Review of Traveling with Sugar: Chronicles of a Global Epidemic. Amy Moran‐Thomas, Oakland: University of California Press, 2019, 384 pp.

“Emergency in Slow Motion”—former UN Secretary General Ban Ki-Moon’s description of diabetes—are the first words of the book and a prescient characterization of the world into which it would be released. The book arrived in my mail in late February 2020, when the first community-spread cases of novel coronavirus were reported in the United States. At the time of this writing, some four months later, there are over 10 million cases and 500,000 deaths and it appears that life in the era of COVID19 is only just beginning.  

At first glance, an account of sugar’s travels through Belize may seem to have little resonance with a highly contagious zoonotic virus, yet this “chronicle of a global epidemic” (the book’s subtitle) offers tremendous lessons for the present moment. One of its central lessons pertains to the concept of the moment itself. Moran-Thomas weaves together bioecological time and social geography to show how any given moment in the present contains within it the “colossally warped inequalities” of the past (p. 183). “Past is prologue” she writes, in the book’s characteristically poetic reflection on the material forces of history. 

Moran-Thomas opens Traveling with Sugar with a description of paging through a photo album, watching as the shape-shifting disease of diabetes comes to settle over families and communities in the form of crutches first and then amputated limbs of bodies that slowly stop healing. She closes it with a photograph of photographs: people stand in a candlelit circle, holding images of loved ones lost to diabetes whom they’ll never forget. In between, readers are taken through an often heart-wrenching journey in which racial capitalism comes to bear on bodies and lives in asymmetrical ways. 

The book is broken into two parts: Contexts (part I) and Crónicas (part II). The structure follows Mintz in attempting to bring “global histories of racial capitalism” and “individual life histories” together in the same book (p. 17). Contexts sets the stage for sugar’s devastating impact by attending to temporalities, landscapes, and relations in the predominantly Garifuna city of Dangriga, on the central coast of Belize.Crónicas weaves archival histories of diabetes technologies together with personal “death histories,” a term borrowed from Jim Boon and a reflection on how 13 of the 15 central contributors to the research died from diabetes-related complications before the book went to print. Moran-Thomas explains that every chapter retells the same story from a different angle, a repetition meant to emphasize how repetition itself becomes a defining feature of diabetic life (p. 25). Throughout, Moran-Thomas encourages the reader to look at familiar images again and anew, since doing so might help better apprehend the elusive boundaries distinguishing what is sweet from what is poison (see especially pp. 60 and 130).  

The literary Crónicas tell stories about Moran-Thomas’s friends, as she calls the people who co-theorize diabetes with her, shying away from the colder terms of informant or interlocutor. Through Crescencia, we learn how people navigate the thresholds between living and dying in Belize’s diabetes-producing landscapes, where industrial plastics litter the coastline and DDT covers the soils. Through Jordan (nicknamed “Muerte”), we learn about the history of insulin and the glucometer and how these promissory technologies fail to function for so many as diabetes fractures kinships, killing people far too young. Through Guillerma and Arreini, we learn about epigenetics and metabolic memory, as people struggle to do care work under the violence of chronic, generational stress. Through Laura, Fede, and Jose Cruz we learn about dialysis machines, the phantom pains of amputation, and subsequent “repair work” that goes into making handcrafted limbs that return the mobility that sugar has stolen, bringing people “back to life” (p. 263). 

The writing is lyrical and etymologically rich, full of nuance and deep meditation on terms. Readers will learn intriguing historical facts about diabetes science—e.g., about the development of hyperbaric chambers or the replacement of ideas of miasma by germ theories of disease—but they will also be asked to think about the conceptual vocabulary that surrounds the global politics of sugar. To summarize one among many possible examples, Moran-Thomas devotes several pages to unpacking the sophisticated linguistic registers of “traveling with,” which implies living with chronic disease in Belize’s English Kriol, but has Garifuna spiritual registers, as well as implications for colonialism, tourism, luck and fortune, migration, transnational publics, and so on (pp. 12–14). 

The impossibility of understanding underlies the text, as Moran-Thomas frequently finds herself confronted by the unjust gaps between herself and others. The people in the stories often tell her things that she admits to not fully comprehending—not because of obvious language barriers, but because they teach her about all she cannot know and she comes to respect this knowledge (pp. 21, 85, 229, 238, 293).If the book is about living and dying with diabetes, it is simultaneously about anthropology’s fraught project of telling stories based on research carried out in close proximity to suffering. “It is painful to recognize that after all these years of trying to share connective experiences and commonality with the people who appear on these pages, the places where our paths diverged may be more illuminating than any of the junctures where they joined up for a short while,” Moran-Thomas writes (p. 18).

One of the most haunting lessons the book has for the era of COVID19 stems from the observation that public health officials have long known exactly how to prevent and treat diabetes and still tens of millions of disproportionately Black and Brown people have died from the disease. As far back as 1967, officials wrote that they could stop the global spread of diabetes simply by curtailing the proliferation of “white man’s food”; the Pan American Health Association’s 1975 diabetes report declares, not incorrectly, that diabetes-related fatalities were largely preventable and treatments were effective (p. 73). The trouble she highlights is not a lack of knowledge, but the cruelty of a profit-driven system that allows, even encourages, living, breathing, loving, always-human people to be treated as disposable. The final Crónica is titled “repair” in an effort to conclude by emphasizing the slow carework people undertake in the face of disease, but the overarching message of the book for me was less of hope than of the crushing weight of racial capitalism.

This is an accessible book, meant to be read in its entirety. It will stimulate important discussions on anthropological methods and ethnographic writing and it would serve as a nice complement to courses that assign Mintz’s ever-relevant Sweetness and Power. Because Moran-Thomas raises them herself, readers are likely to be left with vexing questions about the limited possibilities of ethnography to intervene upon disaster and how to best write about trauma in academic texts.  

In a final vignette, Moran-Thomas travels to the docks of east London searching for clues to better understand the vast historical inequities that have made diabetes the often-unrecognized “plague of our lifetimes” (p. 85). She had hoped the trip would help her reckon with her own position in “sugar’s connected histories,” but concludes that London does not hold the key to many of the unsolvable riddles she encountered in her travels with sugar (p. 290). A final, provocation for readers relates to the book’s titular theme. Today, coronavirus combines with climate change to further expose how the travel expected from classical ethnography is a privileged activity, producing disciplinary exclusions in addition to petrochemical excesses. Moran-Thomas’s work raises the unsettling question: What might anthropology become by slowing down, sticking closer to home wherever and whatever that might be, and traveling less? 

Reference Cited

Mintz, S. 1985. Sweetness and Power.New York: Penguin Books.