Another plague hides in plain sight
चढ़ते उतरते दम की खबर ले
फिर नहीं आना बनता कबीराchaDhte utarate dam kee khabar le
fir naheen aanaa bantaa kabeeraaListen to the rise and fall of breath
Kabira, there’s no life after death
The images from the last plague that ravaged us are already beginning to fade from memory. Away from the paranoia and anxiety of those times, it seems that avoiding the infection was a far simpler matter than was made out. And yet, lakhs of people were displaced, stranded on forlorn, dusty railway stations, dying from neglect. We saw streets outside hospitals crowded with the sick, their breaths slowly fading as an overburdened medical system struggled to mete out care. We saw pyres upon pyres, and deaths so insignificant that they weren’t even granted assurance of statistical acknowledgement.
As these scenes unfolded, what we already knew came into stark relief—how little our social organisation cared for the vast majority of its population. We don’t care how most people live, how they earn their living, where they sleep, what they eat, as long as we can extract the necessary labour from their bodies. As soon as it came time for the state to provide care and aid during an emergency, they were left to fend for themselves, their citizenship a nuisance to the nation.
Then the plague went away and the questions that we faced remained unanswered. ‘Normalcy’ returned, people became accustomed to the precarity of others. What was the need to change it? After all, the emergency had passed. But another plague rages on amongst the disadvantaged classes and castes in India, caused by the same precarious conditions that forced them onto the streets during the pandemic. Tuberculosis. In the West, TB is a rare disease thanks to the successful disciplining of its public over the last couple of centuries. India, however, accounts for 30% of the world’s TB cases. In the year 2023, 28.2 lakh people suffered from the disease and 3.4 lakh died from it. About 50% of the affected suffer from malnutrition.
The systems of care designed for the disease borrow heavily from colonial techniques of surveillance and suspicion. Since the TB bacteria tend to develop antibiotic resistance if medication isn’t provided on time and in a proper manner, the state doesn’t permit patients to either possess or administer drugs themselves. Patients are to visit clinics near their registered address and take only the medicines registered to their names—they have to become transparent before the audit mechanisms of the state. It does not take into account how large sections of the population live far away from their homes, with no permanent address or paperwork. How intersections of identity make it difficult for them to reveal themselves fully. How travel and months-long investment in treatment is a luxury for most. Care, therefore, becomes an ideological battleground tangled with atmospheric impurities, trying to discipline subjects that are too ‘unruly’ to fit into assumptive bureaucratic frameworks.
Andrew McDowell charts these contradictions with profound sensitivity in Navayana’s latest offering, Breathless: Tuberculosis, Inequality, and Care in Rural India. It is rare to find an ethnographic work that is literary and scholarly at the same time. McDowell achieves this by exposing himself to the lives of the people he engages with, writing with a candour and vulnerability rare in academia. He limits his fieldwork to Ambawati village in Rajasthan, midway between Delhi and Mumbai, where the western wind kicks up a dust. Its residents are mostly Adivasis and Dalits, and tuberculosis is rampant. Himself from a farming family in the rural United States, McDowell becomes entangled in the lives of Ambawatians. He learns their languages, works on their farms, becomes a confidant and friend to many.
As he observes their lives and talks to them about TB, he sees how care isn’t limited to the poor services provided by the government. Breath, air, wind, clouds, mud, and all such atmospheric elements, make their presence felt, as people cope with the debilitations of the disease. We meet a young boy forced to leave school so he can take up the seemingly trivial duty of fanning his TB-affected grandfather. We meet an old man stricken by the memories of mud that covered Ambawati decades ago, seeing his TB as an effect of ancient traumas. We find that there are three different kinds of breath—praan, dum and saans—that Ambawatians attend to when they care for each other. We find how the caste status of people changes across different forms and according to the respectability required in different contexts. McDowell spends time at tea stalls, clinics, bedsides, fields, forests, and with nurses, doctors, quacks, mediums and mystics.
The struggles of the residents of Ambawati as they trudge through their torrid landscape is a testimony of the price the marginalised pay for health and policy decisions made in faraway Delhi and Geneva. It shows us how flawed our systems of care are, and how our very conception of care doesn’t take into account the different and complex lives of the poor in India. Breathless is both an act of meditation and a call to action.
Breathless is a rare work of medical anthropology that immerses you in the lives of its subjects, its magical logic and sweeping breadth almost Márquezian in parts. Get the book today from the Navayana website for Rs 500.