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My child got burned at his check-up. It summed up our crumbling public health system

I haven’t used the word ‘kip’ since I was a teenager, but this was the least suitable place on earth to examine a toddler

There were two radiators in the room, one a portable heater in the corner, the other a fully plumbed job, but attached to some hot metal piping. Photograph: Westend61/Getty
Dr Clare Moriarty
Sat Oct 05 2024 - 07:05

Mine is one of those giant Irish babies that is constantly flagged for his status atop the centiles. Our public health nurse referred him to our GP because it was thought he really needed to be measured by a doctor, such was his anatomical bountifulness. Of course, we don’t know his accurate centiles, since he is a formula-fed baby measured using a growth chart based on data from breastfed babies.

Why do that, you might ask? To “normalise breastfeeding as the optimal feeding choice”, apparently, since, as the HSE notes in its policy justification, breastfed and formula-fed babies have different growth charts in the first year. I really don’t see how it normalises breastfeeding, but it’s a spectacular example of normalising using the wrong chart for something. In any case, we find ourselves back in the public health crosshairs this week.

Developmental issues are concerning for parents. Public health is statistically driven, and developmental milestones are salient in the parental mind, bouncing around with neighbouring worries about childcare, schools and general wellbeing. On the occasion of having our lad referred for additional attention, we were fortunate to be met by a brilliantly compassionate, talented community health doctor. She established an instant rapport, and the experience was one of total competence, empathy, and pragmatism.

It’s easy to feel lucky about the wealth of brilliant people who devote themselves to caring for children in this country. I’m reminded of the woman at the Eastdoc front desk who cheer-led my mixing-bowl-wielding, vomiting daughter through her visit, which ended with an introduction to her nearby tiny dog on the way out. Truly, a special person in the right role. I’m also reminded of the many childcare workers from Ireland and abroad whose work in a frightening public health scenario allowed so many of us to continue to put food on the table at the height of the pandemic.

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Public health consultation rooms are intimate spaces, where we first voice the worries we struggle to say out loud, and where many receive life-altering information. They’re also busy. A routine developmental check for a child my son’s age will assess their crawling, walking and engaging with toys. They might want to see them roll a ball over and back, or how they react to others’ movements. And, as anyone with a one-year-old knows, once they’re crawling/walking, they’re basically uncontainable.

I don’t believe I’ve used the word “kip” since I was a teenager, but this was surely the least suitable place on earth to conduct the relevant exam. There were two radiators in the room, one a portable heater in the corner, presumably to mitigate cold coming in through ancient windows, the other a fully plumbed job, but attached to some hot metal piping that ran from the main unit down along the base of the whole wall of the room. I desperately wish my central heating vocabulary was more refined but, as you can imagine, when I searched online for radiator diagrams to try to describe the parts correctly, it was hard to find ones suitable to the relevant equipment, which was presumably installed in the interwar period.

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Perhaps the first burn he received was my fault. I didn’t see the free-standing heater initially, and when he was crawling under the table, I was inclined to let him go, so the doctor could see him behave spontaneously. He tried to use the offending item to pull up to stand and got an unpleasant fright.

Having soothed him and blocked off the relevant corner with a chair, I thought we were safe, but no more than five minutes later he had found his way to that hot pipework that literally lined the floorspace of the room. These were not serious burns, but they did make him cry and put him out of sorts in a meeting for which we had waited a while, and where it would have been opportune to have him as close to behaving normally as possible.

Not every child in that context has good reflexes, and something much worse might have transpired if his grip had not released. Everyone was mortified to have it happen again, but it really does invite the question: who on earth would deem this a safe room in which a toddler might be examined?

Leaving aside a red floor design that closely approximated molten lava – a setting that would surely prove destabilising for anyone with sensory or psychological discomfort – the room was simply unsafe. It felt like a microcosm of so many public health challenges: brilliant and dedicated people working amid crumbling, or non-existent infrastructure.

Appointment burns aside, I still would have left deflated by the warning that the deferred appointment would probably take six months to materialise. As justification for the anxiety generated by the focus on milestones, we’re fed a gospel of early intervention. But if intervention doesn’t at least serve the purpose of getting you to see someone early, what exactly is the point?

I believe in public services and know that private healthcare is often detrimental to public care, but those principles are strained when it comes to our own children – if worst comes to worst, I’ll find the money to see someone privately. Not everyone is in the same ship. Such inequality is completely unfair. And in a week where we were introduced to a budget that leans more towards spraying minimally calibrated surplus funds at voters than at targeted improvement of services, change doesn’t feel close.

I saw the Fine Gael ad last week, announcing the party’s aim to make Ireland the best place in the world to be a child, and when I remember the nightmare with the children’s hospital, the scoliosis surgery lists, the unforgivable lack of additional-needs school places, and the failure again to introduce the long-promised second tier of child benefit for children experiencing the worst poverty in the country, I wonder what planet they’re on.

Dr Clare Moriarty is an Irish Research Council postdoctoral fellow at Trinity College Dublin