Presentation
The fellows of our health department are holding a panel on « Deep mapping transnational therapeutic mobilities » at IMISCOEs’ annual conference in Oslo.
Chairs : Betty Rouland (HEALTH, ICM) & Irene Maffi (University of Lausanne)
Abstract
This panel engages critically with the research triad ‘globalization, health and migration’ and its traditional antagonistic mapping : ‘medical tourism’ vs ‘global health, migration governance and humanitarianism’. By focusing on transnational therapeutic mobilities using deep maps (Bodenhamer, Corrigan, and Harris, 2015), the panel apprehends spatio-temporal, complex, and singular dimensions of health at the intersection of diverse disciplines in social sciences. The narratives of patients seeking care abroad uncover a sensitive cartography where healthcare representations, perceptions of well-being, networks as well as everyday experiences of the body play a crucial role over time and across spaces. Modes of healthcare consumption, delivery and governance have transformed and changed the structure of healthcare landscapes. Individuals (patients as well as healthcare professionals), medical knowledges, imaginaries, and practices circulate forging networks transnationally. It involves a multiplicity of actors including states, NGOs, the private sector but also transnational families and communities which together form what Zanini et al. (2013) have conceptualized as therapeutic opportunity structures. Studies in social sciences have often been looking at these cases in sector silo. The aim of this panel is therefore to consider examples involving diverse therapeutic circulations and actors as interconnected phenomenon. The different papers map out the variety of healthcare circulations while also discussing the micro, meso, and macro-level drivers of such practices. By facilitating the exchange of conceptual approaches and methodological perspectives this panel thus contributes to a multidisciplinary dialogue on migration, health and transnational therapeutic mobilities.
PAPER #1 Therapeutic mobility and breast cancer : documenting the experiences of African women through a multi-site research project (France-Mali) by Clémence Schantz (French National Research Institute for Sustainable Development (IRD))
ABSTRACT : In 2020, over 2 million breast cancers (2.26 million) were diagnosed worldwide. It is the most common cancer. Despite this, breast cancer is insufficiently on the global political agenda. While for a long time it was thought that cancer was almost exclusively a Northern disease, in recent years there has been a very rapid increase in the incidence (number of new cases per year) of breast cancer in Africa, particularly in women under 45. In sub-Saharan Africa, cancer care services are poorly developed and the means available are very limited. In this communication, we propose to present the experiences of Malian women with breast cancer who decide to « migrate to save themselves ». Based on multi-sited research and with a sociological approach, we will show that four levels of therapeutic mobilities are relevant to study in Mali : national mobilities since care is concentrated in the capital ; mobilities within Bamako since women navigate and get lost between different hospitals ; South-South regional mobilities ; and finally South-North international mobilities. Through these narratives of women met in Mali and France, we will test the need to distinguish between national and transnational therapeutic mobilities. This paper will also allow us to discuss the sociological notions of biographical rupture and self-reconstruction in a context of migration that is added to the experience of the disease.
PAPER #2 Crossing borders : drivers of therapeutic mobilities within the hungarian “dental tourism” context by Marton Angyan (Centre Maurice Halbwachs (CMH), EHESS)
ABSTRACT : Each year, over 40 000 people from western and northern Europe travel to Hungary in search of affordable and available dental treatments, mostly seeking for implants, if not complete oral rehabilitation. Based on a qualitative research between France and Hungary, observations in Hungarian dental clinics and interviews with the multiplicity of actors intertwined in the production and consumption of this transnational health service (Hungarian dentists, employees of clinics and dental travel agencies, French patients), the communication explores the drivers and the diversity of borders crossed during these transnational therapeutic mobilities. It critically questions “medical tourism” as an operative concept for sociological analysis. First, the macro drivers are discussed, namely those of departure in the sending country (France), the legal framework of the European Union and the power geometry between nation-states in which these mobilities are embedded. Through a socio-historical perspective on the genesis and the development of Hungarian “dental tourism”, several elements of the conditions of possibility of this transnational dental industry shall be underlined, whether they are economical, legal, social, moral or corporal. A second approach is patient-based. By analysing the micro drivers and the social structures framing these mobilities, we will present a first typology of patients according to their social and medical trajectories. By this case study, we aim at discussing the multiplicity and interconnection of the drivers of medical mobilities and at stressing out how the adopted sociological approach can possibly broaden their understanding.
PAPER #3 Female genital mutilation and reconstructive surgery. Medical practices at the heart of transnational mechanisms of circulation and adaptation in Egypt by Sarah Boisson (Centre for Economic, Legal and Social Studies and Documentation (CEDEJ) in Cairo)
ABSTRACT : This presentation will focus on the circulation of a medical practice, namely clitoral reconstruction surgery for women who have undergone female genital mutilation (FGM). This technique was developed in the 1990s in France by an urologist, Pierre Foldès. Over the past twenty years, the surgery has tended to be ”imported” from European countries to some African countries. This is the case of Egypt where more than 80% of the female population is estimated to have undergone FGM – and where the practice of FGM is increasingly medicalised. Indeed, about 75% of FGMs are performed by doctors (Unicef, 2019). This implies strong divisions within the Egyptian medical sector, which takes responsibility on the one hand for carrying out FGM, and on the other hand for repairing it. The transnationalisation of this practice involves also mechanisms for adapting the procedure to the social context and sexual norms in Egypt. This importation is strongly linked to another international mobility : doctors who often train abroad before returning to Egypt to implement this technique. Egypt represents simultaneously an interesting destination for medical tourism regarding this reconstruction for neighbouring countries. Overall, this research questions how this surgery is implemented in the Egyptian context and how the practice circulates, is adapted, and finally enters into very diverse networks of meaning according to the social milieu and the national context. The data were collected during a four-month fieldwork (in 2021) conducted in Cairo and Alexandria with women, health professionals, and institutional and associative actors gravitating around this surgery.
PAPER #4 : Therapeutic trajectories of French People settled in Romania by Eva Renaudeau (Centre for research on medicine, science, health, mental health, and society, (Cermes3))
ABSTRACT : This presentation focuses on French people living in Romania with a particular interest in their therapeutic practices. Being an area of free movement, the European Union creates a context that is particularly suitable to such mobilities. However, this does not erase the disparities between the different national health systems, nor the ones between the migration conditions of different European nationals. Based on a nine-month qualitative research in Bucarest, this communication aims at examining knowledges and practices that are used and/or emerge in this context. By paying specific attention to biographical and migratory paths, I wish to document the way in which they build their own trajectories between France and Romania. Therefore, I will analyze how migration material conditions and the representation of health systems influence practices and preferences, the use of one structure rather than another, of one country rather than another. While moving from one place to another, they also learn the institutional and social norms of each place they encounter and use them to adapt their movement according to the needs they identify and the answers they are waiting for. Thus, looking at the patient’s agentivity highlights the different scale factors that play a role in the construction of these trajectories. In other words, this communication questions the way transnational anchorage, without being a strategy, is therefore used as a resource in the healthcare access process and contributes to think the articulation between health, migration, and what can be considered as privileges.
PAPER #5 Diasporic therapeutic mobilities to Tunisia : uncovering the emotional dimension in individuals’ health-seeking decisions by Carole Wenger (CEDEM, University of Liège)
ABSTRACT : Although research on therapeutic mobilities has expanded over the past decade, little attention has been paid to diasporic medical mobilities. Yet, they represent an important part of transnational therapeutic mobilities in a globalized world where these migrants-patients maintain links and participate simultaneously in the health systems in the country of residence and in the country of origin. Variations in medical protocols, legal norms, cost of treatment as well as insurance coverage surrounding medical treatments, and the positioning of public and private healthcare actors constitute structuring factors in the transnational healthcare strategies of patients belonging to a diasporic community. This paper proposes to reexamine theories on transnationalism and diaspora through the analysis of healthcare practices of Tunisians from the diaspora. By navigating creatively between the healthcare “infrastructures” at their disposal, individuals balance therapeutic opportunities « here » and « there » and reaffirm their agency in the pursuit of well-being. These therapeutic mobilities are also the result of the transnational life trajectories of these diaspora patients where frequent returns to the country of origin contribute to maintaining ties with the “homeland”. In that perspective, diasporic ties are built and maintained through healthcare consumption. Based on data collected through multi-sited ethnography in Belgium, France, and Tunisia following patients’ therapeutic journey between their place of residence and their country of origin, this paper discusses perceptions and forms of attachment to healthcare systems uncovering the emotional dimension in individuals’ health-seeking decisions.
Discussant : Meghann Ormon, Cultural Geography Chair Group, Wageningen University & Research