On hospitals

Frantz Fanon spent much of his life in hospitals, as a worker, writer, and patient. Much of Fanon’s work examined hospitals as institutions of social control, medicalising criminality, and exercising colonial powers. To Fanon, ‘colonialism in its essence was already taking on the aspect of a fertile purveyor for psychiatric hospitals’ –­ creating the social conditions that enabled the diagnosis of psychiatric disorders, and in turn, the need for institutions capable of housing and controlling the ‘sick’.

Michel Foucault similarly spent much of his career interrogating the role of hospitals. Foucault’s articulation of biopower and biopolitics laid out the ways in which those in power govern the life of their citizens, and how spaces such as the clinic enable this governmentality. It’s useful to recall Foucault’s famous formulation, asking whether it is surprising that prisons resemble factories, schools, barracks, hospitals, which all resemble prisons. I am not an expert on Fanon or Foucault, but the writing of both thinkers highlights the way in which our hospitals continue to be inherently political spaces; spaces that survey and control the lives of the oppressed and marginalised. As hospitals and aged care living centres become the frontlines in the struggle against COVID-19, now more than ever we must confront and interrogate the role these institutions play in our lives, and how we must reshape them towards the social good we need in our communities.

I am confronted by both the immensity and urgency of this task as someone who has spent the better half of my young adulthood in these spaces, caring for sick and disabled family. My mum Julie, a Wiradjuri woman, spent the last years of her life institutionalised in hospitals, subjected to increasing violence and having her identity weaponised against her. Having witnessed the way these places controlled and ultimately ended my mum’s life, I have come to understand the way in which hospitals and health professionals alike are required to perform to a strict set of politics that dispose of disabled people, Blackfullas, other Black and Brown communities, poor people and those considered not ‘human enough’.

My personal experiences have reflected a narrative oppressed people the world over understand to be true: hospitals do not exist in a social vacuum. Hospitals are not inherently benevolent, nor are we promised healing and safety inside of them. They are institutions like any other that grasp tightly to capitalist ideas about which bodies may be productive and therefore considered ‘worthy’ of continued life. They are institutions that grasp tightly to eugenicist and colonial politics that would see many of us killed off, and they are institutions that stratify and limit access to care depending on capitalist paradigms of access and affordability. Poverty is exacerbated by insufficient or inappropriate health resources, and further reinforced by continuing austerity measures. Chronic underfunding of hospitals makes it impossible to ensure the type of care that would see safety and healing for our communities, to break cycles of distrust.

A proper interrogation of hospitals and the broader governmentality of health care requires a greater understanding of health and sickness not only in terms of the biological, but in terms of the social. The ways in which marginalised bodies are forced to navigate this world, and the social conditions we are told to accept, are the greatest predictor of our health and lifespan. You need only ask any Blackfulla or disabled person in this country why we die younger or have poorer health care outcomes. It is not a question of our genes or response to healthcare systems, but of dispossession, ableism, racism and poverty.

It is not the white, abled middle-class who die of chronic diseases in droves, or whose bodies bear the brutality of state violence. Instead it is those of us continually marginalised who fill hospital beds. The apparent social utility of prisons is a pretext to warehouse poor Black and brown people, and abolitionist academics like Liat Ben-Moshe argue that hospitals, asylums and residential institutions function similarly. These places remove disabled people from the community, operating via the same carceral logics as prisons – if there is a ‘problem’ population, the solution is to withhold them from society. The deinstitutionalisation of hospitals in favour of radical possibilities of localised, culturally specific and wellness-focused forms of care is a conversation that still seems impossible for most – a challenge left to contemplate by those who have themselves been victims of capitalist-industrial health institutions.

As the possibilities of abolition take hold of our imaginations, and we collectively question the benefits and violences of incarceration, our movements must also begin to critique the violence oppressed people are subjected to by hospitals. We must ask ourselves who both enacts and aids control in these spaces, even if they might be the same nurses and doctors leading union campaigns, or being praised for their work to stop the spread of COVID-19. We can recognise individual efforts and the personal sacrifices of healthcare workers at the frontline of a global pandemic while also acknowledging that the culture of over-work and paternalism which keeps our healthcare system operating while so drastically under-resourced can only ever lead to systemic failure. We must move our imaginations towards the contemplation of something better for our most marginalised.

In emphasising the complicity of certain medical institutions, I do not wish to disrupt potential solidarity, or to diminish the pivotal efforts of essential workers. I am acutely aware of the systemic limitations of our healthcare system, and the necessity of broad, structural responses, rather than individual blame. Our movements and communities should be empowered to demand dialogue with those who hold power over life and death, with those who profit from institutions which deal so directly with human rights, to ask clearly: whose side are you on?

Since invasion, health professionals in these lands have often acted as agents of control, rather than as agents of care. Settler-colonial states such as Australia have long understood the penal potential of hospitals. The brutal violence of ‘lock hospitals’, such as those established on Bernier and Dorre Islands off the Western Australian coast, are not too distant from our cultural memory. Aboriginal people were removed from their homelands by police, often in chains, and subjected to medical experimentation and deplorable conditions. Forcibly removed Aboriginal and Torres Strait Islander peoples were medically incarcerated on Fantome Island in Queensland until 1973. The workers in these institutions were not neutral agents; they served state programs of genocide and oppressive social control. The role of health care professionals in the violences of Nazi Germany are well-documented, as they are in the history of racist forced sterilisation in South Africa and the United States. Recent arguments have emphasized the race and gender based divisions in healthcare, and the consequences of misdiagnosis. There is a growing movement towards the ethical recognition of the experiences of patients and communities hitherto ignored. Nurses, doctors and researchers working today are not individually responsible for these long histories of medical incarceration, but they are still representatives of a profession responsible for the institutionalisation of the poor and marginalised, and the intergenerational trauma of medical abuse. They operate at the direct interface of health and wellbeing, and as such every aspect of the institution must be held to the highest standards of empathy and responsibility.

To accept anything less of hospitals can only lead to further tragedy. Today, this is the same institution that led to the neglect of pregnant Wiradjuri woman Naomi Williams, who visited health professionals over twenty times in seven months before dying of sepsis in 2016. This is the same institution that abandoned the community of Yuendumu before the brutal shooting of Kumanjayi Walker, ensuring he went without potentially life-saving medical care. This is the same institution denying disabled people dignity and withholding critical care based on assumptions concerning ‘quality of life’. It is the same institution that has been reported as rationing critical care for disabled and aged people in the midst of a global pandemic. It is not enough to improve medical care for marginalised people: we must radically reimagine our health systems.

Given this critical juncture, where hospitals and health professionals are likely to determine how our communities survive after the pandemic, it is important we hold this history in the forefront of our minds. Examining the participation of nurses in the colonising process of Canada, academic nursing leader Sally Thorne argues that there has been insufficient consideration of political agendas in nursing, and the same can be said of the medical profession’s participation in structural violence. Whether voluntary or involuntary, there are long and uncomfortable histories of medical professionals enacting the violent and exclusionary practices of dispossession and genocide, Thorne writes, and while well-intentioned individuals might wish to position themselves as the heroes of the most trusted profession, there must be a collective accountability for the social, economic, and political forces which serve as systemic barriers to the health and wellbeing of marginalised peoples. Individual praise cannot be allowed to obscure the possibility of building a genuinely welcoming and safe system of care.

If we are all to survive this crisis and birth from it transformative and just ways of caring for one another, health professionals must work towards building relationships of solidarity and trust with oppressed communities. This demands a rethinking of how we value life, and how we want our hospitals to function. It demands listening to the voices of the countless Blackfullas, disabled, poor and other oppressed people that have suffered in these spaces, and making space for people from our communities to become leaders in health. It demands that nurses and doctors stand with the people, and not those ideologies that desire our end.

Until then, our communities can and will continue to work towards a world where our healing and care is not only possible, but realised within hospitals. And those of us who have lost health, dignity, homes or loved ones to hospitals, will continue to remember and remind.

A Haunting on the Ward

Antiseptic rips nose, hangs heavy on the senses
bottles of it
marker of passage, movement, boundary,
cling to me like smoke

Sterile corridors are littered with us
behind curtains and charts
held down by bleached linen
many hands have toiled at

The oppressed are a sick people
not in soul or in spirit, but in heart and lung
and mind and every other bit of body
they’ve taken from us too

Here death is armed with pager and jargon
with a million different words
that all end up meaning
you ain’t human enough for us

Outside nurse become warden
become master
surveil and swarm beds
whisper secrets and write code

I think these wards are haunted, mumma
the way this place holds pain.
There ain’t much healing to be done
when you can’t get away from them ghosts.

 

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Vanamali Hermans is a Wiradjuri, Irish and Flemish woman. She is a disabled organiser and writer living in Canberra on Ngunnawal and Ngambri land..

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