Letters

Health beliefs among British Bangladeshis

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7155.412a (Published 08 August 1998) Cite this as: BMJ 1998;317:412

Whole community must be studied

  1. Jim Hardy, General practitioner
  1. London E2 6LL
  2. The Limehouse Practice, London E14 8HQ
  3. Qualitative Research Unit, Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, University College London Medical School, University of London, Whittington Hospital, London N19 5NF

    EDITOR—Greenhalgh et al attempt to combine the techniques of qualitative research with anthropological investigation, but their paper is flawed.1 They draw attention to Bengali views on diabetes in an east London population without giving their reasons for being there. Is this genuine ethnography or is it an exercise in health promotion that has used ethnography to give it credibility?

    Ethnicity may be a source of fascination, but it is insulting to set ourselves up to study it because, as in the case of the Native Americans and the Aboriginals, we become “interested” in a culture only when that culture no longer poses a threat to us. We are not anthropologists, we are doctors in the late 20th century and work in multicultural settings that we find as confusing as those immigrants whom we choose to study.

    As general practitioners we work at the interface between a patient's conception of his or her problem and our own system of beliefs on biomedical health. The two are frequently at odds. On the one hand we worship at the feet of a sacred cow that we have prosaically named evidence based medicine, whereas on the other hand our patients follow their own beliefs and use alternative health care. We should remember that although these models seem quite different to us, they are both a part of the Western culture of consumption—a fact borne out by the enormous use of alternative medical practice and over the counter self medication.

    We have a lot to learn from our patients. Greenhalgh et al identify the main point; we should really be studying the whole of a community (all of east London), with particular emphasis on how one group influences another—a process that anthropologists refer to as acculturation—rather than merely the exotic or idiosyncratic.

    References

    Health promotion for Bangladeshi women in general practice must be appropriate

    1. June Gray, Health promotion nurse,
    2. Anna Eleri Livingstone, General practitioner
    1. London E2 6LL
    2. The Limehouse Practice, London E14 8HQ
    3. Qualitative Research Unit, Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, University College London Medical School, University of London, Whittington Hospital, London N19 5NF

      EDITOR—Greenhalgh et al's study contributes to documented evidence about how Bangladeshis in east London who have diabetes perceive their health.1This kind of information is important in shaping care and directing funds effectively.

      Our clinical work with the Bangladeshi community has made us aware how inappropriate many approaches to health promotion are. For the past three years, therefore, the health promotion nurse and health advocate have run a Bangladeshi women's group in the practice, where women have been able to discuss health issues and worries, overcome individual isolation, and take exercise in a socially appropriate setting. This is a relaxed event in the early afternoon and attendance varies, especially around times of fasting and festival, when the group often does not meet for a while.

      We found out that many of the women could swim and swam regularly in Bangladesh. Sessions for women only at the local pool allowed them to swim in leggings and other culturally appropriate attire. Older women taking part in programmes of increased activity report fewer aches and pains in joints and relief from constipation. They also support younger women and help them to take part in physical activity.

      Having the group has given a social context to chronic disease management in primary care. Small funds from the London implementation zone, as well as practice funds, allowed the group to come together.

      References

      Authors' reply

      1. Trisha Greenhalgh, Senior lecturer,
      2. Cecil Helman, Senior lecturer,
      3. Mu'min Chowdhury, Research fellow
      1. London E2 6LL
      2. The Limehouse Practice, London E14 8HQ
      3. Qualitative Research Unit, Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, University College London Medical School, University of London, Whittington Hospital, London N19 5NF

        EDITOR—We share Hardy's concern that anthropological methods may be misused by the medical profession. Crude and superficial research aimed at describing the exotic and idiosyncratic aspects of ethnic and social minorities may serve a colonialist agenda that is both harmful and insulting to the people studied. We dissociate ourselves from such an approach, and we suspect that Hardy may have misunderstood some aspects of our paper.

        Our aim was to move away from defining our Bangladeshi informants in terms of their differences from the majority culture. We aimed to show the complexity and diversity of health beliefs and behaviour in this community, as in every other society, and to show how these may be seriously misunderstood (and not respected) by the medical profession. One of our conclusions was that the barriers to successful health outcomes in this group are similar to those in other disempowered groups—they often relate more to structural and material barriers to change than to ethnic or religious customs.

        All three of us have social science degrees. Two of us are doctors. MC was born in Sylhet, Bangladesh, and has a PhD in anthropology. He has spent 20 years researching different aspects of culture in Bangladeshi immigrants to the United Kingdom. CH is associate professor of medical anthropology at Brunel University and has written a standard text on the cultural aspects of health and illness.1

        Our ongoing research in this field seems to be greatly welcomed by the Bangladeshi participants—we continue to have a response rate of over 90% to requests for interviews. Participants who acted as informants in the work reported in our BMJ paper have subsequently worked as partners in the design of a further stage in our research, an approach known as participatory research.2

        We had no hidden agenda. We share Hardy's misgivings about the possible misuse of anthropology in health research. Our sole aim was to help in the design of diabetes services that are both medically effective and culturally acceptable to this community, and to develop these in partnership with this community.

        References

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