For Health Autonomy

Horizons of Care beyond Austerity—Reflections from Greece

Author
CareNotes Collective
Publisher
Common Notions
Year
2020
Collection
Liberation
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After the financial crisis of 2008, austerity measures pushed nearly a million people out of the healthcare system in Greece. In response, nearly a hundred social solidarity clinics emerged, providing free preventative and integrative healthcare to thousands of people. In this short book from CareNotes Collective, we get a look into the theory, practices, and challenges the solidarity clinics embraced, and a glimpse of an approach to healthcare that treats people’s minds, bodies, and spirits as a whole—and in which “health” is considered in the context of work, poverty, and migration. The autonomy theorized by the clinics is one in which patients are granted the ability to make choices for themselves within a supportive social structure: that is, it’s an autonomy that is intimately connected to other people. As we arrive at the beginning of an austerity period in the US, we would do well to learn from this history.

Reading notes

Autonomy

After the 2008 financial crisis, austerity measures sprouted up across Europe. In Greece, public hospital budgets were cut by twenty-five percent, and nearly a million people were left with no access to healthcare. In subsequent years, dozens of social solidarity health clinics sprung up, many squatting in abandoned warehouses and industrial spaces.

The solidarity clinics could not reproduce the institutionalized medical system that was in neglect, nor did they want to. In For Health Autonomy, Cassie Thornton visits many of these clinics and talks to the doctors, nurses, and others running them. Patients are referred to as “incomers,” in order to avoid the association, in Greek, of “patient” with “weakness”; and as part of a broader program to eliminate the hierarchy between doctor and patient and create a space for collective healing. Thornton writes:

In this model, the new incomer meets with three health care practitioners at the same time on their first ninety-minute visit: a general physician, a psychotherapist, and a social worker. There is a health card that the social worker or third member fills out, asking questions to which the patient can answer or not. The health card covers the mental, emotional, and physical health, but is also used to note the conditions of the family, home, work, food, sleep patterns, and family relations; all are considered important aspects of health. As Frosso put it, they are trying to make a hologram of every person: a three-dimensional image of health as clear as possible to the members of the Workers’ Health Center as well as to the incomer.

The answers provided by the incomer are used to fill out a health card, a new kind of record that the clinic is developing. It includes a family tree, which also addresses relationship quality and matters of heredity. At a follow-up meeting, the practitioners and the incomer reflect on all the physical, social, and psychological information. Here, the group helps the incomer take steps towards treatment or cure and helps them develop a plan to do so in a way where they can manage and get support for their own healing. What does the person need in order to thrive? What considerations do they need to make in terms of family, work, and money to help them feel healthy? And what I imagine to be a future question—what social movements might they join to experience the healing capacities of solidarity?

CareNotes, For Health Autonomy, page 37

There’s a lot I could say about this, but one thing I want to call out now is how this image of autonomy works. This isn’t a vision of autonomy as isolated or even “independent,” in the way that word often gets used these days—meaning, without succor or support. It depends, instead, on a robust system of care, in which someone arrives in a place where they are attended to, listened to, respected. It’s an autonomy that’s as integrated into society as the healthcare it enables is integrated across mind, body, and spirit. This is autonomy in the context if collective care, rather than the isolation of self-care.

The second thing that strikes me about this model, on today of all days, is how these clinics weren’t merely a substitute for a failing system, but a wholly different structure and ethos. In the ruins of neglected institutions, the solidarity clinics chose to build something new, something that would not reproduce the old inequities but would transform healthcare into an experience oriented towards the fullness of human living and thriving. They not only considered the incomer in the context of their whole world, they also included the experience of the doctors, nurses, and other volunteers in their conceptualization of liberation. That is, they saw the austerity crisis as an opportunity to break from a system that was marked by scarcity, violence, and separation long before the financial meltdown brought it to a head. Perhaps there is a lesson for us here, too.