Self-managed health care during the Spanish Revolution

Socialization of health serviceand the Health Workers Union

The background to the Spanish revolution (1936-‘39) and how health care was delivered in the anarchist (Libertarian Communist) sections of Spain during this period.

Self-managed health care in libertarian Spain during the Spanish Revolution 1936-1939

One of the most, important questions raised by health workers who have been introduced to self-management ideas is WILL THESE IDEAS WORK IN PRACTICE? HAVE THESE IDEAS BEEN IMPLEMENTED IN THE PAST? This leaflet attempts to outline the background of the SPANISH REVOLUTION (1936-‘39) and how health care was delivered in the anarchist (Libertarian Communist) sections of Spain during this period.

THE BACKGROUND

The Spanish Revolution of 1936 marked the culmination of more than sixty years of political activity and agitation by the Spanish people.

The main groups involved in this activity were: i) The National Labor Confederation CNT (the anarcho-syndicalist labor union whose programme was libertarian communism), ii) FAI - Iberian Anarchist Federation - the militant anarchist organisation of committed libertarian communists, i) The General Workers Union U.G.T. (reform oriented socialist labor union), ii) Spanish Communist Party, iii) Franco’s party, the PHALANGISTS (big business, army and Church) were aided by troops and equipment from Nazi Germany and Fascist Italy.

Anarchist ideas were introduced to Spain in the early 1870’s. In the next 60 years more and more people embraced the political philosophy of theCNT-FAI - LIBERTARIAN COMMUNISM. By the start of the civil war in 1936 over two million workers and their families were anarchists (LIBERTARIAN COMMUNISTS).

In this leaflet we cannot deal with the events which led up to the Spanish War or how the right-wing forces aided by Nazi Germany and Fascist Italy crushed the left-wing forces or how the authoritarian leftist (UGT and Spanish Communist Party) sabotaged and destroyed the efforts of their allies, the Libertarians. What we are attempting to do is show how the anarchists organized health care delivery in the areas under their control. (Over 25% of the population were anarchists and over 25% of the Spanish land mass was controlled by then).

SELF-MANAGED HEALTH CARE IN LIBERTARIAN SPAIN DURING THE SPANISH REVOLUTION

The socialization of health services was one of the greatest achievements of the Spanish Revolution. The Health Workers Union was founded in September 1936. In line with the tendency of unite all the different classifications, trades and services serving a given industry, all health workers from wardsmen to doctors and administrators were organized into one big union of health workers. By 1937 the Health «Workers Union, a section of the CNT, had 40,000 members. It goes without saying that such large numbers could not have been assembled so quickly had not the way been shown by others over the years.

The Health Workers Union did not confine itself solely to enrolling new members. The H.W.U. attempted to recreate the health system along libertarian connnurist lines in the areas under its control; ANDALUSIA, THE LEVANT and CATALUNIA. Efforts to recreate a heaalth system were crushed by the right-ving advance in Andalusia and the Levant but they were extremely successful in Catalonia.

SELF-MANAGED HEALTH CARE IN CATALUNIA

Anarchist health workers laid the foundations of a new health system in Catalunia. The new medical service embraced all of Catalonia. It constituted a great apparatus whose parts were geographically distributed according to different needs. In Catalunia the region wss first of all divided into nine large sectors - BARCELONA, TARRAGONIA, LERIDA, GERONA, TORTOSA, REUS, BERGUEDA, RIPOLL and the PYRENEAN zone. Around these nine centres twenty-six secondary centres were established. In all, thirty-five centres of greater or lesser importance covered the whole of the four provinces in such a way that no village or hamlet, man woman or child was without adequate health care. (The population of Catalonia was then 2,5 million).

Each centre was autonomous as far as their method of organization within that centre was concerned, but their autonomy did not imply an absolute independence. Each primary centre met with delegates from the secondary centres associated with it in order to co-ordinate activity within that sector and delegates from each sector would meet in order to co-ordinate health care delivery in Catalonia.

Very soon the population felt the benefits of this vast undertaking. Community health centres were established in the secondary centres. General hospitals were established in the primary centres while specialist hospitals were established in the capital Barcelona. All decisions made in this vast network of health services were based on equal decision-making.

SOCIAL AND PREVENTITIVE MEDICINE

When the Civil War broke out there were no specially organized Health Workers Unions, yet many health care ideas and initiatives sprang up when the time was ripe. This was due to two reasons: A) Health problems had been raised over and over again in the libertarian press. So many libertarian militants were aware of the problems of venereal disease, tuberculosis, infant and maternal mortality etc, B) Health services were administered by religious personnel before the Civil War. With the advent of the war these personnel disappeared overnight.

This forced libertarians to improvise new methods of organization and to set up new health establishments not only to provide the traditional health services but also to operate, to tend and treat the wounded from the civil war who were being brought in all the time.

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* This leaflet written and produced by the group Libertarian Health Workers in Brisbane, Australia, working at the health area in early ‘80s. PRIVATE PRACTICE

By the end of the year the Health Workers Union had not been able to eliminate private practice. But already the Health Workers Union had got rid of the abuses which had previously been so frequent. It had fixed the fees for con-sultations and private operations. (Doctors were paid these fees by the health workers union not by the patients).

EQUAL WAGES

. One of the main aims of libertarian communism is an equal distribution of wealth among each individual (EQUAL WAGES). Under the new system all hospital doctors received 500 pesetas a month (the average wage in Barcelona at this time was 400 pesetas a month). Hospital doctors were also allowed to have private patients. This was not yet economic equality but a great step had been taken in this direction.

THE PHARMACEUTICAL INDUSTRY

The pharmaceutical industry was reorganized by libertarian workers. The industry was divided into four sectors: 1) laboratory and research centre, 2) manufacturing, 3) large-scale distribution, 4) distribution to the consumer.

The research laboratory was the axis around which the general initiatives would develop. The manufacturing centre co-ordinated the activities of the laboratories and factories. The general warehouses were used to control the distribution of supplies while the distributive centre attempted to set up local distribution in accordance with the needs of the people.

FEDERATION OF HEALTH WORKERS CONGRESS – 1937

In February 1937 a congress was held in Valencia by the Federation of Health Workers Unions-CNT. This meeting represented 40,000 health workers through-out libertarian Spain. A large number of tasks and Initiatives were under-taken in this period of creative effervescence.

A health plan for libertarian Spain was evolved at this conference. This plan was based on initiatives approved at the local and regional levels. Health care was divided into four different areas by the conference: a) General medical care, b) Social and preventitive medicine, c) Social assistance, d) Sanitetion.

Projects and plans dealing with certain diseases, war casualties and the provision of health care were discussed. Ideas were exchanged and a large number of tasks were initiated by delegates at this congress. The Health Workers Union congress and the initiatives which derived from this conference were one of the most remarkable achievements of the Spanish Revolution.

THE SPANISH REVOLUTION

The Spanish Revolution was not only a period of remarkable economic growth it was also a period of profound changes.Changes in: a) people’s relationships, b) their traditional values, c)the organization of society, d)people’s ability to control their own lives.

The revolution was remarkable because of the goal of the libertarians - HUMAN LIBERATION rather than economic or national liberation. For the first time in history people were able to control their own lives on the basis of equal decision-making with their fellow human beings. When people realized they had real control over their day to day lives – their: 1) confidence, 2) creativity, 3) energies, 4) interest in life, 5) relationships with other human beings.

Increased tremendously because they realized they would be the ones to benefit from their efforts. For a large number of anarchists in libertarian Spain the Spanish revolution was not only a period of unparalleled economic growth. For these people it was a rebirth - the beginning of a new age where each human being was able to fulfill her/her potentials. An age of equality, justice and prosperity. This is the reason why in the midst of one of the most brutal civil wars seen this century the Spanish anarchists were able to begin to rebuild society.

THE AUSTRALIAN SITUATION

Australia has a long history of organized socialist and communist political activity but no history of an organized libertarian movement. The obvious failure of socialist and communist ideas to change people’s lives has led to the evolvement of small libertarian groups in this country over the past five years.

These groups are organized around self-management ideas and are beginning to have some effect on the current political mood in this country.

Libertarian health workers are only a small minority in these organized libertarian groups in Australia. In Queensland libertarian health workers have only been working in an organized manner for three years. In that time we have developed our ideas on health care and have produced over a dozen leaflets and pamphlets on health care and have distributed over 100,000 of these leaflets. We have also made contact with other health workers overseas and interstate.

It is only over the past twelve months that we have discovered the history of the Spanish libertarian health movement. At this stage of our development we are growing and our ideas about the organization of health care are well developed and these ideas have been implemented in the past with a great deal of success.