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Experiences and Understandings of a Group of Sri Lankan Migrants in Australia with Type Two Diabetes

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Experiences and Understandings of a Group of Sri Lankan Migrants in Australia with Type Two Diabetes Controlling Diabetes or Keeping Life under Control? Experiences and Understandings of a Group of Sri Lankan Migrants in Australia with Type Two Diabetes Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy March Two Thousand and Fourteen Prabhathi Basnayake Ralalage Centre for Health and Society University of Melbourne Thesis Abstract Diabetes is a key public health priority and a major health concern for many migrant communities including the Sri Lankan community here in Australia. Understanding people’s comprehensions of the disease and its management is essential to successfully address any related issues in order to avoid premature deaths and high public health costs. According to many health reports published over the past years Sri Lankan migrants have been identified as having a significantly higher prevalence of type two diabetes in Australia compared to the general Australian population. This ethnography revolves around a group of first generation Sri Lankan migrants with type two diabetes in Australia. This thesis relates their story of encountering and dealing with difficulties and complexities of migrant life while having to build a ‘successful’ life in Australia and also having to concurrently manage a chronic illness. While arguing that understanding of diabetes management cannot be just reduced or confined to level of compliance to medical advice and blood sugar measurement readings on the glucometer, I point out in the research that the stories of Sri Lankans with diabetes in a developed country are different to the stories of other South Asian migrants with diabetes living elsewhere in the world as examined in other studies. I show how Sri Lankans, despite possessing several socio economic and cultural advantages in the land of settlement, still encountered significant challenges to manage diabetes effectively. I demonstrate in the thesis how each person’s socio cultural ‘baggage’ they bring to Australia during migration from their motherland, affects their transplanted lives and how it in turn affects their health care seeking behavior concerning managing diabetes. I demonstrate that aspects that affect the Sri Lankans’ perceptions and actions regarding the management of diabetes derive from personal history, their attachment to the collective cultural history of the community, their aspirations of upward social mobility coupled with attaining a higher standard of living as well as from the pressure caused by the differences in their conceptualization of ‘control’ from that of the doctors. This thesis will be of interest to medical anthropologists, sociologists and social science researchers of migration and migrant health; health care providers particularly teams who provide diabetes care to migrant patients; and community health care workers. It will also be of specific interest to migrants with diabetes living in Australia and in other Western societies, who might be interested to understand the experiences and challenges of living with a chronic illness through the insights of a group of Sri Lankan migrants in Melbourne living with diabetes Declaration This is to certify that: - the thesis comprises only my original work towards the PhD - due acknowledgement has been made in the text to all other material used - the thesis is less than 100,000 words in length, exclusive of tables, maps, list of references and appendices Prabhathi Basnayake 18th March 2014 Acknowledgements This thesis would not have been a reality without the stories of the participants of this research who welcomed me to their houses, shops and other events they took part in, with open arms and trusting me with their most personal of experiences. This thesis (and I) would have fallen apart, if not for the support, understanding and trust in me of several special people who I met before and during this journey of four years. I want to express my profound gratitude especially to Martha, my primary supervisor for understanding, trusting and rescuing me and the thesis from a very difficult period of time in my life, for giving me the intellectual and emotional strength, for all her loving patience, wisdom and kindness to steer my work to complete the thesis; to Cathy for her gentle but very constructive criticisms and great feedback about things in my writing that I had so far taken for granted; to Marilys, for all the support and encouragement she has given me throughout the years and for giving the best work environment that I could wish for at CHS and for assisting as the chair of my committee throughout my candidature; to Dominique, my ‘unofficial supervisor’ for her extraordinarily generous contribution of time and intellect to my work, for her relentless questioning that was always posed to me in the most ‘entertaining and endearing' manner, for making me laugh at my silliest of embarrassing mistakes when stress was at its peak during the last few months. I also thank Richard for his support, contribution and encouragement he gave me during the early stages of my research. My heartfelt thanks also go to Nalika, for staying with me as one of the greatest of strengths in life before and during the PhD journey and beyond, for all the very constructive chats we had about the Sri Lankan community in Australia, for having the tremendous generosity to read and copy edit this thesis while having to mind two little boys at home; to everyone in ‘ex- room 421’ especially Sam, Greg and Assunta for being such wonderful and supportive friends. I want to express my thanks to Ammi and Appachchi for instilling in me the love of learning from a young age and supporting me with everything in life in every way they could. Finally I want to thank Rasika for his unwavering love, support and encouragement in doing this research and in life; and Meth for making me ‘appropriately forget’ about PhD work when I was at home and indulge in his school work and play. Contents Thesis Abstract Declaration Acknowledgements Table of Contents List of Figures Chapter 1: Prologue ............................................................................................................................ 0 11th of February 2012, Kuliyapitiya ................................................................................................ 1 The story of my interest in diabetes ............................................................................................... 8 The journey that unfolds ............................................................................................................... 10 Chapter 2: Locating Myself and the Ethnography ........................................................................... 15 Researching one’s own ................................................................................................................. 16 My stance as an outsider within my own community .................................................................. 18 Personal dilemmas of being an outsider within ............................................................................ 21 Entering the Field .......................................................................................................................... 24 Participants ................................................................................................................................... 27 Methodology ................................................................................................................................. 30 Chapter 3: Background and the historical context of Sri Lankans in Australia .............................. 35 An account of the early Sri Lankan migrants in Australia ............................................................. 36 Recent Sri Lankan immigrants ....................................................................................................... 37 Sri Lankan society and social class ................................................................................................ 41 Social class of Sri Lankans in Australia and its implications on the nature of the community ..... 45 The aspirations of migration ......................................................................................................... 48 Tribulations during settlement ..................................................................................................... 51 Openness, receptivity and genuine interest to ‘fit in’................................................................... 52 Creation of a sense of community ................................................................................................ 54 Chapter 4: Diabetes and illness perceptions ................................................................................... 65 Diabetes – The Medical Perception .............................................................................................. 65 Diabetes in Sri Lankans .................................................................................................................. 66 Diabetes and South Asian migrants in Western society ............................................................... 68 Exploration of lay perceptions of chronic illness .......................................................................... 70 Perceptions about causation of diabetes ...................................................................................... 71 Strong family history, acceptance and fatalism ...........................................................................
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