Vulnerabilities in transnational patient mobility

Linguistic vulnerabilities and translation and interpreting in transnational patient mobility

 

Just. Journal of Language Rights and Minorities, Revista de Drets Lingüístics i Minories

Guest editors:

Sonja Pöllabauer & Katia Iacono 

 

Transnational patient mobility refers to citizens and residents of a particular country of origin (source country) seeking medical treatment in another country (destination country) (Lunt, Horsfall & Hanefeld 2016). Patients are hence not temporary or permanent residents of the destination country and may cross borders for healthcare services for short- or longer-term care. This type of patient mobility has been addressed under different terms (e.g., medical/health/patient mobility, international/transnational/cross-border patient mobility, medical travel, or transnational healthcare) (Freyer & Kim 2013). However, some of the labels used (e.g., medical/health tourism) have been criticized for their negative or misleading connotations (Snyder, Dharamsi & Crooks 2011), for superficially linking potentially severe medical conditions with connotations of leisure and relaxation. Cross-border medical travel can occur from high-income to low-income countries and vice versa (Durham & Blondell 2017). It can involve either insurance coverage or lack thereof (Glinos et al. 2010). And even if the literature mostly discusses patient mobility, there are also types of provider mobility, such as physicians traveling to provide care to patients (Elnawawy, Lee & Pohl 2014; see Snyder, Dharamsi & Crooks 2011 on physician volunteerism).

Patients’ motives for transnational patient mobility may be grounded in availability—either of quantity (e.g., waiting lists) or types of medical services—or in affordability, familiarity with a certain type of treatment (within, for instance, a specific country or diaspora community), or perceived quality (Glinos et al. 2010; Laugesen & Vargas-Bustamante 2010). Types of availability may have geographical, financial, or legal dimensions (see also Lunt & Carrera 2010): certain services may not be available at all or to a sufficient degree of coverage in certain areas, or not at the highest quality (top-notch research); they may be too expensive (e.g., dental treatments, cosmetic surgery, or wellness treatments); not legally allowed (e.g., certain types of reproductive health treatments including surrogacy, gender transformation surgery, end-of-life assistance such as euthanasia and assisted suicide, abortion or anonymous births); or controversial such as certain cancer treatments or stem cell treatments (Laugesen & Vargas-Bustamante 2010). Law-evasive treatments have been included under circumvention patient mobility (Cohen 2012; Snyder 2022), those most usually covered out-of-pocket (Glinos et al. 2010).

Transnational patient mobility has become a worldwide and globalized phenomenon with far-reaching ethical implications (Smith 2012; Whitmore, Crooks & Snyder 2015; Cesario 2018). From an economic perspective, it has turned into a considerable business factor with diverse stakeholders involved (Lunt & Carrera 2010; Smith 2012): millions of patients, with diverse financial and social backgrounds, travel to destination countries every year to undergo medical treatment (Patients Beyond Borders 2023). Some common destination countries lie both in the global South (Meghani 2011) and in industrialized countries or the EU (see Patients Beyond Borders 2023 for country examples), depending on which type of service is sought. Within the EU, Directive 2011/24/EU regulates different types of health mobility and establishes the conditions for reimbursement of the costs incurred if the services are legal and thus covered by health insurance.

Patients choosing to undergo medical treatment in a destination country face a range of organizational, economic, and linguistic challenges (Crooks et al. 2010), though there are few studies based on empirical data about patients’ concrete experiences (Crooks et al. 2010). Informed consent and risk management are considered particularly problematic (Crooks et al. 2013; Snyder et al. 2013; Hohm & Snyder 2015): language barriers may have an impact on the patients’ right to be informed before undergoing a medical treatment; in addition, in case of medical and communication errors, it may also not be straightforward to determine which court has jurisdiction (Iacono 2021, 40).

A smaller body of literature addresses informal caregivers’ perspectives which also point to a lack of support structures and challenges in informed decision-making and risk management (Crooks et al. 2017; Whitmore, Crooks & Snyder 2017). Along with online networks and social media (Hanefeld et al. 2015; Hohm & Snyder 2015), so-called brokers or facilitators (individuals or companies) play an important role as a third party in the global healthcare market in connecting patients with providers in some countries and for certain fields (Penney et al. 2011)—again a partially commercialized practice that carries specific ethical and legal implications (Snyder, Dharamsi & Crooks 2011; Hunter 2020).

Medical providers, as the other major party, are faced with providing a satisfactory servicescape (Kim et al. 2017), including advertising, or making known, their services (Bartłomiejczyk & Pöllabauer 2022), patient recruitment, organizational matters, ethical and legal considerations, and political aspects, such as the impact of transnational patient mobility on destination health human resources (Crooks et al. 2019). Further issues arise from the provision of cultural care structures and competence (Whittaker & Chee 2015) and linguistic support (Angelelli 2015), with language being an important commodity (Muth 2018) where minority language speakers’ needs may not always be fully satisfied (e.g., availability of interpreters’ provision for languages of limited diffusion).

Despite the crucial role of communication, including translation and interpreting, in transnational patient mobility, studies on specific linguistic or cultural aspects of transnational patient mobility remain underrepresented both in translation and interpreting studies (TIS) (for some exceptions, see Angelelli 2015; Lee 2015; Muth & Suryanarayan 2020; Iacono 2021; Bartłomiejczyk & Pöllabauer 2022; Iacono 2022; Bartłomiejczyk, Pöllabauer & Straczek-Helios forthcoming; Pöllabauer et al. forthcoming) and in other disciplines that explore translation in patient travel. Moreover, while the legal, economic, or medical-ethical implications of this type of patient mobility, among other aspects, have been addressed in fields such as legal studies, economics, medicine and health sciences, or tourism research (Iacono 2022, 130), these only scarcely touch upon the particularities of transcultural communication and linguistic support, including translation and interpreting.

Issues of communication and healthcare interpreting have been addressed widely not only in interpreting research (Hsieh 2015) but also in practice guidebooks (Angelelli 2019) and in different health disciplines. This body of literature also examines aspects that pertain to transnational patient mobility (e.g., structural deficits fostering linguistic inequalities, issues of power and language in physician-patient encounters, role confusion and overload and ethical dilemmas encountered by interpreters, issues of emotionality, empathy, and self-care, interpreters’ qualifications). Specific aspects linked to transnational patient mobility, however, have been less widely explored.

So far, studies which (also) adopt a closer focus on linguistic practices in transnational patient mobility have focused on training interpreters for the field of medical tourism (Lee 2015), the commodification of linguistic resources in the framework of neoliberalist healthcare structures and its limitations in transnational patient mobility (Muth 2017, 2018), the need for entrepreneurship among language workers in patient travel (Muth & Suryanarayan 2020) and interpreters’ service portfolio (Iacono 2021, 2022), multilingual websites advertising the service of abortion clinics (Bartłomiejczyk & Pöllabauer 2022), and activists’ motivation for also engaging in linguistic support (Pöllabauer et al. forthcoming). In an exploratory study on language provision in cross-border healthcare in the EU, commissioned by the Directorate-General for Translation, Angelelli (2015) reports on language policies in five (then) EU countries (Germany, Greece, Italy, Spain, and the UK), concluding that “language support/provision for cross-border healthcare patients is neither guaranteed nor provided in an even manner across the MSs [Member States] and sites observed” (2015, 91).

Against this background, this special issue aims to shed light on specific characteristics, challenges, and ethical dimensions of communication in transnational patient mobility, including translation and interpreting. It aims to scrutinize whether these promote or exacerbate linguistic inequalities, which have been framed as linguistic vulnerabilities (Määttä, Puumala & Ylikomi 2021; see also Butler 1997 on linguistic vulnerability). Authors are invited to submit 500- to 700-word abstracts, exclusive of references, in English, Spanish, or Catalan. We particularly welcome case studies, data-driven research, and methodological discussions, both from the field of translation and interpreting studies and from other disciplinary angles.

Topics of interest include, but are not limited to the following aspects:

• challenges faced by different stakeholders in transnational patient mobility, including translators and interpreters, such as ethical, emotional, linguistic dimensions of communication and cooperation, and linguistic vulnerabilities;
• types of cooperation, (linguistic) risk management, and issues of informed consent and decision-making among different stakeholders and patients;
• perceived and assumed role space (Llewellyn-Jones & Lee 2014) of interpreters and translators and other ‘language workers’ in transnational patient mobility;
• linguistic issues in ensuring the legal protection of patients in transnational patient mobility, including issues arising from the use of machine translation;
• activism and feminist approaches to transnational patient mobility;
• motivational aspects related to communication and translation and interpreting in transnational patient mobility;
• needs of and challenges encountered in specific types of treatment, including law-evasive mobility, and by specific groups, for instance, hidden populations (Lomeña-Galiano 2020) and more vulnerable groups in sensitive fields (e.g., women, children, youth, surrogate mothers, elderly patients, end-of-life patients, transgender persons), including intersectional approaches;
• aspects of linguistic vulnerabilities in transnational patient mobility related to bioethics and health communication;
• aspects of linguistic vulnerabilities in transnational patient mobility related to biolaw and biopolitics;
• structural conditions and communication and translation policies, including communication (informal or online) with facilitators networks or brokers.

 

Just. Journal of Language Rights & Minorities, Revista de Drets Lingüístics i Minories is a journal dedicated to disseminating scholarship on the protection, enforcement, and promotion of the rights of linguistic minorities as well as related themes arising from the confluence of language, the social dynamics of dominance and oppression, and the law. All abstracts and manuscripts should use non-exclusionary language and use Just’s author guidelines (https://ojs.uv.es/index.php/JUST/about/submissions), based on the Chicago Manual of Style (CMS) (https://www.chicagomanualofstyle.org/tools_citationguide/citation-guide-2.html) for both citation and drafting. Interested authors are invited to send 500- to 700-word proposals and inquiries directly to the guest editors: Sonja Pöllabauer (sonja.poellabauer@univie.ac.at) and Katia Iacono (katia.iacono@univie.ac.at) by 1st November 2024. Authors of abstracts that are accepted for consideration will be invited to submit a full manuscript that is between 6000 and 8000 words in length (exclusive of abstract and references but including footnotes). Every manuscript will be submitted to a double-blind peer review that includes at least two referees.

 

The publication of this special issue will adhere to the following editorial timeline:

 

Abstracts (500-700 words) due to guest editors	1 February 2025
Decision on abstracts	1 March 2025
Submission of full manuscripts	1 October 2025
Final versions of papers	1 May 2026
Decision to authors	15 July 2026
Publication of special issue	9 October 2026

 

 

References

Angelelli, Claudia V. 2015. A Study on Public Service Translation in Cross-Border Healthcare: Final Report for the European Commission Directorate-General for Translation. Luxembourg: Publications Office of the European Union.

Angelelli, Claudia V. 2019. Healthcare interpreting explained. London: Routledge. https://doi.org/10.4324/9781315310978.

Bartłomiejczyk, Magdalena & Sonja Pöllabauer. 2022. “Communication needs in circumvention medical tourism: Multilingual websites of abortion clinics.” Linguistica Silesiana 43: 237–256.

Bartłomiejczyk, Magdalena, Sonja Pöllabauer & Veronika Straczek-Helios. forthcoming. “‘The heart will stop beating.’ Ethical issues in activist interpreting: The case of Ciocia Wienia.” Interpreting.

Butler, Judith. 1997. “Introduction on linguistic vulnerability.” In Excitable speech. A politics of the performative, 1–42. London: Routledge. https://doi.org/10.4324/9781003146759-1.

Cesario, Sandra K. 2018. “Implications of medical tourism.” Nursing for Women’s Health 22 (3): 269–273. https://doi.org/10.1016/j.nwh.2018.03.008.

Cohen, Glenn. 2012. “Circumvention tourism.” Cornell Law Review 97 (6): 1309–1398.

Crooks, Valorie A., Paul Kingsbury, Jeremy Snyder & Rory Johnston. 2010. “What is known about the patient’s experience of medical tourism? A scoping review.” BMC Health Services Research 10. https://doi.org/10.1186/1472-6963-10-266.

Crooks, Valorie A., Ronald Labonte, Alejandro Ceron, Rory Johnston, Jeremy Snyder & Marcie Snyder. 2019. “‘Medical tourism will... obligate physicians to elevate their level so that they can compete’: A qualitative exploration of the anticipated impacts of inbound medical tourism on health human resources in Guatemala.” Human Resources for Health 17 (53): 1–11. https://doi.org/10.1186/s12960-019-0395-z.

Crooks, Valorie A., Leigh Turner, I. Glenn Cohen, Janet Bristeir, Jeremy Snyder, Victoria Casey & Rebecca Whitmore. 2013. “Ethical and legal implications of the risks of medical tourism for patients: A qualitative study of Canadian health and safety representatives’ perspectives.” BMJ Open 3 (2). https://doi.org/10.1136/bmjopen-2012-002302.

Crooks, Valorie A., Rebecca Whitmore, Jeremy Snyder & Leigh Turner. 2017. “‘Ensure that you are well aware of the risks you are taking…’: Actions and activities medical tourists’ informal caregivers can undertake to protect their health and safety.” BMC Public Health 17. https://doi.org/10.1186/s12889-017-4442-1.

Durham, Jo & Sarah J. Blondell. 2017. “A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries.” Globalization and Health 13 (68): 1–14. https://doi.org/10.1186/s12992-017-0287-8.

Elnawawy, Omnia, Andrew C. K. Lee & Gerda Pohl. 2014. “Making short-term international medical volunteer placements work: a qualitative study.” British Journal of General Practice 64 (623): E329–E335. https://doi.org/10.3399/bjgp14X680101.

Europe. European Parliament & Council of the European Union. 2011. Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. L 88/45. Adopted 4 April 2011, https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32011L0024.

Freyer, Walter & Bong-Seok Kim. 2013. “Medizintourismus und Medizinreisen – eine interdisziplinäre Betrachtung.” Gesundheitswesen 76 (1): 65–68. https://doi.org/10.1055/s-0033-1343439.

Glinos, Irene A., Rita Baeten, Matthias Helble & Hans Maarse. 2010. “A typology of cross-border patient mobility.” Health & Place 16 (6): 1145–1155. https://doi.org/10.1016/j.healthplace.2010.08.001.

Hanefeld, Johanna, Neil Lunt, Roger Smith & Dan Horsfall. 2015. “Why do medical tourists travel to where they do? The role of networks in determining medical travel.” Social Science & Medicine 124: 356–363. https://doi.org/10.1016/j.socscimed.2014.05.016.

Hohm, Carly & Jeremy Snyder. 2015. “‘It was the best decision of my life’: A thematic content analysis of former medical tourists’ patient testimonials.” BMC Medical Ethics 16. https://doi.org/10.1186/1472-6939-16-8.

Hsieh, Elaine. 2015. “Healthcare interpreting.” In Routledge encyclopedia of interpreting studies, edited by Franz Pöchhacker, 177–182. London: Routledge.

Hunter, Benjamin M. 2020. “Going for brokerage: Strategies and strains in commercial healthcare facilitation.” Globalization and Health 16 (1): 1–13. https://doi.org/10.1186/s12992-020-00578-z.

Iacono, Katia. 2021. Dolmetschen im Medizintourismus. Anforderungen und Erwartungen an DolmetscherInnen in Deutschland und Österreich. Tübingen: Narr Francke Attempto.

Iacono, Katia. 2022. “Interpreting in quality-centred medical tourism in Austria and Germany.” Trans-kom 15 (1): 128–141.

Kim, Minseong, Dong-Woo Koo, Dong-Jin Shin & Sae-Mi Lee. 2017. “From servicescape to loyalty in the medical tourism industry: A medical clinic’s service perspective.” Inquiry. The Journal of Health Care Organization Provision and Financing 54. https://doi.org/10.1177/0046958017746546.

Laugesen, Miriam J. & Arturo Vargas-Bustamante. 2010. “A patient mobility framework that travels: European and United States–Mexican comparisons.” Health Policy 97 (2-3): 225–231. https://doi.org/10.1016/j.healthpol.2010.05.006.

Lee, Sang-Bin. 2015. “Medical interpreting for business purposes and language access in ordinary hospitals in Korea.” Babel. Revue Internationale de la Traduction / International Journal of Translation 61 (4): 443–463. https://doi.org/10.1075/babel.61.4.01lee.

Llewellyn-Jones, Peter & Robert G. Lee. 2014. Redefining the role of the community interpreter: The concept of role-space. Lincoln, UK: SLI Press.

Lomeña-Galiano, María. 2020. “Finding hidden populations in the field of translating and interpreting: A methodological model for improving access to non-professional translators and interpreters working in public service settings.” In “Research Methods in Public Service Interpreting and Translation,” edited by Esther Monzó-Nebot & Melissa Wallace. Special issue, FITISPos International Journal 7: 72–91. https://doi.org/10.37536/FITISPos-IJ.2020.7.1.248.

Lunt, Neil & Percivil Carrera. 2010. “Medical tourism: Assessing the evidence on treatment abroad.” Maturitas 66 (1): 27–32. https://doi.org/10.1016/j.maturitas.2010.01.017.

Lunt, Neil, Daniel Horsfall & Johanna Hanefeld. 2016. “Medical tourism: A snapshot of evidence on treatment abroad.” Maturitas 88: 37–44. https://doi.org/10.1016/j.maturitas.2016.03.001.

Määttä, Simo K., Eeva Puumala & Riitta Ylikomi. 2021. “Linguistic, psychological and epistemic vulnerability in asylum procedures: An interdisciplinary approach.” Discourse Studies 23 (1): 46–66. https://doi.org/10.1177/1461445620942909.

Meghani, Zahra. 2011. “A robust, particularist ethical assessment of medical tourism.” Developing World Bioethics11 (1): 16–29. https://doi.org/10.1111/j.1471-8847.2010.00282.x.

Muth, Sebastian. 2017. “Russian as a commodity: Medical tourism and the healthcare industry in post-Soviet Lithuania.” International Journal of Bilingual Education and Bilingualism 20 (4): 404–416. https://doi.org/10.1080/13670050.2015.1115002.

Muth, Sebastian. 2018. “‘The ideal Russian speaker is no Russian’: Language commodification and its limits in medical tourism to Switzerland.” In “Policing for commodification: turning communicative resources into commodities,” Language Policy 17 (2): 217–237. https://doi.org/10.1007/s10993-017-9434-6.

Muth, Sebastian & Neelakshi Suryanarayan. 2020. “Language, medical tourism and the enterprising self.” In “Entrepreneurial visions of the self: Language teaching and learning under neoliberal conditions,” edited by Martina Zimmermann & Sebastian Muth. Special issue, Multilingua. Journal of Cross-Cultural and Interlanguage Communication 39 (3): 321–342. https://doi.org/10.1515/multi-2019-0006.

Patients Beyond Borders. 2023. Quick facts about medical tourism. Chapel Hill: Patients Beyond Borders, https://www.patientsbeyondborders.com/media.

Penney, Kali, Jeremy Snyder, Valorie A. Crooks & Rory Johnston. 2011. “Risk communication and informed consent in the medical tourism industry: A thematic content analysis of canadian broker websites.” BMC Medical Ethics 12. https://doi.org/10.1186/1472-6939-12-17.

Pöllabauer, Sonja, Magdalena Bartłomiejczyk, Maria Bernadette Zwischenberger & Veronika Straczek-Helios. forthcoming. “‘We have a damn duty.’ What motivates volunteer interpreters to engage in activist interpreting in abortion clinics?” Translation in Society.

Smith, Kristen. 2012. “The problematization of medical tourism: A critique of neoliberalism.” Developing World Bioethics 12 (1): 1–8. https://doi.org/10.1111/j.1471-8847.2012.00318.x.

Snyder, Jeremy C. 2022. “Revisiting the ethics of circumvention tourism.” In “Transgender Health Equity and the Law,” Journal of Law Medicine & Ethics 50 (3): 563–565. https://doi.org/10.1017/jme.2022.94.

Snyder, Jeremy, Valorie A. Crooks, Rory Johnston & Shafik Dharamsi. 2013. “‘Do your homework… and then hope for the best’: The challenges that medical tourism poses to Canadian family physicians’ support of patients’ informed decision-making.” BMC Medical Ethics 14. https://doi.org/10.1186/1472-6939-14-37.

Snyder, Jeremy, Shafik Dharamsi & Valorie A. Crooks. 2011. “Fly-by medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists.” Globalization and Health 7 (6): 1–14. https://doi.org/10.1186/1744-8603-7-6.

Whitmore, Rebecca, Valorie A. Crooks & Jeremy Snyder. 2015. “Ethics of care in medical tourism: Informal caregivers’ narratives of responsibility, vulnerability and mutuality.” Health & Place 35: 113–118. https://doi.org/10.1016/j.healthplace.2015.08.004.

Whitmore, Rebecca, Valorie A. Crooks & Jeremy Snyder. 2017. “A qualitative exploration of how Canadian informal caregivers in medical tourism use experiential resources to cope with providing transnational care.” Health & Social Care in the Community 25 (1): 266–274. https://doi.org/10.1111/hsc.12302.

Whittaker, Andrea & Heng Leng Chee. 2015. “Perceptions of an ‘international hospital’ in Thailand by medical travel patients: Cross-cultural tensions in a transnational space.” Social Science & Medicine 124: 290–297. https://doi.org/10.1016/j.socscimed.2014.10.002.