S6E20: Mutual Aid and Healthcare

Leen: Are we good on the mic situation?

Margaux: Yeah. She started recording. But I guess keep talking. "Bundle Of Hers" in the virtual studio. We obviously have the new Dr. Le, or Ha, and Leen and Margaux.

Leen: Burnt out residents who no longer want that title. Just kidding.

Margaux: But I feel like these seasons, maybe a couple episodes ago, it was Leen, Harjit, and I kind of venting about burnout. We talk a lot about the flaws in our healthcare system and that we navigate as medical trainees in this podcast.

And something I've been thinking a lot about is the first step of something is always acknowledging a problem or just identifying something that's bothering you or something that's wrong in the systems that we function in. And I think we've done a really good job of that in the podcast.

But for me, it's like, "What's the next step?" I wanted to do more action. And as you guys know, residency takes up all your time, so I felt a lot of disconnect. And so I've been thinking and connecting more with mutual aid funds. I think something we haven't talked about on the podcast yet is the role of mutual aid in healthcare and just in our lives in general.

And so I was going to give a brief history of mutual aid and kind of an introduction to it, and then we're going to talk about mutual aid funds and their role in healthcare.

In definition, a mutual aid fund or organization or society is basically a voluntary and reciprocal exchange of resources and services for mutual benefit of its members or the community. So it is also usually associated with a form of political participation in making change or social change, and in ways that people will take responsibility for caring for one another.

It's not charity. So it's not like you donate to some big foundation that you're not really part of, but there's a GoFundMe and you just give someone money and it makes you feel better and you don't really know where or how that money's being used. And it's more than just advocacy or volunteer work. It's truly solidarity at its roots.

Hạ: I want to ask then just to clarify and get a better sense of what mutual aid is, because I feel like I understand it, but I always feel there's so much more to learn.

For instance, I know that a lot of black and brown med school graduates on MedTwitter have something where they do med grad wishlists where they kind of post their Amazon link about what they would like to get funded as they make their move to residency and people can donate to it. Is that a form of mutual aid? Because that's what I always thought it was, but I'm not certain, so I just wanted to check about it.

Margaux: Yeah, that's definitely more of a modern sort of mutual aid that we see on social media in our modern climate. And so it can be a form of mutual aid, and I think it's a great one. There's a lot of place and space and accessibility for people who need to reach out to a broader community and network through social media, like MedTwitter and these people.

The problem is there are also a lot of predators and people that . . . If you don't necessarily know that one person, it's kind of hard to know how that money's being used. And so I think you have to be intentional about it. But yes, it is a form of mutual aid.

Hạ: I was definitely curious because you said it's not like GoFundMe, so I was kind of curious what the line is. There are so many MedTwitter or even just general Twitter things where people are like, "Retweet. Please help me with something.' And they're often from a marginalized identity.

Margaux: And I should retract my statement about GoFundMe, because it can be a very good tool for mutual aid. But I think there are a lot of . . . Again, it comes back to being intentional and knowing the community and the people that you are reaching out to support. Intentional community outreach and support.

It's not like if you see someone who throws up a GoFundMe link and you don't really know who or why or what. Sure, go give your money. That's charity and that's still a good thing. But if you happen to be part of that community and understand the needs and maybe why or the drives or things like that, or want to engage in conversation or around that community, then that becomes more of the mutual aid network.

It can be pretty complicated, like an individual asking for charity and money, versus an actual network that also has a secondary platform to drive social change.

Hạ: Yeah, that makes a lot of more sense, and I'm glad we're having a conversation about this because I think it is a very complex and heavy term to think about.

Margaux: And to your point, Ha, both of what we were just talking about, mutual aid networks and individuals asking for charity and funding, those are both valid things to do and to support. Just mutual aid networks and societies also have a larger undercurrent and agenda to them versus just helping someone, like helping another graduate out one-on-one. So neither of those is wrong. It's just different.

So let's talk quickly about the history and more about what mutual aid funds or societies are, and then we can get back to how it ties into our personal lives and healthcare.

So I did a lot of recent learning and brushing up about the history of mutual aid funds from Dr. Tyesha Maddox who's a PhD and an assistant professor at Fordham University in the Department of African and African American Studies.

She has a lot of literature and publications around the history and sort of use of mutual aid funds then and now, and she has a great 13-minute YouTube video called "The History and Politics of Mutual Aid by Tyesha Maddox." So go check that out for more information and to give full credit where credit is due. But a lot of this history I have learned from her.

So, according to Tyesha Maddox, a mutual fund consists of four key tenets, which are self-organization, egalitarianism, which basically means equality amongst all members, direct action, and social transformation.

If we go back to what would be perceived as the conception of mutual aid funds, many people, especially if you're taking a white supremacist/capitalistic lens, would say the start of mutual aid came from a Russian man named Peter Kropotkin, and I probably said that wrong so I apologize.

But his key text, which was really deemed an anarchist text, was titled "Mutual Aid: A Factor in Evolution." And in this way it was easy for the government to target and kind of vilify mutual aid efforts when they framed it around this.

But the reality is that mutual aid and action has been utilized by BIPOC communities for centuries as they came under oppression and occupation by colonizers. It's essentially modeled after many community-centered groups and ways of life of indigenous peoples.

So, essentially, if we look at the history, one of the earliest Black American documented formal mutual aid efforts was called the Free African Society. It started in Pennsylvania in 1787. Its efforts were to support those who were working towards abolition of slavery. Many other societies like it started popping up in neighboring cities and states after the Civil War and abolition of slavery. Many mutual aid groups formed to help support, educate, house, care for the newly emancipated peoples.

And pretty much then every immigrant group that has come to the U.S. also formed mutual aid groups to support their communities and advocate for rights within the U.S. political system.

So for example, many early Chinese immigrants arriving to the ports of San Francisco were met by representatives of what was known as family associations, like, for example, the Lee Association of America, who provided immigrants with temporary housing, food, small business loans, and medicine.

And from this model, Asian American immigrants also started what was known as collective credit to help new members be able to establish themselves and start businesses, overcome any sort of financial obstacles.

Because we function in a capitalistic society, money and funding is sort of necessary for survival in the U.S., and so mutual aid funding is a core tenet in our country. And so there were ways to adapt to that in a community-centered model like these collective credit groups.

And in the 1900s, so at the turn of the century, there was a group called the Sociedades Mutualistas, which had collectives in every city with a major Spanish-speaking population, which was a demonstration that these mutual aid groups could function on a local and national level even before there was internet. So that stands a lot for the strength of these networks.

Also, in 1900s or at the turn of the century, labor unions and mutual aid groups were key to improving working conditions and labor laws. However, it's important to recognize that these movements were segregated and the white people co-opted BIPOC traditions and models of mutual aid, but to benefit themselves and sort of left BIPOC people out of the benefits that they gained from their efforts.

And then in the Great Depression, it also demonstrated the absolute need and benefit of mutual aid funds. There was a huge spike in these groups, but it also was a huge time that strained the efforts and abilities of mutual aid groups.

And so Franklin Delano Roosevelt at the time turned some struggling mutual aid funds into New Deal legislation that would then go on to disproportionately benefit white people. And without needing these sorts of mutual aid community groups, white-dominated mutual aid funds kind of dissipated across the country.

However, because racism was very rampant in the New Deal and there was still a continued need for BIPOC-led and -centered mutual aid groups and funds and labor unions, there still was a lot of strength and power behind them.

Some examples of ones from 1900s were the United Farm Workers Union, the National Welfare Rights Organizations, and then various neighborhood improvement organizations. There are so many. These were just probably some that you've heard about either in school or popular media.

In the 1980s is when we see the first healthcare mutual aids start coming up with the AIDS epidemic, the HIV/AIDS epidemic. These were started by and for AIDS patients because a lot of the general public were refusing to care for these people, and so there was another need that came up for having a community-centered welfare group and to advocate for rights and healthcare for these patients.

Now, more commonly, we see a lot of mutual aid funds that are ignited out of natural disasters, like Hurricane Maria that hit Puerto Rico, or the recent Turkey and Syrian earthquake. But I think one of the biggest reasons that mutual aids have sort of been reignited is with the COVID-19 pandemic. And that's how I really learned about them.

And I think, Leen, when we were . . . So we were fourth-year medical students in the middle of our second semester and everything got shut down. We were kept from the hospital and sort of at home.

And I remember distinctly having conversations with you and Harjit about feeling powerless, and then learning about the Salt Lake COVID mutual aid fund and how you could go and buy groceries for immunocompromised or really ill people who really couldn't leave their homes. And then there were community fridges and things like this, and so those sort of mutual aid funds really cropped up all over the country.

And then, like we talked about in the beginning, social media has given access and space to a lot of mutual aid funds as well.

But that's kind of a basic history. Like I said, go learn more from Tyesha Maddox about mutual aids in detail. But does that help clarify things? Make it more muddy? I don't know. What are your guys' thoughts?

Leen: This is actually funny, because I remember during COVID, I was thinking, "Wow, I have this innovative thought." And I think as a community, I guess in a sense you kind of dismantled the idea of capitalism where it's gain over gain over gain. It's like you build these communities within each other and you try to . . . You spread the resources among each other and then you support building the resources for each other, right? And now you're telling me that, "Oh, wait, that exists. It's called a mutual aid." And so I'm sitting here like, "Wow, isn't that genius?"

But I think it's interesting how you don't often hear about these things, right? I am honestly completely new to this idea as a definition, per se, but as an idea, I think I've always thought about, "Why don't people do these kind of things?"

And I think oftentimes they get kind of covered up into, "Oh, this is charity. You're doing charity work." But by that definition, charity kind of defines who you give it to, what criteria you have to meet to give it to them. It's not really community building per se, right? It's more just supporting a community of your choice. And so I think this is different in that regard.

Margaux: It's totally different. So you can donate to a charity organization and not know anything about that organization, what they do, or who or what they donate. So for example, they can say, "We're sending money to Turkey after the earthquake," and you can feel better about yourself because you're able to give money to this organization who you think is doing something. But there's still a huge detachment from you and that community that you're wanting to help. Whereas a mutual aid is a collective of people who come together and recognize needs.

Exactly like you were saying, Leen, it's not about funding. A lot of charities have to do a lot of marketing to raise money, and then put money back into marketing, and a lot of it is fighting . . . A lot of nonprofit organizations fight for funding, right?

Whereas mutual aids, it's like, "I have this toolset or skillset and I know that this person in my community, because I've talked to them, I've connected with them, I've had face-to-face or Zoom conversations with them, I know how we can help each other." And you also know that what you're doing, that person that is in need, you are giving them actually what they need, not just . . .

Leen: Right, exactly. So then my thought here is, "Why is it called a mutual aid fund?" In a sense, to me, this sounds like a form of economy that's been around prior to colonialism, prior to capitalism, right?

I mean, if you think about it, historically this is the way villages and . . . At least I can't speak for every culture, but I feel like, historically, this is how we all kind of work together, right? It's like our neighbor has a farm, and he grows this. They have a well and they provide the water. We give cucumbers to them to give us some water, and they give us sheep and they give us . . .

But as a collective, I think the survival basis, in order just to survive, like the food, the water, the shelter, was in a mutual fund. Beyond that, it might've been more like for-gain capitalism whether you had something to sell and purchase, but the basis of survival was always a foundation, and that was always built upon an idea like this.

So I'm just wondering why is this separate? Why is this called a mutual aid fund? Maybe because it's on a smaller level than it is nowadays or . . .

Hạ: I think you alluded a bit to it in it, Leen, about the capitalistic society that we live in. For me, yeah, I thought of mutual . . . It was really weird, Leen, because when you described what you understood from Margaux's history lesson of mutual aid, it suddenly clicked in my head. I think it's because I always thought of mutual aid so separately from the idea of just a community being engaged with each other.

And I think it is because we exist in such this capitalistic society that the thought of mutual aid seems as if it's this foreign concept, this foreign ideology, when really it is, as I've now understood . . . It finally clicked as we were just talking and hearing your both perspectives about it. It's just this very idea that has existed across centuries in other communities that move away from the capitalistic mindset that we have.

Leen: Yeah, exactly.

Margaux: That's exactly right, Ha. And the government, I think our U.S. government, our capitalistic democratic state, has done a lot to squash efforts of mutual aid. And they're not all called funds, Leen, just for semantics. Some of them are societies, or union is another keyword. So labor unions and things like that are also considered in this mutual aid groups.

But they have been threats in the past and are accused of having socialist or communist agendas that threaten the U.S. government, and so I think intentionally we are not taught about these in school. It's been divided from its true history, what you were getting at, Ha. It really is just a community-organized group that you probably have been engaged in and not had that title.

Leen: It is a form of economy if you think about it. And I think that when you're growing up, it's taught to be as, "Oh, it's like a tribal system. It's like a village, something small and exotic that people do far away where they lived in peace as a cute little thing together." They separate it from us, right?

And I think that's, one, because of the capitalistic gains that if you have an economy like that, you're not going to be able to get anything.

But then two, if you think about it . . . So I'm not well versed in the idea of communism, but growing up, that's what communism was described to me as. It's like, "Oh, everybody gets equal things and nobody gets better than the other." And I'm just thinking like, "Man, the way they try to . . ." There's so much political playing into how you can use these terminologies, per se, and even implement them. But at its basis, this is what humanity did from day one.

And I think humanity tends to revert to this in times of need, right? I mean, from the experience that I've seen at least in my country, cities will do mutual aid funds together. They'll pool money together, everybody will pool money together, and then if someone needs something they say, "Yeah, here's this. You go buy that thing to support yourself. When you have time, put money back into it."

In communities that do not have a viable economy, whether that's due to oppression or capitalism or some sort of racism or apartheid, all that putting together something that's preventing money coming in and out and preventing these people from succeeding, this is kind of what we revert to anyway, right?

Hạ: And I think it's also very wild to think about, because community is . . . Especially this community and the society that we are raised in, a lot of these basic ideas are framed, like with mutual aid, as you said, Leen, with communism, or Margaux, you said with the history with anarchy, and it seems really, really bad. But then that core of just helping out with communities, people actually do it all the time within this society.

I'm thinking about within in our state, church, if people need a house, I've known church members to come together to help build a house for that person. But why is it that that is seen as something that's great and that's community building, but then things like mutual aid or the principles behind socialism and communism are seen as bad, even though it's all at the same core? It's just people helping each other out and the collective coming together to support each other.

Leen: Exactly. It's the political narrative that the people involved in the mutual aid fund provide, per se, that make them selected against or for. That's exactly what it is.

Margaux: Yeah. And I think one thing we all highlighted is that we don't . . . This whole concept was kind of new or really not overt to us, and I think that's also the point. Mutual aid groups being community organizations are not out there advertising for everyone to come join, right? It's because you are part of that community that then you are part of the collective and working to help them or their efforts. And so they don't need to go out and seek more memberships, right?

And so I think we just naturally fall into our own community collectives or mutual aid groups or societies. But there is power in having the more organized, or what you would call established groups.

So, for example, a key one I think that relates to healthcare is abortion aid. And because we are a society that is capitalistic and requires money for healthcare and access to healthcare is not equitable, there are people who have the capacity to donate money for those who need to receive or want to receive these services.

And it can also be a very dangerous position to be in, a person who's seeking an abortion, in very many states at this time. And so an established network is very valuable in especially things like this in healthcare.

Hạ: It makes me also even think about other collective healthcare works. We've mentioned COVID-19. You've mentioned abortion funds. I think about also harm reduction or very community-engaged health. I guess all of those are forms of mutual aid, but again, they just have that spin that sounds like a little bit better so that people don't feel as uncomfortable about it.

And it's really a shame that things do get so polarizing, I think is the word that can be said, when really the core of this is something that's very beautiful. It's something that's really built out of love, right? Because we're doing collective work for each other.

Margaux: Again, it comes back to that these groups are funded and rooted in BIPOC traditions, indigenous communities, and people that are arguing and fighting for their rights, right? And I think that our racist systems of oppression and the fact that it's a colonized political system is going to squash these efforts.

But the hope, and what I find power in mutual aid funds or groups, is that it does give you a voice. It gives you more power than . . . For example, if I wanted to make change in the hospital for lactating residents and I've hit so many walls with administration, going to a mutual aid group or forming a more community-oriented group of residents to fight back or change things outside and above the reach of the administration is going to be more effective than joining a "resident committee" on lactation or something.

At the end of the day, there will be so many committees and this administration will put up these things to make you feel like your voice is being heard, but action very rarely gets taken.

And when we come back to one of the tenets of a mutual aid society, it's direct action and social transformation and egalitarianist view. To me, it feels so much more powerful.

And so I hope by having this conversation about what mutual aid societies, groups, unions, funds are, you can feel like there are people, there are collectives . . . You are already probably part of a community that is doing this work, and putting more energy and effort into that work will probably be more rewarding, authentic, and functional for you in the things you would like to see changed in your life, in your society, in your systems that you function in rather than trying to fight "the man," right?

Hạ: Beautiful. Snaps to that. Retweet. I mentioned MedTwitter, so we're going to retweet it.

Margaux: Oh my gosh. Literally, my brain. I mean, as we're wrapping up this episode, I think tying it back to healthcare, there are so many ways to be involved in . . . First of all, there's so much need in healthcare. There are so many gaps and so many ways that we can help our communities with healthcare in the skill sets that we will have as doctors that I think it's so valuable to know the mutual aid funds in your local city, your local community.

If you have any issues with the current government policies or things that are happening in our nation, there is probably a group and a collective of people who are working to change that, and so you don't have to feel like an individual person doing it alone. Look for those mutual aid funds.

There's a website called mutualaidhub.org, which highlights a lot of big mutual aid societies that you can search for in your area.

However, I think the best way to find out about it is talking to people in your community, going to local groups and organizations that you might find through social media. Sometimes the algorithms can be really good. And by word of mouth and talking to those people.

Just the first step is reaching out to organizers or just someone on Twitter or on Instagram that may be talking about the same things you are and building and uncovering, I would say, a community like that.

Hạ: I'm really happy that you did this topic, Margaux, because I just found that it really helped clarify. I had heard mutual aid so much and I really strongly believe in mutual aid, but I think this has been a very helpful reframing for me to really see it outside of the politicized lens that the society and a lot of discussion about mutual aid gives to it, and to really understand it at its core.

I think that's so helpful for me to be a lot more meaningful as I go about thinking about how I can contribute to mutual aid funds or mutual aid efforts and how I can move forward as a physician.

Though I guess going back to what we talked about, it's going to be interesting seeing how I'm going to do it with the time that I have as a resident.

Margaux: Yeah, and that's where even if you can only donate $5, but you're part of that community and that collective, I think it's still meaningful because in some way you're still connected and doing the most that you can in that moment. I think it all comes back to connection.

And I would say if you're a person who wants to be an ally, these mutual aid funds that are organized by the people who are oppressed or telling you what they want and need in their own words is a much better way to get involved and practice your allyship if you do it respectfully than trying to just donate to big blanket organizations and nonprofits.

Leen: And it's not insurance. I literally got on here and I'm like, "Oh, man." I'm thinking Liberty Mutual, something with mutual. I was like, "Oh, what are we going to talk about with this insurance situation?"

Margaux: But Leen, it's an important point because I think insurance companies started and was an example of co-opting BIPOC traditions of mutual aid and capitalizing it. We can leave on that note how horrible healthcare insurance is and why we need mutual aid funds.

Leen: It's a whole podcast of itself, not even an episode.

Margaux: Yeah. But anyway, I hope I brought some clarity about mutual aid funds, and I inspired you to look and connect with your community. It doesn't need to be through a formal title of a mutual aid group or society or fund, but the whole core of the tenet and our whole podcast is looking into your identity and supporting your community, finding your community, and being involved that way.

Making change against a system that is not working for a lot of people, including those overworked residents, there are things we can do, and sometimes I lose sight of that myself. But thinking back and coming back to groups in my community that can help me reconnect and fight for change on a bigger level is so powerful.

So I'll leave you all with that note, unless either of you have a closing remark.

Leen: I'm good.

Hạ: I'm good.

Margaux: No? Okay. So thank you for listening to "Bundle Of Hers" on this very rainy thunder day where our brains don't seem to be working too well. But we always appreciate you listening.

And if you have anything you'd like to share about mutual aid funds or societies or just how you get involved with your community and stay active, please leave us a direct message on Instagram @bundleofhers. We'll be happy to send you a "Power Through Identity" pin, so don't miss out. They look great on your lanyard. Especially all you new doctors out there who just graduated, you're going to need some swag for your lanyards as an intern.

Hạ: A reminder about your power while the schedule burns you out. 

Margaux: Yes. So, on that note, until next time, bye-bye.