Diagnosis of Diabetes and Health Issues - Research Paper Example

Analysis The method of analysis for this study is qualitative meaning information based on s of experiences and events. Thisprovides for an analysis that can be explained in day-to-day language, summarizing events and what they meant to participants. Specific patterns and themes were identified from the answers given that provided an accurate summary of the experiences of this group and their shared disease. The information identified was then used to surmise methods of improvement so that the overall experiences of other people in this ethnic group suffering from diabetes become more positive and much less frustrating. Results Diagnosis of Diabetes The first question in this survey simply asked patients to list the age at which they were diagnosed with diabetes. The participants in this group were diagnosed with Type 2 diabetes at ages ranging from 31 to 50, the youngest being a woman who initially developed Gestational diabetes during a pregnancy. Eighty-four percent of the participants were diagnosed when they were in the range of 40 to 49-years-old, supporting the evidence showing that this type of diabetes is most commonly found in adults. Answers referring to the diagnosis of the participants show a trend that most people are unaware that they even suffer from the disease until they are diagnosed by a medical professional. Participants were asked how they were diagnosed with diabetes with the second question of the survey. Almost half of the surveyed group – forty-eight percent – went to their general practitioner based on symptoms that the patients recognized as possibly being linked to diabetes because of family members with the disease or for symptoms ranging from wounds that would not heal to dizziness to rapid weight loss or gain. Glucose tests were then performed to diagnose the disease. Conversely, the other fifty-two percent of the participants were surprised by a diagnosis of diabetes. Three women developed Gestational diabetes during or after pregnancies when no history of the disease was present. The other ten participants were all incidentally diagnosed because of other health problems. Half were being hospitalized for other illnesses and blood tests showed abnormal glucose levels. The other half was having routine blood tests, pre-surgery blood tests, and even an insurance screening when their diabetes was diagnosed. Thus, while almost half of the group was aware of present symptoms of the disease, over half had no idea they had any blood glucose abnormalities until the lab test results were stumbled upon. This half of the group was therefore surprised and shocked by such a diagnosis and ill-prepared to make sudden lifestyle changes in order to cope. Treatment of Diabetes Participants in this survey were asked in questions five and six whether they actively took a role in designing their treatments plans and if alternative treatment options were discussed. Almost half of the participants stated that they played no active part in their treatment for a variety of reasons. One important ethnic and cultural problem arose in a lack of communication. Many Lebanese immigrants in Australia do no speak English well and therefore do not completely understand the disease and its implications, as can be seen by more than one participant in this study: Somebody should explain in my language what I shouldnt do, but there is no one from our community there. So it is very difficult to understand how things should be. They do tell us to make changes in the diet, but they assume that we know all, but the kind of foods that we eat and the kind of advice that they give makes a big difference you know. In most cases, they are clueless why despite doing everything, my weight is increasing or my sugars are not going down. It becomes more difficult when they say they have no time, what they fail to understand is that if they have no time, we have only God to take care of us, who is not always available for people like us. (Participant 9) This participant specifically states that language is a key barrier in his understanding and treatment of diabetes and is frustrated by the lack of availability of resources that will better educate him on the subject. Management of Diabetes Another major problem involving communication revolves around the exchange of information between doctor and patient regarding the management of diabetes. It was frequently stated that doctors simply did not have enough time to sit down and patiently explain the disease, its complications, and its treatment. Patients were directly told to take a specific medication, lose weight, exercise more, and make other specific lifestyle changes in order to maintain appropriate glucose levels: I already told that one of the important needs at my level for smooth management of this problem is education. My GP does a good job in taking good care about me, but I feel even there my need for being educated about the disease is lacking there. Rather than simple advice of exercise, diet, medicines, and side effects of these medications, I often felt that most of these treatments are imposed on me. I could never really feel that I am a part of it. I also feel that I could do better in terms of food if my GP would involve me in the diet plan based on my choices. (Participant 3) Unfortunately the participants in this group feel imposed upon when they are told they must do something but are not given reasons as to why they should do so, as is often the case. If a person does not understand the reason behind an action, it is unlikely he will perform it if it is outside of his comfort zone. Patients do not understand the importance of testing their blood sugar often. Finger sticks can be quite painful and many doctors never ask to see home records of blood glucose levels. Subsequently, patients feel testing is pointless because the results are inconsequential to them and seem to be of no use to their doctors. The diabetic Lebanese participants want to be talked to about their disease. They feel they are not involved in their treatment and healing if they do not understand the mechanisms behind the disease. Telling someone and showing him are two different things and being told to do something that is uncomfortable and inconvenient is not a practical option for this group. It is crucial that they understand exactly why they are being told to change major aspects of their lives. Their level of activity will change along with the foods that they have grown up eating as well as the painful process of testing blood glucose levels and injecting insulin. It is important that doctors understand that these are not life changes easily made by this ethnic group because their culture revolves much around the areas that need altering. For the majority of this survey group they are being told to change aspects of their cultural lives, therefore their individual selves and they do not understand why. Until they do diabetes will continue to go under-treated and under-managed in this ethnic population. The following chart (Table 2) shows what participants found most difficult about managing their diabetes in question seven: Table 2 Participants were then asked why the areas above were considered difficult. The twelve participants who found exercise to be the most difficult part of having diabetes complained that they often felt too tired to walk normally, let alone exercise. Even when they have the energy, familial duties and work take precedent over exercise. Injections and testing glucose levels are said to be painful and many patients do not understand their glucose values and are not confident in their ability to give themselves a correct insulin dose. As a result patients do not monitor their blood glucose and do not regulate it with proper insulin injections. The other major problem with diabetes for the Lebanese Australian population is having a healthy diet. Patients are advised by their doctors to avoid starch-filled foods and cut certain f foods out of the diet and replace them with others. Lebanese people have specific types of food that are eaten commonly throughout their culture. Many foods that are suggested are seen as Western and not considered part of a proper Lebanese diet. This in addition to the imposition of preparing separate food for a diabetic make it extremely hard for a participant to eat foods that are considered health to the patient’s doctor. Effect of Diabetes Physical Health All patients who suffer from diabetes deal daily with multiple physical symptoms and side effects of the disease. This survey is no different in this regard from the rest of the population. It is important to analyze which areas of physical health this group is most concerned with in order to understand how these symptoms along with cultural duties and responsibilities lead to unregulated cases of diabetes. Questions three and four asked participants about how their physical health was affected by diabetes, including complications and side effects due to treatment of the disease. Participant 5 noticed multiple changes in his health when he noted, “Physically, my health at best can be termed as poor. I am gaining weight, cannot manage my diet the way it is necessary. I feel tired always. The usual chores at home seem very hard now; I feel fatigued. I am fairly irritable; my son says I have a very short fuse.” While all diabetic people frequently suffer from one or more of the following symptoms, the effects of the disease are felt on a larger scale by ethnic populations that adhere strictly to cultural practices. Table 1 illustrates the six most frequently listed side effects or complications due to having diabetes; weight gain, high blood pressure, high cholesterol, fatigue, frequent infections and slow healing, and deterioration of vision. Table 1 At least twenty percent of the survey participants reported having at least one of the six side effects or complications in the above graph. Most patients suffered from both fatigue and high blood pressure and rapid weight gain or fluctuation. In addition to fatigue, deterioration of vision was the second leading complication due to diabetes, though most of the complainants suffered significantly only from a loss of vision, not multiple maladies. Psychological/Mental Health So far the results of the survey most likely reflect those of other research done about the onset, side effects, and complications of Type 2 diabetes. In no way are these ailments unique to the Australian-Lebanese-diabetic community. These are all just as likely to affect the physical health other ethic and racial groups. However, the second part of the third question in the survey asked specifically about the participant’s emotional health. Eighty percent of the participants expressed feelings of depression, shame, anxiety, worry, and/or fear with depression and fear being the most commonly felt emotions. A few individuals even seem to be giving up, as one participant said, “You feel that it is easier to die with so many problems, living with this disease is so hard” (Participant 7). Another participant feels that the only thing he can do is sit and wait to die. There is complete lack of motivation feelings of apathy towards one’s life. The Lebanese community consists of close family structures with many of the women staying home as housewives and child bearers while the men support the family. The women in this group often worry about how they are going to take care of themselves and maintain a healthy lifestyle when their days are consumed with cooking, cleaning, and looking after the children. The men are easily fatigued and many suffer from a need to frequently urinate and thus feel like they are no longer able to adequately perform their jobs. As a result a feeling of uselessness and helplessness is shared by both sexes. Social Health Family Frequently, in answers to question three and randomly through the sample, participants stated they had feelings of alienation or isolation from other members of their community. Only three of the twenty-five diabetic participants reported that they suffered no significant emotional problems as a result for their diagnoses. A common theme was that if a person does not suffer from diabetes, he cannot truly understand the impact of the disease. Participants were frustrated by the lack of understanding by their support system of family and friends. Lebanese families also consist of many members. In some minds it is unreasonable for a diabetic member to expect to have separate foods prepared for him from those that everyone else will be eating. Therefore the diabetic member of the family tends to stay at home instead of visiting relatives to avoid the fuss and difficulty of having dietary restraints. Work Many participants in the study stated that their incomes have significantly decreased as they are unable to fully do their jobs or are unable to work altogether. Participant 2 stated, “My life is that of a convict, waiting for the next dose of insulin and the food. I don’t earn…I don’t work, and I am useless.” Not only does the inability to maintain a job affect the patient’s financial situation, his self-worth and self-esteem suffer a dramatic impact as well. Socialization Questions nine, ten, and eleven all ask participants whether they feel different from people who do not have diabetes and how the disease has affected their quality of life, particularly economically and socially. Most participants repeated answers given throughout the survey involving side effects, complications, and consequences of being diagnosed with Type 2 diabetes, especially answers to questions three, four, seven, and eight. Seventy-six percent of the participants feel isolated and different from those not suffering from diabetes. Most are uncomfortable or embarrassed by tiring easily and frequent urination. They also find it irritating and are resentful that others do not have to constantly worry about what they eat. Some even feel shame in suffering from the disease. As mentioned earlier, participants also feel that those who do not share the disease cannot possibly share in understanding its effects. A majority of participants feel their lives revolve around their diabetes. Ten of the participants stated that they suffer a significant loss of income due to their inability to work and the expense of treating their diabetes. Five participants state that their illness has caused family problems but on the positive side, sixty-eight percent of the participants state their illness has no effect on their family life and in two of these cases participants actually stated that their families are very supportive. Unfortunately, the majority views the disease as having been the focal point of their lives since diagnosis: My life has changed since my diabetes. I don’t expect anything good anymore. It I guess is no quality. I am consistently unwell, sitting or lying. I am entirely dependent on my family members for even my daily activities. In darkness I cannot visit the toilet alone. Physically I feel very fatigued and unwell. I guess sugar and cholesterol make this to you. Moreover, the scare to visit a doctor very regularly and the fear of landing on a hospital bed due to something else are no less. I have stopped working; my days pass at home thinking about my future and the other diseases yet to come. Even now, give me any stressful situations at home, my sugar levels shoot up, and then it will take many days for them to come back to normal. This is vicious cycle of very poor body and mind. (Participant 4) In a sense, diabetes equals life. More specifically the diagnosis of this disease means a life sentence of worrying, shame, fear, alienation, pain, and isolation. It is hard for members of this sample group to focus on good aspects of their lives when much of what they experience is so negative. Discussion The main goal of this study was to take a small sample of diabetic Lebanese people living in Sydney, Australia and determine the aspects of their having different social and cultural practices from the majority population affect the diagnosis and treatment of diabetes mellitus as well as the health of the ethnic minority suffering from the disease. “Diabetes mellitus is a disease that affects people of all ages, races, and backgrounds. There are multiple types of diabetes, the most common being Type 2.” As a group the Lebanese population in Sydney, Australia suffers the same effects of Type 2 diabetes as any other ethnic group in the world. The disease and its symptoms do not differ from ethnic group to ethnic group and similarities may be found among all people with diabetes. What must be taken into account is the ethnicity of the individual in relation to the culture of the majority around him. “Cultural diversity has long been recognised to be barriers in understanding issues with a health problem. This enhances the risk factors of a disease where lack [of] awareness about lifestyle associated factors in diabetes is indeed a risk factor.” Someone living in his home country with family and neighbors who share social and cultural beliefs will find it much easier to handle a diagnosis of a disease such as diabetes. Doctors will be able to speak to the patient in his or her native-speaking language and in a way that is more easily understood than translating through a secondary language. Family and friends will have more access to information on the disease for the same reasons and will develop a better understanding of what a person with diabetes is going through. In the Lebanese community, “the preference is explanation of the problems by a family member.” If family members are unable to receive adequate information, it will be impossible to communicate with the one suffering from diabetes, let alone other family members. How can someone who does not suffer from the disease possibly understand it? One can never totally understand what he does not experience but information readily available in a native language and by members of your own ethnic community help to lessen the gap between those affected and those outside the disease. This leaves diabetic members feeling less alienated from their communities. A feeling of still belonging can go a long way to improve mental and physical health as well as the quality of life experienced by those with diabetes. This survey of twenty-five Lebanese immigrants does show that differences in culture, from the language spoken to the types of food eaten, can greatly impact the emotional health of diabetics as well as their physical health. In order for the diabetic Lebanese participants to have more positive experiences involving their diabetes, services must be made available to specifically cater to this group. “Heath et al. (2001) contended that this can be achieved through development of partnership and empowerment of the community group in question…For an ethnocultural group such as Lebanese population in Sydney…it needs equitable power balance with the dominant groups.” The same is true for any ethnic minority surrounded by a very different majority. An immigrant who does not natively speak the language in which his illness is explained can certainly never have a full understanding of the disease. These patients must also have time to sit with their doctors and be given explanations on what is happening in their bodies, what they can do to improve their health, and how their lifestyle changes specifically improve their living. The majority of those suffering from Type 2 diabetes are not diagnosed until middle age. At this point a person has already established a pattern of physical and social activity as well as eating habits, particularly when a large part of the ethnic culture is the food eaten. It is not easy to suddenly change one’s lifelong habits in order to suit a disease that is not even understood by the one affected. Without support from healthcare providers and family, it is very difficult to completely change the aspects of one’s life that have for so long encapsulated it. The Lebanese participants currently feel no one else understands how they feel. In this case they may very well be correct. If a doctor does not ask a patient what his or her preferences are regarding diet, exercise, and taking or injecting medications, the patient will never feel that their treatment is specifically tailored to him or her and will continue to believe that the doctor simply does not understand. If a doctor refuses to take these extra measures in order to improve the patient’s quality of life, the patient certainly has a right to feel as he does. Doctors, dieticians, and patients must work together to mold the treatment of the disease around each patient’s life instead of trying to mold each patient’s life around treating the disease. Certain specific steps need to be taken by members of both the minority and majority communities to work together to establish a better practice of diagnosing and treating diabetes among the ethnic minorities living in a given population. “A valid food-frequency questionnaire could be the best way to assess [pertinent dietary habits], which need to be specially developed for the Lebanese population.” One cannot be expected to suddenly and drastically alter a diet that has been eaten for the patient’s entire life without including parts of the old diet into the new plan. Language is an essential aspect of every person’s life, no matter his cultural and social beliefs and where they fit in relation to the beliefs of those around him. It is unreasonable to expect that a disease explained in a foreign language will not seem foreign. This is true even if there are no gaps or mistakes in understanding or translation between native speakers and those primarily speaking a different language. A word in English will never mean the exact same thing in another language because a person immediately relates to a word in his native language as opposed to feeling at least a small amount of distance between himself and the word used in a secondary language: The people of this community desire a language specific and culturally sensitive service tailored to their needs, and the service designed for the mainstream Australians is inadequate for such purposes. The current model of care needs to be more aligned to such minority population[s] in order to achieve optimal outcomes, where language sensitive education and dietary advices must be implemented. (Public Health Division, 2000) If doctors with similar cultural and social backgrounds are unavailable to patients, a medical translator needs to be made available in order to decrease the feelings of separateness, isolation, and confusion felt by the patient. Doctors must take into account a person’s cultural practices in order to design an individualized program of treatment for diabetes. For example, if the doctor is unaware of what foods a culture frequently eats and what is not eaten, a practical diet plan cannot be established for the individual being treated for the disease. Participant 6 stated “we use food which do not match with these Western diets that these doctors [advise].” A doctor or nutritionist needs to work with the individual in planning meals that cater to the types of foods already eaten by someone in a specific ethnic group. Lastly, information regarding the disease should be easily and readily available to a patient’s family, friends, and community. “Empowerment is the most important measure that can build on community partnerships and collaborations between the healthcare delivery system and the Lebanese population where interest can be generated automatically” (Ross et al., 2000). A person cannot feel as if he is part of a group when he cannot visit family or friends because of special considerations that must be taken for him that are not understood by others. Special foods must be prepared and someone suffering individually from a disease may need to rest more or take other physical precautions. If the people around him do not understand the importance of such differences and be more readily able to accept them and assist him, a person will continue to feel isolated and his quality of life surely declines. Conclusion The Lebanese population living in Sydney, Australia and those suffering from diabetes mellitus are no different than other sufferers of diabetes in regards to when their disease was diagnosed and the symptoms which are prevalent. However, stark differences are made apparent when one considers cultural and social practices of this minority group in comparison to those of the majority living around them. Language barriers keep patients from fully understanding their disease let alone discussing treatments and options with their medical doctors. Doctors do not understand the significance of certain foods in an ethnic diet and may not be aware than individuals in a different ethnic community practice different roles in their families and may not be as easily capable of exercising or taking other steps to improve their lifestyles. Language differences and lack of understanding by medical professionals help to hinder understanding among members of the community who do not suffer from diabetes and as the patient has a lack of understanding, he or she is unable to communicate the seriousness or implications of the disease for which he or she suffers. “Nakkash et al. (2003) indicated that only knowing the problem in these migrant communities is not enough, there must be effective interventions…designed to modify …behaviours through health intervention and health promotion…where participation of target population and healthcare authorities are needed in equal proportion.” More research must be done in order to pinpoint problem areas and risk factors among the Lebanese community in Australia as “a perfect plan of action can only originate through findings from studies done on the specifics of diabetes on the Lebanese population, where inclusion of these people in the mainstream care delivery should be the goal in the longer run.” Until health care practitioners, nutritionists, and patients are able to conveniently and efficiently communicate to each other the diagnosis and treatment of diabetes mellitus, patients will continue to suffer a poorer quality of life that could be drastically ameliorated if the level of understanding could only be improved. 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