https://orcid.org/0000-0001-6861-4314
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Abstract
How can ethnographic methods track implicit & explicit forms of structural casteism in Indian public health policy and praxis? How can a critical attention to ordinary stories and subjectivities of casted lives reveal the underlying Brahmanical moralities, assumptions and imaginations of public health but equally also unravel anti-caste counter-framings/counter-theorizations of symptoms, afflictions, injuries and chronic wounds wrought by caste? How, in other words, can the horizons of anti-colonial theory-making be expanded to capaciously conceptualize casteism as a core determinant of community health outcomes and life-chances in India? By mobilizing ‘counter-storytelling’ as a concept and method for critical medical anthropology from the Global South, and case studies from longitudinal ethnography in northern India, this paper provides a dual critique of: 1. Public health praxis in relation to questions of caste, addiction, respiratory debilitation, air pollution and TB. And, 2. Epistemologies of health policy making pertaining to wellness for ‘the poor’ and the gendered and casted labour of community care workers like ASHAs and non-institutionalized health actors.
Acknowledgements
The author wishes to thank Mangal, Neerja, Bhaskar and a range of other named and unnamed ethnographic interlocutors for allowing him to tell their stories. He also wishes to thank João Biehl, Laurence Ralph, Carolyn Rouse, Kaveri Qureshi, Marlee Tichenor and the senior editors of Anthropology & Medicine for their support.
Ethical approval
Ethics approval was granted by the Institutional Review Board (IRB) of Princeton University, New Jersey, USA (Re. IRB#14164). Oral consent was obtained from each participating interlocutor.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1 The doctor did not earn a living from his facilitation of the group, nor did the group itself receive funds (or medication) from the state. It was started with the help of a global health NGO and catered to ‘lower-caste’ men and women edged out of formal public health facilities such as state-sponsored drug rehabilitation centres. The doctor who had local links to the people of the group said he was using this experience to ‘help his community’ and also gain hands-on experience for a future job that he hoped to secure with the World Health Organization.
2 My role in the group is something I would describe as that of a participant observer-facilitator. The ‘joke’ the doctor told about me was, ‘yeh bhi doctor ban rahe hain, par padhai ke doctor!’ (Trans – ‘He is also becoming a doctor, but a doctor of studies!’). Conversations took place mainly in Hindi and less occasionally in English and Punjabi (or a combination of these three). I am a fluent speaker of all the languages in question. As research protocol, it was agreed that I would use pseudonyms for all my interlocutors, including the neighbourhood/settlement in question and only use state names to mark the field-site, to protect collaborator confidentiality.
3 It was fascinating that the doctor did not jump to label Mangal’s condition (or indeed the condition of any other substance-user) as ‘addiction’ readily. The idea was for the community to come together, listen to each other’s stories and devolve a socially and structurally salient notion of ‘addiction,’ rather than a pathological meaning. (See, also, Garcia Citation2010; Hansen Citation2018). I was intrigued especially by the anthropological connotations and possibilities of this ‘openness.’
4 As trust developed, I obtained verbal consent from the recovering substance-users as well. The doctor frequently started calling on me to lead ‘storytelling sessions’ (kahaniyan bayan karna), in which members would share ordinary stories about their addictions and more broadly their everyday lives. For stories, as Das (cf. Citation2006) reminds us, “make the everyday eventful.” Since I also had previous experience of professionally working as a journalist in the region (2016-18), I was well-acquainted with skills like interviewing, facilitating dialogue and group discussions.
5 In presenting this fieldwork here, my aesthetic choice of telling stories is intentional, and mirrors the ethnographic register in which kahaniyan (stories) function “as a method of social inquiry” (cf. Georgis Citation2013), where casteism can be analysed in the register of the affective, the atmospheric and the structural, through the embodied epistemologies of my interlocutors.
6 The stories presented here are selected from a wider range of ethnographic fieldwork I carried out over twenty-eights months (between 2019-23) for my doctoral research in anthropology, in a region broadly encompassing Punjab, Delhi and western Uttar Pradesh. My method involved moving with my interlocutors between local sites of biomedical care, everyday dwelling and livelihood generation. Fieldwork presented in this paper emerges from twelve months of participant observations in an addiction recovery group on the Delhi/UP border (case 1) and from four weeks of living in (and six months of visiting) a village in western UP (case 2) with the doctor described at the start and local ASHAs training with him.
7 This is precisely what Ambedkar characterized as ‘graded inequality’ (Citation1936), a curious but common aspect of the everyday life of structural casteism in the Indian sub-continent where sufferers of the caste system are themselves internally hierarchized (for example, based on sub-caste, class and ethnic status). As Mangal claimed, “My in-laws took pride in separating my vessels from theirs; not eating food cooked by me; not letting me feed their livestock and claiming that they were ‘risen Valmikis’ (i.e., they lived in the city; had government jobs and even drew pensions to boast.)”
8 Here, I also juxtapositionally have in mind Sullivan’s (Citation2015, 1) argument about ‘the physiology of racist and sexist oppression’, which begins with this quote from epidemiologist Nancy Krieger: “Bodies tell stories that people cannot or will not tell, either because they are unable, forbidden, or choose not to tell.”
9 I recall here veteran Hindi Dalit writer Surajpal Chauhan’s classic short story (Citation2009), ‘Badboo’ (The Stink), in which the central character, a young Dalit woman named Santosh, is married to a family of waste cleaners. The story succinctly chronicles her descent into the stranglehold of shit-cleaning and ends on a sensorial moment that is both openness and foreclosure: ‘Her husband took her into his arms and made love but Santosh had just frozen over. Each gesture of the man made her feel that in reality every follicle of her body was being smeared with shit. In this way Santosh felt she was turning to stone’ (my own translation.).
10 Following Boellstorff (Citation2010), Macharia (Citation2019) and a considerable scholarly tradition on queerness as methodological praxis (Browne and Nash Citation2010), I draw attention to my queerness (‘gay’) here not to suggest that there is a clean (if clear) politics of disclosure, which in turn assumes a stable if legible object called ‘queer’ and erodes the many structural risks of ‘coming out’ in the postcolonial field (India). Rather, in keeping with this capacious ‘queer’ epistemological praxis, I deploy my ‘gay, mixed-caste’ positionality to suggest an analytical opening in the field through ‘queer ways of knowing’, which foremostly animate my analysis and the manner in which I forged ethnographic relationships with my interlocutors. The Dalit doctor in the opening vignette is also gay. Queerness (‘gay’) here is thus less a noun, and more a verb, a way of insurgently inhabiting, witnessing and attuning oneself to the circulation of ideas, affects and moralities in the field. I view my ‘mixed-caste’ position (Bahujan and savarna roots) as braided into this intersectional positionality.
11 Here, I also have in mind scholarship by Geronimus (Citation2023) and Sullivan (Citation2015) on the physiology of ‘weathering,’, which broadly discusses the impact of acute and chronic exposure to racialized discrimination, hazardous habitats and stressors on bodies of colour. I am suggesting that Mangal’s life-history and storytelling can radically allow us to theorize similar claims with respect to caste-based health disparities and how they ‘get under the skin.’
12 Recent studies (eg. Baugh and Thakur Citation2023; Gaffney Citation2020) even make explicit links between racism and respiratory health. Such studies need to be translationally conceptualized in the context of the public health of bodies marginalized by structural casteism, especially in South Asia.
13 Development economists Joshi, Kochhar, and Rao (Citation2022), in fact, use the concept of ‘fractal inequality’ to problematize how poverty and inequality estimates vary not only between ‘sub-groups of groups’ (varna) but also between ‘sub-groups of sub-groups’ (jati).They conclude with suggestions of “a more local approach to poverty targeting” which relates to “details of jati variation at the village level.” This substantiates my point about the excessively quantified nature of inequality-reduction in India.
14 The couple identified as ‘Hindu’, Dalit (Valmiki) and were in their late 30s.
15 Neerja and Bhaskar not only gave me consent to interview them, but also introduced me to their extended family in a village (in western UP) not far from where the addiction recovery group was convened. Neerja, an ASHA, had earlier trained under the doctor (who introduced me to the recovery group). Moreover, I was fascinated by her affective insights on the livelihoods of ASHA workers, who are abidingly SC/ST. I visited their village with the doctor and independently, even staying with Bhaskar and Neerja’s extended family on multiple occasions.