Saturday, 18 August 2018

New book: 'Ungovernable Life Mandatory Medicine and Statecraft in Iraq' by Omar Dewachi


Dewachi, O. (2017) Ungovernable Life Mandatory Medicine and Statecraft in Iraq, Stanford University Press.

Link: https://www.sup.org/books/title/?id=22595

Abstract
Iraq's healthcare has been on the edge of collapse since the 1990s. Once the leading hub of scientific and medical training in the Middle East, Iraq's political and medical infrastructure has been undermined by decades of U.S.-led sanctions and invasions. Since the British Mandate, Iraqi governments had invested in cultivating Iraq's medical doctors as agents of statecraft and fostered connections to scientists abroad. In recent years, this has been reversed as thousands of Iraqi doctors have left the country in search of security and careers abroad. Ungovernable Life presents the untold story of the rise and fall of Iraqi "mandatory medicine"—and of the destruction of Iraq itself.

Trained as a doctor in Baghdad, Omar Dewachi writes a medical history of Iraq, offering readers a compelling exploration of state-making and dissolution in the Middle East. His work illustrates how imperial modes of governance, from the British Mandate to the U.S. interventions, have been contested, maintained, and unraveled through medicine and healthcare. In tracing the role of doctors as agents of state-making, he challenges common accounts of Iraq's alleged political unruliness and ungovernability, bringing forth a deeper understanding of how medicine and power shape life and how decades of war and sanctions dismember projects of state-making.

About the author
Omar Dewachi is Assistant Professor of Anthropology, Social Medicine, and Global Health and Co-Director of the Conflict Medicine Program at the American University of Beirut.

New chapter: 'Transnational Health and Long-Term Care Practices’ in the Routledge Handbook of Health Geography (2018)


Ormond, M. and Toyota, M. (2018) ‘Rethinking care through transnational health and long-term care practices’, in V. Crooks, G. Andrews and J. Pearce (eds), Routledge Handbook of Health Geography, Abingdon: Routledge, pp. 237-243. 

Abstract
Access to and quality of health and social care resources within and between countries is increasingly uneven. Market, state, civic, familial and individual responses to this unevenness produce diverse transnational care practices that, in turn, generate a variety of transnational care spaces around the world and at different scales. This chapter focuses on the ways in which these different social actors are imbricated in a range of transnational care practices and the spaces in which these practices unfold. Drawing on examples from South and Southeast Asia, it first discusses two transnational care practices produced by (perceived) medical care deficits: 1) temporary and circular movements abroad for the satisfaction of one’s specific medical needs and wants (popularly dubbed ‘medical tourism’) and 2) short-/long-term and circular migratory trajectories of skilled health workers seeking to meet the demands of and benefit from health systems abroad. Such practices have generated diverse transnational care spaces, from ‘world-class’ hospitals to dedicated airport immigration lanes to special nursing schools training nurses for ‘export’. The chapter then draws on examples from East Asia and Western Europe to describe two transnational care practices produced by (perceived) long-term care deficits: 1) migratory trajectories for the improved fulfilment of one’s long-term care needs and 2) migratory trajectories of formal and informal care-givers seeking to meet the long-term needs of societies with rapidly ageing populations. A variety of transnational care spaces have also emerged around these practices, including assisted living facilities and nursing homes for foreigners and live-in care arrangements enabling dependent seniors to age in place. In examining these practices and their resultant spaces, this chapter seeks to shed light on the existing and emergent range of scales and complex networks of care.

Monday, 2 July 2018

New podcast with Hiraeth Magazine: Hiraeth Ep. 27- Heritage From Below - Meghann Ormond

Stories about Meghann Ormond's life and work have been featured in a Hiraeth Project (http://hiraethmagazine.com) podcast episode about her personal migratory and citizenship experiences, the extraordinary transcontinental journey her mother undertook to discover her biological roots, and the research she has done for more than a decade on issues related to transnational mobility like healthcare-motivated travel (aka 'medical tourism') and migrant heritage practices. 

Check out the podcast here: https://soundcloud.com/hiraethmagazine/hiraeth-ep-27-heritage-from-below 

Description:
A year ago, Hiraeth was invited to participate in a session on “Whose Heritages Matter” during a conference at Wageningen University in the Netherlands. Meghann Ormond, Associate Professor in Cultural Geography at Wageningen, speaks about her own heritage, from her two passport countries, the U.S. and Portugal, as well as the Netherlands, where she has made her home for the past eight years, and other countries that have touched her life.

Meghann’s own identity has been shaped by both her own travels around the world and her multifaceted family history, including her mother’s search for her birth parents on two continents. Through this experience, she realised:

“We are all inheritors of extraordinarily transnational stories.”

Heritage from Below is an acknowledgement that the everyday stories and lives of ordinary people should be included as a part of history. Meghann started the Heritage from Below Educational and Research Collective (HERC) to bring together cultural heritage and history scholars, practitioners and educators to help children of all backgrounds feel that their history and culture are important and recognised as part of a larger whole.

This episode also features music by Ketsa (copyright) ketsamusic.com/ under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License without endorsement.

hiraethmagazine.com/podcast/

New special issue in Global Public Health: 'Im/Mobilities and Dis/Connectivities in Medical Globalization: How Global is Global Health?'

In December 2017, a special issue on transnational health was published in the journal Global Public Health: Im/Mobilities and Dis/Connectivities in Medical Globalization: How Global is Global Health?

Contents:

  • Im/mobilities and dis/connectivities in medical globalisation: How global is Global Health?
    • Hansjörg Dilger & Dominik Mattes
  • Made in Denmark: Scientific mobilities and the place of pedagogy in global health
    • Branwyn Poleykett
  • (Dis)connectivities in wartime: The therapeutic geographies of Iraqi healthcare–seeking in Lebanon
    • Omar Dewachi, Anthony Rizk & Neil V. Singh
  • State-of-the-art or the art of medicine? Transnational mobility and perceptions of multiple biomedicines among Nigerian physicians in the U.S.
    • Judith Schühle
  • International clinical volunteering in Tanzania: A postcolonial analysis of a Global Health business
    • Noelle Sullivan
  • Stock-outs! Improvisations and processes of infrastructuring in Uganda’s HIV/Aids and malaria programmes
    • René Umlauf & Sung-Joon Park
  • From coastal to global: The transnational flow of Ayurveda and its relevance for Indo-African linkages
    • Caroline Meier zu Biesen
  • Negotiating horizontality in medical South–South cooperation: The Cuban mission in Rio de Janeiro’s urban peripheries
    • Maria Lidola & Fabiano Tonaco Borges
  • ‘Exotic no more’: Tuberculosis, public debt and global health in Berlin
    • Janina Kehr

New book: The Private Healthcare Sector in Johor: Trends and Prospects


The Private Healthcare Sector in Johor: Trends and Prospects

By Meghann Ormond and Lim Chee Han[1]

Citation:
Ormond, M. and Lim, C.H. (2018) The private healthcare sector in Johor: Trends and prospects, Singapore: ISEAS Yusof Ishak Institute. ISBN 978-981-4818-71-1 (soft cover)/ISBN 978-981-4818-72-8 (ebook, PDF) -- Available for purchase at: https://bookshop.iseas.edu.sg/ 

Executive Summary

·         The future of the private healthcare in Johor and in the Iskandar Malaysia (IM) special economic zone in particular is intimately tied to larger property developments and trends in the region, both because private healthcare developers are increasingly the same as property developers and because IM’s future population growth relies heavily on corporate settlement in IM and the jobs that such settlement generates. Volatility in corporate investment and settlement in IM may have significant consequences for the sector’s development.
·         The Federal and Johor State Governments intend to turn IM into a world-class private healthcare destination for local residents and foreign visitors alike. A range of strategies and policies have been launched to develop IM’s medical care, aged care, and lifestyle and wellbeing sectors.
·         It is essential to track the impact of federal and regional fiscal incentives for private healthcare development and monitor actual demand for private-sector capacity in order to assess the value and utility of such incentives, especially given the potential for such incentives policies to promote the generation of excessive private-sector hospital and clinical capacity if left unchecked.
·         Private healthcare providers in the region depend mostly on local residents as their consumer base because Johor and IM are not (yet) significant medical tourism destinations. Given the current rate of expansion of existing hospitals and construction of new ones in Johor and specifically in IM, local demand must be secured via measures that increase the Johor household income base, foster interstate migration, attract higher-income talent in larger numbers to live in the region, and improve quality of life in the region.
·         To strengthen medical tourism, private players – both large and small – require greater coordination and cooperation at the regional level in promoting medical tourism and in setting up centres of excellence and medical tourist-friendly services that cater to the actual needs of international patients.


[1] Meghann Ormond is Associate Professor in Cultural Geography at Wageningen University, The Netherlands. Lim Chee Han is Senior Analyst at Penang Institute, Malaysia.


Tuesday, 6 February 2018

'History in the Making', a kitchen table conversation at the 2018 Families in Global Transition (FIGT) Annual Conference in The Hague, 10 March 2018

Conference:

2018 Families in Global Transition (FIGT) Annual Conference, The Hague, 8-10 March 2018 (http://www.figt.org/2018_Conference)

Session Title:

History in the Making

Session Time:

Saturday, 10 March 2018 from 13:45-14:30 -- http://www.figt.org/2018_Kitchen_Table_Conversations

Session Synopsis:

We all have personal stories of our lives abroad, and most of us end up at least informally documenting those stories in some way, whether in journals, blogs, letters, emails, or even on Facebook or Twitter. But did you know that academic researchers in a variety of fields have an interest in our international lives?

In this session, the Expatriate Archive Centre (EAC) presents a conversation with the EAC’s Director, a researcher, and an expat blogger working on an exciting new project. They talk about why your story is important, what researchers are looking for, different ways you can make your story available for research, and how that research can improve all our lives.Like FIGT, the Expatriate Archive Centre (EAC) began in the 1990’s as a group of women sitting around a table, talking about how their own stories and the stories of people like them needed to be shared, honoured, and brought together. Their quest to document expat life eventually grew into a whole archive dedicated to expat life stories. The EAC provides valuable primary source material to academic researchers and continues to expand its collection to encompass more diverse experiences and new types of personal documents like blogs and social media.

Session Description:

In an era where an increasing number of people from more and more diverse parts of the globe are travelling to, temporarily residing in and permanently settling in countries outside of those in which they were born, scholars from an ever-broader range of disciplines are increasingly trying to make sense of the scale of transnational mobility and its impacts on the individuals, families, communities and societies it touches both directly and indirectly. To do this, linguists, philologists, anthropologists, sociologists, geographers, psychologists and historians are interested in gaining insight into transnationally mobile peoples’ everyday habits and practices and the ways in which they themselves make sense of, negotiate and cope with their experiences of ‘in-betweenness’. While some scholars prefer to generate their own primary research data through undertaking interviews and observation themselves, many others turn to already existing material to be able to tap into the lives of people they wish to study across time and space. The EAC, therefore, offers rich opportunities to scholars seeking to examine the social, psychological, political, economic and cultural impacts of increasingly relevant and diverse temporary forms of transnational mobility – from the postings and deployments of aid workers, missionaries, soldiers and corporate executives to the stints abroad taken by international students and researchers to the refuge sought by people in political exile and so-called ‘lifestyle’ migrants.”

This panel, moderated by Sarah Bringhurst Familia, Public Relations Manager at the EAC, brings together Kristine Racina (the EAC’s director), Dr. Meghann Ormond (a researcher in transnational mobility and care), and Lucille Abendanon, (an expat blogger) to discuss why expat, TCK, and other international life stories are interesting to researchers. We aim to bridge the gap between expats and other internationals and the researchers who study them. We will discuss why recording and preserving our experiences, whether the momentous or the everyday, is important, whatever the medium used. We’ll talk about which types of documents are most useful to researchers, and why, including a discussion about the differences between primary source documents and retrospective memoirs. Finally, we will talk about some of the many different ways internationals can make their life stories available to further academic research.

Bios:

Sarah Bringhurst Familia has lived on five different continents, but she’s still not sure where (or if!) she wants to settle down. In the meantime she lives in Amsterdam and manages Public Relations for the Expatriate Archive Centre in The Hague, where current projects include @wearexpats, a Twitter RoCur, other digital archiving projects, and Saudade: An Intersection of Archives and Art.
She serves on the editorial board of HiraethMagazine.com, a digital magazine and podcast that explores migration and homecoming via the literary, visual, and performing arts. Sarah blogs about her international adventures at Casteluzzo.com: in search of a dream to call home.

Kristine Racina, originally from Latvia, is a self-described “military brat” and has experience as an adult expatriate in Yemen, the Netherlands Antilles and the Netherlands. She attended her first FIGT conference in 2014 and was one of the Ignite session presenters. She collaborated in starting an FIGT affiliate in the Netherlands in 2014. She is the Expatriate Archive Centre’s director. Kristine is an experienced consultant and manager of projects and teams in government roles in Latvia and Yemen, and a number of NGOs and local organizations in the Netherlands. She speaks multiple languages, including English, Latvian, Russian, Dutch and French. Kristine has two Master's degrees in Economics from University of Latvia and Financial Management from Centre Européen Universitaire de Nancy.

Meghann Ormond is Associate Professor in Cultural Geography at Wageningen University in the Netherlands. Meghann is a human geographer, and her research focuses on the intersections of transnational mobility, health and care. Her work offers insight into how shifting visions and practices of citizenship, responsibility and belonging impact health and social care arrangements and transform social and economic development agendas. For further information, please visit: https://www.wur.nl/en/Persons/ME-Meghann-Ormond-PhD.htm

Lucille Abendanon lives an unconventional life on the move. Over the past 15 years she has lived in six countries on three continents. Her identity is stuck, not so much between a rock and a hard place, as between Dutch canals and the African sun…and English country lanes…and Turkish minarets…and chaotic Thai streets… Lucille holds an MA in International Studies and is a published writer. As an amateur historian she explores her personal identity partially through researching her family, which has been moving around internationally for generations. She blogs about her expat life and her exploration of identity at www.expitterpattica.com.

Wednesday, 2 August 2017

Reflections on ‘medical tourism’ from the 2016 Global Healthcare Policy and Management Forum

Reflections on ‘medical tourism’ from the 2016 Global Healthcare Policy and Management Forum
  • Valorie A. CrooksEmail author,
  • Meghann Ormond and
  • Ki Nam Jin

BMC Proceedings201711(Suppl 8):6
Published: 13 July 2017

Abstract

In October 2016, the Global Healthcare Policy and Management Forum was held at Yonsei University, Seoul, South Korea. The goal of the forum was to discuss the role of the state in regulating and supporting the development of medical tourism. Forum attendees came from 10 countries. In this short report article, we identify key lessons from the forum that can inform the direction of future scholarly engagement with medical tourism. In so doing, we reference on-going scholarly debates about this global health services practice that have appeared in multiple venues, including this very journal. Key questions for future research emerging from the forum include: who should be meaningfully involved in identifying and defining categories of those travelling across borders for health services and what risks exist if certain voices are underrepresented in such a process; who does and does not ‘count’ as a medical tourist and what are the implications of such quantitative assessments; why have researchers not been able to address pressing knowledge gaps regarding the health equity impacts of medical tourism; and how do national-level polices and initiatives shape the ways in which medical tourism is unfolding in specific local centres and clinics? This short report as an important time capsule that summarises the current state of medical tourism research knowledge as articulated by the thought leaders in attendance at the forum while also pushing for research growth.

Keywords

Medical tourism Medical travel Research

Introduction

On 18–19 October 2016, the Global Healthcare Policy and Management Forum (GHPMF) was held at Yonsei University, Seoul, South Korea. The goal of the forum was to discuss the role of the state in regulating and supporting the development of medical tourism. By ‘medical tourism’ we are referring to the practice whereby patients travel across international borders in order to privately access medical care [1]. The GHPMF included participants who were established medical tourism researchers from ten countries (Canada, China, Germany, Japan, Malaysia, The Netherlands, Singapore, South Korea, the United Kingdom and the United States) representing diverse academic disciplines (e.g., geography, business/marketing, political science, public policy, health systems management, and sociology), government (e.g., medical travel booster organisations) and industry (e.g., healthcare provider, healthcare marketing and branding, healthcare and health tourism market platform and association). It built on recent conferences organised in Madrid (2016), Wageningen and Leeds (2013) and Vancouver (2010) seeking to bring scholarly, policy and industry approaches to ‘medical tourism’ in conversation with one another [23]. In this short report article, we identify key lessons from the forum that can inform the direction of future scholarly engagement with medical tourism. In so doing, we reference on-going scholarly debates about this global health services practice that have appeared in multiple venues.
GHPMF participants extensively discussed how ‘medical tourism’, a term widely popularised by the media, inadequately captures the diverse needs and experiences of people travelling outside of their countries of habitual residence to privately access medical treatment [456]. A more nuanced categorisation of the scope and scale of, and interactions between, patients travelling for treatment and the diverse array of stakeholders generating and responding to these patients’ needs and wants prior to, during and following their travels in their home, transit and destination countries is necessary. Such categorisation will enable global health researchers to transcend simple documenting of such diversity in order to begin to identify and effectively monitor basic variables that would permit, first, timely assessment of the economic and health equity impacts of travelling patients and, second, evidence-based discussion about and action regarding accountability for addressing these impacts. A key question for researchers is: who should be meaningfully involved in identifying and defining categories of those travelling across borders for health services and what risks exist if certain voices are underrepresented in such a process?
Governments around the world have been motivated to develop and promote their countries, cities and medical facilities as medical tourism destinations, seeking to tap into potential economic gains associated with the emerging sector (see, e.g., [7]). They routinely measure – and, with limited critique, both scholars and the media generally report – the number of medical travellers they receive per year as the key indicator of a medical tourism destination’s significance and its healthcare providers’ competence [8]. Yet, GHPMF attendees believe that such figures communicate very little and, because they are oftentimes arrived at through organization-specific counting processes that render them very difficult to compare, actually serve as hyperbolic obstacles to generating an objective overview of the scale of and diversity within the industry. Since, on the whole, travelling patients are thought to stay longer and spend more on average than conventional tourists [9], we argue that focus should instead be on calculating medical and non-medical spending and resource use associated with different types of medical treatment, and that this information be accessible for broader study of the industry. Researchers can work to produce new knowledge that can contribute to answering key questions such as: who does and does not ‘count’ as a medical tourist and what are the implications of such quantitative assessments?
Significant gaps in our knowledge about medical tourism exist. For example, while data is gathered in some countries on hospital revenue derived from treatment of foreign patients, scarce data is available on the indirect economic impacts of this practice (e.g., revenue for other medical and non-medical sectors, healthcare management innovation, employment generated, etc.), though its most significant economic benefits may well be for non-medical sectors [1011]. Likewise, in spite of significant concerns about the role of medical tourism in exacerbating health inequities in both Global South and Global North countries [1213], presentations at the GHPMF revealed that no research to date has evaluated or established a method with a coherent set of qualitative and quantitative measures to evaluate this exacerbation effect. Why have researchers not been able to address these pressing knowledge gaps? GHPMF attendees agree there is no singular answer. However, unlike the conventional tourism industry, there appears to be neither sufficient recognition of the utility among, nor adequate incentive for, public- and private-sector actors involved to align themselves to establish common definitions and data collection and reporting standards in order to identify economic and health equity impacts. Many GHPMF attendees agreed that this can be attributed to the fragmented nature of the medical tourism industry, characterised by a large pool of individual industry actors concerned with internal and international competition, and political sensitivities surrounding the distribution and management of finite healthcare resources.
Presentations at the GHPMF underscored how numerous governments have allocated significant funds to states, municipalities and medical service providers for the development of services and facilities to attract international patients, including offering land grants and fiscal incentives to build and renovate medical facilities, creating incentives to attract top medical expertise, importing cutting-edge medical equipment, promoting medical tourism and acquiring international accreditation for facilities. South Korea, for instance has spent more than USD 10 million per year on industry development since it identified medical tourism as an economic growth engine [14]. Yet the lack of widely-accepted definitions and their operationalisation into reliably and routinely measured variables effectively hinders bodies from measuring the return on their investments (ROI) and, in turn, from critically reviewing policy outcomes and more effectively executing or revising policy. GHPMF attendees agree this is problematic when we consider how medical tourism has been taken up by governments as an economic growth engine – with potential for generating and diversifying employment opportunities in struggling regional economies, boosting demand for locally-produced medical equipment and attracting biotechnology research and development – and been deployed in economy of scale arguments to justify the acquisition and geographic distribution of high-end medical technology that rarely would be required for use by local patients (e.g., proton-beam therapy). Examining economic efficacy thus calls political attention to the usefulness of policy facilitating medical tourism and to underlying motivations for pursuing such policy.
It is imperative that researchers more rigorously assess impacts not only at the national level but also at the supra-national level and the sub-national regional and municipal levels by asking nuanced questions such as: how do supra-national- and national-level polices and initiatives shape the ways in which medical tourism is unfolding in specific local centres and clinics? For example, certain cities and regions, like Penang in Malaysia or Seoul in South Korea, are disproportionately affected as destinations for travelling patients [1516]. Yet, no studies assessing their specific, local needs and concerns exist to date. Furthermore, simple comparison of national-level industry outcomes without considering the heavy investments made ultimately hinder our understanding of policy performance.
International agreements fostering trade liberalization, including the offshoring of medical-related services, have frequently been cited as key to advancing the globalisation of healthcare [17]. While such agreements have certainly further commoditised healthcare sectors around the world, the imaginary they conjure of a free market in a flat world has not (yet) come to be. Rather, presentations at the GHPMF underscored the continued significance of geographic and cultural-linguistic proximity in shaping transnational flows of travelling patients. Unless travelling for very specific or advanced procedures, long-haul travel is rare; people are more likely to seek care in neighbouring countries and places with which they already have established networks [1819]. A far more nuanced grasp of the needs, wants, material circumstances, origins and impacts of different travelling patients, therefore, would enable more targeted destination marketing efforts, doing away with wasteful promotion of entire countries as destinations for all types of medical treatments to largely undifferentiated imaginary pools of ‘medical tourists’. Likewise, a more nuanced grasp of where travelling patients are receiving care, the type of care, how they travel and are accommodated, and how they spend their time in destinations would enable far better destination and patient management. A useful question for researchers to explore is: what types of data can help us to articulate such nuanced perspectives and how can they be obtained and meaningfully incorporated into analyses? Meanwhile, the outcomes of such analyses can lead to more targeted development and allocation of healthcare and promotional resources and greater capacity to inform and engage local affected populations and supra-national regional bodies about the distribution and management of available healthcare resources and the benefits and challenges this poses.

Conclusion

The GHPMF was held in Korea in October 2016. Forum attendees examined cutting-edge research findings regarding many facets of medical tourism and talked extensively about key research challenges that exist in this domain of scholarship. In this short report, we have characterised the scope of these examinations and discussions, and in doing so we have articulated specific questions that researchers must tackle in order to shape the policy dialogues and inform on-going debates about the potential for medical tourism to transform destination communities’ economies while benefitting or harming local people. We thus view this short report as an important time capsule that summarises the current state of medical tourism knowledge and policy as articulated by the thought leaders in attendance at the GHPMF while also pushing for research growth. We encourage the continued production of high-quality research in this field by scholars from a wide range of disciplines, as was observed at the GHPMF, and for continued dialogue between researchers about how we can advance the state of knowledge that informs contemporary thinking about this particular global health care mobility.

Abbreviations

GHPMC: 
Global Healthcare Policy and Management Forum
 
ROI: 
Return on investment

Declarations

Acknowledgements

The authors would like to acknowledge the insights offered by fellow GHPMF participants Andrew Garman, Ruth Holliday, Tricia Johnson, Irving Stackpole, Ilan Geva and Keith Pollard in the preparation of this short report article.

Availability of data and materials

Not applicable.

Funding

VAC is funded by a Scholar Award from the Michael Smith Foundation for Health Research and holds the Canada Research Chair in Health Service Geographies. Funding for the publication of this article came from VAC’s Canada Research Chair funds.

Authors’ contributions

All authors made substantial contributions to the short report’s conception and design. MO and VAC were involved in drafting the manuscript and KNJ revised it critically for important intellectual content. All authors have read and approved the final manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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