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Circulating Instruments, Situated Contexts: Reflections from 4S Seattle

At this year’s 4S conference in Seattle, our research on global surgical instrument manufacturing was presented as part of the panel “Imagination, Design, and Repercussions of Medical Technologies.” The panel brought together diverse perspectives on how medical devices are designed, circulate, and shape social, bodily, and political worlds.

The Panel Context

The panel featured thought-provoking contributions ranging from wearable technologies for diabetes management to the role of protective hazmat suits in West African laboratories, as well as discussions on robotic surgery and haptic feedback.

Despite these different empirical sites, a shared theme emerged: medical devices are not only technical objects but are deeply embedded in local contexts, social relations, and systems of power. They travel across borders and are shaped by different forms of expertise, while also leaving uneven repercussions for users and producers alike.

Our Contribution: Linking Tuttlingen, Sialkot, and Samsun

Our presentation, “Circulating Instruments, Situated Contexts,” introduced the MediCluster project, which investigates the interconnected manufacturing clusters of Tuttlingen (Germany), Sialkot (Pakistan), and Samsun (Türkiye).

These three regions differ in their characteristics and roles:

  • Tuttlingen represents precision, legacy, and strict regulatory frameworks — a symbolic center of global surgical instrument production.
  • Sialkot focuses on high volume, low-cost production, often without receiving visible recognition for its essential technical contributions.
  • Samsun occupies a hybrid position, combining state support with growing R&D capacities and ambitions for regional innovation.

The project highlights how materials, knowledge, and designs circulate globally, crossing oceans and borders, while the recognition of labor and expertise remains deeply unequal.

“Tools produced in Türkiye are often sent to Germany for final processing or packaging,
after which they are labeled ‘Made in Germany.’
Meanwhile, producers in Sialkot remain essential yet largely unacknowledged.”

This illustrates what we refer to as epistemic asymmetries: situations where real innovation and skill exist but remain invisible because they come from the “wrong” place.

Fieldwork Progress and Scope

So far, our research team has completed extensive fieldwork in Samsun, including visits to multiple factories and workshops and conducting 34 interviews with producers, cluster representatives, and other stakeholders.

While Tuttlingen and Sialkot are central to our comparative study, we have not yet carried out fieldwork at these sites. For these locations, our current insights are based on extensive literature reviews and video materials of production processes.

Because of this stage of research, our presentation focused primarily on Samsun and its position within these global networks, rather than making definitive statements about dynamics in the other clusters.

Regulation and the “Paper Walls

One of the central points raised during the discussion was the role of EU regulatory processes. These processes extend far beyond symbolic compliance: they deeply shape how innovation unfolds and who gains access to global markets.

In Tuttlingen, strict European regulations are a major driver of innovation — but they also create barriers for smaller firms. For producers in Samsun and Sialkot, these regulations often function as “paper walls.”

These paper walls are not physical barriers, but rather layers of documentation, certification requirements, and regulatory demands that determine whose instruments can cross borders.
They reinforce existing hierarchies, making it difficult for manufacturers outside the EU to gain recognition, even when their products meet or exceed quality standards.

The Role of Turkish Steel

Another question concerned the role of Turkish steel in the global value chain.
Historically, high-end surgical instruments relied on imported steel from countries like Germany and Sweden.

  • For premium exports, these imports are still necessary and often explicitly required by clients or regulations.
  • However, there is a growing domestic production of higher-quality steel in Türkiye, which is increasingly important for local manufacturers.

This shift demonstrates how material resources themselves carry symbolic capital — what counts as “high-quality” or “innovative” material is not fixed, but constantly negotiated.

Looking Ahead

The discussion at 4S Seattle reinforced the need to think beyond simple center-periphery models of innovation. Surgical instruments may be small objects, but they embody complex histories of labor, circulation, and recognition.

As our research continues with upcoming fieldwork in Tuttlingen and Sialkot, we aim to deepen our understanding of how these global networks operate and how knowledge, expertise, and value move, and sometimes fail to move, across borders.

We would like to thank the panel organizers, Vaia Sigounas (Case Western Reserve University) and Valerie Leiter (Simmons University), for bringing together such a diverse and engaging session.
The thoughtful questions from the audience, ranging from regulatory processes and material flows to questions of recognition, sparked valuable reflections and will continue to inform the next stages of our research.

 

Melike Şahinol
Melike Şahinol

OpenEdition suggests that you cite this post as follows:
Melike Şahinol (September 7, 2025). Circulating Instruments, Situated Contexts: Reflections from 4S Seattle. Manufacturing Practices of Medical Instruments (MediCluster). Retrieved June 15, 2026 from https://doi.org/10.58079/14lxs


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