Interviews

Medicine in the military: A labour of love

By sa | Apr 12, 2018 | 0 Comments

This month, GP Dr Patrick Kelly will return to the Golan Heights as part of the United Nations Disengagement Observer Force Mission.

The Waterford native will be stationed there for six months. He has been working with the Defence Forces since September 2014, after completing GP training.

While many young GPs choose to emigrate to practice medicine on completion of specialty training, Dr Kelly decided on a different path, having always been interested in the Defence Forces and the vital work it does in international peacekeeping and many other activities.

This has taken him to Syria, a country ravaged by war for several years. But despite the immense devastation wrought by the conflict, Dr Kelly has also witnessed a “beautiful country” with friendly people.

“In winter the mountains are covered in glistening snow, in spring the fields are lush and green, the wadis (valleys) are teeming with animal life. In summer, it’s slightly more barren and hot, only the most robust vegetation survives. The few Syrian people whom I’ve met in order to provide medical care are extremely welcoming, hospitable, gracious and friendly. They have endured so much for over five years but like many people are very resilient.”

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Dr Kelly on a night patrol with the Quick Reaction Force

Working abroad

Although Dr Kelly confesses that it has always been considered a rite of passage that Irish doctors would work abroad for a short period of time, the large cut to new-entry consultant pay and FEMPI cuts to GPs have meant that young Irish doctors have decided to take up permanent residency in countries like Canada, New Zealand and Australia.

“I get to work abroad with the Defence Forces on a consistent basis so it satisfies that ‘grá’, for want of a better term. April will be my fourth consecutive six-month deployment since I joined,” Dr Kelly revealed in an interview with the Medical Independent (MI).

Dr Kelly is a specialist in general practice and is on the specialist division of the Register. He underwent training in the South East Training Scheme based out of University Hospital Waterford (UHW).

“Primarily my hospital training was at UHW and my GP placements were in Co Waterford in the towns of Ardmore and Tramore. My time out in rural areas served me well for my present work in remote locations worldwide,” Dr Kelly said.

“My role as a senior medical officer is to ensure the health of troops deployed overseas. The majority of my work is preventative and occupational medicine – identifying issues before they become a problem. Some things can seem mundane like having mosquito nets for troops when they are outside, but if a soldier is bitten by a mosquito or sandfly, they may not contract malaria or leishmaniasis, but could develop cellulites, which could end up in their repatriation home or not being able to fulfil a key role or duty, which could influence mission success.

“I provide an administrative and human resource role managing medical staff as well as treating patients on ‘sick parade’. Sick parade is akin to a GP morning or evening surgery. I must also be prepared to treat and respond to medical emergencies in the mission area.”

Dr Kelly is happy in his current role, but he admits that six-month stints abroad can be difficult when away from family and friends. Being deployed means that one misses out on family occasions like weddings, baptisms and birthday parties.

“You also miss the simple things that everyone takes for granted; going shopping, cooking your own dinner or even driving a car. I’m sure loads of people reading this will be like ‘sign me up quickly’, but I do miss these things,” Dr Kelly revealed.

“I especially miss fresh pasteurised milk that will actually expire, not like the UHT stuff, which will keep even if you leave it outside in 30 degree heat for a few years! By the way, the National Dairy Council didn’t pay me to say that. You also miss the home comforts like ‘proper tea’. I won’t mention any particular brands, but there are two main ones depending what part of Ireland you’re from – when I’m overseas I’ll happily accept either!”

EHR

Many developments have taken place within the Defence Forces in recent years in terms of information technology (IT). Dr Kelly, who has a keen interest in IT, is involved in IT healthcare projects, such as electronic healthcare records (EHRs) and telemedicine.

In 2015 the Defence Forces transferred from paper-based medical notes, which were stored at soldiers/officers’ home station, to an EHR.

The advantage of the EHR is that no matter where the soldier presents for medical care in the Defence Forces in Ireland, at sea or in one of the larger overseas missions in the Middle East, the medic or doctor has access to the most up-to-date medical information for that individual, Dr Kelly advised.

The EHR has decision support software, which alerts the doctor to drug allergies should they prescribe a medication that the patient previously reacted poorly to.

The system is compatible with Healthlink, thus ensuring that Defence Forces’ doctors can receive reports from civilian hospitals, laboratories or radiological imaging in a secure manner. The system tracks patient presentations and ‘hot spots’ of activity across the country. It allows management to better resource military treatment facilities at times of increased demand.

In another development, colleagues in the Defence Forces physiotherapy service are presently recording patient videos for prehabilitation and rehabilitation, which they intend to make available to soldiers, Dr Kelly noted.

“You can imagine that the work some soldiers do can be extremely physically challenging and injury can result. ‘Prehab’ is providing exercise in order to prevent injury, while rehabilitation is attempting to return a person to their baseline status prior to the injury. We are constantly striving to keep up with new developments in IT,” Dr Kelly outlined.

“Telemedicine allows members of the Defence Forces in remote locations to access consultations with doctors or physiotherapists over Skype for Business. It was first piloted in 2016 actually from the Golan Heights when I needed a physiotherapy opinion remotely as my own physiotherapist was not available.”

Irish general practice

Dr Kelly is acutely aware of the significant challenges facing GPs in Ireland. He believes that GPs are extremely committed healthcare professionals who are working in a challenging system that is under-resourced.

“Not only is the population increasing and ageing, but this is associated with an increase in chronic illness and exacerbated by a generation of GPs soon to retire. It’s well known that FEMPI cuts have reduced the ability of the primary care system to respond to the increased healthcare demands of Irish society,” he said.

But there is some cause for hope, with indications of plans to reverse FEMPI, while two GP training places are being provided through the Military Medicine Scheme, Dr Kelly noted.

“We are not training enough GPs to meet population demands. On a more positive note, the Government has announced removing FEMPI cuts from general practice, which is long overdue. The Defence Forces is responding in a very small way by now providing GP training places each year through the Military Medicine Scheme in conjunction with the ICGP and Faculty of Military Medicine.”

But despite the crisis in general practice in Ireland, Dr Kelly is keeping his options open regarding future career opportunities and may one day return to general practice in Ireland.

“As for long-term career goals, whether I’m in a sweltering hot Ebola treatment centre in Sierra Leone or sitting in the mist and rain of the Glen of Imaal on an artillery shoot, I’m certainly happy where I am at the moment. But sure, I’m always looking for a new adventure or challenge, so who knows. I may even go back to the real frontline of medicine and take up a GP assistant post in Waterford some day – I can’t say I haven’t been offered one or two in the recent past. It’s good to have options.”

‘Outsider’ on the inside

By sa | Mar 23, 2018 | 0 Comments

“I was always a bit of a maverick and an outsider,” Minister of State with special responsibility for Disabilities Finian McGrath tells this newspaper.

“Now I have found myself in a very unusual position, because as an Independent, I just never thought I would be a Minister.”

Minister McGrath was speaking to the Medical Independent (MI) in his office at Leinster House at a pivotal time for Government policy affecting the lives of people with disabilities and their carers. Last year saw the publication of the National Disability Inclusion Strategy 2017-2021 and there are further developments imminent, with the ratification of the United Nations (UN) Convention on the Rights of Persons with Disabilities and the creation of personalised budgets for people with disabilities.

In May 2016, Minister McGrath entered into the current ‘partnership Government’ with an agreed programme as part of an Independent Alliance, and although he is a Minister of State, he sits at the Cabinet table.

Convention

At our interview late last month, Minister McGrath said the ratification of the UN Convention on the Rights of Persons with Disabilities was upcoming. It was subsequently ratified by the Dáil on 7 March and this paves the way for formal ratification by Ireland at the UN.

“I am the person who put it in the Programme for Government; all the political parties were talking about it for 10 years and they did nothing about it,” Minister McGrath told MI.

“People are giving out to me about the delays, but I want to bring all the groups with me and I want to consult them.”

Ireland will be the last of the European Union’s 28 Member States to ratify the Convention, a situation that has seen successive Irish governments receive criticism from the disability rights movement.

But Minister McGrath believes that ratification represents a significant moment.

“The most important thing for me as Minister of State, and as a parent of a daughter who has an intellectual disability, is that it says that Ireland is changing direction,” said the Minister.

“It sends out a strong message to every person with a disability and their families in this country that ‘we respect your rights as a citizen in your State’; it’s based on equality, it’s based on citizen rights, and it’s based on the issue of inclusiveness. It means that we are no longer doing the charity model, no longer doing the medical model; we are doing the social care model, which is mixed in with equality and rights, and I think that is an important statement.”

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Minister of State with special responsibility for Disabilities Finian McGrath

But some within the disability rights sector have raised concerns that the ratification will mean little without funding.

“Of course, you are right to ask the question. Having the rights and ratifying the UN Convention without investing in the services, and without developing the services — and without putting the person with the disability at the centre of the services — would not be good enough for me,” he said.

“My job is to ratify the UN Convention, but as I’m doing it, I want to reform, invest and change the whole direction of the services. They should not be designed for the HSE, or the Department of Health — they should be designed for the person with the disability.”

Liberty

According to the Minister, delays in the ratification in the last year have, in part, been due to legal difficulties around ‘deprivation of liberty’ — for example, where a family has placed a family member in residential care and the person may not want to be there.

Minister McGrath has been involved in a consultation process with disability groups and families to seek some legislative solution to this issue. The Department of Health prepared a draft Heads of Bill on deprivation of liberty safeguards, which will form a new part of the Assisted Decision-Making (Capacity) Act 2015 (it also issued a consultation paper, with the closing date for submissions having passed on 9 March last).

The Department says legislative clarity on the issue of deprivation of liberty in residential facilities for older people, those with a disability or mental health issues is required in order to meet obligations under the UN Convention on the Rights of Persons with Disabilities.

 “It is a significant issue,” said Minister McGrath.

“The ‘hurlers on the ditch’ were saying ‘ratify the UN Convention’, but you have to look at the deprivation of liberty. You are talking about people with Alzheimer’s, people with dementia, in nursing homes, people with disabilities in residential care situations; we are talking about people with mental illness who might not have the capacity to make decisions.

“Of course we want to protect their rights, but we want to ensure that we get the balance right in relation to that, and that is a complex issue. There are thousands of people up and down this country [who could be impacted by this].

“I want to make sure that the families and advocates are on board. There is a huge debate going on. It impacts thousands — I want to get that right. Hence my so-called ‘cautious pace’.”

Personalised budgets

The Minister also told this newspaper he would shortly be receiving the report from the taskforce on personalised budgets for people with disabilities.

A personalised budget is a sum of money which would be funded from the HSE’s budget for disability services and provided to an eligible person with a disability to meet their needs for personal social services and supports. The Department of Health held a consultation last October to assist the taskforce to develop plans for the introduction of a system of personalised budgets in Ireland.

Minister McGrath said that, in the disability community, there were some parents and adults with disabilities communicating to him that they were unhappy with the manner in which funding for personal social services and supports were being deployed.  

“From my own research and listening to the National Disability Authority, there is about 14 per cent of the disability community in Ireland who are interested in personalised budgets. So basically, this is to give people some control and give them a choice.

“Eighty-six per cent of people with disabilities and their families will be happy with their services. I have a daughter with an intellectual disability. I am very happy with her service. But I have friends of mine who are not happy with their service. They are looking at the idea of using the money and spending the money under their control.”

Controversy

Since 2016, the Minister has made headlines on a number of occasions for controversial comments on public health issues — such as when he said he would like to see more smoking facilities in bars and restaurants, and when he questioned the HPV vaccine. These comments were severely criticised by many doctors and others working in healthcare. Minister McGrath has since rowed-back on these remarks.

“Of course I did cock-up in relation to HPV; I cocked-up on the smoking issue,” the Minister admitted. 

“But again, when you are in opposition, you are more of a free spirit and you can say what you want and think what you want. But I do think some over-reacted to some of my little flaws of my personality.

“Because at the end of the day, everyone is human; everyone makes mistakes. But the thing about me is, if I make a mistake, I put my hands up immediately. I don’t try and bury it or I don’t cover up, or not answer the question. I know I made mistakes and that’s life.

“If I have a few frailties, I like to have a smoke, a pint with my friends — that’s me. And I don’t like preachy people, by the way,” he said, smiling, “and we have a lot of preachy people in health.”

Sláintecare

Regarding broader health matters, Minister McGrath said he “fully supports” the Sláintecare Report and believes it is “excellent”.

Asked whether he thinks the Government and Taoiseach have shown enough leadership on the cross-party report, he insisted there is “political commitment from the Taoiseach, the Minister for Health and all the ministers. We are big supporters of Sláintecare and we want to implement it, and of course it’s going to take time to implement it.”

Minister McGrath said that investment announced in the National Development Plan 2018-2027 and other recent health spending is all part of laying the foundations of Sláintecare.

“It is all part of the building blocks for Sláintecare, to build-up our services and improve our services. But I accept the point [from some in opposition that] we need to ‘up our game’. We need to be strong. I am fighting fires in disability every day and sometimes you do take your eye off the ball as regards the broader picture.”

‘Red line issue’

Following the publication of Budget 2018 last year, there were some media reports that Minister McGrath had threatened resignation over concerns about proposed funding for disability services.

“To me it shows you have to fight. I don’t like fighting or getting into rows with ministers. But when it came to the €3 million in funding for the Decision Support Service, I had to fight like hell for that.

“Because if I didn’t get that €3 million in the Budget that would mean the service couldn’t start and be set up. That service is the anchor to ratifying the UN Convention on the Rights of Persons with Disabilities. Yes that was a red line issue for me, no doubt about it.”

Minister McGrath said there was a further “crisis” after Christmas “in respite care services and I had to say to the Government ‘listen I need at least €10 million here to deal with the emergency respite crisis’.

“I had to bang the table and fight like hell. But that’s my job. There are other ministers in education, social protection, etc, across the table fighting for their thing. But my job is to bang the table to fight for people with disabilities.  So far we have done okay.”

Public

Minister McGrath believes the public need to become more engaged in health policy and health issues in general.

“I feel that broader society doesn’t take healthcare seriously enough,” he said.

“They kind of leave it to the politicians. They leave it to the HSE, leave it to the doctors and nurses. I would like to see more public engagement with it.

“But I just feel health has to be the number one issue in this State.  Of course you have to have a strong economy, etc, but health has to be the number one issue. We need the public to be involved in the Sláintecare Report to help us drive it.”


Minister McGrath on…

The future of the Independent Alliance

“I do think there is a future for the Independent Alliance. I think in fairness, some of my other independent colleagues that ‘sat on the pot’ during the talks for the Government; I think they regret it now privately. I get this feeling, they are changing. Even some of the opposition parties. Look at the mood change going on in Sinn Féin. What’s wrong with people from different political backgrounds working together?… I actually think this is part of new politics — that people from diverse backgrounds can come together and work together in the interest of the country; a lot of the other politicians ran for cover, ran to the hills and refused to form a government. The Independence Alliance — I think we are not getting gold medals for going into Government, I accept that and the opinion polls put us on around 4 per cent. But I do think there is a future for this kind of Government.”

Being a Minister rather than in opposition

“Completely different compared to when I was in opposition. I am an outsider who is walking around on the inside. It is very slow; it can be frustrating. But then when you get things done, I always say to myself, ‘if I can get 10 or 12 things done as Minister, I will be delighted’. I already have seven or eight done, so I’m thrilled. But I need to get a few more done before this Government runs out.”

The ‘disability community’

“You see, this is part of the prejudice that is against people — we have to change this mindset. People talk about the ‘disabled community’ but this community is a very diverse group. They have lots of different ideas, which I think is brilliant. But the bottom line is, there are hundreds of people with disabilities and their families, and they all have different views and solutions. That is why I am saying the three key things for my ministry is invest, reform and put the person with the disability at the centre of the service.”

Future funding of the sector

“We have a hell of a long way to go. We forget that the disability services were starved for 10 years during austerity. I’m trying to catch up here.”

Talks over the formation of Government

“When we walked into the talks with the Government, we walked in with five independent TDs and we walked out with four ministers. The other issue is, we got this one for disabilities because we wanted it, crucially, at the Cabinet table. Not just to be a minister, but to be at the Cabinet table.”

Coalition Government

“How the hell can we lecture Sinn Féin and the DUP to get into government [together] in the North when we don’t have diverse governments down here in the South as well?”

His work

“I am very excited; every day, I love coming in here. I love my day job. I love meeting people with disabilities, I love working with them and working on broader issues.”

””

Pictured with Minister of State Finian McGrath at the official launch of Prosper Meath on 23 February are service-users and piano players Ms Andrea Buckley and Mr Michael Jordan

Photo: courtesy of the Prosper Group

The Simon Harris interview

By sa | Mar 14, 2018 | 0 Comments

In an extensive interview, Priscilla Lynch speaks to Minister for Health Simon Harris about a new GP contract, the implementation of Sláintecare, the consultant recruitment crisis, hospital waiting lists and a range of health service issues

Driving down road deaths

By sa | Mar 1, 2018 | 0 Comments

With the introduction of drug driving testing, the Medical Bureau of Road Safety enters a new phase in its 50-year history. David Lynch interviews its Director Prof Denis Cusack

General practice in medical education

By sa | Feb 21, 2018 | 0 Comments

Priscilla Lynch speaks to Prof Liam Glynn about the recently-launched U-LEARN General Practice Network at the Graduate Entry Medical School, University of Limerick

The rise of the surgical machines

By sa | Feb 21, 2018 | 0 Comments

The combination of artificial intelligence and virtual reality has the potential to revolutionise surgery, a leading pioneer in the field tells David Lynch

Putting the politics into health

By sa | Feb 7, 2018 | 0 Comments

Priscilla Lynch talks to Independent TD Michael Healy-Rae about why he believes politics and health go hand-in-hand, inequities in the health service and the dearth of rural GPs

Emergency measures in the public interest

By sa | Jan 24, 2018 | 0 Comments

The perennial crisis in our emergency departments has again dominated the headlines this January. David Lynch talks to President of the IAEM Dr Emily O’Conor about the challenges and potential solutions

In search of new challenges

By sa | Jan 10, 2018 | 0 Comments

Prof Louise Kenny, outgoing Director of the world-renowned INFANT Centre in Cork, takes up a new role in the UK this month. She speaks to Niamh Cahill about her work in Ireland and why she felt it was time for a new challenge

Doran calls time as nursing union chief

By sa | Dec 20, 2017 | 0 Comments

General Secretary of the Irish Nurses and Midwives Organisation Mr Liam Doran is about to bow out after almost 20 years in the role. An often controversial figure within the medical profession, Mr Doran spoke to Catherine Reilly about the relationship between doctors and nurses and health service reform

A new dawn for drug policy?

By sa | Dec 6, 2017 | 0 Comments

Minister of State with responsibility for Health Promotion and the National Drugs Strategy Catherine Byrne discusses injection centres, methadone and the Public Health (Alcohol) Bill with David Lynch

Registering changes in cancer

By sa | Nov 15, 2017 | 0 Comments

National Cancer Registry Ireland Director Prof Kerri Clough-Gorr talks to David Lynch about the Registry’s recent annual report, staffing, legislation and its digital future

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