A partir du cas de femmes maghrébines et africaines atteintes de cancer, venant en France où elles reçoivent un traitement anti-cancéreux, l’article met en lumière la diversité des expériences dont rend difficilement compte la catégorie générique de mobilités thérapeutiques, appliquée à la situation de personnes étrangères en quête de soins. Il montre comment la dimension spatiale est indispensable pour comprendre la manière dont ces femmes utilisent l’offre de soin et, plus largement, saisir les inégalités qu’elles perçoivent, les moyens par lesquels elles tentent d’y faire face et les effets produits sur les parcours de vie. L’article contribue ainsi à déconstruire la dichotomie, fréquente dans la littérature, entre tourisme médical et immigration thérapeutique : dichotomie renvoyant plus à des catégories exogènes, liées au gouvernement des populations et à des régimes de légitimité distincts, qu’à une expérience anthropologique.
This article, based on case studies of Arabic and African women with cancer who travel to Brittany, France to receive cancer therapy, highlights the variety of experiences of foreign people seeking healthcare. Such variety is poorly represented by the generic category of therapeutic mobility. The paper is structured in two parts. The first shows the diverse circumstances in which these women with cancer have come to France; the second addresses the reorganisation, over time, of their logics of presence. By logics of presence, I mean how individuals consider and see themselves in a given space and time, particularly in the country in which they are receiving life-saving treatment. The study thus shows how spatial dimension offers important insights to the analysis of patients’ use of health care services, identifies the inequalities they experience and the ways in which they try to overcome them. Above all, it contributes to deconstructing the distinction made between medical immigration and medical tourism. The first point of deconstruction relates to a socioeconomic dichotomy: the present study shows how the distinction between ‘rich’ and ‘poor’ people, which partly feeds the contrast between medical tourism and medical immigration, is called into question by the combined experiences of disease and migration. The second point of deconstruction relates to the temporal dimension of the mobility in question. In the common representations of medical tourism and medical immigration, the former is associated with a one-off visit to a third territory, whereas the latter is underpinned by staying and settling for a considerable length of time. This same distinction is seen more widely in the root terms of immigration and tourism: the tourist arrives and leaves whereas the immigrant arrives and stays. Yet, measuring this distinction raises methodological challenges which in turn are related to the research approach adopted: should we assess this distinction retrospectively or base it on a predetermined period of time,or even on intent to depart? Length of stay is an issue which is all the more difficult to grasp because along certain life course trajectories, a combination of factors (health-related, economic, social, familial, political, etc.) contribute to redefining initial plans. The paper seeks to make explicit these shifting frameworks of time and explore their implications. The study shows how a combination of events leads women to stay, even though they did not intend to do so at the beginning. The final point of deconstruction relates to the organizational contexts of the two categories. Medical tourism is typically viewed as corresponding to mobilities that are governed and overseen by States (organised flows), whereas medical immigration is more ‘anarchic’ (flows that are not institutionally organised). But even in this distinction, the dividing line is debatable. This can be seen by the conventions signed by healthcare establishments with other countries (specifically Algeria, in the scope of the present study) to facilitate treatment for foreign cancer patients within an institutional framework. These conventions are not always renewed; one reason for this is the possible creation of an uncontrolled ‘inward flow’ involving outstanding payments for the host establishments. In conclusion, the paper argues that the dividing line between medical tourism and medical immigration reflects the political and ideological issues related to modes of population governance in the context of globalisation. It is a division that brings into play differentiated representations of foreigners as more or less suspected of seeking unwarranted treatment/illegal residence in the country depending on their social and geographical origins. Yet, such categories rarely adequately consider the anthropological experience, which is marked by the blurring of temporal, spatial, and social categories. They establish a theoretical division between healthcare configurations abroad without taking into account these shifting logics of presence or the familial, health and socioeconomic eventualities that lead individuals to remain, return and reorganise an initial short-term stay into a ‘long-term provisional stay’ (Sayad 1999).
