Academic journal article MACLAS Latin American Essays

Medical Conflicts: A Comparison of the Folk and Biomedical Models of Adult-Onset Diabetes in Jamaica

Academic journal article MACLAS Latin American Essays

Medical Conflicts: A Comparison of the Folk and Biomedical Models of Adult-Onset Diabetes in Jamaica

Article excerpt

Introduction

Improvement in the standard of living frequently results in changes in the incidence of diseases in a country. In particular, chronic diseases begin to surpass the incidence of infectious diseases. An example of this is found In Jamaica. The chronic disease, diabetes mellitus, also known as Adult Onset Diabetes (AOD), affects approximately 200,000 Jamaicans or one in five people of the population (UDOP 1994: Jackson 1995a,b).

As with many chronic illnesses which require both medical supervision and day-to-day self-monitoring, patient compliance with a long-term regimen is necessary for satisfactory treatment of AOD. Non-compliance for diabetic patients is a well-known problem of a complex nature. While it does not appear to be related to socio-demographic characteristics, personality traits or knowledge of the disease itself, awareness of the therapeutic plan is necessary, though not sufficient, for compliance (Dunbar and Agras 1980; Rainwater 1983; Mathews and Hingson 1977; Surwit et al. 1983; Lawrence and Cheely 1980; Schmidt 1977; and Watts 1980; Fisher et al. 1982; Jenny 1983; and Strowig 1982).

Factors militating against compliance are complexity of regimen and a high degree of behavioral change required, particularly when such changes go against local norms for lifestyle practices such as diet, exercise, tobacco and alcohol use, body image, and self-medication with "bush teas" (ethnobotanicals) (Houpt et al. 1979; Matthews and Hingson 1977; Rainwater 1983). Factors associated with compliance include a positive doctor-patient relationship, familial support system, and especially patient belief in the severity of the disease and the efficacy of the treatment (Watts 1980).

Increased compliance may require successful communication of essential information at all stages: testing, diagnosis, etiology, prescription, nutrition, treatment of related symptoms, and follow-up examinations. Research conducted by Alleyne et al. (1989, 1991) and Payne-Jackson (1995-97) has shown that Jamaican patients underestimate the seriousness of the disease, have only some knowledge of it, and report being given little information by health workers.

In order to begin to understand where potential problems may occur in terms of communication and understanding between doctors and patients, this paper focuses on three aspects of AOD: symptoms, etiology and treatments. In this paper, a brief overview is given of the biomedical model of AOD and the folk medical system. The results of research concerning patients' perceptions of who can treat AOD as well as symptoms, causes, and treatments of AOD are reported. In conclusion, the implications of the findings are presented.

Methodology

Data for this paper were collected as part of research conducted in Jamaica from 1995-1997 by Dr. Payne-Jackson.(1) A total of 94 patients from six diabetic clinics across the island were interviewed in the summer of 1995. The length of time patients had known that they had diabetes was from one year to over 30 years with half the patients having AOD for 15 years or more. Seventy-five percent of the sample was women and twenty-five percent men.

Data on etiology, treatments and practitioners were collected using free listing, a method used to determine the parameters of a cultural domain. In addition, patients were asked questions about: (1) the nature of their illness, (2) how long they had had AOD, (3) the severity, etc. (cf. Kleinman 1980), (4) questions concerning lifestyle factors affecting diabetes (diet, exercise and body image), and (5) a module on communication.

In the summer of 1996, thirty-one patients were asked free listing questions about symptoms, treatments, starchy foods, bitters, bush teas for sugar, and bush teas for sweet blood. In addition, twenty-one individual in-depth interviews were completed with diabetic patients from three clinics in Kingston, (private, public and a non-government organization). …

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