Antibiotics as infrastructure: Labour, precarity and healthcare ecology in a Nepali industrial town

In industrial work environments with limited labour protection and frequent injuries, medicines may function to sustain work capacity rather than facilitate recovery. Focusing on steel production in Nepal, we explored how the local healthcare ecology framed care pathways for steel workers. The analysis draws on concepts of pharmaceuticalisation, local healthcare ecology and the political economy of labour to examine how medicines-particularly antibiotics-enable continued productivity under exploitative work conditions. Ethnographic fieldwork in a steel factory included survey and qualitative interviews with workers, participant observation at the factory clinic, health camps, private polyclinics, pharmacies and one primary health center (PHC). Participants were mostly male labour migrants, Indian, married and with little or no education; nearly half reported recent illness and few had avoided work-related injuries. A mix of providers routinely dispensed antibiotics without prescription. Commercial incentives and demand for quick relief drove extensive broad-spectrum antibiotic use with minimal diagnostic differentiation and uneven awareness about antimicrobial resistance (AMR). Under unsafe conditions, antibiotics functioned as labour-supporting infrastructure and when treatment at the factory clinic failed, workers were channelled into commercialised medical circuits that enabled, rather than alleviated, workplace harm, increasing risks of AMR development.