adherence to previously unknown zoonotic diseases. In other words, this intercultural diagnostic study showed that incorporating traditional medical system approaches facilitated compliance with biomedical response protocols that were otherwise too novel and frightening for indigenous patients. In the above-mentioned case, the woman was treated in a hospital for leptospirosis and brucellosis after laboratory confirmation, but was previously treated for ‘susto’ by the Maya Ajkum, having refused to go to the hospital without her spirit being called back first. For this approach to elicit respect and avoid promoting further divides, social scientists carefully designed and guided the exchanges to facilitate a process for mutual learning between the different kinds of health practitioners and research disciplines by attempting to understand each other’s emic views on human–animal disease transmission. These diverse understandings and their implications were used to stimulate discussions across explanatory models within the research team and with transdisciplinary partners.
Outcome
The analysis of the ‘pilot’ intervention undertaken as a local proof of concept was presented in workshops fed into a larger ‘scale-up’ intervention design. These interdisciplinary workshops and conferences were aimed at promoting the One Health approach to community surveillance at a national level.
Case study 3 illustrates a grounded open-ended adaptive approach to local identification of problems by the community and local health workers, and a co-creation of knowledge and interventions. It illustrates the existence of differing world views on the problems identified and the need to approach health and well-being in a transdisciplinary manner, recognizing the interwoven concepts of human lives, animal lives and the environment affecting health.
Case study 3. Atoifi Health Research Group (AHRG) – how a One Health social science approach is being used in the remote Solomon Islands. Contributed by David MacLaren and Humpress Harrington, James Cook University and AHRG and Chief Esau Fo`ofafimae Kekuabata, AHRG and Kwainaa’isi Cultural Centre.
Background
AHRG is a group of health researchers, health service professionals and community members committed to investigating locally appropriate ways to improve health and well-being in remote locations across the South Pacific Nation of Solomon Islands. Solomon Islands has 600,000 people, who belong to 80 different indigenous language groups. The majority (85%) of the population live in rural/remote villages located on tribal/customary land and are sustained through the subsistence economy or via remittances from family members who work in urban areas. Villages are located across the rainforest mountains, fertile valleys, coastal beaches and coral atolls. AHRG does much of its work in the remote East Coast of the Island of Malaita. Although only 120 km long and 30 km wide, the island of Malaita has ten distinctly different language groups, each following their own cultural traditions on their distinct tribal/customary land.
The AHRG is committed to a learn-by-doing approach to research that centralizes capacity building to enable Solomon Islanders to incorporate diverse social, cultural, spiritual and geographic contexts. This approach has been successfully used for more than a decade to address several social and health problems. (For more details, resources and videos of the AHRG work, see https://www.atoifiresearch.org.sb/ (accessed 15 July 2019).) The AHRG is a transdisciplinary partnership between academic researchers, health service professionals and community leaders that jointly identify local health issues, jointly design locally appropriate studies, jointly record results and jointly inform locally appropriate action. A One Health social science approach characterizes the AHRG and enables a detailed and nuanced understanding of the human–animal–environment interface in specific locations. Because of the hyper-diversity that exists across humans, animals and environments in relatively small geographic locations, the group advocates two mantras: ‘small is beautiful’ and ‘one village at a time’. Thus, the researcher-service provider–community leader network that makes up the AHRG combines skills and approaches to investigate human, animal and environmental issues concurrently or sequentially, and supports cross-village learning. The social sciences are purposely embedded into the design of health studies designed and conducted by the group. This deliberate approach allows for a nuanced practical and theoretical understanding of infectious and non-infectious diseases in their local contexts in order to design or influence the provision of health services to their communities. Use of social sciences allows for the deliberate investigation and incorporation of culture, gender, spirituality, economics, ecology, cosmology, politics, history and indigenous knowledge. Through these lenses, family and household structure, gender, land use, food production, domestic and wild animal ownership/usage, religious and philosophical worldviews, traditional and contemporary political organization, cultural communication, local and external economics, personal and collective hygiene and sanitation and gender roles are incorporated into health and well-being projects. It is our experience that these are all fundamental to subsequent human, animal or environmental action. Examples include the following.
Soil-transmitted helminths
Social science was embedded from the very beginning of our soil-transmitted helminth studies. How villages were engaged in the studies was part of their success. Village engagement included: (i) open community information sessions during church gatherings; (ii) social, cultural and gender considerations for human and animal faeces collection, testing, transport and disposal; (iii) feedback of results to villagers through village forums; and (iv) discussion of location and design of water and sanitation actions to reduce parasite transmission. Local actions to improve male and female toilets, including their design and location in villages, were informed by local cosmological designation of ‘male’ or ‘female’ appropriate locations (Harrington et al., 2015; Bradbury et al., 2017, 2018). For documentaries on how social science was purposely embedded in the design and conduct of the studies see: Parasites in Paradise: a Soil- transmitted Helminth Survey in Marovo (available at: https://youtu.be/ZRzg4C7Mmas) and Toilets and Taboos in the Tropics (available at: http://www.youtube.com/watch?v=FMtc3f6xESU) (both accessed 15 July 2019).
Traditional knowledge of medicinal plants
In the face of large-scale logging in many parts of Malaita, many of the communities involved in the project wanted to preserve areas of the rainforest as a ‘living pharmacy’ to sustain health and well-being for the humans, animals and environment. Social science was embedded throughout this project to document the taxonomy of rainforest plants used by local people for medicine and food. The project worked with local tribal groups in order to document local knowledge of medicinal rainforest plants and create a bilingual book (Kwaio language and English) and set of videos as a health education resource for the community and outsiders. The success of this project was dependent on intimate knowledge of the land ownership structures, local political leadership, gendered knowledge systems, access to remote parts of the rainforest and support for local archive systems at the Kwainaa’isi Cultural Centre. Subsequent action by the community saw the formation of conservation areas designated by local ancestral spiritual decrees that blocked commercial logging as a way to conserve plants and animals in these locations. The conservation areas are managed locally by tribal leaders on their own tribal land and act as an example of the One Health human–animal–environment interface (Esau and the Kwaio Medicinal Plants Project Team, 2015; Atoifi Health Research Group, 2018). Short videos from the medicinal plant project are available at: https://www.youtube.com/playlist?list=PL-m8H163iwTAxHB7bg4JJTfZWlmHyHLSj (accessed
