Salud Promodores, Barefoot Doctors, Home Health Workers, and Iranian Health Houses Come Knocking

Healthcare Workers in Iran

New Orleans   In organizing the process of strengthening weak ties to build the strong welds of solidarity can be very personal, tediously time consuming and therefore prohibitively expensive, and involve huge scale human engineering in order to create deep organizations, which is partly why organizers use other tools like actions and demonstrations to achieve scale and create polarization.  There’s no better or more intensive process than home visits, the door-to-door work that was the ACORN hallmark.

For a long time I have found it fascinating the way similar systems have been successfully adapted in developing countries to provide health care, particularly preventive care.  In Lima and elsewhere many of our organizers were originally salud promodores or health promoters, similar to home health aides doing outreach.  In fact when I was consulting with Casa de Maryland they had an excellent program working among immigrant populations in the suburban counties outside of Washington, DC.  The role of barefoot doctors, who were home health organizers after the Chinese revolution, was well regarded and carefully studied in my generation as both hopeful and inspirational.  The huge explosive growth of home health workers in the USA was more about cost saving than prevention or intervention, but there’s no doubt that when the service worked it allowed better health and independence for millions.

It wasn’t surprising to that Dr. Aaron Shirley, a veteran doctor and civil rights activist in Mississippi, would be attracted to these kinds of programs in dealing with the persistent, scandalous, and tragic heath care crises in Mississippi, but the New York Times Magazine feature advocating a move to an Iranian model of health houses or mini-clinics serviced by promodores of sorts was fascinating.

The Iranians built ‘health houses’ to minister to 1500 people who lived within at most an hour’s walking distance.  Each house is a 1000-square foot hut equipped with examination rooms and sleeping quarters and staffed by community health workers – one man and one or more women who have been given basic training in preventive health care.  They advise on nutrition and family planning, take blood pressure, keep track of who needs prenatal care, provide immunization and monitor environmental conditions like water quality.  Crucially, in order to gain trust, the health workers come from the villages they serve.

All of that seems to make enormous good, common sense.  The article drifts a little towards the direction of being a solicitation for government or private funds for the $3 million the Mississippi organizers and advocates want to build 15 such “health houses” over three years, but it makes me wonder why this wouldn’t be a vital system in not only rural areas, but also cities, and why with some energy and ingenuity and community support versions of this couldn’t be created by community organizations using the talents all around them.  Given the costs of health care, the shrinking of the safety net, and the fact that it’s life-or-death if we don’t start embracing preventive care and create a real ground-level health care system, it seems like it’s worth some thought and work for community organizations to adapt something similar and do so PDQ.

salud promodores training


Joyce Miller: First Lady of Labor

Joyce Miller being honored (1983)

New Orleans   Meeting Joyce Miller was one of those happy coincidences.  Her son, Josh, was working as a researcher for ACORN in Arkansas in the 1970’s, which gave her an excuse to visit the state and the rest of us an opportunity to meet her.  The Coalition of Labor Union Women (CLUW) was something that mattered at the time, because they were the one established group of tough, savvy union women within the ranks of institutional labor that the staid, conservative building trades wing led by George Meany, didn’t embrace, but couldn’t shake off.  As vice-president of the once powerful and progressive union, the Amalgamated Clothing & Textile Workers Union (ACTWU), Joyce had been at the founding meetings of CLUW and an early officer of the organization, becoming in 1977, CLUW’s second national president.

Unions were decidedly “old school” at the time, even more so than now.  The old lions were still roaming the range, even as the membership and movement was sliding down a mountain, having crested without realizing it, and still grasping at this rock or that on the way down, as they tried to get a grip and denied the obvious at the same time.  Joyce was “old school,” too, which is partly what made her impossible to ignore for the old hands, frustrating for the young feminists, and effective in the backrooms in what she referred to as the “sea of men.”  She was from Chicago, had started working on auto assembly lines while in school there, and became an activist.  She first rose to prominence in the unions that became ACTWU as education director of the Joint Board in the Midwest.  Labor education in the old school of labor used to be part of the essential package that prepared leaders, trained stewards and bargaining committees, and, essentially provided the history and ideology that built the struggle “culture” of the labor movement.  This was the “soft side” of a hard movement.   And, not just the soft side either, because part of what went with the portfolio was strike support.  Joyce’s department had to be able to mobilize the social services, get the food stamps and unemployment that allowed the troops to hang on, provide the family support, and a hundred other things that could allow workers to make it “one day longer” and give them a chance to win.  A tall, sturdy woman with a hoarse, gruff voice, Joyce didn’t come off like a social worker.  She wasn’t a back down woman.  It wouldn’t have been hard imagining her puffing a cigar with the old guys if that had made a difference.

Joyce Miller in 1988 second from left with Evy Dubrow (far right), a CLUW founder.

Both of these departments have largely disappeared, but in the 1970’s and 1980’s there leaders at the cutting edge like Joyce could understand that a hybrid community union of sorts like ACORN, starting to expand from Arkansas to other states, could be a game changer as part of the larger progressive forces with their wider view of labor.  I can never forget in the late 70’s while trying to raise money one spring in New York, Joyce inviting me to have lunch in Union Square with some of her colleagues, including the organizing director of the union.  As Joyce moderated the discussion, they explained what they did.  I explained what we did.  The organizing director wanted to know all the specifics.  How many organizers?  What hours did they work?  What were they paid?  Finally at the end of the lunch, he turned to me and said that he would give anything if we could just do an even trade, his organizing staff for mine for a couple of years.  He honestly didn’t think the trade was a good deal for ACORN, but he thought he might save his union and the labor movement if we could make a deal.  Everyone laughed.  Joyce louder than others, feeling she had just stirred the pot.  He wasn’t serious unfortunately, but I was, and it made a different.

In 1980, I was 32 and Joyce Miller was 52.  That year she was named the first woman member of the AFL-CIO’s Executive Council.  Women by that time made up more than 7 million of the 13.5 million members of the federation, so it was fair to say that it was about damned time.  Now there are women running some of the largest unions within institutional labor from the AFT to the SEIU.   More than 30 years later women still don’t have a secure role in the union culture despite their increasing majority.  I can remember the fights in the late 1980’s to get women on the executive board of the Greater New Orleans AFL-CIO.  Women are still disproportionately represented at every level of the labor movement, and that issue alone has to be on the list when noting labor’s decline.

I got an email late last night from Josh Miller, now a long tenured professor at Lafayette College on the Pennsylvania/New Jersey border.  She was in her mid-80’s.  I had written about her in Social Policy in recent years which had given me a good excuse to have a couple of great phone conversations with her, sharp as a tack, and to the point as always.

He said Joyce had died the night before.  He knew I would want to know because “she was one of your greatest fans.”   And, I was one of hers!

I will be looking for Steven Greenhouse’s obituary for Joyce in the Times, because attention and respect must be paid.  Lessons in the special Joyce Miller school of labor education are still being taught and, more importantly, still need to be learned for women and men to lead the way in building the unions of the future.

Coalition of Labor Union Women (CLUW) supports organizing drive at the A&S department store in Brooklyn.