The alarming levels of health inequalities experienced by travelling communities can be better understood and tackled by health professionals, says Richard O'Neill
The health of Gypsy Roma Travellers is more scary tale than fairy tale. I know from first-hand experience of having been born and brought up in a caravan that accessing healthcare while on the road is never easy. In the four decades since then, it has not improved much.
Study after study shows that Gypsies and Travellers have the worst health of any ethnic minority in the country and the anecdotal evidence that my colleagues and I collect on our travels shows an even worse picture.
It can be worse still for men, who can just drop out of the health service altogether, only to re-engage with it when absolutely necessary, usually in accident and emergency. A cause for concern, yes - but also an opportunity to tackle the problem once and for all.
Health professionals often ask me how to engage with Gypsies and Travellers. How do you find them in the first place and how do you break down barriers?
First we need to understand why those barriers are there - and be prepared to work with and have the trust of people who do know where Travellers are. Hopefully these are people who have worked positively with the communities before, and ideally people from the community who have got involved as advocates and health trainers themselves.
They would know, for example, that there are far more Gypsies and Travellers resident in housing than on caravan sites and these housed people are often overlooked as they are effectively invisible to ethnic monitoring.
Gypsies and Travellers also have their own languages and a deep culture. It is essential for people who are going to work with them to receive cultural awareness training, and that community members themselves are made aware of your organisation's culture, what is and is not possible in terms of service and why certain systems exist.
Thinking differently about communication is important too, which is why I always recommend storytelling, as it is excellent for communities where literacy is traditionally low.
Levels of misinformation about health are frighteningly high within the community. For example, one belief is that you can catch cancer from someone who has it. Another is that if you have one chronic condition, you are safe from getting any other serious condition.
When I teach storytelling for communication improvement in organisations, I stress that communication is a two-way thing, with as much listening as speaking. This means that Gypsy Traveller advocates and health trainers can raise awareness among their own communities about what they learn from health professionals.
I now have two new Gypsy Traveller colleagues carrying out awareness-raising with health professionals and the community. Stuart Mounsey and Bobby O'Neill are doing ground-breaking work by speaking freely about their health problems - cancer and diabetes - and how these conditions and the problems that they engender can be dealt with and managed positively. Part of their work is explaining how the NHS works.
We are making progress: both of these men are respected and trusted by the community and up-to-date information is being passed on and on again. Stories of survival and good news encounters with health professionals are really making a difference to how health and the health services are perceived.
The men are currently freelance but I hope a primary care trust will have the foresight to employ a Gypsy Traveller man permanently in the not too distant future.
But does all this make a difference to health professionals? Cumbria primary care trust health improvement specialist Fiona Huntington is convinced it does and, along with Mr Mounsey, Mr O'Neill and me, she ran two training seminars in April. "There is startling evidence of inequalities in the health of Gypsies and Travellers compared with even the most disadvantaged sections of our population," she says.
"There is also a widespread lack of understanding about the travelling way of life. The seminars proved invaluable for local authority and Cumbria PCT colleagues. Overall the message Gypsies and Travellers gave us is to work with them and not for them."
Keep an open mind
There are several things to remember when working with Gypsy and Traveller communities:
Gypsies and Irish Travellers are both recognised ethnic minorities so should be part of your Race Equality Scheme.
Travelling people may be traditionally seen as hard to reach, but they are easy to reach for people who already know them.
Being culturally aware saves time and embarrassment on both sides.
Awareness-raising is a two-way process.
Getting groups together in informal settings and swapping health stories is a great way of breaking down prejudices.
Do not be put off if no one in your organisation has ever worked successfully with Gypsies and Travellers. This can be a great opportunity to start with a clean slate.
Leaflets are a great way to get your message out, but for people with low literacy they should have as many pictures as words.
Keeping appointments may be more difficult for travelling people. Think about sending text message reminders.
If your project is short term, make sure to keep communities informed, even if it is just with the occasional phone call.
It is always good to model good practice, but Gypsies and Travellers can be very different in each area. That is why specialist knowledge can be cheaper than having 30,000 culturally inappropriate leaflets gathering dust in your office. For example, did you know that Irish Travellers and English Gypsies have two different languages?
Keep an open mind, get the correct information from people who are working in the field, plan and realise that in many ways Gypsies and Travellers are very different but in other ways they are similar in that they want to be treated with the same care and respect that everyone else wants.
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