“There’s so much deprivation on your doorstep”: The volunteers tackling health inequalities, one phone call at a time

“I think volunteering at Doctors of the World really humbles me because I’ve had access to healthcare all my life. But to see how difficult it is for some members of the population in this country, it’s an eye-opening experience… there’s just so much inequality and so much deprivation on your doorstep.”

Ga Kitada is a fourth-year medical student at Barts and The London School of Medicine and Dentistry in London. He’s also a Doctors of the World UK (DOTW) volunteer.

During Volunteers’ Week, June 1-7, we’re honouring Ga and some 100 others who selflessly give their time to DOTW and keeping our clinics and advice line running.

Clinic and Helpline Lead, Rita D’Alessio said volunteers are at the heart of the organisation.

“We are grateful and privileged to work with such a beautiful team made up of amazing people who donate their time and expertise to support people to access mainstream healthcare,” she said.

“The service would not exist without our volunteers!”

Ga first joined DOTW as a clinic support worker during a student placement in 2018 and has continued to volunteer as a caseworker during the COVID-19 pandemic.

The medical student said his time at DOTW has given him more of a holistic understanding of everything that underpins individuals’ health.

It has also inspired a passion for ensuring access to healthcare for undocumented migrants, who make up the majority of DOTW’s patients.

“I feel a certain connection as someone who’s not from this country, who, arriving 11 years ago, didn’t speak much English and found it really disorientating,” said Ga, who emigrated to the UK from Japan when he was a child.

“I found that connection with the experience of the migrants (DOTW supports). Obviously, their experiences are a lot more difficult than mine – I went to a good school, I had all those opportunities, and it doesn’t compare in any way to the experience of a migrant, but I felt a certain connection I think.”

There are many reasons why a person may become undocumented, for example, their asylum claim may have been unsuccessful, or they can’t afford to renew their visa.

While often members of our local communities, undocumented migrants still face exclusion from regular services and so experience health inequalities.

“The stories I hear, it feels that they’ve been through so much and are coping with systems that are so opaque sometimes and so difficult to get your head around,” said Sheila Goff, a retired nurse with 35 years’ experience.

“Even if you’re a native of this country it’s sometimes incredibly difficult to get access to things. But for people, service users that we see, they’ve very often been through so much and hit so many brick walls with people either refusing to help them or not listening to their story.

“I think at Doctors of the World, we can provide an opportunity to hear them. Of course, we’re not always able to help, but it’s quite powerful I think for people to be able to be heard, properly heard.”

Sheila first joined the clinic in 2016 and has been volunteering ever since. She said she enjoys the supportive environment and dynamic nature of DOTW.

“I think that’s exemplified by how they so quickly got to grips with going online when all this pandemic broke, it was really impressive but that’s typical I’ve found of them,” she said.

“There seems to be such a can-do attitude to really trying to do everything that they can to help some of the most vulnerable and dispossessed people in our society. That’s what drives me.”

I think at Doctors of the World, we can provide an opportunity to hear them. Of course, we’re not always able to help, but it’s quite powerful I think for people to be able to be heard, properly heard.

Sheila Goff, Doctors of the World volunteer

For Isabelle Pereira, it’s the chance to empower people in vulnerable situations to exercise their basic human right to health, and access to healthcare.

“They can be in a very dark place… and they need to be helped, to be supported to get out of that dark place,” she said. “I think they appreciate the friendly face, the friendly smile… and not being judged.

“Basically, they feel safe when they are in the clinic, or when they talk to us, so it’s nice to support people who have lost their hope or lost trust in the system.

“The first day, it’s a lot to take in, to learn all the systems and all that stuff, but it’s really rewarding to help people to get access to basic primary care.”

Volunteers played a vital role in helping DOTW transition to a fully remote, national service at the start of the pandemic as COVID-19 forced the temporary closure of the East London clinic.

Through three national lockdowns, they have kept the clinic and advice line running, and service users and communities safe.

“We can’t thank our volunteers enough for their support and hard work this past year,” said Rita.

“The Doctors of the World clinic team had to swiftly adapt the services to operate remotely, and our volunteers have worked so hard to make this happen and quickly adjusted to a new way of delivering the service. They have been brilliant, and we wouldn’t have made it without them!”

Of DOTW’s 100 volunteers, 25 are currently supporting the clinic via the advice line, casework, remote GP consultations and post-natal follow ups.

In addition to providing remote consultations and advice on the right to healthcare in the UK, our volunteer doctors, nurses and caseworkers now screen patients for COVID-19, offer information on government guidance in the service user’s language, and explain how to access COVID-19 tests and vaccines.

They have also helped service users access food via foodbanks and mutual aid groups as the pandemic led to job losses and plunged already vulnerable people into further poverty and destitution.  

We can’t thank our volunteers enough for their support and hard work this past year.

Rita D’Alessio, Clinic and Helpline Lead

Ga, Sheila and Isabelle all agreed COVID-19 has created huge challenges, both for service delivery and service users.

“You really miss the face-to-face communication. I find it really hard on the phone and it’s made me realise how much we do communicate with all of ourselves, seeing expressions and just seeing how people are looking and whether they are looking very thin, hungry, tired, those sorts of things. I think it’s hard to get a sense of how people are (over the phone),” she said.

The rapid shift to digital health – not just at DOTW but across all health services in the UK – has left some of those without the skills or means to access it cut off from vital care and support.

Digital exclusion was a key finding of DOTW’s COVID-19 Rapid Needs Assessment, which looked at the impact of the first lockdown on excluded groups in England, such as asylum seekers, undocumented migrants, Travellers and sex workers.

“There had already been massive inequalities to do with accessing healthcare and the NHS, particularly with the rhetoric of the hostile environment, secondary care charging, Home Office data sharing, etc.,” said Ga. “But with COVID-19, I think the barriers have just deepened significantly… barriers to accessing digital health is a huge issue.

“For some migrants who are on the verge of destitution or who are destitute, trying to make an appointment for a remote consultation at a GP practice is actually a huge undertaking because… they have barely any phone credit because they’re so deprived.

“A lot of our work as caseworkers I think nowadays is just going back and forth sometimes between GP surgeries and service users trying to arrange phone consultations. On the digital divide as well, the language barrier that was always a problem for access has just gotten worse.”

DOTW will soon reopen the East London clinic to ensure everyone can access our services, while continuing to offer remote GP consultations and run the national advice line.

This will be essential for ensuring access to COVID-19 services, including vaccination, for a patient group that is often too scared to get medical help – even when they are fully entitled to it.

“Usually when people first contact us on the advice line… they are desperate, they are very fearful, even fearful of telling us their name or details, address, etc., and fearful of accessing services in the NHS,” said Ga.

Years of charging migrants for healthcare and sharing patient data with the Home Office have eroded trust between the NHS and migrant communities, creating a situation where patients don’t trust nurses and doctors and avoid healthcare services.

They (patients) can be in a very dark place… and they need to be helped, to be supported to get out of that dark place

Isabelle Pereira, Doctors of the World volunteer

Sheila said helping service users to understand the system and their rights, then supporting them to access NHS services is hugely reassuring for them.

“It does make a big difference hooking people into the system,” she said.

“I still believe that the NHS and the healthcare system is very good in this country. The vast majority of people working in it are fantastic and they want to give very good care, it’s just if people can’t access it, they can’t do it.

“So, it’s really important that we keep trying to push that.”

DOTW has been fortunate to have the support of many generous individuals who have selflessly given their time and/or money to keep the clinics and advice line running.

It’s thanks to our volunteers and donors that the organisation has been able to continue ensuring access to healthcare throughout COVID-19.  

Ga had a message for our supporters: “It would be an understatement to say this past year has been a hugely challenging year and the inequalities that the migrant population face, and the barriers to accessing healthcare have just widened and widened.

“Without having the support of the donors and being able to deliver these kinds of charity initiatives, many, many more people will suffer.

“I hugely admire the mission of DOTW and its will to make a difference and I think it’s thanks to the donors that we can do this and it’s something that I hope DOTW can continue to do and develop in many different directions in the coming years.”

If you would like to support our work, please consider making a one-off donation or signing up for a monthly gift – every £1 makes a difference.

To find out more about volunteering at Doctors of the World, visit the Jobs and Volunteering page.