Brazilian Doctors Strike for Healthcare Reform and Democracy

*By Louis Pascarella
Time Period: 1977-1981
Location: Brazil
Main Actors: Brazilian Doctor’s Union
Tactics
- Professional Strike
- Slowdown Strike
- Marches
- Establishing new social patterns

In 1964, a military coup overthrew Brazil’s democratically elected president João Goulart and initiated a period of military dictatorship. Following this coup, military repression targeted any member of civil society found favorable to democracy. One target of this repression was the country’s doctors. The military began a purging process, identifying any “progressive” elements in the medical community and removing them from positions in hospitals, schools, and research centers. These medical professionals were then labeled as subversives, and were often detained, tortured, or even murdered by the regime.

About a decade later, doctors began organizing large-scale resistance to the military regime, beginning with junior residents in São Paulo hospitals. Low wages, poor working conditions, and mismanagement of the health sector by the military dictatorship were the primary driving factors. The young doctors also saw an opportunity, as an economic downturn and pressure from civil society had led the regime to express intentions to liberalize. Because of this combination of factors, doctors’ protests quickly spread across Brazil. Residents engaged in work stoppages and slowdowns, eventually recruiting permanent non-resident doctors and hospital staff. Despite threats of dismissal from various state governors, officials were forced to relent in the face of hospital collapse. 

With initial protests a success, reform minded doctors began a campaign to fully transform the Brazilian health sector. Running under “Medical Renewal” and “Movement for Medical Renewal,” progressive doctors won elections to leadership roles in doctor’s unions across the country. These key positions in leadership helped reformist doctors spark a stronger and more prolonged protest movement. Legal fights and additional protest support (including strike assistance) were some of the main strategies pursued by union leadership. Perhaps most importantly, doctors connected their struggles to other unions across Brazil. The powerful auto workers' union (led by future president Luiz Inácio Lula da Silva), teachers unions, public sector workers and others found a strong ally in doctors, coordinating joint May Day rallies and strikes across Brazil. This participation demonstrated the solidarity of workers, regardless of profession, in protecting rights and demanding democratic reforms. Leadership in other unions met with Brazilian doctors, supported and encouraged their efforts as the Brazilian government attempted to “buy out,” and later repress the disgruntled medical community. 

Some within the Brazilian medical community attempted to undermine the resistance efforts. These “old guard” elements profited from the corrupt system and felt doctors should be treated differently (or better) as members of the professional rather than working class. The relationships formed between doctors and other professions (teachers, trade workers, etc.) helped to minimize this influence and isolate voices who were only interested in personal aggrandizement. 

The military dictatorship’s attempts to disrupt doctors’ organizing failed. Hostile takeover of unions and detention of leaders only further galvanized doctors, who were able to fall back on their labor allies in midst of targeting. By July 1981, the doctors won a series of major reforms, including significant pay increases and better working conditions. 

While the movement of doctors ostensibly concluded in 1981, the profound struggle laid the groundwork for the eventual collapse of Brazil’s military dictatorship. The military regime depended on creating divisions across professions and class. With the medical community organized and connected to the broader struggle for democracy, the military regime’s hold on power dwindled. Using work slowdowns and outright stoppages, associations of Brazilian doctors won victory after victory. By 1984, doctors joined millions of other rallying Brazilians, resulting in the end of military rule in 1985 and the advent of Brazilian democracy in 1988. Brazil’s doctors illustrated the power and value of professional associations in a democratic movement.

US activists can learn much from Brazil’s doctor strikes. The importance of coalition building is of note. Doctors occupy a different position among the working population, generally regarded as professionals, rather than traditional labor. Autocratic governments tend to use this distinction to fragment workers, even currying favor with the professional class to keep them sidelined from political struggles. By “bringing in” professional groups like doctors, more traditional labor elements diversify and broaden their ability to put pressure on the government. In Brazil, this meant that the trade unions could rely on the threat of hospital strikes to heighten democratization attempts. Conversely, these professional workers benefit immensely from the large numbers present in labor groups. Professionals make up a smaller share of the working population than skilled labor, which means they lack some of the benefits larger unions can provide. This weakness can be ameliorated through partnerships with mass organizations. Additionally, this partnership helps to insulate the professional movement from internal strife by providing allies and support from outside the movement. Finally, Brazil’s doctors emphasized the power of strikes and work slowdowns in pressuring governments and initiating change. 

Where to Learn More
- White Coats with Blue Collars: Doctors’ Labor Protests and the Struggle for Democracy in Brazil, 1978–1982

You can access all the caselets from the Pillars of Support Project here.

A Missouri Chamber of Commerce Speaks up For Their Community

*By Louis Pascarella
Time Period: 2020
Location: United States, Missouri
Main Actors: Joplin Area Chamber of Commerce
Tactics
- Establishing new social patterns 

In 2020, after the murder of George Floyd and subsequent Black Lives Matter (BLM) demonstrations, members of the Joplin Area Chamber of Commerce (JACC) in Missouri did not want to stay silent. In particular, Black business owners who were members of the Chamber wanted to know they were supported and represented during such an important moment. In a critical and candid op-ed, Chamber head Tobias Teeter condemned systemic racism, indicated support for the BLM movement, and pledged to address inequities in the Chamber of Commerce and its member businesses. Teeter wrote of an intention to change hiring practices and ensure Black owned businesses and business professionals within the chamber and throughout the community were adequately supported.

This action was costly. Following the op-ed, an oppositional movement began calls to boycott the Chamber of Commerce. Teeter himself received multiple threats, and before his scheduled speech in front of city council, an unknown individual(s) threw a large rock through the JACC’s glass front door. The rock was then lodged into the drywall for effect. Internally, some within the chamber were upset with taking such a strong stand. The board of directors offered tepid support and over 40 white-owned businesses canceled their JACC membership.

The Chamber refused to back down and the local community, seeing JACC’s strong commitment to racial justice, soon rallied behind them. Many supporters showed up to the JACC sponsored Unity Walk, a demonstration in support for racial equality. A local activist joined with the chamber of commerce, recognizing ways for the community to help amidst criticism and backlash. This activist worked alongside a local non-profit, raising money to pay for chamber of commerce membership dues of Black businesses. This effort sharply increased the representation of Black owned businesses within the JACC. Equity, diversity, and inclusion (EDI) projects were also instituted and are ongoing.

While its critics hoped to dissolve the Chamber, the JACC’s actions strengthened their organization and built valuable ties with the local community. Infused with new members and forming new connections with the broader community, the JACC demonstrates how taking a stand for all Americans’ rights can benefit both business and local organizers.

Organizers and businesses can learn much from the Joplin Area Chamber of Commerce. Primarily, the Chamber demonstrated how taking a stand and forming connections with the local community can strengthen the position of business and create mutually beneficial relationships. The local community's willingness to help expand the Chamber was predicated on the JACC taking the initiative to speak out in support of racial justice. The initial backlash the Chamber received was mitigated by an outpouring of support from community members. For activists and organizers, a key lesson is in how business can bolster a democratic movement. By engaging with business, activists make connections that unify communities, reduce backlash, and achieve movement objectives. Due to local organizers’ willingness to engage with business, some goals of the racial justice movement were realized.

Where to Learn More 
- See especially Dr. Daniel Kinderman's work, The US chamber and chambers of commerce respond to Black Lives Matter: Cheap talk, progressive neoliberalism, or transformative change? 
- Joplin Area Chamber of Commerce issues letter addressing racism, equality in the community 
- Toby Teeter: An open letter to our community

You can access all the caselets from the Pillars of Support Project here.

SENSEMAKING WITH HORIZONS: The Alabama Brawl, August 2023

https://youtube.com/watch?v=Sf6npTNF8gs

Jarvis Williams, the Director of Applied Research and Julia Roig, the Chief Network Weaver at Horizons come together in this short video interview to reflect on the “Alabama Brawl” that occurred in August of 2023 and its implications for how we incorporate a racial justice lens into our pro-democracy organizing.

We look forward to sharing more of our sensemaking practices in this format. Let us know what you think!

What do we mean by “sensemaking”?

The following is taken from a previous Horizons’ blog that you can read here.

One of the three lines of work of The Horizons Project is “sensemaking.” As organizers who believe in the power of emergent strategy, the practice of sensemaking is something that we are continually reflecting upon: What is sensemaking? What is its purpose? How do we do it better? How can it drive our adaptation? How can we share what we’re learning and doing with diverse communities?

So, what exactly is “sensemaking” and why is it important to organizers? First and foremost, we acknowledge that we are operating in a world filled with volatility, uncertainty, complexity and ambiguity (VUCA). Even if we weren’t such a small team, we could never hope to fully wrap our minds (and arms) around this VUCA world. If our goal at The Horizons Project is to provide value and help connect actors within the social change ecosystem, we must find ways to constantly scan and interpret what’s going on within the system to then strategize, act and adjust as needed. Sensemaking is one of those practices. While there are many methodologies and definitions of sensemaking, we are drawn to the approach of Brenda Dervin that is based on asking good questions to fill in gaps in understanding, to connect with others to jointly reflect on our context and then take action.

For additional resources on sensemaking practices, check out:

Horizons Presents (Our podcast, Season One focuses on sensemaking)

Sensemaking in the New Normal

Facilitating Sensemaking in Uncertain Times

There is no Elephant

Thirteen Dilemmas and Paradoxes in Complexity

Energy System Science for Network Weavers

Bridge-Building and Power-Building: An Ecosystem Approach to Social Change

Rethinking “Polarization” as the Problem

On June 6, 2022 Horizons’ Chief Network Weaver Julia Roig, shared the main stage at Rotary’s 2022 Presidential Conference in Houston with Gary Slutkin, the founder of Cure Violence and Azim Khamisa, the founder of the Tariq Khamisa Foundation. The following article has been taken from her remarks as she followed Gary’s overview of their approach to treating violence as a public health epidemic and Azim’s personal journey of forgiveness and healing after tragically losing his son to a gang-initiation murder.

I’m going to take a deep breath.

Which I invite you to do too.

First, I want to acknowledge what an emotional time it is right now, probably for everyone in this room in one way or another. We all know that Rotary is a non-political organization, and yet these issues of violence, loss, and forgiveness are so very hard when we are living through a moment in history where there is so much pain, and division, and seeming paralysis to solve some of these existential challenges we face. How do we confront these dynamics and think about the role Rotary might play in creating stronger, more resilient relationships at all levels where you are working and have influence?

I was invited to speak to you about polarization. So, I wanted to share some insights that have been galvanizing my work at The Horizons Project. After more than 30 years working on peacebuilding globally, I recently launched Horizons to focus on the conflict dynamics and democratic decline in the United States. When I first conceived of The Horizons Project, honestly, we did start with the framing of polarization as the problem that needed to be addressed. And I was focused on what the peacebuilding approach might be to work on depolarization in the US, bringing with me the lessons from many other country contexts. But over the past year and half, our team has revised that framework, and I see the limitations of polarization as our central problem. In fact, might there be a way of considering polarization as healthy, and even needed for society to change? I’ve recognized more and more that there is a distinction between “good polarization” and “toxic polarization.”

So let me explain a bit more.

One metaphor for the polarization we’re experiencing right now – articulated by Quaker activist and peacebuilder George Lakey – is that society is heating up, like a hot forge. I.e., the fire that we put metal into that becomes so malleable, we can hammer it into something beautiful… or not. Conflict. Disruption. This is the heat rising. And that is not necessarily all bad – because it’s a sign that we need change. What comes out of the forge, the sword or the plowshare – that’s up to us, how we organize ourselves.

Sometimes this takes the form of actions that are loud and disruptive – naming where they see injustice for example. There is a saying that “we need to polarize to organize.” You are staking out a side (a “pole” … saying that “this is what we stand for!”) And after a lifetime of being in the peacebuilding business, I know that we are living through a moment in history when we need to stand up for what we believe in. It is not a time to be neutral. I’m not talking about anything that has to do with partisan politics. I appreciate so much how much Rotary guards its non-partisanship.

This concept of good polarization feels uncomfortable because conflict is uncomfortable and messy. We have different opinions about how to move forward together. Different truths and sources of information that we trust. We have different ways of being in the world. Holding those tensions of our diversity and agreeing to keep going together is what will make something beautiful out of that forge. Rising heat is a sign of change. What we’re really up against right now is complacency. For example, complacency that these levels of violence that Gary spoke about, in all their forms, continues to be tolerated; and complacency against the forces who are actively trying to divide us to stay in power.

Toxic polarization on the other hand is when we may tip over into “dehumanizing” those we consider “other.” We see this rhetoric alive and well from many politicians, on social media, perhaps even behind closed doors when we hear our colleagues use derogatory terms to describe an entire group of people (for their political affiliation, religion, or ethnicity.) Toxic polarization looks like zero-sum thinking; when we think in binaries (everything becomes black and white – there’s little tolerance for gray;) when we fall into group think (“us vs them”) or herd mentality; when we become increasingly afraid to speak up within our friend groups, for fear of being ostracized.

The social science behind toxic polarization shows how much of these dynamics are fueled by a deep sense of threat to our identities and our way of life. These threats can be perceived or real. But this level of toxic “othering” can ultimately lead to condoning violence, or allowing violence to continue, against those we see – even subconsciously – as less than human. When we feel that our identity, or our group, is under threat we no longer have the ability to deliberate. We have a harder time engaging in difficult conversations where we are able to discuss nuanced, complex issues, to debate solutions. How can we come together across difference if we consider those “different” from us as actually dangerous to our way of life? We see these dynamics playing out all over the world and they are manipulated and weaponized by those who wish to stay in power at whatever the cost.

So then, I don’t believe now is the time to turn down the heat. I believe we need to be organizing together across difference to stand up loudly for our values. We all want to live in safety. We believe in the dignity of all human life.

Martin Luther King Jr has a famous sermon, called “When Peace Becomes Obnoxious” where he described peace that comes at the expense of justice as a negative peace. Rotarians know a lot of about positive peace because of your long-standing partnership with the Institute of Economics and Peace that gives a wonderful framework for bringing together all the ways Rotarians are investing in helping to keep societies peaceful. But to actively work against negative peace, this means we have to incorporate injustice into that same framework. Calls for bringing down the heat; for unity; finding common ground – it may be quieter; we may be civil to each other. But are we sweeping the hardest issues under the rug to keep that peace? Are we seeing the violence in all its forms, hearing some of the loudest voices who are asking for the violence to stop, looking at the root causes as Azim did when he recognized there was a system that needs changing to prevent more gang violence?

I am personally trying to sit with the discomfort of the heat, the polarizing conflict that is pushing us to change, demanding louder action of us. And yet, we CAN all be more aware of the temptations of dehumanization. While we organize and work for change, how are we always centering each other’s shared humanity and our interdependence, even as we confront these hardest of issues? Because another way of reframing polarization, is that what we really need to work on is our “fragmentation.”

Interestingly, forgiveness experts will note that one of the signs of being unforgiving is that we start avoiding each other. We stop working with people – those who have hurt us, those who have offended us. In fact, when we feel “offended,” which so many of us do right now, (we are constantly outraged), the very normal psychological response is that we look down on those who have caused the offense. We feel morally superior. This is another form of “othering” and is deepening our fragmentation.

Gary mentioned the violence of autocracy as one of the forms that is spreading like a pandemic throughout the world. Toxic polarization and dehumanization, this keeps us feeling threatened and staying fragmented. We are fearful and outraged. These are all tools of autocratic systems that ultimately lead to violence. We see this in Russia, and in many other parts of the world, including alarming trends in the US – where people are manipulated and denied the ability to have meaningful voice in the decisions that affect them, to assemble and organize, and to stop the spread of violence. Toxic polarization is a symptom of an increasingly authoritarian regime, not the cause.

So here we are at a Rotary convention, and you have to go back to your communities and your clubs. What do you do with all of this? Hopefully, get comfortable living with tensions and being in relationship with those who think differently in your communities (maybe even in your clubs and your districts.) Reflect on when you may find yourself feeling offended or outraged and how you want to channel that – not to turn away, not to feel morally superior – but committed to being true to your values in a way that is restorative of relationships and allows for healing together.

Rotarians are so good at acting together and conducting shared activities that build on a common identity as Rotarians. We need to remind each other of our many shared identities – we are all complex, not just one thing. And we need to put a stop to dehumanizing behavior. Gary mentioned behavior change to prevent the spread of violence and the need to establish new norms.

Rotary can be a big part of establishing these new norms, not just in the projects you fund, but also in the way you work together and with others. You set an example by living your values. These new norms won’t really take hold when we convene dialogues that center our identities as different from each other, for example, blue hats and red hats in the US. They do grow when activities center what we share, as mothers, football fans, or gardeners. Whatever helps us connect as human beings, that slows down our thinking, allows us to live with complexity and nuance again – not black and white. Everything Rotary does, whether it’s projects on maternal health, clean water, girls’ education. All of Rotary’s areas of focus are potential peacebuilding efforts when you bring together unlikely bedfellows and combat that fragmentation, to work on problems together. When you recognize and see injustices in a system that needs to change no matter where you’re working, use your collective voices to call for change, centering those values.

I am here today because I believe in Rotary as a force for changing norms. Sitting with tension, feeling the rising heat. Something beautiful can come out of the forge because we are all here, working on the different pieces of peace together.

Thank you.