With public health doctors now on strike, Dr Muiris Houston, Medical Correspondent, examines the crucial role they play
The State ceased to have a public health medical service from 5 p.m. yesterday. Public health doctors have embarked on a full-scale strike, following a number of weeks of limited industrial action, during which they withdrew their availability for unpaid out-of-hours and weekend work.
Numbering just under 300 in the Republic, who are public health doctors and what do they do?
When a measles outbreak occurs - and this is unfortunately now a regular occurrence as rates of MMR immunisation drop - teams of area medical officers move into the affected area and immunise infants in a bid to stamp out the infection. Notwithstanding that they are not paid to do so, public health doctors have made themselves available at weekends and at night to carry out this work.
Other situations in which the absence of public health doctors will quickly be felt include outbreaks of the winter vomiting virus and food-borne infections such as salmonella.
If a case of bacterial meningitis is diagnosed in a children's hospital next week, for example, who will the authorities turn to? Who will ensure that those in contact with the patient are traced and prescribed preventative medication so that the potentially fatal illness is promptly stopped in its tracks?
At a more senior level, health board CEOs are now without key advisers when it comes to planning and implementing public health policy. Without expert medical advice, the State's response to a bioterrorist threat is seriously compromised. And if a new SARS-type disease emerged tomorrow, then our collective health would be at risk.
Public health doctors range from area and senior area medical officers at the bottom of the health board career structure to directors of community care. At a more senior level, both specialists in public health and directors of public health offer specialist advice to health boards; they also work in the National Disease Surveillance Centre (NDSC) and in university posts.
In larger cities, each community care area is served by area medical officers and a director of community care. They are responsible for public health within each district, working alongside environmental health officers and other professionals to maintain high standards of public and community health.
While GPs focus on individual families and patients, public health doctors concentrate on the overall health of the population. They undertake school medical examinations and child health development clinics. They carry out BCG vaccination in clinics and maternity hospitals and give pre-school vaccination boosters. In some parts of the country, public health doctors staff sexually transmitted disease clinics.
In Dublin, they screen prostitutes for infections such as HIV, hepatitis B and other sexually transmitted infections. They also administer hepatitis B vaccinations to the staff of voluntary organisations.
If you have a relative in a nursing home, then public health doctors have assessed the home to ensure that the quality of care offered to older people is of a sufficiently high standard. They also carry out screening of refugees in order to pick up highly contagious infections such as TB and hepatitis B. Fitness to drive and mobility allowance medical examinations are another important part of their work.
The dispute, which has its genesis in promises made in 1994 to improve the basic pay and conditions of public health doctors, would not be costly to settle, according to a senior public health specialist.
However, the Health Service Employers' Agency has expressed concern that the Irish Medical Organisation has not exhausted all avenues for potential resolution.
Public health doctors have no private practice and are paid salaries that are lower than their counterparts in Britain. After nine years of negotiations and pro-bono idealism, they want promises honoured.