Creating healthier futures in Solomon Islands
...............Reposted from James Cook University website
For many of us in high income countries, access to health resources such as menstrual pads is something we can often take for granted. But for the young women and girls of East Kwaio, Solomon Islands, the lack of menstrual resources and education brings struggles of shame, embarrassment, and missing out on school. Determined to make a difference, Dorothy Esau of the Baru Conservation Alliance has teamed up with JCU’s Dr Michelle Redman-MacLaren to improve the health, confidence and future of these girls.
April 7 is World Health Day, and this year’s theme is “building a fairer, healthier world”. In honour of the day, Dorothy and Michelle tell us about their work in the Solomon Islands that is helping to create a healthier future for the girls of Kwaio, and contributing to a healthier world overall.
In the communities of Kwaio, discussing menstruation or menstrual health is strictly taboo due to complex social and cultural protocols. Because these taboos even occur between women, the result can be partial education, few resources, and limited confidence surrounding menstrual health.
When Dorothy — a Kwaio leader — heard her daughters and their friends talking about the shame and embarrassment that they felt attending school during menstruation, Dorothy wanted to help them gain the confidence to go to school — any day, any week.
“Many student girls don’t attend school because they don’t have a proper pad,” Dorothy says. “So, I want to help them attend school. I also want to help their health. Many girls use dirty clothes or rags during menstruation, so it’s important for us to provide them with clean, hygienic pads to protect their health.”
When Michelle and fellow JCU researcher, Associate Professor David MacLaren, visited the Solomon Islands to meet with the Baru Conservation Alliance in February of 2020, Dorothy shared her concern for the young girls in her community with them.
“We were there working on the strategic plan for Baru Conservation Alliance,” Michelle says. “When Dorothy shared her desire to help the girls who she was meeting in her village, we partnered with her to provide access to resources and funding. Although the initial project concept began as a practical one rather than a research project, our team has since done evaluative work and applied research around Dorothy’s practical work.”
Facing challenges and finding solutions
Dorothy’s project is mainly centred around a hygienic pad development and creation process. The main goal is to provide female school students with a method of managing menstruation in a way that supports their health, confidence, and dignity. The journey of reaching that goal has been both challenging and rewarding.
“At the very start, we were seeking out designs for pads on the internet and looking at what would be most suitable for a very hot, tropical, rainy environment,” Michelle says. “There are health implications for not having dry and clean sanitary options, so we searched and worked to develop a design that would work best for these girls.”
After a long process of trial and error, the design that they developed is a waterproof polyurethane laminate material sewn between an outer cotton casing. Michelle worked to attain a grant from the JCU College of Medicine and Dentistry that funded the purchase of sewing machines as well as the polyurethane laminate. The other materials were purchased in Solomon Islands. Dorothy and her team of cousins and other local women sew these pads and add clips onto them before distributing them to the school girls.
“After we sew the pads, we take them to the schools and distribute five pads to each girl,” Dorothy says. “We’ve faced many challenges along the way because it’s our first time to do this sort of program. One of those challenges is making sure that each girl receives the pads. Sometimes we’ll hear back from the school or the students saying that some girls didn’t get any, so we write their names down and make sure they get them.”
"These girls face challenges that keep them from going to school, so we face challenges and solve problems to help them go to school."
Other challenges that Dorothy and her team have faced include the lack of education around menstrual health. To help raise awareness and provide education, Dorothy asked a local nurse to come with her when she visits the schools.
“The students really had no idea about menstruation or how they experience menstruation,” Dorothy says. “So, now when we go to the schools, we have the help of a nurse and support of a doctor to teach them about menstrual health. And the students are really happy when we do our program.”
Michelle says part of their project involved reviewing the curriculum of the schools in Kwaio, which showed that some aspects of reproductive and menstrual health was included in the curriculum. However, the social and cultural taboos surrounding menstruation has kept that portion of the curriculum from being taught. Michelle explains that in this cultural context, the conventions and practices around interpersonal relationships are always the most important thing, and then after that, professional roles, such as being a nurse or a teacher.
“In some of these communities, it’s taboo to even see someone you are related to go into a toilet, let alone be discussing something such as menstruation out loud,” Michelle says. “For the teachers in these schools, they could have nieces and nephews in their classroom, which would make it even more taboo to speak about menstruation. But of course, the cultural rules must be adhered to, before anything else, which is really stopping girls getting the opportunity to understand their menstrual and reproductive health.”
Bringing in doctors and nurses who feel comfortable to discuss the biological aspects of menstruation with the students ensures that these girls and boys are learning about their own bodies as well as how to understand the health of others. This education is the first step in reducing the stigma and shame around menstruation. Next will be working to improve the elements of the system to sustain change.
Small beginnings are beautiful
Although restrictions caused by the COVID-19 pandemic affected the project throughout the last year, Dorothy and her team have still been able to make and distribute hygienic pads to the students. Michelle and her colleagues have contributed to the project from Australia via regular zoom meetings, ensuring that the team has what they need to produce the pads, as well as working to create the evaluation and document the project.
Now, a year after first starting the project, Dorothy has seen a major difference in the girls who have been given the pads and education. “There have been many girls who came to me last year asking for a pad just so that they could attend school,” Dorothy says. “And now they attend school because they are prepared with the pads. They are really happy because when it’s their time, they know they can just use a pad and still go to school.
"And the principal is really happy with the program. He wants us to continue the program, and the school even requests that new girls are given pads when they start school.”
One of the biggest challenges left to face is that the schools don’t have any toilets and limited or no running water. When the girls need to change their pad, they have to go into the bush and find a safe place to change. Recently, the Baru Conservation Alliance and their fellow JCU researchers have been able to help one school access running water.
There are also opportunities to expand the project, as other schools are expressing interest in the program. Women within the community are also asking Dorothy about the pads and about menstrual health. At this stage, for Dorothy, Michelle, and their respective teams, it’s about taking the project one step at a time.
“When we started this, it was just a small program, but now it is a big program,” Dorothy says. “I always tell the women I work with that we can start small, and that’s okay. Because small is beautiful. And after we work on the small system, we can help make a bigger project for the future.”
Culturally safe toilets improve health and wellbeing in the Kwaio Mountains
...........Toileting is a sensitive topic among tribal groups living in Kwiao Mountain conservation areas. Each village has communal toilet areas, one for men and one for women. If cultural rules about toileting are not followed, people believe the ancestral spirits will become angry and make the family sick.
In mid-2020, Baru Conservation Alliance (BCA) and Atofi Health Research Group members Chief Esau Kekeubata, Tommy Esau, and Dorothy Esau, consulted with tribal chiefs and traditional landowners about the importance of water and sanitation for healthy living. These discussions led to the development of sustainable and culturally-safe solutions for drinking and sanitation needs.
From July to December 2020, BCA supported local rangers to build 10 toilets: one each for men and women at Kwainaa’isi Cultural Centre; one each for men and women at Fulanitofe; and three each for men and women at Kafarumu. Two toilets are under construction at Aifasu.
This new model of toilet, locally designed and constructed from timber sourced from the local forest, is the first of its kind in the Kwaio Mountains. Building these toilets is a breakthrough in Kwaio history and provides a prototype for village sanitation.
Many families who have used these new toilets now want to build their own toilet, because it is safe from both a health and cultural perspective.
For further information, contact Tommy Esau email@example.com
Baru Conservation Alliance Facebook page: https://www.facebook.com/Baru-Conservation-Alliance-100905395374001
Solutions to infection prevention and control challenges in developing countries, do they exist?
by Vanessa Sparke, PhD candidate and Lecturer – Nursing and Midwifery, JCU
As colleagues at Atoifi Hospital and other hospitals in Solomon Islands know, applying Western-based infection prevention and control (IP&C) programs and practices to health facilities with limited resources is difficult. A group of us from Solomon Islands and Australia conducted a literature review to find out what is known about IP&C in contexts like Atoifi Hospital, and to search for possible solutions.
Around the world IP&C is important for patient safety and quality of care however due to a higher burden of disease, a lack of physical and financial resources, geographical isolation, extremes of climate, and differing cultural and spiritual beliefs, the number of healthcare associated infections in hospitals in developing countries is much higher than that of Western nations.
The literature review aimed to look for solutions to this challenge, and while limited success has been documented for some IP&C core program components, there appears to be very little research on the problem overall. The review found that education of health care workers, strong governance and leadership, adopting a systematic approach, participation of patients and taking into account their culture and needs, or a combination of all these have had the most success.
What hasn’t been well-researched is the influence that health care worker knowledge and beliefs have on their understanding and subsequent practices of IP&C. The review found that this gap in the literature is an opportunity for further research.
The integrative review was authored by Vanessa L Sparke, Jason Diau, David MacLaren and Caryn West, and can be found at: https://researchonline.jcu.edu.au/63060/
Photo via: https://www.ijic.info/index
From the Frontline - new article about pandemic preparedness and research capacity strengthening
A timely new article has been published by James Cook University, Atoifi Health Research Group members, WHO and other Pacific collaborators showing how grassroots research can help strengthen surveillance and response capacities of the rural workforce in the Asia-Pacific Region.
Health systems in the Asia-Pacific region are poorly prepared for pandemic threats, particularly in rural/provincial areas. Yet future emerging infectious diseases are highly likely to emerge in these rural/provincial areas, due to high levels of contact between animals and humans (domestically and through agricultural activities), over-stretched and under-resourced health systems, notably within the health workforce, and a diverse array of socio-cultural determinants of health.
In order to optimally implement health security measures at the frontline of health services where the people are served, it is vital to build capacity at the local district and facility level to adapt national and global guidelines to local contexts, including health systems, and community and socio-cultural realities.
During 2017/18 James Cook University (JCU) facilitated an implementation research training program (funded by Australian Department of Foreign Affairs and Trade) for rural/provincial and regional health and biosecurity workers and managers from Fiji, Indonesia, Papua New Guinea (PNG), Solomon Islands and Timor-Leste. This training was designed so frontline health workers could learn research in their workplace, with no funding other than workplace resources, on topics relevant to health security in their local setting.
The program, based upon the WHO-TDR Structured Operational Research and Training IniTiative (SORT-IT) consists of three blocks of teaching and a small, workplace-based research project. Over 50 projects by health workers including surveillance staff, laboratory managers, disease control officers, and border security staff included: analysis and mapping of surveillance data, infection control, IHR readiness, prevention/response and outbreak investigation.
Policy briefs written by participants have informed local, provincial and national health managers, policy makers and development partners and provided on-the-ground recommendations for improved practice and training. These policy briefs reflected the socio-cultural, health system and disease-specific realities of each context. The information in the policy briefs can be used collectively to assess and strengthen health workforce capacity in rural/provincial areas.
The capacity to use robust but simple research tools for formative and evaluative purposes provides sustainable capacity in the health system, particularly the rural health workforce. This capacity improves responses to infectious diseases threats and builds resilience into fragile health systems.
For more information about the SORT-IT training at Atoifi Hospital, watch: https://www.youtube.com/watch?v=p4RHLTyjNTw
To read the new article for free, visit: https://www.frontiersin.org/articles/10.3389/fpubh.2020.00507/full
Reference Details: Larkins, S., K. Carlisle, H. Harrington, D. MacLaren, E. Lovo, R. Harrington, L. Fernandes Alves, E. Rafai, M. Delai and M. Whittaker (2020). "From the Frontline: Strengthening Surveillance and Response Capacities of the Rural Workforce in the Asia-Pacific Region. How Can Grass-Roots Implementation Research Help?" Frontiers in Public Health 8(507).
For more information, please email: firstname.lastname@example.org