BOSIRE: When culture collides with your health

Two weeks ago, a female tout was arrested for a road traffic offence and deeply humiliated by police officers when she was ordered to strip so that the officers could ascertain her biological sex because she had a beard.

It must have been devastating for her to suffer such indignity because of a medical condition. This incident took me back a few years when Candace* walked into my office for a gynaecological review. She had been referred by the dermatologist, who was seeing Candace for severe facial acne, but picked out other signs that needed my attention.

Candace had suffered acne since adolescence, but it had gotten worse that year, pushing her to consult a dermatologist. When I enquired about the visible hair on her chin, she made fun of it. She didn’t understand how having a beard as a woman could possibly be a problem. Where she came from – Democratic Republic of Congo – a woman with a beard was a sign of wealth, and women with beards wore them with pride.

Candace giggled as I explained that it was a sign of hormonal imbalance that not only resulted in male pattern hair distribution, but also the acne that had brought her to the clinic in the first place.

SEEK MEDICAL CARE

These two cases are a clear demonstration of the importance of medical anthropology, which draws upon social, cultural, biological and linguistic cues to better understand factors that influence health, experience and distribution of illness, prevention and treatment of sickness, healing processes, social relations of therapy management and the cultural importance and utilisation of medical systems.

As important as it is, medical anthropology is brushed over in medical school, yet it carries a lot of weight in helping doctors understand disease patterns and health-seeking behaviour.

It helps explain why patients fail to seek care when they are unwell, fail to comply with recommended treatment options and why we sometimes end up with undesired outcomes during care.

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

Many people ail silently without seeking care because they are still able to function and are not in pain.

This is why Alice presents to us with stage four breast cancer, seeing the doctor for the first time after months of ignoring the unexplained hardening of her right breast. Or why Sylvester arrives in excruciating pain having been unable to pass urine for 24 hours, yet the problem of not being able to empty his bladder started three years ago. It is why Hosea comes to hospital with an orange-sized lump on his face, which he ignored until the tumour took away the sight in his 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 melodramatic.

Unfortunately, in the midst of these unreasonable fears, curable cancers proceed to stage four; slow bleeding in the brain causing headache and mild confusion continues to displace brain tissue moving 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.

HEALTH COVERAGE

Successful universal health coverage must be rolled out on the background of well-understood cultural practices.

These are as varied as the communities in Kenya, from the mother from Mandera who would rather lose a baby than have a Caesarean section because she and the community sees surgery as maiming, to the woman from the coast who insists on the traditional pregnancy massage that has been shown to sometimes cause pre-delivery placental separation and heavy life-threatening bleeding.

Counties like Turkana take the crown for being cognisant of the cultural nuances that influence health-seeking behaviour, by 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 also 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 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 in a progressive Kenya, it is imperative that we listen to the end users, and take into account the regional variations in culture and their impact on health-seeking behaviour and 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!