The man with a safety net for marginalised

In the first of a new fortnightly series highlighting the contribution of individuals working in the health service, JUNE SHANNONprofiles Dublin GP Dr Austin O'Carroll.

‘I REMEMBER the doctor looking at me and [saying] into a dictaphone at the end of my bed that, cosmetically, amputation would be a good option.”

This was Dublin GP Dr Austin O’Carroll’s first encounter with a member of the medical profession, which he was destined to join.

It is also one of his most vivid memories of being reviewed in the National Rehabilitation Hospital in Dublin along with a number of other Irish children born to mothers in the late 1950s and early 1960s, who had been prescribed thalidomide for morning sickness in pregnancy.

O’Carroll, who turns 50 this month, was born with significantly shortened legs and, like many others living with thalidomide in Ireland today, he has noticed a deterioration in his condition. He is a member of the Irish Thalidomide Association and has been a strong voice in the campaign for a revised government compensation package for thalidomide survivors.

Despite his worsening condition, he continues to work as a full-time GP in inner-city Dublin. As walking puts undue pressure on his joints, the only concession he has allowed himself is a bicycle, which has become his preferred mode of transport around the city. Neither did thalidomide stop him from working with doctors Neasa McDonagh, Cathy Cullen and Ming Rawat to establish the State’s first scheme dedicated to training GPs to work in areas of deprivation.

O’Carroll was also instrumental in establishing Safetynet Ireland, a network for homeless health services which provides primary healthcare services to homeless people in Dublin, Cork and Galway. Part funded by the HSE, the Safetynet member clinics saw more than 24,000 consultations last year.

Safetynet also provides Ireland’s first dedicated mobile outreach primary care service for the homeless in Dublin. This is run in conjunction with Dublin Simon, Chrysalis community drug project, the Order of Malta and the Dublin GP training schemes. As well as caring for the health needs of the homeless in hostels around the city, O’Carroll and other volunteer GPs operate a mobile GP and outreach clinic. Last year Safetynet raised €20,000 to convert an old Army truck into a modern GP surgery, which operates once a week on Dublin’s St Stephen’s Green.

According to a 2008 report from the Combat Poverty Agency and the Institute of Public Health on health inequalities, a “substantial body of research has established that those who are poorer or disadvantaged are more likely to face more illness during their lifetime and die younger than those who are better off”.

As a GP working in an area of high deprivation, O’Carroll sees a lot of conditions which can be directly linked to health inequalities.

“You get far more smoking-related lung disease, far more respiratory disease . . . and, particularly in the last three years, far more depression and suicide.” The other difference is that you see young death once a month or every six weeks, he adds.

Asked where his deep affinity for caring for people from disadvantaged communities came from, he says he was attracted to the “chaos” of real life. He feels privileged as his job allows him to be a member of the local community, and he admires the honesty of his patients.

“I like that sense of community and being part of the community; now, it is a fractured community, it is a community that has been bombarded, but there is still a sense of community there.”

In inner-city Dublin, he experiences issues that many GPs working in more affluent suburban areas may never see, including the fatal consequences of drug abuse, which he calls the “hidden plague”.

“You see all these people who have died from drugs and no one else knew about it. I suppose it is that reality – when you have seen that reality, it is hard to go back to the cocoon.”

He believes the main challenge facing GPs at the moment is the “backwash of the recession”. Rising unemployment means a lot of GPs’ time is spent filling out social welfare forms, medical card applications and appeals, rather than treating patients.

He says the increased pressure on the hospital sector has meant patients are waiting longer for consultant appointments, with many turning to their GP to get them seen earlier.

“Patients are sicker and more distressed because of the recession. It is bad enough dealing with the effects of recession but you are dealing with the backwash because of the effects of the recession on other parts the health service,” he says. “For my patients, I think the biggest challenge is the sense that they are being slowly shut out by services.”

According to O’Carroll, it is important that scarce resources are used effectively to develop the health service; he says he would like to see an end to blaming the HSE or doctors for all the ills of the service.

“Painting the HSE as the enemy or painting doctors as the enemy is not conducive to developing a good health service. There are great people in the HSE I work with, and likewise there are great doctors. We should try and develop a more co-operative response.”

If you were to look for a theme to his work, it would be a commitment to the health and social needs of Ireland’s most disadvantaged patients. In common with many other heroes of the health service, however, his work is carried out very much below the radar.

“I have a clear mission as to what I want to do in life – that is what keeps me interested and motivated. I admire the GPs who just have a real affinity for the community they work with and that is what drives them. They are just providing a good quality service for the people they are working with.

“I think that is a wonderful thing.”