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This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

Following the recognition that ‘culture matters’ in designing effective public health programs, this paper focuses on one refraction of culture within the so-called ‘homosexual’ community in India, to highlight how attention to local knowledge and its socio-economic underpinnings can impact the politics of health care. Drawing primarily on ethnographic fieldwork conducted from 1995–1997 and 2003 in the South Indian city of Hyderabad among hijras (the so-called third sex of India) as well as the wider community of MSM or ‘men who have sex with men’, the paper argues that public health framings of homosexuality often fail to pay attention to differential understandings of stigma and their socio-economic underpinnings, a failure that accounts in some measure for the ineffectiveness of prevention programs targeted at ‘high risk’ communities such as hijras and MSM. Focusing on the local moral economy of respect and shame as one pathway of stigma and contagion, and in particular on the differences in constructions of respect and shame between hijras and the wider community of MSM, this paper points at one small way in which understanding how culture matters can ultimately address the ineffectiveness of prevention programs and redress the inequalities in health outcomes between the various margins and centers of power. [ABSTRACT FROM AUTHOR]

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism. [ABSTRACT FROM AUTHOR]

Based on fieldwork and archival studies carried out since 1995, this paper is an analysis of the dialogue between the Jarwas and the outside world. The Jarwa tribal community on the Andaman Islands has a long history of voluntary isolation and pronounced hostility towards outsiders. This situation only started to change in the mid-1990s, when a young Jarwa was successfully treated at a local hospital. The Jarwas’ sudden fascination with modern medicine was less to do with its therapeutic powers than the fact that, on each visit, hospital staff gave them food, clothes, and various consumer items. This paper describes events in the Jarwas’ ‘junket to modernity’. Before discussing recent events, the paper first retraces the history of relations between the Jarwas and the outside world during the second half of the 19th century, when life on the Andaman Islands was dominated by a British Penal Settlement. In the face of epidemic outbreaks of pneumonia, malaria, and measles, tribal health has become a major concern for the Indian authorities. The paper discusses continuities and discontinuities in medical concerns with the tribal body, and argues that ‘marginalization’ must be understood as a practice of mutual constitution. [ABSTRACT FROM AUTHOR]

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2–3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful. [ABSTRACT FROM AUTHOR]

This article examines challenges facing implementation of likely mHealth programmes in rural India. Based on fieldwork in Andhra Pradesh in 2014, and taking as exemplars two chronic medical ‘conditions’ – type 2 diabetes and depression – we look at ways in which people in one rural area currently access medical treatment; we also explore how adults there currently use mobile phones in daily life, to gauge the realistic likelihood of uptake for possible mHealth initiatives. We identify the very different pathways to care for these two medical conditions, and we highlight the importance to the rural population of healthcare outside the formal health system provided by those known as registered medical practitioners (RMP), who despite their title are neither registered nor trained. We also show how limited is the use currently made of very basic mobile phones by the majority of the older adult population in this rural context. Not only may this inhibit mHealth potential in the near future; just as importantly, our data suggest how difficult it may be to identify a clinical partner for patients or their carers for any mHealth application designed to assist the management of chronic ill-health in rural India. Finally, we examine how the promotion of patient ‘self-management’ may not be as readily translated to a country like India as proponents of mHealth might assume. [ABSTRACT FROM PUBLISHER]

The Type 2 diabetes epidemic in India poses challenges to the health system. Yet little is known about how urban Indians view treatment and self-care. Such views are important within the pluralistic healthcare landscape of India, bringing together allopathic and non-allopathic (or traditional) paradigms and practices. We used in-depth qualitative interviews to examine how people living with diabetes in India selectively engage with allopathic and non-allopathic Indian care paradigms. We propose a ‘discourse marketplace’ model that demonstrates competing ways in which people frame diabetes care-seeking in India's medical pluralism, which includes allopathic and traditional systems of care. Four major domains emerged from grounded theory analysis: (1) normalization of diabetes in social interactions; (2) stigma; (3) stress; and (4) decision-making with regard to diabetes treatment. We found that participants selectively engaged with aspects of allopathic and non-allopathic Indian illness paradigms to build personalized illness meanings and care plans that served psychological, physical, and social needs. Participants constructed illness narratives that emphasized the social-communal experience of diabetes and, as a result, reported less stigma and stress due to diabetes. These data suggest that the pro-social construction of diabetes in India is both helpful and harmful for patients – it provides psychological comfort, but also lessens the impetus for prevention and self-care. Clarifying the social constructions of diabetes and chronic disease in India and other medically pluralistic contexts is a crucial first step to designing locally situated treatment schemes. [ABSTRACT FROM PUBLISHER]

Over the last three to four years, an increasing number of private and public sector tertiary level hospitals and research centres in India have been using stem cell therapy, especially adult stem cell therapy, in the guise of experimental therapy for a variety of medical conditions. The promotion and growth of this experimental field across local and national borders traverses regulatory, ethical, social and financial boundaries. In this complex context, the article examines how healthcare centres in India negotiate bio-medical and health care circumstances in promoting a therapy that raises questionable medical, technical and ethical issues. The process of promoting experimental stem cell therapy is explained here by employing the concept of bionetworking and illustrated by two case studies of hospital groups. The case studies show how through bionetworking a centre creates and maintains novel networks of mutual exchanges with other collaborative bodies situated in local, national and global relations of inequality. Drawing on a three-month period of fieldwork and interviews in various locations in India, this article shows that: (1) Questionable stem cell therapy is promoted through bionetworks that resonate across local, national and global constellations; (2) Regulatory gaps facilitate the growth of such therapeutic practices; (3) The experimental stem cell therapies augment the healthcare divide in Indian society; (4) The weakening Indian state facilitates commercialisation of health, indirectly supporting the 'bionetworking' practices of therapy providers. [ABSTRACT FROM AUTHOR]