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 open a world of retirement resources to be leveraged back home later, such as when one woman in Dangriga had her specialty diabetes prescription pills (unavailable in Belize for any price) delivered monthly via FedEx from a CVS Pharmacy in Chicago.
Traveling organizations like the Belize Diabetes Associations of New York and Miami coordinate with wider networks from across the Caribbean and Central America to bring care teams to Belize each year. Many individuals who contributed to this said they considered these kindred transnational communities as the publics—along with caregivers and families living with diabetes elsewhere in the world—that they hoped this project might reach. Accordingly, I have placed certain reflections meant for academics alone in footnotes and online, trying to find language that might also travel.21
Of course, the word sugar already contains many journeys and histories. One version of how sugar’s pivotal episodes altered the course of Garifuna history might go like this: Columbus planted sugarcane on what became the Dominican Republic in 1492.22 By 1505, the first slave ships arrived.23 The Caribbean archipelago at that time was one of the most heavily populated geographies on earth. By the late eighteenth century, some 90 percent of the Kalinago population and other Indigenous peoples of the Antilles had been exterminated by military campaigns and European epidemics, as island after island was converted into sugar plantations.
By the late eighteenth century, the last Indigenous-controlled sovereign territory in the Caribbean was Saint Vincent, an island strategically chosen as a fallback point because its mountainous geography allowed for fierce defense. It also became home to a growing community of mixed Indigenous and African ancestry (including men and women who escaped boat by boat from the sugar economies of surrounding islands), which colonial authorities soon labeled “Black Caribs.” This group that came to call themselves Garifuna24 defended their land against European invasions for nearly two hundred years, winning a long series of wars against the British. In 1796, the British military finally managed to exile the majority of the Garifuna families from their land,