So last Spring, I had the pleasure to sit down with Dr. Patrick O’Donnell and discuss his work with the Health Equity Project. I was able to ask what drew him to working with some of the most marginalized and vulnerable groups in society and how the HEP came to be at GEMS. The following series of blogs will be excerpts from that interview.
Charleen: So how did you end up connecting [with Ana Liffey and the St. Vincent de Paul project]...?
Dr. O’Donnell: So, I started here in October 2013 in this clinical fellowship position and part of the agreement of the position was to set up clinics but before you could do that you need to kind of do a review of the context or mapping of the services that are there, what’s needed; [like] is something like this needed? There’s too much money in the health services that is spent on – in my opinion – on things that may not be … that might not be needed before or might be needed somewhere else but because there’s funding, that they’re set up. So that was one of the things in the beginning. So, the good news or the bad news was that was that it was needed based on a kind of mapping exercise that I did with 3 or 4 months on the ground and part of that mapping exercise was to see where the clinics would be set up in Limerick city. One of the partners was Ana Liffey so I have clinics one afternoon a week there and the second is the St. Vincent de Paul drop-in centre. So that’s the second clinic but they’re open to people who are not engaged with either or both the health services. So, the engagement with the Ana Liffey group started then and they have facilitated clinics every Wednesday for four years… on the Thursday afternoons the Ana Liffey workers support me in running the clinics. Because I wouldn’t be able to run it …
Dr. O’Donnell delved into peoples’ perceptions regarding the safety of the clinic.
Dr. O’Donnell: One of the first questions I’m asked by people about running a clinic like this is, is “you must have security” or “who provides security?” or “you must have security guards or whatever” and the short answer is no. Internationally or in other places where this happens like Dublin, they don’t have … security guards are that kind of formality and is actually a barrier for to access. Yes, I understand it’s about keeping people safe and secure and that goes without saying in any healthcare setting, but it doesn’t mean that I accept or take you know… grief or abuse … or accept abuse of any of the people who are working with me or anything like that. It just means that on the front, it’s key workers who are trained in managing difficult situations and chatting to people who are running front of house and they’re acutely aware of security of themselves. So, the people at Ana Liffey have skills in harm reduction.
Since it was so rare to encounter such clinics as Ana Liffey or SVP, Dr. O’Donnell explained how they worked, funded, and operated.
Dr. O’Donnell: [At Ana Liffey and other social services] the way that health and social services [work] – particularly around addiction and homelessness, etcetera – are …are contracted by the government. So, it’s government policy what Ana Liffey are carrying out and they’re funded to do that; so, they would have previously seen a need for access to primary care general practice. So, I’m there fulfilling that need and there’s support to me by key working in that clinic and helping me on the Thursday as well supporting me. So, it’s kind of lead into the relationship now between Ana Liffey and SVP (NOTE: St. Vincent de Paul drop-in centre) that wasn’t there before so it’s kind of developed and fostered kind of engagement around other NGO’s in the city um looking after the health of marginalized groups.
Charleen: Ok well that leads actually into my next question. I know you said that it’s a national mandate that harm reduction is in how we treat people who happen to use drugs and whatnot; so do you find that since working there that there have been attitudes that changed towards people who use – because I talked to the key workers and they said that sometimes people assume the worst in …
Dr. O’Donnell: in…?
Charleen: in the people who access the services.
Dr. O’Donnell: So why do you think that is? Because … mostly because they’ve had bad experiences. The policy at the minute around the national drug and alcohol strategy is called “Reducing Harm, Supporting Recovery”. So even in the name of it, it’s about harm reduction. It’s about supporting recovery, it’s about helping people; the difficulty that most services have is meeting people where they’re at, and where they’re at [is] the very, very early stages. The most chaotic stages before you get to recovery, you have chaos and you need to try to help and support people in that time of chaos to allow them to engage and recover. So that’s where we sit in and Ana Liffey is the same. They work with people and generally, a lot of the people in their books have fallen out or have been excluded from other services because the other services just can’t manage or cope or keep up with the needs of people with chaotic addiction. So…a lot of people come into Ana Liffey and a lot of people would have come to Ana Liffey really struggling to access general practice or having had bad experiences in in healthcare settings.
And Dr. O’Donnell was able to highlight WHY it’s important to have clinics like Ana Liffey or SVP.
Dr. O’Donnell: You read in the literature and there’s this awful qualitative research or good quality research describing awful situations where people will say and I have a couple of slides on homeless patients who in a qualitative study in Canada that said, “There’s no way I’m not going anywhere near a hospital or an emergency department again because of the way that I was treated, I’d rather die out here in the street than go” and to me, that’s wrong… it makes me … and I talk to you guys in third year about this … it makes me feel bad because these are healthcare professionals or are support staff we work with or the admins that made somebody feel like this when we should actually be doing the opposite. We should be probably more understanding, more flexible than other aspects of the state or other services because we meet people when they’re really low. So look part of what we do is … yeah we meet people who have had bad experiences or good experiences who can’t access things and try and develop a bit of a relationship, sign post services… it’s our role is not to create a parallel [system], because I think that would be bad for both the patient and the system if there is this kind of parallel system created and “all of that kind of person” should go into this parallel system. I think the mainstream is the way to go but it is kind of helping people engage with that and part of helping them engage with that is kind of developing rapport, communication, explaining and developing a little bit of trust while encouraging people to engage back into the system, but it’s hard.
He then was able to detail some of the challenges that GP’s face but that it is still really important to treat people, like people.
Dr. O’Donnell: I’ve worked in the system, GP’s are part of the system and they’re overworked; hospitals are bursting at the seams and budgets are pursed but it’s no excuse for not treating somebody the way that I’d like to be treated myself…but I know that there are huge demands on the service and if you have somebody who appears to be… or seems to be not very interested or compliant – and I hate the word compliant – or not very active in their own health or recovery, when you’re a busy SHO or a busy intern then it can be very difficult to understand them. It’s really challenging um throw in other things that you may see, like literacy difficulties, like language difficulties, you know? Um there’s not a huge access to interpreting so it can be really difficult and really challenging um as a healthcare provider. So I can see both sides of the situation but it comes down to relationships and treating people and trying your best; you can’t do everything, particularly in the general practice you can’t do everything and nobody expects you to do everything but sometimes we feel like we should be the ones to do everything and when you see patients with that kind of chaos or that kind of homelessness or addiction and all of that, it can really be overwhelming because you feel like where do I start.
Charleen Salmon is a 2nd year student in GEMS at the University of Limerick
Rotating views on various subjects concerning health (in)equity
Health Equity Nut
Some streams of consciousness on the subjects of the tragic and the mundane.