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Dissertation/Thesis Abstract

Intolerable burdens: Malaria and yellow fever control in Colombia in the twentieth century
by Mejia, Paola, Ph.D., Columbia University, 2009, 184; 3373716
Abstract (Summary)

This dissertation is a history of efforts to control, and then eradicate, malaria in Colombia in the twentieth century. It is also about yellow fever with which, for political as much as public health reasons, malaria control became intimately connected.

The dissertation emphasizes a political economy approach to disease, examining the ways in which geography and economic factors have influenced the rise and fall of malaria.

The dissertation divides malaria control in Colombia into three distinct phases. The first, the Rockefeller Foundation (RF) era, refers to the1930s, when the International Health Division first became active in malaria in the country, right at the time Colombia began to carry out some of its first efforts in malaria control. The Foundation's main interest, however, was not in malaria, but yellow fever; the discovery of jungle yellow fever in the early 1930s had delivered a fundamental blow to the “key center” theory on which the RF's efforts to eradicate yellow fever had been based. This led to intense investigation of the epidemiology of jungle yellow fever. The “paradoxes” of philanthropy in the chapter's title refer to the ways in which yellow fever, a disease of far less importance to Colombia, when considered in relation to the range of diseases that affected the country's population, dominated the RF's investment in the country, to the detriment of anti-malaria work. The malaria control program that was started vanished in the wake of yellow fever studies. Efforts by the Colombian government to turn the RF towards malaria control were unsuccessful. In the end, growing impatient with the lack of involvement of the RF in practical disease control, the Colombians nationalized by decree the field laboratory the RF had set up in the country, in an incident that ended with the expulsion of a RF scientist from the country.

The second phase concerns the period of the 1940s. The war years brought intensified involvement of the U.S. in Colombia, as part of its efforts to protect its military interests and keep Latin America on the side of the allies. Health, and especially malaria, was a key interest of the Institute of Inter-American Affairs, which the Department of State set up to oversee its health programs. The chief mechanism of cooperation in health was the “Servicio Cooperativo Inter-Americano de Salud Publica”, which was set up in Colombia in 1943. The mixed record of the IIAA in malaria control is analyzed in detail, as is the longer-term consequences of the Servicio for the overall organization of Colombian public health.

Finally, the dissertation examines the post-war period, when the piece meal malaria control efforts gave way to more systematic anti-malaria (and anti-Aedes aegypti) efforts. Eventually, Colombia transformed its anti-malaria service from control to eradication, when it joined the global effort to eradicate malaria endorsed by WHO in 1955. The massive campaign in Colombia, based entirely on house-spraying with DDT, resulted in rapid and dramatic declines in malaria incidence. But the work could not be sustained; by the 1970s, financial investment in the eradication service declined, and malaria began to return. The dissertation documents in detail how the eradication program worked, but also the many problems it confronted. Though eventually, the goal of eradication was given up, a Malaria Eradication Service survived for many more years than is usually acknowledged, adapting to new social, economic and epidemiological realities, as well as to changed political priorities.

It is the argument of this dissertation that Colombia's health and malaria situation have been deeply shaped by international health programs which could not, and did not, take into account the social, economic and political determinants of health.

Indexing (document details)
Advisor: Stepan, Nancy Leys
School: Columbia University
School Location: United States -- New York
Source: DAI-A 70/08, Dissertation Abstracts International
Subjects: Latin American history, Economic history, Public health
Keywords: Colombia, History of medicine, History of public health, Malaria, Tropical medicine, Twentieth century, Yellow fever
Publication Number: 3373716
ISBN: 978-1-109-34505-6
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