Healthcare inequality is entrenched

The man waits and waits to see the doctor. When his turn finally comes, he pleads with the doctor to come at once to his sick nine-year-old daughter. The healer can't help. "I know, I know," he says, "Everyone wants the doctor to come at once. I'll come sometime tomorrow."

But word comes that the little girl has died while her father was waiting for help. The father turns to the doctor: "You might have safely said you'd come and kept hope dangling still in front of us that healing still was here and common goodness."

All of this was played out a long time ago, in Sean O'Casey's bitter little sketch of the 1920s, The Hall of Healing. That, in turn, was based in part on his own experiences of the Irish health system in the late 19th century. In the first volume of his autobiography, he describes the death of the boy whose place he took in the family, a namesake who died needlessly in early childhood.

The boy has a choking fit. His mother rushes him to the old Abercorn hospital. She calls out "Get the doctor, get him quick to look at this child of mine quick, to treat this little child of mine, quick please, for he's dying, but can easily be saved if the doctor comes quick." But the system is overloaded and the poor have to wait in line. The mother pleads: "I've been left here waiting too long, too long, and the child choking without any attention." The boy dies there in her arms, on the hard cold waiting room bench.

Later, when O'Casey himself is a young boy, he is taken to the old Eye and Ear Hospital behind Trinity College Dublin to have his diseased eyes seen to. Queuing up to see the consultant, he notices that, even here, a stark inequality prevails. Because his mother can just about afford to pay for his treatment, he has a black admission card. The paupers, who can't afford to pay, have red admission cards, marking them out for a different kind of treatment.

WE ARE talking here of the late 1870s and the 1880s, a time we now think of harsh and cruel and tainted with sickening hypocrisies. In one of the principal cities of the richest empire the world had ever known, the poor were being denied proper access to hospital services, sometimes with fatal consequences. In the routine operation of the public health system there were scandalous inequalities. The lives of the poor were clearly less valuable than those of the rich.

Routine humiliations and constant delays kept the paupers in their place.

It was revulsion at this kind of society that turned a man like O'Casey, growing up in a loyalist family, into a nationalist and a socialist. For many like him, the contempt for ordinary people that was most nakedly manifest in the health system was the ultimate indictment of British ascendancy rule. A regime that could not treat all sick people with the same concern and afford them the same basic human dignity had no moral legitimacy. That system would have to be swept away and a new, decent Ireland put in its place.

Here, almost 150 years later, are a few case studies from the recent St Vincent de Paul (SVP) Society report, "Health Inequalities and Poverty".

An elderly woman in Dun Laoghaire with gangrene in both feet is told she will have to wait six weeks for a hospital bed. Her GP tells her to take a taxi to the outpatients' department and sit there waiting for admission. SVP members call every night to put her to bed, and every morning to get her up. Eventually, the society offers to pay for a private bed. She is admitted that day.

A woman with a medical card waits 18 months for a hysterectomy. In spite of developing an infection she is discharged after six days and is offered no after-care. Another woman with private health insurance has the same operation, develops no infection, but is allowed to recover in hospital for three weeks.

A young woman goes to casualty with severe abdominal pain. She is told she will have to wait six weeks for a scan. If she has £250, however, she can have it done immediately.

A four year-old child who is going deaf because of an easily treatable condition has to wait a year for an appointment to see a specialist. Because he can't hear, his speech has not developed properly. So he is put on a long waiting list for speech therapy.

In an Ireland that is far wealthier than its founders could ever have dreamed, the intolerable injustices of the 19th century persist. Poor people die on the waiting list. The paupers whom Sean O'Casey saw waiting for eye treatment are still waiting. At the end of last year, 484 people had been waiting more than a year for a cataract operation and 3,253 people were waiting for ophthalmic surgery.

Public concern about all of this is sufficiently acute for the Cabinet to have spent much of yesterday trying to come up with a credible health strategy. Where, though, are the outrage and the urgency? Where is the fundamental sense that these things are simply intolerable and that the system must be radically reordered so they will not persist?

Where is the burning sense of shame that the Ireland of the 21st century is, in matters of life and death, barely more just than the scandalous political slum of the late 19th century?

fotoole@irish-times.ie