Medical+Tourism

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What is medical tourism?
Medical tourism refers to the practice of traveling to a different place to receive treatment for a disease, ailment, or condition. People who engage in medical tourism are often seeking lower cost of care, higher quality of care, better access to care, or different care than they could receive at home. In contrast to tourism, medical tourism is undertaken out of necessity for medical care and in some instances desired aesthetic surgeries. It is similar to tourism in that it is capitalizing on the resources of other nations just as land once occupied by locals can get turned into a resort or a Starbucks placed in a historic building in an effort to attract foreigners. Local physicians can turn away from local citizens and focus on foreigners and their needs and desires.

There are a number of factors motivating medical tourism: people may travel to get care that they can't find at home, but more worrisome are those whose travel is in the service of a growing trend in organ harvesting. In the worst case, such harvesting is done forcibly without the donors consent, but other donors may allow organs to be removed because of the money they are promised in exchange for an organ. In such cases, medical tourism exploits existing global health inequalities and has, therefore, increasingly become a topic of interest to many anthropologists.

History and Anthropology
Leaving home and traveling to another place to receive medical care or to find a healing resource is hardly new in human history. Since the dawn of civilization, people have gone in search of resources for health that are not available to them at home. Healers, shrines, and pilgrimage sites [such as The Oracle at Delphi or the Shrine at Lourdes in France, to site just a few] have been avidly sought by those wishing to be healed of sickness or to be given the power of vigor and health that is often thought to be just a pilgrimage away.

Modern day medical tourism is, in many ways, the present day extension of this drive to find the resources for health and healing wherever the promise of such a resource may be found. What is new is the level of promotion and organization for fee-paying patients, the global access to health care through the ease of traveling, the variety of offerings of care, and the perceived attractiveness of coupling medical travel with being a tourist. This trend has helped to commodify international health care.

Sobo explains how anthropological research on medical tourism can be beneficial. She states that, “Carefully conducted and strategically disseminated anthropological research regarding medical travel can help immensely as policymakers struggle to come to grips with the ramifications medical travel has for health and well-being, both nationally and globally as well as at the local level, for patient and host populations alike”. Clearly, the complicated transactions that make medical tourism possible have implications for individual patients, for medical practitioners, and for host nations and their citizens. For this reason, anthropological research into this industry and into the myriad ways in which it impacts biomedicine is vital.

Critiques:
For many, having the opportunity to travel for medical care they need or want that is not available or possible where they live is seen as a benefit. However, anthropologists have unpacked many of the major issues that are raised by medical tourism. The existence of a globalized medical world extends the level of exploitation that is possible with many already vulnerable populations.

Organ trafficking, an underground economy generated by a black market serves as the source of organ parts that are made available to foreign patients. The WHO estimates that 70,000 kidneys transplanted worldwide every year come from this black market. Coercion in the form of bonuses paid to impoverished donors is typically a factor in the harvesting of kidneys, for example, but forced removal of organs happens as well. Medical tourism, no matter what its form, also represents a decrease in care for locals because many local physicians become the caretakers of foreigners who have the money to pay for special attention and care. For these reasons organ trafficking can be seen as the most horrific of the practices associated with medical tourism. Globalization has created opportunities for medical tourists, but if left unchecked, this industry will inevitably continue to exploit local populations and deprive them of access to care.

Examples & Multimedia:
Nancy Scheper-Hughes is an activist in addressing concerns of medical tourism. Scheper-Hughes illuminates issues that in particular come along with the practice of organ trafficking. She regards this practice more precisely as the “human trafficking of spare body parts”. She has been interviewed publicly and her research and work has been present in public media. She has been criticized for being too journalistic/non-academic for this. However, Scheper-Hughes, along with others in the field, argues that anthropologists are not doing their jobs if they are not working for the public and reaching broad audiences.

Lesley Sharp in her landmark examination of the commodification of the body discusses disembodiment as a consequence of organ transplants. The notion of having spare body parts that can be commodified and that can end up taking on a new life in another person is problematic, she notes. As it has been increasingly desirable for people to accept organs from people that are living rather than from deceased bodies, the question that is inevitably raised is when and under what conditions can a body part be given to another person? Must one wait until someone is brain dead in order for it to be acceptable to use his or her organs for transplant? Furthermore, does the state of being brain dead justify enough of a loss of a person to use their organs to save another life? If harvesting can be done with the donor still living, at what point is it acceptable and ethical to begin the harvest? Where do the boundaries of the body begin and end and how do these boundaries differ cross-culturally?

For example, the fact that the Japanese don’t consider the body as belonging to an individual, that society is its true owner, suggests that in that culture, at least, death need not be the point at which an organ can be given to another. Differing views of the body’s true owner will result in nations having different laws and different ways of managing life, health, death and disease. These differences are driving factors in medical tourism as wealthy patients will exploit local customs that provide them with access to care – and on occasion, to organs – that cannot be obtained in their home nation. Anthropologists, who are acutely aware of how these cultural differences can be exploited, are increasingly calling for further research into how an increasingly global society can best respond to the diverse set of needs that medical tourism is currently exploiting on a global basis.

Cosmetic Surgery Tourism:
Cosmetic surgery is yet another type of medical tourism that is often sought out. While price is certainly a motivating factor, with a face-lift in Costa Rica being a third of the price of one in the United States, and one in South Africa being cheaper still, the anonymity of having procedures carried out away from home is often embraced as well.

One of the earliest examples of cosmetic surgery medical tourism was flight attendants having enhancement procedures done in clinics in Costa Rica that were originally built to cater to local elites. Eventually this grew into a full-fledged industry within Costa Rica and other locales, such as Thailand. This industry now boasts recovery spaces that are either part of clinics or standalone facilities that cater to the tastes of Western guests. This is having detrimental effects on the number of surgeons that can participate in offering healthcare to local, less wealthy clients.

Cosmetic surgery patients are not always eager to have procedures carried out in distant places. This can be attributed to stereotypes about inferior care or facilities that are not as clean. Despite these reservations, tourists succumb to advertising campaigns by surgeons that seek to highlight the cleanliness and quality care offered at their clinics. The “exotic” or “picturesque” landscape can also serve as an additional restorative feature of the trip. Ultimately, many consumers view the ability to have enhancements done relatively cheap and without alerting friends and families to the procedures as worth the perceived risks associated with having them conducted in another country. With the reduced cost, many liken cosmetic surgery with other improvements that they cannot receive discounts on back home. Or, as one women stated, “Instead of a new deck, I got a new rack”.

Videos:
1. Bilateral hip replacement in India:

media type="youtube" key="WaRJm7EIYGs" width="420" height="315"

Uploaded on May 29, 2008 on YouTube

Video testimonial about bilateral hip replacement in India by Jerry Mead. All of Jerry's arrangements were made by medical tourism company WorldMed Assist. Jerry had surgery at Fortis Hospital in Bangalore by Dr. Sanjay Pai. (see description on youtube) He discusses his overall satisfaction with both the process of his surgery and his recovery abroad.

2. Organ harvesting in China:

"Between Life and Death"

A documentary in China about the forced removal of prisoners’ organs, particularly those imprisoned for practicing Falun Gong in state-run hospitals to be sold for profit.

Related Terms
Hierarchy of resort, medical pluralism, tourism, moral economy, globalization, organ trafficking.

Online Resources
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References:
Sharp, Lesley. 2000 The Commodification of the Body and its Parts. Annual Review of Anthropology 29:287-328

Scheper-Hughes, N. 2011 Mr Tati’s Holiday and João’s Safari - Seeing the World through Transplant Tourism. Body & Society 17 (2-3):55-92.*

Scheper-Hughes, N. 2004 Parts Unknown: Undercover ethnography of the organs-trafficking underworld. Ethnography 5; 29.

Smith-Morris Caroline and Manderson, Lenore 2010 The Baggage of Health Travelers. Medical Anthropology 29(4):331-335

Sobo, E. J. 2009 Medical Travel: What It Means, Why It Matters. Medical Anthropology 28(4):326- 335

Taylor, JS 2007 'Queen of Hearts’ trial of organ markets: “Why Scheper-Hughes's objections to markets in human organs fail." Journal of Medical Ethics. 33(4): 201-204.

Whittaker, A., L. Manderson, E. Cartwright 2010 Patients without Borders: Understanding Medical Travel. Medical Anthropology 29(4): 336-343.

Further Reading:
Kangas, B. 2010 Traveling for Medical Care in a Global World. Medical Anthropology 29(4):343- 362.

Sobo, E. J., E. Herlihy, and M. Bicker 2011 Selling Medical Travel to US Patient-Consumers: The Cultural Appeal of Website Marketing Messages. Anthropology & Medicine 18(1)

Song, P. 2010 Biotech Pilgrims and the Transnational Quest for Stem Cell Cures. Medical Anthropology 29(4):384-402.

Whittaker, A. and A. Speier 2010 “Cycling Overseas”: Care, Commodification, and Stratification in Cross-Border Reproductive Travel. Medical Anthropology 29(4):362-383.