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122

Veena Das
possible
well

given
or

are we to think of the category "low blood


"
which seems to have replaced any categories that might be
described as "folk"
as
liver or
as
signifier of
whole gamut of conditions under which the
? It is evident
the health of
poor
have to
cannot
thought of
isolation from the circulation of bio
manufactured
medical categories
disease or from the
and dumped not only by
pharmaceutical industry but by
from which
practltloners
spurious industry of
the informal system probably buy the medicines that are then
given to
poorY
what we find is a
and practices, which makes it impossible to distin
of
biomedicine.
in which
individual.
use of inappropriate antibiotics for
childhood
not only
children but poses a
threat to the environment in which microbial resistance
is becoming a major problem.
(YAt',PC

Priti is a seven-month-old baby. Though her


of
nonliterate, they are
aware of the
By
tika (childhood
and
OPV
that the local
weekly morbidity surveys it was
ill with diarrhea, respiratory
or
every week. There are two different
in the area
that the parents visit.
first is a doctor working in a government
hospital, who runs a clinic
the evening
two hours in this
locality.
second is a holder of a recognized university degree
plant
in Electrohomeopathy, which is based upon treatment
is available alm9st until 10 p.m.
his clinic
extracts.
every day.
baby was taken to the first doctor initially and then
to the second doctor because the parents were under a time conand also
that
was
repeated episodes of

Beyond

Boundaries

Bioethics

these
the baby was
and Amoxycillin
diarrhea, Ampicillin for
medicines, probably
doctor. In
remedies made by
a medicine
what kind
doctor, I
he prescribed for his patients. In addition to the plant
he said,
paracetamol
antibiotics
they
name of three antibiotics for
were more effective. He knew
fever: Septron, Ampicillin,
Amoxycillin.
diarrhea he pre
scribed
Getamycin or Metrogyl.
there does not
much
between the medicines
by
doctor who runs a private
in the
The first

In an

U<'-I..H,-,H"_"

was gIven on
was given
for a
when they thought that

resistance to
she was
microbial

one ear,
was taken
was correctly
parents could
meanwhile)
six years. A
hospital, which were
the disease had developed
because
the fact that
was not aware
recelvmg

It would be
cases as simply the results of
inadequate
Delhi
Association has been demanding
legislature should
pass the Quackery Bill, which would make the
of

124

VeenaDas
III

However, our studies


various kinds of
In the localities in which the poor
reside are not strongly marked. In
the patients going to the
qualified practitioners often end
more because
unnecessary diagnostic tests that are recommended in addition
to unnecessary medication.
include
laboratory for tests
already been
in
another laboratory and inappropriate
as well as com
puterized tomography (CT) scans.
have found
who
have been
paracetamol for years: sometimes their
symptoms indicate somatization of psychiatric symptoms, somethe
of managing everyday living in
times
maybe an
conditions of poverty, and
such as tuberculosis or typhoid, that has gone
would appear, then, that the boundaries between what is
and what is public in health are difficult to determine.
One
of this
for policy-making is
tural programs that recommend a
partnership
providers in
private sector
public governsector
be
to a
private sector that may be valid only in the more
sectors of society. Thus, if we continue to
In terms
public/private dichotomy in devising policy and attributing the
to
occurrence
.
private decisions individuals, we may end up seriously under
the force of global and market processes in the
production
.
care on the
basis
a bstract principles about individual responsibility for
personal decisions regarding health care may have adverse
consequences for the health of the poor unless we
.
rethink the public/private dichotomy
this sphere as has been
done by feminist scholars in other spheres.
One
consider the following:
these may
for policy and re
search, do they hold any
? I
these issues hold implications for both anthropology and

Beyond the Boundaries of .

broadly
Discussion in anthropology on
how to reorient
in relation to new objects of inquiry, since
the
distinction between so-called
and
societies has collapsed, cannot be oblivious to the profound
in the definition of what constitutes hu
manity and what constitutes nature. Bioethics is faced with a
should it
as a branch of the
of bio
in the West, which gives it coherence and allows it to
function in the shadow of the law within
such
their meaning, or
as
disclosure, and truth-telling
should it address
larger
to the tensions
and the symbiosis between health as a public
and health
as a private
a recent
Gisli Palsson and Paul Rabinow see the
problem
anthropology as that
itself in
prevI
face
a nature very
from that
ous generations. "For one
" they
"biotechnology
revolutionized the capacity
altering DNA material, raising
new and fundamental 'anthropological' questions. Although
argued for a
the human
body and nature are inextricably
... it is a cliche today
to
that a new
to modify them is with us
they
are increasingly commodified and subject to market exchange. "65
They locate this tension
the ethics
politics of representa
especially through
discussion of controversies sur
rounding the project to map
of the Icelandic people
by DeCode
a biotechnology company. A powerful
of this work
in the idea
to
I-'HUUHF.,

Issues
is another
in which nature is being modified: through
kind of biomedical practices that are leading to the
antimicrobial resistance.
modifications are not
eled on social norms, nor are they well understood. They are
of human actions and uncon
the unintended
trolled exchanges of
occurring in nature.
too hold the ominous potential of
the
new and unpredictable ways. In light of this,
fieldwork must
up to
the

126

VeenaDas

relation between anthropologist and informant can be modeled


neither on "rapport" nor on "complicity" as
recently
67
by
Marcus. For
we
in our own field
work
in collecting
on morbidity it
to
available to the
with which we
of the
potential of some of
the relation between expert knowledge and
norms
difficult
biotechnology in the
fields of new reproductive technology and the genome project
(with which anthropologists continue to engage), the nature
this challenge in
to the everyday
of
in low-income countries is of an altogether different kind.
The
in this context is rarely that of our stake in "human
ity" or "the
condition" as
have supposed but
rather how we can make institutions concerned with large
issues of "human
or "human rights"
to the
small happenings in local communities far away from
of
media or of new technologies-happenings that could
for our experience of the
body, nature, or
and anthropol
intersections of such fields as
ogy,68 or
biology and anthropology,69 appear to pose
challenges. We are likely to be less certain about the
philosophical foundations on which the new concerns
.
from
can
models of bioethics hold as little
as the simple
models of local worlds constructed by anthro
well-honed concepts of political and ethical
which work
in this context for fully
ate and affluent societies.
to
disease, such as
models or illness narratives, are
extremely important, because they make
the connec
tions between individual
and social bodies. We must
understand, though, that such categories have also evolved
through the
of norms and institutions of biomedi
70
cine. Rather than a prior
to "the native point
view," it may be that
way to respond to the suffering of
such persons as Pushpa,
and Priti in the most ordinary
of
might ground such questions better than re