Sunday 25 August 2019

Rude Health: Where's the swab?

As the cost of women's health claims rises to over €60m a year, Maurice Gueret might have a job for expectant dads

Surgical swabs. Photo: Getty Images.
Surgical swabs. Photo: Getty Images.
Dr Maurice Gueret

Irish hospitals used to defend themselves against lawyers, but in recent years this function has been taken over by the State Claims Agency. From an office suite in Dublin's Treasury Building, it employs legal and insurance expertise to manage all allegations of clinical negligence in the State.

Last month, the agency published a review of claims in obstetric and gynaecology services. It makes for worrying reading. (For clarity, obstetrics refers to the business of pregnancy and childbirth, while gynaecology is the treatment of diseases of the ovaries, womb and vagina.) Last year alone, the taxpayer spent €58m on maternity claims, and over €4m on gynaecology claims. Trends show that maternity claims are almost doubling every five years, which means that it may not be long before one year's pay-outs are higher than the cost of building a brand-new maternity hospital.


One claim that is prominent in this recent review is the case of the disappearing swab. Swabs are disposable squares of compressed gauze that are used to quickly staunch and mop up the flow of blood. They are essential in many fields of surgery, but it's just as essential to count them in and count them out. If one is left behind either in an abdominal cavity or a vagina, they can cause unholy pain, infection, smells and further nasty complications. In the last decade, there have been 44 claims made by Irish women for foreign bodies left behind after obs and gynae procedures. We are mainly talking swabs, but epidural parts and the odd surgical instrument feature, too. New designs have been tried using radiopaque swabs that will show up on X-rays, and swabs with tails on them that are more difficult to forget about. But the fact remains that we have a serious problem leaving things in when we are trying to get baby out. Of the claims made in maternity, most are happening in the delivery suite rather than the operating room. Maybe counting them in and out is a job we could give to expectant fathers? Menfolk behave best when given something useful to do.


When Mary Harney was health minister, cries of there not being enough doctors were usually answered by plans to recruit and educate more nurses who would diagnose, prescribe and generally do the jobs of doctors. So what did Minister for Health Leo Varadkar say recently on Prime Time when he faced questions about the shortage of nurses? He said we may need to train up attendants to do the jobs of nurses! I think we know where this nonsense is going. By the time I'm old enough to need my hospital bed, I'll have been referred by the practice secretary, put to sleep by the hospital almoner, operated on by the front-hall porter and my bedpan will have been gently warmed by a former minister.

BCG vaccine

I was telling you recently that Ireland and Portugal are among the last countries in western Europe to give the BCG vaccine against TB to all infants. Until our supplies ran out, that was. Now it looks like we'll only be using it for the 8,000 babies at high risk, rather than the full 60,000 newborns that were getting it each year. Leo has asked the Health Information and Quality Authority to start one of their public consultation thingies, which usually signals that the powers-that-be have their minds made up already. I had an interesting letter from a lady in Cork who told me that BCG immunisation temporarily ceased in the city 45 years ago when she was born. I wasn't aware of that. She wasn't vaccinated, and, lo and behold, she contracted TB later in life. She tells me that one afternoon of sitting in the public TB clinic for your check-ups "would make you wish you could get a BCG every year . . . not a nice experience, with so many potentially infected and definitely infected sitting all together for hours, waiting to be seen in a poorly ventilated Portacabin." She had to tell the quizzical public health nurse that she wasn't a member of any high-risk group or ethnicity, never smoked, enjoyed only an odd glass of wine, didn't sleep around and never spent nights drinking in public parks with large groups of people. After a fair spell spent seriously ill in hospital, and many months of drug treatment, she was cured, but she tells me, as many tuberculosis patients do, that her health never attained its previous perfect status. She points to migration trends in Europe and rising levels of drug-resistant TB in big cities, and wonders if BCG should be left alone. She may have a point. If you blinked, you may have missed the public consultation. It began in September and ended on October 21.


We tugged at the outer part of your ear last week, so today we go inside to examine the earwax. Wax has a higher purpose than as a source of income for penniless doctors. It cleans, lubricates and protects the delicate skin of the ear canal. Earwax also keeps insects and water from the doorway to good hearing and balance. And it furthermore prevents bugs from finding a nice warm nook or cranny to infect. Wax is made up mainly of old skin cells, with bits of hair thrown in. Its magic ingredient is a greasy substance produced by tiny glands in the outer ear canal which contains cholesterol, fatty acids and a drop of alcohol. Wax is called cerumen by doctors, to distinguish it from the candles that once lit their surgeries. Europeans tends to have wet brown wax, but in Asia the wax is greyer, drier and more crumbly. Anthropologists have used the study of earwax to track migration and minglings. It's our brown, soggy Irish wax that gets passed to mixed-race children as the pale, flaky stuff loses out.

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

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