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Dear Steps…

Dear STEPS,

The first day Louis and I joined your team, I have to admit I was nervous and a bit scared. I had never experienced such intimacy working with drug users in their own environment. I had never seen people injecting heroin before. It was a strange feeling watching people come collect a needle from us, opening it up immediately and inject themselves a few meters away. But what I have come to learn is that this trust and intimacy of the way you work and relationships you have built with these people is what makes STEPS so unique.

Working closely with sex workers has been a valuable experience for me. In particular one woman, has taught me about life on the streets and the daily routine of being a sex worker. On my first day with Steps I met this woman who was known to STEPS previously, she had a severe skin infection on her hands. A complicated illness that seemed to be due to her weakened immune system and was likely caused by a sexually transmitted infection. Due to street embrace I was able to see her three times a week, progressively healing her hands, cleaning them and giving her antibiotics to treat the cause. This allowed us both to focus on a mutual goal but also gave me the opportunity to gain some insight of her life. As her hands healed, it became clear that her skin condition was a superficial manifestation of the real struggles she has to endure. Sleeping in a bed depended on her getting a client that day. The food she ate, cigarettes she smoked and drugs she was able to buy all depended on the number of clients she had; and as her hands healed the less frequently I would see her. It was a bitter-sweet feeling as I knew that when she was not sitting in her usual place, she was working or using drugs. To a certain extent I felt I was perpetuating the cycle of her misfortune, but I had to disregard my centered thoughts and realise I was giving her relief and treating her to the limit of my abilities. The difficulty with this kind of work is that there is a limit to what you can give someone. Despite saying she wanted to get off the streets I know that I alone would not be able to change her social situation, as much as I wanted to, but recognising this is crucial as we can only provide people with support and dignity, to enable them to access services that could help.

The emotions I felt working with STEPS ranged from frustration and sadness to happiness and gratification. For a few weeks we saw the same man, with a cage and pins around his legs from a previous surgery. His leg was infected and he needed emergency treatment. The first few times he did not want to go to the hospital as he was afraid of withdrawing if he were to be admitted for a few hours. So we cleaned his leg as best we could, despite his severe pain. After a few more times cleaning his wounds and a few days he agreed to go with us. When we arrived at hospital the doctors refused to treat him, as he was an IVDU and missed his previous outpatient appointment. I managed to convince them to see him the next day, and with great success his pins and cage were removed, we gave him antibiotics and I felt a change in his energy and seemed determined to focus on his health.

That week we tried to get him into a hostel so he could get off the streets and have access to services to enable him to get better. But he was refused a bed due to the fact he had crutches and was not ‘independent’. For a whole week and a half I didn’t see him. Yesterday I saw him for the first time and he did not seem as enthusiastic to see us. He had not finished his antibiotics and he was not able to speak to us very well, a friend of his said he had been using a lot recently. Despite this he did not have an open wound anymore and his pain seemed to be improving. However, it makes me frustrated that he was refused access to the hostel as I really felt he was determined to improve his health and as a result may be able to receive support to get off the streets. From this emotional experience I believe sorting out an open wound has changed his quality of life and his appreciation for us taking time to look after him was an incredible feeling. Working with drug users is challenging as their top priority is getting their next hit; health is the last thing on their mind and as a medic we need to acknowledge this and be patient with their progress. You can not change people and you can not force people to seek medical care, but what we can do is be available to help them when they do seek help and treat them with dignity and respect. Passing judgement on someone’s lifestyle will hinder your relationship with them and further push them away from seeking the services they need.

Wound cleaning is not complex, but what I have learnt is that simply taking the time to clean someone’s injury, gives them an opportunity to speak. Being able to listen to someone is a powerful skill and being able to simply listen and be empathetic is sometimes the best medicine. You are never going to change someone’s social situation in a 10 minute conversation. But what you can do is make them feel dignified, give them humanity and support for a brief moment. Because it may be the only time that day or week that someone has just been there to listen.

What STEPS has taught me, for my future career is that being a doctor is more than fixing a biological problem. It is about making people feel safe, heard and not alone. I hope that I will take this away and keep this as my goal for being a medical professional.

I also want to praise your style, professionalism and the safety of the way you work. Caring for eachother and keeping each other’s safety at the forefront of your minds has really stood out to me. It is a very rare and beautiful thing which you must be proud of, and thank you for extending this care to myself and Louis, and making us feel secure when we carry out our work. Thank you for the opportunity to work so closely with your team for the past 8 weeks. I have truly developed as a person and am looking forward to how this experience will shape my career.

Love from Issy.