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)
ChryssaKousoulenti
Social Worker, Master’s Degreein Social Policy
email:
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 community[1] 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 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, partofthe employee's salarywithheld in the form of stamps, in order to ensure the right to the public primary andsecondary 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 paycontributionsto 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 andsecondary healthcare and medical services. Equallyclear isthe factthat an employee whohas not signedsome kind ofcontract whichlegitimizes theemployer-employee relationship, is in a stateof uncertainty concerning the rights of insuranceand retirement. Finally, an employee whohas failedto collectthe required number ofstamps is notentitled to pensionandinsurance,even in the case that he/she hastypically completedthe yearsof work which are defined by lawasnecessaryforpension 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.
Arguablyraises thefirst question: What happenswhenunder the pretext of development/growth andcompetition, austeritypolicies are adopted and enforced?
Policies which practically deregulatelabour relationsat the expenseof employees. Thederegulationof labor relationsand correspondinglegislationis operatingin the oppositedirectionfromthat whichwas required.Whilethe employment relationship wasinterpretedin favor of theweakpole,in the givenperiod of timeis interpretedin favorof competition. Thatcauses the loss offundamental labour and social rights( statisticsdescribewithclaritythe practical effectsof the implemented austeritypolicies over thelastfive years:
-The generalunemployment indicator increasedat the percentage of26.6% for thesecond quarterof 2014(9% wasthe figurein 2009), whilesubcategoriessuch asyouth unemploymentapproached the percentage of58%(an increase of200%, approximately, comparedwith 2009) (
-The percentage of uninsured employees is approximately up to 38% (
-1/3 offreelancersare unable tosustaintheir smallbusinesses, so they are not able topaytheirsocial security contributions, whilethousands ofmicroenterpriseshave been forced to close[2](
Translating those percentages into real lives means that 3.068.000 people have lost their access to the public health system ( and almost 2.500.000 people live below thepoverty line( 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 increaseof suicidesby 37% and the increasing incidence ofdepressionin32% ( thequalitativedeteriorationof everyday lifefor 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 interventionregarding the financing of the social insurance system and to promote the substitution 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).
Arguablyraises the second question: What happenswhenthe argument ofrationalization weakens the public health?
In April 2010 the first borrowing agreement between Greek government andIMF, 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, where the internal devaluation was forecasted, effected, among others,the significant loss of resources of insurance and pension funds (
Greece, as an exception between the member statesof the Organisation for Economic Co-operation and Development (OECD), reduced social expenditure(pensions, health expenditureandwelfaretransfers)from23.9% of GrossNational Product(GNP) (55.2 bn. Euros)in 2009 to22%of GNP (40.3 bn. Euros)in 2013, i.e.a decreaseof around26.99% in proportion tothedecline in GNPfor the period2009-2013 (
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 findingsof the Report (2014) of the Committee of Experts on the Application of Conventions and Recommendations International LabourOrganisation (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 ( 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 (
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 (
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 thatmillions 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.
Definingandredefiningtheconceptof 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 organisationpresentscommon featureswith workin an enterprise.Which are eventuallythe differencesbetweenprofessionalandvoluntary work (excludingsalary and benefits of course)?
One and only definition is difficult to include the conceptof voluntary workinall itsdimensions. However, in adescriptive attempt, voluntary workshouldinvolvethe followingfeatures in order tobe defined assuch:
-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 nongovernmentalorganisation, 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 provisionare 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 recognizedby some thinkers that the most profound way to contest the economistic worldview of neoliberalism is the development of alternative theories andpractices 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 thesocial bodywith citizens' initiativein orderto addressreal social needs, without biasand without discrimination,demonstrates the social responsibilityand the political maturityofself-organisedvolunteering(Graeber, 2008).
In this case the concept of volunteering acquires consciously political characteristics identified with the kinematic process, as the purposeis notlimited to helpingandmeeting needs, but extendsto thedemand for socialchange, while determiningthe manner inwhich 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 operatingsince December2011.
Apartfromthe adoptionofcollectiveactivistsvolunteering, the establishment of communityclinics, includingMCCH, is inspiredbythe idealsof civil societyin the lightof adecisiveparameter:citizens themselvesacquireone dimension that exceedingthe boundariesofthe capitalist role-model (citizen-consumer), and they appear asdirectsocial and politicalactorsubjectswho act ascarriersconformationof social and politicalreality.
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, withinthe dominantextremeneoliberalism, civil societyis presentedas an outletanda rejoinder in order to preventsocial exclusion, and to reinforce social cohesion and democracy.Civil societyacts as anantidoteformarket failuresand restoresthe values ofmoralityand reciprocityinhuman relationslevel, while itpromotes activesocialandpolitical participation. Furthermore, the concept of civil society is inseparable connected tothe ideals ofdirect democracy, values that aredegraded bythe individualnewliberalism(Zannis, 2013).
Fromtheory 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 orderto make this understandable, adetaileddescriptionof theorganizationandmodus operandiis necessary.