I started off this newsletter in December 2020 talking about Kanti, who died of Guillain-Barre syndrome on my first emergency night-call in 2nd MBBS.
Kanti died because he was admitted to a public Municipal Hospital, which did not have a working ventilator for him. Those in charge of funding the purchase and repair of ventilators in the Municipal corporation did not think that working ventilators were a priority. Knowingly or unknowingly, they had committed structural violence against Kanti, because he was poor and without means and forced to come to a Municipal Hospital because he couldn’t afford to go anywhere else, which eventually led to his death.
Structural violence is a term first used by John Galtung but popularized by Dr. Paul Farmer in his seminal work on the people of Haiti . The concept is best understood after reading a transcript of his Sidney W Mintz lecture of 2001, but even Dr. Abhisake Kole’s article describing the travails of a poor patient named Ranjit who died because of his inability to navigate the healthcare system in India, explains this well. Galtung used the term broadly to describe “social structures characterized by poverty and steep grades of social inequality, including racism and gender inequality, exercised systemically and systematically, indirectly by those belonging to another social order.”
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