Philanthropic Science: An ethnographic study of chronic kidney disease uncertain etiology (CKDu) and health philanthropy in Sri Lanka.

Over the last two decades, an epidemic of chronic kidney disease has gained considerable political attention in Sri Lanka. In the Dry Zone of the country, the identification of high-risk “hotspots” for chronic kidney disease of unknown origin (CKDu), has attracted a range of health and social interventions. This thesis explores how multiple local-level interventions affect the everyday experiences of those living within a designated “high-risk” community. Drawing on 14 months of fieldwork in Ginnoruwa, the thesis documents and assesses the complex social disruption that occurs when a rural village “hotspot” becomes subject to multiple health interventions and thus implicated within the contested national politics of CKDu. Such communities, the thesis contends, become “worksites” (Kierans 2019) in which the political and biomedical uncertainties of CKDu are explored by a diverse array of external actors—biomedical researchers, philanthropists, public health officials, and community activists. In the case of Ginnoruwa, the often-conflicted relationships between these stakeholders resulted in an idiosyncratic and conflicted intervention that incorporated elements of community development, religious ethics, public health, and scientific technology along with its attendant ideologies, ethics, techniques, and technologies. This assemblage, which I term “philanthropic science’, contributed to multiple and contradictory representations of both the disease and the objectives of local interventions. This, in turn, frustrated effective implementation and significantly increased intra-community tension.