Skip to main content
Log in

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

  • Original Article
  • Published:
BioSocieties Aims and scope Submit manuscript

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.

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  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: https://au.int/sites/default/files/documents/34076-doc-auc.report.panafrican.e-network.prc_.29.03.pdf.

  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.

  7. https://www.mea.gov.in/SpeechesStatements.htm?dtl/3961/Prime+Minister+Dr+Manmohan+Singhs+Speech+at+the+HT+Leadership+Initiative+Conference+New+Delhi++India+and+the+World+A+Blueprint+for+Partnership+and+Growth.

  8. For updated data, see: https://wits.worldbank.org/CountryProfile/en/Country/SSF/StartYear/2013/EndYear/2017/TradeFlow/Import/Indicator/MPRT-TRD-VL/Partner/IND/Product/All-Groups.

  9. See: http://www.medical-events.info/event-gallery/event/ethio-health-exhibition-congress.html.

  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.

References

  • Adams, V. 2016. Metrics of the global sovereign: Numbers and stories in global health. In Metrics: What counts in global health, ed. V. Adams, 19–54. Durham: Duke University Press.

    Chapter  Google Scholar 

  • Adams, V., D. Behague, C. Caduff, I. Löwy, and F. Ortega. 2019. Re-imagining global health through social medicine. Global Public Health 14 (10): 1–18.

    Article  Google Scholar 

  • Al Dahdah, M. 2019. From evidence-based to market-based mHealth: Itinerary of a mobile (for) development project. Science, Technology and Human Values 44 (6): 1048–1067.

    Article  Google Scholar 

  • Aneja, U. 2015. India-Africa summit: Is it possible for one country to share a vision with an entire continent? Scroll.in. https://scroll.in/article/765026/india-africa-summit-is-it-possible-for-one-country-to-share-a-vision-with-an-entire-continent. Accessed 28 Oct 28.

  • Apollo Hospitals. 2011. ‘Healthcare 20.20. The Complete Story’.

  • Appel, H., N. Anand, and A. Gupta. 2018. Introduction: Temporality, politics, and the promise of infrastructure. In The promise of infrastructure, ed. N. Anand, A. Gupta, and H. Appel, 1–38. Durham: Duke University Press.

    Google Scholar 

  • Bear, L., R. Birla, and S. Puri. 2015. Speculation: Futures and capitalism in India. Comparative Studies of South Asia, Africa and the Middle East 35 (3): 387–391.

    Article  Google Scholar 

  • Burton, A. 2016. Africa in the Indian imagination: Race and the politics of postcolonial citation. Durham: Duke University Press.

    Book  Google Scholar 

  • BW Online Bureau. 2014. The last frontier. BW Businessworld. http://www.businessworld.in/article/The-Last-Frontier/08-11-2014-67824/. Accessed 8 Nov 2014.

  • Comaroff, J., and L.E. Claudio. 2015. Thoughts on theorizing from the South: An interview with John Comaroff. Social Transformations: Journal of the Global South 3 (1): 3–18.

    Google Scholar 

  • Comaroff, J., and J.L. Comaroff. 2012. Theory from the South: Or, how Euro-America is evolving toward Africa (trans: Taylor & Francis), 113–131.

  • Duclos, V. 2016. The map and the territory: An ethnographic study of the low utilisation of a global eHealth network. Journal of Information Technology. https://doi.org/10.1057/jit.2016.3.

    Article  Google Scholar 

  • Duclos, V., and T. Sanchez Criado. 2019. Care in trouble: Ecologies of support from below & beyond. Medical Anthropology Quarterly. https://doi.org/10.1111/maq.12540.

    Article  Google Scholar 

  • Erikson, S.L. 2018. Cell phones ≠ self and other problems with big data detection and containment during epidemics. Medical Anthropology Quarterly 32 (3): 315–339.

    Article  Google Scholar 

  • Ferguson, J. 2012. Theory from the Comaroffs, or how to know the world up, down, backwards and forwards. Theorizing the contemporary, fieldsights. Cultural Anthropology. https://culanth.org/fieldsights/theory-from-the-comaroffs-or-how-to-know-the-world-up-down-backwards-and-forwards. Accessed Feb 25.

  • Friedner, M., and T. Zoanni. 2018. Disability from the South: Toward a Lexicon, Somatosphere. http://somatosphere.net/2018/disability-from-the-south-toward-a-lexicon.html/. Accessed 16 Sept 2019.

  • Hofmeyr, I. (ed.). 2018. Against the global south. Cambridge: Cambridge University Press.

    Google Scholar 

  • Kalam, A. 2003. Ignited minds: Unleashing the power within India. New Delhi: Penguin Global.

    Google Scholar 

  • Kalam, A. 2007. Indomitable spirit. New Delhi: Rajpal.

    Google Scholar 

  • Kalam, A. 2011. Building a new India. New Delhi: Penguin Books.

    Google Scholar 

  • Kamat, S. 2004. Postcolonial aporias, or what does fundamentalism have to do with globalization? The contradictory consequences of education reform in India. Comparative Education 40 (2): 267–287. https://doi.org/10.1080/0305006042000231383.

    Article  Google Scholar 

  • Katti, V., T. Chahoud, and A. Kaushik. 2009. India’s development cooperation—Opportunities and challenges for international development cooperation, 3. Bonn: German Development Institute.

    Google Scholar 

  • Kaur, R., and T. Blom Hansen. 2016. Aesthetics of arrival: Spectacle, capital, novelty in post-reform India. Identities 23 (3): 265–275.

    Article  Google Scholar 

  • Larkin, B. 2013. The politics and poetics of infrastructure. Annual Review of Anthropology 42 (1): 327–343. https://doi.org/10.1146/annurev-anthro-092412-155522.

    Article  Google Scholar 

  • Lefebvre, B. 2010. Hospital chains in India. The coming of age?, Janvier 2010, IFRI.

  • Mazzarella, W. 2010. Beautiful balloon: The digital divide and the charisma of new media in India. American Ethnologist 37 (4): 783–804.

    Article  Google Scholar 

  • Mbembe, A. 2012. Theory from the antipodes: Notes on Jean & John Comaroffs’ TFS. Theorizing the contemporary, fieldsights. Cultural Anthropology. https://culanth.org/fieldsights/theory-from-the-antipodes-notes-on-jean-john-comaroffs-tfs. Accessed 25 Feb.

  • McDowell, A. 2015. Making the global equivalent: Markets, relations and pharmaceuticals in the anthropology of global health in Africa. BioSocieties 10 (3): 380–384. https://doi.org/10.1057/biosoc.2015.27.

    Article  Google Scholar 

  • Menon, D.M. 2018. Thinking about the Global South. In The Global South and literature, ed. R. West-Pavlov, 34–44. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Ministry of Finance. 2003. Budget 20032004 speech of Jaswant Singh, Minister of Finance and Company Affair.

  • Modi, R. 2011. Healthcare of African in India. In South-South Cooperation: Africa on the centre stage, ed. R. Modi, 116–137. New York, NY: Palgrave Macmillan.

    Chapter  Google Scholar 

  • Naidu, S. 2010. India’s African relations: In the shadow of China? In The rise of China & India in Africa, ed. F. Cheru and C. Obi, 34–49. London: Zed Books.

    Google Scholar 

  • Nehru, J. 1961. India’s foreign policy: Selected speeches, September 1946-April 1961. New Delhi: Publications Division, Ministry of Information and Broadcasting, Government of India.

    Google Scholar 

  • Nehru, J. 2004. The discovery of India. New Delhi: Penguin Books.

    Google Scholar 

  • Obarrio, J. 2012. “Theory from the South.” Theorizing the contemporary. Fieldsights. Cultural Anthropology. https://culanth.org/fieldsights/series/theory-from-the-south. Accessed 24 Feb.

  • Packard, R.M. 2016. A history of global health: Interventions into the lives of other peoples. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Parks, L. 2012. Footprints of the Global South. In The handbook of global media research, 123–142.

  • Peckham, R., and R. Sinha. 2017. Satellites and the new war on infection: Tracking Ebola in West Africa. Geoforum 80: 24–38.

    Article  Google Scholar 

  • Pedersen, M.A. 2011. Not quite Shamans: Spirit worlds and political lives in Northern Mongolia. Ithaca: Cornell University Press.

    Google Scholar 

  • Pollock, A. 2019. Synthesizing hope: Matter, knowledge, and place in South African drug discovery. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Prashad, V. 2013. The poorer nations: A possible history of the Global South. London: Verso Books.

    Google Scholar 

  • Price, G. 2005. Diversity in donorship: The changing landscape of official humanitarian aid. India’s official aid programme. London: Humanitarian Policy Group.

    Google Scholar 

  • Redfield, P. 2000. Space in the tropics: From convicts to rockets in French Guiana. Berkeley: University of California Press.

    Book  Google Scholar 

  • Second Africa-India Forum Summit. 2011. Africa-India framework for enhanced cooperation. Addis Ababa.

  • Simone, A. 2018. Inoperable relations and urban change in the Global South. In The Global South and literature, ed. R. West-Pavlov, 123–133. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Singh, M. 2001. Commanding heights: Interview with Manmohan Singh. PBS (USA). http://www.pbs.org/wgbh/commandingheights/shared/minitext/int_manmohansingh.html. Accessed 6 Feb 2001.

  • Sneath, D., M. Holbraad, and M.A. Pedersen. 2009. Technologies of the imagination: An introduction. Ethnos 74 (1): 5–30.

    Article  Google Scholar 

  • Solomon, H. 2011. Affective journeys: The emotional structuring of medical tourism in India. Anthropology and Medicine 18 (1): 105–118.

    Article  Google Scholar 

  • Subramaniam, B. 2019. Holy science: The biopolitics of Hindu Nationalism. Seattle: University of Washington Press.

    Google Scholar 

  • Sunder Rajan, K. 2006. Biocapital. The constitution of postgenomic life. Durham: Duke University Press.

    Book  Google Scholar 

  • Tsing, A. 2005. Friction. An ethnography of global connection. Princeton: Princeton University Press.

    Book  Google Scholar 

  • Vitalis, R. 2013. The midnight ride of Kwame Nkrumah and other fables of Bandung (Ban-doong). Humanity: An International Journal of Human Rights, Humanitarianism, and Development 4 (2): 261–288.

    Article  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vincent Duclos.

Ethics declarations

Conflict of interest

I do not have any competing interests—intellectual or financial—in the research detailed in the manuscript.

Ethical approval

I confirm that the manuscript comprises original material that is not under review elsewhere. Also, the study on which the research is based has been subject to appropriate ethical review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duclos, V. The empire of speculation: medicine, markets, and nation in India’s Pan-African e-Network. BioSocieties 16, 289–311 (2021). https://doi.org/10.1057/s41292-020-00198-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/s41292-020-00198-1

Keywords

Navigation