AS A DOCTOR who has a tendency to run his mouth, I am frequently – and not at all unreasonably – told to stay in my lane and stick to talking about what I know.
If you feel this is the conclusion you are likely to arrive at after reading this piece, then I suggest, in the manner of a plummy BBC newscaster presenting the soccer results in advance of the highlights being shown later, you may wish to look away now.
Rudolf Virchow, a German pathologist considered by many to be the father of modern medicine, tells us that medicine is a social science and the physician is “the natural attorney of the poor”.
In Ireland, we as doctors have not always lived up to Virchow’s promise. There are, however, very few significant problems in our country that cannot be observed on a short round of a hospital medical ward.
In Ireland, the hospital is the custodian of last resort for societal problems that we have never shown either the requisite curiosity or attention to detail to solve.
As a senior physician, when I look at my very long list of inpatients at any time, in at least half of the cases the fundamental problems keeping them in the hospital have less to do with physical infirmity as they do loneliness, isolation, addiction, obesity, homelessness, familial conflict and chronic under-investment in mental health.
These however pale into insignificance with the capo di tutti capi of reasons people end up in hospital: poverty.
The Covid era
It has become accepted that Ireland – and the world – is totally changed by the virus raging around us.
I’m not so sure anymore.
In exit polls after the election in February, a chronically under-capacity healthcare system was rated as the most important issue by 32% of voters, followed by the housing crisis in second place with 26% and jobs and pensions third at 14% combined.
Climate change was at 6%. Brexit (remember that?) which dominated public discourse in the four years prior to the election, trailed in at just 1%.
Having spent much of spring and early summer neck high, but not quite submerged in the virus, the health service now finds itself with a second wave lapping around our ankles.
The local hospitals of Kildare, Laois and Offaly accommodated almost 700 citizens of those counties on emergency department trolleys last August.
As there is no slack in the healthcare infrastructure to risk a surge, we lock down harder and earlier in affected areas than we might otherwise have to.
Because people in low-paid jobs can’t afford the steep rents of Ireland in 2020, the vulnerable suffer.
The Oireachtas committee on Covid was told last month of a house in Offaly that was accommodating 40 meat factory workers as residents. Try enforcing social distancing there.
Also, in 20 years the state has not found a better solution to welcoming asylum seekers than undignified direct provision centres, so we see significant outbreaks there too.
Because we have allowed the social contract to be perverted to the point where people working on near minimum-wage in food factories can be considered self-employed and this is seen as okay, it is estimated by Siptu that 80% of workers within the industry do not have sick pay.
This nudges vulnerable workers to go to work, even if they may be feeling unwell with possible Covid symptoms.
A weary people faces the back end of this terrible year with uncertainty and fear.
Thousands are mourning. Thousands more have seen their businesses or livelihoods disappear or be threatened.
Two-tier health system
Essential workers are beyond exhausted. The rhetoric of “all being in it together” is dead.
I stopped believing in that fantasy when large parts of our political and medical establishments, waved through by a compliant broadcast media, moved heaven and earth to open up elective private healthcare while expecting the great unwashed who rely on the public sector to cheerfully return to the back of the bus.
I lived abroad for long enough to know that Ireland is a great place to live.
By international metrics this is a prosperous, safe, clean and progressive country.
We are vibrant, funny, brave, imaginative people. However, what we now reap is the harvest of decades of inaction on what voters just six short months ago told us were the major issues affecting our society.
Sars-Cov-2 has not built the character and resilience of Irish communties – it has revealed it. Nor has it created our weaknesses in health, housing and workers rights – it has exposed them.
There are only four routes out of the situation we’re in. Two of those – a vaccine or an effective cure – don’t exist.
This leaves us with the madness of a laissez-faire, herd immunity approach, or a New Zealand-esque, all-island Zero Covid policy which the government appears to see as unfeasible.
If all other options are off the table, all we can do is try our best to live alongside Sars-Cov-2 with as little disruption as possible until a vaccine or cure arrives.
Using NPHET as a punchbag for what is happening in Ireland this month, as so many seem hell-bent to do, seems to me to be demented given they are working within the limits of that structure, and those weaknesses.
We know that what transmits the virus is human contact, so we work off the principle that less human contact means less illness and death. Therefore we must set out priorities, which quite rightly are services like healthcare, education, food, sanitation.
In other areas you do your best to minimise human contact to what is essential to allow those things function.
What must be faced up to is that when the virus is in the community and people are mixing, outbreaks are inevitable and a quick, aggressive response to them by finding, testing and isolating people at risk is necessary.
We’ve given NPHET an awful job to do and now seem to want to lacerate them when they don’t recommend to open up the thing we want to do, when we want it and rail at the injustice that something we have no interest in can go ahead.
In an Ireland where thousands of families will end this year looking at empty seats at the Christmas dinner table, the idea that a few hundred empty seats at club GAA matches is a matter worthy of howls of righteous indignation from the high altars of the sports pages is distasteful.
Yes, many decisions seem arbitrary but given the decade worth of things that have happened and decisions that have had to be made in the last seven months, maybe we could cut them some slack on that, and treasure any respite at all we get in 2020.
If we’re in the same situation in 12 months time it will be a different story. Before then, I hope and believe science will find a way and if it can’t it’ll make one.
There are better days ahead. Somewhere.
Dr Anthony O’Connor MD, MRCPI is a Consultant Gastroenterologist at Tallaght Hospital.
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