The Comical Ali of Health
PAUL O'CONNOR argues that the shambolic handling of the SARS threat by the health authorities in the South points up the need for root and branch reform of an ailing service
Why was anyone surprised last week when a Chinese girl diagnosed as a probable case of SARS was sent back to her hostel with a facemask and a packet of paracetamol? After all, this is the government that put Joe Jacob in charge of nuclear safety.
Remember those iodine tablets, and the advice to shut your windows at sight of the mushroom cloud? Arrogance, cronyism, taxbreaks for the rich and cutbacks and service charges for the rest of us - this is what we expect from the FF/PD coalition. But a modicum of competence in the face of potential catastrophe? You must be joking!
The reality-defying pronouncements of the former Iraqi Information Minister made Comical Ali a worldwide celebrity, with websites dedicated to his increasingly ludicrous claims of Iraqi victories over the invading Americans. Surely it is only time before the Irish Department of Health is likewise celebrated. Comical Micky, attempting to persuade us that the health system has improved during his tenure or that waiting lists will be eliminated any time this millennium, has the potential to be Ireland's biggest export in entertainment since Riverdance.
What could be more hilarious than "voluntary quarantine" - the status imposed on the hostel where last week's suspected SARS patient was staying? This seemingly translates as "we ask you nicely to say indoors to avoid spreading infection, but if you really want to go out and spread the disease across most of Dublin, that's OK too".
It is reported that people were coming and going from the "quarantined" hostel all week. But why should that surprise us, when the health board and minister couldn't even agree on the status of the suspected case? Depending on who you asked, she was "suspect", "probable", and then again "suspect" The minister and his health board weren't so much singing from different hymn sheets as singing impromptu, with each making up a different tune as they went along.
Meanwhile, the public health doctors, the professionals most immediately responsible for the containment of infectious disease, were out on strike, after nine years waiting for a previous agreement to be implemented. Enter Mícheál Martin, Ireland's foremost expert in industrial relations. Last Friday, the minister spoke at the IMO conference in Killarney and, with all the grace of an elephant dancing on a tightrope, accused the doctors of putting patients' lives at risk and of a "total abandonment of responsibility". He also appeared to threaten the careers of nine senior public health doctors, whose role in the health service his speech singled out.
The mishandling of SARS sheds light on a great deal of what is wrong with the 26-county health system and the way in which government operates.
First, there is the sheer bungling incompetence with which the issue has been handled. Two months after the first cases of SARS were announced in Asia, the only precautionary measures in place are information desks at airports. And the people in charge of combating infectious diseases are on strike.
But instead of focusing on the real issue at stake - how to protect the Irish public from a potential fatal disease, with no known cure, which has already reached epidemic proportions in the Far East - debate has focused around the career prospects of Mícheál Martin and his dispute with the doctors.
Should the Minister for Health resign? Frankly, the question doesn't interest me. Martin is guilty of mishandling the doctors' dispute and has done little to improve the health service during his years in office. But it was not the minister who discharged a probable case of SARS back to her hostel, nor was it the minister who came up with the notion of "voluntary quarantine". Were he to resign, his replacement would be yet another Fianna Fáil health minister lacking the will or the courage to carry through the radical reform of the health service that is needed.
Calls for ministerial resignations only serve to distract attention from the real issue. The primary problem is not one of individual incompetence, but of systemic failure.
d this is where the public health doctors' strike comes in. Mícheál Martin's comments last Friday were ill-timed and worse worded, but their substance was just. The SARS outbreak was already a public issue when the health doctors began their strike, and now, as the disease continues to spread, other doctors are preparing to take action in their support. GPs are threatening not to notify health boards of any outbreaks of infectious disease, while hospital consultants may cancel elective hospital admissions. Since the issues at the core of the dispute are long-running, all this has the air of government ignoring problems in the health service until they boil over.
Once again, health policy is being dictated by vested interests rather than the needs of the public. And this is the fundamental problem with our health service - and 26-county policy-making as a whole.
Everybody knows what needs to be done to reform this ramshackle behemoth. Scrap the health boards and their cumbersome bureaucracy. Remove the stranglehold of the hospital consultants from the system. End the use of public facilities for private patients. Explore the availability of cheaper, generic drugs to evade the extortionate prices charged for their products by the big pharmaceutical companies. But no Fianna Fáil- or Fine Gael-led government will ever implement these changes, for to do so would involve standing on too many important toes.
Nearly every administration for the past three decades has made noises about reforming the health boards - and done nothing. Reform of health boards has become like those resolutions you make every New Year's Eve, knowing all the time you won't be able to keep them. The last minister to make such noises was Mícheál Martin himself. Protests followed from Fianna Fáil backbenchers reluctant to lose the leverage a seat on the heath board gives them in their constituencies, and the plan was quietly dropped.
Until we have a government willing to face down the vested interests that batten on the public purse and choke reform, we will continue to have patients lying in hospital corridors and a shambolic response to public health threats such as SARS. While minister and doctors wrangle, the suffering in our hospitals goes on, and a disease with no known cure creeps ever closer to our shores.
d comical Micky keeps spinning excuses.
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