“I noticed that image among the pile of images that we got from our fieldwork in Vietnam. It really got to me. It was this expression in her eyes,” explained Professor Tine Mette Gammeltoft about her photo, which has won this year’s photo competition. The woman in the picture is called Bà Son, a Vietnamese rice farmer. The picture was taken by Tine Gammeltoft’s Vietnamese colleague Doctor Dung Vũ a few days after Bà Son had one of her legs amputated.
Doctor Dung Vũ is one of the five Vietnamese researchers working on the ethnographic part of Gammeltoft’s research project VALID:
“VALID focuses on type 2 diabetes in the Vietnamese province of Thái Bình and consists, among other things, of ethnographic fieldwork, where we work with 27 people with diabetes and their families, which we have followed since 2018,” said Gammeltoft. She continued:
“Bà Son is one of the 27 participants in the project, and Dung and I have been visiting her for several years. Dung and Bà Son have developed a close relationship – she probably couldn’t have taken this picture if the two of them had not been that close.”
Almost a global epidemic
The project in Vietnam is funded by the Danish Ministry of Foreign Affairs and will strengthen health efforts concerned with chronic disease, which is the focus of Denmark’s strategic sector cooperation in Vietnam. The researchers concentrate on the care given in the home and family, where much of the care takes place. In VALID, researchers will collect more systematic knowledge about the informal care practiced daily in the family and in the local community.
Gammeltoft herself has worked in Vietnam for 30 years. She first went there in the 1990s, when Denmark opened an embassy in the country and built up a large aid program. Her research at the time was about sexual and reproductive health, but today, it also concentrates on chronic diseases such as diabetes.
“About 10 percent of the world’s adult population has diabetes. So, diabetes is what you could almost call a global epidemic – a global health crisis, in fact – because it’s a disease that affects a lot of people. Why? Because we have gradually arranged our world in a way that promotes diabetes: Our diets are changing – people are moving less. Many live in huge cities where you can’t move. And there is increasing evidence that air pollution also plays a role,” Gammeltoft said.
“I was really happy when I learned that the judges in the photo competition saw this as a picture that tells us something about global health inequality. If you live with diabetes in a low- or middle-income country, you are far more likely to not get the right treatment and end up with serious complications and amputations, as happened to Bà Son. And one of the things that drive me the most in my research is the fight against inequality in health. To be able to identify the dynamics of this inequality, but also to be able to see where hope is, where people gather and do something that can provide better conditions both locally, nationally, and globally.”
Clubs and classes create more knowledge and stronger communities
When it comes to Vietnam, Gammeltoft’s research has shown that there is a massive need for knowledge and a vast uncertainty in the field of diabetes. People with diabetes and their families often live with unanswered questions and don’t really know where to seek advice about their disease. They cannot always get this knowledge from the Vietnamese healthcare system, where time given to an individual patient is short and the wards are overcrowded and understaffed.
In addition, the disease is still taboo, and there is a tendency that patients do not want to be a burden to their family.
“Bà Son is a good example of the tendencies we have seen in our ethnographic research: She wants to be discreet with her illness, but in this way she easily – indirectly – aggravates it,” Gammeltoft added.
This knowledge has inspired the research team to develop a new initiative in Vietnam – a pilot intervention program – that can help people live a better life with their diabetes. The team has set up diabetes classes and clubs in the villages, and they have developed educational materials that provide the basic knowledge about the disease that research has shown patients and their families lack.
“People meet in the clubs and socialize. And we have arranged classroom training for health workers and individual patients. It has had a huge effect. They report that they feel better. Participants experience less of a stigma and share their concerns with each other to a greater extent.”
A community across borders
VALID is nearing the end of phase 1, and researchers are gathering data from the last five years of research. And when Gammeltoft looks back on the last five years, she is happy about three things in particular:
“In addition to developing the pilot intervention as a model for grassroots health work with diabetes, I am also pleased with the capacity building of young Vietnamese researchers that the project has entailed. I would also like to highlight the knowledge the project has gained about why we humans sometimes act ‘against better knowledge’ in the health sector. For example in Vietnam, people try to care for their families and not be a burden on them, but in the end, they may just be a burden as a consequence of complications and worsening of the disease. The point is that while medical knowledge is obviously important, anthropology shows us why such knowledge is not always enough: sometimes the patient’s life situation makes it socially or emotionally impossible to follow medical recommendations, no matter how clear or medically meaningful they are. For many, it is more important to belong to a group like the family and the community and take care of your loved ones than it is to take care of yourself and your illness.
“And last but not least, lectures in Denmark – about research in Vietnam – have taught me that Danes with diabetes often have the same concerns about not burdening the family and doubts about what is the right treatment, etc. So with our research we can also contribute to creating a kind of global cohesion in this field,” Gammeltoft concluded.
Read more about the research project VALID