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

Abstract

IntroductionOur 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 analysisThe 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 disseminationChallenges 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.

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

“…In addition, a handful of Kalam people from Simbai settled in the community over a decade previously and speak Etp (also Trans-New Guinean16). Our assumption when designing the study was that most potential participants would understand either spoken Tok Pisin or English, and we planned that RTs would arrange translation by KIs for those who only spoke a tok ples (presumed to be a small minority) 4. Primary care assessments were conducted simultaneously with FGs, and involved taking medical history, clinical interview and examinations, using basic diagnostic equipment and malaria rapid diagnostic tests (RDTs) when deemed necessary.…”

“…It also provided immediate clinical benefits. Our methods are detailed in our published protocol 4 ; here we give an outline and describe changes. A reporting checklist following ‘Appraising studies in health using rapid assessment procedures’ 13 is in online supplemental file 1 (p.2) .…”

“…We report a health needs assessment carried out as our first step to simultaneously act on both these crises, by supporting a medically neglected community who are conserving their forest. Here, we outline site-specific context, biodiversity and health issues in PNG and our methodological rationale are discussed in detail in our published protocol 4…”

“…Here, we outline site-specific context, biodiversity and health issues in PNG and our methodological rationale are discussed in detail in our published protocol. 4 …”

Experiencias suramericanas en telemedicina de enfermedades desatendidas

“…Aunado a lo anterior, gran parte de los médicos sanitarios tienen una muy escasa formación para el manejo de tales enfermedades; de allí, que existan muy pocas opciones terapéuticas, alimentadas con una escasa información científica de calidad sobre los tratamientos adecuados (MSF, 2021). No obstante, una de las aristas más influyentes de la desatención de estas enfermedades radica en la dificultad en el acceso al diagnóstico, tratamiento y seguimiento en comunidades remotas (Dos Santos et al, 2020;Engels & Zhou, 2020;Middleton et al, 2020) (Tabla 1); en ese sentido, la telemedicina es una tecnología que se ha estudiado durante mucho tiempo para ayudar a aumentar el acceso a la atención médica (Perednia & Allen, 1995;Zundel, 1996;Worster & Swartz, 2017), y es en la actualidad en una forma emergente y prometedora de mejorar la prevención de ETD, su diagnóstico, la detección de casos, la administración del tratamiento, y el seguimiento de los pacientes (Carrion et al, 2020;Tilahun et al, 2021).…”