Anuj Kumar explores how the graphic narrative “Under the Shadow of a Building” visually conveys the structural exclusions of India’s healthcare system, particularly for urban migrant labourers. He examines medical pluralism, stigma, and the quiet endurance of bodies caught between policy and care through graphic medicine.
India is a land of diverse medical practices. However, this very plurality can sometimes lead to scepticism where communities prefer one system over another due to perceived efficacy or cultural familiarity. The graphic narrative Under the Shadow of a Building by Vidyun Sabhaney and Mohit Kant Mishra, published in First Hand: Graphic Narratives from India, Volume 2 (2018), foregrounds the medical and social invisibility of urban migrant labourers. It is drawn from the India Exclusion Report 2015, testimonies gathered via the Centre for Equity Studies, and interviews with health reporters. The narrative forms part of a larger visual anthology that maps structural inequality in India. It documents everyday forms of systemic exclusion across health, caste, gender, conflict, and sanitation, offering a compelling visual archive of marginalisation in contemporary India.
Operating at the intersection of documentary realism and visual storytelling, Under the Shadow of a Building raises questions about diverse treatment options, the inaccessibility of diagnosis, the stigma associated with disease, and the systemic failure of medical dissemination to a section of the public that remains unnoticed in the larger discourse of medical narratives. Within the broader context of graphic medicine, the work serves as a critical site to explore the subjects who are silenced within India’s healthcare system, individuals whose suffering is made invisible by structural neglect, social stigma, and the absence of empathetic medical engagement.
The protagonist of the narrative is deliberately ordinary—a man named Ashok, a daily wage construction worker who migrates to an unnamed city in search of employment to repay the debt he has incurred back home. His story is not singular but composite, one that could belong to any of the countless anonymous figures who form the backbone of India’s informal economy. His body, in many ways, becomes a symbol of shared experience: displaced from the village, surrounded by crumbling public infrastructure, negotiating basic amenities, relying on public washrooms, and striving to earn a modest wage to send back home.
Comics, as a medium, can craft silence not as a lack but as a narrative device. Under the Shadow of a Building uses consecutive panels where the visual silence speaks volumes. The absence of speech bubbles, haunted faces, and still postures can be read as not just physical fatigue but also broader existential exhaustion. The protagonist dreams of mirrors but cannot find his reflection—a motif that encapsulates both his erasure from the public sphere and his internal fragmentation. In a world where the sick must speak in order to be treated, to lack a voice is to lack existence. However, through the visual language of the comic, this silence becomes the very mode of representation. The genre offers an alternative testimony, one that does not rely on eloquence but on embodied suffering.
The story unravels an ecosystem of illness where public sanitation is inadequate, hospitals are overcrowded, and identification becomes a barrier to care. The narrative shows us the queues outside government hospitals stretching endlessly, and even when treatment is available, such as free cancer surgery, it is never truly free. It comes at the cost of a day’s wage and the risk of termination from unorganised employment. Within the frame narrative, we see that a mother’s cancer recovery is contingent on her child dropping out of school to become a full-time caretaker, with her thirteen-year-old daughter managing her medication, diet, and paperwork. The narrative does not dwell on this moment for dramatic effect; instead, it presents it as part of the fabric of daily survival. The burden of care is passed down generationally, quietly, and with immense emotional and physical cost.
Medical Pluralism in India
Crucially, the narrative also prompts us to consider the pluralism of medical practices in India and the social imaginaries that govern them. While the state often endorses a scientific, biomedically driven public health approach, with 97% of the national health budget allocated to modern medicine, colloquially referred to as angrezi dawa (English/Western medicine), especially in rural spaces, the actual practices of the working class reflect a much more complex landscape. Despite a long history of collaboration between traditional and modern medicine systems in India, an underlying scepticism persists within many communities, particularly when it comes to chronic conditions or treatments requiring sustained engagement. This tension often shapes how patients navigate and negotiate between these overlapping medical worlds.
Under the Shadow of a Building brings to focus a very crucial point where a construction worker says, “I was given injection of God knows what,” expressing an intuitive mistrust not just of the medication itself but of the system that fails to communicate its administration, effects, and risks. The association of unknown medicine signals a more profound fear of ingesting something unknown, industrial, and possibly harmful. In the absence of a dialogic or empathetic medical encounter, medicine becomes not a means of healing but a source of anxiety. The comic subtly pushes us to reconsider medicine not as a neutral or benevolent intervention, but as something that is culturally coded, socially received, and materially ambiguous. This mistrust is not entirely unfounded, given the impersonal nature of many overrun government facilities, rushed consultations, and long waits in line, which are accompanied by frequently illegible prescriptions, some of which are depicted in the narrative itself.
Government Schemes and Navigation of Choices
In 2018, the Ministry of AYUSH formally integrated India’s diverse traditional systems of Ayurveda, Unani, Siddha, Homoeopathy, and Naturopathy under a unified framework, reinforcing their vital role in the healthcare choices of many Indians. That same year, the Ayushman Bharat Yojana was launched to provide accessible and affordable healthcare to over 500 million economically vulnerable citizens through Health and Wellness Centres and the ‘Pradhan Mantri Jan Arogya Yojana’ (PM-JAY). While individual preferences vary, the availability of both traditional and modern medicine options seems to restore a sense of agency to patients navigating illness. Many view traditional systems as more holistic and attentive, often beginning with detailed case histories that include emotional, dietary, and lifestyle factors, offering a personalised care experience absent in the overstretched and impersonal atmosphere of modern medicine hospitals.
Yet, policy frameworks alone cannot account for the complex emotional, social, and cultural realities that shape healthcare access and reception. This pluralism, though inclusive on paper, is not without its complications. It is marked by ambiguity in treatment choices. It intersects with class and caste consciousness, making many hesitant to identify as socio-economically vulnerable, particularly when the Ayushman Bharat health card functions as a visible marker of economic disadvantage. In practice, the proliferation of choices can backfire, as it does not always translate into empowerment or clarity. In the absence of reliable public health education, patients often rely on anecdotal knowledge and trial-and-error. The result is a confusing overlap of systems, as I have observed myself: a dose of Ayurvedic powder here, a strip of expired antibiotics there, a visit to a folk/spiritual healer who heals with his hands, and, when nothing else works, a debt-financed visit to a private clinic.
In the graphic narrative, the protagonist, Ashok, emerges as a socially conscious individual. Although his daughter is eligible for free tuberculosis (TB) treatment under a government scheme, he still takes her to a private doctor for checkups. The stigma attached to tuberculosis is so profound that even its free treatment becomes a liability. “What if someone hears?” is not just a fear of gossip for his family—it is a fear of unemployment and ostracisation from the community.
Recommended by WHO, India’s ‘Directly Observed Treatment, Short-course’ (DOTS) policy, which provides supervised, cost-free treatment for tuberculosis, is a widely lauded public health measure. However, in the lived experiences represented in the graphic narrative, it becomes clear that policy alone cannot dismantle social stigma. The assumption that treatment equals cure ignores the broader social ecology of disease. A cured body is not necessarily a healed one, especially when that body remains socially excluded. The daughter’s recovery does not erase the fact that no one would hire the family for the following agricultural season because she had TB. In this world, recovery is not just a medical event but a social re-entry, and the latter remains far more elusive.
The fear of public revelation envelops the patient in fear, despite the state’s interventions, including the provision of free surgery, the DOTS regimen, and follow-up conducted by community health workers in India called ASHA workers. The narrative raises the question of healthcare as not just a matter of clinical treatment but also logistics, paperwork, emotional labour, and daily wage management. Additionally, it also prompts us to think about medicine in terms of social status, acceptance, and, at times, even a matter of pride. In Ashok’s world, even getting to the hospital is a task fraught with risk: the loss of a day’s wages, the threat of dismissal, and the possibility of not being identified due to missing identification documents. When someone says, “Who can afford to lose a day’s work?” it is not a rhetorical question—it is a diagnosis of the system itself. Hence, free isn’t always free; it always costs something.
There is a quiet urgency throughout the narrative that makes its visual economy all the more poignant. There are no grand declarations, no cathartic moments, no systemic reforms. What we are left with is a kind of stoic endurance. Perhaps that is what the narrative seeks to articulate most powerfully. The comic does not explore resilience in the heroic sense but rather endurance in the most ordinary, exhausting, and unacknowledged way. The characters appear to have accepted the system as it is, fully aware that they lack the agency to demand anything, especially within this displaced and precarious setting. The protagonist bonds with the workers around him and finds out that he is not alone in his suffering. The epidemic, in a paradoxical way, merges his pain with that of the larger public, momentarily making him part of a broader, collective community.
In the Shadow of a Building is not a call to arms, nor is it a lament. It is a document. A testament. A quiet, visual reminder that there are lives lived on the edge of vision, people who remain “in the shadow” not just of buildings but of policy, infrastructure, and national conscience. Graphic medicine, as seen in this work, does not just illustrate suffering—it maps its terrain. And in doing so, it forces us, however briefly, to look at what we have trained ourselves not to see.
About the author
Anuj Kumar is an Assistant Professor in the Department of English at Janki Devi Memorial College, University of Delhi. He is a PhD candidate focusing on medical humanities and trauma studies, with a particular interest in autobiographical graphic narratives. Anuj holds an MPhil in English from the University of Delhi, where his research explored trauma narratives in autobiographical graphic texts, particularly the narrative complexities involved in constructing the self. His current doctoral work builds on this foundation within the emerging field of graphic medicine. His academic interests span graphic medicine, public health, trauma studies, visual culture, and critical theory. Email: anujado@gmail.com
References
India Exclusion Report 2015. 2016. India Exclusion Report 2015. New Delhi: Yoda Press.
Ministry of Ayush. n.d. “Welcome to Ministry of Ayush.” Accessed July 03, 2025. https://ayush.gov.in/#!/schemes.
National Health Authority (NHA). n.d. “Official Website Ayushman Bharat Digital Mission.” Accessed July 03, 2025. https://abdm.gov.in/nha.
Sabhaney, Vidyun. 2018. First Hand. Volume 2, Exclusion: Graphic Narratives from India. New Delhi: Yoda Press.
Shankar, Darshan. 2015. “Health Sector Reforms for 21st Century Healthcare.” Journal of Ayurveda and Integrative Medicine 6 (1): 4. https://doi.org/10.4103/0975-9476.154214.
