Dublin GP Dr Austin O'Carroll is cycling around the Ring of Kerry this Saturday to raise funds for Safetynet – the Republic's first primary care network for healthcare professionals working with the homeless. He talks to JUNE SHANNON
WHILE THE 112-mile route around the picturesque lakes would represent a major challenge to the most able of people, for Dr Austin O’Carroll who has a disability it will be a massive undertaking.
O’Carroll has thalidomide as a result of his mother being given the drug for morning sickness in pregnancy in the early 1960s. He was born in 1962 with shortened legs and, like the majority of those living with thalidomide in Ireland today, his disability continues to deteriorate.
“In 1991 I would have been able to walk five miles. The maximum I could walk now without pain would be 100 yards,” he says.
Walking puts a lot of pressure on O’Carroll’s joints. He suffers from the very painful condition of osteoarthritis in his ankles, which makes walking long distances impossible.
Today cycling is his preferred mode of transport and he can comfortably cycle up to 70 miles. However, the 112 miles, which he aims to cover on July 4th, will be the furthest he has ever cycled.
O’Carroll is the chairman of Safetynet and hopes to raise funds for a mobile outreach clinic that is due to be launched in August in conjunction with Simon, the Salvation Army and Chrysalis.
This outreach service will provide healthcare for the homeless and women engaged in prostitution. The network also plans to provide general and sexual health and cervical screening to women working in prostitution.
As well as delivering services “on site”, the unit will act as a gateway to engaging this cohort with Safetynet Primary Care health services, with the ultimate objective of moving them to mainstream services.
“This is basically a truck which is converted into a surgery clinic with a waiting room attached. It will be staffed by volunteer senior doctors and trainee GPs, a volunteer driver and a nurse.
“They will review homeless people for medical care and try to get them to link in with daytime medical and social services. It has been shown internationally that such clinics reach people who do not visit other services,” O’Carroll explains.
The overall cost of the mobile unit will be €20,000.
According to the 2008 study, Counted In – A report on the extent of homelessness in Dublin, carried out by the Homeless Agency, a total of 2,366 adults were in homeless services in 2008.
The Primary Care Safetynet Network was established in May 2007 with the aim to “ensure the delivery of the highest possible primary healthcare to homeless people”.
It comprises eight centres or clinics in Dublin city centre and two in Cork with eight nurses and 10 doctors providing primary care services for the homeless.
Safetynet endeavours to ensure its members provide a co-ordinated primary care service to the homeless by providing them with a common medical record database, communication channels and a clinical governance structure. It also seeks to identify and plug gaps in service provision.
O’Carroll says Safetynet does not provide the primary care service itself – this is done by the individual clinics – but is a facilitating network “implemented through the energy and commitment of a number of key players including the HSE, GPs, nurses and the voluntary sector who work in partnership to provide the service”.
Members of the Safetynet network operate from specific shelters and hostels. This dedicated service aims to meet the complex health needs of the homeless population many of whom do not have a medical card and cannot afford to pay to see a GP.
One of the clinics is open Monday to Sunday from 9am to 5pm. Doctors also work an on- call rota with nurses and GPs circulating among the hostels. In 2007, the centres had more than 6,500 patients on its records and last year healthcare staff conducted a total of 14,901 consultations.
The service has also facilitated daily health and regular vaccination clinics as well as links with AE at the Mater hospital through emergency medicine consultant Dr John McInerny.
Services offered in the clinics include nursing assessments, wound management/skin problems, general health problems, mental health assessments and referrals, sexual health, harm reduction – safer injecting information – referrals to hospitals and other services, health promotion, counselling, chiropody and dental treatment.
The Safetynet programme is the first health network for the homeless to be linked by a computer database. This means that details of all clients attending the service are contained on an internet-based system, so that when they attend any of the clinics across the city, the attending GP will be able to access the patient’s history on file.
O’Carroll, who sees patients in the Cedar House Salvation Army hostel and two transitional hostels run by Dublin City Council, explains that patients present with chest infections which tend to be more extreme among the homeless population (and includes TB). Other problems include back and muscular pain, foot ailments and skin conditions.
Mental health problems include suicidal and parasuicidal behaviour and drug-related problems such as abscesses. Hepatitis and HIV are also common.
A study commissioned by the National Advisory Committee On Drugs in 2005 found that 90 per cent of people experiencing homelessness had a physical health complaint, 48 per cent reported concerns regarding their psychiatric health, 76 per cent had an alcohol problem and 64 per cent had recently used illicit drugs.
So members of the homeless population need the support of the psychiatric services. The Safetynet programme has the support of the Assertive Community Care Evaluation Services (ACCES) Mental Health Service, an outreach service for homeless people with a severe and enduring mental health illness.
Safetynet is funded by the HSE, which covers both the IT costs and the salary of the co-ordinator. The service has also benefited from a generous grant of €27,000 from the ESB which has been used for the refurbishment of the hostel-based surgeries and the further development of the computerised medical records.
The service also aims to build an Intermediate Care Centre where those who have been recently discharged from hospital or who need further medical care can be looked after in a safe environment.
O’Carroll was instrumental in calling for the provision of such centres in Ireland and his work has now reached the international arena with more countries looking to follow Ireland’s lead in this area.
“At the moment, if you are in hospital and homeless you are discharged straight back to emergency accommodation. But they cannot keep a bed for you so if you had a bed in emergency accommodation and go to hospital for two weeks the bed will be given to another person.
“Obviously if you are recovering from major surgery or intervention and are suddenly back on the streets, it doesn’t make sense,” the Dublin GP explains.
“Also in an emergency hostel you are out on the streets at 8am, so to go from hospital to that facility doesn’t make sense. We want to set up a facility where people can be discharged and where we can have a proper [care] plan with a number of interventions in place.
“We also see people who have abscesses due to injecting who won’t go to hospital but they need IV antibiotics, or people with bad chest infections. They just won’t go to AE . . . partly due to past experiences or because they use drugs and they can’t use drugs in AE.
“We want to have the facilities so we can send them to a particular centre which would be more sympathetic to their needs in terms of maybe getting methadone or which will allow them to leave every now and then if they wanted to.”
If you wish to sponsor Dr O Carroll contact: 01 8303325 or austinoc@hotmail.com