Accepted Paper:

Moral economies of healthcare: contested forms of value in Darwin renal services  
Stefanie Puszka (Charles Darwin University)

Paper short abstract:

New relations of care emerge in the spectre of death, between Yolŋu renal patients and health professionals. This presentation considers the contested forms of value that emerge from polysemic understandings of care in Darwin renal services.

Paper long abstract:

Kidney disease has multiple impacts on the lives of Indigenous Australians. It is not only a significant contributor to the burden of disease, but through centralised health service delivery models, requires many sufferers to undertake permanent relocation to urban centres in order to receive life-sustaining treatment. In the Northern Territory over 80% of people requiring dialysis treatment leave remote communities to take up urban residences, the vast majority of whom are Indigenous. While some contend with the multiple moral economies that emerge in the giving and receiving of care, others ultimately decline or cease treatment, and return to their communities to commence palliation. Yolŋu (Indigenous Australians from north east Arnhem Land) have campaigned for many years to have renal services provided in their communities.

Based on a multi-sited ethnographic study with Yolŋu renal patients, health professionals and policymakers, I trace the emergence of new relations of care and new forms of community in Darwin renal services, in the spectre of death. I contend that disparate meanings and expectations of care, underscored by contested forms of value, shape the ways in which healthcare is rationalised, practiced, embodied and embedded in broader social relations. Conflicting notions of how obligation and power are exercised through care are mobilised by patients and health professionals within bureaucratic settings in coming to terms with difference and affecting value translations. 'Self care' regimes are a key site of contestation through which diverse forms of value are refracted.

Panel P30
Social death by neglect in health and health systems