[EN] Caring With

Isabell Lorey.

[EN] Rethinking care profoundly implies a complex and demanding exercise, which involves comprehending anew connections, and connections_with_others, practicing the _with_. The alternative health service in Trieste that works with micro areas is a very good example how care could be practiced differently as a democratic living together.

Nowadays, public health services are becoming ever more technical and of high intensity, oriented towards efficiency criteria, where the focus is typically on isolated health problems. The person who needs support is frequently reduced to a number on a hospital ward. The extreme individualization  resulting from neoliberal dismantled welfare states where everybody is deemed self-responsible for their health, and where poverty stands as self-inflicted (?) corresponds to a logic in Public Health services where the separate individual is treated for his or her separate health problem.

In contrast to neoliberal individualization, working in Micro Areas means appreciating the two dimensions of the singularity of every person: the person in their uniqueness, with different abilities, interests and skills; and simultaneously their relatedness, their social situatedness, theirconnectedness_with_others. A singularity that needs health support does not just have a separable health problem that has to be treated in a technical way: usually people have multiple  needs. As a health worker in a  Micro Area this means perceiving the social person, the specific subjectivity. It means communicating, it involves active listening, it means allowing an encounter of subjectivities to take place (between the health worker and the supported person, but also between neighbours) that are mutually affected, that know subjectivities are never finished, but depend on their  surroundings, that `the social´ unfolds in the now – subjectivities continue becoming. For the health worker it means becoming aware of the persons´ social situation, and perhaps their lack of social relations. Being interested in healing also involves caring for the demands of the social territory a person lives in and (re-)building connections_with_ the neighbourhood. Sometimes it can be necessary to become another neighbour.

This distinctive health provision is based on knowledge accumulation, on knowing the social situation of the people that need support, and for that reason it is important to be aware of possible control and surveillance tendencies among professionals. (?) Focusing and encouraging the social connectedness_with_others can be very ambivalent, if professionals lack sensibility. The aim of the Micro Areas, however, is not to control people but to build together a common practice?  that enables  each person to take back control over their lives in the midst of their neighbourhood, and the midst of the (new) connectedness in the urban territory.

The power of the Micro Area entails that the isolation and separation of the individual that is the  basis of (neo)liberalism, can be broken open, and the singularity of each one of us can become the starting point of an encounter with a person in need. Singularities cannot be measured in the currently hegemonic approach of quantitative numbers. The sociality which is produced and strengthened in the Micro Area refuses the generation of measurable experiences, which is the point openly attacked by neoliberal health technicians. The Micro Area experience is a provocation to the  hegemonic health model and the normalised standards used in health research and in the profession.

The alternative health practices of Trieste give a lot of importance to  asymmetrical power relations. They assume that nobody ever only lacks something, and also that nobody can help another single-handedly.  The person that has a problem or a weakness also has a lot of resources that are valued through  the practices of the Micro Area, and therefore are introduced into the (re)organisation of living together in the neighbourhood; abilities that can be shared, and can provide for others, as cooking or gardening, for instance.

In recognizing and involving the richness and abundance of people, new socialities emerge that create a vivid neighbourhood, and are a very good inspiration to reconceptualize health services on a local level. Of course, this alternative organisation of health has to be publicly funded in a sufficient way, and should not become another example of the withdrawal of the state which leaves social services as volunteer work carried out by the community to minimize costs. Instead, providing health care in an emancipatory way, starting from and encouraging the _with_ as it is done in the Micro Areas in Trieste, can lead to a new kind of social democracy.

The rethinking of care beyond the asymmetry between those who care and those who are in need of care – the dependent and the independent – is key. Nobody can live on their  own: during our whole life we remain precarious and dependent on the exchange_with_others. Care is the fundament of living together_with_others in connectedness. It is not so much  something that has to be invented anew, as something that mainly needs a change in perspective, in receiving, in referring. The experience?  in Trieste acts in the midst of social connections to unfold practices that are needed to reconceptualize the conditions we are experiencing  in our societies, politics and economies in crises – as ecologies of care.