Sustainability in Healthcare: From independent to interdependent modes of care

Updated: Jul 3, 2019

Pillars of Our Shared Work #16

Author: Danielle Smith (RMT, Artist, Healer)

I have offered much of my life to massage therapy, and have been practicing for over 20 years. Through these years of experience I have learned, as a healing practitioner, that there is a deep rooted and intentional need to also find strategies and tools to sustain myself. Thinking through this article on sustainability as a healthcare practitioner has provided me an opportunity to reflect beyond the care of self, into a care of community, and the resilience practices embedded within. In addition to the real and tangible benefits of receiving care, I have also witnessed some challenges in seeking this care. In this article, I will share some of the self-care practices that I’ve learnt over the years, and perspectives on resiliency which I’ve gained from being involved in communities and movements.


My Practice

My practice has provided a lens for life by studying the complexity of the soma (i.e. the body, not independent of the soul). In my massage work I facilitate several complex physiological processes that occur in the body. It is clear that these processes do not occur independently from the surrounding environment. More and more, the concept of self-care reinforces the inaccurate notion that the soma, within a healing context, creates physiological changes solely within itself based on what we do for ourselves. It is clear that we have personal responsibility for ourselves. However, I wonder how we can shift our concept from independent to interdependent modes of care to sustain ourselves. In reality, the body’s physiology is constantly being impacted by a myriad of external forces. This is relational knowledge. This is Indigenous knowledge. It is the relationship between ourselves and nature; ourselves and the land; ourselves and the elements; ourselves within time and space; ourselves and each other; and ourselves and all our relations. These relationships are a huge part, if not the greatest part, of what sustains us – ourselves in healthy environments, however we may define that. This is especially prevalent for those of us who are living at intersecting oppressions.


Having said that, some self-care practices are powerful and crucial, and may be exactly what folks need at specific points in their journey. The concept of self-care itself has been considered radical in supporting many of us to believe that we actually do deserve care. As a mixed-race Black womxn, I deeply identify with the statement by our late leader, visionary, sacred teacher, Audre Lorde: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” To build on that well-known statement, what I have been in long-term deep contemplation about with regards to sustainability in life and practice, is how we define caring for ourselves, and specifically how “self-care” is not conclusive in meeting our needs in order to sustain us in whatever work we do. Self-care as a solo endeavour can too often be promoted, co-opted, and marketed within capitalism and the medical industrial complex as a wise and right thing to do. Yet in these frameworks it often focuses on an individual’s behaviour and choices without considering one’s social conditions and systemic barriers that are faced. As a method, it can maintain a deep sense of isolation that we feel when we are burnt out or unwell.


The problem of isolation is often invisibilized in our society and therefore so prevalent. Particularly in social movements, so many of us suffer from insomnia due to loneliness, isolation, and PTSD. And these conditions all prevent and block our ability to access the medicine of sleep for body system renewal, regeneration, and soul-visioning through our dreams. Many say they only finally get a good sleep with the return of a partner or when a trusted friend stays over. #Rest4Resistance This simple example illustrates some of the limitations of the idea of self-care, and asks what is beyond this model.


“Change-makers are dying as a result of spiritual and physical deprivation from trauma, stress and unrest in our movements.”Needs assessment by Kindred Southern Healing Justice Collective