Every year we hear the same song: will the hospital survive?

We translated the intro to a new book published by rebellious health workers in France. It contains many examples of health workers resistance in different eras and locations – check out the list of contents below! We will keep on translating bits and pieces, watch this space!

Fewer and fewer health workers and more and more cuts in services. Everyone’s care becomes more precarious and at the same time more expensive. While the struggles in the health sector have never really stopped, in particular during recent years, they failed to stop the march towards the privatisation of the sector. It is this commodification of the hospital that kills it. The commodification produces our powerlessness and threatens our access to effective care. Even though this affects everyone, the movement around these issues remains imprisoned within sectorial narrow-mindedness, its own exhaustion and the obsolete horizon of the regional state departments. In order for those in power to feel threatened it needs the presence of another power, one that is not yet incorporated and that can confront them on both material and ethical terms.

The politics of health were never neutral and there are numerous forms of resistance, despite the heritage of profoundly reactionary attitudes, such as the professional self-sacrifice of nurses or the tendency to leave hospital struggles to those who work there. Still, what do we inherit as forms of confrontation at the heart of the hospital, once we work there or are cared for? Strikes, occupations, demonstrations, direct actions, autonomy of practices…

With this book we share some narrations from France, from various other places and different epochs, in order to inspire the collective imagination that deals with care.

The engagement with struggles for the decommodification of the health system poses a sack of questions. First of all, because it is not about demanding a simple return to the Keynesian model [1] of the post-War era. We think it is neither possible nor desirable to rely on the state in terms of social protection, given the manifest neoliberal interests of the state itself. We observe the dismemberment of the social security system by government imposition each autumn and we see the places where care happens like mirrors of the aggravating consequences that misery imposes on the bodies. The more care workers alert about their conditions and how this affects everyone, the more the economic doctrine affirms itself.

Even though, historically speaking, humanism tends to be the other side of the same coin of western imperialism – and although humanism is also an aspiration that runs through us ourselves – as an ideal humanism often disguises the conflicts and analyses that are needed in order to target those who profit from massacres and precarity. As Simone Weil said, pacifism only makes sense if it is efficient, and like humanism, it does nothing else but put a smile on the face of those who fight us. On one side we have to reconsider the strategy against the current management of the health sector, and on the other hand the defence of access to care, without relying on those who clearly have the destruction of free care in mind. The challenge of reconsidering our relationships within these spaces of care has therefore multiple aspects.

We have to respond to the neoliberal offensive by interrupting the economic flows of the sector. Firstly, we have to maintain our concern for ethical care as part of a daily practice, rather than demanding it from a management that has removed the concern for care from their profit-oriented perspective. If we want to oppose such a perspective on health we have to, at least, formulate our own contradictions, which remains a taboo within the scene of activists and political militants. The health system is an element of social forces that blackmail us and tie us to a system of production, be it capitalist or socialist. It is a guarantee of convenience that ties us to a system in which we delegate all decision making and care to others, which is something that we have become accustomed to. The majority of people don’t care whether their nearest A&E has been closed down or not until they need it. This is perhaps one of the reasons why there is so little memory of a health workers demonstration that gave rise to a black block that was ready to oppose the planned and ultra-violent degradation that the health system entails. While we are writing these words the town of Carhaix [2] is united, using catapults and barricades, to defend their maternity ward and the availability of the A&E department at night.

Certain considerations and questions remain abstract and unsolved at this point, but the effort to think things through can allow us to avoid certain dead-ends on our way. How can we re-appropriate a health science that has been built on judeo-christian charity, the experiences of wars and the entire domestication of an idea of health, based on a society that puts work at its centre? How would this allow us to face up to our fear of death and, more generally, the vulnerability of our bodies? To reconsider our relationship with health allows us to envision a real upheaval and transformation of human relationships in general and an autonomy when it comes to the unique relationship with our bodies. To put it short, it allows us to question in fundamental terms a system of reproduction that centres around putting our bodies to work. Efforts to overcome state management when it comes to substantial issues such as food, housing or education, have, if they exist at all, numerous theoretical and practical limitations.

Like the initiatives of communal health structures, these efforts to create alternatives are often placed between a rock and a hard place of, on one side, becoming independent from capitalist powers and, on the other side, pushing the public health sector to improve its access to care. Things that are invented in these collective processes are often recuperated and become fertile ground for future institutional structures. This is why we should redefine what we call ‘the public’, detached from the notion of the state. The budgets for the social security system which are reshuffled every year demonstrate well how solidarity has to be reconsidered outside of the old and broken framework of trade union and ministerial representation.

The hospital is the place of care, exile and illness, but historically also the place where the population of the town is registered in the interest of a surveillance state. How can we take care of the hospital while freeing it from the central powers whose object it has become? It is within this context that the ultra-technological development of medicine has surpassed all safe limits. An abyss has opened between the access to daily care and the actual market of the hospital machinery. This market has seen massive investments since the 1990s, through management, sub-contractors and the digitalisation, which are nothing but facets of the same logic of neoliberal privatisation. The question of health and its reappropriation has become central. How can we reappropriate the various advancements that have been achieved by research and colonial resources? The development and investments of the hospital are based on cutting-edge technology which couldn’t exist outside of a capitalist framework. On one side, tele-medicine just covers up the lack, if not absence, of face-to-face care, on the other side the medical and surgical specialities offer horizons of healing at exorbitant prices which exploit the individual vulnerability of each person. Who could refuse the blackmail which the current system of exploitation reminds us of every day?

We want free and accessible care that people can use according to their needs. The constellations that guide us in this sky of ruins are made up by the reports and stories of struggles and resistance that we have chosen to share, in order to understand better what the resistance is about and how we can carry it on.

Prozac, Sertraline and Podalire

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Footnotes

[1] A political economic school that advocates that the state should play a central role when it comes to investments in all social sectors.

[2] During the last fifteen years, thousands of people became active to defend the health services of the hospital in Carhaix (Finistere), in particular the maternity ward. This ward and the surgical services were reopened after three months’ closure in 2008, as the result of a broad protest mobilisation. Occupations, road and rail-track blockades, burning tyres and stones against tear-gas grenades of the police, picnics, folk dances… the tense moments of confrontation with the forces of law and order mixed with more chilled situations together. Once more in 2023 the threat of closure has been rebutted thanks to the determined resistance of the local population.
https://www.ouest-france.fr/sante/hopital/ils-se-battent-pour-lhopital-de-carhaix-retour-sur-les-grandes-actions-menees-depuis-quinze-ans-13340b1a-5adf-11ee-bfa3-55d0c0a38439

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Table of contents

 

Page 8: Strikes, Limitations of sectorial and professional strategies

– Report by a health care assistant of the hospital Purpan in Toulouse, 2019
– Striking health workers of the hospital Ducuing in Toulouse, 2019
– “Hospital of the future, hospital without humans!”, communique by medical students in Paris, 2019
– ‘Subpoenas and legal enforcement of having to return to work’, the response of hospital management to strikes in the sector
– Extracts of a collective book of hospital workers in the UK ‘Sick of it all’, 2021

Page 24: Control over health, an everlasting effort

– Occupation of the Regional Health Agency (ARS), report by a general practitioner, 2020
– Direct actions

Page 35: Sub-contracting and new markets

– Direct actions against temp agencies
– Data strike in France, 2019
– Repeated intrusions of the national health insurance CPAM (Caisse Primaire d’Assurance Maladie) against “Mon Espace Sante” (an online health platform)

Page 48: Why should you occupy your hospital

– “The red flag flew over the asylum”, Northern Ireland, 1919
– The mental asylum of Colorno, Italy 1970
– Extract of an article about the Young Lords, New Tork, 1970
– A victory at the hospital in Rouvray, Roen, 2019
– A manual for occupations, London, 1970
– Cross-narratives of the ‘Grave’ hospital occupation, Toulouse, 2018

Page 83: The words that liberate against those which make us sick

– Extracts from various journals and manifestos

Page 101: Blockade the economy – Leave the hospital in order to defend it better

– Demonstrations of paramedics in Paris, 2019
– Actions of Rote Zora in Germany, 1970s
– The movement against the health passport in Guadeloupe, 2020
– Road blockades in Argentina, 2021

Page 113: Against state management, what are the limitations of alternatives?

– Abortion and autonomous practices in France, 1970s
– A space for social health in Greece, 2021
– “Medic!” in France, 2016
– The AERLIP collective of mental health nurses in France, 1970s
– Witness reports of Tosquelles in Spain and France, 1930s and 40s
– The Socialist Patient Collective (SPK) in Germany, 1970
– The MPU union of mental health patients in England, 1973
– Europe, Latin America, USA, 1970s
– The international network of alternatives to psychiatry

Page 153: Beyond the means, for an ethic of care

Page 157: Annexes

– Some actors of privatisation in France
– Non-exhaustive example of a flow-chart of the hospital hierarchy
– Some notes on medical and paramedical temp agencies in France
– Bibliography