Kidneys, Chemicals, and Clinics: A Political Ecology of Health in Rural Central America

Abstract

In 2008, El Salvador registered the world's highest mortality rate from kidney failure, with more than 2500 deaths annually in Central America's smallest country. El Salvador is the ground zero of a new form of Chronic Kidney Disease (CKD) that has become an epidemic among otherwise healthy agricultural workers and rural residents in lowland Central America in the past three decades. While the epidemic is believed to stem from some combination of agro- chemical exposure and/or dehydration, research on the disease remains embroiled in controversy, policy changes few, and medical support for affected individuals challenging. Foucaultian theorizations of 'discursive materiality' provide insights into the ways in which–even as the science remains inconclusive–understandings, discussions, and research on CKD in El Salvador are having material effects on individuals' bodies and health statuses. Based on fieldwork in El Salvador in summer 2014, this thesis uses the lens of Salvadorian CKD to explore the workings of biopower in settings of industrial agricultural production. Focusing on the Bajo Lempa region of El Salvador, in particular, the thesis examines the discourses, materialities, and practices through which CKD has "come to matter" as a medical and political phenomenon in relation to the agriculture through which affected Salvadorians make their living. Thinking through the discursive materialities of CKD alongside the production of spaces of health and agriculture, this thesis provides insights for the growing field of the political ecology of health by investigating the wider socio-political and environmental processes that make CKD management such a challenge in a Central America.