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Ubuntu in Diabetes Care
Sanjay Kalra, Department of Endocrinology, Bharti Hospital, Karnal, India
Sundeep Ruder, Department of Endocrinology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Tessa Dowling, School of Languages and Literatures, University of Cape Town, Cape Town, South Africa
Jeannine Uwimana, School of Public Health, University of Stellenbosch, Stellenbosch, South Africa
Charlotte Bavuma, Department of Medicine, Kigali University Teaching Hospital, Kigali, Rwanda
Ramaiya Kaushik, Department of Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
Silver Bahendeka, Department of Medicine, St. Francis Hospital, Kampala, Uganda

The Nguni word ‘ubuntu’, which means ‘humanity’ or ‘humanity towards others’ is a philosophy, ethic or ideology which is frequently used in Africa and beyond.1 The words ‘ubumuntu’ in Kinyarwanda, ‘botho’ in Sotho languages, and ‘unhu’ in Shona, convey a similar meaning.2,3 The term is made up of two distinct morphemes, the prefix ubu- or bo-, which usually refers to abstract concepts, and the noun root -ntu or -tho ‘person’. Thus, ubuntu directly translates as ‘personhood’. Semantically the concept encompasses ‘respect for human dignity and human life’.1

Used as ‘humanity’ or ‘humanism’, ubuntu was initially used to promote political philosophy and, in some circles, was viewed as a way of life or being that was exclusively African.1 The argument for this more radical view of ubuntu is that when human survival is threatened, they need exclusive philosophies that focus on strengthening the group’s sense of identity and uniqueness.1 In this way, the group will be able to ensure its own survival. In recent years, however, the more inclusive view of ubuntu has been taken to imply the humane, society-oriented or interpersonal nature of all human relationships. It encourages team-work based on reciprocal respect, focuses on preservation of life over wealth, and suggests that the ‘will of the people’ is paramount. An exclusive understanding of Ubuntu could, nevertheless, still be harnessed with reference to the need to strengthen the health of communities to ensure their survival and prosperity.

The essence of philosophy

Philosophy, the search for greater understanding of our world and surroundings, aims to further human knowledge. The human mind naturally reasons about truth. By engaging this pursuit in the external world through selfish acquisition and enjoyment, we find ourselves in states of disease. When this pursuit is unselfish, i.e., for the greater good, societies flourish. So, any philosophy which inculcates an attitude of humanity has universal appeal, simply because it serves the current need in the world.

Science and technology have led to wondrous advancements in the material world. Yet we continue to see suffering and strife, and inequality and inadequacy at all levels. Science deals with the particularised and concrete characteristics of the world. It is theoretical, knowledge-based and is partitive and analytical in nature. Philosophy on the other hand deals with the essential, universal and abstract nature of things. Through ‘wisdom’ rather than knowledge, philosophy plays a unitive and synthetic role. It becomes clear that for the truth-seeking human, philosophy is essential.

African origins, global appeal

Ubuntu is one such humane philosophy, formed by cumulative wisdom. While ubuntu may have origins in southern Africa, this concept has global relevance. Ubuntu has been used in political and social context not only in southern Africa, but beyond as well. The humane ethos of ubuntu finds acceptance across borders, and transcends boundaries of all sorts. Ubuntu can be used to describe a means as well as a goal, of living life. In addition, ubuntu, which places a high value on interdependence, rather than independence, is regarded as part of a high-context culture, which means that ‘members of a household are bound for life in cycles of expectations and obligations to each other’.1 These expectations and obligations to others are often professed in proverbs, such as the following, uttered by the Tshiluba speakers of the Congo: ‘Bubedi bwa disu mbubedi bwa diulu (literally: The sickness of the eye is the sickness of the nose; Your neighbour’s problem is your problem).’1 However, this does not detract from personal responsibility in taking care of oneself. One is invited to take care of themselves so as not to be a burden on the other. However, despite best efforts, if one is to take ill, assistance is at hand through interdependence and not complete dependency as a result of self-neglect.

Ubuntu and diabetes care

Ubuntu as a philosophy has broad applicability to diabetes care. These three maxims, listed by Samkange and Samkange,4 are equally relevant to diabetes care (Table 1). Its focus on societal or community identity, as opposed to individualism, is concordant with the team-work that characterises diabetes care. Ubuntu appreciates the value of human life; similarly, diabetes care acknowledges that it is the person with diabetes who is the centre of the crew of the diabetes-care ship, not the treating physician.5,6 The diabetes care professional has a selfless character, and demonstrates a willingness to listen to and work together with the person living with diabetes, as opposed to handing out advice in a patronising manner.7

Ubuntu-friendly diabetes care is based upon reciprocal respect, and works hard to not only manage, but also pre-empt and prevent disease. Quaternary prevention,8 i.e., avoiding over-labelling, over-diagnosing and overtreatment, is concordant with the ethos of ubuntu; such actions prevent misuse and wastage of scarce resources.

Archbishop Desmond Tutu9 defines a person with ubuntu as being ‘open and available to others, affirming of others.’ This definition is similar to the CARES rubric. CARES is a mnemonic which lists five features of a good diabetes professional.7 The ubuntuistic healthcare professional is one who internalises the essence of ubuntu in his thoughts, words and action. A diabetes care professional who follows ubuntu will practice responsible person-centred care, keeping both biomedical and psychosocial facets in mind.

Ubuntu and the diabetes care system

Ubuntu can be used as an adjective to describe the healthcare system, the healthcare professional, and the process of healthcare delivery. An ubuntuistic healthcare system is one which serves society in an inclusive manner, without excluding any strata. In this regard, ubuntu is similar to the Indian political philosophies of Sarvodaya and Antyodaya. While Sarvodaya means ‘benefit for all’, Antyodaya calls for inclusion of the ‘last in the queue’, i.e., the most down-trodden.10

An ubuntuistic diabetes care system, therefore, should be community-based, community-oriented, and community-responsive. Policymakers must ensure that healthcare is made available, accessible and affordable to the citizenry. Healthcare resources and finances are managed frugally, with maximum benefit and minimum cost, and that profitability of healthcare institutions is not the primary aim. Although, a well-run, ubuntuistic health system will ultimately be automatically profitable through its interdependent approach. Ubuntu-friendly diabetes care ensures not only this, but also ensures that the care provided is appropriate as per societal norms.

Ubuntu and people with diabetes

Diabetes educators have the task of imparting self-management knowledge and skills to patients living with diabetes, but knowledge-based education often involves the educator prescribing instructions based on scientific facts. While this is necessary and good, philosophy (ubuntu) provides an opportunity to reflect on this knowledge. Knowledge plus reflection, filtered through experience, metamorphose into wisdom and lead to integration in practice.

One should reflect on how medical/diabetes education in the context of ubuntu could benefit both the patient and the greater community. This would include assisting people living with diabetes to realise that they are integral contributors to the community and thus need to take care of themselves to be able to function for the collective good. The other unselfish way of looking at it is assisting patients to realise that the disease and lack of management becomes a burden to the community. This improves adherence, as people with diabetes do not want to place the burden on the community. This shifts the responsibility of health back into the patient’s hands, guided by the healthcare profession.

Summary

Ubuntu is a multifaceted concept, which can be interpreted in multiple ways.11 This is uncannily similar to the situation faced by diabetes care professionals, who deal with a pandemic that seems to be spiralling out of control. Multi-pronged measures are needed to control and manage this challenge. While there have been advances in pharmacotherapeutics, they have not been matched by improvements in healthcare delivery. While the healthcare system faces challenges in providing effective diabetes care to all, people living with diabetes report a lack of patient-centredness in their healthcare givers12. Ubuntu helps manage these twin challenges and expectations. As a means, ubuntu sensitises the diabetes care fraternity, and persons with diabetes, to their responsibilities and rights. This approach to diabetes management facilitates achievement of optimal health and wellbeing, which is also the goal of ubuntu.

Inclusion of ubuntu as a guiding health philosophy in medical education curricula and in clinical practice, will enhance the quality of care received by people with diabetes across the world.

Table 1: Ubuntu and diabetes care

Samkange’s Maxim Ubuntuism or Hunhuism Philosophy of diabetes care
1 To be human is to affirm one’s humanity by recognising the humanity of other and, on that basis, establish respectful human relations with them
  • Patient-centred care
  • Reciprocal respect
2 If and when one is faced with a decisive choice between wealth and preservation of the life of another human being, then one should opt for the preservation of life
  • Biopsychosocial model of health
  • Secondary and tertiary prevention of diabetes
  • Quaternary prevention of diabetes
3 The king owed his status including all the powers associated with it, to the will of the people under him
  • Chronic health care model

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