Review of Making Diabetes: The Politics of Diabetes Diagnostics in Uganda By Arlena Siobhan Liggins, New York: Columbia University Press. 2020. 242 pp.

Kayla Patterson

California State University, Long Beach

In Making Diabetes, Arlena Siobhan Liggins offers a meticulously researched and engaging account of the ways that glucometers contribute to the “making” of type 2 diabetes in Uganda. This ethnography draws on a multi-sited investigation of health services in Uganda. Liggins provides an in-depth look at different health facilities and includes the voices of several health professionals and patients alike. Liggins provides a detailed portrayal of the impact of scarcity of medical technology and the compounding stress a confirmed diabetes diagnosis creates for those in Uganda. While diabetes is a growing concern in Uganda, the government recognizes diabetes as a significant public health issue and has prioritized it as one of the non-communicable diseases (NCDs) that require attention. However, the policies and strategies to address diabetes are ineffective as Liggins argues that NCDs like diabetes “are caught in a vortex of suspense provoked by the rigidity and partially inflexibility of the regimes of global health in this 21^st century, which is dedicated to global health security and humanitarian biomedicine” (27). Liggins uses the glucometer to demonstrate how unreliable this technology can be without proper healthcare infrastructure and discusses the importance of locally informed solutions that can sustain the proper use of a diagnostic device to improve the lives of those impacted by diabetes.

The first chapter is dedicated to the biomedical understanding of diabetes. After providing an explanation of diabetes, Liggins explores how diabetes has been understood historically. Awareness for diabetes has existed from a “Western” vantage point. This vantage point informs models to address diabetes in ways that are not sustainable or locally informed. In Uganda, while diabetes is prevalent, the diagnostic evidence does not exist in history and diabetes is treated as a “new” disease with cases rising rapidly.

The next chapters illuminate the complexity of providing the numerical diagnostic evidence for diabetes in Uganda. There are healthcare gaps present when trying to address the increasing rates of diabetes. Liggins argues that “the gaps are yet to be filled with comprehensive numerical evidence and funding” (72). Liggins explains the lack of attention chronic illnesses, such as diabetes, receive in global health initiatives is due to a lack of numerical evidence, it is a challenge to quantify the amount of individuals living with diabetes. As Liggins explains throughout the text, diabetes is a silent, invisible condition that many people may have without awareness. A diagnosis does not mean there is a path to a cure, on the contrary, it means individuals will have to learn how to manage their disease. Infrequent testing and inadequate supplies at health facilities mean that individuals are not getting their diagnosis until too late, but also that those who do are unable to do much to manage their disease.

Chapters 5 and 6 look in depth at how the glucometer “makes” diabetes. In Uganda, glucometers are used to detect and manage diabetes, but can be unreliable. Whether patients use private or government health services, their outcomes are often up to chance. Liggins illustrates this point by sharing the experiences of patients navigating both health systems while seeking a diagnosis. Without routine monitoring of glucose, individuals with diabetes risk severe complications. Glucometers are limited and, in many cases, unavailable due to larger structural issues. Glucometers on their own do not confirm if an individual has diabetes, but if an individual is experiencing low or elevated blood glucose. Medical professionals will use a glucometer to assess blood glucose and symptoms to interpret if an individual may have diabetes, while patients will use a glucometer to manage their condition. Individuals who can monitor their glucose experience favorable outcomes, including the ability to manage symptoms and reduce disruptions to their everyday lives. However, even where the technology is available supplies or the knowledge for the glucometers may not always be. In the final chapter Liggins argues for the need of solutions that go beyond screening for chronic illnesses. Screening for diabetes, and other chronic illnesses “transform a former healthy body into a body with disease” (207). Screening and diagnostic efforts do not ensure that individuals will be able to be granted the human right of access to basic health care to manage their health.

Liggins’ research about glucometers sheds light on disparities in healthcare access and quality of care. Glucometers are critical tools for diabetes management, but their use may be limited due to cost, availability, or lack of resources in certain communities. Examining these barriers and working towards solutions that facilitate access for all patients is important. The lack of accessible technology and additional medical supplies, in addition to the needed knowledge to interpret results, compounds a problem for many in Uganda, and in other places with increasing rates of diabetes. There is a need to increase access to testing and supplies to increase the quality of life for those who have diabetes. This ethnography provides an intimate look at the challenges of inadequate access to health care and medical intervention.

This book offers both theoretical and practical insights for students, healthcare providers, researchers, and global health initiatives. The vivid descriptions and engaging writing style make this a compelling and informative read for academics and general readers alike. Liggins’ research on glucometers can inform broader discussions about access to healthcare technology and its potential to improve outcomes and empower patients. Understanding how glucometers are used in different contexts can help develop more effective technologies and interventions that meet the unique needs of patients. The much-needed attention that is needed for interventions on the global health scale are currently informed by the presence of evidence through numbers, but “different types of evidence, such as narratives and ethnographic evidence, or ‘real-life evidence’…become ever more important to make diabetes, and the individuals who are affected by it, seen” (27). This work demonstrates the importance of ethnographic research in health care. Additionally, this work brings attention to the gaps in global health agendas and initiatives that are meant to address chronic illnesses. Overall, this ethnography is a valuable contribution to the field of medical anthropology and demonstrates the importance of foregrounding the experiences of those who endure invisible conditions that require visibility for more effective global health interventions.

¹ Correction added on 16 January 2024, after first online publication: “Ed.” was removed from the article title.