Biomedical Remoteness and Service Decentralization in the Maldive Islands

Presenter:

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Abstract

Relationships between islands and human health are multifaceted. Today South Asian islands qualify as desired recreational outposts; in the past they served as supply stopover in maritime networks, and inevitably, as hubs in disease dispersion or as epicenters of endemic disease formation. Vulnerable to resource scarcity, seasonal storms and drought, small coral islands were particularly challenging to human wellbeing. Yet, these small-scaled, discrete islands also functioned as liminal quarantine spaces, leper colonies and manageable laboratory and eradication settings. This paper discusses the Maldive Islands as a graphic example. For centuries the archipelago was haunted by endemic Maldive Fever. Genetic founder effects – deposits from ancient monsoon trade and European expansion – sustainably shaped the population, and epidemics traveled fast through the close-knit island communities. The islands remained an uncharted part of the biomedical world well into the 1950s. Successful pathogen eradication programs, esp. of Malaria and Filariasis, proved to be watershed events in the island/health nexus. This transformation allowed for the advent of the thriving Maldivian tourism industry in the 1970s. Since the Maldives have developed into the only upper-middle-income country in South Asia, biomedical remoteness is rooted in tensions between strategies of consolidation and decentralizing power, population and service. The underserved ‘outer islands’ became the contested focal point. Using a medical anthropology approach and an inherited blood disorder as a magnifier lens this paper reveals a perspective from the health periphery on the ongoing struggle for health equity.