Thursday 27 July 2017

Fertility nights - how Italy is tacking its birth decline

The Italian health minister warns of a population apocalypse, says Maurice Gueret, from a smoke-free campus of butts

Health Minister Beatrice Lorenzin (R) talks with Agriculture Minister Nunzia De Girolamo at the Senate
Health Minister Beatrice Lorenzin (R) talks with Agriculture Minister Nunzia De Girolamo at the Senate
Dr Maurice Gueret

Maurice Gueret

Italian politicians are back encouraging young folk to get into bed. Health minister Beatrice Lorenzin has warned of an apocalypse if the nation's declining birth rate isn't tackled. She says Italy risks becoming a 'dying country' and has launched a National Fertility Day, promoted by a series of eye-catching posters. The campaign has got her into trouble. Italians have long memories.

The last time women were cajoled into giving birth for Italy was during the fascist 1930s. One image of a young woman holding an egg timer and rubbing her belly has been judged particularly offensive. Lorenzin has plans to use financial incentives, with improved baby bonuses, to get the population up. There are no plans to follow suit in Ireland. Our birth rate of just under 15 per thousand compares well with eight per thousand in Italy. We mightn't have a designated Fertility Day. But those dark Irish wintry months, warmed by turf and lubricated with plenty of rain, ensure plenty of unspoiled Fertility Nights.

* One factor raised in Italy as contributing to their low birth rate is that the average age of first-time mums is 31-and-a-half. But this is almost universal now in the developed world. In Ireland, the figure is 30 for a first baby, and it's similar right across western Europe, in Japan and in Australia. In the USA, Russia and eastern-European countries, the figure is closer to 25. In African and poorer South American countries, 20 is more likely to be the norm. I am sure that anthropologists and cultural experts can explain away all of these discrepancies. Economic simpletons like myself believe it's all down to the high cost of weddings and house mortgages.

* Over the summer, I got hooked on a TV series called Alaskan Bush People. It features an unusual family of nine who leave civilisation to live in the wilderness of America's most extreme state. There's a touch of The Waltons and Little House on the Prairie about it, but the fascination for me has been their development of basic survival skills that most of us lost generations ago. When doctors, clinics and hospitals are hours away through tough terrain, first-aid know-how and how to watch a sick person for changes become top-notch. The quirky Brown family have their dealings with the outside world, but money rarely enters the equation. Bartering the labour of their five sons pays for almost everything - except medical expenses. Even in Alaska, cash is king for doctors. Medical and dental bills are a constant struggle for America's most self-sufficient family. I'd be interested to hear if any Irish patients do bartering deals with their doctors. I don't want names, but if you know of any interesting stories, drop me a line at PO Box 5049, Dublin 6w or mgueret@imd.ie

* I visited a regional hospital recently and was struck by how unfriendly the rigmarole at hospital entrances has become. Once you manoeuvre into the car park with its minimum €4 charge, you then have to run the gauntlet of a North Korean border-style tannoy system. All day long and well into the night, this plays a loud, recurring and irritating message on loudspeakers, warning that 'This is a no-smoking campus' and that 'Tobacco use is not permitted anywhere on the grounds'. I wish they would turn these bloody things off. Nobody listens to them. Unswept cigarette butts are everywhere, and patients and visitors huddle as close to the entrances as they can to puff on their fags. Like it or not, many smokers are hooked like fish and will light up when they are hospital inpatients. If we are serious about smoke-free hospital grounds, then it is up to hospital authorities to provide a patient courtesy bus or trolley to get their fix off campus. Allowing security staff to taser anyone found smoking is an option but it could cause extra work for cardiac units. If a shuttle bus is too expensive, I'd favour a designated bicycle shed with an ashtray. It makes little sense to have general hospitals pretending to banish cigarettes while mental hospitals and prisons continue to sell them.

* There wasn't a lot of media coverage given to a recent case in the Dublin District Court concerning the unauthorised sale of medicines. Two men pleaded guilty to charges of selling unauthorised medicines at a bric-a-brac stall in Balbriggan market. One received a fine and 200 hours community service, and the other received the Probation Act and paid costs and a donation to charity. The haul included tablets, capsules and suppositories, 5,000 in all. It included the anti-clotting medicine Warfarin, along with a number of potent epilepsy, pain and psychiatric medications too. The danger of these sorts of drugs being available at market stalls would be clear to most, but perhaps the greatest hidden risk is that consumers have no way of knowing what substances these products actually contain. By all means, shop around for medicinal bargains. But make sure it's only pharmacies you shop around in.

* A true story has come to light from the men's room of a London teaching hospital. A distinguished professor of microbiology left the urinal and headed for the door. He noticed that the man who had stood beside him was washing his hands in the sink. The professor shook his head and elucidated his interesting 'no-wash after peeing' policy. "My urine is sterile, my penis is clean," he explained "have you any idea how many faecal organisms are on that tap?"

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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