Disease and Democracy: An Ethnographic Study of Public Hospitals and Public Health Reform in Karachi, Pakistan

Abstract:

This thesis engages with scholarship on social development in the context of debates over public health reform in Karachi, Pakistan. By presenting a historical and modern-day ethnographic inquiry into Karachi’s public health infrastructure, I argue that wider economic and democratic development in Karachi have little causal significance on the state of this city’s public health system. Specifically, I use primary and secondary sources to understand the history of healthcare in Karachi from 1840 to the present and couple this with interviews with patients and doctors in contemporary Karachi to understand the receiving and delivery side of healthcare for the poor. Together with further insights from policy makers and health policy experts in Karachi, I situate the public health encounters of modern-day Pakistan within a broader political economy of the city. Moreover, this thesis explains the way disease and patienthood intersect with the political lives of those I interviewed, and how the history and political economy of Karachi have cemented specific antidevelopment institutions within the city today. Finally, I find that pervasive understandings of democracy among those whom I interviewed—doctors and patients alike—may have stifled social development in Karachi.