Gareth+Memo+5+Project+Definition

Behind this link is the text of my 2008 HSS Research Proposal, submitted and not funded Distributing Suffering & Survival: The History and Social Meaning of International Travel for Health Care. Medical Tourism, International Travel for Healthcare, Global Healthcare, Economic Development, history of medicine, science studies, medical research
 * __ Memo 5: PROJECT DEFINITION __**
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Potential book Chapter Breakdown I. Suffering and Survival: Comparative and Distributed Suffering and Survival -Introduces medical tourism through the story of a medical tourist, local patient and doctor who are directly involved in the practice. Focusing on the way they see themselves as benefiting and penalized. II. Medical Tourists: Popularization and the making of “Common Sense” -Continues the story of medical tourism by tracking the policy and media representations that the protagonists have been framed by. Focusing on the arguments that participants use to mark the practice as acceptable, and to what degree the ‘common sense’ assumptions can be similar or different from their standpoints. III. The Sanitarium and Jet-Set Noses: Class and access to care - Compares the doctor today with the historic role of doctors who receive medical travelers. Looks at the broader context and forms of medical tourism in the idioms of colonialism, transnationalism, and globalization as centrally referencing different class positions. IV. Doctor I need a miracle: Borders and Empowerment in health care choices - Examines the way the participants and two new players, a healthcare activist and a medical tourism agent, understand “choice” and the role of these particular choices in shaping the choices of others. V. Homeward Bound: Immigration and transnational healthcare - Looks at the roots of contemporary medical tourism in the return of immigrants to their ancestral home, and considers how the origins of all five introduced characters arise or differ from their ethnic and cultural traditions. VI. Helicopter Doctors: Global flows of expertise - Examines assumptions about universality and applicability of biomedical knowledge, in the examples is the transfer of the practice of joint resurfacing from India to the US, and the practice of standardization of pricing from the US to the Philippines. In this chapter we meet other healthcare providers who surround the five primary characters. VII. Healing Economies: Neoliberal reform and the end of the developing world - In this chapter we track the payments to and from the five main characters, and look at the broader economic and political scenario in which reside the characters. VIII. Epilogue - Conclusions and theoretical cap
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Medical Tourism, Tourism, Local Knowledge, International Healthcare, Global Healthcare, Privatization, Neoliberalism, -Ethnographic Interviews & Observation - Published accounts - Local Ethnographies of healthcare - comparative sociology of healthcare - qualitative data on tourism and travel - Media and Literary texts Centrally the work will be based around interviews and some ethnographic observation of key stakeholders (suggested in the preceding section and detailed in the populating the project memo) but there will be a need to expand out from this view by looking at the official regulatory discourse, business and economic construction, and the media and popular press representations. Sphere of Official Discourse: Policy and administrative documents and media statements. I take from Foucault the sense that official discourse as materialized in the documents of the policy and legislative dialogue represent a key voice. This is both materially structurally formative in terms of legal allowances as well as representative of the dominant narrative around an issue. These dominant narratives serve as vital framing devices. In Nancy Fraser’s methodology of narrative policy analysis the comparison of the dominant to counter-narratives, as well as the spaces that it forms in response, exemplify key positions in a debate. While the actual participants in medical travel/tourism may find voice here, it is primarily a distinct set of positions that focus not on the individual choice but rather the permissibility of travel/tourism and the structural affordances to it. Central to the example of Medical tourism is the multiple forms of International Certification/Accreditation and regulation that act to delimit and legitimate the practice, while the official discourse of individual nations is transferred, imitated, and reformulated in multiple contexts.
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Sphere of Business/industry: Formal business discourse may fall into this category, the publications, websites and economic outlook documents, as well as governmental data keeping about costs and values have been a vital part in not only defining the practice, but also in inciting formation of infrastructure. While the official and regulatory discourse is the most visibly structuring (or its lack may be most visible) the broader economic field in which it is constituted serves as the vital structure. As market and corporate actors interact to form industry in certain sites and conditions they serve as a de rigueur regulatory environment.

Popular Media Representations: The term and practice “Medical Tourism” arise out of popular discourse, and it is representations and communication of the practice that form a vital infrastructure of the industry. Relationship of place and knowledge eg The universality/locality of knowledge; relationship of econ system and conception of health ; Public responsibility and personal agency; shaping of normal and ideology, transparency v mediation Medical tourism and Neoliberalism:
 * __ SOCIAL/THEORETICAL QUESTIONS __**

The concept of “harmonization” (i.e. Jeffrey Sacks) is closely associated with neoliberal reform in Europe and elsewhere. It is advertised as the leveling of economic disparity through the growth of interlinked competitive “free markets” and participation in transnational institutions. The process appears to be an idealistic reading of the economic redistribution of power, but it is contrary to Harvey’s description of the retrenchment of power within elites, rather than a break down of core-periphery dynamics (away from the 1st world- 3rd world divide). If harmonization were positively effective we should see little growth increase of dominant elites, while expansion of middle classes and increased financial stability within a trading region. One might also expect as part of the neoliberal system of governmentality to see a consequent proportional withdrawal of public services. With the growth and attempted growth of an international private for-profit hospital system these patterns should be visible, but they have not been observed.

The ongoing debate over the diminution or realignment of the importance of the state in late modernity as central to culture and lifeworld has become less prominent as middle ground approaches that no longer announce the death knell of the nation-state have been put forward (i.e. Ong; Harvey…). Rather thought the form of the legalistic and political State has shifted, it appears to bear both resonant meaning for the nation and serve a central organizing function inter-nationally. Despite this literature, the mechanisms by which inter-/trans-national relations has changed has been unclear. With an examination of the local practice and formation of medical tourism in several countries, I hope to show the ongoing relationship between nation-state and neoliberal economic formation, centrally, and between conceptions of state relations by participants as formative. Both how specific material and regulatory constitutions have shaped differential formations, but also how the strong public conception of the state shapes the actual ability of neoliberal reform. For example looking not just at the regulation of medical tourism, in which the Philippines modeled on the success of India, but also how differences in their position as global labor participants and the familiarity with one as a site of contemporary technology have impacted.

Phenomenon has expanded and seems to have changed form in recent years; immediate effect on healthcare provided in involved countries; The last two years has had an explosion of legitimacy, and popular awareness in the US. Huge paychecks and growing numbers of folks involved with little oversight or investigation. I have begun reading and coding published accounts, press articles, and editorial comments about medical tourism. I have read or skimmed all those few books on medical tourism that I have been able to study, and am looking at the work of Nancy Schepner-hughes, Marsha Inhorn, Margaret Lock, and Lesley Sharp as exemplars of the study of international medical phenomena. I have initiated initial study of publications, and discourse as suggested in the description of data sets above. I have begun to look at descriptive ethnographic material on key locations, and have selected three constituative foreign sites, that are as representative as sites can be. I have written to a number of university programs in destination countries in an attempt to make local contacts and am drafting a letter of introduction to send to medical centers that would be optimal for study. I am looking for funding opportunities, and am developing a theoretical perspective on the broader situation (detailes above). I am trying to gain a background knowledge of social science theory and methods that would be useful, specifically I am reviewing: Strauss’s Grounded theory, Smith’s institutional Ethnography, and the multi-sited ethnographic method developed by Marcus and Fisher as methodological references; and the theoretical work of Foucault and Bourdieu to offer a framework to think about the details that I find. Comparative Health Studies; Medical Anthropology; STS; Globalization and Transnationalism Studies, history of medicine
 * __ WHY NOW? __**
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 * __FUNDERS?__**

For Dissertation Research: NSF Disertation improvement, Wenner Gren Dissertation Improvement, SSRC Dissertation research Improvement, Fulbright Post Graduate, and local archival grants for study (especially the AMA and various University Medical Center archives).

For Post Dissertation Research: I have only begun looking at post-docs… But, if as is likely, I do not receive Fulbright as a student, I would also be eligible for junior scholar…