Academic journal article Health Sociology Review

It Hinges on the Door: Time, Spaces and Identity in Australian Aboriginal Health Services

Academic journal article Health Sociology Review

It Hinges on the Door: Time, Spaces and Identity in Australian Aboriginal Health Services

Article excerpt


Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, have a specific history of colonisation, which has negatively impacted on the health of these populations (Kowal & Paradies, 2005; Paul, 2000). Past experiences of colonisation, health and illness inform Aboriginal and Torres Strait Islander experiences and choices in the present (Nathan, 1980). The experience of Aboriginal and Torres Strait Islander people in mainstream health services (MHSs) is presently poor, with services often failing to provide a care experience that is seen by Aboriginal and Torres Strait Islander people as respectful, culturally safe, fair and worthwhile (Kowal & Paradies, 2005; Paul, 2000). According to Gracey et al., this is due to MHSs lacking understanding of Indigenous issues and being unwilling to 'meaningfully engage Indigenous people in their own health' (Gracey et al., 2006, p. 332). Personal and community experience of past and present discrimination and racism has also been linked to poor health and further creates a barrier to service use (Harris-Haywood, Sylvia- Bobiak, Stange, & Flocke, 2007; Humphery, 2001; Larson, Gillies, Howard, & Coffin, 2007; Paradies, Harris, & Anderson, 2008). Indigenous people talking about barriers to the use of Australian MHSs describe the feeling of an alien environment, with no familiar faces or places to link them to the service (Lawrence et al., 2009). Some MHSs have tried to address this by recruiting Indigenous staffas health workers and as 'front of house' staff, using local Indigenous artworks in clinic and waiting places, or by providing sessions available only to Indigenous people (Hayman et al., 2009). These attempts have had limited success and often fade away under the demand pressure of other users (ACT Health, personal communication, 2011). MHSs continue to be spaces in which 'primarily middle- class, university-educated and White' health professionals work (Kowal & Paradies, 2005).

Many MHSs try to optimise patient flow and quality care through the design of health centres such as hospitals [see the Guidelines on Emergency Department Design (Australasian College for Emergency Medicine, 2007)], but do not make significant attempts to make such places welcoming. Nor have they made effort to identify the temporal rhythms that govern health service delivery and how these rhythms intersect with patient and carer rhythms. In particular, temporalities such as past, present and future (Connerton, 1989), and clocked time (Fabian, 1983; Postill, 2002) may operate and be experienced in different ways by health professionals and patients and carers. Aboriginal Community Controlled Health Services (ACCHS) and Aboriginal Medical Services (AMSs), on the other hand, are the service of choice for many Indigenous people, partly because they consistently attempt to make their places (Couzos, 2008) and temporalities welcoming in culturally specific ways. Several AMSs in Australia are ACCHS. They follow a model of comprehensive care that is 'different to mainstream services and contributes to high quality care, acceptability and accessibility of these [AMSs]' (Herceg, personal communication; National Aboriginal Community Controlled Health Organisation, 2008).

This study is concerned with understanding how space and time are operationalised in different health services, and how this operationalisation contributes to Aboriginal and Torres Strait Islander patient and carer experiences. The lessons from these experiences are of use to all health services.

Places and spaces

This paper uses the term 'place' to refer to defined areas within health service environments and the term 'space' to refer to often abstract meanings, boundaries and uses associated with places (Gans, 2002; Gieryn, 2000). Architects, cultural geographers, sociologists and anthropologists of the built environment continue to explore ways in which health care places reflect and shape behaviour and experiences; as well as ways in which discourses, meanings and imaginings about places inform how they are used (Gieryn, 2000). …

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