before they return home, in order to limit exposure of their families.

Dr. Alvi educating Forest Guardians, Gunung Palung National Park staff, and other workers on protocols for how to prevent the spread of COVID-19, and how to identify the initial symptoms of the virus.

ASRI has the only ambulance in the area with a separate cab so drivers can reduce their risk of exposure to the virus. We anticipate this will be in high demand during this time, as ASRI has offered to share the vehicle with other providers.

The 48 Forest Guardians and community health workers located in the communities around ASRI have started providing health education to their communities. We are placing educational posters and banners in all of the communities ASRI serves, and throughout the medical center. Text messages containing pertinent health information will soon be sent out to everyone registered in the patient database – almost 20,000 numbers in total.

At this time, ASRI is preparing for a worst case scenario of the government asking primary care facilities, like ASRI Medical Center, to provide care to potential COVID-19 patients, rather than refer them, if the case load in their region overwhelms the public hospitals.

Madagascar

Update: September 1, 2020

As of September 1, there are 14,696 confirmed cases of COVID-19 in Madagascar. Currently, the government plans to open the country for international visitors in November.

Our team recently traveled to the villages we partner with near Manombo Special Reserve to get approval from village kings and local health authorities to proceed with the mobile clinics. We discussed the country’s situation, precautions, and risks of exposure with village leaders. We also delivered a total of 1,300 face masks and radios.

We also looked at the progress for construction of the physical space where the mobile clinic takes place. The communities identified space for building mobile clinic space that will be used as a school for the rest of the month. During these meetings and while traveling, our team followed strict health guidelines to prevent the transmission of COVID-19.

This month we are starting agricultural trainings to set up nutritional gardens and start rice cultivation training as was requested during the Radical Listening meetings.

Update: July 31, 2020

COVID-19 cases continue to rise in Madagascar. As of July 30, there are 10,317 confirmed cases in the country. At the moment, testing is extremely limited due to a lack of testing kits in country. Medications used to treat coronavirus symptoms are severely limited.

Currently, people are locked down and not allowed to travel in the capital of Madagascar, Antananarivo, and Farafangana. Most people are staying home throughout the day in order to decrease community spread of the virus.

People living in Farafangana are being cautious. Checkpoints are up again, limiting travel into and out of the city. The weekly market is shut down, though the daily market is still continuing.

The above image was taken several months prior to the two-person limit on gatherings, and features community health workers outside of CSB Mahabo.

The currently law states that businesses in Madagascar can be open for only a few hours in the morning and must be closed in the afternoons. The Department of Water disinfects the Health In Harmony office every day.

Because of these regulations, medical trainings must be approved as there are more than two people gathering. We are still hoping to begin mobile clinics for the communities in the Manombo Special Reserve next month, but we are following governmental guidelines, so the date is subject to change. We are exploring alternative avenues to work directly with the CSBs (Community Healthcare Posts).

Dr. Evelyne will be visiting the village kings with the rest of the Health In Harmony team to discuss the COVID-19 situation, precautions, and risks of exposure.

The medical team is also continuing to distribute radios and face masks to better facilitate communication and prevention of community spread. The team will be delivering 1,300 face masks to communities!

This photo was taken last year in Madagascar, before social distancing measures were in effect due to COVID-19.

Agricultural planning is still taking place to best support community health and food security needs. We welcomed two agricultural technicians to our Madagascar team this month: Fidy and Rija.

These technicians will provide training in organic and sustainable farming of crops requested by communities near the Manombo Special Reserve, including manioc, beans, and other nutrient-rich vegetables.

With improved rice cultivation and farming techniques, communities will no longer have to stress the rainforest through slash-and-burn agriculture, bushmeat poaching, over-harvesting food products, and logging for charcoal.

Update: June 30, 2020

As of today, there are just over 2,100 cases of COVID-19 in Madagascar, and the country has continued to evolve lockdown statuses and travel restrictions after a brief attempt to reopen, in order to contain the spread.

Hasina, Health In Harmony’s Madagascar Program Manager, and Sylvain, our newly hired driver, drove the Health In Harmony program car to Farafangana this week, stocked with supplies to set up mobile clinics and conservation programs.

Dr. Evelyne, along with newly hired midwives, Hoby Razanantenainaand Robline Rasoanandrasana.

Along with the car, Hasina brought over 1,500 masks and 30 radios to distribute to the communities, along with other necessary supplies in order to prevent community spread of COVID-19.

Health In Harmony will conduct mobile clinics monthly in seven villages in the Manombo region identified by the community. The team will provide medical services to communities in Manombo. The 30 communities that signed agreements with Health In Harmony in February will receive a discount on healthcare services.

Two new midwives have been hired to support community clinics and are currently finishing up medical trainings with Dr. Evelyne and Dr. Krista Farey, Health In Harmony’s Medical Advisor.

The Madagascar team has been preparing to begin reforestation and agriculture programs. We are hiring two agriculture and rice cultivation technicians, as we are exploring cultivation options that do not use chemical fertilizers.

Update: May 21, 2020

Health In Harmony is rolling out our conservation stimulus package in Madagascar. The following list details some of the programs we are initiating to offer economic opportunities to local communities that will also support reforestation and biodiversity.

  • Rice cultivation and agriculture programs to begin to meet the nutritional needs of the communities.
  • Building fire breaks to prevent forest fires due to droughts and slash-and-burn agriculture.
  • Reforestation programs including seed distribution and community training on building and maintaining seed nurseries.
A health education session taking place with the Antsiranapasy community.

We have received our permit from the Ministry of Health in Madagascar! This is a huge achievement, especially during the pandemic. This means that we can move forward with conducting mobile clinics in Manombo. We want to give a special thanks to Dr. Evelyne for her work throughout this time with the Ministry of Health and her outreach and training in villages and medical clinics throughout Farafangana.

Dr. Evelyne is also continuing to work with communities to keep instilling the importance of handwashing and to support community healthcare posts (CSBs).

All of Dr. Evelyne’s hard work has made our outreach and the start of our medical programs possible in Manombo. A huge thank you to her from all of us at Health In Harmony.

Update: May 5, 2020

Currently, there are 149 confirmed cases of coronavirus in Madagascar, but with limited testing capabilities, it’s nearly certain that more remain undetected.

Women who have received soap from Dr. Evelyne and the medical team in Madagascar.

Last week, the team in Madagascar went out to the 30 villages surrounding Manombo Special Reserve and distributed soap and trained communities on best practices for handwashing and how to prevent the spread of COVID-19. This outreach helped reassure communities and confirm that both the team on site (run by Dr. Evelyne) and Health In Harmony are committed to deliver on promises made during Radical Listening meetings, even through this difficult time.

This week, we are excited to work with communities to get conservation programs started by sending out materials and supplies, and also getting the approvals needed to begin work from the Ministry of Health and the Madagascar National Park office.

Update: April 24, 2020

Rabazokinandrasana Josieas, midwife and chief of Mahabo CSB

In Madagascar, there are 121 confirmed cases of COVID-19 as of today. A shipment arrived last Friday in Farafangana from Antananarivo, (the capital of Madagascar) containing necessary goods and materials including medical supplies, phones for CSBs (community healthcare posts), and material for masks.

On April 27th, Dr. Evelyne and Victorien began a 10-day outreach plan to communities surrounding Manombo Special Reserve. Their focus will be on supporting the communities with education on COVID-19 prevention, distribution of supplies (such as soap and antiseptics), and spreading awareness about best practices relating to the prevention of COVID-19. They will also distribute cell phones to CSB workers, which will support CSB staff to communicate rapidly with Dr. Evelyne, and the Ministry of Health.

Staff member at CSB Iabohazo.

Dr. Evelyne is procuring and training staff on oxygen saturation monitors, which offer the best measurement to determine whether or not someone needs to be referred to the hospital if they are presumed to have COVID-19. This is not only essential for getting patients the care they need, but also keeping people safely at home, if possible, and saving them transportation costs – especially significant during this time of economic hardship.

Together, Dr. Evelyne and Victorien are setting a standard for health and safety in Madagascar, as they are using masks when distributing materials and educating communities, and using PPE when working with patients, if necessary.

Update: April 13, 2020

In Madagascar, medical director, Dr. Evelyne Raherivololonarasoa, has assessed several community healthcare posts (CSB’s) in the Farafangana region, to support their coronavirus preparation and response.

In general, the CSB’s are in good shape, but they need more supplies and resources to support communities as the front-line referral post for COVID-19 cases. A major aspect of care they are working to address is the concurrent health issues that communities face, such as malaria, which compounds their susceptability to coronavirus. The team is sourcing malaria test kits and treatment.

Most of the people working at CSB’s are volunteers and we aim to support them as much as possible through this pandemic.

Dr. Raherivololonarasoa’s training with local medical professionals on safely using PPE.

In addition to assessing the CSB’s, Dr. Raherivololonarasoa conducted a training with local medical professionals on how to use PPE.

Health In Harmony is working with local health officials to put a plan in place for public health outreach education in Manombo to teach effective handwashing techniques and how to properly wear masks. We are also creating a plan to distribute soap and cloth for masks to the local communities and CSBs.

Update: April 3, 2020

Madagascar’s level of need increases every day, and Health In Harmony is prepared to support in any way we can during this time.

Our response is changing daily as the situation is rapidly shifting. Since last week, the number of cases in Madagascar has tripled. At this point, we are primarily supporting the national Ministry of Health and working in coordination with local organizations in Farafangana, planning, training, conducting public health education and outreach and addressing material needs (soap, equipment, education materials, medical supplies etc.) as they arise.

Our medical director, Dr. Evelyne Raherivololonarasoa, is leading efforts to support the prevention and treatment of COVID-19 in the Farafangana region. She has worked with WHO in the past and has over 30 years of experience leading national public health and emergency response in Madagascar.

Currently, local teams are assessing all community healthcare posts (CSB’s) throughout the Farafangana region to equip them with the public health education materials and supplies needed to help prevent the spread of the virus and to appropriately refer cases as they arise.

Health In Harmony is prepared to offer support for patient treatment, case assessment, sanitation and equipment needs requested by the national and local health ministry. Our team is working on distributing phones to the local healthcare posts in the region to provide the above support as needed.

We are supporting the necessary resources for the convening of local officials and front line staff to meet and develop the regional response for Farafangana. 

A five-person medical team, supported by Health In Harmony, is managing a check-point to educate people entering Farafangana from Antananarivo (the capital of Madagascar, where cases have been concentrated) about coronavirus and to conduct medical assessment of suspected cases. 

We have provided an extra month’s salary to staff so that they can stock up and physically isolate, amidst local price increases on supplies.

Resources For Our Readers

From Our Team

Update: May 5, 2020

Update: April 24, 2020

About the Coronavirus & Planetary Health:

uPDATE: April 24, 2020

Update: April 13, 2020

Update: April 3, 2020

Bright Spots During this Time:

Update: April 24, 2020

Update: April 3, 2020

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