Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India

BACKGROUND: Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India. METHODS: This analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6). RESULTS: From the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care. CONCLUSIONS: This analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India

Chinese Migration to Italy: Features and Issues

This essay examines the Chinese experience of migration to Italy. Archival material has been integrated with oral history field work conducted in Bologna and the Romagna. We have identified three distinct waves of Chinese migration to Italy. The first wave occurred in the very early stage of Sino-Italian relations (1850–1915), when only four categories of people moved to Italy from China: the students and priests studying and teaching at the Chinese college in Naples, the diplomats and their families based in Rome, a few sailors and the first street vendors.The sporadic presence of Chinese citizens in Italy was matched by the low number of Italians in China mainly living in the territorial concessions of Tianjin. During the second wave of Chinese immigration (1930–1970), a small but cohesive community started to develop both in Milan and Bologna. The most recent wave of Chinese immigration started in the 1990s, bearing little resemblance to the preceding one. However, all the three waves show a strong entrepreneurial attitude on the part of Chinese migrants and a sense of close community kinship

Another vaccine, another story: BCG vaccination against tuberculosis in India, 1948 to 1960 Outra vacina, outra história: a vacinação de BCG contra tuberculose na Índia, 1948 a 1960

Through an examination of mass BCG vaccination against tuberculosis in India between 1948 and 1960 this article draws attention to the diversity of the history of vaccination. The features of vaccination campaigns often differed from those of the celebrated campaign to eradicate smallpox. Due to differences between smallpox and tuberculosis as well as between the vaccines developed against them, an analysis of BCG mass vaccination against tuberculosis seems particularly well suited for this purpose. Three points of difference are identified. First, in non-Western contexts BCG vaccination procedures were modified to a greater extent than vaccination against smallpox. Second, tuberculosis lacked the drama and urgency of smallpox and BCG vaccination campaigns suffered more from recruitment problems than did the more "heroic" smallpox eradication campaign. Third, the BCG vaccine was contested in medical circles and was much better suited than the vaccine against smallpox as a vehicle for the articulation of concerns about post-colonial modernization.<br>Através da observação da vacinação em massa de BCG contra a tuberculose na Índia durante os anos de 1948 a 1960, este artigo chama a atenção para a diversidade da história da vacinação. As características das campanhas de vacinação geralmente diferem daquelas celebradas nas campanhas para erradicação da varíola. Devido às diferenças entre a varíola e a turberculose, assim como entre as vacinas desenvolvidas para combater essas doenças, uma análise da vacinação em massa de BCG contra a turberculose parece especialmente bem situada para essa proposta. Três pontos de diferença foram identificados. O primeiro é que em contextos não ocidentais os procedimentos da vacinação de BCG foram modificados em uma extensão maior do que a vacinação contra a varíola. Em segundo lugar, a tuberculose não tinha o drama e a urgência da varíola, e as campanhas de vacinação de BCG sofreram mais com problemas de recrutamento do que a mais "heroica" campanha de erradicação da varíola. E por último, a vacina de BCG foi contestada em círculos médicos e foi muito mais bem adaptada do que a vacina contra varíola como um veículo para articulação de preocupações sobre a modernização pós-colonial

Migration in Asia

Asia presents a unique setting for the study of human migration. Home to more than three-fifths of the world’s population and spanning almost a third of global land mass, Asia is host to diverse cultures, economies, political systems and settlement patterns. In tandem with national variations in population size and composition, these factors have led to marked variations in human spatial mobility across the region. This chapter draws on emerging data on international and internal migration to explore migration intensity and patterns of spatial redistribution both between and within Asian countries. The chapter begins by tracing patterns of international migration using data from the United Nations and The World Bank and identifies four distinct migration systems. Turning to internal migration, data from the IMAGE project (Bell et al. 2015a) are used to explore cross-national differences in the lifetime intensity and pattern of spatial redistribution within 16 Asian countries. Results reveal considerable diversity in international and internal migration, reflecting differences in levels of urbanisation, in the effect of government policies, and in stages of economic development.16 page(s