Wednesday, October 28, 2009

FW: Letter to editor - re Donal Og

A conversation at Toastmasters in Kildare last night about bullying in primary schools gave me this idea for a letter to the local papers. It is frightening, in fact, to hear of kids using terms like " gay" and " queer" as verbal abuse.
Parental attitudes still have a long way to go?..

Dear Madam,
The recent " coming out" of Donal Og Cusack has created barely a murmur in conversation, in press or on the media around county Kildare. This could be because our views around the issue of homosexuality have changed in recent years. Perhaps this issue is greeted with a shrug of the shoulders and regarded as barely news worthy. If that is the case then it is a good thing, signalling a broadening of tolerance in attitude.
It could also be because he is a hurler. Hurling is a minority sport in Kildare. In fact it has been said that in Kildare, hurleys are mainly used as instruments to keep down the thistles. A story about a Cork hurler attracts less local interest than say a story about a footballer, or a jockey.
The weigh rooms of Punchestown, Naas, The Curragh and other racecourses remain citadels of swashbuckling machismo.
A " coming out " from within the daredevil profession whom an ambulance follow around as they ply their trade would be the ultimate test of public attitude. A " coming out" of a National Hunt icon would surely strain the fragile liberalism of the midlands. As racing pages and pencils are dropped in a shocked silence around Kildare's betting shops the richter scale would perhaps just register a little tremor.
yours etc,
Des Groome,
Kilcumney house,
Come out, come out, wherever you are....

Thursday, October 22, 2009

FW: letter to editor- Drink Driving Debate

Letter to Irish Times, Friday 23rd October

Rural backbenchers under pressure- Legislation shouldnt have to be a popularity contest!
In fact, The Nationalist of Oct 28th printed this- thank you to the editor, Barbara.

Dear editor,
As opponents of Minister Dempsey's proposed new drink driving legislation once again pressurise their elected representatives there is a need to examine this emotive issue with new thinking. Prime Time's feature of Thursday 22nd October presented incontrovertible evidence that reduction of the drink driving limit to 50 mg from 80mg will reduce annual national road deaths by 10%. Indeed experts cited 18 road accident victims in 2008 in Ireland where the dead were found to have blood alcohol levels between 50 and 80mg. This refutes the argument that in many cases a couple of drinks will not impair driving.

Vested interest groups can not see beyond the defence of their right to allow drinkers to drive quietly home, to acknowledge the need to legislate for the common good. I recommend pinning responsibility for solving this issue squarely back onto those with the largest vested interest- the publicans and drinks industry. A simple solution of providing transport as part of the bar trade's basic customer service could be cheaply introduced and could quickly become the norm.

A publican could absorb a small minibus or people carrier into the business' cost base for less than 500 euro per month assuming a 24,000 euro lease over 5 years. This becomes a business asset both for its mobile branded advertising and for it's vital function of ferrying customers to the pub. A publican would then devise collection and drop-off routes and routines.
An 8pm to 9pm collection loop for OAPs on a wednesday with a homeward loop from 12 to 1, perhaps. Fridays and Saturdays would, it is hoped, become busy enough to require the enterprising publican to send the van out on several pick-up and drop-off runs.

The increase in visiting drinkers would more than compensate for the cost of this drinkers' shuttle service and driver's salary from the publican's viewpoint. The vital social benefits of publican provided drinkers' transport would be safer roads and the re-establishment of social contacts in both rural communities and among the less well off who currently deterred by taxi costs are drinking , perhaps to excess, at home.
yours etc,
Des Groome,
Chairman , Kildare Chamber of Commerce,
Kilcumney House,

Monday, October 19, 2009

FW: Letter to Editor.

Subject: Letter to Editor.
Date: Mon, 19 Oct 2009 13:26:59 +0100
In fact, this was not printed by the paper. Badly written, poor commentary- or Myers doesnt air criticism ?

Dear editor,
K.Myers wrote in the Irish Independent of Friday 16/10/09 "I am grateful to a reader for the following from the Great Green Plan...which says all we need to know about this bossy bunch of scary lunatics"We will develop a template for the establishment of farm-gate shops and ensure that the necessary legislative arrangements are made to facilitate this".K. Myers is apparently critical of this Green party plan to foster farm-gate shops as he then writes a stream of consciousness in which Myers positions a farm-gate shop at the centre of an Enid Blyton children's story. I have a number of questions after reading his piece-Is Myers crediting Enid Blyton with the prescience to predict and endorse a growing self-help movement of the rural economy in the 21st century?Or is he simply writing to appeal to the one third of Ireland's population - those over the age of forty, of which I am one-who MAY have actually read Enid Blyton?

Myer's criticism of the farm-gate shop movement is wide of the mark and unhelpful to our economy's current weaknesses for the following reason; Ireland's is a small open economy in which the majority of what we consume is imported and the majority of what we produce is exported. This model of Foreign Direct Investment dependency was successful in contributing to the phenomenal growth of Ireland's GDP from 1993 to 2007. However the weakness of our dependency on global trading has been exposed during recession. In short, now we in Ireland lack sufficient indigenous means of production, across the entire commercial spectrum, to stimulate sufficient internal cash flow to power our own economy towards recovery. The farm-gate shop movement is one means of stimulating the local economy by generating cash flow for commercial farmers, small food-producing business, small shop-keepers and creates a virtuous circle of cash retention in the local economy. The current reality of farming for the factory and consuming the imported produce of foreign multi-national retailers is contributing to rural and small town unemployment and the shrinkage of our SME sector.

The farm shop movement is of growing economic importance in the UK where there is now a growing market for fresh food from known local sources. Here in county Kildare we have a number of thriving farm food outlets which the local consumer is responding to. The message is travelling across Ireland's SME sector. Countrywide, we now see shop local campaigns successfully spreading the message of spending local euros locally. There is a growing understanding that spending our euro in local producers and local small businesses benefits all of us. The SME sector is the engine of our economy. The self-help principle of the farm shop could be the starting point for recovery and for a new vision of the future shape and balance of Ireland's economy,

yours etc,
Des Groome,
Kildare Vet Surgery,
Chairman, Kildare Chamber of Commerce,

In defence of rural enterprise

Kevin Myers wrote a bizarre and ill-informed article in the Indo last Friday which was critical of the Green Party's fostering of farm shops. Local food shops are, in my view, a great commercial development empowering farmers and small local food producers to grab their own financial fates by the scruff of the neck and snatch their business fortunes back from the grasp of middle-men, factories and conglomerate foreign retailers. I reproduce my letter to the editor of the Indo in response to Myers;

Sunday, October 11, 2009

Hip Replacements and the HSE

Irish Racing Ambassador and Kildareman Ted Walsh once famously summed up the hazards of National Hunt racing for horse and rider with the cryptic comment " Its not the years that do the damage, Its the mileage". Recently as a forty year old ex-amateur rider and ex-marathon runner I stared at an x-ray and heard the consultant describe " the obliterated joint space" on one hip and swallowed hard as he discussed prosthetic hip implant and major surgery as if casually prescribing a muscle rub and a few days stretching. But I wanted an end to over a year's nagging hip and back pain. I needed to resume an active lifestyle and restore mobility to fulfill the demands of my active profession. I researched hip replacement and hip prosthetics and sought the earliest possible date in the Blackrock Clinic with the Surgeon known to perform more hip surgeries than anyone else.

Our private family health insurance with Hibernian Aviva has been the most important two thousand euro we have spent every year for the past decade. We have two sons who were born with congenital heart defects. Our health insurance and ability to pay ensured we obtained immediate expert care. We have never been at the mercy of the HSEs waiting list and both boys have survived and thrived. My own experience of surgery, albeit as a Veterinary Surgeon, is that the margin for error is still high for orthopaedics, high caseload is the key to success, risks of infection are one in two hundred ( too high). Prognosis is also influenced by both attention to detail in hospital processes and post-operative nursing care and expertise. My health insurance gave me the option of an excellent private orthopaedic surgical facility with only a few weeks of a wait.

I mention this to make two points. Firstly I am an advocate for universal health care for Ireland. Every citizen has the right to the same care that I had to shop around for. But the internal costs of that excellence will be high and attempts to seek efficiencies in cost will always create inequality unless excellence becomes the only standard measured. The HSE have moved Cancer Services now to eight designated centres of excellence, with plans to discontinue cancer services in thirteen smaller hospitals. This is a recognition that multi-disciplinary management in centres of excellence acheives excellent prognosis. It is also a recognition that in the high mortality context of cancer excellence is the only standard we should measure. Secondly, I am self-employed and would rather work than not, my insurance card moved me up a queue into a private bed and will help me regain productivity and run my business again in the shortest time possible. A medical card holder in my position would wait six to nine months for a hip replacement and would be medically signed off work for all that time. Unemployable because of pain, this medical card holder costs the state in welfare payments and loss of productivity. Not to mention the administration costs of a two tier system whereby that person may have the same surgeon as myself, but is queued in a different list and assigned to a different hospital.

So it was that I went under epidural and had a Bermingham right hip prosthesis implanted. This is a metal on metal resurfacing technique of screwing in a new tightly fitting metal ball and socket. More of us will have this type of surgery as life expectancy for males rises by 8% to the year 2036. The post-op information describes the surgical aftermath" You will then be able to start walking first with a frame and soon with crutches". This breezy optimistic prediction proved to be spin of Alastair Campbell proportions as I lay stuck to the bed with pain for the first few days. I dragged my misshapen, swollen and lead-weighted right leg to the edge of the bed only by the use of the two-handed hospital trapeze swing made famous by "Jerry Maguire".But there were five hips done in Blackrock that day and the nursing staff knew exactly what pain scores were normal and when precisely to rescue the average Irishman from his own low pain threshold. Furthermore their helpful post-op brochure went on to say" Normal sexual activity can be started again at 6-8 weeks. Although the warning about avoiding extreme positions of the hip applies." But of course you can never believe everything these doctors tell you. Just how well do they make artificial hips anyway ? Even cars dont need a running-in phase these days.

From my own bitter experience I can agree with the findings of a 2008 UCC School of Nursing Survey. Published in the Journal of Orthopaedic Nursing, findings reported pain to be the predominant physical experience after hip replacement, pain was more intense than expected and importantly the absense of a pain nurse specialist contributed to inadequacies in post-op pain management. The survey found that in some centres patients pain was still poorly assessed and concluded that pain management remains a major challenge for orthopaedic nurses in Irish hospitals.

Our expectations of care are very high as we know the excellence that can be acheived in Irish hospitals. We shouldnt suffer in silence. My professional insight into the challenges of infection control, pain control, margin of error control ensured I went to a centre of excellence to have a hip replacement which even so was difficult, very painful and not without setback. I believe everyone to be entitled to that level of care. A margin of error is not acceptable; someone elses brother or grandmother shouldnt suffer as a percentage with infection, bed ulcer or pain just because they have a medical card or because whats not accepted in Blackrock is tolerated somewhere else. But we shouldnt expect that excellence to be available around every corner. We must recognise that excellent people are rare, that standards remain a challenge, remain dependent on people. If medical experts CAN guarantee standards in some locations then we must accept that other locations may have lower case load and consequent resources and expertise scarcity. Those who have fought the removal of some services from regional hospitals have carried placards " Death By Geography"and seek to preserve the availability of specialist service at their own regional hospitals. But they miss the vital point that on the whole list of factors that influence positive prognosis- the medical list- geography is absent. If we allow local concerns to determine where we provide specialist care to patients then we have to expect a margin of error.And then death by geography will become a reality.