People from Gypsy and Traveller communities on average have life expectancies 10 to 25 years shorter than the general population. Pharmacist Lindsey Fairbrother connected with them by gaining their trust…

It was the surprise friendly warning not to talk about contraception that piqued my curiosity into the unknown world of a distinct cultural community.

Was this in a foreign land? Was this whilst backpacking across Asia? No. This was one mile from my place of work on an alien territory where I was well known and welcome but it was me who lacked understanding and needed educating.

I would like to bring you into this world through increased awareness and understanding.

There are around 300,000 Gypsies and Travellers in the UK. Near my pharmacy, there are three Traveller community sites which I look after daily. As with any culturally diverse group, how you act and speak will affect how you are accepted and how well messages, including health messages, are heard.

Around half of community members have little or no literacy, compared to 16.4 per cent for adults in England. I quickly realised a different approach was needed to healthcare (1). Historically, Romany Gypsies arrived in the UK from India in the 1500s. The word gypsy derives from Egypt as Indian migrants were wrongly assumed to be from Egypt.

Irish Travellers came to the UK after the 19th century potato famine and also post-World War II when they were invited to work as labourers to rebuild our country. Scottish and Welsh travellers, New Age Travellers, Boaters, Bargees and Show people are also classed as Travellers.

Most Traveller communities now live on fixed sites, often in static caravans with brick outhouses. Only a third of Travellers are on the move and even fewer are now living with horse and cart at the side of the road, although they can still be seen. Some Travellers live among you and in towns and cities in regular housing.

In common with many cultures, family is extremely important, with youngsters looking after and respecting their elders, and many community members feel family members are the only people they can trust.

Their health beliefs are strong but alien to my own. Often, illness is put down to ‘bad nerves.’ Mental health is not spoken about and often taboo and there are high rates of suicide and self-harm. Confidentiality is very important and sometimes members will only speak to people of the same sex and similar age to discuss their health. Due to low trust in authority, Travellers may share concerns amongst themselves but not want to tell strangers, including doctors.

So, as a healthcare provider, how do I connect with my Traveller communities knowing that trust is a big issue? With any misunderstood group in society, the most important thing is to put the effort in and gain understanding. Through understanding comes trust and with trust we can help and support better health outcomes and a better quality of life for all.

Before I tell you about my own experiences, I would like to give you some more background information. Here is the most shocking statistic of all: on average, Gypsy and Traveller individuals have life expectancies 10 to 25 years shorter than the general population.

Gypsies and Travellers are twice as likely to experience depression, 20 times as likely to experience the death of a child as a mother, six times more likely to die of suicide, three times more likely to suffer anxiety and significantly more likely to have a long-term illness, health problem or disability than the general population (2).

Many Travellers are born-again Christians who do not believe in contraception

The Traveller community have a lack of trust, a deep sense of fatalism, low expectations and fear of authority compounded by poor literacy and often digital exclusion. ‘A difficult nut to crack’ you may argue but that is the challenge and the privilege for our profession. It makes achieving positive outcomes much more rewarding.

So, to go right back to the start, why was I warned off talking about contraception and when did this come about? I conducted outreach work on a Traveller site having been involved with the Covid vaccination programme and provided contraception and extended care services for several years, long before Pharmacy First. I wanted to see if I could support my local communities further and discussed this with the local vaccination team and public health. We received positive support and a grant towards outreach and staff training.

Visiting Traveller sites was not difficult because I had been working with this community for over a decade, helping them with medication, completing forms and communicating. I asked Joe, the site manager and a Traveller, if I could come on-site and talk to people in their caravans and, at first, it was as easy as going into a home to do a housebound jab or deliver medication.

What I had no awareness of was that many Travellers are born-again Christians and do not believe in contraception. Joe helped me make sure I did not cause offense and destroy the trust I had built up. What he did not realise, which of course was confidential, was that some of the younger Travellers had come to me for contraception.

Other successes include helping young families through Pharmacy First, particularly to examine for otitis media and tonsilitis. Some people I help transit between more than one Traveller site and their registered doctor can be hundreds of miles away, albeit still in England.

Pharmacy First enables me to support these families who would otherwise have to register as temporary residents with a local doctor, involving complex and difficult form-filling. It would also mean Travellers would have to be open with yet more people they do not know, posing even more barriers to healthcare. 

Travellers are a vulnerable group who deserve respect. My message to all of you is to broaden your mind, learn from other cultures and work with them. You will gain so much and be able to help others which is, after all, why we are in community pharmacy.

References

1. National Literacy Trust (Adult literacy | National Literacy Trust)
2. Friends, Families and Travellers Charity (www.gypsy-traveller.org)

Lindsey Fairbrother is a community pharmacist and owner of Good Life Pharmacy in Derbyshire.