We started from a biomedically defined syndrome (diabetes) and sought to understand how this disease was defined, located and diagnosed in the thought and help seeking behaviour of people with diabetes and the people living in Bafut. The process of doing justice to this local knowledge meant casting aside the parameters of the initial syndrome altogether. The boundaries of what is or is not diabetes, in biomedical terms, disappeared in this perspective. This has, likewise, meant moving beyond the biomedical naming of a disease. Not only does this involve a shift from a focus on a disease but also to a focus on the experience of illness. As in Robert Pool's [11
] case, though probably not to the same extent, our enquiries also redefine the naming and diagnostic patterns of diabetes. It is also that these changes in taxonomies reshape the nature of the supposed entity in question. Thus there is not an indigenous naming category of illness or disease that occupies the same space as 'diabetes' in biomedicine.
The above may not be a complete representation of all the indigenous approaches in Cameroon, but are of the most popular of them. Whereas Diabetes Mellitus conveys little about the signs and symptoms of the disease to participants, the two indigenous terms are grounded in the experience of the person afflicted – the experience of illness – and also suggest crucial things about the underlying mechanisms of illness and its origin. These diagnosis and interpretations help patients to make some sense of what diabetes means for the body. Yet we also note here that urination can be ambiguous as an informal diagnostic tool. For urinating frequently is also said to be a way of washing out sickness, and therefore, a sign of getting rid of a source of ill-health, rather than as a clue to an emerging health problem.
That urine tastes sweet means that a person has the 'sugar illness'. The sampling of urine, either through its taste or by its foaming after urination or visitation by ants, were back-ups for fasting blood glucose (FBG) test in the absence of money to pay for the test. When patients do this, it enables them to measure qualitatively the magnitude of FBG without resort to figures or clinics. They can stay home until they have enough money to attend the clinics. In other instances, some patients turn up at the clinics when signs and symptoms of discomfort resulting from diabetes are 'confirmed' in urine. We see here the ability of some patients to self-monitor blood glucose by this method.
It is worthwhile stressing how much the linked events of death, succession and conflicts explained through the divination mark a transition that is crucial to an understanding of beliefs about ancestral and witchcraft influences in the appearance (or 'reappearance') of diabetes. But what makes a traditional healer confidently explain after divination that a patient is diabetic? When a patient explains symptoms, without being aware that these are indicators of diabetes, many healers can straightaway diagnose diabetes – but this is the crucial difference from the clinic, not as a straightforward illness, but instead as the outcome of a conflict. Performing a diagnostic ritual is not limited to revealing diabetes, but also the agency responsible for causing diabetes.
Self diagnosis and diagnosis by divination are good indicators for people with diabetes to understand that the signs and symptoms they are having are signs and symptoms of diabetes. They served as the basic relay to informing and steering them to seek help in treating the illness which they had identified and named as diabetes.
Because of the evolving rates of prevalence, morbidity, and mortality among Africans south of the Sahara, type 2 diabetes is a major health problem that health care providers should address with consideration for cultural values. A critical factor in health outcomes for diabetes is self-diagnosis and self-management that leads to metabolic control of blood glucose levels (United Kingdom Prospective Diabetes Study [16
]. Self-management, defined as the knowledge and skills necessary to take care of oneself, manage crises, and change one's lifestyle to manage illness successfully [17
], is an important aspect of controlling blood glucose levels. A major self-management goal set for individuals with diabetes by health care providers regarding self-management of diabetes is tight control of blood glucose levels through adherence to a protocol of blood glucose self-monitoring, diet, exercise, and medications [19
]. However, this prescribed regimen includes a system of surveillance that makes self-management very complex. Biomedical regimens become more complex when indigenous concepts and values are added to them [21
]. Thus, interventions are needed that help Africans to recognise the signs and symptoms of diabetes and for those who live with it, improve their self-management and reduce the morbidity and mortality associated with it. To be effective, interventions that facilitate self-management need to be closely linked to African's cultural beliefs, values and practices. An important cultural resource for Africans that might affect self-management of diabetes is the indigenous naming, beliefs, diagnostic and monitoring procedures. These are embedded in the rich cultural heritage of Africans [22
] and warrant careful study and integrating into interventions.
This study shows the importance of indigenous naming and diagnosis in self-management of diabetes. Further research is required to focus on participants who have other chronic illnesses to research on whether it is the same pattern of disease naming and diagnosis that prevails. More data collection and analysis need to be done with a larger sample to develop this model fully. Little is still known, in general, about how the process of naming and diagnosis affects self-management of chronic illness in general. Further research should also focus on participants who are members of a variety of cultural backgrounds, especially using more or larger language groups. There is a need to extend this research to Africans who are not tied to a specific language or ethnic groups. Although we described in this study the process of how naming and diagnosis affect self-management of diabetes, the ultimate need is to develop and test interventions related to indigenous naming, diagnosis and monitoring of chronic illness. More descriptive work needs to be done to develop such studies. For example, this study has shown that for some Cameroonians, the naming and diagnostic practices are important clues in diabetes self-management. However, the frequency of such practices is unknown. Which of the diagnostic procedures give support in self-management? A pilot survey using questionnaires could provide answers to such questions. Furthermore, information is needed regarding whether interventions should be focused on the individual or groups and the best settings for conducting interventions.