“The homeless suffer from chronic diseases, and people just walking on the street, experiencing a stroke, falling and here works emergency medical care. It is necessary to reach the limit to get help.” In the summer of 2018 in St. Petersburg, earned the project a “Charitable hospital” – to whom and when help doctors, volunteers and how to gain the trust of homeless patients – says the project leader, a physician anesthesiologist-resuscitator Sergei Jukov.
Charity hospital / VK
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“You’re getting discharged tomorrow, because without documents”
“Charity hospital” sounds in the spirit of the XIX century: patrons, the nobility, the patronage of the Royal family. Charity hospital in St. Petersburg in the XXI century, what is?
– Actually this is all wrong. All medical healthcare institutions that exist today in St. Petersburg – originally a former hospital for the poor.
The idea is the following: of course, working in the system, notice the uneven distribution of aid in Russia between different classes of citizens. We, the employees of public medical institutions, we see that there are certain bureaucratic obstacles, crossing which we, on the one hand, can provide medical assistance, and with another – to lose your job and get a lot of problems when we deal with people who have no legal right to receive medical service.
– What kind of people are they?
– People without papers, without medical insurance, without citizenship. Homeless people, migrants, members of their families. They all live in St. Petersburg and can not use a public free medical care. They have the right to apply to private health institutions, private clinics, dental clinics, etc., but sometimes they have no funds for it. It’s all very expensive.
– And you decided to help them?
Yes. Started to think what can be done for the adult population of St. Petersburg, which did not have access to health care. It is homeless people, some of them without documents, or have documents, but are afraid to go to public institution – where they have already felt the discriminatory oppression, contempt, malevolence. Someone was very antisocial, someone smelled bad, someone just did not like.
In General, they may not get what could have been if there were social, domestic, and documents. This is a problem early extracts from hospitals into the “aftercare” on the street, in abandoned basements. This is the problem of outpatient care in contrast to an emergency, which is free and absolutely all without exception.
What is the emergency?
– Situation life-threatening: loss of consciousness, heart attacks, suffocation, trauma, bleeding, accidents. Where sometimes a person can be unconscious, and not to the documents. Coming soon, if there are indications they were taking the man and going to the hospital. He was being treated in intensive care units where fighting for life. Again, there’s no time for formalities.
And then there is the worst situation when a person wakes up, podrachivaya and no longer requires intensive care, moves from the category of intensive care patients in regular care departments of hospitals. And the question arises: what to do with it?
There are cases when a person without documents is delayed for a sufficiently long period of time. And it goes unnoticed until discharge. For example, with a complex fracture after the operation a month lying in hospital of the city without documents.
Legally he has no right to it?
– Not that he had no right for it someone has to pay. If he had a policy it would pay the insurance company. And so he lies in the hospital, and the hospital pays out of pocket. She will not receive compensation for these expenses. Health care financing multicomponent, but, in General, is briefly as follows.
And it so happens that it will take some Professor’s rounds every week, you will see this patient and ask him a question. I recently witnessed a case where dear Professor, after going through the surgery ward, saw a homeless man on aftercare were.
If he was an ordinary home patient, he would have two weeks he lay, the stitches would be removed carefully and was discharged with recommendations, and then it was said: “You are discharged tomorrow, because without documents. We can’t hold you. We do not pay”.
And he after surgery, with stitches, with the risk of infection. It is unclear where he will undergo ligation. So people leave. With that emergency, when a person is in the hospital, was discharged and is able to slip some health problems, is back on the streets, in shelters, homeless hostels, squats and how to live further.
But there is a huge number of health problems that do not require hospitalization. The usual diseases that affect Pets people: chronic diseases of the heart, lungs, diabetes, minor injuries, sprains, colds, infections, which are treated in clinics and on an outpatient basis. A person comes, gets a ticket, sitting in a queue, walking to the doctor, he give direction, recipes. He goes, treated. 3-10 days come again. So watch it: therapist, cardiologist, endocrinologist, and either cure the disease or persistent remission is called, and everything is permitted.
This is the biggest global issue, which deprived people without documents, without insurance. They suffer from chronic illnesses, for example, can sometimes be increased blood pressure, but they are unable to obtain the consultation of a cardiologist.
And people just at one point, walking down the street, experiencing a stroke, falling and here works emergency medical care. It is necessary to reach the limit to get help. Although the disease to complications is the period in which you can help the person to avoid this.
Doctors and volunteers doing this in my spare time: night, day, weekend
– What and how a charitable hospital decides? In General what is it? This building movement project?
Is hard oxymoron, because it is a “hospital without walls”, a mobile hospital, it does not exist physically. A group of people: volunteers, doctors, nurses, physician assistants, nurses, medical students, who at different venues in the city provide medical assistance and advice.
– On platforms, in the sense – in clinics?
– No, these pads just don’t clinic. That shelters for the homeless, is a street. When a group of volunteers travels to the habitat of homeless people without breaking their habitual way, not accusing, not condemning, but only providing documentary, social counseling, basic medical care, distributing medications, holding dressings and correction of therapy.
Is doctors do in their spare time as volunteers?
– They don’t get paid?
– No, do not get. They do this in their free time. At night, in the daytime at weekends.
For example, the project “the Other medicine” Genis Kosovo, which in the spring was a year old. In a rented UAZ the volunteer doctors once a week to conduct visits to places frequented by homeless people, at a prearranged point. And at any time of the year once a week, including winter, in a warm, heated interior of the vehicle is carried out health advice, dressings, handing out medication.
Second in importance, fame is, of course, our colleagues in Moscow. Unfortunately, I killed Elizaveta Glinka, a well – known doctor, philanthropist, philanthropist, organizer. She was a project when once a week on the Area of three stations arrived “Gazelle” with medication, they provided medical care to the homeless. Now her friends and followers organized the Foundation “House of friends”, who also has a project for street medicine volunteers visit and provide assistance on certain days and watch homeless people on the streets of Moscow.
Well, Petersburg is also trying to keep up with national and global trends in street medicine.
– And in the Western world of street medicine what is it? This involved a charitable organization or the state?
– Certainly, it is developed very strongly. It may be a small local group, a movement that emerged in the small town. Any large organization such as the Institute of medicine of street in Pennsylvania, where there are educational programmes, including for University students, so they know that there is a problem, studied the diseases that are on the streets, knew the psychology of the homeless and studied theoretically and practically this.
This whole organizations that are engaged in outreach work; they have public funding including. And they are considered after all non-profit organizations with a license and a fairly large spectrum of medical services. In particular, in the US, doctors, volunteers and medical students, for whom it is a prestigious method of practice, travel to areas of the city, in abandoned buildings, under bridges, and even vaccinated people on the ground from dangerous infections: typhoid, hepatitis A, resulting from the consumption of contaminated water, due to the lack of access to drinking water.
Homeless is a big problem all over the world. And at the state level, particularly in the United States recognizes that cost-effective to help projects for street medicine, because there is a serious medical assistance is in place and it saves the budget money in health care for the homeless.
We understand, of course, that Russia and the Western world is a few different things, but from the point of view of relation to medical care on the street it’s really a huge difference.
No problems with the patients have problems with medications
– How is this happening? You will learn about the fact that somewhere there is a squat (unauthorized settlement, commune – approx. ed.), come and say: “Hello, we came to examine you”?
Contact is different. Sometimes it’s just our joint entry: several people with backpacks, medical supplies, leaflets, some materials that can help not only with medical problems to handle, put forward in the area of the intended life of homeless people. And this has certain risks, risks of failure, and we can see nobody when you get there.
Of the latter, we visited an abandoned horticultural houses, at first glance inconspicuous, but inhabited by homeless people there that are prepared to spend the winter. Although it houses just knocked together from boards, polyethylene, oilcloth, roofing material, banners and other things. But people live there. And we are coming to them, say Hello, and are presented after the greeting and the offer to go to their territory begin to communicate, to ask, to talk. If they begin to trust us during the conversation and they need some medical help: the measurement of pressure, diagnosis of diseases, bandaging, we perform the necessary medical manipulations.
Sometimes we have more closed circuit when just to enter the territory of an abandoned building impossible. You need to know certain moves, which we certainly don’t know a secret “stash”, dungeons; doors that seem closed, and in fact, from a certain angle appears.
Or, for example, has abandoned the five-storey building, but lived only a particular floor in a particular direction. Of course, you do not know such nuances, to find the homeless is extremely difficult and you can lose a lot of time.
So we’re trying to get in touch, to take the phone, make an appointment in advance to “the messenger” people – the homeless, who can live there, was ready to take us.
This field work is aimed at those people who are not even legal aspects can not get medical help, they just physically can’t get to the place where they can this provide assistance. People with disabilities, bedridden patients, those in severe condition.
Coming back, we can meet a man in agony or in a terminal condition that needs emergency medical help.
There are options for shelter residents. There are several organizations in St. Petersburg that deal with the placement of homeless people.
– “Nochlezhka”, the Maltese aid service, points heating, where in winter people have a roof over my head and a warm place. A corner in the tent is just for night time, but where people come regularly. They also have health problems, and they again can be bureaucratic barriers to receiving public health support.
Requests from people who came to the shelter, can also be different. If the high-threshold shelter “Nochlezhka” is rehabilitation, restoration of documents, legal complex cases, fraudulent real estate transactions and other, low-threshold point of heating – it’s just a bed and a bowl of soup. Arriving there, we can see that there is still a medical problem and need to solve it.
There is no problem to find patients. There is a problem with drugs that they were sufficient. There is a problem with time: working on the basic work, having a family, children, their main responsibilities, to volunteer and provide medical assistance on the road, to go somewhere, to return. It’s just a problem with the staff: not all are willing and who are ready, they are, of course, the entire city is not enough. In the city we have an average of 60 thousand homeless, and certainly in every district, each and every is homeless people, including those with health problems.
People don’t believe that someone noble for free assistance
– When it comes to street homeless, is born from the stereotypes: he suffers from tuberculosis, is a carrier of HIV, he has lice. And plus he can be aggressive. How does this compare with reality?
– All homeless people – different people. There are people absolutely desperate in his situation, lost contact with the outside world. This phenomenon of exclusion, profound psychological problem. According to Russian data, since it hit the street an average of 6 months passes, and the man sinks to the bottom, from which he without assistance cannot get out.
It may not be as aggressive, how many self-contained people do deny any help, leaving from the contact. They’re the hardest, because the credibility of the person from the outside these people is extremely low. They had seen on the way the interaction with law enforcement agencies, health authorities, agencies, to ordinary citizens.
Of course, people who have lost all hope, don’t believe that someone noble for free will help them. Therefore, in order to get in touch, even just to talk, not to mention some medical stuff, sometimes you have several occasions to meet, to know you, you know him. These are relatively complex homeless clients. They expect a negative emotion, tend not to catch the eye once again. Used to be discreet and understand that it is their protective strategy.
At the same time among the homeless is very much enough educated people. And absolutely normal, social, oriented in space. People who for some godforsaken reason, was on the street.
They have not lost faith that everything will be fine, they will be able to get out. And they are most open to help. Look after themselves, their appearance, try to be neat, polite in conversation. With such nice people to talk to, and you would never think that this man is homeless. He may look completely normal. It is possible to meet in the subway, on the street, and only in conversation, or for some signs we understand that people seeking refuge for the night, asking for help.
And in terms of diseases, again, absolutely no serious difference.
But the percentage is in fact higher, for example, with TB?
Again, the percentage is a statistic, and statistics are numbers. No numbers, and we can’t say. We can only guess, and it’s all theory which is not confirmed by the practice that homeless people are more sick than Pets, people, including, for example, tuberculosis or HIV infection.
There are statistics on HIV infections among domestic people. And there absolutely amazing cases of HIV infection: this happens with the elderly, with a completely successful people, married couples with children. It happens for various reasons: an accident, a medical procedure, a blood transfusion. It is believed that HIV is exclusively a drug user, but it is not. This epidemiological problem. People get everywhere and all for different reasons. And to say that the homeless among them – is impossible.
– Tuberculosis, lice?
– Well, tuberculosis is a separate problem. First, in Russia the incidence of tuberculosis is quite high. This statistic exists. It covers precisely those people who was diagnosed. To diagnose an adult, you need to do x-rays. Again, homeless people of different social services, charitable or government organizations help in the restoration of documents, housing, arrange them in shelters – all of these homeless people are held in mandatory chest x-rays. And included in these statistics.
Yes, there is a belief that homeless people suffer more. But then again, TB can too. Many cases where a successful girl working in the office, having an apartment, car and good income, in what does not deny, making chest x-rays every year, in one of the images sees the change, and she is diagnosed with tuberculosis. Where did she get infected? When she did that? It is already known, but it happens. And it’s hard to find the ends. Any man, no matter where he is, has the risk of Contracting tuberculosis. Just some factors really increases the disease. First – what not to do in time to chest x-rays.
But this is not a risk factor to disease.
– Yes, but it’s a risk factor, without knowing it, to walk around and infect others. Did chest x – rays do not know, go yourself are ill and can infect others. We go down every day in the subway, and every day I meet patients with tuberculosis, just don’t know. They have been written on his forehead. They may even not know about it, but we can have contact with them. Just someone gets sick, someone gets sick. And it is impossible to say in advance.
There are risk factor is stress, malnutrition, chronic disease, Smoking, close prolonged contact. The last line is the migration and social status, but it is not the most important. This is still a lot of reasons.
– Lice – enough is a contagious disease, but again, so we might have living creatures in your hair, you need to have close contact with a human carrier. To exchange the hat with the sick person, wear his hat, comb the hair and comb exchange. Lice do not jump from head to head. They eat and eat.
– So, you are not afraid?
– Well, let’s say, to get infected – no. When we work with a homeless man, chatting, in contact, we use personal protective equipment. When we make the dressing, use gloves. When we see heavily coughing man, worn masks. Use clothing colored jackets and even disposable medical gowns. And, in principle, this is enough in order to protect themselves.
To step on someone else’s box – how to attack on personal space
– You said to get scary. And what’s scary?
– The main fears for me – fear emanating from the man. People can be unpredictable, and there really is a degree of caution, because not only afraid of a madman. Fear is a defensive reaction, this is normal.
When we enter into someone else’s territory, we understand that if you now step on another piece of cardboard where you just lying or is a homeless person and can’t get up, we can court on a fairly serious problem, because it touched someone else’s. Slightly different values of a homeless man oriented. It seems to us that this card is garbage, wastepaper, etc., and for him, it can be generally the most expensive, that now he has.
– Its space.
– His space, Yes. And we must always keep a certain distance. And only with the permission to sit down. Recently in gardening, I was offered to sit, and I sat down. Sat on a heavily rocking chair, metal frame, on which is simply put something. I knew that should not let on that I don’t like it. In actual fact, it is quite an honor: sitting on it, their friends, their neighbors, such as the homeless. And here I also have to put. And we were sitting on equal talking.
– Have you had conflict? Acute psychological stress?
– Of course, Yes, there was. For our efficient work need order: order of treatment priority. If we came to the Park “Night bus” (a project of the organization “Nochlezhka” in which volunteers on weekdays, distribute hot food in the Parking lots of the city – approx. ed), there are 20 people and they need something from the doctor-volunteer, happened the way that they surrounded the man and each time said something. Our calls to the procedure is not perceived adequately by all. People could be offended, to behave aggressively.
But there is a principle of relationship with great respect for this man. He has some reason to get so upset, swear, get angry, and you need to understand it. In such situations, we just missed it before. We are trying to address by name and patronymic, if someone is willing to tell us your middle name. Or rather, who-it just seems to be “Lech”, although we know the middle name of a person, but he wants us his name was Lech.
And sometimes when we go forward, we explain that next time we will nevertheless stick to the queue. But the man understands, because we he was treated with respect, with reverence. I know of cases where the same person, quarreling one day, next day came and apologized for his last act, for such behavior. And it was revealing. They are people just like us. They are experiencing the same feelings and are no different.
Recently, I went to work and met a man, whose face seemed familiar. And this man also recognized me. I bandaged its broken plaster. He lived in the shelter with the Maltese help service. And every week I gave him a bandage or he tied the splint, saying that it is not necessary to remove the plaster, because it will heal incorrectly, and then someone will he “fix” his leg in the emergency room. The homeless are a big problem: they’re itchy, and interfere with that cast, they quickly take it off, break, throw, then suffer from these improperly healed fractures.
But here I am knowing about this feature, constantly watching the man, the patient, talked to him, convinced, bandaged. Then he removed the cast. All nicely healed. At some point I lost sight of him.
He got out, came from a shelter and I met him a completely normal man. He was dressed well, in nice clothing. An ordinary citizen walking down the street in the day, conscious, sober. Works in construction, builds houses, lives in the barracks. And here he 5 me, hugged, hit in the chest: “Oh, you remembered! And I thought, I do not remember”.
Such cases are, of course, warm the soul: what we do is not in vain.
Like handing out bandages and do not provide high-tech help, not protosiren, no operations we do, and just hand out medication and talk with people. But it is so important to them. A bowl of soup – Yes, and when they have something hurts, and then doesn’t hurt.
You come to him and realize that it is necessary to behave like this, some little news to give them, even just attention. And then say goodbye to them as a friend. Every day they ask about me. And this isn’t some popularity, I just do as we ought to do. And it works.