mav scotland

blogs from the Medics against Violence team about violence prevention in Scotland


Leave a comment

Contagion

Yesterday we had a huddle. A huddle is defined as a ‘close grouping of people or things’. In healthcare it’s a term that has become synonymous with patient safety, a way of anticipating problems and making sure that the views of the whole team are captured. It’s something that occurs in hospitals across the country at the start of every day. So for me, being at a huddle wasn’t that unusual.

Yesterday’s huddle was a bit different, it was run by Navigator and it brought together their partners in health, the police, the government and the third sector and also people who were just interested in what they do. Looking round the room the guest list was pretty impressive.

Navigator aims to divert people away from the cycle of violence, through interventions in the hospital and then in the community and supports them towards better lives. It does this by just being human and by giving people hope. Hope that change is possible.

But what I saw yesterday was that the reach of Navigator extends far beyond their service users, it actually gives everyone hope.

The Emergency Department staff work so hard to improve medical outcomes for patients but know that they can’t sort out the myriad of social problems that patients come along with and that their job ends at the front door. You can see that they wish they could do more. Navigator has filled that gap for them giving them some comfort that they can pass people on to a pair of safe hands.

It gives hope to people who behind the uniform have another story, of violence and loss, and who so bravely shared that with us yesterday. Hope that things can now be different for others in their situation because of some people in pink t-shirts who they might bump into on a trip to the emergency department when life seems at its worst.

I am sure that when the evaluation is done we will know what we already believe, that Navigator helps people get to a better place and live happier and more productive lives. What’s much more difficult to capture but what was so palpable in the room yesterday  is the change in culture that Navigator has brought with it; that different view of life, the eternal optimism, the belief in change, hope that we can do things differently. And that is infectious.  People talk about violence being infectious but violence prevention is a contagion and one that is a whole lot more virulent than violence.

When you hear Emergency Medicine consultants talking about sparkles and unicorns you know that things are changing.

Screen Shot 2018-05-30 at 17.10.09

Advertisements


Leave a comment

The best and the worst of life

So this weekend I saw the best and the worst of life.

The best? Well maybe not the absolute best but it was a pretty good day on Saturday as Saturdays go.  130 women came together in Glasgow to relive (or in some cases experience for the first time) the 70s and raise funds for Medics against Violence at our annual lunch event, ‘That MAV 70s Lunch’. We had a great afternoon of fun and dancing with good friends. It was great to see our partners, the VRU, the Navigators, One Community, the GRI emergency Department and others that we work with having some downtime and just enjoying life.

For us these events are not just about fundraising, we see them as a really important way to raise awareness of what we do but also to make connections, not just for ourselves but between our guests. And amongst the fun we sometimes get to hear stories. Everyone has a story.

Street and Arrow, who came along to sell jam, made many new friends and allies who heard and were inspired by their stories of what they had overcome to get to where they are today. They may have come to sell jam, and their jam is lovely, but they did so much more than that. That sort of connection is priceless because it helps people whose lives have never been affected by violence understand that those who have offended in the past can change and deserve a second chance.

7518822528_IMG_3117

Callum and Stevie from Street and Arrow with Sam from Navigator

Our amazing host Mr Fabulous who coped so well with a room full of crazy women, told us about the 50 children he had fostered, about being part of the first gay couple to adopt a child in Scotland and about his inspiring work in schools on LGBT issues. Young people who are struggling with their sexuality need role models like James.

7518822528_IMG_3123

Mr Fabulous, our host,  with Carol from CEA who won ‘best costume’ and Miss Perthshire

A young woman spoke about her own childhood trauma, and about the one consistent adult who, despite having a whole different belief system from her, provided her with the support she needed to help her get through it.  We know from work around ACEs that those supportive adults are so important in creating resilience. That young person is now an adult who helps young people facing adversity every day. She gave something back.

And we did some fundraising.

So all in all it was a good day.

31946756_10155145096430938_3127179827249938432_o-1

Keith met some of the ladies from Polmont YOI outside the venue.

And then there was today.

Today I returned to the hotel to collect bits and pieces they had stored for us overnight. As I drove looking for somewhere to park I saw a woman lying in the street with others standing over her, my first thought was that she was unwell. But as I came closer I was horrified to see that she was being assaulted by another woman who was hitting her repeatedly around the head. The altercation was brutal but over fairly quickly and both parties walked away. I called the police because that’s what you should do but those involved disappeared into the busy afternoon and may never be found.

A few things struck me about all this.

Many people walked past this event unfolding as if it was normal, they carried on with their Sunday shopping trip and hardly anyone even turned to look. We talk a lot about the bystander effect during various trainings that we do and I saw it in action today. Of course people need to be safe, I was in the fortunate position of being inside a car able to leave at any time, I’m not sure I would have been so brave if I had been on foot but there is always something you can do, even after the event, and safely (because two injured people are no use to anyone!). As Lieutenant General David Lindsay Morrison said ‘the standard you walk past is the standard you accept’ . Violence is shocking, raw, brutal. If we continue to accept it or excuse it as something mundane, something that happens to other people, and indeed, if we continue to think of people as ‘other people’, we will never fix it.

The only people paying attention, were in fact male associates of the assailant who gathered round to watch.  One of these men came over to talk to me through my car window as I called the police to try and excuse what went on by telling me the young woman who had been assaulted was trying to buy heroin and that they had found that offensive because they didn’t sell ‘that stuff’. It was almost as though I should understand that it was OK to beat someone up because they had simply asked a question. Perhaps being associated with selling one sort of drug is more offensive than being associated with selling another? While people in Scotland, in the main, do not plan to be violent, this sort of reactive violence is sadly something that some people are still supportive of and they often have little else on their menu of tactical options to use when faced with conflict. That’s something people need help with.

I’ve seen the end results of violence more times than I care to remember in the course of my career but I don’t generally see the injuries being caused. Today I witnessed first hand an assault on a vulnerable young woman who was clearly desperate. She was physically assaulted by one person but in reality she was assaulted by the complicit group. It was shocking- all the more shocking because the violence was perpetrated by a woman against another woman. As the young girl walked past with her hugely swollen and bleeding lip and I asked her if she was OK she told me just to leave it and disappeared.  She had that sad look that just said this was an inevitable part of her life. But it shouldn’t be part of anyone’s life.

So, I’m left thinking that we still have work to do, in schools, youth clubs, prisons, hospitals and in communities to try and give people other options, to encourage empathy and help them to make better choices. Those who are on the margins of society, who never willingly interact with the police and who are so vulnerable need other ways to access support. One day the young woman who was assaulted will show up in a hospital and hopefully if she does a Navigator will be there to support her. Violence reduction is about trying to stay ahead of the curve, about constantly innovating and as John Carnochan would say it’s about ‘meeting people where they are’. We can’t stop what happened today but we can stop it happening again tomorrow.

We are not done yet.


Leave a comment

A Tale of Two Towns-Part 2.

Today Medics against Violence are publishing two blogs as the 20th anniversary of the Dunblane school shootings approaches. We are very grateful to Michael and Amy who relived these days for us and wrote about their experiences

Fast forward nearly 20 years. I met Amy in 2013 when she came to Scotland to carry out some research for her Master of Public Health  project at St Andrews University.  Amy stayed in Edinburgh for the summer with her family and she loved the time she spent here, exploring the Highlands, visiting ‘Balamory’ with the kids and just experiencing Scotland.

Amy is from the USA, from Newtown in Connecticut in fact. Like Dunblane, Newtown was a small quiet family oriented town, largely free from violence; there had only been one murder in the town in the ten years before December 2012.

Newtown was home to Sandy Hook Elementary School.

On the 14th December 2012, 20 pupils at Sandy Hook Elementary School and six adults were shot and killed by 2o year old Adam Lanza who arrived at the school armed with an array of automatic weapons. He had already killed his mother and when police arrived at the scene he shot and killed himself. Like Hamilton in Dunblane who wore ear protectors, Lanza wore earplugs while he carried out his attack.

The school was demolished in 2013 and a new one now stands in its place.  Despite a public outcry, efforts to change gun legislation in the USA since Sandy Hook have been largely unsuccessful. Since Sandy Hook more than 1347 people have been killed and 3817 injured in mass shootings (defined as 4 or more victims) in the USA. (http://www.theguardian.com/us-news/ng-interactive/2015/oct/02/mass-shootings-america-gun-violence).

Amy’s son was in 2nd Grade at Sandy Hook Elementary School on the 14th December 2012. When Adam Lanza entered the school Amy was in a meeting some distance away in New Haven. These are her memories of that day.

“Amy, it’s Sandy Hook”

‘The voicemail said that all Newtown schools were on lockdown because there was an unconfirmed report of a shooting. I called a friend. “Amy, it’s Sandy Hook.” Newtown has seven public schools including four elementary schools. Sandy Hook School was one of the elementary schools and my son was in second grade. I raced out of my meeting in New Haven to my car and then began the unimaginably long journey (25 miles) to my son’s school. I called the mother of one of my son’s classmates and she agreed to call me as soon as she saw him so that I would know he was ok. I drove and drove. I watched and listened as rescue vehicles and police cars with sirens blaring screamed past me on the two lane road that separated me from my child. I wound my way along the river as I had so many times before waiting for my phone to ring but it didn’t and still I drove. Finally the call came that my son was alive and waiting for me at the fire house near the school. I could finally breathe and still I drove. After 40 minutes I got to the turn off for my neighborhood and saw police cars at full speed racing toward my house. And still I drove to the school. Several blocks from the school traffic came to a complete stop. I pulled my car over and ran to the firehouse. The street leading to the firehouse and the school was clogged with parents, onlookers, cars, police and rescue vehicles, SWAT teams and already media. I ran past the fire trucks which had been pulled out of the bays to make room for over 400 children. We had spent many happy hours at that firehouse on field trips and at the annual lobster dinners to raise money for the volunteer firefighters. It was cold and no one cared. What at first appeared to be chaos was revealed to be kids lined up behind teachers holding signs – “one” for the first graders, “two” for the second graders and so on, but all I saw was my boy.

It took a long time to release the kids one by one. It took a long time to determine that some of the kids could not be accounted for. It took even longer before the parents of missing kids were told the unfathomable news that their children had perished. They had “expired” Governor Malloy awkwardly told them. How does one tell twenty sets of parents that their children have died at school on an ordinary Friday two weeks before Christmas? Those parents were my friends and those kids were our neighbors and my son’s teammates. We stood on the sidelines with those moms and dads and joked about how six year old boys could manage to get so dirty playing baseball, and rolled our eyes when they slid into home plate during practice just because they could. How was it possible that my kid had lived and theirs had not?

I drove my son home and my husband quickly met us. We hugged and cried and then we closed ourselves in the office to watch the news. At first we believed that no children had been killed. We watched and watched and were told facts that we knew to be untrue and all the while we could hear police helicopters overhead. Our son’s class was evacuated through the front of the building past two of the deceased adults. The kids were told to hold on to one another’s shoulders and close their eyes, but they peeked. We knew that two adults had died because that was one of the first things our son told us. “I saw Mrs. Hochsprung laying on top of someone and there was blood everywhere.” Matter of fact, like those are words that any child might say. What were other kids telling their parents? What had they seen? What had they heard? As we watched the news reports and the enormity of what had happened started to become clear we began to look for familiar faces in the clips from the fire house that played over and over. I saw an image of a woman crying inconsolably into her cellphone – she was the sister of my son’s first grade teacher. Miss Soto had died. Reports came in that at least 10 children had died and 2 had been rushed to local hospitals. Then 20 children were confirmed dead. But who were the children? We waited for the list of names to be released and then it was and we had to make sense of it.

The town assigned a police officer to each family who had lost a child to protect their privacy and to act as a conduit for information. The officers parked their squad cars facing out of their driveways and we came to understand what that symbolized. Five squad cars in our neighborhood. Three more on the way to the town center, two facing one another across a street. One facing the house a couple of blocks away where the gunman lived with his mother before he shot her earlier on the morning of December 14. That explained the police helicopters and the squad cars and the media who had descended on our neighborhood. It explained the road blocks and the snipers in the tree fort of a neighboring house.

As the funerals came to an end and the shock began to wear off a few weeks later we were left with a feeling of acute loss – of promising young lives, of happy families, of innocence lost. A new temporary Sandy Hook School was set up in a neighboring town. There were counselors and comfort dogs and activities for the kids at the local community center. Most Sandy Hook families and kids were able to slowly and painfully move forward because there was nothing else to do. Some Sandy Hook families and kids cannot. There are siblings of the kids who died that day, many of whom still attend Sandy Hook School or will in the future. They are not ok. There were kids who escaped from a classroom when the gunman’s gun jammed. They are not ok. There are the parents and grandparents and teachers and coaches and clergy of the children and adults who died that day. They are not ok. As a community we live each day with the reminders of what was lost even in the midst of tremendous acts of kindness and support from around the world. The gunman had access to an arsenal of assault weapons. He used them on our children. When the sign for baseball registration went up a few days ago my heart sank as I thought of the parents who are left with only memories of their beloved baseball players and artists and ballerinas and future firefighters. . . . Something has to change.’

This blog was by Amy Davis, lawyer, public health practitioner and mother with foreward by Dr Christine Goodall from Medics against Violence.  Amy continues to do what she can to make her community safer and started the Kid Safe Heart scheme in a bid to prevent accidental firearm related deaths and injuries. It  allows parents to  indicate, by posting a small green heart symbol in their window, that they either don’t own firearms or that firearms are safely stored in their home.


Leave a comment

A Tale of Two Towns-Part 1

Today Medics against Violence are publishing two blogs as the 20th anniversary of the Dunblane school shootings approaches. We are very grateful to Michael and Amy who relived these days for us and wrote about their experiences.

On the 13th March 1996 sixteen primary school children and one teacher were shot and killed at Dunblane Primary School by Thomas Hamilton who then killed himself. A further 15 children and adults were injured. Most of the victims were taken to Stirling Royal Infirmary and staff from the hospital attended the scene along with other local medical staff. Hamilton’s guns were all, at the time, legally owned.

The massacre at Dunblane led to the Cullen report and two new firearms acts which effectively made private ownership of handguns in Great Britain illegal.

In 2011 there were 13 gun related deaths in Scotland,  3 of those were homicides, there have been no mass shootings in Scotland since Dunblane (1).

In every society there are defining moments that remain etched on your memory and that change things forever, this was one for Scotland, a day when innocence was lost. The violence experienced by many on that day continues to exert its effects today but we owe it to the people who lost their lives, to those who were injured, those who were left behind and to the staff from the emergency services who cared for them that day to remember.

Our first blog is from one of Medics against Violence’s Directors, Dr Michael Murray, now a consultant neuroanaesthetist at the QEUH. He was on duty as a young trainee anaesthetist in Stirling Royal Infirmary on the 13th March 1996; these are his memories of that day.

“There’s been a shooting at a school”

‘There is part of the human brain called the amygdala which records memories. In times of acute stress, it gathers far more information than it normally does which explains the phenomenon of why people talk about things going in slow motion during a traumatic event. Memories in HD if you like. Sometimes you wish it didn’t.

In saying that I struggle to remember who first called me. I think it was switchboard. I was on call for anaesthetics in Stirling Royal Infirmary. I had started there about six months before so in anaesthetic terms I was relatively inexperienced. I did however have the foresight, having received this call, to immediately pick up the phone to call the blood bank and inform them of what I had been told and that they might want to start getting some blood ready. I told my consultant and next I found myself in Accident and Emergency as there was a mass of frantic activity of staff shouting, grabbing kit and preparing to depart in an ambulance waiting at the door to go to the incident. On the verge of leaving, Ross one of my much more experienced colleagues, and fellow trainees nonchalantly offered to go in my place as I probably wasn’t the best person to go. I accepted his offer without too much hesitation and I came to realise subsequently how he spared me a great deal.

A calm descended for a few minutes and myself and a consultant started preparing some drips and drugs. Then the first ambulance pulled up at the door. Lights flashing. No siren. The paramedics raced towards us with the trolley. She actually seemed quite peaceful and oblivious to the absolute flurry of medical activity around her. She could almost have been asleep. Tiny. I suppose all five-year-olds are. Perfect skin. Hair fixed neatly a few hours ago, I suspect by mum. The frenzy of activity stopped fairly quickly at an almost simultaneous moment when we realized we couldn’t do anything and someone took the painful step to say what none of us wanted to say. There is nothing more crushing for people. Patients very rarely die in front of you. Virtually never younger than you and never before for us a child. All I could think to say in my mind was I was sorry.

I turned away and stood outside. I didn’t know what else to do. The next ambulance came in and when the doors opened I almost felt a strange delight it was an adult not a child. In my head all I could think of was from a selfish point of view was “I’m taking her”. I had anaesthetized some children but a “grown up” I could manage. Frankly I was terrified as this was out my league.

I helped lift out the trolley and started chatting away. Like an incident on an aircraft you want an (apparently) reassuring voice to keep talking. She had been shot several times but was conscious and chatting away. Drips were secured, blood taken, pain killers and fluids given and within twenty minutes the theatres upstairs had been cleared and we were in the anaesthetic room of one of the orthopedic theatres. I didn’t see who organized everything but it seemed to go remarkably quickly for all the sudden chaos.

I always remember her telling me he was wearing ear protectors – “like headphones”. I couldn’t help but wonder why protect your hearing if you were about to kill yourself. Or perhaps it was to block out the screaming.

Just as I was about to get her off to sleep again my nerve caved in. I asked for the most senior consultant – the ‘calm do anything to anyone’ type to come in to give me a hand. I just couldn’t face having gotten this far and survived to then have some anaesthetic catastrophe. Uneventfully off to sleep we spent the next four or five hours stitching her back together. The orthopedic surgeon was ex-military and I felt privileged to watch him take broken parts and reassemble them. The theatre for a few hours felt like a cocoon. No TV, no radio. No children. I took my break in the anaesthetic room as I didn’t really want to see around me. I was frightened of falling apart as for the duration there wasn’t much room for people not to do their jobs.

By mid-afternoon she was safely out in recovery. Various children were being recovered. Hands held. Or cuddled in the lap of a recovery nurse if they were good enough to move out of bed. Early finish. It felt bizarre. There was a strange quiet over the department. Stirling had always been a great place to work. A small enough department to work in but filled with ability from all staff. It demonstrated its efficiency and professionalism that day in a way that I have never felt before or since.

I drove home feeling numb. It was only a few miles but I pulled the car into a layby on a country lane and stopped. I let go what I couldn’t all day. I did the same again when I thought about writing this piece. Some pictures are still there – we just try not to look at them.

Twenty years later the effects are still there for me. An outsider. Someone physically untouched. Largely emotionally uninvolved. Physically removed. However, the gain I take is the understanding forced upon me of the damage of others actions and that prevention is always better – while cure may be impossible minimization of harm is a laudable aim. To learn nothing and to do nothing is a slur on the sacrifice that happened that day.’

This blog is from Dr Michael Murray, with foreword from Dr Christine Goodall, both Directors at Medics against Violence.

  1. Scotland. 2012. ‘Deaths: External Causes of Morbidity and Mortality – Underlying Cause, Sex and Age-group, 2011.’ Mortality Statistics: Deaths Registered in Scotland, 2011; Table 6.4. Edinburgh: General Register Office for Scotland. 8 March.


Leave a comment

What are those snakes all about?

If you follow us you’ll be familiar with the Medics against Violence logo, two snakes entwined round a rod or staff over our name. We’ve been asked several times this week what it all means-because it must mean something right? No point having a logo that doesn’t mean anything.

Lots of people think the rod is in fact a knife or maybe even a sword and I suppose that would fit with the theme of violence but remember we’re not about encouraging violence we are trying to fix it in the same way as we try to fix all the varied health problems that come our way in the course of our day jobs. So a sword or knife in our logo wouldn’t be a great plan-we don’t think so anyway!

In fact the logo is an adaptation of the Rod of Asclepius. Asclepius was a Greek physician who practiced around 1200BC and eventually became a god associated with healing. Asclepius was an interesting character with several daughters who were called  Meditrine -Medicine,  Hygieia -Hygiene and Panacea -the universal remedy- so he had a medical family.

The classic Rod of Asclepius is one snake entwined around the rod. So what is the snake all about?

Well there are several theories , some say that the snake represents a type of non-venemous snake (the Aesculapian Snakes) used in healing rituals in Ancient Greece. There were no antibiotics in those days remember so all sorts of weird and wonderful things were used in medicine and snakes were among those.

Another theory says that the snake represents a parasitic worm that was common in ancient times-the filarial worm or guinea worm. This worm sometimes crawls around just under the skin of its host. To remove it ancient physicians made an incision in the skin just in front of its path and then wound the worm around a stick until it had been entirely removed. Physicians used the ‘worm wound round a stick’ symbol to advertise their services.

The Rod of Asclepius over time became the accepted symbol for medicine and so it remains today although it is often confused with the Caduceus of Hermes which actually has connections with alchemy. Asclepius was such a well thought of medical figure that he actually featured in the original Hippocratic Oath sworn by many new medical and dental graduates on the day of their graduation.

So when we were thinking about a logo for Medics against Violence it seemed a good idea to try to incorporate the Rod Of Asclepius in some way but we gave it a twist so there are two snakes to represent the fact that we are multi-professional and they are both facing forward to show that we are looking to the future or into the distance. We’ve always said that the only way to reduce violence was for people to work together and to be in it for the long haul and our logo symbolises this for us.

Maybe this is a good time show you all the new version of our logo for our new primary school project bCSI (brave Confident Strong Individuals). We’ve borrowed two of the most famous detectives for this one, Sherlock Holmes and Watson, because bCSI is all about investigating the lives of two young people who have been injured so our snakes are suitably clothed and carrying a magnifying glass to search for clues. We’d be really interested to hear what you think about it.

We hope this answers some of the questions we’ve had this week about our logo particularly from the primary schools we spoke to on GLOW TV last Friday. Both the original and the new bCSI one were designed especially for us by Harry Griffiths at hgdesign studios-we think he did a great job with the brief.

Image


Leave a comment

It’s not over yet…

Did you see the documentary by David Gillanders last week on violence in Glasgow? David, a brilliant photojournalist (http://www.davidgillanders.com/documentary/glasgow/), took a series of still photographs about ten years ago of his home city and they painted a really bleak picture of violence and deprivation in Glasgow.  So bleak, in fact, that you would have thought recovery impossible. These photos confirmed our reputation as one of the most violent cities in the western world.

 

It was a picture all too familiar to those of us working in health at the time. We all have memories of weekends when the bleep seemed to go off constantly, when you visited A and E and were never just asked to see one patient, when you dreaded that big football game or the 1st and 2nd of January when the trauma victims sobered up enough to realise they had been injured and would come in in their droves. Most of our work was trauma and the vast majority of it was associated with violence and of course alcohol. Ironically for us it gave us a wealth of experience and surgeons used to come to Glasgow to get training in trauma because we saw so much of it, but the human cost was massive.

 

It was the human cost that got us thinking, it didn’t seem right not to do something to stop it happening, we had to be more than just good at fixing fractures and suturing wounds. There had to be something more that we as health professionals could do to make this stop, surely that was part of our job? So with the help of the Violence Reduction Unit, we started Medics against Violence.  5 years on and we’ve spoken to over 13400 kids about the consequences of violence and I think they are getting the message. When we started doing this some kids used to tell me that they thought they should be carrying knives, that they needed them for protection, some even volunteered that they had one in their school bag. Now nobody says that, the universal answer is that carrying knives is a bad idea. So maybe, just maybe, we are winning that war-in most places.

 

Ten years on David Gillanders revisited the scene of his photographic essay and in his BBC documentary and found a very different Glasgow to the one he photographed ten years ago. A more optimistic Glasgow where levels of violence had reduced, so much so that he had trouble finding violent incidents to film. We all see the stats, violent crime has reduced by about half, injury figures are down and this is a true reflection of what is actually happening and the results of the tremendous efforts of many.  The level of violence in Glasgow, however, is not zero, people are still being murdered, maimed and disfigured, just not as many people and not as often. So, there is much still to do. This is probably a bad analogy, but we are teetering on a knife-edge and if we all sit back, congratulate ourselves and give up now things could easily return to where they once were. So let’s harness the optimism of David’s film and keep going, we are winning the war but it’s not quite over yet….

 http://www.bbc.co.uk/iplayer/episode/b03l5grq/Knife_Crime_Winning_the_War/

 

 Image

today’s blog was from Christine Goodall