Shifting Gears: Triage and Traffic in Urban India

Abstract

While studies of triage in clinical medical literature tend to focus on the knowledge required to carry out sorting, this article details the spatial features of triage. It is based on participation observation of traffic-related injuries in a Mumbai hospital casualty ward. It pays close attention to movement, specifically to adjustments, which include moving bodies, changes in treatment priority, and interruptions in care. The article draws on several ethnographic cases of injury and its aftermath that gather and separate patients, kin, and bystanders, all while a triage medical authority is charged with sorting them out. I argue that attention must be paid to differences in movement, which can be overlooked if medical decision-making is taken to be a static verdict. The explanatory significance of this distinction between adjustment and adjudication is a more nuanced understanding of triage as an iterative, spatial process.

Mobilizing Volume: Trauma, Surgical Skill, and Clinical Tourism in South India

“…On rounds, this was occasionally pointed out to patients by the attending surgeon, and I was frequently hailed by patients who heard me speak. While other researchers in hospitals found themselves conducting small and useful tasks, “untangl[ing] IV lines, clos[ing] doors, direct[ing] patients and relatives” (Solomon , 353), I found the most helpful thing I could do in the hospital was to spend time with patients who requested it, relieving some of the boredom and anxiety of a hospital stay, providing diversion and distraction, tasks for which surgeons and nurses had little time.…”

“…Indeed, many of the patients I spoke with did not come directly to Asha but told stories of arriving at other hospitals and being told by doctors there that their injury could be better managed at Asha. Following Solomon's exploration of movement (), these (sometimes long and arduous) journeys to hospital, and the jockeying, sorting, and moving of patients on arrival, are crucial to how care is delivered. I add that this sorting and moving around is part of how the volume of trauma is created, directed, and managed; in the process, it produces opportunities for surgeons to enact both expertise and care.…”

“…I join others (Jain ; Messinger ; Solomon ) in an emergent anthropology of trauma, in which, unlike in the extensive anthropological literature on trauma as an ongoing, chronic, social and psychological reaction to situations of violence or deprivation (see Das et al. ; Fassin and Rechtman ; Kleinman ), trauma indexes its medical or surgical meaning: “an injury (such as a wound) to living tissue caused by an extrinsic agent” (Merriam‐Webster ).…”

Living on Borrowed Breath: Respiratory Distress, Social Breathing, and the Vital Movement of Ventilators

“…My case study emerges from ethnography in an emergency trauma ward in a public hospital in Mumbai, India, that I call Central Hospital. Over 20 months between 2015 and 2020, I studied how traumatic injury from traffic accidents transforms life in public hospital settings such as Central's trauma ward (Solomon 2017, under contract). The ethnographic vignettes in this article derive from those observations and interviews in and around the hospital and describe scenes of intubation and mechanical ventilation for respiratory distress.…”

Dr. Ram’s triage

“…In India, such private-sector consultations average from two to four minutes (Das et al 2012;Irving et al 2017). In these fleeting moments, triage is a constant adjustment in light of unfolding technical and social uncertainties (Solomon 2017). Physicians attempt to chart a course among many possible clinical actions: those determined necessary at all costs, or ideal, or perhaps avoidable, or impractical.…”