We translated a chapter of a book, written by health workers, on health workers struggles in France – check out the introduction and the table of contents here. The chapter takes us on a time ride from hospital strikes in 1968 to a national coordination of hospital assemblies in 1988 to actions against bad staffing levels today. The authors question whether the strike as a form of struggle has become a blunt weapon. We think this is a valid question, but we also feel that we have to deepen it and ask: what kind of strike? We have experienced ourselves that strikes that are organised top down and only address a particular profession or job category tend to be weak strikes. At the same time even limited strikes can be a first step to come together and to address other workers, something that is well described in this beautiful account of the UK nurses’ strike in 1982. What do you think?
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Partial trade union strikes don’t leave the hospital in the control of those who work there
“Fuck the applauding, let it become anger!”
“In a place where everything is measured in relation to death, there aren’t but quarters of an hour, one after the other, and running, we are always caught between the hands of the clock; one has the impression that as soon as they stop for a moment, everything stops for good, the patients and those who circulate around them… you only have to watch the faces of those who wake up from surgery (…) in order to wish that the hands will continue to move forever… and they run…” [1]
The strike is a historic tool, that’s why it has become so easy for its enemies to counter it. While the social movements have managed to enforce certain demands in hospitals, corporatism [2], on the other hand, mainly served the interests of trade union organisations. From 1945 onwards, several great strike movements had significant results within the context of reforms during that epoch, for example the creation of the professional category of health care assistants or the continued access to the pension system in summer 1953, the professionalisation of the nursing roles or the creation of the CHU [3]. Strikes have also managed to defend wages and to resist redundancies.
In 1968, hospitals were one of the sectors where strikes were already complicated to conduct, although several hospital occupations marked the two weeks of the movement in May. For example in Grenoble, the workers at the hospital La Tronche started their strike without previous notice on the 13th of May, and from then on sporadically until June. In Lyon the strike continued every other day from the 20th to the 30th of May; in a hospital centre de la Creuse, staff went on strike for one hour every day. In Marseille the three trade unions that represent workers in the Assistance Publique (public social and health services) regroup themselves within a ‘coordinating committee’, which linked up ‘committees of liaising and action’ that existed in each individual workplace and that drew up a list of demands and decided on the modalities of action. Strike pickets were set up at numerous hospital entrances and in some cases they replaced the hospital security and took over the guard houses at the entrance of the premises. The headquarters of the doctors’ association was occupied on the 23rd of May by medical students, who were less constricted by the straitjacket of sacrifice and trade unionism. In Paris, at the hospital Broussais, where those who were injured during the riots of the night of the 10th of May were treated, the hospital doctor Pierre Vernant started a petition against repression. In Cochin the injured students put up a red flag in the hospital and a young nurse on night-shift, who was also a militant of the trade union CGT, remembered the passionate conversations with these young men and women of her age group: “The students were on the trolleys, we treated them, we discussed, we argued.” The discussions continued after the strike, but primarily in the form of the joint-union commissions which aimed at hospital reforms. At this point, the way that care was organised was not the focus of the mobilisation.
Today the fear of striking is still branded as if it would harm the patients, despite the fact that we hear more and more often about actual deaths in emergency departments or deaths due to a lack of care staff on ‘normal work days’.
On the 26th of May 1968, “in response to rumours circulating within town about patients allegedly not receiving the necessary care at the hospital de Blois”, workers addressed the wider population in a leaflet in which, after a list of their demands, they clarify that “care is assured for everyone in the emergency department; the telephone communication between patients and relatives is running and the visits of patients continue as normal […]. Furthermore, the strikers have made arrangements with the striking refuse workers that the domestic waste is collected.” In many hospitals the visiting times are extended significantly, which allows the next of kin to take over some of the tasks that are normally performed by the hospital staff (toiletting in the paediatric hospital, help with eating in the majority of cases).
There were the same practical limitations in 1968 that we are facing today, namely the fact that people put their hope in reforms. The movement of the health workers didn’t seem to know what else to do, apart from protesting. It seems impossible to go on an offensive in such an environment, where the injunction to assure that care is provided is considered a holy mission, thereby sacrificing the times of struggle to moral considerations or blame games. Going on strike in a hospital is slightly peculiar. At least in the public hospitals it is not about overcoming the power of the employers by attacking their profits: not working doesn’t cost them anything (and even allows management to show positive accounts when it comes to hospital finances and the calculation of the costs for patient beds).
A new and ample movement of nurses emerged again in March 1988 to protest against unpopular reforms by the Minister of Health. This movement shaped a generation due to its independence from trade union structures. On the 13th of September, a coordination of local assemblies brought together 500 delegates at the University of Paris and voted on a program of demands concerning the recruitment of more staff, wage increase and equality of status between working in the public or private sector. The movement grew in the aftermath of a demonstration that united more than 100,000 nurses during the end of September. The slogan of the movement was “Ni bonnes, ni nonnes, ni connes” [“We are neither maids, nor nuns, nor everybody’s idiot”] was an expression of the aspiration to be recognised as a professional group, while the political representatives praised, on the contrary, the quality of the hearts of the nurses, which was interpreted as an attempt to push them to work unpaid ‘as a sign of their caring nature’. On the 25th of October, the nurses finally voted to end the strike. The movement continued in sporadic forms and other types of action until the end of 1989. It inspired nurses in Germany to adopt the assembly as a form of organisation during the early 1990s, though their assemblies brought together health workers from across the city, rather than from single hospitals. They questioned both the working conditions and the meaning of ‘care’ in a sick capitalist society. In these assemblies the daily experience of self-organisation at work fused with those of the squats and the struggles against nuclear power and rearmament.
In 2018 there have been numerous strikes in response to a lack of staff in the entire health and medical-social sector. It seems that only few people remember the strikes and occupations in hospitals that alternated nearly every month, depending on the location. Indifference and the emergence of Covid, with the general public applauding in the background, had a stronger influence than the struggles themselves. Nevertheless, once we look closer into our memories and the archives of the press then we can find a massive amount of strikes and demonstrations that alerted the public about the impossibility of providing care. Often the demands set out from the need for wage increases or related to the problems of shift-patterns or lack of recruitment. The question of ethics and quality of care is never absent, but it nearly seems like a luxury when the main issue is whether to have beds for patients at all. The strikers say that beds are closed due to lack of staff. We could talk about the strike at Cayenne, where 17 doctors of the emergency department [medicins urgentistes] resigned in order to denounce the lack of staff. Or about the University Clinic (CHU) of Pointe-a-Pitre in Guadeloupe, which burnt down in 2018. Or the unlimited strike at the hospital of Vierzon. Or the strike in winter 2018, when ambulance stations closed down all over France. There are calls to go on strike on the 9th of October, 20th of November, then in 2019 on the 18th of March, 11th of June, 16th of June, 2nd of July, 12th of September [4] and 14th of November. [5]
In March 2019 the nurses and health care assistants of the emergency department at the hospital Saint-Antoine in Paris started an unlimited strike which had repercussions all over France and gave birth to the Collectif Inter-Urgences. More than 500 people gathered during a general assembly on the 10th of October at the hospital La Pitie-Salpetriere. 300 out of the 500 were doctors – there are 6,000 registered doctors in the AP-HP (Assistance publique–Hôpitaux de Paris / University Clinics of Paris). The reaction of the political powers was to announce measures, namely the ‘Agreement to refound the emergency departments’, but they were unsurprisingly insignificant. During a demonstration a banner announced that there would be deaths should a catastrophe hit the region: “You count your money, we count our deaths”. The Covid pandemic hit at an already critical time where the primary medical sector and the related areas were already weakened and the hospitals in a situation of permanent understaffing. On the 11th of May 2020, the end of the lock-down, a demonstration took place at the CHU in Toulouse in order to remind people that the financial management of the hospital was a prime factor in the number of deaths related to Covid. On the 16th of June 2020, during a protest march of care workers that set off from the Ministry of Health, the defence of the hospitals was finally taken seriously when hundreds of demonstrators dressed in black set fire to urban accessories and threw projectiles at the state force, shouting “Everyone hates the police”. Yellow vest protestors, care workers and many others anticipated a response by the ‘Segur de la Sante’ to this humiliation. The ‘Segur de la Sante’ is a government institution that consults about ‘reforms’ of the health sector. The government would hastily organise this response in order to silence a possible revolt amongst those care workers and others who, up to that point, knew so well how to be well behaved. When would people shout: “Everyone hates the ARS”? [6] Because the Yellow Vests remain the breeding ground that can help us to break the gentle deadlock of trade unionism.
In 2021, the wave of closures of emergency departments continued because people left for other jobs or because they were on long-term sickness absence. On the 11th of January 2021, the nurses and health care assistants at the pediatric department of the CHU in Toulouse went on strike in order to denounce the increasingly difficult working conditions and the unmanageable lack of staff. They also occupied their department and left only the emergency service functioning. On the 10th of May, a crowd of 3,000 people assembled in front of the local government building in Orlon-Sainte-Marie, protesting against the closure of the local hospital. Then we saw a two-month long strike at the emergency departments of Purpan from June to July 2022. On the 27th of September, the joint union coordination called for another strike, while emergency departments continued to be closed in various regions, like in Calais or Sarreguemines.
From ‘white plan’ to ‘white plan’ [7] we have become accustomed to a permanently degraded health service and emergency departments that are often closed for weeks. Today there is a lack of 60,000 nurses in the public health system. The strikes come and go and haven’t changed anything. We know that something has to change. The following accounts [8] remind us: the situation is not tenable. To start with, the following limitations are still majoritarian within the hospital struggles: limited strikes, that are sometimes prolonged, but largely partial (limited to single days or particular professions), often contained, quickly forgotten. We therefore have to remind ourselves of the persistence of these limitations, and more importantly, of the repeated powerlessness of the strikes. To address managerial strategies that clearly have financial gains at their heart in ethical or humanist terms is a dead-end.
It hits home that the balance of power could not be shifted in our favour, on the contrary, everywhere the feeling of exhaustion is an excuse to desert both the health service and the social movements at large. The containment of strikes creates a feeling of fatalism. Only perhaps in Guadeloupe in 2021, the occupations and direct actions, in close connection with a social movement, made their demands heard – both against the dismantling of teams through compulsory vaccination and against the social contempt. It was simply about being able to continue to provide care properly. It is therefore true that an effective struggle can be born out of a hospital strike if its function to blockade expands well beyond the health sector. Interestingly it is the health sector that didn’t participate in the most recent movement against the pension reform that nevertheless, since then, managed to win over many sectors and to invent all kind of means to blockade the usual flow of daily life and economy.
Footnotes
[1]
‘The day of a nurse or why domesticated animals’ [‘La journée d’une infirmiere ou pourquoi les animaux domestique’]
https://www.theatre-contemporain.net/textes/La-journee-dune-infirmiere-ou-pourquoi-les-animaux-domestiques/
[2]
Corporatism: A perspective that is limited to the well-being of a specific company or sector; ‘corporatist strikes’ are led in the interest of only a specific professional group or company and don’t challenge the power of the employer, but rather argue for a ‘fairer share’ for employees
[3]
Centre Hospitalier Universitaire (university clinic)
[4]
https://www.lanouvellerepublique.fr/niort/hopital-de-niort-greve-et-occupation-reconduites-avec-une-nuance
[5]
https://basta.media/Hopitaux-urgentistes-urgences-greve-fermeture-de-lits-sante-Buzyn
[6]
Agence Regionale de Sante (Regional health board)
[7]
‘White plan’: Inscribed in law after 2004, the ‘white plan’ is a specific plan for medical emergencies and crises in order to plan the enacting of indispensable measures in a rapid and rational way in case of an influx of victims into a hospital setting. The extended ‘white plan’ is a means used by the representatives of the central state for the regional institutions in case of an influx of victims that would overwhelm the existing health services. Within this framework, the state representatives in the regions organise the health service and can requisition all the necessary goods and services, most significantly the service and infrastructure of the entire health staff, regardless of how the plan is exercised.
[8]
We will translate these accounts in the near future – watch this space!
