“Only Possible in a Big City”: Patchwork Care and Coping With Major Illnesses in Urban India

Urban environments are framed as sites of either health penalties or advantages, but this binary obscures how city life structures the everyday labour of care and coping. The existing literature has yet to fully reckon with how low-income households in an urban context cope with disruptions that major and chronic illnesses bring. Drawing on in-depth interviews with low-income households and ethnographic shadowing of community health workers across neighbourhoods in Pune city, India, we examine how the urban condition shapes care and coping when households face long-term, disruptive illness. We engage with urban theory, both classical perspectives on weakened kinship and formality, and southern urban theorisations of the city as a space for improvised, generative infrastructures. Moving beyond the penalties-versus-advantages frame, this paper treats the urban as a constitutive, relational force. We identify three interlinked dynamics: negotiating fragmented kinship; the porosity of urban households; and the mobilisation of improvised care assemblages. Together, these dynamics show how participants’ understandings of the urban actively reshape kinship ties, domestic privacy, and unconventional support practices. We conceptualise these dynamics as ‘Patchwork Care’ – the everyday active labour through which households stitch together fragile networks, formal schemes, neighbourly reciprocity, and institutional resources to cope with illness. We argue for reimagining urban health not as a project of replacing or transforming fragile urban networks, but of repairing and sustaining them. We highlight the importance of place-based research and strengthening socio-spatial conditions that are attentive to limited familial support and improvised infrastructures that typify cities of the Global South.