Elizabeth F.S. Roberts and Nancy Scheper-Hughes give us a sense of the breadth of medical migrations in their introduction:
This special issue of Body & Society brings together articles that describe contemporary forms of bio-medical travel. The conjuncture of mobility and bodily states occurs at a particular epistemic moment: the first decades of the 21st century, when medical travels and travelers are participating in border crossings as self-consciously biological beings, and when biological life, health and sickness, survival and death, are central to subject formation, ethical practice, political struggle, regulation and governance. In the last several decades, increasing numbers of people have crossed national borders and traversed great distances for bio-medical, experimental or alternative (complementary) medical, surgical or cosmetic interventions and/or bodily transformations. Some of these travelers – often described by the mass media as ‘medical tourists’ (a term we subject to a pointed critique) – journey to foreign lands in search of cures and therapies for a variety of conditions. The elderly and well-insured are searching for cures to the maladies that commonly accompany aging: chronic, noncontagious illnesses and afflictions, from heart disease to end-stage kidney failure, from obesity to diabetes to congestive heart disease to dental care and depression. Women and their partners travel in search of solutions to infertility; men in search of cures for sexual dysfunction. Both men and women, young and old, search for cures to addictions and psychiatric illnesses. And many people travel across borders to purchase much sought-after and expensive drugs – Lipitor, Viagra, Xanex – or their generic copies. Other travelers are afflicted with bodily ailments that have no known or ready cure, making them willing to journey to parts unknown to participate in clinical trials, experimental genetic medicine or stem cell transplants not yet (or likely ever to be) approved by the Food and Drug Administration (FDA) or the National Institutes of Health.
Situating the importance of examining such migrations, Charis Thompson writes in her afterword:
Practitioners, patients, purveyors, and researchers of the medical arts and sciences have always traveled, and continue, vigorously, to do so. Likewise, the sick have long embarked on quests for salves and salvation for the body and mind. This volume suggests, however, that medical migrations are increasingly part of the very fabric of the transnational world order. The contemporary period has been characterized as one where we are witnessing the globally differentiated but nonetheless widely diffused rise of ‘biological citizenship’, ‘biosociality’, ‘the biomedicalization of society’, and a transnational ‘biomedical mode of (re)production’. Although there are several versions of these theses, the general idea is that more and more aspects of transnational relations, finance, social organization, human relations, moral and experiential life, and commerce are conducted under the guise of biomedicine, including the weaponization and industrialization of, and promissory speculation in, human life itself. Biomedicalization’s swathe is wide: in the affective realm, hope and desperation structure demand and morally regulate conduct; in the biomedical ‘bench to bedside’ research process, the life sciences are commercialized through the synonymization of research with innovation; bodies become more and less ‘bio-available’ or ‘supplementable’; nations use biomedicine to police their borders, survey their subjects, and for ‘selective pronatalism’; and individuals and groups petition the law, nations, international bodies, and NGOs for access to resources, kinship, and/or citizenship. The genomic risk-society’s ‘previvors’ infinitely extend the need for highly capitalized medicine among those with the ability to pay, while ‘donors’ or participants in clinical trials give up bodies and body parts for a seeming pittance. Biosecurity justifies surveillance, containment, enhancement, and exclusion; and excess private capital, ‘Billanthropy’, engages in non-representative governance through medical projects that redistribute medicine but not usually capital, biomedical infrastructure, or intellectual property from the global north to the south. In all of these phenomena, medical migrations, whether of knowledge, expertise, money, persons, or body parts, are key.
The articles for this issue, with abstracts, are as follows:
Social analysis of transplant organ demand often focuses on either small-scale (familial) tyrannies of the gift or large-scale (global) markets. Media accounts of the scandalous in transplant medicine stress the latter, a homogeneous model of flows of biovalue down gradients of economic and social capital. This article examines particular globalizations of tissue demand organized as much around claims of social similarity as gradients of social difference. To engage apparent ‘diasporic’ networks of organ purchase — Non-Resident Indians traveling to India and Overseas Chinese to China — I elaborate a concept of bodily supplementarity. Supplementarity in this account is the ability of an individual or population to secure longevity through the mobilization or acquisition of the organic form of others. Diasporic tissue circuits are analyzed in the context of ‘experiments’ in supplementarity that proliferate with the transformation of the molecular conditions for supplementarity. The emergence of powerful immunosuppressants renders the scale of tissue recruitment flexible and contingent, and allows clinics to develop alternatives to brain death. These circuits emerge as situations that reorder the relation of the familial and the global in transplantation, in the service not only of migrant supplementarity but also efforts to reimagine the challenges of emigrant belonging within particular configurations of racialized life and its government.
Moshe Tati, a sanitation worker in Jerusalem, was among the first of more than a thousand mortally sick Israelis who signed up for illicit and clandestine ‘transplant tour’ packages that included: travel to an undisclosed foreign and exotic setting; five-star hotel accommodation; surgery in a private hospital unit; a ‘fresh’ kidney purchased from a perfect stranger trafficked from a third country. Although Tati’s holiday turned into a nightmare and he had to be emergency air-lifted from a rented transplant unit in a private hospital in Adana, Turkey back to Israel, Moshe (now deceased) became a poster-boy of transplant tourism for the next decade. João Cavalcanti was among the first of 38 residents of the slums of Recife recruited by retired military Captain Ivan da Silva and his sidekick Captain Gadddy Tauber (of Israel) to travel to Durban, South Africa to provide a spare kidney to an Israeli transplant tourist in Durban. This article examines the logics and practices through which kidney buyers and kidney sellers, organs brokers, surgeons and their accessories convince themselves that they are engaged in an illegal but still mutually beneficial ‘medical-recreational’ adventure, an ‘extreme medical sport’ of sorts. While life, health and survival motivate ‘transplant tourism’, a euphemism for human trafficking in spare body parts, the freedom to roam, mobility, is an essential feature of transplant tours for kidney buyers and kidney sellers.
The article analyses practices, perceptions and political dramatizations of bone marrow donation in Cyprus. Based on empirical data from an ethnographic study on practices of organ and bone marrow transplantation in postcolonial Cyprus, forms of oppositional biopolitics are analysed that are not bound by the modern, étatist regime of governing populations but capitalize on new developments in biomedicine, on new political movements, as well as on transformations in the political sphere. These reconfigurations are interpreted as instances of an emerging bio-subpolitics that transcends national borders and produces new complexities, interrelations, associations and social forms that come into being alongside biomedicine. At the same time, these developments co-produce cosmopolitan citizens and new subjectivities, transcending nationally bound regimes of political deliberation and identification. These forms of biopolitics mobilize local historical experiences and take advantage of affordances provided by biomedical platforms operating on a global scale that make available an opportunity structure for a cosmopolitan bio-subpolitics.
Medical tourism describes a new pattern of movement of people for medical care, particularly from wealthier to poorer countries. Using the example of Thailand, where annually a million non-Thai patients seek medical treatment, this article provides a critical analysis of the political economic contexts for this medical migration. Drawing on urban geography and heterodox economics, the article considers medical tourism as an interaction of bodily, national, and global scales shaped by processes of globalization. This approach provides a thick context for the transnational care of bodies while proposing that the bodily scale also has a role in reformulating the scale of the nation.
How Biology Travels: A Humanitarian Trip
This article explores how ‘biology’ — in the sense that bodies are increasingly understood in biological terms, from the molecular to the species level — is becoming more central in the recognition of political worth, and I argue that humanitarians are key players in producing this reality. I focus on the role biology plays in the politics of immigration. Combining ethnographic research with undocumented immigrants in Paris and asylum claimants in the US, I examine how biology has become a central tool in the ability to travel. How did pathology (i.e. illness) or violations of anatomy (i.e. torture, sexual violence) become the ‘best’ ways to get papers as an undocumented immigrant — better than selling one’s labor power? I suggest that biological evidence — of illness, of torture, of immunity levels — are used as key measurements of suffering, which justifies humanitarian exceptions, in this case, for papers. My argument is that there is a dual regime of truth at work, where the multiple ontologies of biology get reduced to one epistemology of biology as ‘fixed’ when it concerns immigrants and refugees, due to the role of humanitarianism in the politics of immigration. This is explored in the context of profound inequalities between those in the global North and South, asking how the hope offered by biological evidence takes on different meanings and consequences depending on one’s position in the global matrix of wealth and poverty, race and gender.
Barbados is a center of international genetic research premised on race. Drawing on ethnographic fieldwork following Johns Hopkins studies carried out in Barbados, this article explores this travel for research. This biomedical science relies on a conflicting significance of Barbados: as a site of suffering, due to the disparities of disease, and, conversely, a site of ease, playing on desires and pleasures of escaping too much asceticism in biomedicine. For the American researchers, Barbados becomes a locus of desire to ethically address the African diaspora without the quandaries of accusations and recriminations experienced in carrying out such work in urban America. The concept of cathartic science is used to describe an endeavor that creates a controlled space to know and act on some perceived sufferer without risk of being complicit in the suffering. These medical migrations of researchers to Barbados are paralleled by Bajan families participating in the American studies as a kind of proxy medical migration to the US, bitterly reflecting on the care available to them at home. This article explores the motives of this mutual travel, as a biomedicalized Barbados becomes a spectral figure for patients and researchers fraught with race, injustice, and desire. The article extends the concept of cathartic science from genomics of race to medical anthropology to foreground the desires and anxieties of any science of suffering.
This article explores the translation and migration of illegal drugs, humanistic therapies and political ideologies by focusing on China’s first residential community drug treatment center, called Sunlight. I argue that the migration of contemporary treatment therapies from one continent to another initiates certain practices that re-appropriate and remake drug-using bodies that live and work at Sunlight. Reviewing Sunlight ethnographically also allows for broader theoretical exploration. When bodies do not operate under the common trope of possessive individualism different forms of biopolitical and therapeutic power are at play. In keeping with the theme of this special issue, this article begins with a discussion of why migration is a useful rubric for understanding how therapeutics and bodies become global entities and practices through the movement of three things: heroin, humanistic therapy and political ideology. It then presents an ethnographic slice of life at Sunlight to demonstrate how these practices and ideologies play out in the everyday. It finally returns to the question of why these therapies re-appropriate the post-socialist drug user’s body and psyche through a discussion of the term ‘psycho-sociability’. Psycho-sociability can be read as a demand for becoming a good biological citizen, as well as a theoretical rubric for explaining non-Western biopolitic.