![Sample our Area Studies journals, sign in here to start your access, latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5922/TOC-Subject-Sample-2021-Area-Studies.jpg"})
Abstract
This paper is an ethnographic account of traumatic brain injuries (TBIs) based on a study of a public hospital trauma ward in urban India. It explores the contexts, causes and consequences of TBIs in order to make several broader claims. Across two case studies, I argue that epidemiological transitions towards non-infectious disease regimens must be understood as problems of somatic movement. The implication is that bodies make transitions through actual and imagined changes in bodily movements that define how persons become patients, how traumatic injury pulls on clinical resources, and how differences in gender, sexuality, class and caste affect the social dynamics of brain injury in urban settings at every turn.
Acknowledgements
My thanks go to the article’s two anonymous South Asia reviewers, Marika Vicziany, Kama Maclean, Vivien Seyler, Dörte Bemme, Mara Buchbinder, Jocelyn Chua, Nadia El-Shaarawi, Saiba Varma, Nobhojit Roy, Vineet Kumar, Siddarth David, Jyoti Kamble and Gabriel Rosenberg for the insight and support. Research support was made possible by the National Science Foundation Cultural Anthropology Program.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. All names of interlocutors used in this article are pseudonyms, in accordance with the Institutional Review Board approvals from Duke University and the two ethics board approvals from the Indian hospitals in which I conducted my research.
2. Jennifer Terry, ‘Significant Injury: War, Medicine, and Empire in Claudia’s Case’, in Women’s Studies Quarterly, Vol. 37, nos. 1–2 (2009), pp. 200–25.
3. Michele Friedner, Becoming Normal: Cochlear Implants and Sensory Infrastructures in India (Minneapolis: University of Minnesota Press, 2022); and Laurence Ralph, Renegade Dreams: Living through Injury in Gangland Chicago (Chicago, IL: University of Chicago Press, 2014).
4. World Health Organization, ‘Injuries and Violence: The Facts, 2014’ [https://apps.who.int/iris/bitstream/handle/10665/149798/9789241508018_eng.pdf, accessed 15 Sept. 2021].
5. See the introduction to this special section: Marika Vicziany, ‘The Modernisation of South Asia's Disease Burden’, in South Asia: Journal of South Asian Studies, Vol. 44, no. 6 (2021).
6. Harris Solomon, Metabolic Living: Food, Fat, and the Absorption of Illness in India (Durham, NC: Duke University Press, 2016).
7. Julie Livingston, Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic (Durham, NC: Duke University Press, 2012), p. 32; and Amy Moran-Thomas, Traveling with Sugar: Chronicles of a Global Epidemic (Berkeley: University of California Press, 2019).
8. Dwaipayan Banerjee, Enduring Cancer: Life, Death, and Diagnosis in Delhi (Durham, NC: Duke University Press, 2020); Carlo Caduff and Cecilia C. Van Hollen, ‘Cancer and the Global South’, in BioSocieties, Vol. 14 (2019), pp. 489–95; Kavita Sivaramakrishnan, ‘An Irritable State: The Contingent Politics of Science and Suffering in Anti-Cancer Campaigns in South India (1940–1960)’, in BioSocieties, Vol. 14 (2019), pp. 529–52; and Cecilia Van Hollen, ‘Handle with Care: Rethinking the Rights versus Culture Dichotomy in Cancer Disclosure in India’, in Medical Anthropology Quarterly, Vol. 32, no. 1 (2018), pp. 59–84.
9. India State-Level Disease Burden Initiative Collaborators, ‘Nations within a Nation: Variations in Epidemiological Transition across the States of India, 1990–2016, in the Global Burden of Disease Study’, in The Lancet, Vol. 390, no. 10111 (2017), pp. 2437–60.
10. R. Dandona et al., ‘Mortality Due to Road Injuries in the States of India: The Global Burden of Disease Study, 1990–2017’, in Lancet Public Health, Vol. 5, no. 2 (2020), pp. e86–e98; and Nobhojit Roy et al., ‘30-Day In-Hospital Trauma Mortality in Four Urban University Hospitals Using an Indian Trauma Registry’, in World Journal of Surgery, Vol. 40, no. 6 (2016), pp. 1299–307.
11. Mariam Dossal, Imperial Designs and Indian Realities (New York: Oxford University Press, 1997); Prashant Kidambi, ‘“An Infection of Locality”: Plague, Pythogenesis and the Poor in Bombay, c. 1896–1905’, in Urban History, Vol. 31, no. 2 (2004), pp. 249–67; and Colin McFarlane, ‘Governing the Contaminated City: Infrastructure and Sanitation in Colonial and Post-Colonial Bombay’, in International Journal of Urban and Regional Research, Vol. 32, no. 2 (2008), pp. 415–35.
12. Ravi Sundaram, Pirate Modernity: Delhi’s Media Urbanism (London: Routledge, 2009), pp. 170–1.
13. I conducted participant observation during different hospital shifts (morning, afternoon and overnight) to understand the different rhythms of the ward as well as to ensure repeated, representative interactions with the ward’s staff. Individual interviews conducted outside a given shift were tape-recorded when possible, transcribed by me and by a research assistant, and analysed for emergent concepts and connective themes as the corpus of data grew. Broader context about the municipal hospital system came from analysing city newspaper coverage of health care, transit and traffic politics, and reporting on specific accidents. This was done using database software set to search Marathi, Hindi and English news sources. Semi-structured interviews in Hindi, Marathi and English elicited data on a staff member’s own educational and work experiences, memories of the first day on the ward as well as subsequent notable/memorable cases, opinions on the ward’s functions and more generalised opinions about the social aspects of casualty care in the city.
14. Harris Solomon, ‘Shifting Gears: Triage and Traffic in Urban India’, in Medical Anthropology Quarterly, Vol. 31, no. 3 (2017), pp. 349–64; Harris Solomon, ‘Living on Borrowed Breath: Respiratory Distress, Social Breathing, and the Vital Movement of Ventilators’, in Medical Anthropology Quarterly, Vol. 35, no. 1 (2021), pp. 102–19; and Harris Solomon, Lifelines: The Traffic of Trauma (Durham, NC: Duke University Press, 2022).
15. Solomon, Metabolic Living.
16. Saksham Gupta et al., ‘Third Delay in Traumatic Brain Injury: Time to Management as a Predictor of Mortality’, in Journal of Neurosurgery, Vol. 138, no. 1 (Jan. 2020), pp. 150–8.
17. Prashant Bhandarkar et al., ‘An Analysis of 30-Day In-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma Registry’, in World Journal of Surgery, Vol. 45, no. 2 (Feb. 2021), pp. 380–9; Martin Gerdin et al., ‘Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study’, in PloS One, Vol. 9, no. 9 (2014), p. e105606; Vineet Kumar et al., ‘The Great Indian Invisible Railroad Disaster’, in Prehospital Disaster Medicine, Vol. 27, no. 2 (April 2012), p. 216; and Nobhojit Roy, ‘Towards Improved Trauma Care Outcomes in India: Studies of Rates, Trends and Causes of Mortality in Urban Indian University Hospitals’, unpublished PhD dissertation, Karolinska Institutet, Solna, Sweden, 2017 [https://openarchive.ki.se/xmlui/handle/10616/45531, accessed 15 Sept. 2021].
18. See Sameena Mulla, The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Victims (New York: New York University Press, 2014). In speech, injury’s circumstances may become known as an ‘accident’. This is glossed as haadsa in Hindi, apghat in Marathi and aksident in Mumbai’s colloquial Hindi dialect. Both the Hindi term chot (meaning ‘wound’) and the English-derived term injury are used in conversation to refer to an accident’s outcomes. Public health scholars tend to use the term ‘injury’ to assert that there are really no accidents because all events have underlying causes. I am mindful of this distinction, and it is indeed important. However, I will stay with local linguistic forms to reflect the terms that ground the work of the ward.
19. This issue could potentially be addressed by ensuring that data from the ‘gyn/ec’ wards of Central and other hospitals are co-ordinated with case reports in the trauma ward, and vice versa.
20. The dura is the outermost tissue membrane that surrounds the brain.
21. Suryakant Yadav and Perianayagam Arokiasamy, ‘Understanding Epidemiological Transition in India’, in Global Health Action, Vol. 7, no. 1 (May 2014), article no. 23248, n.p.
22. Des Fitzgerald et al., ‘Living Well in the Neuropolis’, in The Sociological Review, Vol. 64, no. 1 (2016), pp. 221–37 [222].
23. Rashmi Sadana, ‘On the Delhi Metro: An Ethnographic View’, in Economic & Political Weekly, Vol. 45, no. 46 (13–19 Nov. 2010), pp. 77–83. Also see Sareeta Amrute, ‘Moving Rape: Trafficking in the Violence of Postliberalization’, in Public Culture, Vol. 27, no. 2(76) (2015), pp. 331–59; Tarini Bedi, ‘Taxi Drivers, Infrastructures, and Urban Change in Globalizing Mumbai’, in City & Society, Vol. 28, no. 3 (2016), pp. 387–410; Tarini Bedi, ‘Urban Histories of Place and Labour: The Chillia Taximen of Bombay/Mumbai’, in Modern Asian Studies, Vol. 52, no. 5 (2018), pp. 1604–38; and Solomon Benjamin and R. Bhuvaneswari, ‘Democracy, Inclusive Governance and Poverty in Bangalore’, IDD Working Papers, no. 26 [https://gsdrc.org/document-library/democracy-inclusive-governance-and-poverty-in-bangalore/, accessed 15 Sept. 2021].
24. On ‘the interval’ as a critical spacetime form, see Michael Fisch, An Anthropology of the Machine: Tokyo’s Commuter Train Network (Chicago, IL: University of Chicago Press, 2018).
25. It is true that some traumatic injuries derive from falls, and that falls can be attributed to cardiometabolic disease events such as strokes. Arguably, this overlap between traumatic injury and other forms of non-communicable disease can happen if someone loses control of a car during hypoglycemia. But it is so rare as to be a theoretical possibility that hardly bears out.
26. Bedi, ‘Taxi Drivers, Infrastructures, and Urban Change in Globalizing Mumbai’, p. 388.
27. Harris Solomon, ‘Death Traps: Holes in Urban India’, in Environment and Planning D: Society and Space, Vol. 39, no. 3 (2022), pp. 423–40.
28. Sundaram, Pirate Modernity, p. 31.
29. Ranjani Mazumdar, ‘Spectacle and Death in the City of Bombay Cinema’, in Gyan Prakash (ed.), The Spaces of the Modern City: Imaginaries, Politics, and Everyday Life (Princeton, NJ: Princeton University Press, 2008), pp. 401–32; and Ranjani Mazumdar, ‘Friction, Collision, and the Grotesque: The Dystopic Fragments of Bombay Cinema’, in Gyan Prakash (ed.), Noir Urbanisms: Dystopic Images of the Modern City (Princeton, NJ: Princeton University Press, 2011), pp. 150–86. Mazumdar’s analysis of the film Borivali Fast exemplifies this imaginative form. Also see Gyan Prakash, Mumbai Fables (Princeton, NJ: Princeton University Press, 2010).
30. Joseph Dumit, Picturing Personhood: Brain Scans and Biomedical Identity (Princeton, NJ: Princeton University Press, 2004); and Barry Saunders, CT Suite: The Work of Diagnosis in the Age of Noninvasive Cutting (Durham, NC: Duke University Press, 2010).
31. Sarah Pinto, Daughters of Parvati: Women and Madness in Contemporary India (Philadelphia: University of Pennsylvania Press, 2014).
32. Shreyas Sreenath, ‘Rowdy’, in South Asia: Journal of South Asian Studies, Vol. 40, no. 2 (2017), pp. 392–94. A related term one hears is badmaash, ‘of bad livelihood’: see Radhika Singha, ‘Punished by Surveillance: Policing “Dangerousness” in Colonial India, 1872–1918’, in Modern Asian Studies, Vol. 49, no. 2 (2015), pp. 241–69.
33. Amrute, ‘Moving Rape’; Rashmi Sadana, ‘At the “Love Commandos”: Narratives of Mobility among Intercaste Couples in a Delhi Safe House’, in Anthropology and Humanism, Vol. 43, no. 1 (2018), pp. 39–57; and Jan Brunson, ‘Scooty Girls: Mobility and Intimacy at the Margins of Kathmandu’, in Ethnos, Vol. 79, no. 5 (2014), pp. 610–29.
34. She thought Aamir Khan’s character in Rangeela was a quintessential rowdy. Others thought that Gabbar Singh was a rowdier rowdy. And, they reminded me, there was Rowdy Rathore.
35. V. Dhareshwar and R. Srivatsan, ‘Rowdy-Sheeters: An Essay on Subalternity and Politics’, in S. Amin and Dipesh Chakrabarty (eds), Subaltern Studies IX: Writings on South Asian Society and History (Delhi: Oxford University Press, 1997), pp. 201–31. Also see Thomas Blom Hansen, ‘Governance and State Mythologies in Mumbai’, in Thomas Blom Hansen and Finn Stepputat (eds), States of Imagination: Ethnographic Explorations of the Postcolonial State (Durham, NC: Duke University Press, 2001), pp. 221–54.
36. Stacey Langwick, ‘Devils, Parasites, and Fierce Needles: Healing and the Politics of Translation in Southern Tanzania’, in Science, Technology, & Human Values, Vol. 32, no. 1 (2007), pp. 88–117.
37. Stuart Elden, ‘Plague, Panopticon, Police’, in Surveillance & Society, Vol. 1, no. 3 (2003), pp. 240–53.
38. Jacob Copeman, Veins of Devotion: Blood Donation and Religious Experience in North India (New Brunswick, NJ: Rutgers University Press, 2009).