Austerity vs. The People's Health: How Greeks Built an Alternative Health System

Vijoleta Gordeljevic
"We don't earn anything, we only spend, but for each other," said a tall, middle-aged man as he entered the little room full of medicine where I was sitting behind a small wooden table, interviewing a 15-year-old volunteer at a solidarity clinic in Pireus, Athens. As he raised his voice, he added: "Write that down, say that we are no NGO that pays people for doing something good. We all do this for free; we do it because we have to." He closed the door and left.

Not only do the hundreds of volunteers involved in Greece's informal health structure consisting of circa 50 solidarity clinics & pharmacies earn nothing, they also do not get the praise they deserve. Like in May of this year when the Medical Association of Athens, instead of supporting the cause, decided to accuse solidarity health clinics of causing unfair competition due to the "unknown work relationship" between the clinics and their volunteer doctors. This was not only a slap in the face for those giving their time and effort to provide indispensable health services for free at these clinics, but also for at least 75,000 Greeks that relied on these services alone in Athens. As a response, the Social Solidarity Clinic & Pharmacy of Arta published a statement saying they pity those who think that solidarity clinics are illegal and that all it does "is have love and respect for the fellow man, nourishing hope for a better future, for a life with dignity."

Over this summer I was lucky to visit dozens of examples of such healthcare-related solidarity. I learned that not only do they provide the sick with medicine and health services, they also help reverse the alienation suffered by many due to unemployment by strengthening social values and practicing open communication and selfless giving.

Greece has lately been seeing its own version of the "economía solidaria"; a term dating back to Latin America in the 80s when a big segment of the population started experiencing economic exclusion due to debt and unemployment and decided to counter it through a cooperative, autonomous and self-managed provision of various services by their members. The same thirst for justice and self-management could be witnessed in the past five years in Greece. Here, austerity has forced self-organization in areas such as housing, food and healthcare. It is especially the latter that has resulted in a remarkable network, quietly saving lives every day whilst listening to announcements of more and more public services being compromised.

'An alternative was needed'
Just two years ago, various authors and journalists referred to Greece's newly-sprung clinics as underground clinics; places people started going to as they increasingly could not afford or access treatment at a private or public hospital. Patients with severe physical and mental problems, many with cancer, diabetes or depression had to neglect their physical and mental problems for months as they were not able to pay the steep private hospital fees.

The public system became inaccessible because of inhumane waiting lists as a result of being greatly underfunded on every level due to austerity. Now in 2015, as Greece's socioeconomic crisis has long become a humanitarian crisis as expressed by Prime Minister Tsipras and other Syriza officials on multiple occasions, these underground clinics have long become known as "social" or "solidarity clinics" and their existence is not even closely as secret as the former term would suggest. Even though they are considered informal and exist without any legal status, solidarity clinics have become the alternative and frankly, quite innovative form of organizing healthcare for the citizens of Greece -- by their own neighbors and friends.

Greater Athens alone accounts for approximately 20 of these clinics and pharmacies. Another 30 are spread all over Greece, including on its islands where public health cuts have resulted in particularly neglected patients. Clinics operate free, without the use of money at any point. The doctors, nurses and administrative assistants are volunteers, buildings are either donated by the local municipality or squatted, leftover medicine is mostly donated by locals and medical equipment tends to come from retired physicians.

What has started off as an emergency solution to the harmful effects of public health cuts has almost become a parallel health structure on which growing parts of the Greek population start to rely. It is a structure that places the idea of health being a human right at its very center. In times when healthcare has become more and more commodified, competitive and selfish, self-organized relationships of care and community demonstrate a way out. They prove that healthcare can work if it is organized and creatively crafted by those most affected.

Health care from the bottom-up, in the middle of crisis-stricken Greece and born out of dire need: How did all of this happen and how did a people decide to take health into their own hands?

The first solidarity clinic -the Social Clinic of Rethymno- was to open on Crete, the idyllic island that is especially popular amongst European tourists. The clinic describes its purpose on its website as supporting people who do not have access to free health, medicines and vaccines as well as highlighting the problem that a big part of the population is being excluded from basic health services. Whereas the clinic was initially founded to serve the influx of immigrants and refugees, it soon started getting demand from native Greeks. Those who came were from diverse backgrounds; most just recently lost their health insurance as a result of unemployment. More than 300,000 people fell into this bracket in 2014, making the total share of uninsured Greeks stand at around 33.2% of the population (not even counting immigrants). Even people that are part of the social security register and formally employed have increasingly been making use of the solidarity structure; a decrease in public spending for medicines by more than half, from ca. five to only two Billion Euro means that many are unable to afford co-payments for drugs of sometimes up to 70%.

Whereas Greece has surely never been a pioneer in health matters - it has always been able to guarantee access to care to those that needed it. Its healthcare has been a mix of social health insurance and tax financed services via its own NHS run structure; comprised of a fragmented, corrupted but nevertheless accessible system. And although quality suffered in the last years, the biggest difference now is not that good-quality services are unavailable, but that people´s incomes are too low to pay for them any longer.

'The right to health'
"It is not just money that is missing. People lost their rights," Nikos from the solidarity clinic in Peristeri told me, a neighborhood in northwest Athens. Nikos is referring to the right to health; a right that was taken away when physicians were laid off and when waiting times became unbearable. If the state does not have the finances to save its population´s health, its people will. As Nikos says "We just want back our rights. We will then fight for the budget, together".

The sheer existence of a solidarity structure makes clear that the times in which health was affordable are long over. The Metropolitan Clinic of Helleniko, by far the biggest solidarity clinic in Greece, reports patient numbers have risen by 375% from 2012 to 2013 with 15,000 patients asking for medical attention in 2013 alone and probably reaching 20,000 patients in 2015.

Meanwhile, the International Monetary Fund was reporting that all of this is part of its plan to "to keep public health expenditure at or below 6 percent of GDP, while maintaining universal access and improving the quality of care delivery." In other words, Greece suddenly needed to do more with much less. It was expected to take care of the health of 11 million people and a rising number of immigrants with only6% of its GDP starting in 2010. This has further decreased to roughly 5% in 2015. Most other EU countries spend at least double as much on health. State-run hospitals have had to cut budgets by as much as 50%, tens of thousands of physicians and other medical staff members were laid off as part of this "modernization" of healthcare.

'Patient-centered care'
In Patission, a formerly wealthy neighborhood in the northern edge of the city, I met Irene and Aleka, who both volunteer their time at the neighborhood´s Social Pharmacy which was founded by two pensioners almost three years ago. My question regarding their feelings about the future was met with head-shaking and ironic laughter. "The future? When Syriza got elected we believed the pharmacy would close, but the opposite happened, we are going backwards." They told me about their patients and the anger they sometimes share with the volunteers at the pharmacy. "People feel betrayed, cheated on and lied to. They feel so much anger". Irene, a former secretary for more than 33 years who lost her job 5 years ago and whose work as a volunteer helped her escape a depression, adds in quiet voice "Now after the news of the new memorandum, I feel I am losing my strength, my hope. I am looking for something small to grab but nothing seems to be improving."

She continued by telling about the pharmacy´s relevance and the 944 patients registered and how they have identified ca. 70 families in need of food assistance. Every couple of months those families can come to the pharmacy to pick up donated food and baby products next to the medical products they receive, helping them survive as many are unable to sustain their families since having become unemployed. Irene and Aleka do not only help organize food assistance, they are also aware of the emotional support the pharmacy provides. To my question of whether she thinks the people coming to the pharmacy come for more than just medicine, Aleka replied "Some people don´t want to be alone, they are understood here. We are all in this together."

It is exactly examples like this that demonstrate the clinic´s far bigger purpose than to simply provide health-related attention. In the process of trying to meet the basic health needs of the people in their communities, these clinics are cultivating democracy and justice, and they are planting the seeds of a more patient-centered health service, one that takes multiple social determinants of health into consideration.

'Beyond medicine'
Through my visits to dozens of clinics in and around the city I came to realize that solidarity clinics can be said to fulfill three main functions: Firstly, the obvious medical function through the provision of free healthcare services to a continuously increasing number of patients at their own locations as well as through a loose network of associate clinics, diagnostic centers and physicians.

Secondly, the function of a social support system, which attempts to assist patients in matters of food and shelter and thus, considers other determinants of health than just access to health services. This function also aids in strengthening social relationships through its inviting and participatory character, it assists people with the integration into social life and gives back dignity to those that felt excluded from society due to illness, unemployment or both.

And thirdly, a political function in which solidarity clinics advocate the right to health and show resistance to all those trying to impose limits on this right. Those are not only the institutions that forced austerity on Greece in the first place but also, national and international policies limiting access to healthy living incl. privatization of water, the country´s beaches or the ongoing commodification of health and health care. Having said this, solidarity clinics as part of Greece´s newly emerged solidarity economy go beyond achieving purely social aims: they aim to put right an injustice by expressing solidarity.

'Being part of something'
They are in the first place about providing medical help, but whoever spends a couple of hours within their facilities, will soon come to realize that their actual relevance encompasses a much wider field and probably an even more important one- companionship in times of crisis.

So regardless of what the near future holds, for the next year or two many of the clinics will continue to be there when no one else is. They will offer a new, innovative form of providing medical attention to people without the use of money and authoritarian principles. "No one will be left alone during the crisis", is therefore a sentence that now marks the websites and leaflets of multiple solidarity clinics and that captures well how the volunteers at the clinics are assisting their fellow people not only in the fight against an illness, but also in the fight against a system that limits their access to good health.

Making their patients "part of something" as Maria Spiliotopoulou - a historian and admin volunteer from the Social Clinic & Pharmacy in Omonia - told me is therefore the essential difference that distinguishes solidarity clinics from other initiatives present such as Doctors of the World. Whereas the latter without a doubt offers great service to the Greek people too, it represents a hierarchical service, where outsiders have come to help the poor and sick. Solidarity clinics in contrast believe in the actual meaning of the word; as Eduardo Galeano said "charity is vertical as it goes from the top to the bottom, while solidarity is horizontal as it respects the other person".

Those who treat and those who get treated have both been hit by the crisis, they understand each other's pain. This way, solidarity clinics do not only provide remedy to physical pain, but they give hope. They make all those visible that have felt invisible the past months and years, they offer social inclusion, companionship and love for the fellow man. Medicine is often just a practical side-effect.

Vijoleta Gordeljevic is a Health Economist & Global Health professional. She currently works as digital health consultant and freelance writer on topics at the intersection of health and politics.
She is also a member of the People´s Health Movement.

First published in Engish on "The Huffigton Post", 6-7.10.2015.
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