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Struggles for maintenance: Patient activism and dialysis dilemmas amidst a global diabetes epidemic

ABSTRACT Diabetes has become a leading cause of death in Belize, making this Central American country emblematic of challenges amplified by a growing global diabetes epidemic. The struggles people face as they seek care for chronic conditions like diabetes (and its complications such as kidney failure) are bringing citizens and institutions alike to revisit longstanding norms about the terms through which healthcare is accessed. Ethnographically tracing Belize’s first patient-driven healthcare protests and activism – an ad hoc movement for public dialysis that began over a decade ago – this paper examines patients’ and caregivers’ struggles to probe and shape a legacy of social justice health activism, drawing on perspectives from an often-overlooked part of Central America where basic healthcare access has not historically been framed as a right of citizens. It considers these dilemmas in relation to much larger chronic struggles ‘to maintain’ and repair bodies, medical technologies, and health systems in the aftermath of colonial legacies – with special attention to the challenges posed for small countries now facing rising issues of diabetes injuries and chronic complications – and the role of civic media and citizen activism in this context.