Marana: Leishmaniasis and the Pharmaceuticalization of War in Colombia

This ethnographic monograph explores how the Colombian armed conflict and a vector-borne disease called cutaneous leishmaniasis are inextricably connected and mutually constitutive. The stigmatization of the illness as the guerrilla disease is reinforced by the states restriction on access to antileishmanial medicines, a measure that is commonly interpreted as a warfare strategy to affect insurgent groups. Situated at the intersection between STS and critical medical anthropology, this work draws on multi-sited field research conducted during the peace implementation period after the agreement reached in 2016 by the Colombian government and FARC, the oldest and largest guerrilla organization in Latin America. 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; the rise of leishmaniasis as a strategic problem for the Army; 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 maraa. Maraa 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 tropical forests where the disease typically occurs. Through this metaphor, I argue that the maraa formed by leishmaniasis and the war makes fundamentally impossible to make sense of this disease without taking serious consideration of the armed conflict. This work illuminates how 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.