People

They call me Dr Chaos on occasion. I’m quite at home in a waiting room when people are acting out

What I Do: Dr Austin O’Carroll, who has worked as a Dublin city GP for 26 years, said he was first told he couldn’t do medicine because of his disability. After meeting Mary McAleese that changed

Dr. Austin O'Carroll has been a GP in Dublin's inner city since the mid-90s while also commissioning street art and becoming a paralympian.
Austin O'Carroll
Fri Aug 04 2023 - 07:00

I always wanted to do medicine. I have a disability due to Thalidomide and, when I applied originally, I was told I wouldn’t be able to do it. I ended up doing law instead.

Mary McAleese was my tutor in second year, I told her I hated law and wanted to do medicine. She organised for me to see the medical board. They were very nice men, but it was a bit surreal. I had to walk around the table and show them my hands and legs. The following week I was in medicine.

At college, I got very involved working with St Vincent de Paul. I’d love to say I was motivated by something good, but my sister said, if you want to meet people, join the St Vincent de Paul.

I fell in love with the work. I always say I had two educations – one inside the walls of Trinity and another outside. It made me aware of the impact of poverty on health. The community has suffered a lot. There is a grittiness and a realism there. Early on, I realised working there was for me.

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I really love the inner city. I love the characters; they are edgy, they are good fun, they are straight with you. If they are annoyed, they will tell you. If I’m annoyed, I can be straight with them.

In my 30s, I got involved with the disability rights movement which was a real learning curve. I learned about the rights-based model. I have great respect for people in charity, but the basic model is that some people are less well-off, and the implication is that it can be their fault and we are here to help. The rights-based model says it is society that created poverty, and people have a right to get out of it. You are going in as an equal, trying to help them because society has disempowered them.

Since 1997 I’ve been working as a GP in the inner city. The practice provides addiction treatment for heroin, benzos, cocaine and alcohol. I set up Safetynet so we would have a common database and could see what medications a person got yesterday at a different clinic. It meant we could provide continuity of care. It has extended to Cork, Limerick and Galway too.

Safetynet now has doctors and nurses who provide services to homeless people, migrants and to members of the Roma community. It holds clinics in hostels and has a mobile health unit that screens for TB and does blood virus screening. It is funded by the HSE.

Homeless people don’t use mainstream health services because of the chaos in their lives. They won’t go to a GP or show up to hospital appointments. Maybe they were severely traumatised as children. Growing up, they learned behaviours that kept them safe in their family and now keep them safe on the street. But this behaviour is not very effective in accessing healthcare, and they end up getting kicked out of services. We try to work with their challenging behaviour and show them we are there for them.

This morning, I had a guy who was getting angry. He wanted tablets. You could say, will you just shag off. But instead you try to charm him, and crack a joke, and eventually he calms down.

Trauma-informed care is transforming healthcare. Ireland probably has some of the best health services in the world for the marginalised. There is still a lot to be done. I still get people coming up to Dublin because their own GP won’t treat them for drug addiction. That needs to change.

Dr Austin O'Carroll: 'I went for seven or eight operations between the ages of five and 13 where I had to get my leg rebroken to straighten it. It had a huge impact on my life.' Photograph: Enda O'Dowd
Dr Austin O'Carroll: 'I went for seven or eight operations between the ages of five and 13 where I had to get my leg rebroken to straighten it. It had a huge impact on my life.' Photograph: Enda O'Dowd

I had a patient, a young woman with a child and she couldn’t get a GP in her hometown to provide methadone. She came to Dublin. She came up to us every two weeks for prescriptions, and would stay in a hostel. One night, she was seriously assaulted. She became very depressed and went on to the street. She died of an overdose two weeks later. If a GP locally had provided treatment, she’d be alive and her child would have a mother.

I founded a scheme training GPs to work in areas of deprivation, and also founded GPCareForAll, a charity that sets up GP practices in areas of deprivation. We get the investment and set up the practice and the GP just has to work.

I’m probably more of an entrepreneur, because of all the things I have set up. That’s what I enjoy doing most. I like finding solutions

I didn’t walk until I was five. When I was 5½, I fell down the stairs and broke both legs. I went for seven or eight operations between the ages of five and 13 where I had to get my leg rebroken to straighten it. It had a huge impact on my life. But I also remember a happy childhood. My brothers and sisters were great. My mother was great, she sent me to an ordinary school and made me survive on my own. It was the best thing, it got me out there.

You go through things when you look different. I am small and I have short legs, and when I was a teenager, that had an impact. I wanted to be a footballer like everyone else. But I had other things – I played table tennis, I did debating. I’m not saying disability is a good thing, but it brought me places I probably wouldn’t have gone.

I ended up doing paralympic sailing by accident. I started sailing when I was about 19, but stopped because it was getting too physical. Then there was a disabled world regatta in Kinsale, a boat needed a third sailor and I was asked to join. We ended up in competitions all over the world. I had a fantastic time.

[ What I Do ]

Early on I learned to be stoic. I used to hope the surgeon would say, we don’t need to do any more operations, but I learned to expect otherwise. If it turned out I didn’t, that would be good news. That approach has served me well.

I have several different jobs, but basically I’m a GP who is passionate about addressing health inequality. I’m probably more of an entrepreneur, because of all the things I have set up. That’s what I enjoy doing most. I like finding solutions.

They call me Dr Chaos on occasion. I’m quite at home in a waiting room when people are acting out. I just love working in the community. I also love the people who work in that sector, because they all really want to make a difference. – In conversation with Joanne Hunt