Taking care of the vulnerable

World Homeless Day was commemorated on 10 October 2019 with the purpose of drawing attention to the needs of homeless people locally and provide opportunities for the community to get involved in responding to homelessness.

In 2018, the City of Cape Town conducted a survey of homeless people over an 18 day period.  According to the survey there were more than 6 000 people living on the streets and in shelters in the Western Cape. Of the 6 000, the survey identified that 3 999 people were sleeping on the street and 2 084 were using shelters when possible.

“Homelessness is a major concern throughout our country and province as street-based people, the most vulnerable members of our society including our women, children and elderly, are exposed to dangerous conditions. The Western Cape Government Health sees its purpose as maximising the health of ALL members of society and will continue in every effort to do so,” says Western Cape Minister of Health, Dr Nomafrench Mbombo.

In 2015, the Southern Western Substructure (SWSS) office of the Western Cape Government Department of Health addressed the concerns about deaths of street-based people related to uncontrolled chronic diseases of lifestyle.  Working in collaboration with NPOs focused on street-based people with chronic illnesses, they entered into conversations and undertook to do a survey as to why street-based residents were not accessing health care at facilities. 

The feedback received indicated that street-based people felt discriminated against when visiting health facilities as other patients did not want to sit next to them and often passed comments about their hygiene. The survey showed that often they felt they got picked on and indicated they would appreciate a service that “comes to them.” Providing patient-centred healthcare to the most vulnerable people in our communities, including street-based residents, remains a priority for Western Cape Government Health. The feedback from the survey meant rethinking the traditional healthcare service model and coming up with a service delivery model that takes healthcare to the streets.

Health related services were started at The Carpenter Shop, a second stage shelter, which also provided access to ablution facilities. The SWSS health team provided a social worker and counsellor and together with St. Johns, the model of health care was changed to provide the same health service package that traditionally community health care workers would provide in the homes of patients.  These health services, which included the measuring of BMI, nutritional screening, screening for hypertension, diabetes, HIV and TB, as well as pap smear services were provided in the hall of the Carpenter Shop as it was deemed “friendly” by the street-based clients.  Where the clients knew of their chronic conditions they would be referred to the nearest health facility and treatment would be provided.  The team facilitated the referral and ensured that either the health care worker accompanied the clients on their visits or that the facility nursing staff were expecting them, avoiding any opportunity of discrimination by fellow patients.   

The team are hailed for the unconventional provision of care.  

Yvette Andrews, clinical programme coordinator for Community Based Services shares, “We didn’t require our street-based patients to be sober, but asked that they remain polite and respectful. 

We took a completely different approach and by bringing healthcare services to the Carpenter Shop, we empowered our street-based patients to take responsibility for their health in their space.”

In 2016 the team won the Best Batho Pele category at the Provincial Service Excellence Awards for their Model of Care. The model has extended across the substructure and currently there are four sites running at various shelters. Western Cape Government Health has stepped in to ensure that medication is administered correctly to patients and that they are adhering to their treatment plans. 

The challenge of chronic medication continues to be addressed as patients often lose their medication, as they do not have a permanent dwelling.  Support is organised so that either the shelter stores it for the clients or alternatively the nearest health facility would store it and the medication will be administered with the help of a community health worker. Collaboration with the Green Point Community Day Centre, District Six Community Day Centre, Chapel Street Clinic and the Spencer Road Clinic have attended to approximately 1700 street-based patients.

As testimony to the success of the new model of care, facility managers have reported a decrease in TB defaulters and an increase in street-based patients returning for care. Most importantly, since the programme was implemented, there have been no unexplained deaths. 

However, the Western Cape Government still faces a quadruple burden of disease. Through a Community Oriented Primary Care approach, we are working with stakeholders such as other departments, academia and non-profit organisations to address these upstream factors and reach patients outside of health care facilities, and in particular, the homeless.

Health Services offered from Western Cape Government Health Facilities across the substructure are provided for all patients, including vulnerable groups like the homeless.  These services include:

•         Chronic conditions
•         HIV/TB Services
•         Acute Problems
•         Child Health
•         Women reproductive clinics
•         Various Rehabilitation Services
•         Pharmacy
•         Dental/Oral health
•         Mental health
•         Offsite points to collect chronic medication

Currently the biggest challenge for the team is the increasing number of mental health patients on the street and the care they require. Andrews says that authority figures are often seen as a danger or threat to their way of being and street-based patients are therefore mistrustful.  

“It takes a long time to gain the trust of street based people and build the relationships, therefore it is so crucial to work with our partners such as the City Improvement District who work full time building relationships with people on the street and in working with them we are seen as safe.”

The Western Cape Government Health endeavours to take much needed healthcare services to the most vulnerable members of our society and to continue to make these services accessible to ALL members of society. 

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