Raising the question of whether intentional communities of care can be a site of struggle, rather than just a place of support. The original post is located here.
*Used with permission*

I have personal experiences in creating and expanding communities of care, street medicing, radical mental health, as an herbalist initially trained through an informal apprenticeship, and in radical clinics. One thing that occurs to me is that I, and others, have talked a lot about communities of care, how we create them, how we get them to grow, but, as revolutionaries, it seems to be that our only focus is how they serve as a support system for other struggles, never as a site of struggle themselves. I want to raise the dual question here of both how they serve as a site of struggle, and what potential there is for broadening those struggles.

First of all, any time we’re talking about caregiving, we’re talking about reproductive labor. The projects I have seen grouped under communities of care have either been a way to collectivize unwaged reproductive labor, or giving people who are denied access to paid reproductive labor (generally health care) that care. One of the ways in which reproductive labor being work is obscured is the way that it is both isolated and naturalized as part of “what women do”. By coming together and doing it collectively, we not only reduce the overall workload, but we struggle against the structure of capitalist society and individual men in our lives who do not view our reproductive labor as work. Creating collectivized reproductive work as its first step necessitates recognizing that as work.

The first step communities of care often take is reviving the practices we have lost through our increasing atomization and isolation, and creating counterinstitutions where we can collectively ensure that those useful practices, such as watching each other’s children, visiting each other when sick, bringing meals to the ill or elderly – all functions that more functional communities did as a matter of course – occur. Of course, the real challenge is to go beyond these more limited practices to ensure that elders do not have to be isolated away from the rest of their communities in nursing homes, that all parents can support their families and organize knowing their children are safe and cared for, and to both provide members of our communities who have no or limited access to the formal health care system with health care, both western allopathic and from alternative systems.

The struggle aspect is perhaps most obvious in advocacy, and this is also the place where it is most obvious on how our community struggles link up with potential avenues of struggle inside the workplace. Many groups are particularly vulnerable to mistreatment by the health care system (trans and gender non-conforming people, queer people in general, people with disabilities, people with uncertain immigration status or lacking papers), and often times the presence, even of a layperson, advocating for them can make worlds of difference in the care they receive. An effort to organize ourselves to make sure no vulnerable person has to go into a hospital or medical appointment alone, could, as it grows, quickly turn into a campaign to change how both health care institutions treat members of vulnerable groups, and by making strong connections with people working in those institutions, how workers are treated in those institutions. Clearly, a great deal of potential solidarity and expansion of struggles can arise out of these projects.

I’ll hopefully have more formed thoughts on this by the time I finish my much longer reflection piece, but, many of us whose path into formal, waged health care work grows out of our desire to have more caregiving skills to give back to our community and in an attempt to get paid while we develop those skills eventually work our way on to health care roles in our work lives that require extensive education and training and have the corresponding high levels of debt. While these often give us a lot of skills and knowledge to put at the service of our communities, we end up limited to supply those skills in alienated ways. The do-gooder option state capitalism presents us with are non-profit community clinics that exist to serve underserved communities, but are in no way controlled by those communities. Not only do our high debt loads force us into working long hours, but, legal concerns with the licensing system can often make us wary of participating in counterinstitutions. While there is a lot that lay community members can do, if we truly wish for our communities of care to expand to the point that they destabilize the isolation and atomization of the reproduction of daily life in our society, we need to be able to offer more than dedicated lay people and short workshops.

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I owe some thanks to the commenter who noted that I don’t actually have to write down all of my trans health thoughts in the same post.  Yes, it seems obvious…now.  I have a tendency to panic a little in the face of large tasks, though.

I’ve been wanting to write a post about how I got started seeing transgender patients.  I’ve talked to several health care providers who have expressed interest in integrating transgender care into their practices, but don’t know how.  I’ve also talked to providers who don’t particularly want to do trans-specific care (ie: hormones) but would like to learn more about how to be a trans-friendly provider.  A lot of people that I talk to want to know why, as a non-trans person, I wanted to get involved in trans health in the first place.  The simple answer is: because trans people are my friends and loved ones, and my community, and I want them to have good health care.  The longer, more academic answer is that if you look at the data about health care access, transgender patients face many barriers to care.  I find it unacceptable that someone would be turned away from care–or discouraged from seeking care–based on their gender identity or expression.  If you want even longer answers, let me know and I can send you some journal articles about health care access and the effects of discrimination on trans people.

I had an advantage going into my training as a nurse practitioner, because I already knew that I wanted to provide LGBTQ folks with healthcare.  Aside from a class about cultural competency that included LGBTQ info, I did not receive any extra training about transgender health.  BUT…I was motivated to learn on my own, and I had professors who were supportive of that.  I did class projects that focused on transgender health care, I brought trans speakers to the school to discuss general info and health care protocols, I worked with the administration on their non-discrimination statement (to include gender identity) and I integrated transgender health into my thesis project.  At the end of all of that, I was at least as qualified to talk about trans health as any doctor coming out of medical school.
When it came time to look for a job, I decided not to look at any LGBTQ-focused health centers.  My larger passion is for working with underserved populations, and I wasn’t actually very interested in working with middle or upper class gays.  I decided to go for a community health center job and see what I could do with the queer health stuff once I got settled there.  I was lucky–really lucky–to end up in a clinic with a very awesome, feminist, lesbian-identified doctor on the staff.  She has done amazing things at our clinic, and she is a staunch advocate for nurse practitioner autonomy.  After a few months of working there, I told her about my thesis topic (trans health) and that I was interested in LGBTQ healthcare.  She was excited and introduced me to one of the only local therapists who sees queer/trans patients within our community (most trans-identified people in our area have to drive 30-40 min to see a therapist who has trans-experience).

The therapist and I met to talk about our experiences and our practice philosophies.  She was excited to have someone to refer patients to who wasn’t 1) 30+ minutes away 2) an endocrinologist who follows the WPATH Standards of Care and 3) was familiar with the community.  Once I started getting referrals from the therapist, I got nervous.  I was excited about the chance to prescribe hormones for people in a way that I thought it should be done, but I was scared to do it alone.  At that point, I had been in practice for a little under a year…long enough to stop freaking out about every patient, but not long enough to feel confident doing new things alone.  Especially when the new thing is often viewed as a specialty best left to endocrinologists (not MY opinion, btw, but a common opinion among primary care providers).

I knew I had to seek out support, both to help me be a good provider, and to cover my ass in case the doctors at my clinic found out what I was doing and started freaking out.  I joined a trans medicine email list.  I started going to more LGBTQ medical conferences.  I read through other clinics’ protocols for care.  I talked to my doctor-ally about what I was doing, and she agreed to support me.  She still co-signs every one of my charts, and I like it like that.  She respects my autonomy and judgement, but I know that the medical world is full of people who won’t treat my decisions as valid without a MD signature at the end.  And this is an area in which I really do want to cover my ass as much as possible.  Sad but true.
So that’s where it all began.  Now, 4 years later, I feel much more comfortable with all the curveballs that I’ve been thrown since those early days, but that’s a story for another day….

Visit www.rebelnursing.org for more information!

We believe that Nursing is an inherently political profession and that all Nurses are rebellious.

The conference will be an opportunity to build community and solidarity, share skills and wisdom, find mentorship/peer support, and develop ongoing creative projects (such as compiling a biographical archive of rebellious nurses throughout history).

We seek to create a world where all people receive and have a say in competent, compassionate, and respectful care in their communities. As opposed to a world where nurses are divided by education and training, as well as structural forms of oppression that pervade society, such as racism and sexism, we seek to include all nurses in our organizing on equal footing, by confronting what divides us. As opposed to a world where a wall is placed between healthcare providers and patients and their friends and families, we envision a world where caregiving is a communal activity. As opposed to a world where access to care and education is determined by money, we seek a future where we all contribute according to our abilities, and everyone receives care according to their needs.

We seek to create networks of Nurses committed to addressing these issues and nurturing these projects. If you’re interested in working with us, we’d LOVE your input  and ideas!