Cancer and Conjugality in Contemporary Delhi: Mediating Life between Violence and Care.

This article tracks the entanglement of cancer and patterns of conjugality in Delhi. Building on fieldwork with about 120 households in Delhi, it describes how the disease put pressure on already fraught marital biographies, revealing durable fissures in household relations. Often, these shifts in the distribution of conjugal vulnerability opened cracks that allowed long histories of domestic violence to seep through. In subtle ways, women could accrue a delicate agency through their practices of care. But at the same time, they continued to inhabit the vulnerable space of affinal homes. This article describes how in these arrangements, care and violence followed each other closely in their tracks. Building on these insights, the article deepens and shifts how anthropologists have understood the social life of the cancer. Specifically, anthropologists writing about the disease have demonstrated the ubiquity of a biotechnical imaginary of hope and survivorship in the Global North. This article develops an anthropology of cancer from the Global South that takes seriously the work of palliation and reconciliation, in the process provincializing Global North imaginaries of hope and survivorship.

Culture, communication and community in palliative cancer care: a view from India.

Two palliative cancer-care models are being pioneered in India. The first has been developed by CanSupport, a cancer-care NGO based in Delhi. The CanSupport model of care emphasizes expertise and focuses on a relatively small number of patients. The second model is the Neighbourhood Network of Palliative Care, advanced by a group of physicians in the southern state of Kerala. The NNPC model emphasizes reach over expertise. It provides short-term training to community workers and civic-minded citizens, mobilizing numbers to treat a wider patient pool. This paper compares the strengths and drawbacks of both models in order to understand the generalizability of each for providing care to lower-income communities in lower- and middle-income countries.

Analysis of Social Science Research Into Cancer Care in Low- and Middle-Income Countries: Improving Global Cancer Control Through Greater Interdisciplinary Research.

This analysis lays a framework for greater collaboration between the cancer community and social scientists in both research and policy. We argue that the growing cancer burden that low- and middle-income countries face is raising social, political, and economic challenges of global cancer that require interdisciplinary research beyond the traditional biomedical-clinical nexus. First, we briefly review some of the most important existing social science studies that have addressed cancer in low- and middle-income countries, including the main methods, approaches, and findings of this research. Second, we give an overview of recent interdisciplinary collaborations between social scientists and oncologists and demonstrate how qualitative research can help us to understand the distinct challenges of cancer care in low- and middle-income settings. Finally, we identify key areas for future collaboration and suggest possible paths forward for cancer research and policy that involve social science.

Markets and Molecules: A Pharmaceutical Primer from the South.

The Indian pharmaceutical industry has historically manufactured low-cost drugs for the global poor. Activist mobilizations at the height of the HIV/AIDS epidemic revealed a vast cost gap between global brands and Indian generics, much to the embarrassment of Euro-American corporations that were in the habit of pricing drugs for only the wealthy or well insured. As new drug access controversies focus on anticancer therapies, they reveal new flows of international capital, emergent genetic technologies, and increasingly coercive trade regimes. Together these favor multinational corporate oligopolies, which imperil the legacy of HIV/AIDS activism and the future availability of essential life-saving drugs for the work of global public health. In this essay, I describe how the future of the right to drug access rests uneasily, and potentially calamitously, on a shifting balance of power between global south interests and Euro-American pharmaceutical capital.

Assessing psychosocial distress: a pain audit at IRCH-AIIMS.

AIM: Recent work in palliative care has recognized that pain is a complex social, psychological, spiritual and psychological experience. In order to assess if each of these components is equally well addressed in clinical practice, we undertook a retrospective audit of psychosocial assessment procedures at the pain clinic at IRCH-AIIMS, New Delhi. METHODS: 686 pain assessment forms collected over 2011 were examined and analysed through SPPS. RESULTS: (I) While physical aspects of pain are recorded at almost 100% levels in the pain forms, psychosocial components of patient distress are found to be less adequately recorded; (II) The layout the assessment is slanted towards functional factors (such interference with daily activities and mobility), while non-functional symptoms are being recorded at relatively low levels (anxiety-1.2%, depression-4.4%). Prior studies in the same clinic as well as in the Indian psycho-oncology literature has shown that non-functional distress (such as anxiety and depression) are usually found at much higher rates of incidence (33-80%); (III) Analysis of the existing data revealed severe demographic vulnerabilities in our patient sample, an aspect that is recorded but not currently addressed as part of a psychosocial assessment. CONCLUSIONS: In light of these findings we surveyed 14 existing pain assessment tools, and chose two for incorporation into our existing pain practice. These tools were the Distress Inventory for Cancer-2 and the American Pain Society Patient Outcome Questionnaire. They were chosen for their balance between functional and non-functional symptoms, sensitivity to socioeconomic distress and ease of completion in the high volume public health scenario.