"Old people problems", uncertainty and legitimacy: Challenges with diagnosing Parkinson's disease in Kenya. (August 2021)

• Record Type: Journal Article
• Authors: Fothergill-Misbah, Natasha; Walker, Richard; Kwasa, Judith; Hooker, Juzar; Hampshire, Kate
• Is Part Of: Social science & medicine. Volume 282(2021)
• Publication Date: 2021-08
• Subjects: Parkinson's disease -- Diagnosis -- Kenya -- Uncertainty -- Sub-Saharan Africa; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2021.114148
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Very little is known about the experience of people living with Parkinson's disease (PD) in low- and middle-income countries, such as those in sub-Saharan Africa. The number of specialists in the region is low and awareness is limited among the population and healthcare professionals. Drawing on ten months of ethnographic fieldwork in urban and rural Kenya with 55 people living with PD (PwP), 23 family members and 22 healthcare professionals from public and private clinics, we set out to understand the experience of diagnosis among PwP in Kenya. The diagnostic journeys of our study participants were typically long, convoluted and confusing. Lack of relevant information, combined with comorbidities and expectations about 'normal' ageing, often conspired to delay interactions with health services for many. There often followed an extended period of diagnostic uncertainty, misdiagnosis and even 'undiagnosis', where a diagnostic decision was reversed. Following diagnosis, patients continued to lack information about their condition and prognosis, making it difficult for friends, family members and others to understand what was happening to them. We suggest that awareness of PD and its symptoms needs to improve among the general population and healthcare professionals. However, diagnosis is only the first step, and needs to be accompanied by better access to information, affordable treatment and support. Highlights: Diagnostic uncertainty, misdiagnosis and 'undiagnosis' were common in Kenya. Parkinson's symptoms can be dismissed as a 'normal' part of ageing. Communication around a Parkinson's diagnosis is lacking in Kenya. Parkinson's awareness needs to improve among populations and health professionals. Access to affordable treatment should accompany improved diagnostic processes.