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

Quantifying unintended effects of an agroecological research project on farmers' practices and social network in Papua New Guinea

1. Agroecological researchers and advocates often make assumptions about the social impact and dissemination of their work: researchers may assume that their work has impact through postresearch dissemination, while advocates may assume that new agroecological practices can be effectively spread through existing social networks. 2. Here, we test these assumptions by quantifying the effects of an agroecological research project on farming practices and the social network in a village community in Papua New Guinea. The project aimed to test the effect of applying banana peel compost, chicken manure and NPK fertiliser on sweet potato yields. Local farmers were involved in the research as project garden owners or research assistants. Using stochastic actor-oriented modelling, we tracked changes in farming practices and the social network. 3. Over the course of the research project, more people started to use food waste on their farms, while animal manure and NPK fertiliser were not frequently adopted. Farmers also took up practices that were not directly researched, such as mulching and planting the specific variety of sweet potato that was used in the project. This suggests that local farmers created meaning from the project, despite the researchers not intending to give advice until the end of the project. 4. The research project also affected the community's social network. Research assistants became more often sought-after for advice, while knowledge about the project did not flow far from those directly involved. These results indicate that who gets involved in a project may have social consequences, and show the importance of understanding existing social networks before they are relied upon for spreading farming practices. 5. Overall, this work challenges often-held assumptions about the social impact and dissemination of agroecological research, provides insights into the types of agricultural innovations more likely to be accepted among farmers, and explores how new practices may most effectively be promoted within a community

Quantifying unintended effects of an agroecological research project on farmers’ practices and social network in Papua New Guinea

1.Agroecological researchers and advocates often make assumptions about the social impact and dissemination of their work: researchers may assume that their work has impact through post-research dissemination, while advocates may assume that new agroecological practices can be effectively spread through existing social networks.2.Here we test these assumptions by quantifying the effects of an agroecological research project on farming practices and the social network in a village community in Papua New Guinea. The project aimed to test the effect of applying banana peel compost, chicken manure and NPK fertiliser on sweet potato yields. Local farmers were involved in the research as project garden owners or research assistants. Using stochastic actor-oriented modelling, we tracked changes in farming practices and the social network. 3.Over the course of the research project, more people started to use food waste on their farms, while animal manure and NPK fertiliser were not frequently adopted. Farmers also took up practices that were not directly researched, such as mulching and planting the specific variety of sweet potato that was used in the project. This suggests that local farmers created meaning from the project, despite the researchers not intending to give advice until the end of the project. 4.The research project also affected the community’s social network. Research assistants became more often sought-after for advice, while knowledge about the project did not flow far from those directly involved. These results indicate that who gets involved in a project may have social consequences, and show the importance of understanding existing social networks before they are relied upon for spreading farming practices. 5.Overall, this work challenges often-held assumptions about the social impact and dissemination of agroecological research, provides insights into the types of agricultural innovations more likely to be accepted among farmers, and explores how new practices may most effectively be promoted within a community.<br/

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