A GEOGRAPHY OF HEALTH CARE : DIALYSIS PROVISION AND THE LIFEWORLDS OF WOMEN PATIENTS

Abstract

Space and time form the fabric on which is inscribed the dynamic relationships and processes which human beings as active agents form with the underlying structures of society. Placed in the social context of Singapore, this thesis examines the nexus between state, mediating structures and individuals in the meeting of needs of dialysis patients as a group of chronically ill people requiring regular treatment for a malfunctioning body part. The investigation of the structural influences underlying the management of the country's social welfare needs of which health care is an integral component begins the analysis. The restructuring of the health care system focuses attention on the allocative principles adopted by the state. These are justified through the "Many Helping Hands" approach to spread the burden of social welfare. This also signifies the apparent relaxation of parameters bounding political and social space with the state-induced creation of a civic society. The rise of voluntary welfare groups attending to the dialysis provision of kidney failure patients is complementary to the state's thrust. However the cleft in the veneer of mutual existence is evident as each carves out and safeguards a space to situate itself. On another level of analysis, these organisations act as mediating structures between the state and the individual, ameliorating the distance between the two and more significantly, reconfigure the lifeworlds and spaces of the individuals by returning them their productivity and sense of well-being. All of the above are carried out through the analyses of published state reports, interviews with the organisations and 41 in-depth interviews with men and women patients to discern the reconfigurations of individual lifeworlds. This study also argues that the subjective experiences of dialysis patients are closely related to social roles and relations. Hence, individuals' management strategies are structured along the gender divide with subsequent ramifications on the renegotiation and remapping of the patients' lives.