The Use of Food and Diet to Manage and Control Type 2 Diabetes in South Trinidad: Intersections of Contemporary Medicine, Folk Medicine, and Every Day Experience by Chantelle Ramsundar A Thesis presented to The University of Guelph In partial fulfillment of the requirements for the degree of Master of Arts In Public Issues Anthropology Guelph, Ontario, Canada © Chantelle Ramsundar, March 2018 i ABSTRACT THE USE OF FOOD AND DIET TO MANAGE AND CONTROL TYPE 2 DIABETES IN SOUTH TRINIDAD: INTERSECTIONS OF CONTEMPORARY MEDICINE, FOLK MEDICINE, AND EVERY DAY EXPERIENCE Chantelle Ramsundar Advisor: University of Guelph, 2018 Dr. Elizabeth Finnis Committee member: Dr. Hannah Tait Neufeld In this thesis, I examine how type 2 diabetes is managed and treated globally in a country defined as an “emerging economy”. In areas of new development, while contemporary medical treatments are more universally accepted, such as prescribed medication, folk medical treatments can still be more accessible to specific areas. Foods, and access, are important variables to take into consideration when discussing the treatment of type 2 diabetes, thus making it a focus of my argument. I argue that the conceptualization of diabetes in Southern Trinidad is influenced by folk beliefs of disease and the human body, and that conversely, the treatment measures provided to those who are diagnosed are reflective of North American ideas of prescription medication and treatment (such as diet and exercise). What this does is create a dissonance between what is “good” versus “bad” for the human body, with variables attached to identity at the centre of the conflict such as gender, culture, food, and memories. ii ACKNOWLEDGEMENTS To my family in Thick Village – Grandma Elaine, Grandpa Bob, Aunty Judy, Aunty Winnie, Uncle Kelvin, Uncle Glenn, Aunty Heather, Isa, and Amirah – thank you so much for your love, help, patience, hospitality, and guidance with this project. Truly, none of this could have been accomplished without you. I would like to thank my committee member Dr. Hannah Tait Neufeld who throughout the course of this project was always willing to answer questions and provide me with feedback and encouragement. Your work is inspiring and has made me more aware of the nuance required to explore topics related to diabetes. To my advisor Dr. Elizabeth Finnis – thank you for your encouragement, guidance, and support. Dr. Finnis is a remarkable human. Without her help, starting from my last year of undergrad, I could not have gotten this far in my academic career. She has helped me develop into a better writer and researcher and embedded into me a deep appreciation and understanding of the history and legacy of anthropological studies – something I wish to continue in my future work. To my beautiful, intelligent PIA colleagues, Merin and Davina, for your support and friendship. To my friends; Bella, Devon, Husam, Jon, Charlotte, Angela, Chelsey, Mimi, Maryam, Bethany, and Bonny – thank you for your help in preparing for my defense and for coming to my presentation to help put my nerves at ease. Your friendship is invaluable, and I am so lucky to have you all in my life. A special thank-you to my friends Jaida and Erika, for your friendship and help with the creation of this thesis, and all the support you have given me throughout my MA. During my toughest days I could always count on your insight and kindness; for this, I thank you. Finally, thank you to the students of Lambton 2B 2011-2012, Prairie Grasslands 1 2012-2013, Lennox-Addington Athletics Cluster 2012-2013, and Lanark 3 2013-2014. There were many days where I did not think I had a future at the University of Guelph – the students in these sections were a constant source of support and inspiration. There were truly no boring days. Thank you all so much. In loving memory of Aunty Heather Chantelle iii Table of Contents Chapter 1: Introduction ................................................................................................................... 1 Background and Aims ................................................................................................................. 2 Key Concept and Framework Development – Biological Citizenship ....................................... 3 Organization of Chapters ............................................................................................................ 4 Chapter 2: Field Location and Methodology .................................................................................. 6 A Brief Colonial History of South Trinidad ............................................................................ 7 Field Location ........................................................................................................................... 11 Trinidad and Tobago ............................................................................................................. 11 South Trinidad ....................................................................................................................... 13 Field Location: Rationale ...................................................................................................... 16 Methodology ............................................................................................................................. 17 Introduction ........................................................................................................................... 17 Explanatory Framework ........................................................................................................ 18 Semi-Structured Interviews ................................................................................................... 23 Pile-sorting Activity .............................................................................................................. 28 Participant Observation – Eid Celebration ............................................................................ 30 Participant Observation – Debe/Penal and Fyzabad Markets ............................................... 32 Participant Observation – 25th Annual Diabetes Symposium .............................................. 39 Chapter 3: Literature Overview .................................................................................................... 43 Introduction ............................................................................................................................... 44 From the Biomedical to the Social – understanding type 2 diabetes through a medical anthropological lens .................................................................................................................. 45 Structural Violence ................................................................................................................ 45 Biological Citizenship ........................................................................................................... 48 Oppression and Empowerment Models ................................................................................. 54 Laying the groundwork for understanding Delocalization and Food Systems ..................... 55 Intersections of nutrition, culture, and consumption – looking at the role of Nutritional Anthropology in contextualizing type 2 diabetes management and treatment ......................... 57 Folk Ideas of Food and Health .............................................................................................. 57 Diabetes in the Caribbean Context ............................................................................................ 59 iv Chapter 4 – Constructing the “Diseased” Identity – The Social Construction of Type 2 Diabetes Unique to South Trinidad.............................................................................................................. 62 The cultural identity ............................................................................................................... 63 The biological identity ........................................................................................................... 66 The medical identity .............................................................................................................. 69 Beyond Food and Medicine – other factors of the diseased identity ........................................ 72 Ethnic and Racial Stratification ............................................................................................. 72 Crime in South Trinidad ........................................................................................................ 74 Concluding Thoughts ............................................................................................................ 75 Chapter 5 – Managing Change and the Pursuit of Healthy Food Consumption – Reclaiming and Re-localizing Diets Informed by Non-Biomedical Definitions of Health .................................... 77 What do dietary changes look like? .......................................................................................... 77 Food and Feeling ................................................................................................................... 87 Deservingness, Charity, and Poverty – Relocalization of diets and reclaiming ideas about health and diet based on personal histories and shared narratives ........................................ 91 References .................................................................................................................................