University of Heidelberg

“The encounters of health tourism in India: Cross-borders patients and the dynamics of healthcare”

Dr. Laurent Pordié, Research Group Leader

Scholarship on health tourism often shows a separation between medical and wellness tourism. In the case of India, however, both sectors are intimately linked to each other and, to some extent, foster each other, in making the country a global health care destination.
This project explores three types of encounters between medical and wellness tourism. The first concerns associations between corporate hospitals and spas. Joint marketing strategies attempt to attract international patients in need of biomedical (orthopedic or cardiovascular) intervention. The proposed packages typically include ‘cultural visits’ and the possibility to recuperate in high class spas, where aromatherapy or soften forms of Indian massages are provided. How are these joint ventures and their services built up, represented, sold and ‘practiced’?
The second type of encounter pertains to the transformation of medicine itself: Here I explore the cultural, social and economic processes that led Ayurveda and Tibetan medicine to shift from the category of medicine to that of practices promoting wellbeing. This is a fertile ground from which to study the production of news forms of therapies and the relations between therapeutic innovations and the market in health tourism.
The third research axis focuses on the patients’ perspectives and their therapeutic itinerary, for whom categories of ‘medicine’ and ‘wellness practices’ largely overlap. Keeping in line with the overall objectives of the programme, this
project aims to complicate and to redefine health tourism,
and to offer a theoretical reflection on the transcultural dynamics of health practices.
  

"The Fabric of Labour for Transnational Spaces: Mobilities, Power and Cosmopolitanism in the Health Industry in India” 

Dr. David Picherit, Postdoctoral Fellow  

This research project intends to examine, through case studies in the health industry, the restructuring of labour, mobilities and spaces in contemporary India. It will investigate how the making of India as a global health care destination subsumes the intersections of state power, global capitalism and transnational and internal flows of culture and people. An in-depth ethnographical fieldwork will be conducted in transnational social fields, such as a medical tourism hospital or a spa, a privileged site of observation of the ways these political, economical and cultural dynamics are enmeshed in everyday social relationships between internal labour migrants, global clients and management.  The main objective is to analyze how State regulations and branding of global India, cultural and economical flows, and overlapping forms of transnational and internal mobilities between Europe and India are consubstantial with the fabric of a migrant labour force on ethnical, physical and/or regional basis (such as Keralese/Assamese masseur or nurses) in order to fit into transnational spaces requirements. But beyond an analysis of the mere embodiment of essentialized identities as imposed, this project will look at the ways workers engage with forms of essentialism assigned to them and with cosmopolitanism as a multi process of appropriation, consent and resistance.  How do migrant labour living in a state of flux experiment, practice and juggle between flexible identities in order to contest attributed ones and to take advantage of economical, political, social power variations? In this way, this project reasserts the need to deal with culture in transnational studies without dismissing its economical and social power background. This research explores how the combination of essentialism and cosmopolitanism defines social relationships between transnational clients and employees at everyday level, while contributing to a new configuration of power regime constitutive of transnational social field, but also of global capitalism.  

"Technologies in Circulation: Assisted Reproduction in India"   

Sandra Bärnreuther, PhD Candidate

Assisted reproductive technologies and procedures today circulate the world. In India a vast number of fertility clinics offers treatments like IUI (Intra Uterine Insemination), IVF (In Vitro Fertilization), or ICSI (Intra Cytoplasmic Sperm Injection). This thesis will explore the socio-cultural dynamics resulting from the travels of reproductive technologies using approaches developed in both anthropology and science and technology studies. These disciplines have demonstrated that technologies lack the neutral and objective nature commonly attributed to them, but are always co-produced with society. In this sense, the project will examine the ways in which technologies and their utilization are influenced and transformed by social and cultural contexts, and, reciprocally, the role they play in shaping these social formations. How are assisted reproductive technologies and related concepts and practices in India appropriated, re-interpreted or rejected? In what ways are they contextualized and modified by both medical staff and patients? And how do reproductive technologies impinge on (and are themselves shaped by) notions of infertility, local biologies, subjectivities, and moralities?  

“Oil Massages, Purges and Beach Holidays: Ayurvedic Health Tourism in Kerala, South India”

Christoph Cyranski, PhD Candidate

This project investigates adaptations of Ayurvedic practice to the needs of European guests in an Ayurvedic resort in south India. In the last two decades, new institutions of Ayurvedic practices have emerged in India and Sri Lanka. Located in popular holiday destinations, these Ayurvedic resorts offer a variegated mélange of therapeutic and wellness treatments for predominantly European guests. The aim of this project is to analyze the ways by which Ayurvedic practice is reconfigured through the interaction between foreign guests and local practitioners and the local management in one such Ayurvedic resort in the south Indian state of Kerala. Which elements have entered the realm of Ayurvedic treatment? Which aspects have been modified, and which parts have been removed? These questions will be addressed together with the transnational processes that have led to these transformations. The project will contribute to current discourses on the global variety of Ayurvedic practice and to debates about the concepts of medical, health and wellness tourism. It will further provide theoretical reflections on the formation of transnational and transcultural practice, knowledge, and institutions resulting from international and intercultural encounters.

"From Healthcare to Hospitality: Transplant Tourism and the Changing Healthcare Sector in India" 

Sinjini Mukherjee, PhD Candidate

This research will analyse the phenomenon of transplant tourism within India and its impact on the healthcare sector of the country. Long waiting lists for organs and the insurmountable cost of surgery has led to the fast growing occurrence of transplant tourism.  Although organ trade and the black market play a big role in making Asia a preferred destination for such procedures, the analysis remains incomplete without looking at questions of how the medical profession is coping with a change in the profile of the patient and how this, in turn, changes the practice of medicine itself.  My endeavour will thus be to document and unpack the intricate workings of a state-of-the-art hospital in India, which is geared to service an international clientele. The hospital, in such a context, becomes the site of confluence for healthcare and the hospitality industry, where hospitals now claim not only to provide the best medical care but also five star rated rooms and guided tours of the nearest tourist sites. It is this crossing over of two distinct professional worlds that will form the core of my analysis. As a result, I will study both the administrative functioning as well as the medical discourse within a modern hospital setting. Over the course of my research I also aim to raise larger questions regarding the hierarchies and structural inequalities that continue to persist in the professional world of medicine in the midst of such a transnational flow of healthcare providers and seekers.    

“In Search of a Tradition: Leisure, Ayurvedic Healthcare and Trans-national Flows in Kerala, 1870-1990”

Dr. Burton Cleetus, Research Fellow (University of Calicut / French Institute of Pondicherry) 
The study seeks to examine the historical relationship between transnational migration and its subsequent impact on cross cultural flow of people for leisure and healthcare. This also seeks to explore as to how such interactions of people and ideas, in turn, shaped the reorganization of indigenous therapeutic practices of Kerala in the twentieth century.
Archival documents prove that migrant concerns in the distant lands had played a major role in the reform of indigenous healthcare practices at home as well as its popularization abroad. Major concerns of analysis are therefore to examine as to how socio-cultural alienation and the feeling generated by a feeling of absence from the domestic society and culture shaped the reorganization of Ayurveda, based on the dominant Sanskrit based literary tradition in indigenous medicine. Following the paths of the migrants, Ayurvedic medicines also found a vibrant market in south eastern countries and Ceylon by the closing decades of the nineteenth century.
A similar flow of ideas, drugs and therapeutic practices occurred from the late 70’s of the twentieth century onwards to the Middle East. As knowledge of Ayurvedic medicines came to be popularised by the migrant population of Kerala in the Middle East, there was also a return of the Arabs to Kerala for Ayurvedic health care. The study also seeks to examine the nature of changes that occurred in the production and preservation of indigenous drugs, as a historical phenomenon, and its subsequent reorganisation as quick fixes to suit the needs of the migrant tourists in Kerala.

"Value Chains and Cultural Economics of a Global Product: Ayurvedic Health Tourism in Kerala, India"

Dr. Harilal Madhavan (Postdoctoral Fellow, French Institute of Pondicherry/Cermes, Paris)
Ayurveda became the Unique Selling Proposition (USP) of Kerala tourism due to the strong traditional and authentic image of ‘Kerala ayurveda’, immense availability of herbal resources, location specificities (Western Ghats and beaches) and availability of human capital (institutional as well as non-institutional practitioners) in the state. This study explores the entire health tourism value chain in Kerala. Global value chain (GVC) research and policy work examine the different ways in which global production and distribution systems are integrated, and the possibilities for firms in developing countries to enhance their position in global markets. GVC is employed here, as it could be used as a theoretical framework for better understanding the shifting governance structures in sectors producing for global markets such as ayurveda.  Considering ayurvedic tourism as a cultural product, which caters to the global consumers, the study examines how the wellness sector cash upon the new forms of ayurveda. Specifically, I ask two questions. The first; how various domestic nodes of the ayurvedic value chain framed and governed by transnational higher nodes of consumer categories within the given institutional structure of tourism (which includes international, national and sub-national policies, firms, other stakeholders within firms, etc.), and the second; whether there are evidences within the ayurvedic tourism sector which creates an asymmetrical agency in the larger ayurvedic sector of the state. For this purpose, I will conduct an in-depth survey of a major ayurvedic tourism resort in Southern Kerala.

“Medical Tourism and the Local Health Care System in Kerala, South India”

Dr. Caroline Wilson (University of Sussex) 
In the last two years, the leading corporate hospitals from Kerala, South India are working in conjunction with the government tourism department to brand the state as an international hub for medical tourism.  Although the industry is still in its infancy, recent development within the health care sector is increasingly being designed to cater to this market. This paper examines the complex ways in which medical tourism is both integrated within and separated from the local health care system.  It explores the role of medical tourism as an important framing device through which the local health care system is further imagined and integrated within the global marketplace for medical care. It examines the ways in which the norms, values, priorities, and practices of private hospitals are being transformed as institutions respond to the distinct needs of local and global patients and as institutions seek accreditation from national and international standards organisation.  The paper analyses how medical tourism is redefining the hospital, medical work, patient care, and conceptualisations of health care costs.  It therefore uses medical tourism as a trope through which to explore the emerging paradoxes of neo-liberal transformation in contemporary India.