When I wrote some weeks ago about the need for a debate about the values that should underpin healthcare reform, I little thought that I would be doing some involuntary research in the field so soon after, writes Breda O'Brien.
Last week I did not write my usual column, because I had passed out from severe abdominal pain and, after a visit to my GP, ended up spending nine hours in St Vincent's Hospital accident and emergency department. Luckily, it was nothing life-threatening or permanently incapacitating, but the visit to A & E was not a pleasant experience.
In many ways it was just as bad as it is depicted. Trolleys were lined up along corridors and walls, so tightly packed that one person's feet were inches away from the head of the next person's trolley.
Had I not been so sore as to be beyond caring, I would never have used the toilet facilities. There was no door, just a very inadequate plastic curtain. And there were the joys of the blue paper gown, designed to demolish whatever vestige of dignity one had left.
For some reason, I was awarded a veritable private suite, a trolley in a little side-ward with doors. I had heard of all the shortages in the Irish medical system, but until two weeks ago it had not occurred to me that doors might be considered a luxury. The semi-private option, so to speak, was an alcove with curtains, but most people lay or sat on trolleys in full public view.
So unusual was my situation that the doctor, who eventually saw me after five hours, hovered at the afore-mentioned doors, unwilling to come in until she was certain that I was not in isolation and that she did not need to gown up. I consider myself lucky to have seen her even at that stage, given there were so many obviously seriously ill human beings all around me.
If ever one needed a reminder of the insecurity and fragility of human life, one only needs to visit an A & E department. Beside one trolley, a mother helplessly stroked the hair of her beautiful daughter, whose pallor was frightening.
On another, a fully clothed young man in his early 20s receiving oxygen moaned from time to time. On yet another, an older man kept up a stream of brittle chat to anyone who would listen, his forced cheerfulness barely concealing his terror.
In the midst of all this, doctors who were obviously tired, remained courteous and painstaking. Nurses moved quickly and quietly, dispensing care and even the odd joke. It might have helped that the nurse on duty in triage that day, Nicky Power, has a Waterford accent.
After we had completed the Irish ritual of discovering whom we knew in common from my home county, somehow the controlled chaos all around me seemed humanised. Nursing staff work 13-hour days, because it provides continuity of care for the patients. Several of the nurses were Filipino. How quickly we have adapted to accepting that they should leave their family and friends to come and prop up our collapsing medical system.
By coincidence, before my own visit to A & E, I had been reading the chapter on healthcare in Theorising Irish Social Policy (UCD Press) by Suzanne Quin and Jo Murphy-Lawless. Let us just say that some of their theses acquired particular relevance.
For example, they query the emphasis on managerialism and efficiency and the tendency to categorise people as "consumers" of healthcare. The language of the commercial market is completely inadequate in relation to healthcare. Our relationship with our nurses and doctors is not primarily that of an economic transaction, but is based on a hope of receiving competent care.
I was struck by the kindness of everyone who dealt with me and by how little we value this most important quality. Eliminating waste and improving the administration of healthcare is important, but should be far from the only focus.
There has been talk this week of Mary Harney taking on the consultants and finally achieving the goal of employing more of them, who will work longer hours to clear the backlog in the public sector. However popular that move will be, much more is needed.
It is somewhat worrying that the Progressive Democrats' main contribution to healthcare has been the National Treatment Purchase scheme to obtain care privately or abroad for the patients who have waited longest for public care. While it has literally been a lifeline for some, it is an ad-hoc solution, another patch on a disintegrating system.
It will be interesting to see if Mary Harney has the bottle to really tackle the inequalities rampant in our system. It is simply wrong that the richer among us can skip queues or are less likely to need medical care in the first place. Given the Progressive Democrats' distaste for higher taxes, it is difficult to see how she will achieve any form of equity in the system.
In our more individualised and fragmented society, people are not being challenged to think about solidarity with others, but instead are encouraged to make sure that they have adequate health insurance for themselves. However, Quin and Murphy-Lawless suggest that many people would be willing to pay in tax as much as they pay in private medical insurance, or more, if they felt it would result in a better healthcare system.
We tend to concentrate on the A & E departments or the long waiting lists. However, we will never solve those problems unless other factors which tie up beds, such as the lack of convalescent facilities for elderly people, are dealt with. More vital still is to begin to concentrate on primary care and prevention, as this is the most important way we can improve health.
A politician once said to me that there were no votes in prevention and no public gratitude for bad things which never happen. She is right, but in the area of health there are enough experiences of how bad things are now for politicians to reap a reward for tackling some of the obvious injustices.