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Past Is Prologue

Sugar Machine

Told me to keep my eyes open for the white man named Diabetes who is out there somewhere carrying her legs in red biohazard bags tucked under his arms.

—Natalie Diaz, “A Woman with No Legs”

Sugarcane sprouted bright green along the dirt road where I was looking for Sarah’s house. Some patches were cultivated by people; but other stalks grew wild in ditches of their own accord, hybrids strayed from forgotten stocks. When colonial botanists collected cane specimens, they often noted which stands had “escaped” from nearby plantations. Sugar only needs to be planted once; then it can keep reproducing, unless interrupted.

Media headlines about diabetes always seem to show bodies getting bigger, but the stories I heard in this stretch of Caribbean Central America more often focused on fears of getting smaller. If you sat and talked with people, missing body parts were often central to how they told stories and measured time. Some felt phantom pains or dreamt at night about running. Others, like Mr. P, watched with dread as it happened in their families or heard about beloved elders lost piece by piece. Nurses said that feet bitten by venomous snakes were easier to heal than those poisoned by sugar.

In Belize, this common name for diabetes traveled across languages: súgara in Garifuna, shuga in Belizean Kriol, azúcar in Spanish, kiha kiik in Kekchi Maya, or ch’uhuk k’iik (sweet blood) in Mopan and Yucatec Maya.¹ Some people described the dismemberments as a quietly surreal spectacle their families were already living with amid a lack of public acknowledgment: “They cut my grandmother down to a lone torso.” Others spoke of dying in small pieces, like “my arm died that time” or “her eyes died first.” A Garifuna spiritualist with diabetes told me of the new addition to her ancestral prayers—protection for “Feet, legs, toes, hands, fingers, arms, eyes. Amen.” When a Maya seamstress walked into a mobile clinic without realizing there was an embroidery needle sticking out of her numb foot, the visiting physician knew that she likely had diabetes before the two ever exchanged a word.

SWEETNESS

Sweet foot—a limb macerated due to diabetic injuries—is common enough that you can find the term alongside other diabetes vocabulary in the Belize Kriol dictionary:

sweet fut n. abscessed foot due to diabetes. Sayk a weh Misa Jan ga shuga, ih gi ahn sweet fut. Because Mr. John has diabetes, it gave him an abscessed foot.

sweet blod phr. 1) sweet personality. Raja eezi fi laik kaa ih ga sweet blod. Roger is easy to like because he has a sweet personality. 2) diabetes. Dakta seh Ah hafu kot dong pahn shuga kaa Ah ga sweet blod. The doctor says I have to cut down on sugar because I have diabetes. See: shuga.

shuga n. 1) sugar. Bileez sen lat a shuga owtsaid. Belize sells a lot of sugar overseas. See: kayn. 2) diabetes. Dakta tes mi ma blod an ih seh ih mi ga shuga. The doctor tested my mom’s blood and said that she had diabetes. See: sweet blod.²

Sweet feet I heard said when it happened on both sides, which had become Sarah’s predicament some seven years before we met. In the Stann Creek District of Belize where she lived, an estimated one in four people (and one in three women) lived with type 2 diabetes,³ and some five out of six amputations were due to sugar’s complications.⁴ Certain images sounded straight out of a war story, like when the hospital’s incinerator broke down once and everything had to be buried. But at the same time, it almost felt like nothing had happened.

The home that Sarah invited me to visit again felt comforting and bright. Its paint flaked into pretty layers, like sycamore bark. The rooms smelled of coconut rice and fresh laundry. I never saw her play the tambourine, but its open crescent hung on a nail next to a mosquito net she had improvised from a bedsheet to prevent insect bites. (She developed this strategy after once hosting a botfly in her knee, which took almost a year to heal because of high blood sugar’s complications). “My treasure chest,” Sarah joked of the container she showed me. Amid the cozy jumble of a lived-in room, her glass box of diabetes technologies looked like a tiny museum case. Among bottles of pills and other archived medical treatments, it held a broken blue and gray blood glucose meter.

“I just don’t know what caused it,” Sarah said of her sugar, which was what she called the condition she had been living with since 1978. She had always been slender in build, like many people I met who defied any easy conflation of diabetes with obesity. When her first foot started going bad, she said, it had started with a corn on one toe. It had just gotten “miscarried away.” Miscarriages also figured centrally in women’s stories about the effects of untreated sugar, and mortality during pregnancy for both mother and child is another diabetes phenomenon that is likely widespread globally (though reliable statistics are hard to locate).⁵ Sarah’s sister living with uncontrolled diabetes had been somewhere among these uncounted women, dying along with her baby during childbirth.

Sarah fondly recalled the Kriol midwife, Mrs. D, who used to go door to door to visit those she knew were sick. “Every house. She would walk.” She used to bathe and bandage Sarah’s ulcers to prevent infection. After Mrs. D died of cancer, the centralized health system was never able to replace her day-to-day care work in the village—part of a bigger story about homecare visits growing less frequent across Belize as old midwives themselves died of chronic conditions. Sarah summarized decades of care in hospitals by evoking a cast of doctors with good medicine that came and went, and the boiled herbs she used in the meantime; raw Clorox she applied for pain when a protruding bone’s edge pushed into the skin. As she narrated the accumulated cuts and recoveries, it seemed like her illness faded into the background, unlike the FM radio she kept that blared theme music from Ghostbusters or a reggae version of the Bryan Adams song Heaven.

“I would like to know how high it is,” Sarah said of her blood sugar level. “Indeed.” The last time she had been rushed to the closest town’s hospital, it was “five change,” over 500 mg/dL. “I have needles, but no strips,” she said of her unusable Accu-Chek meter, which was quite expensive (seventy U.S. dollars) and designed to require special brand-matched parts (around fifty U.S. dollars for one month’s supply). Sarah used to travel to the Guatemalan border town of Melchor—about five hours away by bus—to purchase discounted blood sugar test strips, but had not been able to lately. Her meter rested next to foil-wrapped pills, which she took tentatively because she had no way to gauge her starting point. Diabetes medications at times can make people feel more sick, if the day’s blood sugar is unusually low or high. I was unsettled to realize that the very objects that could have helped prevent her worsening injuries were both there and not there in the room with us, sitting as if suspended in the glass box.

“Sugar machine” was Sarah’s name for the broken glucometer. Even in her lilting voice, this hung in the air with an ominous edge. It was one of the ways we were speaking in history, if not about it; getting to Sarah’s village meant passing the remnants of another structure called a sugar machine. We both knew that just down the road rested a steam locomotive from the 1800s, mounted on eroded bricks like a train running nowhere, which had once boiled sugarcane into molasses. It still stands next to the plantation’s evaporating furnace, a hot-air exchanger, a Tredegar engine that pumped water from the river, and the crusher with its flywheel. Their rusted-out pipes and oil tanks were etched with places and names that I could barely make out under the moss: LONDON and RICHMOND, VA covered in lichen.

That particular sugar machine and its adjacent fields of bourbon cane were established in the 1860s, long before Sarah was born, by a man from Pennsylvania named Samuel McCutchon. He was friends with U.S. president Andrew Jackson, who used to travel on his ship Pocahontas to visit the McCutchon family’s Louisiana sugar plantation. Lists of the enslaved people whom Colonel McCutchon owned in Louisiana fill seven archival folders. He was among the Confederate sugar planters who fled to then British Honduras after losing the U.S. Civil War. By some accounts, more Confederates fled to Belize in the post–Civil War years than any other receiving country.⁶ In Belize, the workers in McCutchon’s cane fields were mostly Garifuna, Kriol, Maya, and Chinese. He founded three sugar estates in southern Belize,⁷ transforming the landscape. Ruins built by Confederate planters after the Civil War, some as far north in Belize as Indian Church, are among many remnants of sugar machines still found across the Caribbean and the Americas. It was said that Belize’s rainfall was so conducive to quick growth that the cane bent over by its own weight and then grew upward again into a field of S-shaped stalks, as if the sugar had started to spell itself out.

SUGAR ROADS

One morning in 2010, Sarah told me that she hadn’t been able to sleep the night before. “I just don’t know what it wants,” she sighed. I prodded with a vague follow-up, and she explained she had tried Clorox. The moment passed before I could figure out a delicate way to phrase my real question: But what was it, that had wants?

I used to think that “sugar” was a popular synonym that meant diabetes. But over time, I came to think that these labels often slipped into each other but were not exactly the same. The effects of sugar routinely exceeded common understandings of diabetes problems. Sugar was alive in the landscape. It named something that escaped from the many containers—biomedical, historical, scientific—of expert accounting. I began to think that any stable account of sugar’s contradictory meanings and excesses would miss the very thing that people like Sarah named as the conditions they were trying to live with.

Belize is among the less cane-saturated places in the Caribbean. Neither Sarah nor her children worked in the sugar fields. Many people in this book never talked about field labor or would trace their diabetes to sugarcane. Yet they lived in a region not only dotted with its ruins, but also fundamentally shaped by its far-reaching material legacies: where people lived and how their ancestors arrived; the way land was partitioned and used today and what kinds of things could grow there; the system through which they bought foods and what foods those were. Other associations were less literal but more pervasive. When a woman drowned together with her four children after she dove into a shallow pool trying to save them, people made sense of the tragedy by attributing her terrified actions to diabetic sugar: “The sugar made her panic.” A man whose loved one had “gone mad” explained her breakdown in this way: “The sugar went to her brain.” Sometimes sugar was not amenable to intervention, but simply a way of speaking about terrible things one could not change.

The way people talked in sugar, though rarely about it, brought to mind Michel-Rolph Trouillot’s notion of implicit memories: “Tying a shoe involves memory, but few of us engage in an explicit recall of images every time we routinely tie our shoes,” he wrote. “Remembering is not always a process of summoning representations of what happened.”⁸

People spoke in sugar so often that I began to hear it as a kind of implicit memory. Trying to understand what hung in its silences, I called someone who worked in curating more explicit memories of sugar: Mr. B, one of Belize’s resident experts in sugarcane history, who suggested a drive north. We met in a pickup truck with seats full of books. As we shook hands hello, Mr. B said that shaking hands with a cane worker can leave your hands itchy all day with the feeling of little fibers under your skin, and I tried not to feel unsettled though that sensation is a common symptom of diabetes. We talked on the road north to Libertad, past Corozal’s British brick pillbox structures with gun windows.

Cane Cutters, by Pen Cayetano.

Since sugar has no season, the fields outside the window were not uniform, each property in its own stage: burnt fields, high ratoon, the overgrown dense green known for snakes and bugs. Harvest leaves a field of stumps that have to be scorched to prevent stubble from sprouting from the stalk’s joint-like nodes. Planting new sugar fields entails burying old cane billets in the ground, which sprout regrowth called stands.

When we got out of the car at Libertad, I thought how that field was the same one that many workers from Stann Creek District had once traveled to reach. Pen Cayetano, a famous impressionist artist in Dangriga, was among the Garifuna men who left home in southern Belize to work in the northern sugar fields of Libertad when he was a teenager. In his studio—fragrant with oil paint and smoked fish and bustling with family at work on art projects of their own—we sat on an overturned canoe, and he recalled how the sugar fields barely felt like vegetation at all: bright but not lush, sticky, known for the blind heat of the two o’clock sun. When I asked if he might want to paint an image of his memories of sugar work in Libertad for this book, he looked startled by my mental image of sugar fields as plantlike bright green. “You think I’d paint the sugar green?” He shook his head. “It felt red.”

By the time Mr. B and I walked through Libertad on a hot day in 2017, the sprawling cane fields and laboratory buildings were long overgrown. As we passed broken-down conveyor belts towering above stacks of rusting vats, it was not difficult to see why historians like Eric Williams viewed the sugar industry as a pivotal “synthesis of field and factory.”⁹ A single watchman kept an eye on the abandoned estate. He led us past a pumpkin patch he was cultivating near the old office, still hung with the rusted sign FACTORY MANAGER. Inside the derelict office headquarters, the wood desk had rotted and most of the inside walls had collapsed. But a metal filing cabinet in the middle of the room was fully intact, sinking into the dirt.

“Time and space have no meaning in a canefield,” Jean Toomer wrote in Cane.¹⁰ If efforts to enclose sugar in time and space often seemed to unleash further misrecognitions, I thought from Libertad, then I wanted to try following its wild entwinings instead. Somehow that sugar factory’s feral filing cabinet became a helpful mental image for me as I gathered together the notes for this chapter, a container to temporarily order these bits of sugar’s far-flung histories.

More intense stories of “sweetness and death”¹¹ elsewhere in time and place shaped how people ended up living where I met them. On Saint Vincent, sugarcane had become especially symbolic of Garifuna people’s struggle to preserve their ancestral homelands at the end of the eighteenth century. As Paul Johnson notes: “Though never laboring as slaves, the Black Caribs lived under the continual threat of enslavement, and very much within the expanding sugar plantation system.”¹² Legendary freedom fighters of what historian Julius Scott illuminates as the “masterless Caribbean,”¹³ Garifuna fighters set fire to sugar fields to combat encroaching British settlers. Sugar’s potent symbolism reached such a point that during one war, Garifuna leaders found it fitting for plantation overseers to meet their end “crushed between the cylinders of a sugar mill, the symbol of British greed for Carib land.”¹⁴

Nearly two thousand miles away, in the mainland territory that later became Belize, commercial plantations were legally prohibited by the Spanish during the colony’s early history.¹⁵ Kriol people like Sarah descended from the enslaved families in Belize who once worked in logging, but were still caught and sold within a broader regional system founded on sugar markets. Most who ended up in Belize were traded through markets of the sugar islands, primarily Jamaica and Bermuda; some labored on sugar plantations elsewhere in the Caribbean before arriving in Belize City.¹⁶ Creating dependence on economies of imported food became integral to control within the logging camps of Belize, especially rationing sugar.

Farther north along the border between Belize and the Mexican Yucatán, sugarcane became a key crop that Maya laborers were forced to grow on encomienda plantations¹⁷ and also an instrument of control and even torture. Thomas Gann gives the example of a “well-known merchant” in Bacalar known to punish Maya servants, “for no very serious offense,” by shaving their heads and burying them up to their necks in the island’s hot sand; “their heads were then smeared with molasses and the victims were left to the ants” to be eaten alive.¹⁸

When Christopher Columbus arrived in the Caribbean, colonial strategies initially favored capturing Indigenous peoples from the Americas and bringing them east to provide labor on sugar plantations in the Canary Islands. Sugar was used to ply local inhabitants and sow discord, as one chronicler on the third voyage of Columbus recalled when greeting the first Taíno boats: “I gave hawks’ bells and beads and sugar. . . . after they knew the good treatment, all wished to come to the ships.”¹⁹

While colonial strategies for both labor extraction and cane plantations’ locations shifted dramatically in the face of subsequent epidemics, sugar continued to impact Indigenous populations of the Americas in a more subtle way than the better-known plantation histories of the Caribbean. Though sugar was often less of a key export (outside Brazil), mainland sugar plantations across Latin America provided a central source of funding for Jesuits and other missionaries focused on capturing Indian souls. They financed large-scale conversion enterprises largely by growing and selling sugarcane within what became the countries of Mexico, Peru, and Paraguay, among others.²⁰ Colonial and military projects of all kinds were indispensably funded and amplified by such sugarcane profits, giving rise to the axiom “Without sugar, no colonies.”²¹

Sugarcane distillation laboratories also became sites for refining racial classifications of the era.²² On conquistador Hernán Cortés’s cane plantation in Mexico, which helped fund his later military expeditions across Central America, efforts to make sugar “emerge perfectly purged and whitened” were key to its market value. Some 90 percent of the sugar emerged in shades of brown, deemed low-value prieta—the same name people with dark skin still get called in that part of Mexico today. After boiled sugar was transferred with a “shoe-like scoop” for settling into sugarloaf molds, darker molasses leaking from the open bottom of the sugar cone was declared “poorly purged sugar [and] removed with a knife.” Once severed, sugar’s “foot form was separated from the rest to be returned to the purging house,” the name of the building where sugar was whitened.²³ The foot of the sugar cone often accumulated heavy metals and other toxicants from the distilling machinery and collected any debris from the vats, at times including (as Edwidge Danticat notes) blood and bodily matter from laborers’ injuries.²⁴ It was fed to enslaved people and horses.²⁵

The English word “amputate” came from the Latin root amputare, meaning to trim plants or cut off the limbs of trees. Somewhere in the late 1500s or early 1600s, the word began to also mean cutting off human limbs.

“Sugar was a murderous commodity,” Vincent Brown observes of the patterns of its violence during that era. Plantations functioned through “symbolics of mutilation,” powered by people “who were themselves consumed” by sugar production.²⁶ Many enslaved families were forced to live in houses with roofs of thatched cane tassels.²⁷ “When we work at the sugar-canes, and the mill snatches hold of a finger, they cut off the hand; and when we attempt to run away, they cut off the leg,” an enslaved character from Suriname famously describes in Voltaire’s Candide.²⁸ In Black Jacobins, C. L. R James describes how some enslaved individuals were forced to wear a “tin-plate mask designed to prevent the slave [from] eating the sugarcane” in the fields.²⁹

Historian Sir Hilary Beckles notes that the disembodiments related to diabetes therefore have especially discomforting resonance in Caribbean and Latin American regions today, as places long known for these trademark injuries of sugar are again called “the amputation capital of the world. It is here that the stress profile of slavery and racial apartheid; dietary disaster and psychological trauma; and addiction to the consumption of sugar and salt, have reached their highest peak. The country is now host to the world’s most virulent diabetes and hypertension epidemic. [The British] parliament owes the people of Barbados an education and health initiative.”³⁰

Beckles, whose enslaved great-grandparents were owned by the ancestors of actor Benedict Cumberbatch, opens his book with homage to those Garifuna and other Kalinago and Maroon peoples who managed to elude plantation captivity and share sanctuary with others, honoring their “principal contribution to the freedom traditions of the Caribbean.”³¹ But he also wrestles with the legacy of those like his own ancestors in Barbados, who either could not escape to nearby Saint Vincent or tried and were apprehended in their journey.

Left: Enslaved man who had his leg cut off for running away. Right: Debilitation device meant to prevent slaves from escaping, c. 1697.

Besides violently cutting off mobility, amputated legs were intended to be a grisly and shame-inducing public spectacle. Colonial-era sugar planters in the Caribbean even invented devices of psychic terror that mimicked amputation—forcing enslaved people to physically experience and imagine something of what it would be like if they were to have a limb cut off in the future.

“What’s past is prologue,” the old truism from The Tempest goes.

But what does that mean when it comes to sugar in the Americas?

“The machinery of the sugar mill, once installed and set in motion, soon becomes almost indestructible, since even when it is partially dismantled, its transformative impact will survive it for many years,” Antonio Benítez-Rojo once wrote. “Its track will be inscribed within Nature itself, in the climate, in the demographic, political, social, economic, and cultural structures of the society to which it once was joined.”³²

The old pipe jutting over the river at Libertad looked like an oil pipeline, but it was built for molasses. For a brief time after 1989, a Jamaican company called PetroJam leased the old sugar estate and used its molasses to refine into ethanol for U.S. markets. But by the time I visited, only sugarcane was being loaded into the tugboats I watched preparing for export. Staring into the water that some call “the river of strange faces,” I thought of Kara Walker’s art installation in the old Dominos Sugar Factory in Brooklyn, where pools of dissolved sugar water reflected each visitor back at themselves. Now that sweet crude oil has been drilled in Belize, there are jokes that even the land has gotten sweet blood.³³

WELCOME TO LIBERTAD read a sign at the edge of town. Welcome to Liberty. If you follow that road going north, a crumbled sugar distillery from the 1700s sprouts vines, a reminder of when Bacardi owned those fields and the ensnared cane workers were mostly Yucatec Maya men. Or go south, where remnants around the British brick sugar mill at Indian Church tell a story of robust Indigenous agriculture until the time of colonial contact, when Maya land use and diets became violently constricted and malnutrition skyrocketed.³⁴

In another direction lies the sugar village of Calcutta. It was founded by East Indians branded “Sepoy mutineers” by the British and deported to Belize for participating in India’s First War of Independence in 1858,³⁵ “sent to sugar estates in the north.”³⁶ Or cut closer along the border, where the cane fields are transected by what people call “the sugar road.” A signboard from Hershey marks the sugarcane’s eventual destination for processing in Pennsylvania. Animal blood is no longer used to clarify industrial sugar, but charred cow bones are still a medium in the process many companies use to whiten sugarcane.³⁷ Before long, some of this refined sugar will return again to Caribbean and Latin American markets as sweet packaged food products, part of the global circuits of production and consumption that Frantz Fanon long ago foresaw as the next stage of exploitation: “The colonies have become a market. The colonial population is a customer who is ready to buy goods,” which Fanon viewed as part and parcel of “that violence which is just under the skin.”³⁸

Colonial sugar economies were driven by “unequal ecological exchange,” Jason Moore noted, not only human labor extraction.³⁹ Sometimes I tried to picture what the old forest in Stann Creek District looked like before it was logged and later burned to clear fields for plantations. Inhabiting a hobbled landscape, some interviewees told me they wanted to grow vegetables, but the soil along highway was too poor to grow anything but oranges and bananas. Was it always? This legacy was not only about land in law, but also about its biology. Once cane grows in certain ground, it depletes nutrients from the soil. This paves the way for further industrial monocropping, since it often leaves behind exhausted land that requires heavy doses of petrochemical pesticides and fertilizers in order to grow.

I didn’t used to know the names of the chemicals they put on sugar in Belize, but I tasted them once. Biting to peel a cane stalk straight from the fields with my teeth, the white powder flaked dry on my tongue and dissolved without flavor. Later, a friend and I stood staring at the names of the agricultural chemicals advertised on a sign in town: Actara, Amistar, Cruiser, Curyam, Flex, Gesaprim, Gramoxone, Karate, Ridomil Gold, Syngenta. Somehow, the advertised list felt taboo to discuss: the shopkeeper did not want to talk about which ones he sold for sugar and which ones for other monocrops, like oranges and bananas. The term pesticide drift that I read about sounded like a sinister enigma. But lab tests in Belize measure it: glyphosate, better known by the brand name Roundup, was found in six out of six test sites in Stann Creek.⁴⁰

“In 2002–2007, the sugar industry alone produced 5,074,261 to 5,950,123 gallons of liquid waste per year,” the Belize Ministry of Health noted. Recent orange and banana blights had further driven the use of pesticides, the report added: “Wash waters and irrigation run-offs contaminate the watershed in the two southernmost districts—Stann Creek and Toledo . . . where runoff and chemical pollution affect adjacent water bodies.”⁴¹ Pesticides found in a Stann Creek water sample included cadusafos, ethoprop, acetochlor, fenamiphos, oxamyl, carbofuran, chlorpyrifos, dimethyl tetrachloroterephthalate, chlorothalonil, trifluralin, malathion, lead, and mercury levels that peaked where the Stann Creek river meets the sea.⁴²

“They don’t talk about it, but I think our diabetes is also caused by all the chemicals,” Sarah’s sister-in-law told me. Publications supporting her suspicion indeed existed in the literature—many chemicals are endocrine disruptors, which population-level studies report lead to a heightened risk of diabetes and weight gain.⁴³ But proof was not possible to demonstrate causality for her case of diabetes in particular, which is of course the point about not being able to tell where sugar begins or ends. An abundance of population studies elsewhere suggests that the growth in both type 1 and type 2 diabetes is exacerbated by exposure to pesticide runoff from agricultural and other synthetic chemicals and pollution in food, air, and waterways. The haze of what Vanessa Agard-Jones calls “accreted violence”⁴⁴ from agricultural pesticides remains a legacy throughout the Caribbean and Latin America. In this context of limited foods and abundant chemicals, Sarah’s name for her glucose meter, “sugar machine,” struck me as an apt frame for the way this region—if not much of the agro-industrial world system—is fast becoming a “diabetes machine.”

CHRONIC LANDSCAPES

“I dug that driveway,” Theo told me as we drove down a road that cut through plantations. We were headed in the direction of Sarah’s village from some fifty miles north. Theo hit the brakes to slow down at the rusty bridge, craning to check for anything coming from the other direction. He said the bridge was so narrow because it was not actually designed for people or cars. It had been built as a railroad trestle for United Fruit’s old banana train. That was why the two-lane highway contracted there and only one car could squeeze through at a time. The traces were hard to detect; United Fruit and their rail lines were long gone by then. There are new companies on the old plantations today, but the most radical change imaginable for this land now is a switch from bananas to other fruit.

I loved driving between Belmopan and Dangriga through the Maya Mountains with Theo because he knew things like that. I gathered between the lines of his stories that Theo, charismatic even as an old man, had been a heartbreaker in his younger years. He knew every village. Itinerant driving was his favorite line of work now, he said, but over the years he had also worked picking oranges, walked survey through Belize’s forests, sung country ballads, traveled abroad, done odd jobs of all kinds, and traded fish when there still used to be a lot of fish in the sea. He described the days when there didn’t used to be any bars but each house distilled its own liquor from rice or pineapples that was crystal clear. He showed me the neem tree with leaves that he boiled sometimes to help manage his blood sugar.

“I see children nine, ten years old dying of diabetes,” Theo said as he shook his head, eyes on the road. He had diabetes, too, as did most of his friends. They were learning from each other’s misfortunes. Theo told me how one of his toughest friends had been found mysteriously dead in a hallway at home. The death looked so odd, with the house suggesting signs of struggle, that the police ran tests to see if he had been murdered. But they could find no signs of foul play. Theo thought that probably his friend had woken up realizing he had low blood sugar (more immediately dangerous than high blood sugar) and had fought to crawl his way to the kitchen. He almost made it. Since then, Theo always kept a few pieces of hard candy in his pocket and in the car, to eat along the road and make sure he didn’t pass out while driving.

Theo stopped at a curve in the mountains and bought two chicken tamales, handing me one. We stopped at a gas station to unfold the banana leaves coated in ash. Most people in Belize speak English, but it is filled with phrases you do not hear anywhere else. In Theo’s words for the highway, the low traffic reflectors edging the forest were “cat eyes” and the speed bumps were “sleeping police.” He showed me the field where he had faced a fer-de-lance in an orange tree and the place where he had emerged from months of working in the forest and learned his father had died. It always felt like whatever scene Theo was describing from decades ago was just out of sight of the window. Theo pointed out where the banana workers that United Fruit brought from Jamaica used to live along the highway and recalled how, as a Garifuna man working nearby, he was often mistaken for one of them.

By the time I had accompanied mobile care teams through those orange and banana plantations of Stann Creek, most of the workers were from Honduras, Guatemala, or El Salvador, with a handful born in Belize. This made it strange to be part of a group that arrived with an English-language diabetes education video depicting white North Americans in sweaters, who did not look like anyone (except me) on the plantations where we showed it. “Your pancreas is the size and shape of an average banana,” one memorable line went, an anatomical cartoon of organs secreting keys and dots that flashed on the screen. A visiting Garifuna nurse prepared her glucometer for testing while the educational video—if anyone was able to understand it—was instructing the banana workers to avoid eating the exact types of food that were sold from the attached company store.

Only a few of the workers had high sugar that day (and were told to follow up at the hospital). I was put in charge of carrying the red plastic sharps box containing several hundred dollars’ worth of used blood glucose testing supplies. The mobile team was attentive and kind, and their gestures seemed appreciated by the workers. But the machines already had theories built in, which made it feel like we were at once too early and too late: years too late to prevent exposures to pesticides or to the carbohydrate-heavy diets that seemed visible all around, but years too early to measure their effects. We all got sent home with bunches of green bananas. I handled mine carefully after seeing the metal claws used to dunk them in caustic chemicals, thousands of bananas floating in shallow baths under signs reading NO FOOD.

Belize’s beautiful landscape, spotted with mango trees and covered in flowering vines, often gives visitors the impression of a paradisiacal garden. This lush appearance makes it particularly paradoxical that much of the country would easily qualify as a food desert today, according to U.S. definitions (which are based on factors like miles of distance and transportation difficulties to purchase healthy food; limited, high-priced selection of vegetables at those locations; and overall poverty levels). Potentially arable land that could (but does not) support vegetable agriculture in Belize only accentuates the manmade ironies underpinning food deserts most anywhere.

The territory now bounded as Belize once produced food for an Indigenous population of two million. Yet today, this same land is unable to grow enough vegetables for Belize’s current population of 380,000. Pesticides are often hailed as necessary for scale, but Maya techniques of soil engineering allowed for larger-scale agricultural productivity than the monocropping on that same land now.⁴⁵ Even a few decades ago, when individual Kriol families in southern Belize used to grow more kitchen gardens along the coast, some would travel to nearby ancient Maya ruins to obtain the rich soil from the areas where pre-Conquest inhabitants buried waste using methods to optimize the soil’s later chemistry (including burning in particular sequences, and strategically distributing materials like nitrogen-rich seashells).

Today, the majority of vegetables sold in Belize are imported and pricey in contrast to surrounding countries. “You know,” a man from the Yucatán told me, “in Mexico, poor people go into town to sell vegetables. Belize is the only country I know where most villagers go into town markets empty-handed to buy them.” As the history book British Honduras: Colonial Dead End reprised of Belize: “Its land laws [are] far behind the Republics of Spanish America [that] have laws for the encouragement of agriculture, which in spite of revolution and misrule, have attracted immigrants when this Colony has repelled them.”⁴⁶ Reflecting on this archival source, the authoring historian acknowledged that “the ‘progressive’ land tenure system in Spanish Honduras was almost a replica of the ejido system or Indian village commons.”⁴⁷

Anthropologist Richard Wilk’s work helps to further unfold the complex history of foodways in Belize.⁴⁸ He calls the colonial food economy in then British Honduras “the first global diet, a kind of nineteenth century equivalent of McDonalds hamburgers,” since agriculture was forbidden in the colony’s early history because of fierce land disputes between Spain and England, and British settlers were made to rely on barrels of white flour and salted meats shipped from London. The economies supporting Belize’s “rogue colonialism”⁴⁹—run by men who called themselves not pirates, but privateers—actually have much in common with the privatization of late liberal economics.⁵⁰ A global industrial food economy—in ways similar to the forced imported foodways and trade constraints that existed in Belize for centuries—is becoming increasingly common in many countries and getting further amplified by harmful trade policies, as Alyshia Gálvez observes of Mexico in Eating NAFTA.⁵¹

Even though I read those things in books, seeing them through the eyes of someone like Theo who had observed change over time brought a more human scale to what I could gather about changing foods and farms. From his car window, the “sclerotic landscapes”⁵² and constricted food systems that scholars write about made more sense. Sclerotic arteries kept showing up in diabetes clinics, but from the road I could also see sclerosis even in the lush land that nonetheless choked free movement through it—like the United Fruit bridges and the roads that followed, still constricting the motion of food and people long after the corporation and its train tracks were gone. Some historians of science used to search for what they called the “machine in the garden,” moments when industrial technologies entered nature.⁵³ But I realized that the banana train, missing now, wasn’t the machine in this garden any more than the crumbling mills and their rusting wheels. When it came to wild sugar and its landscapes, what looked like the garden was the machine—altered infrastructures and biologies, living sugar “absorbed” into bodies and absorbing them in turn, overgrown excesses of fixed and moving parts.⁵⁴

But whenever I thought I had found some connecting plotline to think with across scales, the events I wanted to wrap a story around seemed to shape-shift again. Some months after our last trip, I was shocked to learn that Theo had been murdered in the same car we had driven in the past summer. Memories of those trips and the stories suddenly changed gravity. The last time I saw him, he was listening to country music and said his sugar felt low. He was going to buy a piece of fruit.

No matter how many times I read headlines in Belize like “Sugar and Bullets,” I can’t really grasp the scale of the numbers.⁵⁵ Yet according to national statistics, what happened to Theo is not strange at all in the sense of numerical probability. Murder was the most likely way for a man to die in Belize, followed by diabetes (for women, diabetes was still number one). What makes this reality especially hard for both Belizeans and scholars to understand is that the country’s homicide rate was very close to zero only a few decades ago.

The rise of militarized forms of policing within the United States has deeply affected Central America, as has the growing demand for opioids headed for U.S. markets. Current homicide rates are well over the so-called civil war benchmark countrywide. At last count by the U.N., Belize City’s homicide rates ranked third highest on the planet.⁵⁶ Some 90 percent of Belizean children have seen a dead body, compared to 20 percent in Mexico.⁵⁷ Yet unlike many nearby countries where violence is also a major issue, there is no legacy of civil war in Belize. Once I asked a prominent journalist who regularly publishes on what he calls the “violent triangle” of Guatemala, Honduras, and El Salvador why he leaves Belize out of Central America, even though its violence rates are comparable to or higher than those in the surrounding countries he focuses on. “Nobody understands Belize,” he said.

Since many of my memories of Belize’s landscape were learned through the windows of Theo’s car, now the whole landscape felt learned anew through the memory of what happened to him there. Being afraid to move around at certain times or places was part of sclerotic landscapes too, and one of fear’s many unpredictable effects. You couldn’t easily see it on the surface, but on glucometer screens you could watch the way an untimely death made an entire family’s blood sugar erratically rise and fall. Fear of safely moving through a place could make a daily exercise routine feel like weighing immediate security against future health. I began to learn how easily a country’s relaxed atmosphere can be mistaken for an absence of social problems, rather than a hard-won effect of the way people absorbed hardship and undertook the labor of transmuting it for those around them. These realities are now also part of “what it means to be human in a place advertised as paradise.”⁵⁸

Theo used to say that he was jealous of friends who had HIV/AIDS instead of diabetes. He said the two chronic diseases shared similar daily demands—except that with AIDS, “if you take your medications in time, you can eat just about anything.” And the difference that most preoccupied Theo: “With AIDS, they don’t cut you up.” He started laughing at this harsh contrast, the way blood with high sugar doesn’t make others afraid, unlike AIDS. “They don’t want to cut you!”

They cut him more than a dozen times, face and neck. When I listen back to recordings from his car now, Theo’s storytelling as we crisscrossed Belize feels impossible to separate in my memory from what happened to him later in his vehicle. Slow violence bleeds into violence of other tempos. The stories he told me about food and landscapes as I looked out the window already held the quality of blurring past, present, and future, and now make me imagine looking back at him in the driver’s seat with a similar sense of “simultaneous time.”⁵⁹

I recalled his carefully stowed hard candy in quick reach in the console and thought back to Theo’s story about his tough old friend, who the police initially thought had been murdered but seemed to have died fighting his way toward the kitchen with low sugar. Everyone in Belize called diabetes the “silent killer,” but I never grasped it as clearly as in that story of what police had mistaken for a crime scene. Staying on guard against other violent killers could share a gut-level feeling with diabetic sugar: There were measures you could take, but there were things far out of your hands, and life with it meant just knowing that.

Theo fought back hard, his gashed arteries undoing the delicate investments behind decades of care. The story that he had told me most often was about the time a few years ago he’d tried putting a teaspoon of sugar in his morning coffee, after hearing it was good for diabetes. But it had caused Theo’s toe to “crack open like a statue.” His son had brought him an aloe plant to massage onto the injury each day for months until the threat passed.

DIABETES MULTIPLE

One woman in Dangriga asked whether she had type 3 diabetes. In medical journals, “type 3” would reference theories of Alzheimer’s as an additional or comorbid form of diabetes, linked to insulin disturbances in the brain that interfere with insulin’s role in memory.⁶⁰ But for her, this meant something else. She clarified: type 3, the kind of diabetes that means your arms or legs get cut off.

Nobody needed a visiting ethnographer to tell them about “diabetes multiple,” an interpretation I had once felt clever for proposing. In Body Multiple, Annemarie Mol examined different hospital treatments of sclerotic arteries—the hardening blood vessels linked to ischemic leg ulcers, often associated with diabetes—to reflect on how different bodies come into being, depending on the treatment approach chosen.⁶¹ This insight also has crucial implications for observing care inequalities (though Mol doesn’t choose to go there). Yet juxtaposing her book with this one offers a case in point: its front cover depicts an image of two legs being readied for precisely the surgery that helps to prevent diabetic amputations.

In one sense, this provides an uneasy demonstration of Mol’s insights: physically different bodies get produced through differences in medical practices and technologies. By putting into play (or not) different possible treatments, diseases can become physically distinct entities. This can create multiple versions of a condition like diabetes—as when clinics in Belize amended the preprinted posters that listed the disease’s warning signs, writing in by hand severe manifesting symptoms like “blindness” next to milder warning signs like “blurred vision.”

Yet comparing how multiple versions of diabetes are produced by unequally available treatments and practices also begs another question: how connected material histories shape what care options come to seem “ordinary.” After all, these different norms of treatments are not unrelated, thinking of Body Multiple from the Stann Creek District of Belize—“Stann” being the Dutch word for “Safe Haven,” the name by which early Dutch settlers claimed this Maya ancestral territory. While there are several accounts of how ancestors of Garifuna people first arrived in the Caribbean, some historians believe they descend from African men and women who escaped from the Dutch slaver ship Palmyra.⁶²

In some opaque way, the “ordinary” sclerotic surgeries in a Dutch hospital have a historical relationship to the absence of those restorative technologies in most of the Caribbean. They are obliquely connected by colonial histories of plundered bodies and lands that still today shape institutional resource flows—systems impacting how different forms of medical expertise and technologies developed. To extend Mol’s logic to Belize, these “versions are both different and interdependent: multiple.”⁶³ “The capital amassed in the eighteenth and nineteenth centuries through various forms of slavery economy is still in circulation,” W. G. Sebald wrote, reflecting on what he called the “money laundering” of Dutch art funded by Caribbean sugar, “still bearing interest, increasing many times over and continually burgeoning anew.”⁶⁴

There is also another aspect of “diabetes multiple” that is not easy to trace with hospital observations about disciplinary differences alone. Technologies do not get used equally, even in affluent hospitals, for reasons that occur without the intent or knowledge of anyone involved. In textbooks about sclerotic arteries, for example, the choice of which procedure gets used should not relate unjustly to an individual patient’s skin color. But looking at U.S. population data, it becomes clear that racial assumptions have been systematically enacted on patients’ bodies.

Drawing from ten years of New York hospital data, one study analyzed 215,000 cases of people with diabetes arriving at the hospital with symptoms of peripheral artery disease.⁶⁵ It found that Black patients were 46 percent more likely than other patients to have received an amputation instead of a “salvage” procedure to restore blood flow to their legs. Black patients and women were also more likely to be amputated above the knee rather than at the shin. Above-the-knee amputations notoriously make recovery much more difficult.⁶⁶

Perhaps most disconcertingly, these disparities were actually highest in the hospital units with mostly white patients, so they cannot be easily attributed to preexisting resource or equipment inequalities of segregated cities. Another study mapped the geography of diabetes-related lower limb amputations in Los Angeles, which is actually the largest Belizean city in the world by population. This mapping revealed that people were ten times more likely to experience diabetic amputations in the poorest areas of the city, which were also the most segregated. It shows a disturbingly patterned geography of “diabetes multiple”—inequalities that can make diabetes a physically different condition for people of color and for patients with fewer resources, those more likely to have limbs removed even when experiencing identical symptoms.

Certain scientists still argue that diabetes risk is “inherent” in the DNA of nonwhite people. This text instead follows Anthony Ryan Hatch’s illuminating work in Blood Sugar—including his observation that “race is not biological, but racism has biological effects.”⁶⁷

In hospital labels, the technical name for diabetes is diabetes mellitus. It derives from the Latin word mel for honey, a reference to an old European medical trick of tasting a patient’s urine for honey-like sweetness as part of the diagnosis. Physicians today commonly shorten diabetes mellitus to “DM.” In contrast, the word sugar was adopted into Latin from the Arabic word sukkar around the time sugarcane was adopted into imperial Rome from its plundered colonies. And in the clinics and homes of Belize, people were constantly reworking this label of “honey diabetes.” No, many insisted: they had sugar diabetes.

Not everyone I spoke with in Belize described their condition as “sugar.” Relatively well-heeled patients, more able to manage, were more likely to say they had “diabetes.” The terms slipped into each other constantly. But I noticed some patterns.

For many with diabetes, an event like dying young or losing a limb would register as a surprise, even an outrage—either would be shocking, for instance (by way of contrast) among those with diabetes in my white, middle-class extended family in the United States.

Sugar, on the other hand, I often heard in relation to societally normalized injuries and untimely deaths. Living in foretold death and injury meant that something terrible not happening was also newsworthy. Sometimes I found those comments more haunting than the bad stories. One man told me of his mother, “She died with all her arms and legs on.”

The long fights to which a foot is lost to diabetes often remain illegible as “battle scars,” Kiese Laymon writes in Heavy—and “unacknowledged scars accumulated in battles won often hurt more than battles lost.”⁶⁸ Unacknowledged scars of sugar could be read as one of many distillations in the “climate that produces premature Black death as normative,” in the words of Christina Sharpe⁶⁹—or for others, as part of “the labor of living in the face of an expectant and a foretold cultural and political death,” as described by Audra Simpson. “With settler colonialism came . . . a radical shift in Indigenous diets and their bodies. As a result their blood is excessively ‘sweet’ and has a high prevalence of diabetes—a bodily indicator of these spatial and dietary transitions.”⁷⁰ Seeing disembodiments happen to others only deepens existing traumas, as Mojave poet Natalie Diaz captures of diabetes and surviving such losses: “Asks me to rub her legs which aren’t there so I pretend by pressing my hands into the empty sheets/ Feels she’s lost part of her memory the part the legs knew best like earth/ Her missing knees are bright bones caught in my throat.”⁷¹

The racial logics of normalized injuries and death that distinctly characterize both settler colonialism and white supremacy⁷² came together in sugar for some like my friend C, who was proudly Garifuna—both Black and Indigenous. She was among those who told stories of her doctor’s shock when she returned to the hospital for a long-held appointment after the diabetic crisis he had assumed would cause her death at age thirty-four.

“He said, ‘How are you still alive?’” she really laughed, mimicking his wide-eyed incredulity. It was the hardest that I ever saw her laugh, so I laughed too, but looking back on it I only saw a surface fraction of the joke back then. I appreciated her comic critique of biomedical limits. But I missed the eerier echo of implicit memory: her ancestors had been facing expert iterations of that very same question—How are you still alive?—ever since the first European surgeons arrived on the warships sent to eliminate them from Saint Vincent.

Normalized death, extraordinary survival, transformations that became necessary to live on—whatever expectations sugar indexed, this was the closest thing to a refrain that I encountered across individuals’ stories. People regularly showed up in clinics with blood sugar levels that textbooks said would be fatal. Doctors, caring, confused, faced with sugar escaping the biomedical rubrics of diabetes mellitus, would ask: “How are you still alive?”

STILL. THERE

When I loaded the microfiche about Confederate plantations built in Stann Creek, the first slide said in huge letters: “END.” The reel must have been spooled backward on its last rewind, but it felt fitting—the traces of sugar that it held were the opening frames for the afterlives I was trying to learn about. My vision blurred while scrolling through Samuel McCutchon’s papers: letters, maps, almanacs, sketches, clippings of machines he hoped to buy. His favorite was called “The Concretor,” a device that turned sugarcane simultaneously into molasses and its byproducts into concrete building blocks.⁷³

It was strange to see McCutchon’s bookkeeping straddle countries and decades. In pre-emancipation United States, the enslaved people he legally owned were listed by name alongside his estimation of their dollar value. In southern Belize, he used the same notebook brands and page formats, but this time the price column marked a minuscule hourly wage. The lists contained many last names of Kriol and Garifuna families I had known in Belize. Chinese indentured laborers were listed in McCutchon’s books only by numbers.⁷⁴

But even in its enigmas, the microfiche was an archival loop that I could place back into its cardboard container. The Belizean landscape upon which those diagrams had been enacted, in contrast, presented a more unruly material record of sugar histories’ afterlives.

In addition to Saccharum officinarum, “official sugar” (grown on most plantations), there is a species named Saccharum spontaneum, “spontaneous sugar.” Once “introduced by sugarcane breeding programs . . . S. spontaneum has the potential to become a serious invader of cultivated land . . . host to a large number of pests and diseases.”⁷⁵ With both rhizomes and seeds, it propagates freely. Such cane “looks like wild corn has mated with bamboo,” bearing “fluffy, hair-like flowers.”⁷⁶ Though becoming scraggly and less useful to humans, even “official sugar” breeds of cane can survive in the wild and move across landscapes.

In sugarhouse sketches, there are often circles marked “Still” centering the structure, its vats used for distillation. Seeing that term orient so many diagrams of sugar, the word’s other meanings made me think of a core of time as well as space. Still: ongoing; unmoving; but.

The Confederate families flying flags of Dixie are gone from southern Belize. The sugar industry came and went in the southern region, leaving only rubble on the edges of a global system where Belize was a fringe node at best.⁷⁷ But sugar remains iconic of the larger shifts such colonial forms have unleashed on a global scale: motors of industrial agriculture and ecological extractions; chemicals used to grow crops on spent soils; plantations that led to corporations;⁷⁸ machines rusted in place in fields yet in ongoing motion across landscapes and inside cells of human bodies, even when left behind by all accounts. Long gone; still.

When someone’s glucose is high, it is present not only in the blood but also in sweat, breath, saliva, urine, respiratory fluid, and tears. Once I was invited to a funeral for a friend’s father after his death from diabetes and realized how many people in her family must be crying sugar.

In today’s diabetes markets, even the sugar in tears holds potential capital. Some researchers have argued that such tears could be collected, dried, and cut into pieces for lab tests or public health metrics. “Persons without diabetic symptoms would be less reluctant to give samples of tears than of blood,” one policy proposal read: “Thus a fairly accurate estimate of the prevalence of diabetics could be made with less resistance from the public.”⁷⁹

One could argue that in today’s global markets, the sugar inadvertently cultivated in people’s blood and bodies is more valuable than any sugar growing in the ground. These global sugar markets feed each other in ways that recall Lochlann Jain’s insights about how “key aspects of the economy involve both causing and treating” many chronic conditions.⁸⁰ Importantly, Jain reminds us that such profit engines do not imply any malicious intent or human ill will. But when protecting local foods and environs has no global “market value”—while dietary and therapeutic products that both cause and treat diabetes are highly profitable—those incentives fuel systems that reproduce with a life force of their own.

A number of older people with diabetes I met in Belize diagnosed or monitored their glucose by smelling and tasting sweetness in their urine. Others first realized they had diabetes by noting insects gathering in the places they urinated, drawn to consume the sugar. For them, “sugar” was not an abstract unit mediated by technologies or paperwork—bodily sugar had a sensibility and flavor, a literal taste. And, of course, blood sugar reflects much more than the sweets someone has eaten. Since all carbohydrates turn into glucose in the body, foods like flour tortillas and white rice can cause high sugar levels in bodily fluids too. The ants can’t tell whether a glucose molecule was broken down from cane or white flour, once sucrose or fructose. By then it is just sugar, and they are there to eat it next.

Sugar not only reveals scales but also produces them, like the genes described by Ian Whitmarsh elsewhere in the Caribbean.⁸¹ When a diabetic ulcer refuses to heal, some hospitals actually apply a topical poultice of sugar, which for unknown reasons at times has more medical efficacy than many antibiotics.⁸² Certain foods may be disproportionately eaten due to a history of exploitation, but people have also learned ways to make “dietary disaster” delicious, and often there is “clearly life surging around the sugary rite.”⁸³ Sugar holds contradictory meanings: eating and getting eaten; histories of hardship and labor, but also of love, pleasure, and luxury; both wealth and poverty; security and danger; terror and intimacy; violence and comfort; age-old, growing new; hunger and indulgence; invigorated and devastated agriculture; ancient human staple and disobedient Frankenfood.

The symptoms and injuries of sugar likewise hold contradictory meanings and intimacies. When “a source of value is extracted from the population being injured,”⁸⁴ Jasbir Puar argues, wounding might be better analyzed as maiming, to mark the uneven ways that racial capitalism and settler colonialism play a role in “rendering populations available for statistically likely injury.”⁸⁵ More than disability, she calls this debility—someone profits.

“Hurtful” was the particular word that Sarah used to speak about it. Her language is also helpful to think with—creating her own terms for recognizing pain, but distinct from the terms of “damages.” Sarah’s relational concept of the “hurtful” offers a different mode to recognize injuries and debilities that people were dealing with and actively seeking ways to share about more publically.⁸⁶ Something hurtful points back out, asking us to examine the external forces and infrastructures inflicting hurt. It’s also already being dealt with—requiring recognition of the dignity with which injuries have long been borne, and implying that storytelling is also implicated in processes of cause and effect.

Listening again now, Sarah’s words sound as much gentle rebuke as kind invitation—not just to the searching student who kept coming to talk without always being able to understand, but also for whomever she imagined my voice recorder was a proxy for reaching. I like to think that this included anyone ready to author diabetes policy without consulting the people actually living with it.⁸⁷

Of course, playing back her words in air-conditioned rooms is not without its own double edge. It could be easy, from there, to think we were outside the sugar machine. But on the contrary: sugar plantations across the Caribbean and throughout the Americas played a major role in endowing U.S. and European universities like the one that sent a student like me to study and report back on distant nutritional deprivations.

Who profits when bodies break down from sugar? And which bodies? Is it even possible to examine such unequally distributed problems without profiting too? I used to think this project could find an outside to these contradictions. Now, I just believe in more honest wrestling with the ways we each get interpolated by sugar’s legacies and ongoing effects.

“I’ll tell you, I have a great time, girl.” Sarah said she wanted to get a small Belizean flag to wave for Independence Day in September. “Are you going to the parade?”

In the face of irreparable histories, I wish I knew a better gesture than trying to co-create platforms for thinking with teachers like Sarah and the unauthorized expertise they shared. People are already speaking back—time and again, implicitly and directly—to common public health rubrics by which they are otherwise objectified, managed, and related to. They have ideas about the work of justice. But their insights often do not have a channel back to those who make science, design, and policy decisions that impact their lives. Which kinds of public efforts might help support and expand the vital grassroots care projects already underway? And which policy misrecognitions feed more limbs to the sugar machine?

In this view, any sugar machines that are possible to photograph—like the glucose meter with unaffordable parts that broke down in Sarah’s treasure chest or the colonial equipment rusting among the trees near her house—are only synecdoches, little pieces of a five-hundred-year-old engine. But the larger apparatuses they support are the mechanisms and infrastructures by which the death and dismemberment of nonwhite people had come to seem ordinary—forecast as acceptable or just inevitable, weighed against profits engines and global markets. This again disturbingly echoes earlier logics of sugar, as Saidiya Hartman writes of such afterlives: “Death wasn’t a goal of its own but just a by-product of commerce, which has had the lasting effect of making negligible all the millions of lives lost.”⁸⁸

Many of the “fixes” addressed to normalize sugar seemed not only to fail to contain its loose forms but also to generate additional harms: from pesticides that poison bodies even as they protect crops, to foreseeably insufficient and unevenly accessible care technologies, to the excesses of violence and insecurity that trail long histories of lost lands, foods, and families. With these legacies unleashing material forces, diabetic sugar’s normalized losses emerge from a machine five centuries in the making—overgrown and breaking down yet proliferating and exceeding many remedies meant to triumph over it.

A Confederate sugar machine at Indian Church, Belize.

Over time, I observed experts try to put sugar in many different enclosures. In one archive, I saw pressed sugarcane plants get filed in niches labeled as “pigeonholes,” each numbered. The Kew collection in London included many indigenous plants and vegetables from Central and South America and the Caribbean that are now extinct in the wild, making me realize I did not know of any extinct species of sugar. “Unfortunately, our sugar collection is mostly just tassels,” one caring botanist told me regretfully as she handed me folders of wheat-colored bristles from the Americas, mostly from Mintz-era Puerto Rico. The botanist kindly added that she wished they had more cane stalks on file so that she could show me sugar’s unusual joints. “Try to think of them like knees,” she said. Much later, driving past a patch of cane sprouting along the road in Belize after a day spent talking about lost limbs, I thought of the London analogy’s misfit; only sugar keeps growing back.⁸⁹

Yet if sugar was still there, so was Sarah’s family. And given the heaviness of history that preceded our encounters, I felt surprised by Sarah’s generous parting words in 2010: “It’s a great time to be together. You know, love one another, talk with one another. Feel happy to know that you know someone strange. Make the best of it, love.”