A&E

The controversial Hanly Report sought the closure of many regional hospitals with the loss of full-scale A&E and maternity services. There has been much controversy over the closure of Monaghan hospital A&E department. A few months ago Patrick Walsh, the 75 year old man bleed to death because Monaghan hospital was not allowed to carry our emergency surgery on him. In 2003 Baby Bronagh Livingstone died after her mother who was in advanced stages of labour, was refused permission to give birth at Monaghan general hospital. She was transported by ambulance to Cavan and en route gave birth to a premature baby girl who died shortly afterwards. Over a year later there were renewed calls to put Monaghan back on call. Benny McCullagh a 72-year-old Monaghan man died from a heart attack as the ambulance could not attended nearby Monaghan hospital’s closed A&E but had to travel to Cavan which was more than 40km away. Local GP Dr Illona Duffy said that if he had been taken to Monaghan he would have been given life-saving clot busting drugs that would have given him ‘a fighting chance’..

This does not only raise the issue of inadequate A&E services for rural people, but also of the inadequate ambulance service. Could Benny Mc Cullagh’s life have been saved if the ambulance personnel were allowed to give him these clot busting drugs? The North Eastern Health Board in its statement said that the ambulance services are highly skilled emergency medical technicians who follow standard operating procedures and are trained to respond to all acute care situations, they are trained in CPR and defibrillation’. Ambulance personnel who have been trained in CPR and defibrillation are inadequate when you need drug to save your life. This inadequate training is sure to exacerbate the A&E crisis. If ambulance personnel could widen their scope of practice it would mean that patients could be treated at the scene and would be in better condition arriving into A&E or avoid the emergency department altogether.

Meath Street.

My favourite street in Dublin has to be Meath street. It is one of the only streets that is untouched by the Celtic tiger and the homogenous chain stores. It feels like authentic Dublin.
The street is strewn with stalls with selling everything from shampoo to runners, many of them after “falling of the back of a lorry”. There are pound shops cafes and backerys. Loads of butchers, one of which sells really fresh fish for a great price and you can buy the cheeps vegetables in Dublin in Jack Roche’s fruit and veg market.

What really makes the street special is the banter. The locals chat and gossip among them selves and every shop you go into, the chat is characterised by a dry Dublin sense of humour.

Lets hope Meath street stays that way for a very long time.

End of term party.

On my class night out I learned that mixing cocktails, baby Guinness, gin, beer and wine gives a very bad hangover.
I also learned a new expression “sneaky ram”.

Public Private System

Everyone keeps harping on about the health service and how the government can go about improving the situation. But what no one seems to recognise is that we have a two-tier public-private system which significantly affects the system. Under the present arrangement 80% of the beds in acute hospitals may be designated as public while 20% may be private. It is estimated that the current ratio of private to public beds in public hospitals is being exceeded, with too many patients in public hospitals been designated private. This would raise the question of how this bed ratio affects the public waiting lists and the overcrowding in A&E. One could assume that if we did not have this two-tier system that at least 20% more beds could be made available and thus reduce many of the problems.

A report by Comhairle na nOspideal found that some consultants protect their beds by delaying discharge in order to insure bed availability for their incoming patients. This report found that delays in discharges usually happen over weekends, or other times when consultants were absent. It estimates that nearly two thirds of consultants currently have contracts that entitle them to treat private patients in the public hospital were they work. In the public system they are contracted and are paid on a salary basis, in the private system they are paid on a per patient basis. Figures from 2001 show that having a private practice, in affect doubles a consultant’s salary. Even without a private practice they are the highest paid in EU. So consultants are rewarded hugely to attend to private patients and it is questionable if this is at the expense of the public patients and the public hospital waiting lists. One commentator, Sean Conroy, put it succinctly: “If a publican paid her barman by the hour for covering the bar and by the drink for covering the lounge, it would be hard to get served in the bar”.

Consultants’ daily work is been divided in this two-tier system, and one could come to the conclusion that this is impacting negatively on the public system. Many consultants want to discharge their own patients. If they are absent there will be delays in discharge and causing more blocked beds. The Irish Nurses Organisation recently announced emergency measures to tackle the A&E problem. One of these has been the provision of additional ward rounds (at least three per day) to ensure a speedy discharge. Within the current two-tier system this may be virtually impossible for many consultants to do.

Consultants’ absence may also affect the A&E department directly. Eight out of ten times patients in A&E are seen by junior doctors. These doctors may be inexperienced, and are more likely to give substandard care over a longer period of time causing further delays. The government’s health strategy proposes a programme for improving A&E departments by appointing more A&E consultants and to designating a member of staff to liaise with patients awaiting treatment. Mary Harney remarked recently that consultants would have to change their working hours because patients often ended up staying in A&E overnight, because there was no consultant on duty after 6pm until 8 or 9 am the following morning.
The two-tier system offers unequal access for unequal care. These inequalities cause patients to wait longer to see consultants and to get treatments. During the waiting period the patient’s condition may worsen and inevitably present with more complex problems at a later stage. One radical solution would be to abolish the unequal two-tier health system. Canadians take enormous pride in their state-funded medical system. Many provinces have an outright ban on private health care. Since 1972 every Canadian has been covered by national health insurance for medical and hospital needs. This system could be possible in Ireland with the cooperation of the medical profession. Such a system could be feasible in Ireland. The funding could come from tax or introducing a compulsory insurance system. Maev-Ann Wren, author of Unhealthy State: Anatomy of a Sick Society believes that this would be a realistic solution, by banning private practices in public hospital and investing in public care so that the majority would opt to be treated in a one-tier public hospital by salaried consultants. She also warns against the risk of insufficient investment, which may cause doctors and patients to take flight into the private system and leave the two-tier system dominant. Unfortunately this government shows no signs of veering to a one-teir system and celebrates in the collaboration of public and private.

Deep Blue

The invitation specified two rules; no illegal drugs and use of mobile phones was forbidden. It was a Saturday night in October and I was going to the first Deep Blue party in Dublin. My fellow invitees gathered outside Penney’s on O'Connell Street. We were collected by a hired bus, to be brought to an undisclosed location. Each of us had paid €30 for this uncertain pleasure.As we drove north of the city we speculated where our mystery bus ride would bring us. The Botanic Gardens? Finglas Observatory? An Airport hanger? I never would have guessed that the venue for our party would be Glasnevin Crematorium.On entering the church we were welcomed by Deep Blue, a Belfast based association of artist's, musicians, DJs, poets, writers, photographers and performance artists. The room was dimly lit and a recorded voice repeatedly asked what I was already wondering: What am I doing here?It was eerie. A person had been cremated there the day of the party. Most probably, there would be another cremation in the morning.Everyone commented on this, as if by acknowledging this we would be relieved from the sense of guilt.At the furnace there was a free champagne bar. Why not, I suppose? Soap was laid out around the circumference of the altar where two chairs faced each other. Visuals were projected on to the arched ceiling. I had no idea what was going to happen?The anticipation and wonder added to the excitement and seemed to dispel feelings of discomfort. There was also grandiose feel to the party as we sipped on our champagne, listening to opera in this beautiful spacious old building. This was, after all, one of those events that can truly be called unique.There were performances artists, but they were not focal points. They blended in, adding another curious dimension to the night. After a while it was accepted as normal that a girl was standing still on the altar holding a painting in front of her face for an hour. Another lady got the soap and a bowl of water and washed the doors of the church, which she has previously covered with jam.A girl dressed in a black and white corset appeared and got the attention of the room. She also sported a clear plastic cone around her neck, which amplified the sounds she made. Then she manipulated her voice, making bird-like purring sounds which got louder and louder. I sat dumbstruck, trying to figure out what it was all about.Deep Blue has a policy of not promoting dancing as the exclusive element of clubbing. Each party is at a different venue, and it frequently changes the types of music and visual entertainment. The only constant in Deep Blue is the free champagne bar provided by its sponsors, Lanson Champagne of Belfast, and Piper-Heidseick Champagne of Dublin.Previous venues include Belfast Zoo, a sewage works, an aquarium, a railway station and a gallery. It has also preformed in New York and Barcelona.
Many of the invitees had come alone, and some were of the 30 - 40 years age group. One guy had travelled alone from Liverpool for the event. People had expected a gathering of at least 100 people and were surprised that the group numbered only 40.
There was an eclectic mix of music. Swing, classical, jazz, opera and rock were all played. A lone saxophone player walked around playing moody jazz. Two musicians banged out some techno beats on their synthesizers, accompanied by a keyboard and their friend who was ten feet up on scaffolding playing a hand held keyboard.This heightened the revellers energy levels. As we danced on the altar we joked about excommunication and our journey to hell. A friend, Jeremey, took the microphone for a freestyling MC session and he ingeniously improvised to the techno.The Gypsy Kings were the wind down music. Our bus was there to bring us back to the reality we had just escaped from. I left happy and satisfied wondering when the next party would be. They set out to entice, bemuse, and amuse and this they did.

Pyjama wearing women

I have been living in the inner city since this summer, and I have noticed a strange phenomenon that seems to have taken hold in Dublin 8. No, it’s not junkies wanting to syringe you or travellers riding around on there horse and carriage looking for scrap. Its people wearing their pyjama out doors!

No, they don’t just happen to be in their pyjamas and realise they have to go to the shop for some milk. They wear their pyjamas as a fashion statement. I don’t fully understand what it’s all about but what I have noticed is that it’s mainly the females that are the culprits. There is no age distinction but it’s predominately the over 45 and the under 16 that wear there bed attire outside. These pyjama wearing women wear normal cloths during the day, the women go and do their shopping and the young girls go to school. Once they return home after their daily work done they get straight into their pyjamas.

You may think, there is nothing wrong with this and that you often get into my pj’s early and vegetated in front of the TV. But what you don’t do it get into my pj’s at five o’clock!! It’s not even that they have any intention of staying in and watching the TV, the kids come home from school and get out of their uniform into their other uniform. They then hang out in gangs around street corners (in their pyjamas) or the younger ones play street games (in their pyjamas). You see the older ones in the shop and going for walks in their pyjamas!!

I remember when I was in Vietnam three years ago I stopped off in a place called Delat. Everyone was wearing pyjamas! In the restaurants, in the shops and the cinema! Apparently this is a uniquely asian thing but could this have really spread to Dublin?
Does anyone know what this is all about?

asians

Mad Hot Ballroom

I went to see Mad Hot Ballroom last night. This is a documentary about preteen kids entering a ballroom dancing competition and the adults that are teaching them. None of the children had ever danced before and we see them transform on screen while learning the foxtrot, merenque, rumba and swing.

At first they are awkward in their own bodies and repulsed by dancing with the opposite sex. Their faces even grimace at the teachers order to keep eye contact at all times. By the end of the movie these children are extremely confident and superb dancers.

It follows two main schools of poorer areas New York. Many of these kids are from Dominican Republic emigrant families and we get a glimpse of what there home life is like.

The beauty of the film is the natural charm the children have. They break out of their childhood shells as we get a glimpse of what it was like to be 11 again. These children are still so innocent but very open and become completely immersed in the moment.
It’s heart-warming and inspiring and you will litterly be dancing out of the cinema.

Burningman.

I was at the Burning Man festival for the first in 1999. At the time I was living in San Francisco working on a J1 visa. I had heard of the festival before when I was about 16 on a channel four documentary “Rave New World”. While watching it I promised myself I would go one day.
Five years later I find myself in the middle of the middle of the Nevada desert surrounded by seer madness. The TV had not prepared me in anyway for what I experienced and I quickly understood what “culture shock” meant. I had never before experienced people been so uninhibited and free. Naked people wanting to paint me or having people give you things just for the fun of it. That not to mention wandering in cluslessly to the orgy’s and S&M tents!!
To say it was an education is an understatement. I suddenly knew what the hippy movement was all about and developed a true appreciation of hedonism.
I went back home to Dublin with colourful tails of the event. The next year I returned with a troop of my mates on the promise of the “time of their life”. That they had and we all went again for the third time in 1999.
It’s been five years since I’ve been there and I miss it. Many people claim that it’s got to big and commercial (check out http://www.burningmanisdead.com/). I recently came across an email I got from a friend who was a burning man this year for his first time. It may not be with in not with in “blog” rules to paste another’s mail, but I simply had too as I think it captured the wonder and chaos of the event. Enjoy!
For more info go to www.burningman.com

The Budget

The budget was released today and by all accounts the low-income earners with children and the pensioners did well. But the issue of health care seems to have been put on the back burner for an other year. Our health service is in a mess and the government seems to have done nothing constructive to solve the problem.
The A&E crisis seems to have fallen from the media spotlight over the last few weeks. Some people may interpret this to mean that things are improving, unfortunately not.

According to the Irish Nurses Organisation this year there has been an average of 265 patients waiting on hospital trolleys every day. MRSA is endemic in our hospitals and patients are still waiting too long to see hospitals consultants.

I am aware that money is not the only answer to the crisis in our hospital service. The government health expenditure is above the EU average per had of population. However some provisions should have been made for the promised improved “primary health care” and what about the cancer patient who has to travel from Donegal to Dublin for their radiotherapy, not to mention an improved ambulance service. Money also could have been provided for the appointment of more A&E consultants. This list of worth while causes could go on and on.

It’s so depressing to know that there is no sign of improvement for our hospitals and that patients will continue to suffer for the foreseeable future.

The Irish Ambulance Service

This is a follow up to my last post called “Media Ethics”. Mayoman left a comment asking if the girl survived the incident. I don’t know whether she did or not. If she did, she would have been left with sever brain damage as her oxygen supply to her brain was cut off for a long time. Perhaps now she is been fed by a tube in her stomach and can’t talk, walk or live any semblance of her previous life. This happens regularly to drug users who overdose. They ended up living the rest of there life in a state institution. I wouldn’t call it living.

The sad thing about it is, if this drug addict lived in the UK she would have had a much bigger chance of survival and she might not have had to go to hospital at all.

The drug narcan is classed as an opioid antagonist. It is used in the emergency treatment of opioid poisoning, heroin is an opioid. When some takes an overdose of heroin their respiratory system is suppressed. That why the girl I found was not breathing and was blue in colour. The treatment for heroin overdoses is to give narcan thorough the vein. Within minutes it reverses the effected of the heron and the person is back to a relatively normal state.

The addict I met was given oxygen by then ambulance crew while on her way to the Mater Hospital. She would have received narcan when in A&E but at that stage she would have been brain damaged. In the UK the ambulance personal would have been able to give the drug straight away at the scene of the accident. Most people then walk away and usually do not come to A&E at all. This saves health services money and most importantly it saves lives.

The Irish ambulance service is not covered to give any drugs or difibulate (electrical shock to the heart. You may see them in ER shouting clear before they use it). All they are covered to do is give oxygen. That is unless they are a cardiac ambulance, in which case they are well trained and equipped. Unfortunately there aren’t many cardiac ambulances around. The ambulances personal welcome any extra training but are not given the responsibility they deserve. So instead the Irish public have to settle for substandard ambulances which provide little more than a taxi service ferrying people to hospital.
Check out the site below for a first person account of been revived from narcan.
www.erowid.org/experiences/exp.php

Media Ethics

In class the other day we had a discussion on the media and respect to the individual’s right to privacy. It came about after examining some of the media coverage of George Best’s funeral. The Best family had requested that the family be left alone by the media so they could grieve in private. There was a picture of George Best father standing at the door of his home, presumable looking with distaste at the packs of journalist that had gathered there.

There was a divide in the class. Some would knock on the door saying that it if it wasn’t them it would be someone else. Others wouldn’t as they felt it was disrespectful to the Best family. I was torn. I could see so both sides.

It reminded me of a situation that happened about four years ago. I was walking up O’Connell St with a friend who was studying an MA in Journalism at the time. I had just qualified as a Nurse. We came across a girl who was unconscious and not breathing. She was blue in colour. We quickly became involved in trying to help her. My friend called the ambulance while I commenced CPR. The unconscious girl had overdosed on heroin. Five minutes later the ambulance arrived. By this stage a large crowed had gathered around.

My journalist friend had his camera and wanted to take photos of the ambulance men putting the girl on the stretcher with a view to writing a story. I was disgusted at him. As a nurse you are thought to protect the patient and respect their privacy. I argued with him, that this girl may die or be left brain damaged and all he could think about is writing a story. He put the camera down and wrote no story,

Now I am studying journalism and can reflect on this experience with a different view. Instead of thinking that he’s insensitive and disrespectful, I admire his nose and readiness for a story. Whether or not I could ever become the person that takes the picture is questionable. I suspect I’ve been a nurse too long and would find it difficult to separate my emotion from the drive to be a news journalist.