Guardians of the Trees: A Journey of Hope Through Healing the Planet: A Memoir

By Kinari Webb, M.D.

"EMPOWERING...KINARI WEBB IS AN INSPIRATION." --BILL MCKIBBEN

"A WONDERFUL BOOK." --JANE GOODALL

A TIMELY, HOPEFUL MEMOIR ABOUT A WOMAN SPEARHEADING A GLOBAL INITIATIVE TO HEAL THE WORLD'S RAINFORESTS AND THE COMMUNITIES WHO DEPEND ON THEM

Full of hope and optimism, Kinari Webb takes us on an exhilarating, galvanizing journey across the world, sharing her passion for the natural world and for humanity. In our current moment of crisis, Guardians of the Trees is an essential roadmap for moving forward and the inspiring story of one woman’s quest to heal the world.

When Webb first traveled to Indonesian Borneo at 21 to study orangutans, she was both awestruck by the beauty of her surroundings and heartbroken by the rainforest destruction she witnessed. As she got to know the local communities, she realized that their need to pay for expensive healthcare led directly to the rampant logging, which in turn imperiled their health and safety even further. Webb realized her true calling was at the intersection of medicine and conservation.

After graduating with honors from the Yale School of Medicine, Webb returned to Borneo, listening to local communities about their solutions for how to both protect the rainforests and improve their lives. Founding two non-profits, Health in Harmony in the U.S. and ASRI in Indonesia, Webb and her local and international teams partnered with rainforest communities, building a clinic, developing regenerative economies, providing educational opportunities, and dramatically transforming the region. But just when everything was going right, Webb was stung by a deadly box jellyfish and would spend the next four years fighting for her life, a fight that would lead her to rethink everything. Was she ready to expand her work to a global scale and take climate change head on?

• Language: English
• Publisher: Macmillan Publishers
• Release date: Sep 28, 2021
• ISBN: 9781250751409

Kinari Webb, M.D.

Kinari Webb, MD, is the founder of Health In Harmony, an international nonprofit dedicated to reversing global heating, understanding that rainforests are essential for the survival of humanity, and a cofounder of Alam Sehat Lestari (ASRI). Dr. Webb graduated from Yale University School of Medicine with honors and currently splits her time between Indonesia, international site assessments, and the San Francisco Bay Area. Guardians of the Trees is her debut.

Book preview

Preface

Growing up in northern New Mexico, I shared a horse, Pinto, with one of our neighbors. One day, Pinto and I were cantering along the mesa top when he saw something. I don’t know what it was, but he reared straight up and pivoted around. If you have ever heard the term runaway horse—it is real. Pinto laid his ears back and full-out galloped straight for the edge of the mesa. I knew for certain that we would both die if we went over the edge. But Pinto was not responding to the reins, no matter what I tried. If I jumped off, neither of us would survive. Seconds from disaster, I remembered something I once read—that it is impossible for a horse to run with something hanging from its neck.

So … I swung both feet over to the same stirrup, grabbed his mane with my right hand, and swung myself down under his neck at full gallop, gripping his mane on both sides. Pinto slid to a stop, just feet from the edge of the cliff, saving both our lives.

---

THAT DAY WITH PINTO TAUGHT ME an important lesson. Even when things look hopeless, it might still be possible to avoid disaster. This book is about my own work on what feels like the biggest cliff any of us could possibly face: the danger that our earth will no longer be livable for us. Global warming is happening faster than even the worst models predicted ten years ago. We are only beginning to understand just how dangerous the feedback loops can be, as reflective ice disappears, polar seas absorb sunlight and warm more quickly, and melting tundra releases methane into the atmosphere. The Intergovernmental Panel on Climate Change has said that if we don’t halve carbon emissions by 2030, we may go beyond irreversible tipping points, at which time it won’t matter what we do. In other words, that cliff is very close.

When most people think about emissions, they usually think only about burning fossil fuels for cars, airplanes, and electricity. They don’t realize that deforestation releases as much carbon as the entire transportation sector for the whole world. Despite covering only 2 percent of the surface of the earth, rainforests support 50 percent of the world’s species and hold 25 percent of the world’s carbon, stored in both the trees and the soil. In addition, as trees grow, they continue to suck down carbon from the atmosphere.

Trees, and especially tropical rainforest trees, are our absolute best friends in halting the climate crisis, since they absorb a third of the pollution we emit every year. They are the natural climate solution, exquisitely invented through millions of years of evolution. Rainforests are huge banks of carbon, and the bigger the tree, the more carbon it absorbs as it grows—and the more oxygen it releases. Forests are for this reason sometimes referred to as the lungs of the earth. When forest is logged or burned, most of that carbon gets released into the atmosphere, and the local cooling effects of the trees are lost as well. We do have to transition our world to one powered by alternative energies, but we also have to protect the tropical rainforests of the world, because even if we stopped releasing more carbon, we would need the forests’ help to get the earth’s atmosphere back into a safer balance.

No humans, in all of human existence, have lived through a time like this. Can we stop this runaway horse before we tumble off the cliff? Can we find a way to live sustainably and in balance with our planet? Is it possible for that transformation to be unexpected and profound?

For more than a decade, I have had the privilege to lead a tiny band of people resisting the loss of biodiversity and the poisoning of our earth, serving as a doctor who heals both people and nature. I founded two organizations that support this work, from different sides of the earth: Health In Harmony in the United States, and Alam Sehat Lestari in Indonesia. The Indonesian name translates to healthy nature everlasting, and the short form, ASRI (pronounced AHHS-ree), means harmoniously balanced. I have had the incredible joy of partnering with my Indonesian colleagues as they transcended poor education, lack of opportunity, and a culture of fatalism, to create a multi-award-winning model that honors the local communities as the wisdom holders for how to reverse rainforest loss and improve human well-being.

I hope this story will inspire and motivate you to join in this movement across the planet to bring about change. By listening to rainforest communities and partnering around the world, we can have huge impacts on the health of the whole planet. By working together, we can thrive.

1

Death and the Sun

SUKADANA, WEST KALIMANTAN, INDONESIA: JULY 2011

On the equator, dusk falls so quickly it often leaves me feeling bereft, though the sunsets and orange glow of the light make up in brilliance what they lack in length. One night in July 2011, my husband, Cam, and I were swimming in the warm waters of the South China Sea, watching the sunset from the special cove where we retreated most evenings. We couldn’t see a single dwelling—although it was only about ten minutes’ walk along a sparse path to the thatched roof house that had become our home in the little town of Sukadana, in Indonesian Borneo.

Silvered leaf monkeys chattered in the patch of mangrove behind us, competing with the cacophony of forest insects. One peak of the mountain chain of Gunung Palung National Park rose high above the mangroves, shrouded in wisps of mist and appearing deceptively close. The low clouds began to be lit by bits of pink, and a pair of sea eagles called to each other overhead. I found myself unexpectedly content. It was the perfect ending to a long day of caring for patients in the crowded clinic.

I had helped open the clinic four years earlier, as part of a conservation project designed to improve people’s health as the key to saving rainforest. This was a dream I had conceived eighteen years prior—about twenty miles from this very spot, deep in the forest where Cam and I first met, when I was studying orangutans on the western side of Indonesian Borneo. Cam had continued his research in ecology, striving to understand the complexities of tree species diversity in these magnificent forests. I, on the other hand, had taken a new direction—to become a physician, one who believed deeply that, unless both the environment and the people are healthy, neither can be. And now I was beginning to see, with great joy, that this ambitious strategy was no longer a fragile and untested idea for me but a solid success. In just four years, the staff had grown from the original eight to more than sixty dedicated individuals—and we were already seeing dramatic drops in illegal logging, in addition to impressive improvements in community health.

As Cam and I paddled and splashed, enjoying that golden sunset, I was suddenly overwhelmed by searing pain. My right hand reacted even before my brain was conscious of what was happening. I grabbed at the rubbery tentacles that coiled around my left arm and down my back, where they curled into the scoop of my bathing suit. When I pulled at the lashes, they stung my hand fiercely, but I didn’t let go. Every fiber of my being knew that my life depended on getting them off me. I was scrambling backward toward the shore, screaming, frantic. Neither of us saw the jellyfish, but we both knew that was the only thing it could be.

Reaching the shallow water, I grabbed sand and scrubbed the sting, but that just seemed to make it worse. What were you supposed to do for these toxins? Vinegar? Urine? The excruciating pain felt like hundreds of wasp stings, so anything was worth a try. I looked up at my husband, who had just caught up with me.

Cam, can you pee on me? He obligingly whipped it out, while I crouched in the shallow waves, and … nothing happened. Hurry, Cam, I think I’m going to pass out!

I’m sorry—it’s just not that easy to pee on your wife.

When it finally did happen, it wasn’t pleasant. Nor was there any noticeable change in the fierce pain. Staggering out of the water and sloshing myself clean, I gave Cam the few instructions I could think of. He wasn’t a medical doctor, but he was one of the most intelligent people I had ever met, and he had seen me through medical school. If I lose consciousness, carry me to the house and give me a shot with the EpiPen. I told him to call the two doctors I had been training and quickly ticked off the medicines they should give me.

Every step of the walk home, I doubted I would make it, but somehow I got there. We tried squeezing lime juice on the sting. And then I did the one thing you should never do: I went into our little lean-to bathroom and scooped cold water out of the half-rusted fifty-gallon drum and poured it over my body. The water ran off my skin and down through the wide-spaced plank floor and onto the ground below. I began to scrub the line of welts with soap—but before I could even finish, I started shaking from head to foot. I could feel the waves of toxin flowing through my veins as the fresh water triggered the popping of thousands of tiny pneumatocysts—perfect microscopic balloons of poison, each equipped with a tiny syringe injecting death.

My heart subliminally told me that it was about to stop. As a physician, I found this fascinating—Ah, patients know when their heart is about to fail. I could barely breathe, choking and moaning, in indescribable pain. I stumbled back into the house, where Cam caught me as I fell to the floor. Working in a place with minimal pain medication and almost nonexistent health services, I have seen pain—lots of pain. But I had never seen anyone acting the way I was acting, except sometimes women in the last pushes of childbirth. But this was different; intense fear was layered on top, because I knew my heart was moments from pumping its last pump.

People in the village had warned us not to swim in the sea because of the ampai. We knew the word meant jellyfish, but we thought they meant the familiar moon jellies, whose small stings were an irritating but minor nuisance. So, stupidly, I had not listened to them and had swum in that bay probably more than a thousand times. Now I got it—they must have meant box jellyfish, whose toxin is the deadliest thing on the planet. The firebombs exploding in every muscle could come from nothing else. No wonder they had warned us.

Cam scrambled through storage containers until he found the syringe he was looking for. He plunged the EpiPen into my thigh so hard I knew it would leave a large bruise—if I survived. The epinephrine flooded into my body. Half a second later, I felt my heart leap. I held my breath as a sense of relief reached my brain; at least the cardiac part of the toxin wouldn’t win at that moment. But every nerve in my body told me this battle was only beginning. Cam used his phone to google box jellyfish and discovered that their venom is one hundred times stronger than that of the king cobra we had once had in our kitchen. How could I possibly survive this?

Many hours later, it was 2:00 a.m., and at least fifty people were crowded with me in the clinic. Most of us, including myself, were sure I would die. The action of the neurologic part of the toxin was bringing every muscle in my body to contractions that felt like a seven on a scale of ten—every muscle. Then, one after another, each went to the maximum contraction of ten: the perfect outline could be traced beneath the skin, where my muscles stood out in the most excruciating cramp one could imagine. Each one was horribly painful when it fully contracted, but the absolute worst—and most dangerous—was the diaphragm. With the diaphragm in spasm, one cannot breathe. And that was what was happening to me. I pursed my lips against the pain, trying desperately to suck in a tiny bit of air. I writhed almost constantly, no position tolerable.

In lucid moments, I wished for an anatomy book. Muscles I only dimly recalled from medical school would announce themselves in a visible outline and leave me crying. When the one that controls the tiniest bone in the body, the stapes bone in the inner ear, sent out stabbing pain, it was all I could do to keep from screaming.

We administered four times the maximum dose of every pain medication we had in our pharmacy. The wonderful young doctors I had trained were too scared to give me more than that, for fear of killing me. I knew they were right, even as I struggled to breathe. I looked at my left arm, welted from the stings. I very seriously considered amputating it. We had the tools to do it. It would have to be done without anesthesia, but given the nine-out-of-ten pain I was already in, ten out of ten felt worth it. I decided not to amputate, though, only because the venom had clearly already spread throughout my whole body.

Evacuation insurance was one of the benefits of being an adjunct faculty member at the Yale School of Medicine—but the nearest runway was two hours away, and it only operated during daylight. Besides, as we learned from an internet search on the clinic’s satellite connection, there was no Western medical treatment for this jellyfish venom anyway. The only thing I could think of that a hospital could do would be to paralyze me and put me on a ventilator. That honestly sounded pretty good, but given that every hour had increased the pain, I doubted I would make it to dawn.

As word went out that I was dying, more and more people gathered. First, about twenty staff members arrived, and gradually, around thirty people from the community showed up in the middle of the night. People’s attention soon focused on an argument about potential treatment options. The son of a Chinese shopkeeper in town (whose own life we had saved dramatically—twice) was disagreeing with Ibu Ateng, the traditional massage healer to whom we often referred patients.

"The fisherman who was stung last year only got about this much of the tentacle on him. Ibu Ateng indicated the first joint of her thumb, about an inch. But he was in the hospital for four days! He screamed and cried the whole time, in spite of all the pain medication. How is Dr. Kinari going to survive when she got the tentacle all the way up her arm and all the way down her back? Plus, she bathed with fresh water! She should have known not to bathe for a week!"

The shopkeeper’s son held his ground. "The fisherman almost died because he wasn’t made to vomit. The evilness stayed in him. If we can just get the dukun here to make her vomit, she might survive!"

Hearing this exchange, one of our best nurses begged me, with panic in his eyes, to let him call two dukuns, traditional healers. "Dr. K, please, maybe they can help you!"

I knew that if I died and the staff hadn’t tried every possible remedy, they might never forgive themselves. It was also entirely possible that the community might never forgive them. I didn’t want to put them in that position. In any case, I had nothing to lose.

The dukuns they were talking about come in many different varieties: women who know about herbs, wise religious healers, and crafty-eyed men who know the famous Melayu arts of witchcraft and poisoning. After much consultation, two healers were invited. One was an old woman with kindness in her eyes, wearing a faded batik sarong. She rubbed herbs on the sting—but the painful scrubbing made my muscles contract even more. Then the next dukun stepped forward, an old man so tiny that he would not have come up to my shoulder had I been standing (although I am not tall). He had me drink a glass of brilliant green liquid. This concoction of leaves from a rainforest tree did its job of inducing vomiting amazingly well. In fact, I have never seen a better emetic. Within moments, I was vomiting over and over again, under the watchful eyes of the dozens of people crowded into the hot examination room.

Pak Alvaro vomited up a live fish. I was there and I saw it!

I heard that someone vomited sand. And, Ibu Ateng, didn’t you vomit green leaves?

People were clearly disappointed to see only clear fluid. Now the old man said an incantation over a glass of water and urged me to drink that, too. But for some reason, here I drew the line, and the sweet young Javanese doctor, Dr. Ruth, agreed with me. She pulled the curtain closed, shielding us from view, and stowed the charmed glass out of sight behind the EKG machine. Out of ideas, people stood back as I continued to struggle in overwhelming pain, trying to suck in air using every muscle I could call on to help.

I realized I would probably soon die in my own clinic. I had seen at least ten patients die in this very room. When we first opened the clinic, I was overwhelmed by the large extended families that would gather when someone was critically ill, and I would try to shoo people out. But in later years, I always just let them crowd around. I grew to value this outpouring of love and care. Even children would come, and afterward they often touched the corpse with curiosity, or kissed the body.

After the death, the deceased is taken home, and the whole community gathers. Muslim tradition dictates that the body must be buried before sunset on the day of death. The body is ceremonially washed and wrapped in white cloth; a coffin is made from a freshly cut tree; food is cooked; and wooden posts are carved to mark the head and the foot of the grave. Once everything is prepared, a procession accompanies the family to the cemetery, where a hole has already been dug. In goes the body—and I have always been struck by the way the young men jump down onto the coffin and pack the sand with their bare feet, slowly moving higher as more sand is pushed in from above.

I have sat many times at those funerals, and family members always tell me how grateful they are that we did our best, but when Allah calls, there is nothing that can be done. I was so thankful for this wisdom after working in the United States, where death is always someone’s fault—and chances are, it is the doctor who is blamed. If every physician were perfect, people seem to think, no patient would ever die, and everyone would live forever. But here in a tiny village in Borneo, people recognize that no one escapes death. Sitting under the frangipani trees that shed their fragrant white flowers around the graves, listening to the chanting and prayers, always deepened my knowing that death comes for us all.

But this was different—the immediacy of death was a whole new experience. As the wise Romanian writer Petru Dumitru Popescu observes, There are two things you can never look fully in the face—death and the sun.

By 3:00 a.m., I was looking at the sun—or maybe looking at it the way one looks at an eclipse, reflected upon the ground through a pinhole in a leaf, watching a shadow move over my life. Perhaps the wisdom of my friends in this remote corner of the world was seeping into me; if death called, I would simply accept.

I had fought the good fight, striving to save rainforest and improve the lives of people who faced incredible hardships. Now, surprisingly, I found myself ready to go. I had always been painfully aware of my failings—an intense temper, occasional intolerance of people’s shortcomings, and self-centeredness. But at the end, somehow, none of that mattered. Even my flaws seemed to have had purpose. The bigger choices I’d made seemed simply right. I even had a private chuckle, remembering the warnings of some good friends who told me I was crazy to work for no salary in a remote village in Indonesia and not save money for retirement. They appeared to be wrong, since, apparently, I wasn’t going to make it to retirement! And the years I had had were profoundly meaningful and even fun. I felt a profound sense of grace—deeply grateful for life and for the people I had shared it with. As a friend had said, in the end, we are all as perfect as a grain of sand.

In a dispassionate, rational way, through the crippling pain, I knew I didn’t have much more time. Every breath was already a fight, and with every hour, the pain worsened. I found myself completely unafraid. Cam had not left my side for a moment. He was alternately massaging my muscles and supporting my weight as I tried to find a position I could tolerate or one where I might manage to suck in a breath of air. His worried brow and tender care conveyed all that needed to be said.

I began to say my goodbyes. First to Cam: My darling, I do not regret anything. I love you completely. I needed to say this, because many years of our marriage had been hard, very hard, and six months earlier, I had almost left him. I wanted him to know that I didn’t regret our time together or the separation. We had both grown in the process, and we were consistently happy together for the first time since we met. Our difficulties were the fault of both of us and neither of us. We had each accomplished more in those years together, personally and professionally, than we could have done alone. And we had always loved each other. Dr. Ruth and Dr. Verina averted their faces, and I saw tears in Verina’s eyes as they gave us a special moment to kiss each other and say goodbye.

Hotlin Ompusunggu, my dear friend and cofounder of the clinic, had been pacing around me all night. As a dentist, she showed her care by folding squares of cloth for me to bite on so I wouldn’t break my teeth when the jaw muscles clenched. Now I held her close and gasped, in fragments, I am so proud of you! You have done such a wonderful job. I know you can run the program on your own! You can do it! I love you.

Etty Rahmawati—her green headscarf framing her intelligent black eyes, now streaming with tears—held me as we cried together, telling each other how grateful we were for each other’s friendship. A line of doctors, nurses, conservationists, patients, neighbors, and friends came to say goodbye, clasping my hands, soothing my brow, or dropping light kisses on my hair. Protestants, Muslims, Catholics, and Confucian Buddhists, representing at least ten different Indonesian ethnic groups, all mourned together and comforted one another. This was the most diverse family that had ever gathered at a death in our clinic, and I felt surrounded by love. It was a good way to go.

---

OBVIOUSLY, I DIDN’T DIE THAT night. I survived thanks in part to the U.S. poison control hotline that we eventually figured out anyone in the world could call. When Cam explained the situation, they said they had no idea, but they promised to find someone who did. A few hours later, they got back to us, having tracked down a doctor in Thailand who had experience treating box jellyfish stings.

The Thai doctor’s advice was emphatic: "More pain medication! His experience was that a doctor will never encounter patients more in need of analgesics. Give her enough medicines until she can breathe. Ignore the maximum doses!"

So that is what we did, and I will always remember that moment of relief when I finally started getting full breaths of air into my lungs.

But the ordeal was far from over. For the next few months, I exhibited classic symptoms of heart failure—but I basically just ignored them (doctors are terrible patients!) and slowly improved. The following month, in September, I thought I was well enough to do a fundraising tour in the United States, but midway through the trip, after giving a talk to about a hundred Smith College students, I simply collapsed. My heart rate was through the roof, my blood pressure was tanking, and my respiratory rate went completely haywire.

Cam made the fastest trip a human has likely ever done from a remote island off the coast of Ambon, where he was doing ecological research, all the way to my hospital bed at Brigham and Women’s Hospital in Boston (including walking out of the forest through the night, hitchhiking, chasing down the ferry by motorcycle when he just missed it at one port, and buying multiple tickets in airports minutes before flights took off). He met me in Boston, where my father had already flown in from D.C., for my two-week admission, which was followed quickly by yet another hospitalization.

No one could figure out what was wrong with me, and every day, my health deteriorated. It turns out that dying surrounded by loved ones, in a remote village clinic in Borneo, was vastly preferable to enduring a hostile mega-hospital, with overworked and exhausted staff who were irritated that I didn’t fit into a nice, easy treatment category. One of the team of specialists memorably declared, "Your symptoms can’t possibly be from the jellyfish sting because it isn’t in the literature. We can’t assume this is a zebra if we haven’t ruled out horses."

I raised my eyebrows at him. "You are kidding, right? How much literature do you think is coming out of Indonesian Borneo? The few doctors are so busy saving lives, they don’t have time to write articles about all the amazing toxic creatures that aren’t even known to science. I really was stung by a highly poisonous jellyfish, and all my symptoms started right after the sting. Last year, I climbed Mount Kinabalu, which is over thirteen thousand feet—and now I can’t walk across the room! People from the village I live in say that you can be so sick from being stung that you can’t get out of bed for four years! Just because no one has published it yet doesn’t mean it isn’t real."

But after ruling out everything else with intensive tests and daily lunchtime consultations with multiple specialists, they finally accepted that whatever was wrong with me was caused by the jellyfish. At the end of my stay, my internist summed up what they had concluded. Well, Kinari, all we can say is that your autonomic physiology is profoundly abnormal, we have never seen anything like it, we assume it’s from the box jellyfish, and we have no idea what to do about it.

He clearly felt that they had failed, but I was pleased with that assessment and agreed with it. We had tried various medicines, and nothing worked. The fact is, no matter how much Western medicine likes to believe otherwise, we simply don’t know everything; and in my experience, there is more mystery and magic in the universe than we like to admit. It was frustrating, though, to realize that the money the insurance company had spent on my care was enough to care for many thousands of patients in Borneo.

For all that money, they learned that the jellyfish had apparently damaged the part of the spinal cord that regulates the unconscious nervous functions that are necessary for life: heart rate, blood vessel tone, breathing rate, blood pressure, and the complicated coordination that is required for standing, sitting, walking, climbing stairs, coughing, and concentrating. Marvelous, amazing, simple actions that we only fully appreciate when they don’t work. At one point, just sitting up made me feel that my life essence was slowly dripping out the bottoms of my

Reviews for Guardians of the Trees

[citizenjoyce · Rating: 5 out of 5 stars]

Parts of this book were hard for me to read because of all the spiritual woo, but the author has done great things. Webb couldn't decide between being an environmentalist or a doctor so she became both working as a doctor in Indonesia trying to save rainforests. She and her group practice active listening. Instead of going into an area with great plans to save the poor, naive natives they work with the indigenous people to find what they say they need and come up with a novel solution. People live off the land, but they log the trees to make money. What do they need money for? Health care. So Webb's group established a system of clinics that worked on a sliding scale. First of all, they let people pay with work instead of money. They had them planting trees and food for the community. Next, there's a tier system. The greens were charged lower fees because they pledged not to log, the reds whose communities were still logging had to pay higher fees. It's a great idea, there's just a whole lot of fasting and praying interjected into it. I guess we all do what we need to do to take care of ourselves.