Street Doctors Ireland: a public health approach to reducing street violence

Trinity News speaks to College students trying to empower at-risk youth in a unique way

In 2013, Street Doctors Ireland set out for the first time to deliver their first aid classes at the now closed St Patrick’s Institution, a penal facility for 16 to 21 year olds. Overwhelmingly, the feedback that they got was, “it’s too late for me”; the 17 and 18 year olds had enjoyed learning CPR, but they were already committed to their trajectory in life. If only they had known these skills when they were younger.

Street Doctors Ireland is a charity group, made up of Trinity medicine students and recent graduates, with one mission: to teach first aid to at-risk youth. The students that Street Doctors teach are in their mid-teens, but many have already been affected by knife crime. It’s very much a grassroots organisation; interviewees told Trinity News that they only knew about the charity via word of mouth. While they’re not affiliated with College, they rely on enthusiastic students to keep their organisation going. 

Based on the feedback from St Patrick’s, Street Doctors began to target youth centres around central Dublin –  familiar and comfortable places for disadvantaged youth. “We’ve no premises,” Dr Stiofán Hatton – chair of the Street Doctors board – told Trinity News, and he plans on keeping it that way. 

Once they’ve got their group of teenagers together, they teach two classes, an hour each and typically a week apart. Class one: how to help someone who’s bleeding. Class two: how to help someone who’s unconscious. They try to use what a young person would have at the scene, like socks, or hoodies. Dr Stephen Flannery, a first aid instructor and Street Doctors board member, told Trinity News that while the explicit curriculum might just be the basics of first aid, the implicit goal is to challenge the students’ ideas of violent crime. He explains that many probably see a stabbing as something you either survive or you don’t; it’s important to show them that being stabbed will have medical consequences for the rest of your life. 

There’s not a lot of information about the rates of violent crime in Dublin. Specific and evocative stories might gain media attention, but there’s a distinct lack of reliable statistics. Dr. Flannery, a surgeon who returned to Trinity to teach last year, told Trinity News that doctors are seeing more complex abdominal problems in surgery than they would have even a few years ago, indicating an increase in knife crime and its lethality. 

One of the problems with collecting data, he pointed out, is a disproportionate rate of illiteracy within communities affected by knife crime, making it hard for people to communicate their experiences. “We created a divide by assuming our students were literate,” Stiofán said. “When we wrote on a flip chart, words like “danger”, “response”, … some students couldn’t read those words.” They’ve now adapted to using pictures for their class demonstrations: they draw a stickman on the board, or a heart. 

“It’s really nice seeing people come out of their shells,” said Lisa Codros, a third-year medicine student and current Team Manager for Street Doctors Ireland. Her responsibility is co-ordinating all the volunteers across Trinity. Volunteering can be intimidating at first, she said, especially when you’re dealing with teenagers – a notoriously challenging age-group to teach. But she’s never had any difficulty getting her students engaged. “We crack a few jokes, we loosen up and they realise, oh hey, they’re actually on our level”, she told Trinity News. 

“They expect us to come in here lecturing …Our teaching model is the exact opposite of that”

Most instructors working for Street Doctors Ireland are only a few years older than their students; it’s a near-peer model of teaching. “We’re not some youth worker in their thirties or forties,” Stiofán said. The most important thing to do when you teach at-risk youth is build rapport; if you’re asking the students to list vital organs, and somebody calls out “dick”, you draw that on the board. It’s a point of pride for Stiofán that Street Doctors Ireland has never had to abort a session, something he attributes to their non-judgmental method of teaching. A common question they ask to start off a session is, “what is the safest place to stab someone?” The students are often taken aback that a doctor would say something like that – but it helps to break down the barriers. “They expect us to come in here lecturing,” Stiofán told Trinity News. “Our teaching model is the exact opposite of that.” 

“If it wasn’t for ‘we’re standing here, you’re standing there,’ we could have been mates”

“They’ve been so lovely to teach,” Lisa said. “I think my biggest surprise when I started teaching sessions is that they’re all really sound people. If it wasn’t for ‘we’re standing here, you’re standing there,’ we could have been mates” she said. “I didn’t come from the best area …There was always a really big difference between the teachers that would baby us, versus the teachers that would take us seriously. It’s that respect, I think that’s really important. “

Stiofán emphasised the importance of a good first impression. “When the student walks in, I stand there, say “hello, my name is Stiofán, nice to meet you”  and I shake their hand, and look them in the eyes”, he said. Whatever perception a young person might have of a Street Doctor volunteer, it can be overcome by showing respect, he explains, “saying I see you as a person, I respect you … I’m going to remember your name.” 

Just as eliminating power imbalance is key to good communication, acknowledging the difference in experience between the students and instructors is vital: “Don’t pretend you have the same life that the young people you teach do. You’re in university, you’ve had incredible opportunities…This isn’t something to be embarrassed about, it’s just something to acknowledge.” Stiofán added: “We’ve got two opposite ends of the social spectrum in terms of privilege and opportunities in life. Putting those people into a room and having a closed space where they can talk, there’s lots of value in that.” 

Róisín, a final year medicine student, has been teaching with Street Doctors since her first year. Her experience volunteering in a Dublin youth detention centre, she told Trinity News, taught her how to better interact with patients on her clinical placements in hospitals. “It changed how I approach my placements”, Róisín said. 

Last year as Team Manager she fundraised for the charity by doing bag packing at Christmas. Roísín added that the majority of her students weren’t from Dublin, but from deprived areas in the Midlands, or Limerick, which she wasn’t expecting. Many of the young people she taught were from marginalised groups, such as the traveller community. Several, if they’d continued in mainstream education, would have had a Special Needs Assistant (SNA) to help them in school. Instead, they were in the detention centre.

“for disenfranchised youth, antisocial behaviour is a major way to regain the agency they’ve lost”

While poverty and deprivation have long been issues for youth workers in Dublin to contend with, the pandemic left young people without safe spaces or meaningful community support. “I think they’ve lost something they didn’t even know they were meant to have,” Stiofán said. The Irish media’s focus on “feral youth” doesn’t help matters: for disenfranchised youth, antisocial behaviour is a major way to regain the agency they’ve lost. “It almost becomes a status symbol,” Stiofán added: “If they can be “nothing of value”, at least they can be something powerful.”

Through teaching first aid, Street Doctors wants their students to feel like they could be a positive force: “We paint the picture of a hero”, Stiofán said, “and we say you could be a hero… I get the impression that’s not something students hear very often, or at all.”

While not everyone can teach first aid, everyone can help. “Volunteering as a football coach in the morning has the same charitable purpose as us”, Stiofán added. “Just helping young people get through a very difficult period of their lives.” 

Street Doctors plans on holding several on-campus fundraisers this year, and hopes people can come out to show support for them. It’s not the kind of work that gets a lot of funding or attention, but, all the volunteers agreed, it has its own rewards.