Vaibhav Saria | Care and Crisis in India

While health care practitioners in India made personal sacrifices, such as sleeping in their cars to avoid spreading disease to their families, doctors and nurses also reported being evicted because their landlords feared they would spread the infection. Some practitioners experienced physical violence by the family members of individuals who died from COVID-19, and others received death threats.

Dr. Saria pointed out that epidemics and outbreaks have not always led to violence; some, such as the 1918 influenza pandemic, even brought communities together.

While doctors in India are overworked, patients often perceive them to be “uncaring” and “interested only in making profits either through unnecessary medications or unnecessary tests… both of which would earn providers handsome cuts or kickbacks from the companies.” These perceptions are influenced by several factors and contribute to mistrust between providers and patients.

Provider-shopping is where patients will register with multiple doctors, often because their symptoms do not improve as soon as they had expected after seeing the first doctor, Dr. Saria explained. They noted that because of this, doctors can be unsure if patients will return to see them, so they often prescribe them several medications. 

Additionally, health care providers may prescribe several medications due to pressure to respond to patients’ family and social constraints—such as working men being unable to bring family members to medical appointments because they would have to close their shops, and therefore lose wages, to do so.

Prescribing several medications leads to accusations from patients that doctors only desire the incentives from pharmaceutical companies that come with these prescriptions.

Dr. Saria stated that “the logic of profit and market does not equate with the logic of care,” and that this “mistrust emerges from a history of tension between Western and traditional Indian systems of medicine…that puts pressure on traditional healing systems…to also organize and narrativize [their] history to make claims of equally valid scientific thought.”

Different visions of science, modernity and medicine between India and the West are still perpetuated today. India’s current medical providers use a “revivalist notion of Indigenous medicine” to critique the over-medicalization and pharmaceuticalization of the West’s approach to health care.

Moreover, Dr. Saria talked about the “know-do gap,” which was evident in the TB epidemic, in relation to their work with the multidisciplinary QuTUB research team. The know-do gap describes the delayed, missed and incorrect diagnoses that occur because despite practitioners being aware of the correct protocols, they are not implementing them due to the realities of patients’ behaviours and social constraints.

Dr. Saria emphasized that mistrust between providers and patients has a social impact on the health care system. Patients’ misunderstanding of providers’ values connects to the violence—and threats of violence—that providers experience from patients and patients’ families.

Dr. Saria ended their lecture by leaving us to ponder “whether we are living in a world of crises, or a world in crisis.”