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I situate my research at the crossroads of history, philosophy, sociology and anthropology of science. In the past, I have focused on epigenetics, environmental research, empirical bioethics and environmental justice, within and outside the academia, as you can read here, or here. Now I am focusing on antibiotic resistance, and I use it as a lens to interpret the contradictions of the last century derived by industrial production, environmental degradation and biomedical cultures.

What interests me is the (at that time) new epistemic discourse that since the Forties has been produced to explain morphological changes of organisms produce when they experience new environmental conditions or perturbations. Through an important experiment at the base of the so-called concept of genetic assimilation, Conrad H. Waddington showed that a thermic shock can produce changes in wings’ veins of fruit flies, changes that can eventually be inherited across generations, without the environmental trigger that caused them.

This focus on production and (genetic) storage of biological differences elicited by the environment is nowadays coupled with the knowledge produced through microbiome research that explains the phenotypic patterns that recur across generations.

In a thought-provoking twist, with microbiome research, the focus shifts from production and inheritance of biological differences to production and inheritance of biological similarities. Microbiome research shows that some phenotypic patterns are allowed by ecological communities of microorganisms composing all animals. Bacteria allow the development and functioning of our bodies within an epistemic framework that is now key to understand biology. The network of vessels composing mammals’ stomach is formed through cellular differentiation and expression of genes coordinated by bacteria. The same is true for our immune system that is coordinated by gut bacteria. Food, which is an important aspect of our lives also impacts on this microecology and mediates between our biological functions and functioning of means of production whose parts dedicated to food production have immense importance for our biology and our internal and external ecologies. Antibiotic resistance is one of the crossroads where culture, biology, history and the Anthropocene meet. Indeed, Antibiotic resistance shows that means of production of our societies have an even more widespread, deep and allegedly unexpected impact on the biology of animals and plants. The microorganism can indeed adapt to resist the selective toxicity of antibiotics. Moreover, bacteria can transfer their genetic code horizontally, by touch, so that we can acquire antibiotic resistance by eating food that functions as a vector, by hosting lice on our heads and many other contacts. Bacteria that are resistant to antibiotics that have been used as growth factors in animal husbandry and to prevent diseases in livestock and aquaculture, spread in natural ecosystems and can be found in wild species. Rivers and estuarine waters are places hosting antibiotic resistance.

Searching on PubMed (the search engine for biomedical literature) titles of articles containing the terms ‘antimicrobial’ and ‘Louisiana’ I retrieved just one twelve-years-old article. No results with terms such as 'Mississippi' or 'New Orleans'. The authors collected and analysed Oysters from both waters of Louisiana Gulf and in restaurants and food retailers in Baton Rouge. In most of the samples gathered, scientists recognised the presence of bacteria (Vibrio parahaemolyticus and Vibrio vulnificus) resistant to specific antimicrobials. Food production is indeed the first factor in terms of the quantity of antibiotics used. This use and related antibiotic resistance impact all the living beings present in a specific area, and can easily travel around the globe through many channels. As Littman & Viens have highlighted, a sustainable future is a future without antibiotics as “there may be no truly sustainable way of using antibiotics in the long-run, as microorganisms have shown to be almost infinitely adaptable since the first introduction of antibiotics” (Littman & Viens 2015). But in the meanwhile, we need to use them and antibiotic resistance is a phenomenon that can be better studied through environmental research, by analysing wild species and emissions nearby livestock, for instance.

The study that I retrieved focuses on Oysters. But what about antibiotic resistance conveyed through food that is consumed by the most?

What about exposures of communities that are living in highly polluted areas?

And what is the additive value on antibiotic resistance for individuals who experience the presence of industrial pollutants and that live in areas where cancer epidemics are registered?

In this respect, there is a strategy to cope with the issue of antibiotic resistance promoted by the Center for Disease Control and Prevention. The document doesn’t mention any action to monitor and regulate the production and usage of antibiotics in livestock. Nevertheless, the CDC wants to scrutinise, through genome sequencing, “Listeria, Salmonella, Campylobacter, and E. coli and uploads sequence data into PulseNet for nationwide monitoring of outbreaks and trends.” Moreover, the document reports that “In Fiscal Year 2019, Louisiana will begin simultaneously monitoring these isolates for resistance genes. When outbreaks are detected, local CDC-supported epidemiologists investigate the cases to stop spread.”

The questions that I would like to ask (to local ppl, activists, researchers, practitioners..) are:

What could be the epidemiologic characteristics (socioeconomic status, gender, residence..) of the populations more vulnerable to antibiotic resistance?

What is the additive role of antibiotic resistance for people living in highly polluted areas?

What is the impact of antibiotic resistance for people and patients living in areas where cancer incidence is high?

And on the long run I am interested in imagining possible strategies to not only living with the problem but also to tackle the problem itself, which means to develop strategies to answer the questions:

Why antibiotic resistance, which is known since a century, it’s a problem on the rise?

What is the role and interest of capitalism, in terms of profit-making of corporations, knowledge production and environmental degradation, in not being able to resolve antibiotic resistance?

What can be strategies of local communities to tackle the problem and to promote environmental justice in terms of alliances with ecologists, doctors, epidemiologists and other activists?

Many stakeholders are mentioned in this film. The main group are the Liberian citizens who were directly affected. Those living in Monrovia were interviewed. They show a quarantine zone and show how citizens within it were unable to receive adequate food. They show a 260kg bag of rice meant to feed over 2,500 people. The lack of resources is something the film discusses and highlights. The film also shows government workers and their lack of knowledge and how that caused tension between the citizens and their leaders. The main narrator in the film discusses his challenges with getting his family out of Liberia and to the United States. Doctors and nurses are mentioned as well and their role in the outbreak. NGOs are discussed and how doctors from around Liberia volunteered to come to express their patriotism and assist those in need. The President is shown addressing the country, but the quarantines enacted prove to be inaffective as they caused a lot of rioting. 

I found the most compelling part of the film a portion where an elderly man needing dialysis swears and screams at one of the doctors that he's sick and tired of having to wait for dialysis. He says how annoying it is to come to this hospital and expresses frustrations with having to get dialysis at this particular hospital. He is frustrated to such an extent that he even asks the doctor to remove the catheter and let him die, stating that eveyrone dies so he doesn't care anymore if it's sooner rather than later. He's tired of waiting.

The bibliography includes vast amounts of other papers, many of which governmental. The paper shows that a lot of background research was done, which is shown in the bibliography as well. The vastness of their references adds crediblity and authority to this paper. 

1. amount of articles about violence against humanitarian workers on Google Scholar (found >100)
2. violence against MSF staff in Somalia
3. Number of attacks on aid workers (https://aidworkersecurity.org/incidents/report/summary)

Research into historical case studies provided Knowles with the information to produce the research article. The only modern situation investigated was 9/11. Previous disasaters in history provided a basis with which to form the arguments about past disaster investigations and how they relate to the current ongoing investigations. 

1. "One might be tempted to see this as a medically virtuous circle, ... but one has to be conscious that it institutes the body as the immigrant's site of ultimate truth."
2. "These represent two contrasting approaches to the doctor's civic responsibility. However contradictory, the differing positions nevertheless reveal, each in its own way, how these professionals situated their medical expert opinion in a political space where the deontological points of reference had becommed blurred."
3. "...the organic importance of the body, is, basically, nothing more than the importance of the body as organ, or in other words, first as labor power, and only then as a form of self-presentation."
4. "....era in which demand for foreign labor made immigration a social necessity seems now so remote, the immigrant's body was entirely legitimized through its function as an instrument of production, the performance of which was interrupted by illness or accident."

The argument is supported through various anecdotes and testimonials. The authors use quotes from various victims in order to highlight the ways in which they were affected by Katrina. Notably, Sally, a 56-year-old woman from St. Bernard Parish who was still living in a FEMA trailer 50 miles from her original residence 2 1/2 years after the storm was interviewed. She talks about the living conditions post-Katrina. She describes families being torn apart, the National Guard using unnecessary force, and dead bodies floating in the water. The authors also use statistics and facts in order to back up their point about the horrendous conditions the survivors were in post-Katrina. A psychological and anthropological analysis also helps strengthen their argument regarding chronic disaster syndrome.

1. "First, disasters threaten harm or death to a large group of people, regardless of the actual extent of lives lost (48). Second, they affect social processes, causing disruption of services and social networks and communal loss of resources (42, 50). Third, they involve secondary consequences, namely identifiable mental and physical health outcomes, among those affected"
2. "Having the capacity to continue functioning after a traumatic event is common and characteristic of normal coping and adaptation"

3. "The key functions of pre-disaster preparation efforts are to prevent or minimize exposure to potentially traumatic disaster-related events and reduce likelihood of additional post-disaster stressors, which are both associated with post-disaster mental disorders."