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The sharp end – dealing with knife crime

The Doctor
Issue 13 
September 2019
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PRESSURE POINTS: The StreetDoctors Leeds team teaches resuscitation skills

Witnesses of knife crime may often flee the scene but doctors and medical students are volunteering to educate people on how to react to and contain violence. Keith Cooper reports

Rochelle Pierre signed up as a ‘streetdoctor’ back in 2011, her first year at Barts and The London medical school.

‘An email came around, looking for volunteers. I grew up in Hackney around a lot of youth violence,’ says Dr Pierre (pictured below), now a core trainee 1 in anaesthetics.

‘Somebody close to me had been shot. They weren’t involved in a gang, it was a case of mistaken identity. I knew to call an ambulance but I didn’t know much first aid. I wanted to get involved.

The Doctor
Issue 13
September 2019
Home Hero images

Back then, StreetDoctors, now a growing charity run from a London office, was known as the Liverpool Project. Set up by two medical students and a senior youth practitioner from a youth-offending team in 2008, it helps young people explore the consequences of violent crime and teaches at-the-scene basic first aid in short, informal sessions.

It’s funded by an assortment of charitable trusts and Government bodies, including BMA Giving, a charitable arm of the association.

 

Fight or flight

‘Lots of people end up in situations where they witness a shooting or stabbing and don’t know what to do. They end up not helping out of fear of not knowing what to do,’ says Dr Pierre, now a trustee for the charity, helping to steer its future course.

‘StreetDoctors helps young people gain confidence in those situations, when your fight or flight kicks in. When you don’t know what to do, a lot of people are going to run away.’

‘People end up in situations where they witness a shooting or stabbing and don’t know what to do’

The charity has 20 teams across 16 UK cities and big plans to expand as public concern about violent crime rises and recorded knife crimes reach record levels. Knife crime is now the biggest concern among young people, according to a UK-wide ballot of more than one million 11- to 18-year-olds. It’s no longer considered just a law-and-order problem for the police to deal with.

‘This is not just an issue for the Government. This is not just an issue for the police. This is an issue for all of us,’ Cardiff medical student Adanna Anomneze-Collins (pictured below) told the BMA annual representative meeting in Belfast this year.

‘We all have a role to play. We can all play a part. We need to break the cycle and to be aware of social impacts,’ she added, calling for a public health approach to tackling knife crime.

Medical students conference 2018 speakers
Adanna Anomneze-Collins

The issue had been raised earlier in the year at the BMA medical students conference, put forward by fellow Cardiff medical student, and StreetDoctors volunteer, Omolara Akinnawonu, who was named best speaker at the conference after her impassioned address. 

This approach is defined by the Mayor of London’s office as, ‘looking at violence not as isolated incidents [but]… as a preventable consequence of a range of factors such as adverse early-life experiences, or harmful social or community experiences and influences’.

 

Public health

StreetDoctors fully endorses this public health approach and sees its work as part of it.

‘Stabbings and shootings are not inevitable,’ its volunteer and engagement manager Rebecca Long says. ‘They are preventable and we can play a part in that.’

‘Gang culture can be quite difficult to deal with. I haven’t been brought up with that kind of culture’

Dr Long has taken a career break from training to work full-time for the charity, after almost eight years as a volunteer. ‘As much as I respect and love the NHS, I am enjoying the opportunity of working in the third sector. My medical training has put me in a unique position to bridge that gap between healthcare, the third sector and public health. It has really broadened my horizons. The young people we meet have seen things I’ll never see.’

Simon Smith, about to start his final year at Newcastle medical school, is also persuaded about the public health approach, after three years volunteering.

‘You can compare youth violence to infection,’ he says. ‘Both are contagious, both spread and both can be contained. It is easy in medicine to concentrate only on diagnosis and treatment. What gets overshadowed is the impact of society on people; medicine is just one of the pieces in a larger jigsaw.’

He’s now an impact specialist for the StreetDoctors Newcastle team, collecting and analysing data and feedback from attendees. Last year’s impact study showed volunteers had taught more than 4,000 young people in more than 800 sessions.

 

Ribena

StreetDoctors’ teaching sessions are informal and interactive. Volunteers arrange sessions and funding with local agencies, such as youth groups, young offender institutes and pupil referral units.

Cups of Ribena, standing in for blood, are poured into washing up bowls to prompt conversations about blood loss.

Young people learn, ‘for one pint, you get weaker, start breathing really quickly… five pints of blood, you’ll definitely be dead’.

Attendees are invited – but not pressured – to share experiences. ‘My friend got literally stabbed through the cheek,’ one says in a taped session. ‘He took off his T-shirt, wrapped it around his face and walked to hospital.’ Opening up like this can, of course, be traumatic in itself.

‘Sometimes they don’t want to talk about it, which we totally understand,’ Dr Pierre says.

 

Blood vessels

Then there’s myth-busting. ‘Isaiah thinks it’s safe to stab someone in the bum or the cheek,’ one volunteer says. ‘But there’s a lot of muscle in your bum. There are a lot of important blood vessels, some as thick as your thumb. A little cut in there? You can lose a lot of blood.’

This informality helps volunteers collect and share data on young people’s experiences, giving them voices which are often not heard, says Mr Smith. ‘Everyone is equal in the classroom. We are not authority figures; we don’t talk down to them. These young people are smart and intelligent.’

To extend its reach, the charity has started StepWise – a programme to help young people complete an accredited course in first aid at work and even go on to take part in co-delivering StreetDoctors sessions alongside volunteers. Leeds medical student Tabitha Ashley-Norman (pictured below) is the team leader for StreetDoctors Leeds, one area piloting Stepwise.

The Doctor
Issue 13
September 2019
Home Hero images

‘We go to Wetherby, a young offender institute, to take the young people there through a six-week course,’ she says. ‘It has been quite memorable because you get that continuity of having a cohort of kids in prison. They really like any change in their routine so are really engaged, more engaged than some of the other young people we teach.’

 

Fresh grief

Most of the volunteers The Doctor spoke to had little direct experience of street violence but all knew people who had. ‘In Leeds, somebody I knew quite well got stabbed in a scuffle in a nightclub. I wasn’t there but he was hospitalised. He had a punctured lung,’ says Ms Ashley-Norman. ‘Sadly, it’s quite a common thing for people in their 20s.’

‘Empower young people to act. We see young people as part of the solution rather than the problem’

She recalls an event, which StreetDoctors Leeds took part in, at a knife awareness day, held after a teenager died from a stabbing. ‘Kids who were not invited had rocked up to this party. It was more of a scuffle at a party of drunk teenagers. But obviously they were all really upset. The whole day was quite moving.

It was all quite fresh, the grief, for those kids,’ she says.

 

Encouraging empathy

Working with young people from very different backgrounds can be challenging, too.

Manchester medical student Adnan Nasser (pictured below) recalls teaching his first session in Moss Side, an inner-city area, still home to gang violence and gun crimes, despite largely shaking off the name ‘Gunchester’ it earned in the ’80s.

The Doctor
Issue 13
September 2019
Home Hero images

‘Gang culture can be quite difficult to deal with,’ he says. ‘I didn’t fully understand it. I haven’t been brought up with that kind of culture. But when you’re brought up with it, it’s all you know. Young people will ask, why should I help someone from a different gang? You can say, I understand, then you discuss it, accept their views, and encourage empathy. How will the victim’s mum feel? There really is no excuse not to call an ambulance.’

The questions and attitudes they face can be testing. But StreetDoctors say they aren’t there to lecture, lay blame, or demonise the young people who attend sessions, and sometimes admit to violence themselves.

‘We aim instead to empower young people to act. We see young people as part of the solution rather than the problem,’ Dr Pierre says. ‘Some people seem to forget It can happen to anyone.’

Find out more about StreetDoctors

Find out more about BMA charitable giving

 

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