Working as a GP with the Adult Homeless Integrated Service, Cork, Don Coffey advises patients on diet, hygiene and sexual health matters
Many people working with the homeless want to end homelessness, which is a nice idea but I see my job as the provision of healthcare to those who have difficulty accessing it.
I work with an interdisciplinary team, including an addiction counsellor, a psychiatrist, two community mental health nurses and four community welfare officers. Working with a nurse, I hold five clinics a week for homeless people in Cork; three in the Simon Day Centre and two in the St Vincent de Paul hostel. Our administration work is done from our office at Lough Community Centre in Greenmount.
My day usually begins at 9.30 a.m. when I contact the shelters to see if there are any outstanding issues or if there is anyone they are worried about.
We see a lot of people. In our first year in 2002 we had 1,100 consultations with 300 people. This was when we were just operating three sessions a week.
A lot of my work involves building trust and confidence with the clients. A lot of the people I deal with have no trust in the system and encounter real or perceived obstacles while trying to access services.
For example, it is hard to keep an outpatient appointment when you don't have a roof over your head. We contact the hospital and do some advocacy work for our clients and can get a copy of their appointments sent to our office.
Sometimes appointments are missed because people are afraid to go to the hospital on their own. Just like you or me, if they are going for tests they want someone to go with them. We can organise that. It's a very simple solution.
When I see someone I try to treat them for what they present, such as a chest infection, skin disease or lacerations following an assault. I also try and assess their other needs and maybe refer them to other members of the team. However, we have to accept them as they are and not as we would like them to be.
Many people arrive in Cork from other jurisdictions and don't know what services are available to them. Often people tell me things that they have not told others, such as the fact that they are begging for a living, they have no medical card or are not on the housing list. I will tell them about the benefits they are entitled to and try to help them access the services they need to sort it out. I also advise them on diet, hygiene, sexual health matters and vaccination.
When I see a patient for the first time I try to get a full medical, social and psychiatric history from them. Then I attempt to corroborate this information. Often I just have a name of a doctor in London and I have to track them down to see what medication a patient has been on.
Ultimately we try to get everyone registered with a GP in the city. We treat patients aged between 18 and 80. It is a slow process. They have spent a lifetime getting to where they are and this can't be changed overnight. You can't tell people what to do. All you can do is advise them.
Before this I worked for two years in private practice. I wouldn't go back. I enjoy the job. Working in a team is the only way to deal with the difficulties in the job. The hardest part is dealing with the high level of mortality among homeless people. Many of those who die are young people.