Soc. Sci. Med. Vol. 43, No. 5, pp.

837-848, 1996
Pergamon Copyright 1996 Published by Elsevier Science Ltd
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SECTION S
DAVA, DAKTAR, AND DUA: ANTHROPOLOGY OF
PRACTICED MEDICINE IN INDIA
R. S. KHARE
University of Virginia, Charlottesville, VA 22903, U.S.A.

AbstractThe paper explicates practiced medicine as an operative cross-cultural analytic concept by locating
it within previous major developments and directions of study within anthropological studies of medicine in
India, and medical anthropology more generally. Practiced medicine in India, for example, allows us to see
better how India manages not only multiple traditional and modern medical approaches, languages, therapeutic
regimens, and materia medica, but it also leads us to a sustained moral, social and material criticism from
within. The study of such diversity leads to a loosely shared, and ethnographically attestable, cultural reasoning,
practice and practical ethos across the traditional and modern medical worlds. Also appearing before us are the
usually hidden cultural assumptions, negotiations and compromises of diverse Indian medical practitioners, and
the strengths and weaknesses of modern medicine under normal and disastrous situations in contemporary
India. As India today grapples with issues of availability, affordability, equity, and distributive justice in
medical care, its practiced medicine raises issues of critical consciousness for modern (and traditional), state
supported medicine. Copyright 1996 Published by Elsevier Science Ltd

Key wordsIndia, traditional approaches, cultural assumptions

FROM EMPIRICAL DESCRIPTIONS TO A CULTURAL
MODELS OF PRACTICED MEDICINE
In scope, method and analysis, medical anthropology of
the nineties reflects many of the same major conceptual
directions as cultural anthropology itself. If the mid-
century anthropology produced discrete field-based
ethnographic accounts of diseases and remedies in non-
Western societies, then it became more systematic and
comparative in its observations and explanations during
the sixties and the seventies [1-6], In both phases, modern
Western medicine [7] remained the sole implicit or
explicit superior yardstick of comparison. Its scientific
institutions, procedures and pharmacopeia still help
modernize and develop non-Western societies.
However, medical anthropology today distinguishes itself
as it approaches, dialogues with, and, when appropriate,
criticizes the scientific medical knowledge and practice,
as a cultural domain equivalent to kinship, politics, or
religion [4, 8].
Historically, medical anthropology rests on the
pioneering works of such physician-historians,
anthropologists and medical anthropologists as Ervin H.
Ackerknetch, Benjamin D. Paul, George Foster, Charles
Erasmus, Charles Leslie, and Arthur Kleinman [4, 9-11],
Some early attempts from India related specific cultural
practices to medical and public health issues [12, 13]. In
the intervening decades, medical anthropology has come
into its own, with distinctly sharpened scope, method,
definitions, and analytical approaches, ranging from
the descriptive to the comparative epistemic, to the
critical [6, 14-16]. For example, as we distinguish
between disease, illness and sickness, we also better
explicate the cultural meanings and purposes behind
curing, healing, restoration, and wellness [17].
We are now, however, at a crucial juncture in the
history, cultural understanding, and practice of Western
scientific medicine. Given the major challenges, the
steeply rising medical care costs and old and new
incurable diseases pose to scientific medicine in a
populous, culturally contentious world, medical
anthropological studies cannot but address the issues of
accessibility and affordability of health care. Such an
effort should be integral to cultural- symbolic
interpretations, facilitating study, at local and regional
levels, of cultural translations, epistemic comparisons,
and therapeutic exchanges between modern medicine and
other medical systems. At the core of such discussions is
the notion of practiced medicine and its cultural models
which patients and medical practitioners generate and
uphold together.
We examine a range of background cultural
assumptions, ethical values, reasoning patterns, and
shared sensibilities that shape medical knowledge and
therapeutic practices [18-20]. To do so is to raise, as
Nandy would say, critical consciousness within modern
medicine [6]; and it is also to learn more about what
works in scientific medicine, from patients and peoples
vantage points. With all its scientific advancements and
technological resources,

837
838 R. S. Khare
modern medicine appears before people as a construction
of moral-cultural communication and care. To serve
global health needs, it must successfully convey its
scientific knowledge and technical skill with cultural
sensitivity and human understanding.
Since this modern century has shaped both
anthropology and scientific medicine, their dialogues
should be revealing for what they explicitly state and
what they assume. In such a context, non-Western
medical systems, when adequately analyzed, provide a
necessary external critique and corrective. They introduce
us to their own distinct reasoning patterns, models and
meaning systems, and ethical priorities, evaluating
modern biocultural approaches to the human body and
human wellness. The Indian contributions on these
issues, longstanding and ever better studied and
explicated, are now poised for more critical and
comprehensive examination [21-23]. Concerned with the
life, health and survival of about one billion people,
modern Indian medical practices should be
anthropologically examined for how (and how far) they
address the health and human wellness issues under want,
conflict, and real life crises [16, 24]. Gaps in cultural
conceptions and communications still need to be studied.
Given its modern intellectual roots, medical
anthropology, not unlike modern medicine, also
subscribes to such dichotomies as body/mind,
ideal/practical, science/magic, inside/outside,
Western/non-Western, and traditional/modern.
However, since anthropology also explicates the ways in
which other cultures interpret and interrelate similar
markers and communicate about them in their medical
practices, it helps to open up the modern scientific
body/mind and materialist/symbolic ideology to wider
cross-cultural examination, commentary and evaluation.
Issues of ideology are negotiated under the conditions of
actual medical practice.
In practice, people judge biomedicine in the same way
as any other medical system: Does it work, or has it
worked, for me/us? Anthropologically, it means learning
how actual Indian patients and their care-givers
selectively translate, negotiate or even disregard
conceptual and empirical differences across widely
different medical systems, to get well ([4], pp. 88-115).
Such an account also focuses on peoples practical
reasoning, knowledge, action strategies, and cultural
sense and sensibility, as patients and as care-givers, and
shows how medical practitioners pursue therapeutic
competence and effectiveness in an affordable and
accessible manner, while following divergent cultural
models, ethics and ethos of medicine.
In India, people this way routinely use and make sense
of such diverse therapeutic experiences today as herbal
Ayurvedic medicine, MRI, heart surgery, miracle cures,
organ donation, and shamanism. In doing so, patients and
their care-givers once again lead us to their cultural
logic and its guiding religious-moral, historical, and
political assumptions for forging a working
compatibility across diverse medical practices.
However, this heterogenous cultural model of
practiced medicine [25], when employing modern
medical advances, today attracts new doubts and moral
and political controversies. Urban Indian patients today,
for example, enter social and moral controversies (along
with major economic costs) as they use such front line
treatments as amniocentesis, ultrasound, organ
transplants, in vitro fertilization, and fetus gender
determination. Even more generally, modern medical
practice, the harbinger of such major biomedical
frontiers, also faces cultural-communica- tional dead
ends, no entry or slow entry zones in India,
alongside the doubts about its ability to deal with all
incurable and uncontrollable diseases, and sources of
pain and suffering [26], Even within the West, the home
turf, scientific medical research and health care systems
are known to face increasingly critical economic
pressures and divisive religious, ethical, legal, and
political challenges.
The following discussion examines aspects of
practised medicine in India to get a sense of how it
manages diverse traditional and modern medical
approaches, models, languages, and therapeutic regimens.
With cultural pluralism, conceptual elasticity, and widely
different therapeutic tool-kits already well documented
for traditional Indian medical systems [27, 28], I will
focus on the prevailing cultural reasoning and ethos
found with traditional and modern Indian medical
practices and practitioners, and comment on the working
Indian moral models and practical and critical negotiating
languages. We will consider both normal and abnormal
health situations, and will conclude with crucial issues
and debates facing Indian medicine.
CULTURAL MODELS AND THEIR MORAL AND
PRACTICAL LANGUAGES
All non-Western medical systems of the Indian
subcontinent generally share and overlap in practice even
as their cultural reasoning for conceiving, identifying,
diagnosing, and curing illnesses differ. Most people
closely interrelate moral and material aspects in life, and
employ such reasoning to identify the conduct, effect and
meaning of an illness. Indians thus ground their medical
reasoning and practice within their distinct
religious/moral conceptions of the body, self, personal
well-being, soul, society, and cosmos. The Ayurveda, the
widely practised indigenous medical system, illustrates
well the continuity of such medical reasoning from the
Vedic times [28, 29], It professes comprehensive
medicine by interrelating bodily conditions to humors,
environmental and climatic factors, psychological
dispositions, and moral and spiritual states.
Correspondingly, Ayurveda treats the patient as a whole,
as a person, situated within his/her daily social situation
and moral position in life. In popular practice, morality
and religious faith, particularly prayers (dua), are known
to enhance therapeutic efficacy of medicines and medical
treatment.
This dominant material and moral structure of Indian
medical reasoning has influenced all the subsequent
major Indian medical systems, whether indigenous or
imported. Broadly, two streams could be distinguished,
one shaped by several variants of the Buddhist curative
practices (flowing out to China and Japan and mingling
with their religious and regional cultures), and the other
developed by the Middle East before and after the advent
 Dava, Daktar, and Dua 839
of Islam [30,31]. With illness and its treatment deeply medicines, even when misused, are known to be either
interwoven into its theological and juristic literature, much less harmful or harmless than modern drugs,
Islam developed its medical science with a distinct role which are always considered too strong, hot and full
for hadith in curing and caring of the sick. Illnesses, of long-term harmful side effects [34],
beyond bodily suffering, are awarded spiritual functions. Such practical convergence within Indian medical
They convey Gods purpose, from receiving punishment convergence is ultimately sustained by peoples diverse
to achieving perfection, and hence medical treatment is to cultural and moral expectations from medicine. Yet
be sought when illness is unbearable ([30], pp. 150, 157- modern medicine and its technology are slowly carving
158). out a distinct (but not always positive) social place for
Buddhism, a nontheistic religion, ideally identifies all themselves by either successfully treating acute illnesses,
illnesses with physical and philosophical suffering performing major surgeries, or by raising social, ethical
(dukkha), caused by the impermanent nature of our and political controversies with, for example,
existence, and not by any external or internal agent. At amniocentesis (as used in Maharashtra to abort female
the folk level, however, as Obeyesekere (1989) shows, fetuses) and unscrupulous organ buying and selling
specific disease causing agents, medicines, and curers for transplants. The latter highlighted new exploitation of
and healers amply exist ([31], pp. 144-1473). Yet, not the defenseless and the unsuspecting poor.
unlike the Ayurveda, caring and healing of the sick are Culturally, such aberrant medical practices
greatly valued and emphasized in all major Indian comment as much on the changing image (and
religious traditions, and the prolongation of life is availability) of modern medicine as on the prevailing
considered highly desirable, to do good in life. conditions of injustice, suppression, violence, and denied
Indispensable to this plural Indian therapeutics is that rights within Indian society. Under such conditions,
context-sensitive cultural reasoning which allows Indian illness, body, modern medicine, and its medical
medical practitioners to coordinate, rank and yet practitioners become a distinct focus, as in the West, of
complement their diverse medical practices. For example, social, moral, and legal criticism, creating a new focus of
if such reasoning allows selective crossboundary use study for medical anthropologists [35],
among the culturally and religiously diverse medical All medical systems, traditional and modern, today
practitioners, it also stresses their and their patients take a critical view of medical practices. Without it one
distinct sense of pragmatism and practicality in seeking does not know what works most effectively in a given
the best treatment under the circumstance (for situation (pragmatism), and whether the medical help
illustrative cases, see Section 4). Indian patients thus reaches those most in need (accessibility). Issues of
habitually turn to Ayurvedic, Unani, Homeopathic, and need, entitlement and justice today closely shadow
Allopathic or modern scientific treatments, in any medical systems and medical care. Here the medical
sequence or combination, to secure best treatment. practitioner must encounter, beyond ones own medical
This pragmatic cultural reasoning has, over time, rationality, skill and experience, matters of health care
substantially shaped the organization and practice of delivery and of distributive justice [36]. Any advocacy of
modern medicine and medical technology in India. For "the
about two centuries, India has been breaking down the
traditional/modern and the non-Western/ Western
dichotomies by its contextual therapeutic reasoning. With
Indian independence, if the state, following the same
pluralist approach, began to strongly promote modern
medicine and public health as integral to national
development, it also culturally reinstated and
scientifically rediscovered (by laboratory testing) the
significance of Ayurvedic materia medica [32].
The Ayurvedic (along with Homeopathic and Unani)
practitioners, on the contrary, slowly and selectively
incorporated scientific instruments and techniques (e.g.
stethoscope and thermometers), pharmaceutical practices
(e.g. medicines dispensed in tubes, tablets and capsules),
and educational aids (e.g. anatomical charts in
classrooms) within their own teaching and practice.
Thus, to be more accurate, modern medicine in India
has thus influenced, and has been influenced by the
Ayurvedic, Unani and Homeopathic medical systems.
The current Western notion that modern medicine is (and
somehow should be) the only or even the most exclusive
medical system, still remains alien to most Indians [33].
Actually, the majority of modern Indian physicians and
pharmacies, including famous surgeons are known to
prescribe many appropriate Ayurvedic curative and
recuperative medicines, often in combination with
modern drugs. This is because most Ayurvedic
SSH 43:5-R
840 R. S. Khare
soteriological and humane practice in medicine practical, objective and subjective, and sacred and
today therefore must contend, sooner or later, with issues
of socially just accessibility and affordability of medical
help [37],
NON-COMPETITIVE PRACTICES, ETHICS AND ETHOS
To understand the shared cultural ethos of Indian
medical practices, we must remember that ones health
and illness depend on a host of personal choices and
actions as well as on ones religious merit and demerit,
including astrological and timeless moral cosmic
forces. Accordingly, neither only a religious ideal nor a
purely historical-chronologically fixed, empirically
discrete, and politically conflicted account fully captures
the nature and meaning of illness and health. Instead,
rather a general overlapping and coordinating use is of
those moral, social, psychological and religious factors
and forces which explicate a patients particular illness
and the patient appropriate curing-healing strategies [38],
In such an approach, the arcane and the recent, and the
contested and the modem concurrently constitute the
prevalent multi-layered Indian medical system. For
instance, the oral (mantra), surgical (employing knives),
and pharmacological (herbs and spells) treatments,
recorded by some of the earliest Vedic traditions (1400 to
300 BCE), still remain integral to the current Ayurveda.
Similarly, many special curing invocations such as
charms, spells, and remedies, originating in the
Atharvaveda, are used today [29], An urban Ayurvedic
practitioner (a vaid) simultaneously employs the tridosa
or the three-humor Ayurvedic diagnostics, his personal
experience and intuitive insight (including his personal
religious faith) while treating his patients. On the
contrary, a modern Indian physician supplements or
augments his treatment of illnesses by combining (and
recombining) modern medicines and procedures with
those patently Ayurvedic (e.g. routinely prescribing to
patient elaborate dietary regimen, life-style instructions,
and personal psychological suggestions).
Practiced medicine thus takes after a widely
heterogeneous medical and work ethic. The curing,
healing and caring of the sick in such an ethos are
basically considered moral, non-competitive activities,
especially since human life span, misfortune, and illness
and wellness are ultimately considered beyond human
control [39]. No single medical system is, likewise,
considered to cure all the maladies that humans face in
life. Under such an ethic, Hindus, Muslims, Christians,
and Sikhs are used to seeking cure in life from each
others traditional medical practitioners, holy persons,
and sacred places, and from modern medicine. Each
medical system, likewise, furthers its treatment without
actively impeding the initiative, value, skill, and role of
other medical systems. In a shared civilizational ethic,
such thinking now shapes the prevailing cultural
conceptions of, and assumptions about, human body, self,
life events, illness, death, destiny, and the divine.
Such medical ethics rests in practice on a distinct way
of reading biological facts and moral and social become more potent with sincere prayers. Treat the patient and
meanings from the patient and his/her body. Since India,
unlike the West, disallows rigid distinctions and
dichotomies between body and mind, theoretical and
secular, Indian practitioners variously open up their
therapeutic practices to more inclusive and diverse
cultural knowledge, life experiences, common sense, and
personal insights and intuitions. The Indian patient also
expects his medical practitioner to have open-ended
relationships between medicine, moral order and soteriol-
ogy [40], Recent culturally sensitive accounts describe
how this goes with saints, shamans, doctors, and healers,
under different therapeutic situations [41],
An Ayurvedic practitioner (see also Section 4), for
example, creatively grounds his medicine in religion as
he also borrows from, and bridges gaps with, other Indian
medical systems, especially when (or as) his own
treatment falters. However, equally clearly, he neither
weakens his faith in the Ayurveda, nor adulterates his
specialty. He just occasionally learns from the others
superior virtue (uttam guna) [42]. Actually, while
subscribing to the core of his medical system (i.e. to such
authoritative texts as Caraka Samhita and Susruta
Samhita, Astanga-hrdaya Samhita, and Madhava
Nidana) [43], he renews faith in his preceptor, in the
divine, and in his own accumulated medical skill,
experience and observations.
In practice, similar internestling religious-moral-
ethical frames have also encoded and enveloped Indian
homeopathy (started in the eighteenth century by Samuel
Hahnemanns curative procedures) and naturopathy (a
treatment system relying on the bodys own natural
healing substances and powers). For example, a famous
Lucknow homeopathic doctor (known as Pandit ji),
living a renouncers spartan life, softly hummed the
sacred Om every time he himself dropped the medicine
in his patients mouth [44]. Thus blending medicine with
his moral authority, he also subtly conveyed by bodily
gestures his approval or disapproval of the patients
observance of the prescribed therapeutic regimen
(parheza). When utterly dissatisfied, he would not hum
the sacred mantra. To all his patients, even non-Hindus,
it was a scolding. In awe, they would dutifully touch
his feet, and return with resolve to observe in life the
prescribed curative regimen more rigorously.
Such a distinctly coded moral practice, where
prayers, patients discipline, and Gods will comprise
medicine, is familiar, and normal, to Indian patients.
The practice is designed, as it were, to peep into the
patients soul, and to connect it to the doctor. Together,
the two this way forge a shared situational medical ethics
and an effective therapeutic strategy. Comparatively, a
Lucknow hakim, while training a young novice in his
dispensary (matab) in July 1994, had succinctly
summarized his approach:
Look at a patients body, into his eyes as well as within him;
never [treat] the body alone. Read his pulse as well as what his
eyes and mind show. Assure him, You will be cured; everything
will be all right (Turn acche ho jao ge\ sab thika ho javey ga)".
Remember the patient's suffering by recalling the faces of his
[often accompanying] wife and children... Next, remember to
prepare the medicines with care. Blend them with your care, and
sincere prayers. Our patients expect both from us, and medicines
his ailment by putting full faith in Gods will. You will [thus] do
the best you can, for the patient, and before Allah.
 Dava, Daktar, and Dua
Such an approach and cultural language, which is at
the heart of the majority, multi-stranded Indian medical
practices, receives distinct recognition when a patient is
dying or near death. As a medical practitioner guides a
patients selection and pursuit of a particular medical
treatment, even necessary biomedical hospitalization,
clinical tests, and use of innovative medical technologies,
he never lets the patient abandon hope of recovery.
However, all changes when facing the inevitable. The
popular culture clearly recognizes the phase as when
doctors give up (jab doctor jawab de dete hain). The
doctor and the relatives of the patient now fully and
freely recognize the inevitable role of God, religious faith
and prayers in patients welfare [45].
In modern Western medicine, both birth (as in
abortion) and death (as in euthanasia) today raise serious
religious, scientific and legal debates [46], Questions of
consent and rights dominate. An Indian family doctor,
under the same situation, however, still relies on the
patients sufficient social and personal confidence (itbaar
or bharosa) in him. Consent (izazat or anumati) is mostly
implicit and informal, leaving all the responsibility with
the doctor [47]. In urban practice, however, Indian
doctors (often those working in large public hospitals)
may now be open to increasing legal questions and
formalities [48].
A DOCTOR, A VAID AND A HAKIM: NEGOTIATIONS IN
PRACTICED MEDICINE
Let us now explore further the shared Indian medical
ethics and cultural ethos with the help of three Indian
medical practitioners studied in the field. Here medical
practitioners, patients and their kith and kin are seen
entering into that cultural communication which helps
them make sense of the diverse messages coming to them
from Ayurvedic, Hikmat-Unani, and Homeopathic
medical practitioners, alongside their distinct claims and
treatments. In practice, it also shows how the patient and
his care-givers to seek out and negotiate with their
practitioners, one or more paths of treatment, in a suitable
combination that would work best for the patient,
converged with some past successful experiences.
For attracting and retaining their patients, Indian
medical practitioners, from their side, seriously engage
everyday in the patient-oriented effective cultural
translation, persuasive reasoning, and psychologically
supportive expressions [49]. The three medical
practitioners, described below, represent three major
prevalent medical practicesmodern medicine,
Ayurveda, and Hikmati-Unani. Our first example is a
modern Indian physician (popularly called doctor
saheb), 60 year old America-trained surgeon, who
owned a private clinic and a thriving Nursing Home
(i.e. a small private hospital, a sign of his successful
practice) in Lucknow. He provided, in his own words, an
attentive, caring and state-of-the art medical
technology and treatment to all patients, rich or poor.
Located in a rich section of the big metropolis, he must
compete for patients with two major state supported
medical colleges and institutes [50].
The second is a 72 year old Ayurvedic practitioner,
also from Lucknow, who was well known for treating
841
major political leaders, including a past Governor of the
state. He complements our third example, a 63 year old
Muslim hakim (literally a wise person) and religious
healer from Bhopal, whom I interviewed in July 1986,
living just across the street from the infamous Union
Carbide plant, the sight of the 1984 Bhopal industrial
disaster [51].
A typical therapeutic encounter between a patient and
the medical practitioner starts with salutary greetings
(including how are you today?), moves on to the
crucial disease diagnostics alongside carefully reading
messages from the patient and his/her accompanying
relatives, and ends with prescription of medicines, life-
style (especially dietary) instructions, and appropriate
assurances of moral and emotional support (e. g. you
will be all right; you will be cured; have faith in
God). Once familiar, a patient and his relatives find the
physician mixing his treatment with contextually
appropriate social advice, homilies, moral parables, and
humor.
Some practitioners consciously conformed to the
patients cultural background. The Lucknow modern
doctor thus routinely changed his greetings and other
verbal moral and emotional assurances with Hindu,
Muslim and Sikh patients (e.g. the greetings of Jai
Ramaji ki or Namaste for Hindu; aadaab arz for
Muslims; sat sri akal for Sikhs). However, the Ayurvedic
vaid greeted all his patients with namaste, while Bhopali
hakim uniformly employed the greetings (aadaab arz or
salaam) in Urdu [52], Yet, when consoling or reassuring
their seriously ill patients or their relatives, both
frequently evoked God as Bhagwan or Parmatma for a
Hindu patient, as Allah or Khuda for a Muslim, or as Sat
Guru for a Sikh.
Here the modern doctor was no different. In his
words, to do so is to treat the patient beyond his physical
ailments. The patient and his care-givers expect that I
should be attentive to him/her as well as the disease. In
India in private practice, you cannot just treat a body part
and forget the rest of the patient. When terminally ill,
they expect special care and understanding from us. In
the case of a critically ill old woman, whom he personally
knew and respected, he had announced that she now is
in Gods hands. Let the nature take its course, while I
make her as comfortable as possible. [There is now] no
use inserting needles and tubes in her [53]. The vaid, in
a similar situation, strongly recommended prayers
appropriate to a patients religion (e.g. a special worship
for a Hindu and a visit to a saints grave or mazaar to a
Muslim for a special dispensation). The hakim sometimes
himself prayed to his medical preceptor (a dead Muslim
saint), along with God, for helping his severely ill
patients. Holy spirits (pirs) occasionally visited him, he
claimed, enabling him in the past to cure his three
dying, two Muslim patients and one Hindu patient. His
explanation: Allah is all merciful, I say.
Simultaneously, the hakim evoked God for his
patients as Khuda and karam (Allahs mercy) for
Muslims and Parmatma and karma (the Hindu moral
principle) for Hindus. Without entering into any
theological discussions, he did so just to gain a patients
personal trust. As for my faith, God is almighty; He sees
what I mean and why. His controlled speech to patients
842 R. S. Khare
encoded subtle messages. When his neighbors (mostly up our children, two daughters, in India. However, the
Muslims) once came to relate to me (in the hakim's reality was much more complicated. As the doctor had
presence) their personal loss, and pain and suffering after observed,
the Bhopal accident, the hakim's Urdu suitably changed
We always find ourselves on call". Earlier we cursed ourselves,
to accommodate me and his neighbors, while expressing but slowly we have learned to cope with our lives as physicians
his theological view of medicine and medical practice: within our own culture. I do not know about my wife, but I have
learned to rejoice and cry withand often forour patients. I
Human pain and suffering are never without Gods message. spend more time with them than with my children and relatives.
There is good hidden behind them. But not all can read it. Take My patients show me my limits and of the medical science.
my wifes death. I had told my wife about the coming calamity Medicine is as much about caring of patients and understanding
two days before that factory across the street spewed the them as humans as about curing. But finally it is about the
yellowish cloud of deadly, choking gas into our houses... My wifephysicians skill and timely use of modern medical treatments
and 1 were in Allahs hands. She died and 1 lived. 1 was spared and technology... As a medical educator, I still feel that medical
because I still must heal the suffering. Though now I am slowly schools, here or in America, do not prepare us to be a healer.
going blind, I must treat [patients]. I do so all day long. 1 console
the bereaved; I pray for the sick. I tell stories of hope, courage Flashing professional curtness as well as the infectious
and inspiration to those who listen. Many come to me for my Lucknow courtesy (Lakhnavi tahzeeb) in his clinic, the
special charms, and prayers. Remember, only modern tablets doctor, in his view, tried to practice good, hard science
and injections do not know how to cure, and only hospitals do
not heal [54],
with a human touch. For him, a successful medical
treatment rested on the mutual cultural sharing and trust
Such a culturally encompassing communication, that a physician, with his initiative, forges between
located in ones own and others suffering, gives perhaps himself and his patient [55], The daily stream of patients
the best glimpse of how patterns of practical cultural neither irritated nor exasperated him any longer, though
reasoning and sensibility join together to frame the his patients were, he noted, increasingly cost conscious,
multivocal Indian medicine. assertive, and skeptical of miracle cures.
Sociologically, however, no curer or healer is found The vaid's and hakim's experiences with todays
infallible in culturally diverse India. Yet patients compare patients were similar. They found the young urban
medical practitioners for their known skills and Indian patient skeptical toward the Ayurveda and the
successes, and the practitioners compare each others Hikmat-Unani medical systems. The vaid attracted even
medical systems for their strengths and effectivity. In some foreigners (mostly Western Europeans) [56], while
such a context, the modern doctor had the maximum the hakim practised locally in his neighborhood. For the
secular scientific-technological knowhow, social prestige vaid, Ayurvedic medicine is most about correctly
and economic resources, but his medicine was not reading the host of deeply interrelated physiological,
without flaws or weaknesses. If his injections, surgery, psychological and innate natural dispositions (mizaz) of
and treatments under life-threatening conditions stood a patient. These narrate to him what is going on within
out, chronic ailments exposed modern medicines as well as around the patient, usually diagnosed in the
weaknesses. The Ayurveda, on the contrary, did better language of the triadic humors (tridosa), and expressed in
here. The Lucknow vaid had boasted, Our medicines hot and cold, light and heavy, and impure and
work where doctors treatment fails. Modern medicine poisoned bodily states [57]. But more crucial is, in the
fails in skin diseases, chronic ailments, and allergies. But void's words, the patients faith [in the vaid], in his
we succeed there, provided the patient undergoes our full skilled and experienced eyes and hands, and in his
treatment. Whatever modern medicine cannot treat, it prescribed therapeutic regimen (ausadhi aur acara-
becomes allergy for them... We successfully treat vicara nidana)".
hopeless allergy sufferers. The Bhopali hakim claimed For the Bhopali hakim, medicine began and ended in
one better. He treated patients when both modern ones firm faith in God. Barely earning enough to survive
medicine and Ayurveda have given up. It is nothing if not within a slum, and depending fully on Allahs grace, he
Allahs pure grace. did not have any need to count the patients. Those who
Despite such internal comparisons, the practitioners need my help, come... But, yes, these days as people lack
very well know that they must scrupulously avoid all faith [in God], they suffer more. They neither understand
religious ideological conflicts and display a practical the purpose of health nor illness in life. They miss
knowledge of regional and local cultural ways. By doing knowing the power of prayers, and miss Gods message
so they maintained that historically distinct and purpose hidden behind disease and suffering [58].
complementary-cooperative model of Indian medical In summary, the preceding profile of Indian medical
practices. Though the practice adjusts with historical practices rests on four main cultural assumptions. First,
changes in India, the underlying multiform cultural human diseases have closely interrelated physical,
model has largely remained intact over time. It also natural, bodily, social, and moral and supernatural causes,
influences the life of medical practitioners according to expressions and consequences. They do not concern only
their own cultural location, medical training and life the physical body or some of its parts. But, without
experience. raising impregnable walls of either scientific rationality
For example, living within their own large clinic and or of Hindu soteriology and Islamic hadith between them,
hospital complex, the modern doctor and his wife, who the three medical practices creatively employ their
was also a U.S. trained practising radiologist, struggled to cultural communicational messages among themselves,
separate their personal lives from medical practice. They and with their patients, to perform their curative and
had decided to settle in India rather than the U.S., healing roles. Together, the three practiced medicine that
because we wanted to have strong family life, and bring ranged from biomedicine to shamanism, including room
 Dava, Daktar, and Dua
for magico-religious forces and astrological influences
[59].
Second, human illness closely relates to the unseen
cosmic moral order, ones good and bad karmas,
disbalance in bodily humors, and to good and bad
natural and climatic influences [60]. The powerful
karma principle (shared by all major Indian religions
except Islam and Christianity), unseen and pervasive, is
widely known to explain the causation, course and
meaning of both personal illness and wellness. This
cosmic moral arbiter (popularly called daiva, niyati,
bhavi, kismat, or taqdir) is seldom far from the peoples
mind. Meaning anything from a simple human action to
willed personal effort, to personal destiny and fate, the
language of karma is truly polysemous. Both patients and
physicians use it sooner or later to understand the causes
or consequences of illness. For example, if the Lucknow
vaid spoke about it with full faith, and if the modern
doctor uttered it before his patients to satisfy the
patient, the hakim easily folded it within the all-
encompassing Allahs mercy [61]. is the British-introduced Western scientific medicine that
Third, as we saw, Indian medical practices have to be
practical and pragmatic in their approaches to treatment
and its availability. Actually, here Indian cultural and
therapeutic diversity and the continuing and increasing
need of any and all medical help join together to
strengthen this trend toward doing medically what is
practical and practicable. While doing so, medical
practices cannot discourages Indians from seeking in life
a most effective combination of treatments for their
illnesses. Correspondingly, medical practitioners evolve
their therapeutic ethos, bridging rather than separating
their ideological-scientific or religious or social worlds.
This way one simply seeks, and gives, the best cure
possible under the lived conditions, where want,
inequalities and inequities are as real as is that sense of
cooperative cultural and medical ethos.
Fourth, medicine, medical practitioners, curing, and
healing have become increasingly better organized, and
hence more accessible to Indians throughout this century.
The medical profession and practitioners have acquired
an increasingly positive social and moral profile, and
enjoy higher social prestige and economic benefits,
drawing also many quacks and impostors.
Conceptually, the orthodox Hindu view which disparaged
medicine as a lowly calling, is now countered with an
opposite view which treats medicine and medical
practitioner as forms of the divine [62].
NEW ISSUES BEFORE PRACTICED MEDICINE
Multiform reasoning and practical needs
Any overall evaluation of the current Indian medical
practices must be prepared to address issues that cut
across the instrumental, interpretive, self-alienating, and
critical politico-economic and legal approaches and
theories. However valiantly argued, no single approach is
today adequate to explain the Indian situation. And as
stressed throughout this work, with Indian medical
practices, the analytical key may be to keep the Indian
multiform cultural reasoning at the center, and not
abstract and isolate, or subordinate, distort, and vivisect
843
(in the name of scientific specialism) the prevailing
Indian medical ideologies and practices. In Indian
medicine, as elsewhere in India, ideal values and the
dominant social order today face increasing alienation,
contestation, and contingent meanings. The resulting
major critical issues before the Indian public are about
cultural alienation, economic affordability, and just, safe
and accountable availability of medical services.
Cultural alienation
Anthropologically, alienation is the other side of the
same multi-stranded Indian medicine which, as we
showed, generally emphasizes coordinating,
complementary medical practices. Indians now tend to
alienate themselves in a complex way as they get
incompletely estranged from their own traditions and
from the modernity and its institutions. The same holds
for medical systems and practices. Historically, though
cultural alienation has seldom been entirely absent from
culturally diverse traditional Indian medical practices, it
inaugurated the modern scientific, political and economic
variety [63]. In India, since the modern state has clearly
promoted supported modern scientific medicine as a state
policy, it has also shown its own and modern medicines
limitations. As some recent commentaries show, India
now engages in a critical evaluation of both its traditional
and modern medical systems, from within and
without [64],
Conceptually, the Western and non-Western cultural
dichotomy in India has been ideological and culturally
total for some analysts, and it has been experiential,
conflicted, changing, and open-ended interpretations for
others. While the Westernized Indian may stress a
scientific, experimental approach to human body,
medicine and culture, the massive social majority still
favors an interpretive stance, with ample room for
comprehensive, internally dynamic formulations of
disease, curing and healing [65]. Some recent Indian
social critics, however, find such interpretations
misleading, since it minimizes the hard economic,
political and social struggles of the faceless majority [66].
However, the cultural alienation between modern
Western and traditional medicine in India is, on closer
inspection, found neither homogeneous and passive, nor
totally conflicted and hopeless. Traditional Indian
medical practices have historically interacted with
modern Western medicine long enough to influence it, as
well as get influenced by it. Nandy, for example, shows
how non-Indian and Indian nationalist leaders, thinkers
and doctors, from Helena Blavatsky to Gandhi, Lala Har
Dayal, Srinivasmurthy, and Dr B.C. Roy (spread over
one hundred and fifty years), went about variously
domesticating and reforming Western medicine,
while ostensibly adopting it ([6], pp. 160 185).
My preceding ethnographic examples show how even
local Indian medical practitioners still routinely engage
today in influencing and slowly altering each others
medical ethics and practices in India. The latest modern
medical technologies often trigger contradictory
responses of cultural alienation and of determined use
to suit Indian patients, diseases, resource constraints, and
844 R. S. Khare
social purposes and meanings. A traditional practitioner
is thus sometimes a severe critic of modern medicine and
at other times a grudging admirer. To the Bhopali hakim,
modern hospital was like a cage that separated a patient
from his relatives, home, and even his own self. Doctors
there insert needles and tubes, cut you open to mutilate
the body, change organs, and leave you with hidden
lifelong after effects and consequences (taasir aur
anjaam)... I let my wife die a peaceful death in my arms,
rather than run amok like a headless chicken, suffocating,
crushing and killing each other [67],
Availability, affordability and the issue of justice
These issues are perhaps increasingly crucial to the
India of about one billion people. With highly uneven
and limited availability of modern health care for the
rural (i.e. 80% of the Indian population), the vast
majority every day must continue to depend on a mixture
of several traditional local medical practices. Such a
situation attracts as well as alienates people from modern
medicine. Attraction because modern medicine and its
doctors, sitting in huge hospitals with latest technology,
are popularly known to cure acute, life-threatening
diseases. And alienation because this medicine is clearly
beyond their reach, and the government (sarkar)
chronically falls short on its promises about greater
accessibility and affordability.
The 1984 Bhopal gas disaster, in such a context,
provided a dramatic test of Indian political and medical
institutions, while making modern medical history. The
event produced tens of thousands of dying and acutely ill
people within hours in Bhopal, challenging and testing
the Indian national and state governments, the modern
Indian scientific institutions and medical communities,
and the Union Carbide for its corporate sense of sharing
moral and material responsibility. A uniquely complex
medicolegal event, it also highlighted many complicated,
first-time ever issues of compensatory (Tort) and
distributive justice for the victims [68].
Total initial confusion, followed by severe continued
inadequacies and negligence in hospital and doctor care,
as my 1986 field interviews recorded, left many victims
utterly helpless and abandoned. Some survivors
particularly recalled how the same local doctors and
hospitals, who initially had helped the dying and the
suffering round the clock, had become remote,
inaccessible and unaffordable just a few days later. One
survivor recalled, We packed the hospital next day like a
herd, writhed in pain, but remained uncared for hours.
When we complained to the doctors, they complained to
us about the governments delays.
The local hospital physicians, while tight-lipped about
government administrators, did whatever we humanly
could. Most of us worked nonstop for days, until we
dropped from exhaustion... Yet, absent even basic
medical supplies, little emergency planning, and
overflowing victims, how much could any doctor
anywhere do? A young hospital doctor had added,
Doctors like me lost a relative to the disaster. I was
suffering with my patients... Treating patients, I did not
eat or sleep for the first twenty four hours. I had
nightmares for months, of the victims, young and old and
men and women, shrieking and dying on the bare hospital
floor.
The medical help came last (or not at all), many
bitterly recalled, to those poor, aged, handicapped, and
socially lowest and faceless in the Bhopal hakim's
locality. For its cynics, the government was slow because
the disaster struck only the weak and the poor. The
doctors, hospitals and government leaders knew that we
did not have famous relatives and friends... But what
could we do? The hospital was our best chance to
survive.
New criticism and remedies
With the rest of Indian society and culture, Indian
medical systems are facing new critical tests and
challenges. These are culturally interpretive as well as
politico-economic and legal. Under the first, modern
medicine continues to get ever more Indianized around
the practitioner-patient axis. Indian medical practices
continue to reinterpret what Good calls, in Western
cultural, medical and formal legal contexts, the
biological and materialist individualism and narrow
instrumental rationality [69].
The vast majority of modem Indian doctors routinely
learn in practice how to treat a patient as much more than
a biological and a modern political-legal individual. To
do so is to be a good, caring doctor in India [70].
Indian patients thus often expect doctors to accommodate
requests for diagnosis and treatment of their close family
members during the same office visit. A mother, for
example, may spontaneously ask the doctor to give
medicine to her child also. Sociologically, although such
a practice violates the norms of biological and economic
individualism guiding modern medicine, it remains a
perfectly normal expectation within a culture, which sees
the child as an extension of its mother, and the patient
only as a part of the family.
But such informal traditional medical ethos is now
so severely eroded, according to some reports, in the
majority of urban clinics and public hospitals that the
Indian Supreme Court, rejecting the 1993 appeal of the
Indian Medical Association, ruled that a physician can be
sued under the Indian Consumer Protection Act (1989)
for malpractice and negligence [71]. In such a view, a
patient is a consumer with legal protection and claims,
and a doctor is a professional service provider with legal
liabilities when found negligent in diagnosis, treatment,
and patient care.
Conceptually, the court ruling not only introduces
new legal issues of compensatory justice (Tort) in Indian
medical practices, but it also reinforces the Western
medical biological and materialistic individualism.
Interestingly, however, modern Indian medical
community objected to the ruling because, in their view,
the judiciary misinterpreted the nature of medical
service in India and its technical nature, and that it
will force Indian doctors to practice costly defensive
medicine (as in the U.S.), withhold services in critical
cases, and raise costs of their routine services.
The critical issues surrounding the Indian medical
systems, however, often are, on the one hand, about their
diverse traditional identities and historically changing
interdependent medical practices, and, on the other hand,
about the increasing problems of availability,
 Dava, Daktar, and Dua
affordability, equity, and distributive justice in medical
care. Modern democratic India can neither dismiss the
historically critical issues of cultural alienation between
modern Western and non-Western traditional medical
systems, nor the questions of fair and affordable medical
care across the gender, age, caste, class, and regional
differences.
Still, underlying all such developments, works that
time-tested vast informal network of diverse local and
regional traditional healers, covering innumerable
localities, villages and towns. Irreplaceable, its economic
and medical service value, if computed in monetary
terms, will be staggering. Whether locally strong, frail or
eroded, this multiple medical service network silently
works, guided by its own moral and material logic, rather
than depend on a few culturally superficial, though
critical, social, institutional and legal changes. The
informal network now is neither socially insulated nor
unaware of the ways of the modern city daktar (or
doctor). Yet both traditional and modern medical systems
in must be adequately sensitive to the larger moral
questions the Indian patient facesthe issues of human
body, life experiences, and soteriology. One is reminded
here of the Foucaultian question (but not without a major
cultural caveat), What kind of body does society [and
the divine] want and need? [72]. And of the question
that a medical anthropologist recently posed, where a
sufferer tries to claim to a society that the body needs and
wants [73],
REFERENCES
1. For an early collection of empirical accounts, see Paul B.D.
Health, Culture and Community: Case Studies of Public
Reactions to Health Programs. Russell Sage Foundation,
New York 1955.
2. For a comparative account of medical knowledge and
practitioners, see Leslie C. Asian Medical Systems: A
Comparative Study. University of California Press, Berkeley,
1976; and Leslie C. and Young A. (Eds.) Paths to Asian
Medical Knowledge. University of California Press,
Berkeley, 1992.
3. For a conceptual, methodological and experiential dialogue
between cultural-symbolic anthropology and biomedicine,
see Kleinman A. Medicines symbolic reality: On the
central problem in the philosophy of medicine. Inquiry, 16,
206-213, 1973; also Kleinman A. Cognitive structures of
traditional medical systems. Ethnomedicine 3, 27-49, 1974.
4. For an interpretive cultural approach to medical
anthropology, see Good B. Medicine, Rationality and
Experience: An Anthropological Perspective. Cambridge
University Press, Cambridge, 1994.
5. For a psychocultural ethos of medicine and medical practices
in India, see Kakar S. Shamans, Mystics and Doctors: A
Psychological Inquiry into India and its Healing Traditions.
Oxford University Press, Delhi, 1984; and Kakar S. Health
and medicine in the living traditions of Hinduism. In
Healing and Restoring; Health and Medicine in the World's
Religious Traditions (Edited by Sullivan L.E.). Macmillan,
New York, 1989.
6. For a critical-historical and political-view of modern Indian
medicine and its institutions, see Nandy A. The Savage Freud
and Other Essays on Possible and Retrievable Selves.
Princeton University Press, Princeton, 1995, pp. 145-195.
7. Several terms are in use today to characterize this medicine
including Allopathic, modern medicine, biomedicine,
Western medicine and Western scientific medicine. But
845
since they reflect a range of different cultural and historical
biases for a region like India, their use will vary by the
context of discussion.
8. For a positive review of this position, see Csordas T.J.
Medical anthropology as cultural anthropology. Am. Anthro.,
97, 788-791, 1995.
9. See Lindenbaum, Shirley and Margaret Lock (Eds.).
Knowledge, Power and Practice: The Anthropology of Medicine
and Everyday Life. University of California Press, Berkeley,
1993.
10. For a distinctly critical experiential approach to human
body, health, social deprivation, violence, and medicine, see
Scheper-Hughes, Nancy. Three propositions for a critically
applied medical anthropology. Soc. Sci. Med. 30, 189-197,
1990.
11. Scheper-Hughes, Nancy and Margaret Lock. The mindful
body: A prolegomenon to future work in medical
anthropology. Med. Anthrop. Quart. 1, 6-41, 1987.
12. Khare, R.S. Domestic sanitation in a North Indian village:
Anthropological approach. Ph.D. dissertation. University of
Lucknow, Lucknow, India, 1962.
13. Khare R. S. (1962) Ritual purity and pollution in relation to
domestic sanitation. Eastern Anthrop. 15, 125-139.
14. Returning recently to the subject after two decades, I found
the recent developments in medical anthropology
intellectually invigorating and challenging. With a short
visit to Professor Arthur Kleinmans Harvard Program on
Medical Anthropology in the Fall of 1993, I discussed my
study of Untouchable womens strategies on conceptualizing
body, violence, pain and suffering, Khare R.S. The body,
sensoria, and self of the powerless: remembering/re-
membering Indian untouchable women. New Lit. History,
26, 147-168, 1995.
15. For the Harvard groups approach to human body and
pain, see Good, Mary-Jo Delvecchio et al. Pain as Human
Experience: An Anthropological Perspective. University of
California Press, Berkeley, 1992.
16. Over time, it was increasingly evident to me that whether
one studied a particular medical disease and its treatment
or hunger as a biocultural illness, or the status-dependent
conditions of psychosomatic trauma, pain and suffering,
they all shared, I found, underlying cultural culturallogic
and reasoning". Though unfortunately I was unaware at the
time of the works of Nancy Sheper-Hughes, these not only
illuminate aspects of violence and suffering, but her critical
approach to medical anthropology seems comparable to
Ashis Nandy (Ref. [6]). Compare Sheper-Hughes, Nancy.
Death Without Weeping: the Violence of Everyday Life in
Brazil. University of California Press, Berkeley, 1992.
17. See Hahn, Robert A. Rethinking illness" and disease. In
South Asian Systems of Healing: Contribution to Asian Studies.
(Edited by Valentine Daniel E. and Pugh J.F.). 18, 1-23,
1984 For a wide ranging discussion of curing, healing and
health in major religious traditions, see Ref. [5],
18. Mostly implicit or unspoken, the cultural reasoning and
sensibilities" compose that distinct moral-material world
view which closely guides medical knowledge and practice.
For an exercise on Hindu cultural reasoning and its
sensibilities, see Khare R.S. The seen and the unseen: Hindu
distinctions, experiences and cultural reasoning. Cont. to
Indian Sociology 27, 191-212, 1993. Such reasoning patterns
are a form of cultural bias of the people, whether
traditional or modern.
19. For a sociological exercise, see Douglas M. Cultural bias.
Royal Anthropological Institute of Great Britain and Ireland
35, 1-59, 1978.
20. For a medical anthropological critique of some Western
reasoning behind its medical assumptions, see Scheper-
Hughes, Nancy. Embodied knowledge: Thinking with the
body in critical medical anthropology. In Assessing Cultural
Anthropology (Edited by Borofsky R.). McGraw-Hill, New
York, 1994, pp. 229-242.
21. Modern sociological, symbolic, and narrative approaches to
the Hindu (and Indian) conceptions of body, self, person,
and soul still remain rather incomplete. Even the recent
ethnosociological approach, sensitive to Hindu thought,
846 R. S. Khare
made little headway in dealing with Hindu self and soul. For
the approach and exercises, see Marriott, McKim (Ed.).
India Through Hindu Categories. Sage Publications, New
Delhi, 1990.
22. For a culturally sensitive depiction of body, self and soul in
medical situations, see Kakar S. op. cit. 1982
23. For protesting low caste formulations on the body, self and
soul, see Khare R.S. The Untouchable as Himself. Cambridge
University Press, New York, 1984. On an Untouchable
womans remarks on human body and birth, see Ref. [14],
24. For example, on curing and healing under hunger, violence,
deprivation, and terror in Latin America, see Taussig M.
Shamanism, Colonialism and the Wild Man: A Study in the
Terror and Healing. University of Chicago Press, Chicago,
1987.
25. Practiced medicine deals with patients, their caregivers
and medical practitioners for yielding sustained curing and
healing practices, skills and understanding. Neither an
abstract scholarly cultural theory nor a haphazard
pursuit of practicality, practiced medicine in India is a
product of longstanding cultural negotiations among
diverse healing traditions and their healers, whether Hindu,
Muslim, Christian, Sikh, or any other.
26. For modern medicines approaches to pain and suffering
and their anthropological interpretation, see Ref. [15],
27. For recent anthropological studies and observations on the
South Asian systems of traditional medicine, see Leslie C.
New Research on Traditional Medicine in South Asia. Soc.
Sci. Med. 17, 933-984, 1983.
28. Also Daniel, Valentine E. and Pugh J.F. South Asian
systems of healing. Cont. to Asian Studies, 18, 1-126, 1984.
Though these collections interweave widely different
conceptual themes, symbolic operators, and therapeutic
approaches within the traditional Indian curing and
healing, they all shy away from a comparative study of the
modern medical system.
29. Those prominent among them are the Vedic, Ayurvedic,
Siddha, and Unani systems. For a compact and informative
account, see Knipe D.M. Hinduism and the tradition of
Ayurveda (Ref. [5]).
30. Rahman E. Islam and health/medicine: A historical
perspective. In Ref. [5], pp. 149-172.
31. Obeyesekere G. Despair and recovery in Sinhala medicine
and religion. In Ref. [5], 1985, pp. 127-148.
32. Compare, for perspective, Leslie C. The ambiguities of
medical revivalism in modern India. In Asian Medical
Systems (Edited by Leslie C.). University of California
Press, Berkeley, 1976, pp. 356-367.
33. The propositon is culturally as untenable in Indian cities as
in villages? See Ref. [22].
34. Though separated by distinct ideological and historical
differences, Ayurvedic and modern medical systems do
forge working relationships more in medical practice
than in Indian medical research, teaching and clinical
institutions.
35. For remarks on how the weak and exploited may use their
body and illness under similar conditions. See Refs. [14]
and [20].
36. For a general discussion of distributive justice in culturally
diverse societies, see Walzer M. Spheres of Justice: A Defence
of Pluralism and Democracy. Basic Books, New York, 1983.
37. For proposing humane practice of medicine. See Ref. [4].
38. For such a profile of practiced medicine in a village in
Andhra Pradesh. See Ref. [29],
39. For a discussion of contrasting moral and legal ethic
pursued by the modern Indian state. See Section 5.
40. For medical, symbolic and ethical use of despair
sorrow and suffering" in Sinhala medicine and
Buddhism. See Ref. [31].
41. For culturally sensitive and comprehensive account of
Indian curing and healing. See Ref. [5],
42. The phrase comes from the vaid discussed later. See Section
4.
43. For a discussion of these texts in the larger historical
contexts of Hinduism. See Ref. [29].
44. He followed the practice until he died in his middle eighties.
45. The ethics is accordingly distinctly different from that
pursued by modern medicine, where a physician, "a white
knight", must relentlessly fight death, pushing medical
technology to its ever new limits and costs.
46. For an American physician's account of the issues in dying
and death in America today, see Nuland S.B. How We Die:
Reflections on Life's Fined Chapter. Alfred A. Knopf, New
York, 1994.
47. In contrast, in the West (particularly the U.S.), consent"
has become a highly contentious issue in religion, law and
medicine, raising entrenched biological, legal, political, and
even racial controversies. The test case for all these often is
abortion. In India, only intensive anthropological studies of
actual medical practices might better reveal when (and how
far) does an Indian doctor take the patients consent either
for granted or disregard or override it.
48. In the words of a famous modern Indian physician: "In the
care of the suffering, [a medical doctor] needs scientific
knowledge, technical skill, and human understanding... It is
this nature of human service that gives medicine its unique
status of being a noble profession. See Subramaniyam A.
Enforcing accountability. India Today (North American
Special Edition), 71, New Delhi, December 15, 1995.
However, in practice the cases of medical negligence, not
infrequent in India, are still rarely recorded and pressed
for justice. See Section 5, for a recent legal precedent.
49. The following discussion, based on a field study, focuses on
medical practitioners themselves as the main speakers,
narrators, interlocutors, and interpreters of Indian
medicine and medical practice. It reflects their social
experiences, cultural representations, and personal
intuitions.
50. Though all my examples come from male practitioners,
India has a good number of women doctors practicing
modern medicine in cities. Actually, the Lucknow doctor's
wife, a physician herself, asked me not to overlook this fact.
However, Ayurveda and Hikmat- Unani systems can
seldom make the same claim. They still remain a male-
exclusive domain.
51. The vaid was introduced to me as a scholar and a devotee
of the Goddess [Durga] who treated dignitaries. I
interviewed and observed him in his clinic several times, to
record how he treated his patients. Not unlike the hakim
in Bhopal, he found my interest in his medical and ethical
reasoning" rather amusing and unusual. He lectured me
about Ayurvedic medicine, once with an old, well-thumbed
Sanskrit- Hindi manual of medical practice in hand.
However, he refused to answer questions about his Tantric
worship of goddess, except that it renders my treatments
and medicines more potentsometimes like a Rambaana
(i.e. the unerring arrow of Rama). The hakim, a victim
himself of the Bhopal gas accident (with difficult breathing
and creeping blindness), had also lost to it his wife. In his
words, This gas plant snatched from me the one who
sustained and healed this healer. Yet, with sun glasses over
the eyes and a wet towel in hand, he devoutly treated the
sufferers and dispensed medicine with prayers, and in
Gods mercy (dava aur dua, Allah kay karam se).
52. To most practitioners, initial greetings are about expressing
appropriate social respect and etiquette, and the patient, as
a recipient of medical service, must properly initiate them.
53. Recalling that I lived in the U.S., he had remarked, I am no
Dr Kevorkian (a controversial American physician from
Michigan espousing terminally patients right to assisted
death). But I am also not willing to do what my American
counterparts often technologically do just to prolong
vegetative life... Then, their legal constraints are different
than mine. This interview predated the 1995 Supreme
court ruling. See Section 5.
54. His three nephews had confirmed to me that the pensive
hakim had indeed vaguely warned them of an upcoming
calamity from the clouds, but that nobody could imagine
the calamity that came.
55. Good's account, for the reasons he outlines, stays away from
giving views of experienced [American] clinicians on
similar aspects. See Ref. [4], pp. 83-87. However, they
 Dava, Daktar, and Dua 847
remain crucial to any comprehensive medical doctors, and of the government.
anthropological study of medical knowledge and medical 68. See Khare R.S. (Ed.). Issues in Compensatory Justice: The
practice. Bhopal Accident (Working Papers 2). Committee on
56. With the help of his son, a college trained vaid, who made Comparative Studies of Individual and Society, Center for
annual trips to England, Netherlands, and Denmark, the Advanced Studies, University of Virginia, Charlottesville,
vaid regularly treated small groups of European patients 1987. Also, see Khare R.S. The Bhopal Tragedy:
for allergies and skin diseases. Some regularly visited him in Labrynthine Law and Unending Politics. Anthropology
Lucknow, and others received his treatment by mail. Today, 6, 12-14, December 1990.
57. This language, integral to Ayurvedic practice, betrays 69. Compare Ref. [4], pp. 83-87 and pp. 180-184.
several closely interdependent moral, semiotic, social 70. Outstanding and caring physicians are not necessarily
relational, and ecological and climatic formulations. For exclusive categories in India, though often reputed
example, see Zimmermann F. Rtu-satmya: the seasonal cycle specialists employed in big government hospitals are (and
and the principle of appropriateness. Soc. Sci. Med. 14b, 99- can afford to be) so separated. To succeed, a family
106, 1980; Zimmermann F. The Jungle and the Aroma of practitioner, however, has to be both professionally good,
Meats: An Ecological Theme in Hindu Medicine. University of socially caring and morally attuned and sensitive to
California, Berkeley, 1987. patients needs.
58. The hakim thus echoed some basic tenets of Islamic 71. See Ref. [48], pp. 71-79, The court, however, made a
theology and medical practice. For basic formulations, see distinction between free and fee-paid medical services. The
Ref. [30], p. 157. ruling concerned only those physicians and institutions who
59. For the role of astrology in Indian medicine, see Pugh J.F. charged fee for their medical services.
Concepts of person and situation in North Indian 72. My interpolation to reflect the Indian ethos. For a medical
counseling: the case for astrology. In South Asian Systems of anthropological discussion of Foucaults formulation, see
Healing (Edited by Daniel E.V. and Pugh J.F.). Contributions Ref. [20], pp. 231-235.
to Asian Studies, 18, 85-105, 1984. 73. For example, the landmark malpractice case of Sushila Devi
60. However, since all South Asian religions are not theistic (e.g. that prompted the Supreme Court ruling on the Consumer
Buddhism and Jainism), all medical practitioners do not Protection Act. Ref. [48], pp. 723. For a modified reversal
evoke the divine but rather some sacred force or presence. and use of the Foucaultian question, see Ref. [20].
In daily practice and in common speech, however, the
theistic ethic is so strong that Buddha and Mahavira are
also often spoken as Bhagvan.
61. On curing and healing in folk Islam, see Ewing K. The
Sufi as Saint, Curer, and Exorcist in Modern Pakistan. In
Ref. [59], pp. 106-114.
62. For a classical view of physicians role and position, see
Jolly, Julius. Indian Medicine (Translated from German by
Kashikar C.G.; second revised edition). Munshiram
Manoharlal Publishers, Delhi, 1977, pp. 26-27. Committed
to maintaining and prolonging life, the supreme moral goal,
the archetypic divine healer, Dhanvantari, popularly enjoys
godly status, and the prescribed medicines (aushadhi) are
accorded divine form and function.
63. Though a systematic historiography of Indian colonial
medical science and public health still awaits attention, the
British introduced via modern Western medical ideology
and education a whole range of new biological, political,
economic, and legal conceptions of individualism in terms
of the inside and outside of human body, germ theories,
diagnostic procedures, materia medica, and medical
regimen for patients and their care givers.
64. See Ref. [6], pp. 145-195, for such an intellectual stance, and
for references to works by other recent Indian analysts and
observers. Nandy substantiates the internal Indian vis-a-
vis the external criticisms of modern Western medicine.
As medical anthropology becomes more attentive to such
critical issues, culturally narrow biomedical definitions,
roles and meanings of human body will come under
increasing scrutiny. For example, on illness as resistance,
see Ref. [20].
65. For ideologically contrasting modern West to traditional
India, see Dumont L. Homo Hierarchicus (Revised Complete
English Edition). University of Chicago Press, Chicago,
1980. For a wide ranging study of Ayurveda under such
culturally essentializing theoretical influence, see Ref. [57],
For an interpretive ethnographic approach to an illness
under redefinition, see Egnor, Margaret Trawick. The
Changed Mother or
What the Smallpox Goddess did when there was no more
Smallpox. In Ref. [59], pp. 24-45.
66. For references to activist-scholars of medicine and health
care in India today, see Ref. [6], pp. 148-149.
67. However, other local medical practitioners, including
several homeopaths, vaids, exorcists, and holy persons, were
far less critical of modern doctors and hospitals. They freely
admitted that hospital was their best hope immediately after
the gas disaster, though, two months after, they recalled
they had marched against the failures of hospitals and