Wednesday 2 July 2008

Emergency Care in Ireland - a Sham and a Disgrace

Last night I had the misfortune of having to go to an A&E room in a Dublin children's hospital. Happily my 10 month old wasn't terribly ill - but an out-of-hours GP had recommended that he be seen by a pediatrician. "Go to Tallaght" the GP advised "you should be seen fairly quickly. Crumlin is straight from Dante's inferno, and entering Temple street is like arriving on the Western Front". Ok, we thought, let's give Tallaght a try. We agreed in the car on the way over that we would sign in, take our chances and if the queue seemed impossibly long, we'd simply leave, keep and eye on the young fella and reassess in the morning (thankfully in our case that was an option).

So we arrive at Tallaght Hospital and head to the adult A&E, which is the starting point for finding the Children's A&E nearby. In we go and ask directions."You need the children's A&E?" a security guard asked helpfully "just follow the steps on the floor". And sure enough there were little red (unhappy choice of colour in an A&E?) paw marks on the floor that led to the children's A&E.

We followed the red paws down a series of corridors through the adult section. That trip alone was enough to tell you all you need to know about the state of Irish emergency care. The entire network of corridors was lined with adult patients on trollys. Some of these patients were visibly distressed. You could tell that apart from privacy and facilities, these people were not getting what any sick patient requires: rest.

One man sat on his trolly looking into the distance. He had obviously gone on the emotional odyssey that a visit to an Irish A&E typically entails: you arrive in expectation which the atmosphere alone, together with he obvious chaos, grinds down to mere hope. Then you enter a chasm of uncertainy. The passage of time and the feeling of invisibility begin to lead to doubt. A few false dawns, sometimes in the form of pure lies, give despair. Another few non-productive interactions mixed with a sense of being ignored sends you in the direction of anger. The sheer absence of the notions of care and dignity compounds the anger. But a realisation that the staff are overburdened and working in a vast chaotic morass, soon defeats even anger. Resignation is next. That is where the man on the trolly was. He'd been through the cycle - we were just beginning.

So we sign in and wait for triage. A very pleasant but hurried nurse took basic readings and information. Then we joined the real queue. We were still in the hope stage. The queue didn't seem that long - perhaps a dozen patients. But when three quarters of an hour elapsed without a single patient being called, hope began to evaporate. We were asked for a urine sample from the wee man. (Not easy from a 10 month old - the timing always seems wrong!) Eventually he obliged!

Half hour later we were asked for a second sample. They needed two. Great. This time it was harder. But finally, we get a good cupful! Maith an gasúr!

By this stage the young man is not only unwell, but very very tired, and also overexcited by the other children and the general husstle busstle. Frustration is setting in all round. But here is the key. I asked if there was a list or if the staff could tell me if the young man was anywhere near being seen. Good news. Only two patients before him.

Sadly another long cranky hour passed before two more patients were seen. But at last our chance was imminent. Then hang on! Another patient is called, then another. Oh no. Here we go. I approached and asked again about our status. I was assured we were next. But then another patient and another are seen. Anger is setting in. Not anger that we are not being prioritised: anger that we are being fucked around.

Why is there not a modicum of concern for distressed patients? Not a shred of honesty? Not even a hint of treating people professionally and with dignity? Why no automatic communication? Where have all these basics gone among the hideous, mess that is A&E here? These questions well up in anger time and again as you get fobbed off and lied to or just ignored.

I make a final attempt - citing politely how our curious progress on this list is hard to understand. But if there was an explanation, none was given. Just an interuption "Child's name". I answer. Ok, his chart "seems to" have been taken by a doctor. You'll be called soon. We wait again. Nothing happens. More patients called. I wonder if the chart exists. Another paitent is called. We grab our coats and head off: resignation.

But my heart went out to those who could not leave, yet had to suffer in this shameful, appalling, and chillingly inhumane system. It's a sham and a disgrace. And this is what's on offer after a decade and a half of abundance. It seems this is as good as it gets. We're heading into to cuts now. Sad. Terribly sad.


steph said...

Hi Tomaltach

I spotted this great post of yours earlier today at
and linked to it from my blog.

I also left a comment for you there.

If you would like me to add a link directly to your blog, just say the word.

I was relieved to hear that your little lad was none the worse for wear following his brush with the Irish health service!

It's an appalling mess, isn't it?

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