Transnational connections of health professionals: medicoscapes and assisted reproduction in Ghana and Uganda

Abstract

Objectives. Based on our comparative fieldwork in two private fertility clinics in Accra (Ghana) and Kampala (Uganda), we explore the transnational mobility of providers involved in assisted reproductive technologies (ARTs) and analyze how resulting transnational networks influence the realization and appropriation of these therapeutic treatments. By exploring these case studies from developing countries, this article intends to contribute to the field of studies that examine the diversification and complexity of migration and health care. Design. We first summarize the dynamics affecting the health-care systems in Ghana and Uganda over the last decades. Then, we describe the transnational mobility engaged in the two clinics. Through the case studies, we highlight how ARTs are realized and appropriated in the two receiving countries, and the role transnational contacts play within the negotiations of medical ethos and financial interests. By using the concept of medicoscapes, we analyze the worldwide connections between ART providers, the institutions they work in, their medical practices, artifacts, and their regimes of medical knowledge. Result. Transnational professional contacts have been essential to the setup of both clinics offering ARTs in Ghana and Uganda. These contacts developed along colonial and post-colonial links, integrating also south-south relationship. The clinics' directors act as entrepreneurs and creative decision-makers who capitalize on their transnational professional network. The case studies show the diverse transnational entanglements in both clinics and demonstrate the frictions between the doctors' entrepreneurial interests, medical concerns and cultural values. Conclusion. The transnational professional contacts expose both clinics to varying practices and debates, and make them into sites for negotiating distinct clinical practices. They provoke frictions between entrepreneurial interests and medical concerns including cultural values. In current medicoscapes, in a situation of full absence of any form of financial support and of any national ART regulation in Ghana and Uganda, clinic directors are in the position to apply those practices that fit their interests and local circumstances best.

Cross-border reproduction: the reproductive market in Angola and Brazil

“…Among the reasons that would facilitate the search for treatment in Brazil, we can highlight: the ease of speaking the same language, the link and cultural identity with the country, confidence in the ability of Specialized literature has pointed out that there are challenges related to the availability of ART in many countries of the African continent. This is due to structural instability, political and legal systems, scarcity of financial resources and the unavailability of health professionals qualified in ART (Gerrits, 2016;Hörbst, 2016;Hörbst and Gerrits, 2016;Hörbst and Wolf, 2014). Gerrits (2016) focuses on the importance of transnational connections and collaborations of ART providers for establishing clinics in Ghana.…”

“…Recent studies in Ghana, Mali and Uganda have examined the main difficulties to establish IVF clinics in these countries (Gerrits, 2016;Hörbst and Gerrits, 2016). These include problems related to existing health infrastructure (equipment production, medicines, etc.…”

“…The introduction of technologies by the private health sector is closely related to the potential profitability of the reproduction market in these countries. In the Sub-Saharan region coexists: first, a high estimated levels of infertility prevalence; second, parenthood being valued as an essential attribute of marital relationships; and finally, the emergence of a growing middle class able to afford the high prices involved in these treatments (Hörbst and Gerrits, 2016).…”

Assisted reproductive technologies in Ghana: transnational undertakings, local practices and ‘more affordable’ IVF

“…The article is based mainly on ethnographic research that I carried out in 2012 and 2013 in two private clinics in Ghana offering assisted reproductive technologies (see Hörbst and Gerrits (2015) for more details about the study methodology). Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research-IRB in Accra, Ghana.…”

Is Superdiversity a Useful Concept in European Medical Sociology?

“…The nation state is the territorial unit within which healthcare is planned in terms of funding, provision, and uptake and while transnational patient (Glinos et al, 2010) and despite increasing widespread professional mobility (Hörbst and Gerrits, 2016), people would nonetheless prefer to access care locally (Migge and Gilmartin, 2011). The nation state's healthcare provision is directed at residents within its borders, and the system is designed for relatively immobile patients who stay within a given locality.…”