Surfaces: An interdisciplinary project to understand and enhance health in the vulnerable rainforests of Papua New Guinea

Background New Guinea has the third largest tropical rainforest on Earth. However, one quarter of the forests of Papua New Guinea (PNG, New Guinea’s eastern half) have been cleared or degraded, nearly half through commercial logging.Sustainable development requires supporting good health (Sustainable Development Goal [SDG] 3) and protecting life on land (SDG 15). To remote communities in PNG with low levels of health provision, these goals can seem in conflict. Logging companies’ offer of roads and income can partly extinguish the remoteness that bars access to health services, making desire for health a driver for forest destruction and erosion of health related ecosystem services. Conservation success thus requires synergies be developed with delivery of other SDGs, particularly those pertaining to health. We aim to provide a model of integrated health and conservation in PNGs rainforests. Methods We are mapping and piloting biological, anthropological, and medical methods to address SDGs on health and biodiversity, focusing first on scabies and fungal diseases. At Wanang, team members have a long term collaboration with nine clans with unmet health needs who collectively chose to preserve their 10,000 hectare forest whilst surrounding communities allowed logging. Similar collaborations are being developed along an altitudinal transect on Mt.Wilheim (4,509m). Stage 1 of Surfaces will (i) systematically map evidence on integrated conservation and health programmes, (ii) conduct clinical examinations and rapid anthropological assessments to understand medical needs, and survey skin disease, and (iii) produce a case study of the Wanang agreement, based on interviews with participants. This will lay the foundation for a multi-year health intervention and interdisciplinary study. Findings We are in the projects’ early stages (so do not yet have findings), and would appreciate advice and suggestions of collaboration from others in the Planetary Health community. Funding Sussex Sustainability Research Programme, University of Sussex, UK. Contributions All authors have commented on multiple drafts and approved the final version of the abstract for publication. Conflicts of interest We declare we have no conflicts of interest. Acknowledgments We thank the projects partner communities; New Guinea Binatang Research Centre; and our advisory group

Rationale, experience and ethical considerations underpinning integrated actions to further global goals for health and land biodiversity in Papua New Guinea

The SURFACES project is integrating action on good health and wellbeing (Sustainable Development Goal [SDG] 3) and conservation of life on land (SDG 15) in the threatened rainforests of Papua New Guinea (PNG), and mapping evidence of similar projects worldwide. Our approach is framed by Planetary Health, aiming to safeguard both human health and the natural systems that underpin it. Our rationale is demonstrated through a summary of health needs and forest conservation issues across PNG, and how these play out locally. We outline differing types of integrated conservation and health interventions worldwide, providing examples from Borneo, Uganda, India and elsewhere. We then describe what we are doing on-the-ground in PNG, which includes expansion of a rainforest conservation area alongside the establishment of a nurse-staffed aid post, and an educational intervention conceptually linking forest conservation and health. Importantly, we explore some ethical considerations on the conditionality of medical provision, and identify key challenges to successful implementation of such projects. The latter include: avoiding cross-sectoral blindness and achieving genuine interdisciplinary working; the weak evidence base justifying projects; and temporal-spatial issues. We conclude by suggesting how projects integrating actions on health and conservation SDGs can benefit from (and contribute to) the energy of the emerging Planetary Health movement

Health service needs and perspectives of remote forest communities in Papua New Guinea: study protocol for combined clinical and rapid anthropological assessments with parallel treatment of urgent cases

Introduction Our project follows community requests for health service incorporation into conservation collaborations in the rainforests of Papua New Guinea (PNG). This protocol is for health needs assessments, our first step in coplanning medical provision in communities with no existing health data. Methods and analysis The study includes clinical assessments and rapid anthropological assessment procedures (RAP) exploring the health needs and perspectives of partner communities in two areas, conducted over 6 weeks fieldwork. First, in Wanang village (population c.200), which is set in lowland rainforest. Second, in six communities (population c.3000) along an altitudinal transect up the highest mountain in PNG, Mount Wilhelm. Individual primary care assessments incorporate physical examinations and questioning (providing qualitative and quantitative data) while RAP includes focus groups, interviews and field observations (providing qualitative data). Given absence of in-community primary care, treatments are offered alongside research activity but will not form part of the study. Data are collected by a research fellow, primary care clinician and two PNG research technicians. After quantitative and qualitative analyses, we will report: ethnoclassifications of disease, causes, symptoms and perceived appropriate treatment; community rankings of disease importance and service needs; attitudes regarding health service provision; disease burdens and associations with altitudinal-related variables and cultural practices. To aid wider use study tools are in online supplemental file, and paper and ODK versions are available free from the corresponding author. Ethics and dissemination Challenges include supporting informed consent in communities with low literacy and diverse cultures, moral duties to provide treatment alongside research in medically underserved areas while minimising risks of therapeutic misconception and inappropriate inducement, and PNG research capacity building. Brighton and Sussex Medical School (UK), PNG Institute of Medical Research and PNG Medical Research Advisory Committee have approved the study. Dissemination will be via journals, village meetings and plain language summaries

Integration of medical service provision and nature conservation worldwide 1980–2022: collaborative evidence mapping of 43 projects across 22 countries

Background Biodiversity protection is fundamental to human wellbeing, and, in turn, serving human health in medically underserved areas can sometimes strengthen conservation. We aimed to collaboratively map the evidence on projects worldwide that are, or have been, providing health services with the intention of producing conservation outcomes in addition to health improvements. Methods Scoping indicated many NGO projects are never published in the academic literature. To avoid missing such interventions we asked conservation staff worldwide to contribute data online or through zoom calls. Advertising to join the collaboration was through formal networks (International Union for Conservation of Nature, Planetary Health Alliance, etc.), professional contacts, funders, and a call in The Lancet Planetary Health. Additionally, data and literature were synthesised from libraries and datasets of collaborators at Population Reference Bureau, Sussex Sustainability Research Programme, and Ecological Levers for Health. Findings Forty-three projects from 22 countries fitted inclusion criteria. Around half had not been published in the collected literature, with data only available through direct submission. Tropical wet forest was by far the most common habitat, followed by tropical dry forest, coral reefs, and tropical grasslands. The most represented region was Sub-Saharan Africa with 27 projects, followed by South-East Asia (five), South Asia (five), Oceania (two), South America (two), Central America (one), Europe (one). Projects ranged from basic health interventions bolted on to pre-existing conservation programmes to generate goodwill (e.g., vaccination rounds bordering national parks) to complex schemes jointly acting on health and biodiversity driven (and funded) by concerns for human welfare as much as conservation. Interpretation Synergistic action on biodiversity conservation and health service provision is very often effective and the approach is more widespread than literature would indicate. However, funding was usually provided on a siloed basis for either health or conservation, and this remains a barrier to wider adoption

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea's Ramu lowlands:a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Objectives Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. Design Clinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. Setting Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. Participants 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f&lt;40 years; m&lt;40 years; f&gt;40 years; m&gt;40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. Results Of 113 examined, 11 were 'well' (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) 'malaria', (B) 'sotwin', (C) 'grile') translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. Conclusions This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang's community to develop sustainably, without sacrificing their forest home.</p

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Objectives. Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area. Design. Clinical and rapid anthropological assessment (individual primary care assessments, Key Informant [KI] interviews, Focus Groups [FGs], ethnography) with parallel treatment of urgent cases. Setting. Wanang (pop. c189), a village in the rainforests of Madang province, Papua New Guinea. Participants. 129 villagers provided medical histories (54 females (f), 75 males (m); median 19y, range 1mo–73y), 113 had clinical assessments (51f, 62m; median 18y, range 1mo–73y). 26 ≥18y participated in sex-age stratified FGs (f&lt;40y; m&lt;40y; f&gt;40y; m&gt;40y). Five KIs were interviewed (1f, 4m). Data collectors recorded daily ethnographic fieldnotes. Results. Of 113 examined, 11 were ‘well’, 62 (30f, 32m) treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories, and clinical examinations. For example, ethnoclassifications of three ([a]“malaria”, [b]“sotwin”, [c]“grile”) translated to the five biomedical conditions diagnosed most ([a] malaria, 9 villagers; [b] upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; [c] tinea imbricata, 15), and were highly represented in declared medical histories ([a] 75 participants, [b] 23, [c] 35). However, 29.2% of diagnoses (49 of 168) were limited to one or two people. Treatment approaches included plant-medicines, stored pharmaceuticals and occasionally rituals. Protracted travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols or easily reachable aid post; remote town hospital; unfamiliarity with institutions; medicine costs. FG service introduction priorities were: aid post; child vaccinations; transport; perinatal/birth care; family planning. Conclusions. In a place with no prior health data, this study enabled service planning and demonstrated medical need sufficient to acquire funding to establish local primary care. In doing so, it has aided Wanang’s community to develop sustainably, without sacrificing their forest home

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea's Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

Objectives: determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development.Design: clinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases.Setting: Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea.Participants: 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f&lt;40 years; m&lt;40 years; f&gt;40 years; m&gt;40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded.Results: of 113 examined, 11 were 'well' (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) 'malaria', (B) 'sotwin', (C) 'grile') translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning.Conclusions: this study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang's community to develop sustainably, without sacrificing their forest home.</p

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

ObjectivesDetermine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. DesignClinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. Setting. Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. Participants. 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. Results. Of 113 examined, 11 were ‘well’ (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) ‘malaria’, (B) ‘sotwin’, (C) ‘grile’) translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. Conclusions. This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang’s community to develop sustainably, without sacrificing their forest home.</p

Health service needs and perspectives of a rainforest conserving community in Papua New Guinea’s Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases

ObjectivesDetermine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. DesignClinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. Setting. Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. Participants. 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. Results. Of 113 examined, 11 were ‘well’ (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) ‘malaria’, (B) ‘sotwin’, (C) ‘grile’) translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. Conclusions. This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang’s community to develop sustainably, without sacrificing their forest home.</p