Overall, 75 interviews were conducted involving 101 participants, with a sex ratio (men/women) of 0.87 (Table 1). This included 28 non-Parikweneh (27 interviews) participants who were all professionally linked to the healthcare sector and 73 Parikweneh participants (48 interviews). Two Parikweneh participants were professionally linked to the healthcare sector at the time of fieldwork, whereas another, now retired, had been in the past.

Knowledge of the disease

All 101 participants interviewed were familiar with diabetes. Among Parikweneh participants, 42.5% (31/73) of individuals, spread across more than half of the interviews (56.3%; 27/48), reported having diabetes. Only 2.74% (2/73) of respondents claimed that there was no diabetes in their immediate household (i.e. spouse, child or parent), including themselves. The remainder had at least one family member with diabetes, and one participant stated that she was no longer diabetic. Indeed, participants specified that the disease was particularly common, being one of the major health problems in their communities, along with cancer, high blood pressure and cardiovascular diseases. Participants reported a rise in the number of diabetic individuals, that increasingly younger people were diagnosed with diabetes and that this illness historically killed many community members.

Naming and definition

Regardless of the language of communication, Parikweneh participants most frequently referred to diabetes by the name diabet (100%), a contemporary borrowing of the French and Portuguese words diabète and diabetes, respectively. However, the terms sugku (sugar) and karayt sugku (sugar disease) were used in 50% (24/48) of the interviews. One elderly couple specified that Elders used to call it mbeyevye karayt (Elders’ disease) because it used to primarily affect elderly people. Another participant called it karayt masarahatya, which translates to “disease that causes one to become dry”.

According to the Parikweneh of Saint-Georges and Macouria, there were traditionally no names for diabetes in Parikwaki due to the relatively recent discovery of the disease. However, participants surmised that diabetes may have been around much longer than reported and mistakenly referred to as imasewnti in the past, an illness of shamanic origin sent through spells. Participants now recognize multiple forms of diabetes named according to various criteria of classification, two of which are intricately related (Fig. 2). These include:

two forms based on biomedical nomenclature, i.e. type 1 diabetes (T1D) and T2D;

three forms of diabetes based on colour, i.e. diabet seyne (white diabetes), priye (black) and duweh (red);

two forms of diabetes based on gender, i.e. diabet awaig (male diabetes) and tino (female);

two forms of diabetes based on age, i.e. diabet himanoFootnote 1 (young diabetes) and kiyapye (old).

Fig. 2

The interaction of diabetes types based on gender and colour according to the classification of Parikweneh from Macouria. The colour attributed to a person’s type of diabetes, namely white diabetes or black diabetes, represents the manifested interaction between a person’s sex and the underlying gender granted to the illness: i.e. male diabetes or female diabetes

Symptoms and classification

The current Parikweneh classification of diabetes is based on the observation of symptoms and complications encountered by participants with diabetes. First and foremost, 35 symptoms and complications associated with diabetes, which could be grouped into 15 overarching categories, were listed by Parikweneh participants (Table 2; Fig. 3). The 10 most cited symptoms were (1) weakness and fatigue, (2) weight loss, (3) troubled vision, (4) fever, (5) polyuria (i.e. excessive urination), (6) pain, (7) slow healing wounds, (8) polydipsia (i.e. excessive thirst), (9) diarrhoea and (10) increased hunger.

Table 2 Symptoms, complications and problems associated with diabetes listed by Parikweneh participants from the communes of Saint-Georges and MacouriaFig. 3

Symptoms, complications and problems associated with diabetes listed by Parikweneh participants from the communes of Saint-Georges and Macouria. Refer to Table 2 for details on symptoms and terms in Parikwaki

Although some Parikweneh participants could name the biomedically recognized forms of diabetes, namely type 1 and type 2 (14.6%; 7/48 interviews), the majority of those interviewed (72.9%; 35/48) identified various forms and classifications of the disease depending on how symptoms and complications appeared in an individual and the severity of their outcome (Fig. 2). The most commonly cited classificatory criterion, recognized in Saint-Georges and Macouria, was colour (60.4%; 29/48). Diabetes was primarily distinguished between its black form (diabet priye) and white form (diabet seyne), although some participants recognized a red form (diabet duweh). In all cases, white diabetes was the least severe, characterized by few complications and a slow progression of the disease, and this form is the easiest to manage and treat. Moreover, people reportedly have more dietary freedom, gain weight as expected and, in the best-case scenario, can be cured.

Black diabetes is more severe and deadlier than its white counterpart. It manifests itself suddenly with rapidly devolving symptoms such as polyuria, diarrhoea and vomiting that quickly lead to rapid weight loss and a dry emaciated look. It is difficult to treat and manage; without biomedical intervention from the hospital or dispensary, it may quickly lead to death. Furthermore, people with this form of diabetes can find their skin turning black. Although it is unheard or not recognized by most people, red diabetes is the most dangerous and deadliest according to some. Due to limited citations of this form, how it differed from that of black diabetes could not be clarified.

The second most cited classificatory system, described solely by participants from Macouria, was based on gender (27.1%; 13/48), whereby the illness was personified as being male (diabet awaig) or female (diabet tino) (Fig. 2). As LS6020 from Macouria explained, “You see, you (a male individual) have the female diabetes, it’s because she thinks you’re her husband. That’s why she doesn’t kill you”. In other words, male diabetes and female diabetes were considered incompatible with diabetic individuals of the same sex (i.e. men and women, respectively). Hence, the gender of the disease was determined by evaluating the severity of the illness in an individual through a logic of concordance of sexes and genders. Diabetics who respond poorly to treatments and are characterized by a considerable loss in energy and weight, as well as rapidly devolving health, are believed to have diabetes of the same gender. On the other hand, diabetic individuals who responded well to treatments and lived long and comfortably well with few dietary restrictions were believed to have diabetes of the opposite gender.

In comparison with the criteria of colour, the distinction of diabetes based on gender was not as concise, as their explanation was frequently intertwined with that of colour. One participant explained that male diabetes was in the bone and hard to treat, that female diabetes was in the blood and hard to treat, that white diabetes was in the skin and easy to treat, and that black diabetes and red diabetes were increasingly worse to treat than white diabetes. The most concise picture drawn by participants from Macouria was that the colour of a person’s diabetes was ultimately explained by gender (Fig. 2). Hence, the reason a person manifests a least severe form of diabetes (i.e. white diabetes) is because they are afflicted by a form of diabetes which itself is characterized by the opposite gender, whereas someone manifesting a more severe form (i.e. black diabetes) is the result of the opposite relationship.

Some participants (4.17%; 2/48), notably from Macouria, distinguished between a young form of diabetes (diabet himano) and an old form (diabet kiyapye), although these could not be concisely described. In one interview, participants explained that old diabetes kills a person faster, whereas young diabetes does not, a statement contradicted by the reversed affirmation from other participants in another interview.

While most Parikweneh participants recalled having learned these terms from other members of their community, some specified having acquired these terms from doctors as well, although none of the healthcare staff interviewed could confirm this. Indeed, non-Indigenous participants affiliated with the healthcare sector were not familiar with the Parikweneh classification and description of diabetes. On the other hand, Parikweneh participants who cited T1D and T2D either stated that they were synonymous with black and white diabetes, respectively, or regarded the local classificatory system as something different in its own right.

Historic and current aetiology of the disease

Although the current Parikweneh classification of diabetes is based on observations of symptoms and complications, the evolving nomenclature of the disease reveals the most of its perceived origin and cause. Participants explained that diabetes probably existed in their communities prior to contemporary knowledge of this illness. Pointing to a series of illnesses and deaths in the 1950s in Kumene (Urucaua), in the Brazilian state of Amapá, nearly half of Parikweneh participants (47.9%; 23/48) surmised that these, mistakenly taken for another illness of shamanic origin called imasewnti, were likely some of the first cases of diabetes in their community. One participant from Macouria, LS6021, explained:

“People used to say that it was the shaman who gave this spell. Like imasewnti, he made people who were big become skinny, dry, all that. Then they died. It was virtually false. That [happened] when he got diabetes. Diabetes, him, he acts so quickly that the person doesn’t realise that it’s really diabetes. He just eats and eats and eats. And then when he eats a lot, that’s it. He sees that he’s losing weight and then he loses his appetite, and all that.”

Referring to a rack used for storing, cleaning or grilling food, imasewnti was ascribed to people afflicted by weakness and, more characteristically, sudden weight loss. Resulting in the loss of fluids through polyuria and diarrhoea in people exhibiting extreme thirst, as well as a darkening of the skin, imasewnti was believed to have dried out the afflicted akin to smoked or grilled flesh (i.e. meat and fish). Moreover, imasewnti was contracted through spells (timnaka), malicious intent sent by a shaman (ihamwi) or a jealous acquaintance by means such as performing an incantation (aviriFootnote 2) and blowing into a glass of water meant for ingestion by the recipient in question or blowing into wood burning for grilling or smoking food. As one Elder from Saint-Georges, LS5017, explained, “imasewnti can mean that people know how to blow it. Like a wind that’s going to smoke. That’s who they call imasewnti. You become skinny, skinny, skinny; you become dry”.

The increasing incidence of imasewnti and growing distrust is believed to have culminated in the late 1950s with the assassination of a shaman in 1959 at the hands of over a dozen family heads in retribution for his perceived implication in the death of another. Although this led to the capture and imprisonment of some implicated actors by Brazilian law enforcement, many others fled with their families, taking refuge on the French Guianese border. Indeed, an Elder recalled how her mother, pregnant with her at the time, fled to French Guiana after her father, who had been involved in the incident, left the family. Further corroborating this, Roger Labonté, the current chief of Espérance 1, estimates that eight families, fleeing repercussions, established themselves in French Guiana to later found the department’s first Parikweneh village in 1963, Espérance 1. Antonio Felicio, the past chief of Kamuyene, confirmed this incidence and added that more than 20 families subsequently settled on the French side of the Oyapock River in Ouanary, Trois-Palétuviers and Saint-Georges.

Parikweneh’s oral history subsequently tends to suggest various paths by which Parikweneh came to learn about diabetes in a biomedical sense. The most influential and predominant path appears to be attributed to the arrival of American evangelical missionaries, linguistic scholars and academic authorities of the Parikwaki language: Diana and Harold Green in the 1960s. Participants recall that during their missions in Parikweneh villages in Brazil, where they conducted extensive linguistic work, they witnessed the devastating effect of diabetes and counselled Parikweneh in seeking biomedical treatment for this disease. It is believed that their implication eventually contributed to discrediting the role of supernatural forces in this pathology, and the biomedical concept of diabetes was slowly integrated and subsequently exported to French Guiana in subsequent migration events.

Although at the time of the study, some Parikweneh participants believed that imasewnti still exists as a separate illness to diabetes, most associated its prevalence in their community with a dietary origin (Table 3). The most commonly cited causes and factors involved in the development of diabetes were the introduction and increased accessibility of sugar and sweet food items, namely sweet and carbonated beverages (i.e. juice and soft drinks), candies and treats and manufactured coffee and chocolate, thus highlighting their commercial provenance. When listing coffee and chocolate, which are typically consumed as breakfast beverages, participants pointed to the common practice of sweetening these beverages. Nonetheless, unsweetened and particularly homemade products derived from the coffee (Coffea spp.; Rubiaceae) and cacao plants (Theobroma cacao L.; Malvaceae), both cultivated by some Parikweneh, that retained a bitter taste were not thought to exacerbate diabetes, as bitterness is generally associated with health benefits.

Table 3 Relative frequency of citations (%) of the causes and factors responsible for the development of diabetes

Starch and starchy foods were the second most commonly cited cause and factor involved in the development of diabetes. Although most Parikweneh participants drew a link between cassava tubers (Manihot esculenta) and its food derivatives (i.e. torrefied cassava semolina [puveye, or kwakFootnote 3 in French Guianese Creole] [18], tapioca [kayut] and cassava juice [karahu]) and the development of diabetes (Table 3), they were quick to add that it was not the cause of the illness. More precisely, participants explained this to be the introduction of new food items such as rice (Oryza sativa L.; Poaceae), red beans (Phaseolus vulgaris L.; Fabaceae), wheat-based pasta and bread (Triticum spp.; Poaceae) and potatoes (Solanum tuberosum L.; Solanaceae), which increasingly accompany kwak, the staple food derivative of cassava roots. The link between kwak and diabetes was contentious, as participants frequently reported that healthcare professionals explained this to be the cause. The implications of this have been addressed in-depth in a previously published paper focussing on the role of cassava consumption in diabetes self-management strategies adopted by Parikweneh [18]. Briefly, however, the issue is presented here by participant LS5030 from Saint-Georges:

“Kwak is the basis of our diet. We drink kwak in coffee. We dip mango in kwak, everything! A lot of doctors say diabetics can’t eat kwak. But if you’re protecting your body, you can eat kwak! [...] it’s important to have the cassava fields to be able to eat. But we’re told we can’t eat it or we’ll get diabetes. But if you don’t eat kwak, you don’t eat. But the doctors don’t understand that. What Palikur have is what they can eat. Palikur are obliged to eat kwak. It’s what we know how to grow! We can leave kwak aside maybe for a day, but after that, we want to eat it!”

In fact, new food items to the current Parikweneh diet were the common denominators of most factors associated with the development of diabetes: from fat and fatty foods, often associated with new cooking practices requiring oil, to salt and salty foods (i.e. chips), to commercially processed foods and meats (i.e. frozen chicken [Gallus gallus domesticus (Linnaeus, 1758); Phasianidae] and beef [Bos taurus Linnaeus, 1758; Bovidae]), to easily accessible market foods such as onions (Allium cepa L.; Amaryllidaceae), garlic (Allium sativum L.; Amaryllidaceae), black pepper (Piper nigrum L.; Piperaceae) and spices, which are omnipresent in the local creole cuisine.

The causes and factors associated with the development of diabetes cited by Parikweneh participants were positively correlated with those cited by participants from the healthcare sector (ρ = 0.532, p < 0.001; Table 3). Nonetheless, the rankings of alcohol, genetics and weight control were some of the causes and factors that were markedly different between the two groups; these were some of the least frequently cited by Parikweneh participants. The biggest difference between both groups of participants was the topic of weight control, either through discussing obesity and overweight or the lack of physical exercise as risk factors in the development of diabetes. Whereas weight control was the factor that was the least cited by Parikweneh, it was discussed by nearly half of the participants linked with the healthcare sector (Table 3). Furthermore, in discussing genetics, Parikweneh participants questioned how this could be transmitted from one generation to the next and the role of pregnancy. Alternatively, some participants provided another description of the development of the illness. As LS5030 from Saint-Georges explains, diabetes, embodied by sugar, was already in the body; if you nourish it by eating poorly, it grows and manifests itself. This is supported by LS6020 from Macouria, who explains, “When you’re born, you already have sugar in your blood. And as you grow up, if you don’t know how to control yourself with sweets, well, after that it becomes diabetes”.

The contemporary name diabet is only supplanted in longevity by the name sugku, in reference to sugar, which is perceived as the predominant cause of diabetes. As LS6025 explains,

“Sugku, it’s... it’s the same [as diabetes], actually. It’s when... For example, you go to the doctor to have your blood tested. Well... you can see sugar in the blood. Right... That’s it. And that’s what provokes it. That’s what provokes diabetes”.

Hence, sweetness is a major component in the description of the disease. Nonetheless, some participants had a hard time consolidating sugar with diabetes due to the lack of access to it when it first appeared, as put forth by LS6027: “Maybe in Brazil there is [sugar]… Macapá maybe. But in Urucaua, we didn’t have that. But how do Indians get diabetes if they don’t eat sugar?”.

Knowledge of treatmentBiomedical treatments

In Parikwaki, biomedicine is called nawohtunye giveykis, which translates to “foreign medicine”. Overall, Parikweneh participants recognized that diabetes was treated through a number of its remedies. Pharmacotherapy through injections (81.2%; 39/48) and pills (70.8%; 34/48) were the most cited treatments (87.5%; 42/48). Most Parikweneh participants named insulin as a biomedical remedy for diabetes (62.5%; 30/48), whereas only some named at least one antidiabetic pill, i.e. metformin, stagid, amaryl, velmetia or glibenclamide (8.33%; 4/48). Participants noted how these medications target blood sugar levels, such as insulin, and a number of comorbidities, such as high blood pressure and cholesterol.

Dietary interventions were cited by 83.3% (40/48) of Parikweneh participants who inevitably recognized the dietary origins of diabetes and the necessity of paying attention to diet along with pharmacotherapies. Although dietary recommendations cited by Parikweneh participants included increasing the consumption of vegetables such as tomatoes (Solanum lycopersicum L.; Solanaceae), cucumbers (Cucumis sativus L., Cucurbitaceae) and lettuce (Lactuca sativa L.; Asteraceae), the most cited practices related to food items are already well integrated into the Parikweneh diet. Haemodialysis was the least cited biomedical intervention (8.33%; 4/48). Although few participants discussed the benefits of physical exercise (16.7%; 8/48), it was difficult to determine if this was strictly perceived as a biomedical treatment. Whereas some explicitly stated that doctors advised diabetics to do physical exercise to manage that illness, it was also noted that this was important for maintaining good health in general, especially when reflecting on the lifestyle changes related to self-subsistence activities.

Parikweneh Treatments

Parikweneh call their medicine Parikweneh giveykis, which translates directly to “Parikweneh medicine” or “Peoples’ medicine”. Nearly all Parikweneh participants were able to cite at least one local remedy for diabetes (91.7%; 44/48) that targeted the control of blood sugar levels, other than biomedical treatments. Although these were solely plant-based, 89.6% (43/48) cited both animal and plant remedies against specific symptoms of diabetes (e.g. aches and pains, diarrhoea, polyuria and infected wounds).

Attitudes towards the illness

Parikweneh participants often associated diabetes with heat, whereby some diabetics experienced hot flashes and sometimes fevers. Symptoms such as headaches were compared to the head being hot, and the expression of certain symptoms such as inflammation, polydipsia and the evacuation of fluids through polyuria, diarrhoea and perspiration were linked to the body being hot and needing to be cooled by replenishing with water. Due to its association with sugar, sweetness is a recurring characteristic attributed to diabetes by Parikweneh participants. The notions that sugar and diabetes are in the blood were used interchangeably to describe glycaemic control, whereas hunger was linked to the illness being voracious for sugar. LS5012 goes as far to specify that sugar even finds itself in urine, having observed ants being attracted to it. These hot and sweet attributes of diabetes are important factors driving current attitudes towards this illness, particularly because the organoleptic and physical properties of Parikweneh remedies are often discussed. When discussing the bitterness of certain Parikweneh treatments, one participant, LS5007, drew a parallel with biomedical treatments: “I always have the pills to drink. I drink, I drink, I drink. But… Because here, the pills and tablets… When you drink, it’s bitter, bitter, bitter, bitter in my mouth”.

To make a case in point, a number of diabetic participants were willing to try and experiment with local remedies alongside biomedical treatments. Among diabetic individuals, 88.9% (24/27) were using biomedical treatments, 88.9% (24/27) named a Parikweneh treatment, whereas 88.9% (24/27) were using Parikweneh treatments (at the time of the study or in the past). Of the three who did not use Parikweneh medicines, two had used or tried them in the past. Only 11.1% (3/27) of the respondents reported using only local treatments. One person who did not use biomedical treatments reported no longer having diabetes, having healed from it with Parikweneh treatments. One diabetic respondent who used biomedical treatments reported that their spouse had also healed himself with Parikweneh treatments. Finally, one participant who only used Parikweneh treatments reported having never been to the doctor or receiving a diagnostic, having self-diagnosed herself by borrowing a glucometer.

In general, diabetic individuals (77.8%; 21/27) used both biomedical and local Parikweneh treatments, either at the same time or in alternation, to manage their diabetes. Despite an overwhelming lack of confidence in the healthcare sector and an apprehension about receiving biomedical treatments, diabetic participants recognized that there were too many barriers to relying solely on Parikweneh treatments. Acknowledging the seriousness of diabetes as an illness, diabetic individuals underscored the importance of obtaining a diagnosis when the first signs were detected and continuing medical consultations to obtain examination results, as well as regular use of glucometers. Hence, detection was performed directly at a doctor’s clinic or more conveniently in the village either when home nurses visited a household or by borrowing a glucometer from a family member or friend. These tools are essential for evaluating the success of Parikweneh treatments because biomedical treatments are sometimes excluded and not taken for months at a time; thus, they are replaced entirely by local medicines. These remedies were all prepared in the household by diabetics themselves or another member of their household. Although knowledge of medicinal practices and treatments remained largely familial, sharing of knowledge between households was not uncommon. Only one diabetic patient consulted a knowledge holder who had come to French Guiana from Brazil for that purpose.

Practices

Practices regarding the management of diabetes revolve around a combination of dietary adaptations and surveillance, as well as locally practiced medicines and remedies. Due to the dietary nature of diabetes, Parikweneh participants observed the effect of a number of animal and plant species on glycaemic control and the management of diabetes (data not shown).

Dietary adaptations

Despite Parikweneh participants reporting dietary changes marked by a rise in the consumption of introduced store-bought foods, cassava roots continue to be the primary dietary staple in the Parikweneh food system. Due to the centrality of cassava in discussions, results pertaining to adaptations in the transformation of cassava roots for the dietary management of diabetes have been published separately [18]. Briefly, kwak (or puveye in Parikwaki) and cassava root were discussed by participants in 93.3% of all interviews [18]. However, Parikweneh participants (83.3%) reported two principal types of kwak, whereas this was only brought up by one non-Parikweneh participant working as a home nurse [18]. These were called sweet kwak (puveye kiteye) and acidic kwak (puveye suweine), whose names characterize their organoleptic properties, whereby most participants considered acidic kwak to be better for diabetic individuals [18].

Other dietary changes reported by diabetic participants were adopted on a personal basis. As demonstrated in the case of cassava consumption [18], these choices typically arise from negative reactions experienced after consuming specific food items that result in the following symptoms: (1) numbness in the mouth, (2) dry mouth, (3) sudden fatigue and weakness, (4) perspiration, (5) increase in body heat, (6) diarrhoea and (7) polyuria.

Blood glucose levels were at times assessed during these occasions, either by individuals themselves or with the assistance of a family member or nurse, to verify the presence of hyperglycaemia.

Among food items cited by participants for their adverse effect on diabetic individuals are included those originally listed in the development of diabetes (e.g. coffee [Coffea spp.], chocolate [Theobroma cacao], rice [Oryza sativa], garlic [Allium cepa],chicken [Gallus gallus domesticus], swine [Sus domesticus; Suidae], and beef [Bos taurus]; Table 3). Parikweneh participants also made similar observations regarding foods considered to be classically part of the traditional Parikweneh food system. These include nectars from the fruits of the patawa (Oenocarpus bataua), bacaba (Oenocarpus bacaba) and açaí (Euterpe oleracea) palms (Arecacea), which participants linked to their high fat content, as well as several wild animals. In fact, participants were quick to generalize that white skin-coloured fish were compatible with diabetes whereas red fish with scales were not. A number of notably sweet fruits, locally grown or harvested, were also cited for their negative impact on glycaemic control, although participants noted that this did not apply to the consumption of unripe fruits like bananas (Musa × paradisiaca L.; Musaceae), mangoes (Mangifera indica L.; Anacardiaceae) and papayas (Carica papaya; Caricaceae). Finally, hot peppers (Capsicum annuum L.; Solanaceae) were advised against, especially when mixed with cassava juice as a condiment (atit karahu), with some suggesting that hot peppers should be avoided altogether when sick and undergoing intense treatments, biomedical or Parikweneh.

The key practices for determining which food items to avoid or consume included paying attention to body signals and monitoring glucometer readings. Adverse reactions and poor glycaemic readings have prompted some diabetic participants to identify specific foods that should be consumed in moderation or avoided altogether, whereas the opposite is true to identify which foods have a positive or neutral effect on diabetes. Nonetheless, participants stated overall that the reaction to food items was personal and could differ from one person to the next, as exemplified by LS6006 from Macouria when translating for his partner:

“So in relation to the food she’s going to consume, so her mouth is going to... how shall I put this? Go numb. Yeah. It’ll go numb and... and the symptoms will appear. She’ll feel bad afterwards. So all that. Whether it’s... but mostly, it’s... fish. Fish from the sea. Or else... pig, other... Yeah, deer, all that. But it’s all about the person. Yeah, it’s each person. So she can eat... She could eat that and it goes with her. But there’s other people when they eat the same thing, there’ll be symptoms.”

Animal and plant-based medicines and remediesSpecies cited and used

Out of 48 interviews with Parikweneh people, participants were able to cite at least one plant used to treat diabetes in 44 interviews (data not shown). The consumption of animals for the treatment of diabetes was cited in two interviews, although animals were more frequently cited for treating symptoms associated with the illness (data not shown). More precisely, the grease of animals is used alone or mixed with various plant oils to make creams and cataplasms to treat ailments such as muscle pains, arthritis, swelling and inflammation. Overall, animals and plants species were cited in 43 interviews for treating a number of symptoms associated with diabetes, such as polyuria, diarrhoea, abscesses and infected wounds.

Just as for food items, participants specified that the response to specific remedies targeting diabetes in particular was not the same for everyone. Once again, glucometer readings, taken individually or with assistance, were used to assess a remedy’s efficacy in the absence of symptoms. If a person experienced any of the adverse reactions listed for foods, this remedy was not deemed appropriate for that person.

Due to the sweet and hot characteristics attributed by Parikweneh to diabetes, Parikweneh treatments were frequently described based on their organoleptic (i.e. sour and bitter tasting) and caloric (i.e. cold, cool and refreshing) properties. This was particularly true for plant species. Furthermore, Parikweneh participants noted how many bitter tasting species cited against diabetes were used for other health problems that Parikweneh associated with heat, such as polyuria, fever and malaria.

Remedy administration

The remedies used internally included macerations, infusions or decoctions, and the remedies used externally included washes, tinctorial rubs, steam baths, cataplasms and creams. The remedies were either composed of a single species or a mixture. Although remedies can be prepared from fresh plant parts, the bark is often dried and stored for later use. Some methods of preparation also acted as preservation methods whereby creams and tinctorial extractions could also be stored. Unless deemed inefficient, plant remedies targeting diabetes were rarely treated as single-use cures for this illness and are seldom used only once. Instead, these were consumed for short or long periods of time, ranging from a week to a month, to daily use. In such cases where remedies are used for long periods of time, their posology, or dosage, is akin to biomedical remedies against diabetes particularly in terms of frequency: they are taken two to three times a day (i.e. morning, noon and evening). Alternatively, they may be consumed simply like water when one is thirsty. Remedies prepared for these uses are water-based, resulting from macerations, infusions or decoctions, and are generally stored frozen or refrigerated for later use.

Spiritual interventions

When recounting the history of diabetes in relation to shamanism, many Parikweneh participants added that shamans were no longer part of the Parikweneh medicinal system, having now been replaced by doctors or church pastors. When considering the remainder of Parikweneh participants, it remains clear that if Parikweneh shamans still exist, they are marginalized and live excised from the community, largely due to the effect and influence of evangelization [48, 49]. People who visit them do so discreetly. Although the preparation and use of Parikweneh medicines appear widespread, people are modest regarding their knowledge to not give off the wrong impression.

Not surprisingly, none of the diabetics interviewed reported having consulted a shaman for their diabetes. However, one elderly participant who had begun the initiation rites to become one in his youth had resorted to some of these practices for his diabetes. More precisely, a number of plants were used, not to target diabetes and glucose control per se but to harness the strength of the spiritual relationship he had long stopped cultivating with these plants. These included smoking ceremonies with tobacco (aigFootnote 4 [Nicotiana tabacum; Solanaceae]) and prayers, as well as respect for strict preparatory guidelines and dietary restrictions.

To a certain extent, some participants did evoke the power of prayers in their remedies (27.1%; 13/48), whether for diabetes and its symptoms or for any other problem. These may have a Christian undertone due to the presence of, and the participation in, Evangelical churches in the communities, although some participants were quick to remind that prayers, chants and incantations were also traditional Parikweneh practices. According to LS5017 from Saint-Georges, “For kumeh and wagewni (types of abscesses), they have its prayer. After the prayer, the remedies are applied, and it gets better. They’re Parikweneh prayers, the Elders knew that. Young people don’t know that anymore”.

Despite this intergenerational gap in practices, knowledge of medicinal plants was primarily transmitted between individuals within the Parikweneh community. Knowledge from neighbouring populations (i.e. Indigenous, Creole, Brazilian) was also transmitted and integrated into new practices. Finally, three participants revealed an oneiric origin (i.e. relating to dreams) to some medicines used to treat diabetes, such as carambola (Averrhoa carambola; Oxalidaceae); two participants dreamed of their remedy themselves, whereas another dreamt of a Brazilian who then shared his knowledge. LS6015 explains how this was revealed in a dream:

“But I can’t see the man! He was talking to me like this, he said: ‘Look at the plants.’ I said: ‘Ah, I know these.’ He said: ‘Well, take these! Wash... Wash yourself with this and take the roots. Drink it every day. Six months, he said, you’ll see. All the... All the sickness you’ve got, it’ll pass.’ Well, it’s true, isn’t it? I believed and then... I don’t know... You’re so traumatized by illness, I didn’t know that you had... effects on your dreams. How to put it?”