DPhil Student
Hertford College
Thesis: The Missionary Logic of Care: How Rural Healthcare Legacies Transform Diabetes Care in a Totonac Community in Mexico
Research summary: My doctoral research examines how national diabetes prevention standards are transformed when implemented in a rural Indigenous municipality in the highlands of Puebla, Mexico. Drawing on long-term ethnographic and archival research, I show that guidelines premised on urban imaginaries of autonomous individuals managing “lifestyle” risk are reinterpreted in a rural hospital shaped by longer histories of state-led Indigenous integration and reform. These histories explicitly drew on the civilizing model of the sixteenth-century Spanish missions and continue to inform institutional imaginaries of the rural population.
In this context, the mandate to “motivate” patients becomes an obligation to “convince” them through moral exhortation and fear, while prevention is reframed as the correction of local customs—especially maize-based diets. I describe this transformation as a missionary logic of care: a mode of intervention that treats patients not as autonomous decision-makers but as citizens-in-the-making requiring moral and cultural remaking.
For Totonac patients, these adapted prevention practices can themselves become sources of risk: reducing maize is understood to threaten bodily strength, while accepting biomedical narratives that incite fear of disease onset and progression can, within Totonac theories of thought and causality, play a role in materializing illness. Living with diabetes in Ixtepec thus involves navigating these risks by managing not only food and medication but also thought and emotion in daily life. In this context, partially distancing oneself from medical discourse becomes a form of self-care.
The medical emphasis on individual responsibility is likewise continually negotiated, as local understandings of diabetes foreground emotional experience (susto) and environmental change in accounting for disease onset. Together, these negotiations over risk, care, and responsibility shape what it means to live with diabetes—and with its threat—in a rural Indigenous municipality in Mexico.
This research shows how efforts to adapt national health policy to rural Indigenous contexts can generate unintended moral, practical, and political consequences.
Research interests: Medical anthropology; histories of healthcare and nutrition; governance and care; Indigenous health; chronic disease; anthropology of religion; medical ethics; social and environmental change; concepts of body and spirit in Mesoamerica.
Previous education:
MA in English and Social Anthropology, University of St Andrews (2011)
Master’s in Anthropology, National Autonomous University of Mexico (2015)
Contact: susana.kolbcadwell@anthro.ox.ac.uk
