Diabetic Living: Senegalese Women's Experiences with Metabolic Illness

Abstract

This dissertation draws on the lived experiences of metabolic illness among women in Senegal in order to illuminate the global rise of noncommunicable diseases. Existing literature on noncommunicable diseases in low-and-middle-income countries (LMIC) is scarce while at the same time these countries are poised to experience the highest disease burden. This project seeks to address this lacuna by examining the everyday lived experience of noncommunicable diseases at the individual and community levels. Introducing the concept of interembodiment and looking at production of health within households, rumors, and stigma, this work reframes our understanding of embodiment of illness by situating it in its social context. Medical anthropological research on diabetes and hypertension in LMICs has thus far focused on Guatemala, India, Kenya, and Ethiopia. This dissertation adds to the conversation by introducing a critical West African perspective which is sorely missing. Focusing on women’s experiences of hypertension, diabetes, and kidney disease/failure in Senegal, this project illustrates the nuanced ways noncommunicable diseases are shifting individual notions of self, kin structures, and social communities. It also addresses the ways in which current health infrastructures are and are not prepared to deal with this rise in noncommunicable disease. Through 15 months of mixed-methods research, including participant observation, over 60 interviews, and 100 surveys, this project centers on Saint-Louis, Senegal, located on the Senegal River in the north of the country. Saint-Louis is a small but global city, and its relatively remote location closely links it to rural villages in the region. This setting provided insight into how women with differential access to wealth, nutritional resources, and health care manage their chronic illnesses. Quantitative data was gathered from 107 women, who completed surveys to assess quality of life, psychosocial stress, and emotional well-being. Of these women, 36 were included in ethnographic focal-follows, which involved multiple interviews and participant observation with these individuals as they went about their everyday experiences within their homes, clinical settings, and communities. Doctors, nurses, pharmacists, traditional healers, Ministry of Health officials, and demographers were also interviewed to understand clinical, national, and epidemiological approaches to these disease burdens. The dissertation concludes by asking readers to focus not to the obvious – broken infrastructure, lack of “reliable” data, overwhelmed systems – but rather on how, out of these colonial hauntings, there is potential for this diabetic narrative to be part of a reimagined global health informed by sub-Saharan African perspectives. What does the West have to learn from Senegal? As an interlocuter said: “…the mere fact of thinking about (the) future is a good starting point because when we think about something and we say that that thing is probable, we’re making it possible. We have to think in