How the whiteness embedded in health services impacts on the health and well-being of aboriginal people

Chapter Abstract:Aboriginal women are treated differently by non-Indigenous health care providers based on perceptions of Aboriginality and skin colour and white race privilege within health care environments. The experiences shared below are from some of the Aboriginal woman respondents in a research project undertaken within Rockhampton, a regional area in Central Queensland (Fredericks, 2003). The experiences give an insight into how the Aboriginal women interviewed felt and their observations of how other Aboriginal women were treated within health care settings based on skin colour and perceptions of Aboriginality. A number of the women demonstrated a personal in-depth analysis of the issues surrounding place, skin colour and Aboriginality. For example, one of the women, who I named Kay, identified one particular health service organisation and stated that, ‘it is a totally white designed space. There is nothing that identifies me to that place. I just won’t go there as a client because I don’t feel they cater for me as a black woman’. Kay’s words give us an understanding of the reality experienced by Aboriginal women as they move in and out of places within health environments and broader society. Some of these experiences are examples of direct racism, whilst other examples are subtle and demonstrate how whiteness manifests and plays out within places. I offer acknowledgement and honour to the Aboriginal women who shared their stories and gave me a glimpse of their realities in the research project from which the findings presented in this chapter are taken. It is to this research project that I now turn.During the late 1990s, I commenced a formal research project exploring Aboriginal women’s perceptions and experiences of health, well-being, identity, body and health services within Rockhampton. Using an open-ended question sheet as a guide, twenty Aboriginal women from a range of ages and with a diversity of backgrounds provided in-depth interviews (Fredericks, 2007a; b). Some of these women’s experiences are shared within this chapter in the hope that they will lead to a deeper understanding of how racism manifests through the perceptions and personal practices of health service providers.The Aboriginal women I interviewed want to see evidence that they are part of the places that are called health services. What will become obvious within the following sections is that planners, designers, managers and health personnel need to give consideration to how people access and dwell within places culturally. As Weisman explains; ‘design is a reflection of prevailing social, political and economic values and is often symbolic of the place that each individual holds in society’ (1992:10). Places are not the passive environments we would like to think they are. According to Kitchen they act as a social text that conveys messages of belonging and exclusion and reproduces power relations within society (1999:45). They are also, as suggested by Foucault, sites of social struggle and contested realms of identity (1980:149).In relation to the gendered nature of places, Macgregor outlines the ways in which there are ‘complex interrelations between who women are (identity) and the environments in which women live (spaces and places)’ (2001:342). Miranne and Young explain that it is the aspects of women’s identities such as class, race, ethnicity, culture and sexual orientation that add complexity to the interrelationships between women and space and place. Women don’t just physically use spaces and places: they interpret, represent, and produce and reproduce space (Miranne and Young, 2000). Aboriginal women’s sense of place within health services operates within this complex context.Dyck (1995) and Dyck, Lewis and McLafferty (2003) explore how women manage the physical, social and economic consequences of their illness along with the complex layering of social, economic and political relations that frame their health. It is demonstrated through this research undertaken with Aboriginal women in Rockhampton, Central Queensland that culture and racism impact on the way in which Aboriginal women experience and engage with places that offer health services. It is further demonstrated that if Aboriginal women are not part of the design process and management of such places that they are reflected within the social, political and economic values by their absence, a fact that provides a symbolic representation of the position that Aboriginal women hold within that community.What became apparent through this research project is that Aboriginal women need to feel welcome, comfortable, secure and culturally safe if they are going to access and utilise health services openly, freely and happily, and in an informed and empowered manner. This is also outlined in Kirk et al. (1998) in the research they did focusing on Aboriginal and Torres Strait Islander women and cervical cancer in Queensland. It was additionally identified in research undertaken focusing on breast cancer screening, diagnosis, treatment and care for Aboriginal and Torres Strait Islander women in Queensland (Kirk et.al. 2000a; 2000b). My research builds on the work of Kirk et.al. and suggests that if Aboriginal women do not have a connection to a place, then they will not utilise that health service or they may do so only with a great deal of effort, angst and energy. In a sense these places within the landscape can be contemporary sites of trauma. A research methodology was developed which would offer a form of witnessing, validation and support in asking questions and discussing issues, which would draw emotional responses (Fredericks, 2007a; b; 2008).