Looking at the bigger picture for reproductive health

Republished from James Cook University website, 10 July 2020

World Population Day on 11 July focuses attention on the importance and urgency of population issues, such as population growth, ageing, migration, and urbanisation. The theme for this year’s World Population Day recognises that reproductive health and gender equality are essential in achieving sustainable development and a brighter future. JCU PhD candidate Relmah Harrington is looking to the role the wider community can play in creating a healthier and safer future for maternal and neonatal health outcomes in the Solomon Islands.

As an experienced nurse, midwife, and nurse educator and trainer, Relmah has witnessed first-hand the reproductive healthcare challenges faced by the communities and healthcare workers in her home nation, the Solomon Islands.

Maternal and neonatal mortality, limited access to health services, and high teen pregnancy rates are some of the issues that the she has seen throughout her career. On way of improving outcomes in these areas is through the provision of reproductive health advise and family planning resources.

The availability of such services, however, does not necessarily relate to the number of people using the service. “I didn’t see women come forward very much to access family services,” Relmah says. “We used to give health talks and education talks to them but not many people came forward to take family planning options. I was wondering why women, or men, weren’t coming forward and if there was something I need to know from their perspectives.”

In order to understand the gap between the high-level of family planning knowledge and the uptake rate of family planning services, Relmah decided to combine her experience as a Solomon Islands woman and her time as a nurse and midwife to examine what was happening at the service provision level. “I needed to go back to the other part of me,” she says, “the community member, to see what might work for us in the community and how we can get everyone to be involved so that women can come forward.”

Relmah’s preliminary results suggest that connecting the provision of family planning with community context is key. “We only talk to women when we talk about family planning and not the men,” she says. “In the cultural context, men are the decision makers in the family, and they will have to agree before a woman will accept these resources — we didn’t actually reach the husband.”

Considering the cultural contexts of men and woman is also important when it comes to who is delivering the service. “Men would prefer to deal with a male service provider, but in my remote hospital there was no man in the family planning clinic it was only women. It is like men and boys cannot fit into the service, so we need to make space for them, and involve men in the delivery of family planning.”

The location of the clinic was also an important factor in the uptake of family planning services. “What happened was our family planning clinic in that hospital was a little room attached to the delivery suite,” Relmah says. “The nearby communities in the mountains practice ancestral worship and have a belief that their women could not call near the birthing place. Unless they are birthing it is taboo, so if the building is connected then they can’t come. There is a similar taboo for the men. They believe that they can’t come near the birthing suite, which means they can’t access the family planning clinic. They said if the clinic is a separate building not connected to the birthing suite then they can come there to access family planning resources and advice.”

For Relmah, understanding that a one size fits all approach would not work is key. Health services must meet the community where they are and in their own context. As Relmah points out, cultural values and religious beliefs can play an important role in making family planning more accessible, as opposed to being viewed as an impediment to service delivery and care. “Rather than just blaming culture and religion, if we can also look at facilities and how we actually make the service available to each community it would make a difference to the uptake and provision of family health services,” she says. “The main thing is where the service is located, who is providing the service, and how it is provided.”

While women and their babies are at the forefront of pregnancy and childbirth risk, encouraging the uptake of family planning to improve reproductive health outcomes requires a community approach. “I hope I can change the way that we provide services and change it in a way that suits the context of people who access that particular health centre, so people are able to come forward and utilise the service.”

For more information, please email Relmah Harrington:
Feature image: Shutterstock

Working for health and dignity of school girls in East Kwaio

“I am a mum and I want girls to go to school, every week of the month,” says Dorothy Esau.

Mrs Dorothy Esau is a mother, and Secretary of the Baru Conservation Alliance in East Kwaio, Solomon Islands. She is committed to improving the health and wellbeing of girls and women in both mountain and coastal communities in East Kwaio by leading efforts to improve menstrual health and hygiene, and sanitation for women.

In the remote mountains of East Kwaio, Dorothy and the Baru Conservation Alliance team are carefully negotiating locally appropriate toilet facilities for women at Kwaina’isi Cultural Centre, following a donation from the Australian Museum. This involves many tribal leaders to ensure the new toilets suit local beliefs and traditions.

On the coast, only one school has running water and none have dedicated sanitation for students. Dorothy’s focus is now to improve menstrual health and hygiene for girls by providing water and sanitation in schools that specifically cater for girl’s needs.

Dorothy works at the grass-roots. She daily lives the reality that experts write about in reports: “that women and girls in the Pacific with access to menstrual health and hygiene services, products and facilities enjoy a higher level of health, dignity, autonomy and control over their lives (Criterion Institute and Pacific RISE, 2018). Dorothy wants to enable that dignity for girls of East Kwaio.

Working with senior female teachers and a student nurse, and supported by public health researchers from Atoifi Health Research Group, in 2020 Dorothy is leading a project to raise awareness of menstrual health and hygiene. The project will also explore locally appropriate solutions with girls at two local schools. A pad-making initiative to sew pads for the school girls and a parallel program which raises awareness with boys, women and men in local villages about MHH are planned for 2020.

Funding for these activities has been provided by the College of Medicine and Dentistry at JCU and in-kind support is being provided through support of expertise from Hunter New England Health.

For more information, please contact Baru Conservation Alliance:

You can read more information about Pacific responses to menstruation management here:

Photo (supplied by D. MacLaren): Dorothy Esau, Baru Conservation Alliance (left) with women from the Kwaina’isi Cultural Centre and Michelle Redman-MacLaren, James Cook University (2nd from right), during a Baru Conservation Alliance Planning Workshop in February, 2020 (pre-social distancing).

East Kwaio communities prepare for COVID-19

by Tommy Esau, Baru Conservation Alliance

World Health Organization (WHO), health authorities and other stakeholders around the world are taking action to contain the COVID-19 pandemic. Although Solomon Islands is among the few countries in the world who have not recorded any positive cases of COVID-19, community engagement readiness and initial response for this novel Coronavirus is crucial at this time.

COVID-19 prevention activities are being delivered by Mr Tommy Esau, Baru Conservation Alliance and Mr Gideon Fatalaea, a registered nurse from Atoifi Hospital. Youth and community leaders who are committed are also volunteering their time and service. Community Awareness measures are being implemented in both the Atoifi Catchment Area and Eastern Region Zones 1 – 4.

The Baru Conservation Alliance, a registered Non-Government Organisation in Solomon Islands, is also delivering awareness to people in the mountains. Led by Chief Esau Kekeubata and Maasafi Alabai, Baru Conservation Alliance has provided COVID-19 awareness to six communities on the coast, along with five hamlets and small villages in the mountains.

Challenges that we faced were time, resources and logistics, especially fuel for generators and the outboard motor to travel between coastal communities in East Kwaio. These challenges did not stop the team! Baru Conservation Alliance members volunteered their time and used the Atoifi Health Research Group boat for transport. We also gave community awareness talks during a scheduled trip to remote mountain villages where we are working on a sanitation program.

The Baru Conservation Alliance response team is also working closely with each community to set up their health committees and response team to identify isolation sites, quarantine sites, and develop effective action plans and communication systems. Communities in East Malaita are working to be prepared for this novel coronavirus. This work is an excellent foundation for us to respond to other infectious diseases that also affect communities in East Kwaio like malaria and TB.

Photo: (L-R): Community leaders meet with Atoifi Hospital staff at a COVID-19 planning Day at Atoifi Hospital; Nurse Gideon Fatalaea provides community awareness at Ilinunu village in East Kwaio.

For more information, please contact: Mr Tommy Esau

Atoifi Hospital prepares for COVID-19

COVID-19 is a respiratory illness caused by a new virus. While no COVID-19 has been detected in Solomon Islands, the Government, health services and other agencies are preparing for the possibility of COVID-19 in the country.

Dr Jason Diau, Medical Director and CEO of Atoifi Hospital reminds us that the key messages for COVID-19 prevention are, “wash your hands, stay home when sick, cough or sneeze into your elbow and clean frequently”.

What is happening in Solomon Islands?
On the 25th March, 2020 the Solomon Islands Government declared a State of Emergency which included the activation of a National Emergency center in Honiara and the formation of task-forces in all provinces.

What is happening at Atoifi Hospital?
Dr Diau explains, “At Atoifi Hospital, after consultation with government authorities and church leaders, the Administration Committee has established the “Atoifi Emergency Operational Committee (AEOC) as the Committee responsible for Atoifi Hospital preparedness planning, and for coordination of East Malaita clinics and community responses.”

These community representatives, who are leaders in their communities, have been trained and appointment, with two community representatives also invited to be members of the AEOC. The community representatives are Mr Tommy Esau, representative for communities South of Atoifi and Mr Joseph Ishmael, representative for communities North of Atoifi. The health clinic team in Nafinua will also nominate, train and support community representatives.

The Hospital is focusing on awareness about simple hygiene measures and includes ward talks to patients and relatives about COVID19 and ways to prevent it. Dr Diau reports, “Isolation wards have been selected and are awaiting provincial/national facility inspectors to inspect before further preparation work can be done.”

An alternate public access has been completed from the jetty along the fence line all the way to the hydro station in case Atoifi Hospital has to be quarantined. This is important as the Hospital road has been used as public road in the past.

What is happening at Atoifi College of Nursing?
The Atoifi College of Nursing is planning to resume classes on 25th May and is thus prioritizing completion of the dining hall facility so that all College of Nursing activities will be away from the main hospital buildings.

Community Awareness Measures
Community Awareness Measures are being planned in both the Atoifi Catchment Area and Eastern Region Zones 1 – 4. Some community preparation activities already been delivered by Mr Tommy Esau (reported in a separate news story on Atoifi Health Research Website).

For more information about the COVID-19 response in East Malaita, please email Dr Diau at:

Photo (supplied by J. Diau): Eastern Region Nurses and AEOC members at the COVID-19 Training on 7 April, 2020.