Recently, mass arsenic poisoning of groundwater has emerged as a public health crisis issue in Bangladesh. Apart from hundreds of deaths that have already been reported, 70 million people are estimated to be at high risk of developing deadly arsenicosis symptoms, including symmetric hyperkeratosis of the palms and soles, skin cancer, cancer of the kidneys and lungs, and diseases of the blood vessels. The severity and extent of arsenicosis have obliged the government of Bangladesh to declare it the ¿worst national disaster¿ the country has ever faced, and further to be deemed a ¿state of emergency.¿ To fight this pervasive public health disaster, the Bangladesh government has collaborated with the World Bank, WHO, UNICEF and various other international and national NGOs, which have channeled millions of dollars into implementing development projects to provide arsenic-free water to rural villagers. However, the majority of these projects have been rejected by the communities in which they have been instated and have thereby ¿failed¿.
In this context, this thesis explores two research problems: firstly, why do arsenicosis patients, despite having fairly easy access to biomedicine, utilize alternative healing services, and secondly, why do individuals who are suffering from arsenicosis reject options for arsenic-free water that could save them from this disease? To answer these questions, three areas have been identified for examination: (1) perceptions of arsenicosis by different social actors, (2) health-seeking behaviour of arsenicosis patients, and (3) community participation in arsenic mitigation strategies. Drawing upon ethnographic research conducted over a year in rural Southwestern Bangladesh, I first examine how arsenicosis is conceptualized and understood by different social actors, such as biomedical doctors, development planners and lay villagers. I articulate how biomedical professionals and development experts explain arsenicosis and then focus on how individuals, who are affected by arsenic poisoning, understand, experience and respond to this disease. By deconstructing the labels, vocabularies, etiologies and symptoms that individuals use to explain this disease, this thesis highlights how the biomedical reality of arsenicosis has been vernacularized as ghaa in practice. Taking this demonstration a step further, I analyze how such social construction of ghaa shapes health-seeking behaviour of subjects and their participation in mitigation strategies. This allows me to address these two questions through primary, ethnographic data. The ways in which biomedical and development professionals understand arsenicosis and even formulate solutions do not make cultural sense on the ground. Individuals affected by arsenicosis use a very different cultural logic and worldview to explain this disease. I therefore argue that their low participation in public health-care services and the failure of arsenic mitigation strategies are a result of a ¿mismatch¿ in understanding arsenicosis. This thesis thus suggests that local knowledge, socio-political and ecological factors are collectively crucial and should be reflected in development policy formulations. For any health and development intervention to be successful and sustainable, a bottom-up approach with more meaningful community involvement and ownership could be ensured.