Democracy itself triumphs when cover-ups by public bodies are defeated by the courage and persistence of citizens, as in the hepatitis C scandal, writes Fintan O'Toole
After an expert group report, a tribunal of inquiry, two fine books and extensive newspaper, television and radio coverage, it might seem that the story of the hepatitis C women has been fully told. It is true, certainly, that most of what can be known about this disastrous betrayal of public trust did eventually make its way into the public realm. All the strategies of denial, evasion, cover-up and downright deception were, in the end, defeated by the courage, persistence and acute intelligence of Positive Action. Broadly speaking, we do know what happened.
There is, though, a hell of a difference between retrospective knowledge and the unfolding experience of passing from dark mystery to an even darker awareness. The difference between the public autopsy on the events by doctors, lawyers, politicians and journalists and the actual experience of the women themselves is like that between looking at a map of Antarctica and undertaking the hellish journeys through which those bleak territories were discovered. The great achievement of Brian Phelan's brilliant drama No Tears is that it allows those of us fortunate enough to have avoided that journey to experience it imaginatively.
The drama is all about knowledge and ignorance. To those women whose story it became, it first presented itself not as a story at all but as an absence. Stories are about meaning, cause and effect, the way one thing leads to another. For almost 17 years, from 1977 until 1994, the infection was in this sense not a story at all but a series of isolated, literally meaningless symptoms. Unknown to each other, a thousand or so women were experiencing profound and devastating changes - pain and deep fatigue - for which there was no explanation. There was, as far as their doctors could tell, nothing wrong with them. There were effects but no causes.
At the same time, for a much smaller group of people, the medical leadership of the Blood Transfusion Service Board, things were working the other way around. There were causes but no effects. From very early in the unfolding of the disaster, key medical personnel knew that a very serious mistake had been made. By the end of 1976, repeated tests had shown that blood plasma being used to manufacture the anti-D product was contaminated with what was then called "infective hepatitis" (the actual hepatitis C virus had not yet been identified).
Yet over the coming months, the BTSB went ahead and used this plasma to make batches of anti-D. Even when women who received this product quickly developed symptoms of hepatitis, BTSB doctors did nothing. Astonishingly, indeed, they did essentially the same thing all over again in 1989. By 1992, the plasma being used actually tested positive for hepatitis C, which had by now been identified. As one senior member of the BTSB staff subsequently admitted, they simply "ploughed on" regardless. It was as if, for them, causes had no effects, as if the basic question in any story - "what happens next?" - could simply not be asked.
The whole dreadful saga, then, can be characterised as a breakdown in the chain of narrative. The people who had to live with the consequences didn't know the causes. The people who knew the causes managed, somehow, to pretend to themselves that there were no human consequences, that the people who were suffering as a result of their perverse recklessness really existed at all. In this basic sense, storytelling is crucial to democracy. A healthy political realm is one in which a coherent story is told by putting together the actions of public bodies and the effects those actions have on the lives of citizens. A sick political realm is one in which this connection is broken. It fell to pieces in a nightmarish way for the hepatitis C women and their families.
Symbolically, it matters a lot that another public body, RTÉ, is trying, with No Tears, to put it back in place.
The great strength of television drama is that it can put together, in a uniquely immediate way, public decisions and private lives. No Tears does this superbly by recreating for the audience the journey that the women themselves were forced to undertake. Like them, we start with the immediate explicable symptoms. Like them, we work our way through into areas of knowledge - blood products, liver disease, medical politics - that no longer seem abstract because they have found their way quite literally into the flesh and blood of ordinary citizens.
The dramatic mapping of that journey takes exquisitely fine judgment. The elements of fiction - the creation of composite characters to represent the experiences of thousands of people, the use of fictitious names to avoid unnecessary problems - serves a meticulous adherence to the known facts. The shifting back and forth between the personal intimacies and the bigger political picture is expertly choreographed. The anger burns slowly enough to fuel what must be a long voyage of discovery.
For the women themselves, of course, the story is all too inescapably familiar. But it belongs to the rest of us, too. It is not just that nothing but dumb luck separated us from them. It is also that the virus which was injected into them also entered the bloodstream of the whole body politic. The irresponsibility and deceit, the prioritisation of institutional self-preservation over the lives and health of citizens, presents a bleak image of our democracy. The courage, resilience and compassion for each other with which the women themselves responded in their campaign for dignity and honesty presents the possibility of hope. If, through this series, these vital images finally lodge themselves in the public mind, that possibility will be greatly enhanced.