The management of chronic conditions is not a one size fits all process – Dr Darlingtina Esiaka

Welcome to the Chronic Care Matters podcast, a conversation series of the Chronicity and Care in African Contexts Project.

Chronic Care Matters features conversations with individuals and caregivers with personal experiences of chronic illness, and with researchers, health professionals and advocates who are working with African communities on the continent and in the diaspora. We explore life stories, as well as themes like food, faith, medicine and the mind – tools we can use to prevent and manage chronic diseases, to care for ourselves and for loved ones who live with chronic diseases, and to support caregivers. Thanks for joining us.

Although Africa is becoming modern, resources to provide care for people with chronic conditions are very limited. We therefore have to rely on our informal way of providing care and as well educate more people on how to prevent these chronic conditions. Unfortunately, so many existing social and economic conditions restricts our ability to participate fully in health prevention and promotion.   

In this month’s Researcher of the Month podcast, Syerramia Ohene (SO) chats with Dr Darlingtina Esiaka (DE), we delve deep into how Africa can manage chronic illness with limited resources available.

Listen to the full podcast and read an excerpt from our conversation below.

Please note that this interview has been edited for clarity.

SO: How did you develop a research interest in non-communicable diseases (NCD)?

DE: As I always say, when asked this very question, this research chose me. My dad died from a chronic condition – colorectal cancer – to be specific. I have an elderly mother living the remainder of her life with co-morbidities and requiring palliative care. So these experiences continue to stimulate my interest in finding ways to make the experience better for all the families that may undergo this situation, especially those with limited access to resources that are needed to make the situation better for elders with NCDs and their caregivers.

SO: So, what are you currently working on ?

DE: I am currently collaborating with an NGO in Nigeria called Project PINK BLUE, and a colleague of mine here in US at Providence college, Dr. Candidus Nwakasi, on a project examining cancer risk perception among people living with chronic disease, such as HIV and hepatitis in Nigeria. Our aim is to study the continuum of cancer and chronic condition care in general and the state of the health system in chronic disease control in Nigeria. Ultimately, we hope to use our findings to inform chronic illness survivorship, and care within Nigerian and even Sub-Saharan Africa contexts.

SO: So how does that relate to chronicity and care in African contexts?

DE: Okay. So, one of the reasons we started working on this project is that the idea of caring for people with chronic illness is relatively informal in the African context. And as we are becoming increasingly modern and looking out for more ways of care, we have noticed that there is that clash between formal approach to providing care and informal approach to providing care. We have always believed that those two ways of providing care can actually coexist in the African context, given that as much as we want to engage in formal ways of providing care, we still are not there in terms of resources, in terms of having access to those things. And therefore, we must rely on our informal ways of providing care and trying to find ways to utilize what we have to make the most of the situation. In doing that also, we need to get people to become more aware of the snowballing rate of chronic conditions in Africa, and not just being aware, but being knowledgeable enough to know how to prevent such. And if they ever fall into chronic condition that requires extensive or long-term care, they know how to take care of themselves and manage whatever resources they have.

SO: So Darlingtina, what do you think are the major barriers to reducing our risk of NCDs ?

DE: Holistically, I believe that a major barrier to reducing the risk of NCDs, especially given the African context, is our focus on downstream factors, such as individual decision making. Then on upstream factors, such as the social determinants of health, their ride Gemalto of social and economic conditions that restrict our ability to participate fully in health prevention and promotion. And oftentimes, these conditions which include things like food desert of food insecurity, neighborhoods and beauty environment, housing instability, poverty. Oftentimes we do not recognize that this factor determines health outcomes and quality of life more than individual decision-making skills. So, for me, this factors are hurdles that we must cross to reduce our risk of NCDs to improve our chance. This with NCDs, these are factors that we must continue to acknowledge at the individual institutional and policy levels.

Uh, we always make the mistake of seeing the management of chronic condition as a one size fits all process. In fact, health messages do come in silver bullet trap, right? Do this and you be fine. But to an extent the fundamental of the process can be same. However, we must recognize the need to tweak the process to align with individual lived experiences. What works for A might not work for B or you might have to tweak it a little for it to work for B.

Dr Darlingtina Esiaka

SO: Do you have any advice for someone who is struggling to manage their chronic condition ?

DE: One thing I will say to such a person is to find what works for you. You know, when you find yourself in such situations, advice will be flowing in here and there, and uh, oftentimes you might just get confused or you want to try out what is working for other people, and that might end up not being what worked for you. Uh, we always make the mistake of seeing the management of chronic condition as a one size fits all process. In fact, health messages do come in silver bullet trap, right? Do this and you be fine. But to an extent the fundamental of the process can be same. However, we must recognize the need to tweak the process to align with individual lived experiences. What works for A might not work for B or you might have to tweak it a little for it to work for B.

So, for people struggling to manage chronic conditions, I will say, observe your own body, pay close attention to what seems to ease your symptoms or make them worse. Then present your observation to your primary care provider. Hopefully together you can figure out better treatment plan and coping strategy that will help you navigate that experience. Also, I will say, remember that when you are managing a chronic illness, you are also working to avoid the developmental comorbidities. For example, if you are a woman living with HIV, you are not only managing it. You’re also controlling your chances of developing cervical cancer. So find what works for you. Listen to professional advice, stay positive, find your tribe. This could be other people going through the experience or your support network. And remember that health is not merely the absence of disease, but is state of complete physical, mental, and social wellbeing.

Listen to the full podcast:

Dr Darlingtina Esiaka in a Visiting Assistant Professor at Union College in Schenectady, New York.

Thank you for listening to the Chronic Care Matters podcast. For more insights on Chronicity and Care in African Contexts, please visit our website www.chronicitycareafrica.com and follow us on Instagram, LinkedIn and Twitter [at] Chronicity Care Africa. See you next time.

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