There are some things that Melbourne’s street doctor sees a lot more than other GPs.
Bed bug bites are common. Wounds fail to heal or become infected because some rough sleepers are malnourished, don’t get dressings changed or don’t have access to antibiotics.
“People who are vulnerable are more likely to end up homeless, so there are also more mental health issues and people with drug and alcohol problems,” says Cohealth’s street doctor Kate Coles.
Rough sleeping creates serious health problems and yet people who are homeless are less likely to access health services than the rest of the community.
They face barriers including stigma and discrimination, long waiting lists, no Medicare cards and no money to pay for treatment or medication.
“There has been a move away from bulk billing at a lot of private clinics,” Dr Coles says.
Those that do bulk bill tend to have a high turnover of patients with short consultation times, which do not suit those experiencing homelessness, who often have complex needs.
“A lot of clinics can be very unwelcoming places,” Dr Coles says. “I once heard a doctor saying ‘we don’t treat those sorts of people here’.”
Every Wednesday for the past 18 months, Dr Coles, community health nurse Vaan Phongsavan and a social worker have provided free medical services out of an outreach bus to homeless patients.
In the middle of Melbourne’s winter, Ms Phongsavan’s “uniform” is a puffer jacket and fingerless gloves. The outreach service has never been cancelled because of the weather.
“I’m often sitting in an exposed laneway with a laptop triaging patients,” Ms Phongsavan says. “You are working out of your comfort zone with everything you need in a backpack. Our homeless, marginalised clients don’t have time to wait.”
The Green Cross outreach bus has visited caravan parks in the western suburbs, St Mark’s Community Centre in Fitzroy and boarding houses.
On Tuesday, Lord Mayor Sally Capp will announce the City of Melbourne will invest $200,000 to enable the service to also operate every Monday in the CBD.
All patients are eligible for treatment, including asylum seekers and refugees, who don’t have access to Medicare.
The team is able to treat many patients on the spot, suturing wounds, immunising against the flu and screening for diseases such as cancer.
“One of the exciting things for me is being able to treat Hep C entirely from the bus,” says Dr Coles. “This was a disease that made people sick for a very long time and created stigma and it can be cured in up to 12 weeks.”
Other patients are referred to Cohealth’s clinics throughout Melbourne, which offer services including dentistry, podiatry, mental health and drug and alcohol services.
Four years ago, Tim Williams lost his job and his house and broke up with a girlfriend. “It was just a snowball effect.” He clicks his fingers. “Just happens like that.”
“Kate is easy to get along with, understanding and non-judgmental.”
Cohealth program manager Ben Quinn said the not-for-profit community health service wanted to start a street doctor service earlier in Melbourne but struggled to find a GP.
He said the City of Melbourne funding would cover the expansion of the program and an evaluation so they could demonstrate the impact the street doctor service was having.