Medical Matters: Andy is nearly 40, wears quality clobber as he calls his leather jackets with the big zips and his cargo pants with huge pockets. He only wears shades in winter - "the gougers steal them from me in the summer".
He learned to read in prison and now enjoys complex European history books that describe long and best-forgotten wars. He is on a cocktail of benzodiazepines, antidepressants and methadone which I have been prescribing for him for years. Two years ago he began mentioning his daughter who had made contact with him and he has gradually built a relationship he proudly tells me about every week. I worry he is idealising her but it seems churlish to take her off his pedestal. He has stopped his benzos and his daily methadone requirements have fallen. He is afraid to reduce the antidepressants. Being a father is a good experience for him and his health.
Nine out of 10 prisoners are young males with poor education from our urban blackspots. Half are on short-term sentences of six months or so and many will make it back to prison. Ross O'Carroll Kelly, the south Dublin bounder made famous by Paul Howard, calls one of our urban blackspots Pramtown. If you drive around such areas you will see lots of young girls pushing buggies. They usually travel in groups and you seldom see a male with them. They don't know it yet but they are a young matriarchy entering a prison all of their own which will keep them and their children in poverty for much of their lives. They will use lots of social and health services. Their kids are at increased risk of many things such as cot deaths, accidents, hyperactivity and poor school performance.
Most of all, some of the kids may have little experience of a father in their lives. The girls often want to become pregnant and we as doctors and nurses subsequently give them plenty of care and attention. The boys want sex and are often surprised when the girl announces her pregnancy. There is no place for them as a couple to develop a relationship or a home and he quickly becomes a peripheral figure in both the girl and baby's lives. It is not tasteful to say it but the boy may be reduced to that of sperm donor and the relationship may break down before the baby is born. Hence the boy never actually gets to experience fatherhood.
If you talk to many better-off males they will tell you about the big impact seeing their child being born has on them. They will next describe the feeling of responsibility that leads them to plan for the future, reduce personal risks, buy insurance and look for promotion. The impact of the father as a role model for sons and daughters has hardly been researched which is part of the problem. To explore the role of fathers in a systematic way, society has to deem it important enough to want to know the answer.
It is hardly surprising that young biological fathers who do not experience the responsibilities of fatherhood remain as immature lads, take risks and get into enough trouble to end up in prison. From what I have been able to gather, it is not known how many young male prisoners are fathers.
Taking young fathers out of their communities is not good for them or for their communities. It depletes the area of role models and deprives them of opportunities to care and mature.
If it is possible to teach a feckless young man to read history through a literacy programme, surely it must be possible to help him to understand fatherhood. To make a start we must ask them if they are fathers, and then celebrate the role in the way we do for young mothers.
Back to Andy. I have to alter details to protect his identity. His daughter found a boyfriend of whom he was wary. She planned on doing her Leaving Cert but got pregnant half way through the year. The boy left her and Andy went on a spate of stealing and has ended up in prison.
Prof Tom O'Dowd is professor of general practice at Trinity College, Dublin and a practising GP.