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Reconciliations of Caste and Medical Power in Rural Public Health Services
Drawing from an ethnographic study conducted in a Karnataka village, the unfavourable differential treatments against Dalit patients in rural public health services are delineated. An analysis of medical interactions shows that as compared to non-Dalits, Dalit patients experienced more apathy, denial, and avoidance behaviours from service providers. Surprisingly, most Dalits did not attribute this to their caste, but to the flaws of the public health delivery system. Caste and allopathic medical practice are embedded in the rural public health delivery system, and both camouflage and normalise discrimination in paternalistic medical interactions. This sustains the favourable environment for caste-based discrimination in rural public health services even in places where Dalit consciousness is strong.
This article is drawn from a research project supported by the Indian Council of Social Science Research, New Delhi. The author thanks Shrinidhi Adiga, Lucky Prithviraj, and Hussain Sab for their support in the fieldwork. The author also thanks the anonymous referee for the useful comments and suggestions.
The unfavourable health outcomes of Scheduled Castes (SCs) and Scheduled Tribes (SCs) as compared to other social groups in India have drawn scholarly attention to the possible discriminatory practices against them in the delivery of public health services. Studies, using the lens of inequality, discrimination, and social exclusion, have discussed the poor health outcomes of SCs and STs vis-à-vis other social groups (Kulkarni and Baraik 2003; Dilip 2005; Dasgupta and Thorat 2009), forms of caste-based discrimination against SCs in public health services (Shah et al 2006; Acharya 2010; Pal 2016), possible relationship of inferior health outcomes of SCs and STs to their marginal sociocultural positions (Borooah 2010; Borooah et al 2012), and consequences of discrimination on their health and health-seeking behaviours (Navaneetham and Dharmalingam 2002; Saroha et al 2008). While there are notable academic efforts, it continues to be a difficult task to delineate caste-based discrimination in public health services due to several systemic problems and methodological limitations. First, the dominant narratives on the general problems of the public healthcare system, which everybody experiences in a more or less similar vein, make it difficult for people to differentiate the expressions of caste in medical encounters. The second issue relates to the nature of medical practice itself. For instance, the service provider, being an expert, is always considered to be in a “better position” to decide the nature of personal interactions required with the patient. For instance, certain diseases have known common patterns of symptoms, which sometimes make the diagnosis less cumbersome for the doctor without involving probing, touching, or conducting further examinations.
This mismatch between the expectations of the patient and the requirements from service providers (Bury 2001), hence, becomes a problem while considering perceived negligence as an analytical category to locate caste-based discrimination. The third is the difficulty in understanding the changing nature of caste relations, which are situation specific. Available studies often tended to view Dalitness as a common experience without adequately problematising the strengthening Dalit consciousness, agency, and the many experiential dimensions of caste, which vary from situation to situation.
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