SITUATED ON the east coast of Malaita Island, the Atoifi Adventist Hospital was established in 1966 by the Seventh Day Adventist Church. Now celebrating its 50th anniversary, the hospital has grown to include an extensive primary health-care service to remote villages. The attached college of nursing has become an official campus of Pacific Adventist University (PAU).
In the beginning, the Atoifi clinical staff struggled to deliver culturally safe care. The East Kwaio people, who the hospital serves, include some mountain tribes who have not converted to Christianity and who maintain traditional beliefs and customs. However, in recent years a new crop of hospital leaders have forged deep relationships with community leaders and tribal chiefs.
An effort to have local evidence inform local practice was a driving force behind improving cultural safety. In 2008, Atoifi Hospital invited public health academics at James Cook University (JCU) in Australia to help build research activities for hospital and college of nursing staff. From there, the Atoifi Health Research Group (AHRG) was born. Today, its academic partners also include the PAU in Papua New Guinea, CQUniversity in Queensland and the London School of Hygiene and Tropical Medicine.
Ten members from AHRG presented a series of papers at the forum. Director of nursing and adjunct lecturer in the school of public health, tropical medicine and rehabilitation sciences at JCU Rowena Asugeni presented on how community efforts prompted the establishment of a culturally safe tuberculosis (TB) ward. Malaita Province has the highest incidence of TB in the Solomons, but Atoifi Hospital staff had noticed a problem of patients self-discharging before finishing their treatment.
Through research-based interviews, Asugeni found, in the words of one participant: “Last time hospital keepim olketa (mountain people) just next to the place wea olketa women give birth lo olketa pikinini yia. Lo culture blo Kwaio, dat wan hem very, very, very taboo something nao yia.” (In the past, hospital kept mountain people next to the place where women gave birth. In Kwaio culture, this situ- ation is absolutely forbidden.)
As a result of her research, the TB ward was re-designed and re-built to be culturally ap- propriate for Kwaio people.
A lecturer at PAU and adjunct lecturer at JCU, Humpless Harrington, presented the AHRG’s research model. He described the first research capacity strengthening workshop run by JCU academics at Atoifi. There were over 100 attendees, including village leaders, ministers and tribal elders. Despite sessions being conducted in both Pijin and English, concepts such as “naturalistic”, “induction”, “empirical”, “positivistic”, were barriers for some of the people. They asked the JCU academics to come back for longer periods and use a practical “learn by doing” approach, so they did.
Humpress also presented a paper on eliminating soil-transmitted helminths. He said he had trouble getting his research published because the findings, that public health measures to eliminate these parasites on Malaita should be implemented village by village, were not in line with World Health Organisation (WHO) protocols.
“But that’s why you do research – to test prevailing wisdom,” Harrington said. Following the WHO protocols in the local context would have resulted in an over-use of drugs, rather than finding a local solution, he said.
AHRG researcher Tommy Esau presented on the “Kwaio traditional medicines handbook: customary treatment of head lice with the falange tree”. The medicines handbook has documented medicinal properties and tradi- tional uses of 15 plants found on Malaita.
Since 2009, research outputs from AHRG staff have included 15 papers published in a range of peer-reviewed international journals.
Today, the health service receives some government funding, but continues to rely on church support, foreign donors and local fundraising. More information can be found at www.atoifiresearch.org.sb. •
Solomon Islands face health challenges
THE SOLOMON ISLANDS are made up of nine culturally diverse provinces, each home to many wantok (tribal) groups and languages. It is situated northeast of Australia and just south of the Equator.
In his opening address, Solomons Prime Minister Manasseh Sogovare said that life expectancy in the country of 600,000 people had not increased since 2000, despite health spending making up 15 per cent of his government’s budget. The year 2000 also marked a turning point in the country’s history, when armed militants overthrew the government of Prime Minister Ulufu’alu. A five-year period of conflict was brought to an end in 2003, with military intervention led by Australian and New Zealand, but stability and development had not yet been fully achieved, Sogovare said.
Development issues are evident in the country’s relatively high infant, under-five and maternal death rates. More than 45 per cent of the population is under the age of 15. Efforts to address these issues featured prominently in one of the two streams in the forum’s concurrent sessions.
Less than 60 per cent of Solomon Islanders enter secondary school and fewer than five per cent finish Year 12, which is a requirement to enter a bachelor of nursing programme. Despite the challenges, the Solomon Islands has much to offer other NNAs in the South Pacific.
Decisions at AGM
The SPNF annual general meeting was held on the final day. This saw the adoption of a revised constitution, with the Cook Islands nursing association confirmed as the SPNF host in 2018. The steering committee is to prepare a draft five-year strategic plan. It was agreed the South Pacific Chief Nursing and Midwifery Officers Alliance would work with SPNF to align regional regulatory frameworks and postgraduate education requirements. *The SPNF communiqué can be found at: www.spnf.org.au/2016_General_Meeting/SPNF_Ho- niara_NNA_Communique_V2.pdf. •
(First published in Kai Tiaki Nursing New Zealand, December 2016. Reposted with permission.)