A shortage of GPs is posing a significant risk to the Irish health system, the Irish College of General (ICGP) practitioners warned recently. A growing population with longer life expectancy is resulting in increased demand for primary care at a time when many older doctors are due to retire.
The problem is most acute in rural areas, where it is increasingly hard to find qualified GPs willing to live outside urban areas.
A new initiative aims to ease these challenges. The ICGP is seeking to attract at least 100 qualified doctors from overseas to rural practices this year as part of a two-year supervised work programme. At the end of it, the plan is that they will fully qualify as GPs in the Irish system, stay in their new communities and, if they want to, treat publicly funded patients in practices of their own.
So, who are these doctors? How are they settling into rural areas? And how are local communities responding?
‘They’re lovely people and they need us’
Dr Amara Anwar and Dr Omair Latif Naz, Clonaslee, Co Laois
Relocating from Lahore, Pakistan, with its population of more than 10 million, to a small village in north Co Laois with barely 600 residents might induce culture shock in some – but Dr Amara Anwar is taking it in her stride, with her husband Dr Omair Latif Naz.
“The people are so lovely and we have one of everything, a grocery shop, a petrol station, a pharmacy... tick, tick, tick. And a post office,” she adds, “I like to shop online, once I heard there was one here I was happy.”
They have moved to Clonaslee where their eight year-old son Qasim will soon start in the local school, while 3½-year-old Haider will be looked after by a local childminder.
During the period of supervised work provided under the scheme, Anwar works with Drs Julie Cunningham and Mary Sheehan in Clonaslee, while Latif Naz drives the 30km to Birr each day to the Green St Medical Centre run by Dr PJ McAuliffe.
[ Scheme attracts almost 50 doctors from outside the EU to work in rural surgeriesOpens in new window ]
Their new home is in a quiet cul-de-sac just outside the picturesque village, a stark contrast to their home in the busy and bustling city of Lahore.
We’ve always liked to live in areas that are naturally beautiful and with a less rush, less traffic, less population
— Dr Omair Latif Naz
Family connections have been a factor in the midlands move. Latif Naz’s sister, Zaneera, a paediatrician based in Mullingar, and her husband Imran, a rheumatologist, encouraged them to give it a go. Notwithstanding this, in Clonaslee, they joke, they pretty much are “the international community”.
“People have been so welcoming. And everybody is, ‘oh, you’re the ones who have moved into John’s house’. Everyone we meet.”
They have been struck by the relentless desire of local people to help them settle in. When they sought a school place for their son, they were told, “If you’re coming to the practice, whether we have a slot or not, that’s our headache. We’ll make it for you – because you’re coming for us,” says Anwer.
The feeling of being appreciated is nice, says Latif Naz. “Rural communities can be neglected, you know, people don’t always want to come in here – but we’ve always liked to live in areas that are naturally beautiful and with a less rush, less traffic, less population. And if you’re not exploring this life, you don’t know what is inside, do you know what I mean?
“But it’s not just about that opportunity... they’re lovely people and they need us. They don’t want to drive 30 or 40km and go to the hospital if they have someone they can walk to see here.”
Their long-term future, they say, will partly depend on the opportunities that open up for them.
“We’ll see if things are happening the way they should in two years but if we get good opportunities... definitely. Why should we leave?” says Latif Naz before Anwer breaks in laughing again. “I can see myself here for longer years. I don’t know about him,” she jokes.
‘I see a lot more cancers and malignancies’
Dr Yasin Rhemtula, Co Westmeath
“Rural healthcare tends to be on the back burner compared to cities,” says Dr Yasin Rhemtula during his lunch break at the Bellview clinic in Mullingar.
He’s not specifically talking about Ireland, though. A couple of years ago he was running a network of three thriving GP practices back at home in South Africa’s Limpopo province where, he says, “when I talk about rural, I mean sand roads, mud huts”.
Still, he suggests, these things are relative, and since arriving in Ireland for a second time to work in medicine he has become all too familiar with the reasons behind attempts to coax overseas doctors into rural practices here.
“When I got to Ireland I wasn’t completely aware of the rural GP shortage here, but it’s at crisis proportions,” he says. “Every country protects its citizens. It goes without saying. But when there’s a crisis like this with a workforce, we need to open the doors.”
Rhemtula says he was disillusioned with the growing difficulties at home before moving here. He says a growing threat meant he had to employ armed security at home. “They [criminals] walk into your practice, hold up your patients, hold you up,” he says. “They take what they want... your car, your money, drugs, cell phones, then leave and there’s nothing you can do because you’re defenceless. We’re doctors, we’re not fighters.”
If I have a patient in and I suspect something, I can get a CT scan pronto. In South Africa, we didn’t have that facility
— Dr Yasin Rhemtula
The safety of his family – his wife Aneesa and teenage daughters, Layan and Nurah – was a growing concern too. After they weighed up options that included Australia, Canada and the UK, “everything pointed to Ireland”, he says.
“Ireland was an easy choice, it’s a gateway to Europe and if the girls want to study in Italy, Spain or the Netherlands, that’s an option for them. And Mullingar, it’s a good town and if you drive 15km down the road it’s fully rural Ireland, but Dublin city centre is only 45 minutes away. And the scheme has been great. I didn’t come here on it but when the opportunity arose, I jumped at it.”
[ Over 100 foreign doctors sought for rural GP practices in bid to ease shortageOpens in new window ]
The basics of the medicine are the same, he says: “Heart failure is heart failure. Although there are differences with protocols – and I do see a lot more cancers and malignancies.
“Whether there’s really a higher incidence is debatable perhaps because the pick-up rate in Ireland is very high. And we have the resources here. If I have a patient in and I suspect something, I can get a CT scan pronto. In South Africa, we didn’t have that facility. The closest scanner was probably 300km away from me.”
‘Sometimes [with] talking ... 50 per cent of the problem is solved’
Dr George Leslie Thomas Prekattil, Co Wexford
Originally from Kerala in India, Dr George Leslie Thomas Prekattil – or Dr George as he is generally known – first arrived in Ireland in 1998 as part of his studies at the Royal College of Surgeons. While he has since worked elsewhere, has been become enthusiastic enough about living here to have written a book about Ireland in his native Malayalam, as well as various articles.
I’m living in a country full of freedom and energy. I’m breathing that
— Dr George Leslie Thomas Prekattil
When weighing up whether to spend a spell here or in the UK, he was originally guided by a well-read Indian friend who told him about Joyce, Wilde, Beckett and Shaw. He cites music and film, too, as having made an impression on him. Now, he’s involved in a bit of both locally while also serving as a peace commissioner. He has, it’s safe to say, embraced the place.
“I will give you a 100 per cent mark,” he says with characteristic enthusiasm. “I’m living in a country full of freedom and energy. I’m breathing that.”
When he first arrived, Prekattil stayed in Dublin where, he remembers, he was still regarded as a curiosity when out and about. People, he says, would come over and touch his skin. He loved the city at the time, but feels it lost a lot of its charm in the boom years and since. Enniscorthy, where he now lives, is a “is a beautiful tiny city with a rich history”. He has been joined by his wife Laija Maria and, more recently, one of his sons, Abel (25), who is also a doctor.
He had stints as a locum in other practices before settling in at the Slaney Clinic, where his clinical supervisor on the ICGP scheme is Dr Linda Forde. His feeling of connection with his patients is clear as he recounts moments from his day-to-day work.
[ Almost half of nurses in State earned first qualification abroad, new data showsOpens in new window ]
The people he works with, he says, “are all giving me good guidelines, and good energy”. He also, he hopes, brings “comfort and compassion”.
“We need to be devoted to love,” he says with a smile. “Anybody can write an antibiotic [prescription], but sometimes just [through] talking to each other, 50 per cent of the problem is solved.” If talking things over plays that big a part, his patients are certainly in good hands.
He remembers wanting to be a doctor back in Thrissur, India, where his mother was a health worker who often brought him to the hospital and put him sitting in a corner, from where he watched.
“My passion is writing, though. And history. And poems. Okay, and documentaries. And this place full of creative people.”
That guy who suggested to him to go to Ireland seems to have called it right.
