Gareth+-+Memo+-16+-

MEMO 16 – CONTRIBUTIONS

(Small pieces stolen from my old HASS proposal)


 * Methodological**

Formative STS examinations have made extensive use of comparative and multi-sited methods (Cetina 1999; Jasanoff 2007; Traweek 1992), or attempted to integrate a careful study of language (as discussed in Lynch and Woolgar 1990; e.g. Latour and Woolgar 1986), and the examination of power and practice has been highly developed in empirical studies of local sites (Campbell 2007; Dijck 2005; Dumit 2003) or treated as a theoretical subject apart from primary empirical analysis (Pickering 1995; Turnbull 2000). While these works are exemplary, I believe that there is space for increased inclusion of theories of practice, and theories of language into detailed ethnographic empirical study in STS. This project will centrally use ethnographic interviewing and observation to examine the transnational formation of Medical Tourism, in doing so it responds to the call to expand study of the transnational phenomena (Levitt and Khagram 2007; Basch 1993; Marcus and Fischer 1999). In an effort to capture the complexity of phenomena occurring between sites without losing the richness of local variation I focus on the framework discussed by Marcus and Fischer (1986). This framework considers the potential of ethnographic methods to situate and understand local phenomena in broader contexts of power that render them. It represents the recent anthropological focus on conducting multi-sited research projects (Marcus 1995). I will be implementing the multi-sited structure and analysis maintaining the rigorous observation of the grounded theory approach (Strauss and Corbin 1990). This approach seeks to identify important vocabularies, themes, uncertainties and examples. I foresee interviews staggered between field site observations over the course of 12 months. At each stage, interviews and observations will be used to refine and verify further sites of study and potential target individuals and groups for interview. The ability of an ethnographic interview and observation to represent the experiences of participants from different standpoints will be supplemented with discursive analysis. Through the Foucauldian concept of discourse (Foucault 1969), attention is drawn to the power of social institutions that remain invisible to participants, and remain difficult to study based on the emic perspective. It is intended to serve here as a compliment to the outsiders gaze in ethnography. In discourse the social institution is embodied in individuals and found recorded in texts and conceptions that define meaning and experience. This is expanded in Dorothy Smith’s approach to institutional ethnography (2005) which offers methodological insight into power and the relation of local instances of discourse in replicating the “ruling relations” that exist outside a local situation. I link this discursive analysis to the ethnographic endeavor through the anthropological literature on Imaginaries, or notional constructions as central to culture in meaning construction (Fujimura 2003; Fortun & Fortun 2005). Throughout the research period I will be harvesting regulatory, media, and industry documentation that will contribute to the textual and discursive analysis.


 * Empirical**

It is important here to distinguish between the topic of Medical tourism, and the topic of international travel for healthcare. While limited travel for health has occurred since ancient times, the current scale of the phenomena is novel and demands study in specific ways. Centrally, though more traditional links between travel and health are ongoing, they are distinct from the dominant current form. Traditional forms of travel were based on the perception of a health value of the place itself, as in the historical travel to hay fever resorts (Mitman 2008) or the contemporary travel of those with severe Tinnitus to Salt mines (Singh 2004) where they may find relief. Contrary the traditional specificity of site, the dominant formation of Medical Tourism as an Industry today relies on a perception of universality of medical practice contrary to empirical evidence (i.e. Mol et al. 1998). In contemporary medical tourism there is a sharp divide between health and place, place stands in for economics or cultural difference outside of the main health value which is constructed in a view of medicine as place-less by participants (Grace 2007; Binkhuijsen 2006; Schult 2006). In this new form Medical Tourism has seen little substantive academic study, and of the few academic approaches to medical tourism available all are regionally focused on India (Pruthi 2006) and framed as normative accounts either to criticize neo-colonialism (Bookman and Bookman 2007); or as pro-business accounts calling for expansion (Bose 2008;). The deficit of academic study paralleled a rising public awareness in the popular media as the industry expanded and enlisted more participants and nations. This lack of study and rise in popular awareness has stimulated a recent surfeit of academic accounts focused on reproductive technologies (Georges 2008; Subramanian 2007; Inhorn 1994), organ transplantation (Sharp 2006; Hogle 2003; Lock 2001), and stem cell therapies (i.e. Song 2008) but has paid little attention to the more common forms of care including dental and mundane surgeries. While these controversial forms are drawing study, they fail to capture a picture of the industry as a whole as the procedures they focus on enlist only a small portion of the tourists/travelers, and in general do not have the same structural effect on local populations. While 1000 patients may travel to the preeminent stem cell therapy center in China (Song 2008), over 400,000 patients travel to Bumrungrad from outside the country annually (Bumrungrad Hospital Website 2008).

Centrally I hope to participate in two theoretical fields, the first is loosely the conceptualization of travel, both in terms of the idiom of transnationalism, and in the frame of the negotiation of science and medical knowledge between heterogenous locations. The second, and related topic, is theorization of the variability of health and healthcare and its social constitution in different contexts. It is my hope that in approaching these conversations, with particular theoretical senstitivity to language, power and practice as mutually co-constructed that a theoretical contribution could be made. This study will advance conceptualization of transnational phenomena (Levitt and Khagram 2007) by offering a new emphasis on political economy of health as subject and moving away from its origin in studies of migration (Basch 1993). This is offered to supplement the growing theoretical framing of transnationalism as a cultural form (Khagram 2008; Ong 1998). Investigation of new transnational forms of life serves to expand the discussion of social and theoretical shifts, as key phenomenon are no longer centered in local sites, but rather between sites. I use the framework of transnationalism to emphasize that MT is anchored in and simultaneously transcends the boundaries of one or more nation-states. This de-centering is key to ongoing methodological discussion of the scientific study of what Rabinow (2008) terms anthropology of contemporary phenomena, as well as social theories of place and space. This dislocation of phenomena from a single location has in its turn been part of a process of normalization and change in thinking about the common sense of the experience of time and space that has been observed and criticized (Lyotard 1984; Ong 1999; Harvey 1989). While transnationalism has been studied in information technology and manufacturing (Harrison 1992), little comparable work has been done on medicine. MT offers a vantage point where theories of risk (Beck 1992) and experience of time (Lyotard 1984) are embodied in individual access to medical care. While Western biomedicine has never been fully local, the shift in practices and discourse that have recently reframed surgery as part of recreational tourism represent a distinct shift from historical health travel The traditional subjects of STS have been Euro/American and a growing number of scholars call for STS to diversify. Studies of medical practice are at the forefront of this new direction in STS (Anderson 2002; Harding 2006). This project will contribute to this emerging focus, and my training in political economy and the anthropology of health and medicine will enable me to contribute to both theoretical
 * Conceptual/Theoretical**

By bringing together these theoretical and empirical studies this work can have specific benefits for those seeking healthcare via medical tourism. More broadly, it is my intention to track the effect this new industry may have on the broader healthcare context that surrounds it in constituent sites. In this light a much broader effect may be felt by showing how the shifting arrangement of healthcare services and resources that Medical tourism engenders requires shifting in broader healthcare delivery infrastructure as well. For example, if medical tourism takes off it may provide incentive for physicians to practice in the Philippines as hoped, or it may draw those physicians already staying to work on foreign patients. At the very least, approximately 1,000,000 people annually use medical tourism as part of their healthcare plan, and better scholarship would offer vital feedback for industry and national policies to serve them and others.
 * Practical**


 * Personal/Professional**

Due to the recent formation and expansions of MT, the work will also offer data and analytic insight useful for healthcare regulation. It is my expectation that researching medical tourism will allow me to increase the quality of public policy debate surrounding these practices, as well as publicly provide improved information for decision making about healthcare choices. Professionally, the work will position me to contribute to ongoing academic discussions regarding: transnational scholarship, healthcare systems, medical institutions, and to continue to improve the new methodological focus in framing multi-sited phenomena. My commitment is to advance theoretical expertise in both globalization and medical studies in STS. Tangibly this research will result in publications in major journals in the fields of STS (e.g. __Social Studies of Science, and Science, Technology & Human Values__, __Configurations__), Medical Anthropology (e.g. __Medical Anthropology Quarterly__, __Medical Anthropology__), Industry and organizational studies (e.g. __Industry and Innovation__), Development (e.g. __Perspectives on Global Development and Technology)__. It will be relevant to scholars in STS, medical anthropology, globalization, healthcare studies and political science.

WORK CITED:

Basch, Linda. 1993. //Nations Unbound: Transnational Projects, Postcolonial Predicaments, and Deterritorialized Nation-States//. 1st ed. Routledge.

Binkhuijsen, Charuda. 2006. //Medical Tourism Bangkok.// Breda: NHTV Breda University of Applied Sciences.

Bookman, Milica Z., and Karla R. Bookman. 2007. //Medical Tourism in Developing Countries//. Palgrave Macmillan.

Bose, Jayshree. 2008. //Medical Tourism: Perspectives and Specific Country Experiences: Featuring an Interview with Dr. Prathap C. Reddy//. 1st ed. Hyderabad India: Icfai University Press.

Bumrungrad Hospital Website. 2008. “Bumrungrad International Hospital | World-class Bangkok Hospital in Thailand for Medical Tourism.” http://www.bumrungrad.com/ (Accessed February 14, 2009).

Campbell, Nancy D. 2007. //Discovering Addiction: The Science and Politics of Substance Abuse Research//. University of Michigan Press.

Cetina, Karin Knorr. 1999. //Epistemic Cultures: How the Sciences Make Knowledge//. Harvard University Press.

Dijck, Jose Van, and Jose Van Dijck. 2005. //The Transparent Body: A Cultural Analysis Of Medical Imaging//. University of Washington Press.

Dumit, Joseph. 2003. //Picturing Personhood: Brain Scans and Biomedical Identity//. Princeton University Press.

Georges, Eugenia. 2008. //Bodies of Knowledge: The Medicalization of Reproduction in Greece//. Vanderbilt University Press.

Grace, Maggi. 2007. //State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India//. Oakland CA: New Harbinger Publications.

Hogle, Linda. 2003. “Twice Dead: Organ Transplants and the Reinvention of Death (review).” //Technology and Culture// 44:433-435.

Inhorn, Marcia C. 1994. //Quest for Conception: Gender, Infertility, and Egyptian Medical Traditions//. University of Pennsylvania Press.

Jasanoff, Sheila. 2007. //Designs on Nature: Science and Democracy in Europe and the United States//. Princeton University Press.

Khagram, Sanjeev. 2008. //The Transnational Studies Reader: Intersections and Innovations//. New York: Routledge.

Latour, Bruno, and Steve Woolgar. 1986. //Laboratory Life//. Princeton University Press.

Levitt, Peggy, and Sanjeev Khagram. 2007. //The Transnational Studies Reader: Interdisciplinary Intersections and Innovations//. 1st ed. Routledge.

Lock, Margaret. 2001. //Twice Dead: Organ Transplants and the Reinvention of Death//. 1st ed. University of California Press.

Lynch, Michael, and Steve Woolgar. 1990. //Representation in Scientific Practice//. 1st ed. The MIT Press.

Marcus, George E., and Michael M. J. Fischer. 1999. //Anthropology as Cultural Critique: An Experimental Moment in the Human Sciences//. 2nd ed. University Of Chicago Press.

Mitman, Gregg. 2008. //Breathing Space: How Allergies Shape Our Lives and Landscapes//. Yale University Press.

Mol, Annemarie et al. 1998. //Differences in Medicine: Unraveling Practices, Techniques, and Bodies//. Duke University Press.

Ong, Aihwa. 1998. //Flexible Citizenship: The Cultural Logics of Transnationality//. Duke University Press.

Pickering, Andrew. 1995. //The Mangle of Practice: Time, Agency, and Science//. 1st ed. University Of Chicago Press.

Pruthi, Raj. 2006. //Medical Tourism in India//. Arise Publishers & Distributors.

Schult, Jeff. 2006. //Beauty from Afar: The Medical Tourist's Guide to Affordable and Quality Cosmetic Surgery Outside the United States//. New York: Stewart Tabori & Chang.

Sharp, Lesley A. A. 2006. //Strange Harvest: Organ Transplants, Denatured Bodies, and the Transformed Self//. 1st ed. University of California Press.

Singh, Tejvir. 2004. //New Horizons in Tourism: Strange Experiences and Stranger Practices//. Cambridge MA: CABI Pub.

Song, Priscilla. 2008. “From Cyberspace to China: Biotech Pilgrims and the transnational Quest For Stem Cell Cures.” in //Unpublished Conference Paper//. San Francisco.

Subramanian, Sarmishta. 2007. “WOMBS FOR RENT. (Cover story).” //Maclean's// 120:40-47.

Traweek, Sharon. 1992. //Beamtimes and Lifetimes: The World of High Energy Physicists//. Harvard University Press.

Turnbull, David. 2000. //Masons, Tricksters and Cartographers: Comparative Studies in the Sociology of Scientific and Indigenous Knowledge//. 1st ed. Taylor & Francis.