Woodbine Health Autonomy Center

The Challenge: 

The Question: 

What does health autonomy look like?

The Problem: 

A lack of connection with holistic health models and inability to access Western health structures.

The Solution: 

Develop structures to empower community health, access to resources, and preventative medicine.

Channels: 

Where we started

Woodbine is a hub for building autonomy in the wake of a dying culture. Our mission is to expand collective material and organizational capacities in order to build revolution in the 21st century. With a workshop, library, kitchen, and meeting space, we focus on efforts to self-organize, connect, create infrastructures, and develop greater individual and collective efficacy.  The Woodbine Health Autonomy Resource Center is a communal space in the neighborhood of Ridgewood, Queens.  It is part of the Autonomy General Assembly, which is a gathering space for the different projects that are housed within Woodbine.  The idea behind Woodbine comes in the wake of Occupy, but takes its motivations from the Zapatistas in Chiapas, the ZADs in France, communities in Rojava, and all those who have struggled for liberation.  

As we begin answering questions of autonomy, we are faced with the myriad of material obstacles in our way.  Health, or our lack thereof, can be seen as a crucial weakness in the revolutionary struggle.  We are tied to a “modern” health system that fundamentally removes our bodies from a larger physical reality.  We are made to become cells in revolt, aberrant genes, failed organs, physicalities riddled with disease.  Disease becomes individualized as “health” and “wellness” becomes commodified.  States of mental health become symbols of individualized weakness. Propensities toward depressed states, or anxious disorders, and “imbalances” in the brain necessitate chemical intervention, while never addressing the overwhelming emptiness of modern life.  An insane mind is the mind that can adapt to an insane society, and from the news today, we are surely going insane.  Insanity as the only rational response to an insane world, but what contemporary visions of “health” require of us, in order to perpetuate this economy, is that we be atomized, necessarily taking on our struggles alone, seeing them as the individual product of a weak, chemically imbalanced mind. If we refuse this logic, begin to express the anger necessary for a health that recognizes the truly horrific nature of the time we’re living in and develop shared practices of care that diffuse that isolation, we can begin to grow the collective backbone we so desperately need.

Apart from a critique of modern theories on health, we as a community have lost all control over our health.  Our individualized choices to workout, eat right, not smoke, etc are important, but wholly insufficient to answer the demands of this century.  In order to access healthcare, we are tied to jobs that are literally killing us, whether it be mental depravity or physical degradation.  Many people are in constant fear of losing this state granted access, but then are also in fear of having to access such a system, a system that is the cause of more than 50% of bankruptcies.  Because we have relegated health to these institutions, we have lost our ability to heal ourselves.  We no longer know the abundance of nature in helping to create health.  Most people cannot perform basic first aid or use simple techniques for health.  Many communities lack any cognizance or skill to handle the inevitable emotional collapse of our comrades.  In addition, these institutions fundamentally cannot address the issues of climate change, economic collapse, or disruption of key infrastructure.  They are as weak as we are, as evidenced by the effects of superstorms on the health infrastructure of New Orleans and New York.  How can these institutions help us when the very air we breath is killing us?  How do they help us adapt to a world without clean water?  To answer the sadness in our souls to live in a world where we have killed all the fish in the ocean?  

To answer simply, they cannot.  

They are tied to the same system we are, replete with the same fundamental limitations.  But we are not the same. While we are in chains, we are not of the system.  

We have not always lived this way.  

And to remember this fact is to regain our humanity.  

Where we are now

Within Woodbine, the struggle for autonomy has been broken down into specific “tracks”, meant to focus our attention on tangible obstacles to building functioning communities.  The health track is composed of a mix of health professionals and those with informal training in various health practices.  We place an emphasis on re-creating a sense of community wellness and the dissemination of skills.  We work to create ties with those who practice herbal medicines, massage, kinesiology, acupuncture, meditation, yoga and other forms of so called “alternative” medicine.  We work on owning our own definition of wellness, from the physical to the mental.  In addition, we investigate current systems of western medicine, skills, and ultimately, work to develop an ability to manipulate these institutions to serve our goals.  We do not reject modern methods of medicine, but rather recognize the need to detach the knowledge from the oppressive institutions that guard it. Food and the environment have a fundamental role in health, and because of this, will have their own tracks to address their wide breadth of knowledge.  Overall, this track allows us to answer the questions of how do we begin the process of removing our physical and mental minds from an oppressive system, to reclaim our control over health and use health to increase our collective autonomy.  

Within the city, there is a public health infrastructure with clinics and hospitals.  While there are significant problems associated with these institutions, they do provide much of the emergency and chronic care in the city.  There are also spaces dedicated to holistic type medicine, although many of these are inaccessible to large portions of the population.  For these reasons, we started by building a health resource center within our Woodbine space.  The space is meant to be a means to involve community members, understand the care-related skills they have, and be an informational center.  We have public open times for the community, staffed by one of our members.  We also have begun offering a series of basic skills, including basic first aid, wound care,community health, food and nutrition, wellness, and many others.  Our goal is that participants can use the informational aspect to understand their disease process, find resources of different modalities, and either receive aid in navigating the health systems in place or find treatment within the space itself.  And finally, we have a preventative aspect, with our communal Sunday dinners, organic farm share, and weekly workout sessions, where we are beginning the process of owning our own health.

Where we are going

Our overarching goal is to examine what health autonomy would look like for us here in the city.  We are beginning with the basics by providing ways to interact with neighbors, to think of health in a communal sense, and to aggregate the people and resources from which to begin our journey.  Our short term goal is to continue with our introductory skill shares, create concrete ways to navigate the overwhelming health infrastructure that exists, and build a health community.  We are also beginning to experiment with providing care outside of the realm of state control.  This practice may involve working outside the structure of licenses, certifications and insurance.  Our intention is always to heal, and so we must find ways to do so that protects providers and patients.  As we progress, we will consider creating a larger clinical space, with more emphasis on offering a range of clinical modalities.  Finally, as Woodbine looks to expand our sense of territory to upstate NY, we will look to an expansion of the project to include a more rural context, likely in the form of a functioning low-fee/no-pay clinic.  

 

As we move through the journey towards health autonomy, we find ourselves in a context that has removed us from our ability to understand our reality .  We fight that disconnection and work to build the infrastructure that can allow us the space to envision a new existence.  We look forward to hearing your stories, to understand your struggles and to collectively create the foundations to answer these monumental questions.  

 

My questions for peers doing related work elsewhere…

  • How do you create sustainability?  Donation based/grant based/fee based?

  • How do you interact with existing structures?

  • How do you work with or around licensures/certifications to provide safe care?

Contact us:

Woodbine.nyc

Woodbine Health Autonomy FB group




 

Comments

Just a first, liminal reflection...

markomanka's picture

Thank you again @Nadia for pointing this out.

I am not sure I fully grasped the purpose of this, as the text is touching on so many issues at once. I will just focus on the questions to the peers.

1. Sustainability can be achieved by any of the mechanisms you mentioned, and more (how about connecting a parallel currency to your activity, creating a membership parallel economy, the likes of Sardex?)... However, the key is that sustainability is not something that can be described in general terms. One has to map the entirety of value chain, and interfaces to surrounding ecosystems, to form an idea of how to become sustainable.

2. Again, much depends on what are the incumbents you are talking about, case by case (2 hospitals will react very differently, because their governance is managed by different individuals... even if the general administration may look the same), and by how much, and what kind of, intersection your activities have with theirs... Identifying a few "ambassadors", people that may even be critical but willing to engage and discuss, on both sides (also within your own community) is possibly the first step... verbal communication is easier than written, and maps or other interpretable/symbolic representations can help confronting the different narratives to converge... I would avoid interfacing two different communities by exchanging long texts first :)

3. In your case I am not sure why you would like to "work around" any of this... maybe a specific case could help me focusing on a pragmatic reply. In general demonstrating a solid, well thought-of scheme of access to information, education/training, mentoring, and peer evaluation, helps convincing that the operations are sensible and aligned with the purposes of the law. However, there are many details one should consider only on a specific plan: what safety nets are needed for you and your community? Can you keep track of activities and consequences? etc...

Registrations/certifications/licensing are in place as fences, one of the tools in the arsenal of safety in healthcare... it is possible to negotiate ways out when it is proven that safety is guaranteed never the less... this may imply lobbying and meetings with authorities, but one can find examples from prior cases that are useful... as instance medical students can practice some medical activities under mentoring before being graduated and licensed... but the University Hospital has a wide safety net set up...

It's not impossible to find good solutions, and regulators are often discussing of innovation in this field of regulation, but there are no shortcuts...

 

No shortcuts...!!!!????

Rune's picture

Maybe I'm wrong but I though the OpenCare proposal was to shortcut.

Shortcut waitlinglists

Shortcut ineffective bureaucrazy

Shortcut documents that separates people and not connecting them

I thought that we were supposed to be innovative and find a solution. I got to find out if I'm in the wrong place here. ???

maybe worth mentioning...

markomanka's picture

Although I am personally in favour of leaving behind the "fences" of responsibility, and of redesigning the system for accountability and ultimately more pervasive quality... maybe it's time for me to be my own devil's advocate:

Systems of fences (certification/licenses/etc) are not always an innovator's enemy. Dealing with responsibility is a lot easier (and often, paradoxically cheaper in the long run) than dealing with accountability.
If your innovation is specialized, small in scale, or incremental (hence fitting well in the ecosystem where the incumbents are thriving), maybe it's easier to figure out how to obtain certifications and licenses, than how to establish safety nets and sandboxes to work outside of them (formally, but within the purpose of defending your "users").

Don't always start from the assumption that, because others complain about the regulations (often as a narrative to raise their prices), they are indeed an obstacle for you. Do your own due diligence, before thinking of how to work beyond (rather than around) them.

Objective Costs

Rune's picture

@marcomanca, I do agree to some extent. However we need data. Do you have ideas of the costs & times that you can provide?

cost and times should be including applicants cost and time

eg.

CE marking a medical device (>100k€, 1 year)

Approval  from the ministry of health for a medical device (15k€ >2 years)

Patent (50k€, 4 years)

and there is more

 

 

 

On autonomy, prevention and bleeding out money

Alberto's picture

Very interesting @Woodbinehealth , thanks for sharing. We have been talking about autonomy in a health care context mostly influenced by this article about the Amish and their community-based approach to health care. The article is striking on many levels. They use the word "autonomy" in the sense of "a state of not having to be coupled with the world at large in a way we find troubling." Some people in Edgeryders uphold a similar concept, dependency reduction.

Its implications are manifold (I have made a short summary here, but I would recommend reading the whole article if you have not done it already). But basically, it comes down to emphasizing prevention. Illness is not only bad for the individual, it is a burden for the community. You don't want that, so you try to take responsibility for your health. You adopt a healthy lifestyle: you still might get sick, but at least you'll have down your best, and you will know that the community knows. This is close to your own attitude, if I understand this right.

Which brings me to a question: wellness, exercise, nutrition are the low hanging fruit, the place where you are likely to get most results per unit of effort. Why not stick to them? Why struggle with licenses and regulatory hurdles?

And again: you mention sustainability, and well you should. Are your present activities sustainable? Or are they bleeding out money?

 

Interesting view on autonomy

Woodbinehealth's picture

@Alberto.  Thank you for sharing that article and your comments.  I must admit, being here in the US and have gone to school near some Amish communities, I was quite surprised to see many corrollaries with our work.  There perhaps is a strong negative stereotype ingrained in our culture against these "plain type societies", mainly because of disagreements on their heirarchies and religous aspects.  In addition, across the US, medical students are always taught the example of refusing life saving treatments for children for religous reasons as being paramount to abuse (which can definitely be the case in some instances).  But the article reminded me of the Zapatista models of healthcare, with a strong emphasis on prevention.  As to your specific comments, I definitely agree that prevention is paramount and something that we will emphasize.  But we wanted to differentiate ourselves from other "wellness groups" which focus on yoga and massage and nutrition.  Not to discount them, but the current state of health in the US is that when people do get sick, they are forced to access health institutions.  Most people do not have ready access to primary care doctors (usual wait time is 3 months) and without insurance, it is too costly.  Also, many people who do have insurance, have insurance only for emergencies, hence their propensity to go to ERs, which will always be covered.  And finally, here in NYC, there is always the shadow of Hurricane Sandy which shut down many of the lower Manhatten hospitals, including the large public hospital, essentially limiting people's access to public healthcare for months.  So in that context, we want to be able to provide some care for people so that their minor health concerns can be treated without having to go to the hospital.  But obviously always cognizant of our own limitations in care. 

Thank you again for the comments and I look forward to continuing the conversation!

 

 

Your balancing act

Noemi's picture

Hi @Woodbinehealth, you've surely raised the bar for us when talking about health autonomy. Not much to add after the insightful comments above, but wanted to commend you for what I see is a very grounded, mixed approach - setting up complementary infrastructure to the current state provided one, enabling training for non-medical workers, prevention coupled with basic treatment.. 

At the same time you are adamant about the need for a radical, revolutionary approach, and this is where you make a very clear standpoint which to people like Marco above is intriguing. 

As to your question "How do you work with or around licensures/certifications to provide safe care?" perhaps @steelweaver and his experience can help. He is in the process of setting up an acupuncture clinic at the edge of (commercial) regulations.

One more thing

Natalia Skoczylas's picture

There is a very good story on the New York Times about a guy who dived into the accessible data about patients and used certain patterns to start fixing the most obvious failures of the health care system. For example, he looked at which buildings in the city received huge amount of emergency visits and hospital admissions - and started solving the problem by opening a practice inside the very building, where patients are taught about healthy habits and watched over regularly, successfully decreasing the number of emergencies and helping save a lot of money. It sounds very much like Bookchin to me: small communities tackling local problems, using collectives procedures and new technology.

 

fingers crossed for your work, it really looks promising;)

How do basic needs fit into autonomous health advocacy?

maymay's picture

I really like what you've written and am excited to learn about the existence of the Autonomy General Assembly. I think this sort of advocacy is critical and echo @natalia-skoczylas when she observes that this sort of work sounds like Bookchin's suggestions for a method to free ourselves from Statist and corporate rulers. I think this is one of the most practical and underappreciated methods to grow sustainable, resilient, and free communities.

Also, while I understand the importance of involving "alternative" modalities into healthcare, I am curious about whether your collective has considered how even more basic needs—such as literal access to food and shelter—affect healthcare more broadly. I understand that there is are sensible distinctions to be drawn between, for example, addressing lack of shelter (homelessness/houselessness) and what is more traditionally thought of as "healthcare," but I also speak from experience when I say that the stress of being unsheltered is right up there as one of the worst kinds of stress along with the stress of having a more concrete "health issue."

In what ways do the more foundational elements of human care fit into Woodbine's vision for "holistic" healthcare? Collaborations with shelters and food rescue drives? A culture of hospitality? All of the above? What do you see as the most important immediate connections between these "lower levels of Maslow's Hierarchy" and what some would call the more discretionary elements of health, after basic survival needs are met, like massages and physical exercise outside of the context of employed manual labor?

Startup

Rune's picture

Good story @Woodbinehealth. I was searching for the part where starting up is described. How did you gather the people needed to startup? How do you recruit 'clients'?

Basic Needs

Woodbinehealth's picture

@maymay, you bring up a great point.  One aspect of what we're trying to do is balance the desire for a new world with the recognition of the reality of the world we live in.  That we can strive for prevention, but we must address the material reality of how people live.  The battle to live paycheck to paycheck is very real here in the city, especially for us as a collective.  But many of us are sheltered from things like homelessness and hunger in a more acute way because of our social privilege, education, social status, etc.  Not to say that members haven't experienced that, but on the whole, we are somewhat privileged.  We struggle with the more care driven models of soup kitchens, shelters, NGO-type aid groups because 1) we don't have the infrastructure to develop such aid and 2) we don't want to create another area of dependency, where the NGO model fills a hole in a society.  So likely, we will have to create relationships with such institutions who can and are doing that good work, but that we will continue to straddle the line of revolution.  For example, I work at one of the public hospitals in the city and regularly help people navigate that system.  But at the end of the day, we don't believe these systems have the answer we are looking for, similar to what @Alberto was talking about in regards to the Amish.  Thanks again for the great discussion.  And @markomanko, agree that we have to study the idea of both being within the system and out.  Here in the US, the professionalization of many specialities places it in a realm outside of normal access, ie through insurance companies, inhumane public institutions, high priced private centers.  An on-going struggle fer sure!

Thanks for the answer,

maymay's picture

Thanks for the answer, @Woodbinehealth . :) Your answer helped me understand the position of Woodbine within its context. I think building relationships with existing institutions can be a double-edged sword. It can be valuable, but it can also be a trap (a sinkhole of money, time, energy, etc.). I hope there is still room for discussing how to meet basic needs "outside" of the system, or at least—as there seems to be—a willingness to explore how to support doing that from the perspective of additional care-giving such as you're already doing. Anyway, thanks for clarifying.

Great debate

Alberto's picture

Kudos @Woodbinehealth and @maymay .

Let's make this the topic/theme for the NYC workshop?

Nadia's picture

Would you be up for articulating the question and posting it in a status update on the event page? This would help get the ball rolling. Maybe like to this thread? I'm looking into the accomodation solutions btw. At this end we are actiely working towards settingup a phycial edgeryders space, some kind of coliving and working that would allow us to host people for extended periods of time as they work on their initiatives . i.e. time free from the tyranny of having to pay rent to just get on with the work that needs doing. It's something I would like to bring up at the workshop too- models for doing that sustainable and with very little money.

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