Melbourne School of Population and Global Health - Theses
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ItemLife beyond control: youth, diabetes and care in contemporary Chile( 2017)In this dissertation I ethnographically explore how young Chileans with type 1 diabetes strive to construct good lives while negotiating the limits of a neoliberal approach to diabetes care. The study foregrounds my informants’ efforts to find health in illness, as they aim to live rich lives with diabetes, process that is often reduced or hidden from view within the biomedical understanding of the responsible and autonomous adult diabetic patient. The stories take place, both inside and outside of hospitals, in Chile’s capital city: Santiago. The study takes on a socio-cultural construction of youth, where the macro- and micro-level impacts upon young people’s experiences, while allowing for fluidity and transformation. I thread my informants’ experiences within Chilean history, tracing complex interactions between youth, family, precarity, biomedicine, and the state. I argue that growing up with diabetes constituted a troubling and ongoing process for young people, where their understanding of a good life escaped the limits of diabetes metabolic control. I explore their negotiations with and juggling of diabetes care with competing desires and obligations in relational terms, as they co-created partnerships with other companions. While I examine the entanglements and difficulties my informants faced, I highlight that they were not willing to abandon their illness, deciding instead to stay with its trouble. This represented a realistic alternative to sustain diabetes care or begin again with it, devising paths to be healthier in the future. Having supportive and attentive companions was essential in finding health in illness. This study highlights the role of health practitioners and the health system as partners, showing that, sometimes, they could become troubling ones. I depart from the assumption that only patients who achieve metabolic goals can live well, suggesting instead that a good life with diabetes should tie together biological and social life amid trouble. I problematize the emphasis on disease progression, autonomy and individual responsibility in diabetes care, pointing out its limits and unforeseen consequences. This approach tended to distance young people from clinicians, reducing their possibilities to work together. I contribute to an empirically and theoretically rich analysis that provides a more complex view on the experience of being young and having a chronic condition, threading Chilean history and state decisions with my informants’ experiences. This dissertation will be of interest to medical anthropologists, sociologists of health and illness, health professionals working with young people, hospital officials, and policy makers concerned with health systems and the reduction of health inequalities. Finally, it will be of interest to patients’ organizations, families, and young people themselves.
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ItemControlling diabetes or keeping life under control?: Experiences and understandings of a group of Sri Lankan migrants in Australia with type two diabetes( 2014)Diabetes is a key public health priority and a major health concern for many migrant communities including the Sri Lankan community here in Australia. Understanding people’s comprehensions of the disease and its management is essential to successfully address any related issues in order to avoid premature deaths and high public health costs. According to many health reports published over the past years Sri Lankan migrants have been identified as having a significantly higher prevalence of type two diabetes in Australia compared to the general Australian population. This ethnography revolves around a group of first generation Sri Lankan migrants with type two diabetes in Australia. This thesis relates their story of encountering and dealing with difficulties and complexities of migrant life while having to build a ‘successful’ life in Australia and also having to concurrently manage a chronic illness. While arguing that understanding of diabetes management cannot be just reduced or confined to level of compliance to medical advice and blood sugar measurement readings on the glucometer, I point out in the research that the stories of Sri Lankans with diabetes in a developed country are different to the stories of other South Asian migrants with diabetes living elsewhere in the world as examined in other studies. I show how Sri Lankans, despite possessing several socio economic and cultural advantages in the land of settlement, still encountered significant challenges to manage diabetes effectively. I demonstrate in the thesis how each person’s socio cultural ‘baggage’ they bring to Australia during migration from their motherland, affects their transplanted lives and how it in turn affects their health care seeking behavior concerning managing diabetes. I demonstrate that aspects that affect the Sri Lankans’ perceptions and actions regarding the management of diabetes derive from personal history, their attachment to the collective cultural history of the community, their aspirations of upward social mobility coupled with attaining a higher standard of living as well as from the pressure caused by the differences in their conceptualization of ‘control’ from that of the doctors. This thesis will be of interest to medical anthropologists, sociologists and social science researchers of migration and migrant health; health care providers particularly teams who provide diabetes care to migrant patients; and community health care workers. It will also be of specific interest to migrants with diabetes living in Australia and in other Western societies, who might be interested to understand the experiences and challenges of living with a chronic illness through the insights of a group of Sri Lankan migrants in Melbourne living with diabetes.