Travelling community is the Ireland’s only major indigenous ethnic minority and it is documented that there are bout 22,000 Travellers in Ireland which is about 4,000 families. 15,000 Irish Travellers live in the UK. The Travellers are a close knit community with a strong tradition and culture around a nomadic way of life. They are however, not related to the Roma people of Europe but they share the sense of being marginalized and excluded in the society. So, this paper is about digging deep down how contemporary politics and social influences in the healthcare of the Travelling community in the UK, roles of inter-professional team in healthcare contribution in these adverse conditions, main healthcare issues for the Travellers community and disease prevention and approach to the Travellers. I will also highlight barriers and difficulties that face healthcare deliveries, initiatives and programs.
Contemporary Political and social influence in healthcare for Travelling community
Healthcare in the United Kingdom is a devolved matter meaning that North Ireland, England, Scotland and Wales each has its own system of publicly funded and private healthcare (Nuffield, 2009). This is in addition to alternative, complementary and holistic treatments. Public healthcare is given to all UK permanent residents (BBC, 2008). The World Health Organization ranked United Kingdom as the fifteenth best in Europe and eighteenth in the world (WHO, 2008). The healthcare in the United Kingdom lies with four executives that is the government of United Kingdom for England, North Ireland Executive, the Scottish Government and Welsh Assembly Government. Each of these executives asserts governmental influence over its national health services but with different policies and priorities. In the UK the private healthcare is the smallest and is acquired by means of private health insurance; this is either paid directly by the customer or as part of an employer funded healthcare scheme (OECD, 2009). That kind of arrangement and bureaucracy to a large extent affects the healthcare provision for the purely nomadic Travelling community. Being a close knit community it is also true that the Travellers dwell in rural locations where civilization is not up to date. Since politics is a about numbers, the Travellers community numbers in terms of population does not guarantee them access and use of better facilities like other citizens. Apart from the evenly scattered healthcare clinics and centres which have less manpower and facilities, there are no other high class healthcare facilities within the Travelling community residential locations. Social class has a role to play in the healthcare provision as well, since the Travelling community has a tight tradition and way of life it is tough for them to mingle easily and freely with other ‘normal’ people. This is due to the fact that the travellers have a defined way of life that is inherited from generation to generation and does not undergo major changes. The fact that the community is nomad proves just how tough it is to get the community in a single location for a long period of time. This makes it even harder for the social part of life with other communities to creep in. Without social and political goodwill, the Travelling community has remained marginalised and left behind in terms of civilisation and improved healthcare provision (BMA, 2007).
Main healthcare issues
The Travelling community has major and serious healthcare issues; the male Travellers have a culture of consulting the female Travellers about health related issues. This type of consultation and in quest for help has blinded the males from seeking quality healthcare from government hospitals and clinics (DOH, 2009). Life expectancy levels are way much shorter among Travelling community, they are also likely to die from any given complaint unlike the settled community. Some of the main healthcare issues include accidents, respiratory ailments, hereditary disorders and metabolic disorders. They are also more likely to suffer from deafness and uncorrected vision defects. It is also estimated that Travellers have a large population of 3 out of 4 having never visited an optician for spectacles due to the belief and association of spectacles with literacy and settled community (Irish Health, ac 2008). Travellers also suffer a much higher infant mortality rate than the remaining of the UK population. Statistics have it that a Traveller woman is more than three times likely to miscarry or have a stillborn child as other pregnant UK women (Irish Health & Briefing Note, 2010). Another pressing healthcare issue affecting Travelling women is depression. A survey carried out points out that up to one in three Traveller women in experience a long term depression (Pavee, ac 2008). Living standards are the sole reasons for poor health and short life expectancy. Travelling community, certainly live without heating, shelter, fresh water, poor or even non-existent toilet facilities that settled accommodation and confined halting sites offer (Pavee, ac 2008). Basically, the Travelling community has low level or almost non healthcare provision centers. Those who live in settled accommodation get access to low quality medication and healthcare that such camps can offer. Those who are at halting sites have to rely on traditional means of healing and sometimes even get no traditional herbs and medication. There are clear difference in the incidence of ill health by social class and figures from the UK show that people in lower social class like the Travelling community and children are more likely to succumb to ineffective and parasitic diseases and pneumonia (BMJ, n.d).
Apart from offering the nursing that they are trained and qualified to do, nurses who offer healthcare services to the Travelling community have to offer much more. First of all Travellers are nomads, secondly they are closely knit and conservatives, thirdly they are faced with social prejudice which leaves them more comfortable with one of their own and not an outsider. These factors play a major role in having the Travellers come for the healthcare in the few centers or even the employed nurses’ ability to offer competent healthcare. Those nurses who are willing to offer the services have side roles of creating rapport and ease with the Travellers. The Travellers know that they are looked down upon and are victims of sedentarism which has made them develop defense mechanisms. They prefer being in a crowd of their own because it is easier that way and in fact they do not despise each other. So for one be a nurse and perform a duty perfectly, it involves creating and ensuring the easiness and freeness with Travellers patients. This is an added role that the nurse should be ready for (Surreycc, ac 2008). Secondly, the nomadic natured of the Travelling community entails that the health care services should not only be offered in a permanent location instead there has to be mobile clinic. In comparison of Travelling community and general community in terms of disease prevention, approaches, strategies and resources it is obvious that the general community is way a head in all those categories. First of all, the general community has access to all types of healthcare facilities ranging from high class public hospitals to finest of private healthcare centers. That might not be even a dream to the Travelling community because they do not appreciate the complexity in the healthcare service provision (BMA, 2007). While the general community is involved in matters dealing with healthcare insurance and taking considerable caution incases of ill health or accidents, the Travelling community men take their time when having ill health to consult their women and wives(DOH, 2008).while the general community will go for general health check up and scanning without having any symptoms and signs of a disease infection, the Travelling community takes no such step instead they engage in their primitive economic activities and way of life(Klein, 2006). Since the world is fast changing and many people are now getting services through internet and other e-services, the Travelling community is still reserved and conservatives. For instance medications and healthcare is now available through mobile healthcare applications this is an application that once a person joins they do not have to visit the hospital for constant observation because the physicians will have a continuous access to the patients electronic health records (EHR). This is a step that can not be accessed and used by the Travelling community because, one, they can not access and apply or even understand the process of mobile healthcare applications (Adams, 2007). Two, vast majority of Travelling community holds no formal educations and qualification hence it is very tricky and impossible as at now for them to get the tit bits of e-healthcare(Zhang et al, 2009). There are high levels of non-attendance at secondary and even tertiary level of education for the Travellers (Culturenorthernireland id 751, 2008). It is easier for the general population to access clean water and healthcare due to accessibility and social services availability. But on the other hand, it is very hard for the Traveller to get such services because first, the political class has marginalized and forgotten them. Secondly, they are not empowered in any big way to leave their traditional mind set and follow civilization instead they are looked down upon and ignored. This just proves our politics is a game of numbers and the few the numbers the less the goodwill and even development.
Being in such conditions that the Travelling community is in, makes it hard for the healthcare professionals to offer their services. Healthcare services are provided in hospitals and locations with structures and favorable conditions. Such conditions include good road networks, clean water, power supply and manpower. These services are all absent in the Travelling community settlement area (Thane, 1982). Many Travellers have neither toilet services nor electricity hence it complicates matters for the professional healthcare providers to offer their services perfectly and precisely. The patient who is the Travelling community is not able to access the intended high quality healthcare services due to various reasons. One, they are marginalized and despised by the entire UK populace. They can not get a warm acceptance and accommodation to access the high class medication. Secondly, the Travellers have little know-how and information that can enable them accesses to the ever changing face of world healthcare. It is true that the healthcare is changing and it is possible for one to get services even without visiting the physical location where the hospital is thanks to what is now called e-healthcare or mobile healthcare services application (Ham, 2004). What is important is for one to get his or her information into an EHR database which will be accessed and monitored all the time by the physician. This service is only accessible to those who have the know-how and financial ability. With poor and primitive economic activities the Travelling community is not in a position to buy the required equipments for the achievement and functionality of the mobile healthcare applications. Lastly, their nomadic lifestyle does not allow them to stay in a location for long, which on the other hand does affect the way they can access their healthcare services. Since they are settled in accommodation camps it is very hard for them to get permanent structures for medical dispensation. The carer on the other hand gets it hard to take care of the sick because of the barrier in social class discrimination (Nuffield n.d). The Travelling community males take it up to their women to give advice about medical conditions hence they cannot willing and comfortably offer such information or ask for help from other carers who are not from their community and who are not also women(Thane,1982). The fact that they believe their women to be good in diagnosis engulfs them from trusting other people with their medical or diseases information. The poor infrastructure does not permit other medical services such as ambulance services and airlifting incase of adverse conditions. This gives the carer a challenge that is hard to crack.
It is however time that the political class should throw away the number factor and get the minority their way. This starts by improving infrastructures and other amenities despite the fact that the Travelling community is nomadic.