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- Convenors:
-
Cristiana Bastos
(Universidade de Lisboa)
Salla Sariola (University of Helsinki)
Sanjoy Bhattacharya (University of York)
- Location:
- C302
- Start time:
- 27 July, 2012 at
Time zone: Europe/Lisbon
- Session slots:
- 3
Short Abstract:
Public health interventions, past and present, and most of all current clinical trials, will be subject to critical analysis focusing on the experience of the social actors and on the nature of the facilities, skills, practices, rhetoric and knowledge involved on the interventions
Long Abstract:
Social, anthropological and historical studies about health in South Asia developed into vast bodies of scholarship on imperial science, colonial knowledge, tropical medicine, dependency, development, inequities, systems of knowledge, hybridism and other innovative concepts, but much remains to be known about the actual local experience of large-scale interventions, whether under colonial or independent administrations. This panel will host papers that approach ethnographically, historically and politically the social actors, objects, facilities, rhetoric, representations and practices involved in the implementation of public health programs and clinical trials in South Asia.
Accepted papers:
Session 1Paper short abstract:
The analysis of sanitary actions for epidemic control in colonial Goa shows that beyond the tension between European biomedicine and South Asian systems/practices/beliefs, there were more nuanced ways in which sanitary order was fought & negotiated between different intervening social actors.
Paper long abstract:
The tension between European biomedicine and South Asian medical systems/practices/beliefs has a particularly rich stage for analysis in the nineteenth century outbursts of cholera, plague and smallpox. Those epidemics have often been depicted as sites of confrontation between colonial state politics, policies and police forces, on the one hand, and, on the other hand, the resisting, resistant, relisient local population. Adding to recent works that have suggested a more complex and nuanced understanding of colonial interactions in the field of health and epidemics, this paper will analyse sanitary actions for the control and prevention of epidemics in 19th and early 20th century colonial Goa. Our purpose is to analyse the ways in which sanitary order is negotiated between the different intervening social actors, bound to multiple identities and to overlapping groups and relationships in which their actions are shaped and interpreted, often in conflicting ways: colonial agents, central government delegates, medical doctors and pharmacists trained in the Goa medical school, Christian clergy and practitioners, non-Christian religious leaders, local authorities, local health and religious agents, merchants, urban crowds, villagers.
Paper short abstract:
My paper will seek to fill this historical gap by studying how tropical medicine was perceived at different levels of colonial and independent Indian administration, and how, in turn, this affected negotiations in relation to the design and application of a number of internationally-funded programmes within different locations.
Paper long abstract:
Much has been written about the support received by Patrick Manson and Ronald Ross from within the British Government's Colonial Office. Thanks to this scholarship, we have been left better informed about the growth of tropical medicine as a specialism in Britain and several of its colonies. There have been occasional references to the disagreements within the structures of colonial government about the efficacy of metropolitan tropical medicine, and the efforts to translate and transform policies to the specificities of India. However, the majority of work has concentrated on high-level debates and the musings of elite actors. There has, on the other hand, been little systematic analysis of the attitudes within complex health bureaucracies and their varied roles in using the science of tropical medicine in health programmes.
My paper will seek to fill this historical gap by studying how tropical medicine was perceived at different levels of colonial and independent Indian administration, and how, in turn, this affected negotiations in relation to the design and application of a number of internationally-funded programmes within different locations. By highlighting the fact that the Indian state and international health agencies were not monolithic and marked by attitudinal complexities, I hope to highlight the importance of recognising the co-existence of many forms of tropical medicine, and the many scientific, political and infrastructural factors that ensured this. This, in turn, will underscore the usefulness of developing multiple histories of tropical medicine, which can be combined to present a complex mosaic of interlinking theories and practices.
Paper short abstract:
This paper will chart the political and moral economies and global ambitions represented by two versions of the Indian corporate medi-scape, represented by Cipla and Ranbaxy.
Paper long abstract:
The trajectories of pharmaceuticals in India's urban centres have been transformed since Indira Gandhi unleashed the generics industry by removing product patents. In 2005, product patents returned to an Indian pharmaceuticals industry that was not only dominating the Indian market but also exporting its products to the global heartland, taking over European and US companies in the process. Big Indian Pharma - like Ranbaxy, Dr Reddy's and Cipla - display Janus-faced characteristics. On the one hand, they are providing employment for millions and ensuring that essential drugs at affordable prices are available to the vast population of the sub-continent. On the other, as exemplars of the world of the Indian corporates, they want to join the rich man's club. Their successes are trumpeted by the Indian government, and are part of the imagined goal of a hi-tech knowledge-based economy. Their factories and corporate headquarters appear as futuristic mediscapes, peopled by global citizens.
Here I draw on material collected in the project 'Tracing Pharmaceuticals in South Asia', which followed three drugs from their urban roots to their urban and rural consumers. I focus on the similarities and contrasts between two iconic companies: Ranbaxy and Cipla. Ranbaxy is the archetypal, no-nonsense, go-getting business where dynastic squabbles led to a division of the company and the creation of a corporate hospital chain. Cipla is a quintessentially Nehruvian company which has challenged patent-holders and supplied generic medicines to sufferers from AIDS in sub-Saharan Africa. It remains under the control of the son of its founder. The paper explores the significance of the contrasts between these business models.
Paper short abstract:
This study illuminates why busy, practicing, doctors agree to become investigators in clinical research, the benefits that the doctors expect from clinical trials and how they manage to maneuver their schedules to accommodate the time consuming research activity.
Paper long abstract:
Following a legal change in 2005 that provided stronger patent protection in India, multi-national pharmaceutical companies have been increasingly out-sourcing their clinical trials to the country. As on August 2011, there are approximately 1900 trials registered in the official Clinical Trials Registry of India (CTR-I). Since then, there have been both international as well as national criticisms suggesting that this shift is a form of exploitation of poor patients without any real benefits to the country, science community or local health needs. However, what actually happens on the ground and why trials are welcomed has not been thoroughly documented to date. As part of a research project entitled Biomedical and Health Experimentation in South Asia, in 2011 we conducted around 40 in-depth interviews in three tertiary care hospitals in India with medical doctors and junior research assistants who are the local mediators of these trials, about the conduct of experimental research. The principal investigators we interviewed were busy doctors, often heads of departments. These doctors are crucial to the implementation of a trial but their views on clinical research activities have not been analyzed. This study illuminates why busy, practicing, doctors agree to become investigators in clinical research despite their demanding schedules particularly when research is not an common part of medical practice in India. In this paper we describe the benefits that the doctors expect from clinical trials and how they manage to maneuver their schedules to accommodate the time consuming research activity.
Paper short abstract:
This paper examines how the adoption of new vaccines by India can be situated within the discourses (nexus of power and knowledge) of nationalism by scrutinising the historical and political processes that accompanied the project of nation building after colonial rule.Furthermore in the present scenario the adoption of these new age vaccines can serve as a tool for the consolidation of India’s power position within the global health community.
Paper long abstract:
In this paper I examine discourses on vaccine adoption in two ways. I firstly, I analyse how the adoption of new technologies like vaccines (the specific case of Hib/pentavalent vaccine) by India, can be located in the nationalist discourses of nation building which is to achieved through advancements in science and technology. I argue that improving the health and the productivity of the population through investments in scientific and technological solutions like vaccines has become a marker for 'progressive state'. Secondly, at present when India is actively trying to posit itself as a leader (especially among the third-world countries) of modern, efficient and low cost innovations of technology and also as a fast and effective adapter of the same, disease control programmes though vaccinations and introduction of new age combination vaccines like the Hib/pentavalent serves as an effort in the direction of image building, in achieving the MDGs, and thereby strengthening India's position of power within the global public health community.
I will supplement my arguments by data from interviews with multiple stakeholders in policy making and policy influencing: bureaucrats, politicians, the representatives from the international organisations and the international foundations, academics, people from the media, doctors and public health practitioners who function as consultants in policy making for the Hib/pentavalent vaccine introduction policy in India. Hib/pentavalent vaccine was introduced in the India on Sept 2011 amidst much controversy (regarding contestation over disease burden, vaccine safety and cost effectiveness) as a pilot in the states of Kerala and Tamil Nadu.
Paper short abstract:
This paper traces the evolution and the development of health sector research in the context of Nepal. Based on the mapping of key research activities, actors, journals, investigators and research focused NGOs as well as key informant interviews, this paper begins to attempt to reconstruct a social history of health research in Nepal.
Paper long abstract:
There has been a steady increase in research activities within the health sector in Nepal. With the growing emphasis on 'evidence' in policy and programming and the growth of scientific publications within academia, there is an increasing emphasis on scientific research. One aspect of this is the question of 'rigor' as an important element in the debate within the scientific and policy community. This paper traces the evolution and the development of health sector research in the context of Nepal. We chart the actors, sponsors and modalities of conducting public health research and experimentation within the health sector in Nepal. In particular it examines the growing culture of contract research in the health sector. Based on the mapping of key research activities, actors, journals, investigators and research focused NGOs as well as key informant interviews, this paper begins to attempt to reconstruct a social history of health research in Nepal. The paper concludes with a number of propositions based on our ongoing fieldwork in Nepal and the broader analytical questions and the issues they raise.
Paper short abstract:
The project 'Biomedical and Health Experimentation in South Asia' researched researchers in Sri Lanka. With evidence from two public health interventions followed during the years 2011-2012, this paper will compare and comment on the different research practices within such research enterprises.
Paper long abstract:
The ethnographic material on which this paper is based on is drawn from a project titled 'Biomedical and Health Experimentation in South Asia'. This project undertakes a comparative examination of experimental research taking place in India, Nepal and Sri Lanka. Here we report specifically on a public health intervention project and a randomized control trial in Sri Lanka that was followed during the year 2011-2012. The paper explores the methodological and analytical consequences of undertaking ethnographic research among groups who are themselves undertaking research. It focuses on the relationships between ethnographers, researchers, public health practitioners and other stakeholders and highlights the different approaches to strategies for implementing research design, policy engagement, extent of local capacity, securing of funding and the ways in which collaborations are managed. The evidence assembled enables us to comment on the extent to which the methodology of RCTs contributes to the emergence of public health research in Sri Lanka and how the differences of the two projects inform research practice and its outcomes.
Paper short abstract:
Motherhood which has depended on traditional midwives is becoming a medicalized and institutionalized experience in India. Based on an ethnographic investigation in Jaipur and Delhi, this paper considers how motherhood is constructed through negotiations among doctors, Hindu nationalists, NGO workers and the urban poor for whom such projects are designed and implemented.
Paper long abstract:
As the Indian census 2011 shows, population growth, the rate of maternal and infant mortality, and the unbalanced sex ratio remain high in North India. In response to these societal developments, both national government schemes and a proliferating number of local and international NGOs are creating reproductive health care programs that will guarantee access to healthcare and reduce the maternal and child mortality rates. On the basis of one year of fieldwork in Jaipur and Delhi, I have found that, beyond the stated objectives they have, state and medical actors work according to very different notions of reproductive health, the body, gender, and the medicalization.
I have worked in three ethnographic settings: with the members of an international NGO in urban slums, with a main government maternity care hospital and with a Hindu nationalist association, Sewa Bharti Delhi. I use these three perspectives in my thesis, in which I compare the rhetoric and practices of reproductive healthcare programs from the points of view of the state, civil society, and the urban poor.
Thus, in this paper, I analyze the moral standards, forms of knowledge and power, and techniques that doctors, NGOs, and Hindu nationalist volunteers rely on to attempt to educate the urban poor of North India. I complement this analysis with life stories of women and traditional midwives in urban slums. Such stories give insight into how women reappropriate these state and civil projects, and how such projects affect their knowledge and conception of motherhood.
Paper short abstract:
This paper reports on an anthropological study of Pakistani-origin patients in an IVF clinic in the Northeast of England and explores issues arising as members of a transnational community confront the controversies that come with the choices that new reproductive technologies make available.
Paper long abstract:
Infertility is rapidly becoming one of the most important reproductive health issues in the industrialised world and the new reproductive technologies (NRTs) designed to treat it are becoming more and more widely available. The social and emotional impacts of infertility are variable but, among the British Pakistani population, they are generally acknowledged to be serious, especially for women (e.g. Shaw, 2000; 2004). This paper explores data from participant observation and in-depth interviews with people of Pakistani-origin seeking infertility treatment in an IVF clinic in the Northeast of England. We explore the issues that arise as British Pakistanis confront the controversies that come with the choices that NRTs make available. As others have observed (e.g. Ballard, 1994), many South Asians who live in the UK live highly transnational lives, maintaining close links with family in their country of origin (usually referred to as "home"). These links are pivotal in the ways in which British Pakistanis deal with infertility. These include: seeking advice from relatives or religious figures in Pakistan, travelling to Pakistan for treatment, adopting children from relatives in Pakistan, or seeking new marriage partners in Pakistan. We discuss the ways in which the transnational flows of advice/information, medicines (biomedical and other) and people (children to adopt, new marriage partners) affect the experience of seeking treatment in the UK using new reproductive technologies. Discussions of infertility and NRTs bring out complex relationships between issues of identity and ethnicity; marriage and the family; and relations between science and religion.