International medical travel and the politics of therapeutic place-making in Malaysia

Abstract

Goal and objectives of the dissertationGoalThis dissertation's examination of international medical travel (IMT) - where people cross national borders in the pursuit of healthcare - builds on an intersection of feminist and postcolonial scholarship that seeks to challenge embedded assumptions about the sources, directions and political value of care. In so doing, it contributes to contemporary social science debates on the role of mobility in questions of care, responsibility and interdependence. With many of the countries currently being promoted as IMT destinations holding 'developing' status, IMT poses a significant challenge to popular assumptions about who provides and receives care since it inverses and diversifies presumed directionalities of care. Taking as a point of departure the notion that the boundaries to the terrains and subjects engaged in the provision and receipt of care are constantly in flux, the dissertation examines the discursive and material positioning of Malaysia as one of the world's most prominent IMT destinations at a moment when the status of the nation-state is undergoing profound transformation.ObjectivesThe dissertation seeks to demonstrate how 'Malaysia' gets positioned as a hospitable destination within a range of imagined geographies of care. The extension of care - through the harnessing of IMT - can serve as a place-making technology to re-imagine the state as a provider and protector within a globalising marketplace in which care, increasingly commoditised, is tied to the production of new political, social, cultural and economic geographies. This signals a fundamental reterritorialisation of care aligned with the pursuit of greater 'global' economic, political, social and cultural integration and legitimacy that reconfigures the relevance of the nation-state.In order to trace broader changes between countries, groups and individuals as they negotiate their positions within increasingly commodified relationships of care, I explore how IMT flows and their selective harnessing by the state and the private sector become part of a new postcolonial nation-building project in Malaysia by asking the following questions:* What does the 'extension of caring' through the provision of private healthcare to noncitizens in Malaysia accomplish, and what sorts of power relations does this expedite?* What 'Malaysia' is put 'on the map' to qualify for 'world-class' IMT destination status?* Which characteristics are promoted as national credentials for expert care-giving and which are suppressed, ignored or rendered obsolete?MethodologyFrom late 2007 to early 2008, 49 single in-depth, semi-structured interviews, lasting between 40 minutes and three hours each, were held with respondents in Kuala Lumpur, Penang and Malacca to better grasp how they conceptualise IMT flows and responses and act to influence the course of the industry's development within Malaysia:* Top-level executives and administratives (e.g., CEOs, directors, senior managers, board members and advisors) for governmental, private and not-for-profit bodies;* Research, business development, marketing, policy, public relations and customer service executives and officers;* Medical travel facilitators and medical professionals.An interview guide covering the general development of the IMT industry in Malaysia, changes in the pursuit and provision of medical care and the overall customer base was loosely employed with all interviewees as a point of departure to prompt open-ended responses and discussion.Discourse analysis of the interview transcripts and the secondary (e.g., international and domestic media coverage, private-sector and governmental documents and statistics) data gathered during the fieldwork period was then undertaken in order to interpret claims made to specific forms of care expertise, the construction of such expertise and the manners in which select others are invited to draw upon it. …