YOUR LOVE HURTS DOWN TO MY BONES: EXPLORING PUBLIC UNDERSTANDINGS OF DENGUE FEVER IN MEDELLIN, COLOMBIA, THROUGH AN ANTHROPOLOGY-ART-SCIENCE INVESTIGATION A thesis submitted to the University of Manchester for the degree of PhD in Social Anthropology with Visual Media in the Faculty of Humanities 2015 ALEJANDRO VALENCIA-TOBÓN SCHOOL OF SOCIAL SCIENCES 2 Table of contents List of figures 5 Abstract 8 Declaration 9 Copyright statement 10 Acknowledgments 12 Chapter 1 – THE MULTIPLE KNOWLEDGES OF DENGUE FEVER 13 Introduction 13 Health campaigns and participation 16 Relationality and multispecies ethnography 19 Knowledge-making and art-making practices 22 Overfamiliar and ineffective health campaigns: The example of chikungunya 24 Research on medicine in Colombia 31 The concept of ‘knowledge’ 33 Dengue fever 35 Insects, art and the idea of multispecies ethnography 40 Dengue as a ‘neglected’ tropical disease 43 Health and illness in Colombia: A historical overview 45 Chapter 2 – HEALTH CAMPAIGNS 55 Introduction 55 Medellín: Participation of the Student Committee against Dengue 56 Inspection and discipline: Eliminating mosquito breeding sites as the standard template for health campaigns 62 Repetition: Information vs. critical reflection 70 Causality: ‘Without mosquito-breeding sites there are no mosquitoes; without mosquitoes, there is no dengue’ 76 Logical argument and conditional statement 80 Mechanisms, causal claims and dengue transmission 84 A world without mosquitoes 85 Ovitraps 87 Cleaning/hygiene, guilt and personal responsibility 89 Social mobilisation, patronage and class 96 Eco-bio-social research 103 Communication-for-behavioural-impact 104 The problem of using marketing methods for public health messages 108 Chapter 3 – UNDERSTANDINGS AND EXPERIENCES: SCIENTIFIC, PUBLIC, AND EMBODIED 111 Introduction 111 Scientific and official understandings 112 The clinical management of the disease 114 Etiology, laboratory techniques for dengue diagnosis 118 Dengue virus: Serotype and virus structure 123 Distribution of the different dengue serotypes in Colombia 126 Dengue diagnosis 126 3 ‘Warning signs’ and the experience of being ill 130 Juanita: Getting ill 131 Sara: Getting ill 132 Luis Fernando: Getting ill 134 Juan David: Getting ill 136 Understanding the idea of pain in relation to violence 137 Pain and the body 140 Measuring pain as a subjective experience 143 Illness narratives as a way of re-reading the course of a disease 145 Exploring smell, olfactory memory and the somatisation of the disease 148 Seeking medical treatment: The role of the Colombian health system 154 Literalizing metaphors: Acetaminophen and the idea of health as a service 159 Chapter 4 – ANTHROPOLOGY AND ART 164 The science as art of human-dengue relations: an experiment in ethnography 164 Relationality, participation, appropriation 167 Relationality: Relational art as a way of revealing local knowledge 167 Participation 174 Appropriation 177 Ethnography as a design process 178 Imagination: Art-science as an exploration across time and space 182 Studying the world from a ‘sympoietic’ point of view 184 Reading multispecies relations from a historical point of view 187 Symbiosis 190 Chapter 5 – PUBLIC EXPERIMENTS: INVITING OTHER KINDS OF KNOWLEDGE 192 Introduction 192 My public experiments’ design rationale 193 Vampires: Your love hurts down to my bones 195 Vampires in the Colombian imaginary 196 Vampire: Sucking blood and eating people alive 198 Designing and advertising the central event 200 Cocktails: A sensorial approach to the idea of ‘serotype’ 213 Videos: Bloodlust and break-bone fever 216 Sound installations 220 Shadows of death 227 The Mosquito Kite Project 230 Kite designs 232 Art attacks around the city 234 Collecting stories in form of drawings 237 Serotype: dengue as an embodied experience 239 What is it like to have dengue? 240 Starting with the design 241 Locating the public experiment 247 Public responses to my work 252 Chapter 6 – RESPONSES TO MY WORK 256 Hunting dragons 256 Mosquitoes: The stuff of dreams and nightmares 258 References 266 4 Appendices 319 Appendix 1. Twitter: Álvaro Uribe Vélez 319 Appendix 2. Poster: Dengue symptoms 320 Appendix 3. Advertising dengue as laundry detergent 321 Appendix 4: Examples of anti-dengue campaigns 325 Final word count: 75,494 5 List of figures Figure 1. Colombian Ministry of Health and Social Protection: Participation and decision-making. Source: https://goo.gl/woIZZN 18 Figure 2. Anti-dengue campaign in Medellín. Source: https://goo.gl/1E1Rx7 28 Figure 3. Medellín, a home for life. Mayor of Medellín, Secretary of Health. Programme for dengue prevention and risk-factor control. Source: http://goo.gl/WiXFXy 59 Figure 4. Aedes aegypti breeding places. Source: http://goo.gl/WiXFXy 60 Figure 5. SCAD cleaning brigades. Photos by the secretary of health. Source: https://goo.gl/yaAqY8 61 Figure 6. Macro photo of Ae. aegypti eggs in a dry napkin 61 Figure 7. Ae. aegypti larvae 62 Figure 8. Student Committee against Dengue from the Nuevo Amanecer school. Source: https://goo.gl/k0yOlA 66 Figure 9. Anti-dengue command / Student Committee against Dengue. Source: http://goo.gl/4ARaQd 67 Figure 10. Guerreiros contra a dengue. Source: http://goo.gl/1LkltZ http://goo.gl/QNqUiJ and https://goo.gl/Ey1sK3 68 Figure 11. Flyer distributed in Itagüí. Source: www.itagui.gov.co/ 71 Figure 12. Everybody against dengue. Source: http://goo.gl/vyMk9I and https://goo.gl/Ro84MY 73 Figure 13. Aedes aegypti breeding sites. Source: https://goo.gl/Xa2Sxh and https://goo.gl/4NUHXO 73 Figure 14. We can eliminate breeding sites. Source: https://goo.gl/WTPMq9, https://goo.gl/PTXAl9 and https://goo.gl/3xRzof 74 Figure 15. Without mosquito-breeding sites there are no mosquitoes, and without mosquitoes, there is no dengue. Source: http://goo.gl/dGXHSM, https://goo.gl/dxVZ5G and http://goo.gl/oQB3St 77 Figure 16. Campaign in Cordoba, Argentina. ‘Without mosquitoes there is no dengue’. Source: https://goo.gl/YrpwEL 78 Figure 17. Neighbours don’t understand. Source: Cañas, 2012. 79 Figure 18. Truth table: Logical argument and conditional statement. 82 Figure 19. Poster designed by students of the SCAD. Source: https://goo.gl/uZa9iv 90 Figure 20. Anti-dengue campaign in Singapore. Source: https://goo.gl/SMBu1t 91 Figure 21. Anti-dengue campaign in Malaysian. Source: https://goo.gl/aFL8nf 91 Figure 22. Challenge against dengue at home. Source: https://goo.gl/EpJPTj 92 Figure 23. Challenge against dirt on clothing [percudido]. Ace advertisement. Source: https://goo.gl/rMfQIp 94 Figure 24. Logotype: Challenge against dengue. Source: https://goo.gl/EpJPTj 96 Figure 25. Anti-dengue campaign in Perú: ‘All united against dengue’. Photo by Mario H. Valencia 97 Figure 26. Anti-dengue campaign in Paraguay: ‘Everybody against dengue’. 6 Source: http://goo.gl/ka4qGl 98 Figure 27. Uniforms of the SCAD. Source: https://goo.gl/MPV7JM and https://goo.gl/ehuZ3Q 100 Figure 28. Temporary breaks of the SCAD. Source: https://goo.gl/rgs4w2 103 Figure 29. Schematic representation of the clinical phase in the evolution of dengue. Source: Simmons et al., 2015: 2 117 Figure 30. Images from Graham’s (1903: 212) paper. They illustrate the presumptive causal agent of dengue fever, which was found in red blood cells of infected people. 120 Figure 31. Isolation of dengue in mice. Source: Hotta, 1952: 3 122 Figure 32. Phylogenetic relationships of DENV-1. Source: Vasilakis and Weaver, 2008: 6 123 Figure 33. DENV structure. Source: Gutiérrez-Ruiz et al., 2012: 414. 124 Figure 34. Cytopathic effect in C6/36 HT cells after 8 days of infection with DENV serotype 2 (a). C6/36 HT cells without infection (b). Source: Gutiérrez-Ruiz et al., 2012; Quintero-Gil et al., 2014 127 Figure 35. Photo at Rosa’s house. Photo by Mario H. Valencia 162 Figure 36. From left to right: The origin of mosquitoes (2009), Mosquito (2012) and Mosquito rising from the flames (2014). Source: http://prestonsingletary.com/ 186 Figure 37. Vampires in the Colombian imaginary. Photo by Mario H. Valencia and Susana Valencia 196 Figure 38. Paleta Drácula. Photos by Juan Camilo Vélez 197 Figure 39. Surprise inside a Paleta Drácula. Photos by Mario H. Valencia and Susana Valencia 198 Figure 40. Screenshots from The Vampire (1945). From left to right you see the microscopic Trypanosoma parasite magnified among blood globules, which can be transmitted by the vampire’s bite. The last four images show the ‘salute of the vampire’. Source: Painlevé, 1945. 199 Figure 41. Designing the poster for the Vampires event. 201 Figure 42. Final design of the Vampires poster. Design and layout by Hernán Marín 201 Figure 43. Printing copies of the Vampires poster. 203 Figure 44. Pasting posters on public spots (also see these animations: http://goo.gl/eENnTa ; http://goo.gl/mg8Luh ; http://goo.gl/j7Ug6e) 206 Figure 45. QR code for the Vampires event 207 Figure 46. Setting up the main exhibition 208 Figure 47. Dot-to-dot drawings: mosquito and virus 210 Figure 48. Integrated dot-to-dot drawings 211 Figure 49. Vampires: Dot-to-dot drawings. Photos by Daniel Ronderos 212 Figure 50. Dot-to-dot drawings on vellum paper 213 Figure 51. Serotype cocktails. Photos by Daniel Ronderos 216 Figure 52. Mosquito poem. Source: John Updike, 1960: 32 217 Figure 53. Bloodlust (see the video here https://vimeo.com/76887960) 218 Figure 54. Break-bone fever (see the video here https://vimeo.com/77564874) 219 Figure 55. Sound installation inside a bathroom 220 Figure 56. Sound recordings inside a mosquito colony 221 Figure 57. We are born, we grow up, we infect you 224 Figure 58. Photos of mosquitoes in the houses of my participants 225 7 Figure 59. Tactile experience: Sucking. Photos by Daniel Ronderos and Alejandro Valencia-Tobón 226 Figure 60. Tactile experiences: Squashing. Photos by Daniel Ronderos and Alejandro Valencia-Tobón 227 Figure 61. Shadows of death. Photos by Daniel Ronderos and Alejandro Valencia-Tobón 229 Figure 62.