In this introductory chapter I give an overview of the place of AIIMS in the landscape of Indian healthcare and its status as the country's most prestigious medical college. I outline my argument that by virtue of its elite status and narrow definition of excellence in medicine, undergraduate education at AIIMS works to reproduce rather than interrogate social inequalities, forgoing opportunities to acquaint students with the potential of medicine to be a transformative social endeavor.
I tell the story of the creation of AIIMS, drawing on historical sources and interviews with some of the institute's first students and faculty. I show how the institute was a product of and a response to the politics of medical education in colonial India and I discuss the tensions inherent in its mandate to embody global standards of biomedical prowess while also addressing the needs of the predominantly poor and rural population of a newly independent nation.
I introduce the students who appear throughout the book and trace how they went from being schoolchildren considering a medical career to trainee doctors profiled in the media for winning a seat at India's most coveted medical college. In doing so, I pay particular attention to the social phenomenon that is the AIIMS MBBS entrance exam and the way that it illuminates and entrenches inequalities while also working to fuel narratives that firmly associate concepts of achievement and merit with upper casteness via the general category. Looking particularly at the function of exam ranking, I present the concept of'biographical numbers as a means of exploring the subjective impact of rank on students' sense of self and their potential futures.
Chapter 4 takes us through the gates of AIIMS and into the lives of its students. Reflecting on the discourse of freedom that I often heard from students, I interpret the MBBS as a liminal period in the lives of students, which offers transformative possibilities that nevertheless contain their own limits. This thread becomes a discussion of affirmative action at AIIMS, and the ways in which a discourse of caste and meritorious achievement influences how students think about themselves and each other as citizens and future doctors. The politics of affirmative action counter any idealized vision of AIIMS as an institution transcending oppressive social structures in the pursuit of a universal humanist medical science. The institute, and medicine itself, is not set-apart from but is emblematic of the social unease characteristic of modern India.
I discuss patient labor, a phenomenon whereby students appreciate the number and diversity of AIIMS patients as an educational asset, at an institution that conditions those students to become (super)specialized clinicians unlikely to provide the frontline care that many patients come to the hospital for lack of. I also draw on ethnographic material from wards and outpatient clinics to show how a hidden curriculum naturalizes structural inequalities that play out in the clinical encounter, imparting impressions to students of what it means to be a good doctor and a responsible patient. Integrating other ways of learning about medicine, such as through the humanities, would, I argue, create space for reflection on the social role of the doctor and open up possibilities for addressing rather than reproducing inequalities.
This final chapter is concerned with AIIMS students' perceptions of possible futures, which are shot through with discursive threads about achievement and reputation, family, the state, money, and technology. These threads combine to produce a hierarchy of biomedical practice. Not all medical students go on to pursue medical professions. However, whether a student aspires to a career as a super specialist, a public health practitioner, a civil servant, or an entrepreneur, I argue that the choice is inextricable from the status bestowed upon AIIMS students at the moment of admission. The social life of this achievement, combined with the influence of norms around class, caste, gender and kinship produces expectations of the future and an individual's place within it, offering different but related impressions of what it means to be a graduate of India's most prestigious medical college.
This appendix explains how I was given research access to AIIMS and the methodology of the study. I discuss the ableist narratives that are traditionally attached to anthropological fieldwork and encourage more attention to the experiences of disabled anthropologists in order to make it a more inclusive social science.