The Cathedral Clinic Irish Street Medicine Symposium - Ciara Mc Grath, Crosscare & Alvise Calamai, GP, NDCGP
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The
Cathedral
Clinic
Irish
Street
Medicine
Symposium
Ciara
Mc
Grath,
Crosscare
&
Alvise
Calamai,
GP,
NDCGP
18th
June
2015
The Cathedral Clinic Essen&al GP service for migrants without access to Primary Care 21st January 2015
Background
• Need
for
access
to
primary
health
care
for
members
of
migrant
communi&es
was
iden&fied
separately
by
– Young
People
At
Risk
(YPAR)
network,
– Pavee
Point
– Summer
Hill
Public
Health
Nurses
Iden&fied
site
;
Crosscare
Informa&on
&
Advocacy
Service,
Cathedral
St,
Dublin
1
21st
January
2015
Purpose & start • For minority migrant groups on low or no income without medical cards and not accessing GP services • To provide humanitarian GP services • To lobby / advocate for social inclusion where necessary • To link to mainstream services where possible • Commenced on 21st August 2013 21st January 2015
Intended
target
group
" EU/EEA
Migrants
with
no
income
or
access
to
state
supports
" EU/EEA
Migrants
on
low
income
but
with
no
medical
card
" Non-‐EEA
Migrants,
undocumented
" Non-‐EEA
Migrants
documented
but
with
low
/no
income
" Returned
Irish
emigrants,
deportees-‐oWen
presen&ng
as
homeless
The Service • The service is hosted in Crosscare Informa&on & Advocacy Service (CIAS), Cathedral St, Dublin 1 every Wednesday 2.00-‐4.00 • The GP Registrars work is overseen by Dr A O Carroll and under the clinical gov. structure of Safetynet • The Safetynet recording systems are u&lised 21st January 2015
Establishing Cathedral Clinic • Flyer developed outlying details of service, establishing target group & and circulated among poten&al referral agents • Pa&ents may self refer / be referred in by an agency • Up to 12 appointment slots per session • Pa&ents may be seen on drop in basis if slots remain / at GP discre&on • Roma interpreter may be available with prior no&ce 21st January 2015
Self
Referrals/
Referrals
from
other
agencies
21st
January
2015
Benefits
of
linking
this
GP
Clinic
with
Crosscare
InformaOon
&
Advocacy
Service
Who
are
CIAS
?
CIAS
is
a
programme
of
Crosscare,
the
social
care
agency
of
the
Dublin
Archdiocese
• Crosscare
Housing
&
Welfare
Informa&on
• Crosscare
Migrant
Project
• Crosscare
Refugee
Service
21st
January
2015
What do CIAS do? CIAS provide an informa&on & advocacy service around: • Homelessness & Risk of homelessness • Access to social protec&on & other supports • Immigra&on issues • Se^lement help for people leaving the asylum system • Support for Irish emigrants returning to Ireland including deportees • 90% of our clients were born outside Ireland 21st January 2015
Added Value CIAS also work closely with Crosscare’s Homeless, Food and Community Services to provide as much support as possible across a wide range of needs 21st January 2015
InformaOon
&
Advocacy
Clinics
to
Members
of
Migrants
CommuniOes
• Along
with
services
through
English
we
offer
service
through;
• Polish
• Roma
• Romanian
• Chinese
• Somalian
21st
January
2015
Referrals
to
and
fro..
In
the
course
of
CIAS
work
we
regularly
meet
with
members
of
migrant
communi&es
who
encounter
barriers
to
accessing
health
care
• CIAS
refer
people
to
the
Cathedral
Clinic
• GP’s
in
Cathedral
deal
with
issues
rela&ng
to
health
&
well
being
• CIAS
con&nue
to
work
with
them
on
other
issues
• GP’s
in
Cathedral
Clinic
encounter
pa&ents
experiencing
difficul&es
with
access
to
rights
&
en&tlements,
they
refer
to
CIAS
• CIAS
con&nue
to
work
with
them
on
other
issues
21st
January
2015
Aim
from
CIAS
&
Cathedral
Clinic
perspecOve
• Work
where
possible
on
resolving
the
presen&ng
health
difficulty
• Assist
with
access
to
rights
&
en&tlements
• Assist
access
mainstream
medical
&
other
supports
• Move
them
on
from
reliance
on
the
Cathedral
Clinic
21st
January
2015
• Not all those presen&ng are en&tled to other supports • They will remain reliant on services like the Cathedral Clinic and other essen&al health services provided through SafetyNet • CIAS will a^empt to link them in with other supports where possible 21st January 2015
Cathedral Clinic StaOsOcs Period August 2013 to end May 2015 530 pa&ent visits New / Repeat contacts -‐40/60% 46 different na&onali&es 30% presented as homeless 60% reported having no income 21st January 2015
Case Study 1 • Older Polish migrant presents to Crosscare. He is in receipt of a Polish Pension topped up with an Irish Pension. • He has suffered a stroke and had complica&ons arising for this. • Refused a medical card in error and was really struggling with cost of a^ending a GP and the cost of prescrip&on medica&on. • Presented as well dressed and well cared for. He had to make sacrifices in order to pay for medical care, e.g. some rent arrears, arrears on u&li&es etc. • A^ended the GP service on a number of occasions. • Crosscare intervene in his case and he was awarded his medical card. He no longer requires the Cathedral Clinic. 21st January 2015
Case Study 2 • Older Romanian na&onal came to Ireland to reside with a be cared for by adult daughter who is reliant on social welfare support • Cannot qualify for a medical card as has no assessable income but requires medical a^en&on • Cost of access to GP & prescrip&on medica&on places financial stress on the family • Family are in contact with Crosscare, parent is referred into GP clinic and avails of wider Crosscare supports • Crosscare assists with appeal to DSP-‐s&ll awai&ng outcome. Pa&ent con&nues to avail of GP clinic 21st January 2015
BARRIERS TO HEALTH 21st January 2015
Case
Study
3
• Mr.
L.Y.
–
50y.o.
from
Nigeria
• Moved
to
Ireland
2
months
ago
• Presen&ng
complaining
of:
– 1
week
Hx
of
dizziness,
poor
balance,
headache
and
weakness
R
arm
– Also
10
min
episode
of
visual
loss
R
eye
3
days
ago
• No
past
medical
Hx
or
repeat
meds.
21st
January
2015
Case
Study
3
• On
Examina&on:
– Reduced
power
R
leg,
mildly
hypertensive
otherwise
unremarkeable
• Impression:
– Mild
stroke
+/-‐
TIA
• Referred
to
TIA
service
Mater
Hospital
21st
January
2015
Case
Study
3
• Rea^ended
a
week
later:
– No
residual
deficit
– No
radiographic
evidence
of
major
stroke
– Therefore
TIA
– Also
diabe&c
– Also
hypertensive
• Hospital
prescrip&on
transcribed
21st
January
2015
Case
Study
3
• Rea^ended
anoher
week
later
• Received
le^er
from
Mater
Hospital
with
bill
re.:
– Inpa&ent
stay
– CT
scan
of
brain
– MRI
scan
of
brain
– Caro&d
dopplers
– Etc.
etc.
21st
January
2015
Case
Study
4
• A.C.
-‐
8y.o.
ROMA
• In
Ireland
for
past
month
• A^ending
with
simple
chest
infec&on
• BACKGROUND:
– Profound
learning
and
physical
disbility
– Completely
dependendend
in
everything
– Blind
– Uncommunica&ve
– Wheelchair-‐bound
– No
hads
dexterity
• Never
assesed
by
specialist
services
before
21st
January
2015
Case Study 4 • Physical examina&on • Size of 5-‐year-‐old • Microcephalic • Very thin • Ra^ly chest -‐> ?chest infec&on caused by excessive secre&ons. • No en&tlement to secondary care or any other specialist services 21st January 2015
THANK YOU 21st January 2015
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