I've just finished reading Shawnie by Ed Trewavas. Wow. One of the least enjoyable books I've ever read, but utterly compelling. Written by a Bristol social worker and in first person Bristolian dialect it unravels the mess that is one family from Knowle West's life. I say family, but it's nothing like family as I've experienced it. Drink, drugs, violence, abuse, neglect all viewed as some kind of norm.

In the dermatology department where I work we see a wide social mix, none more so than in Day Care. Here we largely treat people with serious psoriasis, often exacerbated by a certain amount of self-neglect or at least non-concordance with treatment. Those referred for day care have to attend Monday to Friday, so have to have understanding bosses or not be in work. Generally there is are a fair few on our books with alcohol issues, since alcohol is a trigger for psoriasis AND rules out the option of treating their condition with certain medication. So you can get a picture of our clientele. And there are times, talking to some people who repeatedly turn up at random times of day because they lost track of time down the pub or whatever, that you feel that all the health promotion in the world isn't going to help. It's not as if their skin problem, severe though it may be, IS the problem - it's merely the symptom.

More than anything, reading Shawnie underlined to me how useless I am in such situations. I may as well be talking another language. In fact, that's exactly what I'm doing.

I don't know whether to recommend Shawnie, as I'm still feeling the after-effects of reading it. But I'm glad I did. I don't think it told me anything I didn't already know. But it managed to speak with authentic voices, rather than a white middle-class health worker's report.


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