UBC Theses and Dissertations
Sick with sugar : the sociocultural dimensions of managing diabetes in a semi-urban Indian Trinidadian community Parmasad, Vishala
This dissertation comprises ethnographies and narratives of the ways in which Indian Trinidadians in Debe, Trinidad negotiated their life-worlds, life-course expectations, and ethnic identities around Type 2 diabetes mellitus with family, food, and religion as central themes. In overview, this research explores how Type 2 diabetes mellitus, popularly known as “sugar”, is constructed and responded to, as well as the impact of inequities in access to healthcare on people’s ability to manage this disease. Diabetes is the second most common cause of death in Trinidad and Tobago, and has highest estimated prevalence among Indian Trinidadians. Much of the discourse in Trinidad blames high local rates of Type 2 diabetes mellitus-associated mortality and morbidity on unhealthy patient practices and lifestyles. Through participant observation, interviews, and archival research, I explored normative biomedical notions of disease and untangled who is affected by a diabetes diagnosis, how they are affected, and what they do when their lives change, or to change their lives in this context. This research revealed some ways in which overly simplistic notions of patient autonomy projected upon complex, enmeshed societies and polities can be translated as ineffective recommendations for disease management, producing unintended and detrimental changes to people’s life-worlds. Understanding diabetes and its management in Debe required not only understanding the pathological or biological disease process, but more crucially, the explanatory models of people with this diagnosis, how they coped with associated illness, and the crucial communities of care that facilitated therapeutic efforts. Particularly important were narratives of persons with diagnosis of diabetes, and their caregivers. The case narratives produced are grounded in the ethnography of an economically heterogeneous community that has undergone many transitions in the recent past, including the rise in the rates of diabetes and resultant transformations of everyday socialities. These stories are therefore also inherently concerned with temporality on different scales: the progression of a disease over time, the changes in an individual life course over time, and the temporal shifts in a community as it moves from a shared, agricultural past to an uncertain and multitudinous future.
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