I want to begin this talk at the end -- by which I mean the end of property - at least according to
the cyber-utopian account of things, where digital file sharing and online communication liberate
culture from corporations and their drive for profit. This is just one of the promised forms of
emancipation -- property, in a sense, was undone. People, on a massive scale, used their
computers and their internet connections to share digitized versions of their objects with each
other, quickly producing a different, common form of ownership. The crisis that this provoked is
well-known -- it could be described in one word: Napster. What is less recognized - because it is
still very much in process - is the subsequent undoing of property, of both the private and common
kind. What follows is one story of "the cloud" -- the post-dot-com bubble techno-super-entity -which sucks up property, labor, and free time.
Object, Interface
It's debated whether the growing automation of production leads to global structural
unemployment or not -- Karl Marx wrote that "the self-expansion of capital by means of machinery
is thenceforward directly proportional to the number of the workpeople, whose means of
livelihood have been destroyed by that machinery" - but the promise is, of course, that when
robots do the work, we humans are free to be creative. Karl Kautsky predicted that increasing
automation would actually lead, not to a mass surplus population or widespread creativity, but
something much more mundane: the growth of clerks and bookkeepers, and the expansion of
unproductive sectors like "the banking system, the credit system, insurance empires and
advertising."
Marx was analyzing the number of people employed by some of the new industries in the middle
of the 19th century: "gas-works, telegraphy, photography, steam navigation, and railways." The
facts were that these industries were incredibly important, expansive and growing, highly
mechanized.. and employed a very small number of people. It is difficult not to read his study of
these technologies of connection and communication - against the background of our present
moment, in which the rise of the Internet has been accompanied by the deindustrialization of
cities, increased migrant and mobile labor, and jobs made obsolete by computation.
There are obvious examples of the impact of computation on the workplace: at factories and
distribution centers, robots engineered with computer-vision can replace a handful of workers,
with a savings of millions of dollars per robot over the life of the system. And there are less
apparent examples as well, like algorithms determining when and where to hire people and for
how long, according to fluctuating conditions.
Both examples have parallels within computer programming, namely reuse and garbage
collection. Code reuse refers to the practice of writing software in such a way that the code can be
used again later, in another program, to perform the same task. It is considered wasteful to give the
same time, attention, and energy to a function, because the development environment is not an
assembly line - a programmer shouldn't repeat. Such repetition then gives way to copy-andpasting (or merely calling). The analogy here is to the robot, to the replacement of human labor
with technology.
Now, when a program is in the midst of being executed, the computer's memory fills with data -but some of that is obsolete, no longer necessary for that program to run. If left alone, the memory
would become clogged, the program would crash, the computer might crash. It is the role of the
garbage collector to free up memory, deleting what is no longer in use. And here, I'm making the
analogy with flexible labor, workers being made redundant, and so on.
In Object-Oriented Programming, a programmer designs the software that she is writing around
“objects,” where each object is conceptually divided into “public” and “private” parts. The public
parts are accessible to other objects, but the private ones are hidden to the world outside the
boundaries of that object. It's a “black box” - a thing that can be known through its inputs and
outputs - even in total ignorance of its internal mechanisms. What difference does it make if the
code is written in one way versus an other .. if it behaves the same? As William James wrote, “If no
practical difference whatever can be traced, then the alternatives mean practically the same thing,
and all dispute is idle.”
By merely having a public interface, an object is already a social entity. It makes no sense to even
provide access to the outside if there are no potential objects with which to interact! So to
understand the object-oriented program, we must scale up - not by increasing the size or
complexity of the object, but instead by increasing the number and types of objects such that their
relations become more dense. The result is an intricate machine with an on and an off state, rather
than a beginning and an end. Its parts are interchangeable -- provided that they reliably produce
the same behavior, the same inputs and outputs. Furthermore, this machine can be modified:
objects can be added and removed, changing but not destroying the machine; and it might be,
using Gerald Raunig’s appropriate term, “concatenated” with other machines.
Inevitably, this paradigm for describing the relationship between software objects spread outwards,
subsuming more of the universe outside of the immediate code. External programs, powerful
computers, banking institutions, people, and satellites have all been “encapsulated” and
“abstracted” into objects with inputs and outputs. Is this a conceptual reduction of the richness
and complexity of reality? Yes, but only partially. It is also a real description of how people,
institutions, software, and things are being brought into relationship with one another according to
the demands of networked computation.. and the expanding field of objects are exactly those
entities integrated into such a network.
Consider a simple example of decentralized file-sharing: its diagram might represent an objectoriented piece of software, but here each object is a person-computer, shown in potential relation
to every other person-computer. Files might be sent or received at any point in this machine,
which seems particularly oriented towards circulation and movement. Much remains private, but a
collection of files from every person is made public and opened up to the network. Taken as a
whole, the entire collection of all files - which on the one hand exceeds the storage capacity of
any one person’s technical hardware, is on the other hand entirely available to every personcomputer. If the files were books.. then this collective collection would be a public library.
In order for a system like this to work, for the inputs and the outputs to actually engage with one
another to produce action or transmit data, there needs to be something in place already to enable
meaningful couplings. Before there is any interaction or any relationship, there must be some
common ground in place that allows heterogenous objects to ‘talk to each other’ (to use a phrase
from the business casual language of the Californian Ideology). The term used for such a common
ground - especially on the Internet - is platform, a word for that which enables and anticipates
future action without directly producing it. A platform provides tools and resources to the objects
that run “on top” of the platform so that those objects don't need to have their own tools and
resources. In this sense, the platform offers itself as a way for objects to externalize (and reuse)
labor. Communication between objects is one of the most significant actions that a platform can
provide, but it requires that the objects conform some amount of their inputs and outputs to the
specifications dictated by the platform.
But haven’t I only introduced another coupling, instead of between two objects, this time between
the object and the platform? What I'm talking about with "couplings" is the meeting point between
things - in other words, an “interface.” In the terms of OOP, the interface is an abstraction that
defines what kinds of interaction are possible with an object. It maps out the public face of the
object in a way that is legible and accessible to other objects. Similarly, computer interfaces like
screens and keyboards are designed to meet with human interfaces like fingers and eyes, allowing
for a specific form of interaction between person and machine. Any coupling between objects
passes through some interface and every interface obscures as much as it reveals - it establishes
the boundary between what is public and what is private, what is visible and what is not. The
dominant aesthetic values of user interface design actually privilege such concealment as “good
design,” appealing to principles of simplicity, cleanliness, and clarity.
Cloud, Access
One practical outcome of this has been that there can be tectonic shifts behind the interface where entire systems are restructured or revolutionized - without any interruption, as long as the
interface itself remains essentially unchanged. In Pragmatism’s terms, a successful interface keeps
any difference (in back) from making a difference (in front). Using books again as an example: for
consumers to become accustomed to the initial discomfort of purchasing a product online instead
of from a shop, the interface needs to make it so that “buying a book” is something that could be
interchangeably accomplished either by a traditional bookstore or the online "marketplace"
equivalent. But behind the interface is Amazon, which through low prices and wide selection is
the most visible platform for buying books and uses that position to push retailers and publishers
both to, at best, the bare minimum of profitability.
In addition to selling things to people and collecting data about its users (what they look at and
what they buy) to personalize product recommendations, Amazon has also made an effort to be a
platform for the technical and logistical parts of other retailers. Ultimately collecting data from
them as well, Amazon realizes a competitive advantage from having a comprehensive, up-to-theminute perspective on market trends and inventories. This volume of data is so vast and valuable
that warehouses packed with computers are constructed to store it, protect it, and make it readily
available to algorithms. Data centers, such as these, organize how commodities circulate (they run
business applications, store data about retail, manage fulfillment) but also - increasingly - they
hold the commodity itself - for example, the book. Digital book sales started the millennium very
slowly but by 2010 had overtaken hardcover sales.
Amazon’s store of digital books (or Apple’s or Google’s, for that matter) is a distorted reflection of
the collection circulating within the file-sharing network, displaced from personal computers to
corporate data centers. Here are two regimes of digital property: the swarm and the cloud. For
swarms (a reference to swarm downloading where a single file can be downloaded in parallel
from multiple sources) property is held in common between peers -- however, property is
positioned out of reach, on the cloud, accessible only through an interface that has absorbed legal
and business requirements.
It's just half of the story, however, to associate the cloud with mammoth data centers; the other
half is to be found in our hands and laps. Thin computing, including tablets and e-readers, iPads
and Kindles, and mobile phones have co-evolved with data centers, offering powerful, lightweight
computing precisely because so much processing and storage has been externalized.
In this technical configuration of the cloud, the thin computer and the fat data center meet through
an interface, inevitably clean and simple, that manages access to the remote resources. Typically,
a person needs to agree to certain “terms of service,” have a unique, measurable account, and
provide payment information; in return, access is granted. This access is not ownership in the
conventional sense of a book, or even the digital sense of a file, but rather a license that gives the
person a “non-exclusive right to keep a permanent copy… solely for your personal and noncommercial use,” contradicting the First Sale Doctrine, which gives the “owner” the right to sell,
lease, or rent their copy to anyone they choose at any price they choose. The doctrine,
established within America's legal system in 1908, separated the rights of reproduction, from
distribution, as a way to "exhaust" the copyright holder's control over the commodities that people
purchased.. legitimizing institutions like used book stores and public libraries. Computer software
famously attempted to bypass the First Sale Doctrine with its "shrink wrap" licenses that restricted
the rights of the buyer once she broke through the plastic packaging to open the product. This
practice has only evolved and become ubiquitous over the last three decades as software began
being distributed digitally through networks rather than as physical objects in stores. Such
contradictions are symptoms of the shift in property regimes, or what Jeremy Rifkin called “the age
of access.” He writes that “property continues to exist but is far less likely to be exchanged in
markets. Instead, suppliers hold on to property in the new economy and lease, rent, or charge an
admission fee, subscription, or membership dues for its short-term use.”
Thinking again of books, Rifkin’s description gives the image of a paid library emerging as the
synthesis of the public library and the marketplace for commodity exchange. Considering how, on
the one side, traditional public libraries are having their collections deaccessioned, hours of
operation cut, and are in some cases being closed down entirely, and on the other side, the
traditional publishing industry finds its stores, books, and profits dematerialized, the image is
perhaps appropriate. Server racks, in photographs inside data centers, strike an eerie resemblance
to library stacks - - while e-readers are consciously designed to look and feel something like a
book. Yet, when one peers down into the screen of the device, one sees both the book - and the
library.
Like a Facebook account, which must uniquely correspond to a real person, the e-reader is an
individualizing device. It is the object that establishes trusted access with books stored in the cloud
and ensures that each and every person purchases their own rights to read each book. The only
transfer that is allowed is of the device itself, which is the thing that a person actually does own.
But even then, such an act must be reported back to the cloud: the hardware needs to be deregistered and then re-registered with credit card and authentication details about the new owner.
This is no library - or it's only a library in the most impoverished sense of the word. It is a new
enclosure, and it is a familiar story: things in the world (from letters, to photographs, to albums, to
books) are digitized (as emails, JPEGs, MP3s, and PDFs) and subsequently migrate to a remote
location or service (Gmail, Facebook, iTunes, Kindle Store). The middle phase is the biggest
disruption, when the interface does the poorest job concealing the material transformations taking
place, when the work involved in creating those transformations is most apparent, often because
the person themselves is deeply involved in the process (of ripping vinyl, for instance). In the third
phase, the user interface becomes easier, more “frictionless,” and what appears to be just another
application or folder on one’s computer is an engorged, property-and-energy-hungry warehouse a
thousand miles away.
Capture, Loss
Intellectual property's enclosure is easy enough to imagine in warehouses of remote, secure hard
drives. But the cloud internalizes processing as well as storage, capturing the new forms of cooperation and collaboration characterizing the new economy and its immaterial labor. Social
relations are transmuted into database relations on the "social web," which absorbs selforganization as well. Because of this, the cloud impacts as strongly on the production of
publications, as on their consumption, in the tradition sense.
Storage, applications, and services offered in the cloud are marketed for consumption by authors
and publishers alike. Document editing, project management, and accounting are peeled slowly
away from the office staff and personal computers into the data centers; interfaces are established
into various publication channels from print on demand to digital book platforms. In the fully
realized vision of cloud publishing, the entire technical and logistical apparatus is externalized,
leaving only the human labor.. and their thin devices remaining. Little distinguishes the authorobject from the editor-object from the reader-object. All of them.. maintain their position in the
network by paying for lightweight computers and their updates, cloud services, and broadband
internet connections.
On the production side of the book, the promise of the cloud is a recovery of the profits “lost” to
file-sharing, as all that exchange is disciplined, standardized and measured. Consumers are finally
promised the access to the history of human knowledge that they had already improvised by
themselves, but now without the omnipresent threat of legal prosecution. One has the sneaking
suspicion though.. that such a compromise is as hollow.. as the promises to a desperate city of the
jobs that will be created in a new constructed data center - - and that pitting “food on the table”
against “access to knowledge” is both a distraction from and a legitimation of the forms of power
emerging in the cloud. It's a distraction because it's by policing access to knowledge that the
middle-man platform can extract value from publication, both on the writing and reading sides of
the book; and it's a legitimation because the platform poses itself as the only entity that can resolve
the contradiction between the two sides.
When the platform recedes behind the interface, these two sides are the the most visible
antagonism - in a tug-of-war with each other - - yet neither the “producers” nor the “consumers” of
publications are becoming more wealthy, or working less to survive. If we turn the picture
sideways, however, a new contradiction emerges, between the indebted, living labor - of authors,
editors, translators, and readers - on one side, and on the other.. data centers, semiconductors,
mobile technology, expropriated software, power companies, and intellectual property.
The talk in the data center industry of the “industrialization” of the cloud refers to the scientific
approach to improving design, efficiency, and performance. But the term also recalls the basic
narrative of the Industrial Revolution: the movement from home-based manufacturing by hand to
large-scale production in factories. As desktop computers pass into obsolescence, we shift from a
networked, but small-scale, relationship to computation (think of “home publishing”) to a
reorganized form of production that puts the accumulated energy of millions to work through
these cloud companies and their modernized data centers.
What kind of buildings are these blank superstructures? Factories for the 21st century? An engineer
named Ken Patchett described the Facebook data center that way in a television interview, “This is
a factory. It’s just a different kind of factory than you might be used to.” Those factories that we’re
“used to,” continue to exist (at Foxconn, for instance) producing the infrastructure, under
recognizably exploitative conditions, for a “different kind of factory,” - a factory that extends far
beyond the walls of the data center.
But the idea of the factory is only part of the picture - this building is also a mine.. and the
dispersed workforce devote most of their waking hours to mining-in-reverse, packing it full of data,
under the expectation that someone - soon - will figure out how to pull out something valuable.
Both metaphors rely on the image of a mass of workers (dispersed as it may be) and leave a darker
and more difficult possibility: the data center is like the hydroelectric plant, damming up property,
sociality, creativity and knowledge, while engineers and financiers look for the algorithms to
release the accumulated cultural and social resources on demand, as profit.
This returns us to the interface, site of the struggles over the management and control of access to
property and infrastructure. Previously, these struggles were situated within the computer-object
and the implied freedom provided by its computation, storage, and possibilities for connection
with others. Now, however, the eviscerated device is more interface than object, and it is exactly
here at the interface that the new technological enclosures have taken form (for example, see
Apple's iOS products, Google's search box, and Amazon's "marketplace"). Control over the
interface is guaranteed by control over the entire techno-business stack: the distributed hardware
devices, centralized data centers, and the software that mediates the space between. Every major
technology corporation must now operate on all levels to protect against any loss.
There is a centripetal force to the cloud and this essay has been written in its irresistible pull. In
spite of the sheer mass of capital that is organized to produce this gravity and the seeming
insurmountability of it all, there is no chance that the system will absolutely manage and control
the noise within it. Riots break out on the factory floor; algorithmic trading wreaks havoc on the
stock market in an instant; data centers go offline; 100 million Facebook accounts are discovered
to be fake; the list will go on. These cracks in the interface don't point to any possible future, or
any desirable one, but they do draw attention to openings that might circumvent the logic of
access.
"What happens from there is another question." This is where I left things off in the text when I
finished it a year ago. It's a disappointing ending: we just have to invent ways of occupying the
destruction, violence and collapse that emerge out of economic inequality, global warming,
dismantled social welfare, and so on. And there's not much that's happened since then to make us
very optimistic - maybe here I only have to mention the NSA. But as I began with an ending, I
really should end at a beginning.
I think we were obliged to adopt a negative, critical position in response the cyber-utopianism of
the last almost 20 years, whether in its naive or cynical forms. We had to identify and theorize the
darker side of things. But it can become habitual, and when the dark side materializes, as it has
over the past few years - so that everyone knows the truth - then the obligation flips around,
doesn't it? To break out of habitual criticism as the tacit, defeated acceptance of what is. But, what
could be? Where do we find new political imaginaries? Not to ask what is the bright side, or what
can we do to cope, but what are the genuinely emancipatory possibilities that are somehow still
latent, buried under the present - or emerging within those ruptures in it? - - - I can't make it all
the way to a happy ending, to a happy beginning, but at least it's a beginning and not the end.
Graziano
Pirate Care: How do we imagine the health care for the future we want?
2018
Pirate Care - How do we imagine the health care for the future we want?
Oct 5, 2018 · 19 min read
by Valeria Graziano
A recent trend to reimagine the systems of care for the future is based on many of the principles of self-organization. From the passive figure of the patient — an aptly named subject, patiently awaiting aid from medical staff and carers — researchers and policymakers are moving towards a model defined as people-powered health — where care is discussed as transforming from a top-down service to a network of coordinated actors.
At the same time, for large numbers of people, to self-organize around their own healthcare needs is not a matter of predilection, but increasingly one of necessity. In Greece, where the measures imposed by the Troika decimated public services, a growing number of grassroots clinics set up by the Solidarity Movement have been providing medical attention to those without a private insurance. In Italy, initiatives such as the Ambulatorio Medico Popolare in Milan offer free consultations to migrants and other vulnerable citizens.
The new characteristic in all of these cases is the fact that they frame what they do in clearly political terms, rejecting or sidestepping the more neutral ways in which the third sector and the NGOs have long presented care practices as apolitical, as ways to help out that should never ask questions bigger than the problems they set out to confront, and as standing beyond left and right (often for the sake of not alienating potential donors and funders).
Rather, the current trends towards self-organization in health care are very vocal and clear in their messages: the care system is in crisis, and we need to learn from what we know already. One thing we know is that the market or the financialization of assets cannot be the solution (do you remember when just a few years ago Occupy was buying back healthcare debts from financial speculators, thus saving thousands Americans from dire economic circumstances? Or that scene from Michael Moore’s Sicko, the documentary where a guy has to choose which finger to have amputated because he does not have enough cash for saving both?).
Another thing we also know is that we cannot simply hold on to past models of managing the public sector, as most national healthcare systems were built for the needs of the last century. Administrations have been struggling to adapt to the changing nature of health conditions (moving from a predominance of epidemic to chronic diseases) and the different needs of today’s populations. And finally, we most definitely know that to go back to even more conservative ideas that frame care as a private issue that should fall on the shoulders of family members (and most often, of female relatives) or hired servants (also gendered and racialised) is not the best we can come up with.
Among the many initiatives that are rethinking how we organize the provision of health and care in ways that are accessible, fair, and efficient, there are a number of actors — mostly small organizations — who are experimenting with the opportunities introduced by digital technologies. While many charities and NGOs remain largely ignorant of the opportunities offered by technology, these new actors are developing DIY devices, wearables, 3D-printed bespoke components, apps and smart objects to intervene in areas otherwise neglected by the bigger players in the care system. These practices are presenting a new mode of operating that I want to call ‘pirate care’.
Pirate Care
Piracy and Care are not always immediately relatable notions. The figure of the pirate in popular and media cultures is often associated with cunning intelligence and masculine modes of action, of people running servers which are allowing people to illegally download music or movie files. One of the very first organizations that articulated the stakes of sharing knowledge was actually named Piratbyrån. “When you pirate mp3s, you are downloading communism” was a popular motto at the time. And yet, bringing the idea of a pirate ethics into resonance with contemporary modes of care invites a different consideration for practices that propose a paradigm change and therefore inevitably position themselves in tricky positions vis-à-vis the law and the status quo. I have been noticing for a while now that another kind of contemporary pirate is coming to the fore in our messy society in the midst of many crises. This new kind of pirate could be best captured by another image: this time it is a woman, standing on the dock of a boat sailing through the Caribbean sea towards the Mexican Gulf, about to deliver abortion pills to other women for whom this option is illegal in their country.
Women on Waves, founded in 1999, engages in its abortion-on-boat missions every couple of years. They are mostly symbolic actions, as they are rather expensive operations, and yet they are potent means for stirring public debate and have often been met with hostility — even military fleets. So far, they have visited seven countries so far, including Mexico, Guatemala and, more recently, Ireland and Poland, where feminists movements have been mobilizing in huge numbers to reclaim reproductive rights.
According to official statistics, more than 47,000 women die every year from complications resulting from illegal, unsafe abortion procedures, a service used by over 21 million women who do not have another choice. As Leticia Zenevich, spokesperson of Women on Waves, told HuffPost: “The fact that women need to leave the state sovereignty to retain their own sovereignty ― it makes clear states are deliberately stopping women from accessing their human right to health.” Besides the boat campaigns, the organization also runs Women on Web, an online medical abortion service active since 2005. The service is active in 17 languages, and it is helping more than 100,000 women per year to get information and access abortion pills. More recently, Women on Waves also begun experimenting with the use of drones to deliver the pills in countries impacted by restrictive laws (such as Poland in 2015 and Northern Ireland in 2016).
Women on Waves are the perfect figure to begin to illustrate my idea of ‘pirate care’. By this term I want to bring attention to an emergent phenomenon in the contemporary world, where more and more often initiatives that want to bring support and care to the most vulnerable subjects in the most unstable situations, increasingly have to do so by operating in that grey zone that exists between the gaps left open by various rules, laws and technologies. Some thrive in this shadow area, carefully avoiding calling attention to themselves for fear of attracting ferocious polemics and the trolling that inevitably accompanies them. In other cases, care practices that were previously considered the norm have now been pushed towards illegality.
Consider for instance the situation highlighted by the Docs Not Cops campaign that started in the UK four years ago, when the government had just introduced its ‘hostile environment’ policy with the aim to make everyday life as hard as possible for migrants with an irregular status. Suddenly, medical staff in hospitals and other care facilities were supposed to carry out document checks before being allowed to offer any assistance. Their mobilization denounced the policy as an abuse of mandate on the part of the Home Office and a threat to public health, given that it effectively discouraged patients to seek help for fear of retaliations. Another sadly famous example of this trend of pushing many acts of care towards illegality would the straitjacketing and criminalization of migrant rescuing NGOs in the Mediterranean on the part of various European countries, a policy led by Italian government. Yet another example would be the increasing number of municipal decrees that make it a crime to offer food, money or shelter to the homeless in many cities in North America and Europe.
Hacker Ethics
This scenario reminds us of the tragic story of Antigone and the age-old question of what to do when the relationship between what the law says and one what feels it is just becomes fraught with tensions and contradictions. Here, the second meaning of ‘pirate care’ becomes apparent as it points to the way in which a number of initiatives have been responding to the current crisis by mobilizing tactics and ethics as first developed within the hacker movement.
As described by Steven Levy in Hackers, the general principles of a hacker ethic include sharing, openness, decentralization, free access to knowledge and tools, and an effort of contributing to society’s democratic wellbeing. To which we could add, following Richard Stallman, founder of the free software movement, that “bureaucracy should not be allowed to get in the way of doing anything useful.” While here Stallman was reflecting on the experience of the M.I.T. AI Lab in 1971, his critique of bureaucracy captures well a specific trait of the techno-political nexus that is also shaping the present moment: as more technologies come to mediate everyday interactions, they are also reshaping the very structure of the institutions and organizations we inhabit, so that our lives are increasingly formatted to meet the requirements of an unprecedented number of standardised procedures, compulsory protocols, and legal obligations.
According to anthropologists David Graeber, we are living in an era of “total bureaucratization”. But while contemporary populism often presents bureaucracy as a problem of the public sector, implicitly suggesting “the market” to be the solution, Graeber’s study highlights how historically all so-called “free markets” have actually been made possible through the strict enforcement of state regulations. Since the birth of the modern corporation in 19th century America, “bureaucratic techniques (performance reviews, focus groups, time allocation surveys …) developed in financial and corporate circles came to invade the rest of society — education, science, government — and eventually, to pervade almost every aspect of everyday life.”
The forceps and the speculum
And thus, in resonance with the tradition of hacker ethics, a number of ‘pirate care’ practices are intervening in reshaping what looking after our collective health will look like in the future. CADUS, for example, is a Berlin based NGO which has recently set up a Crisis Response Makerspace to build open and affordable medical equipment specifically designed to bring assistance in extreme crisis zones where not many other organizations would venture, such as Syria and Northern Iraq. After donating their first mobile hospital to the Kurdish Red Crescent last year, CADUS is now working to develop a second version, in a container this time, able to be deployed in conflict zones deprived of any infrastructure, and a civil airdrop system to deliver food and medical equipment as fast as possible. The fact that CADUS adopted the formula of the makerspace to invent open emergency solutions that no private company would be interested in developing is not a coincidence, but emerges from a precise vision of how healthcare innovations should be produced and disseminated, and not only for extreme situations.
“Open source is the only way for medicine” — says Marcus Baw of Open Health Hub — as “medical software now is medicine”. Baw has been involved in another example of ‘pirate care’ in the UK, founding a number of initiatives to promote the adoption of open standards, open source code, and open governance in Health IT. The NHS spends about £500 million each time it refreshes Windows licenses, and aside from avoiding the high costs, an open source GP clinical system would be the only way to address the pressing ethical issue facing contemporary medicine: as software and technology become more and more part of the practice of medicine itself, they need to be subject to peer-review and scrutiny to assess their clinical safety. Moreover, that if such solutions are found to be effective and safe lives, it is the duty of all healthcare practitioners to share their knowledge with the rest of humanity, as per the Hippocratic Oath. To illustrate what happens when medical innovations are kept secret, Baw shares the story of the Chamberlen family of obstetricians, who kept the invention of the obstetric forceps, a family trade secret for over 150 years, using the tool only to treat their elite clientele of royals and aristocracy. As a result, thousands of mothers and babies likely died in preventable circumstances.
It is perhaps significant that such a sad historical example of the consequences ofclosed medicine must come from the field of gynaecology, one of the most politically charged areas of medical specialization to this day. So much so that last year another collective of ‘pirate carers’ named GynePunk developed a biolab toolkit for emergency gynaecological care, to allow those excluded from the reproductive healthcare — undocumented migrants, trans and queer women, drug users and sex workers — to perform basic checks on their own bodily fluids. Their prototypes include a centrifuge, a microscope and an incubator that can be cheaply realised by repurposing components of everyday items such as DVD players and computer fans, or by digital fabrication. In 2015, GynePunk also developed a 3D-printable speculum and — who knows? — perhaps their next project might include a pair of forceps…
As the ‘pirate care’ approach keeps proliferating more and more, its tools and modes of organizing is keeping alive a horizon in which healthcare is not de facto reduced to a privilege.
PS. This article was written before the announcement of the launch of Mediterranea, which we believe to be another important example of pirate care. #piratecare #abbiamounanave