Batolebazi

In Bhopal, we have a term called ‘batolebazi’, I think it refers to chatting with your friends with no purpose, but it is more of an experience than a verb. That’s something you tend to do when you’re sitting next to one of the three beautiful lakes that adorn the city. Bhopal is the capital city of the Indian state of Madhya Pradesh (central state) and has a rich history from cave paintings dated 40,000 BCE to three man-made lakes from 1000 AD. More recently, It served as the seat of power to the Mughal Begums and the British in central India . The city has a population of 2.5 million people and is known for it's laidback approach to life. I’ve lived there almost all my life and I have experienced and participated in ‘batolebazi’ more times than I can count. So, I was happily surprised to learn that I would be doing that professionally.

I trained as a medical doctor at the All India Institute of Medical Sciences (AIIMS), New Delhi. During my clinical training, I increasingly found myself drawn towards public health and health systems questions. While I cared deeply about the patients in front of me, my thoughts often wandered to broader questions: why did they come to the hospital in the first place, and what would happen to them once they left? These questions eventually led me to step outside the hospital setting and work with a community health organisation in central India. This transition coincided with the onset of the COVID-19 pandemic, giving me a unique opportunity to work on a public health emergency immediately after graduation. During this time, one issue became particularly apparent: the severe lack of access to reliable diagnostic services. I often found it frustrating to hear calls for universal RT-PCR testing when I had access to only around 100 tests for a population of nearly 120,000 people. This experience motivated me to explore the problem of diagnostics more deeply through doctoral research.

I began looking for opportunities to pursue a DPhil that would allow me to study this issue in a rigorous and contextually grounded manner. Luckily, my hometown hosts one of the largest public hospitals in central India, a sister institution to my alma mater. So with a bit of intention and a lot of luck, I started my PhD as a collaboration between my advisors at the All India Institute of Medical Sciences, Bhopal and my DPhil supervisors at the University of Oxford. After 3 years of continued discussion between the two parties, I understood the local research priorities and decided to focus my research on building a digital tool to help pathology laboratories scale up services to achieve cervical cancer elimination.

Originally, my DPhil research was supposed to focus on the entire cascade of care for cervical cancer, however, upon reaching the case site, I soon realized that due to data availability and feasibility issues, I might need to focus my efforts on the pathology services that are integral to cervical cancer care programs. I immersed myself into the case site and tried to embed myself within the pathology department and learn from them through observations and multiple in-depth interviews or, extended ‘batolebazi’ sessions, to understand how essential diagnostic services are delivered in practice.

Observing the hospital from this perspective was unfamiliar. I was accustomed to being a service provider; this was the first time I had no formal role and simply lingered in the laboratory, taking notes on my tablet and awkwardly asking people questions about their work. Given my age, staff often assumed I was a pathology trainee and took it upon themselves to teach me various techniques. I found it easier and more productive to be perceived as a student rather than an auditor. Over time, I followed laboratory technicians through their daily routines, observed slide processing and staining, attended slide review meetings with residents and consultants, and visited urban and rural primary health centres to observe how cervical cancer screening services operate at the last mile.

Raymond Gold’s concept of the “participant–observer continuum” describes research roles ranging from complete observer to complete participant. Over time, through persistence and many awkward conversations, I gradually moved along this spectrum. as I started helping them carry some admin tasks, acting as a security personnel when they were leaving valuables behind etc. As time went by, I realized that people started to open up to me, they would speak not just about cervical cancer but also about why they liked or disliked a particular colleague, what their future plans are after graduating or what schools they want to send their kids to. We would all, especially in the field of public health, like to think of hospitals and health systems as autonomous machines that work irrespective of the people in it, however at the end of the day, we shape the systems we operate in and are shaped by it in return. More often than not, I felt like I was observing a sitcom unfold in front of my eyes. All the social science theories that I had read in preparation of my fieldwork, all came to life at the same time which made me realise that reality doesn’t operate in neatly packaged frameworks or theories, but simply exists and all we can do as researchers and humans is learn to respect it and provide value wherever we can.

Conducting fieldwork in my hometown was a surreal experience. I got to live with my parents and celebrate Diwali with them after several years. I would often run into acquaintances during my fieldwork from my time as a high school student there. The Murray Speight Research Grant played a crucial role in enabling this work by covering travel expenses and allowing me to be present on-site for extended periods. In addition, prior to fieldwork I had developed preliminary versions of a digital simulation tool; however, each simulation took several hours to run. With support from the grant, I was able to purchase a high-performance computer, reducing simulation runtimes from hours to seconds and enabling rapid iteration across multiple scenarios.

During the first phase of data collection, I have conducted over 100 hours of observations and interviews. I have generated detailed process maps, causal loop diagrams, and a preliminary version of the digital simulation model. I plan to return to the field in March next year to validate findings with stakeholders, incorporate feedback, and prepare manuscripts for journal submission as well as my DPhil thesis.

Thank you very much for the generous support provided through this grant. It has been instrumental in enabling this research in ways that would not have been possible otherwise.