Storying syndemics: understanding migrant women’s experiences of diabetes and distress through narratives of self-care

Migrant women face disproportionate rates of co-occurring type 2 diabetes and distress globally. Biomedicine’s individualized care model for people with diabetes conceptualizes distress as an added comorbidity to be managed. However, this negates the ways in which diabetes and distress may be interwoven with complex forms of social suffering at the confluence of gender, socio-economic status, racialized identity, chronic illness, and migration, and experienced as a co-occurrence of multiple illnesses. Anthropologists have proposed the syndemic framework as an alternative to “comorbidity” in order to capture the synergistic interactions between diseases that are shaped by social inequalities. This study extends the syndemic framework through centering the life narratives of migrant women at the nexus of diabetes and distress. This study draws from a year of ethnographic fieldwork conducted in 2024. We utilized an ethnographic approach to conduct in-depth, participant-led interviews with 20 South Asian migrant women living with diabetes in Melbourne, Australia. Participants followed the prescribed diabetes self-care advice given to them through their interactions with the healthcare system in Australia. Yet in order to navigate distress, they moved beyond biomedical knowledge and interactions with the healthcare system. We identified four key ways in which participants located and articulated the relationship between diabetes and distress, including: 1) The process of becoming a migrant woman and making sense of emotions, 2) Losing relational ties as a result of distance, death, and familial discord, 3) The stressful and often gendered juggle between domestic chores and professional work, and 4) Navigating food within fractured socialities and identities. We argue that a narrative understanding of how diabetes and distress intersect reveals the complex ways in which relational processes shape disease co-occurrence in contexts of migration and social inequality. Ethnographic attention to life narratives offers new insights into the nuances of syndemic interactions between diabetes and distress, which are especially relevant for policymakers and clinicians working with migrant individuals.