A social accountability placement gave Olivia Hoffmann the opportunity to challenge her preconceptions and learn the importance of empathy, preserving your compassion, and connecting with the people who need you most

“Do you have somewhere to live?” asked the support worker. The woman shrugged, took a handful of condoms, and stepped back. It is a winter’s night and I am in a “johnny van” parked on a street in Sheffield’s red light district.

A distant world

When I saw that a charity providing support for sex workers was an option for the social accountability placement at Sheffield Medical School, I thought of the film Pretty Woman. I pictured glamourous women, rich men in expensive cars, and the Arctic Monkeys’ song “When the sun goes down” (written about the street prostitution that the Sheffield based band witnessed near its rehearsal rooms). As my peers chose hospices and primary schools—equally deserving placements, of course—I couldn’t help but be drawn to this placement. I felt lucky to be given the opportunity to see into a world that seemed distant from my everyday life. I presumed that, as with many other experiences in medical school and in life, I would learn, reflect, but eventually detach myself and move on.

The Arctic Monkeys’ lyrics paint a raw and uncompromising portrait of sex work compared with the love story of Pretty Woman. No film or song, however, could have prepared me for the reality of Sheffield’s most deprived streets at night. This placement had a profound effect on me, and the lessons I learnt will certainly shape the doctor I become.

Sheffield Working Women’s Opportunities Project (SWWOP) is a charity that provides support for sex workers. The “johnny van” is one of the projects staffed by a group of support workers. They make contact with women involved in street prostitution and provide an outreach service, offering free condoms, needle exchange, food, and information about “dodgy punters”—warning women when a customer is known to be abusive and potentially dangerous. The charity offers non-judgmental and confidential support for problems such as homelessness and court appearances, and it creates realistic exit support packages for women wanting to leave sex work.

Inside the van

Inside the van it felt warm and safe. It contains a kitchen cabinet, a kettle, and heaps of homemade sandwiches. Some of the women who came in looked pale, thin, and cold. They helped themselves appreciatively to the sandwiches. Many of them depend on their customers for somewhere to live. The support worker was graceful with her questions and gave advice on housing and financial support options when appropriate. I made extremely chocolatey hot chocolate drinks for the women.

The van has a strict “no men allowed” policy to ensure the women feel safe and comfortable. Although the charity workers are trained to provide advice on a variety of problems, often the sex workers simply want to chat. I was told by the charity’s manager that the women would sense my nervousness; “just be yourself,” she said encouragingly. Some of the women said that they liked my trainers, and as we exchanged compliments, I forgot the circumstance of our meeting.

Not all the women were like this, however. Many were quiet and seemed lost. Some appeared restless and detached. Foil was a regular request, and I was directed to a cabinet of drawers in which there was a clinical display of sterile needles and other drug paraphernalia. Unlike me, the support worker was masterful at disguising her concern. After hearing some of their stories of abuse, I was overwhelmed by the urge to stop these women stepping off the van into the cold night. 

Life with few choices

Medical school teaches us about health and social inequalities, but lectures cannot give us a comprehensive appreciation of what life is like when you have few choices. Circumstances can force people into situations that can be near impossible to imagine, let alone demonstrate sincere empathy with. My ignorance of this type of sex work is just one example.

Sheffield Medical School designed the social accountability placement to allow students the opportunity to serve in a spirit of social justice. My night in the red light district was haunting, and it gave me a profound sense of responsibility as a future doctor. For the first time in medical school, I feel empowered with the idea of being accountable to the people and communities that need our help most. SWWOP’s employees, many of whom have decades of experience working with vulnerable women, amazed me with their ability to connect with them. Inside the van, the feeling that we all exist in this world together was palpable. It gave me a visceral understanding of the compassion that will fuel my future work as a clinician.

Student doctors, I encourage you to spend time serving your local community. Listen to people. Challenge your preconceptions. When we become doctors, our sense of compassion and humanity must not be forgotten.

Olivia Hoffmann is a third year medical student at the University of Sheffield, UK. Twitter: @oliviabhoffmann

Competing interests: None.