Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico

ABSTRACT

Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people’s uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

KEYWORDS:

• Diabetes
• Diabetic foot
• health services
• indigenous peoples
• Mexico
• social suffering

Acknowledgments

LM conceptualized, designed, and conducted the fieldwork on which this article is based and drafted the manuscript. MGRR conceptualized and realized the health data analysis component. JER contributed to extensive revision of article drafts. We are grateful to the people with diabetes that participated in this study despite their challenging circumstances. We thank our colleagues at CIESAS, IMSS, and Kingston University London for their feedback on previous drafts of this paper. This research was approved by the Research Ethics Committee of the National Committee for Scientific Research of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social), register code R-2020-785-152.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Identified as speakers of an indigenous language and/or people who self-identify as indigenous.

2. The four-character coding pattern in ICD-10 was: - E10.5 Diabetes mellitus type 1, with peripheral circulatory complications; - E11.5 Diabetes mellitus type 2, with peripheral circulatory complications; - E12.5 Diabetes mellitus associated with malnutrition, with peripheral complications; - E13.5 Other specified diabetes mellitus, with peripheral circulatory complications; - E14.5 Unspecified diabetes mellitus, with peripheral circulatory complications. (WHO 2021)

3. Names are pseudonyms. To further ensure anonymity, we do not provide the names of the localities where our informants resided.

4. Refers to the request for specialized care in the hospital setting issued by the treating physician.

5. To issue a pass, the treating physician at the first level of health care must prepare a summary of the patient’s clinical history and complement the diagnosis with the results of laboratory tests (when appropriate). Often, patients and their families absorb the costs depending on the limitations of the health care services.

Additional information

Funding

This work was supported by the Consejo Nacional de Humanidades, Ciencias y Tecnologías [Cátedras Conahcyt project number 771].

Notes on contributors

Laura Montesi

Laura Montesi (PhD) is a CONAHCYT researcher based at CIESAS (Center for Research and Higher Studies in Social Anthropology), Oaxaca, Mexico. Her research is focused on chronic conditions and health inequalities, particularly among indigenous people in Mexico. She is coeditor of Managing Chronicity in Unequal States (2021, UCL Press) and Los huaves en el tecnoceno (2022, INAH/Editpress).

María Guadalupe Ramírez-Rojas

María Guadalupe Ramírez-Rojas (PhD) is a researcher of the National Council of Humanities, Sciences and Technologies (CONAHCYT) based at the Center for Research and Higher Studies in Social Anthropology (CIESAS). Collaborator in the Indigenous Peoples’ Health project. Coordinator of the Doctoral and Master’s Program in Social Anthropology of Socio-Environmental Processes and Health at CIESAS Sureste. Co-Chair of the Commission on the Anthropology of Pandemics by the International Union of Anthropological and Ethnological Sciences. She has been a consultant for international and national organizations and a scientific researcher for 13 years.

Jesús Elizarrarás-Rivas

Jesús Elizarrarás-Rivas (PhD) is Coordinator of Health Research, clinical researcher, pediatrician and geneticist at the Mexican Institute of Social Security (IMSS) in Oaxaca, Mexico, where he is also a CONAHCYT researcher. He is a Research Professor at the Faculty of Medicine of the Universidad Autónoma Benito Juárez de Oaxaca (UABJO). His research focuses on chronic degenerative diseases (diabetes mellitus), cardiac, hematological and childhood diseases such as leukemia and neonatal jaundice. Author of 40 research articles in indexed journals and collaborator in chapters and books in his specialty.