The treatment of pain in India: power and practice

GN Anthropology;H Social Sciences (General);R Medicine (General)

Roques, Clare ; Clark, David

University:University of Glasgow

Department:School of Interdisciplinary Studies

关键词: Pain, India, palliative care, opioid analgesics, social constructionism, postcolonialism, mixed methods.;   

Others  :  http://theses.gla.ac.uk/41014/1/2018roquesphd.pdf

来源: University of Glasgow

【 摘 要 】

The World Health Organization describes over 80% of the world’s population as living without adequate access to treatment for pain. Improvement initiatives focus largely on the field of palliative care and on increasing access to opioid medications. Predominantly, they are led from the global North while targeting healthcare provision in the global South. I propose that the limited improvement seen from these programmes is in part, attributable to their narrow clinical focus and to a lack of understanding of practice at the local level. Using India as a single case of study, the aim of this research project is to assess critically how medical practitioners, working within and outwith palliative care, treat patients in pain.My research questions address the practice of pain management and clinicians’ evaluations of this care, from the perspective that pain as a medical problem, is a professionally constructed phenomenon. In this cross-disciplinary research, I use mixed methods, combining qualitative and quantitative data, from interviews and surveys administered to clinicians, field observations in India and secondary analysis of a pre-existing oral history archive. I draw on theories of the policy process, postcolonialism and social constructionism. Through critically evaluating practice, I move beyond more familiar descriptions of care delivery and barriers to improvement, to understand how these issues are framed, formed and contested.The study demonstrates salient features of the Indian healthcare system: scarce resources, multiple providers, weak regulation, and the dominant role of the private sector. The availability of treatments, including opioids and non-pharmacological therapies, is low and variable. The framing of pain as a problem requiring medical treatment is ubiquitous and there is consensus regarding the need to improve the delivery of clinical care. There is variation, however, in opinions about how this should be achieved, particularly with respect to the choice of treatment modality. Power is wielded by clinicians in the form of knowledge, and is negotiated with other medical professionals, politicians and patients.In conclusion, although Indian clinicians’ descriptions of individual practice recognise the unique local factors that impact on the delivery of pain management, their proposed strategies for improvement emphasise increasing the provision of medical treatments developed in the global North. There is, however, little acknowledgment of the assumptions and limitations of this western medical model when used to treat pain in India.