table of contents

Gratitude to Stonetree Records for

Thanks also to MIT Libraries for working with UC Press to make the book open access in 2020. In the meantime, the PDF links below give access to sample chapters.

Ella Fitzgerald had to have both feet amputated due to complications of diabetic sugar. Dr. W, who pointed this out, saw this as an example of the “Diabetes Twilight Zone” in which times and places blur….

Part 1: Contexts

Approach: Emergency in slow motion

By 2010, diabetes had become the leading cause of death in the Central American country of Belize.  Strange symptoms of high blood sugar—such as amputation, blindness, and organ failure—affected so many people that their concerns and guidance reframed this project from its intended focus on infectious diseases.  It became reframed instead around the expression “traveling with sugar,” a Belizean turn of phrase that can mean both living and dying with sugar. The struggles with diabetes described in this book could be read as only the latest chapter in five hundred years of traveling with sugar.  Sidney Mintz famously pioneered two approaches to narrating the history and anthropology sugar: the world systems entanglements of Sweetness and Power, and the individual life history in his earlier book Worker in the Cane.  This book tries to weave these two approaches to global sugar—singular individuals’ trajectories, and entwined histories of racial capitalism—together in the same ethnography.  But where Mintz’s classic reflected on “the place of sugar in modern history,” these are chronicles of sugar out of place. The stories of diabetic sugar that people shared give glimpse into ongoing travails trying to seek care for a complex chronic condition.

Past is Prologue: Sugar machine

“Sugar machine” was what one woman called her broken glucose meter, for which she could no longer afford the device’s expensive test strips.  “Sugar machine” was also one name for the rusted wheels and abandoned machinery of a nearby colonial sugar mill.  This chapter surveys the embodied legacies of “sclerotic landscapes,” and the patterned injuries of limb loss that continue in a new era of unequal sugar economies and industrial profit engines.

What is communicable?: Caregivers in an illegible epidemic

Foot care to protect against amputations has become one of the frontlines of day-to-day domestic work and diabetes struggles.  As guided by the nurses, doctors, and other caregivers trying to make sense of and prevent the bodily costs of rampant diabetes, this chapter takes a closer look at some of the unknown aspects and silences around the bodily costs of rampant diabetes.  How are communities and families improvising surveillance, when global institutions are not tracking diabetic injuries?  How much do we really know about the histories and causal dimensions of diabetes?

“Sugar man, you’re the question that makes my questions disappear.”

PRESSURE. Belizean Dub Poet Leroy “Grandmaster” Young performing his hit poem, which linked the pressure in overstrained infrastructures to the pressures rising in families and bodies. Belize City, Belize, 2006. Learn more about his work at Stonetree Records.

MALDITA DIABETES (“CURSED DIABETES”). El Muertho (“The Dead One”), Tijuana, Mexico, 2015.

Read more about El Muertho.

PART 2: cronicas

one: thresholds

Traveling an altered landscape with cresencia

In a context where people regularly have blood sugar levels double or triple its textbook ranges of the ordinary, what was “normal” blood sugar?  And in a time and place marked by warming climates and gentrifying coastlines, what was a “normal” landscape of food or medicine?  This chapter chronicles one young woman’s journey to seek care across various thresholds: national borders, bleaching coral reefs, farmlands changing to tourist circuits, rising sea levels, ancestral feedings, chemical exposures, miraculous transcendence—in a context where her survival had long ceased to be a baseline expectation.  Called “Ms. Lazarus” after a spirit possession offered survival during a time when hospital science could not, her struggles for a good life illuminate alternations in larger ecologies.

two: insula

Technology, Policy, and other units of jordan’s isolations

Insulin (which comes from the world insula, for island), has been sold to treat diabetes for nearly a century.  Yet its prices are actually still rising in many countries.  This chapter traces the recollected story of a teenager struggling into adulthood with Type 1 diabetes, after his mother died from the same condition.  It considers how inconsistent access to insulin and other diabetes care technologies shaped his social trajectory, and how his singular history intersects with the history of diabetes science as it is typically narrated.  Questions explored include gaps in global health policy priorities; scattered archipelagos of both extraction and care; the implications for families; and what Ruha Benjamin calls “discriminatory design” of the assumptions built into many health technology devices.

Cronica three: generations

approaching “biologies of history” with arreini and Guillerma

Perhaps the most fraught debates around diabetes involve contrasting causal explanations for its unequal distributions between populations.  Recent epigenetic research is developing frameworks for making embodied traumas more legible in science, opening new ways of producing evidence about unequal diabetes risk.  Yet as historian Dorothy Roberts points out, the assumption that non-white people were born with inherently dysfunctional metabolisms was a leading argument once used to justify slavery—there is an unsettling sense in which the New World’s racialized inequalities were founded on arguments of “metabolic disorder.” How do attempts to redress historical injustices interface with ongoing inequalities, when it comes to diabetic “stressors”?  This chapter surveys what Hannah Landecker calls “the biology of history” around sugar, juxtaposing histories of scientific racism and “natural history” from the lost Garifuna homeland of St. Vincent together with emerging work on diabetes genetics and epigenetics.  These academic debates are set against one midwife’s alternative account of cause and effect, kinship, and how bodies have histories.

Cronica four: Repair work

maintenance projects with laura, jose, and growing collectives

How are struggles to maintain and repair bodies related to broader struggles to maintain and repair infrastructures?  From protests for dialysis access and cobbling prosthetic limbs to struggles toward remaking systems of food and land ownership, this chapter follows patient and caregiver activism (and forbearance) as increasing numbers live with the costly effects of diabetes’ bodily wear over time.  Guided by the insights of a woman healing from limb loss, its narrative assembles stories from across the makeshift transnational collectives coming together to help each other survive hurtful injuries and continue to rebuild gardens, homes, and bodies.

“Merua”

quasi-sacred, about needing to work together to get somewhere hard to reach.

Epilogue

“OUT OF THE STRONG CAME FORTH SWEETNESS”

This epilogue traces the material circuits of Sweetness and Power come full circle.  It follows Belizean sugar cane traveling on boats across the Atlantic to the “Sugar Mile” of semi-abandoned factories in East London for refining—where machines today continue work in a gentrifying industrialized landscape marked by toxic seepage, though largely de-populated by humans and run by computers.  It closes with a last look back at sugar’s afterlives from coastal Belize.