A lesson on intersectionality

Two patients over the span of three months made me understand intersectionality like never before. Intersectionality is a way of understanding the world where people are seen as having multiple overlapping identities and seeing each of these separately gives an incomplete picture. For example, gender, caste, socioeconomic status are intersecting identities that people live with. Therefore while trying to understand gender based violence, looking at gender as an isolated identity would do injustice to understanding the phenomenon, as gender intersects with caste and class to complicate gender based violence. Dalit women living in poverty experience gender based violence of a worse order than upper class dominant caste women. A poor Dalit woman’s experience of gender based violence is not just the sum of Poverty + Caste + Gender, but there are interacting effects that she experiences that are beyond the sum total of these effects. Though I had a theoretical grasp of this through reading and some real life experiences of how this works through work in the communities, I never internalized it properly and then I saw Mr. K and Mrs. S. 

 

Mr. K has been coming to our clinic for the past 3 years. He comes to get treatment for diabetes and high blood pressure. The schedule is for him to get blood tests done once every three months to check how well his blood sugar is controlled. But recently Mr. K has been missing his blood sugar testing. He is a land owner and practices agriculture for a living. His wife passed on a few years ago and since then he lives alone. His son and daughter in law live in the next street and they give him food two times a day. On the days that he has to come for blood test, he has to come fasting and preferably bring some packed breakfast. But his daughter in law does not cook so early and so he has to eat his breakfast outside on the days he comes for blood test. Our clinic is located in the Dalit colony area of the village and there is a small  idly shop near our clinic which serves delicious idlies with chutney and sambar in the morning. Most of our patients who come for blood test go there for their breakfast. Mr. K belongs to Nayakar caste which is one of the dominant castes in Tamil Nadu. However the idly shop is run by a Dalit woman. When I asked Mr. K why he keeps skipping his blood test his response was, “My greatest problem is that I cannot remain fasting for too long. I have nobody to cook me and pack me a breakfast.” When I suggested the Idly shop nearby he said, “I belong to Nayakar caste and I cannot eat in that Dalit woman’s shop.” I was shocked for a few minutes that one could voice their sense of caste based purity and supremacy so openly. I knew these sentiments existed, but hadn’t encountered their manifestation in this way. I replied to him, “I don’t know if it matters to you, all of us in the clinic eat in her idly shop and we find her idlies delicious. They are hygienic and we are doctors and nurses who are endorsing her idlies” and I moved on with the clinical encounter. I have learned that there is no point in discussing these with older persons with rigid world views. 

 

Two months pass by and Mrs. S came to the clinic. She is also a regular patient who comes for treatment of diabetes and hypertension. There was a heavy rain that day. Mrs. S’s synthetic saree was wet. She was wearing a plastic cover on her head as a cap, protecting her hair from getting drenched. She walked into the clinic dripping wet and sat in the chair in front of me. She placed her mobile phone on my table and said, “Doctor, please correct my phone. When someone is calling me it does not ring anymore.” I noticed that her phone had gone into silent mode and changed it for her. She was grateful. Mrs. S lives alone after her husband died a few years ago. Her only son lives in Chennai and visits her for festivals. Her only source of income is the government welfare subsidy for older persons of 1000 rupees per month. She lives in a small brick house, which has an asbestos roof. She told me, “I did not cook anything today. The cooking gas cylinder got exhausted and I have not placed order for a refill.” When I suggested that she eat in the nearby Idly shop she said, “What choice do I have? If only I had money I wouldn’t stoop down to the level of eating in a Dalit woman’s hotel” She said this with a disgusted expression on her face. When she said this, the episode with Mr. K flashed across my mind. She got her medicines and left to the Idly shop to have her meal there. 

 

Mr. K and Mrs. S have different identities of gender, and socio-economic class. One thing common between them was that they belonged to a dominant caste that considered itself superior to the Dalit and considered eating in a Dalit kitchen as inappropriate. Mr. K is a rich man. He had relatively good health status. So he could afford to skip his blood tests and speak openly about it to the doctor. He had the power to exercise his bigoted caste belief. Mrs. S is a poor woman. Her health status is poorer and though she holds the same caste belief, she has made a compromise and eats in the idly shop. While caste oppression operates equally in both their minds, its manifestation is different and is influenced by their intersectional identities of gender and socioeconomic class. A few weeks ago, during a conversation with a colleague, I was told that nowadays caste discrimination has reduced a lot. I wish they read this blog to just understand the depth of its impact on the society, especially such indirect effects it has on health care delivery.