Credentialism and Culturalism: Colonial Legacies for South Asian Medical Professional Project(s)

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Abstract

This paper explores the historical trajectory of the contemporary South Asian medical profession and the legacy of colonialism in shaping its tendency to privilege credentialism, and to value both profit motive and state support over a commitment to an ethical professional code. Roger Jeffery has shown the preponderant role played by the colonial state in the setting up of professional bodies to regulate education standards, while Rama Baru has pointed to the centrality of private fees in sustaining biomedical practice, even of those employed by the colonial state. This colonial legacy has embedded both state dependence and a pursuit of profit motive in the contemporary South Asian health sector. This paper explores the South Asian medical profession through the conceptual framework of the ‘professional project’. South Asian medical professionals experienced professional marginalization arising from British doctors’ strategies of occupational closure on the grounds of ethnicity, qualifications and surgical skill. To counter this marginalization, South Asian medical professionals employed countervailing strategies that have led to the privileging of western standards in medical education and practice. The dilution of professional commitment to ethics can be understood by examining the deployment of what Didier Fassin has called ‘practical culturalism’. Culturalism is used by South Asian medical professionals to transfer the onus of ethically dubious behaviour and health inequalities onto patients, reproducing colonial discourses characterizing South Asian patients as irrational and socially regressive.