Date of Award

January 2012

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Nancy Angoff

Subject Area(s)

Medicine, Environmental health


There has been increasing interest in the links between environmental degradation and human health among researchers and international organizations. Timber exploitation has contributed to ecosystem degradation and associated health effects in many communities. The rapid deforestation of tropical rainforests in West Kalimantan, Indonesia provides a compelling example of ecosystem degradation in the setting of poverty and unmet health needs. A novel pro-poor financing scheme that links affordable health care to conservation is currently being implemented in West Kalimantan, Indonesia.

The aims of this study were to: assess current healthcare seeking behavior among clinic patients; to study explanatory models of illness; and to assess the community's perceptions and acceptance of a pro-poor financing scheme that links conservation to healthcare. This study was based in West Kalimantan, and the fieldwork took place in 2008 (3 months) and 2011 (3 months). I conducted in-depth, individual interviews with 116 clinic patients. Over 500 pages of transcripts were analyzed using qualitative methods to identify common themes. Results demonstrated pluralistic medical behavior among patients, who on average visited three different health care providers for a given illness episode prior to presentation. Traditional healers were the most common first point of care for patients. Ethnographically grounded analysis revealed terkena badi to be a key indigenous concept that links illness to disturbances to the natural word and informs the utilization of alternative medical resources. Finally, it was found that there is widespread acceptance among patients of a non-cash payment system as a pro-poor healthcare innovation.


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