FASA Weekly Colloquium: Social Networks and Short-term Medical Missions: Understanding Healthcare in Urban Nicaragua
January 15, 2016 at 4pm in Turlington Hall Room 1208
Presentation by Jessica-Jean Casler, Department of Anthropology, University of Florida
Short-term Medical Missions (STMMs) occupy increasingly prominent and complex spaces within the health landscapes of the global south. In light of the increasing role STMMs play in healthcare systems, there has been increased academic attention to the 1) ethical issues, 2) effects on patients’ relationships to local care, and 3) measures for evaluation – related to STMM care. While this research has been informative, it has not contributed to understandings of how STMMs impact and interact with individual healthcare systems.
This research examines the role of STMMs in urban Nicaragua, based on 13 months of ethnographic fieldwork in Matagalpa and other urban areas of the country. I used participant observation and ethnographic interviewing to document how intended recipients of STMM care perceive short-term care opportunities. In addition, I used social network analysis to map the positions of STMMs within the network of healthcare providers to understand how they integrate into and impact existing healthcare systems. Specifically, between November 2014 and March 2015, I constructed a two-mode affiliation network by asking a sample of 53 respondents whether they or someone in their household had visited each of 124 healthcare providers in Matagalpa. Network data revealed that specialty care STMMs were more likely to integrate into the local healthcare network than primary care STMMs. Additionally, interviews and participant observation found that primary care STMMs are principally valued for the medications they bring, rather than their medical services. These findings question the suitability of primary care STMMs for urban Nicaraguan communities, raising larger concerns about how the homogenization of the global south continues to obscure the fact that the primary beneficiaries of STMMs are often the participants.
Studying STMMs from both a structural and social perspective, provides insights into the ideas and experiences of medical missions’ intended recipients, while also identifying how STMMs function within the context of existing networks of care. I argue that there is a violence to medical voluntourism and suggest that until STMMs are reconsidered as global healthcare actors, perhaps they can be re-ordered to better work within healthcare systems.