Contagion and its Guises: Inequalities and Disease among Tibetan Exiles in India
| Published date | 01 December 2008 |
| Date | 01 December 2008 |
| Author | Audrey Prost |
| DOI | http://doi.org/10.1111/j.1468-2435.2008.00488.x |
Contagion and its Guises:
Inequalities and Disease among
Tibetan Exiles in India
Audrey Prost*
ABSTRACT
The paper outlines the trajectories of Tibetan refugees afflicted by tubercu-
losis (TB) within the exile community of Dharamsala (H-P). These stories
reveal the political nature of TB status disclosure, highlighting the often
conflicting ways in which the disease is perceived among different Tibetan
exile regional and generational groups. On the basis of these case studies, I
aim to show that differentiated experiences of treatment and stigma within
‘‘intermediary’’ host communities such as Dharamsala partially determine
the ways in which Tibetans deal with the risk of TB in their ‘‘onward’’
journeys further afield, in Europe, Canada and the United States. With the
now well-established connection between migration-related stresses and the
onset or reappearance of TB symptoms, we may need to consider that, in
some cases, it is the compounding of attitudes to disease in ‘‘intermediary’’
diasporic communities with the stigmatising label of ‘‘migrant menace’’ in
the second stages of migration that impedes the care of migrants and even
precipitates illness. With this premise the paper proposes that investiga-
tions of disease in diasporic communities should explore the totality of
migration ‘‘stages’’ and their impact on health.
INTRODUCTION
This paper investigates how socio-economic inequalities internal to
diasporic communities influence health status. While much research has
focused on the link between migrants’ socio-economic position and ill-
health within the broader context of host-migrant relationships (Grove
* University College London, London, England.
2008 The Author
Published by Blackwell Publishing Ltd., Journal Compilation 2008 IOM
9600 Garsington Road, Oxford OX4 2DQ, UK, International Migration Vol. 46 (5) 2008
and 350 Main Street, Malden, MA 02148, USA. ISSN 0020-7985
doi:10.1111/j.1468-2435.2008.00488.x
and Zwi, 2006; Ahearn et al., 2000), little is known about the ways in
which socially-driven health inequalities internal to particular diasporic
groups compound with external ones to influence health. Furthermore,
what little we know comes from studies of health inequalities within
Diasporas in Europe and the United States, and there have been few
studies of health inequalities within ‘‘south-south diasporas.’’ Drawing
upon data collected during 11 months of ethnographic research among
Tibetan refugees in India, this paper will attempt to show some of the
ways in which socio-economic disparities within diasporic communities
impact on health status and health-seeking behaviour.
1
Whose Diaspora?
According to Raman (2003), there have been two main approaches to the
study of diasporic populations. The first seeks to define key criteria by
which to identify diasporas, usually through reference to a ‘‘prototypical’’
experience, often that of the Jewish Diaspora (Saffran, 1991; Cohen,
1997). The second is an anti-essentialist stance rooted in post-colonial
theory, which challenges modern states’ hegemonic narratives of cultural
identity, and attempts to understand processes of identity construction in
a world characterised by flux, where individuals and groups have become
increasingly de-territorialised and trans-national (Hall and Gieben, 1992;
Gilroy, 1992; Vertovec and Cohen, 1999). The first approach is slowly
being abandoned, while the second has generated some criticism, since
many have taken it to signify that everyone is, or can be, a ‘‘diasporic’’
subject. Clifford, wishing to do away with the ‘‘checklist’’ approach,
defines diaspora as a ‘‘loosely coherent adaptive constellation of
responses to dwelling in displacement’’ (1994: 310). This more expansive
definition has spawned the re-birth of ‘‘diaspora studies’’: anthropologists
now look to diasporic ‘‘imaginations’’ not just as nostalgia for a home-
land, but as processes of identification generative of diasporic subjects
(Axel, 2004 and 2001). In particular, ethnographic studies have unpacked
the ways in which trans-national communities are created and modified
through migration (Gardner, 1995; Ong, 1999), but also through the use
of new media (Bernal, 2004) and practices such as ‘‘roots tourism’’ (Basu,
2001). Equally important is anthropological work which focuses on the
conflicting uses of diasporic sentiments as political tools serving both rad-
ical agendas and reactionary political projects (Raman, 2003).
In social anthropology, the term ‘diaspora’ is now often simply used as
a trope to designate hybridity or displacement writ large. As such it
serves to complexify a crudely essentialising picture, and to highlight the
56 Prost
2008 The Author
Journal Compilation 2008 IOM
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