Panel 12: Health in South Asia

Chair: Santosh Kumar, University of Notre Dame

Panelists

Muhammed Saad Kamil, University of Notre Dame, “Health and Immunization in South Asia”

My individual paper focuses on the impact of medicinal incentives on child immunization rates in Pakistan. Immunization in Pakistan has faced issues in achieving its yearly targets of full coverage of each child born. Children who are vaccinated once do not return for their next doses due to which vaccinations are left incomplete. Pakistan has the highest birth rate in South Asia which makes it prone to more incomplete vaccination cases. One of the most quoted reasons for the low child retention rate by the program is fear of adverse effects following immunization (AEFI). Fever in children is the most common AEFI, especially after being inoculated with doses of Pentavalent 1, 2, and 3. In this paper, I analyze the impact of the provision of medicine (Paracetamol syrup) on each inoculation of Pentavalent 1,2, and 3 on the rate of children returning for their next due immunization dose. The idea is to use a DiD analysis to understand the impact of this intervention. I am a part of a running pilot program in Karachi Pakistan with a local consulting firm and have access to on-ground data at the child-level in select counties (called Union Councils) of the city. My preliminary findings indicate a positive correlation between receiving Paracetamol syrup and the rate of children returning for the Pentavalent vaccine which potentially ties into a change health seeking behaviors of the population. I will be working with Dr. Santosh Kumar and Professor Alejandro Estafan in making the methodology of this paper most robust before the conference.

Prakash B K, University of Notre Dame, “Unraveling the Impact of Structural Violence of Caste on the Healing Process of Mental Health Patients in Nepal”

A nurse was “impolitely” attempting to awaken Santosh (pseudonym), a 21-year-old boy from the “untouchable” community, who was still asleep in a hospital bed at 11 AM in order to administer psychotropic medication. Upon awakening forcefully, Santosh voiced his hunger, stating, “All I’ve been eating here is medicine. Sister, I am hungry. Please give me something to eat.” I encountered Santosh during my anthropological fieldwork at the Mental Hospital Lagankhel in Nepal in 2023. Through our interaction, I later discovered that the free meals provided by the hospital were insufficient, and he could not afford food available just outside the hospital. His mother informed me that Santosh began experiencing “tension” in his life when he left home at the age of 16 due to poverty exacerbated by the 2015 earthquake in Nepal. She explained to me that she had brought him to the hospital to seek treatment for his mental problem (dimakhi samasya) as mental healthcare was unavailable in their village in Baglung, a rural district of Nepal.

Santosh’s personal experiences of mental suffering inform us that the structural violence of caste and poverty remains a significant cause of mental health problems and has hindered his healing process. Anthropological research, in other settings, has shown that structural violence has profound effects on health (Farmer,1997a, 2004, 2009, 2011a; Scheper-Hughes, 2023; Leatherman & Goodman, 1997; Sweet et al., 2013; Wallace et al., 2021). Curiously, there has been a notable lack of emphasis among anthropologists in South Asia, particularly in Nepal, on delving into intersections between mental health and the detrimental environment produced by the structural condition of caste. This paper aims to investigate the far-reaching consequences of structural violence of caste on the mental health of the Dalit patients receiving care in Mental Hospital Lagankhel Nepal. It particularly examines the impact of three factors: nutritional stress, environmental challenges, and social stress on the mental illness of this population. Here, nutritional stress signifies insufficient access to food resources, stemming from constraints such as limited land availability, religious beliefs, and legal provisions. Environmental challenges include humanitarian crises and public health emergencies caused by the 2015 earthquake in Nepal, as well as exposure to toxic chemicals, pollution, and unsafe water faced by the Dalit community. Finally, social stress pertains to the daily experience of caste-based discrimination. By shedding light on these complex connections, the current study enhances our understanding of the structural forces that create adverse environments that not only contribute to mental suffering but also impact the healing processes.

Shriniwas Gautam, University of Notre Dame, “COVID-19, Returnee Migrant Workers, and Options for Their Reintegration in Agricultural Communities in Nepal”

Over the past two decades, migration for foreign employment has become a crucial income source for many Nepalese households. However, with the declaration of COVID-19 as a global pandemic by the World Health Organization (WHO) in early 2020, Nepal experienced a surge in returning migrants, left uncertain by their employers in destination countries. Drawing on data from a household survey conducted between October and November 2020, encompassing 387 migrant households, we delve into these returnees’ employment and income prospects. First, we analyze the immediate impacts of the pandemic on household income and food security, distinguishing between those who returned before COVID-19 and those who returned during COVID-19, as well as based on their migration destinations (India versus other countries). Despite previous involvement in agriculture, many returnees don’t consider it a preferred employment option, citing perceived difficulties or deeming their skill sets more suited to other sectors. However, a portion remains receptive to agricultural employment. Notably, the income threshold necessary to consider agriculture as a viable option varies depending on the returnees’ previous country of employment. Lastly, we explore the factors influencing the reintegration of returnees into their communities through agriculture-based employment. We advocate for targeted policy adjustments to facilitate the reintegration of returnees, encourage youth retention in rural areas, and stimulate rural agricultural growth.