During November, a team of field workers found a man in a very bad state of health on a bench in front of one of Prague’s hospitals.
“We asked if he was hospitalized there, and he described to us that he was there and they sent him away. The gentleman had Parkinson’s dementia. He could not remember what was happening,” describes a specific case from this fall of a field worker.
Despite great efforts, this case ended tragically and the man died a few days later. Even before that, however, he was refused hospitalization several times in Prague hospitals.
“After hygiene, we took him to the doctor, who examined him and concluded that he needed urgent hospitalization because he was emaciated and dehydrated. Imagine a person who was released from a concentration camp. We called an ambulance,” the field worker tells the story of the homeless man.
The editors know her name and the organization she works for. However, she did not receive permission from her employer to speak officially on the topic.
They only hospitalized him when it was too late
The first attempt to hospitalize the man turned out to be such that the paramedics treated his injuries with a bandage. “Sometimes the nurses are so unpleasant that they actually manipulate the person to say that they don’t want the care,” says a worker from Prague who helps homeless people.
The next day, the frozen homeless man reappeared in the care of field workers. In even worse condition. His condition was again assessed as life-threatening by the medic. And another fight for hospitalization in another hospital began.
The homeless man ended up in nephrology only when his condition was fatal, he did not survive. In addition to the wounds, he also had an infection.
“Our team is already collapsing, because we are running a mobile hospital for long-term patients from day to day. Our work no longer has anything to do with the field work we should be doing,” says the field worker from Prague.
He mentions that as the homeless population ages, it is becoming increasingly difficult to get those needed to the hospital in acute cases. “Basically, it seems completely impossible,” says the fielder.
This is also confirmed by Filip Umlauf, a member of the association Medici na street, in which future health workers treating homeless people work. “There are two parallel struggles. The first is that homeless people don’t go to the hospital because they’re afraid. And if they say they don’t want to, that’s the end of it,” Umlauf says, talking about how medicine can be less humane.
People on the streets die 16 years earlier
The Platform for Social Housing is preparing a detailed analysis of the deaths of homeless people, based on data from the Institute of Health Information and Statistics from 2010 to 2022. Preliminary results available to the editors show that almost 14 percent of homeless people died in public spaces, such as streets, parks, and railway stations.
People who have a record of being homeless in the health systems then statistically die on average 16 years earlier than the average person in the country. In Prague, this difference is almost 20 years. Most often, these are external causes such as injury, poisoning and hypothermia.
“Premature deaths of homeless people are not inevitable. They are the result of the failure of a system that cannot protect the most vulnerable among us. Every year, people die right on the street in undignified conditions, and that is scandalous,” says Barbora Bírová, director of the Platform for Social Housing.
In its in-depth report, the non-profit organization Naděje describes that homeless people with life-threatening health complications fall through the system.
“Very often the context is that it is a person who has already been hospitalized repeatedly and is in a very bad state of health. It can reflect the frustration of the hospital staff and the great pressure on beds, which are few in acute and follow-up care. It is a mix of all these factors,” adds Dutka.
We treat all patients the same, says the hospital
Naděje’s chief analyst then emphasizes that a possible rejection of hospitalization is a medical problem. “It’s really their responsibility, how they evaluate a person at a given moment,” says Dutka.
The organization’s in-depth report anonymously mentions directly the doubts of some doctors about the exclusion of homeless people. “For example, can a person who is five days after treatment for pneumonia be on the street? Probably not. But how to solve it? This creates a space for situations where we release these people back to the street and we know it’s not right,” one of them points out in the report.
Another – an internist from a Prague hospital – describes what medical professionals deal with during admission. “He comes and he’s under the influence of alcohol. He comes and he doesn’t have a good level of hygiene. Then there’s a part of purposeful action and it’s a mix. It’s always different, the ratio of these factors. Now he’s maybe 65 years old, which is a risk factor in itself. Questions run through the doctor’s head: why didn’t he come earlier, when he’s already two days old, why didn’t he come in the morning? Why didn’t he come sober? Why doesn’t he wait until morning?” they quote the doctor in the report.
For example, the Motol University Hospital, contacted by the editors, describes that it treats all patients without distinction, according to valid legislation and internal procedures.
“Each patient is assessed individually according to their current state of health and the urgency of the care provided. When it comes to homeless people, here too we proceed according to the health needs of a specific patient and, as far as possible, we cooperate with organizations dedicated to this group,” says Hana Frydrychová from the Department of Communications.
According to data from the Ministry of Labor and Social Affairs, at least 270,000 people are homeless or in housing crisis in the Czech Republic. Of these, about 18,000 people sleep directly on the street, in hostels and shelters.
