Beth Connelly, volunteer nurse at Project:London

Beth Connelly

Beth Connelly is one of our volunteer nurses and has been at Project:London since 2010. She retrained last year and in addition to her voluntary work she is a fulltime caseload community midwife. As a nurse Beth sees clients in the clinic and does basic health checks, gives advice, makes  referrals when necessary and advocates for the service users.

“I was interested in getting involved with Doctors of the World UK and I found out about Project:London and soon realised that health inequalities are not only present in developing countries! It saddened me to think that we neglect so many people when we have the NHS, and I wanted to use my skills to be able to help.

I am inspired by many of the people that come into clinic; many have fled war zones, left violent relationships or were forced to leave their homeland due to political corruption. Many people really do believe healthcare is a luxury rather than a human right, and are very grateful for the service. They do not want pity or money, they just want to be treated with respect and keep as healthy as they can.  I try to ensure that service users find a GP or health services so they can receive ongoing primary healthcare. I have learned a lot about immigration rights in the UK and realise how misleading and manipulative the media can be.”

"Working as a nurse in the NHS for four years has given me to the opportunity to work with many different ethnicity groups. I have furthered my understanding of other people’s cultures and beliefs.. However, I have been appalled by the way in which some people have been treated because of their immigration status. The NMC code of conduct states that as nurses, we should:

‘make the care of people your first concern, treating them as individuals and respecting their dignity.’(1)

However, there are ongoing barriers that restrict our abilities to deliver good quality care to every human being. With an increased awareness of health equalities in the NHS the Department of Health insists that:

‘Putting human rights at the heart of the way healthcare services are designed and delivered can make for better services for everyone, with patient and staff experiences reflecting the core values of fairness, respect, equality, dignity and autonomy’(2).

So if nurses were to act as advocates for those in our care and help them to access relevant health and social care, information and support, why does Project:London need to exist? There is a huge injustice when it comes to  care in the NHS and this problem needs to be addressed.

For example, a very anxious Iranian woman brought her 3 year old child to the Project:London clinic. Escaping from a violent relationship and catastrophic social consequences of her decision to leave her husband, she came to England for safety and protection. Her daughter had previously been diagnosed with epilepsy and had been on anti-convulsants since she was a baby. After running out of this medication, she tried to register her daughter with her local GP in north London. The response she received shocked and saddened me.  She was told ‘to take her to hospital if she has a fit, or come back when you have the correct documents’. This is just one of hundreds of stories I have heard about the barriers people are facing in accessing primary healthcare in the UK. I believe the attitude of staff towards these vulnerable people is due to ignorance and misguided management, not a lack of empathy or compassion for their client’s healthcare needs. Lately there has been a big emphasis on choice and patient-centred care in the NHS.  In contrast to this I now have greater understanding as to why so many undocumented people end up in A&E; ironically, it seems they really do have no other choice.

Why Beth is supporting the Doctors of the World UK E-petition ‘Health Is Not A Luxury’:

I urge all nurses to sign Doctors of the World’s  'Health Is Not A Luxury’ E-petition  calling for the right of vulnerable migrants to access healthcare regardless of their ability to pay.  I’m outraged by the lack of care being provided for these people!  As nurses, we cannot do our jobs properly whilst these barriers remain so do something today to make a difference and help these people."

References:

(1)Nursing and Midwifery Council (2008) The code: standards of conduct, performance and ethics for nurses and midwives. Nursing and Midwifery Council: London.

(2)Department of Health (2008) Human rights in healthcare: a framework for local action. DH Publications: London.

Doctors of the World’s Project:London clinic appeals for volunteer doctors

Dr Lucienne Aguirre

Project:London is a health advocacy and plays a unique role in that it serves as a safety net for those who are struggling to access mainstream health services within the NHS.  The clinic is run by Doctors of the World UK (Médecins du Monde) in support of its work to help vulnerable people worldwide, Project:London’s ethos is that health is human right.

Project:London is currently appealing for volunteer doctors to come forward. The clinic was opened in 2006 and provides medical care. In 2011 we saw almost 1750 service users who had a range of complaints The need for doctors to volunteer at the clinic is vital, as some of our service users haven’t seen a doctor in years, some of them have undetected conditions, while others have illnesses that have gone untreated for a very long time and have become serious as a result. 

Project:London runs three times during the week as well as once a month on a Saturday.   At each clinic a volunteer doctor is needed on hand to meet people’s immediate needs until Project:London’s Support Workers are able to help people register with mainstream services through advocacy and negotiating with GP practices. 

Dr Lucienne Aguirre works as a Psychiatrist, she has volunteered at the clinic since late 2011 and likes to combine both psychiatry and human rights into her role at Project:London.

“I started volunteering for Doctors of the World in Sweden and carried on volunteering for the organisation when I came to live in London.  As a volunteer doctor, I provide healthcare to those that are not able to register with a GP and see to their mental heath problems if required. Since I work in the NHS, I can see the stark difference between NHS patients who have an array of services available to them compared to the vulnerable patients I see at Project:London who have many needs but no access to services. The NHS as a body needs to understand that we are not their enemy and we need their support so we can work as a team.

The qualities needed to fulfill this role include being a good listener and have lots of energy.  You can’t help everyone one that comes to the clinic and fix all their problems but we try our best to help in whatever way we can.  You do your best and learn from each case. I have loved listening to the personal stories of the patients and its been an opportunity to learn about new cultures and languages.  One of the best things has been working in a nice team and knowing what you can and will make a real difference to someone’s life.

Thanks to my voluntary work I have just got a new full-time job.  I am so passionate helping the vulnerable people that visit the clinic I will continue to volunteer around my paid work.  It has always been one of my dreams to work with Doctors of the World UK and I aim to continue this as long as I can.”

Clare Parsons, support worker at Doctors of the World UK's Project:London

Clare Parsons at Project:London

Clare Parsons started out volunteering as a support worker for Project:London in Bethnal Green. She was there from the very start in 2006, and cleared out and painted the rooms prior to the clinic officially opening.  Clare now works closely with vulnerable service users as part of the close follow-up scheme that Project:London runs.  She writes up the client’s experiences to be used as case studies for Doctors of the World’s advocacy work and bears witness to the difficulties people are experiencing in accessing heaqlthcare in the UK.  Clare also uses her Mandarin language skills to accompany clients to appointments at hospitals and to register with GPs. She fits her voluntary work around her full-time job as a Speech and Language Therapist within the NHS.

Thanks to her hard work and dedication with us and other charities, Clare has been nominated to carry the Olympic torch through London. Well done Clare!

Speaking about her work with Project:London Clare says;

“We live in a city where there are thousands of people who cannot access the healthcare they need to survive both emotionally and physically. The people who attend the clinic are the most marginalised and vulnerable in our society but they have frequently had the toughest treatment from local services. At Project:London we offer them a non-judgmental and friendly environment and empower people to take the next step in improving the quality of life for themselves.”

To recognise the support and dedication of other volunteers Doctors of the World UK have joined up with Blue Dot World. Blue Dot World offers a reward scheme for those who support our cause. If you are a volunteer and interested in finding out more about the scheme and its benefits, click the link the below. Blue Dot World

National Student Volunteering Week; featuring Project:London volunteer Claire Ferrero

It’s National Student Volunteer Week from 20 – 26th February 2012. To highlight the wonderful work of our student volunteers we are sharing the experiences of one of our medical students, Claire Ferraro, who worked as a Support Worker at our Project:London clinic while she studied at the London School of Hygiene & Tropical Medicine. She also appeared in the student BMA news.

She says it was an ideal opportunity to practice her communication skills and have contact with patients: “The service users are often so desperately in need of help as a Support Worker you are easily able to see the positive impact of your work. It’s a real "get-away" from academic studies and quite often a harsh reminder of the difficulties some people face on a day-to-day basis. Whilst working/studying in the NHS, it's sometimes easy to forget that there are still people who miss out on our excellent healthcare.”

Volunteering gave Claire practical skills: “I became really confident at communicating effectively with service users via translators, either in person or on the phone, which should be invaluable in my foundation job in east London. In addition, I quickly learnt to be assertive on the phone with GP secretaries and practice managers whilst advocating for GP registration for service users. The clinic relies on working effectively in a team with other support workers, the nurse and/or doctor and communicating back to the office. I had first hand experience of giving explanations, recording accurate information, coping with distressed relatives, being empathic and this was always in the context of language and cultural barriers.”

“Project:London is a really friendly and rewarding place to volunteer. There is nothing better than being able to tell someone you've successfully found them a permanent GP. The overwhelming gratitude and relief at being able to access healthcare when they need it emphasises how much they were in need of help in the first place.” 

If you would like to become involved with Project:London or any other volunteer opportunities for Doctors of the World, read more.

Dr Paquita de Zulueta fights for those on the margins of society

Dr Paquita de Zulueta

Paquita de Zulueta has been volunteering at Project:London as a doctor for over two years. She’s helped many vulnerable people who are unable to register with a GP. When she’s not volunteering she works as a locum doctor. She has been a GP for 26 years. 

Paquita is passionate about Project: London and supports Doctors of the World UK’s work in this area. Paquita feels an affinity with immigrants and asylum seekers having lived abroad and met many people from different cultures and backgrounds while she was growing up. Paquita has worked with many asylum seekers in different areas of London during her time as a GP.  


She says she enjoys the challenge that comes from working at Project:London and the feeling that her work makes a big difference.

Here Paquita’s documents her experiences at the clinic which featured in the BMJ in October 2011 in an article entitled: ‘Asylum seekers and undocumented migrants must retain access to primary care’.

"They come singly, or in huddled clusters, subdued, their eyes downcast, their shoulders stooped. They tell us tales of loss, of devastation, of living in the penumbra, always fearful of exposing themselves to bureaucratic scrutiny. They sleep, if lucky, on the sofas of friends or in hostels, otherwise in doorways, on park benches, in churches and bus stations. They are like Dante’s lost souls, shadows wafting in limbo, neither in heaven or hell, but in a cold and lifeless purgatory, a place the world refuses to acknowledge. They tell me their stories, their faces etched with suffering, their eyes reflecting dull despondency or despair. And yet, as I bear witness, I am humbled by their grace, dignity, and endurance.  Somehow they manage to look clean, orderly and well presented. The tell-tale sign may just be the tightly clutched plastic bag. That bag may hold all their possessions, including documents such as a dog-eared letter, years old, from the Home Office blandly reporting information regarding the status of their asylum appeal. Many of them have not sought medical help for several years despite serious medical problems - some brought on by the lives they lead or the trauma they have experienced.

A support worker assists a service user at the clinic

The stories are varied and at times harrowing. A woman flees her village and elopes with a man she has fallen in love with. But he brings her to the UK in order to sell her to other men, not to marry her. He steals her passport, drugs her, and forces her into sexual slavery. Now she is pregnant and too sad to care, yet she cares enough to refuse abortion. A couple have been refused asylum. Local gangs threatened his life and they cannot go back home. The pregnant wife is in the third trimester. A depressed young woman fled the house where she had been enslaved since she was 14 and is forced to sell her body to get some food. A teenager with severe post-traumatic stress disorder has difficulties controlling his anger and is at risk of harming himself or others (he has already made a serious suicide attempt). A woman in her forties has rheumatic heart disease and is breathless with heart failure. These individuals are all in clinical need yet have been unable to access primary healthcare in the UK. Despite pleas to my colleagues to take them on, and even when they undertake to do so, they still turn them away when they arrive on their doorstep. Secondary care, including antenatal care, may be available, but carries the threat of unpayable fees. Do healthcare professionals expect women to deliver their babies in the street? In fact, some women we see have delivered at home without any clinical supervision. What do they think happens to those who are suffering from severe mental health disorders and chronic untreated diseases? Have they at least considered the risks to public health? The litany of misery continues and I take note of the small acts of unkindness and indifference meted out by my peers. But there are shining exceptions, and some GPs do manage to overcome bureaucratic barriers and register patients irrespective of their residential status. 

Paquita seeing a patient in the clinic

I am a general practitioner and work, when time permits, as a clinical volunteer at Project:London, a health advocacy programme set up by Doctors of the World UK in the East End of London. Here I treat those who cannot access primary care. These include those accepted or refused by the asylum system and undocumented migrants. The BMA reminds doctors that there is no requirement to determine someone’s immigration status to access primary care services. The GMC’s Good Medical Practice requires that doctors do not discriminate unfairly, but provide care and treatment to meet the clinical needs of all patients. The Royal College of General Practitioners (RCGP) endorses this:  “Based on the principle that General Practitioners have a duty of care to all people seeking healthcare, the RCGP believes that GPs should not be expected to police access to healthcare and turn people away when they are at their most vulnerable.

When people evince a lack of compassion and callousness, they use various tricks to preserve their self-esteem. One of these is to comply with bureaucratic diktats and elide responsibility for the consequences of ones actions. Another is to dehumanise individuals and view them as dangerous and unworthy of normal human decency. In mitigation, I recognise that some Primary Care Trusts send officious and misleading guidance. Receptionists and practice managers are exhorted to reject individuals who do not present a range of documents such as utility bills and passports – not easy if you are homeless or someone else holds your passport. These impositions carry no valid legal or ethical authority, but some may believe they do.

A Support worker sees a service user

What does the future hold? Finances are tight. Consortia may be more draconian. The government seeks to expand its existing restrictions to free secondary care and include primary care. This does not augur well for the vulnerable and dispossessed in need of humane clinical care – particularly as compassion appears to be a dwindling resource in modern medicine. "

This article was originally published 18/10/11 on the BMJ blog at http://www.bmj.com/content/343/bmj.d6637