8th January 2003
Christmas was wonderful, it was really wild. The New Year's Eve party was even better - one of Dublin's better known GPs played "The Teddy Bears' Picnic" repeatedly on his newly acquired saxophone. His wife is leading the campaign to get him lessons so that his repertoire will be wider by next year!
The long holiday allowed some catch-up reading to take place, cheerful and otherwise. I got two scrolls, which must have been the pivotal factor in the Dublin postal delay, from the Department of Health and Children. One was addressed to Senator Mary Henry and the other to the doctor version. Both contained poster size communications, to display I imagine, on the subject of the National Treatment Purchase Fund.
Now, whatever about the poster to the Doctor version of me being put up somewhere to alert patients to their entitlements to treatment abroad, my Seanad constituents have a postal vote so they will have to rely on others for information. The desirability of having politicians, even tame ones, going about touting for business for private hospitals abroad is another matter. I have written before about the wonderful campaign the Dublin Lions Club had a few years ago when they brought people with cataracts from the Midland Health Board area who had been waiting for over two years for treatment up to the Mount Herbert Hotel to stay and had them operated on as day patients in our very own Eye and Ear Hospital. Surely this is less expensive and complicated than the Department's present plan for cataract patients.
My mother used to say that but for Christmas and Easter we Irish would rot. She wasn't looking specifically at me but in the pre-Christmas tidy-up I found the October copy of the Irish Medical Journal which I had been looking for all through November and December. It contained a very good article on Irish neonatal mortality by a group from the Department of Paediatrics in Our Lady of Lourdes Hospital in Drogheda and the neonatal mortality rates in 1999 and 1987 were compared. A good decrease was noted in the twelve years although wisely they suggested some deaths in 1999 may only have been delayed to the post neonatal period.
One conclusion in the paper I would query however. "In 1999 the principal cause of neonatal deaths in Ireland was congenital malformations. This pattern has not changed in the past 12 years. However, in 1999, fewer congenital abnormalities involved the central nervous system. This is possibly a reflection of the increased uptake of folate preconceptually".
Now, I would like to be able to hope with the authors that increased folate uptake is the reason for the agreeable improvement but did they take into account the number of women who go to England for an abortion when they discover from a scan that their babies have anencephaly? Since I first wrote about this at least half a dozen people have told me of friends or family members who did just that and I feel this issue needs urgent attention so that we can see what really is going on.
The authors also pointed out the serious decline in post mortem rates for infants dying within the first four weeks of life - down to 24% in 1999 from 90% in 1987 for infants under one week dying in the Dublin maternity hospitals and 54% outside the Dublin area. Rightly, they say this is a cause of major concern and point out that "at least 28% of perinatal and infant post mortems reveal new and vital information. This is particularly important in a situation where the underlying condition has genetic implications".
While there were many unfortunate aspects to the sad death of little Bronagh Livingstone in Cavan Hospital, no post mortem was carried out which might have given her young mother information which would help her and those who hopefully will care for her in a future pregnancy. We will have to find a way of explaining to bereaved parents the great value to them and to others of post mortem findings. Help from the media would be useful.
The pre-Christmas tidy-up of my desk in the Seanad brought to the surface again the difficulties one can have in getting information out of the Department of Health and Children, even with the help of the Freedom of Information Act. Over two years ago some colleagues of mine in the Rotunda asked the Department of Health and Children about the deaths, if any, of full term infants whose delivery at home was planned. They received no reply.
Constituents, usually young women, ask me now and then how safe domiciliary deliveries are and since I believe Irish women should be able to have safe home deliveries I said I would try to find out if there were any neonatal deaths. The Perinatal Statistics Report for 1999 did not have the information either.
Well, two letters, one in April and one in August, to the Chief Medical Officer got me nowhere so in November I made an enquiry under the Freedom of Information Act. The reply said and I quote:
"On receipt of your request the Freedom of Information Unit contacted staff in Information Management Unit (IMU). The IMU is the focal point for statistical data and analysis within the Department. Our colleagues in IMU have advised that neonatal deaths refers to deaths within the first four weeks of birth. Unfortunately the information you have requested is not available to the Department of Health and Children. Information on neonatal mortality is collected by the Central Statistics Office via death certification. However, a person's death certificate does not contain information on whether their birth was in hospital or at home and death certification is not, at present, linked with birth registration. I am therefore unable to provide you with the records requested. This is a technical refusal under Section 10(1)(a) of the Act."
If the Department does not know the outcome of home deliveries, it should know. Independent midwives were far more helpful and gave me as much information as they could with their limited resources. But they do not have national figures. It is extraordinary that the Department does not have such information. Not much evidence of transparency or accountability.
Senator Mary Henry, MD
