Search

This chapter focuses on quotidian scenes through which the state is engaged over infrastructural projects, such as ensuring access to electricity and water in a locality in Delhi that has its origins in unauthorized occupations over land. One of the tasks in this chapter is to simply show the intensity and the kind of labor that goes into the task of getting electricity meters installed in a locality that falls outside the administrative category of a recognized colony. Apart from meeting the endless conditions setup by an inflexible bureaucracy and the mobilization of local support, the local leaders also work to ward off threats of violence from the mafia-like interests that develop around illegal supply of electricity in such localities. The chapter asks, does this work performed by the local leaders and their supporters count as politics? The chapter engages the theory of performative utterances and speech acts develop by of the philosopher J. L. Austin. Elucidating Cavell’s identification of passionate utterances as distinct from utterances with illocutionary force the chapter looks at the way emotion is laced into language putting into question the idea of stability of convention in the context of political work performed by the poor.

This chapter analyzes Wittgenstein’s remarks on Frazer not as pertaining to a theory of religious belief and ritual but to his major preoccupation with pictures of the world produced through what he called “grammatical illusions.” It argues that Wittgenstein faults Frazer not so much for having made a mistake in interpreting rituals as expressions of an erroneous understanding of cause and effect, but rather for being in the grip of a superstition creating false excitement about primitive practices where none were warranted. Wittgenstein draws on our common background as humans—the natural history we might invent to show that had Frazer paid attention to our primitive reactions as humans, he might have found other routes to connect the practices of the so-called primitives to those commonly found in his own society. The chapter offers a sustained reading of some of the most intriguing comments of Wittgenstein to ask such questions as what it is to take the facts of one’s existence upon oneself? The chapter holds that such points of connection create a more meaningful interface between philosophy and anthropology than any grand foundational gestures could do.

Cet essai a pour objectif d’interroger la maniere dont le livre Little Did I Know (2010), que Stanley Cavell decrit comme une autobiographie philosophique, est impregne de la voix de l’enfant, une voix constitutive de la decouverte que fait Cavell des enjeux de la pratique de la philosophie. En effet, la question de savoir si quelqu’un comme lui a le droit de faire de la philosophie est liee a celle de savoir comment l’existence peut etre revendiquee. Parce que l’apprentissage d’une « menace mortelle » qu’une telle proximite avec la mort constitue le point de depart de son ecriture : se donnant a lui-meme la permission de s’en aller, il se donnerait ainsi les moyens de trouver les mots qui seront, d’une certaine facon, les mots justes. Au travers de la voix de l’enfant, la question relative au fait de devoir apprendre a absorber un savoir demesure, qui est aussi celle de savoir comment les blessures et les injustices accumulees dans l’enfance peuvent etre reconnues a l’âge adulte, se pose avec acuite. Quelles sont les tragedies des enfants ? Et peut-on faire de la philosophie depuis la region feminine de soi-meme ? Cet essai a pour ambition de lire le texte de Cavell comme un texte qui revele comment la memoire et l’oubli peuvent etre equilibres dans un texte qui revendique de faire de la philosophie en faisant une autobiographie.

As per the estimates of World Health Organization (WHO) about 80% of world's population depends on plant and plant products for their primary healthcare. Recently the demand for herbal drugs has increased many folds at the global level, as these herbal medicines do not have any side effects and its cost effectiveness. Huge quantities of solid waste is generated during the production of decoction using roots, stems, nuts, barks, seeds, flowers and fruits. This solid waste is recalcitrant in nature and the dried waste is very sharp and prickly in nature. Hence cannot be used as a fodder, like leguminous plants. At present, this solid waste is simply being disposed off on land. So it was envisaged to try vermicomposting of this solid waste using earthworm species of Eudrilus eugeniae, considering the high content of Volatile Solids of Total Solids to the tune of 81.78%, indicating its good degradable nature. Herbal solid waste depicted C/N ratio of 35.34 and the vermicompost had C/N ratio of 12.6. Volatile Solids reduction obtained is around 61.23% indicating good bioconversion of the waste. 18.6% moisture content further indicates good quality vermicompost production. Maturity of the compost was confirmed by microbial analysis and also by Scanning Electron Microscopy. Vermicompost prepared out of this herbal pharmaceutical solid waste depicted efficient porosity of 80.489% and water holding capacity of 87.5534%. Bulk density was around 0.9667 gm/cm3 indicating its suitability for agricultural activity.

The use of standardised patients (SPs)—people recruited from the local community to present the same case to multiple providers in a blinded fashion—is increasingly used to measure the quality of care in low-income and middle-income countries. Encouraged by the growing interest in the SP method, and based on our experience of conducting SP studies, we present a conceptual framework for research designs and surveys that use this methodology. We accompany the conceptual framework with specific examples, drawn from our experience with SP studies in low-income and middle-income contexts, including China, India, Kenya and South Africa, to highlight the versatility of the method and illustrate the ongoing challenges. A toolkit and manual for implementing SP studies is included as a companion piece in the online supplement.

Summary Background In India, men are more likely than women to have active tuberculosis but are less likely to be diagnosed and notified to national tuberculosis programmes. We used data from standardised patient visits to assess whether these gender differences occur because of provider practice. Methods We sent standardised patients (people recruited from local populations and trained to portray a scripted medical condition to health-care providers) to present four tuberculosis case scenarios to private health-care providers in the cities of Mumbai and Patna. Sampling and weighting allowed for city representative interpretation. Because standardised patients were assigned to providers by a field team blinded to this study, we did balance and placebo regression tests to confirm standardised patients were assigned by gender as good as randomly. Then, by use of linear and logistic regression, we assessed correct case management, our primary outcome, and other dimensions of care by standardised patient gender. Findings Between Nov 21, 2014, and Aug 21, 2015, 2602 clinical interactions at 1203 private facilities were completed by 24 standardised patients (16 men, eight women). We found standardised patients were assigned to providers as good as randomly. We found no differences in correct management by patient gender (odds ratio 1·05; 95% CI 0·76–1·45; p=0·77) and no differences across gender within any case scenario, setting, provider gender, or provider qualification. Interpretation Systematic differences in quality of care are unlikely to be a cause of the observed under-representation of men in tuberculosis notifications in the private sector in urban India. Funding Grand Challenges Canada, Bill & Melinda Gates Foundation, World Bank Knowledge for Change Program.

Summary Background Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients. Methods We did a pilot, cross-sectional validation study of a convenience sample of consenting private health-care providers in low-income and middle-income areas of Delhi, India. We recruited standardised patients in apparently good health from the local community to present four cases (two of presumed tuberculosis and one each of confirmed tuberculosis and suspected multidrug-resistant tuberculosis) to a randomly allocated health-care provider. The key objective was to validate the standardised-patient method using three criteria: negligible risk and ability to avoid adverse events for providers and standardised patients, low detection rates of standardised patients by providers, and data accuracy across standardised patients and audio verification of standardised-patient recall. We also used medical vignettes to assess providers' knowledge of presumed tuberculosis. Correct case management was benchmarked using Standards for Tuberculosis Care in India (STCI). Findings Between Feb 2, and March 28, 2014, we recruited and trained 17 standardised patients who had 250 interactions with 100 health-care providers, 29 of whom were qualified in allopathic medicine (ie, they had a Bachelor of Medicine & Surgery [MBBS] degree), 40 of whom practised alternative medicine, and 31 of whom were informal health-care providers with few or no qualifications. The interactions took place between April 1, and April 23, 2014. The proportion of detected standardised patients was low (11 [5%] detected out of 232 interactions among providers who completed the follow-up survey), and standardised patients' recall correlated highly with audio recordings ( r =0·63 [95% CI 0·53–0·79]), with no safety concerns reported. The mean consultation length was 6 min (95% CI 5·5–6·6) with a mean of 6·18 (5·72–6·64) questions or examinations completed, representing 35% (33–38) of essential checklist items. Across all cases, only 52 (21% [16–26]) of 250 were correctly managed. Correct management was higher among MBBS-qualified doctors than other types of health-care provider (adjusted odds ratio 2·41 [95% CI 1·17–4·93]; p=0·0166). Of the 69 providers who completed the vignette, knowledge in the vignettes was more consistent with STCI than their actual clinical practice—eg, 50 (73%) ordered a chest radiograph or sputum test during the vignette compared with seven (10%) during the standardised-patient interaction; OR 0·04 (95% CI 0·02–0·11); p Interpretation Standardised patients can be successfully implemented to assess tuberculosis care. Our data suggest a big gap between private provider knowledge and practice. Additional work is needed to substantiate our pilot data, understand the know-do gap in provider behaviour, and to identify the best approach to measure and improve the quality of tuberculosis care in India. Funding Grand Challenges Canada, the Bill & Melinda Gates Foundation, Knowledge for Change Program, and the World Bank Development Research Group.

Global health programmes are damaged by blockages in the upward flow of information from localities and regional centres about realities of professional practice and about patients' lives and conditions of treatment. Power differentials between local actors and national or international decision-makers present further obstacles to effective action. Anthropological research and action, in its most effective current forms, make important contributions to these issues. This research often continues over the long term, intensively. It can be multi-sited, studying actors at local, national and international levels simultaneously. It studies the relative knowledge and power of impoverished patients and global decision-makers, all within a single frame. By doing so, anthropological research is capable of providing new and important insights on the diverse meanings of patient decision-making, informed consent, non-compliance, public health reporting, the building of political coalitions for health and many other issues.

Summary Background Hospital-based studies have suggested that fire-related deaths might be a neglected public-health issue in India. However, no national estimates of these deaths exist and the only numbers reported in published literature come from the Indian police. We combined multiple health datasets to assess the extent of the problem. Methods We computed age–sex-specific fire-related mortality fractions nationally using a death registration system based on medically certified causes of death in urban areas and a verbal autopsy based sample survey for rural populations. We combined these data with all-cause mortality estimates based on the sample registration system and the population census. We adjusted for ill-defined injury categories that might contain misclassified fire-related deaths, and estimated the proportion of suicides due to self-immolation when deaths were reported by external causes. Findings We estimated over 163 000 fire-related deaths in 2001 in India, which is about 2% of all deaths. This number was six times that reported by police. About 106 000 of these deaths occurred in women, mostly between 15 and 34 years of age. This age–sex pattern was consistent across multiple local studies, and the average ratio of fire-related deaths of young women to young men was 3:1. Interpretation The high frequency of fire-related deaths in young women suggests that these deaths share common causes, including kitchen accidents, self-immolation, and different forms of domestic violence. Identification of populations at risk and description of structural determinants from existing data sources are urgently needed so that interventions can be rapidly implemented. Funding None.

In rural India, as in many developing countries, childhood mortality remains high and the quality of health care available is low. Improving care in such settings, where most health care practitioners do not have formal training, requires an assessment of the practitioners' knowledge of appropriate care and the actual care delivered (the know-do gap).To assess the knowledge of local health care practitioners and the quality of care provided by them for childhood diarrhea and pneumonia in rural Bihar, India.We conducted an observational, cross-sectional study of the knowledge and practice of 340 health care practitioners concerning the diagnosis and treatment of childhood diarrhea and pneumonia in Bihar, India, from June 29 through September 8, 2012. We used data from vignette interviews and unannounced standardized patients (SPs).For SPs and vignettes, practitioner performance was measured using the numbers of key diagnostic questions asked and examinations conducted. The know-do gap was calculated by comparing fractions of practitioners asking key diagnostic questions on each method. Multivariable regressions examined the relation among diagnostic performance, prescription of potentially harmful treatments, and the practitioners' characteristics. We also examined correct treatment recommended by practitioners with both methods.Practitioners asked a mean of 2.9 diagnostic questions and suggested a mean of 0.3 examinations in the diarrhea vignette; mean numbers were 1.4 and 0.8, respectively, for the pneumonia vignette. Although oral rehydration salts, the correct treatment for diarrhea, are commonly available, only 3.5% of practitioners offered them in the diarrhea vignette. With SPs, no practitioner offered the correct treatment for diarrhea, and 13.0% of practitioners offered the correct treatment for pneumonia. Diarrhea treatment has a large know-do gap; practitioners asked diagnostic questions more frequently in vignettes than for SPs. Although only 20.9% of practitioners prescribed treatments that were potentially harmful in the diarrhea vignettes, 71.9% offered them to SPs (P .001). Unqualified practitioners were more likely to prescribe potentially harmful treatments for diarrhea (adjusted odds ratio, 5.11 [95% CI, 1.24-21.13]). Higher knowledge scores were associated with better performance for treating diarrhea but not pneumonia.Practitioners performed poorly with vignettes and SPs, with large know-do gaps, especially for childhood diarrhea. Efforts to improve health care for major causes of childhood mortality should emphasize strategies that encourage pediatric health care practitioners to diagnose and manage these conditions correctly through better monitoring and incentives in addition to practitioner training initiatives.

R. S. Khare. The Hindu Hearth and Home. Delhi: Vikas Publishing House, 1976. vi + 322 pp. Figures, tables, maps, appendixes, bibliography, index. Rs. 90. R. S. Khare. Culture and Reality. Simla: Indian Institute of Advanced Study, 1976. xxi +210 pp. Figures, tables, bibliography, index. Rs. 38.

Introduction - Veena Das Varieties of Life and Word Art and Theology in the Bhagavata Purana - D F Pocock Banaras - Diana L Eck Cosmos and Paradise in the Hindu Imagination Actors, Pilgrims, Kings, and Gods - Anuradha Kapur The Ramlila at Ramnagar Erotic Fantasy - Sudhir Kakar The Secret Passion of Radha and Krishna The Voyage of the Hero - Roma Chatterji The Self and the Other in One Narrative Tradition of Purulia Child and Childhood - Urvashi Misri A Conceptual Construction The Human Condition in Puran Bhagat - Harjeet Singh Gill An Essay in Existential Anthropology of a Punjabi Legend Rule-by-Records and Rule-by-Reports - Richard Saumarez Smith Complementary Aspects of the British Imperial Rule of Law Violence, Victimhood, and the Language of Silence - Veena Das and Ashis Nandy