نبذة مختصرة : This is an ethnographic study which seeks to understand the functioning of a Western Cape primary health care facility, the Hanover Park Community Health Centre, in terms of the space it occupies, transforms and utilises. The study aims to demonstrate that space as an object of inquiry may provide valuable insights into the structuring and interpreting of clinical activity and identity. Fieldwork was undertaken at the community health centre and varied forms of data gathering were used to reflexively observe the manner in which the CHC's space was planned, used and interpreted by staff, and to a lesser extent, patients. Space was understood and examined in the following ways: a) Disciplined and ordered space as an intrinsic component of modem biomedical functioning; b) The role and interpretation of multiple spaces within the staff's cultural construction of the clinic, c) The orthodox and unorthodox use of space as a strategic resource in a context of gang violence and health service crisis. The architectural design of the clinic was analysed in terms of the international criteria and logic for PHC facility design. Unique local features were understood as socially and political contingent. Spatial disorder and insecurity was demonstrated to impact directly upon clinical functioning and social identity. Current changes in health policy, service deterioration and community conflict have amplified staff's anxieties regarding real and metaphoric clinic boundaries and integrity. Staff and patients sought to appropriate and reinterpret spaces as a strategy of power and authority. The Trauma Unit was examined as a particularly vulnerable site where unorthodox forms of power were taken up by staff and patients in a performance facilitated by the uniquely public and chaotic nature of this clinical space. The study concludes practically by stressing the necessity of ·a spatial understanding in health service management and policy development.
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