Trash-for-healthcare: Indonesian doctor accepts discarded plastic bottles in return for treatment

Trash-for-healthcare: Indonesian doctor accepts discarded plastic bottles in return for treatment
They are seen as wasteful trash by many, but for some residents of a small city in the Indonesian province of West Java, empty plastic bottles are viewed as potential lifesavers and pathways to affordable healthcare.

Since 2009, Harapan Sehat Clinic – a 2,000 sqm facility on a winding country road just outside of Cianjur City – has been providing medical treatments and medicines to the needy for the price of ten plastic bottles.

“I wanted to create a sustainable program that not only helps others but also allows people to make their contribution for the sake of this planet. I consulted with my wife and thought that one issue (we can tackle) is plastic,” the clinic’s founder and director, 43-year-old general practitioner Yusuf Nugraha, told CNA.

Plastic waste is a big problem in Indonesia, whose 270 million population produced 12.6 million tonnes of plastic waste last year, according to data from Indonesia’s environment ministry. Meanwhile, a study from environmental group Zero Waste Indonesia Alliance suggests that only nine per cent of plastic waste in Indonesia are recycled while the rest end up in landfills or polluting the country’s rivers and oceans.

“I wanted people in Cianjur to care about global warming and climate change but these are issues which are too distant for them and too complicated for them to comprehend.

“Reducing the use of plastic, recycling plastic and stopping plastic from polluting the environment is a gateway for them to care more about the environment,” Dr Nugraha said.

The clinic founder acknowledged that his programme barely makes a dent in Indonesia’s waste reduction efforts. On a good day, Harapan Sehat patients can only send up to 400 bottles to two plastic recycling companies in partnership with the clinic.

That is a drop in the ocean when compared to the 210 tonnes of waste produced in Cianjur every day, according to data from the regency’s environment agency.

Although the programme’s contribution to the environment is tiny, its impact to the local community has been profound.

The programme has attracted the attention of impoverished informal workers, the unemployed and those who consider insurance premiums – including that of the government’s health social security scheme – too lofty for their low income.

Every day, there can be up to 40 patients utilising Harapan Sehat’s trash-for-healthcare programme to treat a host of health problems ranging from mild infections like fever and incessant coughing to life-threatening illnesses like strokes and heart attacks.

The clinic is only licensed to provide primary care but there seems to be no limit to how far Harapan Sehat is willing to go to help its patients.

A patient at Harapan Sehat, Sumiati, told CNA that she was initially reluctant to take her daughter to the doctors when the girl fell ill in 2021. Her daughter, Kayla, was pale, had a shortness of breath and was too weak to get out of bed.

Sumiati, who had just lost her job at a shoe factory because of the COVID-19 pandemic, was worried about the impending medical bills.

“When I heard about the (trash-for-healthcare) programme at Harapan Sehat, I immediately took my daughter to the clinic,” Sumiati, who like many Indonesians goes by one name, told CNA.

The clinic ran some tests and determined that Kayla had thalassemia, a blood disorder involving lower-than-normal amounts of oxygen-carrying protein.

“(The doctor) said my daughter needed to be treated at a hospital. I refused because I was worried about the cost, because I am poor. But Dr Yusuf insisted that I should (take my daughter to the hospital) and gave me money,” Sumiati said.

Dr Nugraha also made sure the family paid as little as possible during Kayla’s stay at Cianjur’s Sayang Public Hospital. He enrolled the girl in a government-run national health insurance programme known as JKN and helped Sumiati navigate through the bureaucratic processes involved in acquiring the insurance.

He also paid for Kayla’s insurance premiums.

“I cannot express how grateful I am towards the Harapan Sehat clinic,” Sumiati said.

Dr Nugraha told CNA he has encountered many seriously ill patients that the clinic was not equipped to handle.

“We try to help them in any way we can, be it referring them to a hospital, enrolling them to the JKN programme or paying their medical bills,” he said.

The clinic even reached out to impoverished patients who live in dilapidated wooden houses and built them new homes constructed out of bricks made from a mixture of cement and plastic pellets.

“When Dr Yusuf came and asked if I could make a brick using plastic waste, I was confused,” Entang, a worker at a brick factory just a five-minute drive from the clinic, told CNA.

“But when we tested the bricks, the ones with plastic in them were stronger and less brittle because the plastic gives the brick added structure. The plastic binds really well with cement.”

Entang, who also goes by one name, said his factory now only makes plastic-laced bricks, producing and selling around 1,000 of them a day for the clinic’s charity programme as well as regular customers.

Dr Nugraha said he has always wanted to help others since he was little, having grown up in a modest household where his divorced mother had to raise five children on her own.

“My family’s economy was not so good (growing up). That’s why I developed a fear of getting sick. Not just (towards) the illness itself but how much it would cost,” he said.

“I was ten at the time and I was determined to become a doctor. I wanted to be a doctor and help the needy so they don’t have to worry about getting sick.”

That determination grew stronger after he obtained a license to practice medicine on his own.

After spending time in another West Java city, Cimahi, to study medicine and later as a resident doctor at a hospital in East Nusa Tenggara province, Dr Nugraha returned to Cianjur in 2008 to set up a private practice in a three by four metre room of his personal home.

From the beginning, Dr Nugraha was determined to treat any patient that came to him, regardless of their financial situation.

“I thought to myself: ‘I want to help others but don’t want people to be dependent (on donations). I want to change this mentality. I want the patients to also make their contribution, not to me but to their community’,” he said.

And so the trash-for-healthcare programme was born, a year after running his own private practice.

Dr Nugraha uses profits from treating his regular patients to subsidise less fortunate ones, an operating model he still keeps to this day.

He said there were times when he operated at a loss and had to use his personal savings to buy medicines, pay staff members’ salary as well as other operational expenses. But Dr Nugraha was undeterred despite those around him expressing skepticism that his venture would work and urging him to stop.

“Thankfully, over time we are no longer operating at a loss,” he said.

The programme puts Dr Nugraha’s clinic on the map, earning the doctor and Harapan Sehat numerous accolades and praises from the local press and government officials.

Through word of mouth, regular paying patients began flocking to the clinic, generating profit for the business and allowing Dr Nugraha to treat more impoverished patients.

Eventually, Dr Nugraha was able to buy his mother another house in a different part of the city while his former home was turned into a clinic.

Harapan Sehat has since grown. It now employs eight doctors and around 50 nurses and staffers. The clinic now has its own laboratory, emergency unit ward, rooms for inpatients, a small pharmacy and an optical store.

Due to the clinic’s status as a primary care clinic, all of the doctors are general practitioners.

But Dr Nugraha said Harapan Sehat is working to upgrade its status into a polyclinic, providing both general and specialist treatments for a wide variety of diseases.

“This way we can provide better and more varied care for our patients, especially the underprivileged,” he said. 
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