Global health, local realities: neglected diseases in northwestern Uganda.

This thesis explores the everyday realities of neglected diseases among people living and working along the River Nile in Moyo and Adjumani Districts, northwestern Uganda. It is based on ethnographic-epidemiological fieldwork carried out over sixteen months during 2013 and 2014. The fieldwork included participant-observation, in-depth interviews and a parasitological survey with structured questionnaire. This thesis takes an interdisciplinary approach in studying global health, contributing to literature at the intersection between medicine and anthropology. The neglected tropical diseases are a group of diverse diseases framed in global health around common socio-economic-political features, persisting in poverty. They affect neglected populations, neglected by public health policy. Current approaches to their management are largely a collection of technical, diseasefocused programmes that disregard the politics of poverty. Contemporary debates surround the side-lining of social science literature, and the evidence behind the biomedically focussed disease control programmes. Fisherfolk are said to be vulnerable to a number of these diseases. Diseases such as intestinal schistosomiasis (one of the neglected tropical diseases) persist in fishing areas despite a global public health programme. However, as this study demonstrates, in northwestern Uganda levels of schistosomiasis infection appear to have reduced. This study situates the success of the global health control programme within the local biosocial context. Furthermore, it shows that while one neglected tropical disease is controlled, other diseases persist and emerge. These other diseases explored in this research were Buruli ulcer and Hepatitis B, diseases that challenged the global health concept of neglected tropical diseases. This thesis contributes methodologically to the growing interdisciplinary field of global health. It provides empirically-based biosocial evidence of the local realities of neglected diseases. In taking this approach, it argues that this concept is misleading. While it has illuminated particular problems in global health, the restrictive gaze disregards local public health concerns.