鳳山市五甲地區的登革熱與地方的社會文化形塑

Abstract

台灣登革熱的病例多來自南部地區，包括高雄、屏東與台南地區。其中，2002年高高屏地區登革熱流行，以高雄市2,832病例最嚴重，高雄縣也有1,979位病例，當中，鳳山市有一千五百多例，多半集中在與高雄市前鎮區疫區交界的鳳山市五甲地區。2006年高雄縣有185例病例，主要也集中在五甲地區。傳統上，台灣疾病地理學的研究以空間邏輯的概念來探討登革熱的疫情，也有部份文獻著重於政府對於傳染疾病的政策與疾病控制的力量。但是人類的疾病並非僅是單純的生物、生理現象和擴散行為，或純然政治的空間管理議題，它也存有特定的社會文化意涵，並可進一步形塑社會文化空間的意象與特定的空間行為與型態。 筆者選擇登革熱好發區，鳳山市五甲地區為研究區。不同於以往僅以空間邏輯的概念來認識登革熱疫情，筆者以醫療地理學、疾病的社會文化論述和標籤化理論等概念，揭示五甲地區的居民對於登革熱疾病的在地回應，以探索登革熱流行的地方如何被形塑成特定地方印象的「過程」，並討論在這當中個體的實踐、制度的與結構的因素如何作用。 五甲地區位於高雄縣、市交界處，由於地緣的關係，居民於兩地之間流動頻繁，使得一個地方的人們可能會受到另一個登革熱疫區的影響而受到感染。同時，五甲地區相對邊陲的地方，由於積水容器、廢棄物的堆積等而形成環境的危險因子。當登革熱爆發流行時期，五甲地區即成為登革熱確定個案顯著分布的區域，而被賦予登革熱疫區的地方意象。 由五甲居民的語彙反映出登革熱疫區常與不整潔的空間聯想在一起，賦予疫區不整潔的標籤符號。民眾的防蚊形式，生產出對某特定防蚊產品崇尚的象徵形式，以作為行動者的指導原則，並將之實踐於地方，使地方成為有意義的貯存庫。一個社會的文化背景常會影響人們對疾病的反應與詮釋，我們的社會文化已將登革熱賦予「生病」的闡釋，把登革熱指認為羞恥見不得人的「見笑病」，因為患病者容易與不整潔的空間畫上等號而被社會異化。 疫情調查、衛教宣導與噴藥等措施所形塑出的景觀，體現「五甲地區是登革熱疫區」的隱喻，五甲地區因而被符號化為登革熱疫區的形體。五甲地區的居民為了因應結構與法規制度的力量，也相對地回應出他們的應變方式，使之成為符號化的一部份，也成為被文化束縛的一部份。

Most dengue fever cases are found in southern Taiwan. When the dengue fever was prevalent in southern Taiwan in 2002, Kaohsiung city, with 2,832 cases, outnumbered the rest areas. Kaohsiung county had 1,979 cases and among them, more than 1500 occurred at Fongshan, mainly in Wu-Jia area. There were 185 cases in Kaohsiung county in 2006 and the majority was also in Wu-Jia. Traditional geographical studies of disease utilized spatial logics to study dengue fever in Taiwan, and literature focused on the epidemic policies and on governmental disease-control tools. However, human diseases are not simply biological, physical diffusion, or the political issues of spatial management. Human diseases also contain socio-cultural meaning; they shape the spatial image of places and specific spatial behavior. We choose Wu-Jia as the study area because dengue fever has been serious. Not as usual, this study applies concepts of medical geography, disease’s socio-culture and labeling theory to reveal how the local residents’ behaviors were shaped. How the specific place image of disease and the interaction between individual practices, institutional forces are formed, is analyzed. Wu-Jia area is located between Kaohsiung city and county. Geographical proximity and frequent residents interaction between two places make disease spread and disease media spread easily. Water storage containers and waste disposal frequency etc. in Wu-Jia also serve as risk factors. During dengue fever outbreaks, Wu-Jia becomes one evident center of distribution and thus the place image. The vocabularies of residents at Wu-Jia reflect that the infected area of dengue is associated with unclean space and label the infected area as unclean. Protection against mosquitoes produces fetishism symbolic attachment to some specific products. The fetishism against mosquitoes becomes a guideline. The practice of against mosquitoes imprints particular place image and makes place a meaningful storage of images. A socio-cultural context can often affects human reaction and interpretation. Our social culture has given dengue fever a symbol of ashamed illness, because patients are easily associated with living in unclean space and are alienated by society. The disease investigation, hygiene propaganda and chemical spray shape the landscape and embody the metaphor of “Wu-Jia as an infected area”. It symbolizes home of dengue fever. The ways Wu-Jia residents respond to institutional practices make them part of dengue symbol and their behaviors also conditioned by the symbol.