Wounds and chronic diseases, such as diabetes or hypertension, are common health problems among homeless people. Precarious living conditions, limited access to care, and recurrent comorbidities significantly complicate the management of these diseases.
Increased risk factors
Homeless people are exposed to several risk factors that increase the likelihood of injury. Exposure to violence, falls often related to alcohol or drug use, and an increased risk of bites or stings from animals and parasites all contribute to this situation. In addition, the precarious living conditions, characterized by exposure to bad weather and lack of hygiene, favour the onset and aggravation of wounds. Limited access to sanitation also increases the risk of infection and serious complications.
Delays in care
Delays in, and dispensing with, health care are major problems. Homeless people often only consult health professionals if their health problem directly affects their daily lives, such as a leg ulcer that interferes with their mobility. Additionally, a negative perception of healthcare facilities and interactions with healthcare providers can also deter these people from seeking help. A negative experience, often due to stigma or inadequate care, can lead to a loss of trust in medical staff, making it even more difficult to stay in care.
Common types of wounds
The most common wounds among homeless people are often caused by compulsive scratching associated with parasites. Living conditions on the streets encourage the proliferation of organisms such as fleas, lice, and scabies. Excessive scratching can lead to wounds that become severely infected without prompt treatment. In addition, chronic wounds due to falls, drug injections, or conflicts are also common. Leg ulcers, often due to poor blood circulation exacerbated by conditions such as diabetes or poor diet, require regular follow-up and appropriate care, which is difficult to sustain in a precarious context.
Access to care: a challenge
Access to care is another important factor in common wounds. Medical appointments often require punctuality and patience, two elements that are difficult to respect for a person in a precarious situation. Daily priorities, such as finding food or money, often take precedence over health care. In addition, the gaze of others in waiting rooms and the desire to return to the streets further complicate regular access to care.
Comorbidities and malnutrition
Homeless people often suffer from related conditions that make wound healing difficult. Diabetes, for example, is an important risk factor for the development of foot ulcers. Psychiatric disorders and addictions can also interfere with adherence to treatment. Malnutrition, which is common in this population, hinders wound healing, with deficiencies in essential vitamins and minerals, such as vitamin C and zinc, being particularly problematic. In addition, the condition is aggravated by lack of sleep, which is common among people living on the streets, since healing requires adequate rest.
The "Way Towards" Approach
The so-called “the way toward approach” is essential in the work of Street Nurses. In contrast to the classic situation in which the patient approaches a care structure, the professional goes to the patient, trying to encourage him or her to use the care structures with respect for his or her needs and desires. Since the street is neither a place to live nor to administer care, it is impossible there to ensure adequate wound care.
Importance of mobile teams
Mobile teams and local nursing programs are crucial to providing global care, including doctors, nurses, social workers, and psychologists. During each meeting, we map out the person's health problems and provide appropriate prevention advice. Referrals to the right partners are essential to ensure that people have access to sanitation, clean clothing, and a balanced diet, all of which are fundamental to wound prevention and care.
Conclusion
Wounds among homeless people are a major public health challenge that requires a coordinated and comprehensive approach. With support, adapted to the specific needs of this population, it is possible to significantly improve their overall health and reduce the risk of serious complications. Healthcare professionals, especially nurses, play a crucial role in this by making healthcare more accessible and long-lasting.
**Article by Cloé Gautier, street nurse