Solidarity Clinics. Health self-management by citizens – Mar Pino

Three days sitting around a table can go a long way. And if, instead of dishes, the table cloth holds the various parts of a citizen’s self-management project, scrutinised by the “diners” down to the last crumb, it is even more productive.

Starting from this method, the encounter “Culture, the City and the Commons” took place in Seville in late June, bringing together 25 participants representing different initiatives from all over Europe to share experiences and, among other things, reflect on the role of Culture in the processes to democratise our cities.

Each of the four round table “menus” focused on the study of a particular case, the main course of ours being the “Solidarity Clinics” project in Greece: a citizen’s initiative for health self-management which originated in Thessaloniki in 2011, and at present has achieved a network of 40 clinics spread throughout the country, looking after thousands of persons every year (10,000 in Thessaloniki alone).

Taking the account of psychologist, activist and key player in the Thessaloniki clinic Elektra Bethymouti as a starting point, we calmly and thoroughly analysed the case study, turning it into post-its filling each portion of our table cloth/tool, laid out as a timeline.

Thus we gradually gained detailed knowledge of the origin of the project, its organisation and rules, the sustainability of the project, the motivations behind it, its evolution, its relation with institutions, the changes with the Syriza Government (“it is not a friendly government” Elektra would repeat), its fears, its different stances, expectations, similarities with other projects… tens of elements which, on the table cloth, ended up shaping the account.

Origin

We know what the situation was in Greece in 2011. Years of bad government management plus the Troika’s demands had pushed the country into a state of utter chaos that swept away the bulk of public services. That year, 30% of Greek citizens were left without access to Social Security. This means three million people (in a country with a population of 11 million) lost their right to health care.

In this context, around 300 undocumented immigrants started a hunger strike. Many people felt the need to help, among them a group of doctors who offered their aid. After 44 days of fasting and at the cost of serious deterioration to their health, the immigrants achieved legal residence permits. This experience, along with considering the dramatic circumstances faced by millions of citizens (both Greek nationals and immigrants), led this group of doctors to start up a clinic that would “work for the common good”. The main goals of this project were, and still are, “self-determination, equality, a direct and horizontal democracy, not subject to the market dictates and ensuring free access to health care for everyone”.

That small group of 15 committed doctors grew to reach the 300 professionals who nowadays work at the Thessaloniki clinic. 300 people who give their “free time” (“we prefer this concept to the one of volunteer” as Elektra underlined) to ensure the entire population receives medical care.

Solidarity vs Charity

The Social Solidarity Clinic is a 100 percent self-managed, independent and horizontal project born within a community that decided to confront an institution that ignored them. The Thessaloniki clinic is located in a former workers’ centre loaned by a trade union in a neghbourhood with a majority of immigrant population. Though two thirds of its patients are Greek nationals, assistance to the migrant population is provided by establishing the clinic in their neighbourhoods and translating the centre’s information into several languages. This policy has now been extended to the thousands of refugees living confined in refugee camps in the city outskirts, regularly visited by the doctors to inform them of the clinic’s existence. This inclusive character is a part of its identity. The project defines itself as anti-fascist and anti-racist. nonetheles “ if someone from Golden Dawn turns up, he’ll be attended all the same” Electra commented.

The economic management, complicated in a project this size, is based on very strict rules approved by the assembly and adherred to by every clinic in the network: not one euro is to be accepted from institutions, the Church or NGOs. Only personal donations or collaborations by small collectIves from the community or abroad are accepted, and they count on a network of solidary pharmacies where citizens go to buy medicines for the clinics. “Don’t Greek citizens feel shy about going to the clinics out of fear of their exclusion and poverty being known…? asked Federico Alagna, spokesman of Cambiamo Messina dal basso¹. “When health is at stake, pride vanishes”, answered Electra.

The centre’s team divides divides into different work groups (patients’ involvement is encouraged) including one to reflect on medicine itself: “ we seek a holistic approach as an alternative to the dominant model”. They mainly work in primary health care, though they keep agreements with hospital professionals to refer patients who need further treatment, “we open the back doors so that people can get in”. They play a key role in medical attention for refugees, plus they have recently opened a new medical centre in VIOME, the only factory in Europe occupied by its workers… It is such a powerful project it’s not surprising it has been imitated, and even suffered some attempts to be colonised by NGOs, including the Government-created “Solidarity for all”.

The Commons vs public services

But the attempts to colonise them are not the only problem they have to deal with, as Electra related. Given the structure is horizontal, the same faces still tend to be the ones appearing in public; it is very difficult to get patients involved in the project; and the rules are shared by every clinic, but there are two lines of thought which sometimes seem to be miles apart: the view of those who consider the project as a temporary solution until the State takes over ensuring a universal health care system again and that of those who think the clinics should remain as a common good beyond what is done by institutions. A debate, Elektra admitted, that is lately taking up a great part of the meetings and which can be extrapolated to every project regarding the commons, judging by the conversations held aroung and away from the workshop round table.

“Friendly” governments

Regarding the difficult relationship with public institutions, the question arose about the consequences of the arrival of Syriza into power. Federico was the one who brought the subject up, as he recognised the difficulties and contradictions implied by entering institutions and the risk of causing an “appeasing” of citizen struggles. As a matter of fact, as a means to promote and channel this “outsider” social participation, the Messina platform counts on the Laboratory of Common Goods, a key tool to this municipalist experience.

It is true that one of the most usual contradictions social platforms reaching institutional office must face is the possible phagocytosis of social movements. Though, due to its traditional structure this is not the case of the Greek political party, it is nevertheless true that certain hopes for change were placed on Syriza after their arrival to power. Has this had any kind of effect on the clinics? “In my opinion,” Electra marked, “the main change with Syriza is that we no longer know who we’re facing and there is an attempt to silence problems”. “They aren’t a friendly governnment”, she stated.

And now what?

Point by point we completed the analysis until the table cloth was full of data, expectations, principles, fears and dark spots, offering a pretty complete picture of a project that can be considered as a paradigm among community initiatives. Though it is true that its implementation took impulse from an extreme political and social siituation not (yet) reached in other European countries, the mere urgency of the context does not ensure the successful organisation of such a complex project. In this sense, one thing that stands out about Solidarity Clinics regarding other community projects is their commitment to inclusion, and I believe it is an element to take into account.

Having said this, a doubt remains about the common future of “the commons”. As a simple chronicler, I have no answers, but I can say that some voices at the encounter indicated that at this moment the main urgency is the arrival of refugees and the closing of frontiers, and that’s where we have to be; while others reminded us that we should keep on working at a local level at the same time as we continue to build networks… But if there is a sure conclusion, it is that encounters like this one foster learning (about methodology, processes, diversities, people, concepts…) and they constitute an essential tool to keep on working on and for the commons.

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1 Citizen Platform which entered the Messina City Hall after the 2013 elections. The peculiarity of the Italian election system made Renato Accorinti, Cambiamo Messina’s candidate, elected as mayor, though only counting with 4 councillors out of 40, with the difficulty to govern that this implies.