Vincent Duclos

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.

In the last few years, tracking systems that harvest web data to identify trends, calculate predictions, and warn about potential epidemic outbreaks have proliferated. These systems integrate crowdsourced data and digital traces, collecting information from a variety of online sources, and they promise to change the way governments, institutions, and individuals understand and respond to health concerns. This article examines some of the conceptual and practical challenges raised by the online algorithmic tracking of disease by focusing on the case of Google Flu Trends (GFT). Launched in 2008, GFT was Google's flagship syndromic surveillance system, specializing in 'real-time' tracking of outbreaks of influenza. GFT mined massive amounts of data about online search behavior to extract patterns and anticipate the future of viral activity. But it did a poor job, and Google shut the system down in 2015. This paper focuses on GFT's shortcomings, which were particularly severe during flu epidemics, when GFT struggled to make sense of the unexpected surges in the number of search queries. I suggest two reasons for GFT's difficulties. First, it failed to keep track of the dynamics of contagion, at once biological and digital, as it affected what I call here the 'googling crowds'. Search behavior during epidemics in part stems from a sort of viral anxiety not easily amenable to algorithmic anticipation, to the extent that the algorithm's predictive capacity remains dependent on past data and patterns. Second, I suggest that GFT's troubles were the result of how it collected data and performed what I call 'epidemic reality'. GFT's data became severed from the processes Google aimed to track, and the data took on a life of their own: a trackable life, in which there was little flu left. The story of GFT, I suggest, offers insight into contemporary tensions between the indomitable intensity of collective life and stubborn attempts at its algorithmic formalization.

Over the last decades, care has proliferated as a notion aimed at capturing a vast array of practices, conditions, and sentiments. In this article, we argue that the analytics of care may benefit from being troubled, as it too often reduces the reproduction of life to matters of palliation and repair, fueling a politics of nationalism and identitarianism. Picking up the threads of insight from STS, "new materialisms," and postcolonial feminist and indigenous scholarship, we discuss care from "below" and "beyond," thus exposing tensions between the enveloping and the diverging, the enduring and the engendering, that play out in care practices. We propose "ecologies of support" as an analytic that attends to how humans are grounded in, traversed by, and undermined by more-than-human and often opaque, speculative, subterranean elements. Our proposal is for anthropology to not simply map life-sustaining ecologies, but to experimentally engage with troubling modes of inquiry and intervention.

This paper offers a close reading of the ontological anthropology developed by Peter Sloterdijk over the last three decades. Special attention is given to how it resonates with the current political situation, and particularly with the imperative to design spaces and techniques that can sustain life in the midst of revived nativism, triumphant connectivism, and non-stop mobilisation. The paper critically examines Sloterdijk's timely, if often exasperatingly ambivalent treatment of the relation between engendering and enduring, as it plays out in such design. Sloterdijk's anthropology is concerned with the crafting of habitable spaces out in the cold, open sky. It raises the issue of the viability of a vexing exposure to the incommensurable, the monstrous. On the one hand, I suggest that this concern all too often involves the domestication of the political, subsuming the emancipatory potential of collective energies under broader concerns with adaptation and endurability. On the other hand, in his most inspired writings Sloterdijk evokes movements of inspiration and ascent that engender worlds in ways that subsist any transfiguration into mere comfort or tolerance. In dialogue with other contemporary thinkers, this paper thus follows Sloterdijk in exploring the articulation of endurability and intensity, inside and outside, inner consistency and ekstatic decentering. It is a conceptual proposition aimed at the design of spaces capable of sustaining an increase in openness to the world-knowing that spaces of protection which can all too easily morph into spaces of containment.

***Please note that this is the author's copy version of the paper. Pagination in the published version is different.

Recent years were marked by the implementation of many eHealth projects using information and communication technologies to provide health services in developing countries. While generating great expectations, these projects remain poorly documented and available data suggest high failure rates. This raises a practical question: How are such eHealth networks to be effectively designed and implemented? This paper addresses this question. Specifically, it presents an ethnographic study of the Pan-African e-Network, a project which connects many hospitals all across India and Africa, providing medical teleconsultations and distance learning services. The study investigates the low utilisation of the network, an issue undermining its potential and efficiency. Factors contributing to this situation include communication barriers, the presumed ego of doctors, poor awareness of the project, and a lack of flexibility to work with the specificities of the connected sites. Above all, these factors point towards a dichotomous approach across the project's design and implementation, and taking two distinct yet related forms: (a) an ontological divide between technical and 'non-technical' domains; (b) a political sorting out of what is and what is not the project, aimed at neutralising and accounting for heterogeneous processes and practices. In both cases, low utilisation reveals tensions between processes of closure and control, and the openness of a life that will not be contained. Ultimately, this paper intends to destabilise binary modes of thinking as they crystallise oppositions between design and implementation, project and context, technical and social worlds, efficacy and improvisation, mastery and unruliness, map and territory.

This essay approaches digital speed not only in terms of mediality—speed as circulation and transmission—but also of habitability: speed as shock and habituation. My aim is to conceptually and practically explore the articulation of digital speed and of specific life forms. I understand digital speed as an intensive exposure to, and
immersion in foreignness—in an otherness that is more than the otherness of another person, and that affects and constitutes oneself. To inhabit media, then, is to inhabit a margin of contingency and indeterminacy, which is not fully simultaneous or coincident with itself.  To inhabit media is to ceaselessly shake off excessive energy and implications. It implies cultivating shared spaces of nonindifference,
and of relative opacity, in the midst of nonstop reporting, exposure,
and irritation. Life in media thus constantly comes with immunitary responses and skillful mediations—be they semantic, normative, commercial, technical, orotherwise—that require anthropological attention. As this essay will suggest, the distinction between life-nurturing and life-negating habitation is, here, as crucial
as it is elusive. A key challenge in this regard is to critically diagnose the effects of speed on the degradation of waking life, while insisting on the recalcitrance of a foreignness that will not be contained and that keeps life moving in the first place. An anthropology of life at digital speed can be understood as a careful experimentation with untamed forces and protective supplements as they are engaged in processes of human- and world-becoming.

Les dernières années ont vu émerger de nombreuses initiatives ayant recours aux télétechnologies pour prendre en charge la santé à une échelle mondiale. Cet article retrace la généalogie d’un ensemble de discours et pratiques rassemblées sous le concept de cybersanté
mondiale. D’une part, celle-ci émerge dans le contexte de la montée des technologies de l’information et de la communication pour le développement, qui visent à réduire la fracture numérique et favoriser le développement humain par l’accès aux circuits mondiaux d’infocapital. D’autre part, elle participe du plus large secteur de la santé mondiale, faisant de la santé/maladie un important enjeu de croissance et de performance économique. Connectivité,
empowerment et aplanissement des iniquités médicales mondiales participeraient ainsi d’un cercle vertueux, vers l’atteinte des Objectifs du Millénaire pour le Développement et la protection/production d’une « commune humanité ». Finalement, l’article discute de manière
critique certaines prémisses ontologiques d’une telle entreprise d’humanisation, se déclinant autant en l’émergence de formations discursives originales qu’au niveau concret de la pratique
clinique, des interventions médicales possibles.

This thesis investigates the emergence of spaces of care in the era of digital globalization. It revolves around several lines of inquiry into the Pan-African e-Network Project (PAN), an eHealth network through which tertiary hospitals in India provide teleconsultation services and continuing medical education to health centres across the African continent. These lines of inquiry lead into a project in constant mutation in order to grasp its ontological versatility, outline its political relevance, assess its therapeutic value. PAN is a colossal, multifaceted enterprise. It involves the daily work of engineers, doctors, and managers who must tend to technical routines, hardware infrastructures, and patient treatments. At once the flagship of a resurgence in Indo-African cooperation and the consequence of India’s eHealth venture, the network is a poster child for neoliberal India, driven by technical and commercial ambitions that seek to position the nation at the heart of global developments. PAN also enacts a digital opening of the clinic, as it reconfigures the spatiality of healthcare access and delivery. A turnkey solution, it displays an insatiable quest for mastery; it is a massive yet largely underutilized infrastructure. PAN embodies an emergent object of political intervention: a prosperous, healthy, connected humanity.
This examination of the Pan-African e-Network challenges teleological accounts of eHealth on several fronts. To the romantic conception of a fluid, seamless circulation of expertise and knowledge, it opposes the embeddedness, plasticity and sheer materiality of concrete practices. Whether one speaks of “apparatus” (Foucault), “networks” (Latour), or “spheres” (Sloterdijk), spaces of care have little to do with neutral, homogeneous surfaces, and rely on a multitude of local and immanent forces. PAN obliges us to consider technology and care together, untying the question of the “becoming of the clinic” from both the modern triumphalism of emancipation, and the phenomenological contemplation of an authentic experience of the world. The present challenge is to examine the practices, events, and forms of power that shape the “inner spaces” of eHealth networks, in all their turbulence, splendor, and inadequacies.