DOCSLIB.ORG

Negotiating Mental Illness, Treatment and the Adverse Impact of Stigma In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Negotiating Mental Illness, Treatment and the Adverse Impact of Stigma In A ‘St Giles Case’: Negotiating Mental Illness, Treatment and the Adverse Impact of Stigma in Suva, Fiji Natasha N. McDonald BA A thesis submitted in fulfillment of the requirements for the degree of Master of Research (MRES) Department of Anthropology Macquarie University Sydney, Australia October 2015 CONTENTS CERTIFICATION"..................................................................................................................................................................."1" ABSTRACT".............................................................................................................................................................................."2" ACKNOWLEDGEMENTS"..................................................................................................................................................."3" GLOSSARY"OF"ACRONYMS".............................................................................................................................................."4" PART 1: CONTEXTUALISING MENTAL ILLNESS IN FIJI ....................................................... 5" THE"WOMAN"IN"CHAINS".................................................................................................................................................."5" A"CALL"TO"ARMS:"GLOBAL"MENTAL"HEALTH"........................................................................................................"6" CALL"FOR"CONCERN".........................................................................................................................................................."8" CONTEXTUALISING"FIJI"...................................................................................................................................................."9" MENTAL"ILLNES"AND"HEALTH"IN"FIJI"...................................................................................................................."12" STITCHING"TOGETHER"STIGMATA".........................................................................................................................."14" ANTHROPOLOGY,"MENTAL"ILLNESS"AND"HEALTH"........................................................................................."17" METHODOLOGY"................................................................................................................................................................"20" THE RESEARCH QUESTION!.................................................................................................................................!20" CONTEXTS!.....................................................................................................................................................................!20" JUSTIFICATIONS"FOR"AN"ANTHROPOLOGICAL"APPROACH"........................................................................."26" PART 2: MENTAL ILLNESS AND HEALING IN FIJI ................................................................ 28" MENTAL"ILLNESS"/"MADNESS"..................................................................................................................................."28" THE"CURRENT"CONTEXT"OF"ILLNESS"AND"HEALING"IN"FIJI"......................................................................."28" ILLNESS"AND"DISEASE"..................................................................................................................................................."30" THE"CAUSE"OF"ILLNESS:"BIOCHEMISTRY"OR"BLACK"MAGIC?"....................................................................."30" THE"BIOMEDICAL"MODEL"OF"ILLNESS".................................................................................................................."31" THE"TRADITIONAL"MODEL"OF"ILLNESS"................................................................................................................"33" COLLABORATING"MODELS".........................................................................................................................................."36" TREATMENT"TRAJECTORIES"......................................................................................................................................"37" BIOMEDICAL"MODELS"OF"TREATMENT"................................................................................................................"38" WHY DO I HAVE TO TAKE THE MEDICINE?!..............................................................................................!40" TRADITIONAL"MODELS"OF"TREATMENT"............................................................................................................."41" THE POWER OF PRAYER!.......................................................................................................................................!43" TREATMENT:"IN"FLUX"OR"FOREVER"......................................................................................................................."45" PART 3: A ST GILES CASE ............................................................................................................. 48" MORAL"EXPERIENCE:"WHAT"IS"AT"STAKE?"........................................................................................................."48" THE"MARK"OF"SHAME:"ST"GILES"..............................................................................................................................."49" PIO:"ST"GILES"TRUE"........................................................................................................................................................."51" TO"BE"LESS"THAN"HUMAN"..........................................................................................................................................."52" A"FAMILY’S"SHAME"........................................................................................................................................................."53" THE"NONKHUMAN"AND"THE"PUBLIC"......................................................................................................................."54" A"HOME"VISIT"WITH"VILU"............................................................................................................................................"55" THE"SEVERITY"OF"STIGMA"AND"THE"ACCEPTABILITY"OF"STRESS"..........................................................."57" ii" SELF STIGMA TIES YOU DOWN ..................................................................................................... 59" AN"UNLOVABLE"SELF"....................................................................................................................................................."60" SMALL"INTIMACIES"........................................................................................................................................................"62" PART 4: CONCLUSION .................................................................................................................... 65" REFERENCES".........................................................................................................................................................................."68" APPENDIX 1: ETHICAL APPROVALS APPENDIX 2: PARTICIPANT INFORMATION STATEMENT APPENDIX 3: PARTICIPANT CONSENT FORMS iii" CERTIFICATION This is to certify that the following thesis is my own work, except where acknowledgement has been made to the work or ideas of others. This thesis has not been submitted for a higher degree to any other university or institution. __________________ Natasha McDonald 1" ABSTRACT This thesis explores the role and impact of stigma on mentally ill individuals and the provision of mental health services within Fiji. Fiji is home to a multi-ethnic, multi-religious and multi-cultural population, which is currently undergoing rapid social change that is changing everyday life within Fiji. As a result there is a very diverse understanding around mental illness and how mentally ill individuals should be treated, therapeutically and socially. Therefore this thesis first explores the different etiologies of mental illness that exist within Fiji. I also investigate the relationship between understandings of mental illness and help- seeking behaviours, and the resulting treatment choices of Fijians in Suva. Finally, this thesis discusses how the subjectivity of the mentally ill individual is impacted in response to the intersubjective process of stigma, which is a prevalent issue within Fiji. This research project was based in Suva, Fiji’s capital city. A mixed method approach was utilized to meet research objectivities. Primary participant observation was engaged in over multiple sites: St Giles Psychiatric Hospital, Stress Management Ward, and the Community Rehabilitation Outreach Program. Additionally I attended outpatient clinics, home visits and mental health stakeholder meetings. In complement to participant observation, unstructured interviews (n=49) and focus groups (n=4) were conducted with in- patients, ex-patients, carers, mental health professionals and various NGO employees working in the area of mental health. 2" ACKNOWLEDGEMENTS My time in Fiji introduced me to some of the most inspiring and resilient people I have ever met. I will never be able to express how grateful I was to the individuals who allowed me in to their lives and shared their stories with me. I am humbled by the confidence and trust that was placed in me. I give my deepest thanks to my informants without whom there would be no thesis. To the in/out patients and psychiatric survivors I met, I hope you know your worth.
Load more

Recommended publications
  • Fiji Climate Change and Health Adaptation
    Fiji Climate Change and Health Adaptation Proceedings of the Symposium 9 February 2015 in Suva, Fiji Fiji Climate Change and Health Adaptation Proceedings of the Symposium 9 February 2015 in Suva, Fiji © Piloting Climate Change Adaptation to Protect Human Health Project in Fiji. 2015 This booklet is an outcome of a Climate Change and Health symposium organized by the core working group of the Piloting Climate Change Adaptation to Protect Human Health project in Fiji. The views expressed in the document by named authors are solely the responsibility of the named authors. Referencing and quote from this booklet should be acknowledged accordingly. It is a product of MOHMS Fiji and WHO collaboration. The views and opinions expressed in this proceeding belong to the speakers, and do not necessarily reflect those of organizing institutions. Table of Contents Presenters ........................................................................................................................ 2 Acknowledgements .......................................................................................................... 4 1. Introduction ................................................................................................................. 5 2. Keynote Speeches ......................................................................................................... 7 Importance of health adaptation to climate change in Fiji ............................................................ 8 Fiji's response to climate change impacts ....................................................................................
    [Show full text]
  • Wildlife Conservation Society Fiji Country Program Annual Report 2020
    WILDLIFE CONSERVATION SOCIETY FIJI COUNTRY PROGRAM ANNUAL REPORT 2020 Annual Report 2020 Wildlife Conservation Society Fiji Country Program ©2020 Wildlife Conservation Society Cover page photo: Diverse reef system with healthy fish population in Kubulau inshore fringing. ©Tom Vierus/WCS FROM THE DIRECTOR 2020 was perhaps one of the most challenging year many of us have experienced, as the world grappled with the unprecedented COVID- 19 health crisis and the subsequent social and economic effects. The crisis brought scientists and researchers together (albeit virtually) to relook at the critical link between human activities and the health of the environment that we live in and the animals and species we are surrounded by. It is clear that environmental degradation of natural ecosystems is affecting human health. Simply put, the planet’s health is vital in preventing future diseases. Fiji confirmed its first COVID-19 case on 19 March and the last instance of community transmission in April 2020. During this period, strict safety protocols were implemented by the Fijian Government to prevent the spread of the virus and was kept in place until July 2020. These included nationwide social distancing measures, lockdown, local and international travel restrictions and curfews. In compliance to this, WCS Fiji pulled all staff from field work and stopped all community engagements, joining the rest of the world working from home and attending virtual meetings. Upon the lifting of domestic travel restrictions, the WCS team, with support from communities and partner organisations raced ahead to complete projects. Between August and December, three community sea cucumber management plans were launched, the first community pearl farm was established along with training workshops to build skills and enhance knowledge, women fishers and seafood vendors also received seafood handling and mud crab fattening training and supported the Government on the nationwide public consultation on Fiji’s proposed 30% Offshore Marine Protected Area Network.
    [Show full text]
  • Status of Coral Reefs in the Fiji Islands 2007
    COMPONENT 2A - Project 2A2 Knowledge, monitoring, management and beneficial use of coral reef ecosystems January 2009 REEF MONITORING SOUTH-WEST PACIFIC STATUS OF CORAL REEFS REPORT 2007 Edited by Cherrie WHIPPY-MORRIS Institute of Marine Resources With the support of: Photo: E. CLUA The CRISP programme is implemented as part of the Regional Environment Programme for a contribution to conservation and sustainable development of coral T (CRISP), sponsored by France and prepared by the French Development Agency (AFD) as part of an inter-ministerial project from 2002 onwards, aims to develop a vi- sion for the future of these unique eco-systems and the communities that depend on them and to introduce strategies and projects to conserve their biodiversity, while developing the economic and environmental services that they provide both locally and globally. Also, it is designed as a factor for integration between developed coun- - land developing countries. The CRISP Programme comprises three major components, which are: Component 1A: Integrated Coastal Management and watershed management - 1A1: Marine biodiversity conservation planning - 1A2: Marine Protected Areas - 1A3: Institutional strengthening and networking - 1A4: Integrated coastal reef zone and watershed management CRISP Coordinating Unit (CCU) Component 2: Development of Coral Ecosystems Programme manager : Eric CLUA - 2A: Knowledge, monitoring and management of coral reef ecosytems SPC - PoBox D5 - 2B: Reef rehabilitation 98848 Noumea Cedex - 2C: Development of active marine substances
    [Show full text]
  • Data Collection Survey on Current Situation and Countermeasures Concerning Non-Communicable Diseases in the Pacific Region
    Data Collection Survey on Current Situation and Countermeasures Concerning Non-Communicable Diseases in the Pacific Region Final Report January 2013 Japan International Cooperation Agency (JICA) KRI International Corp. 1R JR 13‐004 Data Collection Survey on Current Situation and Countermeasures Concerning Non-Communicable Diseases in the Pacific Region Final Report January 2013 Japan International Cooperation Agency (JICA) KRI International Corp. Data Collection Survey on Current Situation and Countermeasures Concerning Non-Communicable Diseases in the Pacific Region Final Report Map Fiji Tonga Kiribati Source: Fiji and Kiribati - http://www.spto.org/spto/export/sites/spto/japanese/destinations/ Tonga - Joint Country Strategy 2009-2013, SPC i Data Collection Survey on Current Situation and Countermeasures Concerning Non-Communicable Diseases in the Pacific Region Final Report Abbreviations and Acronyms 2-1-22 Programme 2-1-22 Pacific NCD Programme ADB Asian Development Bank AIDS Acquired Immune Deficiency Syndrome AKA Above Knee Amputation Aus$ Australian Dollar AusAID Australian Agency for International Development BCC Behavior Change Communication BKA Below Knee Amputation BMI Body Mass Index CAT Computerized Axial Tomography CK-MB Creatine Kinase-MB CRA Community Rehabilitation Assistant CRD Chronic Respiratory Disease CSN Clinical Service Network CT Computed Tomography CVD Cardiovascular disease CWMH Colonial Memorial War Hospital ChinaAID China Aid Association CoC Continuum of Care DALY Disability Adjusted Life Years DF/R Draft final
    [Show full text]
  • Situation Analysis of Children in Fiji ©United Nations Children’S Fund (UNICEF), Pacific Office, Suva
    Situation Analysis of Children in Fiji ©United Nations Children’s Fund (UNICEF), Pacific Office, Suva December 2017 This report was written by Kirsten Anderson, Ruth Barnes, Awaz Raoof and Carolyn Hamilton, with the assistance of Laura Mertsching, Jorun Arndt, Karin Frode, Safya Benniche and Kristiana Papi. Maurice Dunaiski contributed to the chapters on Health and WASH. Further revision to the Child Protection chapter was done by Shelley Casey. The report was commissioned by UNICEF Pacific, which engaged Coram International, at Coram Children’s Legal Centre, to finalize Fiji Situation Analysis. The Situational Analyses were managed by a Steering Committee within UNICEF Pacific and UNICEF EAPRO, whose members included Andrew Colin Parker; Gerda Binder (EAPRO); Iosefo Volau; Laisani Petersen; Lemuel Fyodor Villamar; Maria Carmelita Francois; Settasak Akanimart; Stanley Gwavuya (Vice Chair), Stephanie Kleschnitzki (EAPRO); Uma Palaniappan; Vathinee Jitjaturunt (Chair); and Waqairapoa Tikoisuva. The contents of the report do not necessarily reflect the policies or views of UNICEF. UNICEF accepts no responsibility for error. Any part of this publication may be freely reproduced with appropriate acknowledgement. Suggested citation. United Nations Children’s Fund, Situation Analysis of Children in Fiji, UNICEF, Suva, 2017 Cover Image: ©UNICEF/UN0249076/Alcock Situation Analysis of Children in Fiji 2 Situation Analysis of Children in Fiji Table of Contents Executive Summary ...................................................................................................................4
    [Show full text]
  • Fiji: Nadi Town Urban Profile
    FIJI: NADI TOWN URBAN PROFILE 1 Copyright © United Nations Human Settlements Programme (UN-Habitat), 2012 All rights reserved United Nations Human Settlements Programme publications can be obtained from UN-Habitat Regional and Information Offices or directly from: P.O. Box 30030, GPO 00100 Nairobi, Kenya. Fax: + (254 20) 762 4266/7 E-mail: [email protected] Website: http://www.unhabitat.org HS Number: HS/067/13E ISBN Number(Series): 978-92-1-132023-7 ISBN Number (Volume): 978-92-1-132594-2 DISCLAIMER The designation employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning delimitation of its frontiers or boundaries, or regarding its economic system or degree of development. The analysis, conclusions and recommendations of the report do not necessarily reflect the views of the United Nations Human Settlements Programme (UN-Habitat), the Governing Council of UN-Habitat or its Member States. This document has been produced with the financial assistance of the European Union. The views expressed herein can in no way be taken to reflect the official opinion of the European Union. Excerpts from this publication may be reproduced without authorization, on condition that the source is indicated. Photo credits: © Adi Nacola. ACKNOWLEDGEMENTS The Nadi Urban Profile was prepared by the Ministry of Local Government, Urban Development, Housing and Environment with information collected through interviews with key urban stakeholders in Nadi Town local government areas.
    [Show full text]
  • Socio-Economic Impact Assessment of Covid-19 in Fiji
    SOCIO-ECONOMIC IMPACT ASSESSMENT OF COVID-19 IN FIJI FULL REPORT AND RECOMMENDATIONS JULY 202 0 TABLE OF CONTENTS Acronyms .................................................................................................................................. 5 Introduction ............................................................................................................................... 7 Pillar 1: Health First – Protecting Health Services and Systems during the Crisis .............. 9 1.1 Introduction ..................................................................................................................... 9 1.2 Approach ......................................................................................................................... 9 1.3 Findings ......................................................................................................................... 10 Overview of Fiji’s health systems ........................................................................................................ 10 Health system COVID-19 preparedness and response ..................................................................... 13 Impact of COVID-19 on health financing ............................................................................................ 17 Impact of COVID-19 on service delivery and access to care ............................................................. 20 Scenario analysis of impact of COVID-19 in Fiji ................................................................................
    [Show full text]
  • Human Health and Climate Change in Pacific Island Countries
    Human health and climate change in Pacific island countries Human health and climate change in Pacific island countries WHO Library Cataloguing-in-Publication Data Human health and climate change in Pacific Island countries 1. Climate change. 2. Health. 3. Environmental health. 4. Risk assessment 5. Pacific islands. I. World Health Organization Regional Office for the Western Pacific. ISBN-13 978 92 9061 730 3 (NLM Classification: WA 30.5) © World Health Organization, 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland (tel. +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, fax: +632 521 1036, e-mail: [email protected]. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
    [Show full text]
  • <Health Reforms: a Case Study of Fiji
    Centre for International Health Health Reforms: A Case Study of Fiji Audrey Aumua This thesis is presented for the Degree of Doctor of Philosophy of Curtin University February 2014 Certificate of Authorship To the best of my knowledge and belief this thesis contains no material previously published by any other person except where due acknowledgement has been made. This thesis contains no material which has been accepted for the award of any other degree or diploma in any university. Audrey Aumua Signed: On: 10/02/2014 ii ii Copyright Statement I warrant that I have obtained, where necessary, permission from the copyright owners to use any third-party material reproduced in the thesis (i.e. questionnaires, artwork, unpublished letters), or to use any of my own published work (e.g. journal articles) in which the copyright is held by another party (e.g. publisher, co-author). Audrey Aumua Signed: On: 10/02/2014 iii iii Acknowledgements This thesis would not have been possible without the many people in the Fiji Health System, together with public sector officials, traditional chiefs and community leaders, non-governmental organizations and political leaders who gave so freely and willingly of their time, and allowed me to enter their space and learn from them. It is my hope that the results of this thesis will benefit the people of Fiji and in some small way help improve the health outcomes of this island nation. I owe much gratitude to Dr. Janice Lewis and Associate Professor Jaya Earnest for their support throughout this study. My special thanks to Jan who started out on the study with me and to Jaya who travelled with me to the end.
    [Show full text]
  • Introduced Land Snails in the Fiji Islands: Are There Risks Involved?
    Brodie, G. and G.M. Barker. Introduced land snailsIsland in the Fiji invasives: Islands: are there eradication risks involved? and management Introduced land snails in the Fiji Islands: are there risks involved? G. Brodie1 and G. M. Barker2 1Biology Division, FSTE, University of the South Pacific, Private Bag, Suva, Fiji Islands. <[email protected]>. 2Landcare Research, Hamilton, New Zealand. Abstract Fiji’s land snail fauna is highly diverse. There are over 230 species of which about 90% are native and 78% are endemic to the archipelago. There are 18 introduced species and four that are of uncertain origin within the Pacific. Information to allow easy identification of these species is lacking, as is related information about the risks involved with the introduced species in respect to trade, crop production or human and livestock health. To address this latter information gap, existing and new data on Fiji’s introduced land snail fauna were collated. This information is urgently required to identify and manage introduced and potentially invasive species and if possible to prevent their spread to non- infected islands. Other Pacific Island countries and territories have suffered substantial endemic land snail biodiversity loss, particularly because of invasive snail species that are not yet present in Fiji. Except for one of these latter species, the giant African snail (Achatina (Lissachatina) fulica), the Fiji government authorities have no baseline reference material that allows them to quickly and accurately identify and understand the biology of even the most common introduced snails. If not addressed this lack of information may have major long-term implications for agriculture, quarantine, trade and human health.
    [Show full text]
  • The Fijian Diploma of Nursing Curriculum: an Indigenous Case Study of a Curriculum Change
    Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. The Fijian Diploma of Nursing Curriculum: An indigenous case study of a curriculum change A thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand Alisi Talatoka Vudiniabola 2011 i Abstract This thesis explores an educational change process in Fiji and used a case study methodology to examine the introduction of the 2004 Diploma of Nursing programme in the Fiji School of Nursing. The three-year competency based curriculum was developed and funded by the Australian government through the Fiji Health Sector Improvement Project (FHSIP) with limited participation of the local teachers at the Fiji School of Nursing. Many problems beset the programme, beginning with its rushed implementation at the end of an academic year and the incompleteness of the curriculum document. Teachers questioned the quality and nature of the competency based curriculum, and the absence of many supportive networks and resources to facilitate curriculum change. The majority of the staff did not understand the competency-based nature of the curriculum and its requirements. Using the vanua indigenous research framework and Fullan’s educational change theory to guide and inform the case study, qualitative methods of data collection and analysis were employed, including documentary analysis, participant observations and interviews. Talanoa, a culturally appropriate method of data collection for Pasifika people was used in both individual and group interviews.
    [Show full text]
  • Ministry of Health & Medical Services
    MINISTRY•fHEALTH & Qj MEDI CALSERVICES Ministry of Health & Medical Services y ' \ - National Strategic Plan 1111~:mm ~-- Contents MESSAGE FROM THE MINISTER ................................................................................................................................. 3 FOREWORD FROM THE PERMANENT SECRETARY ............................................................................................... 4 ACKNOWLEDGEMENTS ............................................................................................................................................... 5 SITUATION ANALYSIS ................................................................................................................................................... 6 Demographics .............................................................................................................................................................. 6 Service Plans ................................................................................................................................................................. 7 Clinical Services Plan (CSP) ........................................................................................................................................ 8 INTRODUCTION ........................................................................................................................................................... 9 Guiding Principles ....................................................................................................................................................
    [Show full text]