© Borgis - New Medicine 3/2011, s. 103-106
*Aranka Kovács1, Gabriella Csépányi2, Sarolta Kurucz2
Comparing health conditions of homeless clients in Budapest day-care centres
1Semmelweis Egyetem Egészségtudományi Kar Egészségfejlesztési és Klinikai Módszertani Intézet Epidemiológiai Tanszék Budapest
Head of the Department: Dr. Domján Gyula CSs
2Diótörés Alapítvány, Budapest
Head: Gabriella Csépányi
Aim. Diótörés Foundation has carried out a complex health condition study among 100 volunteering homeless people – part of the program supported by The Norwegian Found - which aimed at getting correct diagnosis and proper health care services for the clients. Furthermore, we have targeted at estimating the possibilities for helping clients to integrate into society. Given that most of our clients rely on services of various day-care institutions in Budapest, in this paper we have examined whether clients from different institutions have problems of different kinds.
Method. Well-prepared interviewers have questioned the clients on health and social topics, took family anamneses, anthropological data (e.g., BMI, waist circumference), measured blood pressure and took blood samples of clients in order to screen liver enzymes and kidney function, ions, Hepatitis C and HIV infection. The data have been processed with the use of computer.
Results. Earlier undiagnosed diseases have been screened among 46% of the examined clients. Clients from different shelters, differ in various aspects such as age, family anamnesis, and health hazardous attitudes. At the same time, well-distinguished differences have been found in the clients′ health condition. Unexpectedly, the youngest group of clients – who come from own institute – have not been found the healthiest one. In many cases, dual or triple diagnoses could be found.
Conclusion. There may exist differences of clients′ lifecycles, diseases and problems found even among institutions with similar services or social profile. Providing these clients with health services in conventional health care institutions has been considered impossible for mutual intolerance. One of the possible solutions is that the involved social institutions could provide or have direct access to specialists of medical fields such as psychiatry and infectology or hepatology so that they could be more easily available to the clients.
Diótörés Foundation, as the leading partner, together with the Chief Medical Office of State and the Hungarian Prison Service Headquarters, formed a consortium which submitted a grant application to the Norwegian Found for the sources of the ”EEA and Norwegian Financial Mechanism” in order to provide and finance public health services. One activity of the program, which came to its end in October 2010, was to examine a group of 100 volunteering homeless people for their complex health condition. The fact that over 120 people took part in screenings justifies that initiating the program was right, and the team also plans to continue it due to the immense interest.
The primary goal of Diótörés is to work with the young homeless people. The majority of our young clients have grown up in state orphanages. They often become our clients when passing the age of 18 after leaving the orphanage. There is a great number of drug addicts among them as well as individuals suffering from mental diseases. Clients have very often been found with dual – psychiatric and addiction – diagnoses with inadequate anamneses, and it is often impossible to prove which problem preceded the other: the psychiatric or the addictive symptoms. The majority of patients also suffer from internal diseases, however they get neither checked up nor looked after due to the intolerance of the health care system and their own behaviour.
Health conditions, special health care and social needs of the patients described above have been examined in our project. These clients often appear in the world of crime, drugs and prostitution, often as victims and due to their appalling social conditions they are exposed to other infectious diseases. That is why enhancing the screening with special screening for a few infectious diseases such as Hepatitis C or HIV was also found important in this project. Our main aim was to provide the clients with accurate diagnosis and proper health care, in other words, to find needs and opportunities, which help to improve our clients′ health conditions and to assist their integration into society. Our clients were considered as being in a special situation from the point of view of homeless services, therefore it was found important to recruit volunteering homeless people from other institutions with similar profile as well.
We have addressed a number of institutions providing services for the homeless in Budapest, mainly day care centres, and finally the following three of them decided to take part in our program:
1. Day and Warming Shelter (7 Szabolcs Str., 1134 Budapest);
2. Protection Caritative Association (9 Dankó Str. 1086 Bp.);
3. Clean Spring Foundation (373 Üllői Str. 1181 Bp.).
We interviewed the clients on venue and/or we invited them to Diótörés ambulance service centre and offered them an abundant breakfast. We took clients′ blood pressure and blood samples and registered anthropological data before breakfast. When taking blood samples, we screened the samples for Hepatitis C and HIV as well, besides the normal routine laboratory tests (consisting of blood count and liver enzymes, kidney function and ions). During the interview, we asked the patients about their personal and family health history and anamnesis in different ways. During the first interview and also when evaluating the results (second meeting), we offered the patients in need to find the most suitable health care services for them upon request.
The data were processed with the use of Excel software. The number of examined individuals amounted for 120, the youngest person was 17 and the oldest one was 64 years old among them. Age distribution was almost thoroughly even, while the sex ratio shifted significantly towards male patients; i.e. only 10 women participated in the program. It also has to be noted, that more then the half of the patients were born in Budapest.
Besides the regular diseases to be screened such as common cardiovascular diseases, were also screened for hepatitis C and HIV. Apart from these, after having looked at the findings we found a certain group of diseases to be notable. For instance, these were the cases when the number of red blood cells and SeFe significantly differ, so manifested iron deficiency anaemia could be detected among the clients. In other cases the number of white blood cells indicated the infection in progress. Thirdly, the rise of the liver enzymes indicates liver diseases. We considered all diseases, which patients had not mentioned earlier or had been unaware of, even when asked as the result of screening.
Table 1 shows the diseases found in this a way in 46% of the clients screened by the method described above:
Table 1. Newly found diseases and their proportion.
|Disease (group)||Nr. of clients with newly found disease||% of clients with newly found disease||% of all the screened clients|
|Toxic liver disease||9||16||7.5|
|Hepatitis C ||9||16||7.5|
Social workers accompanied clients (both with newly diagnosed and previously known diseases) to obtain proper health services not available at Diótörés, but only at other institutions. Another way of assistance was to book appointments on the phone for the clients.
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