In his first year of teaching for the International Institute's global health minor, Sandesara created two new electives for the program.

UCLA International Institute, September 10, 2024 — Dr. Utpal Sandesara joined the International Institute’s popular global health minor in fall 2023 as the second faculty member — after program chair Dr. Ippolytos Kalofonos — who is both a medical doctor and a medical anthropologist.

Sandesara earned both his M.D. and Ph.D. at the University of Pennsylvania. He went on to complete a three-year residency in primary care internal medicine in a program jointly offered by UCLA and Olive View-UCLA Medical Center, a public safety-net hospital operated by the LA County Department of Health Services.

“I knew when I was in medical school and applying for residencies that I wanted to serve people who historically have been marginalized in the healthcare system and who deserve really good care,” he said. “My three years of residency reinforced my desire to work with those patients in that setting,” he added.

After finishing his residency in 2022, he was hired by the Division of General Internal Medicine-Health Services Research of UCLA Health, which focuses on clinical research, education and patient care. He is now an assistant professor in residence with a joint appointment to that division and the International Institute.

Today, Sandesara lives the life of a scholar-practitioner. He continues to see primary care patients at Olive View once a week, where he precepts UCLA medical students; he also gives occasional lectures to UCLA residents. In addition, he conducts scholarly research on the lived experience of bodily suffering, structural inequality and medical care, and he teaches in the global health program.

In spring 2024, he launched an ethnographic research project on family caregivers for medically underserved patients in San Fernando Valley who are suffering from end-stage liver disease. Supported by a UC End Disparities Pilot Award (funded by a UCLA Clinical and Translational Science Institute grant from the National Institute on Minority and Health Disparities), the project is advised by a community action board.

New courses for the global health minor

Sandesara taught two new global health electives in spring 2024 that he specifically created for the program: Origins & Dilemmas of Global Health Interventions (GL HLT 160) and Global Health: Reproduction and Power (GL HLT 191).

“It’s such a joy for me, given my background and my journey, to teach global health because in both my classes, we had such a diversity of student backgrounds and interests, and that led to really rich conversations,” he said.

“We had people who were coming from anthropology and sociology and people who were coming from molecular and cellular biology. We had people who were bound for medicine, people who were bound for law and people who were still figuring out what they were bound for.”

The Origins & Dilemmas lecture course, he explained, “explores concepts in critical social theory that can help us make sense of global health problems and interventions.” Each week is dedicated to a specific topic, which students explore through theoretical readings, case studies and class discussions.

“We have a week on embodiment: How is the body thought of and taken up in different versions of global health research and practice? We have a week on evidence: How is the scientific evidence we use in global health a social construct of sorts? And how can we take the social constructs that we have, which are very biased towards the needs and interests of the Global North, and democratize them?”

In the evidence module, Sandesara uses a case study of a farmer in rural India, modeled on a social medicine case report that was published a few years ago in the New England Journal of Medicine. “The farmer has a stroke and comes into a hospital, and the issue is that there’s no CT scanner available. All the guidelines that exist — which are generated in the main in North America and Europe — say you get a CT scan first to determine if somebody has a brain bleed. Then if they don't have a brain bleed, you push a clot-busting medication,” he recounted.

“The question [here] is: What’s the right ethical step when the nearest CT scanner is at least an hour away and he’s been having symptoms for two hours? By the time he gets back [from the scanner location], it’ll be too late to do anything.”

The Reproduction and Power course, a senior research seminar, explores “the intersection of reproduction with three forms of power: governance, biomedical control of the body (which includes clinical medicine, but also public health) and social stratification or social domination,” he explained.

“The class follows these three threads of power through lived experiences of reproduction and reproductive health – and reproductive justice or injustice – across a variety of different settings.”

The seminar asks students to engage in intensive discussion around topics such as abortion, population control, maternal mortality, medical paternalism, reproductive racism and obstetric violence. During the quarter, each student has the chance to construct an implosion map – “a structured brain dump,” as Sandesara describes it – about something in reproductive health they care about.

Groups of students then parlay their implosion maps into “UnEssays,” or projects that communicate something new about a topic, using formats that may vary from a board game to an Instagram campaign to a high school curriculum.

“What unites all the projects,” Sandesara says, “is that students really dedicate themselves to taking their passion for a topic and channeling it into the production of something that can change hearts and minds in the real world. Compared to traditional term papers, these reproductive justice projects consistently floor me with the depth of students’ engagement and the amount that I learn from them.”

An unexpected journey to becoming a scholar-practitioner

When he set off for the interdisciplinary undergraduate social studies program at Harvard, says Sandesara, “I was vehemently against being a doctor.” Medicine, he explained, was an over-represented profession in his Gujarati immigrant family.

Yet roughly mid-way through his freshman year, two courses inspired him to become a doctor as well as a medical anthropologist. One of the courses was co-taught by the world-famous Dr. Paul Farmer, who co-founded Partners in Health, and Arachu Castro, former president of the Society for Medical Anthropology (2017–19) and “a medical anthropology and public health powerhouse in her own right,” remarked Sandesara.

“Those courses suddenly opened up an incredible model for me: I could be close to people, learn their stories and write about them, and at the same time, actually serve those same people directly through clinical care. And then teach about both things put together,” he said.

To realize that vision, Sandesara completed his undergraduate major while simultaneously taking the full suite of prerequisites for medical school. “It basically meant that I had zero electives for the rest of my college career,” he said, “but I enjoyed all my courses!”

And amidst all that work, he wrote a book. The large ethnographic research project that he did as an undergraduate elective — which investigates the 1979 collapse of the Manchhu Dam in India, a disaster that Sandesara’s mother had survived in her youth — was published three years after his graduation.

“No One Had a Tongue to Speak: The Untold Story of One of History’s Deadliest Floods” (Prometheus, 2011), coauthored by Tom Wooten, presents an ethno-history of the disaster based on 147 oral history interviews with survivors and extensive archival research. The book has since been published in India in English (2012) by Rupa Publications of New Delhi and in Gujarati (2015) by Pravin Prakashan of Rajkot.

Sandesara is presently completing a manuscript, “She is Not Ours,” which grew out of his ethnographic doctoral research on sex-selective abortion in Gujarat, India. The practice — which he said is discernible “from Beijing to the Balkans” — had been illegal in India for 20 years when he began his research in earnest in 2014.

“You really can’t separate sex selection from the world population control movement and these Malthusian ideas that India and China were going to overpopulate the world that were prominent before and after the Second World War,” commented the professor.

“We know, for example, that the International Planned Parenthood Foundation and the Rockefeller Foundation, as well as entities loosely tied to the U.S. government, were instrumental in getting India’s abortion law passed. And they were instrumental in pioneering the diagnostic technologies that eventually enabled sex election.”

Here, he pointed to two seminal works on this history: “Unnatural Selection” by Mara Hvistendahl (Public Affairs, 2011) and “Fatal Misconception” by Matthew Connelly (Harvard University Press, 2008).

“I think being a clinician in training meant that a lot of clinicians, and by extension, the families they served, felt more comfortable talking with me about a practice that was illegal,” he said.

“In India, as opposed to China during the one-child era, women generally resort to sex-selective abortion after having at least one, if not, several girls… A son is the end — both motivationally and temporally — of reproduction for many Indian couples,” he said.

Daughters in Gujarat typically live with their in-laws when they marry, he explained, whereas sons remain in the parental household after marriage. In addition to the support a son and his wife provide parents in old age, a son earns a family the social recognition associated with a continuing household lineage.

“Sex selection is a problem demographically and morally, but we know very little about the subjective moral experiences of the people engaging in the practice,” explained the scholar. “When we get close to those people and try to understand what it is that they’re doing on their own terms, it becomes clear that they feel trapped by larger social forces into a decision they don’t want to make.

“They don’t need public health campaigns to tell them what they are doing is bad… In the main, they love their daughters and they agonize over [a decision to abort a child]. But for most people in India, you can’t stop having babies until you have a son.”

In the end, says Sandesara, “Patriarchy is not a set of discriminatory attitudes, it’s not a mindset, it’s not even a set of problematic or misogynistic or ignorant behaviors. It’s a system that is very sticky, one that’s impossible for any individual family to change.”

See related article on global health minor

Published: Tuesday, September 10, 2024