The geography of the clinic: spatial strategies at a Western Cape Community Health Centre

Abstract

Clareview Community Health Centre (CHC) is a fortified primary health care facility in crisis. Gang violence, functional inefficiency and antagonistic patient/health worker relations threaten the staff's safety and biomedical roles. ‘Space’ is used here as theoretical lens to understand how these problems are spatially constructed, and how spatial structuring is used as a strategic resource at this biomedical boundary. Principles of modern space and its disciplining effect are shown to be unevenly realised throughout this biomedical space, and the impact of this upon social identity, meaning and embodied practices is explored. The Trauma Unit is examined as a particularly open and vulnerable site of disordered, but creative, spatial practices which utilise local cultural knowledge and performance. The meaning and ontology of space are described as potentially multiple and unstable. The health centre is seen as attempting to maintain and reinforce physical boundaries which have not only functional, but also symbolic significance.