17th International Medical Geography Symposium (IMGS) -2-7 July 2017, Angers, France
Special session: Deconstructing medical tourism: towards “therapeutic” circulations and itineraries?
Organizers: Heidi Kaspar – Betty Rouland
Travels for reasons of health and well-being are not a new phenomenon. Over the two last decades, however, the number of people moving and/or circulating for medical reasons has been growing exponentially around the world. At the same time that the new mobility paradigm is challenging migration studies (Urry, 2005), so called medical tourists have become much more diversified in terms of medical needs and health travel conditions (regions of provenance and destination as well as social, human and financial resources). Consequently, the terms medical tourism or medical travel refer to a heterogeneous set of mobilities that, in their extremes, have little in common. Definitions of medical tourism vary. For instance, Connell (2016) considers medical tourism “a want rather than a need” (p 533) while “mobility for healthcare usually has little to do with tourism, and is primarily regional, centred on needs rather than wants” (p 534).
At the same time, studies on medical tourism show how “poor and medically disenfranchised” persons circulate between “Southern” countries (Rouland et al., 2016; Crush and Chikanda, 2015; Roberts & Scheper-Hughes 2011). Therefore, in this session we propose to deconstruct medical tourism/travel. This can be done for example:
- · by contrasting and discussing different forms of health mobilities and identify commonalities and differences,
- · by critically engaging with the concepts of tourism and travel (but not limited to them) and dissecting aspects of tourism/travel within health care and their effect on health care,
- · by letting empirical data talk back to these concepts and
- · by analyzing who proclaims medical tourism/travel through which practices and with which effects.
In view of those complex set of mobilities, heterogeneity of health conditions and medical purposes, we suggest therapeutic circulations or itineraries (Bochaton & Kaspar, 2016; Kangas, 2002) as alternative or additional concepts:
- · Circulation and itinerary embrace the potential of repeated and non-linear movements, patients often travel to various destinations and/or travel repeatedly (e.g. to treat chronic diseases).
- · Therapeutic denominates the purpose of the journey; the primary objective is to find a cure, access a treatment or diagnostic procedure, alleviate ailments – i.e. to improve health.
Therapies can be of any medicine (traditional Chinese, Ayurveda, biomedicine etc.), religious, a need or a want, approved or not, legal or not. The aim of this session is to sketch out new conceptual routes that allow for more adequate notions and understandings of the varied forms and types of therapeutic circulations. How can we conceptualize, define, approach, measure and categorize such therapeutic circulations and itineraries? In this session, we propose to discuss the following points (but not exclusively):
- - Scales and spaces produced by therapeutic circulations and their itineraries;
- - Data, status and categorization of patients;
- - Nature and roles played by the networks;
- - Multiplicity of actors and their roles;
- - Therapeutic “landscapes”;
- - Multidimensional Impacts ;
- - Bio-perspectives (-power/technologies/economies/etc.)
- - Ethical issues ;
- - Etc.
Patients, pharmaceuticals, knowledge and herbal medicine: various therapeutic circulations from a Southeast Asia perspective - Audrey Bochaton – Université Paris-Ouest Nanterre de la Défense
In this paper, we aim to revisit the conceptualization of medical travel which is generally defined through the sole lens of patients’ movements. The notion of therapeutic circulations allows to refer to a heterogeneous set of movements of individuals, objects, knowledge and to reverse the idea that flows of medical knowledge and treatments are predominantly unidirectional from the ‘developed’ to the ‘developing’ world. Examples of therapeutic circulations coming from or going to Southeast Asia will be presented to define this notion.
Discerning Harms from Benefits: A key challenge in advancing dialogue about the health equity impacts of medical tourism - Valorie A. Crooks, Leon Hoffman, Jeremy Snyder, Ronald Labonte – Simon Fraser University
There is extensive discussion in the international medical tourism literature about the potential or realized health equity impacts of medical tourism in destination countries. While much of this literature is speculative, data demonstrating such impacts is now starting to emerge. Though not exclusively, these impacts often span five domains: domestic government involvement; public health care; private health care; investment; and health human resources. Here we will report on the findings of a multi-year study investigating the health equity impacts of medical tourism in Barbados, Guatemala, and Mexico in these five domains. Drawing on 150 interviews conducted across these countries, we will provide examples of the health equity impacts identified, situating them in context. A key finding is that impacts that are viewed as harms or losses by some are viewed as gains or benefits by others. This difference depends on one's perspective. This is, in fact, an incredibly difficult situation in that in many ways stalls progress on instilling benefits and mitigating or eliminating harms. This situation further challenges our ability to understand who holds responsibility for acting on these impacts. From an intellectual perspective, this finding holds implications for many of the ongoing debates about medical tourism in the literature.
Back and Forth between Tourism and Health (ARTES) - Philippe Duhamel & Sébastien Fleuret – Université d’Angers
In this communication, we study the place of health in local development of touristic areas considering the direct and indirect effects of tourism on the regions, populations and health systems. Will the implantation of touristic infrastructures generate improvements (better performing health systems?) or will it produce inequalities (two-tier health system)?
Re-articulations of patient-subjectivities in transnational cancer care between Uzbekistan and India - Heidi Kaspar – Universität Zürich & Kalaidos University of Applied Sciences
This paper is about therapeutic itineraries of Uzbek cancer patients turning to India for diagnostics, surgeries and chemotherapies. Cancer is not the typical condition for conventional medical tourism: treatments are lengthy, outcomes are hard to predict and chances of failure (including death) are relatively high. Nevertheless, in North India, oncology is among the most frequented medical specialties for international patients. In Uzbekistan, India has become the top destination for cancer care. Patients who are sent home to die in Uzbekistan increasingly find their way to India, where topnotch technology and experienced doctors are ready to help those patients who are able to pay for the expensive treatments escaping her/his fate. In this paper I examine how a transnational health care industry cancer transforms patients into health care consumers – and where the limits of these re-articulations reside. In order to do so, I contrast the practices of for-profit medical tourism and the case of two doctors working in resistance to the commodification of health care.
Deconstructing medical travel facilitation: How medical travel facilitators engage in and engage with practices and ethics of care in order to facilitate therapeutic circulations - Sarah Hartmann - Open University (UK)
Navigating international patients smoothly and carefully through their medical travel journeys demands a considerable amount of work from medical travel facilitators. Analysing how medical travel facilitators engage in practices of care by attuning people and places, reports and relations, channels and circulations in complex transnational networks helps to deconstruct how they enhance, facilitate, control and interrupt therapeutic circulations. Looking at how medical travel facilitators respond to individual caring needs of so-called medical tourists can furthermore illustrate how they deal with, mediate and engage in (conflicting) practices and ethics of care that result from dislocating and emplacing them in different geographical and cultural settings.
Emerging transnational space of care between Libya and Tunisia: why geo-historical and geopolitical contexts matter - Betty Rouland, Sébastien Fleuret & Mounir Jarraya – Goethe-Universität Frankfurt, Université d’Angers & Faculté des Lettres de Sfax
This paper focuses on analyzing the emergence of a transnational space of care between Libya and the Tunisian city of Sfax since the Arab revolutions in 2011. It seeks to understand the evolution of so-called “medical tourism” activity insisting on the role played by geographical and geopolitical factors. Facing a lack of data and an instable geopolitical situation, with a context of war in Libya, the methodology combines a qualitative survey amongst Libyan patients (n=205) in four private clinics in Sfax as well as semi-structured interviews conducted with multiple actors in the health sector. On the one hand, the findings show that the chaos in Libya as well as the geographic proximity to Sfax push the (para)medical staff to invest in the private health sector. On the other hand, the findings point to the growth and the diversification of patients’ profiles (networks, resources, needs of medical care, etc.). Spatial reconfigurations, such as new city planning (medical, residential, commercial) and regional circulations (patients, transports, assurances systems, etc.), are the expression of an emerging transnational space of care. The political context as well as the impoverishment of the patients leads us to reconsider the definition of “medical tourism” and to question the sustainability of the related investments in Sfax, given its dependence on Libyan patients.