Published: 16/12/2004, Volume II4, No. 5936 Page 28

Battling the health profession's prejudice is all in a day's work for Sarah Rhodes. Emma Forrest reports

Sarah Rhodes's office is not unlike that of a typical health visitor. It is heaped with paper and its walls are lined with shelves of files and posters promoting first aid and vaccinations. The difference is that the posters include photos that have clearly been taken in a gypsy caravan.

As one of the country's few health visitors for gypsy travellers, the team leader of the Travellers' Health Project in Bristol is proud of her job.

'It is a privilege to work with gypsy travellers, ' says Ms Rhodes. But since she joined the project 10 years ago she has witnessed staggering prejudice against her clients.

'The worst part of this job is definitely the hassle and the discrimination. All the public debate around gypsy travellers is very acrimonious. I was talking to a gypsy lady yesterday who was telling me about a recent occasion when her child was in hospital. She had gone outside and found a group of gypsies who were visiting a relative of theirs, and security was called. They were told that they had to disperse or the police would be called.' Ms Rhodes has herself heard the level of abuse that her clients are subjected to. Shockingly, this has even come from fellow health professionals.

'I rarely mention, in any kind of setting, what I do. People feel obliged to tell you something detrimental about gypsies. Recently, I was at a training course. I hadn't been there half an hour before I had someone telling me that gypsies are all thieves and someone else telling me that she was frightened of going anywhere near them.' Ms Rhodes admits that she was initially unaware of the fraught nature of the politics around her patients, adding that things have got worse over the years. The repeal of the Caravan Sites Act in 1994 meant travellers' lives immediately became more difficult. Because local authorities are not obliged to provide sites, many gypsy travellers live on unauthorised sites, making mobility of her clients one of Ms Rhodes' biggest challenges.

'Often they do not know when they are going to move on. They move when they are forced to, ' she says. 'I rely on other services to let me know when camps turn up. They always know because people instantly complain.' The upshot for Ms Rhodes and her part-time colleague is a lot of travel to keep up with the 1,000 people - from newborn babies to the elderly - they visit yearly.

In addition to outreach work, including health checks and health promotion, the project runs immunisation programmes, on-site dentistry (Ms Rhodes originally had to go as far as Wales to find a dentist for this, although local help has also now been recruited) and women's health clinics.

'There is a lot in the work that is ad hoc because you are responding to where people are, ' she says. 'And even if you see the same people again and again, you have to fit in with them and their priorities, which will always be around family and family events.' The level of abuse suffered by her clients means that they come to anticipate discrimination. This, combined with poor levels of literacy, can make it difficult for them to access services. Ms Rhodes therefore finds services for them, such as an appointment with a GP.

'If people need treatment, we will help them understand what it is and ensure that they get the same level of screening, aftercare - everything.

Gypsy travellers work in extended families, so the whole family is involved, particularly if It is an older person.

'You need to cater for that and involve everybody. The idea is that they will get the same service that is available to everybody, but they very rarely do.'