Paul Kingsbury

What is known about the effects of medical tourism in destination and departure countries? A scoping review

BackgroundMedical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries.MethodsDrawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1) identifying the question and relevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data.ResultsThe large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution to health system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation.ConclusionsGiven its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and contested phenomenon. This is especially true given its potential to serve as a powerful force for the inequitable delivery of health care services globally. It is recommended that empirical evidence and other data associated with medical tourism be subjected to clear and coherent definitions, including reports focused on the flows of medical tourists and surgery success rates. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.

Theoretical injections: On the therapeutic aesthetics of medical spaces

In this paper we present a dialogue about the seemingly innocuous presence of environmental art in hospital settings as a way of furthering critical perspectives on the therapeutic landscapes concept and its application to medical spaces. We explicitly consider the potential utility of two perspectives, Foucaultian and Lacanian readings, for understanding the relationship between environmental art and the hospital waiting room. We use this paper as a vehicle to demonstrate how such theoretical perspectives can enhance critical scholarship on the therapeutic landscape concept, particularly as it is applied to settings such as health clinics and hospitals. A brief agenda for further critical engagements with the therapeutic nature of health care spaces is put forth in the conclusion.

Geographies of food: 'Afters'

This third and final ‘Geographies of food’ review is based on an online blog conversation provoked by the first and second reviews in the series (Cook et al., 2006; 2008a). Authors of the work featured in these reviews — plus others whose work was not but should have been featured — were invited to respond to them, to talk about their own and other people’s work, and to enter into conversations about — and in the process review — other/new work within and beyond what could be called ‘food geographies’. These conversations were coded, edited, arranged, discussed and rearranged to produce a fragmentary, multi-authored text aiming to convey the rich and multi-stranded content, breadth and character of ongoing food studies research within and beyond geography.

Sociospatial Sublimation: The Human Resources of Love in Sandals Resorts International, Jamaica

Interactions between visitors and workers are central to tourism. In the Global South, this relationship usually consists of the spatial concentration and division of people with vastly contrasting economic resources and cultural identities. Research on the commodification of tourism in the Global South, then, focuses on the uneasy confluence of poor and dependent service workers who labor so that wealthy and privileged tourists can enjoy. Drawing on the work of Slavoj Žižek, this article argues that the current approaches to these interactions, although exposing the capitalist “contents” concealed behind tourisms alluring commodity form, fail to examine the “secrets” of the form itself; that is, the enjoyment generated between workers and tourists. As a result, researchers have yet to fully explain how—with all its socioeconomic contradictions of smiles and servility, luxury and poverty—the commodity form of tourism in the Global South endures. To elaborate my argument, I use Jacques Lacans concept of sublimation and an organizational ethnography of the all-inclusive hotel company Sandals Resorts International, headquartered in Jamaica. I explore two ways through which sublimation, a place- and value-making activity par excellence, informs the commodified interactions between Sandals service workers and tourists: first, how management discourses “elevate” workers to the “place of the Thing”—a place that radiates sublime enjoyment; second, how workers avoid the dangers of overwhelming guests with too much enjoyment by following the practices of “love-sublimation” codified in the fantasies of “Guest Courtesy” and “The Sandals Customer Service Checklist.”

Reexamining the Montgomery Bus Boycott: Toward an Empathetic Pedagogy of the Civil Rights Movement

Geographers have assessed the success and failure of the U.S. Civil Rights Movement in terms of the African American struggle for justice, social identity, and economic survival. Conspicuously absent from the geographic literature are pedagogically oriented studies of the historical geography of the Civil Rights era. The Movements popular image has congealed into a celebratory collection of names and dates, the sum of which is a vague, nearly mythic retelling that students might recognize but not necessarily care about. As a result, the Movement is at once contemptuously familiar yet bewilderingly strange for our students. This article offers a sympathetic critique of conventional Movement narratives, introducing the notion of empathetic pedagogy and presenting a case study of the Montgomery bus boycott. Our pedagogical approach stresses the role of empathy, both as a factor in shaping the actual sociospatial development of the Movement, as well as a strategy for encouraging students to appreciate the everyday courage and sacrifice that animated so many of its participants. Our study brings together two burgeoning literatures that have the potential to cultivate empathy among students: the critical reevaluation of mobility and explorations of subjectivity from a psychoanalytic perspective. Here mobility is understood in both its literal and figurative sense: in the case of the bus boycott, the intricate network established to literally move African Americans around the city, as well as the figurative movement of sympathy and solidarity that “moved” people to support their efforts and now informs popular, selective understandings of the protest.

Locating the Melody of the Drives

Psychoanalysis has profoundly influenced those social theories that inform qualitative methodology in human geography. Yet many geographers are skeptical about the value and viability of psychoanalytic methodology because of its alleged reductionist causal explanations and relativistic interpretations of data. Drawing on the work of Slavoj Žižek, which affirms Jacques Lacans undermining of the dualism of causality versus sense, this article illustrates the potential value of Lacanian psychoanalysis as a qualitative methodology in geography. Using a methodological case study from my research on Jamaican tourism, I illustrate how we can locate a Lacanian understanding of the drives in the interactions between tourists and hotel workers. In so doing, the article provides new insights into the enduring allures of tourisms commodity-form by focusing on how the object petit a—a chimerical object that incites desire and an unattainable object that the drives encircle—takes place in customer service and entertainment activities.

Cool aid? Health, wellbeing and place in the work of Bono and U2

Through a discussion of the sounds and statements of Bono and U2, this paper explores the ways in which music can work in particular spatial contexts, contributing towards both personal and population-wide health and wellbeing. We engage critically with the idea of celebrity diplomacy, and look beyond this notion to suggest ways in which the production, circulation and consumption of music warrants greater attention within the unfolding domain of health geography.

The World Cup and the National Thing on Commercial Drive, Vancouver

Nationalism is central to global sports events such as the Olympics and the mens football World Cup. Recognizing the unique capacity of these multibillion dollar ‘mega-events’ to stage captivating spectacles and generate intense enjoyment for vast numbers of people, researchers usually examine sport-induced nationalism in terms of the socioeconomic staging of national identities, meanings, and ideologies. And yet, few theoretical and empirical studies ask the following questions: Why are nationalist sports spectacles so emotive for so many people? How do sports fans enjoy these televised global events in concrete local settings of, for example, cafés, streets, and sports bars? This paper attempts to provide answers by drawing on Slavoj Žižeks Lacanian concept of the “national Thing” and one month of research on the 2006 FIFA World Cup on Commercial Drive in Vancouver, British Columbia, Canada. I explore how the national Thing—a specific incarnation of social enjoyment—takes place in peoples consumption of the World Cup in terms of community, belief, and anxiety.

Psychoanalytic Theory/Psychoanalytic Geographies

This article explores how psychoanalytic theory has been adopted and adapted by human geographers since the early 1990s. The article is composed of three sections. The first section illustrates some fundamental theoretical tenets of psychoanalysis. Specifically, the focus is on why psychoanalysis devotes so much attention to the concept of the unconscious, as well as how psychoanalysis theorizes causality and psychological effects. The second section addresses why geographers first turned to psychoanalytic theory. Here, how three major psychoanalytic theoretical approaches inform contemporary psychoanalytic geography are illustrated: first, geographers use the theories of Sigmund Freud to address the themes of imaginative geographies, urban phantasmagorias, spatial oppression, as well as racist and uncanny landscapes. Second, drawing on the works by and those associated with Jacques Lacan, geographers have investigated patriarchal and masculinist modes of knowing and representing, as well as the social bonds of enjoyment and antagonism. Finally, following object relations theory, geographers study spaces of exclusion and the discrepant, as well as the spatial processes of childrens identity formation. In the final concluding section, the article briefly discusses the similarities and differences between psychoanalysis and other major theoretical trajectories in human geography.

Rethinking the Aesthetic Geographies of Multicultural Festivals: A Nietzschean Perspective

Critiquing dismissals in geography of the aesthetics of multicultural festivals as bland, superficial, and apolitical, this article illustrates how they can be also invigorating, imaginative, and empowering. To elaborate my argument, I draw on interviews and participant observations of the 2010 Fusion Festival (hereafter Fusion), an annual event located in the “ethnoburban” context of the city of Surrey, British Columbia. My theoretical framework uses Friedrich Nietzsches concept of aesthetic “justification,” which refers to arts capacity to infuse human experience with constructive meaning and affirmative power. For Nietzsche, aesthetic justification incorporates two artistic forces: the Apollonian, which refers to illusion, beauty, and order, and the Dionysian, which refers to music, sensuality, and ecstasy. The article explores three ways through which Apollonian and Dionysian delimitations of space and time justify the multicultural values and identities of Fusions participants: first, how the Apollonian illusions of “cultural pavilions” manifest the creative capacities of local communities; second, how musical and theatrical performances generate Dionysian senses of belonging among performers and audience members; and third, how the embodied and transfiguring practices of dancing, painting, singing, and dressing up shift perspectives in ways that affirm diversity, combat despair, and raise awareness about protecting the environment. The article concludes by considering some future directions in geographical research on the aesthetics of multicultural festivals.