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

Using locally available fertilisers to enhance the yields of swidden farmers in Papua New Guinea

Context Swidden agriculture (a type of small-scale agriculture) is crucial to the livelihood and food security of millions of people in tropical regions. Social-ecological changes, including population growth and anti-swidden policies, are putting pressure on the existing swidden system to increase agricultural productivity in a sustainable way. Enhancing soil fertility is a promising option for increasing crop yields and extending lifetimes of agricultural fields, thereby reducing the demand to clear new land. However, there is limited information on how swidden farmers can best maintain soil fertility. Objective Our aim was to investigate whether using locally available fertilisers can increase soil quality, crop yields and lifetimes of swidden fields. Methods We established experimental gardens on the land of swidden farmers in the Lowlands of Papua New Guinea, where the majority of the population depends on swidden agriculture. Gardens were set up on two types of sites; five were established on new sites that had just been prepared for gardening by cutting and burning vegetation after a fallow period, whereas another five were prepared on garden sites that were just being fallowed. We applied three treatments; i) compost consisting of decaying banana peels, ii) chicken manure, and iii) NPK fertiliser to different plots within each garden; and tracked soil quality and yields of sweet potato over 12 months (three post-intervention cropping periods). We also conducted in-depth interviews with local farmers to understand their perspective on soil management. Results and conclusions Few farmers typically used compost, chicken manure or NPK fertiliser. Many were keen to try these fertilisers, provided they had more information. The performance of treatments depended on the type of garden with chicken manure increasing tuber yields in fallowed gardens but not new gardens, and banana peel compost also increasing tuber yields in fallowed gardens although not significantly. NPK fertiliser was the best option because it was the only fertiliser that increased yields in both new and fallowed gardens, produced tubers of similar quality and taste to control plots and was financially profitable. Treatments affected yield through increasing available nitrogen and reducing soil moisture. We also found that farmers fallow their gardens despite adequate sweet potato yields, so whether using fertilisers can enhance the lifetime of fields will depend on additional factors such as labour input needed. Significance Our work shows how swidden agriculture can potentially be adapted so that it continues to be a sustainable way of farming and living

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