The credit union is a great standby for a new car or holiday. But now people are borrowing to pay for hip replacements and other medical needs, as Kitty Holland discovered.
In the end she couldn't wait any longer. So unbearable had the arthritis in Mary's knees become that last year her husband, Paddy, borrowed €4,950 from the local credit union to have the surgery done privately.
"I was crippled with the pain. I couldn't move or do anything," explains Mary (66).
The Athlone couple are sitting in a hotel in the town explaining how life had become impossible for Mary.
"I could get no relief from the pain. I was on about eight painkillers a day. I couldn't walk into town or anything by the end.
"What had happened was I put this knee out," she says, pointing down to her left knee. "I had been clipping a hedge and the chair went from under me about 10 years ago. From then on I had a 'tender knee'."
She had a number of further setbacks with the knee, and was eventually referred to Dr Geraldine McCarthy, a consultant rheumatologist in Dublin.
Tests, X-rays and MRI scans were done - for which the couple had to use savings to pay - and she was referred early last year to a consultant orthopaedic surgeon, Prof John O'Byrne of the Mater hospital.
"He said the only thing was to get half the knee replaced," says Paddy. "There was a lot of wear and tear on it."
"Then while they were going to do this one, the other one started at me," says Mary. "There was a lot of arthritis in it too. So they said they'd do the first one, and then they'd have to come and get the other one later."
And while the couple's Plan B policy with the Voluntary Health Insurance would cover 90 per cent of the cost of the partial knee replacements, they would have to come up with €2,000, per knee, themselves.
"It was either that or wait 12 months [ on the public list]," says Paddy.
Asked whether he was shocked at having to pay such an amount on top of their VHI subscription, he shrugs his shoulders.
"I was and I wasn't. I knew it was coming, and I knew we were in good credit in the credit union. That was a comfort, to have them there to turn to.
"But, yes, it does annoy you when you you've been paying taxes for 47 years; that you've paid your VHI and still you have to go borrowing money."
Mary had the first knee replacement performed in the Mater Private last August, and the second in March this year. She is still using a walking stick and in some pain, but she says life is transformed.
The couple are thankful that they had the credit union to turn to. The weekly repayments of €42, which they will be making for another two years, they describe as "very reasonable altogether".
On top of the €4,000 for the knee operations they borrowed €950 to pay their VHI subscription this year.
"You'd have to have the VHI," explains Paddy, "for the peace it gives you. There is a health service, but where would you go to get it? I couldn't leave Mary in the pain and misery she was in. We don't mind the cost as long as Mary is able to get up and around. That's the principle thing."
Having worked all his working life as an electrician, Paddy retired two years ago. The couple have eight grown children, and Mary worked at home. Their income is the State pension of €370 a week. They are not entitled to a medical card, and pay about €80 a month on various medications, including blood pressure tablets and mild painkillers.
Paddy says that while they borrowed this year to pay the VHI, a small insurance scheme will come to maturity next year which will pay it for a few years. "We'll get the medical card when we're 70, so I suppose we're winging it a bit until then."
Asked whether their children might have helped with medical expenses, they nod effusively.
"Oh, of course, of course they'd never see us short," says Mary. "But we'd never ask. We don't need to. We paid our mortgage with the bit of money Paddy got when he retired. That was the first thing we did. So we are fine in that way. We are careful."
The couple who spoke to The Irish Times this week did not want their full names published. That they were the only people the Irish League of Credit Unions (ILCU) could find who were willing even to speak about going into debt to pay for medical expenses is indicative of how hidden an issue it is. Their situation, however, is clearly very usual, and becoming more prevalent.
Figures obtained by The Irish Times, show that credit unions lent a staggering €30 million last year for "vital medical needs". The league says people are going into debt to pay for heart surgery, hip replacements, knee surgery, eye surgery, MRI scans, orthodontic work, consultants' fees, outpatient fees as well as to pay for policies with the VHI and BUPA, the British-based medical insurance company which also operates in Ireland.
And the league believes this figure of €30 million to be an underestimation. Given the highly-personal nature of medical needs, Liam O'Dwyer, chief executive of the league, believes a significant number are saying they need the money for something else when applying for a such a loan.
The loans are not being taken out by just the lowest income households. "These are ordinary people struggling to get a decent and timely medical and dental service whether social welfare recipients, low-earners or financially-squeezed, middle class families."
The level of lending for necessary medical expenses indicates the extent to which "people can no longer endure the delay of public waiting lists".
Doctors also speak of a particularly vulnerable group of patients, "the hidden waiting list" who are waiting to see consultants to get the diagnosis just to get on a public waiting list.
Dr Ciara McMeel, a general practitioner in Dublin's north inner city, says she sees people on a daily basis who are willing to borrow money to pay to see a consultant privately just to get a diagnosis.
"These people are not on any list. They are not officially quantified and are hidden. And then there is a lot of borrowing within families and between friends to pay for medical expenses which doesn't show up on any lending institution's books."
She also describes people with neither medical card nor insurance paying to have tests such as X-rays or CT scans carried out rather than wait up to a year. "The worry gets to them and they will somehow put the money together."
A CT scan, she points out, costs about €250, "a big amount of money for someone on a low income".
The Irish Medical Organisation (IMO) is also voicing its concern. Dr Martin Daly, chairman of its GP committee, says most of his patients are on low incomes. He sees patients "every week" borrowing money to pay for diagnoses. One of the most common examples is a slipped disc, he says. A patient could be on a waiting list for between nine months to a year to get an MRI scan to confirm the condition.
"This is an extremely painful condition, frequently causing people to take time off work. Faced with a year-long wait, many will make the economic decision to borrow between €450 and €600 to get an MRI done privately."
It is replicated in a huge number of areas, he continues. He cites examples of women living outside the BreastCheck areas borrowing to pay for mammogram, and women with medical cards borrowing to paying for cervical smear tests. Smear tests are not available under the medical card scheme.
The Money Advice and Budgeting Service is also beginning to highlight this issue, with spokesman Mike Culloty describing personal debt for medical reasons as a "growing concern".
"Anecdotally the situation is that more people are borrowing to pay for medical needs, whether that's hospital A&E charges, GP charges or to pay for drugs. Sometimes people will come in having fallen into arrears on ESB or rent but having done so because they had to put medical expenses first."
As the number of people with medical cards has fallen, he says, "the corollary is that people have to find the resources from somewhere" to pay for basic medical treatment such as a GPvisit, and for more serious treatment if they want it in a reasonable time period.
"People know they can access it more quickly if they could pay for it. That must put enormous pressure on them to borrow, particularly if it's for a child."
Though the number of people with a medical card increased by 2,000 in March, for the first time since Mary Harney became Minister for Health in November, overall since then the number who have lost their medical card is about 10,000. Critics of Government management of the health service point out that since it came to power in 1997, the number of low-income medical card holders has fallen by just under 200,000. This is largely because the cut-off threshold for eligibility has not increased as wages and medical costs have.
The IMO has called for means-tested medical cards to be given to every person on or below the minimum wage.
Another factor placing strain on low to middle-income households is the cost of medicines. The fact is that generic drugs - ie cheaper versions of brand-name drugs - are not generally prescribed here.
The National Centre for Pharmoeconomics has called on the Government to examine the idea of making it mandatory for pharmacists to substitute a cheaper generic drug if available, even if the GP has prescribed a brand-name one.
While the Irish Pharmaceutical Union is in favour of pharmacists having the right to substitute generics it is against it being mandatory. The IMO believes all prescribing powers should remain firmly with the GP.
Dr Daly of the IMO said it was "simply incredible that one of the wealthiest countries in the world" could not provide basic affordable healthcare to middle and low-income families.
A spokesman for the Department of Health said no study had been undertaken into levels of personal indebtedness incurred because of medical need.
And none was planned.