 My name is Francesca, I'm your host tonight. I'm looking forward to an hour and a half with amazing guests talking about a topic that is all close to everyone's heart, no pun intended. We wanna talk about health, healthcare and the profit-oriented healthcare system we are all living under. I'm speaking to you from Berlin, Berlin in Germany where there's now talk of introducing co-payments of up to 2,000 euros for patients because apparently the budgets are too tight. But also just recently we learned that Moderna, Pfizer and BioNTech alone made billions of profits of COVID vaccines for which they also received public funding and they pay less taxes for. And it makes it impossible and make it impossible through intellectual property and patent rights to produce vaccines in cheaper ways for different countries. And of course Western governments are complicit in this crime against humanity which was famously shown when the German chancellor spoke out against the patent waiver in March, 2021. That's not the only bad news around health and healthcare. Half the world lacks access to essential health services as the World Health Organization put out in one of its studies. 100 million people a year are still pushed into extreme poverty because of health expenses. And then of course we've seen recently that a lot of the burden is put on the medical professionals and their unions. We've seen amazing strikes around the world. Lastly in Britain where actually our own healthcare professionals have to defend the patients and their working conditions against the world worst onslaught of capitalism. So overall it's not very difficult to imagine a better system and to have a really long wish list where hospitals have ample resources where care workers are compensated as they deserve and treated with dignity. Where the newest of scientific research benefits all in terms of medication and treatment. Usually we are told that's not really feasible and it's not affordable and we should take more individual responsibility for our health or we will only receive medication if we grant the profits to the pharmaceutical industry or the health insurance companies. We do have examples of humane and better healthcare. We do have historically and now struggles that we see that things could be done better and we wanna talk about those today. And I wanna bring on three amazing speakers for tonight who will, this is the good thing they will introduce themselves very briefly before we then go into the longer contributions and the topics that we wanna talk about today. Let's start with Matthew. 30 seconds, go. Thanks Francisca. Yeah, I'm a researcher at the International Forschungstele DDR which translates to the International Research Center GDR. And our objective here is to re-examine socialism from the 20th century and draw out the lessons for the future. Obviously we're mainly focused on the German Democratic Republic but we also look at its relations with the rest of the socialist camp and also with the third world. We work with Tri-Continental Institute for Social Research on a series called Studies on the GDR or Studies on the DDR. And our latest publication is looking at the healthcare system and it's just been translated and published into English, Portuguese and Spanish. I think we're gonna be posting the link in the chat shortly as well. So this is what I will be drawing on today, this publication. Thank you. Sobo please. Hi, I'm so happy to be here. I'm so pojaparete, I live in Georgia and I'm a trade union leader. It's a general union, general service and healthcare union. And I also tend to do research as well, especially our research in healthcare and also the working conditions of nurses. And I also run a podcast about re-imagining Soviet Georgia to re-examine a lot of history that's distorted about Soviet Union and particularly around Soviet Georgia. Thank you. Thank you so much. Janneke please. Hello everybody, I'm Janneke Ronse and I was a nurse and I'm now the chair of the Belgium organization, Medics for the People. And I hope tonight I will discuss with you how the profit motive is compromising public health and distorting medical services in Belgium and how we work with Medics for the People to address this issue by organizing our own primary care practices and how we link it with a larger political action. Thank you, Janneke. Welcome all three of you and welcome to all the viewers out there. I guess just the smallest housekeeping notes we do. We have planned to answer questions also after the interventions that everybody here will give so that we have a common ground on which to debate. So please post questions in the chat at any time. We will try to see where we are with time, et cetera, et cetera to make sure that we ask a variety of questions of these speakers. Let's get straight to the interventions. We'll start with Matthew. Obviously, you know, the goal cannot be to just hear history lessons of the details and numbers of this really small country that the GDR used to be. But there are principles and mechanisms and rules that they followed underlying sort of the state, like the idea of how the state wanted to prepare healthcare for its people. And some of it can probably be learned or there's maybe some lessons to be drawn around a more socialist practice around healthcare that is not profit oriented. And so please take it away and explain to us how that worked. Yeah, thanks, Francesca. I have some slides that I've also prepared for the presentation. Obviously, as you say, I'm not gonna try to summarize 45 years of East German health policy into just 15 minutes. So what I'm gonna try to do is basically outline the basic characteristics and guiding principles of socialist healthcare using the GDR as an example. So sort of the question is what characterizes the socialist approach to health? Let me try and get up these slides here. Yeah, there we go. So before we begin, I thought it'd be helpful to provide a bit of historical context of where we are. So it's 1945 and the Second World War comes to an end in Europe at least. And Germany is divided into four occupation zones. The areas here in green, blue and orange are then united by the capitalist powers to become the Federal Republic of Germany or as it's commonly known, Western Germany. And then five months later in response to this in the red zone here, it becomes the German Democratic Republic or East Germany. And so we have these two German states and it's interesting because we then have two very different paths that are followed. In the West, we have restoration, not only of monopoly capitalism, but also of traditional medical practices. And then in the East, we have a new beginning. We have a gradual transition to socialized property relations and this serves as the basis for a revolution in the health system, both in terms of care and also in the working conditions. And it's this approach in the East that we looked at in our publication. This new beginning in the East is led by anti-fascists, mostly communists and social Democrats who are emerging out of the Nazi concentration camps or they're returning from exile. And they basically find themselves in a situation that's catastrophic. I mean, German fascism had propagated this idea of total war until the very end. So throughout Eastern Europe, you just have a catastrophic health conditions. Hospitals and clinics have been destroyed. There's no access to medicine. Diseases like typhus and dysentery are spreading uncontrollably. And on top of that, in Germany, you have the problem that about 45% of doctors had been Nazi party members. Many of them had even been involved in euthanasia and other atrocities in the concentration camps. So you were confronted with the question, what do you do with these doctors? Many of them actually end up fleeing the Soviet occupation zone and they go to the West because they know they'll be treated more leniently there. And so from the very beginning, you have a very large shortage of doctors in the East. Now to tackle this situation, the East German health officials basically set out to construct a new system. And they did so by drawing on progressive traditions. The first of which was what's called the feel of social medicine or public health, as it's usually called today. And it sort of emerged in the mid-19th century and then it's taken up by the labor movement after that. But what social medicine does is it looks at the interaction between people's health and their social conditions. So in other words, what we call the social determinants of health. So working conditions, housing, nutrition, education, our social relationships, our free time, all of these factors, they basically form the basis upon which our physical and mental health develops. So this was the first tradition and the second tradition where the experiences from the Soviet Union where health officials had actually put social medicine into practice through a unitary and centralized national healthcare system. And officials in East Germany, they also recognized that it would be necessary to separate people's medical needs for private economic interests. So just to provide an example of this, if we look at the outpatient sector, this is where care is administered outside of the hospital system. So like if you go to your general practitioner for primary care, getting a blood test or having an examination, well in the capitalist outpatient sector, it's usually done by self-employed doctors in private practices. They're working in their own practice basically. And the problem here is that they're financially dependent on sick people coming to them for treatment. That's how they charge insurance companies and that's how they generate their income. So these self-employed doctors are essentially incentivized not to prevent disease but to treat symptoms after they've already manifest. And this is not something that the GDR discovered. This was a fact that had been discussed by progressive health experts long before the GDR was founded. Also in the League of Nations following the First World War, this had also been a topic, but the problem was is that conservative physicians associations who had an economic interest in the old model, they opposed all attempts to modernize outpatient care. And so this was the basic task that then the East German health officials set themselves was separating healthcare from private economic interests. So how was this done? Well, basically required the nationalization of healthcare institutions and the guaranteed rights to healthcare. So in the socialist states, free medical treatment was to be provided through a unitary healthcare and insurance system. So all health institutions from hospitals, clinics, pharmacies, research centers and so on, they were all managed and planned by different levels of government. As you can see in this graph here, which shows the structure of the health system at the regional or municipal level, it's not fragmented between publicly funded services on one hand and privately organized care facilities on the other, as many of us know from capitalist systems today, but it's actually it's a unified system in which all these health facilities cooperate and they're led by the Ministry of Health and its departments. And by linking these various institutions together in this way, it became possible in the socialist states to integrate preventive, therapeutic and aftercare measures, something that's really greatly hindered by the fragmented model of outpatient care where for example, you have little contact between doctors who are administering therapeutic care and those that are administering aftercare or the pharmacists that are providing medication and so on. They're all fragmented in the capitalist system. So with this unitary approach, emphasis in East Germany could now be placed on prophylaxis, which is the medical approach that tries to prevent disease before it manifests instead of just focusing on treating symptoms. And by pairing prophylaxis with social medicine, it becomes possible to approach health policy from a sociopolitical perspective. So how are working conditions housing social relationships and so on, how are they affecting our health? And once we've established this link, what do we do about it? Well, the key development in the socialist states is that you have this gradual creation of socialist property relations. And this was crucial because it meant that all these social determinants of health could now be managed by the state and it's decision-making structures. So you have a, through this large network of public outpatient facilities that are operating in all areas of society, you had a way of systematically investigating and tackling everyday health risks. In the neighborhood, the schools, the universities, the workplace, all of these institutions are basically integrated into the healthcare system. And so with these two guiding principles, prevention and social medicine, the protection of health comes to be understood not as an individual responsibility, but as a social responsibility. So I've just taken a few pictures here to provide some examples from the left to the right. And on the left, we have the workplace where public health officials would carry out inspections to make sure that working conditions are monitored and that workers are receiving care that's really tailored specifically to the relevant health risks, like chemical exposure or heavy lifting and so on. In the middle, we then have residential areas where health inspectors are tied to the local outpatient facilities and they're measuring noise or air pollution in the neighborhood and monitoring health in daily life. And in kindergarten schools, you have then medical checkups and vaccinations carried out directly by the pediatricians on site. So it's no longer left to parents to organize and keep track of various appointments for their children. And so in this way, we have to think of socialist healthcare as kind of a holistic and comprehensive system that's integrated into all areas of society. And it would accompany people from throughout their life, from kindergarten through the school, through the workplace and all the way into the neighborhood where people would retire. And so what's the infrastructure that supports this socialist approach to healthcare? It's a massive outpatient network primarily and we can't go into each of the aspects here, but I think it's worth highlighting the polyclinic because it kind of epitomizes or embodies the socialist approach. Now the polyclinic was basically a facility in which multiple medical specialties are collaborating under one roof. As you can see in this cross-section example here, there are several core departments like general medicine, pediatrics, gynecology, internal and oral medicine and a surgery department, but polyclinics usually also then had other departments like laboratories for diagnostics, physiotherapy, medical imaging and so on. And these polyclinics were to be sort of the central nodes in the wider outpatient network which included smaller facilities and also mobile care units, such as like a community nurse or mobile dental services that would then reach more remote rural areas. And the idea was that all these facilities were linked together to facilitate collaboration and mutual support amongst them. And so why is this polyclinic then designed to replace the traditional model of individual private practices? Well, it was recognized that this private practice model of outpatient care is outdated and there were two reasons for this. First, as I already mentioned, the self-employed doctor in the private practice is economically interested in treatment, not in prevention. But secondly, there have also been advances in science that have greatly improved diagnostics and treatment capabilities. But in order to practice these new methods, you need access to the latest technology and expertise. So small individual practices that are scattered throughout cities, they just cannot house the diverse equipment and staff that's required by modern medicine. So patients end up then being referred to separate specialists or diagnostic centers and this creates inefficiencies and also discrepancies in diagnosis. The thing about the polyclinic though is that all these specialists are in the same place. They work together on cases and patients aren't referred to specialists that are then in different buildings. They don't have to travel to different buildings and wait for available appointments. They also don't have to keep track of their own records because the polyclinic has its own common filing system which all the specialists can then access. And so there are a number of benefits to this approach. Firstly, there's the medical benefit of interdisciplinary collaboration on cases. And again, this facilitates this integration of prevention therapy, aftercare and rehabilitation. And this basically helps to minimize inpatient stays in hospitals and even prevent illness in the first place. Secondly, doctors also have access to laboratory medical imaging services and this helps to cut down on delays in bureaucracy. And then there are also the very practical advantages. For example, the polyclinic can extend its operating hours and continue to provide care even when individual doctors are sick or if they're on holiday. Private practices just struggle to do this. And linked to this idea is that this polyclinic system also allowed doctors to couple their normal consultation hours with on-site visits. This could then be used to provide more extensive care. So in East Germany, for example, pediatricians could conduct regular checkups in kindergarten while other doctors were looking after the walk-in consultations in the polyclinic. Now the other crucial aspect of the polyclinic was that the public employment of its staff. So physicians, nurses and assistants were employed by the state and they were then freed from their financial dependencies on the sick. They enjoyed a secured position and a reasonable income and this allowed them to focus first and foremost on prevention. But it's also worth noting that this transition from self-employment to public employment, it was a very gradual process that took place over the GDR's 40 year existence. And this was also due to the fact that public employment was not embraced by all at the beginning. There was resistance, as I mentioned, there were these conservative physicians' associations who had already been systematically opposing calls for the polyclinic in the 1920s and they continued to do so after the Second World War. And the East German policymakers, they went about this problem basically by trying to demonstrate the advantages of the public outpatient model. And so that meant sort of expanding the technical capabilities and the laboratories in the polyclinic over time, essentially creating sort of model projects which would make the benefits evident. And as you can see on this graph here, the transition didn't take place overnight. For many years, private practices continued to provide a large portion of outpatient care in East Germany. But over time, and with certain concessions to the physicians, it was possible to gradually win over medical professionals, especially as younger medical students who often had working class and peasant backgrounds came to see the benefits of fixed employment and socialist healthcare in general. Now, before I close, I just want to also emphasize that this transformation of healthcare in the GDR, it certainly wasn't a walk in the park, you know? From its very early years, East Germany was confronted with several major challenges, just to name a few. From the very beginning, Western sanctions were imposed on the East and this greatly hindered the importation of modern medical technology and equipment. On top of this, East Germany was alone footing the bill for Germany's reparations to the Soviet Union because the capitalist power suspended their payments in 1946, one year after the war ended. And then on top of this, the construction of socialism, which begins in 1952, is actually taking place with open borders to West Germany. And West Germany at this time was receiving, I think about 1.5 billion US dollars through the Marshall Plan. And this fact, these open borders meant that those physicians who were reluctant to give up the private practice model or who were trying to escape the denazification process in the East, they could just leave, they could just go West. And actually, as a way of bleeding the GDR dry, West Germany would also, it was actively poaching East German doctors with the promise of higher salaries. So you had this massive brain drain of highly trained professionals whose education had been publicly funded in the East going Westward. And it also has to be said that an additional challenge was the internal economic disparities in the GDR, particularly in the final decades when they struggled to balance out investment and consumption. And this meant that medical facilities also had to contend with outdated equipment or suboptimal structural conditions and so on. And so all this meant that East Germany faced significant economic constraints. And not all of its health objectives could be achieved. We have to be honest about that. Compromises were made, for example, in the use of brown coal, which was the only native fuel source available to East Germany after the sanctions, but this brown coal was also a horrible air pollutant. Or working conditions in the factories, for example, they were also strained by the necessities of reindustrialization after the war. And so there had to be these kinds of compromises between economic and health policies and the officials had to weigh up the best way of going about it. So we can't think that eliminating profit from healthcare will solve all of our health problems. You know, they won't just disappear overnight. But I think what we should recognize from this history is that social ownership and the centralized organization of health, industry, housing and education, these are the preconditions for genuine policy debates. In other words, socialist planning is the framework for discussing and coordinating health objectives in relation to other social, economic and political aims. So we're no longer just running around trying to fix market failures, as the liberal economists call it here, but we're actually consciously setting priorities and shaping society around people's needs, not profit. And this is exactly the approach that enables the GDR to progressively improve the health of the population over time, even in the context of limited economic resources and fierce competition with the capitalist West. So as you can see in these two final graphics here, infant mortality rates and doctors per 10,000 residents, you know, nothing happens overnight. It's a gradual process, but from a much weaker post-war position, the GDR is able to reach levels that are on par with other industrialized states by 1989. And it had done so with a system that was run by and for the working people. So they proved that an alternative is possible. Now, this was just a brief overview of our second publication. The link is in the chat if you wanted to look at the full version. I just want to briefly also recommend that on our website, we have a interview archive with filmed interviews that we do with those who actually built and sustained socialism in the GDR. It's a core component of our research. And it means that we don't have to rely merely on Western academia, which as we know, is rather biased on these issues. So if you're looking for a good resource to hear about other aspects like occupational healthcare or vaccination strategies or maternity care, then I could definitely recommend checking out that archive on our website. But first of all, thanks very much for listening. Thank you, Matthew. I think that was very interesting. And I think that we will pick up a lot of these components again in the debates and in the other interventions. You raised a lot of important points. I mean, I don't know, talking about brain drain or social determinants of health, this is not none of that has lost its urgency or its importance in this day and age. Yeah, thank you for that. I think I guess another little component that we shouldn't forget is the GDR only existed for 40 years and also culture is difficult to change. Sometimes it's the hardest when you are talking about conservative doctors and no offense to any doctor who might be listening in, but changing conservative cultural norms and traditions is an incredibly complicated project. So adding that into all the other constraints, economic, et cetera, et cetera, I think also plays a very important role in building up a socialist healthcare system. I don't want to chatter on. Sopo, we'd like to hear from you about the experiences in Georgia. I know that you just co-authored a study that talks about what happened in the transition. So Matthew was giving us how the GDR tried to build up a system and what principles they used and the study that you just co-authored with a bunch of people in Tbilisi is actually about what happened in Georgia after and the transition to the current from the socialist Georgia or from the Soviet Union, from the Georgia in Soviet Union to the current system. And so this is about the privatization of the re-dialing it all back. And was that better or was that worse? And what does it mean for patients, for healthcare workers and for the system? So please just go right ahead. Thank you for that introduction. I think Matthew did such an amazing job putting it out there, what it was like, what were the main motivations and values in building socialist healthcare? Your study is incredible. I'm so impressed actually. I'm like telling everyone about it. So in Georgia, so while the GDR was building 40 years of socialist healthcare, we were destroying healthcare for the past 30 years with the non-stop experiments that were run in Georgia and continue to do so for the past 30 years. And so mostly like we don't have our research not concentrated on what healthcare was like in such detail during the Soviet Union we are really just taking certain health indicators and then seeing what they look like now and comparing them through 1989, 1990. At the same time where what we did was look at the processes of privatization the last 30 years. And so the last 30 years first, so we have three different called stages. The first stage is what we said was like zeitgeist. It's the idea that when Soviet Union collapsed we should listen to international financial organizations and everybody was saying, this is where you have to privatize and liberalize and it was mostly about the economy but the same kind of prescriptive reforms were given overall. So when you have this economic reforms, liberalization of like very rapid liberalization, it also was simultaneously what was happening to the healthcare was similar to what was happening to the economy. So there, so we see them as part of the same process of liberalization and not separate from healthcare to the economy. One of the first things was the rapid decline of funding, the entire system fell apart. It went to from per person how the finances per person dropped to almost zero and because there was no money, there was also no government and no one coming out to pay healthcare because there was no money at all. The government completely lost all ties to Soviet Union. So if you can imagine baby being born without mother or father or anything, it's like survive. And so at first, right when the Soviet Union collapsed there was civil war. So there's moments a couple of years when the World Bank IMF are not here yet. And then they come in around 1994, 1995. And then they do the standard structural adjustments that they have done to everyone else starting with Latin America. And that's what they say, but Georgians don't know anything. They have never really experienced the world outside of Soviet Union and they're incredibly naive. They don't know how to defend themselves. They don't have any arguments if no one else leading them, no one, no other ideas dominate. And of course, there's nothing as a left wing and there's no connections with any kind of left or different kinds of thoughts that could be maybe connected to other movements around the world to give them any kind of different ideas. And so they blindly follow World Bank IMF and so on all of international financial organizations. But they actually lose favor around 1999 where World Bank starts to complain that they're not moving fast enough. And actually right afterwards, a couple of years later we have the Rose Revolution where the government gets overthrown peacefully by Sakashwili and then Sakashwili becomes even bigger reformer than international financial institutions. So the first phase is just pharmacies get privatized. And so, and then you have mostly it's people don't have any money. And so even if it's called a state hospital you still have to pay each doctor like a fee to even get seen. So no one's going to the doctors at all in 1990. At the same time, imagine a country that stopped one day what kind of diseases that would be. Matthew was speaking about total war concept and how what the situation was like in Europe and so many health problems. Well, it was similar to that except not during war time, during peacetime where even diseases that were cured before started occurring and needed to be managed. One of the biggest examples we know in Georgia and also we know in Russia and other post-Soviet countries of course it's tuberculosis. So you have international organizations stepping in to develop some kind of public approach to these sort of pandemic like things that could get out of control, right? Public health, what we have to worry about is like diseases that are communicable. So communicable diseases are then dealt with different monies and funds and grants and so on like usually, but non-communical diseases really become as neoliberalism also progresses capitalization privatization is a personal responsibility, right? And so then this in the second phase with Sakashvili who was so radical in his approach he surpassed all markers that even the reformers wanted. So this is another thing that's important to know about the post-Soviet world is while we see it in Latin America and in other countries with structural adjustment programs that people are resisting our governments were like we're gonna do even more than you're asking. So like they wanted to prove their loyalty to the West they wanna prove that their loyalty to capitalism. And this is sort of the name, the biggest religion that exists is like pro-capitalism, right? Is after the collapse of Soviet Union especially among the elites. And so Sakashvili to prove his weight and his reformer status and this is around Bush years and of course he also changes the flag and sort of goes with the whole war against terrorism and then also the heyday of World Bank is during that time and he takes on all those reforms and he starts going, we're gonna sell everything sells off lots of hospitals, privatizes them. And there's also at the same time there is no real help from the government. Like if you don't have money, you will just die. Sakashvili starts inducing a little bit of like targeted programs that grow. And at the same time we have to realize that all of social determinants have gotten worse. So the air is worse, the food is worse. People are using when there was in the 90s when there was no lights, they were using wood to burn in the house, tires. And so in every possible way their life has gotten worse. The society, the cultural, economic every kind of way we can describe someone's life psychologically it's gotten worse. So social determinants are worse and there's less of access to healthcare when you need it the most. And it becomes privatized even more rapidly in the early 2000s. When we approach 2012 and there's a changing government one of the big promises was that they were going to have single payer government funded healthcare which they did enact. And that was really the only thing they ever said they did for a long time. George and dream was like, we did the healthcare because it was really the only thing people really wanted and that's the only thing they've actually done at that time. So very popular, but then it's too popular. People start using it. So they're sick, well, you know, this is the outrage because people are using it too much and now it's like too much costs are too high, right? So they're bringing the World Bank again to like what's going on are the costs so high. And there was this report which I love how they speak to like this fully funded insurance incentivizes both parties to use healthcare, you know? So it's like saying how the patient, you know, person wants to go to the doctor because they can and as the same thing as the clinic trying to as much as possible steal money from the poor client that goes in and has no idea about their healthcare. And so they have like these extra tests and these needless interventions to try to get as much money from the government. And they try to attempt to say this was sort of the same thing. You know, this was incentivizing both of them to act in this way of, you know, using too much money. So they changed it to target it. So now it's targeted no longer universal which is exactly what we do not want. Just to look at some of the numbers of what life has got, life has brought the last 30 years of what has changed. And morbidity in general has increased threefold. Things like circulatory morbidities five times, nervous systems like nine times, nine times worse now, nine times bigger, the indicator, respiratory digestive, they have all risen cancer, almost everything pretty much. And at the same time, healthcare, though it's privatized in the messy and horrible thing that we do have, it's incentivized doctors to increase while decreasing nurses. What I mean by this is, if we leave everything to the market and we don't have any kind of what Matthew said, consciously setting priorities, right? If we don't have anything like what we are, we care about people, we care about, you know, having a healthy workforce, you know, healthy people, society and so on. If you don't have those priorities and you don't even believe that the central government should even involve themselves, then you have the market deciding. The market has decided that most people wanna be doctors because of course, if you're a doctor, you're much more likely to get more money and have more control over your work. You're not gonna wanna be a nurse that makes 100 euros a month or 150 euros a month. You work insane hours and you're so in the bottom of the hierarchy at the hospital and treated terribly and you have no autonomy at work and no one cares about your opinions or ideas and no one asks you anything. So really, nobody wants to be a nurse, of course. And then you have three times more doctors than you need them and you have three times less nurses than you need. And we know that nurses are incredibly important to a good healthcare system. So if we had to change, like it's from the 1989 to 1990 levels, we'd have to increase three and a half times the nurses to reach the current levels that were in 1989. It's gotten so bad. At the same time, just like Matthew said, while there's also a strain on worsening conditions for nurses in clinics and loss of power and money and status and everything, we also have brain drain. There's a healthcare crisis in the rest of the world and rich countries can just buy. They can just buy nurses from us. So Georgia spends money training them. They get experience in our healthcare system and yet they will go because it's free movement, right? And there's always even, I've been told by an ambassador that we always accept nurses. We may not have visas for other professions, but nurses are in such high demand, there's always room for nurses to migrate. And then you also have recruiters come and from Germany a lot and take these nurses back to Germany. And of course as an individual on an individual level, their life is gonna get much better because they're gonna get way more money and they're gonna be able to also support family back home. Maybe their life won't get better but their paycheck will get better in that sense. And then we have, as our nurses union, we have one of our nurses that is a care worker in Italy who makes 800 to 700 euros in Italy but it's still a lot more than she was making 120 euros working here in Georgia. And she was a specialist and loved her job. She's always wishes she could work in Georgia for the amount of money she gets caring for the elderly in Italy. And she can never see her family and it's like very alienated world that she has and where she can't even have her own profession be in her profession because she's a caretaker but also can't go home to Georgia. So there are many examples like that where health workers are not only working as nurses in clinics but also working in different health workers like care workers in different people's homes like taking care of the elderly. So this is what the snapshot of what Georgia looks like at this point. I don't see how things are gonna get any better so there is sort of the government start maybe starting to realize that free markets completely privatized and we do have almost the entire health system is privatized. Like it's like over 90%, like 95% I think. Can you imagine like this is, there is no public, not that many, there are like couple of public clinics but there really is no public sphere that you can even compare what it would look like with public or private. So one of the things we did at the beginning we wanted to just compare what it would be public versus private and then we just couldn't find any public, it didn't exist. And so the only thing we really had was to go back to the SEMASHKO model which is the Soviet Union model based on principles of taking care of each other and social determinants and seeing that it's a holistic approach that you can't just fix people at the clinic level but you have to give them out this decent home in a better environment. And so this is incredibly important this two different approach like Georgia in 1923, 1917 was in a worse state than Georgia at 1991 yet which having worse health in Georgia had indicators and social determinants in 1920s and then you were able to build and improve life expectancy and morbidity and health and longevity, life expectancy which was like 29 or 32 or something like that and then you have much healthier population in 1989, 1990 and yet you managed to make them sicker in the next 30 years. So just look at the two different approaches. That's, I'll wait for questions. Thank you. Thank you Sopo. I think that's a very, well it's, I'm not 100% sure that we had planned it quite that way that we would come to a point where Matthew describes what is being built and you describe what is being destroyed. It seems to follow like a certain, like an arch of history here that is unpleasant. So I'm really hoping that Janneke will pull it all together now. The Workers' Party of Belgium has long championed health care as one of its main causes. It's actually quite impressive and inspiration to us all. Scrooge's organization, The Medics for the People, this organization has been on the forefront for better care, better working conditions, better access and that actually for the last 50 years I just read that it's been 50 years so congratulations on that. I think that was last year, the anniversary, so amazing. And you have, I've met a couple of the doctors that work with your organization and you have actually created infrastructure to address all the shortcomings that you deal with in Belgium. Obviously after the two presentations we just heard, we need to know what can we do? What should we be doing under the current circumstances? Short of bringing socialism back, which of course is one of the goals, but in the short term and in the current state that we are in. What are the challenges? How do you operate in this neoliberal capitalist setting? And also of course, please share with us what the focus is at the moment, like what you're currently prioritizing in your struggles. Yeah, so please take it away. Janneke. Okay, thank you Francesca and thank you for allowing me to speak here and explain our vision on healthcare. I also have a presentation, I believe it will start soon, but I will talk to you about the healthcare system in Belgium, of course, about our organization medics for the people and then about how we see empowerment and social action. I'm just waiting for my PowerPoint. There it is, thank you. So this is the, so to start, I would like to explain to you all a little bit more about the Belgium healthcare system using this figure. As the figure shows different ways of providing healthcare, as you can see, public, private, non-profit and private commercial. And it also shows different ways of funding healthcare, public and private. So the Belgian system is situated in the B and point B, it's a non-profit healthcare system and it's paid by social security. So in 1945, under pressure of the working class and of course the international context, the working class obtained a social security system. It is an insurance system, but it is publicly funded. So every adult gives a part of their income into a large pot and it's used to pay for sickness, retirement, but also disabilities, things like that. And most people were very proud of this healthcare system. We have a lot of good staff, we have good access to healthcare, but since then, since 1945, a lot is happening and especially in the last decade, we have seen a lot of neoliberal measures trying to break down the system. And that's why I put the blue arrows in place. So we have seen evolutions like private clinics where people have to pay more, but it's also funded by social security. We have also seen, like for example, especially in the nursing homes, a strong privatization where multinationals like Orpea, Armonia, they have a lot of nursing homes and it's the people themselves who pay for them. And then we have also a strong evolution towards private insurance. So many people in Belgium already have extra private insurance to pay for the hospital because social security doesn't pay enough anymore to cover these costs. So as medics for the people, a lot of our actions focus on protecting the social security system against the austerity that we face, but we also need to think further and that is about moving to the left and making a public health system. So the consequences of the current politics on the healthcare system is that we see a two-tier medicine. So for example, if you can pay more money, you can go faster to a specialist in his private practice. We also see the system growing expensive and more expensive every year. So right now in Belgium, almost 20% of all healthcare expenses is paid by out-of-pocket for the patients. We also face a serious lack of staff despite the brain drain that we also do from other countries. But we face a serious lack of nurses. We face a serious lack of GPs, general practitioners and it's still growing because more and more people are leaving healthcare to just do another job somewhere else. For example, we have more than, we have tens of thousands of nurses who are trained as a nurse, but not working in healthcare anymore because they just have had enough. We have also a big problem of over-consumption on one hand under-consumption for certain people, but on the other hand over-consumption because it's driven by money. And for example, we are like ahead of the most scant, CT scans of all of Europe because the hospital needs this payment for the scans to survive. And it's all paid by social security. We also have a serious lack of prevention and the fragmentation that was already talked about, a lack of cooperation between the different systems. For example, between hospitals and primary care, but also for example, during the COVID crisis, nurses from the hospital in the beginning wanted to go and help in the nursing homes because they faced the worst problems there, but this couldn't be done because who would pay for them then? This was an important question. So these are problems that probably are very recognizable to a lot of European and Western countries. And unfortunately, we have now big manifestations and strikes coming up all over Europe and in a lot of countries, I just came back from Madrid where like patients and GPs, they're rising up together to protect a public healthcare system. So I believe there is a lot of hope in seeing these big manifestations and strikes. So to continue, I want to explain you a little bit about medics for the people and how we work. We have 11 community health centers. It's all over Belgium. So as most of you know, Belgium is divided in two parts, three parts with different languages, just the Northern Flemish speaking part and the South is French speaking, but we have medical practices all over the country and it's very important that this is one national organization because also splitting up social security in the Flemish speaking part and the French speaking part is very dangerous and we should not do it to protect it. We have like 250 people working for us. These are GPs, general practitioners, nurses, psychologists, receptionists, but also lots and lots of volunteers. We couldn't survive without our volunteers and of course, many more. And the difference is normally in Belgium when you go to your GP, he is paid by performance. So every time you go, you pay and then social security shall refund you and in our medical houses and some other medical houses for the patients, it's free of charge and it's directly arranged with social security, the payment. So as Francesca mentioned, it exists since 1971. And the origin lays in the May 1969 student protests. There were young founders of the Workers' Party who were students at the time and they saw that among many other things that the health system failed and they wanted to do something about it. They wanted to provide medicine and that put people before profit. And so they started out the first center in the Workers' Community in Hoboken nearby the city of Antwerp because they really wanted to do something and they wanted to show, they wanted to put their principles into practice and show that it's possible to do, to provide a different kind of medicine. So since then we have created 11 medical centers and from the beginning, it was very clear that these centers should also be not only medical centers, but also centers of political action. So this was in the beginning and of course a lot of things have changed since then, a lot of things has happened. And in 2022 also because after COVID, we believed we had something to say about the organization of healthcare. We published our latest mission statement because health is all right. And so if you want to read more about it, you can always ask a publication via our website. So Sopo and Matthew already talked about it, but a lot of different factors influence our health. So it's clear that as a healthcare worker, you can't always solve these problems within the walls of your practice. And that is why we use empowerment as a strategy of change. So as you can see, there's a quote of Che Guevara. He's a doctor and a revolutionary. So a good inspiration for an organization like ours. And he said that ensuring a strong body is not so much done by the skill work of a doctor's hands on a weak body, but rather by the work of a whole community on a social level. So we talk about empowerment, but we also have to say that empowerment has become a malleable concept. So from the World Bank to neoliberal governments, they all use the word empowerment. So what they really mean by it is solve your own problems. So we won't have to bother thinking about them or paying for them. But we wanted to take the term back and for us it means to help people and to make them stronger and to stand up for their rights. In our mission statement, we use a quote of a healthcare worker, an American healthcare worker, Irving Zola. And I just want to read it to you because I think it's very beautiful. As doctors, we stand at the edge of a swirling river. We hear the cry of a man drowning and we jump into the river, put our arms around him, bring him to the bank where we give him artificial respiration. And just when he starts breathing again, we hear another cry for help and the whole scene repeats itself. We are so busy rescuing and resuscitating that we forget to go upstream and see who is pushing all those people in the river. Systemic rescuing means just that moving upstream together with the victims and tackling the causes of their suffering. So from the perspective of the patients, we see empowerment on four different levels. The first one is involving the patients in shared decision making. So in the consultation when we see patients, we try to take the decisions together with them, not for them, but with them. The second one is also increasing critical awareness. So when somebody is sick, we try to explain them why they are sick. We also want to avoid guilt and victim blaming. So we try to explain the social determinants. We try to look at it with a broad perspective to explain to them what makes them sick. Could it be bad housing? Could it be the environment? Could it be the working conditions? So we talk about those a lot with our patients. Then the third one is the collective. So we organize a lot of group sessions for people with the same conditions to come together and to talk about them, to talk about it, to feel less alone, but also to see why they are sick and how they can stand up together to do something about it. And then the fourth one, of course, is the concrete action. And it can be going together to a union manifestation. It can be protesting together with our patients against air pollution in a big city. It can be long-term organizing a community around lead poisoning. And then we see in these concrete actions that it makes people stronger and their self-confidence grows. And it makes them also believe that something can be done about their destiny. All this means that as a health care worker, we have to evolve from only being a care worker to being a health activist. So we have to approach people in their strength. And it's not easy because it is often learned to us that we see people as victims. We see them as too sick to do anything. They can barely solve their own problems. So how can we ask them to go to a manifestation with us? So we have a lot of discussions around that. And we also have the second point, sharing is often a sustainable solution. We take a lot of time in our team meetings, in our medical reunions to talk about why people are sick to explain our cases to one another and to see if we have other cases like that. For example, we have seen lots of patients after the age of 55 being unable to work. And our government willing to raise the age for retirement to 67. So we have decided to do a study about chronic illness in people over 55 and to ask them if they couldn't work anymore and then we published that. And so we helped the debate on earlier retirement. So here you can see us in action at the parliament for people who have long-term sickness together with the union. And then, so the third one as a healthcare worker is we have to put ourselves on an equal level with the patients. So we can't think of ourselves as higher than the patients or superior. We have to work on a symmetric relationship. And of course, the fourth one is very important. We work with a workers party on our sides, the PTB because that's the party that's going for a different economic system and it makes us stronger as an organization to work together and to end my presentation. I would like to read to you a quote that was published in the Lancet in 2018 by the editor in chief, Richard Horton because it was the 200 anniversary of Carol Marx and that's why also we are linked with the workers party of Belgium. It is, he said, Marxism is a call to engage an invitation to strengthen the struggle to protect the values we share. We can conclude that medicine has a lot to learn from Marx. Thank you. Thank you very much, Janneke. I think your presentation really brought home how complex the struggle is for a better healthcare system and how it relates. Like just what Matthew and Soko were both talking about, it was shown that it really is super complex and super complicated to do so in today's sort of neoliberal environment in an environment where healthcare is considered such a specific issue of yes, curing sick bodies for profit where that is often convoluted as being healthcare. It really strikes in your presentation how much work your organization has to do to even raise the awareness around how these things are interrelated and how it is necessary to, I don't know, to struggle for better housing, for better working conditions, for not having the retirement age raised and how that relates to your daily health or your daily healthcare and your individual health. So I think it's very complex and it sounds like a lot of hard, difficult work and I'm not 100% sure how well we are doing overall. I think we saw in the comments, there has been quite a bit about a conversation about the brain drain. Sopo mentioned it. I think I would like to pick that up. Oh wait, let's do a time check. Yeah, we have 20 minutes, we're totally cool. We're very good for time. Thank you for keeping to your, a lot of time slots presenters, well done. And yeah, thank you all for the questions in the chat. Please put up some more, we try to get to them. Let's start with, I would like to hear a tiny bit more about the brain drain situation. We would assume, or at least I think this is what it sounded like a little bit, that Belgium and Germany, we know that, are actually at the moment at the receiving end. We heard, we saw in the chat already that the question of Cuba has been addressed. Obviously Cuba has probably been on our minds. I know that in the GDR study, Cuba is being mentioned because there is, it has been an inspiration for the GDR system as well. Can we talk a little bit about brain drain for a minute? And how this is being, how do we fight against that? Like what is a fair, what is a fair struggle? I mean, we cannot possibly ask individual nurses the way that Soko was explaining to not go to Italy, even though wages there are obviously also even lower than they are in Germany. We cannot ask individual nurses to make these sacrifices. But how do we address this? Matthew, do you want to start? I know the GDR is long gone, but they tried. And maybe there's something in it that would be useful. Maybe there isn't. And then I think the question around Cuba has actually been answered in the chat by Dr. Samira Adri directly. But maybe we can, yeah, maybe we can talk a bit more about brain drain. And then we'll get to the next question. So only short answers from now on. Okay, then I'll be brief. The issue of brain drain was something that affected the GDR, but the GDR also was trying to help the young states in the so-called third world also overcome this issue. And so I'll talk first about how they helped these young states. So the GDR had agreements with national liberation movements to actually train personnel, medical personnel in East Germany, who would then return to their country and act as a kind of multiplicator or multiplier, whatever you wanna, however you wanna call it. So the idea was medical pedagogy. So they would be passing on their knowledge that they learned in East Germany to other health professionals or medical students there. The GDR actually had a medical school entirely dedicated to this. They had I think over 2,000 students. They were then trained and then returned to their countries to act oftentimes as some of the first medical personnel at all because when the colonial powers left, they took all of the medical expertise with them leaving these colonies or former colonies in dire straits. In terms of how the GDR dealt with its own brain drain, of course, as I said in the presentation, it had open borders with the West until 1961. And it tried to convince some of these conservative doctors by making concessions at some point in the form of, for example, promising doctors that they could pass their private practices along to their children. And so sort of prolonging this private practice model that they were actually trying to transcend, but they were making these concessions to keep the doctors interested. And the long-term goal basically to combat the brain drain was training a new generation of doctors. So especially prioritizing young children from working class and peasant backgrounds and prioritizing their medical education so that you also break down this sort of monopoly on education that the medical intelligentsia had traditionally in Germany at least. And so these were the kind of the two approaches that was pursued, but maybe I'll leave it there so that I don't eat up too much time. Do you wanna add something? Do you wanna talk a little bit more about that topic? Me? Do you say something? Yeah, I'm asking you just because it seems so problematic in basically Georgia as being reduced to the state of being a country that was once so advanced and now is in that situation again where actually there's less medical personnel than there used to be. So I was just wondering whether this is part of your struggle in your union, how to address this? Yeah, that's a huge problem because I was saying like even if we managed to get four or five times the pay raise that they have now it still wouldn't be equal to European prices. So it's like we're really just, there's even limitations in that sense of union struggle if you're gonna ask for 500% increase rates. I mean, it still wouldn't be enough. So it's a huge problem. There's not only just the immigration, just like cross borders, but internal migration where regions are being emptied because there are not enough healthcare facilities because there are not enough people or if there are enough people, they don't have money. So you're not gonna open up clinics or at least even have more advanced hospitals because you're like, oh, these people can't afford it anyway. So you're gonna concentrate most of your clinics or hospitals in the city, in the capital, therefore draining away all the staff like hotel, hospital, too many workers, confusing. Hospital staff are coming from the regions as well. And so then you have even less people and then the prices are even lower. So usually the wages are much lower in the regions because of that as well. So there's internal problems where really has been, like to feel like you see sucked like everything out of the rest of Georgia. So there's only one city thriving at the detriment of the entire country. And then the second step is usually migration abroad. We want to do a study where we will really start to look at the patterns with recruiters and immigration because as far as I understand, there's absolutely no tracking of people. No tracking of nurses, how many are going, where are they going? Are they ever coming back? Nothing. So that needs to be done. That kind of just to get a picture of what's, because I just know anecdotal things like what we follow but we know what we, but we don't really have the numbers or say. And so that needs to be tracked. I don't know. I don't have answers to how that we could combat that. I mean, I don't, every situation it's having to either you have to pay a lot of money for people to stay somewhere they don't want to stay, right? So like regions, say high mountainous areas, you're gonna have to really give so much money and then there's no infrastructure around them either. So even if they get to be a doctor in some remote region, there's nothing else around to even have a life. So you're kind of asking people to live sort of a skeptic like monk like life, which I don't see a lot of people agreeing to. And the second we don't have money to offer them. So really, then you have to find some like dedicated, you know, person who's willing to risk everything. And now those are so rare and you can't actually base in a program or plan on people's willpower to overcome every single obstacle ever just to do this. I don't see it other anything else but some restrictions. Like I just see restrictions as one of the ways that you can sort of help this process I think, or maybe even have like, you know, if you're gonna finish nursing, you have to stay here for five years in the region or something, some kind of exchange. I don't really have thought about this in the sense because I know it's a really difficult subject. So I'm trying to get a better picture of it, what could be done besides like restriction, which works, but then, you know, all this other, but then it's like the age of individual, like to pursue our lives and so on. So it's like really hard to limit the individual in this day and age, you know, to tell them to like stay and not pursue something else. But that is, it's interesting because that is in a way also something that Janneke says when she talks about the internal difficulties, we are not just talking about how internally regions may be perching each other and certainly like the cities, like the rural areas are even less serviced. I mean, that's, I think we see that everywhere, but Janneke was even mentioning that people who have been trained in the healthcare professions, like as nurses for example, don't even work in their professions. So you have even, you have their sort of a term a kind of a brain drain that just goes to other jobs because it is so, I don't know, underappreciated such a hard job that it's not even, that it doesn't even make sense for people who have been trained in the field. But this is interesting because Janneke, when you say that you have the 11 healthcare senate, that you have these clinics, how do you motivate people? You say you work a lot with volunteers, you know, how do you motivate people to come together? Maybe this is helping, maybe this will help SOPO to develop like some amazing clinics in Georgia to address the issue in rural areas. How do we motivate people to do what you're, again, you're doing it in Belgium. There's different challenges than there is in Georgia for sure. And surely the, your organization as well as the party are lobbying the government for better healthcare spending and more healthcare spending, et cetera, et cetera. But how do you motivate people on the ground? I think for, for medics for the people, Belgium is a very urban country, so we don't have a lot of very rural areas, but still we have a difference, like even within our organization, finding doctors for the cities is less hard than finding doctors for the more rural areas. So, and I guess the answer to the branding within a country is within the public health system because as an organization, for example, we can specifically discuss with doctors, ask doctors to go to another healthcare center to help out there. And imagine if you have it on a bigger scale and you can motivate people to go to another practice and to practice medicine there and it actually works. We can arrange within our 11 healthcare centers the more distant centers. We can help them to survive and by working together and finding doctors. But I guess the most important thing to motivate people is the vision itself and engaging in action together to realize that vision. Because I think that when, for example, I saw an item on TV last week or the week before about Indian nurses being employed in nursing home in Brugge in Belgium. And they had to learn the language and it was like a very optimistic item. But we have to work with the people who come here to explain our vision about public healthcare and to engage them in the struggle for better working conditions. So that's one thing we have to do and we have to fight together for a better healthcare system here and abroad. And I think what is also important for an organization like Medics for the People is to have international solidarity in our activities. So for example, we have now one person coming back from Turkey who visited the areas of the disaster and we are organizing in many cities together with the Working Party, with the Workers' Party, solidarity meals to collect funds to help organizations over there. But we have also in April and May, a group of young doctors going to Cuba, looking at the healthcare system over there, learning from it. And at the same time developing international solidarity in our practices with our patients, collecting medical material and asking patients to give something for that. So that is something we consciously work on as well. Thank you. I'm just thinking about which questions we should take that everybody can speak some more. There was a question very early on and maybe Matthew can answer it very briefly about psychology and how mental health stuff was dealt with in the GDR. I know that this is not so much explored in the study and I don't know if you can answer it but maybe you can say two words just to respond to the question. Yeah, I would just briefly say that, unfortunately I can't answer that question in too much depth. I mean, our study primarily looks at the outpatient system in the GDR. But I would say in general we have to be a bit careful using today's standards and applying them to the past. Not saying we shouldn't do it but we just need to be careful when we do it. And as Francesca also said in the beginning, it is difficult to actually overcome these prejudices, these cultural prejudices that we have towards certain ailments or even medical professions. I'm not too sure about this. I think the question was about disdain for psychology. I can't say much about that but I do know that one of the pioneering fields in the GDR was actually occupational psychology. So they were looking at this, the question of why is work alienating or how is work alienating in a industrialized society and how do we go about addressing this problem? And I do know that there was quite a bit of research but it was only applied in the GDR in a limited manner but again, it only existed for 40 years. So who knows if it had carried on and maybe they would have applied this more widely but it was definitely a field that was being researched but I can't say it was a priority. Yeah. Thank you. There's a question about that also came up in the chat about whether there was, whether in the research around the USSR and the GDR, whether or in Georgia, whether there were approaches that were shared, whether there's actually like, whether public policy was made together by the USSR and the GDR or by the individual states. I don't know if Sopo or Matthew know anything about that. And again, it is generally about the prevention, the preventive methodology of healthcare that was the goal or was the driving force in that time in the former socialist states. Is there any documentation of this as official policy or is there anything that was coordinated at government level? I don't know if either of you can speak to that Sopo, do you know? I don't know the exact documents or anything like that but the approach is exactly the same. There might be differences but the polyclinic being central to the healthcare, preventive care being number one and prioritized, prioritizing social determinants and almost every possible way. This is what socialist healthcare looks like, same in Cuba and many other places that has been tried. So what we can say for sure is this approach that at every level it should be outside of the individuals like, oh, if I remember to go to the doctor if I have enough money. So it's mostly like from the beginning when you're born from the hospital to school, you're getting checked to when you start working at the factory or whatever, you're getting checked. So everywhere there are these yearly checkups prevention and one of the statistics I didn't say was like in post-Soviet Georgia, nine times less preventative checkups with doctors now. So nine times less. And so then you see how the illnesses are much higher. You cancer especially is about prevention, right? Catching it early is life saving. Catch it late, a lot of people die from cancer here because they're not going to the doctor until it's too late. And so prevention is very much key. And also, we also have the whole system around occupational care. And I really love this occupational psychology that you mentioned, loved it. This is like actually one of my passions, but it really is like this idea that rest is necessary. Because of course, it's like a Marxist sense because we know that people are exerted and that's what value is, right? It's exertion of the physical body at work. So then you're trying to do everything to help this person become whole again and live their best life. And so you had sanatorium systems where you can vacation and have baths and care in other different ways. Leisure, you had rest homes. And I actually make the case and I would actually like that's maybe beyond today. But one of the things I actually looked at in which the IMF sort of World Bank and continuous privatization constantly says we don't need these hospital beds and they're always destroying hospitals and selling them off. Hospital beds were too much, too much, too much. But I look at it as the hospital system was also assuming that like at home you may not get that kind of care because you might have, if you take care of it, if you're like a woman working age you might have to take care of your child or your mother that's living with you or your husband. So like being in the hospital for long periods actually gives you that time where somebody else is taking care of you. So you are not doing all these things at home. So I look at the demolishing of hospitals as an anti-woman thing where care work for sick people by focusing mostly on outpatient there's no such thing as purely outpatient, right? I mean, you always knew like every time I've ever been to the doctor or something you get this like you need to rest for four days you need to eat this, you know who's taking care of you in that time? It's your mom, it's your wife, it's your, you know, maybe if you're lucky your husband or any kind of man but really it's women that are then ending up. I know so many of our workers cannot go somewhere or have to take time off work or we actually fight for medical leave from work that if your parents get sick or if they have surgery for you to be able to leave and then take care of them. And this is actually, I know so many people say like oh my aunt got a surgery I've been taking care for three months at my house. So I see that, you know like I don't like fetishize this outpatient service that I feel like sometimes it's like what they always want to go you don't need to be in the hospital and hospitals are bad. I look at hospital, the original concept of hospitals were poor people who didn't have a home where they could also get money for food or get food and a place to sleep. So to me in this world where it's actually harder to get homes and have enough like at least in Georgia have the kind of lifestyle or like living standards that would be, you know suitable to be at home. If you don't have that I think hospitals are even more important during this time. And also this care work as I said like this care center is like sanatoriums rest areas. And there's so many rest areas, sanatoriums in Georgia that like are now decaying or become five-star hotels or something. But amazing palaces, palaces really was like, you know warm baths and like sulfur and massages or whatever for you to feel better. And especially if you worked really hard jobs like mining, you got even more privileges of like going to that. So I think that's really important. The approach is holistic. It's about a person and understanding that under capitalism the worker is labor power. So it's like coming from that. So I think that would be what it seems like from the studies the same thing. Yeah. I think you raised an important point to which we really will not get today. But of course there's a whole layer to this from to look at to look at healthcare from a feminist perspective and see how socialist healthcare dealt with an issue that is, you know, that a lot of feminists now actually talk about how underserviced women actually are in our current healthcare situation and healthcare system, including that much of the care work at many of the nurses that these are still very gender jobs and that there's a lot of, yeah. So there is like this underserviced and overworked. So there's like all these double and triple things so there's a whole other session in there on socialist medicine and women or how that worked out. I think we can take some time and think about whether we want to talk about that in a different session because I think it would be very, very interesting because again, like you have been explaining to us, so a lot had been gained and a lot has been lost in the former socialist countries in terms of reproductive care and in terms of healthcare for women and in general women's accomplishments and achievements. I know we're running out of time now, like first we did so well and now we're running out of time. So I'm thinking that maybe we should move to sort of final statements and I think we'll do it. Somebody raised the question about reform or revolution and I think we will not link this to any party or organizations. I think we will just, we would really like to hear how is your inner personal revolutionary dealing with all of this and how would you like to see the healthcare system in your current country, in your current region? How would you like to see it changed? And yeah, do you think it can be done via a gentle reform or are you full out on there and this is your personal answer I'm asking Sopo, Matthew and Janneke and I'm not asking the organizations that you work for so you can just let it all out and speak for yourself let out all the frustrations. Matthew, do you wanna start and then Janneke and then Sopo? Yeah, I can. I think I would just briefly also say that concluding on this panel discussion, I think it's important that we are not afraid of looking at our past experiences and the practices of what they call real existing socialism, you know? I think we can't write these years off as failures because there were some shortcomings or mistakes were made and this kind of stuff. So I think we should really try to reclaim this history, make use of it and learn from its ups and its downs rather than just writing it all off and ignoring it. Now, to the question of what Francesca asks, I think I would probably say that I think we should be careful about just taking individual aspects of socialist healthcare systems and then integrating them into capitalist society and thinking that that will work, you know? Like taking the polyclinic for example and just building it in Berlin today which by the way, some people have tried and it doesn't work because the profit motive is just crushing. So I think what I would say is that if we are gonna have effective and thorough transformation of healthcare, it has to be linked with a larger political project and I think that's also what's remarkable about the Medics for the People campaign in Belgium is that it is linked with the Workers' Party, with the PTB and it is part of this larger project to transform society. And so I would just probably highlight that we need to keep these two connected, you know? Concrete gains in the here and now but also long-term political objective. And as part of that long-term political objective, I think that at the center has to also be property relations, you know? We have to ask the question, who is owning what? And if we look at states like the GDR or Cuba, this was kind of the key to realizing this idea of health in all policies, you know? If we're serious about integrating health into all areas of society, we have to recognize the public ownership of all major institutions is the fundamental prerequisite, you know? So I don't think we should settle for any half measures here and capitulate to what Sopo was talking about with this sort of demonization of centralized organization. So I think that even if it's a gradual process, we should still have a long-term goal of socialization of property relations because this is what is going to really deliver comprehensive healthcare for the people. Thank you. Final statement, Janneke. Yes. So I would like to explain, I'm wearing a badge today. I will show it closer to the camera. I hope you can see it. It's in French, so I will translate it. It's a badge from the Workers' Party because last month we had a manifestation of the healthcare unions. And the badges, this one said du travail à la chaîne and they crossed à la chaîne and they wrote humain. Donc care is not a chain production, but it's human work. It is basically saying that and that would be what I want to change in healthcare that patients can be no longer numbers and that caregivers can be no longer seen as machines that have to produce something. So I think we need a more human perspective on healthcare and that is what we fight for with medics for the people and with the Workers' Party. But we also see that everything that we gain is limited in time unless we change the whole system. So it's very important to see that we also need to go further than just change some things, but we have to go for a system change. And with the Workers' Party, we have a method for that and we call it street council street or street street street street. But like at the moment, we have two of our doctors in the parliament and they function as a speaker for the action in the street. So when we do something, they talk about it in parliament, but without the action in the street, without the manifestations of the unions, without the civil movement going for action, they can't really do anything in the parliament and they need that civil movement, that union movement to come into action and just to realize these measures for care no longer being a productive item and being more human. So I think that's my statement. Thank you, Nika, so cool. Yeah, so I'm definitely for completely overhauling all of private care to only being public and similar systems. I think maybe now we know more so we can actually improve so many of the mistakes that Soviet Union or GDR made. And I think we actually have a better standpoint, a position to really work from. And especially because there is also technology, but also so much knowledge has been accrued and everything that we've been saying or before was maybe not able to be evidence-based. Now it really is evidence-based in a lot of ways. So I think even basic things like food, when manufactured food that we really shouldn't be eating, things from a box that's been in the past 30 years, tons of these products have been coming into Georgia, ruining also even the diet and diet is incredibly important to health. So there's so many things that I can discuss that should be changed. So I work on changing these things now but I don't see how, like Matthew said, I think that's sort of taking some kind of socialist trying to make it work in a capitalist system. We can, I think workers, especially in Georgia are so beaten down so any kind of relief for them would empower them to then be able to fight for a better world. So I do believe in reforms in the sense that I don't think the most like poorest, most beaten down people, I don't think they're a revolutionary subject. Like generally, usually that time is when you're just trying to survive. So actually getting people some things for them just to be able to have, see that they're worth more than the life has given them actually, I feel like ignites them to want something. It sort of wets the appetite for what could be. And so I, again, like what the work we do with, and actually I'm so impressed with Mike's for the people as well. I just wanna say like, you're one of my heroes. And I met Sophie last year. So I was like very impressed. And so I think like that kind of work is incredible. Like I wish we had that in Georgia. I really wish like doctors were, they're really conservative here. You know, like just even having small things like doctors being able to go work with PHM or even have like exchange programs with you in Belgium, just to see what it's like, I think would do a lot. Because I do think doctors, even though I think they're the most reactionary out of the healthcare sort of, or staff personnel generally, because they make the most money, but nurses, doctors and so on, they should be learning more about where there are experiments, where there are these attempts to change things. Because right now it's like virtually 100%, you know, or some people may be like, oh, public-private mix. And that's good enough. And that's what the world is all going to public-private mix. And this is what we're the best we can hope for. So I think we can do more. Thank you. Thank you. Thank you so much. Oops, I just disappeared for a moment. I didn't hear your last words, but I hope you'll tell me. Thank you so much. Thank you, all three of you, for staying with us until the end. Thank you for all the people who dialed in, et cetera, et cetera. A huge thank you to people's dispatch. I know that this is always very hard on the people's dispatch crowd at the crew, for the crew, because it's really late in India. So thank you for helping us and supporting us. I think that we can say that we raised more questions than we had answers today. I think there's a lot more to discuss, all the complications, all the changes that are necessary. But I really do hope that we get to a point, maybe we can talk about some of those aspects again, and maybe we can figure out a way to exchange some of that knowledge and some of that expertise and create some more synergies working together to at least make things better slowly, but surely, and then get ready for the real thing. Thank you very much and good night, everybody, and see you soon. Goodbye. Thanks very much. Bye.