Panel « Deep mapping transnational therapeutic mobilities », organized by fellows of CI Migrations’ Health department at the IMISCOE conference – Thursday 30 June 2022, 14h45-16h15, Oslo and online

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