Traveling with Sugar. Amy Moran-Thomas

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СКАЧАТЬ erratically rise and fall. Fear of safely moving through a place could make a daily exercise routine feel like weighing immediate security against future health. I began to learn how easily a country’s relaxed atmosphere can be mistaken for an absence of social problems, rather than a hard-won effect of the way people absorbed hardship and undertook the labor of transmuting it for those around them. These realities are now also part of “what it means to be human in a place advertised as paradise.”⁵⁸

      Theo used to say that he was jealous of friends who had HIV/AIDS instead of diabetes. He said the two chronic diseases shared similar daily demands—except that with AIDS, “if you take your medications in time, you can eat just about anything.” And the difference that most preoccupied Theo: “With AIDS, they don’t cut you up.” He started laughing at this harsh contrast, the way blood with high sugar doesn’t make others afraid, unlike AIDS. “They don’t want to cut you!”

      They cut him more than a dozen times, face and neck. When I listen back to recordings from his car now, Theo’s storytelling as we crisscrossed Belize feels impossible to separate in my memory from what happened to him later in his vehicle. Slow violence bleeds into violence of other tempos. The stories he told me about food and landscapes as I looked out the window already held the quality of blurring past, present, and future, and now make me imagine looking back at him in the driver’s seat with a similar sense of “simultaneous time.”⁵⁹

      I recalled his carefully stowed hard candy in quick reach in the console and thought back to Theo’s story about his tough old friend, who the police initially thought had been murdered but seemed to have died fighting his way toward the kitchen with low sugar. Everyone in Belize called diabetes the “silent killer,” but I never grasped it as clearly as in that story of what police had mistaken for a crime scene. Staying on guard against other violent killers could share a gut-level feeling with diabetic sugar: There were measures you could take, but there were things far out of your hands, and life with it meant just knowing that.

      Theo fought back hard, his gashed arteries undoing the delicate investments behind decades of care. The story that he had told me most often was about the time a few years ago he’d tried putting a teaspoon of sugar in his morning coffee, after hearing it was good for diabetes. But it had caused Theo’s toe to “crack open like a statue.” His son had brought him an aloe plant to massage onto the injury each day for months until the threat passed.

      DIABETES MULTIPLE

      One woman in Dangriga asked whether she had type 3 diabetes. In medical journals, “type 3” would reference theories of Alzheimer’s as an additional or comorbid form of diabetes, linked to insulin disturbances in the brain that interfere with insulin’s role in memory.⁶⁰ But for her, this meant something else. She clarified: type 3, the kind of diabetes that means your arms or legs get cut off.

      Nobody needed a visiting ethnographer to tell them about “diabetes multiple,” an interpretation I had once felt clever for proposing. In Body Multiple, Annemarie Mol examined different hospital treatments of sclerotic arteries—the hardening blood vessels linked to ischemic leg ulcers, often associated with diabetes—to reflect on how different bodies come into being, depending on the treatment approach chosen.⁶¹ This insight also has crucial implications for observing care inequalities (though Mol doesn’t choose to go there). Yet juxtaposing her book with this one offers a case in point: its front cover depicts an image of two legs being readied for precisely the surgery that helps to prevent diabetic amputations.

      In one sense, this provides an uneasy demonstration of Mol’s insights: physically different bodies get produced through differences in medical practices and technologies. By putting into play (or not) different possible treatments, diseases can become physically distinct entities. This can create multiple versions of a condition like diabetes—as when clinics in Belize amended the preprinted posters that listed the disease’s warning signs, writing in by hand severe manifesting symptoms like “blindness” next to milder warning signs like “blurred vision.”

      Yet comparing how multiple versions of diabetes are produced by unequally available treatments and practices also begs another question: how connected material histories shape what care options come to seem “ordinary.” After all, these different norms of treatments are not unrelated, thinking of Body Multiple from the Stann Creek District of Belize—“Stann” being the Dutch word for “Safe Haven,” the name by which early Dutch settlers claimed this Maya ancestral territory. While there are several accounts of how ancestors of Garifuna people first arrived in the Caribbean, some historians believe they descend from African men and women who escaped from the Dutch slaver ship Palmyra.⁶²

      In some opaque way, the “ordinary” sclerotic surgeries in a Dutch hospital have a historical relationship to the absence of those restorative technologies in most of the Caribbean. They are obliquely connected by colonial histories of plundered bodies and lands that still today shape institutional resource flows—systems impacting how different forms of medical expertise and technologies developed. To extend Mol’s logic to Belize, these “versions are both different and interdependent: multiple.”⁶³ “The capital amassed in the eighteenth and nineteenth centuries through various forms of slavery economy is still in circulation,” W. G. Sebald wrote, reflecting on what he called the “money laundering” of Dutch art funded by Caribbean sugar, “still bearing interest, increasing many times over and continually burgeoning anew.”⁶⁴

      There is also another aspect of “diabetes multiple” that is not easy to trace with hospital observations about disciplinary differences alone. Technologies do not get used equally, even in affluent hospitals, for reasons that occur without the intent or knowledge of anyone involved. In textbooks about sclerotic arteries, for example, the choice of which procedure gets used should not relate unjustly to an individual patient’s skin color. But looking at U.S. population data, it becomes clear that racial assumptions have been systematically enacted on patients’ bodies.

      Drawing from ten years of New York hospital data, one study analyzed 215,000 cases of people with diabetes arriving at the hospital with symptoms of peripheral artery disease.⁶⁵ It found that Black patients were 46 percent more likely than other patients to have received an amputation instead of a “salvage” procedure to restore blood flow to their legs. Black patients and women were also more likely to be amputated above the knee rather than at the shin. Above-the-knee amputations notoriously make recovery much more difficult.⁶⁶

      Perhaps most disconcertingly, these disparities were actually highest in the hospital units with mostly white patients, so they cannot be easily attributed to preexisting resource or equipment inequalities of segregated cities. Another study mapped the geography of diabetes-related lower limb amputations in Los Angeles, which is actually the largest Belizean city in the world by population. This mapping revealed that people were ten times more likely to experience diabetic amputations in the poorest areas of the city, which were also the most segregated. It shows a disturbingly patterned geography of “diabetes multiple”—inequalities that can make diabetes a physically different condition for people of color and for patients with fewer resources, those more likely to have limbs removed even when experiencing identical symptoms.

      Certain scientists still argue that diabetes risk is “inherent” in the DNA of nonwhite people. This text instead follows Anthony Ryan Hatch’s illuminating work in Blood Sugar—including his observation that “race is not biological, but racism has biological effects.”⁶⁷

      In hospital labels, the technical name for diabetes is diabetes mellitus. It derives from the Latin word mel for honey, a reference to an old European medical trick of tasting a patient’s urine for honey-like sweetness as part of the diagnosis. Physicians today commonly shorten diabetes mellitus to “DM.” In contrast, the word sugar was adopted into Latin from the Arabic word sukkar СКАЧАТЬ