54 Anthropology Southern Africa, 2004, 27( I &2)

The geography of the clinic:

spatial strategies at a Western Cape
Community Health Centre

Lauren Muller
Department of Psychology, University of Cape Town, Private Bag, Rondebosch 7700
laurenm@teliiomsa.net

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 staffs 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.

Introduction of service delivery, presuming an apolitical and inert context

The facility is changing' exclaimed the tired Sister-ln-Charge
of Clareview Community Health Centre' (CHC), 'I no longer
do nursing duties' she says, 'I am a policeman!' The health
centre has many problems, gangsterism has increased, there
is 'no respect' from the community and 'most staff are think-
ing of leaving. 'Roles have gone astray', she continues, 'I am
sick of people insulting me!' When asked why this situation
exists, she says this is a 'cultural, political thing'. Part of the
problem, she tells me, is the easy access to the CHC 'for
gangsters and mothers. People in Clareview abuse it, it's too
convenient and free of charge. It's accessible for nonsense.'^
Currently there is a plethora of progressive policy that
seeks to develop and improve South Africa's public health
care, and in particular its primary health services, envisaged
as the cornerstone of improved service delivery. However,
there is a growing gap between the development and imple-
mentation of this policy, and the poor 'delivery' and 'capacity'
of public primary health care (PHC is seen as a major obstacle
in ensuring a 'healthy nation', including the prevention and
treatment of HIV/AIDS [Martinson, Radebe, Mntambo & Vio-
lari 2002]).
John Eyies and Andrea Litva (1998) describe how govern-
ment health policy and legislation tend to neglect the specific
significance of place and space in its conceptualisation or
articulation of power. Thus the link between the 'where' and
'how' of biomedical treatment is often severed. Local primary
health care is grounded, however, in particular facilities and
communities, places which are not merely sites of instrumen-
tal biomedical practice, but buildings, spaces and associated
social relations with particular meanings and attachment for
individuals and communities that use and occupy them (cf
Harries 1996). Abstract constructions of public health care
tend to render invisible these material and symbolic realities
for biomedical and civic activity (cf Lefebvre 1991).
Despite the abstract and generalised nature of PHC pol-
icy, there is an implicit localisation of such services within its
discourse. This is the frontier of biomedicine, a front-line
service offered at the level of the local and particular, espe-
cially in more peripheral and impoverished areas. Such health
care facilities are prime sites for the state to interface and
intervene directly with poorer communities, and as such they
are biomedical gateways to limited state resources within a
politicised discourse of health service decentralisation and
local participation (EyIes & Litva 1998). Following Michel
Foucault (1977), David Armstrong (1995) describes this as a
boundary or space in which modern forms of governance are
accomplished.
This article is based on a larger ethnographic study on the
everyday material and spatial worlds of an embattled com-
prehensive primary health care facility in Clareview, an urban
working class, 'coloured' township on Cape Town's Cape
Flats (Muller 1999). Clareview Community Health Centre
(CHC) is an established and respected biomedical institution
in crisis. It is caught in a set of interrelated destructive proc-
esses - the internal pressures of policy change, and 'rationali-
sation', and the external illegality and violence endemic in
parts of the Cape Flats (Muller et al 1998, C.H.S.O 2003). I
examine here the material interface of biomedicine and the
community, at a time when civil governance and health serv-
ice resources are threatened. This is a health service at risk,
and therefore I ask how this space functions as a resource for
strategies of defence and resistance (Shields 1997). The spe-
cific insight at the heart of this study is the fragility of biomed-
ical space and its vulnerability to physical and symbolic
appropriation.
I undertook this study as a clinical psychologist, seeking a

1. The names of the location and CHC have been changed to protect informant identities.
2. Fieldnotes, Clareview CHC.
3. Clareview CHC had a reputation among the local health structures for productivity, cohesion and innovation.
Anthropology Southern Africa. 2004, 27( I &2)
practical and theoretical lens to grasp the contextual and
embodied aspects of, and relations between subjectivities,
social selves and institutions. This is missed by traditional psy-
chology caught in the thrall of time and discourse rather than
space (cf Soja 1989). Indeed, 'space' as a viable object of
study is relatively new, especially outside the field of the
explicitly spatial sciences such as geography and architecture.
Spatial 'events' and anxieties therefore are hard to articulate
in a dominant discourse in which the links between space and
subjectivity have been largely severed. Indeed, the health
centre staff and patients did not talk overtly about 'space'.
Staff spoke of messy, abusive and potentially violent patients,
and the slow, seemingly irreparable loss of their closely-knit
staff body. Patients described long waits for treatment and
insufficient and potentially rude staff.
Henriette Moore (1996) writes of the difficulty in ethno-
graphic narrative of allowing the more embodied aspects of
fieldwork 'into' the narrative. Bodies occupy space, and are
the ontological grounding by which we experience being in
the world. Lefebvre (1991, quoted in Gregory 1994:405) was
the first to point out that, 'the body, [is] at the very heart of
space and of the discourse of power'. Bodies are also not cul-
turally inert, and have been encoded with rich symbolic
meaning, which in turn is used to interpret the social space it
inhabits in a mutually constitutive relationship between spatial
practice, and structure and meaning (Moore 1996).
In order to render 'space' visible and interpretable, I vis-
ited, recorded and sought to experience the everyday, mate-
rial reality and practices of the health centre, and how these
are used and interpreted by embodied social actors, largely
the CHC staff, (cf Bourdieu 1977, Lefebvre 1991). 'Seen'
from this angle it soon became clear that the health centre
was not merely a biomedical service point, but a living 'place'
for staff, patients and the community. As such it had an alter-
native symbolic and affective reality that drew on alternative
social meanings and roles that humanise the functional
machinery of biomedicine.
In the first section of the article therefore, I introduce
briefly some of the ways space has been theorised, in particu-
lar by Michel Foucualt and Henri Lefebvre. The second sec-
tion is more ethnographic and describes these organisational
realities through a spatial lens that these theorists, among
others, provide. My particular project here has been to begin
to explore space from two angles, first as an 'objective' mate-
rial form or structure; sind second, how it is lived, felt and
imagined, part of our personal and intersubjective scaffolding.
Foucault has been essential in linking space, productive
power and subjectivity. But it is to theorists like Lefebvre
(1991) and Boudieu (1977) that one must turn in order to
explore how social institutions continue to be produced and
reproduced through social practices, and how these subjec-
tivities are managed in a less deterministic, more complex
and rich spatial ontology.
Biomedical space & identities
There is a paucity of descriptive and analytic studies on bio-
medical space, and especially the spaces of public health
care.' Such space(s) are seldom investigated as a valid object
I. For a rare international example, see Prior (1992).
55
of analysis per se, let alone as a vital constituent of biomedical
functioning and identity (Prior 1992). Biomedical roles and
identities, primarily the binary of doctor-patient, or more
broadly staff and patients, structure and define the biomedical
encounter and their associated institutions (Good & Good
1993).
Social position, including one's identity and status, can be
read quite literally in a person's spatial positioning and their
agency over this - as clearly attested by South African apart-
heid statutes and urban design (Robinson 1995). Thus access
to certain spaces and the ability to secure such access (and
exclude others) can be read as a measures of social power
and authority, whether this be along the axes of race, gender,
class or professional or biomedical status.
Biomedicine is however neither unitary nor monolithic.
Local and personal contingencies shape both its form and
function, constructing potent local realities in which individu-
als attempt to construct meaning and gain access to material
resources (Good & Good 1993; Muller 1994). Likewise there
is no unitary biomedical patient (or health worker), as
attested by the difference in the social construction of a local
public, as opposed, to private health care patient (or health
worker) (Armstrong 1993, Swartz 1991). Thus we can begin
to ask: how do certain spaces produce certain types of social
identities? And, how do these social identities rebound on
social space in a manner that may determine, but obscures,
the relationship between a devalued and stigmatised identity
and spaces?
Michel Foucault has been a key voice in describing how
this spatialised modern power works. He describes how spa-
tial arrangements and methods of surveillance perfected in
the modern prison began to be incorporated into more open
spaces such as the hospital, school and factory. This shift in
institutional site was possible through the perfection of a spa-
tial technology based upon principles which enabled the pre-
cise control of its inhabitants who are both the objects and
subjects of knowledge (Foucault 1976, 1977). This quintes-
sentially modern form of power is not enacted through spec-
tacles of punishment upon the human body, as in 'sovereign
power' (ibid), but through means which are less repressive,
more voluntary and apparently 'humane'.
Biomedical and community space are both mechanisms or
reservoirs of power, and the health centre is represented
here as an arena or field of competing players and forces such
as staff, patients, local communities, state power and global
biomedicine. This biomedical facility therefore can be envis-
aged as a site of conflict which, following Bourdieu is
'A "field" of antagonistic relations constantly
changing, requiring of its agents habituses that are
fluid and contextual rather than fixed, atemporal.
ideal and homogenous' (Pizanias 1996:651, quoting
Bourdieu 1977, emphasis mine).
Within a post-modern ontology, these identities and subjec-
tivities are theorised as being contingent, multiple, frag-
mented and non-essential (Dear 1997). There is therefore a
relationship here between the security and stability of a space
and the nature of the identities it 'produces', suggesting that
unstable and fluid space could be associated with identities
56
which reflect this flux and insecurity (Robinson 1995).
Henri Lefebvre (1991) alerted us to the ontologically
destabilising notion that social space could be multiple and dif-
ferentiated, and different forms of social space may co-exist in
one physical location seemingly even in antagonistic opposi-
tion (cf Allen & Pryke 1996). Lefebvre's understanding of mul-
tiple and differentiated spaces will be used here to
understand the complexity of spatial meaning and structure
within the health centre. The space of the health centre is
thus profoundly related to the formation and maintenance of
the multiple social identities within It. The heterogeneous
nature of these identities is related to the heterogeneity of
the spaces within (cf Lefebvre 1991; Robins 1998).
The task ahead
The bulk of the ethnographic material discussed here is
drawn from my time as participant observer in the CHC's
Trauma Unit.' The Trauma Unit is a special place within the
health centre and in many ways the functional centre of the
facility. Open twenty-four hours a day, seven days a week,
the Trauma Unit is a site of persistent biomedical presence in
the community. I spent more time in the Trauma Unit than
anywhere else in the CHC. It was an accessible site of heroic,
exciting, dangerous action and camaraderie between staff on
night duty.
I begin by describing the situated spatial production of
public health care, in particular 'the patient', within two con-
texts: the routine treatment trajectory within the CHC
proper, and that received within the Trauma Unit. These
treatment processes occurr within a facility particularly
marked by its fortification which, I shall demonstrate, ampli-
fies the pre-existent disciplining principles of modern social
production (cf Foucualt 1977). I therefore seek to draw a
relationship between the specific spatial-temporal treatment
routines and the social and biomedical 'products' it creates.
These products can also be shown to produce and reproduce
local constructions of race and class.
Second, I present the staff and patients at the Trauma
Unit as skilled strategists who must seek to manage poten-
tially antagonistic relationships at this largely unmediated and
undisciplined biomedicai interface. I ask, how do these social
actors use space as a resource to manage such interactions?
And, what does this tell us about the nature of social space
and the manner in which it is inhabited? (cf Lefebvre 1991).
In asking these questions I am not seeking to demonstrate
the 'poor' practises at a particular health facility or service,
but to demonstrate the essential competencies of 'good'
(staff) members located in the marginal place (Garfinkel
1967). These embodied people must offer health care in
physically unsafe and depleted environments and daily man-
age the contradictions between being accessible, efficient and
safe.
1. I spent three months at the health centre on a part-time basis, July to September 1997, although ongoing contact and visits continued
until December 1997. This article has also been informed by my continued engagement with the broader Community Health Services
Organisation (CHSO) between 1999 and 2001. Recent reports from the CHSO have indicated that the problems discussed here have
persisted or indeed deteriorated (CHSO 2003).
2. According to staff, in the vicinity of the health centre gangs include the 'Nice Time Kids', 'Backstreets', 'Mongrels', 'Americans', Sewe
Lewes ('Seven Lives'), 'Vultures', 'Laughing boys', Bokkies, 'Wildcats' and 'Hard Livings'.
Anthropology Southern Africa. 2004, 27(l&2)
The place and the problems
Clareview Community Health Centre is an unremarkable,
single-storey prefabricated building. It is made conspicuous
only by its razor-sharp perimeter fence haloed by plastic
packets. It looks like many of the larger public health facilities
on the Cape Flats, with its ubiquitous security features -
guards, prison-like doors and burglar bars. There is an out-
dated sign at the entrance announcing the treatment times
for the 'Day Hospital' (its former name) which is now open
24 hours a day, offering largely 'free' comprehensive primary
health care to a 'catchment area' far beyond the border of
Clareview.
The CHC is also intimately related to the built environ-
ment of Clareview which historically has its origins in the
race-based forced removals of the apartheid era. Indeed,
Clareview has largely maintained its working class, racially-
designated 'coloured' identity within a divided and fortified
city (Robins 2000). Made up almost entirely of uniform low-
rise blocks of flats, its design is true to the apartheid state's
racialised modernist vision. Pinnock (1984) demonstrates
how in this environment the traditional delineation of private
and public spaces has been collapsed. These ambiguous pub-
lic spaces have become colonised by street gangs who vio-
lently create and defend their territories at the expense of
the local community. This perception is also held by the man-
agement of the local health district who describe Clareview
as a place where ' a sense of security and belonging is lacking
and crime is rife' (CHSO 2003:3).
The building is our greatest fear
Since the early nineties there have been complaints that the
health centre has been plagued by the many gangs in the
area.^ This has taken many forms: first staff have been injured
while caught in gangwar cross-fire and more frequently, staff
on duty have been threatened by 'gangsters', usually while
treating them or a member of a rival gang. In early 1996 the
staff of the health centre were successful in their community
lobbying and protest action - quite literally threatening to
close the CHC unless their security demands were
addressed. The Provincial Health Department responded by
increasing security measures at the facility and offering coun-
selling to traumatised staff.
In the past few years the CHC building has become pro-
gressively more fortified. This has occurred in conjunction
with the politically generated removal of many social, racial
and financial barriers, such as provision of free health care to
mothers and children. The health centre, as I heard one
patient exclaim, now looks like a 'prison'. Entrances have
been closed or are now guarded, walls, gates and barbed
wire have been erected, and the partitioned interior reflects
the fortification of the exterior. Yet, despite these measures
staff remain fearful of gang-related violence, especially in the
accessible Trauma Unit. Staff describe the health centre as an
unsafe place where people 'burst in', and as a professional
Anthropology Southern Africa, 2004, 27( I &2)
nurse commented, 'the building is our biggest fear'.
Verbal and physical abuse from patients (and staff) did not
occur everywhere within the health centre. It was not gener-
alised. It occurred in specific sites which had become socially
marked as danger zones. These sites were the more public
areas, this includes waiting rooms and corridors outside key
clinical areas such as the 'Prep[aration]' room and the Phar-
macy, and the entire 24 hour Trauma Unit.
Abuse at the health centre is not only contingent on
where you are, but who you are. Abuse was directed at some
staff members more that others, for instance doctors tend to
be less exposed than nursing or domestic staff. Different staff
members therefore have a hierarchically determined rela-
tionship to various forms of biomedical 'dirt' and violation (cf
Hart 1991; Weiss 1993). Nurses are vulnerable as theirs (like
the cleaners) is a more proximal, mediating relationship with
patients and their bodies (Littlewood 1991). As one sister
complained, 'If doctor is slow ... if patients get excited ... the
nurse gets the blame'.
The Centre's general assistants (largely domestic work-
ers) have another mundane narrative of abuse at the CHC.
They bemoan 'onbeskofte' (rude) patients and their conflict
with (waiting) patients, who litter and 'mess' in the public
areas. The general assistants locate the problem elsewhere,
however:
'The way the doctor talks to the patients, the tone
he uses! Dissatisfied, because of the conditions they
[doctors] work under. And now they take it out on
the patients ... now the patients are even more ill
when they go home!'
The spatial production of public health care
Biomedical practice places at its centre the physically intimate
encounter between the patient and health worker (Foucault
1976). An encounter which, according to biomedical archi-
tectural criteria, should occur within an environment that
'allows for privacy, confidentiality and dignity' (Valins 1993:9).
There is a qualitative difference, however, between a medical
consultation at community health centres such as Clareview
CHC and a visit to a private general practitioner (cf Cam-
mock 1981, Wiles & Higgens 1996). The first difference is the
degree of prescribed mobility required for a patient to
receive public health care. The key hallmark of ambulatory
care, as opposed to a hospital consultation, is the mobility of
the patient (Prior 1992). Key components of health facilities
for such patients is the clear and rational 'flow, or circulation'
of patients (Cammock 1981; Cox & Groves 1990; Valins
1993). Design criteria also state that this flow should occur
within differentiated 'territories', namely 'staff, public and
patient care' for, 'the more clearly the building can reflect this
distinction the better it will meet the needs of both groups'
(Cammock 1981, quoted in Valins 1993:23).
The trajectory of the patient at Clareview begins at the
Reception area, where she or he receives a file and begins
their patient 'career' in the system (Weir 1977). After waiting
and being processed at the initial reception administrative
area', the mobile patient must move from one designated
clinical area to another, such as the Prep[aration], Injection or
I. At times the task of the reception area is not only to facilitate patients entry, but more crucially, to limit, or even restrict it. This Is a
means of policing the biomedlcal gateway to limited health resources (cf Rhodes 1991).
57
Dressings room, waiting at each 'to be seen'. Thus there is -
or should be - a visible congruence between where the
patient is in the building and their stage in the treatment
process. This congruence between physical location and bio-
medical function occurs as biomedical spaces have become
encoded with specific biomedical tasks and routines.
Ordered and efficient flow through the health clinical spaces
activates these spaces to undertake their clinical function (cf
Cammock 1981; Cox & Groves 1990).
Controlling the movement and route of the patient
through the CHC, space therefore is an essential disciplinary
component. Like Massey (1996:239), we can assert that 'dif-
ferent social groups have distinct relationships to ... social
mobility: some people are more in-charge of it than others
are'. Thus, we are able to link power within the CHC to con-
trol of mobility, and also the right to occupy and traverse sta-
tus-inscribed territories. The movement of the patient
through the CHC space is marked not only in space but also
time, creating specific 'spatial-temporal rhythms' (Dear
1997:56, quoting Lefebvre 1991) that structure the patients'
and staffs routines. Therefore, routinised movement through
formal space acts like embedded clinical protocols or rules
(Giddens 1984). These may enable relatively junior and unsu-
pervised biomedical staff to undertake routine clinical proce-
dures, such as urine testing and blood pressure readings, and
sequentially insert these in a biomedically meaningful manner
in the treatment trajectory. Thus, Bourdieu could state that
'movement through constructed space ... acts as a mnemonic
and helps to build up practical mastery of these same
schemes' (Moore 1996:84). At the same time these routines
fix the biomedical 'reading' of such space and therefore act
dialectically to produce biomedical space (cf Lefebvre 1991).
It is therefore, following Foucault (1997), not coincidental
that this disciplined choreography of movement between dis-
crete spatialised functional 'stations' resembles a factory con-
veyer belt or assembly line (Hagerstrand 1975 in Giddens
1984). Goffman (1968) called this 'people processing', a hall-
mark of modern efficiency and bureaucracy, and therefore
the control of such a trajectory is an essential component of
the health centre's functional efficiency.
The net result of these spatial practices however, is a frag-
mented medical encounter, which on a relational level, frac-
tures meaningful continual interpersonal contact between
health worker and patient, emphasising the technical and
task-orientated aspects of care. Patients' subjective accounts
of public health reinforce this observation: medical care is
impersonal, authoritarian, mechanistic and often public (cf
Comaroff 1981; Rhodes 1991; Wiles & Higgins 1996). Lorna
Rhodes (1991) has described similar biomedical distancing
devices which facilitate impersonal treatment where maxi-
mum patient mobility 'through the system' is the hallmark of
public health efficiency for the poor and vulnerable. Rhodes
noted that such systems produce and reproduce specific
types of marginal and muted subjects.
Securing modern space
The medical technology in the health centre does not consist
of 'high tech' medical equipment or procedures, but com-
58
prises of mechanisms for spatially ordering people to produce
particular types of biomedical outcomes. Thus 'the patient'
can be said to be spatially produced through such practices, a
'product' contingent upon the specific type of practices asso-
ciated with public health care. Space therefore, defines and
concretises, makes immanent and 'real' the relationships
between people and things (Lefebvre 1991). The health cen-
tre space therefore is adapted to the key social binaries of
public/private, mobility/immobility, staff/patients, doctor/
nurse and clinical/non-clinical staff (Hart 1991; Rhodes 1991).
Corridors and waiting rooms have always had an ambigu-
ous status within biomedicine and as such are always ripe for
appropriation by 'the public' or 'community' (cf Harries
1996). These spaces are the activity areas for the domestic
cleaning staff, and, as such, may not be included in the clinical
topography (Harries 1996; Young 1989). Throughout the
CHC these public spaces are the prime sites of mundane
abuse and antagonisms between staff and the waiting public/
patients. This behaviour is seldom demonstrated within the
clinical areas of the health centre (with the exception of the
Trauma Unit). In these public areas, patients and their
'escorts' tend to crowd noisily or wait; where staff cannot
'allocate' or move patients and where 'bottlenecks' are
formed. These spaces can be read as dysfunctional precisely
because of their failure to achieve the key principles of mod-
ern spatial technology, namely the creation of an ordered dis-
tribution of visible, individualised bodies (Foucault 1977).
Staff and management at the health centre have imple-
mented spatial strategies to address these problems.
Guarded gates have been installed to limit the flow of patients
into the interior of the health centre. They are also located at
key sights of surveillance - the reception area and the Sister's
office. The placement of gates creates partitions and barriers
which reduce the development of crowds of unruly people.
Disciplining power, as Foucault (1977) noted, acts by dis-
sipating and dividing the many - reducing unlavt^ul circula-
tions and conglomerations - under the auspices of visibility
and bureaucracy. It seeks to create 'calculated distributions'
of people in such a way that they became predictable and
governable (ibid 219). Thus the security features are not just
a means to defend biomedical staff and property, but are an
attempt to reinforce the CHC's capacity to function accord-
ing to modern productive criteria. Biomedical products
include biomedical roles, tasks and crucially, biomedical
meaning. In this health centre, the use of prison-like gates has
enhanced this institutional capacity, but destabilised the bio-
medical definition of the space - it appears more like a
'prison' than a health centre. Thus the clinical spaces of the
'coloured' poor potentially reinforce the criminal and 'other-
ing' construction of these spaces. Identities and communities.
The Trauma Unit
Originally designed as a surgery recovery room, the Trauma
Unit is small and makeshift. It consists of five rooms including
storage, toilets, neubulizing room, staff 'tearooms', the Treat-
1. In reality emergency patients only constitute about half of those patients seen here.
2. Betv^een December 1996 and the beginning of October 1997, eleven staff (out of a total of thirty) left the health centre. The desire to
leave is a refrain to most biographies offered by the staff.
3. Statistics at the health centres indicate that there had been an increase of over one hundred percent of children seen between 1996-
1997 (Routine CHSO data). This put a major burden on the service's already strained capacities.
Anthropology Southern Africa, 2004, 27(l&2)
ment Room and corridors that double as a patient waiting
room. Structurally the Trauma Unit is one wing of the build-
ing and its entrance is located within the CHC.
The Unit functions both as a conventional out-patient
health centre and an emergency or trauma unit, but in the
mythology of the health centre it is the emergency patients
that hold centre stage.' It is here that the public health service
must respond to the frequent acts of violence (criminal and
domestic) in the community. Staff emphasise this as the site
where wounded and threatening 'gangsters' must be treated,
often in the lonely hours of the night. This is the space in
which a professional nurse had recently been 'traumatised' by
a 'threatening' weapon-wielding man, 'a gangster'. She
described the Unit as 'a hell', a 'dreadful place', especially on
weekends. She wished she could leave the CHC and the pub-
lic health services completely.^
This space therefore has strong emotional and symbolic
resonances and is the most unsafe space in the health centre.
It never closes and never seems to refuse a patient, etching
its constant accessibility onto the routines and adjoining
spaces of the health centre. In discussion with staff it
becomes clear, however, that it is not the unauthorised entry
here per se that is the problem. The dominant account among
the staff is that the health centre is too open to the wrong
kinds of people. It is, in the words of the Sister-in-charge cited
in the epigraph to this paper, 'too open' to 'mothers and
gangsters. It is accessible to nonsense'.3
Spatial usage and design
The Trauma Unit is entered through a large, wide door
which is usually kept open, the space therefore is highly visi-
ble from the corridor. Access is not strictly controlled, for
instance family members will enter the Trauma Unit and ask
questions of the nurse or doctor. What is striking here are
the variety of activities that occur simultaneously or at differ-
ent times in the same, relatively small space. Spaces here are
multi-purpose, although there have been some attempts to
create specific treatment stations such as the waiting and
treatment areas, or clerical desk and examination bed. In
practice these distinctions usually collapse, along with the
norms of privacy or the safe binary between the public out-
side and the patients within.
The doctor's examination generally occurs in a partially
curtained-off examination area, although patients could be
examined in all areas of the room, even the corridors. Privacy
is often elusive and the clinical interview is frequently inter-
rupted, either by another patient or a staff member who
must access the only telephone located in the examination
area. Thus it is a site where the boundaries between health
clinical, public and administrative spaces are more fluid, and
the separation between Cammock's biomedical 'territories'
is also not fully achieved. The Trauma Unit therefore is often
noisy, chaotic and disordered.
'The security guard appears to be busy trying to
manage the growing numbers of angry patients
Anthropology Southern Africa, 2004, 27(l&2) 59

outside. The room is getting full of people, so that
the doctor orders the patients' escort outside.
There are no quiet places for any form of private
interview, and staff voices are being raised to speak
above the growing noise.''
The trauma area has installed security guards to assist with
the control of patients and presumable violent threats within
this area. It Is clear that the social sanction and privilege of
biomedicine is perceived as insufficient protection for lonely
staff in this vulnerable place. Staff feel most unsafe in the eve-
nings, especially over weekends when the number of crime
and violence-related emergency cases increases (CHSO
2003). Throughout the evenings and busy weekends the
space seems to become even more informal and the unit is
also a place of laughter and chaos. From my notes:
'There are explosions of laughter from the corridor
which the Sister joins in. A woman comes in having
been bitten by a dog. The files are in a jumble on
the table and the staff do not know whose Tile
belongs to whom!' ^
The Trauma Unit is clearly at times a muddle of people, roles
and objects, and bears little resemblance to biomedical order.
Likewise, treatment procedures are often unconventionally
undertaken by either junior or domestic staff who seem
adept at both teamwork and an innovative use of limited
resources to offer emergency care. The most remarkable
feature of the Trauma Unit is its capacity to function at all
with such limited resources and evidently, high patient utilisa-
tion. It could be argued that is able to offer this service pre-
cisely due to its 'rule breaking' and disorganisation which
reach spectacular heights during the frontier times of nights,
weekends and the festive season (cf Garfinkel 1967; Rhodes
1991). Staff appear to be constantly battling to control mobil-
ity and to set spatial limits, and to define and redefine who is
legitimate and belongs.
The nurses also scold patients who are just
"walking in" and they tell them to "gaan terug na die
bankV [Go back to the bench!]. The telephone on
the wall is ringing and we are all having to talk above
the noise. The clerk rushes in and looks harassed:
"The mothers are looking at me ugly", she says. She
is trying to screen the more severe cases, there are
seven children still to be seen and another
seventeen people outside the door.' ^
Theatres, performance and recreating the home
Few patients received traditional private examination and
treatment in the Trauma Unit. These tend to be the sick or
diseased patients, while the 'damaged' patients (stab victims,
car accidents, broken bones etc) are treated in the public
space. In particular, injured men who staff could perceive as a
potential criminal threat are always seen to be treated in the
visible areas of the Trauma Unit.^ These multiple levels of vis-
ibility and surveillance are the greatest security asset for staff
who manage potentially antagonsitic relations in the public
gaze. Treatment in this area always has an audience over and
above the doctor-patient (or nurse-patient) dyad.
This visibility is not simply Foucault's unidirectional gaze
where the patient 'is seen, but he does not see; he is the
object of information, never a subject in communication'
(Foucault 1977:200). Rather this is a mutual visibility in which
both parties participate, often in surprising and unexpected
ways. Thus with an audience, nursing staff in particular, were
observed boldly confronting the very young men they spoke
of fearfully in the tea room. In the Unit bleeding, punctured
and often half-naked bodies are public displays of the effects
of violence for all to see. Their treatment is marked by the
bustle of chiding nurses and often the dramatic performances
of those undergoing procedures.
"'£k is die Wet hier" [I am the Law here]. Sister T.
scolds the young man. Later the 'gangster' returns.
He has missed his place in the queue. Sr T angrily
informs him "Jy loop op en af. Op en af." [You walk
up and down! Up and down]. "Isjy bang?" [Are you
afraid?] she asks with mock concern, for perhaps,
she laughs, 'they' [rival gangsters] are waiting for
him at the entrance.' *
This playful but strategic assumption of the 'Scolding Mother'
or indeed the gang power of 'Die Wet' ^ is facilitated by the
dramatic illusion and ludic reality of the stage (Fabian 1990).
Jensen & Turner (1996) describe how within the home, way-
ward sons are never represented as real gangsters; they exist
'out there' in the street. Within their home they are simply
disobedient sons. Mothers, who often tend to head matriar-
chal households, have been observed to physically assault and
scold their disobedient sons within the public spaces of
nearby Heideveld. Within this often sentimentalised dyad of
mother-and-son, grown and otherwise violent men submit to
this abuse within the home without retaliation or much
resistance (Jensen 1998, personal communication). Thus, by
adopting a mother-son stance, Sr T has articulated a set of
responses and dispositions from home and family which are
locally protective of women within an otherwise violent com-
munity (cf Bourdieu 1977').^ Furthermore, by displaying her
power over this young man, Sr T is at once conquering this
(seemingly harmless) 'gangster' in a public ritual of humiliation

1. Fieldnotes, Trauma Unit, Saturday afternoon.

2. Fieldnotes, Night duty. Trauma Unit.
3. For example general assistants often play an active role in assisting with clinical tasks. I also observed nursing staff innovatively making
a temporary splint for an injured child from a cardboard box (when no other material was available).
4. Fieldnotes, Trauma Unit, Saturday afternoon.
5. This is a gendered positioning as I observed 'damaged' women, survivors of physical and sexual abuse, being examined in the privacy of
a curtained-off area.
6. Fieldnotes, Trauma Unit.
7. 'Die Wet' is not just any law, but a local term used to describe the most feared law within the gangster structure and hierarchy. 'Die
Wet' is precisely most feared as it pronounces guilt, and a mysterious ruthless punishment within the prison-based gangster court of
law, die Kring (the Circle). Oensen & Turner 1996).
8. The majority of the professional staff at the CHC live in middle-class neighbourhoods away from suburbs such as Clareview or Heide-
veld. Thus part of their professional competencies has included specific learned local cultural roles and discourses.
60
which asserts her moral and spatial control of the facility ter-
ritory for all to see.
A medical or emergency consultation in this Unit, there-
fore, differs from that of a regular patient at the CHC. The
treatment trajectory is shorter, less fragmented and regi-
mented, and like other 'danger' zones of the health centre,
the modern spacing (and accompanying discursive) technol-
ogy is incomplete. The clinical consultation with a doctor or
nurse therefore is less mediated, more direct. This clinical
intimacy has multiple dangers, including the loss of the inter-
personal distance required for 'efficient' health care (Good &
Good 1993),' and the exposure of medical staff to security
risk. However, there are other kinds of risks destablising the
traditional staff and patient power relations. Yet, as I have
begun to show, staff (and patients) seem to use the theatrical
nature of this undisciplined space to situationally enact their
social dominance or submission. But 'where' does this behav-
iour 'come from' and what does it tell us about the complex
ontological reality that makes up this blomedical space.
Places, belonging and identity
I have described the patient's treatment process in the meta-
phor of a machine or factory, alienating spaces of fractured
productivity. Yet this metaphor was never consciously articu-
lated by staff or patients. Representation of (biomedical)
space is symbolically mute, it seeks to erase ail traces of sym-
bolic and affective content, and seeks to be read as rational
and functionally streamlined (Lefebvre 1991). This is the
antithesis of Lefebvre's 'lived space' or representational
space, the 'dominated' space of feeling, imagination and sym-
bol, the 'hot' space of fantasy and passion (Soja 1996:68).
Staff, patients and the local community have, over the
years, imbued the health centre with much symbolic and
emotional value. The centre has become a 'place', rather
than simply uninhabited space. 'Place' is qualitatively different
from generic notions of space, places are 'constructed with
our memories and affections through repeated encounters
and complex associations' (Eyies & Litva 1998:206). The most
common trope used by the majority of the health centre staff
is that the health centre is their 'home', onse huis and the staff
are like a 'family'.^ Such domestic and familial tropes are one
means by which the staff give meaning to the health centre as
a symbolic mechanism of place-making (cf Tuan 1977). The
home conventionally signifies the site of the family. It is the
primary site or 'habitus' (Bourdieu 1977), a potent resource
for acting in and understanding the world. The home is both a
lived and abstract space (Lefebvre 1991), and as such, is
accompanied by socially prescribed roles and relations and
consensual expectations (ibid). The home and family are also
a physically and socially bounded phenomenon where social
identity within directly related to issues of belonging and
exclusion (Lefebvre 1991; Moore 1996). Social practices at
the health centre such as mutual co-operation and support
among staff and parental stances towards wayward or sick
patients, articulate with and reproduce this reality.
1. This discursive "threat" is easily counteracted by the public and noisy nature of the unit; this limits talk and thus restricts the potential
'disruption' of the clinical examination process by the patient's stories or confessions (cf Muller 1994).
2. This sense of place is most strongly articulated among the longer serving nursing and general assistance staff. I did not hear doctors (or
patients) refer to it is this manner.
3. Fieldnotes, Trauma Unit, night time.
Anthropology Southern Africa. 2004, 27(l&2)
The staff at Clareview CHC were not ubiquitous biomed-
ical agents, but people located in a particular time and place.
As a group and individually they masterfully juggled their pro-
fessional, class, ethnic and individual roles to produce a rich
variety of identities or subjectivities to suit their needs and
context (cf Robinson 1995). For the staff and patients living
and working in the health centre, this place consists of multi-
ple symbolic systems, namely that of biomedicine and the
more unruly world of the home, family and street (Harries
1995; Young 1989). Social space, according to Lefebvre
(1991) acts as a mediator between these different, and some-
times contradictory, social orders, levels and ontological
realms (cf Jensen & Turner 1997; Young 1989). These realms
are complex and interact spatially in a manner which requires
ongoing redefinition and contest, and which defies the appar-
ent stability of physical boundaries (Harries 1995; Young
1989). Foucault {\977) and Bourdieu (1977) however, have
cautioned against naive notions that such symbolic worlds
may escape the effects and productive utilisation of power. It
is necessary therefore to return to questions of power and
authourity and the form this may take in the disordered but
creative space of the Trauma Unit.
Theatres of hell
The public spacing of health clinical treatment within the
Trauma Unit may facilitate another form of didactic theatre
that shifts from high drama to apparent comedy, as I discov-
ered early one morning:
'It is about 3 am. Three staff members, including
the doctor, are speaking to a (presumably
intoxicated) stab victim with a head wound lying on
the examination bed. He keeps on trying to get up
and is being told to sit still by the nurse who is trying
to clean his wound. He swears profusely, swoons
and pulls away as she wipes the wound and
approaches him vy^ith the suturing material. The
scene is being watched by all the staff and two
ambulance men sitting on the other examination
beds. Sr G approaches him with an injection, "This
will hurt you even more if you swear at me like that"
she says (or words to that effect). The nurse says
to me, "Do you see now how 'they' swear and gaan
acn fcarry onj". I find the scene quite exciting and
amusing. The whole episode has been punctuated
with (nervous?) intermittent laughter. The nurses
'tut tut' and scold him. I am sure that they could
have sutured him with less force and more
gentleness.' ^
It would be inaccurate to suppose that in this ribald and puni-
tive spectacle there is not the active participation of the
patient. The 'gangster' requires medical assistance and as
such must submit to the ministrations of the staff, however
rough. He, like them, adopts a staged identity in which he
performs a humorous parody of himself and stereotype of
the gangster (Jensen & Turner 1996). The gangster's parody
Anthropology Southern Africa. 2004, 27( I &2)
is a familiar face-saving device which is read as a mocking sub-
mission to medical, state, class, racial and even maternal
authority.' This is accomp<mied here by a degree of festival
and carnival which is subversive in itself (cf Harries 1996).
Foucualt describes how historically public spectacles of
pain have been culturally sanctioned forms by which state
power was enacted and reproduced. Here, the infliction and
control of physical pain have always been a potent form by
which power has been expressed and seized in pre-modern
forms of governance (Foucault 1977). In sovereign power,
torture and execution function as 'opportunit[ies] of affirming
the dissymmetry of forces' (Foucault 1997:55), and become a
'political ritual... [a] ceremony by which power is manifested'
(ibid 47). The danger of such a public act of power, however,
was the paradoxical nature of the spectacle, the 'aspect of
carnival in which rules were inverted, authority mocked and
criminals transformed into heroes' (ibid 61). This punishment
tended to become a 'festival' (ibid I I I ) and boundaries
between these theatres of pain and insurrection are often
dangerously unstable.
Conclusion
Biomedicine in general, and primary health care in particular,
have a specific spatial form which gives it a material presence
in the world (cf Lefebvre 1991). In this article I have exam-
ined the social space of a specific primary health facility In
terms of its ability to function as a precariously held biomedi-
cal interface. I have described how the principles of modern
space and its disciplining effect are not uniformly realised
throughout this biomedical space, and the impact of this upon
social identity and behaviour. Disciplining spatial technologies
are both the cause and effect of power. For, as Alan Feldman
(1991:8) notes, power is not a given, but 'is contingent on the
command of space'. Yet, I have also argued that disordered
spaces such as the Trauma Unit are functional precisely
because of their spatial and discursive 'rulebreaking' (cf Gar-
finkel 1967), and the multiplicity of social Identities and strat-
egies available in this heterogeneous space and its
undisciplined subjectivities. This apparent anomaly challenges
Michel Foucault's seemingly linear relationship between
structural design and subjectivity, suggesting a more complex,
open relationship between space, agency and consciousness.
The fluidity of this space therefore is both a source of creativ-
ity and danger for staff, with patients replete with the name-
less anxieties and forbidden pleasures of this process.
Narratives of gang violence and attacks punctuate nursing
staffs' tales and accounts of the health centre. Such incidents
have become emblematic of ongoing anxieties about their
safety and the physical and spatial integrity of the health cen-
tre. But it is not only 'gangsters', but 'mothers' who cause
'nonsense' in the facility, both being unstable and recalcitrant
'patient' categories, and who violate the physical, administra-
tive and moral boundaries of the CHC (cf Swarte 1991). Feld-
man (1991:14 original emphasis) writes that 'The event is not
v/hat happens. The event is that vi/hich can be narrated'. Violent
accounts appear to articulate and give legitimacy to a range of
conditions within the health centre which imply threat, loss.
I. The doctor in this case is a white male. I do not think this performance would have differed should he not have been. The staff of the
health centre represent official biomedical and class-based authority and power.
61
violation and defilement. This violence therefore lies at the
extremity of a continuum of everyday abuse, including mun-
dane mess and the dehumanisatlon of patients and staff within
alienating spaces and treatment routines. This abuse has
become condensed into dominant accounts of extraordinary
violence and abuse which give moral and heroic status to the
stressed and disillusioned staff. Paradoxically, 'gangsters' pro-
vide a more predictable and morally defensible interpretative
frame for the abuse, disorder and uncategorical anxieties of
the health centre. Staff are increasingly exposed to the com-
munity's anger and frustration, especially from 'mothers' who
desperately seek medical care for their children. As such they
are both the agents and victims of ongoing structural violence
that frustrates the public's legitimate rights to health care.
Therefore, it is not that the mythology and fear of the gangs
are not real, but rather that the various subject positions
within it are fluid and the boundary between 'us' and 'them'
sometimes becomes muddled (cf Pile 1996).
Michel Foucault's account of historical trajectory for the
spatialisation of power has been central to my narrative. Yet I
can find little trace of an institution like Clareview Commu-
nity Health Centre within this account. Foucault's institutions
may be criticised for the manner in which its spatial form and
practices are presented as apriori, uniformly achieved tech-
nology, rather then the result of ongoing situational practices
which dialectically rebounded in institutional space (cf Lefeb-
vre 1991). My experience at Clareview CHC alerted me to
the extent to which institutional capacity rested upon its abil-
ity to defend, govern and own Its spatial territory. Likewise
the loss or appropriation of this territory can occur at both a
material or symbolic level. Its differentiation requires both
power and resources (material and symbolic), and is con-
stantly open to challenge and resistance.
The original studies of biomedical spaces describe closed-
off places such as the asylum and sanatorium (cf Foucault
1977; Goffman 1973), which have their origin in the exclu-
sionary rituals for the containment of contagion and the con-
finement and discipline of the prison. Hospitals and later
other forms of public institutions began to open outwards, to
permit, and then require, the entry and circulation of the
public to function. Following Foucault, this apparent open-
ness has been described as an illusion, an indication of the tri-
umph of biomedicine and its disciplinary practices (Armstrong
1995; Rose 1994). For, notes Armstrong (1995:398), the hos-
pital can lose its walls precisely due to the effect of the 'pene-
tration' of 'medical surveillance' beyond the hospital into the
wider population. Thus the notion of biomedical boundaries
is problematised and located within communities shaped by
biomedical practices far beyond the material bounds of the
clinic.
Michel Foucualt's work has been criticised for its unre-
flexive location within a western European cultural and socio-
economic context (Rose 1994). Likewise, implicit in the con-
struction of primary health as 'surveillance medicine' (Arm-
strong 1995) are the governable spaces and communities in
which biomedical boundaries may dissolve in a modern
ordered medicalised society. These notions are not borne
out by practices at this local health facility. The staff and man-
62
agement of Clareview CHC appear to find the space of this
health facility too porous, disorganised and open to appropri-
ation. This is especially the case in the accessible Trauma Unit
where the boundary or frontier of biomedicine must be
negotiated within the inner sanctum of biomedical care as it
directly encounters the body of the patient and their subjec-
tivity. Thus, a study of biomedical space tells us as much
about the nature of social space and governance without, as
within, its walls.
It is beyond the scope of this article to link these spatial
investigations adequately to health policy development and
implementation. It is clear however that physical spaces and
peoples' interpretation of them matter. These variables
impact directly upon the behaviour, function and power rela-
tions within these places. I have also shown how the hetero-
geneity of biomedical space provides the necessary symbolic
apparel to hide and humanise the dominant factory-like treat-
ment routines of public health. But space, as I have described,
also carries historical traces. As Lefebvre writes:
'Nothing disappears completely. In space, what
came earlier continues to underpin what follows.
The preconditions of social space have their own
particular way of enduring and remaining actual
within that space' (Lefebvre 1991:227).
Changes in national governance (and health policy) have done
little to address or articulate the powerful mundane and eve-
ryday spatiality of apartheid rule (cf Robins 2000; Robinson
1995). The spaces of public health care continue to produce
and reproduce these historical injustices within their 'invisi-
ble' spatial relations and practices. This 'invisibility' not only
renders certain powerful variables unpredictable and unac-
counted for, but neglects key resources for positive change
and participation. It is clear also that health care reform can-
not stop at the walls of health facilities (or organisation), and
the 'health' of the community as a whole is part of its func-
tional efficiency. The 'governmentality' of the modem state
and its biomedical technologies have provided modern insti-
tutions which may protect communities from the worst
excesses of physical violence and sickness. I do not believe
that some anarchistic appropriation of the current health
services is in the best interest of these impoverished commu-
nities. Primary health care spaces should use their radical
proximity with local spaces and communities to engage with
their symbolic and relational richness and provide safe alter-
native spaces for positive choices on how to live one's life and
manage one's body and illnesses.
Acknowledgements
I would like to acknowledge the staff and management of
Clareview Community Health Centre who allowed me
access into their space and impressed me with their ongoing
persistence to render health services amidst increasing odds.
My thanks to management of the Community Health Services
Organisation for the permission to undertake this study, and
my appreciation to the staff and patients of the CHC for par-
ticipating in the process. I would also like to thank Sally
Swart2 who supervised the original study, Steven Robins, Pat
Caplan and Lesley F Green.
Anthropology Southern Africa. 2004, 27( I &2)
References
Allen, J. & Pryke, M. 1996. 'The production of service space'.
Daniels, S & Lee, R (eds.). Exploring human geography. London,
New York, Sydney: Arnold.
Armstrong, D. 1993. Public spaces and the fabrication of identity.
Soc/o/ogy, 27:393-410. 1995. The rise of surveillance medicine.
Sociology of Health and Illness. 17:393-404.
Bourdieu, P. 1977. Outline of a theory of practice. Cannbridge:
Cambridge University Press.
Cammock, R. 1981. Primary health care buildings. London: The
Architectural Press.
CHSO Annual Report. 2002. Unpublished report. Provincial
Administration of the Western Cape, Mountain Road,
Woodstock, Cape Town.
Comaroff, J. 1977. 'Conflicting paradigms of pregnancy: Managing
authority in aAnte-natal encounters'. Davis, A. & Horobin, G.
Medical encounters: The experience of illness and treatment.
London: Croom Helm.
Cox, A. & Groves, P. 1990. Design and development guide for:
Hospital and healthcare facilities. London: Butterworth
Architecture.
Dear, M. 1997. 'Postmodern bloodlines'. G. Benko, & U.
Strohmayer (eds.). Space & social theory. Oxford: Blackwell.
Eyies, J. & Utva, A. 1998. 'Place, participation and policy'. Kearns, R.
& Gesler, W (eds.). Putting health into place. Syracuse: Syracuse
University Press.
Fabian, J. 1990. Power and performance: Ethnographic exploration
through proverbial wisdom and theatre in Shaba. Zaire. Madison:
Univ. of Wisconsin Press.
Feldman, A. 1991. Formations of violence. Chicago: University of
Chicago Press.
Foucault, M. 1976. The birth of the health centre. London: Routledge.
1977. Discipline and punish. London: Penguin Books.
Garflnkel, H. 1967. Studies in ethnomethodology. Englewood Cliffs:
Prentice-Hall.
Giddens, A. 1984. The constitution of society. Cambridge: Polity
Press.
Goffman, E. 1973. Asy/ums. Middlesex: Penguin Books.
Good, B. & Good, M. 1993. '"Learning medicine" The construction
of medical knowledge at Harvard Medical School'. Lindenbaum,
S. & Lock, M. (eds.). Know/edge, power and practice. Berkeley:
University of California Press.
Gregory, D. 1994. Geographic imaginations. Oxford: Blackwell.
Harries, J. 1996. Health and literacy: A study of literacy practices in a
day hospital in the Western Cape. Unpublished Masters
dissertation. University of Cape Town: Cape Town.
Hart, L 1991. 'A ward of my own: Social organisation and identity
among hospital domestics'. Holden, P. & Littlewood, j . (eds.).
Anthropology and nursing. London: Routledge.
Jensen, S. & Turner, S. 1996. A Place called Heideveld. Research
Report No. 112. Roskilde, Denmark: RoskildeUniversity.
Lefebvre, H. 1991. The production of space. Oxford: Basil Blackwell.
Littlewood, J. 1991. 'Care and ambiguity: Towards a concept of
nursing'. Holden, P. & Littlewood, J. (eds.). Anthropology and
nursing. London: Routledge.
Matinson, N., Radebe, B., Mntambo, M. & Violari, A. 2002,
Antiretrovirals. South African Health Review 2002. Durban:
Health Systems Trust.
Massey, D. 1996. 'A global sense of place'. Daniels, S. & Lee, E.
(eds.). Exploring human geography. Arnold: London.
Moore, H. 1996. Space, text, and gender. New York: The Guilford
Press.
Muller, L 1994.'Poor' health clinical interpreting for 'good' psychiatric
practice: Xhosa interpreting within a diagnostic interview in an
acute admissions unit. Unpublished Honours research report.
Cape Town: University of Cape Town. 1999. The geography of
Arjthropology Southern Africa. 2004, 27( I &2)
the health centre - Spatial form, meaning and practice at a Western
Cape. Community Health Centre. Unpublished MA thesis. Cape
Town: University of Cape Town.
Muller, L, Ensink, K., Zissis, C , Leon, N. & Robertson, B. 1998.
District level integrated mental health in the Western Cape.
Unpublished report. Cape Town: University of Cape Town.
Pile, S. 1996. The body and the city. London and New York:
Routledge.
Pinnock, D. 1984. The brotherhood: Street gangs and state control in
Cape Town. Cape Town: David Philip.
Pizanias, C. 1996. Habitus: From the inside out and outside in.
Theory and Psychology. 6(4):647-665.
Prior, L. 1992. 'The local space of medical discourse, disease, illness
and hospital architecture'. Lackman, J. & Stollberg, G. (eds.). The
social construction of illness. Stuttgard: Franz Steiner Verlag.
Rhodes, L. 1991. Emptying beds: The work of an emergency psychiatric
unit. Berkeley: University of California Press.
Robins, S. 2000. 'City sites: Multicultural planning and the post-
apartheid city'. Nuttal, S. & Michaels, C. (eds.). Senses of
cultures: South African cultural studies. Cape Town: Oxford
University Press.
Robinson, J. 1995. Transforming spaces: Spatiality and re-mapping
the apartheid city. African Studies Seminar. May 17, 1995.
University of Cape Town: Cape Town.
63
Rose, N. 1994. 'Medicine, history and the present'. Jones, C. &
Porter, R. (eds.). Reassessing Foucault. London: Routledge.
Shields, R. 1997. 'Spatial stress and resistance: Social meaning of
spatialization'. Benko, G. & Stronhmayer, U. (eds.). Space &
social theory. Oxford: Blackwell.
Soja, E. W. 1989. Postmodern geographies. London and New
York:Verso. 1996. Thirdspace. Oxford: Blackwell.
Swartz, L. 1991. The politics of black patient identity: Ward rounds
on the black side of a South African psychiatric hospital. Culture.
Medicine and Psychiatry. (5):217-244.
Tuan, Y. 1977. Spoce and place. London, Arnold.
Valins, M. 1993. Primary health care centres. HaHow: Longman
Building Studies.
Weir, D. 1977. The moral career of the day patient'. Davis, A. &
Horobin, G. Medical encounters: The experience of illness and
treatment. London: Croom Helm.
Weiss, M. 1993. Bedside manners: Paradoxes of physical behaviour
in Grand Rounds. Culture. Medicine and Psychiatry. 17:235-253.
Wiles, R. & Higgins, J. 1996. Doctor-patient relationships in the
private sector: Patient's perspectives. Sociology of Health and
Illness. 25(2):23-36.
Young, K. 1989. Disembodiment: The phenomenology of the body
in medical examinations. Semiotica, 73(l/2):43-66.