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

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.

'You cannot do IVF in Africa as in Europe': the making of IVF in Mali and Uganda.

In sub-Saharan Africa, many gynaecologists and embryologists agree that 'you cannot do IVF in Africa as in Europe'. Based on empirical data from anthropological fieldwork, this article contrasts the establishment of IVF provision in a private fertility clinic in (francophone, Muslim-dominated) Mali with one in (anglophone, Christian-dominated) Uganda. Outlining the history of setting up IVF procedures at each site, the author shows the distinct ways in which the respective clinics have found to juggle structural challenges. The question of how religious moral concepts are integrated in the way in which assisted reproductive technology is practised at the two sites is also considered, revealing the moral ambivalences of practitioners and patients, donors and surrogates. By contrasting the processes of setting up IVF therapeutics in a Malian and a Ugandan clinic, the author shows that sub-Saharan African countries, although sharing similar historical positioning in global power topographies, structural and political shortcomings, nevertheless exhibit a range of developments and societal answers in response to the challenges, both moral and structural, inherent in establishing assisted reproductive technology-based infertility treatment.

ARVs and ARTs: medicoscapes and the unequal place-making for biomedical treatments in sub-Saharan Africa.

Asking why some diseases gain global attention whereas others are neglected, we present two case studies that demonstrate the unequal treatment and financing options available for HIV/AIDS versus infertility treatments. We track three key phenomena central to understanding the unequal public attention given to certain ailments: peace and security, subordination of the social to the biological, and a "global" quality. Existing concepts such as global assemblages or therapeutic citizenship are quite limited when it comes to bodily conditions that result in social suffering and do not satisfy the conditions of advocacy. Since it is not enough to observe "flowing" and "moving," we propose the concept of medicoscapes, to acknowledge that such activities simultaneously entail channeling and carving out. Medicoscapes enhance the analysis of linkages between different health conditions regardless of whether they are biological or social and how they interconnect places, sites, and people.

Biomedical techniques in context: on the appropriation of biomedical procedures and artifacts.

On the assumption that technical practices and artifacts are fundamental constituents of individual and collective attempts to order lives and bodies in health and sickness, in this introduction, we set out three central propositions. First, medical techniques have to take center stage in research on biomedicine. Second, as medical artifacts travel worldwide, they become part of the processes of sociocultural appropriation. Third, anthropologists have to consider how to study the transformations associated with such appropriation and how much they need to know about the technical aspects of their objects of study. The mutual transformative potential of both biomedical artifacts and practices and the new contexts of application have so far been undertheorized in medical anthropology--a gap that we aim to close with our reflections and the collection of empirical studies of various biomedical techniques in this issue.