Situation in Ireland in 1987 - A look back.

This is the full-text of an article by Padraig Yeates, then Health Correspondent, that appeared in the Irish Times on Tuesday, 27th October 1987: Last week the Minister for Health, Doctor O�Hanlon, received a report on the exceptionally long waiting list at the mouth and plastic surgery unit in Dublin�s Steevens� Hospital. Padraig Yeates reports on the plight of one group who figure prominently on it: children suffering from cleft palates. How the cuts hurt the cleft palate kids. Children with cleft palates or the milder condition of hare lip are not entitled to a medical card. The treatment can be painful, slow and expensive. Timing can be crucial. as certain operations need to be carried out at specific stages in a child�s development. The present cutbacks have not made the burden facing parents any easier. In at least one case over the past month a parent has emigrated to London to ensure that her child receives the necessary treatment. �We are not attacking the professional and paramedical staff who treat our children,� says Mister Anthony O�Connor, secretary of the Cleft Lip and Palate Association of Ireland. He describes their service as �sterling�. It is the Government�s cutbacks which have made the situation unbearable for his members, their 400 children and the many other families in Ireland whose children suffer from this distressing, disfiguring, but ultimately fully treatable complaint. A cleft mouth condition is still socially interviewed for this article wished to be lobbying has encouraged official neglect, health ministers and a Taoiseach have had taboo in Ireland. None of the families identified. Their discreet form of even though the families of three former children born with the handicap.

Lack of recognition for the complaint hits hardest at those families whose income is too high for a medical card and too low to make private medicine an easily accessible commodity. One mother I spoke to, with two children suffering from cleft palates, aged 13 and four, said that she had never applied for VHI cover because, up until a few years ago, �there was absolutely no waiting list�. �Then we were told that suddenly, due to cutbacks, they couldn�t finish my oldest boy�s mouth, even though three quarters of the work was done. A small piece of equipment, worth 20 pounds, was holding up the work,� she went on. Another mother told how the first seven operations on her daughter�s mouth were covered by free school dental treatment - now she is too old and the next operation will cost 1000 pounds. �We inquired about the new VHI scheme but discovered our income was too high.� Even for those wishing to subscribe to the VHI, there are major obstacles in obtaining benefit. �Most people are very upset when the baby is born. It's a disaster and usually there is nobody they can turn to,� says Mister O�Connor. Unless they receive advice quickly, they will probably fail to insure the baby under the VHI. For while the company will usually accept children admitted within a short period of birth, in many cases the Cleft Lip and Palate Association has found that its two-month limit is passed. After that any child entered for the scheme will not become eligible for cover for five years. Another VHI condition is that all the children in a family must be insured, not just those with known medical problem. The squeeze on public dental services has been a slow one. As long ago as 1982,

the then Minister for Health, Doctor Woods, in response to the Cleft Palate Association, announced that five new consultant orthodontists would be appointed to ease the demand for treatment. This never happened. The salaries on offer were too low, compared with private practice. In Steeven�s Hospital today there is only one part-time orthodontist on secondment from the dental hospital, assisted by two trainees. They have a nurse who must double up as a secretary/receptionist. During the six hours of treatment per week, around 50 to 60 patients are seen. The fact that there is only one set of instruments, most of which don�t work, does not help. Cleft palates produce related defects in hearing and speech, which can seriously hinder the intellectual and psychological development of children. While Steeven�s Hospital has evolved by default, as a national centre to treat sufferers, four other hospitals - Crumlin, the Ear, Nose and Throat, and Temple Street Children�s Hospital in Dublin, and a new unit in Cork - also provide services. These too, are under threat. In Temple Street, one of three overworked speech therapists is being let go under the cutbacks. Ironically the therapist has 11 years service but is a temporary employee and therefore expendable under the negotiated redundancy deal with the unions. Already it has taken children with cleft mouth conditions six months to be assessed at Temple Street and another three to six months to begin therapy sessions. These delays will now increase and for children with less severe speech defects, the waiting lists will grow even longer. In the surgical area, the pressure on services is also severe. One mother who was told her child would receive a bone transplant operation last February, has now been told it will only be possible after Steeven�s mouth and plastic surgery unit is moved to Saint James�s Hospital. No one is sure yet when that will be, but it should happen before Christmas. The operation, she has been told, could be carried out by February, 1988. Meanwhile her daughter must suffer the pain and social embarrassment that 16-year olds are particularly susceptible to, suffering from such a disfiguring complaint. For parents living outside Dublin, the unpredictability of the delays can be even more wearing, and expensive. Some, but not all health boards, provide transport. Deputy Michael D Higgins, of the Labour Party, says that the situation of sufferers in Galway has been �totally ignored�. He says it took seven years to persuade the Western Health Board to advertise for an orthodontist. When they did only two people applied and only one turned up for interview; even though the salary on offer was 27,000 pounds and allowed time for private practice. The one and only successful applicant declined the post. Dentistry is expensive and we spend only two per cent of our health budget on it compared with an average of seven per cent in other EEC states. Not surprisingly, only ten per cent of medical card holders seeking dental treatment actually receive it. The Cleft Palate Association has gone the usual round of sponsored events and other fund-raising events to raise money for essential equipment. It has also subsidized training courses for health board staff. The uncertainty over the future of the unit in Steevens led the Association to seek representation on the group investigating the huge waiting list at the hospital which reported to the Minister last week. The request was ignored. So

will the Association�s call for Doctor Steevens� to remain open. Some senior surgical staff at Steevens� insist that once facilities are moved to Saint James�s Hospital, the present backlog can be cleared, and at this stage they do not question the inevitability of the move. Wherever the service is based, nothing short of a dramatic improvement in orthodontal resources is going to meet the dental needs of the population in general and those of its worst sufferers in particular. The Cleft Palate Association says that it will be increasing pressure for adequate resources. They are not looking for confrontation, insists Mister O�Connor, �but this can�t be treated as a book balancing problem. The Minister has to carry the can. If no one else does it he must show compassion. (Reproduced by permission of Padraig Yeates). This information is available from www.cleft.ie