[Reader-list] 'Striking AIIMS docs live in a glass house'

[Shuddhabrata Sengupta]

Jai Be-Hind to All on this list,

I have been following with some interest the discussion that has been 
going on the anti-reservation protests for some time now. In any case, 
now that the national media has found the matter of whether the mourning 
Mahajan scion had ingested cocaine or heroin to cope with this 
bereavement, it is likely that the 'burning' issue of reservations (pro 
and contra) will get a momentary reprieve.

Perhaps all the more reason why we should continue to discuss it here.

Much of what I am going to say has been said here, and elsewhere, but I 
am writing this as much for my own internal clarification as anything else.

There are a few interesting spin-offs of the whole issue that I think 
bear some thinking about.

1. It is clear, and demonstrated, that large sections of the media, and 
assorted white collar professional bodies, (industry and professional 
associations) have a clear (upper/forward) caste bias. I do not think 
that there is any doubt left in my mind at least that the medical 
students protesting against reservations at AIIMS and other institutes 
were doing so to protect their inherited privileges. Shivam Vij's posts 
on this list about the 'backroom' politicking of the anti reservation 
movement, and the excellent piece written by Siddharth Varadarajan in 
the Hindu on the media bias in the matter signify a reality we are just 
beginning to understand.

2. The argument that people who come in through the so called 'general' 
(should it be upgraded to 'brigadier' category) do so on grounds of 
merit now stands revealed for what it is worth. A system of admission 
examinations that hinges entirely on the ability of parents to pay for 
their sons and daughters to attend expensive coaching classes is a 
bastion of class (and correspondingly caste priviledge). I would argue 
that for every one person who gets admission into medical and 
engineering college on the basis of their performance in the joint 
entrance examinations, many others, who might make 'better' doctors or 
engineers or whatever, don't get in because their parents cannot afford 
to send them to coaching classes. This perpetuates a system of 
reservation based on priviledge in the most prestigious insitutes in 
this country. Merit has nothing to do with this.

3.I am also amused by the fact that no one in the anti reservation camp 
is expressing their distress about the harm done to the standards of the 
  medical profession by people entering medical education by paying 
capitation fees in a host of 'private' medical colleges. I have not come 
across any all night vigils against capitation fees by people bothered 
by the question of merit being given short shrift.

4. It may be argued, and I think convincingly, that especially in 
professions such as medicine, it is crucial that education and 
employment make room for people with a variety of backgrounds and 
experiences. For an effective medical and theraupetic system to operate 
diversity within medical practitioners, is to my mind as important a 
criterion as the 'merit' of being able to do well in an examination that 
you have paid to do well in (refer to coaching classes argument above)

Let me try and explain why. Large public hospitals are places where the 
majority of the people go for treatment. I have often witnessed an 
intern from a relatively priviledged background completely at sea when 
faced with a patient from a very different social and cultural universe. 
The medical profession (like any that requires interaction and 
engagement with human beings and hteir conditions) is better served when 
it is able to accommodate diversities. A dalit, OBC junior doctor may 
bring with him or her cultural experiences and linguistic competences 
that often make him or her a 'better', more competent doctor than 
someone who's engagement with human beings is founded on the fact of the 
distance of their priviledge.

Not long ago, the medical profession was a preserve of men, and the idea 
that room be made for women doctors was thought of as preposterously, as 
the idea that the social profile of the medical profession be a little 
more heterogenous than it is at present. The masculine prerogative in 
the medical profession has led to the pathologization of the female body 
to a huge extent, which has been challenged only by the increasing 
presence of women in the medical profession. I would argue that the way 
in which I have seen many people in the medical profession treat many 
under-priviledged patients (sometimes bordering on contempt, blaming 
them for the aetiology of their illnesses) has something to do with the 
narrow range of social experiences that the profession is currently able 
to encompass. We need more serious investigation into the sociology of 
disease and medicine, and the cultural mores that are a part of the 
medical profession in India. Don't forget that a former figurehead of 
the medical profession, a Dr. Paintal, once famously remarked that AIDS 
prevention in India would be done best through a strong inculcation in 
the spiritual heritage of India. So, here was a 'meritorious' doctor, 
arguing that the best preventive medicine against HIV infection was a 
strong dose of puritanical brahminical values. I would shudder to think 
how he would actually treat a sex worker who had the infection, were 
such a person to be unfortunate to have been in his theraupetic care. I 
am not making this up. You can check on this by reading an article 
called "Preventive Medicine: AIDS Control Through Cultural Heritage"
by Jayaraman, K.S., which appeared in the prestigious scientific journal 
Nature [(03/14/91) Vol. 350, No. 6314, P. 102 ], in which Paintal's 
social and cultural views on medical treatment are outlined. The reason 
I am saying this at some length is that Dr. Paintal was a former head of 
the Indian Council of Medical Research. I think that the medical 
profession needs fewer Dr. Paintals, and more young doctors, whose 
ancestry and family background have to do with the castes who have been 
traditionally associated with sex work. It is possible that such 
practitioners will find their way into the system only through 
reservation. This will be better for the 'health' of the medical 
profession in India, not worse.


5. Having said all of the above, I also think that it is time that those 
who are against caste, and anti-anti-reservation think creatively and 
imaginatively about the fact that reservation (outside education) is 
also a trap that commits underpriviledged communities to a seemingly 
un-ending compact with the state in India. So that the only 'political' 
dream that a dalit, ST, OBC young person has thrust upon them is the 
possibilty of being a wage slave of the state. This gives an inherently 
conservative, statist turn to most, if not all dalit-bahujan, OBC 
politics, and condemns it to a depressing 'abhimanyu' syndrome vis a vis 
the chakravyuha of the Indian nation state, constitutionalism, and 
nationalism. Perhaps it is time to think  outside this circle, or box, 
or whatever. I have no answes, only questions here.

6. There is something good that has come out of all this, which is, a 
commitment by the state to fund more institutes of higher education, so 
that the pluses of reservations are factored off against a net benefit 
in an increase in opportunities for all. IT is good if a country of more 
than one billion people has more than one 'All India' Institute of 
Medical Sciences. Just as it is always good that there be more than one 
'ALL INDIA' Congress Committees.

But now, it is time to think about what the qualitative content of an 
expanded apparatus of higher education might be. It is time to think 
about what will produce thinking, engaged, critical medical 
professionals, and imaginative, creative, critical engineers. We haven't 
had too many of either. It seems as if the system of 'merit' has 
actually worked against the emergence of this kind of practitioner. TIme 
to change this, maybe?

thanks and cheers

Shuddha