Medical and reproductive migration

Location: Panama City, Panama

role: Ethnographer

Overview

I planned and conducted ethnographic research and interviews at hospitals and clinics in Panama, working with physicians, hospital administrators, and executives of medical tourism companies to gain insight into the recent growth of the industry and to identify challenges they faced.

Process

To learn how the “medical tourism” industry offering biomedical services to foreigners had developed in the past decade, I spent the summers of 2012 and 2013 in Panama City, Panama, and took a multi-pronged approach. I visited and interviewed physicians and hospital executives at the major hospitals and clinics offering medical services to foreign patients, conducted observations at two of the city’s five private hospitals that catered in part to medical travelers, and spoke with the agents – called “facilitators” – who connect international patients to Panamanian physicians and arrange the necessary logistics such as housing and transportation. I collected and analyzed brochures and marketing materials aimed at potential patients, analyzed the clinical outcomes of several clinics, and followed the blogs of several U.S. citizens who had pursued medical treatments in Panama. I also spoke extensively with a wide range of Panamanians not involved with the industry to learn about their impressions of it, and spent time in non-medical settings such as restaurants, museums, hotels, tourist sites, and taxis to see how the provision of medical services compared to other services offered to foreigners.  

Insights

In contrast to my initial assumptions, I found that the individuals involved in constructing this medical industry in Panama – physicians, facilitators, hospital administrators, lawyers, and policymakers – did not want to portray their services to potential patients solely as cheaper alternatives to medical care in the United States and elsewhere, offered in an idyllic setting. Instead, they were striving to construct – both linguistically and physically – a larger "globalized medicine" system. They emphasized the clinical, technical, and legal aspects of the services provided, and framed them as practices that could be governed, organized, and controlled in a way that medical tourism could not be. In the master’s thesis that I produced from this research, as well as in subsequent presentations I made to the Anthropology department at Brown University and at the 2013 American Anthropological Association’s annual national conference, I argued that these individuals’ ideas about the industry were partly a regulation-constructing project, and partly a strategic marketing move to position medical services in Panama as equal in quality to services in the United States and in other countries from which they were trying to attract patients. However, while the discourse and practices of “globalized medicine” had potential benefits for certain Panamanian stakeholders – especially those who were already in positions of power – the rhetoric of comparability and equality obscured hierarchies both within Panama and on a global scale that industry depends on, reproduces, and creates.

Outcomes

My insights were useful to other anthropologists working on projects investigating how people travel for medical reasons in different contexts: while the medical travelers themselves have been fairly well studied, there is little scholarly knowledge regarding the individuals who compose and construct the industry (e.g. physicians, policymakers, facilitators). On a practical level, my insights were useful to industry insiders in Panama, as it enabled them to see the ways in which their regulation construction and marketing strategies were effective in growing their business, but also pointed to ways in which ongoing misperceptions in the United States about the safety and quality of medical services in Panama hindered their ability to attract patients, collaborate with U.S.-based physicians, and become even more financially successful.