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Retrieving Kamala

from the debris of epistemic violence

Dr. Anup Dhar

A good case!

We have a patient of Rheumatic Heart Disease or better Rh.H.D (a good case for final year students!!!) in Green Ward, Bed No~.530.

What(!!!) or who we have in Green Ward, Bed No! 530, is Kamala. Kamli for her mother.


We have Kamli   

                       ~a poor woman-working in the fields-a bonded laborer.

                       ~aged 20-married off at 15.

                       ~now living in a bustee.

                       ~ with a daughter -one and a half years old.

                       ~a not too tolerable husband.

                       ~far too intolerable in-laws.

                       ~all housed in a ten feet by ten feet room.

                       ~suffering from Rheumatic Heart Disease.


A Therapeutic Encounter?

Medical Knowledge ( that is ~the text of medicine), Medical Education and the Practice of Medicine springing out of such education, wants me to treat Rh.HD and surely not Kamla. Kamla makes a very very brief appearance in medical discourse. She is a acknowledged as Kamla only once in a Clinic~ when her Ticket and turn comes~ and the doctor announces her name. She comes forward. A THERAPEUTIC ENCOUNTER  follows!!! The Doctor's Gaze confronts a silent body. Relevant (?) history is noted down hastily. Her symptoms allow the disease set somewhat back~ to show through.

And then Kamala vanishes.

Kamla  vanishes on the examination couch. The patient's bed becomes a field of scientific exercise. A field where sickness has to be determined and delimited.

Long ago, Kamla was a daughter to her mother.

She emerged as wife on her wedding night.

Next morning she became a daughter- in -law to her husband's parents.

Much later she acquired the 'status' of a mother. 

But today, Kamla is no more.....

What remains of her in the 'clinic' is a tapping apex, a diastolic thrill, a loud first heart sound, a diastolic murmur with presystolic accentuation and an opening snap!!

What is a 'clinic'?

A clinic is not just symptoms ,signs and drugs.

The clinic is the first encounter (!) between doctor and patient~ a space for an inter personal doctor-patient


The doctor is re-defined  " as an applied scientist rather than a healer". He is reconstructed as a specialist and as a professional.


The patient on the other hand is "methodically decomposed" as a person. She (the whole/entire being~ the real being )is first reduced to relevant(!) history~ then to a classification of symptoms~ then to a "grammar of signs". Last to possible possibilities.


And from the debris of possibilities, out springs a doctor with a loudly announced diagnosis ~ a dramatic disclosure.

The diagnosis actually makes the doctor happy ~content!! NOT SAD!! The diagnosis actually brightens the face of some.

For the rest of the hovering stethoscopes, it is a defeat. They have lost in the Christening-Competition. They wait for a re-match.

On another pulsating chest ground.


MS!! Whole Truth?

Kamla is now a 'diagnosed case'. A good case for 'case hunters'!!

The whole being is now re-interpreted as a 'system'. "In order to know the truth of pathological fact, the doctor must(?) abstract the patient."

She is now no more Kamla~ Kamli or anything even remotely resembling her past self~ her actual self. She is MS!! ( MS is the short form for Mitral Stenosis~ a disease of one of the valves of the heart, the mitral valve).

As if MS and Kamla correspond!!

As if name and object have a one to one correspondence.

As if the very act of naming, defines the whole object.

Definition delivers truth!! Whole Truth!!

Omnipotent~ Ubiquitous~ Universal! Homogenous Truth.

With no breaks. No differences. No Unassimilated Contradictions. No undecided Fragments.

And so the doctor armed with the whole truth investigates MS.

As if there is no reality ~other than MS. As if Kaml a was never born in a poor family of 12 ~as if she was never a victim of malnutrition ~as if she was never housed in a 10 ft. by 10 ft. room~as if Kamla was never married  off at well below 18~as if she never had an alcoholic husband ~as if she never spent unimaginable days with her in-laws~ as if.......

Social Medicine~ the clinic's backyard ?

There is not much space for Kamla in Modern Western Medicine. She is silent or silenced.

The most silent patient is the best patient.

The best patient is the most silent patient of Post -Mortem.

Kamla speaks only in the secluded world of "Preventive and social medicine"~ only in the segregation of 'Para Clinics'. 'Social Medicine' is that shelf of the modern doctor where he can dump his conscience. Kamla's epdidemiology is carefully preserved there~ only to be forgotten ~while the clinic organises the violent reduction of Kamala to MS ~ while the clinic" situates the being of the disease with its cause and effects in a  three dimensional space".


Social Medicine ~the clinic's backyard ~is the dumping ground of our values, of the rights of a patient, of all customary WHO declarations of the social responsibilities of a doctor, of all healing traditions ~all of it encased in a fat para-clinical volumes, in hardbound texts~ shelved far away from the violent operations of the clinic ~so as not to be remembered while we encounter the patient.


Social Medicine is the Clinician's 'defense'!!

A defense to ignore the real lives of real human beings.

And so, the doctor investigates MS. The "Medical Gaze" scrutinizes Mitral Valve Leaflets. It measures Pulmonary Capillary Wedge Pressure. It sees the inside of an atrium. But it fails to see Kamala. Because Kamala is not Kamala kamala is MS.

Kamala is 0.9sq.cms.

That's the size of her valve orifice.

Detached from her life's reality, the doctor reduces her to a "Lab Reality". She now inhabits the "lab World"~ a man machine interface. Her valve leaflets show Rheumatic Nodules. From a "Molar Reality" she is reduced to a "Molecular Reality".

"Tissual expanses form the perpetual correlative of the surface gaze that defined the clinic".

Lab tests provide a series of 'Readings ' for Kamala. Her suffering can now be reduced to a structured set of 'Variables' Readings become the 'Operational Definitions' of reality. Kamala becomes MS with PAH in a case of Rh.HD.

She is now a "Clinical Body" fully compartmentalized for the doctor's therapeutic intervention. She becomes a site for Pharmaceutical  Experimentation. For diuretics and digitalis.

                           This is the end of Kamala~ sacrificed at the altar of a knowledge system.


Do I sound anti-science? Is this a crusade against western medicine? So what if she is reduced to MS? How can the doctor treat Kamala if he does not diagnose MS? Western medicine receives Kamala in the emergency. May be it is a question of life and death. Where is the time to philosophize on Kamala's biography. I know these questions come up in the reader's mind.

I am not anti-science. I am  not pro-science either. there can be some position,betweenor beyond the conventional for and agaainst paradigm.

All I want to do is to carve out a little space for Kamala in the clinic. Kamals is  usually dumped in the clinic's backyard. We ant the clinic to be a little less confident, hence a little less arrogant about the correctness-hence superiority- hence greatness of its methods.

Let the clinic wait a while for Kamala. Let it defer its too quick, too violent reduction of Kamala to MS.I n the little extra time and space that the clinic now accords to Kamala, her neglected histories surface. Her epidemiology co-in-habits her symptoms and signs. She speaks.


Our critique of the clinic is a summoning of the clinic's limits. Making boundaries unstable and questionable. It is not a blanket dismissal of the clinic . It is not a negation. It does not consist in passing from one concept to another. But in overturning ~ displacing ~ disrupting the secure confidence of conceptual orders. If there is an element of violence in the CLINIC, then one must contest clinic with a certain other clinic, in order  to avoid the worst violence. The critique of the CLINIC is carried out in the name of another sort of clinic~ sort of.