Parasites, ghosts and mutualists: a relational geography of microbes for Global Health

Scientific research on the microbiome offers an ecological model of the human, comprised of myriad forms of microbial life. The composition and dynamics of this human microbiome are increasingly implicated in discussions of health. Attention has focused on missing microbes and their links to a range of inflammatory and autoimmune diseases. Pathological dysbiosis is understood to result from both the excessive presence and the absence of microbes. Microbial declines have been indexed to modern hygiene and healthcare practices and there is a growing interest in the therapeutic use of beneficial microbes. This reappraisal of the salutary potential of microbes challenges the negative associations prevalent in health geography and the field of Global Health. This paper develops relational and multispecies approaches to the health geography to examine situations of microbial excess, absence and controlled reintroduction. The analysis focuses on human relations with hookworms. Hookworms areanimal members of the microbiome. They co-evolved with humans, live in us and are understood to manage the human microbiome to enable immunological tolerance. Both the excessive presence and the absence of hookworms can be pathological. They are currently the subjects of concurrent, but spatially discrete, programmes to deworm and reworm avariegated world. Focusing on this seeming spatial paradox, the analysis examines three types of human-hookworm relation: the parasite, the ghost and the mutualist. The conclusion reflects on the implications of this analysis for the human and nonhuman subjects of Global Health and the microbiopolitics of prevalent forms of antibiotic and probiotic healthcare