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Homeless women deprived of their dignity in contact with healthcare services


“These women often face prejudices in contacts with healthcare services, as all homeless people tend to be seen as addicts who use healthcare services for their own personal gain,” says Martin Salzmann-Erikson, researcher in caring sciences at University of Gävle.

Hemlös kvinna i Stockholm

Researchers from University of Gävle and Ersta Sköndal Bräcke University College have conducted in-depth interviews with 26 women in Stockholm who are or have been homeless on how they have been treated in their contacts with healthcare services. The study is one article in a larger project focusing on health equity and health on equal terms, starting from the facts that these are individuals who are women and homeless.

Martin Salzmann-Erikson

Martin Salzmann-Erikson

“We want to make these women's voices heard and when they tell us about their experiences of their contacts with healthcare services, it is sadly a rather dark picture that emerges,” Martin Salzmann-Eriksson says.

Human dignity needs to be restored

The women convey that they often encounter controlling and suspicious healthcare staff who cultivate a confrontational approach that becomes offensive to the women.

Martin Salzmann-Erikson points out that there are so many prejudices: homeless people are seen as addicts who use healthcare services for their own personal gain.

Seemingly, they believe that addicts have themselves to blame when they need to use healthcare services.

According to Martin Salzmann-Erikson, the struggle to restore human dignity in certain parts of the health care sector is a struggle that is neglected due to, for example, lack of resources and prejudices.

Becoming a cynic in the coffee room

If the jargon in the coffee room becomes harsh, that attitude may spread and infect contacts with patients as well. Moreover, healthcare staff would gain from support in adopting a humane attitude and in daring to trust these women as that would also in fact benefit themselves very much as individuals, according to Martin.

“There is no need to make an issue about whether the person is dirty or just comes to eat something. If you always try to see the individual, you grow yourself and can lead a better life. Becoming a cynic in the coffee room is a gigantic personal failure.”

Healthcare services demand an orderly life

Public health care requires a basically organized life, with a permanent address, an ID card and access to a telephone used to get in touch with primary care.

“However, these women do not have a telephone because that would increase the risk of being robbed, and if priority number one is to survive the day, you may be give lower priority to a gynecological examination.”

Another major obstacle is that health services are structured into units providing different specialty care, and women who need significant collaboration between social services and different care units are met by watertight silos.

“A broken foot, in combination with a very poor physical health, can also be an enormous trauma linked to abuse and fear of a potential perpetrator. Healthcare services are not prepared to deal with this complexity, the focus is usually solely on fixing the broken foot.

“The current structure with its expert units does not work for all people. People fall between the cracks, although they should be cared for as well. “

Islands of positive experiences

The survey also includes islands of positive experiences. Here, the women felt seen, cared for, and respected, and, in this context, they tell stories about healthcare staff who changed their lives.

In the future, the project will be continued, and a training program aimed at nursing students as well as nurses will be implemented. The researchers aim to explore if such a program can lead to an improvement in attitudes and a positive change in prevalent prejudices.

“This is important, as the homeless women here function like the canary in the coal mine. I think that everyone has experienced being depersonalized when needing healthcare services and that can be quite hard to go through,” Martin Salzmann-Erikson says.


Martin Salzmann-Erikson Docent in caring sciences, University of Gävle
Phone: 0724 651256
E-mail: martin.salzmann@hig.se

Text: Douglas Öhrbom
Photo: Erik Mårtensson / TT
Photo Martin Salzmann-Erikson: Private

Published by: Douglas Öhrbom Page responsible: Anders Munck Updated: 2021-09-27
Högskolan i Gävle
Box 801 76 GÄVLE
026-64 85 00 (växel)