Osteopathy on the front line

If someone we are treating at the Manna Centre osteopathy clinic is not getting better, they say so. Or they don't come back. Patient feedback at the Manna clinic is as simple as that. This is 'no frills' osteopathy – a service which we are pleased to provide, but which also offers an important learning curve for the teams of British School of Osteopathy (BSO) students who work there.

There has been an osteopathy clinic at the Manna Centre since 1998. It is one of a small portfolio of outreach clinics run by the BSO – itself a registered charity and Europe’s oldest and largest osteopathy training school. To namecheck a couple, we also offer free osteopathy to older people in their homes at two Southwark sheltered housing projects; at the local Beormund School for children with social, behavioural and emotional difficulties, and at the new 1^st Place Children’s and Parents’ Centre off the Walworth Road. We were delighted, earlier this year (2008), to win a Southwark Civic Award for our outreach work.

Winning awards is great, but our priority at the Manna clinic is to provide the best treatment we can for our patients, especially as some of them walk for miles to use the Centre and its services.

Osteopathy is a primary healthcare system, complementary to other medical practices. It is suitable for almost anyone and can contribute to alleviating an enormous range of conditions.  Osteopaths primarily work through the neuro-musculo-skeletal system, mostly on muscles and joints.

That’s the textbook definition. In practical terms, as I’ve seen first-hand during two years leading the British School of Osteopathy’s (BSO) weekly drop-in clinic at the Manna Centre, lifestyles such as sleeping out take a heavy toll on the body. We also see people who may have basic accommodation, but who either can’t look after themselves or who aren’t receiving the care they need. Many of our patients have some form of psycho-social issues, whether diagnosed or not.

Along with fellow BSO tutor Jeff Grumball, each Wednesday morning I lead a small team of BSO osteopathy degree students as they work in pairs from two treatment rooms, seeing between four to nine patients on a first come, first served basis after they have put their names down on our register. Sadly, we don’t always have time to treat everyone – especially if we have seen someone earlier in the morning for the first time, because we need to take a medical history for a new patient before treatment. I’m currently looking into increasing the number of students working at the clinic, and whether we can bring a portable treatment table to enable us to see three patients at once.

New patients come to us mainly through word of mouth recommendations, but the team at the Manna Centre also help spread the word. On mornings when the clinic might be quiet, staff working in the kitchens and elsewhere are great at going through the building, calling out 'Anyone for the osteopath?' and generally encouraging people to come and see us.

For a lot of the people we see, we’re 'on the frontline' of their health care options. Without a permanent address, many of them are unable to register with a GP, so we are their first port of call for all sorts of health problems – we carry out relevant clinic testing and then refer them on, where necessary, to walk-in medical centres or even A+E.

Sometimes there are simple things that we can do to help. One man we saw recently had arm and hip pain from sleeping on the ground. As well as treating him, I talked to him about putting extra clothing or padding into his shirt and trousers before he slept. Some of our patients simply come for a chat. That’s valid and worth our time; social contact can relieve the physical effects of stress and worry.

Because of the holistic way that osteopathy works, we do need to take a medical and lifestyle history. We’re respectful and non-judgemental about what people tell us, and it is all strictly confidential. But knowing if someone takes drugs, or drinks heavily, is important in how we will look at what’s happening with their body. Unlike most GPs and health centres, we don’t need patients’ full names or addresses, a note on their history about what they want us to call them is fine. And, unusually for osteopaths, we don’t ask them to undress. We do need to touch, and work on, the part of them that hurts, but we’ve learned that many of our patients can be guarded or embarrassed about their bodies, and we need to do all we can to put them at their ease.

Working at the clinic is both challenging and rewarding. It offers us the opportunity to provide osteopathy to patients who may not otherwise be able to get it. It can also be really refreshing to treat people without some of the extra administration and paperwork that is often inherent in other clinics or private practice – processing payment, dealing with health insurance claims and so on. It is an opportunity to do what we are supposed to be doing.... treating patients. And it is great when we get to see a visible improvement in patients. One man who came to us with major lumbar spine and leg problems is now, following regular osteopathy and yoga, only experiencing a bit of stiffness – we’re pleased to be able to keep him 'up and running' and mobile.

For BSO students, the clinic offers a glimpse of what life in general osteopathic practice can be like – needing to provide effective care to patients one after the other during a busy clinic, and  never knowing what sort of person, with what sort of health issues, will walk in next. Most importantly, it helps them shed any misconceptions they may have had about homeless people as simply 'mad, bad or dangerous to know'.

Samantha Fennell spent several of her final months before graduating from the BSO this summer (2008) working at the Manna clinic, and has continued to work there whenever she can on a voluntary basis. I can’t think of a better last word than what she told me when were chatting recently:

 

'I hadn’t thought much about homelessness beforehand. But all the patients at the Manna clinic have hearts and souls and stories to tell. It’s been a privilege and an important learning experience for me.'

NB: This article first appeared in the Manna Society’s Christmas 2008 newsletter, and is reproduced with their kind permission.