Originally published on Counterpunch, 4 October 2013
During the weekend of 27-29 September, the first ever Rebellious Nursing! (RN!) Conference was held at the University of Pennsylvania School of Nursing in Philadelphia. Originally inspired by the annual Rebel Law conferences hosted by Yale University, the organizers of RN! 2013 based their desire to hold the conference on the impetus to restructure both U.S. healthcare and global politics on the basis of human needs rather than capitalist profit. According to the RN! mission statement, conference organizers view the provision of health as “a communal activity where all people [should] receive and have a say in competent, compassionate, and respectful care.” Fashioned in a horizontal manner, RN! 2013 sought to provide “safe, energetic spaces for engagement in liberation, justice, and health equity.” By means of the 24 workshops, 2 plenaries, and 9 lunchtime caucuses offered over the course of the two days of RN! 2013—not to mention the contributions of the estimated 300 registered participants, comprised of Registered Nurses (RNs), Nurse Practitioners (NPs), nursing students, and allies—the weekend lived out well the principal idea of the conference: “to create energy and community around the idea of nurses for social change.”
During the first session of workshops on Saturday 28 September, I attended “Health Worker Roles in the Environmental Movement,” a panel discussion led by three activists, one of them an R.N. Sustainability advocate and PASNAP1 affiliate Jerry Silberman opened by discussing the devastation promised by climate change, noting the well-known fact that its projected human impacts will be most acutely felt among the most impoverished peoples of Earth, who have of course contributed least to the problem in historical terms. Claiming the struggle against climate destruction to be yet another manifestation of the seemingly eternally recurring impetus to radically redistribute material resources, Silberman claimed the environmental crisis as being impelled by a generalized psychological block on the part of relatively affluent Northern peoples to honestly square with the bleak reality of climate devastation. It is this cognitive dissonance which makes a general societal response to such apocalyptical health threats as climate change, widespread cancer, and antibiotic resistance increasingly unlikely, he claimed, despite the intensifying nature of these worrying specters. Against the conformism which equates the development of history with progress and thus upholds the colonization of nature and society by hydrocarbon-powered cars, trains, and airplanes, Silberman counterposed a vision of modesty and voluntary simplicity. Next, eco-organizer and journalist Peter Rugh opened his comments by citing the world-famous poet Walt Whitman, who he revealed to have worked as a nurse in the U.S. Civil War, from his preface to Leaves of Grass (1855):
“This is what you shall do: Love the Earth and sun and the animals, despise riches, give alms to every one that asks, stand up for the stupid and crazy [sic], devote your income and labor to others, hate tyrants….”
In his presentation, Rugh greatly emphasized the highly precarious and life-threatening conditions faced by those who labor in the oil and gas industries. Like Silberman, Rugh observed the destructiveness of climate change to function by grafting itself onto existing social inequalities. Theoretically, he favorably cited the (questionable) work that John Bellamy Foster has done over the past decade to rehabilitate Marx and Engels as ecologists, as through the Marxian theory of the “metabolic rift,” whereby the imposition of the capitalist mode of production dramatically accelerates humanity’s separation from its origins in nature. In parallel terms, Rugh also endorsed the vision proposed by Stanford engineering professor Mark Jacobson, who in a 2012 article on Al-Jazeera English argued for the “Securing [of] public health forever through clean energy.” Practically, Rugh sees great potential in the interlinking of trade unions, community groups, and environmentalists advancing an ecosocialist politics. Lastly, Sean Petty, R.N., spoke to the experiences of nurses responding to Superstorm Sandy in New York, claiming the collaboration between these rebellious nurses and the Occupy Sandy relief efforts to follow in the tradition of those responding to Hurricane Katrina in New Orleans, and importantly to prefigure a grassroots, popular model whereby the State is displaced as administrator of social life altogether. Expressing disagreement with Silberman, Petty claimed the environmental crisis to be a problem more of power relations than psychology: while capitalists will go to the very “ends of the Earth” to extract hydrocarbons, and despite the fact that the U.S. military is the single-largest contributor to climate destabilization, the developing environmental movement is the “most dynamic” social process in the U.S. today, in Petty’s estimation. As encouraging signs of the contributions health-care workers can make to this movement, Petty enthusiastically cited the decision recently taken by both the National Nurses United and his own New York State Nurses’ Association to explicitly and publicly oppose the construction of the Keystone XL pipeline. With regard to the roles that nurses in particular can make to the struggle against eco-destruction, Petty cited three important considerations: that nurses are most often on the “front lines” of prevailing socio-environmental realities, that they represent the most respected profession in the States, and that many nurses are collectively organized in unions.
During the subsequent discussion following panelists’ initial presentations, Petty argued that the present struggle must amount to nothing less than the total abolition of the fossil-fuel industry. In dialectical terms, Petty observed that nurses have collective power, but he lamented the yawning gap which has separated the environmental movement from the larger social-justice movement in the U.S. for some time. Critically in this discussion, Silberman discussed the needless breadth of medical waste as produced by the hospitals and the health-care industry at large, positing the alternative of sterilization and re-use of the various implements used by doctors and nurses in their everyday work—at present, as is well-known, these tools are overwhelmingly made of plastic and so are disposable. He also took a more negative view than his co-panelists of organized labor, noting it historically to have operated as an appendage of capitalism to help integrate workers into the dominant system—hence his trepidation over its potential for effecting the thoroughgoing anti-systemic transformations which must be realized if the looming environmental apocalypse is to be mitigated and largely averted.
Next came what was perhaps the most compelling workshop of the weekend: the analyses made by Family Nurse Practitioners2 Ronica Mukerjee and Linda Wesp of health disparities involving people of color and HIV+ and trans* individuals in the U.S. Giving consideration to the highly unequal social determinants of health and brutal historical trajectories which have greatly influenced the health disparities seen presently in U.S. society, Mukerjee and Wesp discussed six examples of gross medical abuse of oppressed social groups in U.S. history: germ warfare as a means of clearing Native Americans from the land, as conceived of originally by Jeffrey Amherst in the late eighteenth century; the infamous 40-year Tuskegee experimental observation of syphilis-infected black sharecroppers in the twentieth century (1932-1972); the subsequent intentional inoculation of Guatemalan patients with syphilis (1946-1948), undertaken toward the end of “advancing science”; the employment of forced sterilization schemes by the U.S. government, particularly in its Puerto Rico colony, where up to a third of all women were subjected to tubal ligation without informed consent; the groundbreaking advent of sex-reassignment surgery at Johns Hopkins University in the 1960s, followed by a reactionary backlash at that institution in the following decade, which lead generally to a marked decline in access to care on the part of trans* individuals in this country; and the outrageous neglect to the emerging HIV/AIDS epidemic practiced by the the Reaganist State on the one hand and for-profit pharmaceutical corporations on the other. Mukerjee and Wesp correctly situated these examples of abuse and disregard as contributing centrally to the development of distrust of and alienation from the medical establishment as experienced by black Americans, Native Americans, queers, and trans* people in the U.S. Furthermore, they righteously posed the question of how many HIV+ individuals died in the U.S. while awaiting treatment for their condition: as they noted, at least 41,000 Americans had died by 1987, the year when Reagan first publicly acknowledged the existence of HIV/AIDS. In contemporary terms, they observed that black Americans bear a disproportionate percentage of new HIV infections: 44% of the total, while corresponding as a group to little more than one-tenth of the overall U.S. population. This sobering reality—like that of the high incidence of diabetes mellitus among indigenous populations—cannot be divorced from historical considerations, as they stressed. In positive terms, Mukerjee suggested that the way forward “sounds a lot [more] like community organizing” than it does the mere administration of primary health care.
On Sunday morning, an RN/PhD, an FNP, and a nurse midwife presented on “Nurse-managed clinics as accessible models for primary care.” Lester Cohen, FNP, and Patricia Gerrity, R.N. and PhD, spoke to their experiences in Philadelphia in working in and advancing NP-run health clinics which have catered to especially disadvantaged and oppressed individuals and groups in that city. Like the audience with which they conversed, Gerrity and Cohen agreed that the nurse-managed clinic model provides a more collective, less hierarchical example of healthcare provision, compared to the typical MD-dominated practice. However, such an alternative model is not entirely bereft of hierarchies, as some audience-members pointed out, given that “mere” Registered Nurses face a limited scope of practice for engaging with patients, as compared with NPs, who are allowed by law to treat and diagnose disease and disabling conditions. Addressing this sort of divide between RNs and NPs, Gerrity and Cohen insisted nonetheless that their practices still allow RNs a relatively broader role in attending to patient education, especially with regard to diabetes and nutrition. Arguing (like Mukerjee and Wesp the previous day) that health is comprised of the foods one eats, the activities in which one engages, and the state of one’s emotions, Gerrity demonstrated how it is that the 11th St. Clinic which she has spearheaded seeks to address all of these health determinants: besides providing access to primary care in its 10 “patient remediation spaces,” the Clinic contains a kitchen, a fitness center, a legal clinic, and an urban farm! This 17,000 ft2 institute, erected originally in 1996 as the first nurse-managed clinic to be constructed in the U.S., attends to the needs of the community of North Philly, 60% of whom apparently go without any health insurance. Gerrity explained that the Clinic bases its philosophy on self-determination and proactive health, such that patients themselves are their own best primary care providers—indeed, it was through an intensive original 3-day session of dialogue with the North Philly community that the future character of the Clinic was shaped, urban farm and all. Similarly, Cohen explained his work with the Health Annex, which began as a UPenn-supported clinic located in a Philadelphia park comprised of 3 exam rooms. To his audience, Cohen recommended Barbara Ehrenreich and Deirdre English’s American Health Empire: Power, Profits, and Politics (1971) as a dated yet still illuminating account of the U.S. healthcare system, and he noted the various significant frustrations he has faced in his work with marginalized populations over 3 decades, in light of the seemingly perpetual exacerbation of social inequality and exclusion. Noting that he entered nursing in the 1970s as a practical means of resisting the rightward shift seemingly gripping U.S. society that predated the rise of Reagan, Cohen observed that the Left and working people have suffered great losses since the beginning of his career—but at least the contributions he has made in his own work are good ones, he feels. For her part, Gerrity shared with us her basic guiding philosophy, as expressed by Victor Hugo: “Man [sic] is the only animal that cries because [ze] alone sees the difference between what is and what could be.”
The lunchtime caucus which immediately followed the session on nurse-managed clinics—one of four occuring simultaneously on the second day of RN! 2013—proved fascinating: “Migrant health justice.” From the self-introductions provided by those participating in the caucus, a common past commitment included sustained work with No More Deaths/No Más Muertes in the Sonoran desert on the US/Mexico border, as well as current collaborations with the Brooklyn Free Clinic. The discussion began with an elucidation of Canadian health law, which against the country’s reputation as a haven of humanity—or at least, as compared to its southern neighbor—stipulates the denial of health-care to non-citizens, much as the U.S. state governments do, a sick tradition in which Obamacare continues. Much of the conversation revolved around the tensions experienced between one’s identity as a social activist and a nurse at the same time; some participants expressed concern for the reduction of free time in which to engage in said activism that is implied by being a full-time nurse, while others thoughtfully observed that the work of a nurse itself constitutes legitimate political activism. One FNP noted the worrying tendency of the relatives of Mexican migrants to mail medicines from Mexico to their family-members, given that undocumented residents of the U.S. have no access to pharmacies here; the problem, as she noted, is that she often is not familiar with these Mexican equivalents. Most alarmingly, participants in the caucus discussed the trend whereby “illegals” are deported directly from U.S. hospitals and emergency departments after having received treatment there! Against such brutal realities, initiatives to declare “solidarity cities” which refuse to cooperate with the INS and other police agencies represent important countercurrents, though, as one caucus participant noted, there really does not exist any safe space for migrant workers under the dominion of U.S. immigration law.
During the final session on Sunday, Dr. Suzanne Smeltzer, R.N. and EdD, spoke to “Disability and the profession of nursing.” Smeltzer began by making the obvious point that people with disabilities “get a raw deal” under prevailing conditions, but the main focus of her comments was to indict the nursing profession for its complicity with the perpetuation of the marginalization of disabled persons. Noting disability to be an essentially universal experience, she revealed that a full one-fifth of the U.S. populace, or 60 million persons, live with disabilities, thus comprising the largest single minority in the States. (An estimated 1 billion people are disabled globally.) Crucially, Smeltzer distinguished between disabling conditions and the experience of disability, noting nurses and other health-care providers to be quite familiar with the physiological bases of the former, but remarkably clueless in terms of the embodied experiences of the latter. Indeed, citing a number of studies she and other colleagues had performed to investigate the attitudes of nurses with regard to disability, she found highly negative results among nurses in general, particularly nursing faculty. Specifically, nurses were found to have a marked lack of awareness, knowledge, and sensitivity to the lives of persons with disabilities: in the opinion of disabled persons themselves, nurses generally do not demonstrate respect for them but instead fear, ignore, stereotype, and even abuse the disabled, treating them like children! Unsurprisingly, then—and in parallel to the arguments of Mukerjee and Wesp on black Americans and indigenous persons—Smeltzer noted the tendency of disabled persons to avoid accessing primary care until it becomes quite impossible to continue to do so. The formal education of nurses in the U.S. seems intimately to contribute to this unfortunate reality, given that astonishingly few nursing textbooks even mention disability. Hence, the profession of nursing and nurses themselves are currently a significant part of the problem, in Smeltzer’s analysis—though potential exists for both to do otherwise.
To sum up, then, I would say that RN! 2013 proved highly successful in openly addressing a myriad of problematic realities related to the practice of nursing and the current manners in which healthcare is provided in the U.S. It is moreover to be celebrated that, beyond the already encouraging fact that the overwhelmingly majority of participants were female-presenting, a substantial percentage of conference-goers were trans* and queer-presenting. It is nonetheless true, as one participant observed in the closing plenary, that people of color were greatly underrepresented at RN! 2013—I do not know how the planned Nurses of Color lunchtime caucus went on Saturday. It is to be hoped that subsequent iterations of RN! conferences—and the daily work of rebellious nurses themselves everywhere—will serve to better advance and represent societal diversity. In doing so, they would carry on in the tradition which Herbert Marcuse identified, referring to a previous historical epoch: that of the medieval “traveling community of musicians and mimes […] whose assault shatters the stability of the established and ecclesiastical restrictions.”3
1 Pennsylvania Association of Staff Nurses and Allied Professionals
2 Or FNPs
3 Herbert Marcuse, Der Deutsche Künstlerroman (Frankfurt: Suhrkamp, 1978), 13.