Download Paper - International Labour Process Conference

International Labour Process Conference
13-15 April 2015
Title:
The new meanings of voluntary work in the case of Metropolitan
Community Clinic at Helliniko (MCCH)
Chryssa Kousoulenti
Social Worker, Master’s Degree in Social Policy
email: [email protected]
Panteion University of Social and Political Sciences
Faculty of Political Sciences Department of Social Policy
Athens, Greece
Introduction
The constantly increasing number of people who have lost their rights concerning the
public healthcare and medical services as a result of the rapid changes that took place
the last five years in the wider economic, political and social field, generates the
development of the self-organized community1 clinics. The clinics are organized by
volunteers in order to provide health services to unemployed, uninsured and pauper
population. Τhe structural composition of the clinic consists on direct democracy,
lack of typical hierarchy, co-decision and social activation.
“Metropolitan Community Clinic at Helliniko.” (MCCH) is a representative case of
community clinics. The structural model of the clinic is inspired by the most radical
principles of the civil society, while the professional composition of voluntarism is
going over all the levels of settlement and function, such as the highly professional
constitution of the volunteers, the multilevel operational structure, the commitment
and mainly the provision of high quality medical services to people with multiple
needs. Under this consideration, the participation at the Community Clinic generates a
new meaning of voluntarism, which includes discernible elements of professionalism
in an attempt to restore the provision of public medical services. Furthermore, since
the volunteers are operating on a social-collective action basis, an urgent demand for
active participation in the social and political field arises.
Methodology
For the purposes of the postgraduate program “Methodology and applications of
social policy” of Panteion University, an empirical research took place at the
“Metropolitan Community Clinic at Helliniko” (MCCH), which was selected as a
representative case study. The research lasted 4 months (April-July, 2014). In order to
raise primary qualitative data, which allow a basic theoretical framing, the field
research is consisted of qualitative interviewing. Particularly eleven in depth
interviews were taken with volunteers, who are actively participating for a period of at
least three months at the MCCH. The participants are five women and six men. The
range of their age is between 22-67 years. Four of them are doctors. The others are
1
The accurate translation from the Greek language is “social clinic”.
offering services in other sections of the clinic. All the participants are highly
educated.
Literature review
This attempt seems to be the first empirical research that investigates the community
clinics in Greece. Therefore the theoretical framework of the research focuses on
designation of the elements and data which demonstrate the causes that generated the
community clinics. At the same time the theoretical approach of the broader
significance of voluntarism and volunteer work was necessary, in order to define the
innovative facet of the volunteerism that takes place at the MCCH.
The causes and the conditions that generated community clinics
In Greece the insurance and pension rights are directly dependent on the
labour/employment. On one hand, part of the employee's salary withheld in the form
of stamps, in order to ensure the right to the public primary and secondary healthcare
and medical services for himself/herself and for the dependents members of their
family (e.g. minors). On the other hand, the employer is obliged to pay contributions
to public insurance institution. Also, the final amount of employee’s pension is issued
from the same withholding. It is clear therefore that the employment loss implies loss
of insurance capacity and loss of insurance capacity involves loss of access to the
public primary and secondary healthcare and medical services. Equally clear is the
fact that an employee who has not signed some kind of contract which legitimizes the
employer-employee relationship, is in a state of uncertainty concerning the rights of
insurance and retirement. Finally, an employee who has failed to collect the required
number of stamps is not entitled to pension and insurance, even in the case that he/she
has typically completed the years of work which are defined by law as necessary for
pension entitlement. Although the above is fairly simplistic, allow to give a glimpse
of the basic structural principles of the pension system in Greece, where it is apparent
that the individual insurance and pension right is directly linked to the broader
regulatory employment context.
Arguably raises the first question: What happens when under the pretext of
development/growth and competition, austerity policies are adopted and enforced?
Policies which practically deregulate labour relations at the expense of employees.
The deregulation of labor relations and corresponding legislation is operating in the
opposite direction from that which was required. While the employment relationship
was interpreted in favor of the weak pole, in the given period of time is interpreted in
favor of competition. That causes the loss of fundamental labour and social rights
(www.inegsee.gr). The statistics describe with clarity the practical effects of the
implemented austerity policies over the last five years:
-The general unemployment indicator increased at the percentage of 26.6% for the
second quarter of 2014 (9% was the figure in 2009), while subcategories such as
youth unemployment approached the percentage of 58% (an increase of 200%,
approximately, compared with 2009) (www.statistics.gr).
-The
percentage
of
uninsured
employees
is
approximately
up
to
38%
(www.inegsee.gr).
- 1/3 of freelancers are unable to sustain their small businesses, so they are not able to
pay their social security contributions, while thousands of microenterprises have been
forced to close2 (www.inegsee.gr).
Translating those percentages into real lives means that 3.068.000 people have lost
their access to the public health system (www.amcham.gr), and almost 2.500.000
people live below the poverty line (www.inegsee.gr). In a country where the general
population is no more than 11.000.000 people, this ratio constitutes humanitarian
crisis. Further information concerning the life quality, such as the increase of suicides
by 37% and the increasing incidence of depression in 32% (www.thelancet.com),
indicates the qualitative deterioration of everyday life for millions of people.
The "Annual Report 2013: The Greek economy and employment"3 notes that the
adverse developments that arise from the respective implemented policies constitute
the pretext for the European Commission, international analysts, Ministers of Finance
Member States and central banks to legitimize ideologically and politically social and
insurance options. Options which are aiming to reduce the state’s intervention
regarding the financing of the social insurance system and to promote the substitution
2
Based on a moderate estimation more than 200.000 microenterprises have closed during 2010-2013,
while the general tendency is increasing (www.imegsevee.gr)
3
The research was conducted by the Greek Institute of Labour.
through three axes: a) the significant reduction of social benefits, b) the
institutionalization of private management of social resources and c) the enlargement
of individual responsibility in risk insurance (funded system), as well as the reduction
of social service of democracy. The result of these options is that the social right of
public health is perceived as an individual right. In addition, the management of social
needs is performed on market terms, as they are considered personal desire and not a
collective-social need which should be guaranteed by the state (www. inegsee.gr).
Arguably raises the second question: What happens when the argument of
rationalization weakens the public health?
In April 2010 the first borrowing agreement between Greek government and IMF,
ECB and EU was signed. The context of the agreement included the terms under
which Greece could borrow money in order to address the debt crisis. It also included
directions regarding to the policies that the Greek government was obliged to
implement in order to sanitize the management of the state general economic policy.
Two more Memoranda followed, as well as the PSI agreement (October, 2012,
www.minfin.gr) where the internal devaluation was forecasted, effected, among
others, the significant loss of resources of insurance and pension funds
(www.hellenicparliament.gr, www.minfin.gr/portal).
Greece, as an exception between the member states of the Organisation for Economic
Co-operation and Development (OECD), reduced social expenditure (pensions, health
expenditure and welfare transfers) from 23.9% of Gross National Product (GNP)
(55.2 bn. Euros) in 2009 to 22% of GNP (40.3 bn. Euros) in 2013, i.e. a decrease of
around 26.99% in proportion to the decline in GNP for the period 2009-2013
(www.inegsee.gr).
As consequence of the above, Greece was referred for violation of minimum social
security thresholds and safety (International Labour Convention 102). The referral
was based on the findings of the Report (2014) of the Committee of Experts on the
Application of Conventions and Recommendations International Labour Organisation
(ILO). The Greece falls for the third time in the blacklist of countries with serious
violations of labor / insurance rights and referred directly for control to the competent
Committee on Application of International Standards for International Labour
Conference of the ILO (www.gsee.gr). Specifically: The Commission notes that the
increasing contraction of the economy, employment and public finances due to the
ongoing austerity policies imposed, threatens the sustainability of the national social
security system, while is violating the recommendation of the Convention for the
implementation of the European Code of Social Security (www.ilo.org).
The actual state of public health service structures reminiscent war scene or other
emergency situation. For example: The dismissal of medical and nursing staff layoffs
lead to the understaffing of the public hospitals. Especially in the province, critical
specialties of doctors (e.g. pathologist, cardiologist, pediatrician) are rear or absence.
Intensive care units are not working thus at risk daily lives. Basic medical supplies
(bandages, syringes, catheters) are often in shortage, so patients are forced to produce
them (www.healthview.gr).
Obviously, the above constitute a very limited overview of the changes that the
political practices of austerity have brought about the public health sector. These
policies have led into the condition of humanitarian crisis that millions of Greek
people are facing in their everyday life. Under these circumstances, the citizens are
mobilized to create structures that operate on volunteer and collective basis, aiming at
two levels: to provide indiscriminate health services to the uninsured population and
to highlight, record, and report both the changes in the public health services, and the
derived dramatic impacts.
Defining and redefining the concept of volunteerism
On 2 -13 October 2013, held in Geneva the 19th international conference of labour
statisticians. According to a general definition of work, the work includes all activities
performed by individuals, regardless of gender and age, in order to produce goods or
services for their own consumption or consumption by others. The adopted resolution
proposes an international and clear definition of work which includes various forms of
work. According to the resolution four types of work are defined:
a) The work that products for personal consumption
b) Employment as a form of work performed by third parties in exchange for fee or
profit
c) Employment in the form of unpaid work performed by third parties in order to
obtain professional experience or skills in the workplace
d) Voluntary work, which includes non-compulsory and unpaid employment for those
who are performing the work (Concialdi, 2014 at Lymperopoulou, 2014).
Essentially, the resolution recognizes voluntarism as an official form of work. Suffice
it to define the volunteers as workers or professionals? If one goes back to the way
that the general concept of organized voluntarism has developed in the context of
capitalist western states, especially in the field of welfare state, realizes that the
voluntary organizations incorporating distinct elements of professional organizations
(Zannis, 2013). Although the organized volunteerism is a vast area with many
variations per object, purpose, ideology, place, time etc., one can distinguish some
common features benchmarks:
i) The statute, the institutional framework, the identified sources of funding, sponsors,
board, etc., defines the establishment of an organization for servicing a specific social
purpose.
ii) Designated operational framework and way of intervention, according to the
general purpose, field of action, the law, target group etc. (know how of the object).
iii) The training of the volunteers in accordance with the principles, values and
expertise of the organization (taking into account the skills of the volunteer)
(Bourikos, 2013: 1-35).
It is quite clear then, that, under a broader consideration the work in a voluntary
organisation presents common features with work in an enterprise. Which are
eventually the differences between professional and voluntary work (excluding salary
and benefits of course)?
One and only definition is difficult to include the concept of voluntary work in all its
dimensions. However, in a descriptive attempt, voluntary work should involve the
following features in order to be defined as such:
-The work must be provided for free, without financial remuneration. The incentives
of the volunteers could fluctuate from completely selfish to completely altruistic.
Essentially the absence of salary separates voluntary work from paid employment.
-The work should have a positive impact on individuals, groups, communities or
society as a whole, no matter if the volunteer is completely aware of the final result
and impact. The volunteer could be indifferent or could even have selfish ambitions,
expecting some personal benefits. Nevertheless, the effects of his/her work could be
significant and the results could actually serve social purposes.
-The work could be provided by a government or profit entity or nongovernmental
organisation, but it could also be provided by an informal institution, either organized
or individually.
-The work should not be associated with a forced command, but it should arise from
social, economic or personal needs.
-The work should be addressed to a third party and not to a friendly network, relatives
or other social networks related to the volunteer’s personal environment (Zannis,
2013).
This specific descriptive definition has the advantage that is both precise and flexible,
confirming the view that the organized volunteer work is governed by rules which are
determined by an institutional context.
However, what happens in the case where the basic rules are observed, but there are
radical structural and functional differences in the whole institutional and practical
organisational framework? What happens i.e. when the ethical principles of voluntary
work along with very high professional features are maintained, but the mode of
operation, decision-making and services provision are differentiated, when i.e. the
whole operational and mainly administrative structure that characterizes a formal
organisation, is missing? Then, a new model of organized and professional
volunteerism possibly arises and a redefinition of the concept of volunteerism is
formed.
The above definition offers three parameters that form the core of the redefinition:
i) The work is not associated with a forced command, but arises from social,
economic or personal needs.
ii) The work must have a positive impact on individuals, groups, communities or
society as a whole.
iii) The work can be provided by informal institution, either organized or individually.
Thus, volunteering provided by informal operators organized under special economic
and social conditions, gravity is attributed on the characteristics of free choice and
social purpose which are promoted by the participants. In this case the voluntary
organization is driven by the social need that determines the set-up target and refers to
a structured group whose members are consciously united in order to achieve the
social purpose that they serve. This approach of organized volunteerism finds fruitful
application in the development of alternative models of volunteer structures. Models
related to the creation of innovative service provision structures are being organized
based on the principles of civil society, aiming to promote both social solidarity, as
well as the questioning of the dominant economic-political status quo in practice.
It is recognized by some thinkers that the most profound way to contest the
economistic worldview of neoliberalism is the development of alternative theories and
practices inspired from the tactics of the empirical tank of the social movements.
Tactics and practices that expose the inherently alienating version of reality promoted
by neoliberalism is promoting on one hand, and focuses on the ability to create new
social structures on the other. This is reflected in projects based on collective
kinematic self-organised initiatives which are covering social needs. Those projects
are realizing the ideas of social solidarity and altruism and are adopting the principles
of direct democracy, giving a revalidation of the concept of volunteering into the
direction of collective, socially inclusive and politicized action, highlighting, in this
way the adaptation of volunteering into the new social demands. The fact that those
attempts are developed from the base of the social body with citizens' initiative in
order to address real social needs, without bias and without discrimination,
demonstrates the social responsibility and the political maturity of self-organised
volunteering (Graeber, 2008).
In this case the concept of volunteering acquires consciously political characteristics
identified with the kinematic process, as the purpose is not limited to helping and
meeting needs, but extends to the demand for social change, while determining the
manner in which this change is perceived. Adopting this emerging conceptual and
pragmatic approach of volunteering as an action with the dual purpose that
simultaneously aims to meet social needs, but also to political interference and
change, the Metropolitan Community Clinic at Helliniko (MCCH) is operating since
December 2011.
Apart from the adoption of collective activists volunteering, the establishment of
community clinics, including MCCH, is inspired by the ideals of civil society in the
light of a decisive parameter: citizens themselves acquire one dimension that
exceeding the boundaries of the capitalist role-model (citizen-consumer), and they
appear as direct social and political actor subjects who act as carriers conformation of
social and political reality.
Civil society as a concept refers primarily to institutions and organizations which are
developed out of the framework of state, market and family (that of typical and
traditional informal care networks). Democracy and civil society are concepts directly
linked, as the former is a prerequisite of the latter. Furthermore, within the dominant
extreme neoliberalism, civil society is presented as an outlet and a rejoinder in order
to prevent social exclusion, and to reinforce social cohesion and democracy. Civil
society acts as an antidote for market failures and restores the values of morality and
reciprocity in human relations level, while it promotes active social and political
participation. Furthermore, the concept of civil society is inseparable connected to the
ideals of direct democracy, values that are degraded by the individual newliberalism
(Zannis, 2013).
From theory to practice (or vice versa):
Α) The professional composition of voluntarism in the case of MCCH
MCCH is a self-organized voluntary structure, which promotes the social solidarity.
The elements that support the professional composition of voluntarism are going over
all the levels of settlement and function. In order to make this understandable, a
detailed description of the organization and modus operandi is necessary.
The clinic opened its operation in December 2011 in a building donated by the
municipality of Helliniko-Argyroupoli. In the initial steps it was flanked by seven
doctors, while all the other volunteers who had entered the organizational functioning,
including the pharmacy, amounted to 60 people. Soon, however, became evident the
need to create specialized groups:
“We didn’t have a specific model on mind.... It all happened quite spontaneously ...
Little by little our needs led us and so we started creating specialized groups and
“positions” for volunteers who had very specific duties" (C.S., Volunteer).
The founding decisions concerned the fundamental code of operation and
cooperation:
A) No offers in money are accepted, only offers in species or services.
B) No one is allowed to be advertised for any offer, nor sponsors accepted.
C) No partisan identities or conversations are accepted inside the clinic.
Also initially was decided which categories of people the clinic would:
Unemployment, uninsured and pauper people, regardless of gender, nationality, race
and religion. Later on low pensioners and low-income earners unable to afford their
medications were added.
After three years of operation the potential of the clinic has more than 250 volunteers,
of whom 115 are doctors of all specialties, therapists and pharmacists, making it one
of the largest self-organized clinics of the country.
The clinic has the potential for providing primary health care and medication and for
practicing some medical examinations such us ultrasound and MRI. Also dental and
gynecological department are operating. In addition, there is the possibility for
providing baby food and products for baby care, as well as paramedical species.
Sometimes very vital needs of some patients are covered through the fund volunteers
or through extra calls on internet.
For better management and organisation of the workload, the following groups with
different tasks each, were developed:
1) The central secretariat, which manages the maintenance and updating of individual
patient files, the appointments with their doctors and the communication with the
served population. 2) The secretariat of the dentist, which has the same duties with the
central secretariat, but limited to the dental department. 3) The pharmacy’s group
which is undertaking receipt, control, recording, classification and disposal of
medicines. 4) Material management group, which deals with the recording and
distribution of paramedical materials (e.g. people with special needs strollers). 5) The
contact group takes contact with journalists, MPs and MEPs in an attempt to lobby
through notifications and complaints. Also contact with foreign journalists, schools
and civic groups wishing to visit the clinic, update for medicines missing. The
observatory is a separate operation of this group that aims at recording the reality
concerning the reality about the health sector and promoting denunciatory facts
regarding the situation of the people who are excluded from the public health services,
the results of the implement policies, as well as governmental announcements that
deals with the current health policy. 6) The organisation group, which is responsible
for anything that have to do with the functioning of the clinic (from timetables and
shifts up to the cleanliness of the building). 7) The examination group that manages
the partnerships with private medical centers or private practitioners and makes the
referrals of the served patients. 8) The group of cancer, which deals solely and
entirely with cancer patients. 9) The patient control group that crosses and verifies the
patients' data. 10) The group who records and informs patients are entitled to
insurance but do not know it. 11) The group which undertakes to receive medicines or
other medical species
from people who leave in remote areas or people who are
unable to travel. 12) The steering group which is elected by the general meeting and is
responsible for compliance with the decisions taken jointly. 13) The theater group that
organises performances in order to communicate the purposes and the principles of
the clinics, to collect medicines, to sensitize and to mobilize the citizens.
The mode of volunteer’s acceptance has also been decided collectively, in order to
ensure that everyone understands and accepts the broader principles of the clinic.
Each volunteer candidate whether is doctor/therapist/pharmacist or someone who
lacks specialized medical knowledge, completes an application. When a critical
number of candidates is completed, each volunteer goes through an interview, having
been informed about the clinic, the purposes, the offered services and the fundamental
constituting principles. Subsequently, the volunteer participates into a seminar and
practical training which lasts one month, in order to consolidate the operational and
administrative structure of the clinic. The distribution of the volunteers who are not
doctors into one of the aforementioned groups is based on the needs of clinic, as well
as the individual skills and personal wishes of each volunteer.
The average of people who addressed for help in the clinic is about 80 people per day,
if counted and the provision of medicines and other items. It should be noted that only
the first two years of MCCH’ s operation, over 16.000 people received services
(www.mkie.org). For anyone who is addressed in the clinic a personal file is opened,
containing the data, medical history and the benefit received from the clinic
(examination, medicines etc.) In that way a useful patient’s record concerning to
every action that has taken place, as well as the particular characteristics of each
patient's needs is available, so that the possibility of mistakes or misunderstandings
referred to the received services is minimized.
On the other hand, the clinic receives everyday people offering medicines or other
species. In several cases, the contribution of medicines is made by pharmacies or
collective initiatives (e.g. there are cases of schools, associations, clubs, etc. that
gathered medicines and offered them in the clinic). When someone is willing to give
money, volunteers are indicating at him/her the category of medicines where there is a
shortage, so he/she can buy them and offer them to the clinic, respecting the principle
of not receiving money. Moreover, there are many cases of collection and delivery of
drugs from abroad at the initiative of individuals, groups, clubs, etc. Also, at the
website of the clinic are posted the shortcomings or some urgent appeal for a
particular drug or other type (e.g. some specialized infant formula).
Through cooperation developed with public hospitals4, other community clinics and
pharmacies, NGOs, with a loose network of private doctors, and private diagnostic
and medical centers, in some cases there is connectivity for secondary healthcare
services provision as well as the possibility of conducting medical examinations. In
other cases, MCCH through public notifications presses the hospitals administration,
in order to be admitted patients with serious health problems requiring immediate
secondary healthcare services.
The way that the clinic is organized, constitutes by itself a strong argument in favor of
the high professionalism that characterizes all the operational levels of MCCH.
Specifically: The volunteer doctors or therapists are de facto highly qualified,
especially when almost all are professionally active. Therefore the offered services are
distinguished for their high quality and professional training. The same of course
applies to volunteers pharmacists. The other volunteers that complete the staff of the
clinic are also highly qualified in order to correspond to the multiple needs that the
work in clinic demands. The seminar and practical training, as well as the equivalent
interaction among the volunteers, enforce further the development and cultivation of
their professional and personal skills. And it is not just the quantitative response to
workload, but mainly the qualitative approach of people targeted in the clinic. That
4
The relationship between MCCH and public hospitals is bidirectional, as several times MKIE has sent
medicines and medical supplies to hospitals where there are deficiencies.
also implies that extra social and humane skills, such as sensitivity, empathy,
comprehension, social awareness, patience and tolerance for diversity, are required. It
also requires a strong commitment both to the social role of volunteers, and the role of
professional, as well as strong sense of responsibility.
The structure of the clinic is layered and covers services that move in a very wide
range (from direct provision of medical assistance to social-services, information,
empowerment, education, etc.). Also the way that the whole work is allocated per
services sectors, strengthens the argument of the high organizational level, since each
one of the groups is specialized according to the cognitive object and the specific
abilities that every type of service requires. In this way, each volunteer utilize his/hers
individual abilities and develops new skills, each group separately is evolving by
optimizing performance, while the entire operation of the clinic is expanded in
response to increasing demands and needs. Equally important is the fact that the
volunteers through friction are acquiring new knowledge and skills, but mainly they
are shareholders and partners of the whole process as equal participants in the
planning and significant decisions, enriching in this way their individual professional
life.
It is obvious that the structural and functional levels of the clinic approximate with
accuracy to a very well designed and funded professional organisation. Each
participant seems to know very well what he/she does. Moreover, and most important
is the fact of the flexibility of the organization, since its operational structure remains
“open” and proceeds according the needs that arise and is not stagnant in what it have
been conquered. Finally, the patients are receiving immediate, humane and versatile
service, since the basic principle of dealing with patients is respect and equality.
From theory to practice (or vice versa):
Β) Self-orginising, co-decision, direct democracy.
The hitherto analysis and presentation of MCCH project describes a well-organised
social structure, with multiple levels of operation and service, with evolutionary
dynamics and highly trained and educated volunteers. These alone could constitute a
standard organisational model of social volunteering. What happens, though, when all
these are taking place under the terms of social solidarity, self-organisation, lack of
typical hierarchy and direct democracy?
The clinic does not have any legal status. It is a self-organized solidarity structure.
However, this does not mean that there are no clearly worded operating rules. There is
an informal contract that imprints in sixteen pages the way that each group operates
within the clinic. This contract is a result of the general assembly and is guided by the
principles of equality, solidarity and collective responsibility.
The observance and the enforcement of general rules is a top priority in order to avoid
misunderstandings and errors that may be at the expense both the patients and the
volunteers. Moreover, the application of rules ensures smooth operation and
transparency of the clinic, as they have universal validity even among the volunteers
who wish to make use of clinic services. However:
"The rules should be individualized ...should have flexibility so they can be adapted to
the needs and temperament of each person because that is the way that the whole
society must operate" (G. V., Volunteer).
The clinic's supreme body is the general Assembly, where all decisions are
collectively taken on any issues arising. Respecting the principles of direct
democracy, co-decision and equality the Assembly is open to all the volunteers who
have participate to the clinic over three months and each one can set in advance the
subject which he/she wishes to be discussed:
"From the first moment we decided that we don’t want presidents, heads etc., and that
all volunteers are equal. We introduced our general Assembly which is the supreme
institution of the clinic. All decisions are taken collectively ... the purpose of any given
powers is to serve organisational goals "(C. S.., Volunteer).
Assembly's result is the coordination group which is consisted of nine people who
have been elected by the Assembly and whose position is revocable. The operational
objective is to ensure that the clinic operates according to the decisions taken by the
Assembly, while it helps in proper functioning of the clinic by assuming the role of
internal "auditor".
The direct-democratic and participatory style of decision-making enables volunteers
to a political awakening that is expressed through active participation in shaping the
social environment and the development of social citizenship in the context of civil
society:
"I think that is the first time that I realise what means to be a citizen and a member of
a society "(N. K., volunteer).
In addition, it constitutes in practice a counter-proposal for a different social and
political model. Particularly the general Assembly is the best way to demonstrate the
collective and the participatory character of the clinic, creating the place where the
real social policy is formed by the base of the social body in opposition to the policy
which is conducted from above, redefining in this way the very concept of
democracy.
In direct correlation of the decision making process is also the avowed goal of the
clinic for political intervention through denunciations announcements and public
information, cultural events and active participation and support in demonstrations
related to the health sector, scientific conferences, discussions on health issues but
also major social issues such as racism, violence etc.. The political exercise is isobaric
with the social service provision, whether it stems from the principles which the
community clinics demonstrate through their living example, either from regular
complaint policy. Specifically:
"So, according to the levels of our action, on the first level we have the social services
which is mainly the medical treatment, on the second level we have the political
context of the conflict and the responsibility to highlight the reasons why people go to
clinics and on the third level we promote an idea for the model of society we want to
live" (C. S., volunteer).
The triptych social volunteering - political context -social vision that promotes the
MCCH has been formatted by all self-organised community clinics and pharmacies in
the country and is reflected in the informal nationwide contract which was agreed to a
nationwide general Assembly of Solidarity Social Clinics and Pharmacies (SSCP):
"In SSCP we do not have the intention nor the illusion about the possibility of
substituting the State which withdraws from liability of the healthcare of citizens. We
build a social safety net in order to support people, while through a constant daily
democratic, social and political struggle we demand from the government to assume
its responsibilities. We do not offer charity, nor want to educate our fellow citizens
into the sense of compassion and supplication, but together to collectively fight for
our right to public health and to demand free access to healthcare services for all
people without exception "("Charter" Solidarity Social Clinics and Pharmacies, 2013
Common place-common principles, par.4).
Conclusions: Composing the new meanings of volunteerism
The creation of community clinic is the immediate response of the citizens to the
degradation of public health sector and the consequent creation of new forms of social
exclusion of large population groups that previously not encountered similar problem.
The upward trend of people who have no longer the right of access to public health
units is a multifactorial phenomenon and involves many aspects that are clearly a
result of the policies practices. The social response came with the creation of
community clinics and pharmacies. The aim is not only to meet the needs, but also to
develop political action demanding the specification of health as what must be: public
good and social constitutionally guaranteed right, not a commodity. Additionally,
community clinics are developing through an argument of resistance and counterproposal, while are inspired from a different economic, social and political approach,
which renders every citizen active subject in the formation of his/her living
conditions.
Volunteering becomes a vehicle for providing professional services related to life
itself and at the same time for redefining the dominant social relations. In this context
volunteer work is disconnected from charity and acquires a dynamic characterized by
offering social services in terms of solidarity, respect and equality, the political
activism and the quest a new political and social model. Typical values of this form of
volunteering are the voluntary assistance without discrimination to anyone in need,
the co-decision, the self-organising, the lack of formal hierarchy, the expressed social
solidarity, the direct democracy and the political interference.
An analysis of individual elements of voluntary work exerted in community clinics
shows that it is a form of volunteering beyond the classical assumptions which
generates new standards.
The innovative nature of volunteering applied to community clinics is not only
reflected on the functional, organizational and moral framework, but is also reflected
on the obtained results, as thousands of people have received medical services and
assisted on their survival. In several cases thanks to the operation of the clinic literally
lives have been saved. Nevertheless, this is done in terms of respect, equality, dignity
and solidarity. Additional important aspect is the fact that whoever comes in contact
with the clinic becomes an active participant. Patients are encouraged to participate in
a similar project in their area or contact somehow the work and values of the
community clinics. On the other hand, the citizen’s offers are medicines, medical
kinds etc. rather than money. This involves in an active process where anyone who
wants to offer comes in real personal contact with the clinic and the people who
surround, instead of donating some money through a bank.
At the same time, the basic principles of the community clinic are invalidating
dominant capitalist values such as money, advertising and sponsor adopting.
Furthermore, dominant capitalist organization models (social and corporate) such as
the hierarchical structure, the authority of the expertise, the ingrained professional
and social roles, the hierarchical method of decision-making, are deconstructed, since
it becomes clear that a collective corporative model is equally functional and
productive. Also innovative is the fact that a form of social barter economy is
developing, as well as medicines and other items and services are exchanged and
being recycled.
Particularly important is the fact that all this friction generates empirically new
knowledge and expertise regarding the management of crisis situations, the lack and
poverty. The fact that this primary knowledge is generated by citizens in an everyday
real condition and not by experts for the purposes of a research is also indicative of
the originality that distinguishes the project. This, on a first level produces creative
responses. On a second level produces empirical knowledge regarding the effective
resolution of problems, since through the daily routine the root causes are identified
and recorded, while realistic solutions are emerging. What finally results from this
fruitful process is a model of participatory social planning that begins by the citizens
themselves and refers to their own citizens.
To the extent, then, that the offer of voluntary service performed in a context where
the very conditions of the social are being redefined and the social contract is being
renegotiated, volunteering becomes a means for offering, and at the same time for
awakening and creating.
In conclusion the practice of volunteering work under the terms of the community
clinic is giving meaning again to the whole of volunteerism as the participants act and
interact, are forming and are being formed through three levels:
A) Through the provision of high quality services related to life itself, in terms of
solidarity, respect and dignity, but also the actively claiming to the benefit of all
people, regardless of gender, race, ethnicity, religion.
B) Through the political interference, protest and complaint, as well as the recording
and highlighting the dramatic changes in the field of public health, but also through
the fruitful cooperation with formal and informal institutions.
C) Through the
promotion of a practical counter-proposal concerning the
configuration and operation of the society where every citizen becomes a co-creator
of his/her living conditions through co-decision, accountability, equality and
democracy.
References
Graeber, D.
(2003). "The Twilight of Vanguardism": History Matters: Social
Movements Past, Present, and Future. Indymedia DC. Retrieved February 15, 2012.
Zannis, P. (2013). Democracy and Social Policy in Transition. The third sector: A
General Theory. Only in Greek: Ζάννης, Π. (2013). Δημοκρατία και Κοινωνική
Πολιτική σε Μετάβαση. Ο τρίτος τομέας: Μία Γενική Θεωρία. Αθήνα: Παπαζήσης.
Lymperopoulou, V. (2014). Volunteering as an unpaid work in the field of Welfare:
The Case of T group of volunteers in KAAP Voula. Only in Greek: Ο εθελοντισμός ως
μια μη αμειβόμενη εργασία στον τομέα της Πρόνοιας:
Η περίπτωση της ομάδας
εθελοντών Τ στο ΚΑΑΠ Βούλας. Διπλωματική εργασία. Πάντειο Πανεπιστήμιο
Κοινωνικών και Πολιτικών Επιστημών. Τμήμα: Κοινωνικής Πολιτικής.
www.inegsee.gr/ereynes-meletes/ekthesh/869-etisia-ekthesh2013--i-ellinikioikonomia-kai-i-apascholisi.ht Access: 23/12/2013:10.50.
www.statistics.gr/portal/page/portal/ESYE/BUCKET/GENERAL/ELLAS_IN_NU
MBERS_GR.pdf Access: 29/12/2013:21.10.
www.healthview.gr/περιεχόμενο/άρθρο/4398/Εοπυυ-όπως-ερττελος-εποχης-στις31-δεκεμβρίου Access: 30/12/2013:14.30.
http://www.imf.org/external/np/loi/2010/grc/080610.pdf “Greece: Letter of Intent,
Memorandum of Economic and Financial Policies, and Technical Memorandum of
Understanding” May 14, 2014. Access: 14/6/2014:08.36
http://www.imf.org/external/np/loi/2014/grc/051414.pdf “Greece: Letter of Intent,
Memorandum of Economic and Financial Policies, Technical Memorandum of
Understanding, and Memorandum of Understanding on Specific Economic Policy
Conditionality” (European Commission and European Central Bank) August 6,
2010. Access: 15/6/2014:10.49.\
http://www.inegsee.gr/wp-content/uploads/2013/10/enhmerosh-teyxos-209.pdf
Access: 19/6/2014:23.42.
http://www.gsee.gr/news/news_view.php?id=2274 Access: 21/6/2014:08.22.
Bourikos, D. (2013). "Social solidarity in Greece crisis: New wave emergence of
civil society or consolidate fragmented social citizenship?" Greek European and
Foreign Policy (ELIAMEP). No 3/2013, pp 1-35. url: www.eliamep.gr,. Only in
Greek. Μπουρίκος, Δ. (2013). «Κοινωνική αλληλεγγύη στην Ελλάδα της κρίσης:
Νέο κύμα ανάδυσης της κοινωνίας πολιτών ή εμπέδωση της κατακερματισμένης
κοινωνικής ιδιότητας του πολίτη;» Ελληνικό Ίδρυμα Ευρωπαϊκής και Εξωτερικής
Πολιτικής
(ΕΛΙΑΜΕΠ).
Νο
3/2013,
σ.σ.
1-35.
url:
www.eliamep.gr,
www.crisisobs.gr Πρόσβαση: 23/6/2014:23.56.
http://www.gsee.gr/news/news_view.php?id=2274 Access: 9/7/2014:22.17.
http://www.ilo.org/ilc/ILCSessions/103/reports/reports-totheconference/WCMS_235054/lang--en/index.htm Access: 9/7/2014:23.52.
http://www.mkiellinikou.org/en/video/ Access: 15/9/2014:23.04
http://www.imegsevee.gr/dtimegsevee/830-18-03-2014-2014-0-49-9963/12/2014:17.01
Access: