Travellers' take on health - Ireland

From the Irish Times

Discrimination and racism can takes its toll on Traveller health but a Primary Healthcare for Travellers Project is making inroads in improving their access to care and knowledge about their health, writes ANGELA MEZZETTI

FAKE-TANNED Traveller women getting ready for big gypsy weddings – this is the cartoon picture of Traveller life that’s portrayed regularly on TV screens for entertainment. Far from being the norm though, daily life for Travellers is more of an uphill battle with difficult living conditions and subtle and not-so-subtle racism that has a direct effect on their health.

The effects of anti-Traveller sentiment is not simply hurt feelings, it affects life expectancy in very real measurable ways. Anti-Traveller perceptions that many people are unaware they possess can have a detrimental effect on Travellers’ quality of life, education and mental health.

Older Travellers are few and far between with just eight over the age of 85 living in Ireland, according to the All Ireland Traveller Health Study in 2008.

Their child survival rates are much lower than that of the settled community too.

Traveller women’s life expectancy is 11 years less than the settled population and 15 years for men. The population pyramid for Travellers in Ireland is like that of a third-world population, according to Brigid Quirke, Pavee Point’s national health adviser.

“Our research shows that there is institutional discrimination in the services. They assume you can read, write, that you have education to interpret and that you have access to transport so they exclude people at the margins.”

Molly Collins, an older member of the Primary Healthcare for Travellers Project team, which works from the Pavee Point base in Dublin, has faced overt racism and snobbery all her life. Simple courtesy when going to doctor or outpatient clinics would make a world of difference, she says.

“They could make you feel welcome, that would be a start. We face a lot of barriers when we go to use services. As soon as we say where we are from or they hear our accent, they look down at us.” She says that medical staff often complain that Travellers don’t show up for appointments. “We don’t always get them because we mightn’t have a postal address and many of us can’t read them anyway.”

Bridgie Collins, a fellow healthcare worker, says: “When we go to hospitals we can’t read the signs, so we don’t even know where to go.”

Post and literacy problems aren’t the only obstacles they face. “You may be embarrassed about seeing a doctor if you don’t have running hot water to get yourself ready,” Collins says.

These women, who are community health workers, focus on getting healthcare information out to their communities in ways that can be understood, through one-to-one conversation, illustrative posters, leaflets and videos.

Two men also work on the team of 19 and they have never been more necessary with male suicides in the Traveller community six times higher than the rest of the population and male mortality four times higher.

Another key function of the team is to gather information on Traveller health and family circumstances and assist other healthcare professionals such as community nurses.

The team also collects detailed Traveller-specific health information from various sites mainly in Finglas and Blanchardstown.

Because many of the team members themselves don’t have full formal literacy skills, the information forms they complete are colour-coded with icons to show births, deaths, immunisations, developmental health check information, etc.

“They collect the information, it’s their data and the information gets fed back into the community,” says Quirke.

One of the positive impacts of the project has been the higher uptake of vaccines. “Before now, Travellers would have been afraid of too many needles. They stopped getting them after the MMR scare,” says Mary Brigit Collins. “Our job is to go out and explain how it protects the children from measles and other diseases.”

They also give out general health advice on topics such as dental hygiene and diet, assist with appointments and provide contact numbers and links for helplines.

Kathleen Mac Donnell says: “It makes me happy to help my own people and not to have to hide my identity. We have now linked with organisations like the Alzheimer’s association to develop specific resources.”

According to Fran Keyes who has worked with Travellers for many years, they provide information at a time that suits families to call and in ways they can understand. “They build relationships and highlight gaps in services.”

Other team members concentrate on advocacy and lobbying for changes in areas that have a real effect on Traveller health such as accommodation, education and employment opportunities.

Travellers often meet racism and discrimination in the education system in ways that may not be obvious.

Mary Brigit Collins says when her child comes home from school she says, “Mammy, the teacher asked me to draw a picture of a house.”

“They never ask her to draw a picture of a trailer.”

The Pavee Point project is integrated with the Health Service Executive and was the first of its kind in the country. The model has since been rolled out to 40 other centres.

“There is a steering group with representatives from the HSE and Traveller community, so if an issue comes up with medical cards or environment, a decision-maker can be brought in to move things forward,” Keyes says.

“One of the ways in which we have changed behaviour is in accessing services for women.”

The team found Traveller women were not availing of routine smear tests and breast checks, so they worked with the Well Woman centre in Coolock and block-booked evening appointments. “Initially two healthcare workers would go on a bus with a group of about 12 women for reassurance.”

Having got used to the clinic and the system the women now make their own appointments and go alone, but that reassurance had to happen for quite a long time.

The project’s 2008 study found that survival outcomes from disease are much worse for Travellers than the general population. “They are dying from the same causes as the general population but at much higher rates,” according to Quirke. She believes this indicates that they are not getting diagnosed and treated in time.

One of the aims of the project is to have ethnic identifiers in all information collected by Government bodies particularly healthcare systems.

Quirke believes it’s needed to identify gaps in the system such as why there are such low referrals from GPs to outpatients rather than emergency departments.

Keyes says they continue to work with providers for solutions such as arranging for family clinics so that everyone can go at the same time.

If this policy is successful – and with more icons and colour coding of signs in hospitals – this could be a huge improvement not just for Travellers but for everyone with reading problems, visual and hearing impairments and the confused state of mind that goes with entering a healthcare setting.