Culturally Appropriate Health Care in Kwaio, Solomon Islands: An Action Research Approach

Abstract

The Kwaio people of central Malaita, Solomon Islands who retain the culture and religion of their ancestors, face a stark choice when seeking treatment at Atoifi Adventist Hospital—relinquish fundamental precepts of Kwaio culture and religion by entering the hospital, or remain true to Kwaio beliefs and stay away. Many choose the latter. The result is considerable untreated acute and chronic illness and preventable death. For people who have converted to Christianity Atoifi Adventist Hospital poses fewer cultural barriers and is one of the most respected and best equipped hospitals in Solomon Islands. However, for those who have chosen not to become Christian, the ongoing exclusion they face has resulted in antagonism and mistrust between their community and Atoifi. This thesis describes and analyses the colonial-Christian discourse in which the hospital was established and action taken to achieve a long held desire of many Kwaio people—a facility at Atoifi where health services are attainable without the rejection and desecration of Kwaio culture and religion. Using a Participatory Action Research methodology that challenges the dominant colonial-Christian paradigm, this study seeks to understand the nature of Participatory Action Research through its pursuit of culturally appropriate health services at Atoifi. This thesis outlines how the research process brought together a disparate collection of groups and individuals to analyse the oppressive situation at Atoifi and propose action to establish a culturally appropriate health facility there. It describes how, in the final stages of the participatory planning process for the facility, Atoifi was thrown into crisis when its Australian business manager was murdered on campus. The resultant near collapse of hospital services and the tenuous relationship between the hospital and the local community required the facility be re conceptualised. A local village health worker, a key collaborator in the research process, who had established a culturally appropriate health post in the mountains fifteen years previously was central to this re-conceptualisation. He coordinated local community action which eventually led to the community funding and constructing the facility at Atoifi. This facility does not require the rejection or desecration of Kwaio culture to access health services at Atoifi. The implications of using Participatory Action Research as an anti-colonial methodology and its utility in addressing oppressive situations such at that at Atoifi are discussed in the final section of the thesis. The methodology’s application and ability to facilitate significant personal and social change are embedded in the emancipatory theory established by Paulo Freire. The importance of participative processes which work with people not on or to people is discussed as well as the importance of embracing flexibility and complexity, rather than attempting to control. Reflecting on Freire’s work, the thesis finally analyses how love of people can act as a foundation for commitment to others through dialogue and participation and how, based on this, praxis has the ability to liberate oppressive situations such as those faced by the Kwaio at Atoifi.