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History is to Practice

I've been in many debates where "science" is accused of being wrong. As if science is a set of things written down in a book or a set of ideas that are arrived at by a group of people. Something that has to be consumed by others. I'm baffled by this argument because, to me, science is a tool available for every human being to practice. It is my use of science to understand the world that matters to me. When I say "scientific method" I am talking about the method *I* use to arrive at the truth. It might be the same method that a professional scientist used, but I have to replicate that method and arrive at the truth on my own.

When chatting with Ravi Narayan (RN) yesterday about the SOCHARA archives, I had a very interesting realization. The way I used to look at history was the way these people looked at science. I thought about history as a set of facts written down in many books, as a scholarly consensus available to those who are in the elite universities. The thought I had was this: What if, like I practice science instead of consuming it, I start practicing history instead of just cataloguing it?

I can't say that this thought had nothing to do with the discussion I was having with Upendra Bhojani about a Masters in History that UB was pursuing. History is a science. It is the science of the past. And without knowing the methods of studying history, I was basically being less effective as a historian.

And without being a historian, it is difficult to be an archivist!

So, I'm doing two things now:

  1. Take on the identity of a health historian seriously and consciously.
  2. Start practicing history.

Another insight I had about myself was that I learn a subject the best when I have a framework that fully encapsulates the topics in it. The more there are unknown unknowns in a subject, the less I'm interested in studying it. But when I have a complete and comprehensive "table of contents", my brain feels comfortable in taking on that skeleton, slowly going through all of the actual contents and attaching things one by one into that skeleton. I need to first have the big picture before I let in even one of the finer details.

So, I made RN sit down and help me build that framework of how to think about the history of community health in India. After the discussion there's a rough framework that is now emerging in my mind:

  • Prehistoric times of British India
  • Bhore committee and the first 25 years of independence. 
  • The search for alternatives in the 70s and 80s
  • Whatever happened in the 90s towards "Health for All by 2000"
  • People's Health Movement
  • NRHM and NHM
  • Ayushman Bharat and so on...

Much of the discussion with RN yesterday was about the 70s and 80s. RN took out 4 books on to the table:

  • Health for All - An Alternative Strategy (ICMR/ICSSR)
  • Alternative approaches to meeting basic health needs in developing countries (UNICEF/WHO)
  • Health and Family Planning Services in India (D Banerji)
  • Community Health - In Search of Alternate Processes (CHC)

I swiped them into my bag for weekend reading.

The NRHM bit was interesting. In my mind, the people's health movement, the alternatives, all of these were failures. But, RN was like, "25 people out of this movement, who had by then (by NRHM formation time) formed the Jan Swasthya Abhiyan, are (were) consultants to the NRHM". That was a light bulb moment for me. NRHM, in the biomedical colleges is taught like just another chapter, without giving it the emphasis that it deserves. That ASHAs who represent the shift into decentralization came through NRHM and how significant that is, is kind of forgotten. For me who started medicine in 2011, the idea of ASHA that was passed on to me was that of a healthcare worker like nurse or doctor, working with a very small population. But that's totally missing the spirit and heritage of ASHAs and NRHM.

The story of ASHAs and the story of NRHM is thus the story of evolution of community health in India. And that's the story we're interested in.


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Akshay S Dinesh
I am a general practitioner rooted in the principles of primary healthcare. I am also a deep generalist and hold many other interests. If you want a medical consultation, please book an appointment When I'm not seeing patients, I code software, advise health-tech startups, and write blogs. Follow me by subscribing to my writings

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