The purpose of this paper is to examine the value of decolonial approaches (DAs) such as epistemic locus (Mignolo, 1995, 2000) in studying innovation.
This paper is based on a case study of a stem cell surgical innovation developed in India. A critical hermeneutic analysis method has been followed for data analysis.
Epistemic locus influences the framing of the problem, perceptions of risks/opportunities as well as the envisioning of alternate institutional systems. Persistent and strategic effort at building connections changes local improvisation into a globally legitimate innovation.
It indicates the value of using DAs for innovation studies especially epistemic locus, enactment and connections in understanding knowledge generation and innovation.
Innovation in Global South can be encouraged by giving more space to the innovator to attempt or experiment. More conscious conversation of epistemic locus of the researcher could help.
Countries have to move beyond a mere technological imitation to include discussions on epistemic imitation. Epistemic imitation prevents one from seeing what one has and one only looks at conditions from the eyes of the dominator.
This study documents the development of an innovation from an Indian epistemic locus which differs from a western epistemic locus and the impact this has on an innovation.
Jammulamadaka, N. (2019), "The contradiction of Indian innovation: an epistemological explanation", Qualitative Research in Organizations and Management, Vol. 14 No. 2, pp. 194-216. https://doi.org/10.1108/QROM-04-2018-1632Download as .RIS
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India has been ranked as the number 1 innovation destination in Asia and number 2 in the world for new innovation centres
The top 20 list [of patent granting offices] includes […] […] India
“India ranks abysmally at 43rd out of 45 countries in a global innovation index”, (PTI, 2017). “India ranks 81 out of 141 countries on the Global Innovation Index 2015”
The above figures capture the contradiction of Indian innovation – a nation which is world’s preferred innovation destination with over 1,200 R&D centers of 943 MNCs (John and Phadnis, 2017), and yet is an “abysmal” innovator. As a member of India’s knowledge producing community who increasingly feels the pressure for innovation and research, this contradiction is something I am unable to ignore. The vast literature coming from diverse perspectives on innovation in countries like India, such as, systems of innovation approaches, developing country innovation studies, jugaad studies, postcolonial technoscience; offers little comfort because this contradiction has hardly been examined. How can a place, here India, be an innovation destination (India is preferred as a destination because it has skilled people or possesses human scientific capabilities) yet not be able to claim a place in the world (Pollock, 2014) of scientific knowledge production as a knowledge producer? Even less clear is the meaning of the term “Indian innovation.” Is it Indian innovation because it has happened in the geographic place India? Is it Indian because it came about through some process that has been considered peculiar to India such as jugaad? Is it Indian because it is based on indigenous ethnoscience? Is it Indian because the innovator is thinking from an Indian locus? Literature does not clarify this. Even though jugaad (or frugal engineering) has been advanced as India’s innovation gift to the West (Kaur, 2016; Radjou et al., 2012; Sekhsaria, 2013), jugaad is seen as inferior to scientific knowledge by several scholars since it generally has not led to creation of intellectual property rights (IPR) (Birtchnell, 2011; Krishnan, 2010), thereby frustrating Indian claim for a place in the world (Pollock, 2014) of knowledge production.
The belief that understanding this contradiction could help in reconfiguring the relations that constitute and define modern scientific knowledge production; where South – souths in the South and souths in the North – is the lab and recipient, but never a legitimate producer (Pollock, 2014); drives this paper. I explain the contradiction by drawing upon Mignolo’s idea of “epistemic locus” and enacting solidarities through connections (Connell, 2015). The paper advances a particular perspective that the contradiction is an outcome of India being referred to often as a geographic place where universal science is pursued as against an “epistemic location” (Mignolo, 1995, 2000). An “epistemic location” as Mignolo explains is the “place from which one thinks.” It is knowing “with” and “from” a civilizational awareness of oneself, “[…] with all the implication of what ‘speaking’ as someone from a place means” (Mignolo, 1995). This paper examines the emergence of a specific surgical innovation in the stem-cell field in India. Through this, it suggests how a eurocentric locus of innovation, makes one focus on constraints and lacks especially of capital, markets, etc., and impedes innovation. It also shows how “enactment” and the invocation of “India” as an epistemic locus (Mignolo, 1995, 2000; Mignolo and Walsh, 2018; Ndvolou, 2016) enables a different understanding of problems and constraints which could then lead to the emergence of a novel innovation from India. Such innovations are likely to have planetary (Quijano, 2000) value. It thus shows the relevance of decolonial approaches (DAs) to studying innovation.
The rest of the paper is organized as follows. The first section briefly reviews literature on innovation in India. The words knowledge, innovation and technological innovation are being used interchangeably since the context here is technological knowledge. This section identifies the way place and knowledge have been treated in said literature. The second section provides an explanation of the decolonial idea of epistemic locus on knowledge and science used in this study. The third section briefly summarizes the critical hermeneutic analysis (CHA) method followed for data collection and analysis. The fourth section presents the data, detailing the chronology of the text of this study as well the levels of contexts used in the hermeneutic analysis. The fifth section presents the analysis. The paper concludes with sharing some learnings. My epistemic position has been clarified all through the paper.
Configuration of place and knowledge in India’s-innovation studies
Since the contradiction in knowledge production is tied to place, this section examines the configuration of place and knowledge in some common perspectives in literature on innovation and knowledge production in India. I look at indicative studies from innovation capabilities (IC), national innovation systems (NIS), social innovation (SI), jugaad, postcolonial approaches and postcolonial technoscience (please see Table I for key ideas and indicative literature of these perspectives). In this work I think from and with decoloniality as the epistemic locus, even if in a constrained and limited way, and delink (Mignolo and Walsh, 2018) from the disciplinary place assigned to it i.e., within decolonial and/or postcolonial technoscience sub-discipline, in the hope of contributing in a small way to “changing the content and terms of the conversations” on innovation (Mignolo and Walsh, 2018, p. 212). (At the same time, the possibility of postcolonial revenge (Gandhi, 1998) is averted as this is a paper in English in a Western journal). In the spirit of decolonial praxis (Mignolo and Walsh, 2018, p. 10) it seeks to converse with diverse views as local views (even those which have become global-universal). Therefore, this review’s focus is not limited to postcolonial technoscience even though it uses a decolonial concept for analysis. This is not an exhaustive and systematic review. I acknowledge that there are many differences and similarities across these perspectives. I broadly summarize the configuration, i.e., the way in which place and knowledge are conceptualized (whose relationship is of particular relevance to the contradiction) across these perspectives to understanding develop this paper’s argument.
In both IC and NIS perspectives, India figures as a geographic place whose systems and capabilities are compared with capabilities of western firms. Institutional structures, systems and incentives of the West are taken as a standard against which India is assessed. In this narrative, India figures as a geographic place possessing scarcities/lacks such as underdeveloped markets, capital at the firm/industry level (IC); at the national level (NIS). These perspectives are anchored in an artifactual view of knowledge. Here, scientific knowledge implies private IPR such as patents and publications, that can produce rents for the producer (Andjelkovic, 2006). Across these perspectives, innovation is measured through IPR and anticipated rent streams undergird capital investments. This is broadly the universal eurocentric perspective on innovation. Here, West is unproblematically recognized and accepted as a knowledge producer, with India playing “catch-up.”
SI sees India as a geographic place not producing scientific knowledge but consuming it. It unproblematically advocates for an engagement between West and Rest in a global distribution of knowledge labor – West as producer, Rest (including India) as a user, basing its rationale on scarcities/lacks of places such as India and skewed distribution of benefits of scientific innovation. Wong and Soman (2014, p. 6) suggest that the South should focus on SI by using North’s technical advancements. SI too, subscribes to IPR view as it denies inclusive SI the status of true knowledge since it is not IPR.
Jugaad perspective does not actively recognize West as the producer, it focuses on India as a geographic place using existing knowledge irrespective of site of production to overcome resource scarcities in India. It is therefore seen by some scholars as nonserious about systematic production of scientific knowledge or IPR (Kaur, 2016; Krishnan, 2010). Jugaad literature implicitly recognizes knowledge as a public good or commons through its disregard of IPR and practice of piracy (Gupta, 2002; Rai, 2015). This perspective deploys knowledge in the creation of other functional artifacts of everyday and immediate use rather than the production of knowledge in and of itself as artifacts, thereby disengaging from contribution to IPR making it partially similar to SI (Gupta, 2002; Prasad, 2008; Rai, 2015). To some, this approach contradicts rent seeking IPR and is therefore inferior (Krishnan, 2010).
Postcolonial approaches view knowledge as discourses – universal scientific knowledges and place-based local indigenous knowledges/alternative sciences – that are in conflict with each other. They problematize universalization of scientific knowledge with its artifactual, extractive and exploitative features such as medicine or green revolution. They identify an oppositional, oppressive relationship where such Western scientific knowledge is displacing local, place-based indigenous knowledges (Shiva, 1991). Discourse using science education explains the formation and transformation of a native into a modern scientifically rational subject (Nandy, 1995a, b; Prakash, 1999). This is particularly important in a country like India where even after independence, the colonial education system that had slowly replaced traditional forms of formal knowledge transmission (Basu, 1974) continues and thrives, with a marked preference for English/Western education (Annamalai, 2004). Place here enlarges to an ethno-geographic entity carrying different local knowledges. Postcolonial technoscience shifts the discussion from a local geographic place to subjects embedded in unequal North-South networks and looks at scientific knowledge as the production of private knowledge property artifacts by such subjects. It emphasizes interactive bi/multi-directional, uneven flows across place-times (Abraham, 2006; Prasad, 2006, 2008).
The above strands of literature enhance our understanding of innovation in India in its own particular ways. However, it is largely based on a geographic view of place. India figures prominently as a specific geographic location either associated with intense lacks/scarcities such as capital that impede knowledge production or place based knowledges. While it is evident from postcolonial approaches that lacks/scarcities are not just material but perspectival, it does not help us imagine how changing the perspective to place-based indigenous knowledges could mobilize particular lacks or resolve the contradiction. Shifting toward global flows and interactions, beyond place, as postcolonial techno-science suggests, limits our ability to apprehend the contradiction and re-claiming a place in the world, since the contradiction itself is constituted in and through place. Nevertheless, postcolonial technoscience, also suggests that it is only by examining actual practice of knowledge production that we may improve our understanding (Abraham, 2006, p. 217; Prasad, 2006, p. 226). I follow this suggestion and look at the development of a stem-cell eye therapy in India to understand place as epistemic locus and how such a locus might interrupt the contradiction.
Theoretical scaffold: epistemic locus, enactment and connections
This paper draws its support from DA. DAs have been used in management and organization studies in recent years (Chakraborty et al., 2017; Ibarra-Colado, 2006; Faria, 2013; Ruggunan, 2016; Westwood et al., 2014). DA are a diverse array of theoretic-analytic-praxistical practices (Mignolo and Walsh, 2018) that centerstage colonization i.e., hierarchialisation of peoples and civilizations in analysis of phenomena. In the essay “Being African and Innovative” Ndvolou (2016, p. 157) asks “Who is an African? And what knowledge serves as the basis for the concept of an African-based solution”? Ndvolou adds, “The idea of colonisation of the mind, of knowledge and of the imagination is crucial in understanding where the thinking is located epistemically.” Mignolo (2000) argues that Western epistemology using the myth of a “disembodied third person universal position of knowing,” aided by institutional resources of publishing, educational infrastructure, syllabi, language, etc. of the metropolitan center has turned a eurocentric epistemic locus of “knowledge as will to truth” into a universal locus of objective scientific knowledge thereby controlling knowledge and thinking around the world. As Ndvolou (2016, pp. 162-163) explains – because of hegemonic nature of contemporary eurocentric educational knowledge institutions and structures within colonised societies, even though, politically free, the people of these societies are still likely to think from eurocentric epistemic loci, from the colonizer’s side of the colonial difference and view their societal condition as one of incapacity. In contrast, thinking from their native epistemic loci with all their awareness of their culture’s and civilization’s commonsense including one’s geo-body-historical position (Grosfoguel, 2007) opens up alternatives. Mignolo (2000) adds that, such native epistemic loci, being denied space in western denotative epistemology or theory (itself differentiated from action), reveal themselves as enactment or action. While there is no outside of coloniality in the realm of coloniality; enactment rooted in a “praxis of living” (Mignolo and Walsh, 2018, p. 7) comes from all ways of knowing-doing – Western and (silenced) native. Through such border dwelling-thinking, decolonial praxis transcends epistemology’s theory-action hierarchical binary, building pluriversal, planetary knowledges. Decolonial praxis of living enacts solidarities with a “will to life” as against a will to truth (Mignolo, 2000, p. 26; Mignolo and Walsh, 2018); through building connections and inter-linked narratives (Bhambra, 2014; Connell, 2015) among various locals as the condition for, with and in decolonization. Connell argues “The alternative to a pyramidal epistemology, […] looks for connections between knowledge projects, as much as differences […]. It is critically aware of the history of the global knowledge economy […].” (Connell, 2015, pp. 14-15, emphasis added). I recognize that there are differences in the way Bhambra, Connell and Mignolo invoke geopolitics of knowledge. However, they are similar in their quest and shared solidarity for decolonizing. Baghidoost (2018) too recognizes this. It is this similarity that I draw on to proceed with the argument.
Understanding Indian innovation from the perspective of epistemic locus requires that micro and macro dimensions are simultaneously examined critically. CHA method facilitates this by linking micro and macro (Prasad and Prasad, 2002) through iterative, interpretive movement between text and context (Prasad, 2002; Prasad, 2005). CHA allows us to account for a “cultural common sense” through various contexts such as organizational, social, cultural and/or historical (Prasad and Mir, 2002, p. 95). In contemporary CHA text refers to any phenomenon, document, social or organizational process, etc., chosen for analysis (Prasad and Prasad, 2002). Similarly, researcher defines the context and derives it from an interaction between his/her own position and the research question (Prasad, 2002, 2005; Prasad and Mir, 2002; Gopinath and Prasad, 2012; Jammulamadaka and Saha, 2018; McLaren and Mills, 2010). Such context is specified in the form of successive levels such as organization, institution, field, history, geopolitics, to facilitate an interpretation of the text (Prasad, 2002). Contemporary CHA has been increasingly used to inform organizational analysis (Jammulamadaka and Saha, 2018; Prasad and Mir, 2002; Gopinath and Prasad, 2012; McLaren and Mills, 2010). CHA includes four steps (Prasad, 2002, 2005; Prasad and Mir, 2002). Step one is choosing the text and reading it. Step two is laying out the context. Step three is an iterative process of moving in the hermeneutic circle by analyzing the text in relation to its context till a sense of closure, coherence and internal consistency is achieved in interpretation at which point the hermeneutic circle is said to be closed and there is a fusion of hermeneutic horizons of the text’s author and the interpreter. CHA accepts that its particular interpretation does not exhaust interpretive possibilities (Prasad and Mir, 2002). Step four involves critical theoretical interpretation.
The text chosen for this study is the development of a particular stem-cell surgical innovation in eye care known as Simple Limbal Epithelial Transplantation (SLET). SLET was invented by Dr Sangwan of LV Prasad Eye Institute (LVPEI) in India. This text has been chosen because it is a unique and singular case. It is a new knowledge of planetary value emerging from India and allows us to transcend knowledge commons/IPR and producer/consumer divides in knowledge in innovation literature. Studying unique or rare single cases is an accepted convention in social science research (Mir and Mir, 2009; Gopinath and Prasad, 2012; Miles and Huberman, 1994; Yin, 1994). Context levels were defined in keeping with the theoretical concepts of epistemic locus and enactive epistemology and described at multiple levels in order to create a “net” (Prasad and Mir, 2002) within which the text can be placed. This research is analyzing a living and developing text, i.e., development of SLET by Sangwan that even though began in 2000 was ongoing during the time of my data collection. Thus Sangwan has been an active part of the research process in the true spirit of fusion of hermeneutic horizons of the text’s author and the interpreting researcher. I as an interpreter was not operating from a privileged position above the author but working together with the text’s author in deriving interpretation. Consequently, to reveal the place from which Sangwan is thinking, context levels for this research have been specified based on interviews with Sangwan, at various levels. They are Sangwan’s personal context; LVPEI organization and leadership context; social-cultural context of clinicians in India specifically, clinician-innovation relationship, clinician-patient relationship, patient profile and burden; stem-cell work in ophthalmology around the world; stem-cell innovation policy in India and abroad. During the interviews, it appeared that Sangwan accepted modern science as the background condition of his existence, the research therefore does not invoke a history of Western science in India as a context but treats it as the existential reality in coloniality where native or “locals […] are forced to accommodate themselves to such new [imposed] realities” (Mignolo, 2000, p. 17). To this extent, this study departs from studies in CHA organizational research that investigate sedimented texts such as textbooks or letters and frequently invoke history. Table II provides details of data collection i.e., interviews, documents consulted and other sources along with the rationale for the same. Open ended interviews were conducted in Hindi, Telugu and English languages. The data on both text and context were collected as part of a larger research with the organization. Repeated interviews and observations were carried out at LVPEI during March 2015 to March 2017 through bimonthly visits. Interviews were transcribed. Transcripts, observation notes, stem-cell research papers and other documents were perused to first develop a chronology and key decisions in the discovery of SLET. See Table II for details of data collection. Sangwan’s concurrence was secured on the chronology, decision circumstances and decisions made. The text for the analysis was developed based on data from interviews, organizational documents, observation as well as published papers on SLET. Subsequently, contextual levels were also elaborated from the same data sources.
For the iterative analysis of the text, this paper followed Prasad and Mir (2002) entry point strategy. Entry point “offers a foothold, a means of shaping a theoretical focus to illuminate the phenomena under study […] is inescapably political […] born from desire to make visible […] [that which have been] hitherto invisible” (Prasad and Mir, 2002, pp. 111-112) thus, it allows me to illuminate the epistemic locus of Sangwan’s work, even though it offers only a particular interpretation of SLET. Sangwan’s articulation of his research problem was used as the entry point based on the perception that most knowledge production begins with some sense of one’s research problem. The various decisions were then analyzed by interpreting the text against context levels to identify epistemic locus, enactment and connections till closure was achieved. Broadly, the process involved:
identifying the research problem(s) and chronology of SLET’s development;
identifying various decisions, actions and connections in the development of SLET, the choices, constraints;
situating the above within the broader context of ophthalmic stem-cell research and policy in India and abroad as well as the socio-cultural-personal milieu of Sangwan;
identifying departures made by Sangwan in SLET’s development, from the conventional norms in scientific research in his field as revealed through the work of the other global actors in ophthalmic stem-cell field; and
thereby assessing the epistemic locus of Sangwan, his enactment as well the connections in SLET development.
The iterative process also involved moving back and forth in sharing analysis with Sangwan to facilitate the fusion of hermeneutic horizons of Sangwan the text’s author and myself, the researcher. The largely first person narrative approach in writing this paper, is for offering a sense of my own locus to the reader of this paper and facilitate a similar inter-subjective hermeneutic process with the reader thereby engaging in a decolonizing praxis, albeit in a limited, constrained way with the hope “that (it) overcomes the distinction between subject and object, on the one hand, and between epistemology and hermeneutics on the other” (Mignolo, 2000, p. 18) or the hierarchy of author-reader.
In the following paragraphs, SLET’s chronology is presented first. Though some contextual details are interwoven into chronology, additional details of context levels have been explained subsequently.
The text: Sangwan’s development of SLET- a chronology
Dr Sangwan, SLET’s creator was a corneal surgeon at LVPEI. LVPEI (www.lvpei.org) is a nonprofit eye care hospital based in India founded by Dr Rao a corneal surgeon for providing world class eye care irrespective of patients’ paying ability. It bothered Sangwan that even though LVPEI’s corneal transplant surgeries were free to the poor, several patients could not afford at-home post-operative immunosuppression medication, making their surgeries futile. He wanted better procedures that reduced need for medication. Cultured Limbal Epithelial Transplant (CLET) developed in USA and Europe between 1997 and 2000 partially reduced need for medication. It involved taking healthy stem-cell tissue from the patient’s good eye, growing it in the lab into a multilayered corneal tissue, and transplanting such corneal tissue into the blind eye. CLET required expensive lab infrastructure such as airlift equipment and culture inserts. In this cultivation method, most cells had lost their “stemness” having differentiated into a complete corneal tissue.
Sangwan saw CLET’s clinical value. But he lacked in stem-cell lab infrastructure and cultivation skills. He recounted, “I knew the procedure was good. I knew we could not afford it. I knew it would be a long time if we waited for west to make it affordable for us. But I did not want to give up. I thought, we have to stop waiting for the west to develop solutions for us. For how long will we wait for them to tell us what to do? And why should they do? I told Dr. Rao, at that time, I am not afraid of failing. When will we come out of ghulami (hindi word referring to slavery, subordinate status and colonial rule)? I have enough confidence to try, and if I fail, it is fine.” After discussions with Rao, Sangwan and a colleague Dr. Vemuganti “started experimenting with whatever equipment [they] had” (Vemuganti and Sangwan, 2010, p. 337) for directly growing human stem-cells. They did not begin with animal model experiments like other groups in India or abroad were doing. He recounted, “Why should we repeat? Why waste time when we know that it works? Developing something ourselves need not mean we start from scratch. This is the mistake many others make in developing something by themselves. We can use, and will use what works for us (and leave what does not) (emphasis Sangwan).”
In two years, they had hit a dead end. Their submerged culture technique could not produce multilayer tissue. Instead it produced only a monolayer. But their monolayer cells retained stemness unlike CLET’s multilayer. Stemness indicates the ability of the cell to grow and form different kinds of tissues. At that moment Sangwan pursued the institutional review board repeatedly for permission to perform a monolayer transplant even though it departed from CLET. He believed, “as stemness was retained, the monolayer should be able to generate into corneal tissue naturally in the damaged eye, since growth is a natural process and eye has all the other ingredients necessary for such healing and growth.” After several rejections, he persuaded the board on the grounds of “informed consent,” “risk assessment” and “absence of an alternative.” Sangwan’s beliefs were validated thus leading to discovery of monolayer CLET (mCLET).
Sangwan, did not stop with the 20 trials that Department of Biotechnology (DBT, 2017) grant permitted (Interviews, Annual Report, 2002). He persuaded Dr Rao using clinical data to offer mCLET at LVPEI. “Why deny a solution to patients when it exists and risks are minimal” he contended. Dr. Rao, himself an empathetic surgeon, researcher, Sangwan’s teacher and boss, agreed. Rao raised donations from Ravi brothers for a cGLP lab and other grants to support mCLET surgeries. Sangwan started training surgeons from India and abroad in mCLET. Consequently, other surgeons were performing mCLET.
By 2003, Sangwan’s group had done largest number of mCLET surgeries in the world. When questioned whether such therapy was permitted by regulation, he responded, “But I don’t call them therapy, I call all of them trials.” By 2010, they had served 700 patients. Epidemiological studies had indicated that 15–20 percent of India’s 8.9 million corneal blind could benefit. Trials were supported by multi-year DBT grants, Portugal’s Champalimaud Foundation grants and internal resources. Sangwan’s team published in national, international conferences and journals. Sangwan believed sharing findings widely enabled quicker validation, built credibility and increased access. However, publications reported far fewer cases than the actual surgeries done.
By then, Sangwan realized their research was evolving differently. Ophthalmological groups abroad pursued research in identifying markers and patented products associated with eye stem-cell therapy. Sangwan instead aligned with a Chicago based skin stem-cell researcher who shared their sensibility about clinician, research and access. They improved safety of the cultivation process using patient’s own blood. They shared their novel cultivation technique as a standard protocol in Nature in 2010. Being pioneers, senior LVPEI members also advised government on stem-cell regulation.
Sangwan’s research was growing along two lines: handling both-eye blindness; and analyzing their vast clinical data to define mCLET treatment protocols for various conditions. Sangwan’s success in translating lab research gained wider visibility and a tissue engineering group at University of Sheffield seeking collaborators for developing synthetic membranes approached him. On a Skype call Dr Sheila from Sheffield wondered about growing stem-cells inside eye or tea-bag approach. Sangwan, had responded, “I know tea-bags, but not tea-bag approach.” Sheila had explained that this was similar to laying of a lawn, small pieces of grass are placed on soil, allowed to grow in-situ into the lawn. Excited at the prospect of getting rid of lab Sangwan recounted, “lab was always a nuisance. I preferred getting rid of it. It only increased costs for me, my patients, subjected me to interference by several regulators, administrators. Possibilities of errors, infections and contamination were higher with many more involved in lab processes. Moreover many third-world surgeons like him did not have access to a lab limiting the procedure’s reach to patients. He was lucky, he had access to a lab as LVPEI strived to provide good infrastructure. Not everyone was that lucky.” As a clinician he saw how the idea addressed multiple problems. He successfully experimented the technique, leading to discovery of SLET in 2010. In SLET in a single surgery, stem-cell tissue is taken from patient’s good eye, cut into tiny pieces, placed on a scaffold inside damaged eye and safely covered. It is allowed to grow undisturbed for three weeks, at the end of which period vision is restored to the damaged eye. This technique completely bypasses lab, requiring only glass slide, petri dish and can be practiced by most corneal surgeons with some training. It dramatically reduced cost for patient, costing between Rs12,000 and 15,000 (about US$200) at LVPEI thereby improving access. When asked, why he had not thought of SLET earlier Sangwan replied, “don’t know. I think one is simply used to doing things in a way. Not really thinking. Not really questioning. It just did not occur. Come to think of it. It is simple idea. Easy. But it did not occur. Talking to Sheila, our differences in our practices, brought us into it, into questioning and made the conversation happen.”
After SLET, Sangwan and Sheila worked together on a synthetic membrane to replace human amniotic membrane being used in SLET (another bottle neck in access and safety risk). During their grant application review process for this, one of the reviewers of an international agency, had adversely commented that instead of pursuing such cutting edge stuff, being an Indian, Sangwan was better off, studying diarrhoea. Even though, they had eventually secured the grant, and had developed an off-the-shelf synthetic membrane Sangwan had found the comment annoying and colonial and protested in writing to the agency. During my interviews, Sangwan noted that inspite of SLET being practiced abroad, they had still not broken into the mecca of ophthalmology – the West. Recounting his visits to top international conferences which coincided with my data collection Sangwan shared, “it was as if -there must be something missing or not right about what we people were doing, our SLET […] after all […] how can we figure this out […] how could we [from this part of the world] do it?” (emphasis of Sangwan). He felt he was having to go through hoops to prove his case.
Undeterred, Sangwan utilized LVPEI’s training programs to spread SLET. In addition SLET user group international workshops were held at LVPEI with international figures as key note speakers. By this time, Sangwan’s group had performed world’s highest number of stem-cell surgeries. Other star surgeons like Dr Basu who internalized and developed variations of this procedure, emerged from his team. Some surgeons from abroad who learnt of SLET through conferences, workshops and clinician networks, approached Sangwan for variations of SLET. Sangwan recounted, “this man, from South America I think, came and asked me if he could do SLET differently. I was surprised, I said of course, why not. I said, Try what you think works. He was a little concerned that I would hold on to some proprietary notions of SLET and reject departures. I told him, you try and if you need my help at any stage let me know. He was so happy.” Sangwan added, “Who am I to sit and control. Methods grow, develop, die. That is how it is. If there is strength in it, it will survive. I had not foreseen some of things they are doing now.” Sangwan encouraged and where necessary helped try out variations depending upon specific needs, such as, limited scope of stem-cell lab cultivation in a country or regenerating conjunctiva.
Formal recognition in ophthalmology came only in 2016 with publications in American Journal(s) of Ophthalmology (Basu et al., 2016) and British Journal of Ophthalmology (Vazirani et al., 2016), a cross-country comparative study almost 14 years after mCLET and six years after SLET. Even though Sangwan had published in British Journal of Ophthalmology in 2011 and 2012, these did not bring recognition. In 2017, Sangwan was formally invited to teach SLET in a highly prestigious surgical training program in USA, signaling eventual acceptance of the innovation within the metropolitan center.
Sangwan, a member of jaat community and from rural north India joined LVPEI as a faculty after post-graduate training at LVPEI, He had also interned under a world-renowned Harvard faculty. Jaat community in India is popularly perceived as community known for their aggressiveness and sense of self-determination. As a surgeon, challenges attracted him, he had deep empathy for poor and believed, “My job does not end with being a corneal surgeon. I need to listen to them.” He frequently encountered poor patients blinded by chemical burns such as industrial workers (who were sole bread winners) and young girls (of marriageable age) surviving acid attacks from jilted stalkers and lovers.
Clinical and organizational context
Rao, returned from USA to India to serve masses. He founded LVPEI on a community funding and cross subsidization model to offer free service to poor. Rao explained his giving philosophy, “we become doctors by learning on bodies of poor patients who come to government hospitals. Once we become doctors we often forget about them and pursue our careers.” He regularly made a distinction between India and Bharat (the vernacular identification of the Indian subcontinent), between India’s urbane glitz and Bharat or its rural masses and their hardship, to impress upon young trainees at LVPEI, of the reality. Service to poor was operationalised by empowering clinicians to waive all clinical and other charges for poor as deemed necessary. LVPEI pursued excellence, efficiency and equity as foundational values and hardwired them into its standard operating procedures (Bagchi, 2012; website; commemorative volume). They continually pursued high quality research, publication, engaged international ophthalmic community and developed infrastructure. There were many accomplished clinicians and researchers at LVPEI, and it was a designated World Health Organisation (WHO) Collaboration Center for Vision 2020.
By 2014, LVPEI was serving upwards of 750,000 patients per annum. Clinicians like Sangwan were handling an average of 100 patients a day of whom at least 1–2 required corneal transplantations, Whereas, clinicians in Europe faced an incidence of something like three in 100,000 adults (Illic, 2015; Smith, 2018; EU, 2017). LVPEI offered widely subscribed training programs. As their training head stated, “We try to give preference to those from other developing countries because they are in a position to go back to teach many more and improve access. We also have many coming from developed countries for experience, since we deal with very high patient load and disease burden. They do not get such hands-on experience in their countries.”
In Indian cultural milieu inspite of neoliberal corporatization and profiteering in medicine and education, doctors and teachers hold an exalted status and responsibility as noble, giving roles ensuring societal well-being. Doctors are viewed as gods or “vaidyo narayano harihi” who care and rescue patients. This saying is part of everyday lexicon where LVPEI is situated and its patients come from. Special festivals and official celebrations such as Guru Purnima, Teachers’ day are celebrated for teachers or gurus. From a socio-economic angle, Indians pay 78 percent of their medical expenses from their pocket (Sinha, 2011) and one in five Indians is officially poor (World Bank, 2016) making doctors’ care and therapeutic advice decision accountable for affordability. LVPEI clinicians including Sangwan were acutely aware of this and bound by these expectations as doctors and teachers (Facebook, website and souveniers).
Ophthalmic stem-cell therapy context
American and Japanese groups were leading in eye stem-cell research. Tseng, of American group alone had 56 patents. In Europe, Pelligrini’s group was leading. Whereas Japanese used air-lift, others used mouse derived feeder cells with culture inserts for growing stem-cells in lab. Sangwan’s group did not have either. They were expensive and had to be imported. These other researchers knew that their method reduced stemness as against submerged methods. Other groups’ work also viewed human body as a source of problematic variation that “reduce[s] the reliability of the in process controls, and hamper the definition [of] […] quality criteria” (Pellegrini et al., 2014, p. 30). The norm was animal models-lab studies and clinical trials aimed at developing patentable or publishable knowledge. This research followed the standard universal approach to scientific research, IPR and investment in research. Pelligirini group invested in a central lab based model for CLET. They used standardised fetal bovine serum and central lab facility in Italy to “accomplish strict safety […] provide the manufacture process with precise, highly reproducible quality controls, product specifications, and release parameters” (Pellegrini et al., 2014, p. 30). Eventually, their Holoclar® became first commercially approved stem-cell therapy in EU in 2015. Their process required two surgeries, first for extracting stem-cells which were transported to Italian lab. In three weeks, a grown tissue sheet -Holoclar was sent back, put into the damaged eye through second surgery. Even by EU standards, this was expensive (NICE, 2017). An Indian company also followed Holoclar model running trials for Relinethra but it was a nonstarter after 25 trials.
Countries such as China, India and others agreed that that their regulation of stem-cell research had to differ from the West (Isasi et al., 2004; Walters, 2004; DBT, 2017). Culturally India and other countries were accepting of stem-cell therapy due to belief in natural healing systems (McMahon and Thorsteinsdóttir, 2013) and the governments believed that this research could address their daunting disease burden. India permitted experimentation and trials after due approval by an institutional review board within the specific organization conducting research, and registration in a national registry. cGLP labs were permitted as against cGMP lab in the West.
Sangwan’s epistemic locus, enactment and connections
Sanwan was thinking from western medical science, as a corneal surgeon not indigenous ethnomedicine. Western medicine was an accepted part of his life for him. Yet he looked at corneal surgery as an Indian (used here for want of a better word. I am acutely aware that it is a problematic word; it is not used here to indicate any essentialised Indian essence), developing country surgeon-researcher-teacher, as a doctor from Bharat and serving Bharat’s patients. Sangwan never said “Indian,” but constantly referred to “we, us or hum (in Hindi).” His epistemic locus was socio-geo-culturally native.
Even though he was born in post-independence era and India had not seen slavery of the African kind under colonial rule, his use of “ghulami” (slavery) reveals the intensity of his felt subordination as a native. He referred to his willingness to boldly confront “our inferiority” and risk failure. He disliked being a receiver sitting in the “waiting room of history” (Chakrabarty, 2009) of scientific practice. His pride and sovereign sensibility as a clinician, as an Indian, and as a jaat (he had himself identified his jaat origins). informed his impatience and actions. Rao who shared similar views helped him. Within this cultural milieu, he thought of his role as a doctor, as relating to patients’ lives and hardships providing affordable relief. As a teacher he thought of his trainees’ working conditions. From the interviews and other literature, it appeared that this was not the usual situation with doctors elsewhere in India (discussing those reasons is outside the scope of this paper). Lander (2016) found that in Canada, “clinician-scientists often struggle to integrate the science and care institutional logics in their day-to-day work” (Lander, 2016).
Sangwan’s native epistemic locus influenced enactment of SLET in multiple ways some of which are elaborated below. Table III provides more details. First, is cost and affordability being implicit in all decisions. Unlike a European clinician’s disease burden, Sangwan faced a heavy disease burden. Listening to his patients made the socio-economic side as important as the clinical side. His scientific objective was therefore growing stem-cells and developing a therapy “within the means available.”
It is true that lowering cost or affordability is often integrated into objective scientific research. It usually happens as an objective function, of holding the cost below a certain price-point. However, this was not Sangwan’s approach. Instead they explored what was possible in their circumstances. Cost was an inseparable part of his thinking, influencing cultivation method, lab standards (cGLP lab over a cGMP lab because it was less expensive), lab processes, dissemination of research, refusal to create proprietary intellectual property among others. From his Indian epistemic locus the research problem was simultaneously clinical-social-economic. Problem definition differed from eurocentric locus where social and economic was post-factum to scientific/clinical, as in Holoclar. Pollock (2014) finds that in medical pharmaceutical research, problems are often clinically framed. This was not the case for Sangwan. Access for Sangwan was not producing own IPR or deploying subsidies for production, sales and distribution or infrastructure (Pollock, 2014). Instead it was integrated into the research problem right from the initial moment, the word cost appears repeatedly in Sangwan’s writings, whereas it is literally non-existent in others’ publications (comparison of 21 papers).
Second, he was operating from a very Indian jugaad sensibility of “making do with what he had.” Jugaad appeared, not only in cultivation process but also in the bold decision to transplant a monolayer. He knew the only way he could overcome his lack was by using what he had – a monolayer. He knew as a surgeon of the Global South, recognition from metropolitan center was scarce, so he focused on training and service, to improve access. Practical impact did not follow intellectual legitimacy as is usually the tenet in western clinical-epistemic practice. Rather, practical impact and training were de-linked to significant degrees from intellectual legitimacy. Even though all research occurs in the context of scarcities, Srinivas and Sutz (2008) and Prasad (2008) suggest making a distinction between generalized conditions of scarcity in developing countries and temporary scarcities elsewhere.
Third, that Sangwan is thinking from a native locus is evident in his attitude to knowledge which again has a jugaad sensibility, as a commons meant to serve society (this is not to imply that nobody in the west thinks of commons, some people do, but the mainstream eurocentric locus on innovation does not allow this) and, his disregard for rent generating IPR and proprietary control. Even though he was acutely conscious of intellectual subordination, his’ was not a fundamentalist, ideological patriotism that rejected western knowledge. Instead he was practical using existing knowledge and skipped animal models. For him clinical trials were not for creating proprietary knowledge, they were incidental to helping the patient. Whereas, the team had done surgeries and restored vision for over a 1,000 patients, they used far lesser number of cases to publish. Even so, Sangwan’s sample sizes in publications hovered around 100 compared to 20 or less for others. SLET was not proprietary to Sangwan, he refused to control it. Sangwan’s work was guided by the desire to apply knowledge for patient well-being and democratizing knowledge. Knowledge was not an end for profit or control, but a means to patient well-being.
Commons attitude is also reflected in development of open, affordable protocols rather than proprietary products, sharing findings and training, encouragement of other surgeons to develop their own variations and his fervency in perfecting SLET, to make mCLET and lab-based control (such control was integral to Holoclar) obsolete. It is worthwhile to note that Sangwan was sharing knowledge, much before he discovered SLET or fame as India’s most cited stem-cell researcher, thereby precluding the possibility of fame as his goal. Inventing SLET was secondary to helping patients. This knowledge attitude coming from his native epistemic locus allowed him and LVPEI to offer SLET to patients at large, irrespective of its legal status as a clinical trial.
One of the most important implications of epistemic locus for knowledge production is that it influences scientific trajectories. See Table IV for more details. The scientific fact of stemness being retained in submerged culture method was known to all research groups, but American and European groups ignored this fact and operated from an epistemic locus that pursued IPR-driven economic rents, viewed human body variation (patient and doctor’s) as a problem and created proprietary lab-based science. From Sangwan’s native epistemic locus, IPR was insignificant, human body (patient and doctor) was a source of regeneration and the fact of “retained stemness” offered a potential solution to all his constraints. He therefore pursued an alternative scientific pathway that used the human body.
Interestingly, Sangwan’s native epistemic locus sets in motion an alternative pathway of claiming a place in the world. Treating clinical trials as opportunities to serve patients, gave his group an enviable, exclusive, non-tradable, and inimitable knowledge resource - clinical data and experience. This resource attracted Sheffield group to collaborate. In developing SLET, Indian epistemic location manifested in an array of actions, i.e. enactments (Mignolo, 2000) of the research group rather than theoretical or denotative statements on native worldview, making the epistemology enactive. Even after SLET’s success had been established; no denotative writings (publications) of Sangwan’s group made their enactment explicit. This paper is doing it.
SLET case also reveals the working of connections in transforming a jugaad “or local solution developed with whatever is available” into planetary knowledge. Atleast three kinds of connections and several years made SLET an inter-linked planetary innovation. Sangwan’s team was conscious of its subordinate position in the global knowledge hierarchy. One set of connections focused on practice, training surgeons from similar developing country resource contexts and sympathetic surgeons from West. These programs mobilized LVPEI’s subordinate status and assigned legitimacy (as a WHO center) and star power of western key-note speakers (not LVEPI or Sangwan); to attract wide participation thereby facilitating wider clinical diffusion of SLET (access), everyday south-south (souths in south, souths in north) connections among shared contexts, while also postponing metropolitan validation for SLET. Conference participation worked similarly, enabling them to create a critical mass of success stories from below and pull for SLET across parts of the world (Table V).
A second set of connections was with metropolitan center. They forged transdisciplinary connections working with skin researchers rather than ophthalmologists. This enabled them to draw from outside the field, protecting their early-stage research from hostile critiques in ophthalmology and strategically postpone conflict with the “mecca” which would eventually follow subversion of colonial difference, to a favorable moment. Subsequently, accumulating enough clinical evidence, they consistently, aggressively, directly challenged and engaged the metropolitan center to recognize SLET. A third set of connections involved various local actors, especially Indian regulatory authorities to create favorable policy climate. As is evident, Sangwan leveraged his subordinate position to slingshot the development of local and transdisciplinary connections of practical solidarity across souths by reflecting off the center; eventually engaging with the center for intellectual legitimacy. This strategy resulted in transforming the peripheries into new centers that shared knowledge.
Conclusion: some answers and learnings
I began this paper to make sense of the contradiction in Indian innovation and figure out the role of place of thinking or epistemic locus in Indian innovation. After reviewing SLET’s development, it appears that decolonial praxis involves the silent enactment of native epistemic locus; as well as the noisy street-smart enactment of street politics for connections that build solidarity and competencies. From the native epistemic locus, Indian in SLET’s case, the individual understands the problem differently and converts the so-called scarcities/lacks (of lab for instance) into conditions of possibility (of regeneration within the body) of alternate worlds. Native epistemic locus allows envisioning of alternate scientific trajectories and institutional systems anchored in different sets of beliefs about world and knowledge.
However, with a eurocentric epistemic locus, these conditions of possibility do not appear apparent, since they present themselves as insurmountable systematic scarcities/lacks with the innovator succumbing to the lack and staying a laggard. In coloniality, a researcher, can think from eurocentric epistemic locus merely replicating practices of the West, and view his/her situation as a situation of lacks and incapacities (Ndvolou, 2016). This is exactly what Relinethra did. In this scenario, because a country like India is short on capital, it is unable to mobilize investments for knowledge, and its educated workforce (to the extent it has technical capabilities) is able to participate in the labor market for innovation or knowledge creation within R&D labs of western MNCs, as against an investment market for knowledge creation of Indian organizations. This constitutes the contradiction in Indian innovation. It appears that claiming a place in the world is actually the process of allowing worlds to emerge and shape themselves interactively by sharing across connections; by refusing to see the world/reality as already constituted and final, and controlling and subordinating through giving knowledge.
My sensibility aligns with Sangwan’s and therefore as a decolonial praxis, I would have preferred not writing this section at all welcoming instead the reader’s own meaning making. However, consequent to my implication in hegemonic academic writing and institutional structures, inspite of my decolonial beliefs, I write the next few lines through engaging in border dwelling. However, rather than invoking authorial authority in specifying contributions to and within disciplinary boundaries, I am sharing what I have learnt in a limited act of moving out. I began researching SLET, to make sense of the positive vibes I felt when I first visited LVPEI on a private matter. Inspite of believing in decolonial praxis, I was unsure of where to begin lacking sign posts within innovation literature. Sangwan was not doing indigenous science so to speak. But persisting in my effort has enabled me to see that it is possible to be indigenous in doing science, even if one is not doing indigenous science. This implies that a conscious conversation on the epistemic locus invoked in doing science and innovation can help realize decolonizing objects of those who have been colonised. It has also reinforced my understanding of decolonialising as theory-praxis with both its silent epistemic loci and noisy enactments of connections of solidarity, and not just as a theoretical perspective of critique appropriated into the cause of Eurocentric hegemonic academic theorising. Accordingly, even as I await academic legitimacy for this writing, I have followed Sangwan’s footsteps in sharing my learning with other teachers/innovators/students.
Brief summary of literature review
|Approach||Indicative literature||Key ideas, features||Configuration of place||Configuration of knowledge|
|Innovation capabilities||D’Costa and Sridharan (2003), Wang et al. (2012), Wang et al. (2012), Kristinsson and Rao (2008), Kumaraswamy et al. (2012)||Industry focus, markets, technologies, etc., generating new intellectual property||Accepts the premises of universal scientific knowledge and standards||West as producer and western universal scientific standards, IPR and knowledge as artifact|
|Frugal innovation/jugaad||Srinivas and Sutz (2008), Radjou et al. (2012), Krishnan (2010), Gupta (2002), Sekhsaria (2013), Rai (2015), Zeschky et al. (2011, 2014)||Frugal, low resource use, making do, stimulated by scarcity, not scalable, largely working with existing knowledge, not creating new intellectual property||Not particularly concerned about where knowledge is produced. Use oriented. Jugaad seen as an Indian practice||Knowledge commons, disinterested in IPR or knowledge artifacts|
|National systems of innovation||Dutz (2007), Dutz and Dahlman (2007), Guennif and Ramani (2012), Ramani and Guennif (2014), Chaminade and Vang (2008)||Institutions, governance, incentives, late industrializing countries||Accepts the premises of universal scientific knowledge and standards,
Institutions promoting knowledge production could be different for different kinds of capitalism, stage of industrialization
|West as producer and western universal scientific standards, IPR and knowledge as artifact|
|Social innovation||Utz and Dahlman (2007), Wong and Soman (2014)||Use existing knowledge for social good, avoid cutting edge science||West as producer of scientific knowledge, rest as user for socially useful adaptations||Knowledge as artifacts, IPR. Innovation can also be business practices|
|Postcolonial approaches||Nandy (1995a, b), Shiva (1991, 2007), Prakash (1999)||Discourse approaches distinguishing between of modern science, indigenous science
Modern western scientific knowledge as an imposition on the Rest
|Place based indigenous knowledges and modern, western scientific knowledge in an oppositional, oppressive relation||Knowledges as discourse, formation of subject|
|Postcolonial technoscience||Abraham (2006), Prasad (2006, 2008)||Technology network based approaches, sociological and discursive studies of individual scientific fields/developments unhinging the fixity of place||Uneven flows across North-South among actors embedded in discourse, generally western scientific||Production of knowledge as artifacts|
Sources of data, details of context levels used in analysis
|Type of context||Source of data||Purpose|
|LVPEI: Organization and leadership||Through interviews (25 interviews of Sangwan’s colleagues, team members and Rao and other LVPEI staff, ranging from 30 min to 2.5 hours). Observation, internal reports and communication material including annual reports and souvenirs (30 documents)
Published interviews and reports (6 documents)
|To understand the relationship internal conditions of the SLET emergence and movement|
|Sangwan’s personal history||Interview (total 10 interviews, ranging from 30 min to 1.5 h per interview), observation, 5 published interviews||To understand Sangwan’s beliefs, concerns, preparations, etc.|
|Stem cell work in ophthalmology around the world||40 published research papers, interviews in LVPEI, 4 industry reports||To establish the other movements and trends in innovation and sources of influence, learning and challenges for SLET, to delineate border thinking|
|Clinician- innovation relationship||Research papers and FDA discussion papers guidelines (15 including website documents)||To understand Eurocentric approaches|
|Stem cell innovation policy environment in India and abroad||Interviews, official websites, and research papers (10 including website documents)||To understand the policy support and/or constraint for SLET|
|Patient profile and disease burden||LVPEI interviews, data at LVPEI and published reports (4 documents)||To understand the pressures on doctors at LVPEI|
|Stem cell innovation in corporate India||Research reports, published industry interviews (5 documents including websites)||To understand the context of stem cell innovation in India|
Differential knowing from different epistemic positions
|Knowledge about||Approaching stem cell eye care from a Eurocentric epistemic location||Approaching stem cell eye care from India as an epistemic location|
|Problem of research||Clinical problem||Socio-clinical problem
Helping the blind (even poor) see
|Clinical challenge||1. Regenerating corneal stem cell tissue
2. Standardising stem cell therapy processes
|1. Growing stem cell tissue
2. Reducing need for post-operative medication, poor patients can not afford to buy medicines regularly
3. Scalable- technique should be usable widely by clinicians who do not have heavy support infrastructure
|Social challenge||1. Outside the scope of the problem||1. Reduce cost of treatment
2. Should be workable even under conditions where minimal infrastructure is available
|Interpretation of the human body||1. Source of unexpected variation, which can be a problem
2. Treatment should standardize against such variation by eliminating the need to engage with these differences
|1. Body has the natural healing capacity (cultural belief)
2. Individual variation in human body makes clinical judgment important
3. Treatment should incorporate this variation by embracing it
|Role of doctor||1. An implementer of scientific knowledge that is generated
2. Bound by protocols
|1. God like status, someone who rebuilds life for the patient
2. Work with protocols to help patient
3. Affordability is important
|View of the self||Not available||Privileged than many, so more effort, risk and initiative has to be taken|
|Views on infrastructure||1. Create the infrastructure,
2. get investors to invest
|1. Attempt with the equipment we have
2.Things will come along the way
|Trials view||Clinical data||Help patient
|View on lab||Lab source of control, recovering profit||Hindrance to access, a nuisance|
|Knowledge view||Knowledge is property||Knowledge should help|
Different arriving at the solution/innovation based on epistemic location
|SLET||Comparator mainstream eurocentric approaches|
|Starting point||Not repeating animal models, use existing knowledge, stem cell cultivation directly||Animal studies also, enables generating appropriate data or making stronger ownership claims|
|Cultivation technique||Suspension culture cultivation||Airlift and other techniques of cultivation|
|Stem cell status (Privileging stem cell survival over multilayer)||Monolayer tissue, more surviving stem cells
|Multilayer tissue, few surviving stem cells
|Growth medium||1. Low cost suspension culture medium standardised, widely shared
2. Reduce individual risk by using patient’s own material for medium, incorporate individual variation
|1. Proprietary media/reagents, etc., opportunity for rent
2. Reduce risk by standardising against individual variation
|Knowledge dissemination||Training and publishing widely to enhance access and build credibility||Publishing widely for establishing authorship and ownership claims|
|Capital||Get philanthropic funds to help patients with surgery
Limited rent claims
|Get research grants and/or investments to fund research|
Limited property/ownership claims
Involve sharing of property and rent claims
|Solution structure||1.Relinquishing the dependence on a central control, wider access
2. Adaptation to local knowledges, conditions and contexts
|1.Retaining and strengthening central control, opportunity for rents
2. Not amenable to local knowledges conditions and contexts. (with reference to Holoclar)
Connectedness with different locals and metropolitan center and the emergence of SLET as a planetary innovation
|LVPEI efforts/action||Connection made and used||Implication for planetary knowledge project|
|Growing eye stem cells||Skin stem cell researcher at University of Chicago (going outside eye researchers’ network)||Ignores the metropolitan center on eye research as source of knowledge, seeks a new local in another field inside geographic West|
|Financing initial cGLP lab, surgery costs||Ravi Brothers
Welcomme trust, Champalimaud Foundation (philanthropic funding, outside either corporate investment or public research grants)
|Ignores metropolitan funding logic, creates a new local connection and alternative logic of funding research, even though they are expats|
|Early publishing||Connecting with eye clinician and research community||Creating diverse local connections and disseminating to metropolitan center to gauge acceptance|
|Training and workshops||Connecting with many clinicians worldwide, Dissemination
Generating critical mass and quick clinical data
|Creating diverse local connections, especially with the non-West and sympathetic ones in the West
Shifting locus of power by creating voluminous clinical data as a new resource
|Preference for those from developing countries in training||Building alliances with those in similar resource constrained conditions by enabling and empowering them to operate||Strengthening the local-local connection, bypassing the metropolitan center|
|Artificial membrane work||University of Sheffield tissue engineering group
Accessing new knowledge, Remove need for lab and human amniotic membrane
|Accessing another unrelated local within geographic West, building alliances outside of the metropolitan eye stemcell discourse|
|Adaptations of technique||For conjunctiva with an American group
For conditions by groups in Mexico and elsewhere
|Enabling the other locals to emerge into new originators on their own thereby creating many nodes rather than one center and several peripheries|
|Later publishing||Premier journals of Ophthalmology to establish the credibility of the knowledge created and trigger mass uptake||Engaging with the metropolitan center of eye discourse directly with an alternative knowledge staking equal status claims as knowledge producers|
|Later cGMP lab||TejKohli Philanthropic funding to support larger research and clinical agenda||Mainstreaming philanthropic funding as an alternate model for knowledge production in the periphery
Creating infrastructure equivalent to the metropolitan even in this local from a better bargaining position
|Policy participation||Participation in government committees of Biotechnology and stem cell research and treatment guidelines||Aligning with different locals within the country and also abroad in developing policy regime favorable for Third world and Indian contexts|
Please see Pollock (2014) for a detailed discussion on the importance of place and geography in the production of pharmaceutical knowledge. Data on patents from WIPO (2014) or on publications (Gingras and Mosbah-Natanson, 2010) more broadly supports the arguments Pollock makes about place of knowledge production.
Jugaad and frugal engineering have been used interchangeably here.
The word planetary has been used frequently by decolonial scholars rather than global. Whereas global is a Eurocentric concept of a particular notion of the world as seen by the West, planetary is a decolonial concept and pertains to the planet and different lives and living around the world.
Decolonial scholars such as Alex Faria, have argued that assigned disciplinary places are ways of containing difference and managing resistance in the geopolitics of knowledge. Therefore, this paper looks at innovation studies broadly and does not restrict itself or focus only on de or postcolonial technoscience, which is the disciplinary space assigned to it by convention.
I recognize that there are differences between postcolonial and decolonial approaches. This paper sees them as related because of their common decolonizing object.
One of the reviewer’s comments has suggested that I clarify my position about postcolonial revenge. Gandhi (1998) denying postcolonial revenge (p. x) says her work does not “[…] seek […] to marginalize the West […] excluded […] to cryptic exchanges between, for instance, Africa and India”. Clearly this paper being in an imperial language in a Western journal eliminates the possibility of postcolonial revenge or exclusion. However, I think that for a pluriversal world to emerge under conditions of coloniality/decoloniality, exchanges with and in both West and Rest are needed. West need not be an obligatory passage point for exchanges between the Rest if we desire a pluriversal world where all parts of the world are both centers and peripheries. Decolonially speaking, such direct exchanges need not amount to revenge.
Even though varieties of capitalism is invoked West remains the standard.
A detailed overview of decolonial approaches and related postcolonial approaches is outside the scope of this paper. Readers may usefully refer to for postcolonial approaches to organizational analysis and to the vast writings of Walter Mignolo, Enrique Dussel, Maria Lugones, Achille Mbembe and others for decolonial concepts and the writings of Anshuman Prasad Alex Faria, Ibarra-colado, Nimruji Jammulamadaka and others for decolonial approaches to management and organization studies.
I felt clarifying this was needed after reading reviewer comments and surmising about the role of our own epistemic loci as scholars. Much academic reading is built on a hierarchical relationship between the author and the reader with author specifying everything. Consequently, the reader is seen as a consumer of knowledge instead of a co-producer of meaning. My attempt at writing differently is to disrupt this hierarchy.
It has been a convention within some post and decolonial writing to use Global South rather than Third world or developing countries. This paper uses all three terms. Developing country(s) and third world have been used by Sangwan and his colleagues in interviews and in publications. Therefore the paper retains those words.
This is not a stereotype that I am invoking. This is a self-identification of Sangwan and reiterates popular perceptions in India about jaats.
The word god here does not refer to masculine or male god, it is a reference that transcends any gender characteristic. Within the part of India where LVPEI operates, this phrase even though originally from Sanskrit language has been incorporated into the vernacular Telugu. Further, it is also important to recognize that “religion as faith” (Nandy, 1988, 1995a, b) has fluid boundaries in India and everyday practice is highly plural. For instance, anthropological studies show how Muslims in India have internalized diverse notions of dharma, ritual practices or even caste system (Heitmeyer, 2009; Pool, 2016) that have otherwise been identified with Hinduism. Thus the perception of doctor’s exalted status is more general.
The word Bharat invoked here is to refer to the distinction made in LVPEI between India’s relatively rich urban and Bharat’s relatively poor, rural population. It is not invoking the more recent ideologically loaded connotations of Hindutva.
The reference to jaat is not to be construed as a racist or stereotyping. This is part of Sangwan’s self identity and these specific lines of the paper have even been approved by him.
Abraham, I. (2006), “The contradictory spaces of postcolonial techno-science”, Economic and Political Weekly, Vol. January, pp. 210-217.
Andjelkovic, M. (2006), “Intellectual property rights and access to knowledge models: managing innovation, public goods and private interest”, BSIS Journal of International Studies, Vol. 3 No. 1, pp. 1-15.
Annamalai, E. (2004), “Medium of power: the question of English in education in India”, in Tollefson, J.W. and Tsui, A. (Eds), Medium of Instruction Policies–Which Agenda? Whose Agenda, Lawrence Erlbaum, Mahwah, NJ, pp. 177-194.
Bagchi (2012), “The power of vision: Dr Gullapalli N Rao”, available at: http://blog.valueadded.in/tag/lvpei/ (accessed November 17, 2017).
Baghidoost, B. (2018), “Can non-Europeans think?”, Postcolonial Studies, Vol. 21 No. 2, pp. 267-270.
Bakshi, I. (2015), “India ranks 81 among 141 countries on the global innovation index”, available at: www.business-standard.com/article/economy-policy/india-ranks-81-among-141-countries-on-the-global-innovation-index-115091800041_1.html (accessed June 1, 2017).
Basu, A. (1974), The Growth of Education and Political Development in India, 1898-1920, Oxford University Press, New Delhi.
Basu, S., Sureka, S.P., Shanbhag, S.S., Kethiri, A.R., Singh, V. and Sangwan, V.S. (2016), “Simple limbal epithelial transplantation: long-term clinical outcomes in 125 cases of unilateral chronic ocular surface burns”, American Journal of Ophthalmology, Vol. 123 No. 5, pp. 1000-1010.
Bhambra, G. (2014), Connected Sociologies, Bloomsbury Publishing, London.
Birtchnell, T. (2011), “Jugaad as systemic risk and disruptive innovation in India”, Contemporary South Asia, Vol. 19 No. 4, pp. 357-372.
Capgemini (2016), “The spread of innovation around the world: How Asia now rivals silicon valley as new home to global innovation centers”, available at: www.enterpriseitworld.com/index.php/india-ranked-leading-innovation-destination-in-asia/ (accessed June 1, 2017).
Chakrabarty, D. (2009), Provincializing Europe: Postcolonial Thought and Historical Difference-New Edition, Princeton University Press, Princeton.
Chakraborty, K., Saha, B. and Jammulamadaka, N. (2017), “Where silence speaks-insights from Third World NGOs”, Critical Perspectives on International Business, Vol. 13 No. 1, pp. 38-53.
Chaminade, C. and Vang, J. (2008), “Globalisation of knowledge production and regional innovation policy: supporting specialized hubs in the Bangalore software industry”, Research Policy, Vol. 37 No. 10, pp. 1684-1696.
Connell, R. (2015), “Social science on a world scale: connecting the pages”, Sociologies in Dialogue, Vol. 1 No. 1, pp. 1-16.
D’Costa, A. and Sridharan, E. (Eds) (2003), India in the Global Software Industry: Innovation, Firm Strategies and Development, Palgrave Macmillan, New York, NY.
DBT (2017), “National guidelines for stem cell research”, available at: http://pib.nic.in/newsite/PrintRelease.aspx?relid=104095 (accessed October 10, 2017).
Dutz, M. (2007), Unleashing India’s Innovation: Toward Sustainable and Inclusive Growth, World Bank Publications, New York, NY.
Dutz, M.A. and Dahlman, C. (2007), “The Indian context and enabling environment: unleashing India’s innovation”, in Dutz, M. (Ed.), Unleashing India’s Innovation: Toward Sustainable and Inclusive Growth, World Bank Publications, New York, NY, pp. 23-48.
EU (2017), “Healthcare activities statistics”, available at: https://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_activities_statistics_-_consultations#Consultations_of_doctors (accessed September 10, 2018).
Faria, A. (2013), “Border thinking in action: should critical management studies get anything done?”, in Malin, V., Murphy, J. and Siltaoja, M. (Eds), Getting Things Done, Emerald Group Publishing, Bingley, pp. 277-300.
Gandhi, L. (1998), Postcolonial Theory: A Critical Introduction, Columbia University Press, Crows Nest, New South Wales.
Gingras, Y. and Mosbah-Natanson, S. (2010), “World social science report: knowledge divides”, International Social Science Council, UNESCO, New York, NY.
Gopinath, C. and Prasad, A. (2012), “Towards a critical framework for understanding MNE operations: revisiting Coca-Cola’s exit from India”, Organization, Vol. 20 No. 2, pp. 212-232.
Grosfoguel, R. (2007), “The epistemic decolonial turn”, Cultural Studies, Vol. 21 Nos 2/3, pp. 211-223.
Guennif, S. and Ramani, S.V. (2012), “Explaining divergence in catching-up in pharma between India and Brazil using the NSI framework”, Research Policy, Vol. 41 No. 2, pp. 430-441.
Gupta, A. (2002), “Transforming Indian mind: from a victim to a victor’s perspective”, available at: www.nif.org.in/dwn_files/Y%20transforming%20Indian%20mind.doc (accessed July 25, 2018).
Heitmeyer, C.M. (2009), “Identity and difference in a Muslim community in central Gujarat, India following the 2002 communal violence”, doctoral dissertation, London School of Economics and Political Science, London.
Ibarra-Colado, E. (2006), “Organization studies and epistemic coloniality in Latin America: thinking otherness from the margins”, Organization, Vol. 13 No. 4, pp. 463-488.
Illic, A. (2015), “Europe’s first marketing approval for stem-cell product granted. Bio news”, available at: www.bionews.org.uk/page_501176.asp (accessed June 1, 2017).
Isasi, R., Knoppers, B.M., Singer, P.A. and Daar, A.S. (2004), “Legal and ethical approaches to stem-cell and cloning research: a comparative analysis of policies in Latin America, Asia, and Africa”, Journal of Law, Medicine & Ethics, Vol. 32 No. 4, pp. 626-640.
Jammulamadaka, N. and Saha, B. (2018), “Theorising the state (or its absence?) in anti-corporate protest: insights from post-colonial India”, in Murphy, J. and Jammulamadaka, N. (Eds), Governance, Resistance and the Post-colonial State: Management and State Building, Routledge, Oxon, pp. 200-231.
John, S. and Phadnis, S. (2017), “For MNCs, India still an R&D hub and it’s growing”, available at: http://timesofindia.indiatimes.com/city/bengaluru/for-mncs-india-still-an-rd-hub-and-its-growing/articleshow/57421665.cms (accessed June 1, 2017).
Kaur, R. (2016), “The innovative Indian: common man and the politics of jugaad culture”, Contemporary South Asia, Vol. 24 No. 3, pp. 313-327.
Krishnan, R.T. (2010), From Jugaad to Systematic Innovation: The Challenge for India, The Utpreraka Foundation, Bangalore.
Kristinsson, K. and Rao, R. (2008), “Interactive learning or technology transfer as a way to catch-up? Analysing the wind energy industry in Denmark and India”, Industry and Innovation, Vol. 15 No. 3, pp. 297-320.
Kumaraswamy, A., Mudambi, R., Saranga, H. and Tripathy, A. (2012), “Catch-up strategies in the Indian auto components industry: domestic firms’ responses to market liberalization”, Journal of International Business Studies, Vol. 43 No. 4, pp. 368-395.
Lander, B. (2016), “Boundary-spanning in academic healthcare organisations”, Research Policy, Vol. 45 No. 8, pp. 1524-1533.
McLaren, P.G. and Mills, J.H. (2010), “Appropriation, manipulation, and silence: a critical hermeneutic analysis of the management textbook as a tool of the corporate discourse”, Management & Organizational History, Vol. 5 Nos 3-4, pp. 408-427.
McMahon, D. and Thorsteinsdóttir, H. (2013), “Pursuing endogenous high-tech innovation in developing countries: a look at regenerative medicine innovation in Brazil, China and India”, Research Policy, Vol. 42 No. 4, pp. 965-974.
Mignolo, W. (2000), Local Histories/Global Designs: Coloniality, Subaltern Knowledges, and Border Thinking, Princeton University Press, Princeton.
Mignolo, W. and Walsh, C.E. (2018), On Decoloniality: Concepts, Analytics, Praxis, Duke University Press, Durham.
Mignolo, W.D. (1995), “Afterword: human understanding and (Latin) American interests – the politics and sensibilities of geocultural locations”, Poetics Today, Vol. 16 No. 1, pp. 171-214.
Miles, M.B. and Huberman, A.M. (1994), Qualitative Data Analysis: An Expanded Sourcebook, Sage, Thousand Oaks, CA.
Mir, R. and Mir, A. (2009), “From the colony to the corporation studying knowledge transfer across international boundaries”, Group & Organisation Management, Vol. 34 No. 1, pp. 90-113.
Nandy, A. (1988), “The politics of secularism and the recovery of religious tolerance”, Alternatives, Vol. 13 No. 2, pp. 177-194.
Nandy, A. (1995a), Alternative Sciences: Creativity and Authenticity in Two Indian Scientists, Vol. 4, Oxford University Press, New Delhi.
Nandy, A. (1995b), “An anti-secularist manifesto”, India International Centre Quarterly, Vol. 22 No. 1, pp. 35-64.
Ndvolou, A. (2016), “Being African and innovative”, in Muchie, M., Gumede, V., Oloruntoba, S. and Check, N.A. (Eds), Regenerating Africa: Bringing African Solutions to African Problems, Africa Institute of South Africa, Pretoria, pp. 152-166.
NICE (2017), “Holoclar for treating limbal stem cell deficiency after eye burns”, available at: www.nice.org.uk/guidance/ta467/resources/holoclar-for-treating-limbal-stem-cell-deficiency-after-eye-burns-pdf-82604910595525
Pellegrini, G., Rama, P., Rocco, A., Panaras, A. and Luca, M. (2014), “Concise review: hurdles in a successful example of limbal stem cell-based regenerative medicine”, Stem Cells, Vol. 32 No. 1, pp. 26-34.
Pollock, A. (2014), “Places of pharmaceutical knowledge-making: global health, postcolonial science, and hope in South African drug discovery”, Social Studies of Science, Vol. 44 No. 6, pp. 848-873.
Pool, F.W.W. (2016), “The ethical life of Muslims in secular India: Islamic reformism in West Bengal”, doctoral dissertation, The London School of Economics and Political Science (LSE), London.
Prakash, G. (1999), Another Reason: Science and the Imagination of Modern India, Princeton University Press, Princeton.
Prasad, A. (2002), “The contest over meaning: hermeneutics as an interpretive methodology for understanding texts”, Organisational Research Methods, Vol. 5 No. 1, pp. 12-33.
Prasad, A. (2006), “Beyond modern vs alternative science debate: analysis of magnetic resonance imaging research”, Economic and Political Weekly, Vol. January, pp. 219-227.
Prasad, A. (2008), “Science in motion: what postcolonial science studies can offer”, RECIIS: Electronic Journal of Communication, Information & Innovation in Health Rio de Janeiro, Vol. 2 No. 2, pp. 35-47.
Prasad, A. and Mir, R. (2002), “Digging deep for meaning: a critical hermeneutic analysis of CEO letters to shareholders in the oil industry”, Journal of Business Communication, Vol. 39 No. 1, pp. 92-116.
Prasad, A. and Prasad, P. (2002), “The coming of age of interpretive organisational research”, Organisational Research Methods, Vol. 5 No. 1, pp. 4-11.
Prasad, P. (2005), Crafting Qualitative Research: Working in the Postpositivist Traditions: Working in the Postpositivist Traditions, Routledge, Armonk.
PTI (2017), “India placed at 43rd among 45 nations in global innovation index”, available at: www.hindustantimes.com/india-news/india-placed-at-43rd-among-45-nations-in-global-innovation-index/story-4gtIA7cWoUnaJklPe95BfJ.html (accessed June 1, 2017).
Quijano, A. (2000), “Coloniality of power, Eurocentrism and Latin America”, Neplanta, Vol. 1 No. 3, pp. 553-580.
Radjou, N., Prabhu, J. and Ahuja, S. (2012), Jugaad Innovation: Think Frugal, be Flexible, Generate Breakthrough Growth, John Wiley & Sons, San Franscisco.
Rai, A.S. (2015), “The affect of Jugaad: frugal innovation and postcolonial practice in India’s mobile phone ecology”, Environment and Planning D: Society and Space, Vol. 33 No. 6, pp. 985-1002.
Ramani, S.V. and Guennif, S. (2014), “The secret behind India’s success in pharmaceuticals”, in Ramani, S.V. (Ed.), Innovation in India: Combining Economic Growth with Inclusive Development, Cambridge University Press, Cambridge, pp. 143-185.
Ruggunan, S. (2016), “Decolonising management studies: a love story”, in Goldman, A.G. (Ed.), Critical Management Studies in South Africa, AOSIS Publishers, Pretoria, pp. 103-138.
Sekhsaria, P. (2013), “The making of an indigenous STM: technological jugaad as a culture of innovation in India”, in Konrad, K., Van Lente, H., Coenen, C., Dijkstra, A. and Milburn, C. (Eds), Shaping Emerging Technologies: Governance, Innovation, Discourse, IOS Press, Leiden, pp. 137-152.
Shiva, V. (1991), The Violence of the Green Revolution: Third World Agriculture, Ecology and Politics, Zed Books, London.
Shiva, V. (2007), “Biodiversity, intellectual property rights, and globalization”, in Sousa Santos, B. (Ed.), Another Knowledge is Possible: Beyond Northern Epistemologies, Verso, London, pp. 272-287.
Sinha, K. (2011), “Indians pay 78% of medical expenses from their own pocket”, available at: https://timesofindia.indiatimes.com/india/Indians-pay-78-of-medical-expenses-from-their-own-pocket/articleshow/7270363.cms (accessed August 15, 2018).
Srinivas, S. and Sutz, J. (2008), “Developing countries and innovation: searching for a new analytical approach”, Technology in Society, Vol. 30 No. 2, pp. 129-140.
Smith, C. (2018), “GPs see more than 40 patients a day”, January 18, available at: www.thetimes.co.uk/article/gps-seeing-too-many-patients-put-safety-at-risk-hspw3jqlr (accessed September 1, 2018).
Utz, A. and Dahlman, C. (2007), “Promoting inclusive innovation”, in Dutz, M. (Ed.), Unleashing India’s Innovation: Toward Sustainable and Inclusive Growth, World Bank Publications, New York, NY, pp. 105-128.
Vazirani, J., Ali, M.H., Sharma, N., Gupta, N., Mittal, V., Atallah, M., Amescua, G., Chowdhury, T., Abdala-Figuerola, A., Ramirez-Miranda, A. and Navas, A. (2016), “Autologous simple limbal epithelial transplantation for unilateral limbal stem-cell deficiency: multicentre results”, British Journal of Ophthalmology, Vol. 100 No. 10, pp. 1416-1420.
Vemuganti, G.K. and Sangwan, V.S. (2010), “Interview: affordability at the cutting edge: stem cell therapy for ocular surface reconstruction”, Regenerative Medicine, Vol. 5 No. 3, pp. 337-340.
Wadhwa, V. (2008), “Industry trends in engineering offshoring”, in National Academy of Engineering (Ed.), The Offshoring of Engineering: Facts, Unknowns and Potential Implications, The National Academics Press, Washington, DC, pp. 209-212.
Walters, L. (2004), “Human embryonic stem-cell research: an intercultural perspective”, Kennedy Institute of Ethics Journal, Vol. 14 No. 1, pp. 3-38.
Wang, J., Cheng, S. and Ganapati, S. (2012), “Path dependence in regional ICT innovation: differential evolution of Zhongguancun and Bangalore”, Regional Science Policy & Practice, Vol. 4 No. 3, pp. 231-245.
Wang, Y.L., Huang, S. and Wu, Y.C.J. (2012), “Information technology innovation in India: the top 100 IT firms”, Technological Forecasting and Social Change, Vol. 79 No. 4, pp. 700-708.
Westwood, R., Jack, G., Khan, F. and Frenkel, M. (Eds) (2014), Core-Periphery Relations and Organisation Studies, Palgrave Macmillan, Basingstoke and New York.
WIPO (2014), “World intellectual property report”, World Intellectual Property Organization, Geneva.
Wong, J. and Soman, D. (2014), “Introduction: rethinking innovation”, in Soman, D., Stein, J.G. and Wong, J. (Eds), Innovating for the Global South: Towards an Inclusive Innovation Agenda, University of Toronto Press, Toronto, pp. 3-9.
World Bank (2016), “India’s poverty profile”, available at: www.worldbank.org/en/news/infographic/2016/05/27/india-s-poverty-profile (accessed August 15, 2018).
Yin, R.K. (1994), Case Study Research: Design and Methods. Applied Social Research Methods, Sage, London.
Zeschky, M., Widenmayer, B. and Gassmann, O. (2011), “Frugal innovation in emerging markets”, Research-Technology Management, Vol. 54 No. 4, pp. 38-45.
Zeschky, M.B., Winterhalter, S. and Gassmann, O. (2014), “From cost to frugal and reverse innovation: mapping the field and implications for global competitiveness”, Research-Technology Management, Vol. 57 No. 4, pp. 20-27.
Amescua, G., Atallah, M., Nikpoor, N., Galor, A. and Perez, V.L. (2014), “Modified simple limbal epithelial transplantation using cryopreserved amniotic membrane for unilateral limbal stem-cell deficiency”, American Journal of Ophthalmology, Vol. 158 No. 3, pp. 469-475.
Nair, A., Guldiken, O., Fainshmidt, S. and Pezeshkan, A. (2015), “Innovation in India: a review of past research and future directions”, Asia Pacific Journal of Management, Vol. 32 No. 4, pp. 925-958.
The author gratefully acknowledges the financial support received from IIM Calcutta for this work. The author also acknowledges the access provided by Dr Sangwan and colleagues at LVPEI. The author is also thankful to the helpful comments provided by colleagues Biswatosh Saha, Gavin Jack and Anshuman Prasad.