“You’re dealing with an emotionally charged individual…”: an industry perspective on the challenges posed by medical tourists’ informal caregiver-companions

Abstract

BackgroundPatients engage in medical tourism when they privately obtain a medical care abroad. Previous research shows that many medical tourists travel abroad with friends and family members who provide support and assistance. Meanwhile, very little is known about this important stakeholder group, referred to here as caregiver-companions. In this article we examine the challenges that can be posed by caregiver-companions and the overall practice of informal caregiving in medical tourism from an industry perspective. Specifically, we report on the findings of interviews conducted with international patient coordinators (IPCs) who work at destination facilities. IPCs come into regular contact with caregiver-companions in their professional positions and thus are ideally suited to comment on trends they have observed among this stakeholder group as well as the challenges they can pose to medical tourists, health workers, and facilities.MethodsWe conducted 20 semi-structured interviews with 21 IPCs from 16 different facilities across nine countries. Topics probed in the interviews included caregiver-companion roles, IPCs’ and others’ interaction with caregiver-companions, and potential health and safety risks posed to medical tourists and caregiver-companions. Thematic analysis of the verbatim transcripts was employed.ResultsAlthough most participants encouraged medical tourists to travel with a caregiver-companion, many challenges associated with caregiver-companions were identified. Three themes best characterize the challenges that emerged: (1) caregiver-companions require time, attention and resources; (2) caregiver-companions can disrupt the provision of quality care; and (3) caregiver-companions can be exposed to risks. IPCs pointed out that caregiver-companions may, for example, have a negative impact on the patient through cost of accompaniment or inadequate care provision. Caregiver-companions may also create unanticipated or extra work for IPCs, as additional clients and by ignoring established organizational rules, routines, and expectations. Furthermore, caregiver-companions may be susceptible to stresses and health and safety risks, which would further deteriorate their own abilities to offer the patient quality care.ConclusionsAlthough caregiver-companions can pose challenges to medical tourists, health workers, and medical tourism facilities, they can also assist in enhancing best care and offering meaningful support to medical tourists. If caregiver-companions are open to collaboration with IPCs, and particularly in the form of information sharing, then their experience abroad can be safer and less stressful for themselves and, by extension, for the accompanied patients and facility staff.

Ethics of care in medical tourism: Informal caregivers' narratives of responsibility, vulnerability and mutuality

“…These landscapes are a product of the social and working conventions present in destination facilities, and of informal caregivers' own internal narratives of responsibility, vulnerability, and mutuality. The interviews show that caregiver-companions have to interweave care across a number of micro-landscapes, playing a key role in enacting the landscapes of care in destination facilities and across other care settings (e.g., the hotel), and mediating interactions between medical tourists and health care professionals abroad (see also Casey et al, 2013aCasey et al, , 2013b. These microlandscapes were nested within the larger context of enabling the provision of care across countries, cultures, care contexts, and sometimes also languages.…”

“…Industry reports and recent studies show that these individuals are often active participants in the practice of medical tourism, although the scope and scale of their care work has only been partially documented (see NaRanong and NaRanong, 2011;Yu and Ko, 2012;Yeoh et al, 2013;Margolis et al, 2013;Casey et al, 2013aCasey et al, , 2013b. These reports and studies document caregiver-companions taking on roles such as providing hands-on care, liaising with health workers, booking accommodations, coordinating travel, monitoring symptoms, and maintaining communication with friends and family at home.…”

“…The value attributed to informal caregiving varies across landscapes of care. The often invisible labor of caregiver-companions in both private and formal spaces complements the labor of health care workers and others employed in the medical tourism industry in destination countries (Casey et al, 2013a(Casey et al, , 2013b. Ethics of care theorists point to the tendency for informal care work to be devalued, in part because it often occurs outside the institution, while privileging formal care work in institutional settings (Tronto, 1993;Lawson, 2007).…”

“…Ethics of care theorists point to the tendency for informal care work to be devalued, in part because it often occurs outside the institution, while privileging formal care work in institutional settings (Tronto, 1993;Lawson, 2007). We contend that medical tourism reproduces this positioning of care: first, by devaluing the labor of caregiver-companions (see Kingsbury et al, 2012;Casey et al, 2013aCasey et al, , 2013b, and second, by hiding care from view in foreign places and private spaces, such as the hotel room.…”

Medical Tourism: An Emerging Terrain

“…Hospitals measure numbers differently, like whether a tourist travelled there specifically for treatment or just happened to get sick while traveling for business reasons. Both may be considered the "international patient", while there is a clear distinction between the business traveler and the medical tourist [10][11][12][13][14][15].…”