Gareth-+Memo+32

Back at the beginning of the semester I did a chapter outline, I was trying to think through a title and idea for the book that I was using in the speculative biography, the scattered overview of medical tourism that it represents doesn't really appeal anymore and I have a more cohesive idea and a narrative trope.

In January:

Distributing Suffering & Survival: The History and Social Meaning of International Travel for Health Care. I. Suffering and Survival: Comparative and Distributed Suffering and Survival. II. Medical Tourists: Popularization and the making of “Common Sense” III. The Sanitarium and Jet-Set Noses: Class and access to care IV. Doctor I need a miracle: Borders and Empowerment in health care choices V. Homeward Bound: Immigration and transnational healthcare VI. Helicopter Doctors: Global flows of expertise VII. Healing Economies: Neoliberal reform and the end of the developing world VIII. Epilogue

The current version:

Or
 * Navigating Care: Medical Travel in the new Global Biomedicine**
 * Navigating Choice: Travel and the new global biomedicine.**

The structure of the chapters is to focus on distinct steps in an idealized journey of medical travel. Each focuses on a significant waypoint in which either a border is crossed or a new territory (metaphorically speaking) is entered. The initial chapter focuses on the era, the current industry formation generally, the crossing into a modern biomedical/neoliberal/global healthscape, and introduces the concept of a healthcare field that attempts to overlap the imaginary/discursive scape of Appadurai and the field of social reality of Bourdieu, it establishes the terrain of the journey documented in the book, this orienting device sets stage for chapters to follow that focus on the steps in the journey: The way patients find their way into the role of medical tourist; step into the planning process and go to digital travel agents; the process of negotiation of citizenship and national border in the process and preparation for travel; the two fold meeting as the traveler and the local at the destination come face to face, the shorter scale journey for patient within hospital and the longer travel of technique and technology into new hospitals far from the land of their birth; then the departing trip of the patient, of new medical technique, of stories, and often of the money; finally the narrative of the book carries the reader and the story back to the consequences upon return as I hope to be able to offer an insight into where it goes from there.
 * Chapter Nil - Introduction – Global Biomedicine: a new healthscape.**

Along with the broad sweep of defining the health/healthcare-scape, I would also like here to introduce several theoretical/conceptual figures that would carry through the book, Moral Biologies (Sienna 2009) and Local Biology (Locke), and biological citizenship used to describe the way groups are marked or strive to coalesce around perceived biomedical/biological difference (Heath, Rapp and Taussig 2003; Rose and Novas 2002; Petrayna 2002) and to relate this concept to Foucault’s biopolitics and  “biosociality” (Petrayna; Rabinow, Rapp. This assemblage may change or things get dropped out, but it is what is making sense to me at the moment. I would also like to keep these ideas grounded at least a little in political economy and development in forming the arrangement of healthcare between and within nations, not simply to link to macro issues but because materialism seems like it will help me ground the work in bodies that are experiencing a need for medicine, suffering and healing.

I think today (it may be different tomorrow) that the book is about how the big changes in the world, are related to, and constrain/enable the little choices that people make. How system/structure promotes the idea of choices while determining those choices readily available. Changes in the larger world making common sense about things like what counts as good medicine, what the connections are between nations, what healthcare reform will look like, and whether medical tourism is right for an individual. The book is about what counts as being healthy, as fulfilling responsibility, as searching out good medicine or quality care, and the ways that these take different paths depending on the conditions one starts from.

In each chapter there may be comparison between the two case study locations, or these may be divided up, if the contrast between the cases turn out to be particularly fruitful I’ll have to restructure around that. As it is, the first chapter introduces the comparison and marks the destinations for the trips being started in chapter 2.


 * Chapter I – Two far away lands.**

Here I introduce the comparison between India and Philippine medical tourism, briefly the history of colonial medicine there, and the strong links to large immigrant populations in the US who maintain ties. I talk about the founding of the national initiatives and the comparative failure of the Philippine one, in light of the expansion in India.


 * Chapter II- Setting Out**

This chapter looks at the discourse and artifacts used by the medical tourism industry to enroll people and to define itself; the news coverage, as well as the exposure stories of coming to be aware of the practice by patients, of coming to be a part of it by workers in the industry. It tries to see the way participants find their way into the roles of tourist, agent, or doctor in the place they do. How they start to learn to play the service worker medical professional, the healthy sick person, or the excited traveler on the way to hospital. It is the first steps into the planning process for the tourist as they get directions or go to digital travel agents;


 * Chapter III- Following the Path**

Looking at the infrastructure of traveling such as new visa requirements, the relation and competition of nations, and the process of negotiation of citizenship and national borders in the process of travel, as well as the experience of travel, and the justifications individuals adopt for travel. It looks at the growth of medical tourism destinations out of formerly national health services, and economic development plans as one side of the border, and the privatization and differential access to healthcare in departure countries as two different responses to a shared changes in the world including the widespread demise of welfare/entitlement systems and the preponderance of neoliberal governmentalities.


 * Chapter IV- Meeting Face to Face**

This chapter focuses on the moments of contact between tourist and hosts, the authenticity/performances of culture and roles, the construction and negotiation of service and care. The portrayal of medical expertise, the way doctors negotiate about patient care across oceans, patients negotiate care across cultural divides. The meeting as the traveler and the local of the destination come face to face in the hospital/clinic setting designed to be both universal to both and alien to either.


 * Chapter V- Home and Away, where the heart is**

Looking at the movement and treatment of patients within the clinical spaces of the hospitals, this chapter focuses on the movment and use of medicine within the clinic and the way choices vary as well as techniques and knowledges. This is in part where I’ll talk about the way the patient sees medicine in destination sites and the practitioners see medicine in the US, how each imagines their home and the other.


 * Chapter VI – Off the beaten path**

This will be one or two specific case studies about biomedical/sociotechnical practice. It will be framed as the long travel of technique and technology into new hospitals far from the land of their birth. One case may be the history and transit of the joint resurfacing technique in India which has been exported to the US, potentially another is the development of Stem Cell therapies in China and the Philippines spurred on by the limitations in the US. I’d like this to focus on the messiness of the system not always following predictable flow per World System Theory.


 * Chapter VII- While in Shangri La**

Part of the phenomena of medical tourism is that it brings in tourists during recovery, family members throughout the trip. What is happening around treatment time, outside of clinical settings. What happens in the basement, or the alley out back.


 * Chapter VIII- Homeward Bound**

The departing trip of the patient, of stories, and often of the money; are discussed in an attempt to finally the narrative of the book carries the reader and the story back to the consequences upon return as I hope to be able to offer an insight into where it goes from there.


 * Chapter IX- Conclusions**

Conclusions, and theoretical wrap up and final stories.


 * Chapter X- Epilogue**

For the dissertation if not the book, the final epilogue would likely be the policy suggestions, the evaluative or normative moment.