Habits of Maintenance

When infrastructure is invoked as a vital element for human possibility and looms as a battleground for public health contestation, the developmentalist emphasis on creation and upgrading obscures an essential dynamic of infrastructure: maintenance. Who tends the care infrastructures that sustain vulnerable lives? Who keeps public systems running against breakdowns? By describing the ways in which the home dialysis program has been instituted in northern Thailand, I shed light on the uncommon perseverance and precision required to learn to self-administer dialysis. End-stage renal disease patients who choose or are forced to choose publicly funded home dialysis can live with their failing kidneys as long as the lines running between their hands, dialysis bags, and the peritoneum are safely maintained. Here, habit making is of critical importance, for it tasks those who are dependent on public health infrastructure with an indispensable role in keeping it going. By paying close attention to the relation between damaged bodies, structural vulnerabilities, and the habits of maintenance, I envision peritoneal dialysis as an alternative model for operating infrastructure in conditions of debility and debilitation.