Madam, - When I hear or read of how bad the 1980s were, I am inclined to smile, though I know that some people did suffer much.
In 1884 I returned to Ireland from Nigeria, where I had worked as a doctor. Shortly after I came home, there were stories in the media about a child who needed specialised treatment abroad. The cost of treatment was estimated at £250,000.
It was good, in a recent edition of RTÉ's Reeling in the Years, to see archive footage of the child returning home healthy and well. Almost 25 years on, one wonders how that young person is now, but the media have moved on to fresh fields and pastures new.
The reason I smile is that in the 200-bed hospital which I had left in Nigeria, our yearly budget was just that - £250,000. It was a busy general and maternity hospital with 300 sick children seen in the out-patients' department every day and with 2,000 deliveries per year - a quarter of that in any of the large Dublin maternity hospitals. We had, of course, a 24-hour emergency service.
While our standards were obviously not as high as in Ireland, they were good. But this certainly brought home to me the extent to which costs escalate as treatment becomes more sophisticated.
Public expenditure on health in this State was €3.7 billion in 1997; by 2006 it was €12.6 billion. It is hard to believe that this entire rise in costs was necessary, and beneficial to patients.
Take, for example, Caesarean section rates, which have have almost tripled in the past 20 years and, in 2006, stood at 27 per cent of all births. However, neither maternal death rates nor the health of new-born babies have improved over this period.
The World Health Organisation recommends that the Caesarean rate be no higher than 12.5 per cent. One could therefore estimate that 10,000 unnecessary Caesarean sections are done here every year.
An audit commission in the UK in 1997 estimated that a 1 per cent rise in Caesareans cost the National Health Service an extra £5 million every year. By this calculation, unnecessary sections here cost about €10 million every year. Additionally, extra Caesarean sections lead to calls for extra beds, new maternity hospitals and so forth.
Is an obstetrician justified in acceding to every request for a Caesarean, even if the woman has had one previous section? And even if she is a private patient?
Cost is not the only factor, of course. Caesarean section is very safe today, but not completely so. Few studies have been done on the psychological effects of the operation, but the few which have been done seem to suggest that it leads to an increased likelihood of post-natal depression and is bad for mother-child bonding. This can lead to subsequent psychological problems, including autism, in the child .
One wonders what a mainly lay Medical Council will do about these problems.
With cutbacks in the health service, I hope no sick person will suffer while unnecessary and expensive treatment goes unchecked. - Yours, etc,
Dr HELEN T. O'BRIEN, Rosemount, Booterstown,Co Dublin.