UCSF UC San Francisco Electronic Theses and Dissertations Title Translating Where There Is No Doctor: How the production of local knowledges propels global travels Permalink https://escholarship.org/uc/item/4dj6s68d Author Walkover, Lillian Berry Publication Date 2018 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California Translating Where There Is No Doctor : How the production of local knowledges propels global travels Lillian Berry Walkover DISSERTATION Submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in the GRADUATE DIVISON of the UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Copyright 2018 by Lillian Walkover ii Acknowledgements “All that you touch, you change. All that you change, changes you.” – Octavia Butler This dissertation was dreamed up, researched, and written in the best of company. To everyone who has wondered, asked, answered, pondered, and imagined with me, thank you. Thank you to my committee for supporting and challenging me. To Janet Shim, my chair, for endlessly thoughtful feedback, and an unwavering calm belief in my ability to integrate it and continue learning. To Howard Pinderhughes, for believing I didn’t need support to maintain a social justice lens, and always providing it anyway. To Shari Dworkin, for helping me to map and connect to global health at UCSF, and reminding me to write about power. To Vincanne Adams, for inviting me into interdisciplinary conversations, and supporting engagement from a critical position. And to Brandee Woleslagle, for making everything happen. This research was funded by NSF GROW (Graduate Research Opportunities Worldwide), in partnership with USAID Research Innovation Fellowship. The work, and my graduate education, was also supported by NSF GRFP (Graduate Research Fellowship Program), and by UCSF Graduate Division Dean’s Health Science Fellowship. To the members of JAMS (Janet’s Advising and Mutual Support), thank you for providing visions for the future, support in the present, and a grounding in the past. Extra thanks to my colleagues Ariana Thompson-Lastad, Emily Treleaven, Taylor Cruz, Sara Rubin, Florencia Rojo, iii Meredith Van Natta, and Sonia Rab Alam for the excellent company in and outside of dissertations. Janet’s writing seminars in fall 2016 – with Emily, Maryani Rasidjan, and Ariana – and in winter 2018 – with Sara and Ariana – helped to produce and shape the fourth and third chapters, respectively. Thank you to all my colleagues in the Structural Competency Working Group, Public Health Justice Collective and Berkeley Free Clinic for helping to keep this project grounded in work at the intersection of public health and social justice. Thank you to my participants for your insights, time, and support. Data collection for this dissertation was made possible by nine months spent living in Delhi and traveling back and forth across India. Thank you to V. Sujatha and the Jawaharlal Nehru University (JNU) Center for the Study of Social Systems in Delhi for your time and support in maintaining a critical social science perspective. At JNU, thanks to Lakshmi Krishnakumar for all the talks, walks, lunches, and lounges. Thanks to Hannah Johns for the doctoral student perspective. Thank you to Bobby Joseph and the Department of Community Health at St. John’s National Academy of Health Sciences in Bangalore for your time and support in maintaining a community health perspective. Thanks to Sonila Swaminathan for sharing your home, and thanks to Jeremy Blanchard for unfailing real-time support across zones. This dissertation was also made possible by the support and encouragement of Sarah Shannon, Tawnia Litwin, and everyone at Hesperian Health Guides. Thank you for bringing me in and supporting my next steps. Thanks to ISSI (Institute for the Study of Societal Issues) at UC Berkeley, where I was a Graduate Student in Residence, for providing office space and intellectual community in the East Bay over the last two years. Feedback from moderators and iv participants at ASA and SSSP in 2016 and 2017 helped to shape the second and third chapters. For the final push, thanks to SWAG (The Sociology Writing Accountability Group) at ISSI for the excellent writing company and inspiration. Finally, thank you to my extended communities of friends and family for all the love and companionship that made this project possible. For the soup exchanges and shared meals, the car loans and excuses to revel in the mountains and ocean, the bicycle lessons and repairs to keep moving. To Ariana and family, for close to a decade of companionship. And to Duke Halsey, for walking alongside me in the time-twisting final stages. This dissertation is dedicated to my parents, Barbara and Andrew Walkover. v Abstract This dissertation focuses on how health knowledges are produced and travel through an analysis of the translation and adaptation of Where There Is No Doctor , one of the most widely used health manuals in the world. First published in the 1970s, it spread around the globe with health social movements, and has been translated into over 80 languages. Using qualitative methods and grounded theory analysis, this research explores translations and adaptations in Hindi, Tamil, Kannada, and English for use in India. The analysis sits at the intersection of sociology of health and illness, critical global health, and postcolonial science and technology studies. I make three key arguments: (1) the book serves both an instrumental role as a tool for people training community health workers, and a symbolic, political role, for health professionals focused on advocacy; (2) the book’s invitation to adapt content and illustrations to meet local needs, and to integrate lay and expert knowledges across a variety of medical systems, allows it to travel as a successfully global object; and (3) health knowledges produced in these editions are fundamentally new knowledges. vi Table of Contents Chapter 1 – Introduction: traveling texts ................................................................................... 1 Background ................................................................................................................................. 3 Where There Is No Doctor: a traveling text ............................................................................ 3 Hesperian Health Guides ......................................................................................................... 6 Where There Is No ______ ..................................................................................................... 8 A background note for health education research in India .................................................... 10 Where There Is No Doctor in India ....................................................................................... 11 Literature Review ...................................................................................................................... 14 Postcolonial STS and critical global health studies: locals, globals, and the knowledges produced in between .............................................................................................................. 15 Postcolonial theories of knowledge: India as global ............................................................. 19 Sociologies of knowledge: lay knowledges and the production of expertise ........................ 21 Methods ..................................................................................................................................... 24 Research Approach ................................................................................................................ 24 Interview Recruitment and Consent ...................................................................................... 25 Interview and Observation Procedures .................................................................................. 27 Interview Sample ................................................................................................................... 28 Data Analysis ......................................................................................................................... 31 International Collaboration and Mentorship.......................................................................... 31 vii Pilot Project ........................................................................................................................... 32 Overview of Dissertation .......................................................................................................... 33 Chapter 2 – Mutable mobiles: from hope handbooks to taking sides .................................... 37 Introduction ............................................................................................................................... 37 Historical framing: Health for All!............................................................................................ 40 Community health in India .................................................................................................... 42 Theoretical findings: Where There Is No Doctor as a mutable mobile .................................... 44 Mapping mutable mobiles: Non-human and implicated actors in situational analysis ......... 46 Books as boundary objects .................................................................................................... 55 Empirical findings: Expressing milk and excising politics