Written By

Nicolette Ward


College of Medicine and Dentistry

Publish Date

10 September 2021

Related Study Areas

Hailing from the Highlands of Papua New Guinea, College of Medicine and Dentistry recently completed PhD candidate and Registered Nurse, Rachael Tommbe, has made it her mission to help improve sexual health and wellbeing in PNG.

Rachael recently conducted a sexual health education project called Strongim Meri Lida, which translates from Tok Pisin as ‘Strengthening Women Leaders’, in collaboration with JCU Associate Professor Michelle Redman-MacLaren.

“Traditionally, sexual health and wellbeing are culturally and religiously sacred and taboo topics that are not openly spoken about in PNG,” said Rachael. “The topic is considered as being almost offensive. As a result, women are hesitant to talk about such issues amongst themselves; mothers don’t even talk about it with their daughters.

“However, when necessary, women will seek advice on these kinds of issues by asking women in their community who they look up to, and who act as informal leaders in their community. Providing accurate sexual health education to these informal women leaders is really important because most of the current support around sexual health is provided through these kinds of informal social conversations.”

Researchers Rachael Tommbe and Dr Michelle Redman-MacLaren
Meri Lida Education Particpants
Rachael Tommbe and Associate Professor Michelle Redman-MacLaren research ways to improve sexual health in Papua New Guinea.

Local women as informal leaders

While women in rural PNG do not commonly hold formal positions of power within the community, often it is their role as spouses or partners to male community leaders, such as pastors or teachers, that carries authority, says Rachael.

In fact, it was the female partners of male university students studying at the Pacific Adventist University (PAU) in PNG who in 2018 first approached Michelle and Rachael, who is also a senior lecturer for the nursing program at PAU, with a request for sexual health education training, so that they could be better prepared to help women in their community when asked for help or advice on such issues.

In partnership with researchers at PAU and sexual health consultants from PNG’s National Department of Health, Michelle and Rachael devised a sexual health and wellbeing educational training package for the women’s unique social and cultural context. The training was then delivered by Rachael, with assistance from PAU’s Claire Kokinai and sexual health consultant Kelwyn Browne.

“Many of these women knew little about the basics of sexual health so we included education about the female anatomy and the role of sexual and reproductive organs,” said Rachael. “But we also covered a lot of other topics in the two-day program relating to sexually transmitted diseases, women’s self-care, communication skills to deliver sexual health information to family members and community, and the importance of taking on a women’s leadership role in the community.”

“These women then had the self-confidence, knowledge and support to communicate this knowledge to their husbands, their children and, also importantly, to the women in their community.”

Building confidence and empowering with knowledge

“What we have seen from the workshops is that these women feel empowered to speak about sexual health issues that previously they would have been too afraid or too embarrassed to comment on,” Rachael said.

It is hoped that the Strongim Meri Lida project will have a longer-term impact on rigid, culturally prescribed gender roles and assist in bringing social and cultural change to gender relations in the developing Pacific nation.

“What we are doing is challenging the gender norms in a way that empowers women by giving them information to safely communicate with their spouses and the community about sexual health and wellbeing,” said Rachael.

“Many of the women on the training program also asked for more detailed information on certain topics such as STIs and transgender sexuality, so that they can then pass that knowledge onto their male spouses or partners who continue to hold positions of being the community leaders, especially for male members of the community.”

The Meri Lida team: Rachael Tommbe, Kelwyn Browne and Dr Michelle Redman-MacLaren
Group of young Papua New Guinea people
Meri Lida team; Rachael Tommbe, Kelwyn Browne, Dr Michelle Redman-MacLaren (L to R)

Polygamy and sexual violence

Another important aspect of the sexual health education project has been how the common practice of polygamy in PNG impacts on sexual health issues, such as STIs, HIV transmission and sexual violence.

“Many husbands in the Highlands of PNG have more than one wife, some even having up to five wives. Traditionally this practice was common for the village chiefs, so as to guarantee more male children who were needed to protect the community from tribal enemies. However, the traditional practice of polygamy very much continues in PNG contemporary society as a sign of status and wealth. In fact, some professional women even prefer it if they are wife number four or five as they don’t get ‘bothered’ as much by the husband.

“On the other hand, it can also create a lot of problems, especially if the husband spends more time with the youngest or the most recent wife. Often in this case, the other wife/wives will manage her own sexual energies by having a sexual life independent of the husband. But this practice is often not accepted by the husband, who may retaliate with violence.

“Sadly, violence is quite commonly part of a woman's sexual experience in PNG. So when it comes to sexual health, we really need to be having an impact on both women and men, which this project has the potential to do.”

Reducing HIV and STI transmission

HIV transmission is an ongoing area of concern in PNG which continues to have the highest rate of HIV infection in the Pacific region.

“Obviously the practice of polygamy, of having multiple sexual partners, increases the risk of HIV transmission, as well as rates of sexually transmitted infections (STIs).

“So the issue of sexual health in PNG is quite a complex area, and there is a lot of information that needs to be included in the Strongim Meri Lida education curriculum without overwhelming the participants who are mostly women from villages and smaller communities.”

In the future, Michelle and Rachael, as lead program coordinator, are hoping to roll out the Strongim Meri Lida workshops across the country by partnering with women’s ministry groups within the network of churches that feature strongly in PNG society.

“Church groups are well established in PNG communities,” said Rachael.  “People in PNG tend to trust their church and the programs they provide, and most people tend to gather together at the churches. We feel it is more powerful for the success of the Strongim Meri Lida project to work with these local, church-based, grassroots communities.”

Using the Meri Lida Model for Covid-19 health information

Rachael has also been leading a collaborative joint venture between JCU’s College of Medicine and Dentistry and PNG’s Pacific Adventist University, to further utilise the Strongim Meri Lida model of education within PNG to share accurate information relating to Covid-19.

She has also recently completed her PhD at James Cook University, focusing on the capacity of health systems within PNG to support the male circumcision practice that has been linked to reducing HIV transmission rates.

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