Type 2 diabetes mellitus is a disease with rapidly increasing prevalence in Southeast Asia, and implications for health service delivery. This thesis explores the lives of people with type 2 diabetes in Bangkok, the capital city of Thailand. The study site is the district of Ratchatewi, which contextualises the complexities inherent in a modem Southeast Asian city.
In this study, I examine explanations of diabetes and its consequences, and the ways in which people accommodate diabetes as its sequelae render it a visible disease. I explore approaches to disease treatment and control, and locate diabetes in relation to perceptions of self. The study is organised around the lives of 12 key participants living with type 2 diabetes, their families, friends and health care providers. Information from 21 other people living with diabetes provides added depth.
Ethnographic methodology provided both the epistemological framework and research methods. Fieldwork conducted from August 2001 to February 2003 collected data using participant and non-participant observation, and interviews that ranged from focus group discussions and in-depth qualitative interview to casual conversation.
The lived world of study participants links past and present, and contextualises a view of diabetes as a physical illness which, in some ways, articulates with biomedical models of diabetes. However, among participants there is a range of understandings of diabetes pathology and trajectory. Explanations of the disease and its effects vary according to the length of time from diagnosis, and whether or not symptoms are visible.
I argue that the process of control is at the heart of the diabetes experience. Individual and social control is part of being Thai. Among participants, discourses of control are very different from those of medicine and health promotion, which situate control of diet, exercise and medication as the foundations of diabetes control. Participants emphasise self-control as a Thai societal value, yet explain diabetes control as an adjustment to and negotiation of a changed way of life. I conclude that, while diabetes changes personal identity, social identity is unchanged. I argue that maintenance of social identity is crucial in contemporary urban social life.
This study contributes to an emerging understanding of the experience of living with type 2 diabetes, in culturally and socially distinct settings. Thai health promotion strategies and approaches borrow heavily from industrialised country models. This study presents lay understandings of the diabetes trajectory and of diabetes control that are different from the models used in diabetes health promotion and education. As Thailand searches for appropriate models of service delivery, it is hoped that this study will challenge existing approaches and provide a beginning point for further social research on the increasingly important problem of type 2 diabetes.