1. 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
Warsaw

2. INTRODUCTION 0,2 % of Slovaks are homeless New phenomenon in Slovakia
The term „homeless“ is not recognized in Slovak law
Health and social care for the homeless is rather the domain of church and non-profit NGOs
Organizations targeting only homelessness do not exist
Homelessness is a new phenomenon in Slovakia. It has developed more intensively since the end of the Its development is noticeable especially in Bratislava, where the number of homeless people has escalated, however it has multiplied also in other cities of Slovakia, where it was unknown in past.
Estimations of the number of homeless people are too optimistic and they are not based on official researches.
Laws of the Slovak Republic do not know the term „homeless“. There does not exist a strategy for solving homelessness on a national level.
There is no organization authorized to keep the figures of homeless people.

3. DEFINITION OF HOMELESS PEOPLE
Lost of housing → lack of „fixed“, regular, and adequate nighttime residence
Social contacts
Marginalization
Isolation
Homelessness categorizes the condition of people without a regular dwelling because they are unable to acquire, maintain regular, safe, and adequate housing, or lack "fixed, regular, and adequate nighttime residence

4. „HELP YOURSELF“ ACCOMODATION
„ 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

5. SHELTERS PROVIDED BY INSTITUTIONS
Lodging houses
Hostels
Warming centers
Rehabilitation centers
- drugs
- alcohol
Food, clothing and possibility of personal hygiene
Health care, social counseling and prevention
Internal rules
Limited time
Payments
Dominant services for homeless people are aimed at tackling immediate needs of homeless ( food, shelter...). There are also wide-spread resocializing projects for homeless aimed at their integration into society.

6. GROUPS OF HOMELESS PEOPLE IN SLOVAKIA
Homeless people in Bratislava could be sorted out according types of shelter to three groups: living on the street, living in shelters like desolate houses, self-made shanties, sewerages; and people living in lodging houses and hostels provided by voluntary and charitable organizations. This categorization is not fixed, because homeless people usually use one type of shelter only for certain period of time.

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

8. 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 MUNICI-PALITY 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
60 KM FROM
NGO GOODNESS OF ST. ELISABETH
These shelters provide social and health care in average to 100 people. All these people lost their homes because of poverty, unemployment, domestic violence or health problems and ended up on the street of Bratislava.
The Aim of this intervention is not only to provide shelter for people, we would like to help people to start with the new life.

9. 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
Education: failed primary education up to University
The most frequent age category years
12% of clients are women
Almost 50 homeless people (40 males and up to 10 female) are daily cared for in the shelter Mea Culpa for 1 euro per night. The social care is provided for them, overnight accommodation, warm dinner, hygienic materials, basic social counseling. Health care includes basic treatments, offering of the analgesics’ - antipyretics, antihypertensive drugs, bronchodilators etc.
There are clients in Mea Culpa of different education level . Some of homeless did not finish primary education, some of them are well educated.

10. BETHANY, ASYL CENTRE MALACKY
Fee 15 USD / month
Target group: battered women with children, released from prison,
from orphanages
Maximum 1 year
Accommodation, clothing, food, health care, counseling
In two azylum houses, Bethany and Josephinum are accommodated families (mothers with their children) for 15 USD per month. They have temporary accommodation in their own rooms, common kitchen for preparation of food, washing, toiletries. There is basic health care and school transportation for the children. Education for children is for free of charge. Social workers provide basic and specialized social counseling.

11. PUBLIC OPINION ABOUT HOMELESSNESS
Homeless people are satisfied with that what they do and do not want to change their life
There are transmitting serious diseases such as bacterial diseases, TB, HIV and hepatitis
The most common myth about homeless people is that they want to stay in their status.
People use to keep distance from homeless because they are afraid of the infection they may spread.

12. 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
21 Staph. aureus
13 Candida albicans
3 Strept. pneumoniae
3 Klebsiela pneumoniae
2 Staph. pyogenes
According to the questionnaire realised by the students of the University of St. Elisabeth gathered from the shelters of the university, the homeless people want to change their life, the problem is, that they don't know how to do it.
As our health status research shows, homeless people from shelters are not more frequent colonized or infected with multiresistant respiratory pathogens than the overall population in Slovakia.
Of 104 cases 42 had positive status for pathogens.

13. STRATEGY OF THE UNIVERSITY OF THE ST. ELISABETH TO HELP HOMELESS
Educate social and health professionals to work with this targeted group
Connection of academic study of social work, nursing and health to support homeless people
Close cooperation with media helps breaking myths about homelessness
Education of social workers, who are specialists in this area of social work, is very important. St. Elisabeth University in Bratislava therefore connects academic study of social work, nursing and health care to support the people, who lost their homes.

14. HIV PROGRAM PRE SIROTY V Kambodži
Clinic of St. Maximilian Kolbe, House of Family (2003)
House of Smile (2006)
St. Elizabeth University was one of first organizations, which have begun to treat HIV positive children in Cambodia. The University established an NGO called „House of family“ in Cambodia and opened the first orphanage with a medical care for HIV positive children in Phnom Penh. Starting with a few children, the orphanage has soon reached the capacity for 45 inpatients, having a number of out patients, which are treated and supported but they live with their family. The University decided to open one more house in the same area, House of Smile in 2006.
Sihanoukville is located in the South coast of Cambodia, it is a city with alot of prostitution and drugs, therefore there are many cases of HIV. There has not been HIV treatment available in this area, for this reason the University opened two more houses for HIV positive street children and their siblings in Sihanoukville.
Peter Pavol Gojdic Children’s Hospital (2007)
Daniela’s House of Family (2008)

15. Iniciálne diagnózy u hiv pozitívnych sirôt zaradených do hiv programu (neliečené n=137)

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

17. 8 ročný monitoring spektra patogénov a rezistencie na antiinfektíva (N = 882 kmeňov)

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

19. Záver
Potreba edukácie zdravotníckych pracovníkov v oblasti špecifických ochorení a zdravotných potrieb tejto cieľovej skupiny
Prepojenie akademického prostredia a praxe pri tvorbe projektov zameraných na riešenie zdravotných a sociálnych problémov

20. „Maybe this is what it´s like being poor and ignored today“
Liu Bolin, China’s Invisible Man artist
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