Décryptage de la trajectoire sémiologique et phénoménologique des complications chez les diabétiques de type 2: Le cas des Polynésiens autochtones

The complications faced by persons suffering from Type 2 Diabetes justify that the disease be taken as a public health priority. This is because the illness may generate both micro and macrovascular complications that can lead to disabilities and increased morbidity rates, as well as placing an economic and human burden on healthcare systems and societies.

This thesis retraces the semiological and phenomenological trajectory from the onset of Type 2 Diabetes mellitus towards complications it poses to indigenous Polynesians living in urban areas of Tahiti. The interpretive and synchronic analysis follows an anthropological and public health perspective. It proposes and demonstrates that the evolution of Type 2 Diabetes into complications is not reducible to the natural history of the disease, nor to strictly physiopathological processes.

The case study of 30 indigenous Polynesian carriers of diabetes mellitus recruited in both clinical and non-clinical milieus, and interviewed in the Tahitian language in their home environments, permits the analysis of narrative trajectories of the disease's experience from a semiological-phenomenological model. It is argued that the apparition and development of complications among these Polynesians result - beyond the influence of a person's socioeconomic and educational status - from complex processes that involve the impact of a sufferer's interpretation of medical discourse and the lived experience of diabetes on the construction of one's representations of the illness, in this way structuring one's health attitudes, conduct and reactions. Mechanisms at the heart of producing complications are hereby organized according to the influence that representations of diabetes mellitus faced by Polynesians has on their behaviour vis-à-vis health problem(s), integrating psychosocial and cultural factors that influence the development of their illness into a serious condition. Spanning 30 case narratives, the analysis permits to distinguish different forms of the production of complications, and to reveal the inner structure of their mechanisms. Representations of diabetes constructed by Polynesians through their interpretations of messages received in the clinical space and of those diffused in the media, most notably through prevention campaigns, permit us to understand the origin of potential difficulties and obstacles (e.g. resistance by ill Polynesians to the Western medical system), and public health actors in their everyday practices.

If the results of this study confirm and illustrate the fruitful nature of studies involving medical anthropology in the field of public health, they appeal to actors in the clinical domain, programme designers, and public health agents to reflect on their practices and the effects they produce. More largely, this thesis contributes to our deepening knowledge of indigenous communities and reinforces arguments by those who plea for a radical cultural change in public health (Bibeau, 1999).