Metabola: Chronic Disease and Damaged Life in Belize

Abstract

Diabetes is the leading cause of death in the Central American country of Belize, making it profoundly emblematic of the emerging pandemic of metabolic disorders today. It is estimated that diabetes now kills 4.6 million people a year, more than double the global death tolls from HIV/AIDS. Approximately 80% of diabetics today live in low- or middle-income countries, but there is a dearth of social scientific literature about what it is actually like to live with diabetes in the developing world.

This dissertation is an ethnography of diabetes in Belize--its causes and treatments, communities and contradictions, and what it means to live with a new human condition often imagined as a disease of excess in a context marked by scarcity and chronic insecurity. It is based on fourteen months of fieldwork and structured around cases studies. Key questions raised include epigenetic links between diabetes and trauma; food systems warped by colonial legacies and neoliberal policies; the side effects of drugs that can hurt people as often as they help them; and makeshift forms of medicine, where supernatural healing might be enfolded into therapeutic ruptures. As metabolic disorders play across time, policy, ritual, commerce, history, science and law, the calamitous burden of chronic conditions signaled by metabola--a mutation of disease, symptoms, and treatment--also speaks of broader mutations in the global political economy and the place of postcolonies such as Belize within it. The prevalence of diabetes shows how the intricacies of human biology are constantly interacting and keeping pace with deranged economies and overheated environments, unequal market policies, erratic medical and humanitarian interventions, violent histories, and unstable futures.

The dissertation ultimately argues that diabetes is not non-communicable at all: It represents a category of "para-communicable disease" emerging between infectious and non-communicable disease as they are traditionally inscribed by biomedicine. The divisions and toxicities causing diabetes stretch far beyond the clinic walls and deep into the messy realities of actual life. We need more apparatuses of care that can do the same. Experimenting with elegy as an anthropological form, this dissertation draws from both life histories and death histories.