Master of Rotunda: ‘The amount of social deprivation on the north side of Dublin has been an eye-opener’

The riot of last November 23rd brought Dublin’s city centre to a standstill, except in one crucial way.

On a night when the streets around it descended into shocking violence, the Rotunda Hospital continued doing what it has been doing for the past 278 years.

Seventeen babies were delivered in the hospital that troubled night, oblivious to the mayhem unfolding in the streets outside.

“It went from relatively quiet to absolutely terrible in a short period of time,” Prof Seán Daly, master of the Rotunda, said. “When you looked out there was a row of gardaí between the hospital and the mayhem. They kept us safe. God knows what might have happened otherwise.”

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Things have quietened down since, but the hospital is still scarred by the events of that night.

Staff members were among the first on the scene of the stabbings that happened earlier in the day on the east side of Parnell Square, which triggered anti-immigrant protests and, ultimately, the riot.

Bags of blood were rushed over from the Rotunda for the lines put in by paramedics into the five-year-child who was severely injured in the knife attack. The pavement turned into a mobile field hospital as staff rushed to estimate the amount the young patient would need based on her age and size.

Physically, the hospital was unharmed by the rioting. Staff, many of them from overseas, were ferried in to work the following day because they didn’t feel safe and security was beefed up.

Long before the riot, the Rotunda’s security, many of them not from Ireland, had been bearing the brunt of abuse, sometimes from people using the hospital. “It’s just unacceptable, the abuse they take,” Daly says in an interview to mark the end of his first year as master.

The 60-year-old is the first person to serve as master of two of the Dublin maternity hospitals, having previously headed up the Coombe from 1999 to 2006.

“Ireland is a totally different place now,” he observes. “Everything has changed – the medicine, the development of genetics, especially pre-natal diagnosis. The population is getting older. Benign gynaecology is a big issue, one I want to concentrate on.”

[ Some Rotunda staff commuting from Spain due to cost of living in Ireland, says hospital master ]

He is struck by the differences between the Coombe and the Rotunda since he moved hospitals three years ago. “Since I’ve come over to the Rotunda the amount of social deprivation on the north side of Dublin has been an eye-opener for me.”

More than 500 women giving birth in the hospital each year give Romania as their country of origin, he points out, and a significant number of these are Roma.

“Those women don’t really engage, they don’t come to all visits. They are a particularly challenging group to deal with.

“We’ve put in support systems to encourage them to come. If we can create an environment where they feel safe and cared for (during their pregnancy) maybe they will continue to engage with healthcare, go for screening and all that.”

His appointment attracted criticism last year after he was recommended ahead of two female candidates of equal rank by an overwhelmingly male interview panel. He has not courted the limelight in his first year as master.

“I kept my head down,” he acknowledges, “I’m very happy to fly under the radar. A lot of people still think Fergal (Malone, his predecessor) is the master.”

Caution remains his watchword. Asked whether the laws on abortion need to be revised after being in place for four years, he replies: “Whether the legislation should be reformed or changed... to be honest, that’s not up to me. I have just one vote in many.”

Really? “I would see us as implementing the legislation,” he says, adding that each termination currently performed in the hospital is the subject of indepth discussions and, sometimes, input from outside experts.

Legislation to make it illegal to protest within 100 metres of facilities providing abortion services passed through the Dáil last month; Daly says he can’t remember when the last protest of this type took place outside the Rotunda.

He gets most exercised in a discussion about the impact of “challenging” coroner’s inquests on staff morale.

Inquests, he says, can be the first stage of a process that is inevitably going to end up in the courts. “They frequently end up with legal people representing both sides. Staff get quizzed about what they did and why; many really worry about that.

“There have been some very difficult inquests. The outcomes are obviously tragic and the family understandably wants answers. Our staff go to these inquests in good faith but sometimes come out traumatised. We need to take care of that, otherwise we will have midwives leaving the service.”

[ New Rotunda outpatient and ambulatory services to be in revamped Clerys Quarter ]

Advances in genetic testing are posing “huge” ethical issues for his profession, he points out. “When I came back from the States to the Coombe, all we could look for were whole chromosomes. You could identify Down or Edwards syndrome, but that was it.

“Now we can look for individual genes. All of our genome has been decoded, so we know what everyone’s genes should be. We know their future. It opens up a nightmare of possibilities and huge ethical issues.

“Say you were expecting a little girl and something happened and you had amniocentesis (a common prenatal test that takes amniotic fluid from around your baby in the womb). You could test that and see if she had the BRCA gene (that influences a woman’s chances of developing cancer).

“Is she more likely to get breast cancer as she gets older? What do you do with that information?

“Of course you would want to know, if you could modify the expression of the gene and do something to reduce your chance of getting cancer.

“But if you currently can’t or if it’s currently unclear, then should you tell people that? I don’t know what the answer is. I’m sure people much more intelligent than me will try to find that out.”

About 8,300 babies will be born in the Rotunda in 2023, 1 per cent up on the previous year but well down on the 10,000-plus figures that were racked up in the Celtic Tiger era. Births at the National Maternity Hospital and the Coombe are falling, he points out, leaving the Rotunda as the capital’s busiest maternity unit.

While not particularly exercised by the HSE’s current recruitment embargo, he says the 420 approved nursing posts in the Rotunda is “not nearly enough”. The hospital hopes to make itself more attractive to potential staff by providing better on-campus accommodation for nurses and midwives.

“We have staff who live in Spain or Germany and work here for a week and then fly back. They stay in the nurses home that was built in the 1930s but it’s not fit for purpose.” Plans to remodel or rebuild the building are in preparation.

The Rotunda’s caesarean section rate is 38 per cent. “We’re not the highest, we’re in the middle,” Daly says; the figure is still well above the World Health Organisation’s recommended rate of 10-15 per cent.

Half of these sections happen on foot of a request from the patient: “I firmly believe women should be allowed request how they want to have their baby”.

The Rotunda’s efforts to lower the caesarean rate focus on first-time mothers. “If we can look after women in their first pregnancy, they’ll look after themselves in later ones,” he reasons.

With the aim of streamlining the referrals process, Daly has proposed the Rotunda become the hub for managing benign gynaecology for north Dublin.

Funding has been provided for a second suite to treat women with conditions such as complex menopause, prolapse and incontinence. Daly says waiting lists have been reduced to a maximum of nine months and 2024 will see a focus on those waiting six to nine months.

The hospital recently began seeing expecting mothers off-campus in the Earl Building, which is tucked in behind the old Clery’s department store on O’Connell Street. Now, the HSE has bought a 24,000sq ft ground-floor building on Dominick Street, to which Daly hopes to move gynaecological outpatients.

All of this investment and redesign of services suggests the Rotunda is in no hurry to move to a greenfield site in west Dublin, even though this is official Government policy.

“That is the policy, but in practical terms the HSE is committing to the Rotunda here in the city centre. We’ve been here since 1757. We’re very comfortable here, we’re a big employer. I would see the Rotunda as an essential component of north inner city.

“In the grand scheme of things will we move out to Blanchardstown? Maybe,” he smiles, “but I’ll be well retired by then”.

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