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This Electronic Thesis Or Dissertation Has Been Downloaded from the King’S Research Portal At This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Special Medicine: Producing Doctors at the All India Institute of Medical Sciences (AIIMS) Ruddock, Anna Louise Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 07. Oct. 2021 SPECIAL MEDICINE: PRODUCING DOCTORS AT THE ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS) ANNA L. RUDDOCK 0200945 PHD ANTHROPOLOGY 1 ABSTRACT This thesis is an anthropological study of the All India Institute of Medical Sciences (AIIMS), with a primary focus on undergraduate, or MBBS, education. Established in 1956, AIIMS is an enormous government-funded hospital, anomalous in the public healthcare landscape for employing many of India’s most respected doctors, who consistently provide a high standard of free or low- cost care to patients of low socioeconomic status. It also occupies an unassailable position atop the hierarchy of Indian medical education. AIIMS is a postcolonial institution, with origins in a colonial proposition, informed by global expertise, and realized with the support of international donors. Despite its profile, AIIMS has received little attention from social scientists. The same is true of medical education in India more broadly. Attending to these lacunae, I position my thesis in relation to literatures on hospital ethnography, and the training of health professionals in the Global South, as well as attending to other determinants of students’ experiences, including the dynamics of reservation-based difference, and their conceptions and experiences of aspiration and attainment. My analysis proceeds from an understanding of the All India Institute as simultaneously insulated from, permeated by, and complicit in the sociomedical landscape beyond its gates. Maintaining this perspective through a series of ethnographic chapters, I interrogate what is contained within the description of AIIMS and its students as ‘the best’. How is ‘the best’ defined and experienced? How does it inform articulations of aspiration and excellence, at global, national, and individual levels? And what implications might the ways in which India’s ‘best’ young doctors are produced contain for the politics and practice of health and medicine? 2 CONTENTS ABSTRACT ..................................................................................................... 2 CONTENTS .................................................................................................... 3 LIST OF TABLES ............................................................................................ 5 LIST OF MAPS ............................................................................................... 6 ACKNOWLEDGEMENTS ............................................................................... 7 1. INTRODUCTION: ‘BUT AIIMS IS AIIMS…’ ................................................ 8 ‘AIIMS is AIIMS’ ................................................................................................................10 Situating the study ............................................................................................................ 15 A hospital with a college attached… ................................................................................19 Corruption talk ................................................................................................................ 22 Resources ......................................................................................................................... 24 …And a college with a hospital attached ....................................................................... 26 Medicine beyond the gates ............................................................................................. 30 Illness and infrastructure ................................................................................................ 33 Producing doctors ............................................................................................................ 38 Structure ............................................................................................................................ 41 2. ‘ARE YOU A SPY?’: ON METHODOLOGY ............................................... 44 Accessing the Institute .................................................................................................... 45 The students ..................................................................................................................... 50 On hospital ethnography in particular .......................................................................... 54 Ethics ................................................................................................................................. 56 Disability and fieldwork .................................................................................................. 59 3. IMAGINING AN INSTITUTION ............................................................... 62 Recollections of the beginning (1) – Dr S ........................................................................ 64 Early institutions .............................................................................................................. 66 The Bhore Committee ...................................................................................................... 71 ‘An Indian institute established in India, for the training of Indian workers by Indians’.............................................................................................................................. 73 Recollections of the beginning (2) – Dr T ....................................................................... 77 Nehru, and the science of development ........................................................................ 78 Recollections of the beginning (3) – Dr V ....................................................................... 87 4. BEING THE BEST: GETTING IN .............................................................. 90 Why medicine?..................................................................................................................91 ‘Non-combustible data’: a brief history of mugging up ............................................... 102 The ambiguities of education (or, the opportunity to aspire) ................................... 108 ‘Lakhs of people just mugging stuff’ ............................................................................... 113 Taking the test… ...............................................................................................................117 Rank, and the life of ‘biographical numbers… .............................................................. 123 5. ‘FREEDOM’: BEING IN ............................................................................ 133 ‘The cream of people’… ................................................................................................... 134 ‘I think AIIMS is like heaven’: on freedom… ................................................................. 138 AIIMS as a liminal space ................................................................................................ 141 ‘The coasters’: the social life of reservations at AIIMS… ..............................................144 A history of protest ........................................................................................................ 144 3 The Mandal Commission................................................................................................ 147 ‘Caste doesn’t matter here’… .......................................................................................... 152 ‘You have to fight your fight’ ......................................................................................... 164 ‘Pull him up, pull him up, pull him up’ ........................................................................... 167 ‘Chaotic confrontations’… .............................................................................................. 172 6. ‘THE CLOSED WORLD OF WORDS’: COMMUNICATING MEDICINE . 177 ‘You can build your own brain afterwards’ ................................................................... 178 Communicating medicine .............................................................................................. 185 ‘The least you can do is
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