Caring for Gypsy, Roma and Traveller families

17 Aug 2017 Amyholgate

Our team of health visitors supports children and parents with a range of different needs. Amy Holgate goes out and about with Steph Lovell to find out how she helps Gypsy, Roma and Traveller families while they are in the Bristol area.

You need to be able to think on your feet to work with Bristol’s Gypsy, Roma and Traveller (GRT) community, says Steph, a specialist health visitor: “I once knocked on the door of a caravan and found a lady in quite advanced labour. I had to grab time in between contractions to ask her some very quick questions about how far along she was, allergies, any complications she’d had and ring ahead to the maternity hospital in Bristol. She just made it there in time!”

Who are Gypsies, Roma and Travellers?
Although they share a travelling heritage, the term Gypsies, Roma and Travellers describes a wide variety of cultural and ethnic groups and includes: English Romany and Eastern European Roma (originally from north India); Welsh Gypsies; Irish and Scottish Travellers; Showpeople; Circus People; New Travellers; Vehicle Dwellers; and Boat People. These days GRT people have a range of living arrangements and aren’t always on the road. About half of these communities live in permanent housing. Some live on authorised permanent council and private sites which are subject to council tax and utility payments, and some live on transit sites while they visit the area for work. Only a small minority live on unauthorised sites.

Health visitors usually only work with children up to the age of five, but in this role Steph supports the health and wellbeing of both children and adults in travelling families. Although she never really knows what her day will be like, it usually includes things like advising on medication; helping people manage conditions like eczema and writing prescriptions where necessary; giving information about healthy lifestyles; assessing illnesses and injuries; helping arrange appointments; advising people on registering as a temporary resident to visit the GP; giving immunisations and offering advice about them; and monitoring the growth of children.

Talking things through is often more helpful than just leaving leaflets as adults in these families often have a low level of literacy. And it’s not just what you say, but how you say it, says Steph: “There are certain ways of approaching things which work better when you understand how the families are set up. The matriarch of the family is often very influential, so if I want to get some important information across, like how to make a bottle up for a baby, for example, I’ll tell the grandmother to make sure the message gets through to the whole family.”

Today I’m joining Steph on her regular Wednesday morning visit to a council-run transit site near Lawrence Weston. Families can stay here in their caravans for up to 12 weeks at a time, often to pick up seasonal work like strawberry picking, landscape gardening or scrap metalling.

Steph tells me that a lot of Irish Travellers favour this site, arriving for the summer with lots of extended family. “I never know who I’m going to see. There could be anything from one or two vans to a full site with 20 vans. Sometimes I recognise family names but often I’ve never had any contact with them before,” she says.

Living with stigma
As we pull off the main road into the Lawrence Weston site, wind turbines busy on the skyline, Steph talks with feeling about the unique health challenges GRT people face. Life expectancy in this group is 10 years shorter than the rest of the population, mums are 20 times more likely to lose a child and suicide rates are 6 times that of the national rate.

“I love working with this community – I love the whole culture. But there are loads of challenges. GRT people have the poorest health outcomes of all national groups, because they have such hidden needs,” she says. “I think our healthcare system is really set up with settled people in mind. We live in a world of waiting lists based on where you live, but that will never work for people whose way of life is to travel. They just don’t access healthcare in the same way as the settled community.”

Steph is particularly driven to find new ways to pick up and treat mental health problems in GRT families, especially postnatal depression (often known as ‘bad nerves’). It’s difficult to identify because she isn’t seeing women regularly over a series of routine appointments: “Mums don’t just suddenly tell you about postnatal depression. Often you need to have a relationship with them and they need to trust you before they tell you that they’re struggling. I don’t often get that chance with travelling mums. It’s sad, because we know that getting help early makes a huge difference over the long term with mental health problems,” she says.

Steph is currently working with professionals in other regions to tackle this: she wants to improve the sharing of health information with other professionals around the country to provide continuity of care while balancing the needs of patient confidentiality.

It can be hard to change things for the better when there is stigma, too, says Steph. “The travelling community is commonly blamed for things like theft, mess and anti-social behaviour – but as always that’s just the minority. They are the only ethnic group in our society where open racism seems to be ‘allowed’. You see it everywhere in the media. So it’s hard to change things for the better.”

We meet one of the mothers at the site, Ellie*, at her caravan, and she agrees that she often comes up against negative attitudes from the settled community: “People disapprove of this way of life.” But, she says: “I think it’s a good lifestyle – I get to see different people, and you can be self-sufficient. It’s really social, and I love watching all the children playing together. I think people should try it!”

Ellie is over here with her three-year-old daughter and her husband, who is working in a short-term power-washing job. They usually spend the summer over here and go back to their house Omagh, Ireland for the rest of the year. “We like visiting London, too – we stay in Hayes and Finsbury Park. This is the first site we’ve been on where someone has come out to us [to give health advice] though. It’s great.” Steph has been able to talk to Ellie about immunisations so her little girl can stay up to date with her jabs which Ellie says has been really helpful.

Team tactics
“I’m probably biased but I think Bristol is one of the best areas for supporting GRT communities,” says Steph. She thinks a lot of that is down to different local teams working together to provide support.

GRT Liaison Officer, Steve, works for Bristol City Council and advises people on tax, planning issues, equality and more. He’s enthusiastic and upbeat about the task in hand: “I love the culture and the different way of life, and knowing that I can actually help and engage people. Half the battle is getting rid of the barriers – once you’ve done that it helps massively. Steph is brilliant with the
community and gives really good help and advice.”

Another part of the multi-agency team working here is Louise from the local Long Cross Children’s Centre, which has decked out an old shipping container at the site so children have somewhere to do craft activities, play games, read and sing.

While I’m here ‘Old MacDonald’ is in full swing and the little group of singers is obviously keen for an audience – all the adults nearby clap loudly at the end and the children beam. “It’s a safe, creative place for children to engage with each other,” says Louise. “It really helps us build trust with the families, too,” she says.

Steph sees that one of the little girls at the activity centre, Katie*, seems to have badly infected cold sores around her mouth and she’s keen to get them seen to. Katie’s mother Hannah* has popped out to the shops so, sitting on a step outside the children’s container in buffeting winds, Steph rings her and helps Hannah arrange a GP appointment for Katie. While they are talking, Steph also encourages Hannah to tell her more about her own stomach ulcers that have been causing problems. Steph discreetly gives her advice on managing the symptoms and helps to arrange an appointment for her too.

Afterwards, Steph tells me that she’s had a few good chats with Hannah before, and that she is really grateful for input. There have been several cases of cervical cancer in Hannah’s family and she’s really keen to know how to help protect her daughters. So Steph has been able to tell her more about HPV immunisations for young girls, which can help give protection against this type of cancer.

It’s time to go – Steph needs to get back to her office to make a record of who she’s seen so she can follow up in case they return to the area. Then she’ll be out again to visit another transit site in Patchway this afternoon.

As we start the car, Katie taps on the window for more of a chat. She’s soaking wet from a water fight with her friends but wants to find out more about what Steph does. As we pull away she restrains herself from throwing the water bomb wobbling in her hand and we’re treated to a cheeky wave goodbye instead.

*Names have been changed

Find out more about Bristol Community Health’s Health Visiting service here.

In numbers

  • 300,000: Estimated number of Gypsy, Roma and Traveller (GRT) people in the UK
  • Life expectancy is about 10 years less than the national average and lower than any other ethnic group
  • Suicide rates are about six times higher than the rest of the population
  • GRT mothers are 20 times more likely to have experienced the death of a child**

**Statistics are estimates only and are taken from a variety of sources

Steph Lovell
Steph Lovell, at the Avonmouth traveller site