CULTURE AND YOUR HEALTH

A few years back, a young lady walked into my office for a gynaecological review, having been referred by the dermatologist. It was a hot January afternoon, with the sun blazing hot and air so still, that all one wants to do is doze off like a well fed lizard. Candace* was a welcome distraction from the heat. She was so cheerful and bubbly in an infectious way, making fun of herself while describing her complaints.

The referring dermatologist had seen Candace for severe facial acne but had picked out other signs that needed further care. Candace reported having had acne since her adolescent years and she thought that it had gotten worse in the past year, necessitating a visit to the dermatologist.

When I enquired about the obvious hairs on her chin, she was full of mirth. It came as an utter shock to her that having a beard as a woman could possibly be a problem. You see, Candace was from the Democratic Republic of Congo. In her country, a beard in a woman was a sign of opulence and wealth. For this reason, women wore them with pride!

Two weeks back, I read an article in a local daily about how a female tout, having been arrested for a road traffic offence, was deeply humiliated by police officers at the police station, where they ordered her to strip naked for inspection regarding her gender because she had a beard. I couldn’t imagine how devastating it must have been for her to suffer such indignity because of a medical condition.

While Candace merrily giggled at the thought that she was suffering from hormonal imbalance that resulted in the development of acne and male pattern hair distribution, the opposite was happening to this lady at the police station because of difference in culture. These two cases are clear demonstration of the importance of medical anthropology.

According to the Society for Medical Anthropology, Medical anthropology is defined as a subfield of anthropology that draws upon social, cultural, biological, and linguistic anthropology to better understand those factors which influence health and well-being, the experience and distribution of illness, the prevention and treatment of sickness, healing processes, the social relations of therapy management, and the cultural importance and utilization of pluralistic medical systems.

To us as medical practitioners, this is a field that is poorly taught in medical school yet carries a lot of weight in understanding disease patterns and health seeking behavior. It helps explain why patients may fail to seek care when they are not well, fail to comply with recommended treatment options and why we may sometimes end up with undesired outcomes during care.

It took a lot of explaining to Candace to appreciate that she suffered polycystic ovarian syndrome, a condition that resulted in hormonal imbalances that caused her acne, the abnormal hair distribution and her irregular menses. She was then able to fully participate in planning her care from an informed point.

In a resource-poor setting, many people ail silently without seeking care because they are still able to function and are not in pain! This is the reason why Alice presents to us with stage four breast cancer, being the first time she has bothered to see a doctor after months of ignoring the unexplained hardening of the right breast. Or why Sylvester comes in excruciating pain from complete inability to pass urine for 24 hours yet for the last three years he has been struggling to difficulty in emptying the bladder. Or why Hosea comes to the hospital with an orange-sized lump on his face, which he has completely ignored until the tumor has taken away his sight in the left eye.

Many people carry a deep-seated notion that seeking medical care in the absence of pain or severe complications is akin to being a bother. Men are scared of being regarded as sissies while women do not want to be seen as histrionic. Unfortunately, in the midst of these unreasonable fears, curable stage cancers proceed the onward march to stage four; slow bleeding in the brain causing headache and mild confusion continues to displace the brain tissue towards a definite coma; and the irritating post-menopausal vaginal bleeding is first mentioned two years later, when the cervical cancer is the size of a cauliflower with foul, infected, smelly vaginal discharge.

Successful universal health coverage must be rolled out on the background of well understood cultural practices in Kenya. These are as varied as it gets, from the Somali community where a mother would rather lose a baby than have a caesarian section as surgery is almost equated to maiming her; to the coastal community pregnancy massage to prepare for birth, which has been shown to sometimes cause pre-delivery placental separation and heavy life-threatening bleeding.

It is in this vein that Turkana County today takes the crown for providing a modified traditional birthing stool to allow women to deliver in hospital but in the birthing manner that they are accustomed to at home. This has increased the number of births taking place under the care of skilled medical providers, averting death and severe morbidity. It is obvious that providing free maternity services is not always enough incentive to discourage unsafe home births.

Health policy makers can borrow a leaf from the Coca Cola Company. Upon successfully launching the two-litre coca cola bottle, they couldn’t understand why it wouldn’t sell as anticipated in Mexico, a country where they sold millions of litres of soda annually. It took a local Mexican to tell them that in Mexico, most homes had small refrigerators that could not accommodate the two-litre bottle for purposes of chilling it.

As we discuss access to healthcare as a major pillar of universal health care, it is imperative that we listen to end user, the regional variations in cultures and its implication on health seeking behavior and its impact in service uptake.

Candace may have gotten help but thousands of Congolese women will continue to walk around with hormonal imbalance proudly displayed as a good luck charm in form of a beard. This must not be our portion!