Communia

Health systems are at a critical juncture

Well over two years after the start of the pandemic, a new wave of Covid is overwhelming emergency rooms in Spain, France and some German regions. The causes are not new. All the demands of the wave of strikes in French hospitals in 2019 and Spanish ones in 2020 remain unfulfilled despite the hollow promises and the massive applause organized from the state in several countries during the lockdowns.

Closures of hospital floors, reductions in staff and beds, and reductions in geographic coverage keep ongoing. As French emergency staff reminds:

We don't need bed managers. We need beds. We are at a dead end. And this also applies to maternity wards. Some maternity wards will close this summer. A woman who was planning to give birth 10 km from her home, may receive the news that the maternity ward is closed and she has to go 50 km away. And she risks giving birth on the road. That's the reality. It's catastrophic.

Many workers still think that it' s just a matter of governmental neglect of public health care. And it's true that states let the situation fester, but they also aggravate it: they keep closing more floors and centers and reducing hospital staff.

Governments like the French one hire consultancy firms to actively squeeze and cut public health, while deploying privatization of the sector. It seems that "we have lived beyond the means" -of national capital- and now we have to accept a higher mortality in order to save... the economy (=accumulation).

From the collective struggle to the debacle of the "individual way out"

Demonstration during the urgent care strikes in France in 2019

The first major symptom of a profound change and a turn among healthcare workers towards demoralization and individualism emerged during the protests against compulsory vaccination.

The same unions that in Italy or France had previously led isolated strikes disconnected from the rest of the sectors, devoted themselves to creating a tense atmosphere among co-workers by dividing the workforces. The result was, as could not be otherwise, devastating.

In the corridors of the Robert-Debré hospital in Paris, the time for debate has passed. The time for education has also passed. "It is becoming uncomfortable to talk about vaccination with colleagues who have not been vaccinated," says Alice, a pediatrician tired of heated debates "that no longer lead to anything."

According to her, caregivers who are not yet vaccinated (without a first dose or a scheduled appointment) are somewhat intransigent. The pediatrician describes some awkward moments, "especially when someone claims not to be vaccinated, or when colleagues start mocking each other. As a result, the topic is now almost taboo."

[A] trade unionist is regularly harassed in the corridors of his hospital by bewildered staff. "Why are you doing this, why are you saying all this in public? "While others tell him to keep his distance. "The other day, a guy told me, 'Stay two meters away if you're not vaccinated.' It's a weird feeling."

The underlying issue was always very different from the official one echoed by the media. Health workers had not "stopped believing" in medicine from one day to the next. When asked directly, many of those who demonstrated against mandatory vaccination did so as an individual way of showing their rebellion against a state they felt had abandoned them:

"At first, it didn't bother anyone for us to work with Covid, but today it bothers everyone," Yasmina, a nursing assistant and secretary general of the Sud Santé union at the Marseille-Nord hospital, told BFMTV.

"Since the beginning of the crisis, hospital staff have been cheered, but all the promises made to them have vanished," ironizes Kader Benayed, who assures that neither the number of staff nor the resources have increased in the Bouches-du-Rhône.

"Health workers feel cheated," he says, in addition to being the object of suspicion. Also, the variable-geometry vaccination requirement, with an exemption granted to other professions such as the police, is proving difficult for caregivers to accept without batting an eye, he says.

In various parts of France, demonstrators began their arguments with mentions of the applause of the first days of the pandemic and denounced the fact that the situation had only worsened since then, only to bring up much later - and generally in a manner inconsistent with the rest of the discourse - the argument about the lack of safety of vaccines.

It is this same rebellion, fueled by the angriest wing of the petty bourgeoisie and globalized by Bannonism, that guided the apparently opposite reaction of the anti-vaccine people of the French Antilles, who "welcomed" by threatening and qualifying as murderers the health workers arriving as reinforcements to the islands.

Individual solutions can only worsen the situation

The danger of the normalization of "individual solutions" is that its inevitable social outcome is "every man for himself". This much was obvious, but the unions did nothing but encourage it. Instead of redirecting the anger to its original causes, they validated the excuse and encouraged "individual ways out" by worsening disputes and quarrels among medical center workers.

Meanwhile, the press was filled with articles celebrating the disciplinary measures and the public was convinced that there were only two options: either celebrate the repression or celebrate the individual opt-out. Health care workers had once again suffered a serious setback.

The truth is that, from the individual point of view of the health workers and after countless sterile union strikes, faced with state pressure and all political parties, the only remaining solution seemed to be to flee, either by abandoning the sector altogether or by fleeing to better pastures.

A year later, the situation in hospitals in many countries has not improved one iota. Demoralization in the face of daily tragedy is spreading in the UK:

There are people in the back of ambulances for hours on end. There has been no change since the winter; I suppose the only change is that staff have gone from being outraged to accepting it.

The staff is demoralized, defeated; it's really demoralizing to be stuck in an ambulance when you can see that someone is getting worse and worse. Many of the people we see are elderly people who have been on the floor for a long time, and then they are on the stretcher in the back of the ambulance for even longer. There is a sense of helplessness among the staff; I can see why people are leaving. The other thing is the schedule. [...]

Staff demoralization is a big concern: we see a lot of emergency nurses leaving. It's difficult to recruit staff in this specialty and ER nurses are very difficult to replace: they are not interchangeable with general nurses.

At the same time, we have never been busier; I am witnessing worse scenes than ever. There is a lot of moral damage, especially for younger colleagues, seeing people receiving such terrible care, being condemned to lose their dignity, being left stranded in the corridors and there are queues stretching from corridor to corridor. It is horrifying.

In France, they are now asking themselves "who is going to want to remain a sanitarian," because French hospital workers are leaving en masse or emigrating, which not only worsens the situation for the rest of the workers, but opens the door to the "import" of seasonal health care workers at much lower salaries without anyone protesting about a difference in salaries that, in the end, impoverishes everyone.

You find a lot of foreign doctors there," confirms Jafar. That means that many French doctors no longer want to work there. The emergency room is hard and exhausting work. [...]In practical terms, we are the front line, we are the emergency room, we are the operating room, we are the intensive care unit, we are the whole hospital. But when it comes to status, it turns out we're not.

"We are in the same situation as hospital doctors with a French diploma," Haifa explains, "we perform the same functions, except that we are paid a quarter or even a fifth of the salary." For example, if we consider the salary of a hospital doctor with an average of €8,000, we will have a base salary of €2,200 or €2,500.

These are the same Tunisian healthcare workers who left the country after the last healthcare union strikes. It goes without saying that those strikes, following a universally recognizable trade union pattern, were disconnected from the strikes in the other sectors and ended without practical consequences for the workers.

The overall result of the accumulation of defeats imposed by the trade union logic is a global flow where health care workers aspire to be the low-paid foreigners of the country to which they arrive. Something that does not only occur between relatively poor countries and rich countries:

Migration of healthcare workers "is not an exclusive movement from the global South to the global North," Campbell says, noting that there have also been shifts in OECD countries. Dana (not her real name), who works for an international nurse recruitment agency in Australia, says that most of the healthcare workers she encounters migrate from the UK and Ireland.

Many of them previously worked in Covid wards or intensive care units. "They've had a hard time in Europe in the last two years or so," she says. "The opportunities are better here, too. The healthcare system is impeccable [in Australia], so it's not as hard to be a nurse here as [there], especially in Covid times."(/quote)

But, when they arrive in these supposedly better pastures, it turns out that they are not what they seem. Migrants arriving in Australia these days will be able to find several active mobilizations in the sector. At this very moment well over a hundred nursing homes and thousands of paramedics are on strike. There is no corner of the world where public and even private health care are not under attack.

The need to fight collectively

According to the WHO, in 2018 almost six million nursing positions remained unfilled worldwide. With countries such as Canada or Great Britain driving the demand, one eighth of the total number of active nursing staff worldwide was already originating from a country other than the country in which they worked.

The situation has worsened with the pandemic. Expected resignations this year in European and North American hospitals amount to over 3 million jobs. No one is unaware of the implications. The ratio of health personnel per population in the semi-colonial countries closest to the EU may simply implode, while in France or Great Britain even more services are being closed.

Nothing can be expected from governments. Capitalism neither wants to nor can improve public health and no change of management is going to change that.

The impact on all workers - active and retired - is easy to imagine. In these same weeks we discovered that infant mortality rose 7% in France during the last decade of "expenditure containment and cutbacks" and that conscious government inaction has allowed the spread of monkeypox despite WHO warnings.

Yet unions, which drive strikes around the world, keep struggles in a limbo of diffuse and artificially particularistic goals that virtually guarantees both their isolation and their inconsequentiality. This is neither new nor limited to healthcare or to a few countries: the model of trade union action repeats the same nonsense country by country and sector by sector. And in all of them it leads to the same place: demoralization, atomization, disbandment and every man for himself.

That is why the experience of the healthcare workers cannot stop there. It applies to all sectors and all countries. Without regaining morale and fighting collectively, without breaking union control of strikes and extending and organizing them by ourselves, across divisions of contract, origin or sector, we will not only lose purchasing power and working conditions, we will not even retain the minimal health care that until recently was taken for granted.

The struggles themselves can no longer remain within the narrow boundaries of the collective bargaining agreement. For it is not within the four walls of the company that we stake our needs. It is the general working conditions that matter.

When union nonsense disarticulates health care workers and their struggles, it jeopardizes access to health care for all. But by isolating the struggles in categories and hospitals, the rest of the workers are left out, powerless at best, mostly ignorant, of the consequences of what is happening.

When the unions co-organize the famous downward auctions of working conditions between factories of the same car brand in different countries, the consequences are paid by the workers of entire towns, counties and cities. But when the very existence of a single workforce is broken - because the workers of the same industrial process are the same workforce even if they are in two different countries - any struggle is already lost before it has even begun.

To the centralization which means the transition to the war economy, it is necessary to respond with.... ever broader assemblies that break down the division by categories, contracts, companies and sectors. Assemblies that must be coordinated even across national borders.

The unfolding of the crisis, the entry of capitalism into a phase marked by the formation of blocs, militarism and the growing orientation of the economy towards war makes the "trade union mode" and its logic increasingly counterproductive.

Many of these struggles are coming, and if we do not want to lose them one after the other following the unions, we have to rearm morally and raise the struggles in another way. Not on the basis of category, contract, work center or sector. But as workers talking to other workers and urging them to common demands to be achieved through assemblies and common strike committees.