Hospitaller Order of Saint John of God
Provincial Curia, “Granada”, Stillorgan, Co. Dublin
Wednesday 12th December 2012

Thank you for asking me to participate in this conference on the very important topic of respect. Let me describe our work in TRUST
TRUST was founded in 1975 – see our website 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. Many people we meet we have grown older with. In November this year we had 16 different nationalities through our door. They came from Ireland, Romania, Latvia, Poland, Somalia, Lithuania, Slovakia, Estonia, England, Russia, Iran, Hungary, Wales, Malasia, South Africa and the Czech Republic. This month we had 33 (15 Irish & 18 non-Irish Nationals) new people using the services of TRUST – a figure not seen since July 2008 (19 Irish & 14 non-Irish Nationals)
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 to us 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. Let me describe the Tuesday morning after last Bank Holiday.

It was calm but cold in Dublin, a marked contrast to the massive storm, the worst in U.S. history experienced by those living on its East Coast. Carl O’Brien, Chief Reporter, Irish Times in America covering the Presidential Elections wrote about America’s working poor, struggling to make ends meet. He described the Friends of St. Andrew Hospitality Centre, the food banks and other centres in Aurora, Colorado.

When we opened our gate at 9.00am we were informed that Tom (not his real name) known to TRUST for years had died. He called regularly for a cup of tea, shower, clothes, wounds dressed as he battled with addiction that was tearing him apart. Unlikely we would be contacted by anyone about him as accommodation providers are too often seen as the only service providers working in the field. Weekly we hear second hand of people we know who have died and continue to be saddened by the fact.

In a 3hr period 44 people, all labelled homeless, 42 men and 2 women visited TRUST. All were cold, the majority dirty and unkempt and I suspect ashamed of the fact. All were known to us. Some attempted to sleep, all had a hot drink, some chatted, others were lost in their thoughts.

People had come from across the city: Irish Life Centre, Aviva Stadium, Stephens Green, Molesworth Street, Harcourt Street, Nassau Street, Heuston Station, some didn’t quite know the location or were reluctant to tell us.

A number came from hostels for showers and clothes in spite of the fact that these hostels were heavily grant-aided by the State, 1 was fearful he would loose the flat he called home in Dublin 4. In the 3hr period 27 people had showers and 28 got complete outfits of clothes, all donated. 6 people had painful feet, treated after soaking then dressed, or foot powder applied and new socks given to help the upcoming hours of walking around aimlessly. 5/8 people had various wounds cleaned and dressed.

Of those who called the majority were Irish and 10 were from Poland, 4 from Latvia, 2 from Slovakia, 1 from Russia and 1 from Romania.

We looked back on the same day following October bank holiday in 2002 (10 years ago) which was a very wet day 23 people, all Irish, called – 3 were female. 19 had showers/clean-ups and clothes, 1 dressing, 2 had chiropody.
4 of above still use the service of TRUST and 4 have died – we suspect others who were struggling have died too.

In the 10 year period [2002 – 2012] there has been a huge increase in the numbers of people attending TRUST in spite of the fact that massive funding has been spent addressing homelessness and this includes the production of numerous glossy reports. When TRUST was founded we thought we could be done without in a short time – how naïve we were.
10 year ago we had no non-Irish Nationals using our service apart from perhaps a number of people from our near neighbour which we have now who are attending in large numbers, some months meeting people from up to 20 different countries – all living in appalling conditions and many of these people known to us have died.

My last book was entitled “Wasting Time with People?” and so is the title of this paper. 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 – am I wasting time?
Due to demand we had a re-print of the book and are promoting it through our website at a reduced price. Former President Prof. Mary McAleese very kindly wrote the introduction for the web promotion together with pieces from Carl O’Brien, Chief Reporter, Irish Times and Prof. Aidan Halligan, Director of Education, University College London Hospital.
Professor Aidan Halligan who is Director of Education, University College London Hospital and former Deputy Chief Medical Officer for England, a man I greatly admire said when he was keynote speaker on the first day of The Sunday Business Post iQuest 5th Annual National Healthcare Summit in June 2008 which was reported on by Aileen O’Meara:- “How can healthcare be managed more efficiently?.. His presentation was made to the private sector healthcare companies, academics, HSE senior managers, senior hospital management, trade union representatives and business consultants. He spoke about “rediscovering [the] lost values” of caring for the patient, and the struggles to change attitudes and expectations among frontline nursing and medical staff, attitudes like “a subtle withdrawal of enthusiasm”” – or burnout, disillusionment and lack of interest…. The Irish health service was “overmanaged and underled. You should get leadership from the frontline staff” he said. Why aren’t doctors and nurses, everyone, rising up and putting patients first?”

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 definition could be used I think too when referring to the various disciplinaries you have in the wonderful service you provide where we are all challenged too to look at our own humanity and vulnerability especially when working with vulnerable human beings and the current changing climate.

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 when resources – human and financial were scarce.

But how can we ensure that people are treated as people? This is the most basic human right – the right to be treated as a human being and not a statistic, as the award winning South African Satirist Pieter Dirk-Uys said so eloquently to me when I met him some years back.

We hear a lot about research and of course we need good quality supervised research to plan services but I am mindful of the words of Andrew Lang (not the well known or should I say controversial psychiatrist Ronnie Lang) over 100 years ago.
“He uses statistics as a drunken man uses lampposts – for support rather than illumination”.

Some people who are homeless, poor, vulnerable or just different feel pressurised to take part in research into homelessness in case they lose their hostel bed or their entitlements. We only become involved in research, when we believe the research design is sound, ethical and likely to provide useful information and would be concerned about the sharing and storage of confidential information without due regard to the rights of our fellow human beings.

Of course research is essential to plan services. “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”.

This last quote is from Leahy and Magee – Report on Broad Medical Services for Single Homeless People in the City of Dublin – March 7th 1976 – 30 years later, in a new millennium –what has changed? Our concerns have led us to complain to the Data Protection Commissioner – our concerns remain.

The language of 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 planners who are wasting time by not listening to you and the system therefore ironically becomes more uneconomic.

I strongly believe that 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 people in our care 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”.

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 or even admit its own inadequacies as we see daily in the media and indeed without a well informed and resourced media many people would be so much worse off.
I am extremely conscious of the role we all have 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 as leaders too must remind yourselves of those working on the frontline and support them at every turn. It is by working together and challenging if necessary that we can maintain a service we should be proud of – not something we can sadly say with any conviction currently about our broader health service.
I would like to pose a few questions:-

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?

All contact with human beings moves us and when it doesn’t it is time to question why we are here, but increasingly it has become too easy for managers, particularly in the area of public service to remove themselves or allow themselves to be removed from the coal-face or have we allowed this to happen?

This means that the focus on people is being lost even as more resources are being deployed because it becomes almost impossible to advocate for a philosophy of caring when we distance ourselves from people, aided by technology, voicemails, emails etc. and a flawed consultative process – all seemingly designed to keep people at a distance and increasing numbers of experts and expert groups.
Respect, the theme of this Conference is hugely important and of course has different meanings but the definition I favour is due regard for the feelings or rights of others. This definition, if it’s the one you use, has then to be about human rights.

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”.
Eleanor Roosevelt
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.

Why in a country I once referred to as one of extreme wealth and great opportunity, sadly I cannot say now with the same conviction, for some and as a society we profess we are committed to human rights and guaranteeing everyone’s rights is supposed to be important, however, as I can see everyday with the people I work with, their rights are not respected and on a day to day basis, as I have already described, they are humiliated and must endure the almost casual denial of their human rights also so many who care are very far removed from the planning table. However, we need to be able to articulate the poor treatment of the voiceless, this includes many carers, some if not the most vulnerable in our society. Of course we use words and phrases like denying human dignity but seldom mention their rights. Staff at all levels, frontline and management are often too tired and weary to even look beyond the immediate – too weary even to anticipate your own needs and rights, can find this difficult but this is the challenge in today’s Ireland.

Oscar Wilde also said something that is probably more true of today’s Ireland as our values have become much more materialistic:
“we know the price of everything and the value of nothing”.

How often have many of you said that in frustration? Only by wasting time with people and putting a value on time will society ensure people, especially vulnerable people are treated with respect in what is increasingly seen by many as a State and particularly a health service loosing its way. Looking at our recent budget, it appears to me and many others that we have a long way to go and much food for thought.

Time and caring is a priceless product. In our rush to develop services are we forgetting those providing love, care and hands on service. We should have the confidence to reflect on this – not confining the debate to academic circles and visiting experts – we should not be afraid to pose awkward questions.

I am often reminded of the quote by American author and poet Maya Angelou “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”.

When reflecting on the morning in TRUST after October Bank Holiday 2012 and preparing this paper I wonder if little had changed since John, your Founder, slept in a doorway in Spain. He died over 400 years ago before his life had such an impact on future generations, including all of us here – clearly he may have been considered mad and so too are many of us by those in positions of power and responsibility. I spoke recently with a friend and former John of God staff member who reminded me of his visit with others to Grenada and watched the John of God Brothers, all working for nothing and living the Gospel – meeting, greeting, clothing & feeding but most importantly welcoming hundreds of people to their centre and of course this is where St. John of God eventually settled in that lovely city in the south of Spain.

Today perhaps we are too politically correct to utter simple words of concern but from what I see daily little has changed for some of the people we see in TRUST. It behoves all of us to speak out on their behalf in the knowledge of the support of the spirit of St. John of God and if we cant ourselves support those who do, including staff working at the coal face. If we don’t, leadership and respect are meaningless words. A wonderful world-wide organisation like yours have shown the way in so many areas of caring – don’t allow jargon attached to findings to stifle you, do not be afraid to say unpopular things – after all you are doing it on behalf of those unable to do it for themselves and their families, constantly reflecting on your values with confidence:-
“The values of Saint John of God Hospitaller Services are Hospitality, Compassion, Respect, Justice and Excellence” Nice words can so easily give the impression that all is well. Language has a great capacity too to stifle real debate where it should take place.

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”. I think John of God would agree with him.
Let this be your thought for the day.