by Claire Scott
Week three in Zambia and I am still pondering why there appear to be so few incontinence sufferers in the country, or at least few cases reported to conventional medical professionals. Following discussions with a number of stakeholders, I can suggest the following:
- For incontinence as a standalone condition this may be due to misdiagnosis, as a case of urinary incontinence reported in the Central Province district was only retrospectively re-diagnosed as being incontinence following conversations for this study.
- A reported case of urinary incontinence had undergone six months of treatment using traditional medicine prior to visiting the rural health centre. This suggests that a lack of disclosure to medical professionals could be due to the (usually) successful treatment of incontinence at the community level.
- A further explanation for the lack of reported cases could be a reluctance to disclose. Despite most claiming that if incontinence was an issue it would be discussed, in reality there may be such a stigma attached to incontinence that it is not disclosed outside of the family.
- Or perhaps incontinence is just not perceived to be an issue for those that have it. A distinction here must be made between mild (or intermittent such as urge urinary incontinence or stress urinary incontinence) and severe (or constant) incontinence, as it is mild incontinence that appears to not be an issue for Zambians. That is, symptoms that may be medically defined as mild incontinence may not be recognised as such by sufferers in Zambia. This could be due to toilet habits and accessibility, and Zambian culture may also play a role: some interviewees suggested that female sufferers may regard the symptoms as a(nother) challenge to be silently managed, perhaps in the same way that the menstrual cycle must be managed.
- Finally, there is always the possibility that incontinence just might not be a problem in Zambia.
As well as my pondering, I have also continued to explore Zambia. Monday and Tuesday were both bank holidays here: Monday was Heroes Day to honour citizens accorded the status of heroes and heroines, and Tuesday was Unity Day to promote the idea of national unity that has existed in the country since independence in 1964 (there are over 70 ethnic groups in Zambia). The holiday is also known as the International Trade Fair weekend, and I took advantage of the long weekend by visiting Kafue National Park. The Park is about the same size of Wales, giving the wildlife plenty of room to hide! I was lucky though, and spotted lions, hippos, baboons and elephants (my favourites!). I also took my research efforts to the Park, and I can confirm that after asking all of the humans that I met, incontinence ‘isn’t a thing’ there either …