Dissertation Research: Dengue in the Landscape: Waste Management and Infectious Disease Ecologies in Urban Nicaragua

尼加拉瓜和国际政策制定者都认为，当地参与蚊子控制是阻止登革热传播的最佳方式。登革热是一种由蚊子传播的疾病，主要袭击热带贫穷的城市地区，目前还没有疫苗。参与往往需要改变废物管理做法。这项由科学、技术和社会计划资助的论文项目是关于废物管理和登革热预防的两部分人种学研究的第二部分。它将CoPI目前在尼加拉瓜桑迪诺市的研究扩展到尼加拉瓜卫生部和美国疾病控制中心(CDC)。目的是了解当地有关登革热的生态知识如何进入尼加拉瓜卫生部和疾控中心的国内和国际登革热专家的实践，包括流行病学家、昆虫学家、医生和公共卫生营销员。通过美国疾控中心健康营销办公室和波多黎各疾控中心实验室对政策制定的研究，马那瓜卫生部的政策采纳，以及在桑迪诺市的应用，该项目解决了一个继续困扰医学和生态人类学家的问题。即使专家认识到跨地区力量(如气候变化、结构调整、城市化)在环境健康危机中的作用，媒体和政策制定者往往没有宏观层面的解释，而是在参与战略旨在增强能力的弱势群体中传播指责。该项目将城市公共卫生视为一系列社会实践，将桑迪诺市的人们与科学家和营销者联系起来，其中关于病因、诊断和预防的共识仍然难以达成。科学和技术人类学家帮助将医学专家之间的共识斗争置于更广泛的历史和社会背景中。该项目遵循了这样的争论，因为它们在实验室外延伸到尼加拉瓜城市的临床和预防环境中，暴露了潜在的模糊之处，这些模糊之处使国际上制定的登革热倡议与当地改善基础设施和创造可持续城市生计的努力相悖。摆在对生态、疾病、城市居民、科学家和政策制定者之间的社会和文化联系感兴趣的学者面前的问题是，增加对卫生和基础设施的参与是否会导致关于这两者的知识生产的有意义的变化。通过对健康危机采取基于地点的方法，这项研究揭示了一些物质和话语机制，公民、专家和将他们联系在一起的非人类行为者通过这些机制进行沟通、冲突，可能还会进行和解。该项目具有更广泛的影响，因为它有助于促进对城市居民如何产生知识的理解，这些知识可能对公共卫生政策制定者有利。通过跟踪这些知识到疾病控制中心，PI能够识别与知识部署相关的过程，并提出改进方法。

Both Nicaraguan and international policymakers view local participation in mosquito control as the best way to stop the spread of dengue fever, a mosquito-borne illness that primarily strikes poor urban areas in the tropics and for which there is no vaccine. Often, participation entails making changes in waste management practices. This dissertation project funded by the Science, Technology & Society Program is the second in a two-part ethnographic study of waste management and dengue fever prevention. It extends the Co-PI's current research in Ciudad Sandino, Nicaragua to the Nicaraguan Ministry of Health and the U.S. Centers of Disease Control (CDC). The objective is to find out how local ecological knowledge about dengue fever works its way into the practices of national and international experts on dengue, including epidemiologists, entomologists, physicians, and public health marketers in Nicaragua's Health Ministry and at the CDC.Through research on policy development at CDC Health Marketing offices in the USA and CDC laboratories in Puerto Rico, policy adoption at the Ministry of Health in Managua, and application in Ciudad Sandino, the project addresses a problem that continues to vex medical and ecological anthropologists. Even when experts recognize the role of translocal forces (e.g. climate change, structural adjustment, urbanization) in environmental health crises, media and policymakers often dispense with macro-level explanations, circulating blame among the vulnerable people whom participatory strategies are meant to empower. The project treats urban public health as a set of social practices that links people in Ciudad Sandino to scientists and marketers, among whom consensus about etiology, diagnosis, and prevention remains elusive. Anthropologists of science and technology have helped place the struggle for consensus among medical experts in wider historical and social contexts. This project follows such debates as they ramify outside the laboratory, into clinical and preventative settings in urban Nicaragua, exposing underlying ambiguities that have placed the internationally developed dengue initiatives at odds with local efforts to improve infrastructure and create sustainable urban livelihoods. The question before scholars interested in the social and cultural connections between ecology, disease, urban dwellers, scientists, and policymakers, is whether increased participation in health and infrastructure leads to a meaningful change in the production of knowledge about either. By taking a place-based approach to a health crisis, this research uncovers some of the material and discursive mechanisms by which citizens, experts, and the non-human actors who link them communicate, conflict, and possibly conciliate.The project has broader impacts in that it helps facilitate understanding of how urban dwellers generate knowledge that is potentially beneficial for public health policymakers. By following this knowledge through to centers for disease control, the PI is able to identify processes related to the deployment of knowledge and suggest means for improvement.