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Village Doctors and Vulnerable Bodies: Gender, Medicine, and Risk in North India

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Village Doctors and Vulnerable Bodies: Gender, Medicine, and Risk in North India Syracuse University SURFACE Dissertations - ALL SURFACE December 2018 Village Doctors and Vulnerable Bodies: Gender, Medicine, and Risk in North India Jocelyn Killmer Syracuse University Follow this and additional works at: https://surface.syr.edu/etd Part of the Social and Behavioral Sciences Commons Recommended Citation Killmer, Jocelyn, "Village Doctors and Vulnerable Bodies: Gender, Medicine, and Risk in North India" (2018). Dissertations - ALL. 962. https://surface.syr.edu/etd/962 This Dissertation is brought to you for free and open access by the SURFACE at SURFACE. It has been accepted for inclusion in Dissertations - ALL by an authorized administrator of SURFACE. For more information, please contact [email protected]. ABSTRACT This dissertation tracks an uncommon migration: the movement of young women doctors from urban medical colleges to rural clinics in Rajasthan, North India. The ability for young women doctors to transfer their lives to a rural clinic, even for a year or two, is vital for career advancement in Rajasthan’s government health sector. Yet I found that women, over and over, rejected this opportunity, turning this urban to rural migration into a trickle rather than a flow. Through interviews, observations, and travel in urban and rural Jaipur district, I explore the meanings of urban and rural spaces as well as contested understandings of what role doctors should play in the health of the population. I found that rural spaces were discursively marked as particularly dangerous for doctors who are urban, middle-class women. First, moving to a “village of strangers” required shedding one’s protective social network and the paternalistic surveillance that accompanies it. Second, the presence of the wrong kind of men – lower class and rural – was seen to threaten urban middle-class women’s reputation and bodily integrity. Rural and peri-urban migrants were often blamed for the surge in sexual violence in India’s cities; for women doctors, moving to the village meant entering the origin point of these threatening bodies. The inability of women doctors to counter rural risk ultimately affects two groups of women: the doctors who find it necessary to turn down a village posting, thereby compromising their career in the government sector, and the patients who desire gender concordance in healthcare but find it unavailable in their area. My goal is to highlight the disconnect between the assumption, inherent in Rajasthan’s health policy, that women doctors can transport their lives seamlessly to village clinics, and the actual experiences of women doctors in rural work. Village Doctors and Vulnerable Bodies: Gender, Medicine, and Risk in North India By: Jocelyn Killmer B.A., Smith College, 1997 M.A., Syracuse University, 2012 Dissertation Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Anthropology Syracuse University December 2018 Copyright © Jocelyn Killmer 2018 All Rights Reserved ACKNOWLEDGEMENTS First thanks goes to my advisor Cecilia Van Hollen, whose book started me on the path toward medical anthropology before I even met her, and whose gentle critiques and encouragement have sustained this project. I would like to thank my committee members, Sue Wadley, Ann Gold, Azra Hromadžić, and Claire Wendland, for guiding and inspiring me throughout my graduate school career, and for providing incredible examples of what an academic can be. I also wish to thank the many scholars who have read phases of this project: my colleagues in the South Asian Studies writing group at Syracuse; Gesa Kirsch, Patrick Berry, and the Writing and Rhetoric writing group at Syracuse; Will Suk in Morningside Heights; E.J. Sobo in San Diego; and anonymous reviewers in the Council on Anthropology of Reproduction and the Science and Medicine in South Asia special interest groups of the Society for Medical Anthropology. Thank you to Meredith Ellis and Rachel Wright for providing humor, lodging, and writing accountability over the past many years. Thank you to Lalit Narayan for your endless enthusiasm on the topic of public health and for sharing your contacts in India. Thanks also to my fellow graduate students who have helped me in so many ways: Faris Khan, Emera Bridger Wilson, Kwame Otu, Madhura Lohokare, Laura Klepinger, Liz Mount, and Anna Ruddock. I could not have faced bureaucratic hurdles or conducted interviews without the Hindi skills I gained at the American Institute of Indian Studies in Jaipur thanks to the endlessly patient work of the teachers there, especially Rashmi Sharma, Anita Tripathi, and Neelam Singh (and thanks also to Tej Bhatia back home). Sunita Reddy at JNU guided my initial inquiries in Delhi, and Bela Kothari at the University of Rajasthan took over when I moved my project to Jaipur. Thank you to Anuradha Jain, Nutan Jain, Kabir Sheik, and Rama Baru for productive conversations in Delhi and Jaipur. I owe Suman Singh, who has been a constant presence during all of my journeys to India, a great debt of gratitude. I met Suman even before entering my graduate program and have managed to find my way back to her on every trip to India since. Thank you also to Seema for putting up with my ignorance of village life. I am forever indebted to the many people who must remain anonymous for generously taking me into your lives and homes in Jaipur and beyond; this dissertation is dedicated to you. This research was funded through a Foreign Language and Area Studies fellowship provided by the South Asia Center at Syracuse (and funded by the US State Department). Preliminary research was made possible through a Bharati Memorial grant (also through the South Asia Center), a Goekjian summer research grant through the Moynihan Institute of Global Affairs, and a Roscoe-Martin grant through the Maxwell School of Citizenship, all at Syracuse University. Thank you to Zinnia, my three-year-old, for your patience as I worked non-stop to finish this, and thanks also to my “village” at San Diego State University who stepped in with support and childcare as soon as I asked: Kate Rubin, Rebecca Bartel, Javier Nuñez, Trudi Andres, Leah Abriani, Isaac Ullah, Jen Roulette, and Casey Roulette. Finally, I owe a great academic debt to my partner Drew, with whom I talk about everything. Thank you for your intellectual, emotional, and practical support, and for understanding what finishing a dissertation is like. iv TABLE OF CONTENTS LIST OF ILLUSTRATIVE MATERIALS ................................................................................... vii CHAPTER 1 INTRODUCTION AND METHODS: WHY STUDY DOCTORS? ................... 1 Introduction ................................................................................................................................. 1 Doctors in the Ethnographic Literature ....................................................................................... 4 Why Study “Women”? ............................................................................................................... 6 Traveling as a Method ................................................................................................................ 9 Research Sites: Jaipur City ....................................................................................................... 16 Research Sites: Villages ............................................................................................................ 18 Interviews and Observations ..................................................................................................... 22 Access ....................................................................................................................................... 27 Language ................................................................................................................................... 30 Who Should Work in the Village? ............................................................................................ 32 Outline of the Chapters ............................................................................................................. 34 CHAPTER 2 GENDER AND HEALTH CARE IN RAJASTHAN ........................................... 38 Health Care in the Government Sector ..................................................................................... 39 Women’s Health and Population Control ................................................................................. 44 Medicalized Birth ...................................................................................................................... 48 Doctor Shortages ....................................................................................................................... 53 Public Health Approach to Rural Avoidance ............................................................................ 56 History of Women Health Care Providers ................................................................................ 61 Gender Seclusion and Women’s Careers .................................................................................. 64 “Lady Doctors” in Contemporary India .................................................................................... 68 Gender Concordance ................................................................................................................. 73 The Female Seclusion Paradox ................................................................................................. 76 CHAPTER 3 ON BEING A DOCTOR ......................................................................................
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