Doctors without borders?


As a young girl growing up in Karol Bagh, contemplating a career in medicine, Hemani Thukral could not possibly have foreseen the twists and turns in the global economy that would transform the profession of medicine and her life with it (see: A career in medicine was the safest path to professional success and social status in India. Those were the days when the nation state and the national economy presided over a state of affairs that ensured a secure place for many professions and trades. Doctors as a class of professionals seemed to be insulated from the ups and downs in the labour market, and economy.

The prestige of modern medicine was seen as the outcome of the dedication of a class of professionals who were committed to scientific progress and humanity. The medical doctor was the best example of the superiority of scientific medicine yoked to the cause of social welfare as defined by the nation. A whole set of institutions, like hospitals, together with new norms, crystallised in society around the figure of the rational, scientific and benevolent doctor. It seemed as though the doctor made all these institutions possible so s/he could practice medicine efficiently.

Even though most people encountered doctors within the institutions of modern medicine, like clinics and hospitals, these institutions were seen as complementary to the doctor’s skill and knowledge. While the doctor’s art was made possible only through the institutions and technology of modern medicine, it was not always easy to see that these same institutions and technology had created a situation where the doctor’s place in the medical hierarchy and labour force was protected and mystified. Although monetary gain played a significant role in the trade of medicine the doctor-patient relationship forged through the health care system made it virtually impossible for the wider public to see themselves also as consumers seeking a service from a particular type of professional.

Whether it is malaria, polio or diabetes, the prevalence of disease is a social phenomenon. So is society’s response to disease. The medical profession also often reinforces cultural prejudices, preferences and myths related to a society’s dietary habits, or an ethnic group’s belief in its racial pedigree etc. The function of medicine is the management of a population’s health within certain social parameters. Disease in many ways is closely tied to the ways of life, the culture and the social conditions of a human population at any given time. A society’s ideas of health and well-being too are often social norms rather than medical or scientific truths. We could say that the management of these, ie health and disease, through existing social institutions, and the interests and social mores they serve, is the role of modern medicine.

The development of a particular treatment or drug in itself does not rid society of a disease. Crucial though the role of medicine may be in the management of disease, a variety of other changes in a human population’s way of life and living conditions determine the history of a particular illness in a human population. Despite this, we continue to believe that it is the doctor who cures us of a disease or medical condition.

Published in Sydney Indian diaspora magazine, The Indian Sun

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