Virtual Seminar: Topic 1 Reading Seminar Group 2

This is a follow-on from both David and Vanessa's posts.  Its interesting reading both of them as they pick up on issues around identity.  I read Vanessa's first and thought of a paper I've often used in teaching, about the experiences of what we would consider to be post-natal depression in Black Caribbean women in the UK (I will post details of the paper during the week when I'm in the office in case anyone is interested).  The paper also ties in with the issues David discusses.  Despite the relatively high level of risk in this group of women the level of diagnosed post-natal depression is low.  This is in part due to wariness of health services and a cultural norm of being a 'strong-black-woman' and not giving in to being labelled as depressed.  One of the difficulties is how to get the balance right between encouraging people to be self-reliant and to seek help appropriately as there may be ways that medicine can improve people's quality of life that they're not aware of or taking advantage of.   

Hi Vanessa,

I found your post really interesting. I was brought up in Nairobi, Kenya and have had the experience of family members living with hypertension and diabetes. I observed a generational difference when it came to concordance with prescribed medicines. For example, my aunt died from complication related to diabetes and was quite vocal about not taking her 'western medicines'. She held a strong belief in 'folk' medicine and used these as her treatment. On the other hand, i have siblings living with hypetension and they would shudder at the thought of taking the herbs my aunt subscribed to.

Then again, I have British patients now in London who are suspicious of modern medicine and prefer what they perceive as more natural herbal remedies. This is only a personal perspective and i'll see if i can hunt down any academic papers that discuss this. Simon Singh's and Edzard Ernst's book, Trick or treatment? makes for interesting reading around alternative medicine.

Jackie

Thanks for that Vanessa, really interesting. Unfortunately, I had already written a reply but QMPLUS decided on die on me so I lost whatever I had written. Note to everyone please copy your post before clicking 'post to forum' just incase the system decides to fall asleep on you! 

Anyway, back to your post. I think as health professionals, particularly medics, we tend to over medicalise our patients and not treat their disease in a holistic manner. Non compliance is quite common amongst patients who suffer from chronic disease. I think this is because chronic disease is influenced by lifestyle factors and therefore health behaviours. Sadly, there is no drug that eliminate 'bad' health behaviours such as smoking or eating a bad diet. It's important to also ask why did these conditions develop in certain individuals and to identify how much of an impact lifestyle has had. 

Back home (Middle East), there is also a terrible issue of non compliance. Interestingly, there are also cultural and religious beliefs that affect health behaviours. For example, many will believe that illness is from God. Personally, I believe that this stems from a lack of education and a lack of public health awareness. This, in relation to the Middle East, I think is linked to the fact that there there isn't much of a platform, in terms of primary care infrastructure, to actually promote healthy lifestyle and to educate. 

Hi Vanessa,

I found your story very interesting and it reminded me of my grandfather, who is 84 now and still feels very healthy. Similar to many other senior members of Georgian sociaty, he doesn't trust prescription medication and never sees doctor as well. To say the truth, I don't remember that he has ever been ill and according to him, this is the result of one glass red wine he used to drink every day and living in the countryside. In spite of this, I believe that prescription medication is the essential part of treatment and people refusing medical treatment posing a threat  to their own life. In my opinion, people have social responsibility to co-oparte with health proffesionals and take all reasonable steps to get better.

On the other hand, because of differences between cultures and tradions, there are different social approaches to helath care. Therefore, in different regions health care system need to be relevant and characteristic in terms of their traditions, culture, religion and beliefs.

Nino

hi vanessa: some of these patients may have a point (if their BP is under 150/100)!

http://www.cbc.ca/news/health/story/2012/10/02/blood-pressure-mild-drugs.html?cmp=rss

Hi Vanessa,

In India and lots of indian communities in the UK, ayurvedic medicine is always an alternative to Western medicine. My mum (who has been here all her life) has diabetes and insists on drinking 'Bitter Melon juice' there are quite a few papers on it, and she beleives it will improve her insulin secretion as much as Metformin. 

She also had hypertension for which she drinks beetroot juice and 'white gourd' juice (an indian vegetable) and eats various other herbs! She clearly does not beleive Western medicine is enough!

I have talked to many other Indians about traditional medicine, and one person even used a strict diet to control epilepsy and said it was better controlled with the diet in addition to tablets.

However, unlike your article the people I know of from experience adhere to Western medicine but use traditional medicines synergisticly. 

There are also rumours which many people listen to which can be damaging. Such as 'rock salt can reduce hypertension in comparison to normal salt' (my parents argue with me about this everyday). As people don't understand the mechanisms of hypertension, advice like this can be damaging to people who are not well informed of their condition. 

Hi Vanessa,

This is definitely a really interesting topic. I've been meaning to post a reply since I read it. I agree with the general theme of the rest of the comments on here and I think it definitely boils down to culture. I am of Nigerian descent myself and our culture as well as strong religious beliefs than run through most of the country definitely have an impact firstly on what people will even acknowledge as being a "medical illness" and as such their adherence to medication. Even when they formally accept a diagnosis, there seems to be a preference for more familiar 'herbal' remedies which were used and seen to work for their ancestors.

Having said that, I would classify myself as a 2nd generation immigrant to this country. My parents being 1st generation. This kind of mind set seems to water down as you go further down the line. I for one would not seek herbal remedies over prescribed medication, purely now because of my education and upbringing in this country. 

In all I think doctors need to be culturally aware of the sort of people they are dealing with, which in the country will vary tremendously and thus put a lot more emphasis on educating their patients and treating them in a holistic manner in order to get the best all round results.