Media headlines about diabetes always seem to show bodies getting bigger, but the stories I heard in this stretch of Caribbean Central America more often focused on fears of getting smaller. If you sat and talked with people, missing body parts were often central to how they told stories and measured time. Some felt phantom pains or dreamt at night about running. Others, like Mr. P, watched with dread as it happened in their families or heard about beloved elders lost piece by piece. Nurses said that feet bitten by venomous snakes were easier to heal than those poisoned by sugar.
In Belize, this common name for diabetes traveled across languages: súgara in Garifuna, shuga in Belizean Kriol, azúcar in Spanish, kiha kiik in Kekchi Maya, or ch’uhuk k’iik (sweet blood) in Mopan and Yucatec Maya.1 Some people described the dismemberments as a quietly surreal spectacle their families were already living with amid a lack of public acknowledgment: “They cut my grandmother down to a lone torso.” Others spoke of dying in small pieces, like “my arm died that time” or “her eyes died first.” A Garifuna spiritualist with diabetes told me of the new addition to her ancestral prayers—protection for “Feet, legs, toes, hands, fingers, arms, eyes. Amen.” When a Maya seamstress walked into a mobile clinic without realizing there was an embroidery needle sticking out of her numb foot, the visiting physician knew that she likely had diabetes before the two ever exchanged a word.
SWEETNESS
Sweet foot—a limb macerated due to diabetic injuries—is common enough that you can find the term alongside other diabetes vocabulary in the Belize Kriol dictionary:
sweet fut n. abscessed foot due to diabetes. Sayk a weh Misa Jan ga shuga, ih gi ahn sweet fut. Because Mr. John has diabetes, it gave him an abscessed foot.
sweet blod phr. 1) sweet personality. Raja eezi fi laik kaa ih ga sweet blod. Roger is easy to like because he has a sweet personality. 2) diabetes. Dakta seh Ah hafu kot dong pahn shuga kaa Ah ga sweet blod. The doctor says I have to cut down on sugar because I have diabetes. See: shuga.
shuga n. 1) sugar. Bileez sen lat a shuga owtsaid. Belize sells a lot of sugar overseas. See: kayn. 2) diabetes. Dakta tes mi ma blod an ih seh ih mi ga shuga. The doctor tested my mom’s blood and said that she had diabetes. See: sweet blod.2
Sweet feet I heard said when it happened on both sides, which had become Sarah’s predicament some seven years before we met. In the Stann Creek District of Belize where she lived, an estimated one in four people (and one in three women) lived with type 2 diabetes,3 and some five out of six amputations were due to sugar’s complications.4 Certain images sounded straight out of a war story, like when the hospital’s incinerator broke down once and everything had to be buried. But at the same time, it almost felt like nothing had happened.
The home that Sarah invited me to visit again felt comforting and bright. Its paint flaked into pretty layers, like sycamore bark. The rooms smelled of coconut rice and fresh laundry. I never saw her play the tambourine, but its open crescent hung on a nail next to a mosquito net she had improvised from a bedsheet to prevent insect bites. (She developed this strategy after once hosting a botfly in her knee, which took almost a year to heal because of high blood sugar’s complications). “My treasure chest,” Sarah joked of the container she showed me. Amid the cozy jumble of a lived-in room, her glass box of diabetes technologies looked like a tiny museum case. Among bottles of pills and other archived medical treatments, it held a broken blue and gray blood glucose meter.
“I just don’t know what caused it,” Sarah said of her sugar, which was what she called the condition she had been living with since 1978. She had always been slender in build, like many people I met who defied any easy conflation of diabetes with obesity. When her first foot started going bad, she said, it had started with a corn on one toe. It had just gotten “miscarried away.” Miscarriages also figured centrally in women’s stories about the effects of untreated sugar, and mortality during pregnancy for both mother and child is another diabetes phenomenon that is likely widespread globally (though reliable statistics are hard to locate).5 Sarah’s sister living with uncontrolled diabetes had been somewhere among these uncounted women, dying along with her baby during childbirth.
Sarah fondly recalled the Kriol midwife, Mrs. D, who used to go door to door to visit those she knew were sick. “Every house. She would walk.” She used to bathe and bandage Sarah’s ulcers to prevent infection. After Mrs. D died of cancer, the centralized health system was never able to replace her day-to-day care work in the village—part of a bigger story about homecare visits growing less frequent across Belize as old midwives themselves died of chronic conditions. Sarah summarized decades of care in hospitals by evoking a cast of doctors with good medicine that came and went, and the boiled herbs she used in the meantime; raw Clorox she applied for pain when a protruding bone’s edge pushed into the skin. As she narrated the accumulated cuts and recoveries, it seemed like her illness faded into the background, unlike the FM radio she kept that blared theme music from Ghostbusters or a reggae version of the Bryan Adams song Heaven.
“I would like to know how high it is,” Sarah said of her blood sugar level. “Indeed.” The last time she had been rushed to the closest town’s hospital, it was “five change,” over 500 mg/dL. “I have needles, but no strips,” she said of her unusable Accu-Chek meter, which was quite expensive (seventy U.S. dollars) and designed to require special brand-matched parts (around fifty U.S. dollars for one month’s supply). Sarah used to travel to the Guatemalan border town of Melchor—about five hours away by bus—to purchase discounted blood sugar test strips, but had not been able to lately. Her meter rested next to foil-wrapped pills, which she took tentatively because she had no way to gauge her starting point. Diabetes medications at times can make people feel more sick, if the day’s blood sugar is unusually low or high. I was unsettled to realize that the very objects that could have helped prevent her worsening injuries were both there and not there in the room with us, sitting as if suspended in the glass box.
“Sugar machine” was Sarah’s name for the broken glucometer. Even in her lilting voice, this hung in the air with an ominous edge. It was one of the ways we were speaking in history, if not about it; getting to Sarah’s village meant passing the remnants of another structure called a sugar machine. We both knew that just down the road rested a steam locomotive from the 1800s, mounted on eroded bricks like a train running nowhere, which had once boiled sugarcane into molasses. It still stands next to the plantation’s evaporating furnace, a hot-air exchanger, a Tredegar engine that pumped water from the river, and the crusher with its flywheel. Their rusted-out pipes and oil tanks were etched with places and names that I could barely make out under the moss: LONDON and RICHMOND, VA covered in lichen.
That particular sugar machine and its adjacent fields of bourbon cane were established in the 1860s, long before Sarah was born, by a man from Pennsylvania named Samuel McCutchon. He was friends with U.S. president Andrew Jackson, who used to travel on his ship Pocahontas to visit the McCutchon family’s Louisiana sugar plantation. Lists of the enslaved people whom Colonel McCutchon owned in Louisiana fill seven archival folders. He was among the Confederate sugar planters who fled to then British Honduras after losing the U.S. Civil War. By some accounts, more Confederates fled to Belize in the post–Civil War years than any other receiving country.6 In Belize, the workers in McCutchon’s cane fields were mostly Garifuna, Kriol, Maya, and Chinese. He founded three sugar estates in southern Belize,7 transforming the landscape. Ruins built by Confederate planters after the Civil War, some as far north in Belize as Indian Church, are among many remnants of sugar machines still found across the Caribbean and the Americas. It was said that Belize’s rainfall was so conducive to quick growth that the cane bent over by its own weight and then grew upward again into a field of S-shaped stalks, as if the