DEATH IN THE TIME OF SAVING LIVES: THE CHOLERA EPIDEMIC AND HUMANITARIAN GOVERNANCE IN BANGLADESH SAYDIA GULRUKH KAMAL A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Anthropology Department at the University of North Carolina Chapel Hill 2016 Approved by: Peter Redfield Arturo Escobar Barry F. Saunders Sumathi Ramaswami Jocelyn Chua © 2016 Saydia Gulrukh Kamal ALL RIGHTS RESERVED ii ABSTRACT Saydia Gulrukh Kamal: Death in the Time of Saving Lives: Cholera Research and Humanitaran Governance in Bangladesh (Under the direction of Peter Redfield) “Histories of cholera exist in a reciprocal relationship with science. Knowledge of cholera is changing quickly; new findings invite a new history, which will feed back on how we think about cholera in the present.” So Christopher Hamlin (2009) concluded in his historiographical account of cholera as a disease with global ramifications. The discussion and analysis presented in this dissertation substantiates Hamlin’s hypothesis, additionally developing a particular account of cholera in Bangladesh. The scientific advancement in the understanding of fluid loss in a cholera patient and the discovery of a rehydrating solution slowly changed public perception of the disease in Bangladesh. A massive nationwide campaign to disseminate this new knowledge chased away the fear of death from cholera and diarrhea. This dissertation offers a new history of cholera, charting its descent into the realm of the ordinary in Bangladesh. Despite a significant decline in the incidence of cholera cases, the scientific gaze and governmental attention in Bangladesh continue to focus on the disease. Recognizing cholera prevention programs as fetishized objects of national and transnational attention, this dissertation shows how facts of cholera and diarrhea––their incidence and prevalence–– have historically dominated public health missions of Bangladesh, creating the categories of preventable death and savable lives. Cholera research and prevention programs do not sanctify human life in general; rather, they selectively fulfill a right to live only when the life saved fits within the iii purview of regimes of global health, and so could reflect on the state and non-state actors’ performance as managers of life. In what follows, this dissertation examines the way these programs operate as an infrastructure of distributing governmental attention and resources rather than as a system of providing more comprehensive care for the people in poverty. Drawing on ethnographic fieldwork in Shatnal (Chandpur, Bangladesh) and the intimate realities of public health there, including everyday stories of living and dying and the extensive social vocabulary used to describe cholera and other forms of death, this dissertation records the government's asymmetrical care for the dying and ill, revealing the production of inequalities between different kinds of life and death. iv To Ma-Mita, Shamim Mahipara Kamal Amma, you were wired up with many machines. Chest tube. Tracheostomy tube. Central venous Catheter. Low blood pressure. Irregular heart rate. One day, in that half-lit intensive care unit, you wrote on a paper, “I will not die here.” Friends and family in our lives believed in the biomedical story of the moment. You did not. Thank you for always telling us stories untold. Thank you for teaching me love, laughter, mourning empathy and endurance. and Sumaya Khatun Thank you for teaching me how to become a mother v ACKNOWLEDGEMENTS I was trying to sit comfortably on a minibus – Matlab express. At each turn, I thought I would fall down from my seat, but I never did. The passengers were mercilessly swearing at the underage bus-driver. Half way through the journey, the scuffle between the driver and the passengers reached its peak. The driver abruptly reached for the break, our head almost hit the roof of the bus. He turned around, and said, “bancha morar hishab oto shoja na, oto doran kyan. (The calculous of life and death is not that easy. Why so scared)?” In later months in Shatnal, I came to recognize the significance of this first encounter. My first debt of gratitude is to the unknown bus drivers, boatmen, shareng (water-taxi driver/launch captains) whose wisdom and vision provoked the thoughts and arguments presented in this dissertation. At each of my research stops from Shatnal, Matlab, Chandpur to Dhaka, to Berlin, to Atlanta and New York I was fortunate to have friends and hosts wait for me. The chapters that follow make a far better chronicle of my debts to the villagers, researchers, journalists, researchers, community health workers, public health experts, activists than I could write here. Thank you for not only opening your doors and offering countless meals, but also sharing your understanding of public health and cholera epidemic in Bangladesh. I am particularly indebted to my sisters who shared their philosophy of life, death and illness on hot summer nights in Shatnal. I came out so much richer and content in life through these interactions than I could describe in this dissertation. My time at Chapel Hill is especially important to me. I want first to thank my dissertation committee members for teaching me about the links between scholarship, intellectual vi community, and politics. As a graduate student, I took many unconventional turns and pauses. In this journey, Peter Redfield has provided me with an essential component – trust. He has been a trusted advisor and gracious colleague. He has cultivated me with patience, wisdom, and hope. Arturo Escobar’s commitment to other ways of knowing opened new spaces to think and act as an anthropologist from Bangladesh. Even in a dark time, his mystical optimism enriched this work and my life. Barry F Saunders did me the favor of carefully break open the concept of death and giving me a way of approaching questions of life and death as folded together. I must thank Sumathi Ramaswamy for nurturing my historical imagination and for her fine grained reading of many versions of this project. Jocelyn Chua guided me through writing grants, complexities of fieldwork and translating ethnographic experience into a dissertation. Terry Evens support and incisive commentary sharpened my thinking immeasurably. I am ajibon hrini to them for being model mentors. The circle of my dissertation committee has an extended arm to include Stacy Pigg, Laura Wagner, and Brian D. Stacy Pigg taught me how to imagine writing as a process of weaving. There are threads of many colors of life. In writing, we make patterns, designs, and tell stories of relationships, resistances and regimes. Laura Wagner is my soul sister. Together, we plan to write satire and so much more about the international politics of intervention in Bangladesh and Haiti. Brian D introduced me to the world of contemporary anarchist spaces and practices of critical thinking. I owe a particularly important debt to all of you for reading all or parts of the dissertation in great detail. I will never be able to express how grateful I am for all the time and care you have put into reading, editing, and then often rereading and reediting. Many of the materials gathered in this dissertation would have never fallen into my hands were it not for the dedicated work of numerous librarians and archivists. I would like to thank vii archivists and staff at various archives: Robert Koch Institute, Berlin; National Archive of India, New Delhi; National Archives of Bangladesh, Dhaka; and, Bangladesh Central Public Library, Dhaka. Eminent scientists A K Mansur’s family provided me access to his family archive. I would like to particularly thank Delowar Hossain for helping me sort through many boxes of material from his family archive. Part of the archival research was supported by Social Science Research Council’s pre-dissertation funding. I would like to thank them for their generous support to my research project. I have an unfortunate relationship with any bureaucracy. This relationship took a worst turn during my time at UNC – Chapel Hill. Each semester, I have somehow managed to create an emergency situation where my registration is about to get cancelled or something similar. And, each semester I have been rescued by Suphronia Cheek, Matt McAllister, Shamecia Powers, Irina Olenicheva and Katie Poor. I am particularly thankful to Silvia Tomaskova for magically navigating university bureaucracy for me. I am thankful to the presence of friends and graduate colleagues in Chapel Hill/Carrboro without whom I would never have reached this moment. I thank Erica A. Scott, Vincent Gonzalez, Clarisa Mondejar Valdespino, Amelia Fiske, Dragana Lassiter, Paul Schissel, Eloisa Burman, Amanda Black, Ahsan Kamal and Dayuma Alban for invigorating me with their intellectual passion and humor. I am particularly indebted to Dayuma Alban and Ahsan Kamal for co-laboring in grief as we mourned the loss of human and non-human lives in Amazonia and South Asia. My family patiently supported me as I have struggled to manage my varied ambitions and geographically distributed life in Dhaka, Chapel Hill, Sebring and Winnipeg. Adlul Kamal, Asfia Gulrukh, Maliha Mehbub and Wahid Palash – my siblings suffered through my silences as I viii wandered off to Shatnal for fieldwork. Asfia single handedly shouldered the responsibility of our critically ill mother during the writing of this dissertation while she herself wrote a wonderful dissertation on environmental justice. Chompaboti, Samin and Samia – my daughter, nephew and niece literally grew up to be gorgeous and thoughtful teenagers with this dissertation. Born in a different time, they were the first to notice the ordinariness of cholera that I am alluding to in this dissertation. I am grateful to Majeda, Romija, Tara Mia and Abdur Rob for their precious wisdom and continual good humor. With exceptional patience they have shared their views of life, death and illness which have a decisive influence on the development of this dissertation.