The ongoing process of the self organisation of Health in Petralona
Social Health Space of the Neighborhood Assembly of Petralona, Koukaki and Thissio
The current edition is the second attempt to record our experience from the entire course of the project. This brochure was our presentation at the meeting of social health centres, which was held in April 2013 in Thessaloniki.
The first edition was presented at an event we organized in May 2012 in the Polytechnic School of Athens entitled ‘health and self-organization’, in the context of the overall presentation of the project of the social space for health.
The beginning of the occupation
The social space for health is housed in the squatted former PIKPA building in Ano Petralona. It is a stone house (as are the rest houses of this neighbourhood) where until the late ‘90s immigrant families and locals from Petralona and Thissio would receive primary health care.
In the beginning of the last decade PIKPA was shut down. The two-story house remained abandoned. In April 2009, the Neighbourhood Assembly of Petralona, Koukaki and Thissio driven by the momentum of the December 2008 revolt, decided to occupy the house and use it to meet its needs (and the needs of the neighbourhood).
The assembly for health
People from ‘the assembly for health’ (a collective of health practitioners and others which was formed in December 2008) also participated in the local neighbourhood assemblies. And so, a parallel processing was initiated of issues such as ‘health as a right’, health care, free access to medical services and working conditions in the medical field. The main aim of the assembly for health, aside from intervening in medical issues and from creating a social health space (which would not exclusively target the poor), was to develop a theoretical and practical approach to another kind of health and health care, away from commercialisation, power relations and medicalisation, a kind which aims to diffuse the knowledge and maximise the ability of every individual to participate in the decision-making for his/her own health.
After a series of theoretical studies and interventions in hospitals the next practical step was to squat the stone house in Ano Petralona. Soon after the ‘advisory space for health’ was set up and was open two days per week for two hours. This was the first attempt to put in practice a primary health care project in a neighbourhood. And this first attempt evolved from its initial form in the summer of 2011. At the time the project gave an account of how it had worked so far which was published in a brochure entitled ‘The ongoing process of the self-organisation of Health in Petralona’, May 2012).
Since November 2011 the primary health care structure in former PIKPA has been reformed, the breadth of participants has increased both in number and quality and the project has been rename to social space for health.
Why social space for health (SSH) and not simply social health care centre? Because we want to emphasise that the project is not merely a place where somebody can seek a meeting with a health practitioner. We strive to create a space where the specialised knowledge of a health practitioner will interact with the opinion of the patient regarding their body and their life. And that this interaction will not be based on a power relation between the two parts, but on an ongoing search for balance. We see this goal realised in cases where someone visits the space with a particular query and that query has been answered before the person actually gets a private consultation with a health practitioner. The experience of another visitor who happens to be in the SSH at the same time will provide answers, convey similar symptoms as well as ways of treatment.
The name of our project signifies the equal participation of health practitioners and other members. We don’t give more value to either part, we believe that they are intertwined. The SSH is an ongoing learning process for everyone, through discussions with people with medical knowledge. Discussion that is often derived from the queries we receive. In some cases non-health practitioners have obtained the ability to handle simple and specific patient requests (e.g. blood pressure measuring).
We use the term SSH because through seminars and self-education lessons we aim to diffuse this knowledge in society. We use this term because alongside setting up a health-care space we are concerned with organising our collective response to the collapse of the health-care system and the exclusion from it of an ever increasing part of the society. We use this term because there are no white medical uniforms or sterilised walls, but a warm environment where someone can feel relaxed and discuss their problem with us. The process of constructing a different approach to health involves contributing to the reinforcement of the ‘patient’ so that they may take an active and decisive role in the procedure. To open a discussion about one’s health problem in an assembly procedure contributes to this direction. We don’t see illness as an accursed disease that should stay enclosed within depressing hospital corridors, but as a state that needs its own time, space and care. To incorporate in the social web a space for health that also combines other social activities and groups of people (e.g. children’s group, Spanish lessons, film screenings) creates a more immediate relation of the ‘patient’/ resident with health, as part of their social life and not as an intermission from it. Moreover we use this term because we consider ourselves part of the society which acts from and for society. Consequently, any mediation by and connection to institutional “solidarity” agents is unthinkable and unnecessary for us.
The SSH opens twice a week (Tuesday and Wednesday), for six hours in total (5-8p.m.). The monthly schedule is publicized in the neighbourhood through posters in fixed spots (pharmacies, mini markets, bakeries, grocery shops, bookshops, super markets) and through the internet. This practice creates a fixed point of reference for the neighbour who can see (and can search for) the schedule any time and ensues a sense familiarity that can make one feel comfortable enough to visit the place.
The pharmacies play a very important role in this network, as much in communicating the information to someone (usually the elderly) who is searching for medicine (that they cannot afford) or a specific doctor, as because in this way there remains an open invitation to pharmacists to participate in the SSH project.
Health practitioners: categories of specialisation
At the moment the following doctors participate in the SSH: a general doctor, an otolaryngologist, a pulmonologist, an orthopaedic, a psychiatrist, psychologists, pharmacists, dentists and a dental technician. From time to time a reflexologist, a neurologist, and a surgeon have also participated.
Through an evolving process (which arose not by chance but out of the main targets of the project) a group of socio-psychological support was formed which is now fully functioning. Non-health practitioners who first encountered the project in order to seek psychological support also took part in setting up this group.
The programme also involves herbal medicine consultation which in interaction with western medicine attempts to broaden the range of solutions that the latter has to offer. A herbal medicine workshop operates in the SSH; an initiative in the context of the self-management of health, where people from the local community and beyond try to break – where possible – their dependency to pharmaceutical companies and to make their own medicine for common illnesses (e.g. cough syrup, Echinacea tincture for flu and the common cold).
Finally, the social space for health hosts the Group of relatives and friends ‘Hearing voices network’ of Athens. It is particularly notable that people who visited the space seeking help are now equal participants in the project’s assembly.
The weekly assembly of the SSH consists of about 30 people.
Since November 2011 (and until the end of February 2013) the social space for health has received hundreds of requests. The majority of these is for orthopaedic problems followed by socio-psychological support. In the past few months socio-psychological support has become very popular. Many requests that seem at first to be pathological in nature have socio-psychological roots and demand the appropriate treatment. This piece of statistics clearly stems from the social restructuring derived from the intensity of economic depredation and marginalisation.
On average the social space for health receives 4 requests per shift, with the majority of those coming from people aged between 21and 40. There is however a respectable number of people over 60 who have visited the space. This is an important step, since usually people of a certain age carry more prejudice than younger people, keeping in mind the fact that this is not just a social health centre, but one that is hosted in a squatted building (squatted spaces are rather aggressively received by dominant media and petty bourgeois reflexes).
The neighbourhood of Petralona, obviously since the project is located there, is where most of requests come from. However, a constant flow of requests is recorded coming from all over the city (ranging from Keratsini to the suburb of Kifisia).
With regards to migrants, we haven’t yet developed a way to establish contact with them (many migrants from Asian countries live in Kato Petralona while in Koukaki the migrant population is mostly from Balkan countries). However, a number of them have already visited the space mainly through contacts established though the movement and through personal relations. For some time now we recognise that we lag behind on this point The qualitative analysis of requests coming from migrants confirms their class origin as workers who find themselves in the bottom of the pyramid: mainly hepatitis (from working as rag collectors and being exposed to various infections) and orthopaedic problems (which often derive from accidents in the work place).
For some time, while the local assembly was still active, one of the records we would keep was to what extent did the requests we received were coming from people who also participated in the neighbourhood assembly. It was a way of observing to what extent the project remained connected to the local movement and its procedures.
The practice of recording and analysing the incoming requests serves to understand the kind of demands that the SSH has been able to respond to so far. Moreover, it will help us examine what further steps can be taken (e.g. more equipment) in order to meet a higher standard that may result in the course of time.
Reception; the context
The Social Space for Health is open to all, locals and migrants, neighbours from Petralona or elsewhere, insured or uninsured. Just as we aspire to a health system that is available to everyone, so have we in our self organised space chosen to never ask for papers, pink and orange cards or utility bills. We would rather rack our brains so as to find a way to manage demand if that were to increase radically, than impose terms and conditions.
A crucial reason behind the choice to not impose term and conditions is that for us this project is a wager that goes beyond the initial step of tending to health care needs and which brings to the fore issues of biopolitics and the management of our bodies (in relation to those who appear as the experts on the matter, i.e. Doctors).
The prospect of us getting licensed by the state sounds rather like an oxymoron and a joke. The SSH is housed in a squatted building and as such has always been outside legality. Not with regards to medical criteria, but with regards to criteria set by the language of power, which wants everything to be controlled and mediated by it. Housing this project in an occupied space was not a choice made haphazardly or of secondary importance. We defend this choice and juxtapose it to the abandonment of the primary health care point that PIKPA was originally by the relevant authorities. Naturally, we also defend this choice as a tool in our struggle with which to respond to social needs. Housing our project in PIKPA had from the beginning a double meaning: practical and symbolic. Part of the equipment that was abandoned there is now being used. At the same time, the symbolism in the fact that the local community has taken over the servicing of its medical needs on a self-organised basis where the state has failed to do so since leaving this primary health care centre to rot, speaks volumes. Our existence and the consistency of our activity throughout these 4 years is living proof that such a choice since it is desirable is also possible.
The only licensing that self-organised projects require is the sense of responsibility of the people who build them and their social legitimacy. Satisfying any medical criteria needs not be confirmed by some official institution, since we are not dealing with obligations arising from the agreement between two parties (such as between the doctor and the ministry), but with a choice of struggle which we made selflessly, willingly and with a sense of responsibility. When in our day, confidence in any product is gained through state certifications which later prove false (see for example food scandals and many other paradigms), it is time for us to reclaim confidence in interpersonal contact, away from the concept of “service” as a “product”.
We perceive the possibility of social clinics and other such projects getting funding by the ESPA* as an attempt to assimilate/ incorporate social projects. Of course this process of assimilation and incorporation is not confined to EU funding but is also manifested though the activities of NGOs (as vague as those can be), of various media (e.g. Sky network) and of political party mechanisms. The debate on this issue is ongoing in our assembly, however we invariably express our position in our texts. The most recent of those was a text entitled “We will speak for ourselves” and was a response to the website “Solidarity for all”**.
In short we shall mention two points concerning this issue:
1. This gesture (“Solidarity for all”) was an attempt to incorporate social projects so that they no longer provide a fertile ground for potentially anti-systemic voices. At the same time the state through the choice of which projects it will integrate (depending of course on the acceptance of that process by the projects themselves) can then decide which will be left out. And so an artificial distinction is created, such that can be manipulated by the rulers according to their own aims.
2. Voluntary service in place of a welfare state? If we were to pinpoint one fundamental target of the capitalist restructuring that has been taking place these past four years, that would be for the state to shed those welfare obligations which it had assumed as a way to pacify the intense class struggle of previous decades. So today, we call unpaid labour “voluntary work” and cover it up with the cloak of charity so that it fits in with the melodramatic tone of the crisis years. Our stance is that social clinics should refuse to integrate into future schemes. That they defend the core of their existence on the basis of solidarity and not charity. Active participation and not mere voluntarism.
The SSH does not receive any funding and has no relation with any political party, with the City of Athens, with NGOs or medical companies. We have chosen to be autonomous and self-funded. The fact that this project is far from being self-referential or isolated, but rather is part of the wider movement is evident in the solidarity expressed by workers and collectives (from Greece and abroad). For example, in April 2012, the group for social solidarity of the Post Bank Workers handed us medical equipment (cardiograph, saccharometer, oximeter) bought with money gathered from the workers themselves.
The SSH puts no price on the services it provides. There is a free donation box in the space that goes towards medical expenses as well as running and maintenance costs of the building.
We have chosen to distance ourselves completely from institutions. This is not only because we don’t believe that the end justifies the means, but also because the way of thought that dictates that we could cover our needs through any means offered regardless of political cost in the prevailing grim climate provides an alibi to as well as reinforces those mechanisms which at the end of the day have imposed on us the conditions for the shortages we need to cover (e.g. dismantling of the public health system, shortages of staff and infrastructure, exclusion).
Consequently, we believe that any collaboration with this death machine results in feeding this vicious circle and consenting to the dominant strategy. Every act of legitimising state policy by receiving funds, despite the torrent of verbal condemnation that may go with it will eventually lead more and more impoverished people on the doorsteps of social clinics. At the same time their sponsors, driven by self interest and responsible for this policy of destruction are content knowing that some naïve persons (putting it mildly) are selflessly doing their work for them. For decades now, ngo’s have been servicing the needs of those rejected by the NHS through apolitical charity (even though exclusion from health services is a deeply political act) and focusing solely on the medical/technical aspect. Any health practitioner who is exclusively concerned with tending to this huge number of demands could easily take part in such organisations resting easy on the thought of having given to a humanitarian cause (albeit only partly). On the other hand those who find meaning in resisting enslavement as a whole, in putting a stop to this production of rejects brought about by specific policies, in ending this narrative of death, they should man the autonomous social clinics.
Lastly, we consider the argument that accepting funding from ‘light’ institutions (such as local councils or companies) is not a serious breach of our values (as would for example getting funded by the government or the E.U.) is stale as well as naive. We will not become pray to future vote soliciting (municipal elections are on the way) nor do we buy the idea that there is good and bad mediation. Both our words and our actions are of value in themselves and form part of the movement; they are not a vehicle for participants or anyone else involved for that matter for climbing up the political ladder or gaining high office positions.
Organisational model/ aims
SSH is not a product of the capitalist crisis even though it has been called to manage the consequences of the crisis. In our minds, even if this were not a time of social decay, we would still find a million reasons to create this project. Because we have a particular understanding of health: physical, mental and social harmony with oneself and the environment in a context of collectivism rather than individualism. Because we aspire to realise the experiment in the self-organisation of Health which takes place in PIKPA today in a future classless society. Also because we believe that in order to get there we must build our own self-organised structures of self-constitution here and now; so as to experiment and to test ourselves.
Our aim is the diffusion of knowledge as well as the communication of issues that arise regarding Health. With this in mind we have organised several events, talks and workshops which in themselves provided an opportunity for deepening our analysis, for contemplation, for developing relations and building trust within the neighbourhood. Some of these were: a talk on “drugs of the crisis” (co-organised with the initiative “collective action of social solidarity Over18”***), a talk on medicine during the third Reich, medicine in crisis, health issues in the workplace, first aid and herbal medicine workshops, stress relief workshop as well as several film and documentary showings.
We want to strengthen this project further. We would like to see more and more people (from the medical profession and not only) getting inspired to support this primary health care infrastructure. Step by step we want to up the challenge. Already, within the coming year, we are setting up a dental surgery in the space. At the same time we are looking into getting equipment for an eye doctor to be incorporated into the programme.
Lastly, one of our initial aims which we think has been achieved is the diffusion and the reproduction of this project; naturally not as some kind of franchise. It gives us plenty of joy and satisfaction to see a number of social clinics spring up both in Greece and abroad (there are clinics in Rome and Barcelona which refer to our experience) even if we differ in our core values. Since the beginning we have aspired to witness the creation of many social clinics, not as a sterile and mechanical response to the crisis even if they reject charity, but as points of struggle, as living cells of social self organisation aiming to build those material and social prerequisites for truly taking our health into our own hands.
This last point is not so much a general vision but a proposal to other social clinics, because we think that the struggle in the field of health must be approached within a context of communities of struggle inside the social body, in our neighbourhoods and beyond wherein health will become something tangible, approachable, comprehendible, something that belongs to us, something worth fighting for. Integrating the issue of health care into the context of social struggles, through interventions and actions in hospitals, through propaganda done about social struggles in the SSH, contributes to integrating our activity as a point of struggle into the wider social struggles. In short talking about solidarity and not about health care.
* A government institution that channels european funding
** This is an organisation linked to the parliamentary leftist party Syriza; its website referred to the SSH as one of the social solidarity structures operating in the city without the latter’s permission.
*** Over18 is a drug rehabilitation support group without the use of substitutes.