Women, Homelessness and Health

What do we know about the health issues facing homeless women? Of having no meal at all or eating five meals in one day for fear of having none the next day, of getting bed bugs and respiratory illnesses from sleeping on dirty mattresses and in damp places, of feeling too ashamed or exhausted to seek help?

Because homelessness is often seen as a male phenomenon, the experience of homeless women has been largely neglected by researchers and policy makers. We know far less about women’s homelessness than men’s – and almost nothing about health issues they face. Yet, homeless women have differing health needs to those of men and these specific needs are often overlooked in policy or service responses.

Women, Homelessness and Health, a new study by the homeless charity Groundswell and funded by the Greater London Authority, is focusing on these overlooked issues. The study is particularly valuable because it used researchers who have experienced homelessness, in all stage of the research process.
Groundswell researchers interviewed 104 women aged from 19 to 75 in London, using questionnaires, face-to-face interviews and focus groups.

They found that the trajectory to homelessness is often different for women and men: for women, the main causes are relationship and family breakdown, physical health issues and domestic abuse.  Not only is violence a cause of homelessness, but women also experience violence or harassment at homelessness services, day centres, hostels and on the streets, which is often a factor in perpetuating homelessness. Here is what one woman interviewed said:  “Being approached by men too often; being made fun of in the street; some guys take the micky out of you; guys touching but the tiredness from homelessness makes me let down my guard and get tired of fighting back. ” It is not surprising then that women are often reluctant to use services designed for and dominated by men, which can often be hostile places for women.

The research stresses that there is a clear need for gendered specific services, but they are not provided because homelessness is seen mostly as a men’s problem. “Women are not measured and counted – they are not as visible,” says Dr Joanne Bretherton, Co-Director, Women's Homelessness in Europe Network, University of York.  Rough sleeper statistics, for example, count people visibly sleeping rough.  Many homeless women sleep rough, but they make efforts to remain invisible – sleeping in hidden places or on buses - and so remain unknown to rough sleeper teams. 

“Often women will only access services when all other avenues, such as friends and family, have been exhausted,” adds Dr Bretherton.  “And they don’t seek help for fear that their children will be taken away.  They feel their mothering skills are judged all the time.”   Nearly half of the women in the Groundswell study are mothers and 22% of those women had children taken into care – an experience that was incredibly traumatic. 

Among the main findings, the study shows that participants have long and complex histories of homelessness, with 42% having been homeless more than once before and 70% having slept rough at some point of their lives. This suggests that women experience a cycle of repeated homelessness.

Three-quarter of the women interviewed have physical health issue problem compared to 37% of the general population. They mostly complain about joints, bones and muscles pain, problems with feet and stomach issues.  Many said that their health issues arose as a result of being homeless. This is unsurprising given the poor conditions women are sleeping in, the stress of homelessness and the amount of time women spend on their feet.

Sixty-four percent have a mental health issue- most commonly depression, anxiety/phobia and PTSD - compared to 21% of general population, suggesting that mental health conditions can develop and/or are exacerbated upon homelessness. In some circumstances, declining mental health can lead to addictions that where not present before homelessness.

Many participants spoke about how the stress and trauma of homelessness put pressure on their physical and mental health. “You are under stress constantly.  It means you are very vulnerable...in terms of illnesses and everything,” said one woman interviewed.  Stress causes headaches, hair loss, stomach pain, eye irritation, rapid heartbeat, panic attacks, chest pain and periods to stop.

Many say that the stress of being homeless and the lack of routine mean it is difficult for them to look after themselves or attend appointments.  Sixty-five percent say that they struggle to find the motivation and confidence to deal with their health issues. “I can’t make appointment, [I need to] wash first and eat first. Survival comes first.  Last thing we have as dignity is to keep clean.”  
 
“Until we have a larger body of evidence about women's homelessness, there is a risk that policy responses to, and services for homeless people will not adequately meet the needs of women,” says Dr Kesia Reeve, Principal Research Fellow at the Centre for Regional Economic and Social Research (CRESR), Sheffield Hallam University. “It raises issues about, for example, maternal and reproductive health and wellbeing issues that rarely feature in other research but are central to some homeless women's experiences and needs.”
 
The report concludes that in order to better support the health of women experiencing homelessness there is a need for:
- a deeper understanding of the health of women experiencing homelessness
- more flexible, considered and participatory commissioning 
- flexible, compassionate and consistent support centered around individual need 
-  focused approach on the health of women who are homeless within NHS services
- joined up working between services and sectors who support woman experiencing homelessness 

You can read the full report here

Dementia Awareness Week - I am still there

On Our Radar's hand-held device giving a voice to people with dementia

This week is Dementia Awareness Week (15/05/16-21/05/16) and many charities and organizations come together to raise awareness about the condition, tell persons touched by dementia that they don’t have to face it alone and encourage people to remember the person behind the dementia. 

The person is more than the dementia. “Even whilst the 'wall of dementia' is in front of them, they should be held in the same regard, and treated in the same manner as they were, before they had this condition," urges the Alzheimer’s Society. "Even at an advanced stage, people with dementia can sometimes indicate they are aware of those around them; they are still ‘there’. 

 Paul Hitchmough from Liverpool couldn’t agree more. “…Suddenly because you’re diagnosed with this thing called dementia, in some shape of form you become an alien,” he said recounting how an old work colleague recently avoided him at the supermarket. “I really do think it needs to be opened up, this thing.…Just to let people know that you are still the same...” 

Paul’s words are part of the Dementia Diaries, a national project funded by Comic Relief, which brings together people’s diverse experiences of living with dementia as a series of audio diaries. I love this project because it gives a voice directly to people living with dementia.

The Dementia Diaries were launched in January 2015 by On Our Radar, a social enterprise which uses technology to give a voice to marginalized communities. So far, the On Our Radar team has trained 31 people living with dementia across the country to use simple 3D printed mobile phone handsets to record their thoughts and experiences as they occur.  The team then edits and transcribes the diary entries and uploads them onto the Dementia Diaries website, where they can be listened to and shared. 

In their entries, the diarists, who are all part of the Dementia Engagement and Empowerment Project (DEEP), document their daily experiences of living with different forms of dementia.  They talk about their frustrations and joys, what they have lost, what they can still do and what they want people to know.

You can read an entry’s transcript, look at the photo of the diarist and listen to the audio. It is a moving and very powerful.

You can read a story I’ve written about the Dementia Diaries for Positive News here.

And here is short extract from a diary entry by Anne McDonald from Glasgow:

“Why do you call me victim? No one attacked me. Many people live with this condition. We’d rather not have it, but we just get on with it. Language is not difficult…But please remember, this is real life for us. None of you know the shifting sands we walk on daily. None of us know what is ahead. Seize the day and be kind to each other. Thank you.”

If you're worried that you, or someone close to you, might have dementia, call the Alzheimer's Society's National Dementia Helpline on 0300 222 1122 or email helpline@alzheimers.org.uk for advice and support.

 

World Leprosy Day 2014 - shining a light on the ‘hidden’ disease

A young woman affected by leprosy in Myanmar (Burma) is benefiting from a new mobile prostheses clinic.
Credit: Leprosy Mission

This Sunday, 26 January, is World Leprosy Day 2014. Few people might take notice; few might even know that leprosy still exits today. But it does.

For me, World Leprosy Day always has a special resonance because when I was very young – just after high school – I worked in a leprosy centre for a few months. It was in Polambakkam in beautiful Tamil Nadu in the south of India.  At the time, the multidrug therapy hadn’t been developed yet and the stigma of the disease was so strong that very few Indian medics wanted to work there, so volunteers like me were brought in to help clean infected wounds and bandage damaged limbs.

Leprosy has now been curable for the past 25 years or so, but is still a global problem, affecting more than 15 million people worldwide  (including 100 in the UK), and each year, at least a quarter of a million new cases are detected - that is almost one person diagnosed every two minutes (World Health Organization). Over half of all newly-reported cases occur in India. And the stigma is still as damaging as it was when I was young.

On World Leprosy Day, the Leprosy Mission England and Wales, an international organization working to eradicate the causes and consequences of the disease, wants to “shine a light on this hidden disease.” Here is their message:

• Did you know there are still leprosy colonies in the world today where people are ‘sent’ or ‘seek refuge’?  There are 850 in India.

• Did you know that stigma surrounding leprosy in many parts of the world today is akin to what it was during Biblical times?  Even beggars begging for their own survival will often shun a leprosy-affected person.

• Did you know that leprosy is completely curable with a simple combination of antibiotics?  Yet 85 per cent of people in Delhi, India - still believe there is no cure.

We’re confident that leprosy rates would be slashed across the world today were it not still shrouded in age-old stigma.  Three million people would not be living with irreversible disabilities as a result of late treatment of the disease.

What other disease sees someone outcast from their family, sacked from their job, thrown off public transport and pushed to the very fringes of society?

The tragedy is when leprosy is ‘hidden’. It damages and disables, slowly destroying each aspect of a person’s life.  If it wasn’t for stigma and misunderstandings surrounding leprosy then people would seek treatment and all healthcare professionals would recognise its symptoms.

Leprosy is a disease.  Those affected deserve dignity not discrimination. Please spread the word.

For more information, click here.

World Leprosy Day 2013: breaking the cycle of poverty and stigma

Evelina Juba, Leprosy Village, South Sudan

This Sunday is World Leprosy Day 2013, but few people are likely to take notice. Few might even know that leprosy still exists today.  But it does: it affects more than 15 million people across the world and each year nearly a quarter of a million new cases are detected: that is almost one person diagnosed every two minutes. Over half of all newly-reported cases occur in India. 

It might be the oldest disease known to mankind, but it is very much a disease of our time - a disease of poverty caused by a bacillus called Mycobacterium Leprae (a distant relative of the TB bacillus). Most people are naturally immune and the disease is easily cured with multi-drug therapy, but the majority of people affected live in developing countries where resources are scarce and poverty is widespread.

South Sudan is a case in point. Unofficial data points to the UN’s newest member state as having the world’s highest prevalence of leprosy.  After decades of civil war, South Sudan became an independent country in 2011.  But nearly two years after its independence, its people face a daily struggle for survival with severe food shortages. Recent field trips made by The Leprosy Mission England and Wales revealed a woeful lack of healthcare available to those affected by this devastating disease.

The charity’s head of programmes coordination, Sian Arulanantham, said: “I witnessed such abject poverty in South Sudan and there is a real humanitarian crisis within this new nation.  Leprosy is thriving in the squalid conditions in which people are forced to live and there are insubstantial health services available to diagnosis and treat what becomes an extremely debilitating disease.”  The charity is working with the government of South Sudan to try to alleviate some of the suffering people with leprosy have to endure.

While leprosy is not very contagious, the fear and stigma associated with it are – and that’s what makes it such a difficult disease to eradicate. Bible-old stigma and discrimination are still prevalent today and see entire families having their job opportunities, education, marriage prospects and dreams shattered.

Fear fuels a vicious circle which begins with people hiding the first telltale patches on their skin in order to avoid being shunned by their families and driven to the fringes of society. Since 1982, leprosy is easily cured with a simple course of antibiotics, but if left untreated, it can cause irreversible disabilities. The antibiotics can halt the progression of the disease, but cannot undo the damage.  Leprosy causes nerve problems, which can lead to a loss of sensation in the hands and feet, meaning everyday activities are fraught with danger.  Burns go unrecognized and stones in shoes unnoticed, causing ulcers and bone resorption.  The resulting disability can lead to the amputation of limbs.  Leprosy also damages nerves in the face causing problems with blinking, eventually leading to blindness.

On World Leprosy Day 2013, The Leprosy Mission of England and Wales is urging government and people to “concentrate on breaking the cycle of poverty which, along with stigma, sees leprosy remain a 21^st century disease.” 

Stop Female Genital Mutilation in the UK

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Each year, tens of thousands of girls in the UK are forced to have their genitals cut, often with no anesthesia. But there has been never been a conviction for female genital mutilation here -- even though in London alone, police have received 166 complaints in the last four years.

Undercover reporters for the Sunday Times recently caught three medics on film offering to mutilate young girls, massively scaling up the pressure on law enforcement to act. Avaaz, the global civic organization, is urging all of us in the UK to use this moment to call on Home Secretary Theresa May for real accountability. She is in charge of every police chief in England and Wales -- if she takes the issue up personally, the entire police system could be shaken into action.

Avaaz member Ruth Burnett has created a petition calling on the Home Secretary to start prosecuting people involved with these assaults and already more than 2000 people have signed. If they reach 20,000 signatures, Avaaz will deliver it directly to Home Secretary May and the head of Metropolitan Police Force -- click here to sign and forward to everyone:

Female Genital Mutilation is a custom widespread in nearly 30 Middle Eastern and African countries. But FGM has been illegal in the UK since 1985 and in 2003 the law was tightened to stop girls being taken abroad for the operation -- on so-called “FGM holidays”.

Still, the practice is widespread here in the UK. When the undercover Sunday Times reporter explained to Mohammed Sahib, an alternative medicine practitioner in East London that he represented a Ghanaian couple who wanted to have their two daughters -- aged 10 and 13 -- circumcised, he said “I can do it here,” confirming that he would both remove the clitoris and sew up the vagina. “This is my work. I know what I’m doing. I’m going to do it. I will tell you how [much] to pay [for one]: £750.”

Home Secretary Theresa May -- who oversees women’s issues for David Cameron, and who has the power to hold police chiefs all across England and Wales accountable -- recently admitted people would be “shocked” by the number of young girls in Britain subjected to FGM. Now we can push her to take concrete action to end FGM in the UK -- please to sign Avaaz' petition now and share with everyone.

For more information, click here.

Afghanistan is world’s most dangerous place for women – followed by DRC, Pakistan, India and Somalia

Afghanistan, Congo and Pakistan are the world's most dangerous countries for women in 2011 due to a barrage of threats ranging from violence and rape to dismal healthcare and "honour killings", an international expert poll showed today. India and Somalia are the next worst places to be a woman.

The global report is shocking and also depressing for showing dismal lack of progress. When will things change? Most of these terrible situations, statistics and suffering are well documented – what more do we need?

The survey has been compiled by the Thomson Reuters Foundation to mark the launch of TrustLaw Women, a website aimed at providing free legal advice for women's groups around the world.

Not surprisingly Afghanistan is named as the world’s most dangerous country for women because of its high levels of violence, poor healthcare and poverty. And the war was supposed to improve the plight of Afghan women…

“Afghanistan has one of the highest maternal mortality rates in the world. That aside, it is also a context that gives a woman minimal opportunity for education, health access, reproductive choice, etc. The lack of hope of the situation of women improving in the near future, as opposed to countries such as Sierra Leone and Southern Sudan, makes the situation comparatively even worse," says Dhammika Perera of International Rescue Committee.

Continuing conflict, Nato airstrikes and cultural practices also combine to make Afghanistan a very dangerous place for women. "In addition, women who do attempt to speak out or take on public roles that challenge ingrained gender stereotypes of what is acceptable for women to do or not, such as working as policewomen or news broadcasters, are often intimidated or killed," says Antonella Notari, head of Women Change Makers,  a group that supports women social entrepreneurs around the world. 

 

The second worse place goes to the Democratic Republic of Congo for the staggering level of sexual violence in the lawless eastern part of the country. One recent US study claimed that more than 400,000 women are raped there each year. The UN has called Congo the rape capital of the world.

Pakistan comes next on the basis of cultural, tribal and religious practices harmful to women. "These include acid attacks, child and forced marriage and punishment or retribution by stoning or other physical abuse," the poll finds.

The fourth worse place goes to India, which is more surprising for a country emerging into an economic super-power and a country not at war. India’s inclusion to the danger list is due to its high level of female infanticide and sex trafficking.

And Somalia completes the list. The country, in a state in political disintegration, suffers high levels of maternal mortality, rape, female genital mutilation and limited access to education and healthcare.

The poll asked 213 experts from five continents to rank countries on issues like overall perception of danger, access to healthcare, violence, cultural discrimination and human trafficking.

"This survey shows that 'hidden dangers' like a lack of education or terrible access to healthcare are as deadly, if not more so, than physical dangers like rape and murder which usually grab the headlines," Monique Villa, chief executive of Thomson-Reuters Foundation, says.

For more information, go to the TrustLaw website, which provides in-depth information, statistics, interviews and videos on the study. Also read the Guardian’s article by Owen Bowcott. The piece also provides links to case studies in all five countries.