The Role of Universities in developing developed world Healthcare

The Role of Universities in developing/developed world: Healthcare for homeless and orphans Vladimir Krcmery St. Elizabeth University, Shelters Bratislava, Dolná Krupá, Malacky, Slovakia and St. Maximilian Kolbe Tropical programes, Cambodia 8. 12. 2012 Warsaw

INTRODUCTION o 0, 2 % of Slovaks are homeless o New phenomenon in Slovakia o The term „homeless“ is not recognized in Slovak law o Health and social care for the homeless is rather the domain of church and non-profit NGOs o Organizations targeting only homelessness do not exist

DEFINITION OF HOMELESS PEOPLE Lost of housing → lack of „fixed“, regular, and adequate nighttime residence Social contacts Marginalization Isolation

„HELP YOURSELF“ ACCOMODATION 1. „ ON THE STREET“ Homeless without any shelter, bus stations 2. „ SELF-MADE SHELTERS“ empty houses, tunnels, garden houses - living in small groups (migration) - specific rules - violence

SHELTERS PROVIDED BY INSTITUTIONS o Lodging houses o Hostels o Warming centers o Rehabilitation centers - drugs - alcohol o Food, clothing and possibility of personal hygiene o Health care, social counseling and prevention o Internal rules o Limited time o Payments

GROUPS OF HOMELESS PEOPLE IN SLOVAKIA

SHELTERS FOR HOMELESS PEOPLE o 48 homeless shelters, daily stationers, refugee houses, health centers and hygiene houses in 15 cities in Slovakia o St. Elisabeth University involved in the field of homelessness since 2003 o Provides -the only shelter in the capital city available for all homeless people -two asylum houses for battered woman with children

SUPPORT OF HOMELESS PEOPLE PROVIDED BY THE UNIVERSITY OF ST. ELISABETH NAME CAPACITY NUMBER OF PERSON TARGET GROUP REMARKS PARTNERS MEA CULPA SHELTER BRATISLAVA 36 BEDS 55 PEOPLE HOMLESS WOMEN/ MEN ZERO TOLERANCE OF ALCOHOL THE MUNICIPALITY OF BRATISLAVA BETHANY ASYL CENTRE MALACKY 7 ROOMS 22 PEOPLE MOTHERS AND CHILDREN 40 KM FROM BRATISLAVA NGO KRIZOVATKY JOSEPHINUM ASYL CENTRE DOLNA KRUPA 12 ROOMS 24 PEOPLE MOTHERS AND CHILDREN 60 KM FROM BRATISLAVA NGO GOODNESS OF ST. ELISABETH

MEA CULPA SHELTER, BRATISLAVA No tolerance of alcohol Fee 1€ per night Stay: max. 2 months Services: dinner, laundry, hygiene, counseling, law and social services inc. job search, primary health care o Education: failed primary education up to University o The most frequent age category 31 - 60 years o 12% of clients are women o o

BETHANY, ASYL CENTRE MALACKY o Fee 15 USD / month o Target group: battered women with children, released from prison, from orphanages o Maximum 1 year o Accommodation, clothing, food, health care, counseling

PUBLIC OPINION ABOUT HOMELESSNESS o Homeless people are satisfied with that what they do and do not want to change their life o There are transmitting serious diseases such as bacterial diseases, TB, HIV and hepatitis

WE ARE BREAKING MYTHS Questionnaire: 634 homeless people during 6 months 14% satisfied with their life 26% would like to change what they do but they don't know how to do it 60% of homeless people decided to change their life None serious infection confirmed 104 homeless → 42 had positive cultivation of pathogens o 21 Staph. aureus o 13 Candida albicans o 3 Strept. pneumoniae o 3 Klebsiela pneumoniae o 2 Staph. pyogenes

STRATEGY OF THE UNIVERSITY OF THE ST. ELISABETH TO HELP HOMELESS o Educate social and health professionals to work with this targeted group o Connection of academic study of social work, nursing and health to support homeless people o Close cooperation with media helps breaking myths about homelessness

HIV PROGRAM PRE SIROTY V Kambodži Clinic of St. Maximilian Kolbe, House of Family (2003) House of Smile (2006) Peter Pavol Gojdic Children’s Hospital (2007) Daniela’s House of Family (2008)

Iniciálne diagnózy u hiv pozitívnych sirôt zaradených do hiv programu (neliečené n=137) 1, 2% 2, 3% 4, 7% 5, 8% 7% 8, 1% 9, 3% 11, 6% 12, 8% 14% 17, 4% 22, 1% 27, 9% 31, 4% Pneumónia Bronchitída Herpes simplex Uroinfekcia Infekcia kože Parotitída Scabies Herpes zoster Diarrhea Orálna kandidóza Otitis media Tinea capitis Weisting syndróm Dermatitída Tuberkulóza Eozinofília Hepatopatia Lymfadenopatia Anémia 51, 2% 65, 1% 0 20 40 60 80

Oportúnne infekcie a koinfekcie pozorované v súbore liečených pacientov, N=137 (2003 – 2011)

8 ročný monitoring spektra patogénov a rezistencie na antiinfektíva (N = 882 kmeňov)

Prehľad multirezistentných kmeňov baktérií izolovaných od HIV-pozitívnych sirôt N=586 N % Všetky MDR 98 16, 7 Gram-pozitívne MDR 88 15 Stafylococcus aureus OXA, ERY, TET, CLI, CXM, GEN 39 6, 7 3 0, 5 Stafylococcus aureus OXA, ERY, CLI, CXM Stafylococcus aureus OXA, ERY, TET, CLI, CXM Streptococcus pneumoniae PEN-R, ERYR, TET-R Moraxella catarrhalis PEN-R, ERY-R, TETR 27 4, 6 2 0, 3 11 1, 9 6 1, 0 10 1, 7 Klebsiella spp. GEN, CAZ, COT 3 0, 5 Acinetobacter spp. GEN, CAZ, COT 2 0, 3 E. coli AMP, GEN, COT 3 0, 5 Enterobacter GEN, CIP, CAZ 2 0, 4 Gram-negatívne MDR

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