A special issue of Medical Anthropology on "Medical Travel"

The latest Medical Anthropology is a special issue on “Medical Travel” — a topic which has received surprisingly little attention from medical anthropologists until now.  In their editorial to the issue, Carolyn Smith-Morris and Lenore Manderson write:

“As the authors of this issue of Medical Anthropology illustrate, the ability of people to find and exploit new health care markets outside national borders highlights the infrastructural, technical, and educational inequalities between nations. Ironically, doctors and nurses leave poorer countries to work in superior clinical and research settings in highly industrialized settings, even more sharply delineating global inequalities mapped onto local geographies. In addition, as illustrated briefly before, while traveling for care is not confined to certain countries and populations, still the primary flows are from developed to less developed nations. The combination of low-cost and world-class facilities is seductive, and for those unable to afford timely care at home, an obvious choice. The contrast of these facilities with their surrounds—the urban slums and squatter settlements—is a visual reminder of the distributive inequity that private sector health care offers at the expense of the public sector (Ramirez de Arellano 2007), and of its global reach. Here anthropology has both empirical and ethical tasks,” (2010).

Here are the titles and abstracts:

Carolyn Smith-Morris; Lenore Manderson, Editorial: The Baggage of Health Travelers

Andrea Whittaker; Lenore Manderson; Elizabeth Cartwright, Introduction: Patients without Borders: Understanding Medical Travel

The rapidly growing medical travel industry has implications for the health sytems of both sending and receiving countries. This article outlines the political economy of the industry and the potential opportunities and disadvantages it poses for access, equity, and the right to health. Although the trade carries economic benefits for countries receiving foreign medical patients, it comes at a cost to the provision of public health, through distortions in the health workforce and the development of two-tiered health systems. Inequalities and failures in the health systems of sending countries largely drive the need to travel for care.

Beth Kangas, Traveling for Medical Care in a Global World

The international medical travel of Yemenis provides insight on terminology and models to use for the growing global phenomenon. Terminology for medical travelers ranges from “medical tourists” to “medical exiles.” Differing models prioritize the global arena in which transnational medical travel occurs as (1) a global medical marketplace, (2) a global medical commons, (3) interlinked nation-states, and (4) national or global citizens. Medical anthropology has a specific role in uncovering the lived experiences of patients who travel to often unfamiliar destinations to pursue care believed capable of alleviating suffering.

Andrea Whittaker; Amy Speier, “Cycling Overseas”: Care, Commodification, and Stratification in Cross-Border Reproductive Travel

Cross-border reproductive travel involves the movement of patients to undertake assisted reproductive treatment through technologies, such as in vitro fertilization and associated procedures otherwise denied to them due to cost, access, or regulatory restrictions. Based on fieldwork in Thailand, the United States, and the Czech Republic, we explore the commodification of reproductive bodies within this trade and the reduction of the nurturing affective labor of reproduction to exchange value. Second, we examine the intensification and globalization of the stratification of reproduction. These inequalities are illustrated though discussion of the trade in poor women’s bodies for surrogacy and ova donation. Even reproductive body parts, ova, sperm, and embryos are stratified—marketed according to place of origin, the characteristics of their donors, and gender. 

Priscilla Song, Biotech Pilgrims and the Transnational Quest for Stem Cell Cures

Thousands of patients with incurable neurodegenerative conditions from more than 60 countries have sought fetal cell transplants in China since 2001. Drawing on 24 months of ethnographic fieldwork, I investigate these transnational encounters occurring in the realm of experimental medicine. Critiquing popular notions of “medical tourism,” I develop the alternative concept of “biotech pilgrimage” to reveal how faith intertwines with technology, travel, and the political economies of health care and medical research in a global era. Insights from pilgrimage theory enable us to question assumptions of leisure embedded in claims of tourism while also exploring new biopolitical practices that extend beyond the borders of the nation-state. I also demonstrate how materialist visions of salvation underlie medical practice and contribute to China’s rising influence as a global technological leader.

Sara L. Ackerman, Plastic Paradise: Transforming Bodies and Selves in Costa Rica’s Cosmetic Surgery Tourism Industry

Long popular as a nature tourism destination, Costa Rica has recently emerged as a haven for middle class North Americans seeking inexpensive, state-of-the-art cosmetic surgery. This paper examines “cosmetic surgery tourism” in Costa Rica as a form of medicalized leisure, situated in elite private spaces and yet inextricably linked to a beleaguered national medical program. Through historical context and ethnographic analysis of activities at medical hotels and clinics, I describe how the recovery industry operates on the embodied subjectivities of visiting patients and their local caretakers. Recovery sociality and healing landscapes facilitate patients’ transition through a period of post-surgical liminality and provide nostalgic transport to an imagined medical arcadia, while clinicians are attracted by a neoliberal promise of prosperity and autonomy. Ultimately, Costa Rica’s transformation into a paradise of medical consumption and self-optimization is contingent on a mythology that obscures growing uncertainties and inequities in the nation’s broader medical landscape.

Aren Z. Aizura, Feminine Transformations: Gender Reassignment Surgical Tourism in Thailand

Every year, hundreds of transgendered people from the United States, Europe, Asia, Canada, and Australia travel to Thailand to undergo cosmetic and gender reassignment surgeries (GRS). Many GRS clinics market themselves almost exclusively to non-Thai trans women (people assigned a male sex at birth who later identify as female). This article draws on ethnographic research with patients visiting Thailand for GRS to explore how trans women patients related their experience of medical care in Thailand to Thai cultural traditions, in particular “traditional” Thai femininity and Theravada Buddhist rituals and beliefs. Foreign patients in Thai hospital settings engage not only with medical practices but also with their perceptions of Thai cultural traditions—which inflect their feminine identifications. I draw on two patients’ accounts of creating personal rituals to mark their gender reassignment surgery, placing these accounts within the context of biomedical globalization and debates about the touristic appropriation of non-“Western” cultural practices.