ADDRESS BY PRESIDENT McALEESE FOR THE BARTHOLOMEW MOSSE LECTURE ‘A HEALTHIER CENTURY AHEAD?’
ADDRESS BY PRESIDENT McALEESE FOR THE BARTHOLOMEW MOSSE LECTURE ‘A HEALTHIER CENTURY AHEAD?’ GATE THEATRE
Is breá liom bheith anseo i bhur measc tráthnóna ag an ócaíd speisialta seo, agus ba mhaith liom mo bhuíochas a chur in iúl díbh as an chuireadh agus as fáilte fíorchaoin.
Ladies and Gentlemen,
When I was invited by the Master of the Rotunda Hospital to deliver the Bartholemew Mosse Lecture for 1999, I reflected on what might be an appropriate theme for that historic hospital and the phenomenal contribution it has made in the many years of service since its foundation in 1745. It occurred to me that this generation is the first to sit on the threshold of the full realisation of the dream of this hospital’s founder.
Bartholomew Mosse wanted more than just better physical health for his poor patients. He wanted hope - hope that a savage world of social exclusion would give way to a world where every individual mattered.
Delivering those ambitions in eighteenth century Ireland truly was a herculean labour of love, for many people faced each new day, each new decade and even the dawn of a new century, with nothing less than sheer dread. By contrast late twentieth century Ireland faces the twenty first century with a breathtaking confidence in tomorrow, for ours truly is the age of miracles. The healthy society, which is more than a society of healthy people is now within our reach.
There is an old saying in Irish: ‘Tús maith is leath na hoibre’ – a good start is half the work - and Bartholomew Mosse made exactly that, a good start. It must have seemed to him however, in those grim times, that he resembled Sisyphus pushing that infernal stone up the hill, never quite making it to the top, never quite seeing the view from the summit. He died without seeing the summit. We, the blessed generation, now see its awesome vista, the one he believed in, dreamt of, worked for and painfully built a causeway to.
Mosse’s Ireland was the Ireland of Swift and Goldsmith. Said quickly, it conjures up an image of intellectual discourse, of celebrated poetry and literature. It was however a cruel world and in particular it was a very cruel place for women and for children.
The year 1741 was known as ‘bliadhain an air”- the year of the slaughter. Over a quarter of a million people died from famine and from the litany of diseases which accompanied it. One contemporary account says:
“…. Whole villages were laid waste by want and sickness and death in various shapes; and scarce a house in the whole island escaped from tears and mourning.”
Maternal deaths and infant mortality rates were appalling with the poor bearing the brunt as always. Side by side with their world was an altogether different world, inhabited by the wealthy, the pleasure seekers,many of whom exhibited a frightening absence of any measurable social conscience. But even in that world all was not well for women and children.
Letitia Pilkington was a woman of those times. Her father was a doctor whom she describes in her memoirs as “the one man midwife in the kingdom,… {who} had made himself useful in that art and practised it with great success, reputation and humanity.” She died at the age of thirty eight, just five years after the first patients entered the one time concert theatre which Bartholomew Mossse had transformed into a lying-in hospital for poor women. Letitia Pilkington describes a world unhealthy in many more respects than mere physical health. Her brother died in infancy and she herself an ailing, sickly child, was a victim of her mother’s callous severity. She describes “frequently being whipped for looking blue on a frosty morning.” She was forbidden to learn to read but did so by stealth and describes being obliged to enjoy the joy of reading “with fear and trembling.” The ultimate indignity concerning her arranged marriage to a clergyman is itself a cameo of both women’s power and powerlessness. She describes it this way:
“My mother’s capricious temper made her reject every advantageous proposal (of marriage) offered and at last condemn me to the arms of one of the greatest villains, with reverence to the priesthood be it spoken, that ever was wrapped up in crape.”
That was the callous world in which Bartholomew Mosse lived – Ireland of the 1740’s.
He dared to care when negligence was the norm. For many among the ruling classes the high incidence of maternal and infant deaths were simply unalterable facts of life. Left to them little would have changed. Certainly the scale of grimness was overwhelming but as always, it is those who light the candle instead of cursing the darkness who reshape the trajectory of life, doing the impossible because they refuse to accept the inevitable. Mosse believed in the future, he believed in its potential to be better, healthier, happier, more hope-filled. When he saw the dreadful conditions of the poor, the mercy and compassion in him made these things his problems too. His hospital for poor women was much more than a place where women and children’s health came first it was also a place whose very existence called for a radical re-ordering of social concern and social inclusion. The sheer scale of the change his work encompassed, the sheer scale of the tide which seemed to be against him, is hard for today’s Ireland to understand, though the poor of Honduras know it, the mothers of Calcutta know it, the street children of Vietnam know it and in each place there is a Bartholomew Mosse making a start, setting down the challenge for future generations to build on.
The social conditions which so distressed Mosse were no better in the nineteenth century when the scourge of famine culminated in the catharsis of the great Hunger. This world of misery continued, right up until the first part of this century. Around the time of the Dublin Lockout in 1913, the death rate for members of the professional class was estimated at 16.5 per thousand. For what was termed the ‘general service’ class, it was more than three times that figure, at 40.2 per thousand, mainly due to higher child and infant mortality. Poverty really did kill.
These latter days are still within the memory of somepeople in our community, leaving todays’s Ireland a first world country with a third world memory. Indeed the high early mortality rate among our travelling people is one indicator of the journey we still have to travel.
Through those years it would have been understandable had all hope been obliterated. Certainly those who worked tirelessly to improve things must have been drained of energy manys a day and yet they kept on doggedly pursuing the germ of a vision, nurturing the fragile seed of human decency, determined that a day would come, and probably not in their lifetime, when their faith in the sacredness of each human being would be rewarded with a healthier, prosperous, more equitable and caring Ireland.
Ireland has come a long way over the course of this century, from a time in the early 1920’s when infant mortality claimed one child in every fifteen, to the 1990s, when Ireland can boast one of the lowest rates of infant mortality in the world. The extraordinary pace of economic and social advances – and the improvement in general living conditions they brought about - have been major contributing factors in this reduction. But there is another key element which is worth remembering and celebrating. That is the tremendous care and concern, dedication and commitment which the medical profession demonstrated over the generations in Ireland and so often in the face of a tide of disinterest in the plight of the poor among their social peers. We owe a tremendous debt of gratitude to all those who work in the Rotunda and hospitals like it all over the country. We remember with thanks also, their predecessors in the medical profession, men and women like Bartholemew Mosse who struggled with such bravery and commitment to reverse the appalling death rates of their time, to tackle the ignorance and apathy and hopelessness which surrounded them.
How amazed and proud Bartholemew Mosse and Letitia Pilkington would be if they were able to witness the tremendous strides that have been made since then, in the Rotunda, in medical care and in life generally in Ireland.
Over the past few generations, advances in medical care and medical discoveries have transformed the lives of women: first, and most obviously, by practically eliminating the risk of death in childbirth. Women have been enabled to choose whether, or how many, children they wish to have; we have witnessed the opening up of the discussion and treatment of women’s specific issues like the menopause, breast cancer, cervical cancer, osteoporosis, postnatal depression. These developments have greatly improved the quality of life for women, enabling them to create and avail of opportunities and choices that their grandmothers could only have dreamed of. Letitia Pilkington would undoubtedly see this as the age of miracles too. Women voting, women running business, women emerging from under the shadow of a social system which profoundly, unsubtly and subtly, disabled them, a system manifestly being dismantled but not yet consigned to history. The final dismantling of that system will be the work of the next century. It is interesting, in this context, to examine how women have fared within the medical profession itself. From a time when they were barred from admission to medical schools, women now account for 50% of graduates of medical schools; their share of junior hospital doctor posts is about 37%; they have a similar proportion at registrar and senior registrar level; and the percentage drops to about 19% at Consultant level.
These are, of course, huge improvements compared with the past, but is it simply a matter of time before women filter through in equal numbers to the top, or will these numbers remain static? Do women encounter a glass ceiling, or are they disproportionately put off by lack of flexible training and working opportunities? By the long hours? By problems in combining work and family responsibilities? By overwhelming levels of stress? We need to discover the answers to these questions, not just on the principle of equity, but because these are the questions which in answering will make for a healthier profession, a healthier society.
Ireland used to be a country where people died young as did Letitia Pilkington, their potential never fully realised, their giftedness never given its best opportunity to blossom. Today while we see ourselves as a young country with a healthy young population, in fact, in the years ahead the proportion of individuals aged 65 and over, indeed aged 80 and over, is set to increase dramatically. The spectacular increase in longevity we now enjoy, owes much to the stunning advance of medical science in the latter part of this century. Even more significant has been the way in which this progress has not just increased life expectancy, but the quality of life for older people. In this UN International Year of the Older Person, I have witnessed time and time again how so many individuals have gained a new lease of life, a new source of energy, many new interests, at an age when the previous generation, if still alive, were barely clinging on, often in a great deal of pain. Last week in Galway I met 104 year old Brigid Derrane who wrote her best-selling autobiography at the age of 102 with the help of her nursing carers. We owe the medical profession a great deal for giving so many extra years of activity and enjoyment to so many.
In Mosse’s world people died young and they died hard. For all our progress, the best we have been able to do is postpone death, we cannot avoid it. But today’s new consciousness about palliative care, thanks to the efforts of the Hospice movement, has begun to take the fear and dread out of the final journey we all face one way or another. We are fortunate in Ireland to have so many professionals and volunteers, whose unswerving care and commitment have enabled people to face those final months, weeks and days with a sense of peace and acceptance and as pain-free as modern drug therapies allow, in the company of family and friends. This new discipline is growing from strength to strength, offering reassurance that where there is death, there will also be dignity. Its growth is fuelled by an amazing public level of financial support. Last week I had the privilege of opening the new Galway Hospice in-patient centre at Renmore. The people of Galway have raised six million pounds to support the Hospice. Bartholomew Mosse would have more idea than most just what that represents. To found and fund his hospital he had to run concerts and entertainments, the precursors to today’s charity auctions, lotteries, coffee mornings and annual balls. That is one thing which has not changed in over two hundred years. Fund raising is still very hard work.
His world heard no talk of respite care, of the need for our carers to be healthy, to have support in their relentless work of caring for the disabled, the chronically ill, the elderly. Today the respite care movement is also growing, holding out the promise of significant change and development in this historically most neglected of areas.
Mosse would of course be especially astonished at the way in which new technology, awesome in its power and sophistication, has transformed medical care in the Western world. In fact so accustomed have we become to this age of medical miracles, that we now take as routine discoveries and technology that just a few years ago seemed unimaginable. I remember the enthralling news from South Africa of Dr. Christian Barnard’s adventure in heart surgery. Most of us here remember too the hullabaloo which greeted the first test tube baby, Louise Browne, 21 years ago in England, an event which provoked reactions ranging from new-found hope among infertile couples to outrage at what some alleged was humankind playing God. We have long moved on from the era when society had years, perhaps even generations, to come to grips with the moral and ethical dimension of new discoveries.
Each new day now seems to bring with it new hope but also new dilemmas. Shortage of human donor organs creates market pressures with potential consequences which disturb many people, such as organs for sale or organs from animals? Where do we stand on genetic experiments or cloning, with their potential for discovering more about the prevention or cure of genetic diseases, but carrying with them what some people see as the threat of opening a Pandora’s box for the future? The advertising of potential ‘designer babies’ on the Internet is the latest manifestation of a world no longer limited by much except its capacity to imagine and science’s capacity to keep up. How do we react when we see as we did last week the amazing picture of a 21 week foetus wrap its tiny hand around the finger of a surgeon operating on it in utero to correct serious medical problems? How do we convince people to take effective responsibility for their own health and the health of others whether the issue is smoking or road safety or sensible diet? Will we have children suing their parents for poor diet alongside the smokers suing the cigarette companies?
There is no escape from the implications or the impact of these developments. Medical researchers and practitioners are among the many important sources of insight in this debate. Your diverse voices, need to be heard in the public discourse, for you are the people working at the coalface of the human misery caused by disease, infertility, injury and premature death.
There is today a barrage of ethical questions which have to be confronted in the education of medical and nursing students, at undergraduate and postgraduate level. They represent some of greatest challenges which all of us, including the medical and nursing professions, face in the next century. But there are other familiar, old challenges not yet adequately resolved.
The issues which dominate the agenda in the Western world, may seem esoteric maybe even self-indulgent in the extreme to societies in what is termed the Third World. Children on this small globe of ours continue to die for the want of inoculations against basic diseases and illnesses that are part of history in the West. Yet that past is not so distant in this country. We have only to think of how TB devastated this country just a couple of generations ago – and how it was possible to bring it under control. That knowledge confers on us a special responsibility to look beyond our own borders, to be moved by the same sense of compassion and determination that drove Bartholemew Mosse to found the Rotunda, to refuse to be satisfied until the same standards and expectations we enjoy are the norm in every part of the world. The responsibility for outreach to the rest of our common human family does not rest with the medical and nursing professions alone yet so often it is our nurses, doctors, medical technicians, paramedics who are the hands of our work. They take the name of Ireland to so many parts of the earth, ambassadors for a caring and a sharing world, ambassadors Bartholomew Mosse would undoubtedly be proud of.
It is perhaps inevitable that the extraordinary medical advances in the latter half of this century have raised public expectations as to what medicine – and medical practitioners - can achieve. We have witnessed miracles, and have come to expect perfection. We expect to be healthier and happier in the next century. We expect greater opportunities, fewer impediments. All these things Mosse would undoubtedly salute but perhaps he might do well to remind us that if these things are to happen they have to be made to happen. They cannot be taken for granted. In his world there were those who lived for themselves alone and those who worked for others, those who accepted things as they were, those who worked for change. We still need the doers, the visionaries who strive to make things better. Today is no time to become paralysed in self-congratulation or complacency.
This generation has been blessed with a new-found prosperity but it still has its poor. It has been blessed with the widest extension of educational opportunity our people have ever known, yet we still have our illiterate, our early school leavers, our unskilled, our people whose potential is trapped.
More people are in the mainstream but there are too many still on the margins, mere spectators at the success of others.
This is still a country which could gainfully employ Bartholomew Mosse and more like him. This is a country which needs to commit itself anew to the vision he had for a country where each person truly matters from the start of life through to its last breath.
This generation is the first since Mosse, perhaps the first ever, to have the tools, the wherewithal, to actually make real the achievement of a republic of equals, to fuse the political and social realities into the achievement of a true experiential republic.
In the end, whatever new marvels and cures are brought to us by medical research and technology, the focus of medical care, political care, social care must always be on the individual human being. Wherever there is a person, there is a person in need of reassurance, of a kind look, of a consoling word, of mercy, forgiveness, respect, equitable treatment, of being made to feel that his or her needs, worries and concerns matter. Wherever there is a person, male or female there is a responsibility for creating a world in which those values are put to work. We are all of us both givers and receivers in that regard. These are things that no money can buy, no computer can generate, no technology can replace. They start in the human heart and are fostered in the lives of people like Bartholomew Mosse who would accept nothing less in a world where a lot less was the norm. They are precisely the qualities that have earned the medical profession and the nursing profession the special place they hold in the hearts of the Irish people. We like to think they are values which are held in common by a critical mass of the Irish people, values which sustained us through awful times and which today challenge us to use well and generously the gifts of progress which are peculiar to our generation. In all we do, we are laying foundations not just for health care in the 21st century but for what we hope will be a caring and healthy 21st century. Nothing less will repay the debt we owe to both the patience and the righteous impatience of Bartholomew Mosse.
Go raibh míle maith agaibh.