A thriving private health industry is bringing benefits and disadvantages to an Indian border state that has endured decades of insurgency and counterinsurgency
On the outskirts of Imphal, the capital city of Manipur—a state in India’s north-east bordering Myanmar—stands Shija Private Hospital.
The reflective blue glass of Shija’s domed main building stands out in the landscape of Langol, a ward of the city where the valley meets the foothills and the boundaries between districts and land regimes create ambiguity around legitimate settlement.
Branching out from the main building is a series of single-story clinics and specialist centres, offering everything from obstetrics, to cosmetic surgery (rhinoplasty and blepharoplasty), to cardiology. Along the walkway connecting these clinics is a huge board listing the names of all the doctors who practise in these clinics and in the wards; almost all of them are from Manipur.
This is significant given the brain drain out of the region usually creates the opposite scenario. Part of Shija’s car park is given over to the hospital’s own ambulance service. At the rear of the compound is a new blood bank and transfusion center funded by the Indian government’s special ministry to orchestrate development of the region.
In mid-2013 I toured the blood bank with the hospital’s public relations officer. After mentioning how impressed I was by the technology on display in the facility, he said, ‘We need a reliable supply of blood because a lot of people get shot here,’ referring to decades of insurgency, counterinsurgency and extraordinary laws that have shaped everyday life in the city.
At night, while much of Imphal is in darkness and the hills of Langol are speckled with small kerosene house lights, Shija glows from the lights generated by its own power supply. The site has been dubbed ‘Health City’, a phrase that even the chief minister of Manipur has begun to use.
The private health sector in Imphal is apparently booming. Indeed, Shija is one of twenty-seven private hospitals in the city. This poses a very peculiar puzzle. How is this possible? Imphal struggles with electricity, water supply, and waste disposal. Violence is routine and prolific. Corruption flourishes in all virtually all aspects of life. The development projects of the civilian government produce dysfunctional infrastructure that marks the city and contributes to a shared melancholia among residents, who lament the loss of knowledge of traditional architectural styles and the alienation of high outer walls, watchtowers, security guards and the disappearance of trees, ponds and wild animals.
By way of contrast, just a short walk west, is Hebron Veng Street, a dirt road stretching 200 meters or so out into the surrounding fields. Hebron Veng Street is named after the Hebron neighbourhood populated by members of the Paite tribe in the city of Churachandpur, capital of the district of the same name in the southwest of Manipur. Inter-ethnic conflicts and demands for autonomy for different communities within Manipur (and secession from Manipur) have shaped politics in Churachandpur in the last decade, resulting in a cycle of protests, violence and crackdowns by the armed forces. Like many other communities in the state over the last twenty years, scores of families from Churachandpur have found themselves in Langol starting a new life for a year, two, or twenty.
Hebron Veng Street features small houses made from sheets of asbestos fibre mixed with cement—termed ‘Rhino’ in Imphal after the well-known Rhino brand manufactured in neighbouring Assam—and a few woven with bamboo are set in neat rows a few metres back from the dirt road. A few have small kiosks and shops added to the front selling snacks, eggs, akhuni, and second-hand clothes. Calendars produced for student organisations and ethno-nationalist groups hang on the outer walls of the shops.
At the end of Hebron Veng Street is the recently completed Langol Independent Church. In the parallel Spring Villa Street are the Chongtu Baptist Church, Bible Baptist Church, Kuki Baptist Church Langol, and Layman’s Evangelical Fellowship. On the other side of the main road there are scores more churches, and throughout Langol it seems there is a church every hundred meters or so, quite a sight on the outskirts of what is believed to be—and politicised as—a majority Meitei city full of Vaishnavite Hindus, Muslim Pangals, and animist Sanamahis.
Imphal—and the frontier more broadly—is subject to state-orchestrated plans to create new markets and better connect the frontier to the rest of India and to Southeast Asia
Some churches are complete and functioning. Others are half built with a functioning room or two. Some are just a cement frame with a crucifix and a name, often of a village in the faraway hills. The caretaker of one church with just a façade, door and crucifix said the money was coming slowly from a congregation in Chandel district. He hoped it would be finished soon and more people from the village would come and settle. It was important that this happened quickly, as the community needed to stake a claim in Langol before all the land was taken. He quickly added, ‘the government will not remove a church’.
These two landscapes sit adjacent on the edge of the city. One, a high-tech ‘health city’, the other, an improvised neighbourhood created by communities feeling violence in other parts of Manipur and seeking opportunity in the city. They reveal two competing—and contrasting—dynamics that characterise life in Imphal and the frontier more broadly, militarisation and liberalisation.
While militarisation in Imphal and the frontier more broadly has been the focus of scholars and activists for decades, significantly less attention is given to the liberalisation of the frontier. Imphal—and the frontier more broadly—is subject to state-orchestrated plans to create new markets and better connect the frontier to the rest of India and to Southeast Asia. Articulated in the ‘Look East Policy’ (now ‘Act East’) and the North East Vision 2020 document, Imphal is to be recalibrated as a ‘gateway city’ opening up the recalcitrant frontier to the forces of national and global capital.
Yet the liberalisation of health in Imphal is an endogenous endeavor borne out of medical professionals making do in the face of state dysfunction. It is not imposed from afar nor is it driven by an overt embrace of the policy agenda espoused by former and current Indian and Manipur politicians. It is also an expression of self-sufficiency, of what can be achieved independently of the Indian and Manipur state governments.
In a context where state-led development reflects neocolonial occupation, self-sufficiency is a powerful symbol of both lost autonomy and future capacity. Furthermore, Manipur has an oversupply of health workers (though shortages in rural areas), who form perhaps the most valuable export in a polity where dependence on remittances is increasing.
As Shija grows and Imphal’s reputation as a health hub spreads to surrounding polities, including across the international border with Myanmar, the surrounding area continues to receive migrants and displaced communities fleeing violence and military occupation in other parts of the state. Indeed, the growth of Shija has increased the value of land in the area and many settlers now face a battle to produce title and prove their legitimacy.
Ironically, the success of endogenous liberalisation intended to demonstrate autonomy from the state has expedited state control of the city’s own frontier, making the once-anarchical zone legible to military and civilian authorities. Staying put means making a firm claim to place, most visible in the spread of churches across the landscape.
Shija Private Hospital, one of twenty-seven private hospitals in Imphal, which is experiencing a boom in private health services.