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 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 1990. 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.

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

„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

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.

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.

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

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.

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 31 - 60 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.

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.

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.

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.

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.

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)

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

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 % 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

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