Resistant bugs, porous borders and ecologies of care in India.

As social science scholarship has routinely illustrated, professional practice is rarely as contained or coherent as it is often imagined to be. The increasing emphasis on the rise of antimicrobial resistance (AMR) has drawn renewed attention to the interconnectedness of clinic, community, environment and planet, and how proposed 'solutions' to major problems such as AMR require a broad, cross-cutting lens. In this study, set in Hyderabad, India, we draw on a series of interviews with hospital-based clinicians completed during 2019 and early 2020, to unpack the multidimensional, ecological acceleration of AMR and the implications for everyday practice. Their accounts make visible how practice operates in relation to industrial economies, community vulnerabilities, and ecologies. This in turn highlights the problem of epistemic bordering, where 'sites' of AMR are targeted but are prone to leakage and transgressions. We propose an ecological approach to conceptualising antimicrobial practices with implications for AMR interventions being rolled out in the sub-continent and beyond.

Waste policy reforms in developing countries: A comparative study of India and Brazil.

Over the last decade India and Brazil implemented waste policy reforms to tackle the constraints of their waste management. This study compares those reforms using the methodological framework proposed by Wilson where waste policy evolves through a series of subsequent stages, depending on two aspects: local circumstances; and stakeholders' groups. The current research is exploratory in its scope, adopting this method to describe, compare and evaluate both Indian and Brazilian cases, and also verifying how the model performs when applied to developing countries. The paper confirms Wilson's conclusions, and adds a perception that in developing economies a special local circumstance is to be considered the point of departure, that is, the particular starting point of Wilson's evolution. In addition, the research concludes that participation of diverse stakeholder groups throughout the political process is fundamental, and could be key to overcoming the risks of policy setbacks.

Antimicrobial Resistance, Politics, and Practice in India.

India is considered the epicenter of the global antimicrobial resistance crisis, with unprecedented antimicrobial consumption, production, and "misuse." But the story of resistance in India is complicated-emerging from intersections of industrial pharmaceutical development, rationing/purchasing of health care, policy infrastructure, and dynamics of disadvantage. What looks like rampant, escalating antimicrobial misuse and a need for tighter controls over drugs and "prescribers," emerges as a complex social problem. These dimensions reach the bedside, although variously, with doctors in India dealing with precarious infectious disease landscapes, threats of multidrug-resistant organisms, and (pan) national imperatives for "more judicious" practices. Drawing on 24 semi-structured interviews with doctors in Hyderabad, we explore their perspectives on resistance (literal and figurative) in everyday practice, and how practices articulate intersections of power, influence, and governance. This offers broader context to reframe resistance in India as multifactorial, enacted through cultural/local practices, and irreducible to singular problems of control or regulation.

Traditional medicines, collective negotiation, and representations of risk in Indian cancer care.

Cancer is emerging as a key disease in India, but there has been virtually no research exploring understandings of cancer and practices of communication within oncology settings. This is despite the fact that the Indian context presents clinicians, patients, and family members with a range of unique challenges, including those related to disease awareness, interpersonal dynamics, and the use of traditional, complementary, and alternative medicines (TCAM). Drawing on a series of qualitative interviews with 22 Delhi-based oncology clinicians, in this article we examine clinicians' accounts of communication with their cancer patients. The interviews reveal the challenges of communication given cancer's relative novelty, cultural practices around collective negotiation, and rhetorical practices evident in advice-giving regarding TCAM. We conclude that with cancer set to become a major burden in India, research exploring competing forms of expertise, the politics of representation, and the nexus between traditional beliefs and techno-scientific development is urgently needed.

The rise of cancer in urban India: Cultural understandings, structural inequalities and the emergence of the clinic.

Cancer services in India have evolved and expanded significantly in recent years, with a surge in the availability of biomedical oncological treatment facilities for certain cohorts of the Indian population in urban areas. Despite significant and sustained economic development in many areas of India, major issues persist in the delivery of cancer care, even in the context of relatively prosperous urban populations. This article explores the dilemmas evident in Indian cancer care as perceived by a group of Indian oncology clinicians. Specifically, the interviews focused on their perspectives on the key challenges facing cancer patients, particularly in relation to help-seeking and access to care. The main concerns that emerged in the interviews were: (a) practical constraint (i.e. access and treatment); (b) cultural values (i.e. communication, stigma and the clinic); and (c) structural conditions (i.e. inequalities related to place, gender and class). We unpack these as important elements of cancer care in contemporary India, and present Farmer's notion of structural violence, among other concepts, as potentially useful for understanding some facets of this social problem. We conclude that without a greater understanding of social and cultural issues shaping cancer care in India, little progress will be made in coping with a disease that is set to become a major burden within an increasingly prosperous and ageing population.

The inequalities of medical pluralism: Hierarchies of health, the politics of tradition and the economies of care in Indian oncology.

India has an eclectic health system that incorporates biomedical as well as traditional, complementary and alternative medicine (TCAM). Our understanding of the co-existence of these therapeutic modalities in this diverse, postcolonial and developing nation is extremely limited, and in the context of cancer care, to our knowledge no sociological work has been carried out. Contemporary Indian oncology represents a fascinating site for examining the interplay and articulation of forms of tradition/modernity, economic progress/structural constraint and individual beliefs/cultural norms. In a context of an increase in the prevalence and impact of cancer in an ageing Indian population, this paper reports on a qualitative investigation of a group of oncology clinicians' accounts of 'pluralism' in India. The results illustrate the embeddedness of patient disease and therapeutic trajectories in vast social inequalities and, indeed, the intermingling of therapeutic pluralism and the politics of social value. We conclude that notions of pluralism, so often espoused by global health organisations, may conceal important forms of social inequality and cultural divides, and that sociologists should play a critical role in highlighting these issues.