Treating Diabetes in Cameroon: A Comparative Study in Medical Anthropology

336 Pages·2015·18.34 MB·English

Treating Diabetes in Cameroon: A
Comparative Study in Medical
Anthropology
Paschal Kum Awah
(MSc)
NEWCASTLE UNIVERSITY LIBRARY
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204 26706
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Thesis submitted for the degree of Doctor of Philosophy,
University of Newcastle upon Tyne.
Research conducted in the School of Population and Health Sciences
and School of Geography, Politics and Sociology
October 2005
Abstract
This thesis presents and analyses the findings of research into the management of
diabetes in one urban and one rural district of Cameroon. The phenomenon of non
communicable diseases like diabetes mellitus is becoming a recurrent problem in middle
and low-income countries, notably in Sub-Sahara Africa. This ethnographic study, in the
tradition of medical anthropology, involved over two years of fieldwork, and has been
undertaken to shed more light on the paradoxes that underpin the interpretation and
management of diabetes in Cameroon. Initially, I set out to study how diabetes was
managed in clinical settings; but as the research developed my enquiries led out from the
clinic to encompass first the perspectives of patients and their families, and in the end the
perspectives of traditional healers also. It thus draws together four distinct sets of actors
engaged in the process of treating diabetes mellitus: clinical staff, patients, their families,
and traditional healers. In this research, I explored the ways in which Cameroonians
negotiate a meaningful and manageable path between alternative therapeutic regimes.
But as my analysis shows, behind different therapeutic approaches lie alternative
presumptions about aetiology and efficacy, about behaviour and the body.
In integrating the perspectives of the different actors identified above, the research
highlights three major themes. The first concerns the concept of 'compliance', and the
language of frustration voiced by clinic staff about patient reluctance to adhere to
medication and advice. The second concerns 'aetiology' and the ultimately incompatible
styles of reasoning and understanding advanced to explain the causes and consequences
of diabetes, including its complications and its significance as chronic and incurable in a
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cultural context where the notion of an incurable disease is still seen as unconvincing.
The third concerns ideas of 'power', and the differing ways in which power is attributed
or assumed, ranging from the apparent power of biomedical knowledge and clinic
injunctions, to the assumed power of traditional explanatory frameworks, or the powers
of divination of traditional healers, or the powers of witchcraft or ancestors in inducing
diabetes.
My thesis is unusual (a) in subject matter, (b) in its comparative scope, and (c) in being
done by a Cameroonian ethnographer. While rural Bafut has been the site of several
previous ethnographic studies, almost nothing has been done ethnographically in
Yaounde. This thesis shows that, contrary to my initial working hypothesis, the
similarities in outlook and behaviour between rural and urban settings are more striking
than the differences. The universe of the clinic and biomedicine is not more effective and
accepted in the city, as might have been anticipated, for in both settings traditional
healing beliefs continue to hold a strong influence, creating the problems around
'compliance' mentioned above.
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Dedication
I dedicate this thesis to my family: my mother (Futeh Kai Awah), my wife (Ana
Nkouetcha Awah), my kids (KaIseuh, Awah Jr, Ikaititchia and Ngando), my brother
(Awah Mbeh Azibou) and sisters (Mrs Rebecca Ihims, Mrs Ateh Evelyn, Ms Margaret
Awah, Ms Magdalene Awah).
IV
Declaration
I confirm that this is my own work and the use of all material from other sources has been
fully and properly acknowledged.
Paschal Kum A wah
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Abbreviations
AIDS: Acquired Immuned Deficiency Syndrome
ANSA: Action on Non-communicable diseases in Sub-Sahara Africa.
BP: Blood Pressure
CHC: Catholic Health Centre
CHU: Centre Hospitaliere Universitaire (University Hospital Centre)
DFID: Department For International Development
DH: District Hospital
OM: Diabetes Mellitus
DMO: District Medical Officer
DO: Divisional Officer
EBHC: Etoug Ebe Baptist Health Centre
Ed: Editor
Ed(s): Editor(s)
ENHIP: Essential Non-communicable Diseases Health Intervention Project
EPC: Eglise Presbyterienne Camerouniase
EPCH: Eglise Presbyterienne du Cameroun, Hopital de Djoungolo Annexe de
Biyem Assi
FGD: Focus Group Discussions
HIV: Human Immuno-deficiency Syndrome
Hrs: Hours
HT: Hypertension
101: In-depth interviews
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IEC: Information, Education and Communication
KI: Key Informants
MOH: Ministry of Health
NCO: Non-communicable diseases
NGO: Non-governmental organisation
PHC: Presbyterian Health Centre
RAP: Rapid Assessment Procedure
SSA: Sub-Sahara Africa
WHO: World Health Organisation
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Table of contents
Page
Title
Abstract ii
Dedication iv
Declaration v
Abbreviations VI
Table of contents viii
List of Figures XII
List of Maps xiv
Note on orthography xv
Acknowledgement xv
Chapter I - Introduction
1.1 Introduction 2
1.2 Aims, objectives, purpose and research questions 4
1.3 The problem of diabetes in Cameroon 9
1.4 Summary of main arguments 11
1.5 Outline of the thesis 15
Chapter II - Background to Two Fieldwork Settings 20
2.1 Introduction 21
2.2 The two study settings: an introduction 23
2.2 Biyem-Assi 25
2.2. J Historical background 28
2.2.2 Current administrative and political structures 30
2.2.3 Earning and spending: work, markets and consumption 33
2.2.4 Urban-rural links and family structures 35
2.3 Bafut. 37
2.3.1 Historical background to the Bafot kingdom 40
2.3.2 The political and administrative structure of modern Rafot 43
2.3.3 Earning and spending: work, markets and consumption 46
2.3.4 The ritual calendar in Bafut 48
2.3.5 Urban-rural links andfamily structures 57
VIII
Chapter III - Methodology 61
3.1 Introduction 62
3.2 Access and data gathering 64
3.3 Data sources and data types 72
74
3.3.1 Observation
3.3.2 Conversations and interviews 74
3.3.3 Focus group discussions (FGD) 75
3.3.4 Transcription and analysis 79
3.3.5 Language offieldwork 81
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3.4 Social interaction
3.5 Comparison between doing fieldwork in Yaounde and Bafut 85
3.6 Insider and outsider - home anthropologist 89
89
3.6.1 Doing anthropology at home
3.6.2 The strange scientist-doctor 92
93
3.7 Local power relations in this ethnography
3.8 Concluding discussion on fieldwork 95
Chapter IV - Chapter IV - Literature Review 101
4.1 Introduction 102
4.2 Epidemiology of diabetes in sub-Saharan Africa 104
4.3 Medical sociology and anthropology in West and Central Africa 112
4.4 Ethnography of Cameroon 119
4.4.1 Historical Overview 120
4.4.2 Yaounde 123
4.4.3 The Grassfield and Bafot 124
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4.5 Concluding note on literature review 130
Chapter V - Case study 131
5.1 Taa Samuel Ntumngia, his status in Bafut, my connection to him 132
5.2 Setting up of Diabetes Association 134
5.3 His illness and death 135
5.4 The funeral, Takumbeng and the Fon 138
5.5 Themes 141
5.6 Conclusion 143
Chapter VI - Clinic perspectives on treating diabetic patients 145
6.1 Introduction 146
6.2 Treating diabetes: clinical settings and procedures 148
6.3 Staff-patient relationships 158
6.4 Issue of compliance and non-compliance 169
6.5 Conclusion 175
Chapter VII - 'If they were not there, we would have died'. Patient 177
and family perspectives of diabetes
7.1 Introduction 178
7.2 Popular understandings of diabetes 179
7.3 Adapting to life with diabetes 195
7.4 What does 'compliance' mean? Dealing with competing regimes of 209
treatment
7.5 Conclusion 216
Chapter VIII - The perspective of traditional healers 218
8.1 Introduction 219
8.2 Who are the 'traditional healers'? 221
8.3 How traditional healers explain diabetes 229
8.4 Healing practice: carrying conviction for patients 243
8.5 Relationship between traditional healers and clinic staff 245
8.6 Traditional authority and the reproduction of knowledge about diabetes 248
8.7 Conclusion 254
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