Don Saul & Type-2 Diabetes

The intent of this interactive visualization is not to provide definitions for structures of violence and their associations with health disparities but rather to highlight a personal and familial narrative to showcase the impact that different structures have on the health of my grandfather: Don Saul. Through this interactive visualization, I will be pointing to different structures outside and within the United States that my grandfather had to navigate in order to manage and treat his diagnosis, along with using an image of the Maguey plant, a plant native to my grandfather's region and one that holds a cultural significance to our culture. To learn more about my grandfather's story and, more importantly, the structures he had to navigate, the leaves of the maguey plant will be used to tell various parts of his narrative.

Don Saul & Type-2 Diabetes: A Narrative of Structural Violence

Intent

Don Saul & Type-2 Diabetes: A Narrative of Structural Violence

Click to learn more about Don Saul's narrative

The origins of my grandfather started in the southern region of Mexico, specifically in the Silacayoápam District of Oaxaca located amongst the Mixteca region of the State. My grandfather's community was comprised of the Mixtec people, which had seen two major periods of colonization: the Aztecs and the Spanish Empire. After the independence of Mexico from the Spanish Empire, structures of separation and marginalization meant to oppress the Indigenous people and their relatives failed to be broken down, leading to these structures being present in modern

Structures of Violence: Colonization

day Mexico. These structures included the economic suppression of many indigenous communities living in Mexico, with the majority of these communities being located in the southern part of Mexico. In comes my grandfather's community, which prides itself in being a region of agricultural abundance due to its rich climate and fertile soil. Don Saul began agricultural labor in his early teenage years, later becoming a migrating agricultural laborer through different regions.How is this connected to Colonization?The structures that were left during colonization, where bodies of Indigenous people were not prioritized, led to economic and political policies that ultimately pushed many Indigenous communities to rely on agricultural labor and migration as a form of survival.

When my grandfather first migrated to the United States, an action backed by the need to provide for his family as structures in his home country did not allow for his survival, he along with my grandmother continued their work as agricultural workers. After working a few years within the United States, he began to expereince symptoms, the most impactfil being extreme fatigue and constant urination. These symptoms at first were deduced to the fact that his body was beginning to feel the years of intense labor and migration. It wasn't until his work "efficiency", something that would directly impact his financial ability to care for his family of 7, began

Structures of Violence: Colonization

to be impacted that he decided to see a medical practitioner.How is this connected to Colonization?The structures that were left during colonization, in Latin America and The United States, include the denying of resources being allocated to indigenous communities within Mexico. This eventually lead to economic despair in the communites and the need to immigrate to an entirely different country in order to survive. Another factor worth mentioning is the fact that my grandfather had felt these symptoms for months, worsening over time, and the fear of deportation and dealing with colonialist immigration policies had not allowed him to care for his health in time.

Once my grandfather had made the decision to see a medical practitioner, he traveled to two different medical facilities, where he would ask about his symptoms and he was constantly pushed aside, with medical professionals constantly negating his symptoms and pushing them on the fact that he was just "too tired", but my grandfather knew something wasn't right in his body. This led to him ultimately seeing a curandero, a traditional spiritual and physical healer. Here, the curandero told him that he would prescribe him traditonal herbal

Structures of Violence: Racism within Medical Infrastructure

medicine, but his symptoms coincided with those of many others the curandero had seen in the past: Type-2 diabetics. It was at this point the healer recommended that my grandfather push for biomedical care. Don Saul tried one more time, and he was able to find a facility that took his symptoms seriously only after stating that he thought that he had Type-2 Diabetes.How is this connected to Racism within Medical Infrastructure?The denial of treating my grandfather's symptoms seriously and pushing him away is a product of a racist structure that does not take marginalized communities' health seriously and is usually deduced to either work or as a cultural characteristic rather than a real health issue. Another important factor to note is that biomedical practitioners were not willing to take him seriously until he had said something that only sounded familiar to them and unknown to him.

Once my grandfather was able to attend a biomedical facility, practitioners ran an A1C test along with a blood sugar test in order to confirm the curandero's suggestion; where the results confirmed that he was in fact a type-2 diabetic. Following this my grandfather was told to make dietary restrictive choices, demonizing many cultural foods that were rich in carbohydrate sources such as rice, tortillas, and bread, without properly explaining it to him as there was a language barrier and there was no telling whether practitioners were thorough in their explanation. As a result, my grandfather completely cut accessible carbohydrates from his diet which led to his fatigue and other symptoms worsening. Another recommendation was to include exercise in his daily routine, but my grandfather could not add time to exercise as he worked all day picking produce and then caring for his children after work, all while navigating other social structures that made his life as a Latin American Immigrant more difficult.How is this connected to Medical Education and Recommendations as a form of structural violence?Through their explanation, the practitioners failed to see my grandfather working in a labor-intensive job that required carbohydrates as a source of energy and that they were economically accessible. Not only this but in medical education, until recently, there was no emphasis on the diverse diet of Latin Americans and only an emphasis on the Standard American Diet; no recommendations on pairing carbohydrate sources with protein, etc. leading to recommendations that patients of different cultural backgrounds could follow and ultimately leading to faulty management of health conditions. Apart from the inadequate nutritional recommendations, the practitioners failed to realize the agricultural labor as an exercise/movement that could aid his diabetes and failed to realize that in his social conditions, he simply couldn't add exercise to his daily life.

Structures of Violence: Medical Education and Recommendations

After my grandfather received this diagnosis and recommendations, and not being able to meet the recommendations, he was prescribed Metformin as a treatment. This mismanagement of his diabetes, heavily weighted on the medical systems' inadequate care for him and the social structures supporting them, led to nerve damage in his left foot that ended in a two-toe amputation that put him in a negative economic situation as the operation was expensive and put him out of work for an extended period of time as he needed to heal from the surgery. To this day my grandfather works as an agricultural laborer in Santa Barbara County, where he now is able to manage his condition but has been ultimately left with health complications.There were several factors and structures that were clearly present within my grandfather's story that were not expanded on as my goal was to open eyes to one of many narratives impacted by structural violence within the American medical infrastructure. These include the racist policies that led him to continue to have to work as low wage agricultural laborer, the lack of support from government health organizations, no safety net to fall on during time off in order to support family, etc. but ultimately my grandfather, as many others with similar backgrounds, have been able to perceive and continue to live their lives under structures of violence. This narrative is not to highlight my grandfather's perseverance but is rather an implicit criticism of how a condition that could have been easily managed, was prolonged with all the negative consequences falling on the individual and their community of support.

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