Traveling with Sugar. Amy Moran-Thomas

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      Once, I rode through the Maya Mountains in the back of a slow-moving ambulance with Paulo and his young daughter Elisa, wondering about tipping points. Elisa’s pharmaceutically induced high blood sugar was a secondary concern to the fact that her skin was “coming unglued,” which may also have been a side effect of the steroid medicines. We never knew for sure. There was no IV rack, so Paulo and I took turns holding the bag until our arms shook. None of us had been inside an ambulance before. We had imagined speeding to Belize City, but instead we told each other jokes about wishing bus drivers would travel this slowly along the precipitous highway.

      Years later I followed behind Paulo as he chopped dense jungle plants away to clear Elisa’s grave, the surrounding vegetation’s growth a ruthless account of the years I had been gone. I have never felt more responsibility than when I learned that her mother, Angeline, had waited three years for me, and together we made the trip to see her daughter’s grave for the first time. Afterward, Angeline handed me a photo of herself kneeling with open arms as Elisa took her first baby steps. The fact that the picture’s chemical exposures had outlasted Elisa’s seemed to dissolve all the words we tried to say. I gave them an image in return, an ornament engraved at a Pennsylvania Christmas shop. They cut the ribbon off and nailed it to the dash of their pickup truck.

      Elisa’s real name is written on that ornament, but not in this book. One difficult decision in finalizing this project was that most of its contributors requested that I use their actual names. “But then it wouldn’t be true,” one research contributor protested, when I asked for her input choosing a pseudonym. Others did prefer to create new names, as Belize is such a small place.¹⁵ For this reason, I have mostly stuck with typical anthropological conventions of changing people’s names unless they are public figures whose names have been previously published, changing place names except for district capitals, and at times blurring particular identifying details. Still I remain uneasy about these trade-offs, wanting to recognize people’s intellectual contributions to this project.

      On the other hand, most everyone I met in Belize has more than one name. When Antonia later told me to call her Beh, she said that when I first arrived at her door with a nurse asking for her by her legal name, she knew we had not been sent by friends. Her neighbor Kara had not even known her own legal name until she went to vote for the first time and discovered that in the state’s eyes her name was Roseanne. Her mother had chosen to call her children by one set of names in real life and to write another name on official documents for them to claim one day or not as they saw fit. I offer this book’s names in something of that spirit, an extra name that could be opted into or plausibly denied by each of these individuals as lives change over time. It also remains a way of asking readers to engage with the larger health and social issues being described, but to respect the privacy of individuals unless they have reached out first.¹⁶

      The slow time-lapse stories unfolding in Mr. P’s album were also shaped by a gradually changing landscape. Erosion touched human bodies as well as their environs, atmospheres, and infrastructures. They all wore down in ways that were materially connected. In fact, Mr. P and I first started up our conversation while standing in the doorway of a stranger’s barn, watching the broken-down yellow school bus we’d been traveling on get pulled up a hill backward by another school bus. That road strained many engines, and bad weather chronically worsened already rough terrain. That particular afternoon, the hours sitting around the farm where our bus broke down felt like the opposite of a crisis. But that same trip for someone urgently needing medical care would have been a very different matter. One woman recalled how her surgeon planned to cut below the knee, but the vehicle carrying two necessary bags of blood sent by a loved one got stuck in flooded roads after a storm. The infection moved faster than the ambulance. By the time the blood delivery arrived, the surgeon had to cut above.

      TRAVELING WITH SUGAR

      One of the first expressions I heard for diabetes when I arrived in Dangriga was “traveling with sugar.” Sugar is a very common phrase for diabetes—though “traveling with sugar” is not a set label, just one possible translation. In Belize’s English Kriol, to “travel with” has long been a term for living with chronic disease.¹⁷ This striking turn of phrase stayed with me as I saw how trips in search of care were a significant part of how many people with diabetes spent time, often traveling by slow public transportation to far-flung clinics, hospitals, temples, or other destinations in search of materials “to maintain” themselves and support their family members. “Traveling with sugar” also echoed common reflections that living with diabetes could feel like being on a strange trip or a very long road, chronic routes that people had to navigate for themselves without knowing where it all might end up.

      In Garifuna idiom, one could also “travel” in a spiritual sense, through forms of inner reflective work or metaphysical communication with visiting ancestors. That is why expressions like “to take a trip” or “to get a passport” can double as Garifuna euphemisms for death.¹⁸ I remember stopping by Ára’s house on the night before she died, its familiar rooms suddenly filled with children who had made the trip from Chicago when they heard the news. They told the nurse I was accompanying not to worry about checking Ára’s sugar unless she woke up again. “She is traveling now.”

      If some of the people I met were traveling with sugar, I was trying to travel part of the way with them: to be worthy company in moments when people invited me somewhere, to write down what they offered up, to ground my questions, and to learn what I could from faraway libraries or locations abroad that might fill in some blanks about the deep divides between us and the uneven conundrums people faced. Foods, technologies, and medicines were also traveling. Like the movement of people, objects’ mobility could be capacitated or curtailed by larger infrastructures. Some of the most profound “travels with sugar” were the first journey across a room on a new prosthetic leg or learning to travel on one’s hands, people teaching each other to move again as bodies and worlds change.

      An ambulatory anthropology of sugar draws attention to how differently we each circulated through the same infrastructures, and how my own comings and goings contrasted so starkly with the mobility of others. Sometimes, but not always, I could borrow a pickup truck and offer rides to the hospital for emergencies. I accompanied hitchhiking friends to doctors and glimpsed the terrible frustration along certain junctures as air-conditioned resort vehicles sped by, but I have also been a passenger in precisely such private vehicles that passed by good friends. There was no eschewing the tourist infrastructures I moved through and no avoiding their troubled histories and ongoing implications they carried. And, of course, traveling with sugar can mean all of this too, trailing charged colonial legacies: travel with money, pleasure, illicit gains.

      Tourists were hardly the only ones coming and going. “Garifuna people, we travel,” Antonia told me emphatically. “We traveled from Africa.” For many proud members of the Garifuna diaspora, traveling is an important idea far beyond health alone. It signals a deep history of fierce persistence against ongoing dispossessions and today includes a diasporic community of more than three hundred thousand strong around the world. “Travelling the ocean under British control” is the first theme that Joseph Palacio highlighted in his oral history work, when he italicized the word to signal its meaning as both a specific historical practice and a more abstract ideal of active navigation through a matrix of oppression.¹⁹ “I Have Traveled” (Áfayahádina) is a well-known Garifuna song that describes the composer’s good fortune: “While she has traveled and seen the world, she chooses to remain in her home village.”²⁰

      Others wished for such luck. Reliance on medical technologies like dialysis often thwarted people’s plans to eventually return home. Some in U.S. cities even considered themselves in medical “exile,” stranded abroad with diabetes and its complications. Still others in Belize who were more tenuously connected to kin networks abroad nonetheless lived with full details of the medical specialists they could not reach. Even a modest job in a U.S. paper cup factory could СКАЧАТЬ