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Globalisation and medicine in Trinidad

In talking about the past, they described patients as able to explain their maladies without time limitations, while doctors were preoccupied with understanding the suffering of patients. Nowadays, however, physicians have become involved increasingly in momentary, standardised, and fleeting encounters with patients, with little to no attention paid to any particular circumstances or idiosyncrasies. As one participant indicated:. When I went to [America], I'd never seen healthcare managed so badly, I could not believe!

It was like a total disconnect. The doctors have no time to talk, they have the attendants, therapists, but no time to talk with the patients. So this disconnect, I think you [Americans] can learn from that with us, that feeling of collective [between doctor and patient].

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Ultimately, participants described mainstream medical practice in Trinidad as having shifted to a more individualistic model consistent with medical globalisation. By following the dictum of absolute doctrines, the individualistic fragmentation of Trinidadian society is thought to be resolvable.

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Several participants noted the importance of adhering to a single, universal message as a key aspect of globalisation. This quote illustrates the belief that assimilating to a common standard will ensure social harmony and reduce the antagonisms increasingly plaguing Trinidadians as a result of globalisation. And that isn't always the case, and so they feel that it is a deficiency. I don't think, I don't think medicine has really become global in the sense that we don't see other influences coming from other countries; it's largely North American influences coming in.

The technological imperative at the heart of the Western model automated data collection and documentation, standardised forms and registers and the computerisation of all record systems was thus idealised as the most effective means for solving Trinidadian health problems. Through interviews with urban Trinidadians involved in the medical industry, four key principles of medical globalisation emerged.

The first, and perhaps most important, was the idea that globalisation is an abstract, autonomous, evolutionary process of history that is beyond human control. In this section, an attempt will be made to consolidate, contextualise, and account for the findings of this study. These themes are also representative of important theoretical debates in the literature on globalisation, including the issues of structure vs.


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Trinidad is a geopolitical space with a long history of Western colonial rule and postcolonial economic dependency. This tragic historical legacy has had a significant impact on popular consciousness in Trinidad. This belief in the fundamental distinctions between subjectivity and objectivity has important implications for the way participants in this study conceived medical globalisation. They viewed time and history as autonomous forces that stand above and outside the individual, and thus dictate human action.

In other words, they saw the micro processes of everyday medical practices as determined by, rather than mutually constitutive of, the macro historical process of globalisation. Participants thus understood medical globalisation as a distinct stage on the macro stage of history separated completely from their quotidian existence. Often they characterised globalisation as irreversible and progressive, thereby suggesting that history has a singular autonomous path of development.

Ultimately, all social life is thought to reside within the purview of unalterable historical laws and mandates. Another theoretical principle that emerges from Trinidad's history of immersion in Western dualism is the theory of knowledge known as realism. This epistemology is characterised by the idea that the knower is separable from what is known Murphy Thus, valid knowledge has to overcome and transcend all sources of contingency, so that its supposed objective purity is not contaminated by subjectivity.

Medical globalisation thus appears as a macro historical process promoting the logic of objectivity and a progressively rationalised medical system. As another consequence of its colonial heritage, Trinidadian society has been pervaded by a Westernised, atomistic account of the individual. Since Independence, urban Trinidadian social life has been characterised by an even greater sense of fragmentation. Trinidadian healthcare has been affected by this growing atomistic individualism and market logic.

From family life to medical practice, participants described globalisation as advancing individualism and materialism as the guiding principles of modern social life. Participants also discussed the growing importance of market mechanisms in maintaining social stability and the proper allocation of medical goods and services.

The accelerated emergence of this market morality in Trinidadian mainstream medicine has also spurred significant increases in the number of everyday activities brought under the purview of the medical industry Allen In this vein, participants complained that patients are exposed to more direct pharmaceutical advertising than ever before. They also voiced concern over the increasingly expanding definitions of disease. Finally, participants cited the public idealisation of Western medical technologies regardless of their actual utility in patient care.

Overall, then, the individualism and the market logic behind medical globalisation appear to push growing numbers of otherwise healthy people into becoming patients who purchase unneeded healthcare goods and services on the medical market. As this study demonstrates, there is an obvious relationship between the macro trends of globalisation in Trinidad and the everyday lived experiences of the Trinidadian mainstream medical community.

Although the abstract historical process of globalisation is neither autonomous nor a determinant of human agency, participants demonstrated that this process can be internalised as if this were the case. Such internalisation is manifested in persons adjusting their everyday activities, including medical practices, to the norms that are thought to be imposed and outside of their control.

Ultimately, as was the case in this study, the realm of experience begins to simply reflect the historical conditions that are conceived to exist sui generis Durkheim Hence there appears to be a strong ideological element that occludes these Trinidadians from recognising the intertwined, mutually reinforcing praxis of their subjective activity and objective historical conditions.

As Mannheim points out, ideology emerges when ruling groups propagate a mode of thinking that allows an idea to obscure the real material conditions of social life, thereby stabilising the power relations of the status quo. In this particular case, medical globalisation is sustained by an underlying belief in the inevitability of historical cycles and development. But such historical autonomy is a myth and must eventually be substantiated at the level of experience. In other words, persons must begin to believe in this inevitability and reinforce publicly this outlook.

In this study, the participants have seemed to internalise this belief in historical inevitability and continually reiterate the need to adapt to historical trends. Indeed, such adaptation is thought to be wise and lead to further growth. And as a result of voicing this opinion, the mythical autonomy of medical globalisation is further established. The continuation of this cycle, moreover, helps to establish the necessity of medical globalisation and related outcomes in the mind of the public. One way to undermine such ideological conceptualisations of medical globalisation is by negating any attempt to divorce the macro realm of history from the micro realities of everyday living.

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Future scholarly research on medical globalisation can help in this regard by emphasising the interplay of praxis and ideology, rather than continuing to separate the macro and micro realms of experience. Ultimately, as Trinidadian intellectual C. Volume 29 , Issue 4. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

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Nothing in these terms will affect or limit anything agreed between you and the Operator. These are binding between you and the Operator and separate from the Contract between you and us for the sale of the relevant products. Use Flubit Points. Learn More! Jens-Uwe Wunderlich. Readings in Planning Theory. Susan S. Samir Amin. Globalization: The Key Concepts.

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