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The empire of speculation: medicine, markets, and nation in India’s Pan-African e-Network

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And to God the Almighty! Make my people sweat. Let their toil create many more Agnis that can annihilate evil. Let my country prosper in peace. Let my people live in harmony. Let me go to dust as a proud citizen of India, to rise again and rejoice its glory.

A. P. J. Abdul Kalam, Ignited minds: Unleashing the power within India.

A Shining Example of South–South Cooperation.

—Slogan of the Pan-African e-Network.


In September 2004, former president of India Abdul Kalam proposed to connect Africa with India through a network aimed at providing healthcare services. Five years later, the Pan-African e-Network (PAN) was launched. PAN is a digital infrastructure connecting doctors and patients across the African continent with tertiary care hospitals in India. It is integrated solution to care for patients at a distance. But beyond everyday medical care, this article suggests that PAN exists primarily as a state of desire. Drawing upon ethnographic research, it explores PAN as a speculative project which makes present uncertain futures. The argument laid out is threefold. First, I suggest that PAN speculates on the South as a market and medical formation, emerging not in response but in blatant indifference to Euro-American spaces, assumptions, or priorities—including those dominant in global health spheres. Second, I argue that PAN acts a medium for the Indian nation to perform itself as an ascendant global healthcare provider, and power. As a gift, the network remakes the identities of the giver and receiver. Third, I examine PAN’s distinctive infrastructural qualities, showing how their imaginative, material, and territorializing effects are critical in shaping both market and nationalist speculation.

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  1. The network also runs an extensive tele-education program, in which African students enroll in Indian universities. Both are administered relatively independently. In this paper, I restrict my focus to the telemedicine component of PAN.

  2. I sometimes use “network,” “network infrastructure,” and “infrastructure” almost interchangeably. A word of clarification may be useful. If we were to understand a “network”—as a still dominant aesthetics of connectivity suggests—as a vector of seamless circulation and growth, PAN would clearly not qualify as such. To such anemic conceptions of connectivity, PAN opposes the embeddedness, plasticity, and materiality of concrete ways of relating. In PAN, fragile, immanent medical spaces are molded out of uncertain, erratic connections—although these spaces are not the object of this paper. The notion of “network” as it is commonly used fails to capture this strong spatial and situated dimension—something that “infrastructure” does a much better job at. However, as PAN’s very name suggests, this conception of network remains central to its power of seduction. For this reason, I was hesitant to let go of the notion, of its power, and of the vision it conjures, including growth and technological sophistication.

  3. Actual costs are hard to verify. In the course of this research, I have come across or heard about a whole range of estimations. US$ 200 million is the official figure published by the African Union in the First Progress Report of the Chairperson of the Commission on the Pan African E-Network on Tele-Education and Tele-Medicine. The report is available here:

  4. As was noted by Randall Packard (2016, p. 11), in spite of some examples of South-South assistance, at its core the history of global health “remains predominantly about flows of goods, services, and strategies along well-trod, north–south pathways.”

  5. Attention given to India remains nevertheless rather marginal in anthropological, or STS work on global health, which tends to focus on Western-centric markets and networks. As was noted by Andrew McDowell in a fine book forum, global health tends to be primarily associated with the provision of pharmaceuticals, and associated knowledge practices, aimed for instance at creating global bodily equivalences (McDowell 2015). The question of how South–South trajectories might alter or challenge the way such equivalences are being experienced remains open to investigation.

  6. This is also made very evident by PAN’s indifference to the kinds of evidence-based practices that have become hegemonic in development and global health spheres in recent years. The scaling of global health interventions is indeed increasingly expected to be based upon metrics produced by methods likes randomized-controlled trials (RCTs), in order to determine which interventions are deemed valuable, and showing they can be scaled up (Adams 2016). PAN had no time for any of this.


  8. For updated data, see:

  9. See:

  10. In 2018, just a few months after the Pan-African e-Network had been temporarily shut down, the Ministry of External Affairs of India announced the launch of a new version of the network. The new version is to undergo some technological modifications, moving to a web-based platform. But more importantly it has been given a new, Sanskrit name: e-AarogyaBharati. The nationalist impulses of PAN have, at last, been molded into a proper Hindu form.


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I am grateful to Ramah McKay, Jean-Paul Gaudillière, Marine Al Dahdah, Mathieu Quet, Sauman Singh, and two anonymous reviewers for insightful comments on earlier versions of this article.

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Correspondence to Vincent Duclos.

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Duclos, V. The empire of speculation: medicine, markets, and nation in India’s Pan-African e-Network. BioSocieties 16, 289–311 (2021).

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