Mercado Martínez, Francisco. Entre el infierno y la gloria: la experiencia de la enfermedad crónica en un barrio urbano. [Between hell and glory: experiencing chronic disease in an urban neighborhood.] Guadalajara: Universidad de Guadalajara, 1996. 354p.

Objective: To analyze the effect of a chronic disease (diabetes mellitus) from the point of view of those who live with it; and, to place this experience within the larger socio-economic context.

Methodology: Ethnography (qualitative, analytic, and interpretive).

Results: This investigation links the macro- and micro-social levels. This approachrecognizes that disease is not only physically present in the body but that it also exists within specific temporal, historical, and socio-economic contexts. Chapter one introduces the central questions and methodologies of the investigation and explains why the analysis focuses on lower-class diabetes patients. Chapter two describes the personal context of the subjects under study. The author analyzes general demographic, economic, and social characteristics of working class neighborhoods. In chapter three he analyzes the social origins, material circumstances, and employment patterns of specific patients. Chapter four describes how individuals perceive their illness and what impact such perception has on their daily lives. Chapters five and six focus on how individuals represent and make sense of their illness, relating this to other factors such as individual treatment regimens and the social epidemiology of diabetes. Chapter seven addresses the wider theoretical and conceptual implications of the study, with reference to current models for treating diabetes and for analyzing general population health and morbidity. The patients on whom this study focuses are primarily Catholic women from rural areas who live under impoverished conditions in a Mexico City slum. They experience diabetes mellitus as a series of problems and difficulties in their everyday lives. When symptoms first appear, the lack of knowledge about the disease creates difficulties in coping with it. Later, the women become “experts” in choosing the remedies they consider most effective. The majority do not follow medical indications. Religion plays an important role in the search for support. As patients acquire information and experience, they choose the treatments that will yield the best results in reducing or eliminating discomfort. Theavailability of economic resources likewise plays an important role in the selection and completion of treatment, as does the patient’s gender.

Conclusions: Diabetes mellitus, as it occurs in an urban, low income community, entails a complex of cultural and socioeconomic conditions. Ethnography helps clarify diabetes mellitus in the lived experience of patients with this diagnosis.

Copyright 2007 University of New Mexico