Fighting the good fight
Hospitals in Glasgow treat a serious facial injury every six hours, most of which are the result of heavy drinking. Over a quarter of these patients will be back again with a similar injury within the year.
Oral surgeon Christine Goodall has seen thousands of young men who have been injured as a result of ‘recreational violence’ – in other words, violence perpetrated for no discernable reason.
She explained: “It’s not a terribly good word to use because there is nothing recreational about it, it is all quite nasty. The violence is not for any purpose, they are just being violent for the sake of it.
“Probably the most common injuries we see are fractured mandibles, fractured cheekbones and fractured noses from blunt trauma. But probably about 25 per cent of all the injuries we see will be knife-related, such as slashes. But we often see a mixture of blunt trauma and knife wounds, for example.”
It was this cumulative effect of seeing patient after patient coming through the doors of the various A&Es and operating theatres she has worked in that led Christine, along with two colleagues at Glasgow Dental Hospital, to set up an innovative charity to try and stop violence before it happens.
Christine, along with maxillo-facial surgeons Mark Devlin and David Koppel, founded Medics Against Violence (MAV) in 2008, becoming a registered charity the following year. Their aim was to reduce violent injuries, especially among the young, seeing it as an entirely preventable problem.
“Mark, David and I all felt that perhaps we could do more than just fix the people,” said Christine. “That perhaps we should be thinking about stopping it happening in the first place. And that is really why we set up Medics Against Violence.”
Before she qualified as an oral surgeon, Christine worked as a research scientist. It was her current research into alcohol-related facial trauma that put her into contact with Strathclyde Police’s Violence Reduction Unit (VRU). The VRU co-sponsored a brief interventional programme called COVAID (Control of Violence for Angry Impulsive Drinkers), which Christine co-ordinated.
The VRU was formed in 2005 following an initiative by Strathclyde Police to develop sustainable reductions in violence. Detective Chief Superintendent John Carnochan and his deputy, Karyn McClusky, were tasked with developing a long-term strategy that evolved into the creation of the unit. Det Ch Supt Carnochan explains that, early on in the life of the unit, they came across a World Health Organisation report that identified interpersonal violence as a public health issue. “If you look at violence through the lens of public health and through the lens of a scientific model, it allows you to be far more forensic in identifying what the issues are.
“So it’s not just about more cops on the street, but rather at looking at what happened the night before that incidence of violence? What happened in that life beforehand?”
However, while the COVAID programme identified victims of interpersonal violence, it wasn’t able to wind back the clock and stop the violence occurring. Christine said: “The brief interventions with facial trauma patients try to help them cut down their drinking and cut down their involvement in violence, but these are all things that happen after someone has been injured. What we wanted to do is get to people before they get injured.
“We felt that the best way to do this was to speak to young people, not older teenagers but 13 to 14-year-olds, before they think about getting involved in those kind of activities.”
With funding support from the VRU and the Scottish Government, MAV was formed in November 2008. Christine, David and Mark carried out the first visit themselves to St Mungos Academy in Glasgow and since then they have recruited 120 doctors and consultants from across Glasgow, Ayrshire, Lanarkshire, Forth Valley and Dundee. So far they don’t have any members further north than that and they don’t have any general dentists on board, as yet.
The charity has visited about 5,000 pupils from more than 20 schools in Glasgow, Ayrshire and Lanarkshire, with more than a dozen extra schools expressing an interest for the coming school year. MAV members, who include doctors and consultants from a broad range of disciplines and departments, give interactive presentations to the pupils, showing them the real consequences of violence. The presentation includes a short film that tells the stories of real-life victims and perpetrators of violence.
Christine said: “I think the kids relate quite well to the patient stories and, personally, I just draw on the thousands of people that I have seen over the years. They are all broadly similar, it is often young guys who have been out fighting. They don’t appreciate at the time that they are going to be left with a scar for life or how the broken facial bones will affect them.”
Christine explained that around 75 per cent of the kids they speak to will be okay and won’t get involved in violence, whereas there are around 5 per cent who will not respond to their presentations and will inevitably become involved. However, it is the remaining 20 per cent that they are trying to reach.
She said: “These are the kids we are really trying to get at – we could potentially change their minds. This 20 per cent could go either way, they could get saved by a good role model – parent, uncle, teacher – or they could fall off the edge and it will be happenstance as to why that happens. Which is why we believe MAV is so important.
“Even if it is to get them to leave the knife behind when they go out at night, or to walk away from a certain situation. It just has to be one little thing, it doesn’t take much to stop these things from happening. It just takes somebody making a positive decision not to do something.”
And, according to Det Ch Supt John Carnochan, in some cases the ability to make these decisions needs to be learned. He said: “We don’t learn to be violent, we learn not to be violent. Learning these life skills allow us to develop a whole range of other strategies to deal with the challenges we’ll face in our lives. But the young guys who are getting into trouble don’t have these other strategies. The only strategies they have is to fight, to be aggressive and to resort to violence.
“If young people acquire these skills it then becomes about more than just the violence, it will affect whether they will make good decisions about themselves; about what they drink, about socialising, about relationships.”
Det Ch Supt Carnochan believes that MAV is an important force in helping to reduce violence in communities across Scotland. He continued: “MAV has a powerful role to play. Their members’ advocacy, the fact that they say it out loud, the simple fact that they exist.
“The fact that they are saying, ‘Look, we exist because we believe we can prevent some of this happening in the first place’, is absolutely vital.
“Our motto at the VRU is ‘violence is preventable, not inevitable’, so the fact that MAV is standing up there and saying just that, confirms it and it really is a powerful message.”
Christine explained that while the response from teachers and pupils has been encouraging so far, this needs to be a long-term project. She said: “I don’t think the change in attitudes will happen overnight, but we’re in this for the long haul. We just hope that if we see enough kids, and speak to enough kids, that they will see that this is not the way to go.”
GDP Case study
Catherine Jones, GDP from Belhaven Dental Surgery in Port Glasgow
“The most common injuries we see in practice are broken teeth, occasionally avulsed teeth that are completely knocked out.
“Also young boys who have had broken or lost teeth in the past through fights coming in with broken dentures, that’s a fairly regular occurrence.
“Quite often they come in and they are not entirely sure what has happened to them due to alcohol. They’ve been out drinking and they really don’t know what’s happened.
“It is just indicative that they are really out of control when they have absolutely no idea how they have received their injuries.”
Find out more
If you are interested in joining Medics Against Violence, or finding out more information about their schools programme, email the charity’s administrator ator visit the MAV website at www.medicsagainstviolence.co.uk