Workers from Medics for the People’s (MPLP/GVHV) health center in the district of Deurne in Antwerp are currently providing care from an alternative location, while their original building is being expanded. The idea behind the reconstruction is to create a space where patients can access care but also meet health workers and participate in planning joint actions for the improvement of health conditions in Belgium.
Social determinants of health are one of the core concepts around which Medics for the People’s work is organized. Physicians, nurses, and other workers employed by MPLP take an active role in organizing at the community level, speaking in favor of strengthening public infrastructure and protecting workers’ rights. In fact, health centers operated by Medics for the People emerge where struggles for better living conditions are under way.
This was also true for the health center in Deurne, the second such facility set up Medics for the People after its founding in 1971. At the time of its creation, a group of left-wing lawyers was launching a campaign for safeguarding a public park. Medics for the People moved in to the same building with the attorneys, addressing the health needs of the people in the neighborhood. When the lawyers moved to a different locale, Medics for the People stayed behind with the intention of building a different model of providing primary care in the district.
Workplace equality and inter-disciplinarity for the benefit of patients
Today, people still walk into the health center with the knowledge that they will not have to pay for the consultation. This is not the norm in Belgium. In many general practices and health centers, patients are asked to pay up front, which means that those who cannot do so find it difficult to access care. Every year, 900,000 people in Belgium postpone care due to financial reasons. The health workers at Medics for the People’s centers know this is an effect of the current system, which prioritizes a commercialized idea of healthcare over people’s well being.
The fact that the health center in Deurne, like other Medics for the People’s facilities, is able to provide care without demanding money from the patients is related to its internal structure. The funds which enable the center to function come from a combination of capitation and health insurance payments, as they do in many other practices in Belgium. But instead of using the money to cover a couple of higher-end earnings and using the rest for everyday operations, Medics for the People distributes it evenly to cover their workers’ salaries and provide forms of care which are rarely provided at primary care level because of limited resources or cost concerns, for example consultations with psychologists.
“We follow the national agreement for health care workers to define salaries in the organization. In practice, that means that the doctors at the health center have lower salaries than other physicians. The idea behind it is that we are able to protect the rights of all workers and strengthen workplace equality,” says Sofie Blancke, one of the physicians at the Duerne center.
As Blancke walks us through the center’s temporary building, most of the staff is already on their way to Ostende to finalize Medics for the People’s program at ManiFiesta. But a group of psychologists, nurses, receptionists, and doctors is still there to care for the patients in the waiting rooms. For the past 10 years, the center has put a strong emphasis on building interdisciplinary teams. They are now shifting away from the narrative where the physician is considered the center of the health system and the others as mere extras. Once again, it is not something that should be taken for granted, since most other health institutions still struggle with this concept.
Many of the nurses who joined the health center after working in hospital departments were surprised when they were asked to take such an active role in the care process. “Nurses have different expertise compared to physicians. For example, they will know wound care better than I would. So it’s very nice to be able to work together on an equal footing, each with our own expertise, for the benefit of the patients,” says Blancke.
Another group of workers that Medics for the People is trying to empower at the moment is receptionists. Blancke explains that the intention is to provide the receptionists with thorough training to allow them to do effective triage. “Receptionists play a key role in ensuring that people get the care they need. If they have adequate training for triage, they can make sure that the patient reaches the form of care they need in the fastest way possible,” she says.
Health as a question of politics
Medics for the People’s Deurne center has 30 workers in total, including Blancke. While some of them came to know of the organization through placements at universities, others arrived after working in other health institutions. “Before coming to Medics for the People, I used to work for another group practice in Flanders. The doctors at that practice were also very dedicated to caring for their patients. But the difference that Medics for the People brings to the table is the recognition of health as a political topic,” Blancke recounts.
Speaking to the health workers from Deurne and other Medics for the People’s centers, it is instantly clear that they are very different from the conventional medically professional operating from their dispensary. Instead, they are on the street with their patients, observing the living and working conditions, and constantly looking for ways to improve them. One of the current focus areas for Medics for the People is the relation between work and health. During consultations, health workers at the organization’s centers note down information about how workers’ bodies are worn out through labor, especially when it comes to positions such as cashiers, cleaning workers, or temporary workers. But they also make their findings public, pushing for change in alliance with the workers and trade unions.
Blancke refers to this method as “listening through the social stethoscope” – carefully listening, canvassing, and sparking action based on the people’s needs. The technique should not be mistaken for a purely theoretical approach. In the vicinity of Antwerp alone, health activists from Medics for the People and the local community fought a decade-long struggle against a highly polluting highway and won. Similarly, they were quick to put in place COVID-19 tracking, tracing, and testing operations as the government lagged behind. Workers from the Deurne health center operated a testing center at a local church after it turned out to be the best fit when it came to spatial requirements.
Even as the organization grows, Medics for the People’s health workers remain committed to their understanding of people’s health. They also remain unwavering in their political interpretation of health. Through their strong links to the Workers’ Party of Belgium and the communities they work in, they are able to mount resistance even as a difficult winter looms over workers in Belgium. For Medics for the People, the key is to remember that health workers have a double role in building a health society. As Janneke Ronse, president of Medics for the People, stated in a recent announcement of the organizations’ vision paper: “In your consulting room, you cure diseases; together, in action, you cure the whole society.”