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"They don't teach you this in med school": Caring for the most vulnerable at Christmas

Patrick O’Donnell works with sex workers, drug users, homeless people and undocumented migrants in Limerick.

Image: Mark Stedman/Photocall Ireland

WHAT IS CHRISTMAS like when you’re looking after people who are society’s most vulnerable?

Patrick O’Donnell trained as a GP and is based in Limerick, where he runs two clinics for people who are marginalised – such as sex workers, drug users, undocumented migrants, and homeless people.

He has had about 300 consultations with 150 different patients over the past four months in the clinic, and says that Christmas comes with its own specific challenges.

He trained as a GP, and went on to do a Masters in global health in Trinity College Dublin. Now he works with the University of Limerick as a GP and researcher and does academic work and teaching around social inclusion.

As part of his work in UL, part of his brief was to set up a service for people who don’t have access to GPs.  He runs a clinic for two afternoons, within the St Vincent de Paul and Anna Liffey.

“We do meet people at their lowest ebb”

Christmas can be a time of “huge stress” for the people he sees. He says that not a huge amount of them are sleeping on the street – about 15 out of 150 new patients he would have seen over the year would sleep rough.

Christmas time means winter, which can mean bad weather, which in turn can affect people’s health, particularly drug users.

“One of the obvious things we do is vaccinate against the flu virus,” he says.

People can also experience financial stresses, as some would have children and be trying to save money. “A lot of them are really really stressed or worried,” he says. “Some will have a pretty chaotic hand-to-mouth daily existence.”

These are also things people in the outside world don’t think people using heroin worry about.

“There’s always the underlying mental health problems that go with drug addiction,” says O’Donnell. These can include low mood and family stress, which get worse around Christmas.

“It’s not any different for homeless patients or patients I would see,” he says. “In my mind alcohol use seems to increase around Christmas as well, whether it’s to counter those negative depressed feelings.”

The other thing that he sees in winter time is that a lot of the services are relied hugely on by other people in need over the festive season.

“People on social welfare are at the bottom of the heap in a house or with family, they would rely hugely on the SVP Christmas appeal. A lot of the are services relied upon by people in need. The other guys fall out the bottom a bit. Not because the services aren’t trying – they are literally overrun.”


He says that a lot of the people who come to him have “been treated pretty shoddily by some services”.

They have been to services where they’ve been told off for using drugs and ‘you’re causing your own problems’. Whether it’s said to them or whether it’s the attitude or whether its implied – if you don’t show some sort of insight or awareness they’ll pretty quickly decide they’re not coming back.

His clinic “was able to be set up with a list of things drug users or their family or key workers felt were actually need rather than setting up what I thought was needed”.

When he gives a patient a prescription, but can come up against barriers like:

  • Some can’t read the prescription
  • Some are sleeping in car parks on the street
  • Some don’t have money

For him, it’s about “creating an atmosphere of confidentiality, of trust, of non-judgement. Of creating this kind of space where instead of ‘saying of course I don’t inject or I’m not street working’, where they can come in and say [the truth].”

“The other issue who are on quite a few medications will come and say ‘OK, I have a tenner which means I can only get four of these meds, I know you’ve prescribed six but which four should I take.’ You don’t prescribe lightly. That’s a problem summer and winter time.”

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But as bad as Christmas can be, “the worry is they face barriers on a normal day in June” says O’Donnell.

If the basic services are under stress, winter time exacerbates a lot of things, says O’Donnell.

“They don’t teach you this in med school”

“You get to know a lot of these clients and some of the stuff they have been through in life is through no fault in their own,” says O’Donnell. “The first thing they will say is a lot of it is their fault. Often when it’s family situations or violence or drugs or suicide things that happened in their past growing up that affects them and as a consequence of this they have ended up in depressing situations.”

He adds: ”Talk around junkies or addiction gets me a little bit angry because you don’t get the story behind it”

He believes that harm reduction is the way to go. “”Me saying ‘drugs are bad, you are a horrible person’ isn’t going to fix anything. It’s ‘when did you inject last’; ‘would you try smoking twice a week instead of injecting’.”

He says it’s about having a “big picture view”: “This isn’t something they teach you in med school.”

What are the solutions? He believes they are around education; housing; family issues; addiction. “A lot of of these things are the solutions whereas I treat the [short term medical issue],” he says.

It’s the things that happen outside of the waiting room that affect people’s lives on a daily basis. He’s there to help with what he can, whatever the time of year. 

Read: ‘Somebody dying on the street outside the Dáil is not acceptable’>

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