Year: 2023

Today Guru, John, Swamy, Ravi, and I met in the Health for All – Learning Center workspace at SOCHARA. We discussed an action plan for the next 3 years (with a focus on 2023-24) for the Digital Archives Platform unit at SOCHARA. The archives becomes a core activity for a community of community health activist-scholars and activist-professionals to do study, reflection, action, and experiment online towards “Health for All”. 

The larger hypothesis is that when we flood the internet with content related to community health, the second order and third order effects of that will lead to a massive movement by narrative building and discourse shaping towards community health.

The DAP at SOCHARA is going to focus on SOCHARA’s own reports, publications, presentations, videos, audios, etc for the first year (along with medico friend circle’s archive). This comprises items from Appendix A of Silver Jubilee Museum Archive Project that happened between 2016 and 2022. The year after that we will focus on Appendix B (which includes networks and organizations SOCHARA is connected to) and Appendix C (which has special focus themes and topics). What to do in year 3 will emerge by the end of 2023.

While this is just the Digital Archives part of it (which many organizations are now entering – NCBS, AICTU, APU, WIPRO, etc), there are many many other activities that this community can do:

• Communications for community health with things like podcasts, memes, reels, and so on need to be built.
• Stories of people and organizations need to be captured on wiki.sochara.org (which communityhealth.in now redirects to).
• A public discussion forum needs to be created (either as part of something like Azad Maidan or independently).
• Content of high quality and relevance like mfc bulletins and health taskforce report need to be modernized by conversion into web pages with hyperlinks.
• Effective sharing of resources with other similar efforts in the network has to be accomplished.
• The team at SOCHARA itself has to become comfortable with and active on these public documentation efforts.
• … (your idea here)

There’s plenty of interesting work that lies ahead. This month we will be focusing on the website and SOCHARA’s evolution story, physical clean up of the unused sections of the library, and getting “systems of sustainability” available for use of the team.

The workspace in HFA-LC, after the meeting. I forgot to take a photo while the meeting was happening. The empty chairs symbolize the space for anyone reading this to come in and be part of the community.

“Should a doctor treat an alcoholic who is injured due to drunk driving? Would your opinion change if it were just a solo accident v/s injuring/killing other people on the road?” asked @arshiet. The regular controversy. Should doctors judge their patients? Is it ethical to even ask the question of whether it is ethical for doctors to withhold treatment to anyone? What are the social determinants of alcohol use?

The issue is straightforward in the emergency room. You save life first and worry about alcohol and justice later.

But what about elective issues? If you are an obstetrician and you are pro-life, do you avoid elective abortions? If you are a pediatric surgeon and you consider circumcision as genital mutilation, do you avoid ritual circumcisions? Conscientious Objection – apparently that’s what it is called.

One of the solutions offered is that the healthcare provider can be upfront about the moral position and arrange a different provider. This helps the patient to retain autonomy and the provider to retain moral clarity.

Basically, doctors can’t simply cancel patients.

If we refuse to see the doctor-patient relationship as special, we can see that what’s at play here is the tension between “personal is political”, cancel culture, etc on one side and the practical realities of the world on the other side. I’ve personally gone through the self-isolation of ideological purism and come out with the ideology that it is okay to be altruistically pragmatic.

The world is full of people with incompatible ideas, values, and norms. If we start cancelling, we end up cancelling almost everyone. If we don’t cancel, we become an apolitical mess. The point is then about finding alternatives to canceling everyone. You cancel some, you strategically avoid some, you engage sincerely with some others.

That intelligent, “nuanced”, intersectional approach to politics is called life.

I’ve been in many debates where “science” is accused of being wrong. As if science is a set of things written down in a book or a set of ideas that are arrived at by a group of people. Something that has to be consumed by others. I’m baffled by this argument because, to me, science is a tool available for every human being to practice. It is my use of science to understand the world that matters to me. When I say “scientific method” I am talking about the method *I* use to arrive at the truth. It might be the same method that a professional scientist used, but I have to replicate that method and arrive at the truth on my own.

When chatting with Ravi Narayan (RN) yesterday about the SOCHARA archives, I had a very interesting realization. The way I used to look at history was the way these people looked at science. I thought about history as a set of facts written down in many books, as a scholarly consensus available to those who are in the elite universities. The thought I had was this: What if, like I practice science instead of consuming it, I start practicing history instead of just cataloguing it?

I can’t say that this thought had nothing to do with the discussion I was having with Upendra Bhojani about a Masters in History that UB was pursuing. History is a science. It is the science of the past. And without knowing the methods of studying history, I was basically being less effective as a historian.

And without being a historian, it is difficult to be an archivist!

So, I’m doing two things now:

1. Take on the identity of a health historian seriously and consciously.
2. Start practicing history.

Another insight I had about myself was that I learn a subject the best when I have a framework that fully encapsulates the topics in it. The more there are unknown unknowns in a subject, the less I’m interested in studying it. But when I have a complete and comprehensive “table of contents”, my brain feels comfortable in taking on that skeleton, slowly going through all of the actual contents and attaching things one by one into that skeleton. I need to first have the big picture before I let in even one of the finer details.

So, I made RN sit down and help me build that framework of how to think about the history of community health in India. After the discussion there’s a rough framework that is now emerging in my mind:

• Prehistoric times of British India
• Bhore committee and the first 25 years of independence. 
• The search for alternatives in the 70s and 80s
• Whatever happened in the 90s towards “Health for All by 2000”
• People’s Health Movement
• NRHM and NHM
• Ayushman Bharat and so on…

Much of the discussion with RN yesterday was about the 70s and 80s. RN took out 4 books on to the table:

• Health for All – An Alternative Strategy (ICMR/ICSSR)
• Alternative approaches to meeting basic health needs in developing countries (UNICEF/WHO)
• Health and Family Planning Services in India (D Banerji)
• Community Health – In Search of Alternate Processes (CHC)

I swiped them into my bag for weekend reading.

The NRHM bit was interesting. In my mind, the people’s health movement, the alternatives, all of these were failures. But, RN was like, “25 people out of this movement, who had by then (by NRHM formation time) formed the Jan Swasthya Abhiyan, are (were) consultants to the NRHM”. That was a light bulb moment for me. NRHM, in the biomedical colleges is taught like just another chapter, without giving it the emphasis that it deserves. That ASHAs who represent the shift into decentralization came through NRHM and how significant that is, is kind of forgotten. For me who started medicine in 2011, the idea of ASHA that was passed on to me was that of a healthcare worker like nurse or doctor, working with a very small population. But that’s totally missing the spirit and heritage of ASHAs and NRHM.

The story of ASHAs and the story of NRHM is thus the story of evolution of community health in India. And that’s the story we’re interested in.

Reflexivity. That’s a word very dear to sociologists. It just means how we look at the world is influenced by who we are. But like many things sociology, you give it a word and then you make a big deal out of it.

So much that some of the sociologists reading this post are already raising their hand saying “Hey, but you’re talking about ‘positionality’. Reflexivity is actually about how we take into consideration our positionality in our research”.

Shouldn’t the fact that how we look at the world is influenced by who we are automatically also mean that we should be cognizant of that and take that into consideration in our research? Apparently sociologists can’t do that automatically without having a different word for it.

Or maybe they can and I’m just stereotyping them. After all, my identities put me in the positionality of an anti-academic-sociologist.

This post is not about sociologists who don’t care about the world. And therefore I am not going to write about how there are some of them who just keep doing esoteric debates funded by public money in public universities.

This post is not about the superficiality of academia. And therefore I am not going to write about the publication game.

This post is about the sociologists who overcompensate for their identities.

It starts with privilege. By their very nature, there are a lot of people in academics and sociology who come from very privileged backgrounds. For some of them, academics might have led to their understanding of their own privileges. This can probably explain why they keep going back to jargon to describe the plight of the world, because it appears that without the words given to them by academics they find it hard to understand or describe the wrongs in the world.

My conjecture is that when they look at a subject like traditional medicine in the context of pluralist health system in India, they go “Oh, I’m from a privileged background and therefore I should compensate for my biases against traditional medicine. I shouldn’t be part of the ‘undemocratic’, ‘elitist’, and ‘self-centered’ biomedical field of this country, I should rather side with the ‘downtrodden‘” because I cannot imagine any other reason for one to claim that traditional medicine being sidelined as “unscientific” is because of the “political economy of knowledge production” and that scientific community has to devise ways to legitimize traditional medicine.

Modern medicine has several problems. The practice of modern medicine is riddled with problems too. Knowledge production in modern medicine has a definite politics. But to use these as arguments to promote traditional medicine is a sophisticated form of whataboutery. And some of these academicians do this as well so as to talk about traditional medicine.

I call these people “the overcompensating sociologists of public health”. Their “solidarity with the oppressed” is more about their own struggles than about the struggles of the people. They would rather stick to their arguments romanticizing traditional medicine (getting applause from the cult of anti-science orientalists) and have people die eating roots and leaves than have their praxis in the form of advocating for better access to quality healthcare.