Treating diabetes in Cameroon : a comparative study in medical anthropology

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 noncommunicable 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 11 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.