HEARTBEAT:The people of Monaghan have been misled and betrayed, writes Maurice Neigan.
"Who owns them hungry hills,
That the water hen and snipe must have forsaken?"
SO WROTE the Monaghan- born and bred, but universal poet Patrick Kavanagh in Shancoduff, a poem evocative of his native place. He was writing about the heartland of his county with its "stony soil" and "black hills".
The rhetorical question above, posed by the sheltering drovers, prompts the suggestion that as well as the water hens and snipe, that more recently the area has been abandoned by the HSE in removing essential medical services from the area by closing Monaghan General Hospital.
This hospital has been in the town for a very long time and has served all citizens faithfully, regardless of means or political or religious persuasion. In Lewis's Topographical Dictionaryit was described in 1834 as having "provided relief to 286 inpatients, and medicines and attendance to 900 outpatients".
The then population was 3,900 and the whole county 11,900. The hospital developed over the years to provide a wide range of services for the people of the county. It was typical of the genus of general hospitals such as Roscommon, Nenagh, Ennis and Mallow, etc.
It provided maternity and basic gynaecology, general surgery both acute and elective and also general medicine. There was an AE unit available at all hours. The hospital functioned well and the people were happy, indeed proud of it and it was an integral part of their community. In passing I might note that another part of their community has also been recently challenged by the almost inexplicable decision to withdraw the grant available to Protestant schools to allow their community maintain its own ethos.
Monaghan Collegiate School would be one of those to suffer. The money was nothing special but the gesture was, and its removal raises questions about the bona fides of those who preach respect for each other's traditions.
However, for the hospital the clouds were gathering. Firstly, the Fitzgerald report and then Hanly suggested that the population might be better served by bigger regional hospitals - the so-called "centres of excellence" serving populations of about 350,000. This would allow for economies of scale and concentration of expertise. It seemed superficially logical.
Implicit in all of this was that the population would gain rather than lose from such reorganisation. It appealed to common sense. How many times have you heard "you can't have a hospital at every cross roads"?
Furthermore, it was clearly understood by all and promised repeatedly, that no downgrading or closure of such units would take place until better alternatives were in place and that the logistics in the form of better roads and an upgraded ambulance service were available to transport patients quickly to the new or upgraded facilities.
To revert to Monaghan; this has not been the case. The people have been misled and betrayed. Monaghan Hospital has been downgraded and its services curtailed. This is a fact.
Alternative, let alone better, services for Monaghan patients have not been provided. This is also a fact.
Such services were to have been provided by additional capacity at Cavan General Hospital. Apart from a small Medical Admissions Unit (MAU) of four to six beds or trolleys, no additional capacity has been provided in Cavan.
This is hardly surprising, since Cavan itself faces an uncertain future as it will almost certainly not be the site of the new "centre of excellence" planned for the unfortunate northeast.
On a nightly basis, patients lie on trolleys in Cavan and this before the closure of Monaghan has actually occurred. However, two ambulances with advanced paramedics have been supplied. This is to expedite Monaghan patients to their trolley time in Cavan.
This is clear discrimination. There is no social balance here. There was little effort to bring those affected by this major decision into the equation and together determine what is best for the region. Those responsible for making these decisions must be accountable to those most directly affected by such life-changing planning.
I attended a standing room only, 800-strong meeting in Monaghan town and I listened. Many spoke.
Many had been born in the hospital, many more had surgical and medical treatment there of the highest quality. Some owed their very lives to its proximity and the care of its dedicated staff. Caoimhghín O Caolain of Sinn Féin was there and Seymour Crawford of Fine Gael united in efforts to save their hospital.
No Government or HSE representative raised their heads. It was a humbling experience for me from my big Dublin teaching hospitals, assuming that our way was best. It set me thinking. Monaghan lost its maternity services, then its surgery. Now its excellent medical unit is also to become a memory. In all of this there is no gain for the good people, only hardship and pain.
I am indebted to John Robb FRCS for sending me the pamphlet Long live the small hospital. This was based on Rex Lawrie's suggestion that 85-90 per cent of all hospitalised illness could be treated in the small local acute hospital.
Rex Lawrie FRCS was a consultant surgeon in Guy's Hospital throughout his career. John Robb, thinking, caring Irishman and one-time Senator, needs no introduction. It was so in the small, proud, little hospital in Monaghan. Maybe it's time to think again.
• Maurice Neligan is a cardiac surgeon