Culturally Safe Tuberculosis Ward at Atoifi Hospital, Solomon Islands. Rowena T. Asugeni Director of Nursing, Atoifi Adventist Hospital rowenaasugeni@gmail.com November, 2016

Background Providing health service in East Kwaio is a challenge due to: Remote location Limited infrastructure Social and Cultural issues Tuberculosis (TB) remains a major health concern Malaita has highest rates of TB in Solomon Islands

Background 2011: Research capacity building workshop, the hospital and community chose TB as a research priority. Undertook study investigate barriers to access to health service Traditional medicine Food Loneliness Transport/Distance Cultural issues of TB ward being next to OB ward 2012: Provincial TB Health Managers attended research workshop 2013-14: TB Ward was re-designed and re-built to be culturally appropriate for Kwaio people

Aim Explore community and health service responses to new culturally safe TB ward Component of Master of Leadership Development course at Pacific Adventist University

What we did…

Reasons for relocation and re-development of new TB Ward Cultural reasons “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. Olketa man even olketa women never go next to a place wea hemi dirty and hem a curse. Dis kind wea OB ward hem stay next door lo place wea olketa man live, hem samting wea hem no accept lo culture”. (Female, Community participant 4, Interview). [“In the past, hospital kept them (mountain people) just next to the place where women gave birth to their babies. In Kwaio culture, such situation is a very! very! very! forbidden thing. Men even women never live next to a place that is unclean or a curse. Having obstetric ward next door to the place where men live, is something that is not culturally accepted”.]

Operational Challenges Disposal of sputum “Sputum olketa no allowim fo flashim lo toilet, u flashim lo dea, u compensation too. But if olketa garem proper slush room fo olketa sputum an explainim lo patient why nao no can takem olketa sputum den torowe olbaot hem gud” (Male, Nurse Probationer 2, Focus Group 1). [“Sputum is not allowed to be flushed in the toilet, you flush there (toilet), you compensate too. But if they have proper slush room for sputum and explain to patient why not to carelessly discard sputum is important”.] Gender "Wane ola e toto’o mola, tee ola ne ame lea na lauta noni ani leka mai ani aga afuia ta agea maka tobi, ngaia na gila ki ame siria (Male participant, Mountain hamlet). [" All of us just the same.. no one is higher than the other, however, ladies who are to take care of the TB patient must be free from menstrual period".]

Opportunities for positive impacts Cultural awareness “…leader (mountain leader) ya nao bae hem orientatim olketa students or other RN fo u mi adjust according lo culture blo olketa lo dea. hao bae u mi treatim olketa, hao bae umi care fo olketa olsem in a way, bae hem no makem olketa feel out…” (Female, Nursing student 2, Focus Group 1). ["…leader (mountain leader) will orientate students or registered nurses so all of us will adjust to their culture. How we should treat them, how we should care for them in a way not to make them feel out"]

Factors for sustainability Appropriate leaders Olketa should advicim nao olketa gang wea stay kam lo bush yia, olketa should involve lo makem idea blo olketa fo fair wantaem blo u mi (Male, Nurse Probationer 1, Focus Group 1). ["They (health administrators) should advice those people from the bush, they should involve in sharing their ideas equal with our ideas".] Appropriate leadership and management system The right leaders are those with public health and community health oriented leadership experiences. Leaders who are willing to discern and work things through people and community. Leaders who do things through bottom-up approach and not top-down approach. Leaders who look at the community needs and try to build communities! rather than telling them what to do or leaders who abuse the right of the community. They can be church leaders who understands the need of the community because they are the head of the institution. Therefore, at the management level, church leaders are the ones needed to be recognised leaders for the new change.(Female, Health Administrator 1, Interview )

Outcomes Change Management Process at AAH is being directly informed this study Assisting change to Culturally Safe Tuberculosis Ward (CSTBW) Three influencing factors identified:

Sustainable Leadership Model

Current Situation The culturally safe TB ward is now complete but has not been officially opened There needs to be a bridge built across a gully between the TB ward and main hospital The TB ward was an isolation ward for people from the mountains during recent measles outbreak After the measles outbreak then TB patients were admitted – again from mountains Nurses attend to TB patients in the culturally safe TB Ward and are gradually adjusting to a different way of delivering TB services Patients from the mountain are now requesting that other diseases be diagnosed and treated in new culturally safe TB ward

Where to Next? Bridge designed and plans finalized Funding secured to build the bridge (hospital administrators need to arrange the bridge to be built) Further research is needed throughout the Change Management Process to evaluate the transition to Culturally Safe Tuberculosis Ward Further research with TB patients admitted to the Culturally Safe TB ward to ensure it meets the needs of people in Kwaio Investigate other hospital services to investigate whether cultural appropriate Utilise research in future planning at AAH

Bao lea baita