Ayu is a petite, soft-spoken 13-year-old girl from a village near Garut, in the mountains of West Java, Indonesia. She is one of five children in her family, and her parents are farmers who cultivate tobacco and other crops on a small plot of land.

“Since I was a kid, I’ve been going to the fields,” she said. “My parents plant tobacco. Mostly I help my parents and sometimes my neighbours. I have an older sister, an older brother, and two younger siblings. They help too.”

Ayu is in her first year of junior high school, and she mostly helps on the farm outside of school—early in the morning before classes, in the afternoons, and on weekends and holidays. But she told Human Rights Watch she occasionally missed school to work in tobacco farming. “My mom asked me to skip school last year when it was the harvest,” she said.

She told Human Rights Watch she vomits every year while harvesting tobacco:

    I was throwing up when I was so tired from harvesting and carrying the [harvested tobacco] leaf. My stomach is like, I can’t explain, it’s stinky in my mouth. I threw up so many times…. My dad carried me home. It happened when we were harvesting. It was so hot, and I was so tired…. The smell is not good when we’re harvesting. I’m always throwing up every time I’m harvesting.

The symptoms she described—vomiting and nausea—are consistent with acute nicotine poisoning, an occupational illness specific to tobacco farming that occurs when workers absorb nicotine through their skin while having contact with tobacco plants.