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Primary Health Care has been identified and used as an innovative approach to health care in the developing world.  The concept of Primary Health Care was established at the joint WHO/UNICEP conference in Alma-Ata in 1978.  It acknowledged the need to reform the conventional health systems.  Health was no longer regarded as a matter for health bureaucrats but the concern of society as a whole.  Primary Health Care is a statement of health philosophy.  It is not a package, or a complete defined methodology.  It is a flexible system which can be adapted to the health problems the culture; the way of life and the stage of development reached by the community.  Successful Primary Health Care Projects have emphasised a process that valued empowerment, partnership, community development and advocacy when designing and implementing health care interventions.

Background                                                                                                                                 

Travellers require special consideration in health care because:

  • They are a distinct cultural group with different perceptions of health, disease and care needs.
  • These distinct characteristics imply that innovative approaches to service organisation, content and delivery are required if health conditions are to improve.

The Pavee Point Primary Health Care for Travellers Project (PHCTP) was the first time Travellers went out into the Traveller Community with the aim to identify the health needs of Traveller.

The PHCTP was established as a joint partnership initiative with the then Eastern Health Board and Pavee Point.  The project began as a pilot initiative in October 1994.

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Primary Health Care for Travellers has the following objectives:

  • To establish Primary Health Care as a Model of Good Practice to address Travellers’ Health
  • To develop the skills of Travellers in providing community based health services
  • To liaise and assist in dialogue between Travellers and health service providers
  • To highlight gaps in health service delivery to Travellers and work towards reducing inequalities that exists in established services

This model of Primary Health Care for Travellers requires the use of a Community Development approach, engagement with health service providers, and effective Traveller participation to address the specific and collective needs of the Traveller Community. The work of the Project is based on outreach work in the community with Traveller families. It also provides training on Traveller culture and specific Traveller health needs to service providers and other Traveller groups. Traveller Community Health Worker’s experience and understanding of the needs and concerns in their community is both comprehensive and extensive.

  • Providing health education and information to Travellers in the Finglas and Blanchardstown area.
  • Organising community health education sessions.
  • Working in partnership with the HSE and other statutory organisations to address the health needs of Travellers
  • Designing and publishing culturally appropriate health promotion materials and education posters on issues such as Immunisation, Healthy Living and Suicide Awareness
  • Organising appropriate clinics for Child Health, Diabetes, Obesity and Cardio-Vascular Health
  • Development of innovative approaches to address issues impacting Traveller health
  • Networking with Traveller organisations at a local, regional, National and European level
  • Providing in-service training for health professionals on anti-racism, Traveller Culture, Traveller health needs and Traveller led responses
  • Traveller representation at local, regional and national committee levels
  • Policy development, advocacy work and position papers
  • Providing support and resources to Travell

Awards
In 1998 the Pavee Point Primary Health Care for Travellers Project was awarded the World Health Organisation 50th Anniversary Commemorative Certificate for a national community-based health project that promotes health for all values of equity, solidarity, participation, intersectoral approaches and partnership; presented by JO E. Asvall, M.D. Regional Director WHO. In 2001 the Pavee Point PHCTP received the Guinness Living in Dublin Award for its achievements in the area of Community Development.

In 2014 the project was awarded the Traveller Pride Award for Enterprise & Employment and the overall Traveller Pride Award for 2014.

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Mental Health

The All Ireland Traveller Health Study highlighted the issue of mental health for Travellers

  • Suicide among Travellers is 6 times the rate of the general population and accounts for approx. 11% of all Traveller deaths.
  • 62.7% of Traveller women said their mental health was not good for one or more days in the last 30 days compared to 19.9% of GMS female card holders
  • 59.4% of Traveller men said that their mental health was not good for one or more days in the last 30 days compared to 21.8% of GMS male card holders
  • 56% of Travellers said that poor physical and mental health restricted their normal daily activities compared to 24% of the GMS population

The PHCTP has worked with the Traveller Health Unit Mental Health sub group and the Traveller community to try and raise awareness and develop ways of addressing the issue:-

Bullying in Schools

Bullying in Schools was identified as a potential trigger in teenage attempted suicides among Travellers. A template was developed, and the projects in ERTHN were asked to record information/incidents of bullying on this from September 2011 until Easter 2012. The MHSG will also develop/adapt a best practice guide for Traveller parents in relation to bullying.  The sub group agreed to develop a resource for Traveller Parents on what to do if their child was being bullied.  The PHCTP in Pavee Point designed and piloted a leaflet which identified:

  • Definitions of Bullying
  • Signs and Symptoms
  • How to talk to your child
  • What as a parent you should and should n’t do

The leaflet was widely disseminated to Travellers and schools in the region and was also made available to PHCTPs nationally.

The leaflet was launched by Martin Rogan on 25th July 2013.

Self Harm Team Temple St

The team from Temple St Hospital approached Pavee Point to try and identify why Travellers were not using their service.  The main barrier for Travellers accessing the service was lack of information and knowledge of it existence and purpose.  In partnership with the team in Temple St hospital we developed an information leaflet explaining in a culturally appropriate way the work of the Self Harm Team and how to access it.  Information was provided to the PHCTPs in the Eastern Region who were also in the catchment area of the hospital and the leafleted was disseminated by community health workers as part of fieldwork.  This leaflet was also launched by Martin Rogan on 25th July.  Since this initiative feedback from the Self Harm Team in Temple St is that a number of Travellers accessed the service.  We are continue to work with the team and are now looking at their parenting programme ‘SPACE’ to see if it is appropriate for Traveller parents.

A significant amount of media attention was generated by the launch and it served to highlight awareness and promote discussion of the issued faced

Cyber Bullying

Another issue which was highlighted by the sub group was cyber bullying and the impact of this and young people’s mental health.  In order to create awareness of the issue and impact of cyber bullying the sub group organised a full day workshop.

The target audience  for the workshop was PHCTPs, Youth workers and mental health service providers in the region. The workshop was on 8th December 2014 and key speakers spoke about

  • Social Media – types etc
  • Legal perspective
  • YMCA Tech space
  • Reach Out
  • Two Travellers on their personal experience of cyber bullying.

The workshop was very successful with a lot of relevant information provided.  Since the workshop, further more detailed information sessions have been provided to the Eastern Regional Traveller Health Network and the sub group are going to develop a Traveller specific resource on ‘How to keep safe on line’.

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Green Ribbon Initiative                                                                                                        

During May 2015 the PHCTP were involved with the Green Ribbon campaign See Change, the National Stigma Reduction Partnership roll out a month long national Green Ribbon Campaign to get people talking openly about mental health problems in May 2015.

Community Health Workers distributed the ribbons to approx. 1,200 Travellers in the Finglas and Blanchardstown area and encouraged the following:-

  • Talk, but listen too: Simply being there will mean a lot.
  • Take your lead from the person: As a first step, ask them how best you can help.
  • Avoid the clichés: Phrases like ‘Cheer up’, ‘I’m sure it’ll pass’ and ‘Pull yourself together’ definitely won’t help – Being open minded, non-judgemental and listening will.
  • Keep in touch: There are lots of small ways of showing support – Send a text or just ask someone how they are doing.
  • Don’t just talk about mental health: Just be yourself, chat about everyday things as well.

Ribbons were also distributed to the Traveller Primary Health Care Projects in the Eastern region and at our National Traveller Health Network.

Youth Mental Health                                                                                                                  

A group of young males from Finglas developed a short film on access to water. The film which was part of NYCI’s One World Week can be viewed via the following link: https://www.youtube.com/watch?v=xEDhbfYTlFg&feature=youtu.be

RTE’s News2Day children’s news show contacted Pavee Point and wanted to include this piece of work in their show. The group were recorded in Dunsink, Finglas and explored the process they were involved in, revealing their learning and sharing their understanding of access to water both locally for Travellers and globally for many millions throughout the work. The segment that was aired on 2/12/2014 and the team received good reviews from those who saw it.

LGBTQ                                                                                                                                    LGBT Poster Black

The Youth programme, working with the Drug and Alcohol programme worked together on  the  development of  Traveller Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) awareness raising campaign.

Pavee Point, along with LGBT Pavee and BeLonG To Youth Service set about to develop a Traveller specific Lesbian, Gay, Bisexual and Transgender poster. This process began in 2013 with some informal meetings, which acted as the starting point for awareness raising of LGBT Travellers. It was envisioned that this process would have a number of distinctive stages from awareness raising, to the development of best practice guidelines, to the possible creation of safe spaces for young Travellers identifying as LGBT. It was decided at the beginning that for such a process to have the maximum impact it was essential to have the voices of young people represented from the first steps. It was through the bringing together of the respected youth groups that the process gathered momentum and direction.

 

This process, brought together young people from Traveller and LGBT communities which provided a space to share lived experiences of belonging to a marginalised group within society. After a number of creative meeting, which allowed for young people to learn about each other’s history and cultures, the group feed into the process what they felt a poster which was targeted at young LGBTQ Travellers should look like. The result of this input was the desired outcome of the creation of an awareness raising LGBTQ poster.

The launch of the poster coincided with both Traveller Pride Week and Gay Pride Week in June. The launch which was a great success took place in the Office for Child Ombudsman.

Building on this initial work will be a main aim of all parties involved for 2015. It is envisioned that the groups will reconnect with the aim of exploring best practice guidelines for engagement with LGBTQ Travellers.