When darkness falls at mid-day: Young patients’ perceptions and meanings of chronic illness and their implications for medical care

Background: This study illustrates the perceptions and meanings that patients who have had the onset of certain chronic diseases at young adulthood ascribe to their condition of chronic illness. The paper further examines the implications of such perceptions and construction for medical care.Design: Qualitative and ethnography.Setting: Outpatient chronically ill patients were recruited from the Korle Bu Teaching Hospital, Accra Ghana. Patients were followed up and studied in-depth in their homes.Participants: Purposive sample of 24 consenting patients diagnosed of cancer, renal disease and stroke.Methods: Anthropological data collection techniques mainly in-depth interviews, narratives, conversation and observations were used. Issues explored included patients’ perceptions, causal explanations, meanings ascribed to diagnosis, and search for treatment and cure.Results: Young adults had very low knowledge of chronic illnesses and did not consider themselves at risk to chronic diseases. The search for diagnosis, upon the presentation of symptoms, was long and winding. Families of young patients were more likely to make future search for “spiritual diagnoses” than elderly patients and their families. Keeping silent and maintaining secrecy about diagnosis are important ways by which young adult patients cope with their condition. Irrespective of the prognosis, young patients nurture a strong hope of cure.Conclusion: Young adults diagnosed of certain chronic illnesses ascribe supernatural interpretations to their disease condition. These determine their attitude to their condition as well as health seeking behaviours adopted by them and their families. Responses interfered with their biomedical care and thus have implications for health promotion and healthcare planning and policy.Keywords: young adulthood, chronic illness, causal explanation

Book Review: Medische Antropologie.

Journal about Culture and HealthJaargang 22, Nummer 1, 2010Special issue: Care and Health CareTheme editors: Anja Hiddinga, Jeannette Pols, Deanna Trakas and Sjaak van der GeestSingle copy: € 20.ISSN 0925-437

Guide for in-depth interview.

Induction of labour (IOL) has become a major and vital maternal health intervention to facilitate childbirth and minimize the rising caesarean section rates globally. However, there is limited information to facilitate appropriate client counselling, birth preparedness and informed decision making although the procedure has inherent tendency for adverse maternal/perinatal outcomes. Given the need for optimal client education and shared decision making in maternal health, this study explored women’s knowledge and their lived experiences of IOL. This qualitative study used in-depth interviews, conducted at the largest teaching hospital in Ghana. Purposive sampling was used to recruit the study participants. Data analysis was performed based on thematic content using inductive framework synthesis. We included 17 women who had undergone IOL, delivered and discharged. Most participants(52.9%) were ≥30 years old, married(88.2%), and 41.1% had no previous childbirth experience. The main indications of IOL were postdate(47%), pre-eclampsia(29%) and gestational diabetes mellitus(11.8%). Data synthesis resulted in three broad themes: women’s knowledge on IOL, women’s experiences of care and women’s difficult experiences including coping mechanisms. We determined mixed responses concerning the themes explored: adequate versus inadequate knowledge; positive versus negative experiences of care and satisfaction. Nearly all women mentioned vaginal examination as their most difficult experience due to severe pain, extreme discomfort, and being psychologically traumatic. The main coping strategy the women developed to navigate the traumatic vaginal examination was by “psyching” themselves. Our study indicates women encounter significant negative and positive experiences during IOL and childbirth in Ghana with vaginal examination cited as the most painful experience. Appropriate antenatal counselling, women empowerment and pre-labour education on childbirth processes and expectations are recommended to enhance birth preparedness and complication awareness. Health system improvement and regular refreshers courses for health workers are urgently required to promote positive women’s experiences of care during labour induction and childbirth.</div

Socio-demographic characteristics of women who had induction of labour.

Socio-demographic characteristics of women who had induction of labour.</p

Socio-cultural Determinants of Human-Bat Interaction in Rural Ghana

Bats are known to be a natural reservoir for a lot of disease pathogens and can spread several diseases. All 11 genera of fruit bat found in West Africa are found in Ghana, and human–bat interactions are common. However, there is a dearth of knowledge about the socio-cultural factors that shape these interactions. This paper explores the socio-cultural factors that bring humans into contact with bats. Data were obtained through focus group discussions and in-depth interviews. The findings indicate that gender, religious affiliation, and belief systems influence the interaction between humans and bats. We conclude that the hunting and consumption patterns of bats have farreaching consequences for the transmission of bat-borne zoonotic diseases. Educational campaigns, therefore, should be intensified and, in particular, target groups that are most at risk of contracting bat-borne zoonotic diseases