Modelos educativos flexibles en la educación rural

Illustration 5. The community health initiative’s 'health bus’

The original idea to use a camper van as a mobile health unit came from the past experiences of the Project Lead and Project Health Worker as Health Visitors, working with Gypsies and Travellers prior to the project. The Health Visitors did not work with Gypsies and Travellers exclusively, but as part of a larger case load. They were aware of the low immunisation rates in this group and attempted to provide an outreach service to the Gypsy/Traveller site to immunise the children. The difficulties they experienced carrying the equipment from caravan to caravan drew them to the conclusion that outreach work would

be better done from some type of mobile unit where Gypsies and Travellers could visit it on site, rather than the Health Visitors trying to visit every caravan.

The ‘Health Bus’ is a 23 foot camper van that has been converted into a mobile health unit. It has two distinct areas that can be divided by a curtain if needed.

One area is fitted as a clinical examination/treatment area. The clinical area has an examination couch, washing facilities and is fully equipped. In this area, the Project Health Worker is able to carry out blood pressures, venepuncture, immunisations and other simple nursing procedures. The other area is a less formal seating area where people can talk and informal and formal health promotion takes place.

The ‘Health Bus’ is taken onto the council run Traveller site three times a week and is used to visit private sites and housed Gypsy/Travellers (where

appropriate) on the remaining days. When on the council run site, the ‘Health Bus’ is parked near the entrance to the site. A drop-in service is used, where Gypsies and Travellers are free to come and discuss any problems they may be experiencing. It is also used as a venue for more formal health promotion

activities.

5.3.5.1 Service users' perspective of health bus

The Health Bus is very much valued by the Gypsy and Travellers communities who make use of it.

7 think it’s very good. I think they should be on every site.”

(Resp.8, female, 20yrs, Irish Traveller) The Health Bus fulfils several functions; by far the most important to the

Gypsies and Travellers is the privacy that it provides. The Gypsy and Traveller’s culture is one of close communal living; people live in an open door fashion, where people will walk into another person’s caravan without knocking. People do not lock their doors when they are in. Often, several people will be sitting together in a caravan. Seldom is there privacy and it is not acceptable to ask people to leave.

The Health Bus is run differently, it is an open door, drop-in style service, but the Project Health Worker can lock the door or ask people to leave on the grounds of needing to talk to someone privately about their health. This is accepted by the Gypsy and Traveller communities.

The privacy that the Health Bus provides is a vital element, allowing Gypsies and Travellers to open up to the Project Health Worker. Without this privacy, it would be very difficult to establish the close, trusting relationships that have

been forged since the start of this project. Furthermore, it is unlikely otherwise, that the high levefs of depression or domestic violence would have come to light.

The privacy that the ‘Health Bus’ provides also allows Gypsies and Travellers to talk to the Project Health Worker about health concerns that would be seen as culturally taboo, such as women’s health, knowledge of the reproductive system, contraception and sexually transmitted diseases.

This privacy is highly valued by the Gypsy and Traveller communities.

“In the bus you can sit there, you can talk, you can express the way you feel, you can express your feelings, you can tell yers whats up with us and how you’re feeling... They can open up more. They can see more what’s up with 'em, you can see deep down what’s inside. I’m not being funny with yer and I might be the only Gypsy person that’s got the guts to say it, every one o f ‘em puts a face on, nobody knows deep down what’s happening inside, nobody. ”

(Resp.2, female, 22yrs, English Gypsy)

“The health bus is really good. You can come in here and talk to Janine in private. You can't do that in our caravans cause there is always people coming and going. People would know your business.”

(Resp.7, female, 23yrs, Irish Traveller)

“Yeh, because you can come in and sit down and have a chat, with no one like, if someone came in and you didn’t want them

listening, the Health Worker would put them out. When they come into your caravan you can’t, can you.”

(Resp.13, female, 21yrs, Irish Traveller) As well as providing privacy, the Health Bus also provides a quiet environment to discuss worries and concerns and to talk over health issues. Gypsy and

Traveller caravans are far from quiet. They are often full of friends, family, and children. Gypsies and Travellers have large families and are a young

population, so many families have young children at home. As well as the noise, children are a natural distraction when trying to talk. Often, a woman will leave the children with another family member to come to the Health Bus for this reason.

“If you want to talk and you want somewhere peaceful, then you can ju st sit with the Health Worker; and want to know about health and asking things about the kids and you can relax. No, can’t (do this in own caravan) because everyone’s in the caravan, there’s always the kids and people just walks in and out, visiting and

whatever. ”

(Resp.5, female, 37yrs, Irish Traveller) People liked the service being ‘drop in’ and felt reassured by the Health Bus’s presence. They can call in with any problems while it is on site. Other’s felt that it was good to have the Health Bus because all the equipment for health checks could be easily transported. One person mentioned that she felt easier visiting the Health Worker in the Health Bus than going to the doctor’s surgery where she felt uncomfortable because she felt she was ‘looked down on’ there. She felt that she was shown more respect in the Health Bus. Also, being a camper van, it is a familiar environment to Gypsies and Travellers, a more culturally acceptable environment that puts people at ease.

5.3.5.2 Service providers’ perspective o f health bus

The health bus has enabled the gathering of CHD and mental health status data. The privacy that the health bus offered allowed participants to be candid in their accounts of CHD lifestyle and mental health questions without fear of being overheard by other members of the community. This may be a weakness in other studies that use interviews in the Gypsies’ and Travellers’ own caravan or house, as they are seldom alone and liable to be interrupted. These

interruptions had been witnessed at first hand by the Project Health Worker and Project Lead while they were Health Visitors and they hoped that the health bus would provide a more suitable environment for data collection.

The practical advantages to the community health initiative of having the health

vaccinations are carried on board, as are other pieces of equipment such as a sphygmomanometer, scales and syringes for blood testing. Also, health

promotion equipment and materials are carried on board, such as books, visual aids and health promotion videos. Often when a topic arises in an informal discussion of health in the health bus, educational and health promotion materials can be used to help illustrate a health message. Having these materials to hand is very important as Gypsies and Travellers prefer a casual approach rather than a scheduled ‘session’ about a health topic.

The privacy that the health bus provides is also valued by the project workers, enabling them to have more intimate conversations and therefore gaining a better understanding of people and their problems. The extent to which people would ‘open up’ in the health bus and discuss their most private concerns was not foreseen by the project workers. It proved invaluable in learning about some of the problems that Gypsies and Travellers suffer but do not necessarily wish to talk about openly, such as family planning and domestic abuse issues.

‘The bus brings privacy to an extent, although its an open door type thing, you can lock it up a little bit, you couldn’t do the same practically, equipment wise, it gives the Travellers a chance to come and have a word with us, because quite often you will go to a trailer and there will be several women in their and its difficult to have a personal conversation. ”

(Multi-agency Traveller Forum Member)