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The work of cosmetic surgery tourism II

Health workers and patients

Ruth Holliday, Meredith Jones and David Bell

This chapter discusses the work of nursing staff and surgeons in cosmetic surgery tourism. For surgeons, our research uncovered ambiguities surrounding professional standing and identity, and we explore how surgeons narrate their career trajectories and the pride they have for their work, as well as how they attempt to head off criticisms of their specialism. The discussion draws on sociological research on care work, body work, emotional labour and aesthetic labour. We discuss how surgeons negotiate an increasingly entrepreneurial role, showing how tensions emerge in their interactions with medical travel facilitators. We show how key moments such as the clinical consultation frame both doctors’ and patients’ understandings of surgery. The consultation is not simply about surgeons asserting their professional authority over ‘duped’ patients; instead, it is a negotiation towards a desired outcome for both parties. This leads us into a discussion of the forms of work that patients themselves undertake in cosmetic surgery tourism. Rather than passive recipients of others’ labours, patient-travellers work hard to accomplish their surgical journeys – and some later capitalise on this work by themselves becoming medical travel facilitators and guiding others through the same journeys.

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The work of cosmetic surgery tourism I

Caregiving companions and medical travel facilitators

Ruth Holliday, Meredith Jones and David Bell

This chapter begins an exploration of the forms of work or labour that are brought together to make cosmetic surgery tourism happen. The analysis is framed by discussions in the sociology of work about care work, body work, emotional labour and aesthetic labour. The chapter opens with an overview of the cosmetic surgery tourism industry to provide context for the analysis of forms of work. The remainder of the chapter focuses on forms of work undertaken by those who travel with cosmetic surgery tourists and the various intermediaries who work to facilitate surgical journeys. In the former category we show how informal caregivers who travel with patients perform a vital function in enabling and supporting those travelling for surgery. In the case of intermediaries, facilitators and coordinators, we explore how this novel set of roles has emerged as a new business sector with increasing heterogeneity and complexity. We provide a typology of medical travel facilitators (MTFs), drawing on our ethnographic material to show who these workers are and the forms of work they perform. We show that MTFs occupy a central but contested position in the cosmetic surgery tourism assemblage.

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Ruth Holliday, Meredith Jones and David Bell

This chapter consists of a plate section of forty-three colour images.

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Ruth Holliday, Meredith Jones and David Bell

This chapter outlines the theoretical framing of medical tourism that we deploy in the analysis presented in Beautyscapes. It draws on Appadurai’s notion of disjunctive global flows and ‘scapes’, combining this with insights from work on networks and from assemblage thinking, in order to theorise how cosmetic surgery tourism is assembled by heterogeneous actors, and to show how this coming together is contingent and emergent. Global flows come together in particular places at particular times, and this notion helps us understand the comings-together that characterise cosmetic surgery tourism. Empirical detail drawn from our fieldwork enables us to develop a nuanced analysis of how networks are assembled and how cosmetic surgery tourism takes place and makes place. Our analysis is guided by a further conceptual framing that we also introduce in this chapter: Mol’s discussion of the logic of care and the logic of choice. Rather than simply counterposing these two logics, we see them as intricately entangled in the ways in which cosmetic surgery tourism is understood by the many actors with a stake in it.

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Ruth Holliday, Meredith Jones and David Bell

This chapter challenges some of the dominant framings of international medical travel through a discussion of the shifting geographies that have reshaped patient flows, redefined centres of excellence and expertise, and redrawn the world map of medical tourism. We show how cosmetic surgery tourism has ‘decentred’ previous models of medical travel, drawing on previous discussions of South–South, cross-border and regional patient movements. We explore how our empirical work and its theorising helps us in decolonising and disorienting understandings of how cosmetic surgery tourism is assembled geographically – where geography is as much imagined as it is a material reality. Using insights from fieldwork in South Korea, Thailand and Tunisia, we counter the dominant view of footloose global elites gliding seamlessly around the world in search of transformation. Our patient journeys were very different, often leading to disorientation.

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Ruth Holliday, Meredith Jones and David Bell

This chapter presents our theoretical approach to cosmetic surgery and its discourses. We argue that cosmetic surgery tourists are seeking value, and that for many of those we spoke with, their bodies were the only asset it was possible for them to invest in. We argue that existing feminist theories of cosmetic surgery fail to account for material, fleshy bodies that change over time. Whilst most cosmetic surgery theories point to an external (‘perfect’) body of popular culture to which the cultural dopes of cosmetic surgery are subject, we point instead to instances of melancholy for a lost body, when comparisons are more often with one’s own body as it used to be than with ‘image culture’. Images do however provide guides and possible styles: when one wants to change one’s body, one has to illustrate how. So, while we do not see cosmetic surgery as totally outside any regime of images, we argue that images have a more complex and nuanced role than cosmetic surgery discourse allows. The chapter includes a discussion of the PIP scandal as a way to interrogate the workings of this discourse.

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Ruth Holliday, Meredith Jones and David Bell

This chapter explores how some of the patients we spoke with experienced the places they found themselves in as they travelled for surgery. We provide a detailed account of a trip we took to Tunisia with a group of British women, and then work to unpack this encounter by drawing on work discussing cosmopolitanism and conviviality. The ways the women worked understand both their own journeys and those of the other people they met in Tunisia can be usefully interrogated by thinking about conviviality. In their meetings with each other, with medical staff and crucially with patients being treated for injuries sustained in the civil war in Libya following the Arab Spring uprisings, these patients experienced both a global geopolitical reality that they were unaware of, and moments of empathy, vulnerability and generosity that were as transformative as the surgeries they came to Tunisia to access. Such encounters can be read as producing cosmopolitan beginnings – shifts in worldview that emerge as unintended effects of the surgical journeys this group of women embarked upon.

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Ruth Holliday, Meredith Jones and David Bell

Our conclusion summarises our principal arguments and addresses the role of the neoliberalism and austerity in producing a globalising healthcare market. The chapter draws on one case in detail, that of Leigh from Australia who sadly died from medical complications after returning home from Malaysia, having undergone multiple procedures. Leigh’s case highlights some of the risks of travelling abroad for treatment. But it also illustrates many of the reasons that patient-consumers are prepared to take that risk in a neoliberal culture of declining national healthcare where health and happiness is constructed as being in our own hands.

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Ruth Holliday, Meredith Jones and David Bell

This chapter examines cosmetic surgery tourist communities in ‘real life’ and on social media. It examines the socialising, bonding and support networks that circulate around and within the practice of cosmetic surgery tourism, showing how a distinct form of sociality arises from – and also constitutes – this phenomenon. Group tours are analysed as particularly illustrative of this distinctive sociality. The chapter argues that bodies transformed by cosmetic surgery tourism are ‘worked upon’ by both surgery and by social media because these media provide platforms for vital interactions that facilitate caring human relationships and supportive communities that could otherwise not exist. Social media platforms such as Facebook are shown to be part of the networks and assemblages that create both cosmetic surgery tourism and cosmetically altered bodies. Our discussion here centres around temporality, using the familiar time slices of before, during and after that structure many cosmetic surgery and tourism narratives.

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Clinical trails

Researching cosmetic surgery tourism

Ruth Holliday, Meredith Jones and David Bell

This introductory chapter provides an overview of the book and of the research project on which it is based. It grounds the analysis of cosmetic surgery tourism through a detailed discussion of framing ideas – such as defensive subjects and identity knowledges – that shaped the epistemological approach of the research. It provides detailed accounts of two ethnographic fieldwork encounters, and reflects on how these were experienced by everyone involved, including the researchers. In so doing, it foregrounds the value of experience as a research resource. The chapter ends with outlines of the chapters of the book.