Contact with the Guyanese Diaspora

Maintaining contact with the Guyanese diaspora was an important finding in this inquiry as the women developed profound loyalty and found support from each other when trying to live with their diabetes. They travelled great distances and made multiple journeys within the UK and abroad to keep in touch with friends and family. Much of this was linked to reunions and national events within the diaspora on a local and international basis. The reunions created a space for Guyanese to meet long lost friends and to recall memories of living in Guyana. Trotz (2006) drew on two examples of Caribbean/Guyanese communities in Toronto and New York which reflected a similar finding. In her article, she argued that people from Caribbean communities made meaningful connections across borders. She referred to the “Last Lap Lime”, a known Guyanese event that took place yearly in Toronto. The second example was a regular charter bus service that took Caribbean people to and from New York and Toronto. Evidence suggests that Guyana is a country that has more Guyanese expatriates than residents (Trotz 2006). Therefore it is not surprising that so many overseas organisations exist for this displaced national community where supportive connections are an important part of Guyanese lifestyle.

Many Guyanese have maintained active relationships with each other in order to connect and recapture memories and experiences of times past. Trotz (2006:55) believed these “interactions raise issues of nostalgia that sentimentalizes memory among diasporic Guyanese but in ways that obscured the complex and uneven practices through which identifications with Guyana and with others ‘like us’ are made”. Trotz (2006:56) further questions whether “we need to consider the kinds of imaginative geographies that are called on by those who do not regularly return to their homeland” but feel the need to maintain links regularly with those from other diasporic places. Further research is needed to explore our understanding of the social networks that sustain people across time and place including the availability and usage of technology driven social media.

Reflection on the inquiry

For the findings of this inquiry to be meaningful, I need to reflect on the process that I have undertaken as I engaged with this PAR inquiry. I am aware that coming from a similar background as the women and having similar beliefs and values, I may have taken for granted some of the information shared, strengths that the women acquired in managing their Type 2 Diabetes and the support offered to each other in bringing about changes in their lifestyles. It is only following a supervision session that my supervisor reminded me how much I had taken for granted in the inquiry so I had to reconsider how these may have influenced my involvement in this inquiry.

Researcher influence

In this PAR inquiry I shared a cultural background with participants. Maintaining a reflective journal is part of the methodology which allowed me to record my observations. I fully endorsed the points raised by Kelly and Simpson (2001) about the importance of developing skills and training when conducting action research and the need for collaboration, negotiation and assertiveness when using this approach. As a PAR researcher I was guided and mentored by my supervisors during the apprenticeship phase as I developed collaborative and facilitative skills. I acted as a catalyst to assist participants to define their concerns and support them as they found solutions. PAR involved learning to listen and to hear the voices of the participants rather than judging them. I also developed skills in building sustainable relationships because it is through the building of these relationships that individuals can be facilitated to make changes in their lives. Building relationships took time to create a flourishing environment for the participants to feel confident to make those changes.

In the effort to establish rigour of this inquiry I wrote about the way in which I became aware of and dealt with my prejudice or bias. In my journal I describe this as my ‘subjectivity’. I recognise that subjectivity can either enable or disable the research process. On the enabling side subjectivity allowed me to establish my research domain and that alerted me to our shared Guyanese/English background that had the potential to influence data generation and analysis during the research process. I was aware that my personal orientations were rooted in the same cultural background and that could potentially make me blind to difference. Naively like my female participants, I originally made claims that Guyanese were happy human beings, who are compassionate and gregarious, keen on family life and engage in social activities with friends. Notwithstanding that I feel happy when I am amongst my Guyanese kin, I recognise that this observation resembles stereotyping and not everyone in the group felt the golden glow of kinship. In the discussion on being Guyanese, Vera admitted that she never gave it a thought. Bea said it gave her freedom; she felt it meant that she could arrive as an unannounced visitor. Nevertheless I learned to question my personal orientations, test my prejudices, examine my biases as I realised these could potentially make me blind. I was aware of how it felt to be from a BME community living in England, fighting to have my personal experiences heard. Similarly, participants had not had a voice; they had not been heard.

As a result, I claim it is impossible to be neutral; I believe that we bring our assumptions, values and interests to all research situations. I gradually became more aware about the influences on my inquiry. Consequently I had to monitor my subjectivity in my daily journal. As a PAR researcher I reflected continuously on how my own interests, values and perceptions had the potential to obscure the research process. As PAR has both participatory and collaborative aspects, it emphasised the importance of personal experience and of acknowledging the subjectivity of the participants and the researcher. I considered my response to the issues raised in the interviews and PAR groups about racist experiences encountered. How the participants transcended these experiences were not always recorded. I reflected on why these experiences were shared with me. Was an assumption being made that as I was from the same BME community and background I was in a better position to understand their situation?

I drew on the work of Schurr and Segebart (2012) to summarise how my feminist leanings, post colonialism concerns and PAR have impacted on this inquiry. On reflection in Chapter 4, I argued that I have drawn on my feminist background to inform this inquiry by giving voice to Guyanese women from a BME community who for the first time have been given time and space to tell their stories of living with Type 2 Diabetes and have their voices heard which are reflected in Chapters 5 and 6. Feminist researchers (Reinharz 1992; Wilkinson 1996) have been critical of male dominated knowledge production and argue for a participatory relationship with female participants that are considered to be a good way to find out about individuals’ lives. Schurr and Segebart (2012) postulate that PAR responds to feminist and post-colonial claims of decolonisation by breaking down hierarchies of knowledge production that celebrate and are grounded in the daily experiences of women’s lives. I too want to celebrate what we have achieved together as a group of Guyanese women as the group had given the women confidence to appraise and review how they lived with their long-term condition.

Theoretical framework

The theoretical framework underpinning this thesis is the confrontation of the taken for granted meanings of culture, ethnicity and identity which resulted in the women in the PAR group and myself becoming empowered through cultural identity. The work in the PAR group facilitated in my PhD ended with the construction of a theory of togetherness as empowerment in a group of migrant women.

When I first started to think about Guyanese culture I considered the economic reasons for Guyanese migration to the UK. I used the term culture narrowly but I later understood that the term culture has multiple meanings. For example, in the context chapter I write that the Guyanese culture reflects the influence of indigenous Amerindians merged with several centuries of British, Chinese, African, Portuguese and Dutch colonial infiltrations. When I first approached the term culture I saw it as a community sharing a common space and history. I understood culture to be a system for perceiving, believing, acting and evaluating. Despite our various backgrounds, the women tended to insist on a Guyanese culture as being separate and distinctive. Authors like Helman (2007:2) describe culture as “an inherited lens through which the individual perceives and understands the world that he inhabits and learns how to live within”. This definition was plausible originally but on further reflection I am not satisfied that culture is exclusively heritage. I claimed Guyanese culture was unique and I have since revised my understanding. I now hold the position that we cannot deny the persisting continuities of long traditions and cultural geographies, but to insist on cultural separation and distinctiveness based on separation does not reflect the migrant’s experiences of being from one culture and living in another.

This tension between being from one culture and living in another revealed itself in the women’s sharing ‘culture’ which predominantly pertained to sharing memories when growing up and the food eaten. The women were lyrical about pepper pot, eddoes, fried chicken, garlic pork and black cake. Conversations in the PAR groups made sure that their homeland memories were not annulled; instead they were glorified. Later my understandings of the importance of food were validated. In the group, fond memories enhanced a sense of belonging and at risk of stereotyping, a belief that food in the Guyanese culture appeared to mark togetherness when socialising. Being diagnosed with diabetes meant the cultural importance was diminished through the necessary preoccupation with food that being diabetic demanded. For example, reading food labels is one of the constructs that emerged from the women’s stories which suggested a loosening of cultural meanings attached to food and locating food within the dominant food culture.

Another way in which the women became aware of their cultural shifting between the Guyanese culture and the UK culture, was in their talk of relatives ‘back home’ having a ‘touch of sugar’. We heard from the groups that how to manage ‘sugar’ was accomplished by ignoring the symptoms. Diabetes management was laissez-faire, without the need for health advice or medical restrictions. Although we cannot deny the persisting continuities of tradition, the women recognised that while these beliefs had currency in previous generations, a ‘touch of sugar’ was an ‘Old Wives’ Tale’. The women began to question diabetes mismanagement of their ancestors; after all they had lived in England for many years. Participants, well educated, middle class women were no longer able to accept spurious truths of Guyanese ‘culture’ when it came to diabetes. I argue that what was viewed as unique, separate or distinctive about their culture appeared to be silently eroding their health. I say silently because the women had absorbed the questioning culture of the English ‘other’. This shift in awareness of their cultural positioning brought on by their diabetes meant making connections between a Guyanese past and an English future, becoming bicultural.

Along with the women’s shifting understandings of their cultural positioning, my use of the terms ethnicity and self-identity shifted during the course of this inquiry. Kelleher (1996) summarises the importance in continuing the use of terms ‘ethnicity’ and ‘culture’ in health research. He believed that it does not entirely give a complete explanation of the behaviour of that ethnic group that is being studied but indicates how individuals respond to illness. Kelleher (1996) sees construction of ethnicity as a structure of relevance and a process that individuals engage in in order to give meaning to their experiences in life and argues that people selectively draw on elements in the culture of their group to help them manage the situations they face. In recognising the importance of ethnicity and culture in people’s lives, you are less likely to deny that the experiences of racism are real and threatening and that life chances are not equally distributed. Kelleher (1996) proposes that people find a sense of support as part of a community, real or imagined and it is that community that gives them a sense of belonging and a basis for an identity.

However, sharing a common Guyanese background was conducive to understanding identity and contributed to what I refer to as cultural cohesion. Initially it was important to share their common background stories as it linked the women; however group discussion that had focused on glorification of sunny Guyana in 1960s prior to migration became less dominant after 12 months of group sessions. Being with other Guyanese women was a strong motivation. The women rarely missed a chance to meet together. We heard that making connection with other Guyanese people living elsewhere in the world was important. This group could afford to travel; few women hesitated to network with friends and family living in Canada, USA and ‘home’. Most had returned to Guyana on several occasions. Travelling regularly to meet with other Guyanese was a powerful impetus; perhaps it made living in ‘cold’ England bearable.

Earlier (in chapter 2) I talked about ‘being’ Guyanese and that the women had adopted various meanings of what ‘being’ meant to them. In our frequent sessions at the women’s homes including mine, there appeared to be a palpable sense of belonging in the group. We acknowledged each other and this seemed to strengthen our self-esteem. I believe that bonding was immediate because we shared a common if somewhat privileged Guyanese background. We were middleclass (Savage et al 2013), middle aged and well educated. As a BME group, we are often confused with our West Indies / Caribbean cousins, but we all spoke English at ‘home’. On arrival in England in the 1950s, 1960s and 1970s we remembered our innocence and our taken for granted meanings about the world and our place in it. In the early 1960s we recalled the sign on rental accommodation ‘no dogs or blacks allowed’ because prior to arriving in England we had not encountered colour to be a feature for categorisation and / or discrimination. We learned from each other. We wondered whether the delay in being diagnosed with diabetes was a consequence of being the ‘other’. Did we imagine it or did we experience discrimination in health care delivery? In the group we talked about the horror of racism having the power to disrupt a person's life. Yet were we different? Our multicultural colonial forebears destined that we were women from BME communities, yet our outward appearance varied enormously. We did not share skin colour hues, body size and shape. Living with a chronic illness had brought us together but we rejected the label ‘diabetic’. We were more than these socially constructed categories. I agree with (Phoenix 2002) that identities like age, gender or race are fixed, other identities reflecting personal qualities are a matter of construction during an interaction. Identity is a dynamic process that evolves from an ongoing interaction between the individual and her social environment. I concur with Phoenix (2002) who believes identity is constructed through social relations including language, and our interactions with other people. In our case we continued our comfortable lives and mixed with people of similar middle class backgrounds.  As became evident in this group, I believe that we embody multiple identities that shift and change as we influence and are influenced by our circumstances, our learning and social contexts. The group’s social context became a fertile bed for learning. Group cohesion and working together to improve our lives are two of the most important findings. One identifying factor was I did not share diabetes with the women but the group had reconnected me with the Guyanese community which I had lost contact with.

I have tentatively used the term bicultural competence because they are new terms for consideration. It makes sense when I think about the way in which we straddle two cultures whilst living in one. Bicultural competence possibly occurs when individuals develop the values, norms and beliefs of two countries so that they can function in both societies. Alongside the women I readily identify as bicultural and believe I am competent in both.

As Guyanese/English women we may be able to accept a bicultural identity; however we are constantly confronted by a literature that suggests that we express our ethnicity / identity through our food choices. There is a large literature around the complex relationships with food, culture, and society from numerous disciplines in the humanities and social sciences. I have referred to some studies in the literature review (Chapter 3) but it is beyond the scope of this text to dwell with cross-cultural perspectives, philosophical perspectives on food and the body, the importance and politics of the family meal, and the social construction of family rituals. Instead I will focus on food identity and dietary transitions that we have made over time.

When we were growing up in Guyana we prepared dishes from locally grown produce - our staples were crops grown in our tropical climate and fish from the Atlantic Ocean. Of course there were economic considerations tempering cultural expression of food choices. It was inevitable with the impact of imperialism that the local food culture evolved: local products merged with spices, herbs and varied cooking styles contributed to a 'melting pot' cuisine. Dishes were made with these local products: fish with plantain or rice with black beans. As Vera said “the diet in Guyana was quite healthy, root vegetables, lots of greens, beef, fish, not a great deal of pork, mostly beef and fish. We had lots of fruits. I ate plantains, there is a green one cooked in a certain way which is very good for you”. I said earlier that the women were lyrical when talking about Guyanese cuisine. We were emotional about foods from childhood, a time when identities take shape. Understandably, our identities were heavily invested in this ‘melting pot’ food culture. Jillian said “I think that because we all lived together no matter what race you were, we inter married and everybody adopted everybody’s meal, culture and everything. That is the link. Most of us still have our school friends and I think not many people around the world can say that and I think because I cook Indian food, African food”. …

The women made a transition to English food on arrival and concluded that they did not always choose wisely. Vera said “everybody went to the staff canteen and had a meal: that was part of the culture, so then you had soup, steak and kidney pudding, potatoes and a sweet”.

The PAR group reflected on their acquired eating habits and collectively decided to transition to a healthier food style, a necessity if ‘we are to manage our diabetes successfully’. I contend that bringing these women together enhanced their diabetes self-management. Questioning self-management was accelerated within the PAR group. Women questioned their food choices often, recognising that ‘traditional’ foods could not be construed as healthy eating; healthy eating is a prerequisite for diabetes self-management. The lunches provided by the hostess of the PAR groups changed to healthier options as the inquiry progressed.

However a further complication is the way English food culture is evolving and the effect this has on us as bicultural women. Recently attention to sustainability and food security means we pay more attention to locally grown produce, we attempt to eat seasonally and we are all more aware of healthy eating. In the group we spent many hours talking about food. It seemed imperative that the link between food and identity was acknowledged first and foremost in the context of our bicultural identities before the group was able to make a transition to healthy eating. The women claimed that they had left behind the dense carbohydrates that were part of Guyanese and English food. And while I do not have empirical data to support the positive changes the women made in their lives, more exercise was taken and their body weight reduced. The women together felt empowered to make alternative food choices. They had an audience with whom to share their success stories. The group was empowered. The women made remarkable headway in managing diabetes. I have consistently argued that meeting as a Guyanese/English group prompted reform and lifestyle changes.

This change in my identity, the women’s identity and their food choices was possible because of the PAR methodology underpinned by the feminist principles outlined in Chapter 4. Feminist research aims to capture women’s voices through empowerment. The participants in this inquiry felt empowered as they expressed their previously unheard stories of living with their long-term condition. Findings indicate that this group continues to function extremely well. As argued this can be attributed to our cultural cohesion and our background similarities. Although the women were diagnosed many years ago, it was realised that it takes several years of trial and error to learn self-management of a long-term condition. In the group the women became motivated to learn about diabetes together what had previously been a neglected and solitary journey. In the PAR groups, the women set the agenda and this was true collaboration with the participants. There is no doubt this was collective action to improve the participants’ well-being.

Apart from sharing a similar background we were exclusively a women’s group which does not mean I cannot research alongside men, but I doubt whether group cohesion would have occurred in the same way. Women, not men, tend to make the social and domestic decisions about shopping for food, nutrition, preparation and eating and for the first 12 months of meeting together, the women were preoccupied by food. However the PAR groups gave them the time and space to reflect and learn from each other about diabetes self-management which accelerated during this inquiry.

The learning and other shared lifestyle actions that they gained from interacting with each other and the diabetes specialist nurse could be coined as experiential learning which is learning that occurs informally through reflective activity but requires initiative and an intention to learn. Kolb’s (1984) experiential learning cycle gives a rational explanation and captures this collaborative learning that developed among the women in this inquiry. Kolb’s model is normally used to improve student learning but seemed to be appropriate to explain the learning that had taken place among women in the group. The cycle comprises four different stages of learning and for successful learning; all stages must be followed sequentially even if entered at a different point. The first stage is the concrete experience; the individual must engage with the experience and be actively involved in thinking and doing. Within the second stage of reflective observation, experiences are reviewed and discussed with each other and that aids reflection. Abstract conceptualization is the third stage; as a result of reflection new ideas are formed, sense is made of what is already known, various explanations are gathered inclusive of knowledge developed from books and ideas from each other. In the final stage, active experimentation, consideration is given to how the individual applies learning gained into practice; learning has to be relevant within context which has brought about changes in behaviour (Kolb 1984).

This four staged model provided a structure of the women’s learning process that adds to the constructivist theories of learning. Individuals are more likely to learn when it is an active process, as we add to what we know and believe already; however we need to be fully involved in this learning process as we make sense of what is happening in the world. The women needed to make sense of living with their diabetes as they shared their experiences with each other in the PAR group sessions. These facilitated group sessions encouraged their exchange of ideas and experiences which is a social process of constructing a shared understanding of their long-term condition and actions taken to improve it. Whilst I facilitated the group conversations by asking questions, prompting reflection and suggesting alternate ways of thinking, the women reviewed their current practices in managing their diabetes whilst learning at their own pace, reflecting on their own experiences and understandings, and applying the learning gained into practical situations. The learning cycle provided a focus for action and evaluation to complement the PAR approach. The cyclical nature of the PAR process led to an acceleration of the women’s learning and subsequently enhanced the women’s lives. The learning has continued as the women have stayed connected with each other.

I was initially blinded to this development because I was so used to Guyanese people seeking support from each other at great distances. I too had engaged in similar behaviour as the women in the inquiry, as I sought support from my family and friends who lived abroad. I attended several reunions each year and kept in touch with the diaspora even if it meant travelling overseas. There was a special bond among us which I felt I had not been aware of and had lost. However this inquiry has reawakened my passion for what is good about my culture as I begin to develop my own supportive networks within community groups and organisations that exist in London. As a result of the inquiry, I now engage with many individuals within the diaspora.

Feedback to Health Care Practitioners

The women in the group wanted an improved service for those individuals who have diabetes. All except one had expressed resentment in accessing the care and treatment that they required. They felt that all diabetic clinics should have all facilities housed under one roof including services for testing vision and monitoring feet. For some, the services were disorganised and fragmented. They also wanted better preparation when individuals were newly diagnosed which included their own families and to be kept informed of new treatments in the field of diabetes. All the women identified the type of ideal service that should be available which included a service that listens to their respective needs and provides a more holistic approach to diabetes care. As previously mentioned in this chapter, holism refers to care that treats the whole person including their physical, social, psychological and spiritual wellbeing rather than focusing on just one aspect of need within the individual. Koch et al. (2004) highlight that when medical help and support is required, a collaborative model of care based on the individual’s decision to seek help rather than the health care practitioner deciding what is best for the individual is preferred. Health care practitioners need to adopt practices that reflect the diversity of need among BME communities. These practices are referred to as cultural capability that encourages an acquisition of skills and knowledge that enable a practitioner to become culturally competent. Papadopoulos (2006) argues that practitioners need to develop specific knowledge and skills such as being empathetic towards minority clients, sensitive to the diverse ways culture is demonstrated and celebrated, knowing about a range of diverse needs and how these can be met and becoming self-aware in order to recognise and challenge discriminatory and oppressive practice. This feedback will form part of the outcome of the inquiry.