Harper, Ian

Qureshi, Ayaz

Street, Alice

Bhatiasevi, Aphaluck

School of Social and Political Science, University of Edinburgh

2024-10-14T12:56:38Z

2024-10-14T12:56:38Z

2024-10-14

This thesis is about the complexities and challenges surrounding the understanding and management of a lesser-known infectious disease within global health framings in Thailand. Through fourteen months of multi-sited ethnography, my research attempts to make sense of how a highly fatal disease, melioidosis, remains largely neglected despite significantly impacting rice farming communities. Although epidemiological data and biomedical research show that rice farmers are at the highest risk of melioidosis infection, the disease is little heard of even in endemic areas where the microbe is dispersed in the environment. This is the first anthropology and social science study on melioidosis. I trace melioidosis through spaces of public health, medical research, hospital care, and health policy, to investigate how it becomes known, to whom it remains unknown and why. I explore melioidosis in public and scientific spaces, and in spaces where policies and practices on infectious diseases that impact people’s lives and livelihoods are made. I investigate the efforts made by scientists to draw attention to melioidosis nationally and internationally. My thesis shows melioidosis to be what I call an “enigmatic disease”, which remains difficult to know and control despite first being identified over a century ago. The biology of the disease contributes to its enigmatic character. Melioidosis is caused by bacteria that live in tropical soil and water and can therefore be present in diffuse environments, making its transmission difficult to control. Melioidosis can cause a wide range of symptoms and can mimic tuberculosis, pneumonia, and sepsis. The disease can impact multiple body organs and melioidosis patients can develop co-infection with diabetes or multiple infections of other diseases. Patients treated for melioidosis can develop a relapse or become reinfected with the disease. Furthermore, the nature of the disease-causing microbe makes it challenging to identify, even in spaces of scientific practice like laboratories where multiple tests are performed to make it visible. The thesis follows efforts by researchers, clinicians, patients, and public health officials to know melioidosis and make it visible through what Annemarie Mol (2002) terms multiple enactments, in different spaces, including hospitals, laboratories, offices, fields and homes. I focus on one place where melioidosis has been consistently made visible and known in a coherent form over several decades. This is in Sunpasitthiprasong Hospital where this visibility has been enabled by long-term international investments in biomedical research on the disease. However, contrary to Mol’s argument that diseases can be simultaneously multiple and “hang together” as a single object, I argue that it is very difficult to make different enactments of melioidosis cohere across different spaces. This is in part because the public health response to the disease is divorced from the policies and practices that promote rice cultivation, which I argue is due to the cultural value and political economy of rice in Thailand. The failure to fully recognise the epidemiological association between melioidosis and rice cultivation limits the public health response to the disease which is narrowly focused on individual-based behaviour change activities, while public communication on the disease is almost absent. This lack of public activity on melioidosis leads to confusion, leaving patients and their family caregivers to experience the disease in isolation. In addition to the importance of the cultural politics of rice cultivation and the biological uncertainties associated with melioidosis, I argue that barami, a form of Thai social capital contributes to, and complicates its visibility. In biomedical research, clinical medicine, and public health policies and practices, barami, which is associated with Thai Buddhist values, facilitates the construction of scientific knowledge and public health policies and practices on melioidosis in Thailand. On the other hand, barami complicates the visibility of melioidosis in other public and social spaces where people interact and engage with each other. Each chapter of this thesis discusses how melioidosis is made visible or problematic in different spaces. My research contributes to medical anthropology and the anthropology of global health in the study of infectious diseases by reviewing the interconnected biological and social factors that shape the visibility of a disease. This includes paying close attention to the social construction of the disease as much as its biology to understand how they influence one another.

https://hdl.handle.net/1842/42291

http://dx.doi.org/10.7488/era/5011

en

The University of Edinburgh

melioidosis

Thailand

tropical soil and water

Sunpasitthiprasong Hospital

rice in Thailand

rice farming communites

barami

Enigmatic disease: making melioidosis visible in Thailand

An enigmatic disease: making melioidosis visible in Thailand

Thesis or Dissertation

Doctoral

PhD Doctor of Philosophy