Socio-territorial approaches to health: living with Type II diabetes and hyptertension in Bobo-Dioulasso and Saint Louis

This paper presents some of the socio-cultural findings from the SANTINELLES project, which takes a socio-territorial approach to examining health inequalities in Bobo Dioulasso, Burkina Faso and Saint Louis, Senegal. As part... [ view full abstract ]

This paper presents some of the socio-cultural findings from the SANTINELLES project, which takes a socio-territorial approach to examining health inequalities in Bobo Dioulasso, Burkina Faso and Saint Louis, Senegal. As part of this larger study, we interviewed male and female adults living in eight neighborhoods about their experiences living with Type II diabetes and hypertension. In particular, we sought to understand their experience of diagnosis, their subsequent therapeutic itineraries, and the social and economic challenges they faced managing these chronic conditions. Our interviews demonstrate that accessing medical care regularly and following dietary recommendations requires significant financial resources. Few individuals have health insurance and many rely on their social networks to finance their care. Beyond economic challenges, many individuals revealed that the lifestyle changes associated with the treatment for these conditions pose threats to their notions of self, identity, and sociality more broadly. Notions of self and identity are embedded in food culture, particularly ceeb u jen (fried fish with fried rice) and attaya (heavily sugared green tea). Eating from the common bowl and drinking tea are fundamental to social life, and some respondents were unable or unwilling to forgo common meals. The notion of chronic, ultimately incurable diseases also posed challenges. We found that many patients engage in episodic treatment of their conditions. Once their condition has stabilized, many patients return to their preferred diet and cease taking medications. In conclusion, we discuss commonalities in illness experiences in both urban settings and the ways that neighborhood residence shaped health-seeking strategies.