FOCUS: "...it can feel like the system is conspiring against you"

Thursday 29 December 2022

Since 2020, a small group of doctors have been holding free clinics at Jersey's homeless shelters, with the aim of providing essential healthcare to some of the Island's most vulnerable residents.

In some ways, the statistics speak for themselves. The latest Care Model Report claimed that whilst the Shelter Clinics were operating, there was a reduction of... "67% in emergency department presentations between 2018 and 2021, with an annual reduction of around 42%."

Feedback from users was also positive: "I have really valued being able to access a GP on a regular basis." Or, "The GP's avaliability to allocate these sessions every week to all, is invaluable. The two GPs are respected and trusted and provide an excellent service."

Dr. Deryn Evans is one of those GP's providing clinics to Shelter residents. She is also one of five forensic medical examiners for the Jersey Police, responsible for "ensuring that anyone's who in Police custody is fit to be there...and quite often it's our job to arrange ongoing care for those in custody." 

Pictured: Dr. Deryn Evans is one of the Forensic Medical Examiners for the Jersey Police and provides care for those who end up in Police custody. 

While working in this role, Dr. Evans saw that those in Police custody who were homeless or frequently stayed in homeless shelters, were simply not getting the medical care that they needed and realised that a potential solution was to run a clinic at the island's homeless shelters.

The process was slow going at first with funding proving difficult to come by; however, that changed during the covid-19 pandemic.

Around once a week, GP's will hold a clinic at homeless shelters run by the Shelter Trust and Sanctuary Trust. Dr. Evans said: "...the staff are amazing, I cannot sing their praises enough." So far, there are three doctors involved. Aside from Dr. Evans herself, there is David Bailey, a specialist in treating drug and alcohol-related issues and a member of the Misuse of Drugs Advisory Committee in Jersey, as well as Dr. Fred Rud.

Pictured: The Clinic Room at Aztec House

The community they look after often present with serious medical conditions that would otherwise be left to get worse. Dr. Evans mentioned that they have previously diagnosed serious heart murmurs, identified the need for valve replacements, diagnosed serious infections, and have identified the need for major surgery.

She has even diagnosed pregnancies, and ensured the correct pre-natal care was received. She said: "...a lot of the pathologies we see from people would not be addressed by a doctor, and as a result it wold just get worse and worse until they end up in hospital for weeks. Of course this is bad for them, and it will end up costing the States an awful lot more money." 

Pictured: Many shelter residents suffer from the effects of substance abuse.

There are a number of reasons why shelter residents are unable to access the right medical care.

Some of the patients suffer from the effects of alcohol and drug abuse, or mental illness, such as hearing voices, depression, post-traumatic stress disorder and childhood trauma.

This often results in them being unwilling to seek medical help, but also makes them more likely to miss pre-arranged appointments.

Dr. Evans said: "They're all a little bit wary...they can be a bit chaotic! So its so important that they get to know us. If we go regularly, we can start building rapport and building trust. They know me, so they're more likely to come along to their appointments and get the help they need." It's often a challenging process, "...there are times you feel a bit intimidated, but I know a number of them from my Police work and they know me. You have to understand your clientele so to speak."  

Moreover, the financial situation faced by shelter residents often creates a vicious cycle. 

Dr. Evans cited the example of a woman with a serious medical condition who did not have a passport, and could not afford to get one. As she couldn't afford a passport, she couldn't  register for a GP. As she couldn't register, she couldn't get a doctor's note which in turn meant she was unable apply for the income support she was entitled to, and as a result had no income. "In some ways it can feel like the system is conspiring against you."

One major problem that Dr. Evans pointed out was the lack of dental care provided to shelter residents. She said: "Some of these residents have very worrying teeth, often as a result of drug use, Methadone for instance." However, many residents simply cannot afford the right dental care - one shelter resident was left with an injury that required literally thousands of pounds worth of dental work to fully treat.

Moreover, the dental department at the General Hospital "has a fairly tight acceptance rate" and so often referrals are turned down. In short, Derys said: "they need more investment and more funding...often these people will wait until they end up in prison before they get their teeth looked at, because at least there they're guaranteed a dentist...which is just not right."

Overall, the project has had a huge impact for those who take up residence in the shelters.

David Wright, the Manager of Aztec House, said: "A lot of the time people, not just in here but in general life, don't put their health first. By having a clinic which is free, residents will actually come and get the care, whereas if they weren't here they just wouldn't. It's been very positive. They get a good service here, and its usually pretty busy....By having the same people come through, it's definitely beneficial, all the residents know the doctors now so they're a bit more open with their issues. It's worked really well, it's important that it keeps going and the funding stays in place."

Pictured: "People often turn to substances as self-medication for trauma so we should understand it as a response to something awful that's happened in their lives, rather than as a reason for anti-social behaviour."

The care these GPs provide is vital to this often neglected community of people.

Dr. Evans feels there's an unjustified stigma surrounding this vulnerable community, often stemming from the well-acknowledged issues of alcohol and drug use.

She said: "people often turn to substances as self-medication for trauma so we should understand it as a response to something awful that's happened in their lives, rather than as a reason for anti-social behaviour...society tends to turn a blind eye to these people, but its important to remember that if any of us had a different journey in life we would end up in the same position...you get plenty of people from all walks of life down there...lots of people who've worked in finance for instance...society tends to judge them...but if we can get them the help they need then that will ultimately benefit society as a whole."