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MARAÑA Leishmaniasis and the Pharmaceuticalization of War in Colombia

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MARAÑA Leishmaniasis and the Pharmaceuticalization of War in Colombia MARAÑA Leishmaniasis and the Pharmaceuticalization of War in Colombia Lina Beatriz Pinto-García A dissertation submitted to the Faculty of Graduate Studies in partial fulfillment of the requirements for the degree of Doctor of Philosophy Graduate program in Science & Technology Studies York University Toronto, Ontario April 2020 © Lina Beatriz Pinto-García, 2020 Abstract This dissertation is an ethnography concerned with a skin disease called cutaneous leishmaniasis, transmitted through the bite of sandflies that belong to densely forested tropical environments. It is a non-contagious, non-deadly, and usually painless disease, which starts with a tiny sore that continues to grow into an ulcer. In Colombia, soldiers, guerrillas, and paramilitaries constitute the populations most affected by this disease, as a result of spending months immersed in the same landscapes where sandflies thrive. Among those who have heard about leishmaniasis, this illness is often stigmatized as “the guerrilla disease.” The misconception that leishmaniasis is a guerrilla illness solely has deeply infused certain imaginaries with gruesome consequences. This is reinforced by the state’s restriction on access to antileishmanial medicines, a measure that is commonly interpreted as a warfare strategy to affect insurgent groups. This work explores the ways in which leishmaniasis and the war are inextricably connected and mutually reinforcing. Situated at the intersection between STS and critical medical anthropology, it draws on fifteen months of multi-sited field research (October 2016 - December 2017), conducted during the peace implementation period after the agreement reached by the Colombian government and FARC, the oldest and largest guerrilla organization in Latin America. Research also involved more than 70 interviews with a diverse array of actors, including Army members, FARC guerrillas, scientists, medical professionals, peasants, representatives of multilateral health institutions, civil servants, and survivors of kidnapping. This work reveals how warfare suffuses in fundamental ways the interrelation and co-evolution—the co-production (Jasanoff, 2004)—of technoscience and society in Colombia. It engages not only with the stigmatization of leishmaniasis patients as guerrilla members and the exclusionary access to antileishmanial drugs but also with other closely related aspects that constitute the war-shaped experience of leishmaniasis in Colombia. It traces the social construction of non-deadly leishmaniasis as a life-threatening disease; the systemic and systematic use of a highly toxic drug for a relatively benign disease; the mutual constitution of wartime social orders and pharmaceutical regimes that results from turning a drug into a biopolitical instrument of war; the rise of leishmaniasis as a strategic problem for the Army and the institutional measures to address it; and the vulnerability shared by human and non-human military populations towards the disease. I have chosen to represent the intricate association between leishmaniasis and war in Colombia as a maraña. Maraña is a word in Spanish that means tangle but is also commonly used in Colombia to name the entangled greenery, braided lianas, and dense foliage that characterize the environments where the disease typically occurs. Through this metaphor, I argue that the maraña formed by leishmaniasis and the war makes it fundamentally impossible to make sense of this disease without taking serious consideration of the armed conflict. I show that leishmaniasis has been socially, discursively, and materially constructed as a disease of the war, and how the armed conflict is entangled with the realm of public health, medicine, and especially pharmaceutical drugs. ii To Diego iii Acknowledgments A little over seven years ago, I decided to turn my training and professional path around. Joining York University’s Department of Science and Technology Studies, first as a master's student and then as a doctoral student, allowed me to reinterpret my previous training and experience as a biologist and biomedical scientist. I was able to immerse myself in the world of social sciences and discover in ethnography a space for intellectual and political engagement, as well as of reflexive and creative practice that was new and surprising to me. This dissertation is the product of that transforming and exciting journey in which many people and institutions supported, accompanied, and helped me. I would like to thank them. Kenton Kroker, Jagdish Hattiangadi, Aryn Martin, Natasha Myers, and Kean Birch were very helpful at different moments in my institutional path through York. I am genuinely thankful to Eric Mykhalovskiy, who was the supervisor of my master’s thesis and encouraged me to continue exploring the entanglements between war and disease that crystallize in the case of leishmaniasis and the Colombian armed conflict. Bernie Lightman was highly supportive, and it was he who advised me to work with Denielle Elliott as my PhD supervisor. My doctoral research, from conception to writing, consistently benefited from Denielle’s pedagogical support, enthusiasm, openness, and sensitivity. I feel very fortunate to have been able to count on her insights and encouragement along this process. The members of my examining committee, Eric Mykhalovskiy, Deborah Neill, Alex Nading, and Carlota McAllister, have provided me with rigorous and dedicated feedback that has helped me to improve this dissertation significantly. My fellow graduate students offered help, motivation, and friendship. I would like to thank Drew Danielle Belsky, Erin Grosjean, Yana Boeva, Duygu Kasdogan, and Ellie Louson. Special thanks to Serena Naim for the long conversations and the joy she always shared with me in Toronto. My deepest gratitude goes to all the people, institutions, and organizations who participated in my research and whose immense generosity not only made my work possible but also shaped my field research into a beautiful and remarkable life experience. I valued and enjoyed every conversation I had with Army members, FARC guerrillas, iv scientists, medical professionals, peasants, representatives of multilateral health institutions, civil servants, and survivors of kidnapping. I regret that, in order to ensure anonymity, I am unable to thank most of them individually by name. Among those who I can mention, I am extremely grateful to the Colombian Public Force (Police, Navy, Air Force, and Army), particularly the Colombian Army. Since the moment I requested access, members of these institutions have always been very respectful of my work. They did not require the products of my research to be reviewed by the Army and granted me absolute intellectual independence. It was a privilege to accompany both soldier-patients and the military and civilian personnel of the Leishmaniasis Recovery Center through the ups and downs of their daily lives. I also want to express my heartfelt gratitude to the dissolved FARC guerrilla (Revolutionary Armed Forces of Colombia), to all those individuals committed to peace who gave me the chance to hear their stories, to get closer to their past and present realities, and who considered my research relevant and important to the difficult process Colombia is going through. I am deeply grateful to have had the opportunity to learn, from such different perspectives and situations, the complexities of ending a protracted armed conflict amid hopes, promises, violence, and adversity. My doctoral studies and field research would have not been possible without the financial support from York University, COLCIENCIAS (the Colombian Administrative Department of Science, Technology, and Innovation), and Manulife. I also would like to thank Karime Ríos and the team at Sociedad de las Letras who transcribed all the interviews I did. I exchanged several conversations and received very helpful feedback from a variety of people at different events, settings, and institutions. These include the Technoscience Salon in Toronto; the Exploring Ethnography Workshop at York University; the Doctoral School of Political and Social Studies of Science and Technology, organized by the Latin American Association of Social Studies of Science and Technology (ESOCITE); the National Colloquium of Social Studies of Science and Technology at the National University of Colombia; the Feminist Perspectives on Science and Technology Colloquium at Los Andes University in Bogota; the Centre for Imaginative Ethnography; the Symposium on Non-Traditional and Experimental Methodologies in Social Research at the Javeriana University in Bogota; the Ethnographic Transdisciplinary Engagements Roundtable organized by the Science & Justice Research Center and Feminist Studies v Department at the University of California, Santa Cruz; the seminar of the Rosario University's Research Group on Social Studies of Science, Technology and Professions (GESCTP); and the Group of Social Studies of Illegality (GESI) at the National University of Colombia in Bogota. Heartfelt thanks to the Program on Science, Technology, and Society at Harvard University, which I joined as a fellow in the fall of 2019. During that semester, I had the remarkable opportunity to be continuously immersed in conversations rooted in STS that shaped my reflections and informed this dissertation in decisive ways. I greatly appreciate the invaluable feedback and insightful comments from Sheila Jasanoff and the group of STS fellows at Harvard. Especially, I would like to thank
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