GP and Street Doctor, Rotterdam; Netherlands

Michelle van Tongerloo is a general practitioner and street doctor in Rotterdam. She links
major social issues to the raw reality of her consulting room.

She works as a GP in IJsselmonde, a neighbourhood in Rotterdam South with widespread
poverty. She is also an independent street doctor at the Pauluskerk, where she provides care
to the most vulnerable people – often homeless, addicted, or undocumented.
She jots down what she experiences during her consultations on the backs of prescription
slips, to later work out into articles. In doing so, she connects large societal issues with the
stark reality she encounters day to day. When she started as a street doctor, she mostly saw
people without valid residence papers. Over the years, that has changed radically. First came
the labour migrants who keep a significant part of our economy running. There is no social
safety net for them when they lose their jobs and often their housing as well. She
increasingly sees Rotterdam residents who are homeless and uninsured. In the beginning,
these were mostly very vulnerable people with behavioural or addiction problems who could
no longer find a place in mental health care or sheltered housing. Now she sees more and
more ordinary people, often young, with nothing major going on, who suddenly become
homeless due to a few setbacks.

An important theme in her work is the cycle of poverty and limited opportunities. Van
Tongerloo sees how vulnerable children become vulnerable parents who in turn raise
vulnerable children – the consequences of living under one unsafe roof. Many illnesses are
caused by poverty, stress, and an unhealthy lifestyle. This is not new knowledge, yet we are
still too late when these children, overweight, with behavioural issues and decayed teeth,
show up at the GP. She sees like no one else how care systems can fail – while early and
effective intervention can make a world of difference.

“What I do isn’t out of defiance, but always in the best interest of my patients.”

What they ask for is often simple: a decent income, a good education, and a proper home.
But support in achieving that repeatedly turns out to be too complicated for care and welfare
organisations. Because these organisations are supply-driven, they often can’t devise
solutions for something as simple as children staying home because of transport issues and
therefore not attending school.

Market forces in healthcare

The system she speaks out against is partly the result of a society that does not accept
mistakes or failures. With rules and protocols, organisations try to protect themselves against
criticism of their actions.

Up close, Michelle van Tongerloo sees the far-reaching consequences of rising demand for
care combined with market forces and decentralisation. As a GP, she plugs the gaps for
patients who actually need help from mental health services, youth care, hospitals, or nursing
homes. Waiting lists are long everywhere, so patients return to her. After all, the GP is their
first point of contact.

Van Tongerloo also advocates for a different approach to patients. Treatment starts with
listening: not the illness, but the patient’s story should be central. She describes, succinctly
but powerfully, what makes it difficult for a European Dutch person to integrate into this part
of the kingdom: “As an individual you are subordinate to a community that doesn’t
necessarily welcome outsiders and often makes no distinction between work and private life.”

As a journalist, Van Tongerloo publishes in outlets such as De Correspondent, Vrij
Nederland, NRC, and Trouw. She writes about the healthcare system, but also about the
difficult and murky space in which she operates as a street doctor. She has also written about ethical questions around a “completed life” and about the complex and unequal relationship
between Sint Eustatius and the European Netherlands.

Van Tongerloo speaks with passion and conviction. Her strength lies in her ability to make
major systemic issues and societal problems personal, explaining them through patient
stories. This makes her work deeply moving.