["American Ethnologist, Volume 53, Issue 2, Page 171-182, May 2026. ", "\nAbstract\nIn Colombia's northeastern borderlands, agrarian economies shape how disease risk and stigma are understood and managed. As shown in ethnographic fieldwork in and around the Catatumbo region, cutaneous leishmaniasis—a sandfly‐transmitted disease that produces chronic skin lesions—appears in two radically different guises across adjacent territories. In coca‐growing areas, the disease is driven underground and treated as a marker of criminality. In coffee‐growing areas, it appears as an occupational hazard that calls for professional attention and minor but impactful attempts at environmental sanitation. This contrast defines a structural “counterpoint” between coca and coffee, commodities that encode alternative versions of Colombia's agro‐political identity and shape narratives of legitimacy and illegality. Comparing labor conditions, ecological dynamics, and public health responses, we show how the visible symptoms of suffering caused by the disease become more or less conspicuous depending on the social value attributed to different kinds of agricultural work.\n"]