Still a Collective

March 14, 2012


From the time that we first wrote our Covenant, we at PUHC recognized that access to primary care was a fundamental social justice issue.  So like many in the community, we’re excited that our allies at Phoenix Allies for Community Health (PACH)  are planning to open a free clinic.

As word of the clinic-to-be spreads, we’ve noticed that many in the community are calling it “The PUHC Clinic”.  The confusion isn’t surprising; Since PUHC and PACH are both health-justice groups, there’s more than a bit of cross-membership.  But despite some overlap on the member lists, PUHC and PACH are fundamentally different organizations.

PUHC is, and will always remain, a consensus-based network; a group of autonomous individuals bound only by a shared commitment to the PUHC covenant.  We do not have, nor are we interested in seeking, any kind of formal organizational status.

Why?  It’s not that non-profits are an inherently bad idea.  But those of us who spent time in post-Katrina Louisiana saw first-hand how dangerous it is to rely too heavily on the non-profit industrial complex.  While large non-profits were on the phone asking permission from their liability insurance companies to make a move, Street medic collectives from across the country were already on the scene getting the job done.  What the Street Medics lacked in resources and formal training, they more than made up for in courage, creativity, and flexibility.

PUHC started out as a Street Medic Collective, and although we may have branched out into house calls and Public Health advocacy, we’re still (and will always be) a street medic collective at heart.  PACH, on the other hand, is a registered 501(c)3 non-profit organization.  In contrast with PUHC’s horizontal structure, PACH is required to have formal leadership (a president, vice president, etc.) and the PACH clinic will need a medical director.

Of course PUHC and PACH are allies; it would be silly to pretend otherwise.  But PACH can never replace PUHC.  I expect PACH to accomplish some amazing things, but in the end they’ll have a bank account, and grant obligations, and possibly even a mortgage to worry about, and those sorts of things always undermine a non-profit’s ability to be as nimble and courageous as an unincorporated collective.

Is 501(c)3 status a compromise of values?  Only if we forget how to organize outside of the limits of that model.   PUHC is still together, and hasn’t given an inch of ideological ground.  While PACH is applying for grants, PUHC will be running drills and preparing for the next action.

See you in the streets,



Official Covenant

February 17, 2011

Phoenix Urban Health Collective

Action ° Outreach ° Advocacy

1.      The Phoenix Urban Health Collective (PUHC) is a non-institutional collective of healthcare professionals and community health organizers who are dedicated to promoting community health among vulnerable populations in the Greater Phoenix Area.

a.      PUHC recognizes that poor health is not evenly distributed within our Valley: minorities, the poor, and immigrant populations suffer from a disproportionate share of the public health burden.  If these disparities are to be resolved, we must understand and address the socio-political determinants of poor community health status.   Factors such as (but not limited to) environmental pollution, inadequate public investment in education, a shortage of affordable housing, lack of access to primary care, and  the criminalization of homeless and immigrant populations all serve to perpetuate and expand these health disparities.

b.      In addition to the services generally recognized as being fundamental to public health – such as access to healthy food and primary care —  the PUHC believes that healthy communities cannot exist without the following:

i.      Economic justice: In this country, poverty is the most significant risk factor for negative health alterations.  A community that cannot afford healthy food, or that lacks access to quality primary care or safe, healthy jobs & housing, can never be truly healthy.

ii.      Community organization and empowerment:  Members of healthy communities know what their rights are, know how to identify and articulate problems within their communities, and are empowered to advocate for their own interests, and the interests of their communities.

iii.      Education: healthy communities have access to quality education that provides people of all ages with the ability to understand the world around them, and to advance themselves and their communities economically, spiritually, and socially.

iv.      Safety: Healthy communities do not face disproportionate risk of violence. Whether a community is struggling with domestic violence, gang violence, or state sponsored violence such as police brutality or raids that separate immigrant families, communities must be empowered to work together to secure their ability to live together without fear.

2)   Membership:  As medical professionals and community health organizers, we are committed to supporting – through direct action, public outreach, and political advocacy – underserved communities who are struggling to remove the structural barriers to improved community health status.

a.    PUHC shall be organized into three teams: Action, Outreach, and Advocacy. All PUHC members are members of one or more teams.  While many members may not be directly involved in all of the above groups, all members commit to maintaining an awareness of the work that all three teams are doing.

b.     In order to become official members, prospective members must attend a training session for the team they are joining, and assist in one PUHC supported action.

c.     Members are expected to attend at least two PUHC supported events per year in order to maintain active membership.

d.     When representing PUHC,  members shall act professionally at all times.

e.     Membership may be suspended or revoked by the consensus of the rest of the group.

3.     Action:  When large groups of people are mobilized in protest, EMS response times may be delayed due to logistical difficulties secondary to the crowds themselves, or due to protocols that prevent them from entering a situation “Until it has been secured”.    Furthermore, many members of marginalized communities may be uncomfortable interacting with EMS.  For this reason PUHC Action team will, when possible, organize a team of protest medics as a solidarity presence in support of marginalized communities that are asserting their rights.

a.     The PUHC Action team shall consist of medical professionals with current licensure and/or EMT certification.  Exceptions may be made by consensus.

b.     The PUHC is not neutral in issues of structural injustice, believing that neutrality always benefits the oppressor — never the oppressed.  Nevertheless, PUHC members commit to offering quality care to any person who is injured at an action, regardless of the patient’s ideology or role.  This includes counter-protestors, law enforcement, and bystanders.  When the number of people injured exceeds our capacity to serve, members shall triage based on their best clinical judgment, without regard for the patients ideology.

c.     The Phoenix Urban Health Collective is non-hierarchical.   Every member practices within the scope of their own training and/or licensure, and each is independently liable for their own actions.

4.     Outreach: PUHC seeks to provide community health outreach for underserved communities.

a.     The PUHC Outreach Team shall consist of medical professionals, dietitians,  psychiatric health professionals, social workers, and others  who are committed to providing a community health presence for underserved communities.

b.     The PUHC Outreach Team seeks to support underserved communities through screenings, public health education, and community health support.

5.    Advocacy: Often, poor community health is the product of public policies that are reactionary, rather than evidence based, and which result in the structural oppression of certain subsets of the population.  PUHC seeks to promote evidence based solutions to public health challenges.

a.     The PUHC advocacy team shall consist of community organizers and logisticians who are interested in organizing around issues at the intersection of community health and human rights.

b.     The Advocacy Team shall work to organize marginalized communities around community health issues.

c.     The Advocacy Team shall work to educate society about how poor community health is constructed, and to create dialogue around issues of structural oppression, racism, empowerment, and their relationship to community health status, as well as the role, practice, and definition of liberation medicine.

6.     Structure:  PUHC is consensus based, and non-hierarchical.

a.     PUHC shall have general meetings on an as-needed basis.  Reasonable effort shall be made to provide adequate notice to all members.

b.     Each team shall, by consensus, chose a convener who shall serve a one year term. The Convener shall have no power or authority above the rest of the team, but shall be responsible for the following tasks:

i.      Promoting communication within their team

ii.      Promoting communication between teams.

iii.      Ensuring that the consensus process is honored, and that all voices are heard.

iv.      Scheduling meetings, and managing their teams’ list-serve.

c.     Changes or exceptions to this covenant, and official position statements may be suggested by any member of the Collective by writing the proposed minute in a Google Doc and e-mailing a link for the document to the PUHC list-serve for peer-review.   All minutes must pass the peer-review by consensus in order to become official.  Any member who does not respond to the proposed minute within five days forfeits their right to participate in the peer-review process for that minute.

d.     Decisions other than the approval of position statements and changes or exceptions to the covenant may be made by the process described in 5(b), or in an open meeting by consensus of the members present.  Decisions made in an open meeting shall be disseminated via the PUHC list-serve within 48 hours after the meeting.

7.     Protocols:  All members agree to adhere to the following protocols when representing PUHC.

a.     When representing PUHC, members are expected  to limit public statements to the following:

i.       Talking points informed by official position statements (see section 5(b) for information about position statements).

ii.      Statements informed by clinical knowledge and direct observation – eg. “At this point we can confirm that six people were injured, including two children.”  or “Significant exposure to pepper spray can lead to serious complications, especially among  children, the elderly, and those with pre-existing cardio-pulmonary illness”.

b.     When serving at a PUHC supported action, all members agree to act within the limits of their training and competency.

c.     When providing patient care, members are expected to make every reasonable effort to protect the privacy and autonomy of our patients.


Official Minute on SB1405

February 17, 2011

Phoenix Urban Health Collective

Action • Outreach • Advocacy

Official Minute on SB1405:

The Phoenix Urban Health Collective is a coalition of medical professionals committed to reducing health disparities in the Phoenix Metropolitan Area.

As medical professionals, we view our relationship with our patients as a sacred one, built on trust and a shared commitment to health.
While we oppose any legislation that has the effect of criminalizing vulnerable populations, we find bills such as SB1405 — which would turn every hospital in the state of Arizona into a de facto immigration agency — to be especially repulsive.

SB1405 would further erode the trust between our patients and the medical resources that we all depend on. This would undermine community health efforts and inevitably lead to an increase in avoidable suffering and mortality.

As medical professionals, we are bound by our professional codes of ethics to do no harm to our patients.  We cannot, therefore, comply with any law or regulation that asks us to participate in the criminalization of our patients, particularly when such policies serve no discernible purpose in promoting community health or public safety.

We are medical professionals; not immigration agents.  No act of the legislature will compel us to violate our professional ethics by blurring that line.

We call on our elected representatives to desist from such harmful and frivolous distractions and return to work on legislation that will address actual problems facing our state.


Official Minute on the Falsification of Public Health Data

February 15, 2011

Phoenix Urban Health Collective

Action · Outreach · Advocacy

As medical professionals, we understand that successful public health efforts depend on the accurate and timely dissemination of public health information.  Falsification or misrepresentation of public health data poses a threat to the health of our communities, and betrays a concerning lack of respect, not only for those who are working to promote public health, but also to the populace that is being lied to.
The Phoenix Urban Health Collective (PUHC) condemns, in the strongest terms, the practice of misrepresenting and/or falsifying public health data to further a political agenda.
The Phoenix Urban Health Collective is committed to holding public figures accountable for any falsification and misrepresentation of public health data.  In order to avoid such embarrassment, community leaders who intend to place the blame for public health problems on the vulnerable populations existing within our community need to first read the following steps:

If you intend to sound the alarm about a public health problem, first make sure that the problem you are referencing actually exists.

An epidemic is defined as a statistically significant increase in the incidence of a disease.  If county, state, or federal officials have not declared an epidemic, it probably doesn’t exist.  In recent years, we have heard local community leaders cite numerous non-existent epidemics, ranging from malaria to leprosy, to beheadings.   Likewise, several community leaders have recently stated that immigrants from Mexico lack immunization, while the Pan American Health initiative lists Mexico as having a better immunization rate than the US (1).

If an increased incidence of a specific disease is found to be present within a vulnerable population, please be prepared to explain why you chose to frame the members of said populations as being the perpetrators of the problem, rather than the victims of failed public health policy.

Public health is a policy issue.  Poor public health is a policy failure.  To claim that the populations with the least voice in how our public institutions are structured and funded are somehow more culpable for public health failures than those who wrote and implemented the failed policy is a remarkable claim.

If you are a policy maker who has recently voted to cut funding for public health programs, please be prepared to explain why you feel that the victims of public health failures are more culpable than you.

Please be prepared to cite sources

This should go without saying.  Reliable public health data is remarkably accessible: the  CDC, as well as state and county health departments perform and publish detailed studies when there is a statistically significant increase in a disease that has been deemed to be of epidemiologic import.   These reports are written by trained epidemiologists with many years of academic preparation.

If the data from public health agencies is in conflict with the claims of an organization that is not recognized as a valid academic source, please do not expect to be taken seriously if you cite the latter – especially if the source you are citing has been recognized as a hate group by the SPLC (2).  It greatly disappoints us that we must specifically state this.


1. Pan American Health Organization.  http://ais.paho.org/phip/viz/cip_coverageandsanitation.asp
2. Southern Poverty Law Center. http://www.splcenter.org/get-informed/intelligence-report/browse-all-issues/2002/summer/the-puppeteer


Some Thoughts About Safety and the 29th.

July 27, 2010


As the State of Arizona prepares to begin implementation of SB1070 on July 29th, there is much talk in the local immigrant’s rights community about civil disobedience and escalation.  So far as the PUHC is aware, all plans for escalation are non-violent in nature.  Yet just as we recommend wearing seatbelts whether or not one anticipates a car accident, it seems prudent to prepare for contingencies whether or not we expect such preparation to prove necessary.

Thermal injuries

In Phoenix this time of year, the most dangerous thing out there is the pavement; if the temperature is 110 degrees Fahrenheit, expect the asphalt to reach temperatures in excess of 225.  This is hot enough to cause second degree burns almost immediately, and third degree burns with exposure times of under two minutes. 

Often, people are told not to move a patient who has been injured, lest they complicate an undiagnosed spinal cord injury.  This is good advice for when the patient has been in a car accident, where the kinetic forces result in a high risk of this type of injury.  If someone passes out from the heat however, the risk of spinal cord injury is very low, and is far outweighed by the danger of serious burns.  Unless there was a strong kinetic element to the injury, get the patient off the pavement as quickly as possible.

If you are planning on sitting on the pavement for any reason, don’t assume that a given form of insulation (eg. a piece of corrugated cardboard) will be adequate.  Go out the day before, find an empty parking-lot in full sun, and test it.

Be aware that burns continue to get worse for as much as 48 hours after the exposure that caused them.  If you or someone you know sustains a burn that looks like it may need medical attention, please get it looked at.  If you don’t have easy access to medical care, and would like someone to help you decide whether the burn is serious, call us and we’ll send someone to check it out. 

Chemical Agents

There are two types of chemical agents that may be deployed in protest situations: pepper spray (OC gas) and tear gas (CS gas).  If you are healthy,  CS exposure doesn’t usually cause any serious lasting effects, with symptoms generally subsiding within an hour of the removal of contaminated clothing.  Pepper spray (OC gas) is a bit more serious, and much more painful.  It’s known to cause severe exacerbation of asthma, and heavy exposure can occasionally cause blistering and pulmonary edema (a potentially life threatening complication).  Pulmonary edema secondary to OC exposure is very rare, but it can arise as much as 48 hours after exposure.

The first thing you should know about these agents, is that neither one is really a gas – they’re lipid-soluble  aerosolized particulates.  This means that bandannas or cheap droplet masks (available at your friendly neighborhood Wallgreens) actually do provide some protection.  Being an aerosol, these agents are much heavier than air.  When a person is in respiratory distress and having  difficulty seeing, one of their first instincts is to sit down; as understandable as this is, remember that the closer you are to the ground, the greater your exposure.  Try to make it out of the area before sitting.

Management of exposure

  1.  Stay calm.
  2. In any medical situation (not just pepper spray exposure), THE FIRST CONCERN IS ALWAYS THE PATIENTS AIRWAY.  Everything else can wait until after that.  If pepper spray is deployed, there will be a lot of people running around screaming in pain.  Ignore them for now; if they can scream, or even talk, their airway is fine.  You can come back to them later.  The person who is sitting quietly on the curb is likely to be gasping for air.  No one who’s been hit with pepper spray should be sitting quietly unless something is very wrong.  If they’re having trouble breathing, call one of us right away, or call 911.
  3. Remove children from the area.
  4. If you’ve been exposed, and are wearing contact lenses, they need to come out right away — and tell your friends to do the same.  Better yet: don’t wear contacts if you believe there may be a chance of exposure.
  5. Don’t pour water on pepper spray; it only makes the pain worse.  But do flush out the eyes with water, saline, or milk of magnesia.
  6. Remove contaminated clothing as soon as possible.  Bring a spare shirt if you think you may be exposed.  Heavily contaminated clothing should be cut off, rather than pulled over the face.
  7. Rinsing exposed skin with a solution of milk of magnesia helps with the pain a little, but not much. 

Heat Distress

  1. Please bring twice as much water as you think you’re going to need.  Several groups are working together to provide water, but don’t count on there being enough.   
  2. If you’re feeling overheated, get inside for a bit — even if you’re only inside for fifteen minutes, it could make a big difference.
  3. If you see someone else who looks like they might be overheated, take care of them.  Ask how they feel, offer them water, suggest they go somewhere air-conditioned for a bit — anything.  We really do need to take care of each other.
  4. Remember that kids are proportionately closer to the hot pavement, and overheat faster.  Take care of them.

We’ll have a presence at Cesar Chavez Plaza, and others out biking around.  Look for the red shirts with black crosses. 

In Solidarity,

–The Phoenix Urban Health Collective