Get set for a short, sharp shock

Doctors are going on the offensive to warn Scottish youths about the dangers of knives – and it isn’t pretty

Christine Goodall lives with violence on a daily basis. As a leading oral surgeon at Glasgow University’s dental school, she deals with the grim reality behind the statistics that make her home city the most violent in Europe.

Eighteen months ago, exasperated by the mindless violence with which she was constantly confronted, she decided to do something about it and, with two fellow surgeons, launched Medics Against Violence, a charity that teaches children the consequences of carrying a knife.

Last year, 1,170 victims of knife crime were admitted to Scottish hospitals, at a cost to the NHS of more than £500m. The majority of them were treated by Goodall and her colleagues in oral and maxillofacial surgery in Glasgow, where the workload is similar to that experienced by army surgeons in the field of battle. Here, surgeons treat someone with a facial injury every six hours: 70 per cent of these patients have been attacked with a blade and 80 per cent have been drinking to excess. In three Glasgow wards, homicide by knife is the most common cause of death in young men.

“Some of the injuries you see are horrific,” says Goodall. “The face is the most likely place to be attacked and many victims of violence have facial injuries. They cause a lot of deformity, and it has a big effect on people’s lives and on their confidence. About 40 per cent suffer post-traumatic stress disorder. Over the years, I’ve often thought this must be preventable.”

Medics Against Violence began with Goodall and fellow surgeons Mark Devlin and David Koppel, both surgeons at Glasgow’s southern general hospital, talking to secondary school pupils about the impact violence has on the lives of the victims, their families and the professionals who work with them.

Goodall has scripted a talk that lasts seven minutes, the time it takes to bleed to death. On average, an ambulance takes eight minutes to arrive at the scene.

Children in Glasgow get caught up in violence at an ever younger age. Police have found children as young as nine carrying knives. Goodall and her colleagues are now looking at expanding the scheme.

“We’re dealing mainly with 13- to 14-year-olds just now,” she says. “The idea is to catch them before they are caught up in violence. For some kids that’s fine, but for some of the schools we go to in the more deprived areas by that age kids are already caught up in violence or on the fringes of violence. We’re looking at extending our work to include pupils in the final years of primary school.”

The children view a film in which three people — a young murderer, a middle-class mother whose son was murdered, and Scott Breslin, who was paralysed from the neck down after being stabbed at the age of 16 — tell their stories. Afterwards, the pupils discuss questions such as: Is there a safe place to be stabbed? By the end of the lesson, they know the answer is no.

“We do show some gory pictures,” says Goodall, “but not many. We also have CCTV footage, which the adults find very shocking but which generally doesn’t shock the children. What they are most affected by are the true stories, particularly the boy in the wheelchair who can’t do anything for himself. They can really identify with him. Young people often don’t understand the consequences of what they are doing. They think they are invincible. We wanted them to see something of what we see every day.”

Medics Against Violence was launched officially in November 2008 with £80,000 of public money. Since then, it has taken its message to more than 4,000 teenagers in the west of Scotland. Now, 120 doctors have signed up to the school visits. The service is about to open in Dundee and Goodall is optimistic it can be extended to Ayrshire. The organisation is also planning to tackle other forms of aggression.

“One of the other things we’re hoping to deal with is the domestic violence issue,” says Goodall. “The plan is to try to get dentists to raise the subject with people they think might have been affected. They see a lot of people with broken teeth.”

She says the trigger for her taking action was meeting Karyn McCluskey from Strathclyde police violence reduction unit. McCluskey, who has been instrumental in setting up an initiative for tackling gangs in Glasgow, showed Goodall a presentation about the life of a young murderer. “He was a young man from a very deprived background,” says Goodall. “His parents were involved with drugs and he didn’t have a lot going for him but the social services, the police and his teachers all had opportunities to step in. That didn’t happen. Hearing his story really affected me.”

She knows that changing Glasgow’s teenagers’ lives is a tough prospect. “We’re trying to change attitudes that have been ingrained for generations,” she says. “Changing that is not going to be a quick process. It will take a lot of effort from a lot of people. There is a culture of violence in Glasgow. There is something about the west of Scotland males which means they don’t communicate well and they very quickly resort to violence.

“Alcohol makes people more vulnerable and it makes some people much more violent. That is a real factor. It’s not helped by establishments in Glasgow selling hunting knives. I defy you to find anybody in Glasgow who actually goes hunting. There are [also] a lot of baseball bats sold in Glasgow but very few balls.”

Despite her regular exposure to extreme violence, it still has the power to shock her. She remembers one 15-year-old boy arriving at Monklands hospital in Airdrie with a knife wound to his face, accompanied by his distressed mother.

“It’s just really upsetting when you see somebody that young because you know that’s them scarred for life,” she says. “There’s not a lot you can do to make the scar disappear. I remember one young lad of 14 in Glasgow, who had been drinking. He got into a fight and he had every bone in his face broken. His mum brought in a photograph of him. Because he was in such a mess, there was no point of reference for the doctors. I remember him coming back for reviews and he looked nothing like the boy in the picture. He was unrecognisable. He left home one night one wee boy, and came back another.”

Is speaking to school children a good use of doctors’ time, especially when the NHS is under so much pressure? Goodall insists that it is. Pupils understand that because doctors have taken time out from their busy schedules, it must be important. Goodall does on average one school visit a week during term time. Doctors who sign up for the programme are asked to do around four a year.

“They are not all surgeons,” she says. “We have a number of emergency medicine doctors, quite a lot of psychiatrists and a big number of anaesthetists. We also have specialists who you wouldn’t expect to be involved, such as oncologists and gastroenterologists. These doctors don’t work with people who have been involved in violence but they feel very strongly about it. People often get involved because they have kids themselves. They don’t like thinking about their own children getting caught up in violence.”

Goodall, who is married without children, has overseen a study in Falkirk, Lanarkshire and Glasgow which involved nurses undertaking alcohol counselling with facial trauma patients. It takes just 20 minutes of a nurse’s time, looking at the patient’s alcohol intake and going over strategies for cutting back, but it works. A study using nurses to give aggression counselling has just finished and the results will be published soon.

“The alcohol counselling certainly makes them reduce their drinking,” says Goodall. “I don’t know whether we can change people’s tendency to be aggressive but we can save some people from becoming victims. A lot of patients are very shocked at how much they are drinking compared with the norm. They tend to compare their drinking with that of their friends. If everybody they know is drinking to excess, they are often not aware. You are reaching them at a time when they are open to changing their behaviour because they have been injured. After 20 minutes they have worked out a plan which suits them. These things really work and the government should give some consideration to scaling them up.”

She supports the government’s bill to increase the unit price of alcohol but is less keen on Labour’s plan to look at the caffeine levels in alcoholic drinks such as Buckfast.

“Buckfast has a high alcohol content, it’s full of sugar and it has a high caffeine content,” she says. “I would rather people weren’t drinking Buckfast at all. If you’ve got a young man from a deprived social background who is very impulsive and not very good at communicating, taking an ingredient out of a drink is not really going to change things for him. People will mix all sorts of substances with alcohol. Increasing the price of alcohol would be more effective.”

She says more professionals should get involved with finding a solution to the problem.

“We’re actively seeking to recruit more doctors for Medics Against Violence,” she says. “People need to come together more. Specialists working in isolation in their own discipline are not so helpful. We need a multidisciplinary approach.

“We are working with the violence reduction unit. I’ve learnt a lot from them which I didn’t know and I expect they’ve learnt some things from us. If we are going to get anywhere we have to have all the agencies working together to stop the violence.”

Until that happens, Goodall and her colleagues will continue dealing with life at the sharp end.

Medics Against Violence www.medicsagainstviolence.co.uk

Gillian Bowditch. The Sunday Times 07-03-2010

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