Dengue in the landscape: Pollution, poverty, and the politics of public health in urban Nicaragua

This dissertation describes how Ciudad Sandino, a low-income suburb of Managua, became a waypoint in the global spread of dengue fever. The focus of this study was a series of house-to-house dengue prevention campaigns in which Nicaraguan officials and epidemiologists linked urban livelihood practices---specifically the collection and sale of recyclable waste---to the propagation of dengue mosquitoes. From 2007 to 2009, the author observed numerous such campaigns and worked in streets and dumps alongside informal garbage collectors. The author also interviewed local health workers, national policymakers, and international dengue scientists. To varying degrees, state and scientific attention to dengue prompted Nicaraguans to become more alert to the dangers posed by mosquitoes and to alter their conceptions of waste. The findings indicate, however, that ostensibly neutral biomedical ideas became bound up in a complex history of urban poverty and political mobilization. Public awareness of dengue's spread reignited longstanding local debates about women's responsibility for household hygiene, the effects of an informal waste economy on the environment, and the role of the state in the private lives of the poor. Residents of Ciudad Sandino were concerned less about the complexity of dengue's etiology than about the fraught ethics of urban connectivity. Dengue united patients, state authorities, formal and informal economic actors, medical entomologists, and urban planners, but also raised ethical questions about the relationships among these. Dengue control measures were humanitarian endeavors, but they also were governmental. House-to-house mosquito and waste control tied the goal of stabilizing and ensuring the health of human bodies to the process of stabilizing and ensuring social, political, and economic orders: the sovereignty of states, the circulation of goods, and the division of people across urban space---in this case, by social class, occupation, or gender.