The Road to Recovery?

This evening a debate is due to take place in Seanad Éireann to discuss the future of the HSE. Last week, the Labour Party announced a set of proposals to reform the HSE. It has now put forward a motion to the Seanad seeking it’s support in facilitating reform of how healthcare is delivered in Ireland.

Senator Alex White leader of the Labour group in the Seanad writes “The motion is not a personal attack on the Minister, the Government or anyone else, nor is it a retreading of old arguments; it is comprised of a positive set of proposals regarding how the HSE can be reformed.”

The wording of the motion and the Labour Party’s six step recovery plan can be found here.

You can learn more about the Labour’s plans for reforming the HSE by clicking here.

Having listened to RTE’s recent Prime Time investigation into the HSE where our health service was described as a poorly integrated, fragmented, poorly structured, inadequately resourced, appallingly planned service, I think the HSE would do well to take heed of some positive suggestions.

I welcome any debate which facilitates the best way forward for our health service. Otherwise the road ahead looks depressingly bleak.

Anything’s Possible

On reading Grannymar’s post One Armed Bandit last week, I was reminded of a time in my own life when I fought a one-armed battle. I have an inherited connective tissue disorder known as Ehlers-Danlos syndrome (EDS) which leaves me with a tendency to stumble and fall a lot. Being right-handed, my right shoulder has taken many blows over the years but it’s still going strong.

When I was in college many moons ago, I slipped and fell dislocating my right shoulder in the process. Luckily it went back into it’s socket spontaneously but the damage had been done. The anterior ligaments of the joint were torn and my arm needed immobilisation in a sling for many weeks to facilitate repair. From that day onwards, my right shoulder was unstable and certain movements were extremely painful. The joint would easily sub-locate and on numerous occasions this happened when swimming, leaving me stranded in pain with one arm stuck up in the air!

When my first child was a toddler, I stumbled one day while carrying him and again badly tore the shoulder ligaments. As my arms were full, I could not reach out to save my fall and landed on my right elbow sending the full force of the blow through my shoulder joint. I was seen by an orthopaedic surgeon who recommended an operation to stabilise the joint. I underwent open surgery (it’s done by micro-surgery these days) to have the ligaments of the shoulder joint re-structured to form a support network and they were also shortened to limit movement in the joint. A large metal screw was used to hold the re-attached ligaments in their new position. When I awoke from the anaesthetic, my whole right arm was tightly strapped across my chest and it was a struggle even to breathe. I was to spend the next six weeks in this tight strapping with only one arm usable. It was a difficult time as I had a small toddler to look after but we soon devised ways and means to get around most problems. I became a dab left-hander at doing most tasks though it took a while to get used to getting dressed one-handed and trips to the toilet took rather longer than usual. You try pulling up and down your clothes with one hand and you’ll realise what I’m talking about!

Once the ligaments had healed, all the strapping was removed and I started on a long programme of physiotherapy to recover movement in the joint. This was a very painful process and as time went on, the pain got worse instead of better so I was sent back to the surgeon for review. He was puzzled by the pain and recommended further rest for the arm, in a sling. A few weeks later I noticed a protruding lump at the top of my right arm which was very painful to touch. The metal screw used to fixate the ligaments had wriggled it’s way loose and x-rays showed that at least one inch of it was protruding from the bone. Back I went into hospital for more surgery to remove the piece of offending metal which I still have to this day, as a souvenir. Yet more weeks ensued with my arm in a sling before I was allowed to start physiotherapy again. You have no idea what pleasure it was to finally eat a meal using a knife to cut my food.

One of the aims of the surgery was to restrict movement of my arm in certain directions, to reduce the likelihood of further dislocation. No matter how hard I try, I cannot rotate my arm outwards and have learnt instead to rotate my body to reach objects on my right-hand side. I used to love playing tennis but my restricted shoulder movements made this impossible. Not to be defeated, I went back to tennis lessons starting at beginner level and learnt to play the game left-handed. Anything is possible when you’re determined to succeed. This all came to abrupt end however with another stumble which resulted in torn ankle ligaments but that’s another story. These days my right shoulder joint makes lots of strange creaking noises but it remains pain-free. I only wish the rest of my joints were as good.

All I want is…

It’s reached that time of year again when big money has to be found to renew my health insurance policy. I freely admit that this has proved to be a good investment over the years as I have a complicated medical history which has resulted in higher than average expenses. I’m happy to pay out good money for health insurance but I would much prefer to contribute to a scheme that funds an efficiently-run single tier, not-for-profit health service rather than contribute to what is fast becoming an apartheid approach to healthcare in Ireland.

The Irish health service is set to be radically privatised over coming years. Tax incentives introduced by our government, are leading to the rapid development of private hospitals throughout the state. Some of these hospitals will be co-located on publicly owned land thus duplicating the need for highly trained staff in the one location. Privately insured patients will soon have every luxury imaginable available to them while public patients will continue to suffer in our poorly funded health service. Furthermore, the revised contract of employment for hospital consultants is set to complicate the system even more. Some of the consultants will be allowed to work with public patients only, others can opt to engage in limited private practice on the public hospital campus or in the co-located hospitals while a third type will work in the public system but will also treat patients outside the public hospital campus. It strikes me that this system of healthcare will benefit the consultants and the private insurance companies but does little to improve conditions for public patients. It’s no harm to bear in mind that every citizen in this state is entitled to a bed in a public hospital but with the chaos in existence, more than 50 percent of the population have opted to take-out private health insurance. With the escalation of private hospitals, it’s inevitable that a sharp increase in premiums will follow and more and more people will be forced to drop their private insurance. If the underfunded public sector cannot cope with it’s present burden, how on earth is it going to cope with a further influx from the private sector?

Patients shouldn’t have to negotiate a minefield of options when choosing health insurance. I don’t want to be forced to buy into a 2-tier health system where the type of care offered depends on the type of insurance held. When I become ill, all I want is to be guaranteed a bed in a clean, efficiently-run hospital which will provide good care when it’s needed. Public patients are presently being denied this basic right. I’m prepared to pay for this right but I believe that it should be available to everyone via a universal system of health insurance. What’s good enough for one, should be good enough for all. When I’m sick, I don’t want or need an á la carte menu. I want doctors who will treat me because I am ill, not because of the insurance I hold or because they can make a fast buck by offering me a bed in a high tech facility. The present plans for the reform of our health service are totally absurd. Is it really too much to ask for some common sense to be applied before it’s too late?

The real McCoy

If you enjoy fly-on-the-wall medical documentaries, then hold on to your seat as another series of Surgeons is about to begin. Following on from the success of the series produced by Mint Productions last year, this three-part observational documentary series returns to capture the real lives of both the practitioners and the patients in our hospitals. Prepare to be amazed.

The first programme looks at organ transplant surgery and the work of Oscar Traynor in St. Vincent’s Hospital and Freddie Wood in the Mater Hospital, in Dublin. The series also looks at some of the issues facing the health service today: waiting lists, public versus private practice, centres of excellence and hospital politics.

This is no docudrama. It’s the real thing and it provides an excellent insight into what goes on in our hospitals. The series uncovers some powerful human stories at the cutting edge of Irish medicine. If you’re squeamish, this may not be for you. Otherwise, I highly recommend it.

Thursday 22 May on RTÉ 1 @ 10.15pm. Don’t miss it!

Strange Cures

Some people will go to any lengths to rid themselves of hiccups. In the west of Ireland, a favourite remedy for hiccups is to distract the patient by getting them to visualise a green cow grazing in a blue field. One doctor in the US has found a unique way to terminate intractable hiccups.

“Hiccups can be a distressing symptom, especially when it lasts for some time. The term intractable is used for hiccups that have lasted for a month or more. Hiccups occur when the diaphragm goes into spasm, followed by a quick and noisy closing of the glottis. The diaphragm is the large muscle (shaped like and upturned sauces) that separates the chest from the abdomen; the glottis is the opening between the vocal cords that closes when we are eating to stop food entering the lungs. There is some evidence for the existence of a “hiccup centre” in the lower part of the brain. The vagus nerve, which controls the opening and closing of the glottis, is linked to it, as is the phrenic nerve which carries signals to and from the diaphragm.

Most bouts of hiccups have no obvious cause. They may be triggered by a combination of laughing, eating, drinking and talking. Occasionally, hot or irritating food is the culprit. Hiccups also occur post-operatively, probably due to irritation of the diaphragm, but they usually settle quickly. Persistent hiccups raises the possibility of a serious cause, such as brain tumour or stroke interfering directly with the hiccup centre in the brain.

No single drug treatment has been found to be effective, so a plethora of home and medical remedies have emerged over time. Probably the most popular is holding your breath while counting to 10 or breathing into a brown paper bag, both of which raise the level of carbon dioxide in the blood, which helps stop hiccups.

Stimulating the vagus nerve also helps. This is achieved by drinking water quickly or by swallowing dry bread or crushed ice. Gently pulling on the tongue or rubbing the eyeballs also introduces vagal stimulation. The pharyngeal nerve can be stimulated by drinking from the wrong side of the cup.”

A doctor in the US came up with an unusual solution when a patient of his did not respond to standard therapies. Aiming to stimulate the vagus nerve, he stuck his (gloved) finger up the patient’s rectum and gave the patient a digital rectal massage. To the doctor’s delight, the hiccups stopped and the doctor went on to publish a research paper on his cure, winning an award in the process.

I dunno what you think about this but I know I’d rather stick to my own home remedies. You’ve got to feel sorry for this guy though.

With thanks to Dr. Muiris Houston at The Irish Times for his informative article on hiccups.

Sleep Deprivation

Ever heard of sleep apnoea? The most common form of this is known as obstructive sleep apnoea (OSA). It is a chronic condition which causes poor quality sleep and results in excessive tiredness during waking hours. OSA can affect people of any age and of either sex, but it is most common in middle-aged, somewhat overweight men, especially those who use alcohol. During inhalation, the airway will collapse causing pauses in breathing for about 30 seconds, then the person usually startles awake with a loud snort and begins to breathe again, gradually falling back to sleep. OSA has the potential to have serious negative effects on a person’s quality of life and many people go undiagnosed. In order to confirm the diagnosis, it usually requires an overnight stay in a specialized sleep laboratory where sleep is monitored and measurements are taken while the person sleeps.

In Dublin, there is only one sleep apnoea clinic available to patients in the public hospital system and this is based in St. Vincent’s Hospital. There is a delay of at least two years for an appointment to see a specialist in this clinic and if sleep apnoea is suspected, the patient is referred on to the specialized sleep laboratory at the hospital to be monitored overnight. Again there is a long waiting list for an overnight bed in this unit. At present the sleep apnoea unit in St. Vincent’s Hospital is undergoing renovation and the old casualty unit at the hospital is being used as a temporary sleep laboratory.

A recent radio programme exposed major flaws in this temporary accommodation. The conditions sound horrendous. Firstly, the one toilet in the unit, is filthy and unfit for purpose. The unit is used as a pain management clinic during the day and by evening time, it’s unsuitable as a sleep environment. The windows cannot be opened due to noise outside in the corridor and patients complain that they cannot get to sleep due to the heat and lack of air. It is a shared unit for men and women, with little or no privacy. It makes no sense whatsoever to call it a sleep laboratory if the conditions are so bad that patients cannot sleep. And remember, these are patients who have been waiting for years to be monitored. Frankly, this is sleep deprivation of a different kind and it could even be called obstructive.

Just another example of bureaucracy gone mad, while patients continue to suffer.

You can listen to a podcast of the programme by using the link below.

http://www.rte.ie/podcasts/2008/pc/pod-v-130508-27m42s-liveline.mp3

Blog Post of the Month

The Irish Blog Awards under the able leadership of Damien Mulley, have come up with another great idea.

“As a way of keeping interest going in the Blog Awards, there will be a “Blog Post of the Month” awarded to an Irish Blogger/Group of Bloggers who has/have written what the judges deem the best post that month.”

And here is my nomination for this award:

I have no hesitation whatsoever in nominating Grannymar for her post The light went out.

This post quite simply blew me away. In fact, judging by the comments, everyone who’s read it was blown away. It touched the hearts of all, young and old and indeed many of us were reduced to tears.

Grannymar wrote this post on the tenth anniversary of the death of her husband, Jack. It is a beautiful tribute written with great courage, wisdom, honesty, grace and enormous love.

By writing about her loss, Grannymar has overcome the taboo surrounding death and dying and I’ve no doubt that her words will help to ease the journey of others through bereavement. She also deals brilliantly with the thorny subject of the insensitivity shown by some people on meeting a bereaved person. She reminds us to be careful of what we say as ill-chosen words can be very hurtful when emotions are raw. But most of all, Grannymar illustrates beautifully how the human spirit can overcome adversity and begin to find joy in life once more. She is truly inspirational and her daughter, Elly can rightly be very proud of her.

I highly recommend you pop over to Grannymar’s to share in this uplifting post but don’t forget to bring some tissues. It’s moving stuff!

This post truly deserves to win a Blog Post of the Month Award.

Paying the Price

Today, I came across an article at irishhealth.com which lifted my spirits. It was refreshing to find such a well-balanced look at the multiple problems within our health service. Claire O’Reilly, a former nurse, spent a night in A&E last year because of complications following an angiogram. She has decided as long as she has the choice, never to return to an A&E department again. You can find Claire’s article here.

I was delighted to find another patient and former healthcare worker, who is prepared to stick her head above the parapet and ask pertinent questions about our health service. Claire blames the nurses, her own profession, for failing to speak out and take action about the conditions endured by patients. She believes that Mary Harney and Brendan Drumm are not listening to advice given and have forgotten about the patients in their determination to reform the system. She accuses them of constantly talking about the cost of running the health service and asks if they cannot see that it is the patients who are paying the ultimate price!

Patients are suffering and will continue to suffer as long as they remain silent. The time has come for everyone to join forces and make their voices heard. Please don’t wait until another scandal happens. Our new Taoiseach was installed yesterday. What better time to start?

So Dat’s Dat!

After ten years, ten months and ten days in office, Bertie’s finally gone! You cannot but wonder if Mary Harney will soon be following him. Brian Cowen, our Taoiseach-in-waiting, is due to receive his seal of office tomorrow and will announce his new cabinet shortly afterwards. Will he show Mary the door?

I had to laugh when reading about the HSE in the Sunday Indo yesterday. “A bloated system”. “HSE belt tightening is a fat lot of good”. “The HSE like everyone else needs to tighten the belt, to cut a little fat”. “The HSE will soon resemble a hippopotamus in bondage gear”. I”ll give you one guess as to what stimulates this sort of language from newspaper columnists. You’re right! Our present Minister for Health is no advert for healthy living and after three and a half years in the job, she’s definitely looking the worse for wear. Harney took on this role in September 2004 with promises to reform the health service. During her time in office, she is credited with achieving a reduction in A&E waiting times, putting a new cancer control programme in place, reducing operation waiting times and the introduction of hygiene audits.

A recent report provided by the HSE, showed that in the first two months of this year 44 per cent of patients in hospital emergency departments awaiting admission, had to wait longer than the official maximum target period of 12 hours. The report also revealed that the number of patients waiting more than 24 hours for admission increased by 57 per cent over the same period last year. The only thing that has improved is the HSE’s daily fiddling of the figures to make it look like there is a reduction in the numbers on trolleys.

As regards the cancer control programme, Mary Harney secured at enormous cost, the appointment of a top cancer specialist, Prof Tom Keane. His mission is to restructure cancer care in this country with the introduction of 8 new centres of excellence. According to John Crown, a medical oncologist, none of the four centres planned for Dublin will be comprehensive. “The plan is that colon cancer is treated in one place, lung cancer in some other place. That is not excellence in care. It is a system based on compromises which are in turn based on medical politics”. Under the new plan, there will be no centre of excellence located north of a line between Dublin and Galway. This system is already doomed to failure.

Waiting lists for operations have been reduced but at a huge cost. Surgeons and their operating teams in our public health system are frequently left twiddling their thumbs when their operating lists are cancelled because of the shortage of beds for elective admissions. Meanwhile the HSE is paying top dollars to the private hospitals via the National Treatment Private Fund (NTPF) to have public patients treated in the private system. This madness is Mary’s solution to the long waiting lists. Talk about false economy.

And finally the hygiene audits. Mary Harney promised back in 2005, to tackle health care associated infections (HCAI) and said that the target over the next three to five years would be to reduce hospital-acquired infections by 20 per cent and MRSA by 30 per cent. The numbers of patients becoming infected with MRSA fell only slightly last year. Newly released figures show there were 533 cases of bloodstream MRSA infection reported last year, compared with 588 in 2006, a reduction of less than 10 per cent. Overcrowding, poor cleaning, haphazard hand hygiene, infrastructural defects, and lack of infection-control staff particularly microbiologists, is favouring the spread of the hospital superbugs. Our Minister for Health is more interested in budget control than infection control and patients remain at serious risk of infection.

New official figures have shown that the HSE is now €95 million over budget for the first four months of the year. The HSE has drawn up a series of controversial proposals to claw back on the financial overrun. These include hospital bed closures, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements. There is also a proposal to divert the €185 million earmarked for the development of services for the disabled, older people and those in palliative care. We ain’t seen nothing yet in terms of cutbacks and the impact this will have on patient care.

There is increasing unrest amongst those working in the health service and patients too, are fast losing patience. Mary Harney’s credibility has been badly damaged by a series of cock-ups and system failures during her tenure in office. The failure to get the new consultant’s contract up and running has been a major blow to her plans. Her promises to reform the health service, have not materialised. The question remains. Will Brian Cowen take the easy route and leave Mary Harney to continue to take the flak or will he have the courage to show her the door?

Battle of the Bugs

Steph’s back! And so is Staph. I had a bit of blip with my health last week but I’m back on form again. At first, there was concern that it might be the unwelcome return of the superbug, MRSA. As it turns out, I have a nasty Staphylococcus aureus (Staph A) infection in my head but luckily, I have a non-resistant version of this bacterium which is very treatable. The problem I now face is finding a way to effectively eradicate this bug from my system.

It’s just over a year since I had surgery to stamp out a chronic osteomyelitis in my skull which had resulted from an MRSA wound infection following previous surgery. A few months later, I started to develop minor sinus infections and was reassured when laboratory tests showed that I was only positive for the more common form of the Staph aureus bug rather than it’s resistant form, MRSA. This bacterium is commonly found on the skin and in the nose of healthy people but it is not harmful unless it gets into the bloodstream. Approximately 20–30% of the general population are ‘Staph carriers’. I was treated with an sensitive antibiotic but the minor infections still continued to occur. Last November, I developed a nasty infection in my hand which turned out to be another Staph A infection. I was treated aggressively with oral antibiotics for 3 weeks and commenced a 6-month decontamination programme with the application of a topical antibiotic ointment to the inside of my nose. This process would appear to have failed as last week, nasal swabs and blood tests showed that the infection in my head is due to a heavy growth of Staph aureus. This latest development is worrying as it confirms that I am again systemically infected with this bacterium. I have responded well to a tetracycline antibiotic so there is no immediate cause for concern.

The reality is that Staph aureus is everywhere. It may well be that I have just been unlucky to have been contaminated/infected on several different occasions. My own theory is that my immune system has been weakened following intensive antibiotic treatment for MRSA and it has become a breeding ground for opportune bacteria like Staph aureus. The problem now is how to find a way to shake off this damned bug before it gets an even greater hold on my system. I cannot afford to let things go wrong with my head again. My GP has gone away to think about the options over the weekend. If anyone reading this has any knowledge on how best to proceed, I would be eternally grateful for your advice. I intend to win this battle.

When I became generally unwell last week and my head started to hurt, I lost all enthusiasm for blogging. I deserted the blogosphere but it didn’t desert me. My new-found blogging friends reached out and gave me the support and encouragement needed to get back on track. Thanks guys! I’m really, really grateful. Blogging – Yes! it’s the way to go!