Medical missions have long addressed the health needs of the world's most vulnerable populations. Typically, volunteer teams travel to resource-poor countries on a short-term basis to treat common ailments, promote health and attend to other primary care needs. A recent trend in medical humanitarian aid, however, emphasizes the movement of technologically-sophisticated, state-of-the-art care from rich to poor countries. Pediatric heart surgery missions exemplify this trend, thus defining a new context where biotechnologies and associated knowledge circulate globally.

This study investigates the social and medical ramifications of this emergent form of technology transfer in contexts where surgeons from the United States make visits to El Salvador to repair damaged pediatric hearts. The research examines how heart surgeries are performed in resource-poor settings; how humanitarian medicine is imagined and experienced by providers and recipients of care; and the long-term consequences of efforts to treat patients, train physicians and bring in new supplies. The researcher will conduct 14 months of ethnographic field research in two countries (the United States and El Salvador) to examine the practices, significance and long-term effects of pediatric heart surgery missions in El Salvador. By focusing on the practices, meanings and grounded impacts of pediatric heart surgery missions, this study expands or refines theories related to bodies and biotechnologies: namely, bodies as not things-in-themselves but objects made and unmade through practice (namely, surgical intervention) and biotechnologies as global flows that are imagined, embraced and reworked in local settings. In addition, this study will contribute to knowledge on humanitarian science aid more generally.

The project will have broad impact by providing insight into the political and cultural effects of knowledge transfer in global settings. Although this project focuses on one particular technology, research findings will offer insight into the social science study of technology transfer more broadly. Research findings will be shared at academic conferences and academic publications as well as through presentations and publications geared toward health care professionals.

Project Report

In poor countries, children with congenital or acquired heart disease either go untreated, which can result in an early death and or a limited opportunity for a full life, or are transferred overseas for surgical intervention. Now these children are treated in country by traveling teams of medical volunteers. Armed with expert knowledge, specialized machinery, and the desire to serve, these volunteers make routine visits to under-resourced settings to repair damaged hearts and train local practitioners to treat this condition independently. I conducted 13 months of ethnographic field research in clinical and non-clinical settings in Honduras to study the practices, meanings, and effects associated with this contemporary form of medical technology transfer. Foreign clinicians develop innovations to address the challenging situations they encounter in the settings where they work. One innovation is the ultra-fast recovery of patients after open-heart surgery. Strategies such as early removal from mechanical ventilation, early feeding and walking, and minimal use of sedation and addictive painkillers allow patients to return home in less than three days. Other innovations involving new designs for patches and heart valves allow patients to be treated with a single open-heart procedure as opposed to a staged repair. Current literature about global biomedicine and its associated technologies recognizes that biomedicine is not practiced the same universally, an idea that this study supports. This study also lends new insights. Contrary to my initial assumptions, I learned that such modifications are driven by not cost alone but the desire to institute a superior model of pediatric heart care. The ultra-fast recovery of patients, for example, is thought to be easier on the body and protective against hospital-born illnesses. This model of care has yet to be adopted on a global scale. The ability for patients in Honduras to receive innovative treatments available in their home country challenges our understanding of how medical migratory flows work. It is typically assumed that the best medicine exists in rich countries, accessible internationally only to those with the financial means to travel. In this case, a superior form of pediatric heart care is reserved for those who stay put. I also found that not all foreign clinicians innovated new techniques when working in Honduras. Instead, some tried to emulate in Honduras what clinical practices would be at their home institutions. Clinicians that innovated wanted every child born with a heart defect to have a fair chance to have it repaired; by innovating, they could offer surgeries to patients who would otherwise be denied treatment. Clinicians that did not innovate, by contrast, interpreted fairness to mean applying the same standard of care as they would apply at home, even if this meant limiting the number of children treated. These differences highlight the nuances of humanitarian medical practice, specifically, that within this field the notion of justice is contested terrain. Third and finally, observations and interviews with parents revealed that many parents were eager to consent to even the riskiest procedures. Such enthusiasm must be understood as a reflection of the socioeconomic realities that define their lives. I learned that raising a child with a heart defect in Honduras was a tremendous emotional and financial burden. It required regular visits to medical facilities, extended in-hospital stays, and the purchase of expensive medications, all of which exhausted household resources. The decision to undergo surgery, thus, intersected with desires to fashion a better future. Such desires, however, were complicated by the fact that post-surgical outcomes were not always ideal. Surgical complications resulted in a need for ongoing medical care. Even when patients regained near perfect health, parents struggled to meet their children’s educational and nutritional needs. In line with other studies about medical humanitarian aid, this study extends the idea that humanitarian efforts to address immediate suffering tend to restore only minimalist forms of survival, a problem that must be understand as not the fault of humanitarian actors but as a function of the wider contexts in which they work.

National Science Foundation (NSF)
Division of Social and Economic Sciences (SES)
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Kelly Moore
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Columbia University
New York
United States
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