Street Medics are Community Health Workers

Comprehensive primary health care (CPHC) is the health system strategy that, outside of the US at least, is considered to be the basis of a health system. The World Health Organization defined primary health care at the Alma Ata Conference in 1978 as:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

CPHC is only given lip service in many countries, but in many others it is implemented as well as the country can given the limitations on its budget, personnel, etc. Although hardly mentioned in the Alma Ata Declaration, community health workers (CHW) are the principal work force in most CPHC systems. CHWs are often women with average literacy for their community who serve as both basic health care providers and health educators, as well as community organizers. The latter is key because in CPHC the health worker not only treats common illnesses but also helps community members understand the root causes of their health problems in order to work together to prevent disease. Since root causes are the relationships of power that mean one neighborhood or village is clean and gets the services it needs, while another doesn’t and is built next to a toxic factory, improving health is very political.

For many readers in the US, most of this post so far will be completely new information. The US health non-system is the pariah of health systems and has almost no instances of true primary health care. Even most community health centers take a curative/individual behavior modification approach to community health problems and use community health workers in a limited fashion, if at all. One of the only “legit” organizations I’m aware of that understands and implements the primary health care strategy using community health workers is Latino Health Access in Los Angeles.

An interesting historical fact about community health workers is that the concept and practice of community health workers was significantly developed in the context of revolutionary struggles and their aftermath. Chinese barefoot doctors, the early village health workers of Tanzania and Zimbabwe, and Gonoshasthaya Kendra in Bangladesh are principle examples. With few trained health personnel available to take care of people wounded in battle, or just the regular health needs of fighters and their social base, doctors and nurses were forced to train those around them to carry out most of the healing work. In these situations, the community is already mobilized to tackle the inequalities of power that underlie their health problems.

A similar process in the US has produced the other major type of community health worker in the US – the street medic. The Medical Committee for Human Rights is often cited as the first street medic organization:

Medical Committee for Human Rights (MCHR) was formed in June of 1964 to support Freedom Summer. More than 100 northern doctors, nurses, psychologists, and other health professionals, — Black and white — came to Mississippi. Though MCHR volunteers were not licensed to practice professionally in Mississippi, they could offer emergency first-aid anywhere and anytime to civil rights workers, community activists, and summer volunteers. Working without pay, they cared for wounded protesters and victims of police and Klan violence, assisted the ill, visited jailed demonstrators, and provided a medical presence in Black communities, some of which had never seen a doctor. They established and staffed health information and pre-natal programs in many Black communities. Appalled at the separate and unequal care provided to Blacks by Mississippi’s segregated system, they soon involved themselves in political struggles to open up and improve Mississippi’s health care system for all.

After Freedom Summer, MCHR continued working in Mississippi and expanded its operations into Alabama and Louisiana. Like battlefield medics, with their canvas medicine-bags marked with a red cross slung over their shoulder, they were easy to spot in Selma, on the March to Montgomery, and in the hellish violence of Bogalusa. They marched side by side with the protesters, set up their emergency clinics in Black churches, taught community health and pre-natal classes, and fought the white health system to end its segregationist policies. And just like the organizers in SNCC, SCLC, and CORE, the courageous sisters and brothers of the MCHR were targets for arrest and Klan violence.

Today  street medics are less likely to be doctors and nurses and more likely to be EMTs or lay health workers. They are often organized in collectives that provide training and support for members and act autonomously from the health care system. They continue to provide health support during demonstrations and other actions, and to participants in protest movements. There is a street medic wiki that presents much of the knowledge and practice standards generated by street medics and a brief history of street medics. However, street medics are unrecognized in mainstream medical and public health discourse. I have never heard them referred to in discussions of CHWs. Although I have known about street medics for a while, I have become much more familiar with street medic practice through my involvement in the medic group of Occupy Oakland.  Two OO medics were arrested just last night while attending to a person injured by police during a demonstration. Luckily they were released without charges.

Unfortunately, street medics here do not seem to be aware of the comprehensive primary health care model. As the Occupy Movement continues I hope there will be opportunities to discuss it and what CPHC might look like in the US context.

From now on when I am discussing CHWs with my international health colleagues, I will no longer just lament the absence of CHWs in the US Health system, but also proudly point to the health workers of our communities in resistance.