Athlone Institute of Technology
Department of Nursing & Health Sciences
Monday 16th April 2012
TRUST was founded in 1975 – see our website www.trust-ireland.ie for more information. Our work would not be possible without the enormous generosity and support of people from all walks of life, rich and poor, and even very poor. We have always said that in an ideal world there would be no need for TRUST – but of course this is not an ideal world.
“To be without a home is to be suspect. The homeless are easy targets. Their bodily integrity is constantly at risk. Their lives are an offence against the sacred canons of private property and consumerism. Their privacy is regularly intruded on as part of the price of being statistics in the poverty industry; their painful experiences are reduced to sociological research data. The true test of a civilised community is how people at the margins are treated. Not only must individual liberties be defended, but society should be educated and sensitised towards a broader vision of life and living. In an area dominated by the culture of individual acquisition, homelessness may have important lessons for us all.” – Dan Sullivan, then President of the Irish Council for Civil Liberties, describing what it means to be homeless in Ireland in a piece I asked him to write in 1995 for a book I co-authored with Ann Dempsey “Not Just a Bed for the Night” published by Marino Books in 1995.
The service we set up was the first of its type, and has been used as a model for services here and overseas. We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in the Liberties area of Dublin. We work in the basement of the Iveagh Hostel and are grateful to the Iveagh Trust who only charge us a nominal rent.
The philosophy of TRUST is based on two central principles:
The recognition of every individual’s right to be treated as an autonomous and unique human being.
The need to restore the dignity of individuals whom society has labelled deviant and undesirable.
Everyday we meet up to 60 men and women who sleep rough. We meet with people as they present themselves to us – all outsiders in our Capital City. Many come from outside the city, some from the remotest parts of rural Ireland, some returning to the land of their birth to be buried in the “old sod” and many from outside this jurisdiction. In February this year we had 15 different nationalities through our door. They came from Ireland, Romania, Latvia, Poland Czech Republic, Lithuania, Slovakia, Hungary, Estonia, Spain, Iran, Russia, Moldova, Slovenia and Canada. However, the numbers are decreasing – in February 2011 people from 25 different countries used the services of TRUST.
Many people we meet we have grown older with. Sometimes our place looks like a casualty department, as many people we work with will not go to A&E, and if they do go they will not wait, which obviously poses huge problems for hospital staff.
As part of a holistic service we provide bath and shower facilities. We have lobbied Dublin City Council to provide public shower facilities. Ironically, one of the best-known public baths in Ireland was sold by Dublin City Council and is now home to a very expensive gym, which is located just across the road from where we are based.
We seek to treat people as people recognising that they need help and have rights, especially the right to privacy and a right to be heard.
Hospitality is important. We provide tea and coffee, as we would welcome visitors to our own home and, most importantly, provide a listening ear. We frequently receive phone calls from members of the public about their entitlements and on behalf of people in prison and other institutions we know, with no one else to call. A lot of the calls we receive from members of the public are due to the frustration of having to deal with machines rather than an actual person. Many people we meet have no family contact, and often family members contact us about loved ones who have disappeared.
The people we meet are perceived by the wider society as being different and difficult; and indeed many are difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by what are often described as chaotic lifestyles. Accessing mainstream services – often basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again, an experience that often makes them feel even greater failures and more isolated.
People present to us with a wide range of medical problems including bodies that are ravaged by disease and violence. Some have pressure sores from sleeping out in all weathers, sometimes in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems e.g. leg ulcers and gangrene; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. We are now coming across conditions long disappeared since the advent of good food e.g. trench foot and impetigo (wild fire). These are conditions clearly associated with extreme poverty and many of the people who suffer in this way are our new neighbours from Eastern Europe, who like our own Irish who emigrated in the past. In addition we witness the consequences of racism, a new and worrying phenomenon in Ireland.
Some people we meet cope with very serious addiction problems, including drugs, alcohol and gambling. They suffer from despair and the pain of loneliness. They are pushed from service to service, often unable to get relief for minds at breaking point. These people are seen just as statistics in our increasingly bureaucratic world. Some people we meet have literacy and numeracy problems of which they are so often ashamed.
Many people we meet struggle to create a sense of normality after years locked away in institutions and others who have been relocated from one institution to another eg. psychiatric hospitals to hostels, much cheaper to run but often as institutionalised without the expertise available to them. Some people who are locked in prisons they have created for themselves, often out of the frustration of not being understood or ignored. Many people who were known to us have died on the streets and many more will. The true number is impossible to gauge because very often families feel ashamed that their loved ones ended up on the streets – some didn’t even know. The lifestyle of many who died would have been a contributing factor to their demise. A number of people we knew ended their own lives tragically and others have attempted to.
We meet some people who are so cut off from everything around them that they at times appear to be beyond reach. Others however challenge and inspire us every day to look at the way we all live our lives.
My last book was entitled “Wasting Time with People?” This title I chose having read a piece in British Medical Journal by Simon Challand, a former Medical Adviser from the UK in Uganda about the advice he had received from “an African Bishop with a smile –“ “Waste time with people”… You Europeans are always concerned about projects and budgets. The African does not worry about them–just waste time with people”. He gave me this advice in 1996 shortly before I came out to work in Uganda. Since then his words have kept coming back to me, and I reflect on their truth and wisdom and how difficult it has been for me, as someone with European values and attitudes, to apply them.” A contributor to the book suggested the question mark in the title. I am sure there must be times if you were honest with yourselves when all of you or at least some of you must ask yourself that question too.
In the area of work I am involved in it is shocking to see how debate around the issues of confidentiality is non existent. Resistance to compiling reams of data, storing and sharing it to fit into case management agendas, designed all too often by faceless bureaucrats has led to people being dismissed as “not being progressive enough”. I can vouch for that as we have ongoing contact with the Office of The Data Protection Commissioner about our concerns.
The following description of nursing was used to promote nursing as a career which I noticed a few years ago – “Nursing is inextricably linked with life. What other career permits practitioners to be present at birth, death and every life enhancing moment in between? Equally while few careers offer such opportunities to share in and care for the lives of others, nursing is about self-development too”.
This perhaps captures what nursing is about – or do you think so? Nursing challenges us too to look at our own humanity and vulnerability especially when working with vulnerable human beings and the current changing climate.
All contact with human beings moves us and when it doesn’t it is time to question why we are nursing.
Has it become all too easy to just become technicians and report compilers than listen to or touch fellow human beings. Have we lost ourselves to bureaucracy in the name of progress and are we afraid to even speak simple language to express human needs, not just that of those we provide services for but our own needs and those of our colleagues?
After one year working with TRUST, which we founded in 1975 we decided to compile a report. This document now makes depressing reading because it illustrates how little has changed for people apart from closure of small hospitals, changing landscape of the city and of course technology. From what we see on a daily basis it would appear that the most difficult people were ironically better cared for then.
However, while we may have made a valuable contribution to the development of services in that our approach has been used as a model for the delivery of care we find ourselves increasingly isolated because we insist on highlighting how nothing has changed for many of the people we meet everyday. More “experts” with little or no “hands on experience”, new legislation, more bureaucracy and a very intrusive approach through research into peoples lives with little regards for their rights.
I attended a conference on Health Reform just a few weeks ago and must admit I found its focus so narrow as to be depressing. There was little reference to nursing apart from referring to the changed model of nursing, no mention of carers, home helps or rural transport etc. and a lot of reference to research and figures. Of course good quality supervised research is crucial to good planning however it is worth reflecting on the following:-
“He uses statistics as a drunken man uses lampposts – for support rather than illumination”.
Quote by Andrew Lang, over 100 years ago.
I will give you just a few statistics from recent monthly figures and last year’s.
Sometimes the only hearing the people we meet ever get is when they are being researched – an issue we have grave reservations about because of the amount and quality of research being undertaken today. In that context nothing has changed in the last thirty years as a quote from a report we wrote in 1976 which could be published in its entirety today: “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.
Until those in positions of power or influence are prepared to sit with people in their misery and poverty, feel their pain, smell the smell of human misery and waste, feel the trembling body and listen to the cries of frustration rather than looking at statistics in neat boxes with grandiose titles nothing will change. If they cannot do it they should listen to those who can otherwise the vulnerable patients will continue to suffer and those of us working with them will only be adding to their misery through our silence. To speak out can mean exclusion, no promotion and a lonely existence – a situation that a philosophy of caring would simply prohibit and make impossible. I am reminded of the words of our esteemed former President Mary Robinson who in 2001 said “Each time you speak out with a critical voice you pay a price”.
An interesting observation worth reflecting on made by Judith Chavasse, former Director the Department of Nursing, University College, Dublin who contributed to my first book “Not Just a Bed for the Night”, which I co-authored with Anne Dempsey (1995), published by Marino Books:
“Nurses are the only professional group trained exclusively within the health service. Most student nurses enter straight from school into a hierarchical training system. To survive, they rapidly learn to conform. Hospital research in the 1980s found that student nurses’ experiences encouraged adaptation to the system, an adaptation seldom reflected on and usually internalised by the end of training. Most nurses are women. It has been argued that, out of mistaken loyalty, women often support structures and practices which are oppressive to others. Alternatively, the internalisation may have been refined to the extent that nurses have ceased to see injustice and have identified with the oppressive system. Anyone who demonstrates against this may provoke a storm of protest, as happened when research showed that some patients are treated differently if they are unpopular with nurses. Rebels, whether patients or staff, have a hard time in hospitals. Many nurses who maintain a rebellious streak leave the hospital system and exercise their caring role to great effect in a different environment”.
What has changed? Yes, we now have degree courses but is this creating a two-tier system? We do need to support each other and recognise each others skills and experience. We also now have more males in nursing but I recall we had a male student working with us a few years ago who left nursing because of bullying.
We should not allow human contact and frontline care to be devalued, it is not easily measured as you know. A philosophy of caring is good for people but is also the most economic in the long-term. The current management philosophy which is supposed to expose inefficiency has done little to highlight its own inadequacies.
The language of the current management philosophy is about performance indicators, benchmarks, outcomes and best practice etc. and is widely used, and goes unchallenged. Where does this leave the most vulnerable of people most in need of understanding, care and time and unable to speak for themselves. You are not “wasting time with people”, an essential part of a caring culture so often perceived as being uneconomic, to my mind it is the managers who are wasting time by not listening to you and the system therefore ironically becomes more uneconomic.
I am extremely conscious of the role we have as nurses within the system where we can – if aware – use our knowledge based on hands-on experience to ensure a culture of caring exists to ensure people are treated as people, not mere statistics and indeed to my mind we have an obligation to do so.
You nurses are highly educated academically, you should not be instrumental in creating a two-tier nursing service where the hands on work of those not academically trained is undervalued and so easily dismissed. It is by working together and challenging if necessary that’s required to make our health service a service we should be proud of – not something we can say with any conviction currently.
We should never forget the words of Eleanor Roosevelt:
“Where, after all, do universal human rights begin? In small places close to home – so close and so small that they cannot be seen on any map of the world. They are the world of the individual person: the neighbourhood he lives in; the school or college he attends; the factory, farm or office where he works”.
We of course have no real definition of ‘nurse’, and much time now perhaps is spent trying to distance ourselves from the vocation image of Florence Nightingale. However, the nurse intuitively comforts and cares – this quality is hard to quantify at a time when, to quote Oscar Wilde, ‘we know the price of everything and the value of nothing.’
In writing this I looked back at a paper I presented in 2005 when speaking in Cork at the presentation of the Miller Trust Scholarships organised by the Institute of Community Health Nursing. In a press release at that time I stated:
“We constantly hear complaints that health services are insensitive to people’s needs and allegations that unfeeling bureaucracy is out of touch. In most cases this is true but only because those in the frontline with the knowledge and experience are not consulted.”
I would add to that now – because we don’t speak out.
You nurses of the future will hopefully not be lost to our nation – we need you now more than ever before.
A Christmas morning a few years ago I happened to catch Eurovision Mass from Circus Pinter Top in Paris. Apart from the charm and artistry of Parisians I was struck by a few quotes from the Pastor and find myself reflecting on them regularly: “Encounters with people move us” he further said “It is the blind application of the law which makes us inhuman”.
Let this be your thought for the day.
Director & Co-Founder
A befriending social & health service
for people who are homeless
Founded in 1975
Tel: 01 454 3799 (w)
16th April 2012