Title: Where There is a Doctor
Description: Traveling teams of cardiovascular specialists visit poor countries to treat children born with life-threatening heart defects. Working within challenging settings, volunteers may need to build temporary operating theaters and neonatal intensive care units before beginning their work. They also try to extend their humanitarian reach beyond the confines of an in-country visit: they train locally-based personnel in surgical and critical care techniques considered routine in rich countries yet locally unavailable; they donate machines, hardware, and disposable materials to local hospitals; they even build permanent surgical centers. Pediatric heart surgery missions thus define a new context where medical technologies circulate globally. It is well-known that medical technologies have far-reaching effects, transforming societies while at the same time being transformed by them, but few scholars have explored these processes in medical humanitarian arenas. This study investigates the moral logic, medical logistics, and unanticipated effects of short-term surgical missions.

The setting is Honduras: a known hub of medical mission activity. The study begins with an examination of why Honduras attracts scores of medical missions, and why children with heart defects have emerged as central objects of humanitarian concern. I argue that humanitarian sentiments dovetail with other interests and desires on the part of surgical volunteers, such as adventure travel, learning, and the allure of practicing an alternative, low-tech version of biomedicine as a corrective to disappointments, frustrations, and lulls in their everyday professional lives. I then describe how this humanitarian ethos reconfigures biomedical practice. This is followed by a discussion of the implications of pediatric heart surgery missions for host countries, such as how they inadvertently re-inscribe social hierarchies and place strain on existing health services. Finally, I follow the lives of pediatric heart patients after their surgeries, show how their parents contest any stereotypical assumptions about humanitarian aid beneficiaries, and unpack the logic underpinning consent for especially high-risk procedures.

My analysis emerges from 13 months of ethnographic field research primarily in Tegucigalpa, the nation’s capital, during which I participated in six pediatric heart surgery missions, and observed and interviewed volunteer clinicians, locally-based clinicians, and the parents of pediatric heart surgery patients.