Final reflections from my diabetes project

NOTE: I am still working through all my data and conclusions, so everything here should not be regarded as academic data driven arguments, but rather general observations

When I started reading about the growth of diabetes in India, all the public health literature boasted about the impending doom of growing chronic disease among the urban poor in developing countries. In fact, the Hult Prize social enterprise challenge, created jointly by PepsiCo and the Clinton Foundation,  for this year was a “call to improve chronic disease care in slums by 2019,” on the basis of the fact that chronic disease is growing in slum communities all over the world. Their call to action can be read here: http://www.hultprizesix.com/pdfs/2014-Hult-Prize-Challenge.pdf

The call to action, while important is a bit problematic because one, it assumes that all people slums all around the world face the same issues (and that only poor people live in slums). Two, it assumes that the government or private sector are not finding solutions for chronic disease (not true in my experience). And three, it makes claims despite the fact that there has not been much research done in the reality of diabetes in slum areas, especially from the perspective of the slum dwellers. We do not know a lot about what people think of the disease and what strategies they are already using to cope with the disease. While I understand that the Hult prize competition is well-intentioned, it seems to make a lot of broad sweeping generalizations about slum communities and chronic diseases in those communities without attention to the diversity of circumstances across all countries where the urban poor live in slums.

Community where I conducted most of my interviews

Community where I conducted most of my interviews

After interviewing over 70 diabetes patients and about 20 private doctors in a slum area in Mumbai, I have come to the conclusion that the slum dwellers are not victims of their disease but rather people who navigate a range of financial and health considerations to manage their diseases and live a normal life. People speak openly about diabetes in the community, share information about the disease with one another and together find ways to address the issue.

That is not to say that there are not any problems, or areas for intervention . Most people I talked to only found out about their diabetes after they developed some symptoms, which is a sign that they likely had high glucose levels in their bodies for a long time that were harming their internal tissues. People unfortunately are not in the habit of going to the doctor regularly for a health check-up. However, there was plenty of good news, everyone was taking medication currently or had taken it in the past, got their glucose levels under control and are now managing the disease through diet, exercise and/or alternative treatments. Thanks to Mumbai’s diabetes program, people can get free diabetes medicines in the government hospitals, but they have to return to the hospital every fifteen days for a check-up to receive their medicines. Because of this program’s structure, people are regularly up to date with the medicines and frequently check their glucose levels. The vast majority of the people I talked to were taking advantage of this program, even though they have to travel for quite a long time to get to many of the government hospitals.

The result? Only one of the people I talked to was taking insulin injections (a sign that the disease has progressed pretty far) and few had ever been admitted to the hospital or undergone any operations for complications due to their diabetes. The conclusion: people are working to actively keeping their diabetes in check. Everyone had received diet advice and most had received exercise advice from their doctors. While most people struggled to maintain a perfect diet on limited means and to exercise in a community with few public spaces, most said “Jitne hum kar sakte hain, hum karthe” As much as we are able to do, we do. Many of the doctors I spoke to in the community confirmed that community members were managing their diabetes well.

There are definitely some limitations with my study. I did my interviews during the daytime, so most of the people I spoke with were women who did not work during the day. Therefore my respondents had more time in the day to go to the government hospitals, wait in the long lines and get the care they needed. It would be interesting to explore how working adults are managing their diabetes and where they are getting their healthcare from (unfortunately, the timings of many government hospitals are not suited to long working hours). But it’s pretty hard to catch people who work 12-14 hours a day, so I’ll leave it to someone else to tackle that question.  It would also be interesting to explore the knowledge about diabetes among people without the disease to see if people are aware of preventative measures and risk factors for the disease.

Of course, there are probably places that fit the circumstances that the Hult prize aims to alleviate: limited access to healthcare, formidable costs for diabetes and widespread ignorance about the diseases. After doing my research I still think it is important to look critically at the resources and knowledge on the ground before designing any type of intervention.

In our well-intentioned but sometimes naive quest to help people, we often underestimate people’s abilities to understand complex information, access resources and address their needs. Sometimes, all people need is for the resources to be within physical and financial reach.

On Being a Woman in India: Final Reflections

Last August, during my first few weeks here, I wrote a blog post about being a woman in India. Re-reading that post now makes me cringe a bit. At the time, I was conflating my fear and constant confusion from being new in this country with being a woman in this country. I can now say, contrary to what I wrote in that initial post, I feel really comfortable here because I live in Mumbai which, unlike most other places in India, has a large population of working women and a relatively liberal and cosmopolitan culture. I’m never the only single woman on the street, especially in the area where I live.

But it is extremely important to keep in mind: my life is privileged, it is not representative of most Indian women’s lives and of how patriarchy, more specifically sexual violence, affects those lives.

I spent last week visiting my family members who live in small conservative towns in southern India. The visit has been a needed reminder that not all of India is Mumbai. Women there dress very traditionally, and very few women venture out onto the streets alone. While walking around on those streets, it feels like simply being a women gives men license to stare at me. My cousin who works as a lecturer at a college told me that she never leaves work alone. She always waits until a colleague is also leaving. Talking to them and experiencing a bit of life there made me realize just how nice it has been to live in a place where single women are relatively free and unthreatened when out in public space.

Still, though Mumbai is better than most places in India, my life here is still gendered in many ways. In any given public space, like a street or a train station, 80% of the people around are male. The male domination has an effect on those spaces and how I experience them, but I’ve gotten so used to my gendered behavior here that it feels like second nature. When I get onto a bus, I immediately scan for an empty seat next to a woman. I have mastered the art of avoiding eye contact with anyone (which is pretty difficult in the most densely populated city in the world). I don’t loiter; while men may hang out on any given street corner, even stopping for a moment to check my phone makes me nervous. As a woman my job is to go from point A to point B (otherwise, I might as well be a prostitute). Whenever I am lost or have a question, I always ask a woman or a shopkeeper, i.e. someone who is unlikely to “show me the way” to where I want to go.

All of these behaviors and considerations, though minor, add up to this huge gendered weight I carry with me. When I came home to the United States for two weeks in December, I remember walking around on a street and realizing the weight was no longer there. It felt like such a huge relief. That isn’t to say that sexism does not exist in the United States, but that as a woman I have a much larger right to public space in the U.S.

And again, my experience is not at all representative, but my point is that even with my relatively free and privileged life, that gendered weight is still there. So imagine how bad it would be for a woman with limited freedoms and privileges? Pretty damn terrible.

The other week, at a talk on sexual violence in India, the speaker pointed out that sexual violence is intertwined with a larger system of patriarchy, class and casteism in India. It is an integral weapon that the patriarchy uses to maintain power. While much of the media attention around sexual violence and rape centers around gang rapes of upper class women by lower class men or sexual violence against foreigners (which are still problems), the vast majority of sexual violence that occurs in India are inflicted by upper class/caste men against lower caste/class women. These instances of sexual violence often occur by male heads of households against house maids and servants or by members of the upper class/caste community against female members of the lower caste communities. Since May, there has been a big controversy about the Badaun gang rape case in a village in Uttar Pradesh. Two girls from a backwards caste had gone out to the field at night to use the toilet. They did not return home, so the family reported them missing to the police. The police did nothing that night. The two girls were then found dead and hanging from a tree in the morning. In a post-mortem report, they were found to be raped and DNA evidence showed that the assaulters were members of a slightly higher caste community. The police and the UP government have unfortunately been slow to do anything in the case. They are repeatedly defending the rapists, and discounting evidence because of inconsistencies in the girls’ families’ accounts. They have ordered a second autopsy of the girls and another post-mortem report, so the investigation is still going on. The case is indicative of the kind of indifference and victim blaming used by the police and the government in sexual assault cases, which goes all the way up to senior government officials. To quote the state chief secretary, “Rape is a trivial incident and it should not be blown out of proportion by the media. The media should also look into the incidents where people have been falsely implicated in such cases.” No wonder many women never approach the police about their sexual assault. Because of the sheer power differences between the upper caste men and the lower caste women, most women feel completely unable to do anything about the situation.

Unfortunately, the sexual assault cases that are taken to court are often not the ones that need to be. A recent study by The Hindu of the sexual assault cases that came before six district courts in Delhi showed that 40% of the cases involved were filed by parents against their daughter’s husband or boyfriend, accusing him of rape and abduction. This was usually because the girl entered an inter-caste or inter-religious marriage against her parents’ wishes. Another significant portion of the cases involved women who had consensual sex with a man on the condition that he would marry her, and then he later retracted that promise. Only 162 of the 600 cases involved actual nonconsensual sex, and most of those involved older men, family members or neighbors, preying on young children.

The situation is grim, the cases that need to be prosecuted are ignored by the police and the ones that get into the courts are ones that are usually pushed through by the girl’s father, not the rape victim herself. In other words, men control who gets to be called a rapist and what gets to be called rape. It is no wonder that little justice for sexual assault is ever achieved.

Unfortunately, the media attention around sexual assault and common perception of increased violence against women in India is achieving exactly what the rapists and beneficiaries of patriarchy want to achieve: increased fear among and control over women. While more women in India are working than ever, they are increasingly told not to leave the house after a certain time (as early as 5-6 pm) or even to never leave the house without being accompanied by family members. Because of all this policing, the women who do choose to leave the house alone, especially at night, are even more vulnerable and considered “asking for it.”

Fortunately, there are now many more public protests and many women’s rights groups working to improve the situation for women in India. There is so much more media attention around women’s issues and global pressure for the situation to change. I can only hope that this pressure is strong enough to meet the sheer power and predominance of patriarchy in this country.

I hope that one day in my lifetime I will return to India and see streets where women represent half of those in public space, where they feel free to loiter and hang out and most importantly, where they feel unafraid to be themselves.

Constant contemplative confusion: My last few months

“India is a pluralist society that creates magic with democracy, rule of law and individual freedom, community relations and [cultural] diversity. What a place to be an intellectual…I wouldn’t mind being born ten times to rediscover India.”- Robert Blackwill, US ambassador

The above quote, taken from Ramachandra Guha’s India After Gandhi perfectly encapsulates how I have felt during the past seven or so months. After interviewing well over one hundred people for my project, having casual conversations with people from from all over the country, participating in the intellectual life of this city and the university, and reading plenty of journal articles and books I have been mulling a lot of ideas. Ideas about modern India, about disease and healthcare, about world and its huge social, political and economic problems. As most students eventually find out, the more I learn the stupider I get. I become more and more aware of all the things I don’t know. And that’s why I haven’t been updating my blog as much. I am in a state of permanent confusion about what I think of the world.

Staying in a place for longer changes you, it changes your thoughts and it makes you slower to jump to conclusions and it makes you take everyday life for granted. As an author I met in Vietnam once said, you live in a place for a year and you can write a book about it, but if you live in a place for ten years you would never write a book about it.

My time in Mumbai has been a constant process of thought revision. I think things are one way and then I learn something that challenges that notion, and the process continually repeats. This happens with everything from women’s issues, to the health issues that I am researching to broader social, political and economic issues I observe and think about on a daily basis. I am constantly learning and evolving, and therefore constantly confused. There have been numerous blog posts that I have started, wrote almost completely, but then felt dissatisfied. This argument does not quite fit my opinions on this issue, but I can’t quite put my finger on what the real argument should be.

But now I’ve been contemplating these issues for long enough that it’s time to wind up those blog posts. It’s time to end my last month here with some solid reflections. So hold me to it friends. I’m going to publish a post every week this month. Please pester me if I do not.

On the Indian Elections

Tomorrow, after a month of voting all over the country, India will announce its next prime minister. It has been exciting to witness this massive and historic election. It has made me think deeply about nature of India today and its imminent future. I will admit that I am no expert in Indian politics. While I have tried to follow  the news, there is still so much context that I am continually learning. I therefore write this, not as an informed expert, but as a casual observer in awe of India’s colossal democracy.

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Voting in Mankhurd in Mumbai

Unlike in the U.S. I do not have much at stake in this election, so it has been interesting to just watch and to just ask the opinions of people I meet. Unlike in the U.S., politics is not such a touchy subject, when I ask people are more than willing to tell me who they voted for or what they think about the country’s situation. 

This election is particularly exciting, because as the media harps, it is India’s first “presidential style election.” What that means is that this election is based more on the personalities of people poised to become prime minister. In the past, where voting was generally based more on issues or parties.

To give some background, since Independence, India has been primarily governed by the Congress party started by Mahatma Gandhi and India’s first prime minister, Jawarhal Nehru. The Congress party is primarily secular and somewhat left leaning. Since Independence there have also been various religious oriented parties, like the Bharatiya Janata Party that have campaigned for a India based on Hinduism. Aside from these two major parties, there are thousands of local parties who elect representatives that usually form alliances with the two major parties. In the past, people have often voted based on the local representatives and the platform they represent (or the money they give out to voters and outlandish promises that are made). 

This election, however, is different, in large part because of the characters running for prime minister: Narendra Modi, Rahul Gandhi and Arvind Kejriwal. 

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Narendra Modi. Image from Forbes

Modi is the main BJP candidate and he is a contentious character. People either fervently love him or strongly fear his ascension to power. He has an amazing rags to riches story: he was born to a low-caste family and sold tea at a train station with his father as a child. He was a volunteer for the RSS, another Hindu nationalist party from a young age and became a strategist for the BJP after finishing his education. He rose the ranks to become chief minister of Gujarat, but during the first few months of his term, some of the worst religious violence of India’s modern era occurred in Gujarat. Thousands of Muslims were killed In response to rumors that Muslims had burned a train car full of Hindu pilgrims. Modi was accused of doing little to stop the violence and even of condoning the violence and having direct involvement.  

Despite this blight on his record, Modi has been known for his work to improve economic development in the state of Gujarat. He is said to have helped attract industries to Gujarat, reduce corruption and help improve the state’s infrastructure. While his record in Gujarat is also debatable, he is also quite popular because of his arousing speeches that move people to Modi bhakt (worship). 

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Rahul Gandhi. Image from wikipedia

Rahul Gandhi, the Congress party candidate would be expected from historical experience to win this race. He is from the family that has produced India’s prime ministers since independence, when his great grandfather Jawarhal Nehru served as India’s beloved first prime minister.It would seem that he has a right to the throne, but India is quite tired of the Congress party. Many Indians I have talked with feel that the stagnated economic growth, corruption and high prices of goods is due to the Congress party’s poor leadership. Rahul Gandhi is also somewhat awkward and fails to really inspire anyone; many who are voting for Congress are doing so to counter Modi.

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Arvind Kejriwal. Image from Wikipedia

To add some masala to the curry pot, Arvind Kejriwal formed the Aam Aadmi party (the common man party) to protest the corruption in both the congress and BJP party. He worked for the Indian Revenue Service, and through grassroots initiatives worked to campaign against corruption in the government. In 2012, he launched the Aam Aadmi party as an anti-corruption alternative to Congress and BJP. He was elected as Chief Minister of Delhi. It surprised everyone to see someone from an outside party win such a huge seat. However, 40 days after entering office he resigned because the government failed to pass an anti-corruption bill. People either admire Kejriwal for sticking to his values or think he is a quitter who cannot be trusted to make the compromises and negotiations needed in a diverse government. He is now contesting for a seat in the parliament and campaigning to be considered for prime minister. 

Everyone I have met seems to have strong opinions towards these candidates in one way or another. Both Modi and Kejriwal are immensely popular amongst many young people. As one girl said, “The only thing keeping India from becoming a superpower is its government, if India is governed well we can become a first world nation” Many young people see Modi as India’s opportunity to renew its economic growth that has stagnated over the past few years. Getting a good job has become ever harder for recent graduates. They see Modi as an opportunity to relive the years when companies competed for employees rather than the other way around. Others, who are not convinced of Modi’s rhetoric and are worried about his involvement in the Gujarat violence, believe in the idealism of Kejriwal and believe that he represents a commitment to morality that is missing from the current government. 

Still, politics are heavily divided along sectarian lines. While much of the western and some of the Indian media raises concern that a Modi win could increase sectarian violence in India, many Hindus dismiss this as hype. Yet, the other day while sitting in the home of one of my Muslim research assistants, an ad for Congress came on T.V. I asked the teenage girl what she thought about the Congress party and she told me that “The Congress party does everything they say they are going to do” and that, “If Modi wins, there are definitely going to be fights between Hindus and Muslims.” I worry what a Modi win could mean for safety all over India, given that Muslim communities are already generally poorer and more marginalized.

The recent exit polls suggest a strong win for Modi, which does not surprise me. Many people I have talked to from auto drivers to my host family in Jaipur are tired of the increasingly high prices of goods and rampant corruption in the government; they want change from the old Congress establishment. If Modi does win, the election will mark a huge historic shift in India: a sharp and complete departure from the slowly eroding Gandhian ideals that founded the Congress party to a focus on neoliberal capitalism and modernization with Modi.

While I understand the frustrated Indian’s desire for such a shift, I can’t help but wonder what India is going to lose over the next decade. Will the local bazaars be replaced with giant Walmarts? Will even more farmers shift to work labor jobs in the cities after being displaced from their land? Will India continue to lose its age old medical and agricultural knowledge in favor of flashy technical advancements? I could continue to articulate my fears and questions, but this editorial does a much more beautiful and concise job: http://www.dnaindia.com/analysis/column-when-leaders-try-to-become-six-pack-technocrat-heroes-that-machismo-can-be-dangerous-1988370

No matter what happens, tomorrow will be a new and interesting day.

 

 

What Public Health Looks Like: Community Health Volunteers in Mumbai

Despite her limp, Priya* navigates quickly and steadily through the narrow lanes and puddles of the slum. When she reaches a door,  she leans against the frame and uses her cane to pound against the door shouting “Baaabi, eh baaabi!!” The people next door laugh. They tell me that everyday she wanders through the community. From her shouting, they can anticipate her arrival long before she gets there.

Priya is a community health volunteer (CHV) at Shivaji Nagar slum. I accompany the CHVs into the community to help identify people to work with for my research, but I find it fascinating to see them working daily to promote health in their communities.

On the day I followed Priya, she was going door to door to make sure the children of the community were vaccinated, especially against polio. India has very recently eradicated polio and through efforts of women like these, India stays polio free.

We would visit some homes to have the families roll their eyes. Yes, we got the vaccine like you told us to. Here is the vaccination sheet. Priya would quickly jot down the vaccination dates and carry on to the next house. Some homes, however, would shamefully admit they hadn’t gotten the vaccination yet, giving some excuse or another. Priya would admonish them to go to the health center that very afternoon to get vaccinated.

After spending so much time reading negative portrayals of public health in India, it is encouraging for me to see people doing such a good job improving the health of their communities. I regularly read about the alarmingly low amount of money spent on health in India and the alarmingly high prevalence of disease and malnutrition, especially in comparison to countries with lower average incomes.

Walking around with the CHVs presents a different story: health matters and these women are invested in it.

I accompanied another women, Ash, who was trying to find a patient who had been admitted to the hospital for severe gastrointestinal problems. We searched and searched throughout the community, with only the name of the woman and neighborhood (one in which several thousand people live) on hand. After lots of nos and perplexed looks, Ash finally came across one woman who heard the name and immediately recognized it. She led us to a very narrow lane and we came across a green painted metal house. Despite the time spent looking for the woman, the conversation was quick and then the CHVs immediately started asking the neighbors about whether they had the same disease symptoms.

Ash explained to me that they needed to search for the woman to make sure there was no disease outbreak. Polluted water or contaminated food could potentially lead to a devastating outbreak if not curbed early. They wanted to make sure that this was an isolated incident.

Many of the women have been doing this work for over twenty years. They tell me that it was very difficult before. They struggled to get people to listen to them. Now people are more aware of the importance of their advice.

Following the CHVs makes me appreciate the kind of effort it takes to address health inequalities. I often think or hear about public health on such a huge and abstract scale: numbers, percentages, growth rates, etc. But walking around with the CHVs, I can’t help but think: this is what public health looks like, real, raw and day to day

*Name changed

Food as a Gift: Chronic Disease and Culture

“Take more! You have eaten too little!”

Is perhaps the mantra of gracious Indian hosts. In many families, it is considered an act of generosity and the duty of a host to insist that their guests continue to eat, no matter how much has already been consumed. While I always appreciate the hospitality, I can’t help but feel a little unnerved when I get goaded to overstuff myself. As someone who has struggled with my weight for the majority of my life, I resent being pressured to act in a way that harms my health.

In a paper on diabetes among Emeratis in Dubai, Rosslyn Badar  wrote about how the culture of food as a gift is contributing to a rise of chronic disease in Dubai. Giving guests large amounts of food when they visit is considered expected, and the greater quantity and richness of the food, the better the host. As Dubai’s economy has boomed and processed foods have become increasingly accessible, this food culture has contributed to the growth of diabetes and chronic disease. The food culture also makes it difficult for those with the disease to maintain a healthy diet.

Indian meal

This culture exists, not because hosts want to make sure their guests get fat, but because it developed in a time of food scarcity. In the past, the quantity of food available was generally smaller and of higher nutritional quality. People also did plenty of physical labor, and were in need of large quantities of food.  Getting your guests to eat more food really was a gift that contributed positively to their health.

Now, there is a mismatch between environment and culture. I am fortunate that I get to control my own food intake on most days, but there are people who face such cultural expectations around eating food from their families everyday. In this environment, it is easy to lose a sense of what foods are healthy and of how much food is enough. It’s no wonder that obesity and chronic disease are rapidly growing in India and in the Middle East.

I have also noticed that sometimes the idea of eating for health, especially for young people without a chronic disease, simply does not exist among many of the older generation.

Last week at a meeting, my host served me some very sugary mango juice. I took a small amount to be polite, but the host insisted “Drink more! drink more!” I thanked him for offering but told him that the juice had too much sugar for me. He then said “Oh, I should have brought Pepsi.” I realized in his mind, he conflated sugar with sweetness, which was not what I meant. The idea of not drinking something because of its sugar content seemed foreign to him.

Another time, at a conference chai break, I saw “sugar free chai” and I went for it, given that I had already had a few servings of sugary chai that day. The older man who preceded me in line stopped me and said “No, this is sugar free chai” and I replied “Yes, I know.” He gave me a strange look and baffledly asked “You like drinking this?”

Last week, the maid at our apartment saw my leftover oatmeal, made without milk and sugar and got angry with me. “This is not good!” she said, “Do not eat it like this!” I tried to explain that I liked it that way, but she took my oats and made a sugary soupy concoction. “This is much better,” she said. I admit it was tasty, but I had trouble explaining that for me, “good” means healthy not tasty.

It seems to me that in many older Indian adults’ minds, it makes no sense to control one’s diet when young and healthy. Controlling one’s diet is something one does after being diagnosed with a chronic disease like diabetes or hypertension. Few realize that preventing a disease is much easier than managing or treating it. I have a family history of diabetes, so I know I am at high risk. I know that the best I can do is to develop a healthy lifestyle now, rather than later.

I realize I am also viewing these issues with my own cultural biases. Anthropologists have written about how many communities in the United States view being fit or thin as a cultural measure of one’s value as a person. People who appear more fit gain more respect and admiration in our culture. In a sort of social ritual, women especially, often discuss what they eat and how much they exercise to boost their image. Refusal to eat unhealthy food is highly admired, and eating excessive quantities of unhealthy food is shamed (especially for people who appear overweight or obese).

Ironically, our culture does not necessarily lead to better health. It can contribute to fat shame: feelings of inadequacy and hopelessness among people who struggle with controlling their weight. That sense of shame can make it even harder to change one’s habits. The American culture around food can also lead to obsessions about food and weight that result in eating disorders.

Worldwide, we need to find a way to think about food and our relationship to it in a healthy way: a way that celebrates food for the life it gives us, but ensures we eat it in a way that sustains us.

What do you think an optimal food culture would look like?

The east-west academic divide

Recently, I attended a lecture at Tata Institute of Social Sciences (TISS) on epistemologies of the global south. For those of you who scorn academic speech, it was basically about how people who live in developing countries (the global south) view truth and create knowledge differently (epistemologies). For anyone with an anthropology/social science background, the talk was pretty elementary: it was about how social science is too dominated by western scholars. Many communities in the developing world see the world differently, and those viewpoints need to be captured to produce better scholarship and solve social problems. 

But the talk left both my friend and I feeling uncomfortable. Here was a man from Europe, lecturing to an audience of Indian social scientists at one of the best institutions in the country about how their voices needed to be heard on the global stage. Yet, who was talking? The question and answer session revealed that the audience was full of scholars who thought about the issues he was posing on a deeper and more nuanced level. 

Spending time in the Indian university setting, especially at a social science based institution, has made me more aware of the big divide between western scholarship and that of developing/non-western countries. 

TISS produces a lot of great work and there are many people here with deep knowledge about social problems in India. Yet, these scholars often only publish in Indian journals or do not publish at all. Confined to these publications, it is hard to gain exposure outside of Indian academia.

Then, there are western scholars from the United States and Europe who publish work about India, exploring the same issues, but often getting more “credit” for publishing and presenting their work in the western world. 

I have done a lot of reading on alternative systems of medicine in India, and I’ve seen two different conversations that barely acknowledge each other: that of the Indian academics and that of the western academics. I remember one Indian paper even used the world “sketchy” to refer to sociological and anthropological work on Indian alternative medicine produced by scholars in the west.

There are many reasons why Indian scholars may not be publishing in western journals.  Anthropology, like any other field, requires scholars to frame their work within existing theories. Many of the major theories are created by dead white men who were involved in colonization. 

Why should an Indian scholar, working to boost the cause of the oppressed frame her work through the lens of an oppressor?

To quote the lecturer mentioned at the beginning of this post: “The theories we have developed do not allow most people in the world to conceive of them as their own”

There’s also the general problem of being institutionally excluded from the academic dialogue in the west. Often, I find an article that looks relevant to my research and then click on it only to find that the university does not have access to the article. This happens even with major journals. I find it surprising that even a great institution like TISS has limited access to journals, but it makes sense. Journal access is expensive. 

Without proper journal access, it can be hard for an Indian academic to have a full sense of the ongoing debates in social sciences. 

Finally, the whole project of people from the west coming to the east to “study the Indians” is itself problematic. It ignores the ability of Indians to construct their own evaluations about their society and its problems. It is a continuation of an ugly history that positions people in the west as “the researcher” and people in non-western countries as the “studied.”

Understanding more about the issues around academics in India has made me rethink my Fulbright grant. At first, I dreamed of producing “original” or “cutting-edge” research. I’ve realized I need to be more humble. There are many people around me with much, much more knowledge than I have. There are people who have explored the issues I am interested in, in much more depth than I will by the end of this grant. The mission of the Fulbright program is “to create mutual understanding amongst people around the world.” I’ve realized that I should rather use this time to listen to the expertise of the people I meet and work with them to elevate their voices on a larger scale.