Traveller health 'not being prioritised' despite 'shocking' outcomes for children

Noteworthy delves into the uphill battle facing Traveller children and reveals a lack of targeted health actions.

By Maria Delaney

Noteworthy and TheJournal.ie logos with girl sitting at desk in the middle

“WE ARE WORKING with young women who are leaving maternity wards post-pregnancy onto the street, homeless.”

Mary Nevin, a community development worker with Longford Traveller Primary Healthcare Project, told Noteworthy “it’s important for our children to be healthy [and] to be safe” but for the Travellers she works with, this is often not the case.

Hidden homelessness is often to blame for health problems in children, said Nevin, with families living in inappropriate accommodation such as a caravan in a relative’s yard or sleeping on the floor in a sitting room.

“As a result of homelessness, women and their families will not engage with services. It has a huge impact physically, emotionally, and mentally.”

Nevin, a Traveller herself, said she regularly helps mothers who are coming home with a new baby to a “house packed with other family members” and “if someone gets sick, everyone’s going to get sick”.

This year more than any other, due to both the damning Children’s Ombudsman report on overcrowded and unsafe conditions at a Cork halting site as well as the terrible impact of Covid, issues with housing in the Traveller community have hit the headlines.

However, the health implications of living in poor conditions, often with no access to sanitation, electricity and running water, as well as issues including discrimination by health and education providers, have been known by authorities for decades.

These are revealed in the stark health statistics facing Traveller children in every study and piece of Census data available: almost four times higher infant mortality rates than the general population, increased levels of disability at all ages, poor mental health with six to seven times higher a rate of suicide in the Traveller community. The result – a decade lower life expectancy compared to the general population.

Mary Nevin wearing a red jacket sitting at her desk in front of her computer Mary Nevin says that hidden homelessness is having a huge impact on Traveller children's health

At Noteworthy, over the past number of months, we examined supports for Traveller children as part of our TOUGH START investigation. In this part of the series, we looked at health outcomes and spoke to Traveller health workers across the country.

We can today report that:

  • The long-awaited Traveller Health Action Plan will be published “soon” but has taken years to develop
  • Travellers have the highest rate of perinatal deaths – the number of stillbirths and deaths from 22 weeks’ gestation to seven days after birth – out of all ethnicities
  • There was no documented internal discussion that mentions Travellers in relation to the National Maternity Strategy in the months leading up to its publication
  • There is no mention of Travellers in HSE hospital staff induction training, in spite of a recommendation in the All-Ireland Traveller Health Study over a decade ago
  • Ethnicity identifiers are not being recorded as part of numerous HSE reports, health statistics and, most recently, the Covid vaccine rollout
  • Travellers are missing health appointments due to having no postal delivery service
  • High rates of Covid in the Traveller community were the “tip of the iceberg and may not reflect all cases”, according to the National Social Inclusion Office
  • Systemic issues with housing and education issues are impacting the health of Traveller children

In part one, Children’s Minister Roderic O’Gorman told Noteworthy that “there’s ingrained institutional racism against the Traveller community”. Over the next two weeks will also be investigating systemic issues facing Traveller children in education and housing. 

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‘Not getting a start in life’

Travellers face an uphill battle even before birth as Ireland’s perinatal death figures reveal that they have the highest rate of perinatal deaths out of all ethnicities measured.

Perinatal mortality is the number of stillbirths and deaths from 22 weeks’ gestation to seven days after birth and is an important measure of maternity care, with the World Health Organisation (WHO) stating it can be used to “assess needs and develop programmes that will reduce avoidable child deaths more quickly”.

Mary-Brigid Collins works with a lot of young mothers through maternal health initiatives run by Pavee Point Traveller and Roma Centre. She is the assistant coordinator of the Primary Healthcare Project in the Dublin-based organisation. 

There’s a huge amount of young babies not even getting a start in life – as soon as they’re born, being taken away. 

The National Perinatal Epidemiology Centre produces a report on this each year – the most recent in 2017 – and each year since 2013 it stated: “While the numbers involved were small, Irish Traveller, Asian and Black ethnicities were overrepresented in the mothers who experienced perinatal deaths.”

Out of these ethnicities, Noteworthy analysis found that Irish Travellers are by far the most overrepresented for the years 2011 to 2017, with Travellers having an average of more than four times more perinatal deaths than expected for their population size.

This trend continued into recent years with seven deaths recorded in Travellers in 2018 and 10 in 2019, from unpublished HSE data obtained by Noteworthy through a freedom of information (FOI) and press request.
https://public.flourish.studio/visualisation/7383604/

Other measures relating to maternal and neonatal health are also poor in Travellers, with Collins recently highlighting the low breastfeeding rate in the community – just 2% in comparison to the national average of 56% – at a Pavee Point event for National Breastfeeding Week.

The All-Ireland Traveller Health Study in 2010 – which compiled most of the statistics still used in relation to Traveller health, found that infant mortality – children who die under one year of age – was almost four times that of the general population. One of its key priority recommendations was that: 

All sectoral aspects of mother and child services merit top priority to reduce infant mortality, support positive parenting outcomes and break the cycle of lifelong disadvantage that starts so early for Traveller families.

More recent data show that Travellers are also experiencing more trauma around birth. Irish Travellers are overrepresented in experiencing severe maternal morbidity which measures unexpected outcomes of labour and delivery that result in significant short- or long-term consequences to a woman’s health.

Traveller babies are overrepresented in infants undergoing therapeutic hypothermia – a treatment for those exposed to reductions of oxygen or blood supply before birth. 

The latest report on planned home births reported no Traveller mothers were intending to have home births in 2016 or 2017 – both of the two years reported.  

Lack of actions in Maternity Strategy 

Despite all of this, Travellers received just one mention in the National Maternity Strategy 2016-2026 in relation to the “lower average age of mothers giving birth”. No mention of higher infant mortality, no mention of lower breastfeeding rates, not one other mention. 

Noteworthy found, through FOI, that there were no memos or correspondence within the Department of Health that mentioned Travellers in relation to the strategy in the months leading up to its publication in 2016.

In addition, Irish Travellers didn’t get any mention in the National Maternity Strategy Implementation Plan – a set of actions designed to implement the 10-year strategy.  

When asked about this lack of mentions, targeted actions and lack of internal discussion, a spokesperson for the Department of Health said that the pathways within the strategy “are designed to ensure that every woman can access the right level of care, from the right professional, at the right time and in the right place, based on her needs”. 

Baby in clear hospital crib in the background with quote by a Department of Health spokesperson on the Maternity Strategy Implementation Plan - No ethnic group is identified, but there is a focus on providing additional supports to the pregnant women from vulnerable, disadvantaged groups or ethnic minorities.
Source: Photo - sukanya sitthikongsak via Shutterstock

The Department spokesperson added that consultation, both online and in person, was conducted and as a result of this a number of “key recommendations” were made in the strategy “in the areas of targeted additional supports, tailored information and cultural sensitivity”.

The consultation summary reported that “specific groups, such as Travellers, reported feeling stigmatised, which made them reluctant to engage with services for future pregnancies” and also mentioned that “interpersonal skills of healthcare professionals is very important”, using the example of the label ‘Traveller’ and not the care requirement, being put on a cot to ensure appropriate feeding in the context of a metabolic disorder.

“It’s very important that we are included in all these pieces of research and strategies,” Collins told Noteworthy, but added that Travellers should also be included in the resulting targets and plans. 

Lynsey Kavanagh, health researcher and policy analyst at Pavee Point, said that this type of “one-size-fits-all policy is developed for the mainstream” but “when groups aren’t equal, you need targeted measures to ensure equity of outcomes”. 

There was also no mention of Travellers in any of the following maternity-related reports: National Women and Infants Health Programme Report 2020, Development of Supported Care Pathway Irish Maternity Services 2020 or Irish Maternity Indicator System National Report 2020. 

When asked about this, the Department spokesperson said that these “deal with progress made or reports on specific metrics and were not designed to cover ethnicity issues”.

A spokesperson for the HSE also noted that ethnicity is not included in the Maternity Safety Statements which contain information on metrics covering a range of clinical activities and incidents, including perinatal deaths.

They added that these reports are “reviewed by the HSE’s National Women and Infant’s Health Programme and discussed with the six maternity networks at the regular meeting” and though ethnicity is not included, they “do focus discussion about challenges associated with perinatal mortality and actions that may be required”. 

‘Outcomes-focused approach’ is key

Lack of targeted actions or specific mentions across a range of Government strategies, policies and implementation plans was an issue highlighted by almost all Travellers that spoke to Noteworthy over the course of this investigation. 

When we asked Minister for Children, Equality, Disability, Integration and Youth Roderic O’Gorman about this, given many issues disproportionately impact the Traveller community, he said that with the review of the National Traveller and Roma Inclusion Strategy (NTRIS) happening this year, a “more outcomes-focused approach” is key. 

NTRIS is the Government policy framework for addressing the health and other needs of Travellers. In relation to health, it contains over 30 actions across four themes.

O’Gorman said that currently NTRIS is focused on actions such as “implement a policy” or “pass a law” but what people really want to see is “tangible outcomes” such as by a certain date, there will be a certain increase in Traveller-specific accommodation. 

Minister Roderic O'Gorman - wearing a navy suit with light blue shirt and blue dotted tie - talking at a podium with two microphones on it. Minister O'Gorman plans to change approach in the revised National Traveller and Roma Inclusion Strategy
Source: File photo - Eamon Farrell via RollingNews.ie

These targeted and measurable actions with dedicated funding behind them are what Traveller advocates told us they will be hoping for when the long-awaiting Traveller Health Action Plan is published. 

This action plan was one of the main recommendations made by the All-Ireland Traveller Health Study over a decade ago and there is a commitment in the Programme for Government to implement it.

It is also a key NTRIS action and one that Pavee Point’s Kavanagh uses as an example of the lack of implementation of key parts of the Government’s inclusion strategy. “We’re 11 years trying to fight this battle,” waiting for this plan.

The Traveller health researcher welcomed the plan’s consultation process in 2018, but said Travellers on the ground and Traveller organisations are frustrated because they “just don’t see Traveller health being prioritised despite really shocking [health] statistics, which were exacerbated even more during Covid”.

Michelle Hayes, project manager at the HSE’s National Social Inclusion Office said they will be publishing the action plan “soon” and that it is her understanding that it “will be resourced and that there will be further resources for Traveller health in the coming years”.

A spokesperson for the Department of Health (DOH) said that “consideration of the plan and its resource implications has been delayed by the prioritisation of the rollout of the Covid-19 vaccination programme”. They continued: 

The Department is committed to providing the leadership and resources to ensure the implementation of the plan by the HSE.

Noteworthy sought all DOH records from 2018 to the end of August in relation to the the action plan – including minutes of meetings and reports – but none were released as they contain “matter relating to the deliberative process”. 

However, the FOI response does reveal that over this 2.5-year period there were 23 records relating to the plan, mainly internal interactions or updates and emails between the HSE and DOH. All four in 2021 relate to the DOH seeking comments or sending observations on the draft plan.  

Though the HSE was a “key partner” during Covid, when it comes to Traveller health, Kavanagh feels “there is a block somewhere in the Department of Health” and a “lack of prioritisation”.

In addition to the slow development of the action plan, Kavanagh uses the example of  the National Traveller Advisory Committee not meeting since 2012.

When this was brought up in the Dáil in 2018 then Minister of State at the Department, Fine Gael’s Catherine Byrne, said that ”there is ongoing and extensive engagement with Traveller organisations” in regards to health inequality experienced by Travellers. 

However, Kavanagh said that the advisory committee was “was a mechanism to develop Traveller policy and work with the Department”. She added: “We see his as a huge gap because we don’t have a direct relationship with the Department.”

She also told Noteworthy that Traveller health has received no new development funding since 2008, following austerity cuts – with the exception of some funding provided by initiatives through the Dormant Account Funds. 

Though this was raised in the Joint Committee on Key Issues affecting the Traveller Community in 2019, when then Minister of State at the Department of Health, Fine Gael’s Jim Daly, stated the Department was “open to suggestions” for new development funding for Travellers, Kavanagh said there was no new funding was in recent budgets. 

When funding is provided, it does work, she added. The health researcher cited primary healthcare projects that targeted cervical smear and breast cancer screening, with uptake in Traveller women almost double that of the general population. 

Childhood trauma impacting health

In addition to stark outcomes facing Traveller babies, older children continue to have poorer health than the general population. For every disability documented in the 2016 Census, Traveller children have a higher proportion recorded than the general population. 

For under 15s, the percentage of Traveller children with a disability increased from 8.6% to 9.2% between the 2011 and 2016 Census, with boys being most impacted by all disabilities recorded. This is consistently higher than the level of disability in under 15s in the general population – 5.4% in 2011 and 5.9% in 2016.

The rate of disability worsens – with a growing gap between Traveller children and the general population – in older age groups. 
https://public.flourish.studio/visualisation/7475778/

One issue that all Traveller healthcare workers brought up with Noteworthy was poor mental health among all ages, which they said often go back to issues relating to childhood trauma.

The 2010 All-Ireland Traveller Health Study found that suicide represented 11% of all Traveller deaths. It was reported to be seven times higher in men – most commonly in young men aged 15-25 – and five times higher for Traveller women than the general population.

Over a decade later, suicide continues to be a problem in the Traveller community. The HSE gave Noteworthy initial findings of a study underway in the National Suicide Research Foundation examining emergency department presentations due to self-harm and suicide-related ideation.

Though still in progress, the study already found the highest rate of self-harm was observed among Traveller patients aged 50 or older, with Traveller men between 30 and 39 years having the highest risk of presenting with suicide-related ideation.

Patrick*, a Traveller community development worker from Cork City, said “you have to go back to the early days of school, children being segregated, people having childhood trauma, bringing that throughout their lives”.

Segregation policies were present in schools for Travellers throughout the last century, with activists saying that they continue today through the use of reduced school days. This will be the main focus of the next part of our TOUGH START series examining education – out next week.

Adverse Childhood Experiences (ACE) are potentially traumatic events that occur in childhood and are linked to chronic health problems, mental health conditions, and substance use problems in adulthood. Patrick said he often sees this in the Traveller community:

A lot of community I know of through a personal capacity and through my work would have had issues of childhood trauma and would have never engaged with a service to deal with that. 

He felt that not feeling valued by Irish society plays a huge part in this with “decades and decades of fallout” from the 1963 Report of the Commission on Itinerancy which framed  Traveller culture and way of life as a ‘problem’. This “has had a generational impact on people’s mental health”, added Patrick.  

Children he works with often have a bleak outlook on life as “from a very young age, they are made feel very different and not wanted”.

Patrick spoke of one seven-year-old he worked with recently who was shocked to realise that Patrick was a working Traveller man as the boy felt he would not be able to get a job in the future. “Imagine all the issues that child will face going forward if that’s their outlook.”

He also said some were left isolated in council estates as “all the settled children were told not to play with the Traveller children”. 

When asked if the HSE has any tailored mental health programmes aimed at Traveller children and young people, a spokesperson listed services and mental health supports for Travellers that it, as well as NGOs, provide – including initiatives in collaboration with Traveller organisations around the country.

The spokesperson added that the HSE has recruited eight out of the nine mental health service coordinator posts “to support access to, and delivery of, mental health services for Travellers in each Community Healthcare area”.

A ‘ceiling full of black dots’

Poor accommodation was also listed by every Traveller advocate we spoke to for problems with mental health as well as other – often chronic – health conditions. 

In the recent Children’s Ombudsman report, it stated that one parent on the halting site “advised that their mental health team told them that their children’s poor mental wellbeing were linked to their living conditions”. 

Overcrowding – according to one of the Ombudsman’s findings – “has resulted in serious risks on the site which present a real and present danger to the safety and health of children”. 

Mary Nevin sees a “very high number of children with asthma and other types of chronic illnesses” in her work as a community development worker in Longford.

She was recently helping rehouse a woman with an asthmatic baby living in damp and cold private rented accommodation. She said that Travellers are looking for the basics and are not looking for luxury.

Ceiling with black mould in the background with quote from Mary Nevin of the Longford Traveller Primary Healthcare Project - We’re looking for a nice warm house – not a damp house with the ceiling full of black dots and the cold air coming in, with the mother doing her best to keep her child wrapped up.
Source: Photo - Dina da via Shutterstock

Missed health appointments

During the course of this investigation, Noteworthy uncovered an obstacle to healthcare that is very specific to the Traveller community – access to the postal service. 

Pavee Point’s Collins, who lives in a large Traveller group housing scheme, said that no post has been delivered to the over 60 families living there since 2018. She said there have been similar issues on a number of halting sites as well as temporary sites.

To pick up their post, Collins and her neighbours have to travel to their local sorting office which she said is a 35-minute walk, with no direct bus route. “A huge amount of people can’t even get to their post.”

This has resulted in people missing health appointments – something that can result in them or their children being removed from patient lists due to non-attendance policies in most hospitals. “That’s having a huge impact on people’s health,” explained Collins.

The reason the residents were given by An Post for ceasing delivery was that there were loose dogs in the area, the advocate said, but she felt frustrated that delivery was stopped to all houses – not just those with dogs. 

By law, on every working day, An Post must deliver to the home of every person in the State, except in such circumstances or geographical conditions deemed exceptional by ComReg.

Noteworthy asked An Post if they plan on resuming postal deliveries to this specific group housing scheme and also for figure on the number of Traveller housing units and halting sites they do not deliver to. However, at the time of publication, no response was provided.

We also asked ComReg is they were addressing this lack of service provision by An Post. A spokesperson said that it “is not aware of, nor has there been any complaint to ComReg from any addresses [in the specific Traveller group housing scheme], of disruptions to the provision of the universal postal service by An Post”.

Collins said they are currently trying to sort out the issue with An Post head office.

Literacy a barrier to children’s health

Even if Travellers do receive their health-related letters, low levels of literacy in the community can have an impact on care. 

“Female literacy is a strong determinant of child health and is recognised by WHO,” according to Dr Margaret Fitzgerald, public health lead for social inclusion and vulnerable groups at the HSE National Social Inclusion Office.

When it comes to health literacy, the All-Ireland Traveller Health Survey found that half of Travellers who take prescription medications have difficulty in reading the instructions.

In addition, better provision for those with literacy problems was one of the top actions that Travellers said would improve their health and wellbeing, alongside better accommodation, education and uptake of preventative care services. 

From her work with Travellers, Collins has seen the impact of this on maternal care and breastfeeding uptake. 

One woman who “wasn’t able to read” and “had literacy problems” was given a book with hundreds of pages of information on pregnancy. “She got the book and put it in the bin as it was no good to her.” 

To help with this, the Pavee Mothers initiative – which is funded by the HSE National Social Inclusion Office – published a book and an online resource that “was culturally appropriate and was by Travellers for Travellers”. This month, a new booklet was launched to promote breastfeeding in Traveller women.  

Cover the breastfeeding booked with a young infant wearing a flat cap smiling while being held by their mother. Small images depict mothers breastfeeding their babies. The new Breastfeeding Information for Traveller Beoirs booklet includes photos of Traveller women and babies
Source: Breastfeeding Information for Traveller Beoirs via Pavee Mothers

However, when it comes to health, Traveller health workers mentioned trust and fear frequently when they spoke to Noteworthy

Nevin encounters this regularly in her work in Longford and said that “sometimes doctors can use very highfalutin’ words so language can be a barrier”. It can be difficult to build trust, she explained, as “Travellers have been let down so many times”. 

Mothers and families can also be fearful of health services for children “because they don’t have the appropriate accommodation” and worry about social worker involvement.

No mention in induction training

One way of addressing this is cultural training for healthcare staff. One of the recommendations of the All-Ireland Traveller Health Study was that a section on Travellers be included as part of routine staff inductions for hospitals with a significant Traveller catchment population. This was also recommended for GPs with a Traveller list.

Through FOI, Noteworthy asked a number of hospitals that treat children for staff induction training records such as reports, policy documents, presentations and information materials that related to Travellers.

This included CHI Temple Street, Crumlin and Tallaght as well as the paediatric section of the six hospitals in areas with a large Traveller catchment population – Cork, Limerick, Galway, Wexford and Drogheda.  

The response from all Children’s Health Ireland (CHI) hospitals stated that their induction content doesn’t include “any reference to the Traveller community”. All of the other hospitals provided a similar response.

The statement from Our Lady of Lourdes Hospital, Drogheda, added that guidelines on newborn screening in the Traveller community form part of midwifery education in the college curriculum and this is “supported with practical education during clinical placements”. 

When asked if any HSE hospitals include a section on Travellers as part of routine induction of staff, a HSE spokesperson said that “Traveller organisations and the Primary Health Care for Traveller projects around the country provide cultural awareness training on an ongoing basis in response to requests from health service providers”.

They added that with Covid, “they are recommending use of the eLearning module [Introduction to Traveller Health] until this can be complemented with face to face training post-Covid” and this is available to all staff through the HSE’s learning and development portal. 

Cultural awareness builds trust

All Traveller advocates we spoke to felt Traveller cultural awareness training was important in healthcare. Traveller community development worker, Patrick*, said people can “have stereotypical views based on negative media” and assumptions can be made.

This training “works to break down those stereotypes and educate people about who Travellers are and what the needs are in the community” which results in better engagement in services.

Training was also important to Nevin, but she said that alongside it, having Traveller-specific workers integrated across the health services is also needed. “A peer-led support available to a Traveller who may feel vulnerable and fearful to engage with health and nursing staff” would make it a lot easier for Travellers, she explained.

This is particularly needed in maternity wards, she added, where Traveller workers could not only support Travellers but also be able to support nursing staff and doctors. 

A HSE spokesperson said that “the National Social Inclusion office have provided funding for two Traveller specific maternity resources to support Traveller women’s engagement with the Maternity Hospitals”. They said this “is in response to the challenges identified by Traveller organisations on the ground”.

Dedicated healthcare workers for Travellers also enables greater trust, according to Nevin, who has seen this first hand when they had a public health nurse specifically for Travellers in Longford. 

Because of the bond the public health nurse had built with the community, more women were connecting with the nurse and if mothers with small babies had a problem, Nevin said that they felt “they could talk to that nurse about ailments”.

However, their last Traveller specific nurse left for another job in 2018 and wasn’t replaced since. Nevin said because of this young women are being left untreated, and this has been exacerbated more due to Covid. 

The community worker knows of one mother with a young baby who was hospitalised with postnatal depression, but Nevin felt she “wouldn’t have needed to go to hospital if she had been seen a little bit earlier”.

When asked if this public health nurse was going to be replaced, a spokesperson for the local HSE community healthcare organisation said that “the Longford Westmeath Travellers health post will be filled when transfers off the national panel are completed”. They did not give a timeline or date for when this would happen. 

The added strain of Covid

Mary-Brigid Collins wearing a light top smiling while sitting against a blank wall Mary-Brigid Collins says Covid has not helped the poor health situation of Travellers
Source: Pavee Point Traveller and Roma Centre

Pavee Point’s Collins also said that Covid has not helped the situation in terms of Traveller health, with isolating a huge problem within the Traveller community. She added: “You knew you had to do it, you wanted to do it, but it was very difficult to do it.”

Collins lives in a four-bedroom house but with eight others living there, when she had Covid she found it difficult to isolate from her children and grandchildren.

She, alongside other Traveller healthcare workers across the country, were on the ground throughout the pandemic helping with the response and distributing information on prevention measures, testing and the vaccine.

Having Traveller primary healthcare projects already running meant the HSE had somebody to bring materials “straight to the doors” by people who were Travellers themselves, according to Hayes from the National Social Inclusion Office.

There was also “huge cooperation” on sites, said Hayes. “Families themselves were brilliant in outbreak situations – before we even get to the point of engagement, they would already have reorganised themselves.”

Travellers were among the hardest hit by Covid, with over 5,200 cases between March 2020 and April 2021. That was three times the rate of the general population. To put those case numbers in context, there were just over 30,000 Travellers recorded here in the last Census. 

The community was also sicker from the disease, with a hospitalisation rate (4.5%) nine times that of the general population (0.5%).

Outbreaks were a regular occurrence, with more notified in Irish Travellers than any other vulnerable group recorded by the Health Protection Surveillance Centre.  
https://public.flourish.studio/visualisation/7078099/

‘Tip of the iceberg’

“At the beginning of Covid, we were very cognisant of the challenges and we knew that we were going to have problems with some of our vulnerable groups,” the HSE’s Fitzgerald told Noteworthy.

“We tried to put in place quite a significant amount of prevention, awareness and a response,” she explained. “Generally it worked very well. But what we feared did happen, and we saw particularly high rates of Covid in Travellers.”

Fitzgerald said the high rates in Travellers were “the tip of the iceberg and may not reflect all cases”. Though Travellers “weren’t that sick” during the first and second waves, she said that “by the third wave they were”. 

By the end of the latest wave, there were nearly 250 hospitalisations, 28 people in ICU and 15 deaths in the Traveller community, according to Fitzgerald. Those in ICU included young pregnant women. 

Many Travellers were presenting later and sicker in the second and third wave due to, Fitzgerald said, “a combination of culture and social isolation”, including finding it difficult to source medical attention because some “had disengaged from mainstream health services”. 

During the pandemic, the HSE “never had such an intense engagement with Traveller health units” and organisations, with “Travellers themselves looking for HSE involvement and health advice”, she added.

When asked if enough was done to address problems with social isolation and other issues encountered by Travellers during the pandemic, a spokesperson for the Department of Health said that there were “concerted efforts by departments and agencies to protect this group from Covid-19″. 

The spokesperson said that the Department of Housing “acknowledged the constraints facing people who live in halting sites in adhering to public health advice” and that additional accommodation and sanitary services were provided. This will be covered more extensively as part of our article on Traveller accommodation – out later in this series.

The production of guidance of vulnerable groups, other HSE measures as well as work by the HSE Social Inclusion and Primary Care teams were also listed by the spokesperson, who continued: 

“Overall, the impact of Covid-19 was greatly minimised by an intensive and collaborative response from government, the HSE and civil society. Socially excluded groups were prioritised and received priority action in terms of detection, case management and contact tracing.”

Given the large number of cases that occurred, Pavee Point’s Collins is worried about the future impact of the disease and felt “the long-term effects of Covid are going to be showing up” across the community – one which already has a significant disease burden.

‘Not systematically recorded’

Though the Health Protection Surveillance Centre reported outbreaks in Irish Travellers, ethnic identifiers were not a standard part of the pandemic response and are not integrated into the health service – or many other State systems. 

For instance, it was recommended in the ‘HSE Vaccine Approach for Vulnerable Groups in Ireland’ report by the HSE National Social Inclusion Office in March 2021, that ethnicity be included in data capture to monitor progress. However, this was not implemented in the Covid vaccine rollout.

Dr Margaret Fitzgerald wearing a light grey top standing talking at a podium Dr Margaret Fitzgerald says they gather information from Traveller healthcare workers on the ground
Source: Irish Global Health Network via YouTube

The HSE’s Fitzgerald said this was due to the “cyber attack and because of the difficulty with recording ethnicity” which she added is seen “across the whole government system” as it is “not something the State gathers, as a routine”. 

Noteworthy asked the HSE about this as well as the vaccine uptake in Travellers by age group but did not receive a response to this query before publication. 

Adding ethnicity to all datasets is something that the HSE National Social Inclusion Office has been advocating for many years, according to Hayes. She felt that once the health system is joined up with a unique identifier, that an ethnic identifier would be included. “It would be ridiculous if not,” she added.  

Lack of ethnicity data collection in Ireland contrasts with the UK where over 90% of general practices have ethnicity data recorded. Over 80% of acute inpatient and day case records in Scotland also include this data. 

When asked about the use of ethnic identifiers, a HSE spokesperson said that “a number of hospitals and health services” are collecting data as per the ethnic categories in the Census, which includes Irish Traveller. These include the Rotunda Maternity Hospital, CHI Temple Street and other services include the Child and Adolescent Mental Health Service.

There is a commitment to incrementally roll out the Ethnic Identifier in the National Traveller Roma Inclusion Strategy as well as a commitment in the forthcoming National Traveller Health Action Plan (NTHAP) using the learning emerging from these programs to roll it out further in the health services.

The lack of an ethnic identifier means that much data and statistics relating to Traveller health come from academic research, Census data – now five years old – and the All-Ireland Traveller Health Study – over a decade old. 

When Noteworthy asked the HSE for more up-to-date information on suicide in Travellers, a spokesperson said that the Central Statistics Office (CSO) is the source of official suicide data and its sources include findings and verdicts from Coroners.

However, the spokesperson added that ethnicity “is not systematically recorded” across the Coroner system. “Therefore official, complete data on suicide rates in the Traveller community is not available.”

Noteworthy was also unable to obtain records of Traveller complaints in the same eight hospitals we sent an FOI to in relation to induction training due to a lack of ethnic identifier in complaint data. 

A whole-of-government approach needed

Though the data may not always be recorded, inequity between the childhood facing Travellers and their peers in the settled community jumps out from every statistic that is available. So, what can be done to close this gap and improve Traveller children’s health? 

The HSE’s Fitzgerald said there “had to be greater investment in primary care and resourcing [of] Traveller community health workers”. She added that “Traveller children need wraparound care and support” with other sectors also needing to take action. 

Pavee Point’s Kavanagh said that “it’s not just the HSE’s role to address Traveller health inequalities, but a role for all government departments”.

Leinster House - a large grey stone building with many windows - with quote by Lynsey Kavanagh who is a health researcher and policy analyst for Pavee Point - We've seen, during Covid, a whole-of-government response and we would like to see the same effort and energy given to Traveller health, in particular in relation to children.
Source: Photo - Laura Hutton via RollingNews.ie

Kavanagh added that “the fact that Travellers are a really young population is indicative of health status” which is in turn “indicative of institutional racism, appalling living circumstances [and] severe overcrowding”.

In 2016, almost 60% of Travellers were under 25, almost double that of the general population (33%), with just 3% aged 65, less than a quarter that of the general population (13%) .

Community development worker Nevin also felt sorting out the bigger picture – including housing and education – is important to “improve the lives of all Travellers”.

“Our children are our future and it’s important they are treated with the respect and dignity, are able to get an education, go to further education and make an impact in hospitals, council offices, right across the board.”  

*Name has been changed. 

***  

This article is part of our TOUGH START investigation being led by Maria Delaney of Noteworthy and Michelle Hennessy of The Journal. Over the next two weeks will also reveal systemic issues facing Traveller children in education and housing. 

Design for Tough Start project - An old football that has too little air in it sitting on the side of the road.

This Noteworthy investigation was done in collaboration with The Journal. It was funded by you, our readers, with support from The Journal as well as the Noteworthy general fund to cover additional costs.

You may be interested in a proposed investigation which is almost funded – BLIND JUSTICE - where we want to look at the experience of Travellers in the justice system.

You can support our work by submitting an idea, funding for a particular proposal or setting up a monthly contribution to our general investigative fund HERE>>

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