Healthcare Interdisciplinary Research Conference in TCD

Points from a Keynote Address by Alice Leahy, Director of Services Alice Leahy Trust at the 17 th Healthcare Interdisciplinary Research Conference in TCD on November 10 th 2016

On the theme: Contemplating the Past, Present & Future, Alice Leahy, Director of Services of Alice Leahy Trust in her presentation “Wasting Time with People?” said: “the theme of the conference “Contemplating the Past, Present & Future” was a hugely important one at a time when our country is struggling to cope with what seems to be a chaotic and sad health service. She said she wasn’t using PowerPoint because to her mind it prevents a real connection between the presenter, the topic and the audience……….. She said she was deeply honoured to receive an Honorary Fellowship from the faculty of Nursing & Midwifery, RCSI a number of years ago – that Faculty was the first of its kind in these islands and the founders in October 1974 were acutely aware of the need for post graduate nursing training. The first Dean Mary Frances Crowley said “we are fortunate in Ireland in having a surplus of applicants for the nursing profession; it is right that we should improve their academic standing and career prospects, but we must guard against some of the dangers of specialisation in this technical age, remembering that to the ill patient it is the nurse’s sympathy, kindness and understanding which are her most valuable assets”. Alice said she thought Florence Nightingale would agree with her and as she (Florence) once said “nursing is a progressive art, to stand still is to regress”………… Alice said we all need to look outside the box, particularly in the area of nursing and healthcare and look at healthcare in a wider context. Note the socio economics determinants of health and the environment in which health policy is made. She said the nurse who is well informed has a huge contribution to make to health policy and can make the work more interesting and help avoid the culture of powerlessness and victimisation, something she had noticed creeping into the discussion around the role of the nurse………… She said some of you have or will have a key role in nurse education, others of you will move up the ladder of promotion and she said she guessed some of you might find yourselves on the margins because you ask the awkward questions, others will emigrate and hopefully not too many of you will become disillusioned, because nursing, in spite of what appears to be happening, is a very special profession. In College Choice 2005 – an Irish Times supplement 11th January 2005 the following description of nursing was used to promote nursing as a career – “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 captured what nursing is about and could be restated over and over again. We all know that nursing challenges us to look at our own humanity and vulnerability especially when working with vulnerable human beings and particularly in the current changing climate. No one group have all the answers but all of us together and aware of our own humanity can make an enormous contribution to making our health service one to be proud of – something we cannot say with any degree of confidence currently. But we can and must promote caring, hope, vision and positivity. We can only do this if we have confidence in our unique role………… She described the daily work dealing with people who are homeless from across the world, sometimes meeting people from 26 different counties in a given month….. She said today you are only too well aware of the housing shortage in our country and this has been allowed to develop over the years; it didn’t happen overnight. This crisis has been well publicised. Women and children are living in cramped hotel rooms, with all the negative consequences that these circumstances involve. It should be pointed out however that there is a difference between houselessness and homelessness and no matter how many units of accommodation we provide, there will always be people who feel excluded and don’t fit in. There are deeper problems which take time, patience and commitment to work through; the application of some simple solution from a distance will simply not work………. She said caring for others challenges us too to look at our own humanity and vulnerability especially when working with vulnerable human beings and suggested that so many people needing healthcare are vulnerable because others unknown to them so often make crucial decisions about their lives without their involvement – their personhood handed over to others. All contact with human beings moves us and when it doesn’t it is time to question why we are working in the field of healthcare………. She said conferences on Health Reform like many conferences can be academic with a lot of reference to research and figures and little reference to human beings. Of course good quality supervised research is crucial to good planning. 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. Of course we know research is required but we all know reports are gathering dust all over the place. In that context nothing has changed in the last forty years as a quote from a report we wrote in 1976 which could be validly 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”. We all have an obligation to use knowledge based on hands-on experience to ensure a culture of compassion exists to ensure people are treated as people, not mere statistics…. She said we should never 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…… She said sometimes we blame Florence Nightingale for the image of nursing presented as being a vocation – it’s not cool in the present day to suggest that nursing is a vocation. We should never forget that Florence fought a lone battle with parliamentarians, army personnel and so many others to set the strong foundations we are now working from…… She said its time to treat people properly and that it is the one thing that is increasingly difficult in the modern Ireland where we are all statistics reduced to a quantitative or monetary value and where caring is at times taken for granted. In a world, which is increasingly governed by performance indicators and benchmarks, is it even possible to preserve even the concept of a philosophy of caring and compassion? We should not allow ourselves to be distanced from people, aided by technology, voicemails, emails etc – all this seemingly designed to keep people at a distance while increasing numbers of expert groups and bureaucracy flourish….. She said we all need to consider where we stand and what kind of Health Service we want. The power to change things is in our hands. At times we can be overwhelmed by the amount of caring required of us, we can loose confidence, our compassion can be taken for granted, our energy sapped. While acknowledging she was speaking to some of the converted she said we can all get invaluable support from each other and must never give up. It was Maya Angelou who said “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”.

Hospitaller Leadership Conference – Respect “Wasting Time with People?”

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 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. 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 www.trust-ireland.ie. 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.

50th International Eucharistic Congress

“We are all equal in the eyes of God”

Alice Leahy
Director and Co-Founder Trust

To be invited to address you today at a very important time in our country where hope and vision is in short supply is an honour.
TRUST is a non-denominational, befriending, social & health agency working with people labelled homeless since 1975. Those we work with are generally treated and seen as outsiders in our world. Cities are about diversity – a fact we should not forget.

I am not a theologian and I am not exercised in challenging theologians but I do find the language of theology like law and medicine for example – a bit daunting with the potential to isolate. Institutions of all types fail to encourage debate and we can all be institutionalised in our thinking. We are here today to look at the basic values of Christianity and what the Gospel message means to us I think.

The aim of TRUST:
“to serve homeless people in need by promoting human services which would meet their immediate and long-term needs and by these means to encourage their development and give their lives a dignity which is their birthright.” (…from the Deeds of TRUST.)

We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in the Liberties area of Dublin. We own no property and work in the basement of a Hostel building over a hundred years old.

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.

Our work would not be possible without the enormous generosity and support of people from all walks of life, rich and poor, lay and religious of different denominations.

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. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again – becoming part of a community something they are unable to do without support and acceptance, and what about Parish life?

The people we meet suffer 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. malnutrition, trench foot and impetigo (wild fire) – conditions clearly associated with extreme poverty and many of these people are our new neighbours from Eastern Europe, we should not forget our own Irish who immigrated in the past seeking work. Racism is a daily challenge.

Some people we meet cope with very serious addiction problems, including gambling, drugs, alcohol – all seen just as statistics in our increasingly bureaucratic world.

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. Some people locked in prisons they have created for themselves, often out of the frustration of not being understood or ignored. Many people we know have attempted suicide, and many have died on the streets.

Everyday we meet up to 50 women and men who sleep rough as they present themselves to us – all outsiders in a European Capital City. These women and men, many of whom are extremely vulnerable come from all over Ireland and from right across Europe and beyond. Many people we meet have lost contact with family and we regularly get calls from people looking for their loved ones who have disappeared. Some of the people we meet may be in touch with other agencies who attempt to meet their needs while others may be totally cut off from mainstream society. At times some people we meet appear to be beyond reach, they bring their own challenges and others inspire us everyday to look at the way we live our lives.

I am reminded of Joe who one day with tears in his eyes told me that when attending morning mass in an Inner City Church the woman beside him refused to take his hand at the sign of peace – yes he had the weather beaten cigarette stained hand of poverty.

Homelessness is not just about housing alone, it is much more about not fitting in, being different, being an outsider.

“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.

Today many people including those in Church, State and Community groups who work hard in building and fostering community involvement are frequently challenged by an insensitive bureaucracy and meaningless jargon. But that challenge forces us all to question our commitment to love our neighbour and dig deeply into our human resources and beliefs.

The message of the Gospel is an inclusive one and silence in the face of people being excluded cannot be an option. We also need to care for each other and defend those who speak out.

I reflect often on the words of Pastor Martin Niemoellen in 1945 – “First they came for the Communists, but I was not a Communist so I did not speak out. Then they came for the Socialists and Trade Unionists. I was neither so I did not speak out. Then they came for the Jews, but I was not a Jew so I did not speak out and when they came for me there was no one left to speak for me”.

A number of years ago on Christmas Day I happened to catch Eurovision Mass from Circus Pinter Top in Paris. I was struck by a few quotes from the Pastor: “Encounters with people move us” … “It is the blind application of the law which makes us inhuman”. I am of course not encouraging breaking the law but we are all humans sharing this earth at this time in Creation. The dignity of every individual should be at the very centre of everything we do. We should not be afraid to pose awkward questions and if we don’t I suggest Christianity is a meaningless word.

We should never forget the amazing work being done daily by Religious groups all over the world and so much of it now being taken for granted, particularly in our own country. Their energy has been sapped and their vision in danger of being obliterated.

Let me describe to you one hour in TRUST last Autumn

To our small inner city basement centre (TRUST) on an autumn morning in 2011 one after the other they arrived, all in the first hour: 23 women and men. (Lack of space meant others had to be turned away). All having a hot cup of tea or coffee with fresh brown bread, lost in their thoughts, waiting to have a shower and change of clothes their first in ten days, socks and shoes not removed in that time, feet treated and wounds attended to etc.

People came from squats, open spaces and under bushes all over City:
Earlsfort Tce., Merrion Square, The Quays, Civic Offices, Dawson Street, Portobello,
Garda Stations, Drumcondra, Dollymount, Ulster Bank, Cook Street, Bray, some not knowing where they slept, two lucky to get a hostel bed for one night, 1 female sofa surfing after one night in Casualty. The universal look of misery and hopelessness, life’s history private to themselves etched in their faces reflecting on a life less ordinary. All reluctant to leave to make way for others. Some were Irish, others from Poland, Romania, Russia, Latvia, Lithuania, Hungary, Slovakia. Common denominator the label homeless – labels do define us and stick.

Tom who lives in a hostel, attends a psychiatric clinic made his usual visit to sit quietly with a hot cup of coffee listening to Lyric FM. Josef who is hard of hearing always pleasant and gracious, shaking hands on arrival and leaving, says it is better here than in the place he once called home. Pat called with his mother. His shoes soleless, walking around on his sore bare dirt caked skin like a dogs paw. He asked for nothing more than a hot cup of tea in a quiet space.

Most were unkempt, unshaven, filthy and ashamed to be, apologising for their state – the majority known to us for some time. Joan called for the first time after two months on remand in prison. On release after attending Court, the urge to meet old friends on the day for a drink or share other drugs too much to resist. All pre-release plans if any gone in 5 minutes. Some trying to sleep for a short time, others drunk from early morning to blot out the pain of living.

We see too often the anger and despair replaced by apathy and resignation to ones plight. Dull, dead eyes have replaced the once bright ones when dreams of a better future existed.
The work is difficult, hard, dirty, misunderstood, devalued, time consuming, unquantifiable, challenging and especially soul destroying at times, but invaluable when you see people better able to face the day, confidence regained to meet a friend, reconnect with family and address one’s addiction – all this takes time, money energy and commitment.

If Christ in person visited Dublin today I have no doubt he would be sitting amongst these people and challenging us to the limit.

Seeing people lose all they have, including hope, others where truth has become the first victim of addiction, some whose life from birth has been defined by misery and poverty likely to be seen as a problem for life, never having a chance to reach their full potential. Seeing 3rd generations coming through our door as we did in that hour is challenging. We learn so much from these people, all who live in the moment who inspire us to reflect on the world we live in.

How does Parish defined conveniently by geographical boundaries look at these people/outsiders? Boundaries after all create exclusion. Many working in the field of poverty and social exclusion can too feel excluded. My colleagues and I are daily called Sister – this highlights the fact that people seen to be working with the poor are only religious often giving the illusion that only the religious have the commitment and expertise required to create caring and inclusive communities. Theological expressions of love become tiresome and lofty at times. Love is about justice often requiring personal sacrifice and being unpopular. The Church is about all of us, no matter what the label and a vibrant Church can only claim to be so if it practices love. Ordinary men and women living extraordinary lives believing in Gospel values expressing concern for their fellow human beings are important to Christ who makes no distinctions.

Many people who are part of Parish and speak of love never see the real miracles that take place on a daily basis when barriers are broken down.

The simple words of Eleanor Roosevelt to me are very important:

“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

I would add to this “and in our Church, particularly our Parish”. Her words and the words of the Gospels written in simple language accessible to all are all that’s required to help us question our commitment to create a better world and live our faith to the best of our ability.

Women and men, lay and religious must discuss and debate what type of world we want, indeed what kind of Church we want. In former times when Ireland was poor Churches provided services through some very dedicated people and this has been dissected under the microscope in recent times. We know only too well that these were well documented tragedies at many levels. In TRUST we have met people who were abused in their own families, and by the many institutions including Church and State run. We also meet some deeply hurt women and men left to deal with the after-effects that was not of their making – added to by the non- acceptance of our shared humanity.

If we believe in the Gospel in action we must be prepared to be unpopular, questioning the status quo relentlessly and supporting those unable to speak for themselves, even if of a different faith or no faith.

We are after all, all vulnerable, its part of our shared humanity. There is a tendency to think that Christians, and I guess all religions to think they are the only ones who care. On the contrary, there are many with no religious or dormant religious beliefs who care for vulnerable people in society and we are all as Bob Dylan said “prisoners in a world of mystery”.

ALICE LEAHY
Director & Co-Founder
TRUST
www.trust-ireland.ie
Friday 15th June 2012

Human contact challenges us as Nurses to speak out

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”.
Eleanor Roosevelt

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.

ALICE LEAHY
Director & Co-Founder
TRUST
A befriending social & health service
for people who are homeless
Founded in 1975
Bride Road
Dublin 8
Tel: 01 454 3799 (w)
Email: www.trust-ireland.ie
16th April 2012

© TRUST