Searching for CKDu: Mystery kidney disease, differentiated (in)visibility, and contingent geographies of care in dry zone Sri Lanka

Abstract

In Sri Lanka's dry zone, an epidemic of Chronic Kidney Disease of Unknown Etiology (CKDu) has evaded scientific explanation for more than two decades. Unsurprisingly, the search for CKDu's cause has become the focus of intense study. Comparatively, less is known about local attempts to neutralize biomedical uncertainty within disease “hotspots” or how this creates new contingent geographies of care. As a consequence, I examine what is at stake in the label CKDu and how these stakes, and indeed the visibility of the mystery disease itself, varies across scale and space. I argue that despite the hypervisibility of mystery kidney disease in news media, existing clinical practices within disease hotspots cannot actually differentiate between CKDu and regular chronic kidney disease (CKD). As a consequence, distinctions between categories of illness routinely collapse in everyday life. And yet, evidence collected over 15 months of ethnographic fieldwork reveals that other types of difference profoundly shape access to care in the dry zone. Specifically, I demonstrate that it is not a diagnosis of CKDu but residence in areas designated as disease “hotspots” that determines access state-sponsored kidney disease stipends. In short, I suggest that some experiences of kidney disease are more visible than others and this often has much more to do with where these cases are than with what may have caused them. As a consequence, the article concludes that CKDu has produced new forms of difference in the dry zone, but that the main axis of differentiation is more geographical than biophysical.