STANFORD
UNIVERSITY PRESS
  



Breathless
Tuberculosis, Inequality, and Care in Rural India
Andrew McDowell

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Contents
Acknowledgments
chapter abstract

This chapter establishes the concept of an atmospheric entanglement. It introduces readers to the book's setting, Ambawati, as well as to anthropological conversations around atmospheres and entanglements. It oulines the implications of an atmospherically entangled perspective for the ethnographic study of tuberculosis, subjectivity, caste, biopolitcs, and care. It concludes with a reflection on the insights and challenges that atmospheric entanglement might bear on ethnographic methods before outlining the plan of the book.

A Note on Language
chapter abstract

This chapter establishes the concept of an atmospheric entanglement. It introduces readers to the book's setting, Ambawati, as well as to anthropological conversations around atmospheres and entanglements. It oulines the implications of an atmospherically entangled perspective for the ethnographic study of tuberculosis, subjectivity, caste, biopolitcs, and care. It concludes with a reflection on the insights and challenges that atmospheric entanglement might bear on ethnographic methods before outlining the plan of the book.

1Atmospheric Entanglement
chapter abstract

This chapter establishes the concept of an atmospheric entanglement. It introduces readers to the book's setting, Ambawati, as well as to anthropological conversations around atmospheres and entanglements. It oulines the implications of an atmospherically entangled perspective for the ethnographic study of tuberculosis, subjectivity, caste, biopolitcs, and care. It concludes with a reflection on the insights and challenges that atmospheric entanglement might bear on ethnographic methods before outlining the plan of the book.

2Breath
chapter abstract

Centered on a young man afflicted by TB, this chapter traces the ways that he and his family organized their attention to his breathlessness. It develops the concept of social breathing and shows how, for this family, breathlessness indicated three potential forms of bodily air. It describes and follows the Hindi-language categories of sans (respiration-breath), dam (strength-breath), and praan (life-breath) that the family attempts to manage though there care. From this vantage it explores a breath multiple with its affiliated frames on the body, care, and disease causation as well as its implication on TB care seeking and meaning making. Breath it argues is a central entanglement of biological and social worlds. Breath is deeply cultural and its bodily, vital, and cosmological connections must be understood ethnographically.

3Dust
chapter abstract

Meditating dust accumulated on boxes of TB medications in Ambawati's clinic, this chapter considers how dust is a material metaphor of ruination. It argues that India's TB control program, based on Directly Observed Therapy Short-Course, is similarly covered in the dust of colonial-era counterinsurgency measures. It show that TB treatment is also aimed at surveilling and localizing India most marginalized communities. It then considers the kind of care giving and care receiving subject that the TB program aims to form. It argues that programmatic care is habit forming and scrutinizing. Then introduces a man who left TB care, but not biomedicine, to suggest that subjection or rejection TB's biopolitics may not extend to all of biomedicine. Next it examines a scandal caused by the health system's attempts protect pills from people before describing how dust has prevented the use of new diagnostic technology in clinics like Ambawati's.

4Air
chapter abstract

This chapter considers how people work on air in contexts of TB. Inspired by a young boy leaving school to fan his TB stricken father. It further develops the concept of atmospheric care. It argues that atmopsheric care can expand anthropological and public health lenses on the care necessary for TB treatment. It also highlights the air entangled subject and its casted potentiality. Drawing from Dalit literature and Dalit Studies' affective turn, the chapter considers how caste and TB may coalesce in concerns for air rather than contagion. When the young man's father gets well, he becomes a migrant labor who family members say has been changed by Surat's air. It ends with a consideration of how a particular place's air—as exposure to an entanglement of caste, lifestyle, weather, and economy—changes people. The chapter wonders how TB shapes people by shaping relations to the air.

5Mud
chapter abstract

Joining another TB stricken man and his family on a trip to a TB hospital, this chapter examines an atmospheric entanglement of mud, development, illness, and subjectivity. Our journey, like his interpretation of his sick body, is caked in mud which indicates a failure of development promises. Mud prevents our on-time arrival and requires we ask for admission under exceptional circumstances. The atmosphere encourages us to lie to physicians about medical history. On admission the man and his family confess three different political identities. The chapter considers the role that families play in hospitals as atmospheric care givers. It also shows how people, often without reflection, subvert and evade biopolitical formations. Together with corruption and adjustment fail, flexible identities and lies suggest that the TB hospital is not a total biopolitical institution.

6Clouds
chapter abstract

This chapter wonders what kinds of biosociality might form around breathy susceptibility to clouds. It shows that cloud effects have biomoral impacts and argues that atmospheres are biomoral too. Atmospheric entanglement with a particular kind of cloud in Ambawati, this chapter shows, might legitimize a withdrawal of care practices often expected from kith and kin. Clouds allow for a view on the atmospheric entanglement of TB and recombinant kinship. Organized around people's reaction to a TB death and cousins who are differently affected by clouds, the chapter considers the vexed biomoral biosociality of those not connected by kinship or caste but by their breath's vulnerability to clouds. It also traces an Ambawatian theory of bodily susceptibility to the world and to the self's moral actions.

7Forests
chapter abstract

Inspired by an MDR-TB afflicted man, this chapter considers what lenses a forest might provide for public health and anthropology. It highlights the forms of relationality opened to a forested or jangali self. Instead of viewing the self and antimicrobial resistance as cultivated, it argues for an anthropological use of microbiological concept of reassortment. The entanglement of disease and forests might reassort social forms and microbial genes. First, it attends the ways language and public health's patient pathway model cannot account for pharmaceutical and ecological simultaneity. Second, it describes TB care's attempts to interpolate the man's convalesce as 'government duty,' before imagining his possible ironic use of this term to describe a differently productive self. Finally, it considers theft as reassortment of relations between people and things to wonder if the man might have used similar tactics to access standardized MDR-TB care without being fully cultivated by it.

8Afterlife
chapter abstract

This chapter takes the possibility of a breathing afterlife seriously. It centers on my friend, a prankster, who though killed by TB continues to live and afterlife in Ambawati. The chapter focuses on the atmospheric entanglements of grief, ghosts, and breath. It first attends to the potential effects of ghosts in a hospital where atmospheric care and dignity in death is lacking. Then it considers the possibility of ghosts too being haunted by breath and breathlessness before suggesting that my friend may have become one. Finally, it engages his mother, who after his death has walked with a limp, to wonder what it might mean to live in an atmosphere in which others, who are dead, can and do live on in bodies and breaths.

9Entanglement Again
chapter abstract

This chapters sums up the book. It engages a young man in Ambawati's diary during the Covid-19 pandemic to show how the atmospheric entanglements that framed TB's biological and social forms are reiterated by another airborne infectious disease. It then outlines the implications of this book for global public health's TB interventions by highlighting the need for public sector atmospheric care. Next it summarizes atmospheric entanglement's conceptual claims on anthropology. It shows how an epistemic entanglement of rationalism, vitalism, climate, and affect is a condition of everyday life in this marginalized community. Finally, it outlines the implications of an entangled view of subjectivity for moral anthropology before reflecting on the methodological opportunities and challenges that atmospheric entanglement opens for anthropology.

Notes
chapter abstract

This chapters sums up the book. It engages a young man in Ambawati's diary during the Covid-19 pandemic to show how the atmospheric entanglements that framed TB's biological and social forms are reiterated by another airborne infectious disease. It then outlines the implications of this book for global public health's TB interventions by highlighting the need for public sector atmospheric care. Next it summarizes atmospheric entanglement's conceptual claims on anthropology. It shows how an epistemic entanglement of rationalism, vitalism, climate, and affect is a condition of everyday life in this marginalized community. Finally, it outlines the implications of an entangled view of subjectivity for moral anthropology before reflecting on the methodological opportunities and challenges that atmospheric entanglement opens for anthropology.

References
chapter abstract

This chapters sums up the book. It engages a young man in Ambawati's diary during the Covid-19 pandemic to show how the atmospheric entanglements that framed TB's biological and social forms are reiterated by another airborne infectious disease. It then outlines the implications of this book for global public health's TB interventions by highlighting the need for public sector atmospheric care. Next it summarizes atmospheric entanglement's conceptual claims on anthropology. It shows how an epistemic entanglement of rationalism, vitalism, climate, and affect is a condition of everyday life in this marginalized community. Finally, it outlines the implications of an entangled view of subjectivity for moral anthropology before reflecting on the methodological opportunities and challenges that atmospheric entanglement opens for anthropology.

Index
chapter abstract

This chapters sums up the book. It engages a young man in Ambawati's diary during the Covid-19 pandemic to show how the atmospheric entanglements that framed TB's biological and social forms are reiterated by another airborne infectious disease. It then outlines the implications of this book for global public health's TB interventions by highlighting the need for public sector atmospheric care. Next it summarizes atmospheric entanglement's conceptual claims on anthropology. It shows how an epistemic entanglement of rationalism, vitalism, climate, and affect is a condition of everyday life in this marginalized community. Finally, it outlines the implications of an entangled view of subjectivity for moral anthropology before reflecting on the methodological opportunities and challenges that atmospheric entanglement opens for anthropology.