On reclaiming the autonomy. Collectivising medical care

photo: Katarzyna Czarnota

Can healthcare system be a public good today? People living in Greece have been trying to answer this question affirmatively for quite some time. The economic crisis, which destabilized Greece in 2009, forced Greeks to try to answer the question “how to survive?” again, in times when workplaces are being closed and people start losing social insurance and access to healthcare. Besides being obviously dissatisfied with passing the cost of the crisis on the poorest people, the society proposed a specific alternative opposing the benefit-driven capitalist logic many times.

As a response to the criminalization of the exclusion of the non-insured people in Greece, many initiatives have been created, aimed at sharing and redefining healthcare services – e.g. ADYE – Free Self-Organized Healthcare Clinic, bottom-up healthcare clinics based in Athens and governed by the society. Privatisation of the Greek healthcare system and cutting on the government spending on health services that resulted from the economic crisis forced many people to “take matters into their own hands”. Grassroots initiatives related to healthcare, besides providing demonstrators with immediate access to medical assistance (economic crisis demonstrations often ended in riots), are also setting up stationary clinics.

Today in Athens every non-insured person, including immigrants, can take advantage of free medical help. However, the character of a bottom-up healthcare system is not limited to the fact that it is free. It is worth noting that its organization is based on rules entirely different from what we are used to. This is why, as pointed out by Silvia Federici, the policy of creating commons implies redefining the capitalist modes of action and the meaning of the community relations. Citing Federici, we could compare them to the attempts to build new communities that have specific traits –

If sharing has actually any meaning at all, it must imply creating self as a collective entity. This is the way in which the slogan “no commons without community” should be understood. This is not, however, about a “community” defined as an enclosed reality, or a group of people focused on the issues that exclude others, as it is in the case of communities based upon ethnic or religious identity. This is about a community as a form of relation based upon different values, such as cooperation and co-responsibility: for each other, for earth, forests, seas, animals (Federici 2013).

Another, also Greek, example of a new potential of an almost revolutionary change, not dependent on neoliberal state policy, political parties, or NGOs, is Vio.Me plant based in Thessaloniki.

photo: Katarzyna Czarnota

photo: Katarzyna Czarnota

When self-government has been set in motion… VIO.ME – redefining social bonds

“We want jobs and better lives, not charity” – this is one of the postulates of the Vio.Me plant workers who were the first to attempt to introduce workers’ self-government in crisis-stricken Greek industry in 2011. The workers took over a bankrupt plant they were fired from and began working under completely new rules, created on their own terms. After resuming production, they faced numerous problems, yet despite the initial high costs of production, lack of access to loans and uncertainty caused by the market slump, the plant functions well and provides jobs and sense of security, as well as medical care.

Guided by the jointly made assumptions, the workers reformed the whole production line, functioning of the plant, its aims and marketing. Today they make beauty and cleaning products made of non-toxic ingredients, suitable for domestic use, quality of which is increased, while production costs – and therefore prices – are lowered. Instead of a typical marketing, there is a rule: “The secret of our success are strong social bonds!”.

All our decisions are made horizontally, during the meetings of our team, whose members refuse to be victims of unemployment, cuts in healthcare and social welfare services, and instead decide to take charge of production and the local clinic – and they do it on their own terms.

photo: Katarzyna Czarnota

Even though the self-governing workers’ cooperative was met with indifference from the state and trade unions’ bureaucracy, since January 2016 there is also a free medical clinic available on-site, initially founded jointly with Social Solidarity Clinic of Thessaloniki. As declared by its founders, it was created by workers, for workers and for everyone in need. The workers primary goal was a practical realisation of a vision of a different society, based upon interpersonal and environmental bonds, solidarity and self-government. However, the clinic lacks specialized equipment and, most of all, specialists – doctors, nurses, psychologists – so this is why the offices are open only once a week. Apart from providing medical assistance, one of the clinic’s aims is to regain equality between specialists and patients, build comfort, mutual support, and search for deeper causes of health problems.

After conducting a thorough medical history and asking about issues regarding working conditions, living conditions, and the influence of a patient’s job on his or her mental state, the specialists make decisions concerning treatment and the type of support they can provide. Patients, as well as the clinic’s staff, are called “incomers” to highlight the equal status, despite differences in expertise. Such change in the language usage is supposed to “point out the linguistic structure of meaning”, as mentioned by Dimitra Pouliopoulou (Georgiades, 2019), psychologist and member of the initiative. In such a community, health, both physical and mental, means building and strengthening bonds – based upon direct democracy, not valuing people according to their material or symbolic wealth.

photo: Katarzyna Czarnota

photo: Katarzyna Czarnota

Alternatives – care and revolution 

Vio.Me or ADYE are just two examples of bottom-up “autonomies”, understood as an alternative to institutionalized divisions, relations, and dependencies. These are not rare cases; many cooperatives in Venezuela, Spain, Bolivia, or Mexico guarantee – on completely different terms – access to essential services (funeral, medical, educational, transport, hotel, banking, etc.) as a response to economic exclusion and privatization of public services.

All such initiatives were created as a response to a more and more common economic exclusion. What is most important, regardless of their scale, their value builds on an entirely different system of working, which actually shows what the postulate of “regaining control over our lives” means in practice.

Federici writes:

“through the lens of these social movements we can detect, in many different ways, the emerging of a changed rationality, not only opposing social and economic inequality, but also reconnecting us with nature and rediscovering what it means to be human. However, this new culture is only starting to appear on the horizon, since the harnessing of our subjectivities within capitalist logic is still very strong”. (…) “ reproduction work as a material basis of our lives and the first platform on which we can practise our ability to self-govern is a “ground zero” of revolution” (Federici 2019).

Katarzyna Czarnota – activist, sociologist, author of texts, PhD student at the Department of Methods and Techniques of Sociological Research of Adam Mickiewicz University in Poznań.


Georgiades, Niko (2019). Workers Healthcare Center of Vio.Me., Created by the Workers for the Community. Unicorn Riot 2019,

Federici, Silvia (2019)., [in:] Praktyka Teoretyczna. 2019. „Obrazy motłochu”. Praktyka Teoretyczna 3(33): 7‒13.

Federici, Silvia (2013). Feminizm i polityka dóbr wspólnych w erze akumulacji pierwotnej. Tłum. Marcin Marszałek. Feminist Think Tank’s Online Library.


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