teaching and advising for the collective good. They shared their knowledge, offered tips about what worked for them, were brutally honest in their prevention messages (e.g. ―You are fat.‖), and provided motivation about weight loss, cooking, healthy eating, and exercise. Participants described their role, and motivation for helping, in the following ways:
Oh yes, sometimes people come and ask me how it feels when one gets diabetes I tell them, ―No, you feel dizzy, uh tired, and you have a dry mouth uh that‘s it. One feels badly. And you feel like using the bathroom. . . They ask me, ―And how can one manage their diabetes? I tell them that the doctor told me, she explained to me in a piece a paper that one should not eat a lot of fat, uh, eat more vegetables, and less carbohydrates, . . ..I pass on information to them. (Lilia)
Yes, it was [unintelligible] classes, and that‘s why I can tell other people, ―Don‘t eat this, eat this instead.‖ . . . I tell them . . . Don‘t eat so much fried food.‖(Rafael)
Because it helps other people. I mean, I can explain it to other people who have the same problem I do. There are people who don‘t know anything about diabetes. It is nice to give information to people. (Carlos)
This assistance included providing supplies and information to family members in Mexico. Claudia described, ―Everything I do over here [in the US], they do over there [in Mexico]. I send them medicine. When I know that something is good, I send it to them for them to have it.‖
Advice about medication use was tempered with caution, but at the same time, the participants used the opportunity to teach others about the differences between medications. They also encouraged people to ask their doctors questions. Isabel related on experience she had:
I met a man who has diabetes and he was asking me what medication I use. So I tell him, well, I tell him, ―But you cannot use the same medication I am using. You really need to be asking your doctor if it is good for you. Because it may be appropriate for me, but not necessarily for you. He told me he was taking a medicine and the whole time he was sick to his stomach. ―That‘s exactly what I am talking about‖, I told him. Ask your doctor to change your medication, because he knows your body, he can prescribe you one. Because maybe, the medication that fits me, may not fit you. It may not do anything, or it may do something bad, or make you sick.
The responses of family members‘ to the participants‘ advice often revealed the level of misinformation that exists in the community about receiving medical treatment for
diabetes. Alicia described the typical reaction of her family members to her advice:
I tell them they should get it treated. I tell them [unintelligible] because it is bad and they say that . . . they say that the doctors over there [her country of origin] tell them that if they start taking medication for diabetes uh, then it is easier for their organs to degenerate. I don‘t know whether that is true or a lie because what I think is that if they don‘t take the medication that can happen to them.
Providing support for others offered benefits for both parties. Jorge explained this relationship:
168
My brother-in-law has diabetes . . . . .He and I, we experiment. The other day, I asked him, ―How did you feel?‖ ―Well, like this or that.‖ ―And you, what did you do?‖ ―Well, I tried this.‖ ―I did not drink this.‖ He walks, he runs, and he does not drink sodas, and his level is very high.
The difference between culturally defined boundaries of Anglo Americans and Hispanics emerged again as participants described how they helped others. Their roles as community and family resources reflected the dynamics of familismo and collectivism. Familismo is a cultural construct that views the needs of the family as more important than those of the individual (Caballero, 2006). Collectivism is the connectedness an individual has with the larger community beyond that of the family, this connectedness often carries with it a strong sense of obligation (Bandura, 1986; Giger & Davidhizer, 2008). Both familismo and
collectivism contributed to the participants‘ frustration when their advice went unheeded: There are a lot of people who do not take care of themselves . . . It makes no sense. You don‘t love yourself, you don‘t value yourself. That makes me mad because if I talk to him, I always get the ―I don‘t care about what you are telling me.‖ These are people who do not value their life or their family, I don‘t know. To me, what is it about diabetes? It is that there are some people [who] don‘t . . . like nothing is important. (Jorge)
I have a sister who is extremely obese, she is fat and I think she has sugar [diabetes] . . . . and she says no, that I am crazy. And I say, ―What do you have to lose? Go for a checkup.‖ And I have another sister who is fat too, but she says she might have it. . . . But who knows? I say. ―What do you have to lose? Just make an appointment and go for a checkup.‖ I say. ―That is what I used to think, ‗I don‘t have that, I don‘t.‘ And now I have it,‖ I say, because she is very fat, she is 200 and some pounds. (Pilar) Because we would tell her [Nadia‘s mother-in-law], ―The soda, it is very bad. Don‘t drink soda‖ or ―Don‘t eat so much bread‖ . . . . ―Don‘t eat all these things because you have diabetes.‖ One would tell her and the only thing she would answer, ―Anyway I will die. At least, I will die with a full belly.‖ They would tell her, her children, ―No, try to take care of yourself.‖ But no, she did not try to take care of herself. No, she would not. She was contrary . . . . One would tell her, but she would not do it. (Nadia)
Question 6B: Family members with diabetes. This question examined participants‘ memories of relatives who had diabetes. The themes that emerged were family members, stigma and secrecy, care in the country of origin, and immigration–living apart.
Theme 1: Family members. Participants‘ answers on which family members they remembered having diabetes covered a full range of relatives:
As far as I know, nobody . . . nobody was a diabetic.(Martin)
In my family, there are three siblings who have it, and my dad, and my paternal grandparents, and all my dad‘s siblings.(Angela)
My mamá has diabetes. And a brother too. My mamá got diabetes too, when I came here. She is in Mexico. My brother is also in Mexico. My brother does not know well how it started but with my mother it started suddenly . . . . .my mother-in-law also has diabetes, but she is stubborn [laughs] and has severe diabetes. (Anna)
My mamá did not, my papá[n]either, and my brothers, the majority, have already died. Only the one . . . was diagnosed with diabetes, but just the one that lives in Los Angeles. . . . One of my sisters-in-law died from diabetes . . . My sister . . . has diabetes . . . type 2 . . . She suffers a lot . . . . She has had diabetes for 2 years, and my brother for a long time. My brother was in Guatemala, but he died . . . We really do not understand how he died . . . But yes, he was sick from diabetes. My other brother . . . . has had diabetes for 8 years now. Yes, there are one, two . . . four, we have four who have diabetes in the family. (Claudia)
Yes, my mamá, my grandpa, my grandma, too, and one of my uncles who died from it, too. . . . Now my mamá, she is suffering from it. They have just diagnosed her. . . .I think my grandmother probably died from it. She said she had a tumor, but I [would] know if it was a tumor. (Alta)
My mamá and my sister, too. She [her mother] is doing badly. She is sick. I work a little, so I help her so she can buy her medicine over there [El Salvador]. Each month, I send her money so that she can buy medicine and food and clothes. . . . She has suffered a lot. . . . Last year in April, my brother died, and in April of this year, my sister died [cries].She had diabetes, too. . . . My nephew took her to the hospital. She fell in[to] a coma, and she only lasted 3 days. Then she died because she got like a shock or a stroke. Her sugar went up to 300, and she was not able to stand it. So now, I do not eat anything sweet, because I don‘t want this to happen to me. My brother, also, he was told he had diabetes, but he was young. He was told he had it, but he did not give it any importance. (Sylvia)
170
He [an uncle diagnosed with diabetes] would tell us, ―Take care of yourself. Do not eat too many sweets, too much sugar.‖ We were young; how can you live without sweets? Coffee without sugar? What is a tortilla without chilies? [laughs]. (Jorge) My papá was diabetic, and he in fact died as a consequence of this. . . Ay, very bad memories. My parents, both of them. . . Mostly my papa because I saw him, I saw him after being a man like me, tall and . . . very strong. . . . To be honest, it made me really sad seeing him like that in that depression. (Eduardo)
However, there were several issues that prevented participants from knowing if family members had diabetes. First, knowing if a relative has a condition requires a diagnosis. Many of their relatives who may have had diabetes did not seek medical care due to lack of desire or resources, and thus did not have a diagnosis of diabetes. Second, the stigma and resulting secrecy that surrounded the condition meant that some relatives never disclosed their illness to anyone other than their spouse, which will be discussed in the next section. Third, living in the U.S. and the resulting changes in communication with relatives contributed to
participants not knowing about family members‘ health statuses.
Theme 2: Stigma and secrecy. Some participants had not told their parents or other