Background to the scope of this study and positionality

My personal experience has served as the driver for my research interests and tempered the politics of my intellectual engagement with international medical travel (IMT). Using IMT as a lens through which to examine healthcare’s role in linking people and making places has permitted me to work through a broad spectrum of categorisations of human mobility and the equally broad spectrum of care-giving and -receiving relationships to which such categorisations fundamentally relate.

As someone who considers herself somewhat of a global nomad, I have tended to think that I have been rather fortunate to hold an American passport. It has been relatively easy to pass in and out of many countries as a tourist because of it. Yet, while categorised in many moments and places as a ‘tourist’, in many others crossing borders with different intentions and more extended time- frames has rendered me subject to many new and different levels of surveillance and regulation. ‘Even’ as an American, I have had to have my lungs checked for TB in the presence of a notary in order to enter Belgium on a student visa. I have waited in many day-long queues at immigration authorities’ headquarters to receive the assortment of documents and rubber stamps that attested to my legal status as an economic migrant in Portugal, only to, years later, use my blood donor ID and library card to help prove my active ‘membership’ and demonstrate to the Portuguese state that I was worthy of that country’s citizenship. Armed with two passports these days and benefiting from the entitlements that Portugal’s membership to the European Union has afforded me, I now live and work in the Netherlands and enjoy accessible, quality healthcare that my family in the United States can only dream of. While I have been able to more permanently escape the woes of the US healthcare system, they have not. My grandfather used to cross the border into Mexico for affordable arthritis medication. My aunt has been bankrupted by a liver transplant. My mother worries about whether she will be able to afford health insurance as she gets older. Undertaking these journeys, performing different mobility categories and coping with these disparities, I have often wondered about what sorts of belonging permits a sufficient exchange of recognition to occur to allow for a relationship of care to take root.

If simply being a citizen of a country was, in most places throughout the world, not sufficient to secure adequate access to quality healthcare, then what was? With the privatisation of healthcare throughout the world, having enough money to pay for care is clearly quite an effective lubricant for access. Yet it is not always sufficient. In the wake of 9/11 and tighter entry restrictions into many Western countries, ‘even’ wealthy passport-holders from Muslim (especially Arab) countries that had long been medical tourism habitués in Western countries found that, because they were Muslims, they and their money were no longer as welcome as they had been just a year before.

Several countries with Muslim majorities or significant minorities, already promoting themselves as IMT destinations (e.g., Dubai (UAE), India, Jordan, Thailand, Singapore and Malaysia) to Western and regional markets, began to tout their ‘Muslim-friendly’ expertise and advertise their more relaxed entry requirements to capture this temporarily detoured market. With my educational and research backgrounds in Middle Eastern and migration studies sensitising me to the challenges of religious and ethnic discrimination to fulfilling basic needs, I was compelled to develop a PhD proposal that initially focused on IMT destinations that promoted themselves as offering ‘Muslim-friendly’ healthcare in the years after 9/11, as places that extended recognition and care (albeit in a commodified form) to people in otherwise economically comfortable positions that had been turned away elsewhere. I sought to explore how the emerging IMT care sector intersects with shifting notions of transnational identities and belongings (e.g., building stronger relationships with the transnational Muslim community [‘umma]) and the ways in which these changes are linked to broader geopolitical changes in relationships between nations, groups and individuals, even in instances in which those relationships are commodified.

Malaysia – with its multiethnic society, ongoing projects to promote itself as a modern, moderate Muslim-majority country and strong state support of ‘medical tourism’ – stood out as the most fitting case through which to explore relationships produced through the extension of recognition and care to select non-citizen Muslim others. It was while undertaking the early fieldwork in Malaysia that I came to grasp the bigger picture – to recognise that the ‘Muslim- friendly’ IMT campaign I had first sought to explore was only one facet of the many fascinating ways in which ‘Malaysia’ was being promoted both within and outside of the country by IMT proponents. The media coverage I read and the interviews I had with state, private-sector and civil society stakeholders revealed a wealth of ‘Malaysias’ that demonstrated complex layers of colonial, religious and regional discursive and material linkages being used to frame correspondence to, and legitimise the harnessing of, lucrative and otherwise strategic global flows. The fieldwork expanded my initial focus and ultimately resulted in the thesis chapters that follow, each grounded in empirical material that correlates to different supply-side framings of ‘Malaysia’ projected to and upon perceived allies and markets through the extension of care. While the scope of the research ultimately expanded, the rationale has remained the same: with this thesis, I seek to contribute timely insight into the dynamic and rapidly expanding IMT sector by broadening the field of theoretical inquiry around IMT through introducing a critical cultural reading that has often proven absent in the literature and by decentring the dominant narratives of IMT often cast in terms of a neo-colonial ‘metropole’/periphery dichotomy that only serves to obscure the significant underlying interdependencies inherent to care exchanges.