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.