“Almost Invisible Scars”: Medical Tourism to Brazil

Introduction

News stories and policy reports often present medical tourism as a troubling instance of globalization. In these accounts wealthy westerners are portrayed as taking advantage of cheaper care available in the developing world (Roberts & Scheper-Hughes, 2011, p. 2). Yet, while medical tourism does indeed often reflect and contribute to health care inequities, the ethical questions posed by the practice are complex and unpredictable, and often upset familiar narratives of globalization as westernization.

Medical tourism challenges conventional representations of the geopolitical and economic relationships among the countries that participate in it for example. For example, a Mexican official in the US-Mexico border town of Juarez argued that medical tourism will be “bigger than the maquila,” arguing that the “biggest patient is the United States” (Cuddehe, 2009, p. 15). This metaphor reverses the narrative of the needy Mexican migrant traveling to the US in search of economic opportunity, and puts the wealthier of the two nations in the subordinate role of the patient. Some medical tourism networks are not based on unidirectional relationships between center and periphery but are rather “rhizomatic,” this is, creating or following multiple links, sometimes within the global south. Brazilian hospitals, for example, target patients from the Middle East, designing brochures and websites in Arabic (Sarruf, 2007). One hospital in India attracts patients not just from Germany, Canada, and Australia, but also Oman, Qatar, Bahrain, Saudi Arabia, the Maldives, Sri Lanka, Nepal, East Africa, and Bhutan (Connell, 2006, p. 1096).

The term medical tourist presents the image of the westerner traveling to the developing world for medical treatment, perhaps combined with a holiday. It partly implies a frivolous or at best leisure and recreation oriented activity (Roberts & Scheper-Hughes, 2011), and as such, masks the fact that many so-called medical tourists are “poor and medically disenfranchised persons” in search of life-saving drugs or surgery that they cannot otherwise get. For example, many would-be medical tourists are Mexican and Central Americans who travel to the US without a tourist visa in order to get health care, often accessed via emergency rooms. Others are North Americans lacking health insurance, which the New England Journal of Medicine dubbed “America’s new refugees” (MacReady, 2007, p. 1849). Because the term medical tourism seems to minimize the economic and health hardships endured by patients, Roberts & Scheper-Hughes (2011) propose instead the more neutral “medical migrant.”

In the case of consumers seeking cosmetic surgery overseas, however, the term medical tourist may be appropriate precisely because of its associations with leisure. Cosmetic surgery is sometimes combined with a vacation or nature tourism (Ackerman, 2010). Moreover, it involves an elective procedure performed on patients who are already healthy, though they may become sick in the course of recovering from surgery. The cosmetic surgery patient’s absence of medical need, at least in any conventional sense, poses complex ethical issues about the fair use of health care resources (see Chapter 6, this volume).