Veena Das

In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps

This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. Whats more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.

Fire-related deaths in India in 2001: a retrospective analysis of data

BACKGROUND Hospital-based studies have suggested that fire-related deaths might be a neglected public-health issue in India. However, no national estimates of these deaths exist and the only numbers reported in published literature come from the Indian police. We combined multiple health datasets to assess the extent of the problem. METHODS We computed age-sex-specific fire-related mortality fractions nationally using a death registration system based on medically certified causes of death in urban areas and a verbal autopsy based sample survey for rural populations. We combined these data with all-cause mortality estimates based on the sample registration system and the population census. We adjusted for ill-defined injury categories that might contain misclassified fire-related deaths, and estimated the proportion of suicides due to self-immolation when deaths were reported by external causes. FINDINGS We estimated over 163 000 fire-related deaths in 2001 in India, which is about 2% of all deaths. This number was six times that reported by police. About 106 000 of these deaths occurred in women, mostly between 15 and 34 years of age. This age-sex pattern was consistent across multiple local studies, and the average ratio of fire-related deaths of young women to young men was 3:1. INTERPRETATION The high frequency of fire-related deaths in young women suggests that these deaths share common causes, including kitchen accidents, self-immolation, and different forms of domestic violence. Identification of populations at risk and description of structural determinants from existing data sources are urgently needed so that interventions can be rapidly implemented.

Disability and Domestic Citizenship: Voice, Gender, and the Making of the Subject

The figures of the diseased and the disabled have been at the center of analysis in conceptualizing certain postmodern forms of sociality. Paul Rabinow (1996) formulated the concept of biosociality to suggest the emergence of associational communities around particular biological conditions. Many others (Ginsburg 1989; Rapp 1999) have theorized that major transformations in biotechnology have led to new forms of community in which people with disability or impairment have formed associational relationships in order to act in civil society and to influence, on the one hand, the decisions of the state, and on the other, the course of scientific research. But while such political mobilizations are extremely important in changing the environment of the disabled, they locate the subject positions of the disabled firmly within a liberal political regime. Issues of sexuality and reproduction can only be addressed in such a framework in terms of the legal rights guaranteed by the state to its community of citizens. As Anne Finger (1992: 9) states the issue, “It is easier for us to talk about—and formulate— strategies of discrimination in employment, education, and housing, than talk about our exclusion from sexuality and reproduction.” In this essay, we propose to analyze notions of impairment and disability

O ato de testemunhar: violência, gênero e subjetividade

The context is the Partition of India in 1949, with the creation of Pakistan, as seen from the point of view of Punjabi culture (the Punjab was the province closer to the frontiers of the new state) and particularly through the eyes of Asha, a widow 21 years old in 1941, who lived with his deceased husbands family. The transformations derived from the Partition give rise to Ashas following reflections. A daughters food is never heavy on her parents. But how long will ones parents live? When two pieces of bread are experienced as heavy by ones own brother… then it is better to keep ones honor… make ones peace … and live where one was destined to live. The exegesis of this text is the analytical nucleus of the text. The author is not asking how the events of the Partition were present to consciousness as past events but how they came to be incorporated into the temporal structure of relationships.

Masks and faces: an essay on Punjabi kinship

Man need not be degraded to a machine, by being denied to be a ghost in a machine. He might, after all, be a sort of animal, namely a higher mammal. There has yet to be ventured the hazardous leap to the hypothesis that perhaps he is a man. GILBERT RYLE

State, citizenship, and the urban poor

This paper examines the dynamic, moving relationship between three concepts – those of life, law, and exception. Following a brief exposition of these concepts, this paper provides an ethnography of struggles over housing waged by the urban poor in a squatter colony in Noida that adjoins the city of Delhi, India. I argue that each concept in this triad exerts force on the other and is the dynamic relation that creates the conditions of possibility for the emergence of claims over citizenship for the urban poor. In suggesting that citizenship is a claim rather than a status, which one either has or does not have, the article shows the precariousness as well as the promise for the poor of ‘belonging’ to a polity. Joining the discussion on the politics of life, the paper argues that the notion of life allows the mutual absorption of the natural and the social, and thus illuminates aspects of citizenship forged through the struggles waged by the poor for their needs. These are aspects of citizenship which remain obscure if we reduce democratic citizenship to the domain of rational deliberative processes alone.

Trauma and Testimony Implications for Political Community

This article examines questions of trauma and testimony from the perspective of political community. It argues that terms such as riots, pogroms, and genocide reflect the points at which the body of language becomes one with the body of the world. Hence the performative force of these terms comes from their capacity to relocate narratives of violence and to anchor them to juridical-political discourses. The article asks for double vision in which life and its forms are subjects of the political but then are remade at the level of the personal. Critiquing grand projects for building identity and/or self, the article asks for mindfulness towards experience and forms of making the experience of violence knowable when saying gives way to showing.

Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study.

Summary Background Indias total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India. Methods In this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardised patient cases: first, a patient presenting with 2–3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). Standardised patients were scheduled to present each case once to sampled pharmacies. We defined ideal management for both cases a priori as referral to a health-care provider without dispensing antibiotics or steroids or both. Findings Between April 1, 2014, and Nov 29, 2015, we sampled 622 pharmacies in Delhi, Mumbai, and Patna. Standardised patients completed 1200 (96%) of 1244 interactions. We recorded ideal management (defined as referrals without the use of antibiotics or steroids) in 80 (13%) of 599 Case 1 interactions (95% CI 11–16) and 372 (62%) of 601 Case 2 interactions (95% CI 58–66). Antibiotic use was significantly lower in Case 2 interactions (98 [16%] of 601, 95% CI 13–19) than in Case 1 (221 [37%] of 599, 95% CI 33–41). First-line anti-tuberculosis drugs were not dispensed in any city. The differences in antibiotic or steroid use and number of medicines dispensed between Case 1 and Case 2 were almost entirely attributable to the difference in referral behaviour. Interpretation Only some urban Indian pharmacies correctly managed patients with presumed tuberculosis, but most correctly managed a case of confirmed tuberculosis. No pharmacy dispensed anti-tuberculosis drugs for either case. Absence of a confirmed diagnosis is a key driver of antibiotic misuse and could inform antimicrobial stewardship interventions. Funding Grand Challenges Canada, Bill & Melinda Gates Foundation, Knowledge for Change Program, and World Bank Development Research Group.

On the Modalities of the Domestic

ABSTRACT This article focuses on experiences of the domestic—of houses, of intimacy and privacy—and what relation these bear to the kinds of sentiments about life which are given expression as fragile, endangered or fleeting. We think of singularity as lying in the potential for multiple domesticities that emerge at different times and are neither coterminous with family nor indeed with household. Based on fieldwork with African-American and Caribbean families in Miami, Florida and Baltimore, MD, the article tracks how intimacy and alienation marks the constant moves from, to, and through households. This oscillation engenders an itinerant domesticity and life lived in the interstices of the house, the clinic, the prison, and the street. These spaces and places come to bear on what comes to be marked as so-called “African-American kinship.” Given the disproportionate incarceration of African-American men in US prisons, the article contemplates the permeable relation between carceral institutions and the home, as well as the constitution of kinship as “criminal.” All names used in this text are pseudonyms to protect the confidentiality of respondents.

Politics of the Urban Poor: Aesthetics, Ethics, Volatility, Precarity An Introduction to Supplement 11

Based on longitudinal ethnographic work, the authors of this special issue on the politics of the urban poor examine how regional events as well as scholarly traditions in these places have influenced the way the categories of the urban poor and of politics have emerged in both scholarly and public discourse. As the discussions that follow make clear, the relation between urban processes and city forms is a volatile one, and this volatility in turn has a decisive effect on how the poor emerge as political actors. Further, liberal forms of citizenship are but one form among others that become materialized through the claims that the poor make on the state. More importantly, the essays show that the socialities that undergird the lives of the poor are constantly being shaped by the experiences of precarity that go beyond material scarcity.