Rural Health Symposium: Patients and Practitioners
Special Issue of Health Sociology Review
Volume 13 Issue 2 December 2004
96 pages ISBN 978-1-921348-27-3
Editors:
Brian Cheers and Jane Edwards
University of South Australia
It is becoming increasingly challenging to recruit and retain health care workers in rural settings. A worrying consequence is more constrained access to health care in rural areas. This symposium, Rural health: patients and practitioners, offers an important sociological analysis of issues peculiar to rural health care and considers the experience of rural practitioners.
Amanda Kenny's paper challenges some dominant themes in recent sociological literature on general practice, particularly the erosion of medical power by managerialism, corporatisation, and increasing numbers of salaried, rather than self-employed, practitioners. Kenny suggests that such factors tend to be less relevant in rural communities. By contrast with their urban counterparts, rural medical practitioners continue to experience considerably more autonomy and power.
In the second paper, Angela Durey argues that the traditional model of rural general practice assumes that GPs are male and have wives who attend to domestic labour and child-rearing. Such a model, she suggest, sits oddly with the experience of women rural general practitioners. The male-centered, 'heroic', model of practice, where GPs work long hours - leaving little time for their families - does not fit the many women practitioners who struggle to balance work and domestic life. For the most part, this balancing act is perceived by both male and female GPs as a personal problem, whereas, as Durey observes, it is a structural feature of rural general practice. Durey's findings have important implications for the issue of how to sustain general practice in rural areas.
Lee Thompson's paper focuses on the ways in which the professional identity of rural nurses is enmeshed with techniques of governance, requiring a considerable degree of self-surveillance by nurses. Rather than celebrating the much-vaunted autonomy of rural nurses, Thompson analyses the constraints they experience. She identifies the struggles that rural nurses confront in reconciling the demands of professional practice and maintaining a personal life in the face of community and professional expectations to fulfil 'duty of care' obligations.
Eileen Willis, Meryl Pearce and Tom Jenkin switch the focus from rural health practitioners to the social determinants of health: in this case, the impact of the River Murray's degradation on the well-being and livelihoods of local Aboriginal people. The parlous state of this important river system is attracting considerable attention although, as is so often the case, the impacts of its degradation on Indigenous Australians have received very little. This paper is welcome for re-dressing that imbalance. The authors reconcile what are frequently treated as divergent approaches to Indigenous health problems: those focusing on disrupted cultural practices, on the one hand, and those concentrating on the material environment, on the other. In doing so, they draw our attention to the idea of 'balance' between all aspects life, culture, and community, which is deeply embedded in Indigenous ways of knowing.
In considering the experience of rural practitioners, this Special Issue provides a broader understanding of rural health within sociology and attempts to open up new ways of understanding social forces and possibilities for innovation and change. It provides an overdue balance to the 'metro-centricity' of most Australasian health sociology and demonstrates a lively diversity in the field, in terms of both conceptual frameworks and subject matter. The collection encourages renewed engagement with rural health care and is informative reading for anyone involved in this area.Current concerns about the difficulties involved in rural health care, including the recruitment and retention of health care professionals in rural settings, makes examination of their experience timely.
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