Access Type

Open Access Dissertation

Date of Award

January 2021

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Anthropology

First Advisor

Mark R. Luborsky

Abstract

This dissertation examines how contemporary approaches to Legionnaires’ disease (LD) narrowly view it as a biomedical entity that obscures critical moral, temporal, and contextual dimensions creating gaps in how LD “cases” are defined and mitigated. Those who receive an LD diagnosis experience many unique challenges (e.g., personal, existential, community-based, and environmental) yet little is known about how this group of individuals experience recovery and attach meaning to their individual experiences. Using an anthropological lens of illness and recovery and a syndemics view of infrastructural violence this study examines those inadequately addressed multiple dimensions which limit our ability to confront the increase in LD and its differential harm in populations. A total of 48 participants (55-65 years) were recruited following LD diagnosis and treatment in the South Bronx, NY at various stages of diagnosis, treatment, and recovery over 14 months. This multimethod study examines, at least in part, how Legionnaires’ disease survivors experienced their diagnosis, treatment, and recovery and the impacts this had on their overall return to a pre-infection state of health and the various types of disruption experienced by LD survivors. The findings suggest that posttreatment follow-up, LD-related care, and support networks are critical yet rarely utilized aspects of LD infection and there remains a pressing need for more holistic and inclusive posttreatment care for this growing demographic. Similarly, the role of infrastructure and environment plays a significant role in exposure and recovery as a result of infrastructural violence. Qualitative analysis indicates the following outcomes: (1) LD has long-lasting impacts on health status among older adult patients in the Bronx (2) legionella and pathogens play a previously unexplored role in infrastructural violence (3) urban infrastructures often create barriers and exposures currently overlooked concerning LD and (4) older adult patients recovering from LD from lower socio-economic backgrounds have various unmet needs in managing their recovery and other comorbidities as a result of LD infection. These outcomes are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors.

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