A Culture of Prevention Indian Feast

A Culture of Prevention: 2018 Scholarship Shortlist (BC)

Rawel Sidhu

University of British Columbia – Doctor of Medicine – 2022

“Our traditional diet is what we’ve followed our whole lives; why should we change that now?” With nods of approval from her peers, the frail woman returned to her seat – satisfied with her objection. As the research facilitator of the 22-member diabetes support group for elderly South Asians, this was not the response I was hoping to hear.

For many months I had been explaining the intricacies of type 2 diabetes management to the group, yet the stubborn resistance to stray from their traditional lifestyles was proving to be an almost insurmountable barrier for me. With panicked desperation, my eyes darted between the insulin-glucose graph hung on the board and the carb counting worksheets I had carefully constructed the night before, struggling to find a retort to the woman who had – in such few words – rendered naked the internal struggle I had each and every class. As the wooden clock above my head (mercifully) whirred to life, chiming three times to indicate the end of class, I thought back to the circumstances that had led to me becoming a weekly effigy for the denizens of the dusty, humid senior center I currently found myself in.

From an early age, I admired the human body as a remarkable amalgamation of complexity and purpose: its ability to self-regulate and repair overshadowing even our most sophisticated machinery. However, every time I witnessed my grandfather reaching for his blood-glucose meter, I was reminded that with great complexity comes immense fragility. The thought that the deficiency of a small peptide produced in the pancreas could impair such an extraordinary machine was both frustrating and fascinating to me. As my grandfather’s condition deteriorated, I  developed a strong interest in the pathophysiology of diabetes. This interest motivated me to join the PLEASED study – first as a volunteer, later as a research assistant – which seeks to build a sustainable infrastructure of diabetes support currently lacking for South Asians with type 2 diabetes. As a South Asian myself, I wasn’t completely surprised that a traditional diet high in carbohydrates and fat increased our risk of developing diabetes, but what was startling was the apathetic outlook many of the research participants I talked to had about their ability to prevent diabetes-related complications. To better understand this fatalistic outlook on disease, I requested responsibility of the study intervention group – a group which would test my resolve for this decision each and every week.

The next class, I made sure to amend the mistakes made in the previous week by creating a list of reasons for why my participants should change their unhealthy lifestyles in order to prevent long-term complications. To my disappointment, however, the woman with the pointed question wasn’t there at the class. I scanned the room for the familiar beige overcoat and bespectacled face that usually signified her presence, but to no avail. Unbeknownst to me and the rest of the class at the time, she was in the hospital fighting for her life. She would not make it, I would later learn.

The tragic and untimely death of my participant proved to be a pivotal moment for the class, and the source of my newfound perspective on preventative healthcare that seemed so simple in retrospect: all this time I had been telling them what to change, rather than listening to what they wanted changed. Through focused inquiries on the traditional lifestyles and values held by my South Asian class, I was able to structure my lessons in a way that leveraged – rather than resisted – the cultural and ethnic differences that had made this group such a challenge to reach. My suggestions for whole-grain pasta fell way to encouraging the use of whole-wheat flour in their rotis. Bhangra dance soon became the exercise of choice (replacing chair aerobics), and my participants seemed happier, more engaged, and – to my immense pleasure – healthier. Culturally-tailoring diabetes education revealed to me the significance of a patient-centered, empowerment-based approach to preventative healthcare: when patients are vindicated of a lifestyle they subscribe to, they are able to see themselves as partners in their own health. Through listening, I became a proponent of their culture.

My commitment to preventative healthcare in the South Asian diabetes community spans four clinical studies and has yielded several conference presentations and publications, including a first-authored manuscript in the Canadian Journal of Diabetes, which advocates for the use of culturally-tailored treatment approaches for this ethnic group. With the passing of my grandfather, I am now less concerned with how diabetes can be managed, and more interested in learning what inspires people to manage it. It is with these sentiments that I am helping create and assemble a culturally-relevant, comprehensive diabetes guidebook for South Asian Canadians with type 2 diabetes. My hope is that this resource will enable South Asians across the country to take ownership over their diabetes, and feel empowered to take steps in preventing diabetes-related complications.

As a first-year medical student at the University of British Columbia, I aspire to continue my involvement in understanding the burden of diabetes in the South Asian community and advocate for culturally-tailored approaches to preventative healthcare. By sharing this newfound perspective on patient-empowerment with my peers and medical colleagues, I help ensure my impact extends beyond the four walls of a dusty, humid senior center.