It was a theme that Indian ideologues would develop elaborately over the coming decade. As China rose, as wars against Islam brought America into engagement with India’s neighbours Pakistan and Afghanistan, Indian elites made a fervent case for the ‘natural’ partnership of their country with the superpower. “In terms of the scale and ambition of our respective political experiments, we can only be compared to one another,” said Indian historian Ramachandra Guha to Time magazine.10 The argument could of course be profoundly self-serving, as was demonstrated with its most conspicuous outcome, the Indo-US nuclear deal of 2008, which, since India refused to sign the Nuclear Non-Proliferation Treaty, went against existing American law, but which Indians skilfully lobbied for nonetheless on the basis that India’s interests, in these days of Asian instability, were an essential outpost of America’s own. “The nuclear deal [is one] that the Indians regard as basic recognition of their status as a major power,” approved Fareed Zakaria, columnist at Newsweek and conspicuous promoter of the Indo-US partnership, and even if it destabilised the global nuclear equilibrium, it could present no grounds for anxiety since “India’s objectives are exactly aligned with America’s.”11
As America’s global predominance fell subject to an increasing range of challenges, the US too found it soothing to imagine India as a ‘second America’. If the centre of global power was to shift to Asia, if American hegemony was to decline, perhaps India could provide the guarantee that American values continue to reign. The future managers of the world might look somewhat different, but inside they were exactly the same. The future of the world, in other words, presented no unpleasant surprises. It would be exactly like the present.
But American newspapers’ bucolic descriptions of couples in shopping malls and bourbon-drinking corporate executives listening to jazz seemed, in their emphasis, profoundly foreign to those who were actually living through India’s transformation. ‘Globalisation’ was not homogenisation, nor even Americanisation. The presence of American brand names did nothing to alter the fact that India was a vastly poorer country than the US, whose relationship to Western capitalism was full of historical ambivalence — and what was emerging in India looked like nothing ever seen in America. Even those Indians who sipped coffees in shopping malls felt a very different content to that activity from the one felt on the other side of the world. The shopping mall was only one part of a carved-up landscape, inner and outer — for there was no continuity between the world inside the mall and the one on the other side of its walls, where street traders, shanty towns and traffic jams awaited the departing consumer. The mall itself, moreover, had arrived as part of a rapacious economic torrent that had turned everything upside-down, destroying things human and divine, scattering objects and energies, and setting down alien needs and rituals in the rubble. Global capitalism might have appeared serene and civilised in its ancient heartlands but this was not how it felt when it suddenly burst in somewhere new. This is why the system failed to produce, at its edges, those tranquil, docile citizens that Westerners so often assumed were an inherent part of the package.
Crudely materialist accounts of India’s rising middle classes assumed that, since they now had incomes many times larger than twenty years ago, they must be that many times happier. But many of the things that drained life of its happiness had also swelled proportionately in that time, and many people did not actually feel any kind of spiritual profit. It was true that there was an exhilarating freedom to earn and to buy. But there were, correspondingly, very few guarantees: if something went wrong you were on your own. The middle classes who benefitted from that new market freedom often realised only too late that, though their salaries might be high, they lived more vulnerable lives, in many respects, than the poorest members of many another society.
• • •
I park in the car park of one of Delhi’s new corporate hospitals and walk towards the building. As I arrive, I am shocked to see a dead woman lying face down on a stretcher right outside the main entrance. She blocks the door, and I have to skirt around her to go in. She is heavy-set and only middle-aged. I sit down in the waiting room, where I’m supposed to meet some people. They haven’t arrived yet and through the glass I regard the stretcher with continued disquiet. I decide to go out and see what is going on.
Standing with the dead woman is a young man who turns out to be her son.
“She was in this hospital for three weeks. After they discharged her we took her home, but her condition got worse and she died early this morning. We didn’t know what to do. So we brought her here.”
He has been crying. He adjusts the scarf that has been thrown over her, the better to cover her face.
“We asked for a stretcher and we got her out of the car, but when we tried to take her inside they stopped us. They said she was none of their business anymore. So we don’t know what to do.”
We both consider her, lying under the hot morning sun.
A car pulls up in front of the entrance. It is the man’s brother. He gets out, and between them they lift the woman off the stretcher and try to get her into the back of the car. She is a big woman and it is a tiny car. The two distressed men are unable to bend her legs, and they cannot force her through the opening onto the back seat. It is an unbearable scene.
At that moment, another family member drives up. He embraces the two men hurriedly and considers the scene. He is furious. He storms into the hospital and emerges with two members of the staff. A vociferous argument ensues, during which the hospital representative repeats, “She is not a patient in this hospital. We cannot take responsibility for her.”
“Their mother has just died!” the relative shouts. “They need your help! How do you expect them to move her?”
A crowd has gathered, and the situation becomes impossible for the hospital staff, who concede defeat. A few minutes later an ambulance pulls up, the dead woman is loaded inside, and a small procession sets off for the cremation ground. The crowd disperses and I sit back down in the waiting room.
It is a well-appointed room, with the sort of good fittings and bad paintings that grace such rooms all over the world. Over the entrance is the sign displayed in every Indian hospital which informs patients that it is illegal to engage in ‘pre-natal sex determination’ — this being an important, though far from watertight, measure against female foeticide. Since this is a corporate hospital, there are all kinds of helpful corporate flourishes: a suggestion box, for instance, and an information desk with a friendly ‘May I help you?’ sign over it. A TV screen shows computer animations of medical procedures that can be purchased here. Posters advertise laser surgery for vision defects, and various treatments for scars, stretch marks and wrinkles; the happy, healthy families in the pictures are, as they are in so many contemporary Indian advertisements, white.
Corporate hospitals like this one have been a conspicuous addition to the Indian landscape. Until the 1980s, all hospitals were run by the state. India had a distinguished medical fraternity and several of these government hospitals, such as Delhi’s All-India Institute of Medical Sciences, set up by Nehru in the 1950s as the nation’s flagship research institute, had international reputations for medical excellence. These older institutions still provide care to the majority, but precisely for this reason they are unable to offer the sophisticated medical apparatus that has become so familiar to the middle classes through American hospital TV dramas. For this ‘world-class’ care, the affluent turn to the new corporate hospitals, which are nearly all majority-owned by billionaire business families — members of the entrenched power elite with the political connections required to negotiate the acquisition of the necessary tracts of urban real estate. Three such healthcare moguls live in Delhi and belong to one Punjabi family — whose members arrived in the capital as refugees from Partition, as is the case with most of the city’s leading business families — which collectively runs finance companies, insurance companies, clinical research companies, film production companies and airlines — as well as hundreds of hospitals, not only in India but all across the world. In India, these corporate hospitals have not only generated an entirely new healthcare experience for the Indian middle classes — stylish, well-equipped and, of course, expensive — but have also gone a long way to pioneer, through medical tourism and telemedicine, entirely new kinds of global healthcare marketplaces.