Monday 18 November 2019

What Andorra can teach us about fixing our health system

'The people who are working in A&E, it's not fair to ask them to go in and face that each day' (stock image)
'The people who are working in A&E, it's not fair to ask them to go in and face that each day' (stock image)
Deirdre Conroy

Deirdre Conroy

I lay on a trolley in A&E last week. No, come back. Next thing I knew, a kindly female radiographer stroked my cheek and said I needed another X-ray. The fracture was confirmed and the orthopaedic surgeon was contacted to assess the urgency.

He wasn't due for at least an hour, but the staff busied around me doing tests and trying to remove my clothes without me screaming. I was frightened and suffering what felt like the worst labour pain multiplied by 1,000. The grey-haired surgeon in a pin-striped suit that I expected turned out to be a tanned, long-haired snowboarder-type. He explained it was an "important" break and my blood vessels could be damaged and that there was no time to check my medical insurance.

All I wanted to know was whether I would walk again. He nodded reassuringly. The area outside my cubicle was filling with new patients.

The medical staff needed rid of me and I was wheeled through what seemed like underground channels into basic lifts and a very large single room with a private bathroom. They slid me on to the bed. I gasped as half my body seemed to be seared by hot irons.

I assumed that, once they discovered my health care didn't cover such a luxury, they were bound to move me to a room with five strangers and their assorted visitors.

I said nothing, I just wanted to be put out of pain and put back together again.

En route to the operating theatre, I saw ceilings of exposed blockwork and the pipes and cables of a simple building. The one thing that kept popping into my head before my femur repair was that, after all we hear, I was glad I wasn't in Ireland. I was in a public hospital in Andorra.

The anaesthetist explained she would be giving me an epidural, and I would be partly awake. There seemed to be a lot of women in charge. Hours later, tucked into my pristine bed, a nurse told me that when they phone the Irish health insurance companies and explain that a patient is in their own room, they are told to take them out, as they don't have private room cover. To which she asks: "Why would we put two people in the same room?" Indeed, why would you?

Next day there were further surprises. I even thought of taking photographs for Health Minister Leo Varadkar and his Michelin foodie pal Oliver Dunne.

The post-op diet included rabbit for lunch, day two was monkfish and next day was poached salmon, all accompanied by fresh vegetables and followed by fruit.

While one cannot compare Ireland with Andorra, I'd like to think that if I fell off a bike here and broke my leg, I wouldn't be one of those 600 who were left waiting on trolleys last week. But I am Irish and I broke a leg, so why should a tiny foreign co-principality treat me far better than the place I pay health insurance?

The investment in health here is exponentially greater per capita than Andorra, yet we have had health crises since I can remember. The hospital in Andorra clearly invested in systemic procedures, equipment and staff - without any wastage on grand monumental architectural statements and luxurious fit-outs, indoor gardens, fountains, ponds and glass elevators.

They were all about fixing you quickly and getting you well, with a private room.

There is no private health insurance there, everybody pays a small contribution from their income, no tax, but health contributions.

If Irish people saw that adequate, functional medical facilities were being built, where nobody ever had to wait on a trolley or risk an infection, there might be some chance of a universal health scheme.

As for now, just like the water meters, there is no point in levying a charge for a service that is not provided.

Solve the health crisis by re-configuring our hospitals and spending money on space rather than decoration, on staff that will operate equipment after 6pm. And union officials shouldn't be able to dictate what training and assistance staff should avoid.

A little more action, Leo, roll up your sleeves and make change happen.

You showed courage last weekend, but you are needed back on the wards now.

Irish Independent

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