Abstract
Multidrug-resistant tuberculosis (MDR-TB) has been a widely recognized threat since the TB epidemic was declared a global emergency in the 1990s. The epidemic is particularly critical in the borderlands where humans and microbes move across geographic borders. In this article, we explore the contingency of human-microbe relations in Thailand-Myanmar borderlands. Initially constituted by the colonial encounters, the Siam–Burma border’s continuing existence was constantly enacted, negotiated, and co-produced through the entangled interplay of various actors, microbes and pharmaceuticals included. We examine how global forms such as biomedical science, epidemiological practices, and public health interventions were actualized in an attempt to control MDR-TB in this borderland. While disease surveillance and control were seemingly hindered by the permeability of the border and geographic mobility of migrants, the potency of Mycobacterium tuberculosis to lie dormant in human bodies for long periods of time without symptoms posed an additional challenge to epidemiological attempts to segregate the healthy from the contaminated. Combining ethnographic materials from Umphang District, Tak Province at the western border of Thailand with national policy analysis, natural history, and microbiological insights, we reveal how the indeterminacy of borders and complex microbe-human entanglements necessitate changes in the prevailing biocontainment model of infectious disease control. We propose that disease surveillance and response need to transcend the rigid geographic notion of space and include a more flexible topological conception of spatiality that embraces the fluidity of pharmaceuticals, microbes, and human relations. This reinvention of the spatial approach in epidemic control begins by attending more closely to the entanglement of human-microbe relations in the more-than-human borders.
Highlights
Tuberculous bacilli have a long history of co-existence with humans
As TB incidence in Myanmar is more than two times higher than Thailand,2 patients with tuberculosis seeking care in Thailand were viewed as potential risk of spreading disease (Voravit, 2008) and alleged of being “non-compliant,” discontinuing medication before completion, further complicating the national effort to control TB (Hemhongsa et al, 2008)
While the effort to control TB relied heavily on the “outbreak narrative” (Wald, 2008) to identify sources of infection, or carriers, who spread disease across epidemic geography, we reveal how its actual operation in this borderland was complicated by the complex border topology, and the mundane biotic and material encounters that create the conditions of pathogenic possibility
Summary
Tuberculous bacilli have a long history of co-existence with humans. Geographically, the bacterial ancestor, just like ours, first appeared in and later migrated out of Africa (Gutierrez et al, 2005). As TB incidence in Myanmar is more than two times higher than Thailand,2 patients with tuberculosis seeking care in Thailand were viewed as potential risk of spreading disease (Voravit, 2008) and alleged of being “non-compliant,” discontinuing medication before completion, further complicating the national effort to control TB (Hemhongsa et al, 2008). While the effort to control TB relied heavily on the “outbreak narrative” (Wald, 2008) to identify sources of infection, or carriers, who spread disease across epidemic geography, we reveal how its actual operation in this borderland was complicated by the complex border topology, and the mundane biotic and material encounters that create the conditions of pathogenic possibility.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
