Challenges_with_Disability

A person with a long term health condition may face many challenges in sticking to a treatment programme. Using diabetes as an example, discuss these challenges and the kind of health care support they may help a person to overcome them. Around 4.26% of the UK’s population have been diagnosed as diabetic [Diabetes UK 2010] and this chronic disease presents many challenges to the people it effects. Diabetes is a disorder in which the mechanism for converting glucose to energy no longer functions properly, or not at all thus leading to an abnormal high level of glucose in the blood, creating a vast multitude of complications. It is currently estimated that 10% of the NHS budget is spent on diabetes [Diabetes UK 2010]. Cultural, psychological and personal challenges attribute to the difficulties experienced by diabetics. I intend to discuss each of these in turn and ascertain whether there are any schemes in place or any that could be introduced in the future to overcome these barriers. One of the biggest difficulties especially with South Asian diabetics are the cultural constraints. A study carried out by Lawton et al,(K101) highlighted some of these issues. The study was carried out because it was found that South Asian residents in the UK were 4 times more likely to be affected by diabetes and also have a 40% higher mortality rate. [K101 resources p13] Obviously in the long term the NHS would seek to improve , so better care and self management would be beneficial to there finances. In the study undertaken by Lawton et al it was found that whilst most of the South Asians interviewed had made slight changes to their diet ie by reducing their refined sugar intake to sweeteners, they were having difficulty with substituting some of their traditional food As one respondent quotes “Roti is our kind of food something us people cannot be without” [Respondant22] [K101 resources p15] . I feel it is quite difficult for people of this culture to move to a different dietary plan. Also within this category most males stipulated that the woman was traditionally required to prepare the food and thus lack of knowledge on their part could provide problems.. One way of overcoming this is to set up more cookery workshops like the Khush Dill project in Edinburgh.[K101 unit 3 p87] I feel that a more holistic approach by health care professionals and maybe employing a cultural representative to ensure that these Asians patients appreciate the risks involved. language barriers appeared to be a great concern to the respondents in lawtons Et al study as many of these did not practice English as their first language [K101 resources p16] and some Asian patients had suspicion that through the transference of information some information could be lost even though it was from fully trained biologists. I feel that this could be conquered by employing a doctor from the same cultural background as the biologists do not fully understand all the medical terms. OR even trains the biologists to be formally trained to have a layman’s knowledge of diabetes so medical terms could be expressed to the service user. The last cultural barrier I wish to discuss is the physical aspects of a long term diabetic plan It is often advised to increase physical exercise as an integrated care plan, but Muslims have strict rules about the exposure of women’s flesh, so it is always easy for women with diabetes to join a gym or even to a swimming pool. I feel that if the integrated Health trusts provided more culturally correct gyms within there buildings sidelined for different religions, this would make a great difference, not only in getting people active but people interacting with people with the same affliction. Finally many Asians do not want to burden the NHS. [K101 P71] Being diagnosed with any long term chronic condition is psychologically challenging especially so diabetes. Once diagnosed patients may develop a fatalistic attitude. [K101 resources p20] It places a huge responsibility on ones own health and sometimes grief of what ones health once was can be experienced. These can be very hard to overcome. Diabetes commands a gruelling regime of hospital appointments, self medication, dietary changes, lifestyle disruptions and so forth. Another factor to consider is how the patient accepts the sick role concept introduced by the American sociologist Talcott Parsons [K101 p66] who gives us three key features. However diabetics usually have no significant symptoms so the diabetic can feel that they cannot play the sick role model correctly to their advantage. One way to address this is to maybe to produce leaflets to distribute to family and friends in order to make them realise just how dangerous the condition can be. More than 40% of patients with diabetes worldwide reported poor psychological wellbeing [K101 resources p19] which ultimately leads to depression. Depression can ultimately make people feel that nothing is worth the effort including the arduous task of self management. This negativity can sometimes spread to the consultations with health care provider [K101 resourcesp20] leading to the diabetic not being totally honest, or cancelling appointments. I feel that once diabetes is diagnosed more time and effort should be given to understanding how the patient feels, maybe not with a Doctor but a trained counsellor to make the patient accept their disease. Also they may think “why me”. The one factor that makes it difficult for diabetics is there is no magic cure so some feels “I’m doing all this work but not benefiting, not realising that without the work they would feel considerably worse. For example when we have a headache we take an aspirin and feel better, diabetics do not get many benefits from all the hard work they put in, it only keeps them stable. Better education and awareness I feel would overcome some of these difficulties. The healthcare commission recently found that only 11% of people with diabetics had been on an education course. [K101 resources p26] DESMOND [Diabetes education and self management for ongoing and self management for ongoing and newly diagnosed] helped Tim. [K101 resources p26] He was on the verge of depression and by seeking this group to acquire more skills and knowledge, feels much better. The last challenge I wish to discuss are the personal implications and obstacles that diabetics face. All of us have different personal circumstances and it would be impossible for health care proffessionals to take everything into consideration. Economic restraints contribute, as obviously if someone is on a low income they can not really afford fresh vegetables as one patient quotes “money is the main thing”. [K101p91]. She goes on to suggest that on a limited budget, cannot afford the dietary responsibilities placed on her as simply as she quotes “we have to eat whatever we have”. [K101p91] Also we have take into consideration the proximity the diabetic lives to local shops selling fresh produce. Not all of us have a greengrocer round the corner. Teenagers too have been found to neglect their treatment plans. Sometimes they may feel invincible and it has been known that teenagers with type one diabetes can be in denial paying little or no attention to the monitoring of their diabetes. Also an issue featured in many male diabetics is impotence. According to the website [www.impotence-guide.com], up to 75% of men with diabetes will experience chronic impotence. As you can imagine this would put a major strain on most marriages. Most diabetics do not receive incapacity or employment and support allowance from the government. Even if it was maybe shopping vouchers for fresh food, it would help. I believe that more money invested in diabetes would reduce the long term financial outlay as we know that better self management leads to less risks and complications. One of the NHS targets was achieved by providing a multidisciplinary approach so instead of patients attending hospital appointments PCT’S have taken over. As Dr Dean quotes “Patients find us more approachable”. [K101 resources p28] I feel health care professionals should engage with their patients more not just about the sypmtoms or the disease [ill at ease] but should respond to them with understanding, patience and above all compassion. So to summarise, there are three challenges facing diabetics, cultural, psychological and personal. But as we have discussed there are schemes in place and a number to be looked into. I feel health care professionals should strive more for an understanding of these challenges and some GPS should discard their paternalistic concept of care. Diabetes is a complicated disease so the treatment will also be complicated. By the integration of PCT’S and secondary care trusts hopefully we may be able to make massive changes in the treatment of this terrible disease.