Tuberculosis in the borderlands: migrants, microbes and more-than-human borders
Tuberculosis in the borderlands: migrants, microbes and more-than-human borders
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DOI：
10.1057/s41599-019-0239-4
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发表时间：
2019-03-12
影响因子：
4
通讯作者：
Limsawart, Wirun
中科院分区：
文献类型：
--
作者：
Chuengsatiansup, Komatra;Limsawart, Wirun
自20世纪90年代宣布结核病流行为全球紧急情况以来，耐多药结核病（MDR-TB）一直是一种被广泛认识的威胁。这种流行病在人类和微生物跨越地理边界流动的边境地区尤为严重。在这篇文章中，我们探讨了泰缅边境地区人类-微生物关系的偶然性。暹罗-缅甸边界最初是由殖民时期形成的，通过各种因素（包括微生物和药物）的相互作用，不断制定、协商和共同产生，暹罗-缅甸边界的持续存在。我们研究了全球形式，如生物医学科学、流行病学实践和公共卫生干预措施是如何在这一边境地区控制耐多药结核病的。虽然边境的渗透性和移徙者的地理流动性似乎阻碍了疾病的监测和控制，但结核分枝杆菌在人体内长期潜伏而无症状的能力，对流行病学将健康者与受污染者隔离开来的努力构成了额外的挑战。结合来自泰国西部边境德省Umphang地区的民族志材料，国家政策分析，自然历史和微生物学见解，我们揭示了边界的不确定性和复杂的微生物-人类纠缠如何需要改变传染病控制的现行生物控制模式。我们建议，疾病监测和反应需要超越刚性的地理空间概念，并包括一个更灵活的空间拓扑概念，包括药物、微生物和人际关系的流动性。这种对流行病控制的空间方法的重新发明，首先是更密切地关注超越人类边界的人与微生物关系的纠缠。
Multidrug-resistant tuberculosis (MDR-TB) has been a widely recognized threat since the TB epidemic was declared a global emergency in the 1990s. The epidemic is particularly critical in the borderlands where humans and microbes move across geographic borders. In this article, we explore the contingency of human-microbe relations in Thailand-Myanmar borderlands. Initially constituted by the colonial encounters, the Siam-Burma border's continuing existence was constantly enacted, negotiated, and co-produced through the entangled interplay of various actors, microbes and pharmaceuticals included. We examine how global forms such as biomedical science, epidemiological practices, and public health interventions were actualized in an attempt to control MDR-TB in this borderland. While disease surveillance and control were seemingly hindered by the permeability of the border and geographic mobility of migrants, the potency of Mycobacterium tuberculosis to lie dormant in human bodies for long periods of time without symptoms posed an additional challenge to epidemiological attempts to segregate the healthy from the contaminated. Combining ethnographic materials from Umphang District, Tak Province at the western border of Thailand with national policy analysis, natural history, and microbiological insights, we reveal how the indeterminacy of borders and complex microbe-human entanglements necessitate changes in the prevailing biocontainment model of infectious disease control. We propose that disease surveillance and response need to transcend the rigid geographic notion of space and include a more flexible topological conception of spatiality that embraces the fluidity of pharmaceuticals, microbes, and human relations. This reinvention of the spatial approach in epidemic control begins by attending more closely to the entanglement of human-microbe relations in the more-than-human borders.