The Big Red Sign
By Olivia Taibel and Anja Flamer-Caldera
It is no secret that homelessness in Sydney’s CBD is an ongoing issue, fuelled by substance abuse, domestic violence and high cost of living, and it has restructured the city’s demographic. The thing with homelessness however, is that we often don’t hear about the vital role that the public health system plays. Nonetheless, the medical professionals who work in St Vincent’s Hospital, surrounded by this epidemic, agree on one thing – that theyare the primary point of contact for the homeless, and have been for decades. When people see that ‘big red sign’ at the end of the road, they know they have found a safe haven, where they can seek help and be treated without judgement every time.
For the last 24 years, Dr Iromi Samarasinghe has worked as an Emergency physician at St Vincent’s Hospital, and as she would tell you, she has seen it all. Since starting her medical residency there in 1995, she has grown to love the madness and fast pace of her department. “Emergency is one of those things here every shift is unpredictable. You can have one day where you’re just moseying around seeing general practice type patients, and then the next minute the ambulance ‘bat-phone’ goes off and you’ve got a cardiac arrest or a major trauma coming in.”
It is clear that Dr Samarasinghe is proud of the service she is able to provide, especially for those most vulnerable in our city. She recalls a man who used to sleep in a bus stop on Burton Street. He would come into St Vincent’s every night for basic necessities and he quickly became a well-known character of the department. After many years, he sadly passed away in the very spot that had served as his bed. In his memory, the hospital conducted a funeral service and established a plaque on the bus stop, which can be seen to this day. It’s this compassion and acceptance of these medical professionals that not only drew Dr Samarasinghe to working in emergency but demonstrates the lengths that our public hospitals will go to in order to make a difference in the lives of homeless people.
All medical professionals see the homeless and provide a service for them when they are at their most vulnerable states, be it sick, badly injured, or suffering psychologically. That’s the egalitarian nature of emergency departments at work, as Dr Samarasinghe explains it. “One thing about the health system is that our doors are open 24 hours a day and are staff are open to receiving you no matter what your condition. We make no judgement on how you appear and meeting your physical or mental needs is the service we provide.” She stresses that this is why hospitals are a pivotal point of contact for the homeless community. Every day, about half a dozen homeless people venture into Dr Samarasinghe’s department in need of treatment, mostly for infections, drug overdoses, harsh weather exposure or alcoholism related problems.
“Every so often there are cases that stick in your mind,” Dr Samarasinghe recounts. Recently, Dr Samarasinghe met a homeless woman in need of urgent gynaecological surgery, whose case involved a multi-disciplinary team to get her adequate treatment. She had been living on the streets for 10 years, and also had an underlying mental health illness. Despite the agonising pain of her condition, her “paranoia grew to a point where she couldn’t be in a crowded space, which prevented her from being admitted for treatment,” Dr Samarasinghe recalls. What drew her to the ‘big red sign’ was her connection with Dr Samarasinghe, as being a female doctor created a sense of trust.
From there, her team organised a guardianship board to ensure she acquired her necessary treatment. This process of disempowering her, in order to empower her, through the various of interactions between aspects of the service sector, meant that she would eventually recover from her mental illness enough to give consent for the surgery. Dr Samarasinghe reveals that this woman’s case unravelled a bunch of feelings and emotions. She felt a great sense of pride and said that “despite all the cases that don’t come to fruition, it’s success stories like this one that make it worth it”.
The construction of the health department is large, with each member playing an integral role in the process of helping the homeless community. Social worker and therapist, Beverly Hurwitz, has worked in the medical profession for over 20 years, and has been intricately involved with many homeless women through her work at The Royal Hospital for women. Beverly has come into contact with many of her clients through Jarrah House, a supportive environment where women dealing with substance misuse can receive treatment. She recounts that “the women come to the centre at the point in which they want to detox off their drug or alcohol of choice, where I am responsible for analysing their psychosocial functioning and running a number of different groups”. These groups include relationship, parenting and psychodynamic groups, general cognitive behavioural sessions and programs that look at all aspects of one’s life such as budgeting and eating. Beverly tells of how these programs have resulted in a positive outcome for most of her patients, ultimately enabling them to recover and live a relatively normal life. These outreach programs and housing provisions are the kinds of essential post discharge mechanisms that make a huge difference in homeless patient recovery.
The biggest problem however, as Dr Samarasinghe describes, is that the actual needs of homeless patients are quite different from most others, as it’s not just about treating the physical condition that they’re in. “There’s a lot of other things that impact externally on their recovery,” she says, especially in terms of their post-discharge care. For example, if a homeless patient presents with macerated feet, you know that they’re going to be walking around from place to place every day, carrying all their belongings, and their foot’s not going to heal without a place to rest. “We can’t just treat the foot by handing them antibiotics and a dressing and saying ‘Off you go!’,” Dr Samarasinghe explains. “There’s no way to sustain a rehabilitation process once they walk out the doors, so we have to think about the next step.”
Much of the difficulty then, with the often limited resources, lies in making sure that there’s someone else who can monitor their recovery. “The sad reality is that the dollar for healthcare is constantly under surveillance,” says Dr Samarasinghe. “Unfortunately, there’s only a certain amount of money for us in health and it’s easy for the most vulnerable people to get a resources cut first.” She says that much to her dismay, many social workers, community nurses, transport vehicles and accommodation services have been cut from the hospital in recent years, as they had become too much of an “expense”. But, the hospitals are doing their best. “They’re not people to abuse the system,” she reminds us. “They’re people at the end of their tether… And when you’re at your weakest time and you’re greatest need for health support, our doors are open and they know that.”