The Manna Centre is a drop-in centre for the homeless, but I often have to explain to students that whatever they imagine a homeless patient to be, the patients we see there are unlikely to fit that description. Often, we see patients who are on limited income, but who are housed and not experiencing the difficulties associated with sleeping rough. Nevertheless, students do encounter the effects of drug or alcohol abuse, mental illness and sleeping on the streets
Sometimes a patient presents who is exactly as a student might imagine…..
A man of 55 presented as bent forward with lower back pain and was clearly having trouble standing comfortably. Osteopaths are often dealing with some uncertainty about whether or not a patient’s mattress may be a causative element of pain, but in this case, it was fairly clear.
The patient had been sleeping rough on a mattress (probably not a choice orthopaedic mattress, but at least it was on a firm base) in a somewhat hidden niche around London Bridge Station, for several months. The mattress was no doubt used, old and needed changing; but other patients usually have a level of choice in the matter. In this case, the mattress was taken away by station staff, so our patient was left sleeping on bare concrete in mid-winter. Unsurprisingly, this led to some back pain. He found heat relieving, but rarely able to get it.
Although there was nothing to be done about the patient’s circumstances and the real cause of his pain, the student was able to provide osteopathic treatment. Results were expressed in the patient’s phrase “really relaxing” and in the patient being immediately able to stand more upright.
It was genuinely rewarding for the student to make a real difference on various levels. There was certainly immediate relief, but as much from the action of having had someone reach out to them as a human being, as from the physical intervention.
Many homeless are ex-military: they may be discarded from the forces on medical grounds and find themselves unable to adapt to a society which lacks rigid structure. Whilst they may be unable to adapt to a very different society, their (outdoors) training often means they are more at home with homelessness. One 35 year old lady presented with elbow pain and had been assaulted the night before by three assailants – she had been unable to get out of her sleeping bag so was unable to fight back. Rather than hospital, the student osteopaths were the first port of call, as she had presented to us before.
In this case, the student was trained to be alert to the possibility of fracture. The patient was offered no treatment but immediately referred for an X-Ray, which showed the suspected fracture of the elbow.
More on the Homeless Clinic at the Manna Centre.