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On the bus on the way to my job interview today I found myself scribbling comics about the public health concept of upstream. Just in case anyone doesn't know, the metaphor goes that you see someone floating down the river and pull them out to keep them from drowning, then you see another, and another. After pulling out a few, it occurs to you that you'd better go upstream, find out what's causing all the people to fall in the river, and address that. It is still a guiding metaphor of community health nursing, and health care reform, and other health care arenas. But like many good ideas, there's cooptation. I got this flash in my head today of a bunch of us walking upstream and there's a huge fence so we can only go so far upstream, but, hey, at least we tried to walk upstream, so at least we can fish people out of the river a few minutes earlier to reduce the risk of drowning. That truly feels like where we are in terms of so many public health and welfare issues. If we want to go upstream at this point, we have to start cutting some fences, and if you are just throwing terminology around to show you've paid attention in policy class, that's not really going to happen.

I know I said i'd be posting about my travels, and I am, really. I visited a cooperatively owned coffee finca in the mountains of Guatemala, and spent lots of time at a lefty language tourism project where the locals were so damned grateful that us wide minded progressives wanted to spend our unfairly distributed dollars learning about their struggles as they taught us language. I met women weaving amazing textiles to support midwifery clinics and programs for unmarried and or domestically abused women. All of these things are upstream; forward thinking solutions to alleviate problems which get at the source, right. i mean, if your communities are dirt poor and can't afford basic health maintenance measures (like enough food), well, you buy the finca collectively and control the wealth and put it all in community improvement, not the owners hands. But the owners started selling fincas when global capitalism was such that making a profit on coffee wasn't as easy as it used to be. It was part of a restructuring of capital which kept things in the same old order. And now the new collective finca owners are trying to figure out how to stay in the black with all these lands they are paying off. It is better, they can grow their own subsistence crops to keep from starving, there is a type of stability, but they have not beat the system. they are still floating in a current which threatens to take them down.

We are all floating in that current, but being in these rural places on the other side of our precious borders gave me a deepened sense of how far downstream we have all floated. I spoke with health care promoters who participated in amazing programs to be trained to work in the community on basic health care teaching, how upstream is that? But the funding ended so now the work has all but stopped. And that model is the same public health model here: fund an exciting new project but if it doesn't pay for itself or produce some kind of growth after the initial investment it's not sustainable. Well, just go back to throwing people in the river. Seeing how these things played out reminded me how the global capital agenda is one huge continuum. Those fuckers are so far upstream we will never really see anyone actually getting thrown in the river, so we just pretend that our little scraggly ass flotilla never actually touched the water. Nobody will mention how we're all a bit wet and shivering and smelling vaguely of poorly regulated waste water. "Yeah, we were just upstream, preventing problems".

Back in Chicago, more and more of the work i am peripherally involved with is service provision. It is what radicals do now, because if we don't provide basic human services, people will fucking drown. My friends are fundraising to create awesome community driven youth homeless shelters. Because we have no idea how to change the fact that all our rents are doubling and the layer of built in safety net gets smaller and smaller and we know, for this reason, that homelessness will keep skidding out of control when nobody can afford "market value". We are doing sliding scale community care nights, because everyone knows that affordable care does not live up to its name in any way. We are spreading around crowd sourcing for people's surgeries, preventing individuals from becoming homeless, paying of debts for lawyers to deal with someones horribly abusive ex. We are so far down stream we can't even see the fences we would have to cut to start finding up stream solutions.

This is about my travels because I haven't thought so much from this framework since I was 26. It's not that i'd become a different person over the years, but something about travelling broke some glass for me, glass i hadn't realized I'd put up. I think about the core all the time, the thing that has to change for things to really shift. It's almost like I have a new litmus test having seen some other effects of the tendrils of global capitalism, and i'm less satisfied with some of the ideas for alleviation which don't travel the whole length of the problem. I'm not sure what to do with it yet, but I'm going to ask a lot more folks in my periphery what it looks like to cut the fences that prevent us from going upstream.

Maybe it's just my mid life crisis talking, I don't know though, so much of it feels like thoughts that never really left my heart.


( 1 comment — Leave a comment )
Mar. 26th, 2014 04:53 am (UTC)
The problem of not being able to get past the fence is not confined to health care or community poverty or anything really. Its part of the reality of the global capitalist modern-feudal system. Never even getting near the fence can be damn wearing.

Some people out on the edges are doing their best to just walk away from the river entirely.

I haven't gotten there yet. I don't know where I am. Thanks for this, it is why I still have an LJ.
( 1 comment — Leave a comment )


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