So last Spring, I had the pleasure to sit down with Dr. Patrick O’Donnell and discuss his work with the Health Equity Project at Ana Liffey and at the St. Vincent de Paul Drop-in. 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.
I started off by asking Patrick why he started working with the Health Equity Project in UL: Dr. O’Donnell: I suppose I would have always had an interest in marginalized groups and vulnerable groups before getting into medicine and through high school projects. So, we had social inclusion projects and I went to a school that kind of had an ethos like looking into that. [My] family back home … my grandmother would have done quite a lot of work for charities back in the day. She was active and so that’s a little background on my family and then I went to secondary school and then I went to medical school and there [were] some outlets in medical school but not very many. Um the focus was on learning the basics and just doing the exams and passing so there really wasn’t much of an outlet for that type of interest. When I was in the latter years of my undergraduate degree – I did a 6-year degree in UCD – the group for physicians for social responsibility or something like that was set up and it was linked to kind of groups across Europe and that was kind of an eyeopener for me. I’m not sure if it’s still in existence; I don’t think so but it was a lot around the topics and discussion around inclusion health, around vulnerable groups, around probably kind of moving from a charitable model or this kind of benevolence kind of model to right-spaced thinking like, “well actually it’s not helping people up or well actually everyone is kind of entitled to [healthcare] … so it was switched to that kind of thinking. After completing his medical degree, Dr. O’Donnell described the training that lead him to continue with his interest with working with marginalized peoples: Dr. O’Donnell: [After graduating] I did a GP training scheme and I was at a few of the events for that, I met some people that I would call role models like I met Austin O’Carroll who it turns out I kind of now collaborate with various things around education and health education here. But at the time I was just kind of a star-struck medical student and he was an advocate for the local and regional and national level for vulnerable groups in the inner city in Dublin – many being homeless stuck, using … and lots of groups, disability groups. So, then I did 4 years in GP training and most of that was rural practice. I did the Sligo GP training scheme so that was slightly different – lots of marginalized people and excluded people but in rural settings. So, lots of rural isolated elderly people. [Then] I went to Dublin and did a Master’s in Global Health in Trinity College and it was a non-clinical Master’s. It was looking at health policy, health systems. Mostly I would look beforehand at low- to -middle-income country context but ironically, when I was doing the Master’s, a lot of the teachers’ examples they used were from the Irish context. So, talking about the disadvantaged and vulnerable people in the Irish healthcare system and Irish health context. So that kind of cemented a lot of thought around the Irish system and kind of rights…and rights to access and health if there’s such a thing in the Irish system. And then this job came up; being clinical fellowship in social inclusion with Professor McFarlane linking with the North Dublin City GP training scheme, which is an area that is… it’s an area specifically centered around areas of deprivation run by Professor O’Carroll run by us and the HSE. [I’m] currently doing a PhD in social inclusion in health care. During the discussion, Dr. O’Donnell laments that he wished that there was something similar to HEP when he was a student, considering that this type of work was not as popular or seen as glamorous. He further touched upon on the privileged position that we are all in as future physicians. Dr. O’Donnell: I wish that when I was a student that I had … well outlet is probably the wrong word but uh a focus or somebody to ask about um this type of work because it’s not … it’s not very common, I think. In my experience, it’s not very popular… in my experience. It would have been said to me like, “why don’t you just be a normal GP?” And it’s a hard question to answer sometimes so yeah it’s been very interesting for me and it’s been very rewarding. I like explaining to students about the day-to-day difficulties that people have so whether they’re going to be GP’s or brain surgeons or emergency department or psychiatrists, they’re all going to encounter the same people and how they interact with them depends on the experience they’ve had in training, in my opinion and looking at kind of the evidence internationally. If people in the formative stages of education get to see and experience and talk to people from marginalized or vulnerable groups and realize actually they have the same basic needs and wants and aspirations for security, for happiness, family – even though they are sleeping under a bridge and injecting heroin – that they’re the same basic person and if it was me but by some basic luck of birth I’ve been born into the situation that I’ve been in. And I was lucky enough to have an education and train as a doctor but it’s kind of almost a twist of fate and the flip side of that is to … to help or to just allow space and time to allow that discussion between well we try and do it in the clinic and have the patients that I meet kind of teaching or discussing their lives with students. Because most students like us are kind of generally – not all – but most are middle class, had a lot of opportunity, are very educated and it can be hard to imagine why people make the choices they do. The choices seem kind of bizarre at time like why would some body do this, or why would someone apply for this or get this and it would make things a lot easier for them but we don’t often have the full story. There’s a concept in the literature called social distance, and its interesting cause it’s not blaming, it’s not saying, “you’re bad” because you’re a lucky person who has an education, you’re a doctor. You know you have this big distance with this patient sitting in front of you, socially and you find it difficult to understand or empathise because you can’t understand it; it’s just kind of naming it – but it’s not used to hit them over the head and make them feel bad about so… anyway that’s a long winded answer to uh your first question. Links to social distance:
Charleen Salmon is a 2nd year student in GEMS at the University of Limerick
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CaesuraRotating views on various subjects concerning health (in)equity Health Equity NutSome streams of consciousness on the subjects of the tragic and the mundane. Archives
February 2021
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