Association of Hungarian Societies of Medical Sciences
Hungarian Scientific Society of Rural Health
Medical Care of Misery
Specific needs of coming down and hard up social classes and its effect on public health
2016. november 30. 9.00-16.00
Semmelweis University, Nagyvárad Square Academic Block, Johan Béla hall
Scientific executive: dr. Simek Ágnes Ph.D. e-mail: firstname.lastname@example.org
Medical care demands
9:00 dr. Opporunities of survival for cumulatively underpriviledged people in the current Hungarian medical care system dr. Simek Ágnes Ph.D., titular associate professor, Semmelweis University, Department of Public Health
9:30 Multiple disadvantage in the prostitution industry prof. dr. Forrai Judit, professor, Semmelweis University, Department of Public Health
10:00 Health condition of gipsy children and medical services for them in the primary care dr. Huszár András, family pediatrician, former president of Society of Family Pediatricians
10:30 Effect of the residence of the underpriviledged persons in hospital and outpatient care dr. Frankfurter Márta, head of Infectology, Kenessey Albert Hospital, Balassagyarmat
Opportunities of Solution
12:00 Treatment of misery dr. habil. Krémer Balázs, associate professor, Department of Sociology, University of Debrecen
12:30 The most important element: prevention. Education training from the nursery Orbán Zsuzsanna Hungarian language and literature teacher
13:00 The validation of the professional and ethic principles of the social work in the process of the treatment of hard up people Nemes Judit, vice rector of Wesley János Metodist College
13:30 Harmful effects of inequalities on the global society - what would be the function of the social policy? Misetics Bálint, social politician, Eötvös Lóránd Scientific University, Faculty of Social Policy
Required comment: dr. Chen Sheng Wei, lawyer
The conference is appreciated 6 credits for family phisicians, internist, pediatricians, infectologists and experts of public health
VI. Conference of Hungarian Scientific Association of Rural Health
Prevention of homeless life-style
Change of paradigm in homeless-care
28-29. September 2012.
Office of Chief Medical Officer, Fodor József hall
on the base of the presentations and comments of participating experts and lays
The correct definition of homelessness is yet missed also in everyday expressions and also in the law. The denomination means not only “flatlessness”, but also a special lifestyle: separation from the uniformity of the society, from its habits and laws, - while it is reconstructed in their micro – environments, - and revaluing of the system of rights and duties, social and personal connections.
There were approximately 25 000 persons living without constant shelter in 2009 according to Central Statistical Office.
The local governments’ duty is to record the homeless people living in its territory.
In 2010 the Public Health Department of the Office of Chief Medical Officer collectsthese data. According to these 42 437 homeless persons lived in Hungary, from them 29 764 were registered and accepted some kind of homeless supplying services – accommodation, free catering, dresses, medical care.
This number is 28 855 versus 20 934 in Budapest.
The data are ready for a provision of every settlement and aggregated in every county.
After a personal interview with the specialists dealing with the homeless registration and their supply turned out the fact: apart from these official data there are also different kinds of latent homelessness:
Ø People, who get housing in the shed, in an unheated porch, on the attic of a weekend-house as compensation of smaller-bigger works around the house
Ø People with registered home address, but dismissing the accepted social lifestyle living in caves, forests or different communas.
To collect valid data about them is the most difficult activity.
Regarding the lifestyle is already homeless, but there is a shelter above them:
Ø individuals and families who live in some flat as an act of grace: at
friends, at acquaintances for some months, then move toward an other recipient, finally reach the street
Ø very poor people, who cannot satisfy their payment liabilities,
Ø who are not able to match continually with the social expectations and
subsistence of themselves and their family happens already according to the homeless lifestyle
According to discreet estimation of municipal and social politicians the real number of people living homeless existence is 2-3 times more than the compiled data.
The social roots of the homelessness:
The mass of homeless people is compound of the sources found below:
1. Many prospering industrial branches ceased after the political transformation: textile industry, leather industry, food industry, coach and other machine building, as a result of what the workers' hostels were closed down.
The people living in villages working in the big cities met their family only weekly or monthly before the ckosing. New workplaces weren’t established in the neighbourhood of their own settlement. The family received the recurrent parasites with difficulties, was not able to provide them due to the lost of the principal income source. Returning from the city the unemployed husband, son couldn’t accept the village-lifestyle again, they weren’t able, didn’t want to adjust to the previous circumstances.
The excessive alcohol consumption assisted a lot to the refusal. The only choice was left over: back up into the city, where the unemployed workers were known, where acquaintances lived, wher was the only oppurtunity to survive.
2. As a result of the economic, social changes many people have been declassed.
The unemployed workers weren’t able - did not want to learn other profession, to get job in an other occupational branch or to move toward another town for safe employment.
– In many cases the alcohol was the reason (and/or the consequence) of the loss of emplosment, flat and social connections. An economist, a French teacher, an electrical engineer, medical doctor have already occurred in the homeless hostels. doctor.
- In many cases not proper huosekeeping, wrong financial decisions drove to an irreparable economic status, to the loss of the flat. The media generates the widening scale of real or supposed needs, the necessity of the continual fulfilment of the misinterpreted social expectations.
The society of consumers presses people into a mad spending even those who haven’t safe economic background, while the people unable to consume more, or impossible to pay the loans are dropped out from this society.
3. The legal loss of the flat:
Its reason border the criminality in many cases, or exceeds it.
• Aged persons are often done out of their flat by their own children, their relatives taking off their properties many times, their real estate is taken away – promising nurture, nursing for the donation.
· Gallant or not enough cautious men may find themselves int he street following their divorce. A man paying child support does not need a lot to be unable to pay his tenancy, flee from the continuous stress effects into alcohol, in cosequence of it he loses his work – from this point it is very hard to return.
· The society has accurate informations about the civil flat-mafia's existence. Much less provable data are caught about state, organized flat acquisition inside local governments:
• Soulless colleagues working in the Social or Child Welfare Departments of Local Governments are watching the executable debts – currently above 20 000 HUF (1/4 of the minimum wage) may already be implemented, - and it is passed to a relative, an acquaintance, a sales manager of a real estate agency, for a fraction of the real price – for an abundant compensation.
4. The victims of the domestic violence:
•The maltreated mothers, unmarried mothers, children find a temporary asylum in a home supported by local governments, civil organisations, but with a limit of the possible residential time. After a repetitive taking back, violence, re-escape the mothers mostly get in the street, the children into an orphanage.
The criminalisation is not rare in their case too. The mothers as well as their children may easily come under the influence of the beggar-mafia or become prostitutes regardless with age, gender.
5. Inhabitants of Orphanages
The children being picked up from the family, educated in an orphanage turn often to the victim of emotional blackmail of their parents and relatives turning up suddenly after reaching the legal age and leaving the orphanage with a big sum of collected allowance for orphans. The considerable bank deposit is distributed for a little real or imagined love and care in a short time.
In other cases the hundred thousands, million sums run out in cosequence of their unpreparedness to the everyday life, due to lack of their financial experiences.
Családi háttér, támogató, személyes odafigyelés hiányában gyakran kerülnek a hivatalos utógondozás ellenére is az utcára munka és megélhetés nélkül.
6. A hajléktalanok létszámát tetemesen emelik a pszichiátriai gondozást igénylők.
A pszichiátriai gondozók, majd az Országos Pszichiátriai és Neurológiai Intézet bezárásával ezrével kerültek az utcára olyan betegek, akik folyamatos ellátás, felügyelet mellett alkalmasak lettek volna családban, civil lakókörnyezetben történő elhelyezésre.
They get to the street often despite the official aftercare without work and living in the deficiency of family background, a supporter, personal attention.
The 6. The homeless staff numbers claimants raise the psychiatric nurture considerably.
The psychiatric nurses, the national psychiatric one and Neurológiai Intézet got to the street with a thousand with his closure then patients like that, who would have been fit for placement happening in a family, civil surroundings beside continuous supply, supervision.
Kiszámíthatatlan dühkitöréseik, folyamatos gyógyszerelésük elmaradása miatt agresszív viselkedésük, kiszámíthatatlan realcióik miatt azonban családjuk nem meri vállalni az együttlakást, a civil lakótársak pedig kiközösítik az ilyen, valóban veszélyforrást jelentő betegeket. Sokan közülük mentálisan is károsodottak, így az alkohol, a droghasználat mellett ebben a populációban sem ritka a kriminalizálódás.
Their incalculable temper tantrums, continuous medicating their family does not draw it to undertake the living together however because of their aggressive behaviour, incalculable realcióik because of his lag, the civil roommates exclude the patients reporting a source of danger really like this though. Many people from among them mentally damaged, like this beside the alcohol, the drug usage in this population rare the criminalising.
Aktív formájában kisebb nagyobb lopások, garázdaság, passzívan ismét a koldusmaffia, a prostitúció. Ez utóbbi legszégyenteljesebb formája a gyengeelméjűek bordélyházakban történő alkalmazása akár begyógyszerezve, bedrogozva.
7. Az egyéb krónikus betegségben vagy fogyatékkal élők tartós gondozásának, ápolásának megoldatlansága is tovább növeli a hajléktalanok számát.
Smaller bigger thefts, a nuisance are active in his form, passively again the beggar mafia, the prostitution. This his latter most shameful form the imbeciles' application happening in brothels even medicine, taking drug.
The 7. You are the unresolved of living persons' lasting nurture, his nursing in the other chronic illness with a deficiency longer increases the homeless number.
8. The deliberate choice of an antisocial or sociopathic behaviour may be the base of homelessness – that means in this case only the choice of an alternative shelter which differs from the socially accepted ones. This number according to the experts however is only 1 % out of the homeless people. They are reached by the street social workers, their follow up is easy, in case of urgency their supply and support is assured.
- a megélhetés hajléktalanként folyamatosan biztosított
Reservation of the homeless existence
The reasons which nourish the homelessness:
- By the side of the homeless person - personality disorders
- anomalies of socialisation
- mistakes and lacks in communication
- Deficiency in motivation
- the wages are low, from allowances, free supplies basic requirements
may be granted better
- the subsistence for a homeless is continuously assured with the same
- the refusal of the soxiety: instead of the constant failure experience (does not receive work, because of homelessness, can’t obtain a definitive accomodation, because of unemployment) the homeless people are building a mini society in the homeless hostels: artistic, fine art, folk art, sport clubs
- economic status - there is no job opportunity, the wages are not enough for living, especially not for economic rehabilitation
The homeless lifestyle turns chronic one after a year, from this period the motivation is almost inpossible.
2–3. generation of homeless people are appeared: teenagers, young twenties from the villages, from the poor quaters of cities integrated into the homeless world following their relatives, their acquaintances dreaming a safe living, escaping from the daily worthless slave-work which can not provid that.
The rate of women is increasing. In the beginning of the ’90 this rate was 3-5 %, currently it is more than 20 %.
The basic social and personal deviances, the chronic abuses (alcohol, medicine, drog, game dependences, the fear from the real society lead to the fact: 90-98 % of homeless persons are currently not fit for resocialization.
Scientific surveys, valid data collection did not happen on these experiences.
The social judgement of the homelessness:
Many people consider homeless people as the conscience of the society.
On one hand the positive regret for a fellowman needing help, on the other hand the neutral fear to get into the same situation, and finally the rude refusal, particularly in case if the homeless people live among better circumstances due to the free social supply (accomodation, dresses, food, entertainment,) than employed people working for the minimum wage, or people working illegaly as slaves, who’s taxes are also support homeless care. This experience may turn even to aggressivity.
The individuals of the society are solving this confrontation differently.
There are some, who don’t want even to see homeless people,
- because they disturb their quiet environment
- because their heart is broken for them…
There are some who look for virtual solutions:
call for - ambulance
- night duty to the homeless sitting peacefully in the street
and some who do not take care of the appearance and resort to violence:
- call the police
- mistreat the homeless person
There are some who provide individual help: food
to the homeless person living near by their flat in a park, in the street.
There is a negative attitude of the socity regarding that registered homeless people live on a higher living standard due to social benefits and individual allowances, gifts than many employees working actively in the labour market.
Health care projection of the homelessness
Currently there are 84 institutions supplying homeless in Hungary, 70 out of them provides different kinds of health services.
Regarding with the approximately 30 000 registered homeless people, one provider takes care for about 360 homeless people. Assuring infrastructure, educated staff, building and services.
There are 70 family doctors for this which means 420 patients per practice without optional territorial supply, while this number in emong average population is 1500-2000/practice..
Great help in the patients' tracing and in their transport to the doctor the moving social ambulance service, whichis supported by three big Budapest providers.
The homeless medical care according to the statistical data is solved, indeed better than that for the average population.
.. and what is the reality:
The stress-tolerancy, the communicational, conflict handling ability of homeless people is worse than that of the average population, in consequence of this they apply for medical care rarely, with more serious complaints, or with complications. Many times their family doctor according to their previous residence does not receive the homeless person as his patient any more. Mostly the do not know the special places for homeless medical care, where nobody ask for their valid health insurance.
Frequent is the polymorbidity among the homeless people; more alcoholic, psychical illnesses, than among the aberage population, the malnutrition, vitamin deficiency, the infectious diseases are common. They have many illnesses of the upper respiratory tract although they adapt largely to the cooling.
Different complications of cooling, alcohol, drogs, atherosclerosis and infections are also frequent.
Many of them are unprovided, who do not consulting a doctor at all. The screening, prevention, continual care, rehabilitation is quasi unknown concept in the homeless health care – except the X-ray screening of TB and the cheque of parasite exemption which is necessary for the accomodation to a homeless hostel.
There is much abuse with medicine prescription (tranquilliser, painkiller is possible to sell by tablet, free prescriptions –payed by the local government - get frequently into an inner market), with the allowances of different institutes in consequence of the living problems.
A legkevésbé megoldott ápolási, krónikus gondozási szükségleteik kielégítése. The accurate surveys, analyses on these experiental facts are missed.
Also their polyclinical, hospital care hide many anomalies. While they often have to endure humiliating, dismissive behaviour, on the other hand they may take advantage in acute care as a homeless person: they reach diagnostic, therapeutic procedures much more easily, more quickly, than the average population.
Their nursing, continual care necessitites are less solved. The chronic departments and first aid places of the big homeless care centres are insufficient for these services.
There is no a survey no a research have been made until now by our knowledge on the reasons of the homelessness, thereal number of homeless population, on their different kind of residence, on their health conditions, their living sources. It would be very useful and cost-effective to develope the alternatives of the supply, prevention on the base of valid data and facts.
Currently this fundamental lack of information and in cosequence the ad hoc activities characterize all of the homeless services.
This lack of information is one of the obstacles for homeless people to get suitable social and his medical care.Office of Chief Medical officer prepared a placard in 2011 with the availability of health care provider places and their availability on it, but a uniform, national information service is necessary: for the homeless and for the average population as well.
Az információk terjesztésében igénybe lehetne venni önkéntes hajléktalanok és működő szervezeteik segítségét.
Az információáramlást, a kapcsolattartás lehetőségét szolgálná, ha minden hajléktalan számára biztosított lenne egy ingyenes e-mail cím, és a lehetőség, hogy az elektronikus levelezést használni is tudja.
Szükséges a már aktív és a leendő orvosok, egészségügyi dolgozók képzésébe beiktatni a hátrányos helyzetűek ellátásának specifikumait. Az információk terjesztésében igénybe lehetne venni önkéntes hajléktalanok és működő szervezeteik segítségét.
Az információáramlást, a kapcsolattartás lehetőségét szolgálná, ha minden hajléktalan számára biztosított lenne egy ingyenes e-mail cím, és a lehetőség, hogy az elektronikus levelezést használni is tudja.
Szükséges a már aktív és a leendő orvosok, egészségügyi dolgozók képzésébe beiktatni a hátrányos helyzetűek ellátásának specifikumait.
Orvosi egyetemeink foglalkoznak egy-egy részterülettel – migránsok, roma népesség, idős betegek, de egységes, minden hátrányos helyzetű csoportot magában foglaló oktatási anyag még nincs.
A hajléktalanellátók magas száma, működésük összerendezetlensége jelentősen rontja az ellátás költséghatékonyságát. Nemcsak a hajléktalanellátók, hanem a határterületen dolgozók – egyéb szociális ellátók, egészségügy, oktatás – tevékenységét is össze kellene fogni, egységesen tervezni és végrehajtani. Our medical universities deal with a subfield – migrants, Romany population, aged patients, but uniform, educational substance including all underprivileged groups not yet.
The homeless providers' tall number, the order of their function spoil the cost effectiveness of the supply significantly. Not only the homeless providers, but on the frontier employees – other social providers, public health, education – it would be necessary to coordinate his activity, uniformly to plan and to execute.
A hajléktalanok ellátása nem oldható meg kerületi-területi szinten, eseti megoldásokkal, csak átgondolt, egységes, szervezett integrált és rendszerszerű országos stratégiával.
Megoldás lehet a mikroszinten (Csenger) már működő feladatmegosztás: a meglévő, működő, megfelelő infrastruktúrával és szervezeti hálózattal rendelkező hajléktalanellátók között fölosztani a szociális ellátás feladatait:
The homeless supply on a district-regional level which cannot be solved, with special solutions, only thought through, uniform, with an organized integrated and systematic national strategy.
There may be a solution the mikroszinten (Csenger) task sharing working already: to divide the tasks of the social supply up among the homeless providers at who the existing, working, suitable infrastructure and an organizational network are:
az éjszakai szállást
a nappali ellátást (melegedő, foglalkoztató)
az egészségügyi szolgáltatást
az utcai szociális mentőszolgálatot
a társadalmi rehabilitációt.
Így nem verseny, hanem munkamegosztás, nem pénzügyi osztozkodás, hanem a pénzeszközök költséghatékony felhasználása lenne a cél.
the night accomodation
the daytime supply (warming, employing)
the dress supply
the hygienic service
the street social rescue service
the homeless education
the social rehabilitation.
Like this not competition, but division of labour, not financial sharing, but the aim would be the bugdet use of the finances.
A hajléktalan számára sem kényelmes hotelszolgáltatás lenne egy helyen, és válogatás a kényelmesebb jobb ellátási lehetőségek között, ami a legkevésbé sem inspirálja, hogy visszatérjen a munkaerőpiacra, és megtanulja, vagy újra gyakorolja a gazdálkodást a legkisebb jövedelemmel is.
Több szempontból is hasznos lenne önkéntes nyugdíjasok bevonása a hajléktalanok ellátásába:
- költség nélküli aktív munkaerő
- óriási tapasztalat és energia felhasználása
There would not be a comfortable hotel service on a place for the homeless, and selecting between the more comfortable right supply opportunities, that the does not inspire it little in order to return onto the labour market, and learns it, you are again practises the farming with the smallest incomes.
From more viewpoints voluntary pensioners' withdrawal would be useful into the homeless supply:
- active workforce without an expense
- the use of an enormous experience and energy
- rengeteg frusztráció, elmagányosodás, bezártság elkerülése, ezek összes pszichoszomatikus és költség-vonzatával együtt.
Az önkéntes nyugdíjasok bevonása egyben óriási lépés lenne a hajléktalanokkal történő személyes, egyéni foglalkozás, törődés felé.
A jelenlegi hajléktalanok ellátása mellett fontos – fontosabb a hajléktalan lét megelőzése, a hajléktalanság újratermelődésének megakadályozása.
- many frustrations, desocialisation, bezártság his avoidance, these all psychosomatic and his expense argument together.
The voluntary pensioners' withdrawal would be an enormous step with the homeless in one towards a happening personal, individual occupation, care.
Beside the present homeless supply important – more important the prevention of the homeless existence, the homelessness producing his prevention.
A megelőzés lehetősége:
Az általános iskolától a pénzügyi ismeretek
a konfliktuskezelés - stresszoldás
folyamatos, életkornak megfelelő elméleti és gyakorlati oktatása.
A hátrányos helyzetű gyerekek fölzárkóztatása, a szegregáció megszűntetése.
A törvényalkotás szintjén nagy védelmet jelentene az állampolgároknak
a magánszemélyek csődtörvényének megalkotása
a lakástörvény és
The opportunity of the prevention:
From the primary school the financial knowledge
the household leadership
the conflict management - stress solution
his continuous, theoretical and practical education being equal to age.
The underprivileged children catching up, the segregation megszűntetése.
The legislation would means big protection to the citizens on his level
creating the private persons' Bankruptcy Act
the housing act and
a végrehajtási törvény módosítása (jelenleg közérdekre hivatkozva 20 000,- Ft köztartozás esetén már végrehajtható a kilakoltatás).
A hajléktalanság újratermelődése és a reszocializált hajléktalanok visszaesésének elkerülése érekében szükséges:
folyamatosan megújuló és elérhető információ hajléktalanoknak
és a lakosságnak a szállás
a szociális ellátás
az egészségügyi ellátás
a szociális rehabilitáció lehetőségeiről.
the modification of the execution law (referring to a public interest currently 20 000,- Ft in case of a public debt already executable the eviction).
The homelessness producing and the reszocializált the avoidance of homeless decline in a vein plough necessary:
available information being renewed continuously hajléktalanokna and for the population the accomodation the social supply the medical care from the opportunities of the social rehabilitation.
Fontos a hajléktalanok oktatása – képzése a reszocializáció érdekében: kommunikáció, konfliktuskezelés, önismeret, informatika, viselkedés-társadalmi elvárások.
A társadalmi elfogadottság tekintetében sokat segíthetne a közmédia:
- valós reális képet nyújtva a hajléktalanokról
- információkat az ellátási lehetőségeikről
az önkéntesek munkájáról és jelentkezéséről
- megoldási javaslatokat bemutatva.
Important the homeless education – his training in the interest of the reszocializáció: communication, conflict management, self-knowledge, informatics, behaviour society expectations.
The public media could help a lot in the look of the social acceptance:
- giving a real real idea of the homeless
- informations their supply opportunities
from the volunteers' work and his registration
- presenting solution proposals.
Így ha lassan is, sok nehézséggel, de az egész társadalom összefogva – a hajléktalanokkal is, - elérhető, hogy a mai szállás és étkezési lehetőséget felkutató vegetatív lényekből ismét homo sapiensként élhessenek.
Like this if slowly, with much difficulty, but all of the society rounded up – with the homeless, - available, that let the today's accomodation and culinary vegetative one seeking out an opportunity be allowed to live on beings as a homo sapiens again.
V. Conference, Budapest
20. September 2011.
Fodor József Conference Hall, Budapest, IX. Gyáli Str. 2-6.
Equity and equality for the underprivileged groups in the public health services
9. 00 Opening of the conference dr. Simek Ágnes PhD, Hungarian Scientific Association of Rural Health, president
prof. dr. Szócska Miklós, Ministry of National Resources, state secretary for Health Care
dr. Paller Judit, National Public Health Institute, Office of Chief Medical Officer, chief medical officer
9.30 Scientific basis of public health, prof. dr. Cseh Károly, Semmelweis University, Public Health Isntitute, head
10.00 Ensuring equality in different public health systems, prof. dr. Ádány Róza, Debrecen University of Science, Public Health School, head
11.00 The role of primary health care in the national public health movements, prof. dr. Hajnal Ferenc, Szentgyörgyi Albert University of Science, Institute of Family Medicine, head
11.30 Public health and health-economy, prof. dr. Boncz Imre, Pécs University of Science, Health Management Department, head
12.00 Detected inequalities in health care in Hungary, dr. Vitrai József, independent health expert
13.30 Forming health-conscious behaviour of the next generation, dr. Somhegyi Annamária, Ministry of National Resources, chief advisor
14.00 Social first aid – providing dignity for handicapped people, dr. Simek Ágnes PhD, Hungarian Scientific Association of Rural Health, president
14.30 Specific claims of Gypsies in health care dr. Szabó János, Semmelweis University Department of Family Medicine, scientific advisor
15.00 Restorative method in education of handicapped children for achieving equality, Negrea Vidia, Foundation of Community Services, president
15.30 Sexual abuse under the legal age – self-defence education, Pregunné Puskás Gyöngyi, “Don’t hurt me World!” Foundation, psychologist
16.00 Closing of the conference, dr. Simek Ágnes PhD, Hungarian Scientific Association of Rural Health, president
IV. conference Horvátzsidány - Peresznye
Hungarian Scientific Association of Rural Health - IV. Conference
IAAMRH European Chapter - I. Congress
in collaboration with EURIPA
Horvátzsidány - Peresznye
June 13-16, 2oo7
Disadvantages beyond living in rural areas
– through minorities for healthy villages
The official language of the conference is Hungarian.
Simultaneous translation is available in English.
18.oo Addresses - Mayors of the two host villages
18.3o Reception Party given by dr. Ashok Patil, president of IAAMRH
9.oo Opening Ceremony
Opening of the conference – dr. Simek Ágnes, president of Hungarian Academic Association of Rural Health
Addresses: Mayor of the County Commission, president of IAAMRH, president of IAAMRH European Chapter
Children’s folk show
1o.oo Plenary session: Problems of different minorities
Moderated by: dr. Ashok Patil, president of IAAMRH, prof. dr. Hans-Joachim Hannich, president, IAAMRH European Chapter, dr. Simek Ágnes, president of HAARH
Dr. Ashok Patil, president of IAAMRH: Equity and equality in rural areas
prof. dr. Hans-Joachim Hannich, president, IAAMRH European Chapter: From ageing to dignity of death
dr Simek Ágnes, president of HAARH: Strangers in the night…
dr Balogh Sándor PhD. chief officer, National Institute of Primary Health Care: The role of National Institute of Primary Health Care in providing equality
Dr. Csehák Judit, chair, Foundation for Patients’ rights: Equity from the point of view of the patients
IAAMRH European Chapter – board meeting
IAAMRH European Chapter – general assemble
13.oo Siesta – sightseeing in the villages, anti-stress exercises, healing lamas, lifesaving first aid, fruits&vegetables, portrait-making by artists, screening investigation, blood-pool
15.oo National minorities
Moderated by: dr. Jaume Banqué Vidiella, Euripa Excutive member, SEMFYC Rural Working Group, Catalunya, Catalunia, Bognárné Várfalvi Marianna, senior lecturer, Miskolc University, prof. dr. Natalia Zarbailov, State University, Moldova
Keynote presentations: Quality of life - markers of health status from the point of view of ethnical minorities - Bognárné Várfalvi Marianna, senior lecturer, Miskolc University
Joining presentations - dr Laura Hancu, president of Rumanian Association of Rural Practitioners: Possibilities and limits for family doctors in villages with minorities
- dr. Szabó János, senior lecturerer, Semmelweis university: Why is the health care for Gipsy patients often problematic?
17.30 Museum of Local History with guide – Folklor show of natives Horvátzsidány
2o.oo Dinner in the thermal bath – fashion and jewel show
9.oo Minorities in healthcare
Moderated by: dr. George Haber, president, Rumanian Association of General Practitioners, dr. Claudio Carosino, Italian Representative of EURIPA
Presentations - dr. Heim Szilvia: lecturer, PTE: A hospice service in general practice
- dr. Maricarmen Martinez Altarriba, SEMFYC, Spain: Sleeping problems of elderly
- dr. Paulik Edit, senior lecturer, SZTE: Social and health status of patients suffering from chronic illnesses living in small villages
1o.oo Coffee break
- dr. George Haber, president, Rumanian Association of General Practitioners,: Elderly care in Romania
- dr. Claudio Carosino, representative of EURIPA: Model of home care provision of old people
Hungarian Academic Association of Rural Health - general assembly
13.oo Siesta – sightseeing in the villages, anti-stress exercises, healing lamas, lifesaving first aid, fruits&vegetables, portrait-making by artists, screening investigation, blood-pool
Visit to Vinarium of the local priest
14.3o Minorities in the villages
Moderated by: prof. dr. Francesco Carelli, board member, WONCA-EURACT ,dr. Kovács Lajos, member of National Professional College of Family Medicine, prof. dr. Christos Lionis, regional editor, EURIPA-Journal of Rural and Remote Health, vice president, WONCA-EGPRN
Key note presentation: Family Medicine today, what can we hope for? - dr. Hidas István, honorary president of MÁOTE
Sándor Klára, senior lecturer, SZTE Library and Informatical department: Status of women in the society
dr. Forrai Judit PhD, associated professor, Medical History department, Semmelweis University: Women in marginalized situation
prof. dr. Christos Lionis, regional editor, EURIPA-Journal of Rural and Remote Health, vice president, WONCA-EGPRN: Content, scope, review process and prospect of the European Section of Remote and Rural Health Journal.-
Contributors: - Charity Religional Organization
- Red Cross Organization
- Children’s Wellfare Fund
Workshop: …complex treatment of the patient and his/her social surrounding… - prof. dr. Francesco Carelli, board member, WONCA-EURACT
17.oo Religion and health
Moderated by: dr. Páldy Anna, chief officer of Johan Béla Institute for Public Health, dr. Neducsin Míra, HAARH, dr Chiara Somaruga, occupational health expert
Key note presentation: dr Neducsin Míra, HAARH: Faith and health
Joining presentations: - Betty Sebastian, verbita monk: Indian minorities in Hungary
Workshop: Health and religion, view of family doctor - dr. Apolonija Steinmann, lecturer, University Ljubjana
16.3o EURIPA - IAAMARH European Chapter – Conversation at white table
19.oo Museum of Local History with guide – Peresznye
2o.oo Ethnical programs, excursion in the moonlight, campfire, international folklore show palinka-tasting
9.oo Modern migration - international minorities – permanent inhabitants of the cities
Moderated by: dr. Szilárd István PhD, chair, International Organization for Migration, WHO, dr. Sirák András, senior lecturer, Semmelweis University
Key note presentation: - dr. Szilárd István PhD, chair, International Organization for Migration, WHO: Refugees
Joining presentations - dr. Chiara Somaruga, occupational health expert:Migrant and seasonal workers in agriculture in Italy: the case of the Region of Lombardy
- dr. Sirák András, senior lecturer, Semmelweis University: Passengers
1o.3o Coffee break
11.oo Slovakian session
Moderated by: dr. Pásztor László, president, Slovakian Private GP-s’ Association, dr. Hubert János, chief officer of Public Health in Veszprém County, dr. Stéger Miklós, senior lecturer, PTE
Introduction of the Slovakian Primary Health Care - dr. Pásztor László
Joining presentations - dr. Princzkel J., dr. Princzkel M.: Financing technique for GPs in Slovakia
- Gajdosík J., Sebok Z., Pásztor L.: CME for GPs in Slovakia
- dr. dr. Princzkel J.: How does a rural GP work in Nemesócsa, Slovakia?
12.oo Conclusion, statement – Closing: dr. Simek Ágnes
12.3o Reception by the Mayor of Kőszeg
13.3o Visiting Kőszeg
Permanent exhibition from the pictures of Drigovich Lajos artist-teacher Horvátzsidány childrens’.drawings
Academy of patients – continual petients aducation screening for the participants.
Our association's continuous and unbroken aim is to lessen disadvantages of people living in rural and remote areas. Regarding this the topic our IVth conference was:
Disadvantages beyond living in rural areas – through minorities for healthy villages
in Horvátzsidány - Peresznye, on June 13-16, 2oo7.
It was a joint conference with IAAMRH European Chapter and in collaboration with EURIPA.
The four-day program was organized in the magnificent area of the soft hilly landscape
in the Western part of Hungary.
The main topics were:
National minorities, minor nations
Minorities in healthcare
Minorities in the villages
Modern migration - international minorities – permanent inhabitants of the cities
The presenters were well-known experts of the topics like dr. Ashok Patil, president of IAAMRH, prof. dr. Hans-Joachim Hannich, president, IAAMRH European Chapter, dr. Csehák Judit, chair, Foundation for Patients’ rights, Bognárné Várfalvi Marianna, senior lecturer, Miskolc University, dr. Maricarmen Martinez Altarriba, SEMFYC, Spain, Sándor Klára, senior lecturer, SZTE Library and Information Department, dr. Forrai Judit PhD, associated professor, Medical History department, Semmelweis University, prof. dr. Christos Lionis, regional editor, EURIPA-Journal of Rural and Remote Health, vice president, WONCA-EGPRN, Francesco Carelli, board member, WONCA-EURACT, dr. Chiara Somaruga, occupational health expert, University Milano,dr. Szilárd István PhD, chair, International Organization for Migration, WHO, dr. Sirák András, senior lecturer, Semmelweis University in order of appearance.
All our presenters gave a well structured, practical, useful and available knowledge to the audience.
We had to miss famous lecturers like prof. dr. Hankiss Elemér, academist, sociologist, prof. dr. Igor Svab, president of WONCA-Europe or prof. dr. Alexander Kalache, chief officer of WHO-Friendly Aging program due to their other engagements.
We found that beside the villagers' elementary disadvantage - worse accessibility due to the distance, condition of the roads, traffic schedules, work-time of health care providers - there are many other disadvantages such as uneducation, poverty-unemployment, suffering from different chronic illnesses, necessity of hospice or home care, status of women, children and elderly - including many discrimination and violence, migration, national and international minorities, limited access to other social infrastructure points, lack of important information. Minorities living in isolated communities keep their cultural-social characteristics and the health care providers reach them hardly for a long time.
Belonging to any of these groups - generally to more of them - means harder accessibility and appropriation of health services, which will be the causes of worse life-style, worse health promotion, less healthy life-period, worse results of rehabilitation.
Further problems are the lack of knowledge on different cultural and social behaviour of the minorities while they haven't any evidence or education on the "minority-care" and the isolation of the villages, which may cause often burn out syndrome or depression of health care providers.
We suggest different solutions:
- Intervention of the state for decreasing objective disadvantages of rural population /road, infrastructure, accessibility to health care in time,/
- Continual medical education on problems of minorities for health care workers /different social and cultural customs of ethnical minorities, different claims of minorities in the society and in the health care, different way of communication, sharing information and responsibility/
- Continual patient education /on their body, on health promotion, on prevention and screening opportunities, on different symptoms, on domestic care, on first aid, on alternative care/
- Collaboration with minorities, with patients organizations, with social care, with leaders of local communities
- Utilization of international experiences, researches and building networks
- Community health care
We are sending our proposals all of our decision-makers in the policy and in the health care as well.
Beside the main topics there were two satellite programs:
Religion and health and the Slovakian session.
First one rose up the question of holistic medication of the human integrity, while in the second session Slovakian colleagues had the opportunity to introduce Slovakian primary care and to make comparisons with others in Europe.
We had three important meetings of different organizations:
Ø reorganization of IAAMRH / International Association of Agriculture Medicine and Rural Health/,
Ø a joint IAAMRH-EURIPA / European Rural and Isolated Practitioners’ Association/ board-meeting
Ø and general assembly of HAARH /Hungarian Academic Association of Rural Health/.
You will get details of the meetings by prof. dr. Hans-Joachim Hannich, president, IAAMRH European Chapter and prof. dr. Christos Lionis, regional editor, EURIPA-Journal of Rural and Remote Health on the website of IAAMRH European Chapter and that of EURIPA.
The consequence: EURIPA and IAAMRH European Chapter will harmonize their work in improving of villagers' health care. EURIPA will focus on scientific problems of rural health while IAAMRH ECh will put community health care in the middle of its interest.
The next board-meeting of the two organizations will be held in Budapest, in March 2oo8 arranged by our organization. There will be more opportunities to work out the opportunities of the collaboration.
The conference was located in two small villages: Horvátzsidány and Peresznye, near the western border of Hungary.
We enjoyed their hospitality in Horvátzsidány, where the mayor guided us in the local museum and sang to the visitors with the local choir,
such as in Peresznye,
where we have a nice campfire a folklore show under the ancient wood of Széchenyi Castle,
or in Kőszeg where the mayor of the town gave reception to the participants
and showed the sights of the town
and in Bükfürdő where the fashion and jewel show was celebrated over the pools for the scientists taking just thermal bath.
We made a trip to the fountains in Kiszsidány
and a very-very scientific visit in the famous pub to the "Beads" owned by the local priest.
I hope the conference was not only a scientific event but also a great jamboree of well-known friends and opportunity to have some relaxation far from the everyday monotony.