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Book Review of Rakku’s Story: Analysis from Political Economy of Health

Assignment Submitted for Dr. Santhosh M.R.

Submitted by

Megha Marik
(gm2017ss017)

Tata Institute Of Social Sciences

Guwahati
2018
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Introduction

About the author:

According to a post on the website Canadian Voice of Women for Peace (2014);

Sheila Zurbrigg is an independent health history researcher. A physician by training,

several decades ago she turned to full-time research in human health history following

five years of work with traditional village midwives in southern Tamil Nadu in the

later 1970s.

Zurbrigg is also a professor at Dalhousie University and a member for Physicians for Global

Survival. Rakku's Story Structures of Ill-Health and The Source of Change (1984) her iconic

work, was written by Zurbrigg during her fellowship while she was researching on the

midwives of a small village in Tamil Nadu, India.

Context of the text:

It is highly important to understand the context of the text. The text was first

published in 1984, the version which this review deals with is the third impression (1991),

which is why it suffices to say that there are no major changes in the text. The reason why the

timeline is important is because it helps us to understand the political and the economic

context of the text and analyse it accordingly. The ’80s was a time when the Indian economy

was in huge amounts of debt and the government was finding it increasingly difficult to

maintain the economy of the country. Added to this was the political scenario whereby India

was facing internal turmoil which also demanded the government’s attention. Zurbrigg’s

work comes at an important junction of time as it reflects on the many difficulties that the

Indian health system faced and the deeper political and socio-economic contexts behind it.
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Summary of the Text:

The text is divided into four main parts. The chapterisation under those parts attempts

to go to the deeper roots of the issues at hand and raises questions about the Indian health

scenario. The first part Rakku’s Story illustrates the helplessness of a young village woman

who is anxious about her child’s health and describes the different obstacles that she has to

overcome in order to seek medical attention for the child. Through a poignant tale, Zurbrigg

very beautifully brings out the daily life of village folk, especially women and how the

identity of the woman as a lower caste woman performing farm labour is something which is

tied to her at every step of her life.

The second part of the book is where Zurbrigg’s documentation of the obstacles in

India’s medical programmes begins. The second part at a strong note where we move on from

the incident of Rakku’s infant’s death and Rakku resuming her life in order to be able to keep

her other children alive. The second part of the text attempts to contextualise Rakku within

the huge health system of India. It is quite similar to when Zurbrigg narrates Rakku’s visit to

the city and eventually to the city hospital where everything is confusing and alien for her.

What Zurbrigg tries to do is start with the city hospital and trace each and every aspect of the

incidents which take place with Rakku and explain why things are in the manner that they

are.

The third part of the book is where the documentation gets interesting as the author

raises larger questions with respect to the political and the economic aspects of the Indian

health system. Zurbrigg raises questions with respect to the origin of the existing medical

structure in the country and theoretical and the ideological motives behind them. What is

interesting to understand here is the fact that different policies which have been created and

enforced by the Indian government at different points in time, reflect the deeper causes and
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international motives behind such causes. For the reader feeling angry at Rakku’s

helplessness in the initial part of the text, this is where the bigger picture starts to paint itself,

and she realises that the entire scenario is not so simplistic.

The fourth and the final part of the text provides a probable solution or a model which

can be followed and eventually certain community checks and balances which can help attain

a better future in terms of access to medical attention. It offers a broader framework through

which significant change can occur.

Critique of the text:

If we take a deeper look at the text, there are a lot of observations that can be made.

The text is a milestone in medical history research and the vast amount of knowledge it

exposes the reader to, is incomparable. The manner in which the text is structured is quite

remarkable. It makes the text more approachable to a layman who has very little or no idea

about the political economy of health. The way the story is weaved with the larger issues of

poverty, lack of awareness and other such factors is brilliant. In case the reader gets confused

with any part of the text she or he can reflect back to the story and understand it from the

storyline.

The language of the text is quite lucid and does not have technical jargons which

would intimidate or disinterest the reader to pursue reading further. Medical and technical

terminologies are well explained and used only when required. Being a historical

documentation, the text does get a little repetitive at times. However, that might also be

because the author tries to link it back and contextualise every aspect of the larger picture of

the health system.

One of the issues that comes to mind when we go through the text and near the ending

of the text is the agency of villagers like Rakku and how their stories are reflected. There
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have been repeated examples in research where there have been questions of agency with

regard to the researcher and the subject or ‘object’. In this case the fact which keeps on

circling in the mind of the reader is the fact that this text is another example of Europeans

doing research on third world countries and representing the text to the world. What is of

concern here is the fact, that how much of Rakku’s voice is being reflected in the text? Rakku

and villagers like Rakku would be unable to give their voice or even point out

misinterpretations because the language of the text prevents them from doing so. Thus, what

one keeps on questioning is if the voice of the subject gets lost amongst the different linkages

being made to the Indian economy at large.

Furthermore, another issue which is somewhat related to the previous issue is the fact

that a large part of the text links the deprivation and the lack of awareness to poverty. Even

though it is largely true, it must be acknowledged that there are many urban educated and

comparatively richer individuals who are if not equally but to a large extent unaware of basic

health issues, their prevention and about access to medical facilities. It has to be pointed out

that this is largely due to a lack in dialogue amongst people with regard to health, between the

government and the society at large and between the different stakeholders and society as

well. This lack of awareness can largely be cured through dialogue and the normalisation of

discussions on health and illness.

Finally, from a thorough reading of the text, one feels that at times the Indian

government has been largely portrayed as being stuck between its desire to perform well and

its desire to prosper in terms of an economy. As has been rightly pointed out that the

government has largely resorted to foreign investments from charitable institutions in order to

keep the economy well and running. These institutions have largely influenced political and

economic policy making and the larger fate of most Indian citizens. The government in its

desire to acquire funds have often resorted to inhumane medical action like enforced
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population control policies. However, it cannot be denied that the ruling political party’s

desire to maintain its stronghold over the Indian population was also a driving factor to

‘perform’ well. In that case, what Zurbrigg rightly points out is the fact that there is no one to

fight for the requirements of the poor.

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Conclusion

The sad reality that the text leaves the reader with is the fact that even though 34 years

have passed since the text had been published, the reality of the Indian health system has not

changed much. It remains quite similar and what raises alarm in the minds of the common

citizen is the fact that more and more private conglomerates are entering the health sector and

influencing policy making at the Union level. Rakku’s village might have changed a little bit

in terms of physical structure, it might have modernised to some extent, Rakku’s grand-

daughter might now go to the local school thanks to Right to Education (2004), but little has

changed in terms of health. The fact of the matter might be that Rakku’s village might just

have Public Health Centre (PHC) but no doctors or health workers are interested to work

there.
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REFERENCES:

Canadian Voice of Women for Peace. (2014)

Zurbrigg, S. (1984). Rakku's Story Structures of Ill-Health and The Source Of Change.
Madras: Centre For Social Action.