Positive Health Online

In this, my last regular column for Positive Health, I would like to tell you about my recent experiences, working as a general practitioner at a specialist GP surgery for homeless people. It has proven to be a considerable challenge, both professionally and emotionally.

Furthermore, for reasons which I will enlarge upon below, it has led me to reconsider my approach to homeopathic practice.

The patients who register at the practice are all homeless when they first come to the surgery. Some succeed in obtaining, and keeping, a place at one of the local hostels, others sleep rough or in the Night Shelter. A very few are eventually housed in privately-rented or local housing association property and can move on to a regular general practice once they have stabilised.

What is shocking is the incidence of major mental illness (50%) and substance misuse (almost 100%) among homeless people. Many of the patients whom I see are living on a knife-edge of despair, and use/misuse substances in order to blot out their feelings. The despair can arise from previous life events, going back to childhood but sometimes related to marriage / family breakdown or redundancy, or from an underlying mental illness, which is usually inadequately treated, due to a lack of permanent address. Add to this physical complaints from poorly healed injuries, bad physical environment, inadequate nutrition, or blood borne infections from injecting drug use, and you have a recipe for complex, multiple needs displayed by the majority of homeless people.

Unsurprisingly, a regular GP surgery is not well-equipped to deal with this kind of patient. With the usual presentation being a crisis of some kind, it takes a great deal of time to even begin to sort things out.

Health issues come fairly low down on the average homeless person's list of priorities, and our initial input is usually to try and help to arrange some kind of safe accommodation. In the meantime, the practice nurse does an immediate and very thorough medical, on the grounds that it is unlikely that the patient will return for a booked medical later on. Information is obtained by fax from previous medical contacts so that any intervention that we perform is sensible in the light of past medical history.

So, what role does homeopathy have in this patient group? I find myself going back to basics – Arnica montana has come into its own again, in low potency for all the terrible bruising and injury which is a concomitant of life on the streets and in higher potency for ailments relating back to an old injury; likewise Hypericum perforatum for nerve pain and neural injury and the depression that often accompanies such chronic pain. Rhus toxicodendron is infinitely superior to non-steroidal anti-inflammatory drugs such as ibuprofen for this patient group to treat rheumatic pain, as it does not carry the risk of gastric bleeding in a stomach already inflamed by alcohol and stress.

Panic attacks and feelings of overwhelming fear are often self-medicated by out patients either by drinking alcohol or by using heroin or tranquillisers bought on the streets. For someone who wants to find another way of dealing with these symptoms, a vial of Aconitum napellus in the pocket can offer an alternative approach.

Others present with an anxiety picture more suitable for Argentum nitricum or Gelsemium sempervirens. Some patients, who are used to manipulating their mood with drugs, are very aware of their exact feelings and give an excellent and insightful description of their symptoms, and are then very pleased to receive a 'tailormade' homeopathic prescription.

There are caveats though. Firstly, these are not patients who will come back over and over again for treatment. These are people who are used to experiencing a quick reaction from anything they take.

Thus, I tend only to offer a homeopathic prescription when the remedy picture is very clear and when I can be certain of a good response.

Another issue is the vulnerability of these patients. I am very aware of the ability of homeopathy to cause aggravations, both emotional and physical. If you are already 'on-the-edge' with no support network, the last thing you need is an aggravation of your symptoms.

Thus, it is vital to only risk aggravations in situations where the patient has some support, such as in a hostel environment, and to liaise with the patient's keyworker regarding what to expect and what actions to take, should there be any difficulty.

Finally, it is a sad and sobering fact that homeless people die young. When our practice started out, the average age of death was only 45 years of age for a rough sleeper in our area. That has improved over the years; however, our patients still have a higher than average mortality rate, and their deaths are usually sudden and unexplained, requiring referral to the coroner. It is vital, in these circumstances, that the patients have had any complaints that they presented with at the surgery thoroughly investigated and treated according to accepted medical guidelines. It would not do the cause of homeopathy any good if I had failed to treat a chest infection in a rough sleeper with antibiotics and if he subsequently died of pneumonia on the streets, even if, when I saw him in the surgery, it had appeared to be viral infection and I had chosen to give a homeopathic remedy rather than antibiotics. In these circumstances, I fear that the General Medical Council may have a less than tolerant attitude to complementary approaches, and I therefore tend to hedge my bets with any 'at risk' patient, only giving a homeopathic medication alongside the conventional prescription.

Some readers may feel that this is a cowardly approach and that I should stick to my guns and stand by my homeopathic principles. In reply, I would say that I have learnt in this job that we have, under our very noses, people who are extremely needy and vulnerable and who deserve the best that conventional and complementary medicine can offer. Not only that, they may well NEED the best of both systems in order to survive the slings and arrows which they themselves, their families or wider society have meted out to them and I intend to spend the next few years working out how best to use my therapeutic abilities towards this end.