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
Baru Conservation Alliance Facebook page:

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:

For more information about this review or IP&C research being facilitated at Atoifi Hospital, please email: Dr Jason Diau or Ms Vanessa Sparke

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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:

To read the new article for free, visit:

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:

Family planning to save lives

JCU PhD candidate and Atoifi Health Research group member, Relmah Harrington, is one of the many women in health working to create a safer future for families in the Pacific. Relmah is an experienced nurse, midwife and educator researching how family planning services could save lives in the Solomon Islands.

Imagine a commercial plane, carrying 200 passengers crashing every six hours, killing all passengers continuously the whole day, the whole week, the whole month and the whole year. In 2017, more than 800 women died worldwide every day from preventable causes related to pregnancy. Globally, strong advocates support the use of family planning contraceptives as cost effective interventions to reduce these deaths.

The Solomon Islands is a low-income pacific nation. About 80 per cent of people live in rural and remote areas. On average, one woman dies every three weeks from pregnancy complications. Imagine you are a father in the Solomon Islands expecting the birth of your next child. You did not plan this pregnancy, it just happened. Your wife leaves to give birth and does not come back. You are shocked to hear she tragically dies giving birth. No more hugs, no kisses, there was no good bye. Thoughts raised in your head, "who will bring home food from the gardens?", "who will take care of the children?", "who will do the washing or cook?". How can these tragedies be prevented and the situations improved?

Read how at this story from James Cook University:

For more information about this research, please email:
Photo: Relmah Harrington