Re-emerging infectious disease and ethnic stratification: Dengue fever in Trinidad and Tobago.

摘要

This dissertation examines the relationship between ethnicity and dengue fever in Trinidad and Tobago. It is based upon twelve month of fieldwork in Trinidad, drawing on household surveys, semi-structured interviews, illness narratives, and epidemiological data. Dengue and dengue hemorrhagic fever outbreaks have continued to increase in frequency and severity in Trinidad since the appearance of dengue hemorrhagic fever in the Caribbean. Over the past ten years, epidemics have been concentrated in central and southern Trinidad, regions primarily inhabited by Indo-Trinidadians. This dissertation examines the various factors that contribute to dengue outbreaks, exploring reasons why Trinidadians of East Indian descent have a higher risk of developing severe dengue. My primary research goals were: (1) To illustrate the relationship between infectious disease and social inequalities; (2) To integrate critical medical and meaning centered theoretical approaches into the study of infectious disease; (3) To explain the contemporary epidemiological pattern of dengue in Trinidad is the inadvertent result of geographic inequalities, the results of ethnic stratification that has been shaped to colonial/neo-colonial processes and local politics. Urban areas in southern Trinidad, historically East Indian communities with less reliable access to water, have experienced more frequent and intense outbreaks of dengue and dengue hemorrhagic fever over the past decade. As a result, people inhabiting areas with poor infrastructure, predominant Indo-Trinidadians, are more likely to contract the potentially fatal hemorrhagic manifestation. Data collection included structured (household survey), semi-structured (in depth interviews about health related issues), and unstructured (illness narratives with former dengue patients) interviews. My informants conveyed the belief that dengue outbreaks were the result of a lack of government support, especially in the central and southern parts of the island. Throughout my interviews, Trinidadians themselves located disease within a breakdown of political and economic support, frequently identifying inadequate resources as the ultimate causes of dengue. Finally, I discuss the applied and theoretical implications of my research findings.