Discussing the ethnography of public institutions, Didier Fassin (2013: 642) has described its dual ability to ‘interrogate the obvious’ and ‘illuminate the unknown’. The All India Institute of Medical Sciences (AIIMS), a large public teaching hospital in Delhi, represents both of these conditions. This made it an enticing site for my PhD research, but also one that proved particularly challenging to access. While everything hinged on the crucial letter of official permission that was eventually written by the dean of research, personalities and the establishment of rapport…were central to the negotiation of the institutional labyrinth, writes Anna Ruddock
Opened in Delhi in 1956, the All India Institute of Medical Sciences (AIIMS) is an enormous government-funded hospital, anomalous in the Indian public healthcare landscape for employing many of India’s most respected doctors, who provide high-standard free or low-cost care to patients of low socioeconomic status. The AIIMS outpatient department (see Figure 2) sees an average of 10,000 people a day. Many of these patients travel from across northern India, seeking competent and affordable treatment that they cannot find at home. AIIMS also occupies an undisputed position atop the hierarchy of Indian medical education. Each May, around 90,000 candidates compete over 72 seats at the college, making for a notorious acceptance rate of less than 0.01%. The tiny minority of successful students are catapulted into an exclusive club, with their achievement celebrated in the national press.
Virtually everyone has an opinion about AIIMS, especially in Delhi. AIIMS is there: embedded in the landscape, and in the imagination of people both within and beyond the city. It is a phenomenon as much as a collection of concrete buildings. This in itself made it a compelling site for my PhD research. Its relative neglect by social scientists added to the appeal. Writing about the challenges and rewards of conducting ethnography in public institutions, Didier Fassin (2013: 642) notes that while ethnography must pay attention to understudied social locales, it also retains salience in ‘spaces saturated by consensual meanings’. In the first circumstance, he writes, ethnography ‘illuminates the unknown; in the second, it interrogates the obvious’ (ibid.). AIIMS encompassed both sets of circumstances, making for a research site that was both enticing and particularly challenging to access.
In April 2014, having listened patiently to the wry and occasionally despairing account of my effort to gain research access to AIIMS, a friend gave me a copy of Kafka’s The Castle. In the novel, K. arrives in a village believing he has been appointed as a Land Surveyor by the authorities that inhabit The Castle, which sits on a hill and pervades the life of the village. The story revolves in increasingly dizzying circles around K’s efforts to have his position recognised by The Castle in order that he may begin work. The challenge of securing access to AIIMS was similarly inflected with moments of comedy, suspicion, despair, and, ultimately, triumph.
…in things of that kind the Castle moves slowly, and the worst of it is that one never knows what this slowness means; it can mean that the matter’s being considered, but it can also mean that it hasn’t yet been taken up … and in the long run it can also mean that the whole thing has been settled, that for some reason or other the promise has been cancelled … One can never find out exactly what is happening, or only a long time afterwards.
– Kafka, The Castle