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

尼加拉瓜和国际决策者都认为，当地参与蚊虫控制是阻止登革热传播的最佳途径。登革热是一种蚊子传播的疾病，主要袭击热带地区的贫困城市地区，而且没有疫苗。参与往往需要改变废物管理做法。本论文项目由科学、技术与社会计划资助，是废物管理与登革热预防两部分人种志研究的第二部分。它将联合项目目前在尼加拉瓜桑迪诺城进行的研究扩展到尼加拉瓜卫生部和美国疾病控制中心。目的是了解当地关于登革热的生态知识如何运用到国内和国际登革热专家的实践中，这些专家包括尼加拉瓜卫生部和疾病控制与预防中心的流行病学家、昆虫学家、医生和公共卫生营销人员。通过在美国疾控中心卫生营销办事处和波多黎各疾控中心实验室进行政策制定研究，在马那瓜卫生部采用政策，并在桑地诺城应用，该项目解决了一个一直困扰着医学和生态人类学家的问题。即使专家们认识到跨地方力量（如气候变化、结构调整、城市化）在环境卫生危机中的作用，媒体和决策者往往也不作宏观层面的解释，而是在参与性战略旨在增强权能的弱势群体之间推卸责任。该项目将城市公共卫生视为一套社会实践，将桑迪诺城的人们与科学家和营销人员联系起来，而这些人在病因、诊断和预防方面仍难以达成共识。科学和技术人类学家帮助将医学专家之间达成共识的斗争置于更广泛的历史和社会背景中。本项目跟踪这些争论，因为它们延伸到实验室之外，进入尼加拉瓜城市的临床和预防环境，揭示了潜在的模糊性，这些模糊性使国际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不一致。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临的问题是，增加对卫生和基础设施的参与是否会导致有关这两者的知识产生有意义的变化。通过对健康危机采取基于地点的方法，本研究揭示了公民、专家和将他们联系起来的非人类行为者进行沟通、冲突和可能和解的一些物质和话语机制。该项目具有更广泛的影响，因为它有助于促进了解城市居民如何产生对公共卫生决策者可能有益的知识。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，并提出改进的方法。

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.