Therapeutic Clientship Of Diabetes Clubs: Engagement In Chronic Disease Management Programs In Guatemala’s Western Highlands

The increasing global mortality and morbidity of chronic disease signals that a major epidemiological shift is underway in more-economically developed and less-economically developed countries. This epidemiological transition is especially salient in the Western Highlands of Guatemala as the prevalence of type 2 diabetes has risen steeply and poses great challenges for health practitioners and the public health system. This thesis is based from ten weeks of ethnographic fieldwork that I conducted in region surrounding Lake Atitlán. Collected through participant observation and semi-structured interviews, the data this thesis analyses attempts to examine the nature of and motivations for engagement in a diabetes management program that focuses on “self-care” as a form of therapy. I argue that engagement is socially mediated. A heuristic of therapeutic clientship offers analytical tools with which to understand the behaviors that express engagement. First, I unpack the diabetes management methodologies and philosophies behind one programmatic attempt to address the growing incidence of diabetes called diabetes clubs. Next, I demonstrate the centrality of relationships between club-goers and clinical staff that drive patterns of decentralized and centralized recruitment into clubs, sustained attendance, and active participation. Though the social theory of therapeutic clientship, I examine the exchange of ‘transactables’ between clients and patrons, the existence of disparities of accessibility for diabetes treatments, and the discourse of compliance that “self-care” treatment modalities assert. I end with a discussion of how treatment-associated technologies, simple and complex, shape the way that people makes sense of their illness.