High medical costs, the impersonality of technology-intensive speciality medicine and the difficulty in accessing curative primary care constitute a crisis for medicine in India. Towards a Critical Medical Practice is the outcome of a dialogue between a self-critical medicine and the new social sciences that offers original perspectives on the crisis.
A set of historical studies provides fresh insights into the dilemmas that surround cholera, kalaazar, post-traumatic stress disorder, ischemic heart disease, and undernutrition in contemporary India. Another group of papers argue that the public health focus on large-scale preventive programmes has resulted in the underdevelopment of primary care in the curative mode. This deficit in curative care is targeted by the new corporate hospitals that adopt as standard an expensive and inappropriate form of tertiary care that is marketed globally. Doctors trained in a tertiary setting are ill-equipped to provide appropriate medical care in any other context. This book is a path-breaking study which captures the drama of the crisis as mirrored in the lives of the poor battling illness on an everyday basis.
Doctors practice against this formidable backdrop of knowledge, orientation and elitism of modern medicine. The constant everyday work of translating knowledge and experience to address a local situation and do justice to the individual patient remains largely invisible and undervalued in modern medicine. We argue that theorising this practice, be it in teaching or in research, will open up new directions in health care and medical education.
Introduction: The Dilemmas of Medical Culture Today
Anand Zachariah, R. Srivatsan and Susie Tharu
Section I: Genealogies of Medicine in India
1. What Makes a Disease Marginal: Tracing the History of Kalaazar
Anand Zachariah and R. Srivatsan
2. PTSD, DSM and India: A Critique
K. S. Jacob
3. Medicine and Government: Histories in the Present
Section II: Health in the Time of Development: Primary Health Care, Nutrition and Population Control
4. Working the Contradictions: Three Decades
5. Andhra Pradesh: Ground Level Observations
A. P. Ranga Rao
6. The Career of Hunger: Critical Reflections on the History of Nutrition Science and Policy
7. Different Readings: Demography and Population Control
8. Development and the Administration of Public Health: An Overview of Contemporary History
Section III: Tertiary Care Medicine, Evidence Based Medicine, Pharmaceuticals and Cost
9. Rethinking Organophosphate Poisoning/Suicide in India
10. Development of the Cardiovascular Epidemic in India and Inappropriate Tertiary Care Treatment Guidelines
11. Drug Pricing and Access to Health Care: Some Issues and Options
Section IV: Thinking with the Patient
12. The ‘Intractable’ Patient: Managing Context, Illness, Health Care
13. Patient Questions
Duggirala Vasanta and Seemanthini Niranjana
14. After Ervadi: Healing and Human Rights in the Context of Mental Healh
Section V: Resources of Practice: Calibrating Medicine to the Needs of Patients
15. Rethinking Practice(s)
16. Practice in the ICU: The Case of Organophosphate Poisoning
Sujoy Khan and Anand Zachariah
17. Peoples’ Struggles Producing a Curative Public Health for AIDS 299
18. Reclaiming Primary Care: Managing Depression and Anxiety in a Different Framework
K. S. Jacob
19. What Constitutes Evidence Based Practice in Rehabilitation?
Anand Zachariah is Professor of Medicine at Christian Medical College, Vellore.
R. Srivatsan is Senior Fellow at the Anveshi Research Centre for Women’s Studies, Hyderabad.
Susie Tharu was formerly Professor and Coordinator, School of Critical Humanities at the English and Foreign Languages University, Hyderabad.