OBJECTIVES: Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. DESIGN: Clinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. SETTING: Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. PARTICIPANTS: 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f<40 years; m<40 years; f>40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. RESULTS: Of 113 examined, 11 were 'well' (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) 'malaria', (B) 'sotwin', (C) 'grile') translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. CONCLUSIONS: This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang's community to develop sustainably, without sacrificing their forest home.

Clinical Informatics Research Unit Faculty of Medicine University of Southampton Southampton UK

Department of Anthropology University of Sussex Falmer UK

Department of Ecology and Evolution University of Sussex Falmer UK

Department of Environmental Engineering and Renewable Energy School of Environment and Climate Change Papua New Guinea University of Natural Resources and Environment Kokopo Papua New Guinea

Department of Primary Care and Public Health Brighton and Sussex Medical School Watson Building University of Brighton Falmer UK

Department of Zoology Faculty of Science University of South Bohemia in Ceske Budejovice Ceske Budejovice Czech Republic

Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine London UK

Health and Nutrition Research Cluster Institute of Development Studies Falmer UK

Hospital for Tropical Diseases and Department of Dermatology University College London Hospitals NHS Foundation Trust London UK

Institute of Entomology Biology Centre Czech Academy of Sciences Ceske Budejovice Czech Republic

Medical Statistics Brighton and Sussex Medical School Watson Building University of Brighton Falmer UK

New Guinea Binatang Research Centre Madang Papua New Guinea

Papua New Guinea Institute of Medical Research Port Moresby Papua New Guinea

PNG Institute of Medical Research Goroka Papua New Guinea

School of Applied Sciences Cockcroft Building University of Brighton Brighton UK

Wanang Conservation Area Wanang Papua New Guinea

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