“We take healthcare to people who need it most,” says Sive O’Regan, a health inclusion nurse with the NHS service Find and Treat, whose team in London cares for the city’s homeless, sex workers, drug addicts and asylum seekers. “We work with disadvantaged and marginalised groups who don’t get much healthcare normally.”
Nurse Yasmine Appleby of the UCLH Find and Treat service at work on the Strand in London. She looksfor the cause of Clifford Hughes’ tooth pain before encouraging him to have a chest X-ray to check for tuberculosis, and a Covid booster jab. Clifford is homeless and living on the street.
Unlike typical NHS services, Find and Treat, which is run by the University College London hospitals trust (UCLH), is proactive rather than reactive. Its team of doctors, nurses and outreach workers are trained to identify people among vulnerable populations who need treatment and to administer care in a sensitive way.
To do this, two vans fitted with medical equipment serve as mobile health clinics, which stop near hostels, drug services and soup kitchens. People frequenting these services are at a higher risk of contracting blood-borne viruses, sexually transmitted infections, tuberculosis or Covid-19. Here, patients can be assessed and diagnosed on the spot.
Find and Treat’s main van includes a mobile X-ray machine, which the staff use to test for tuberculosis
O’Regan works on the smaller van, which she calls “the blood van” because it tests for blood-borne infections such as hepatitis B and C, HIV and STIs, including syphilis, chlamydia and gonorrhoea. The bigger van, a long white vehicle bearing the service’s name and UCLH logo, is fitted with a mobile X-ray machine that is used to test for tuberculosis. “Every week, we spend the week in a different part of London and link up with places like hostels and drug services, to arrange to come and do some testing on their sites in the back of our van,” she says.
In the smaller of the blood van’s two rooms, people are asked to detail their drug use, alcohol intake and sexual behaviour, to help the doctors establish how likely they are to have been exposed to diseases. “These are serious diseases. These viruses are spread very easily, so if you share equipment it’s very likely that you will get it,” says O’Regan.
Above: Inclusion Health CNS Sive O’Regan gives Theo, a former dancer from Paris now homeless in south London, a Covid-19 vaccine and has a chat about his physical and mental health. Right, O’Regan gives another homeless man, Sam French, a Covid-19 vaccine, while outreach specialist Adrian Bean Noctor logs details of treatment administered throughout the day. Far right, O’Regan gives Eyob Yohannes a Covid-19 vaccine
Those who have shared drug equipment are offered new needles, to prevent the spread of hepatitis C, which is closely associated with intravenous drug-taking. This is “an important public health intervention”, says O’Regan.
Find and Treat tests asylum seekers and refugees for hepatitis B, which is more prevalent in the countries they come from than Britain. Both diseases are very treatable with medication, O’Regan stresses. The team operating in the evenings offer their services to street-based sex workers.
O’Regan and her colleagues take a tiny amount of blood from a patient’s fingertip and, using testing equipment onboard, can find out within 15 minutes if the patient has any infection. During this time they offer a fibroscan to test the health of the liver for anyone who has a history of heavy drinking. Unidentified liver disease can lead to death from liver failure or cancer. But anyone found with cirrhosis can start treatment right away. This is how, the Irish nurse points out, Find and Treat’s intervention saves lives.
Working with vulnerable patientshas its challenges. “Not having a home is not generally good for your health because that can deny you access to care. These groups don’t always get the care and compassion that healthcare professionals usually extend to the general population,” says O’Regan. “If you experience hostility time and time again, that’s going to create a resistance to healthcare, for example a resistance to taking medications that are good for them, and mistrust of the system. Our job is not just to find the infections but also to rebuild trust.
“The work we do is really important because these are hard to reach populations that tend to be ostracised from society in general. We have a lot of fun. It’s really rewarding to see someone go through treatment who was reluctant [to engage] in the first place, and come out the other end.” Building a rapport with patients is vital.
Ousainou Sarr, above, now works as a tuberculosis outreach worker for the service that saved his life
That is where the team’s peer support workers like Ousainou Sarr come in. The former restaurant manager lost his job years ago, ended up homeless and contracted tuberculosis, an airborne condition spread by coughing and sneezing. After battling symptoms such as fatigue, weight loss and night sweats for years, he spotted a leaflet for Find and Trace in 2011. He received an X-ray in the back of the big van and began treatment – then joined as one of its staff.
Sarr, who was born in the Gambia, is now an integral member of the team on the tuberculosis van. “My main role is to talk to people, give them a leaflet about [tuberculosis] and persuade them to come and get screened. When they ask why they should get screened, I say that getting X-rayed is important and that rough sleepers are more likely to get [tuberculosis].” Homeless people’s habit of “skippering” – gathering in groups for food, warmth and company – increases their risk of tuberculosis. His experience of homelessness and the disease helps him convince people to do what he did and get X-rayed.
“[Tuberculosis] screening makes a big difference in people’s lives. To get these people into treatment means a lot, especially given the stigma attached to [tuberculosis], which stops people getting screened,” he says. “The satisfaction I get from my job is that I wake up every morning knowing that I will make a difference in someone’s life. Without Find and Treat I wouldn’t be here talking to you.”
