Most people in Irish society have been affected in some way by the economic downturn of recent years, but few would deny that the most tragic consequence has been the numbers of men, women and children who are living on our streets.
Whether it’s the almost 100 regular rough sleepers or the sizeable number of others who rely on some form of temporary accommodation, those without a permanent home face complex challenges, with access to basic healthcare a primary concern.
On a cold Tuesday evening last month, Jean Twohig from Safetynet and her colleagues from Dublin Simon stood sentry outside the mobile health clinic – a specially fitted van with onboard consultation and waiting rooms – on the north side of St Stephen's Green in Dublin.
In existence since 2007, Safetynet provides GP and other health services to those who are homeless.
From what started out as a small organisation, the charity has expanded and now operates fixed-premises GP clinics in Cork, Galway, Limerick and many locations across Dublin along with a mobile service in the capital.
Twohig and her colleagues are waiting for members of the typical client group to make an appearance, and it isn’t long before the first patient of many arrives for their free check-up.
“The demand for primary healthcare services is definitely expanding and we’re trying to introduce new things to improve the services: the Hepatitis C programme; the needle exchanges; the methadone programme,” Twohig says, explaining some of Safetynet’s various initiatives aimed primarily at homeless people and women sex workers.
“There are lots of new things that we’re trying to expand from one clinic to another to try to spread the workload,” she says, as more people begin to congregate in the modest-sized waiting room.
Nearby, Martina Bergin from the Simon Community is chatting amiably with a familiar face she spotted ambling down the road nearby.
Their chance encounter provides a prime example of the benefits of having a presence at such a busy junction of the city every Tuesday and Thursday night, as well as it being a transportable base from which the team can reach out to people who tend to lead a transient lifestyle.
“What’s lovely about the bus being in a consistent location is that the clients will come up for a chat with the outreach team and then realise ‘okay, you know what, I’m not feeling too well, I might go in and see the doctor’,” she says. This is what happened tonight.
“The service opens the door for everything else, it’s not just the medical side of things. We can do referrals to things like treatment services, mental-health services, detox services . . . We also do medical card forms and housing applications,” she says.
Inside the GP room itself, Anne Grace and Clare Shields from Trinity College's GP training scheme – which provides a strong contingent of volunteers to the service – are busy attending to a growing number of patients.
Grace explains that she and her colleagues continually encounter the same kinds of ailments during these shifts, with respiratory and skin problems common complaints alongside wounds associated with drug use.
“A lot of what you see in day-to-day general practice is ‘worried wells’ – healthy people who are worried about becoming unwell. A lot of what you see in here are ‘unworried unwells’,” she says.
“Frequently we have conversations with people and we’re saying ‘You need to go to A&E,’ and they’re saying ‘Yeah, maybe, I might go tomorrow if it suits.’
“You are trying to convince them to go rather than the other way round,” says Grace, referencing one case in which a patient who was covered head to toe with severe psoriasis was reluctant to have it treated because the medication could not be taken with alcohol.
Bergin says that most of the people she deals with are hugely appreciative of the facility. One of these is 28-year-old Christine Joyce who regards it as an uncomplicated means of accessing clinical help and prescriptions.
“I come when I need to. I think it’s great because some people haven’t got medical cards and they can just come here.
“Some people would get scripts for things like antibiotics and they don’t bother going to the chemists, or you have to pay for them in the chemists and you mightn’t have the money.
“But I got mine straight away so now I can start taking them and hopefully I’ll feel better,” says Joyce.
She says she “probably wouldn’t go anywhere” and would get sicker if the service wasn’t available.
When Safetynet founder Dr Austin O’Carroll began the primary care clinics almost nine years ago he would typically get about 10 visits per session. This figure has increased sixfold in some instances despite the organisation’s expanded presence over the intervening years.
With about 1,500 children now homeless in the State, another worrying development has been the large number of young people who have been coming to the clinics recently.
“We are definitely seeing an increase in the amount of children. The issue that would worry me is we do childhood vaccinations but not in all the clinics, so that needs to be addressed,” says O’Carroll, who continues to offer his own expertise as a GP and in a supervisory capacity.
By providing alternative avenues of treatment to people who are among the most frequent health service users, O’Carroll says the activities of Safetynet and its partner groups help to significantly alleviate the burden on acute hospitals as well as saving the State considerable sums of money.
However, the case of a person with brain and abdominal injuries being discharged straight onto the street four days after admission to intensive care, as happened in one recent case, according to O’Carroll, is entirely unsatisfactory.
He says instances like this can be addressed by providing a step-down intermediate care centre, but is concerned that the HSE has still not followed through on its commitment to do so.
“An intermediate care centre takes them in, gives them rehabilitation and addresses any other issues such as drug and alcohol addiction, and after six weeks moves them onto other accommodation.
“We’ve been fighting for this for years. We are worried that the funding, even though it’s in a HSE service plan, may not arrive and we’re fighting for that actively at the moment,” says O’Carroll, who is otherwise complimentary about the financial support that is provided to Safetynet by the HSE.
The charity’s laudable efforts continue to receive widespread commendations in a difficult climate, not least its successful methadone programme which has improved the accommodation situation of the vast majority of participants.
Still, greater challenges may be ahead with the prediction that the unprecedented homelessness crisis will continue to worsen before it gets better.
“I’m predicting it’s going to get worse. If the rental crisis isn’t addressed, we’re definitely going to see more through that source. We’re also going to see more through drug addiction as well I think,” says O’Carroll.
With that in mind, Safetynet has embarked on a fundraising campaign to help pay for a new mobile health clinic which could help to satisfy demand in other parts of the country as well as in the capital.
“The van is well past its sell-by date. It was a private donation over 20 years ago and had been used as a private vehicle at that time.
“It’s very cold . . . it’s a little bit old-fashioned in terms of some of the medical equipment we have in it,” says Twohig.
“Because it’s idle for three days, the vehicle doesn’t start because the battery is dead and then we have to call out a Garda.”
The fundraising campaign will run on April 30th and aims to raise €100,000, which will be used to buy and adequately equip a new mobile clinic.
The new direction constitutes a change from the charity’s former policy of not actively seeking private donations, but then extraordinary times call for extraordinary measures as is the situation when more and more families and individuals continue to try to make the best of life in hostels, hotels and on city streets.
The planning group behind the new 100-place Brú Aimsir hostel on Dublin’s Thomas Street – an integral element to the 2015-2016 cold weather initiative – was determined that it would be more than just a roof over the heads of its occupants.
Following an inspection by Dublin City Council and Crosscare last October, the rather dreary looking warehouse was transformed into a welcoming space for those who did not have a place to live. Those involved were quick to identify the opportunity for a primary care clinic there.
“There was only one room in there with a door and I said ‘okay, this can be the clinic,’ but it was big so we had to put a wall down the middle and split it into two because then you’d see more patients,” says Fiona O’Reilly, a director with North Dublin City GP Training Programme.
In conjunction with Safetynet, trainees from the programme now run a clinic there every Tuesday morning between 8am and 11am, with further services provided on Thursday evenings along with supplementary nursing clinics.
Brú Aimsir’s high turnover of clientele makes it an ideal outreach centre for an often hard-to-reach community, O’Reilly says.
To date, about 150 patients have received consultations, vaccinations and Naloxone, a drug which reverses the effects of overdoses.
“It’s an eye to the homeless population in general,” she says.
“You’re accessing, in one spot, the most vulnerable and, therefore, you can do the health screenings, the vaccinations . . . you can link them into services and the doctors are seeing a lot of people who haven’t accessed any health services anywhere before,” O’Reilly says.