Breathless. Tuberculosis, inequality and care in rural India.

Breathless. Tuberculosis, inequality and care in rural India. Andrew McDowell. Navayana, New Delhi, 2024. 253pp, ₹599. ISBN 978-81-94631-36-1

‘Breathless’ is an ethnographic treatise on tuberculosis (TB) by an anthropologist who did 14 months of fieldwork in rural Rajasthan. This research, supported by a Junior Fellowship from the American Institute of Indian Studies, followed preliminary fieldwork funded by the Harvard South Asia Initiative. The village depicted, referred to as Ambawati, is a pseudonym used to safeguard the identities of the people described in the book.

With nine chapters, the book uses ‘atmospheric entangle-ments’ as a trope to connect the various perspectives in the narrative. It is used to express how TB connects bodies, microbes, pharmaceuticals, relationships, and bureaucracies in ways both intimate and systemic. These entanglements blur boundaries: between health and illness, care and control, personhood and policy. Breath emerges as a motif symbolising more than physiology; it stands for vulnerability, survival, transcendence, and the uneven distribution of care.

Through the story of a TB patient and his family’s desperate search for healing, the book captures the human side of disease: how decisions are made when medicine collides with kinship, poverty, and hope. The author critiques what he sees as a reductive focus on transmission and individualized diagnosis. He argues that it sidelines the more profound questions about social environments where illness thrives.

Dust, a recurring metaphor, becomes a symbol for bureaucratic residues, colonial legacies, and the opacity that sometimes enters the public health space. The layered dilemmas faced by frontline workers, especially nurses, reveal how control and care get sedimented in the cracks of the healthcare system. Dusty funeral processions are described as unintended consequences of a global TB control paradigm focused on preventing resistance and protecting our meagre pipeline of new antibiotics.

Meanwhile, air is likened to both contagion and caste, shaping invisible lines of exclusion and access—while forests evoke deferred justice and alternative temporalities for those left on the margins. Forests are seen to foster lateral ways of existing in the world, providing survival benefits to a drug-resistant patient living at the forest’s edge. A district TB official jokingly says that providing expensive TB drugs free of cost to this forest-land usurping patient is equivalent to putting him on ‘government duty’ to get well. This makes for an ironic, yet dutiful, government ‘service’.

Moments of death, mourning, and whispered hauntings are described, showing that TB is not a closed chapter for death. Its breath lingers, both as memory and as a reminder of past events. Death is seen to transform an individual from having breath to being breathless. The wheezing, disembodied breath of a TB patient, who succumbed to the disease, is thought to haunt humanity.

The book effectively highlights the social dimensions of TB, offering a nuanced perspective shaped by the author’s immersive experience within a community deeply affected by the disease. This firsthand engagement lends sensitivity and insight to the narrative. There are undertones suggesting a lack of commitment from the state, and the back cover explicitly specifies state and policy-level apathy. This injects a jarring note, bringing into question the credibility of such blanket statements based on 14 months of fieldwork. The tremendous strides made by our TB elimination program over the past decade, despite major challenges, are ignored. Acknowledgement of these achievements would have added more discernment to the narrative.