Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Study Design
2.3. Procedure
2.4. Data Analysis and Feedback
3. Results
3.1. The Complexity of Those Who Live on the Streets
- Individual vulnerability and the singularities and “repeated” trajectories
“People are there in the square, also because we put them there, because we see that there are several trans, gay, and homosexual girls who are homeless, because their parents threw them out. Then they go live on the streets and lose everything, because what they look for all the time on the streets is this: family, understanding, acceptance, respect, which they don’t have at home, so this is difficult.”(2)
- Social vulnerability and violence
“The Cathedral is the largest church in the city, where many [homeless] people stay sleeping nearby. And one way to meet the request of the churchgoers, who enter the Cathedral and say that the church door is always smelling of urine, poop, was to wash the church’s sidewalk. And they were doing that at dawn, in winter. And then blankets got wet, and then they went to sleep wet on the wet blanket, cold, then several of them were with pneumonia, several were hospitalized, several of them died.”(2)
- Programmatic vulnerability and the difficulty of access
“They [homeless population] are very badly treated when they arrive at the hospital, in many ways they are neglected, abused, left aside, it’s a life that we realize that is not worth investment in both in terms of health and all other other spheres of [social] care.”(2)
“You already see the extreme condition, you know, you don’t get it from the beginning, you get a diabetic with diabetes at 600, you can hardly identify it, the device doesn’t read it.”(5)
3.2. The Work of the Street Clinic from the Perspective of Harm Reduction
- Harm reduction
“This pipe, you won’t share it, because your mouth has several cracks, so you can get tuberculosis, hepatitis, you can get some other disease, that’s why you can’t share your pipe. You have your lip balm and it’s yours, yours alone, because it treats the chapped lips.”(5)
- Street Clinic activities
[Fixed field]: “We have our work process, which we call fixed fields, in which we use our own work apparatus, our tent, we have a van, you know, that takes us to these places we call field, where we are going to provide health care, based on our clinical practices.”(3)
[Mobile field]: “We go to places in the municipality to conduct activities that can be harm reduction, or we can even go there with no plan, for whatever occurs, we go around some regions of the territory there to be able to access some users; some of them we have already met, we try to maintain a bond there in order to maintain regular care.”(3)
[Team meeting]: “We try to carry out this collective construction of clinical cases, I think that what mostly determines this are our meetings with users in the field, where we are be able to build bonds and build a history of care and treatment with them.”(3)
- Building the bond
“We suffer with them, feel their anguish, because that’s it, the contact of being very close, because we don’t have barriers, walls, we’re here, in the open, so we’ll touch, we’ll talk.”(8)
3.3. Beyond the Street Clinic: Networked Relationships
- Partnerships
“Our work will only work if we have a network formed, alone is no use either.”(8)
- Conflicts
“The impression we get is that it’s as if it were our responsibility, for being homeless, only ours, only ours.”(5)
“Perhaps because some services do not know us, our work, they do not believe in partnerships, they may believe that we take the user there, and then we will not continue our care on the street.”(7)
“Sometimes we are invisible with them [homeless people].”(8)
- Coping
“There are great partnerships with some services, others we even go there for confrontation, we take the bull by the horns and try to hold our ground to make them understand that they really have to care for them, that there are people here.”(1)
- Network building
“It doesn’t mean that everyone has to have the same opinion, but they should produce a certain alignment and a certain coherence of longitudinal care, so what we call network health care—and this happens a lot in the field of micropolitics, I say that because, you know—it will depend a lot on who is in what place and in what situation.”(3)
4. Discussion
4.1. The Complexity of Those Who Live on the Streets
4.2. The Work of the Street Clinic from the Perspective of Harm Reduction
4.3. Beyond the Street Clinic: Networked Relationships
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Id | Gender | Age | Profession | Time of Experience in CnaR (Years) |
---|---|---|---|---|
1 | Male | 38 | Harm Reducer | 7 |
2 | Female | 45 | Nurse | 7 |
3 | Male | 41 | Psychologist | 4 |
4 | Male | 36 | Physician | 4 |
5 | Female | 35 | Nursing Technician | 4 |
6 | Female | 53 | Social Worker | 7 |
7 | Female | 43 | Occupational Therapist | 6 |
8 | Female | 43 | Harm Reducer | 7 |
Script | |
---|---|
1 | How does it work and what are the daily activities of the Street Clinic? |
2 | How is your relationship with the homeless population? |
3 | What are the main characteristics and vulnerabilities of the population? |
4 | In your opinion, does the Street Clinic meet the needs of the homeless population in its place of work? Comment. |
5 | How does harm reduction occur in the Street Clinic? |
6 | How is the Street Clinic articulation with the healthcare, mental health and social assistance network? |
7 | What are the strengths and problems of the Street Clinic? |
8 | In your opinion, what is need to maintain or improve health care for the homeless population, considering the articulation with other services, in addition to the Street Clinic, and comprehensive and humanized care? |
9 | How is the assistance provide by other services in the health network in relation to the homeless population when the Street Clinic contacts or forwards them? |
10 | Do other services know how to deal with the issue of alcohol and other drugs? Do you know how to deal with abstinence from patients? Do you apply harm reduction? |
Steps | Description | ||
---|---|---|---|
1 | Pre-analysis | Test skimming and rereading | The research team becomes familiar with the interviews, the concepts emerging in the transcribed corpus |
2 | Exploration | Coding | Identification of codes that, organized, constitute the initial themes. |
3 | Clustering | Organization and systematization of codes | Themes and sub-themes are grouped into common categories through both implicit and explicit relevance. |
4 | Exploration | Interaction | During the interactive process, which involves several reviews, processes for peer verification of themes and sub-themes are included. |
5 | Treatment | Account | The theme that emerged from the research corpus develops into a narrative (context units) based on the findings. Accordingly, there is the beginning of the triangulation of accounts and the use of citations as units of record (discourse fragments) to illustrate the themes that emerged from the analysis. |
6 | Treatment | Contextualization | Researchers interpret findings within the context of the existing literature. |
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Share and Cite
Bombonatti, G.R.; Saidel, M.G.B.; Rocha, F.M.; Santos, D.d.S. Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study. Int. J. Environ. Res. Public Health 2022, 19, 2573. https://doi.org/10.3390/ijerph19052573
Bombonatti GR, Saidel MGB, Rocha FM, Santos DdS. Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(5):2573. https://doi.org/10.3390/ijerph19052573
Chicago/Turabian StyleBombonatti, Giulia Romano, Maria Giovana Borges Saidel, Fernanda Mota Rocha, and Débora de Souza Santos. 2022. "Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study" International Journal of Environmental Research and Public Health 19, no. 5: 2573. https://doi.org/10.3390/ijerph19052573
APA StyleBombonatti, G. R., Saidel, M. G. B., Rocha, F. M., & Santos, D. d. S. (2022). Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study. International Journal of Environmental Research and Public Health, 19(5), 2573. https://doi.org/10.3390/ijerph19052573