An ethnographic study of medicines, care, and antimicrobial resistance amidst disorder and decline in Yangon, Myanmar

Antimicrobial resistance (AMR) has gained much attention, described by some as a global health emergency. At the 2015 World Health Assembly, countries around the world were asked to create national action plans to address AMR, following a blueprint of the World Health Organization’s Global Action Plan (WHO GAP). This thesis, positioned in a suburban area of Yangon, Myanmar, provides a reflection on the expected state-centric approach to implementation. My ethnographic fieldwork illustrates how efforts under the umbrellas of awareness-raising and changing behaviours to curb antibiotic misuse can reinforce rather than relieve the conditions that lead to reliance on antibiotics through informal routes. Myanmar, with its authoritarian state and ongoing civil wars, is governed by a fragmentary and volatile rule of law. Others have previously shown how the residents of Myanmar have developed everyday coping mechanisms to adapt to a governance structure characterised by caprice and neglect. My ethnographic research explored how coping mechanisms have also developed in the context of medicine regulation and use as I traced medicines from within households, drug shops, private practices, markets, to pharmaceutical companies. I argue that medicine ‘misuse’ behaviours (overuse of medicines, inappropriate use of medicines) in Yangon as characterised from a clinical perspective, are less shaped by individuals and more so by the failures and biopolitical abandonment from the institutions/systems which are, in theory (according to values promoted by the liberal international order /also values promoted by the WHO GAP), supposed to protect individuals. Medicines have become a quick fix to care for and support individuals in place of these failures. These findings illuminate universalist assumptions in AMR action plans that expect a particular order and development trajectory of states and citizens. Attempts to regulate or restrict medicines should take the context of disorder and decline – a situation that is not unique to Myanmar in a post covid-19 world – into account, or they risk intensifying pre-existing pressures on those who are already self-governing or coping on their own.