Many years ago I worked briefly at a health clinic in, Ampilatwatja, a remote Aboriginal community in the Alyawarr country, 400km North East of Alice Springs. What struck me most about my visit and has stayed with me was my naivety. I was embarrassed by my lack of history, understanding of the culture of my country’s first people and their connection to Country. At the time many scenes bewildered me, two to mention, the services, school, shop, council and health clinic was run by eight white people in an aboriginal community of up to 400, and how the poorly designed and constructed built environment had no relationship to the residents way of living, or the land…no connection to anything really (and that at times included water and sewerage). On reflection these were examples of the social determinants making communities unhealthy.
It has been well documented that aboriginal people have poorer health outcomes and life expectancy rates than non-aboriginal people in Australia. The determinants of aboriginal peoples health is extensive and complex, and disadvantage can be attributed to factors such as social, economic, environmental, lack of self-governance, to list a few. Improving wellness and health within aboriginal communities needs to be a holistic approach and all determinants require attention.
Three themes consistently come up in my research; firstly improving the health outcomes of aboriginal people requires their involvement in either or all of the design, implementation and provision of programs and understanding the high importance placed on, ‘cultural, family and community connectedness’ as being a factor ‘central to their health and wellbeing’.(¹)
The second factor which is recognised as contributing to positive health outcomes is to make health care more accessible, geographically and culturally, as suggested in the Summary of Aboriginal and Torres Strait Islander health, 2016, this includes a ‘greater cultural competence of service providers’(²). This I think could be extended to include service facilities and is where architects can play a role delivering positive health outcomes for aboriginal communities.
Designing a health facility is a complex task within itself, designing a health facility for rural and remote aboriginal communities needs to provide the functional facilities but also take onto account other factors to ensure the facility is accessed and sustainable. Understanding the sites environment, distances, determining appropriate materials based on cost to transport, ease and expertise available to construct need considering. As too does the materials lifecycle in often harsh environmental conditions that can include extreme temperatures, flooding, cyclones, dust, salt, pests and local fauna. Service connection and availability is taken for granted in metropolitan areas, in rural and remote locations water, power and sewerage can be limited or non-existent.
There has been minimal evidence based research in Australia regarding whether healthcare design plays any role in aboriginal peoples’ perceptions, experiences or accessibility. However, anecdotally from aboriginal conversations, speaking to architects and researchers who have undertaken community consultation have said that spatial planning, connection to the outdoors and culturally decorative elements that are community specific do play an important role. Research is currently underway, ‘Understanding the importance of architectural design for improving Indigenous health care experiences’, by the University of Queensland is one of the first papers to specifically examine this area with an aim to identify the best design principles and practices.
There are numerous state and federal guidelines to assist architects undertaking these unique projects. Guidelines such as Queensland’s Health, ‘Guidelines for the Planning, Design and Building of Primary Health Care Facilities in Indigenous Communities’ for consultants, contractors and subcontractors who have been engaged by the government. The document suggests successful outcomes can be achieved through research and community engagement before the design process begins. It recommends design professionals gain an understanding of the communities ‘History, Relationship with health/other government service providers, Languages, Social structure, Family structure, Gender relations, Conception of death, Spirituality, and Social issues’ (3). Community consultation is not a new concept, and although there are guidelines nationally promoting this important process, principles translating to practice is not always a reality. The receptiveness of some lead agencies remains paternalistic and their brief is focused on functional, management and operational outcomes and any community engagement can be only seen as symbolic.
Greg Grabasch, a Director of UDLA noted that engaging with rural and remote aboriginal communities does not cost any more to the client, however can mean that the end user will feel more connected, a sense of ownership and identify with the project and will more likely access the space, making it a more sustainable project. “Instead of telling communities what they need from the comfort of your office in the city, you’re building relationships with a community, and facilitating the communities’ project.” Finn Pederson of IPH echoes this, noting through community engagement they were able to design an aged care rehabilitation centre which not only provided for the elderly in a culturally appropriate manner, but is also a cultural meeting place for the wider community keeping different generations connected, a cultural layering a functional brief would not have identified.
With the adoption of a more engaged design process, whether that is community consultation during design, or engaging local communities in joint ventures to build the facilities, I’m optimistic that future generations of health professionals will have a different experience to mine when working in remote communities. I’m hopeful they will be struck by the unique, culturally and environmentally responsive buildings and the facilities will be ‘owned’ and operated by the local aborignal community.
References
1 Government of Western Australia, Department of Health (2015)WA Aboriginal Health and Wellbeing Framework 2015 –2030 (p4) Accessed 18/04/18) http://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Aboriginal%20health/PDF/12853_WA_Aboriginal_Health_and_Wellbeing_Framework.pdf
2 Australian Indigenous HealthInfoNet (2017) Summary of Aboriginal and Torres Strait Islander health, 2016. Retrieved [access date] from http://www.healthinfonet.ecu.edu.au/health-facts/summary
3 Queensland Government Queensland Health. Queensland Health Guidelines for the Planning, Design and Building of Primary Health Care Facilities in Indigenous Communities. (p19)(Assessed 18/4/18) https://www.health.qld.gov.au/__data/assets/pdf_file/0017/150920/qh-gdl-374-7.pdf
Interviews
Dr Timothy O’Rourke, AERC, The University of Queensland. ‘Understanding the importance of architectural design for improving Indigenous health care experiences.’ (Phone interview)
Greg Grabasch, Director, UDLA. (Face to face interview)
Finn Pedersen, Director. Iredale, Pederson Hook. (Face to face interview)
Images
1. Ampilatwatja,personal photograph
2. Ampilatwatja,personal photograph
3. Fitzroy crossing renal hostel, WA,Http://iredalepedersenhook.com/?portfolio=fitzroy-crossing-renal-hostel
4. Wanarn Health Clinic. Kaunitz Yeung Architecture, Australia https://idesignawards.com/winners/zoom2.php?eid=9-8824-15
5. Walumba elders Centre, http://iredalepedersenhook.com/?portfolio=wulumbu-aged-care-centre
6. Numbulwar Health Centre Http://probuildnt.com.au/achievement//