Missionaries, Radicals, Feminists: a History of North Yarra Community Health
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Missionaries, Radicals, Feminists: A History of North Yarra Community Health Hamish Townsend First published in Australia 2012. Copyright © 2012. North Yarra Community Health. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) under the Act. Use of the photocopies must be for educational purposes exclusively, not for commercial publication or for other commercial purposes of any type. This history was commissioned by the Board of North Yarra Community Health in 2008. The final manuscript presented by the commissioned authors has been edited by the NYCH History Committee preparatory to publication. North Yarra Community Health 365 Hoddle Street Collingwood Victoria 3066 Australia Ph: (61 3) 9411 4333 Fax: (61 3) 9411 4300 www.nych.org.au Cover Design by Ben Hall, PsychOz Publications. Text design by Cameron Crawford www.cameroncrawford.com National Library of Australia Cataloguing-in-Publication-entry: Author: Townsend, Hamish. Title: Missionaries, radicals, feminists : a history of North Yarra Community Health / Hamish Townsend. ISBN: 9780646585574 (pbk.) Subjects: North Yarra Community Health (Vic.)--History. Community health services--Victoria--History. Dewey Number: 362.12099451 Contents | 3 Contents Introduction 5 Chapter One Singleton and Singleton’s 11 Chapter Two Two world wars and two depressions 21 Chapter Three From museum to laboratory 29 Chapter Four Territorial jostling 51 Chapter Five A crisis in health care 73 Chapter Six ‘I own a health centre’ 83 Chapter Seven Life on Easey Street 101 Chapter Eight New structures 117 Chapter Nine ‘Jeffed’: Occupation, amalgamation and renewal 129 Afterword 145 References 151 Interviewees 157 4 | Missionaries, Radicals, Feminists: A History of North Yarra Community Health Singleton’s Dispensary. C 1950. Photo: Courtesy of Collingwood Local History Photograph Collection Introduction | 5 Introduction ‘A hospital is a complex of human relationships, a small stage upon which the wider dramas of life and society are enacted’ (Janet McCalman, 1998). “Even more so a community health centre.” (Brian Stagoll, 2012). The old building everyone called Singleton’s is still there at 162 Wellington Street, Collingwood, now part of Victoria’s heritage.1 A classical two-storey brick building, it was built in 1889 with funds from public subscription as the Collingwood Free Medical Mission Dispensary ‘for the relief of the destitute sick of every creed and clime’. It was built on the site of the earlier Mission started by Dr. John Singleton in 1869. The building was active as a health facility until 1977 when, with a radically altered mission, it shifted to 365 Hoddle Street, as the new Collingwood Community Health Centre, later to become North Yarra Community Health (NYCH). Symbolic of the changes in the neighbourhood, 162 Wellington Street, a former bastion of medical evangelism once renowned for its bathhouse out the back, (a public cleansing station dubbed the ‘Star Hotel’), is now WOW, ‘Wet on Wellington, Melbourne’s finest gay pool and sauna’. This book is the story of what became of John Singleton’s Mission, an account of Community Health as practised over 140 years. Community Health has always been a chaotic, passionate and politically-charged project that insists on a social model of health. This model offers an alternative to the medically dominant, conventional models of health care in this country. Conventional medicine moves towards models of care that are private, individual, acute, hospital-based, hierarchical, and technology-focused. In contrast, the social model proposes an emphasis on the social influences and connections in peoples’ lives. It is sociable as well as social, and aims to be accessible, non- hierarchical, and directly accountable to the community it serves. It is usually low fee or free at the point of delivery and seeks options other than fee-for- service. Its catchwords are ‘public’, ‘population-based’, ‘participatory’ and ‘preventative’. 1 Victorian Heritage Register[VHR]HO497 6 | Missionaries, Radicals, Feminists: A History of North Yarra Community Health Of course, the reality of health care is more complicated than a simple division into ‘medical’ and ‘social’ would suggest. Effective health care requires both a biomedical and a social approach, a point some health policy makers now finally recognise. The great triumphs of 20th century acute and hospital-based medicine (e.g., anaesthesia, surgery, antibiotics, diagnostic imagery, intensive care) have failed to come up with answers to the joint challenges of chronic illness and ageing, coordination of care, and effective strategies for prevention. This has brought the importance of the social model to the fore. It deals with problems that do not fit easily into the neat categories proposed by technology and biomedicine. As somebody quipped, ‘Medicine is a very interesting intellectual and technologic discipline. Pity the patients mess it up’. A social model is about clearing up the mess. Its institutional expression, Community Health, calls for a change in focus. Patients and their families living in their communities are placed at the centre of care. How can they participate actively and cooperate to improve their health, and that of their community? How are people affected by the powerlessness, marginalisation and lack of control that comes from poverty or social dislocation, prejudice or a toxic environment — the ‘social determinants of health’? What is to be done? This book is an attempt to show how part of inner city Melbourne faced these challenges. It is not an exhaustive account of NYCH’s history since 1869. Writing it has been a messy process, just like the subject it tries to capture. In fact, at one point ‘Messy Health’ was put forward as a possible title! Several times the book threatened to be swept up in anecdotes of social movements and political struggles and the vivid personalities they spawned. They are good stories, but in the main the authors have tried to move on past them, to capture the challenges of health care in different eras, and how they were addressed. The particular focus is on two eras — the early Singleton Dispensary days, and the 1970s Whitlam reform era and its aftermath — because these were the times when the opportunity and need for reform was most evident. It begins with the redoubtable Dr Singleton and his equally formidable wife, Isabella, whose portraits still overlook the Collingwood waiting room alongside a portrait of the recently retired Dr Chris O’Neill, a 20th century counterpart to Singleton. The energetic fire first lit last century by this great Victorian doctor and evangelist has burnt in many directions, but has never been extinguished. Like other great institutions, Singleton’s and its successors have hosted missionaries, radicals and feminists along with charlatans, worthies and quiet heroes. All have been both provocateurs and victims of major social struggles Introduction | 7 in Melbourne. Most of all, they have been an ornament and an inspiration for the important idea of Community Health. The roots of Community Health may be taken back to the idea of the Dispensary, an 18th Century response in Britain and colonial America to address the unattended health of the urban poor. The Dispensaries were to fade with the rise of hospitals, but there are still important lessons to be drawn from them. The history of the Dispensary Movement is recounted by the eminent medical historian, Charles Rosenberg (1974, 1992, 1997). He argues that this is a neglected history that can provide ‘would-be reformers with a potentially useable past’. This book is an attempt to redress the neglect outlined by Rosenberg. Established in January 1869, Singleton’s was the first Dispensary in the Colony of Victoria.2 How it operated will be detailed in later pages. The ideas that infused the Dispensary remain the foundation stones of Community Health: recognition of the social determinants of health; community accountability and local involvement as an expression of democracy in health care; focus on primary care at the centre and not the margins of health; and, support for prevention, and health promotion and literacy. These foundations of community health were reinforced in 1978 by the famous World Health Declaration of Alma Ata, ‘Health for All’. This was an historic assertion of health as a fundamental human right. Its resounding principles deserve repeating: equity, social justice and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action. More than thirty years on, these principles are still ‘relevant, revolutionary and revitalising’ (Lawn et al, 2008). Of course, the ‘Alma Ata Declaration’, like great works of literature, has more than one layer of meaning and has been interpreted in different ways by different people across the globe. This book is about one local interpretation of Alma Ata, played out in Carlton, Fitzroy and Collingwood. The three small suburbs exist side-by-side on a gentle slope from the City of Melbourne down to the Yarra River. The descent reflects the fortunes and health of its residents. Carlton at the top of the hill is a unique suburb, home at different times to the centres of trade unionism, the nation’s parliament, and the city’s oldest and most prestigious university. Through its history, Carlton contained many areas of poor housing and poor health, but was largely a suburb of shopkeepers and the mobile working class. Fitzroy had a greater mix of middle class and poor with greater extremes of poverty, with the slums 2 A Free Dispensary was also started in Richmond in March 1869.