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The Wanang Clinic in Papa New Guinea

Jo Middleton is a Senior Research Fellow who, with backgrounds in both biodiversity conservation and the health service, is jointly appointed at Ecology and Evolution (Life Sciences) and Brighton and Sussex Medical School. They tell us about their SSRP-funded action research protecting rainforests and providing medical care in Papua New Guinea (PNG).

Can you tell us why you are working in PNG, and what is threatening its rainforests?

I have been involved in forest preservation and indigenous health in Oceania on-and-off for 28 years, most recently as part of my SSRP work from 2017 onwards. New Guinea has the third largest remaining rainforest on Earth, and some of the world's worst health metrics, so it is a global priority for action on both conservation and health.  

Presently, the leading threat to PNGs rainforest is commercial logging by multinational corporations, servicing commodity demands from our global industrial system. This is the same story that’s been played out in rainforests across the planet. What is different about New Guinea’s forest is that over 70% remains intact, whereas even places which had very substantial rainforests in the 1990s, such as Borneo, are now left with just fragments. We don’t want the last great tropical rainforest wildernesses - the Amazon, the Congo, and New Guinea - to go the same way. Without action, this will happen.

I should clarify that when I say ‘wilderness’ I mean it in the traditional sense of the word: self-willed, largely untrammelled by agriculture and its associated cities and states. This does not imply unpeopled. The rainforests of PNG are home to hundreds of indigenous peoples, speaking around 800 unique languages, and living in primarily subsistence-based settlements largely outside the money economy.

They mostly live on food they garden, gather, or hunt, are sheltered by housing built from forest materials, and drink waters from its rivers. Almost uniquely, clans in PNG each retain collective, not private, ownership over most of the nation’s territory and therefore most of its forests. My focus therefore is to provide advocacy and resources to communities who want to protect their forest homes.

What then are the local and global implications of logging in Papua New Guinea?

Locally, communities who allow logging rarely see any long-term benefits, and suffer from deteriorating ecosystem services that the forest once provided. Globally, if these rainforests are destroyed vast numbers of species will become extinct, and the carbon locked up in its trees will contribute to exacerbating the ongoing climate crisis. Additionally, the transformation is eroding New Guinea’s cultural diversity, denying people globally (as well as locally) of alternative and ecologically sustainable social systems from which to learn from.

Your research sits at the intersection of deforestation, biodiversity conservation and human health. Could you please explain how these issues are connected?

PNG has the 3rd worst combined health metrics of any country outside sub-Saharan Africa. There's a number of reasons for this, but chief among them is that over the last 150 years communities in New Guinea have had diseases introduced to them from our crowded industrial societies that they have no prior experience with. In addition, the health system inherited from colonialism sited medical care predominantly in the few major towns, even though most of the population live very far away in rural areas, and so can find it very difficult to access healthcare.

For example, in 2017 villagers in Wanang, where one of our projects is based, had to walk multiple days just to buy antibiotics or attend a clinic. To such ‘remote’ communities in PNG with low levels of health provision, Sustainable Development Goals (SDGs) on health and land biodiversity can seem in conflict. Logging companies’ offer of roads and income can partly extinguish the remoteness that bars access to health services, making desire for health a driver for forest destruction and erosion of health-related ecosystem services. Conservation success thus requires synergies be developed with delivery of other SDGs, particularly those pertaining to health. 

So how has your SSRP work responded to these interlinked crises?

I have been working in Wanang in an indigenous-led conservation collaboration to integrate action on biodiversity, health, and climate. When the logging frontier reached Wanang, local clans mobilised and together declared 100 square kilometres of their forests as the Wanang Conservation Area. This was a major conservation victory. However, they understood that to make the victory hold over the long run, conservation would also need to bring benefits to the community. To do this they reached out for allies, and as part of that process, Sussex organised a community planning exercise, in which clans identified establishing health services as the highest priority for their conservation collaboration.

So, in response to that request, SSRP funded me to lead a multi-disciplinary team from Brighton and Sussex Medical School (BSMS) and New Guinea Binatang Research Centre to Wanang to conduct a health needs assessment. We travelled four hours up a seasonal logging road in a 4x4, and then hiked more hours through the jungle. Then in a temporary research structure, we examined patients, treated urgent cases, and carried out interviews and focus groups to determine what disease burdens were affecting the community, and what solutions would fit it.

Then we came back to Sussex, and using that research data, we successfully obtained UK government funding from the Darwin Initiative. This enabled me to return and train the local community in medical evacuation, trauma care, and management of common medical conditions. This was partly a stop-gap measure while we set out to establish permanent primary care in the community. And we've done that. The Wanang clinic has now been built, staffed, and supplied by our Sussex and BSMS obtained grant from the Darwin Initiative.

Can you tell us more about the clinic?

Previously people from this entire area had no access to in-community medical support. But now, if they have, for instance, a severe case of malaria, they can get treatment from wonderful nurses working in the clinic. And we've seen some really positive health outcomes. For example, a reduction of cases of neglected tropical diseases, specifically Yaws. And improvements in maternal health and other metrics. So, it’s a successful health intervention.

However, more than that, it's also incentivized conservation. It's reinforced the will of the local community to continue to defend their forest. In addition, it's really impressed neighbouring communities who previously decided to allow logging. Six of those communities have now joined the conservation alliance, expanding the conservation area from 100 square kilometres to 150 square kilometres, directly as a result of the health intervention. In turn, that is preserving 500 species of plant and 10,000 species of insect.

We know from field work conducted by School of Life Sciences researchers and in-country staff measuring trees across a thousand hectares, that the conservation area is storing around 1.5 million tons of carbon. If released this would have contributed to the climate crisis. Thus, it’s also a successful climate action.

What are the key takeaways from your work in Papua New Guinea so far?

Our project has worked because it's been an action-research partnership between forest peoples on the ground, SSRP, and an amazing generation of indigenous ecological and health researchers, many who’ve come to Sussex over the years for training.

The key takeaways are that local environmental victories are possible, but they require careful long-term alliance building and multidisciplinary expertise. Importantly, where communities continue to live on the land in question, conservation of biodiversity and indigenous lifeways must be experienced as a better option than the offers of extractive industries.

What are the next steps in this research?

I am continuing to support the clinic at Wanang and evaluate its health and conservation outcomes. I am also aiming to scale-up this approach with communities at three other sites across New Guinea, providing medical services and expanding indigenous-led conservation areas. Beyond PNG, I am spreading information about this successful approach to integrating action on climate, health, and conservation SDGs, so as to encourage replication elsewhere.

To learn more about this, and related SSRP work in PNG, read these open access articles:

• Middleton, Colthart, Dem, et al. 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. BMJ Open.
• Stockdale, Middleton, Aina, et al. Mobilising Papua New Guinea’s conservation humanities: research landscape, capacity building needs, future directions. Conservation & Society.
• Middleton, Abdad, Beaucamp, et al. 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. BMJ Open. 
• Middleton, Cassell, Colthart, et al. Rationale, experience and ethical considerations underpinning integrated actions to further global goals for health and land biodiversity in Papua New Guinea. Sustainability Science.

This research supports the fulfilment of the following Sustainable Development Goals:

SDG 1 – No Poverty
SDG 2 – Zero Hunger
SDG 3 Good Health and Wellbeing
SDG 13 Climate Action
SDG 15 Life on Land

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