Tuesday 18 December 2007

Horror Street

The experience of Bean Thomaltaigh and I in two Dublin hospitals before and after the birth of our son four months ago confirms the general perception of the Irish Health Service. The medical staff were friendly, professional, and effective throughout. With few exceptions, clerical and administrative staff ranged from the incompetent, through indifferent, to downright rude. For an outside observer the combination of dire communication, pitiful information management, and lack of direction would be comic. For patients in long queues, often worried or distressed, it is nothing short of horrific. A few examples will suffice.

On the day of our three month scan at Holles Street, pregnant women queued standing on a stairway after first cramming through a tiny, stuffy prefab at the rear. We had seven separate interactions with five staff members, three of whom were clerical. We were asked the same set of questions four times (Yes, I counted). Is this your first baby? How many weeks? Have you diabetes? And so on. Then we’d pass to the next person who again started from scratch as if we’d just walked in the door. At one stage we filled out a form with all of these questions. No one wanted it later, they just kept on asking the same questions. A nurse pointed us down a corridor but there was confusion about which doctor would see us and where. During Bean T’s medical examination a woman burst in the door before anyone had time to answer her one-touch knock. So much for privacy. She then grabbed an enormous bundle of dog-eared files from a table. So much for technology. Thankfully we had no specific medical problems that day. Otherwise the warlike chaos would have completely broken us. As it was, like others, we just raised our eyes and sighed.

On the the night Bean T’s waters broke, while waiting in the foyer at Holles Street, a woman in the early stages of labour burst into the bleak Victorian reception area with her partner. The woman was breathing heavily and while in no immediate danger of giving birth, the couple expected to be reassured and directed towards some kind of hospital care. Instead a porter in a woolly jumper nervously asked “how often are they coming?”. When the woman said “every 10 minutes”, the man turned away and said “take a seat, you’ll be alright”. The couple looked at each other in bewilderment wondering whether they had arrived in a warehouse or the National Maternity Hospital.

A few weeks ago my son needed a lactose intolerance test. Bean T brought him to Crumlin Childrens hospital and provided the sample as instructed. As she headed out the door the receptionist must have noticed something was missing in the discharge forms. She shouted after Bean T “Come ‘ere, sorree, come ‘ere, ya need ta…”. So much for manners. Worse still, after weeks without word from the test Bean T phoned to be told in indifferent tones that the record of the test had been lost. Well well, what a surprise. Perhaps a dog-eared file was whipped out the window by a thieving breeze. When Bean T persisted, asking for a double check, she was eventually told that no, in fact the results hadn’t been lost, but there was insufficient material in the sample for proper analysis. We obviously weren’t going to be informed about this until we came looking. How utterly depressing. I really feel for those undergoing more serious testing or treatment in this gruelling environment.

These are but a handful of instances which back up the perception that the entire system is a shambles. Organisation, direction, and accountability are absent. Instead of compassion, patients get contempt, by the shovelful. For sure there are many decent people working hard at all levels. But whether through lack of resources, lack of moral, or otherwise, a culture of shameless indifference to the patient has taken hold. It really is the medical version of Fawlty Towers and it’s a national disgrace.

Thursday 13 December 2007

We Are All Smarter Now

I read an article in the New Yorker lately which showed how much smarter we are now than a couple of generations ago. Essentially a social scientist in New Zealand called James Flynn studied IQ test results from all over the world and discovered that IQs are rising by about 0.3 points per year. The rate may seem insignificant but the cumulative change over a few generations is striking. It means for example that the average 20 year old today is way smarter than his grandfather was when he was 20. Perhaps this seems obvious, but it challenges the entire concept of IQ and of how intelligence is measured. It was believed until recently that IQ measured an innate intelligence level, but this cannot be true: obviously humans cannot evolve a higher mental capacity over two generations. So what does IQ measure?

The authors of the piece cited the American biologist James Watson who landed himself in deep trouble recently for saying that he was "inherently gloomy about the prospect of Africa" as "all our social policies are based on the fact that their intelligence is the same as ours — whereas all the testing says not really." Even if tests show that Africans have lower IQ than Europeans, that doesn’t mean very much. It all comes back to the question, what does IQ measure?

The answer given in the New Yorker articles seems emminently sensible. How we process information depends on how we relate to the various parts of the information in our everyday life. For urban, educated people today, the relationship between dog and rabbit is ‘both are mammals’. For a 19th century farmer the relationship was ‘dogs are used to hunt rabbits’. IQ therefore, measures not so much how intelligent we are, but how modern we are. Innate intelligence is just one variable among many of which IQ results are a function. To conclude the piece drives home the point by saying “I.Q. measures not just the quality of a person’s mind but the quality of the world that person lives in”. It applies as much to the difference between the wealthy and the deprived in Dublin as it does to the difference between America and Africa.

Tuesday 4 December 2007

Tea or Coffee?

I love a coffee in the morning, but throughout the day I'm a tea man. Tea is more subtle - its flavours are slowly coaxed from the leaf by infusion while the essence of coffee is blasted from the bean by force. And tea is lighter and more refreshing. Listen to the hypnotic jingle of the stirring spoon: in tea it is high pitched, sprightly and musical; in coffee, monotone and serious. Tea is pleasure, coffee is business.

Of a heavy, tired morning, I simply need coffee. I like mine with lots of milk and just shy of being hot. I take large mouthfuls and swirl the liquid around my mouth, inviting the lactose and caffeine to contest their differences over my tongue. Lactose is a strong starter but the drug always prevails. The result is delightfully bitter-sweet. Best of all, the dutiful caffeine sets to work immediately. It conquers lethargy and defeats gloom, allowing colour to seep back into the office greys.

But if coffee is necessary to launch the day, tea is required to sustain it. A cup at three is the mainstay of my afternoon. On the odd occasion when I have to miss it, my whole day collapses. After lunch the lazy clock runs slow , and tea at three gets it moving again. On particularly long days a second cup is needed after 5 to repel the plodding soldiers of tedium.

At home tea is king because it can be made to perfection. Tea tends to get set in its ways and hates change. A new tea pot or an extra minute can destroy it. The pot must be scalded and I heat the cups as well to make sure. I give the flavours enough time to timidly emerge from the leaves and I pour each cup half way first and then top up in reverse order. This guarantees consistency.

It is easy to understand why the Japanese developed a ceremony based on tea. You see, making tea is a ritual. While coffee is individual, tea is social. It brings people together and kicks off the conversation "do you like yours strong or weak?". "Milk or sugar?". Before the first sip strangers are on talking terms.

In some ways tea feels older because, especially in Ireland, it came way before coffee. In that sense tea is nostalgic. When I think of perfect tea, served repeatedly throughout the day, I think of home. It brings me back to an earlier time. While the latte is unashamedly modern and chic, tea remembers tradition.

In coffee I have found a necessary acquaintance, someone to meet for a time to bridge the gaps. I have no loyalty to it. If I gave up work tomorrow, coffee might well be jilted too. But tea is a soul mate. It deserves - and gets - my respect. The passion is heartfelt. Coffee may well be a phase, but tea is for life.