Robin Lim

Robin is creating a new standard of a rural healthcare delivery system that is built on a foundation of upskilled midwives and traditional birth assistants and a gentle birth model as part of collaborative work with doctors, nurses, public healthcare centers, and an international philanthropy network that has brought investment to extend it throughout the Indonesian archipelago and beyond.

Robin realized that rural healthcare services in Indonesia, especially childbirth practices, including pregnancy and postpartum care, were inadequate for mothers as they were dehumanizing, traumatic, and lacking community support. The MMR (Maternal Mortality Rate) in Indonesia is one of the highest in Southeast Asia, and most of the cases come from rural areas. Indonesia has 10,435 Community Public Healthcare Centers that cover 278 million people, and 41% of public healthcare officers are midwives. This number shows how the government heavily relies on midwives, especially in rural areas in Indonesia. Robin saw midwives as a core tenet of healthcare service providers for people. By upskilling midwives, Robin contributes to improving the government’s healthcare system standards, which, until now, it has struggled to provide adequately. At Yayasan Bumi Sehat, Robin trained midwives in how to make the most of the role of local midwife. That can mean having an alternative to the C-section that the rules of some hospitals require for at-risk patients, nutrition and breast-feeding support, the mother being empowered to choose aspects of the birth where men or mother in law might have overruled, not having to leave a new baby in hospital until the bills were paid, confidential AIDS and cancer screening—or the difference between life and death for babies and women in a context of high maternal mortality.

To achieve her idea, Robin created a community health education and childbirth center, Yayasan Bumi Sehat, a not-for-profit organization that is specifically designed to serve childbirth practices, including pregnancy and postpartum care for mothers, babies, and families. It combines evidence-based research and promotes empathy, care—with an emphasis on nutrition, and a culturally appropriate approach. Bumi Sehat’s care extends to the community and is inclusive for everyone: poor people can get free-of-charge services for anything with the same standard as others. The payment received from patients who can pay is then allocated to cover patients in need. The Bumi Sehat system greatly increases access to healthcare and creates community togetherness, orienting everyone to support each other. The center puts professional midwives and traditional birth assistants in charge and on the frontline of the service. Midwives receive training from the center, which recruits from rural areas and introduces them to its gentle birth model: it encourages midwives, doctors, and nurses to empower pregnant women and uplift the mindset of new mothers. It reminds them that giving birth is a miracle process to be celebrated by mothers and their ecosystem regardless of their social status, race, and religion. This model allows every woman a choice in ways of giving birth as their fundamental human right and educates the family to be a supporting system for the mother.

Robin realized that she needed a bigger avenue to spread the Bumi Sehat model to key stakeholders. She found the key to demonstrating her model by actively participating in disaster response. Since 2004, Robin and her team have been involved in disaster response in Indonesia, Haiti, and the Philippines. The turning point for Bumi Sehat was during the 2006 tsunami disaster response in Aceh, when she successfully built a temporary birthing clinic for the victims and engaged with the local community. Robin not only demonstrated the crucial role of midwives and traditional birth attendants during disasters, but also proved the need for collaborative work between doctors, midwives, traditional birth attendants, nurses, volunteers, and the government to create comprehensive healthcare services during and following disasters. Even more, her work impressed international philanthropic organizations, leading to the opening of Bumi Sehat in Aceh & Lombok as a permanent clinic, which was supported by a network of international philanthropies and run by local midwives and communities. Robin's consistent involvement in disaster response not only uplifted the significant role of midwives but also created an opening for attuned international philanthropies to target support to local governments in order to create a better healthcare system.

The combination of Bumi Sehat’s new standards for childbirth and rural healthcare and Robin’s credibility in disaster response brought Bumi Sehat recognition from the midwives’ community in Indonesia. The Bumi Sehat Model became a benchmark of what rural healthcare centers should be, especially in utilizing the skill and devotion of the midwives to build on resources from international organizations as responsibility for healthcare provision devolved onto local governance. As a result, Bumi Sehat has become one of the destinations for Universities, Vocational Health Schools, and government health institutions to learn from it. Robin took this opportunity to build a network with educational institutions and local government and spread her idea. Almost 6,000 students, midwives, traditional birth attendants, and government institutions per year across Indonesia participate in the Bumi Sehat capacity-building program that teaches about the gentle birth model, breastfeeding support, and building a community support system for mothers. In addition, universities from the United States, Japan, and Australia have been sending their students to learn from the Bumi Sehat since 2019. Several international midwife networks have also recognized the framework by actively sharing the practices and made Robin one of the figures in global midwifery. The gentle birth model has been spreading through online platforms and books, which global publishers have now translated into five major languages (English, Italian, Spanish, French, and Russian).

Almost all global maternal deaths could be prevented by ensuring women have access to quality, respectful, and equitable maternity care. Yet, according to a report by the World Health Organization (WHO) published in 2015, mothers and their babies globally are still at significant risk of death (commonly referred to as maternal mortality) due to complications during pregnancy, childbirth, or the postpartum period. Every Mother Counts reported that more than 800 women die every day from complications related to pregnancy or childbirth. Globally, the maternal mortality ratio (MMR) reached 211 deaths per 100,000 live births from 2000 to 2017. The MMR in Indonesia is one of the highest in Southeast Asia: 305 deaths occur for every 100,000 live births, according to the official estimate of the Government of Indonesia. In addition, a study in Indonesia found that mothers who reported any delivery complications experienced a higher risk for postpartum depression than those who did not report any complications. Mothers with postpartum depression may not be able to care for their babies adequately. It leads to long-term impacts on a child’s development and results in more severe mental disorders, emotional problems, behavioral and cognitive disorders, and dysfunctional interpersonal relationships with the family. Studies show that the health and well-being of a mother and child at birth largely determine the future health and wellness of the entire family. However, in many cultural settings, especially in Southeast Asia, women are pressured to choose the childbirth method according to what their families say, irrelevant to their preference.

Between 2004 and 2006, Indonesia was hit by earthquake disasters in Aceh, Nias, and Yogyakarta. At the time the Indonesian government was not prepared to provide childbirth service due to a lack of traditional birth attendants and midwives in the location and, in response, created Public Health Centers (PUSKESMAS). Health centers were then institutionalized in 2007. However, the Indonesian government continues to face the issue of inequality in terms of public healthcare centers, where the rural areas are often neglected because of a lack of resources. Indonesia's decentralized governance system means that the burden is on the local government to fund healthcare, education, and infrastructure, or to make a choice when there isn't enough funding to cover everything; unfortunately, the healthcare budget is often the third or fourth priority, resulting in poor people being unable to access healthcare facilities.

In 2011, there were just 9,321 Public Health Centers in Indonesia, or one center for every 25,750 people. Ten years later, the number of health centers increased to 10,292, but the ratio to population widened to 1:26,494. This means that compared to 2011, each health center has an additional population burden of 750 people. In addition to the extra burden, there are serious disparities in the distribution of health centers. While one health center is available for every 10,000 residents in Papua, in Banten, one center serves 49,000 residents, nearly five times more. Such wide ratios also occur in other regions in Java, despite the fact that health development has been predominately in Java. Interestingly, although Papua has many health centers, 9 out of 10 centers in Papua do not have enough government healthcare workers, compared to Java, where 60 percent of centers have sufficient personnel. This suggests that the government is building health centers but has not been able to provide the necessary healthcare workers.

Robin began her early efforts in Bali by preserving traditional midwives' empathetic care and culturally viable practices and inspiring hospital-based midwives, nurses, and doctors to integrate these methodologies into their practice. She interviewed women, the families of women who died in childbirth, traditional birth attendants (TBAs), village-based midwives, and doctors to understand the obstacles faced by pregnant women. Meanwhile, she began to understand the challenges traditional midwives and medical professionals faced to preserve the lives of mothers and babies, and subsequently opened Yayasan Bumi Sehat (Healthy Mother Earth Foundation) in 2005. Robin decided that Bumi Sehat would focus on prenatal care, natural birth services, postpartum care, and breastfeeding support for the most at-risk populations: marginalized, poor, rural, and disaster survivor communities. Robin was Filipina and an immigrant, and in the beginning, many people doubted her as an outsider; even some of the midwives in the community felt threatened. But Robin persistently invited local midwives in Bali – who were not legally recognized as healthcare workers – to be part of Bumi Sehat’s network and offered them training. Gradually, her respect and outreach to midwives earned their trust and buy-in and showed how Bumi Sehat's presence could help people in Bali get access to more proper healthcare. Robin incorporated local midwives’ feedback in developing her methodology and then began to put local midwives on the executive team at Bumi Sehat. Her openness successfully gained the trust of local midwives, which was essential for Bumi Sehat's existence. Local people began to spread the word about Bumi Sehat, as Robin increased the capacity to provide free healthcare for poor and marginalized society members. Robin also created a cross-subsidy system where the revenue from regular patients was allocated to subsidize care for poorer patients who ordinarily could not afford services.

Robin has been involved in various disaster responses since 2004. Her active involvement became an effective tool to show her expertise and demonstrate the Bumi Sehat model to key stakeholders, including government and international philanthropy organizations like Direct Relief. Following the tsunami in Aceh in 2006, Robin demonstrated how to activate the community to build a temporary childbirth center in disaster areas, working hand in hand with volunteers and mobilizing local traditional birth attendants and midwives. Her teams of skilled midwives were uniquely prepared to meet the needs of a disaster-struck community. Bumi Sehat midwives knew how to triage and respond as urgent, changing situations demanded. Robin also proved the importance of culturally appropriate disaster responses, by using midwives as the first point of contact, but also providing the Koran and hijabs to survivors, for example, which helped people feel more comfortable. Her capability in leading the team impressed organizations that were involved in the disaster response. The international philanthropy community increasingly recognized her credibility not just as an effective partner on the ground, but one who also had the trust of local people.

Robin took this opportunity to build partnership programs with Direct Relief to set up additional clinics. The establishment of Bumi Sehat in Palawan Island, Philippines, Aceh, and Bumi Sehat Lombok resulted from the trust Robin gained from the organization after working together during the disaster response period. Direct Relief was willing to invest in Bumi Sehat and build a permanent community health center post-disaster recovery. To staff it Robin intentionally recruited local midwives from Aceh, Palawan, and Lombok to become part of the executive team in Bumi Sehat. They received training for one year, after which, they could run the local Bumi Sehat independently. Robin also created a scholarship program for young girls from disaster locations to become midwives. This scholarship aims to create the next generation of midwives who have a devotion to contributing to society. Once they graduate, participants work in Bumi Sehat Bali for one to two years before they can work in their hometown. With these ongoing programs, Robin aims to enable everyone in the community to work hand in hand with Bumi Sehat to provide healthcare for all. Robin has also been invited by many countries and International Disaster Response organizations to train midwives preparing for disaster response. She notes that climate change is increasing the rate and severity of disasters, and that the world is increasingly recognizing midwives as their asset to protect women if a disaster happens. Robin and Bumi Sehat had already built a model that was ready to share with the world. Today, her clinics across the region continue to work together, even as Robin increasingly empowers local midwives to run the centers outside of Indonesia.

Realizing that the community healthcare system in Indonesia needs systemic change to create better healthcare, Robin adjusted the Bumi Sehat business model from a service provider to a larger community health, education, and childbirth center, where people can learn, share love with each other, and, most importantly, feel welcome despite their race, religion, background, and economic status. The integration of her health care model into rural communities shows how quality accessible care can be provided even in low-resource, high-risk environments. Since then, Bumi Sehat expanded support from donors to provide health products (medicine, vitamins, etc.), community learning programs, and healthcare facilities that can be used free of charge for the rural community. Data from the local health department in Bali showed that attended deliveries in health facilities increased to 90.8% in Bali by 2010, after Bumi Sehat had been operating in the region. In addition, the maternity mortality rate in the villages decreased from 72.1% in 2013 to 68.6% in 2017, which gave the Bumi Sehat team confidence that they were contributing to the improvement. In 2022 alone, Bumi Sehat Indonesia (Aceh, Bali, Papua, Lombok) and the Philippines provided over 200,000 services, including attended births, pregnancy check-ups, and general medicine patients.

This shift has also created an opportunity for Bumi Sehat to activate a network in the healthcare ecosystem. One of their core programs is capacity building for midwives and Traditional Birth Attendants (TBAs). Bumi Sehat consistently trains 4,000 to 8,000 midwives, TBAs, and university students annually from across Indonesia and the Philippines. The capacity building also introduces the gentle birth model and Bumi Sehat protocols, so that the Gentle Childbirth vision and practices are widely implemented while equipping midwives with a new mindset and skills to promote empathy in the hospitals and clinics they serve. Reputable universities in Indonesia that focus on midwifery have connected their students and future midwives with Bumi Sehat to learn an alternative model that had not previously been included in the formal curriculum. Since 2018, POLTEKKES KEMENKES, an educational institution under the Ministry of Health, has provided professional health education at the diploma level (D3/D4) , the certification required to become a public healthcare worker, sending its students to learn from Bumi Sehat. POLTEKKES from Sumatera, Java, Sulawesi, and Kalimantan have also worked with Bumi Sehat. In 2022, 52 Kutai, East Borneo Health Department staff visited Bumi Sehat to learn the Bumi Sehat Model and share the practices with their staff. Students can see an alternate management style – non-profit, local clinics – as opposed to the traditional government or for-profit-based healthcare systems. Recently, a new curriculum for the Midwifery Diploma program in Indonesia has integrated gentle birth practices into the curriculum. This is a huge success because formal education institutions are finally on board to teach the practices to their students. Moreover, universities from California, Japan and Australia have shown interest in integrating the gentle birth model into their curriculum. Since 2019, these universities have actively sent students to learn, observe, and research at Bumi Sehat.

Moreover, in 2023, Bumi Sehat Bali and Lombok both received formal A+ Accreditation from the Ministry of Health, recognizing them as the nationwide standard as a clinic. The accreditation process evaluates clinics and hospitals to ensure facilities have met quality and safety standards and indicates that the government now views Bumi Sehat as part of the formal healthcare system, something not often granted to clinics. Robin has proven that there is a way to create healthcare that can help as many people as possible in a creative way. Resources are not the only thing that matters in developing such a healthcare model; unlocking the ecosystem of international philanthropy, corporate sponsors, and international midwife networks is equally important, which Robin successfully demonstrated with Bumi Sehat.

To increase the impact and reach more women and midwives across many countries, Robin actively shares free learning materials, distributing thousands of copies of guidance books for mothers, midwives, and families. Through her midwives and traditional birth attendants' network, these books help rural families learn about prenatal care, breastfeeding, and other topics. Her book is also available online and is being used by a network of midwives worldwide. Her most well-known work is entitled “Placenta the Forgotten Chakra,” which was released in 2010; due to publicity within midwives’ networks, it has since been translated into major languages like English, Spanish, Russian, French, and Italian. In 2023, Bumi Sehat received 16,000 € from book sales, which supports the production of free printed material for families in rural areas in Indonesia & the Philippines. In addition, Robin is conducting and planning online Master Classes for doulas and pregnant women on her social media platforms. During the global pandemic, the number of participants in the online masterclass increased, reaching more than 1,500 participants in 2021 alone from various backgrounds, including some Indonesian influencers. The diversity of online masterclass participants has helped the Gentle Birth model become well-known among more women and midwives.

Robin is also actively involved in many programs organized by the International Congress of Midwives and the Indonesian Midwives Association. These two organizations allowed Robin to spread her work to a network of midwives worldwide. In 2023, The International Congress of Midwives hosted its annual worldwide conference in Bali so that the participants could visit Bumi Sehat as one of the agenda items. In addition, this is also allowing more Indonesian midwives across Indonesia to join the conference and upscale their network with midwives worldwide. Robin played a crucial role in advocating this scenario, which is huge for both Bumi Sehat and the network of midwives in Indonesia.

Born in 1956 to a Filipino-Micronesian American family, Robin shadowed her grandmother, a Hilot (practitioner of the ancient Filipino art of healing and receiving babies into the world). Her grandmother served the people before, during, and in the aftermath of World War II. When all infrastructure and healthcare systems were destroyed, it was Vicenta Munar Lim’s expertise in traditional medicinal herbs that preserved lives. When starvation plagued the refugees, Robin’s family practised charity. Robin’s grandmother placed an “anting-anting” traditional charm on her so that Robin would not rest until she helped heal as many people as she could.

Since her early age, Robin has been marching for justice and peace. She experienced discrimination due to her mixed-race origin when her family had to migrate to the United States, especially when it came to health facilities. She also lobbied for women’s empowerment at school after witnessing and experiencing unjust treatment based on her physical appearance. In her first experience of giving birth as a teenage mother, she suffered obstetrical violence when taken to a hospital for a simple suturing procedure, and she realized it was something many women experienced. It led her to advocate for skilled, kind, respectful care for all humans, especially mothers and babies, who are so vulnerable during childbirth. Another traumatic event occurred in 1991 when her own sister, living in the United States, died from complications of her third pregnancy under the care of an OB-GYN. Her death was preventable, but even though she was fully insured, the healthcare system did not work equally for a mixed-race woman who was married to an Asian man. The deaths of women in childbirth at the rate of one every two minutes worldwide is very personal to Robin. She promised herself to do everything she could do to improve maternal care.

In 1993, after giving birth to her youngest child in her own home in Bali, many local women started to come and learn from her. In the same year, she began to offer pre-natal care, birth services, and post-natal care in the small village where they lived. She began volunteering to promote maternal and child health in 1995. The demand for birth services grew until Robin and her team decided to open a small clinic in Nyuh Kuning, Bali. She then founded Yayasan Bumi Sehat (Healthy Earth Mother Foundation) in 1996, became a Certified Professional Midwife (CPM) by the North American Registry of Midwives in 1998, and officially registered Bumi Sehat as a not-for-profit organization in 2005. With a meaningful vision for building Peace, one Mother, one Child, and one Family at a time, Yayasan Bumi Sehat is built on three principles: Respect for Nature, Respect for Culture, and the wise implementation of the Science of Medicine. The foundation of Robin’s ability to innovate and sustain her work has been her husband, Wil, her eight children, and her six grandchildren.

After all of her hard work helping her mother deliver her baby in Bali, Robin later met Eka, a local midwife from Bali, during the 2006 Tsunami Aceh disaster response. Eka was inspired by Robin’s devotion to save as many mothers and babies as possible during the disaster. She was also surprised that Robin had already made a significant contribution to Bali’s people. Without hesitation, Robin asked Eka to be part of Bumi Sehat, and later on, Eka played a significant role in the executive team, which led Bumi Sehat to gain more trust from the local people and reach more community in Bali. The meeting between the two was like a destiny for Robin’s effort to create a better healthcare system in rural areas in Indonesia. Since then, Robin began to engage local people to be part of Bumi Sehat and run Bumi Sehat within their own community. They founded of Bumi Sehat in Aceh, Lombok, and even Papua are the result of collaboration with the local midwives.

Robin perceives the current medical model of maternal health care as a broken system, as it has failed to deliver respectful, culturally appropriate, kind, skilled, accessible care to women globally. She puts forward the concept that wise implementation of systems of well-being has the potential to uplift individuals, support families, and strengthen communities and countries. Robin believes if we can welcome generations of babies to Earth without trauma and with intact capacities to love and trust, they will become the stewards of our air, land, water, and all species on this ailing planet. She believes that we should follow the kindest protocols for mothers, babies, and families because Robin believes that peace begins with birth. Success stories of Robin in creating a better world for women and children through gentle birth services in Indonesia & the Philippines received recognition from the Woman of Peace Award in 2005, the Bayanihan Award in 2015 from the Republic of The Philippines, the People of Change Award in 2016 from Republika Indonesia, CNN Hero of The Year in 2011 and Earth Company Impact Hero 2016.