REMARKS BY PRESIDENT McALEESE ON THE OCCASION OF THE HANNA-LOANE MEMORIAL DINNER, CANAL COURT HOTEL
REMARKS BY PRESIDENT McALEESE ON THE OCCASION OF THE HANNA-LOANE MEMORIAL DINNER, CANAL COURT HOTEL, NEWRY, FRIDAY, 26 NOVEMBER
President, Members of the Ulster Surgical Club and guests,
Thank you for your warm welcome and for the invitation to spend this evening in your company. I have Brian Cranley to thank for the invitation to deliver the Hanna-Loane Memorial Lecture which also means you have him to blame! As a former patient of Brian’s I can understand why he might want to inflict such revenge on me but I cannot imagine why he would want to inflict such punishment on his colleagues. I said yes readily not just because of my respect for Brian, not just because it brings me back to my beloved County Down, but because it brings me into the company of eminent men and women who belong to a profession which provokes unanimous admiration and respect.
I, on the other hand belong to the legal profession, a profession which provokes – well generally it just provokes. My credentials as a speaker in this medical company are a bit on the thin side for I cannot imagine that my honorary ties to the Royal College of Surgeons or my marital ties to a certain dental surgeon would cut much ice in a gathering like this. I have a very tenuous link to your first President, the renowned Sir Ian Fraser whose portrait hangs in the Great Hall of a University which I know links many of us here, the Queen’s University of Belfast. A couple of years ago shortly after the Great Hall was extensively refurbished, and its portraits re-hung, I was asked back to my Alma Mater to open the Centre for the Advancement of Women in Politics. I invited anyone who was sceptical about the need for such a centre to take a look at the large collection of portraits on the surrounding walls - not a single female. Even the dog on Sir Ian Fraser’s lap was male. Subsequently the omission of women was remedied for the portrait of the College’s foundress Queen Victoria hangs there now along with the redoubtable medic, the late Professor Molly McGeown and I am embarrassed to admit one of myself which will teach me never again to use an example which could rebound on me so mercilessly.
Some generations are condemned to live in interesting times, we on the other hand have lived through times of fascinating contrasts and huge change on many fronts, not least the rapid acceleration of women through the worlds of business, commerce and the professions from which they were traditionally either excluded or to be found in only small numbers. The evidence of that has probably been most obvious in our two professions, medicine and law. Today medical and law schools are dominated by women, a remarkable contrast to what seems a short thirty-five years ago when I first entered Queen’s as a law student. Women were then a tiny minority and if the truth be told a less than wholly welcome minority. The first book on our reading list was entitled Learning the Law by Professor Glanville Williams one of the most distinguished lawyers of his day. Three quarters way through the book I came upon a chapter rather ominously and tersely entitled “Women”. I looked but could not find a matching chapter entitled “Men”. No, Professor Williams deemed it important to make certain things clear to us women if we were still hanging around by chapter twelve. He reminded us that it was a well known scientific fact that our voices didn’t carry as far as men’s and so that ruled out a career at the Bar. He had clearly lived a sheltered life remote from the dulcet tones of an Ulster mother calling her children in for tea. Still he told us not to worry that the law provided us with ample opportunities to find suitable husbands and thus an honourable way out. That man vexed us women no end and he can take considerable credit for the head of steam we built up, though now of course his book is no longer on the law syllabus but on the social anthropology course and its author died before he could be frogmarched down to the Equal Opportunities Commission. But the advance of women is simply one measure of these times of remarkable widespread transformation.
Ours have been strange times overshadowed and complicated by the skewed forces of centuries long unhealed history and yet simultaneously part of a dynamic western world of huge innovation and change. Your work has so often on a daily basis synthesised those two forces - one so wasteful of human life the other so determined to enhance it. Through thirty years of conflict your role as healers has been nothing short of an heroic and powerful vindication of the human spirit at its best. I have been privileged these seven years as President of Ireland to visit many hospitals and attend conferences dealing with a myriad of medical matters all over this island. I have met those whose lives have been transformed by your skill and care. I have met the men and women who choose this life knowing that there will not be a day when they can say their training is truly complete, knowing that there will never be a day when the public is utterly satisfied, nor a day when there is enough to do all you want the way you want, for in the chaos of everyday life which is where you pitch yourselves, there is always a new technique, a new frontier, a fresh possibility, a seed of hope born of your research, born of your restless imaginations and ambitions to keep on solving more and more problems.
The transformation from barber surgeons to a top-ranking profession far surpasses the advances in virtually any other field. The first appendix was removed shortly before the house I now live in was built over 250 years ago. I remember the awe with which we gathered around the television to hear of Christian Barnard’s pioneering heart surgery. I visited Dublin’s eye and ear hospital this week where cataract removal that used to involve two weeks in-patient stay is now an outpatient day procedure. The future of surgery seems dazzlingly boundless even to those of us outside the profession who hear so much of the new and exciting possibilities your profession is creating and chasing.
We so easily accept the breathtaking realities of such things as robotics, three-D imaging, diagnostic testing that can be transmitted over telephone wires from a primary-care doctor to a specialist at a distance. Distance learning is growing into distance doing and the potential in terms of patient care seems almost limitless. Your success brings its own pressures as the expectations and resources graphs follow different trajectories. Yet through it all your commitment to innovation, to sharing knowledge and to promoting the highest standards has earned you an unequalled level of public trust and respect. One of your greatest assets is the very collegiality, the culture of skill sharing which this very club is an exemplar of. This collegiality of surgery is one of the great lessons that people in so many other areas of life can learn from your profession. The team spirit of the operating theatre is a model, which would benefit many other aspects of Irish society and organisational life. It is widely cited by management gurus and organisational theorists as the perfect model of a machine because of its absolute efficiency. Equally impressively, is the manner in which you compete to excel while, at the same time, supporting, encouraging, informing and assisting one another along the way. We all benefit from that ethos, that value system. It is one which has much to teach us in fields of civic endeavour far from medicine. In a world where the focus is so often on either frivolous trivia or the same old political boomerangs, your daily work can seem almost surreal to the outsider and yet can any profession be as close to the big metaphysical realities of life and death, of illness and cure, of hope and despair? How many people can claim to struggle with the kind of practical problems and ethical dilemmas that surgeons so often have to face precisely because you have seen the patient’s despair, striven for the new frontier and you can see its potential long before the public has caught up. How many people work under the kind of pressure you do, life and health in your hands, lawyers waiting to take their metaphoric scalpels to your judgment, your skill, for margins of error are tight and the demands of professional accountability and of the law are unforgiving.
The public are blessed that there are men and women of such passion, human decency, such openness and intellectual curiosity that they commit as you have to this great vocation of care and its sister vocation of training the next generation of surgeons. This Club has its own heroes and heroines, lives which if we were to unpack them would fill us with gratitude and with admiration for all they accomplished so quietly, so humbly.
I visited the Burma Railway museum on the River Kwai in Thailand some years ago and saw in that ramshackle bamboo tent they call a museum the black and white photographs of young men who lived a nightmare of unimaginable cruelty and misery. And yet the picture which I remember best, which stays with me over all the grim, stomach churning stories, is of an Australian surgeon standing knee-deep in water, his own flesh rotting, as he performed lifesaving surgery with the most rudimentary of equipment in the most hostile of environments, his simple human decency and generosity of spirit a powerful antidote to the inhumanity all around him. There was an air of triumph in that photo, in his brave stoicism, his refusal to give up. It is that spirit that infuses today’s corps of surgeons who refuse to give up, who keep on searching for better answers, better solutions, better lives for all in their care even when we are endlessly careless about our own lives and health.
The utter daftness which you have to battle against was brought home to me lately when visiting my father in a coronary care unit. I arrived just after another visitor who had kindly brought him a gift of a bottle of brandy and a packet of cigarettes. It’s a strange world where a hospital goes to such lengths to keep a man alive and his best friend goes to such lengths to polish him off. But it is a far from rare phenomenon. From obesity, to smoking, from binge drinking, to drug abuse, from avoiding exercise to driving too fast- day in and day out we, the public make stupid decisions and stupid lifestyle choices, many of which have consequences which you and your colleagues are left to sort out, to say nothing of the adverse consequences for family and for community. What is tragic and frustrating is that it is all so utterly avoidable. What is tragic and frustrating is that, life itself brings enough illness and accident through no-ones fault and simply dealing with those problems is a monumental task in itself without the added burden of damage caused carelessly or wilfully to the self or to others.
In my inauguration speech just two weeks ago I asked people to opt for responsible citizenship over irresponsible individualism, to focus on creating a culture of prevention where possible rather than cure. That culture of social responsibility needs to be generated on the widest possible front with individual responsibility matched by public policy. A team effort - rather like the very culture of your profession itself. A good example is to be found in the Republic’s ban on smoking in public places, including pubs. All indications are that it has been a great success and is being studied closely in other countries. It was even the subject of editorial comment in Argentina’s newspapers when I was there earlier this year. One regrettable manifestation of the ban from a health perspective is that a number of people now cross into Northern Ireland’s hostelries for a smoke with their drink. I know we have been long promoting a new climate of cross border cooperation but somehow I don’t thing that was what the peacemakers had in mind.
One aspect I am glad to see is the extent of, and the growing, joint acceptance of responsibility to bring medical resources to bear across borders. Co-operation between our two jurisdictions and between these two neighbouring islands has never been better on many fronts including the Treatment Purchase Scheme which assists in facilitating treatment of people who would otherwise spend longer than necessary on waiting lists. The European Health Insurance Card (replacement for E111) is another welcome development for EU citizens travelling to member states, establishing a very welcome safety net and covering Europe as a whole.
But the co-operation closest to my heart is that between the peoples on our small island. Accident and Emergency Services, Planning for Major Emergencies, Health Promotion can all benefit from co-operation and while business continues in these areas, it must do so currently, regrettably, without the impetus generated by regular meetings of the North South Ministerial Council - unfortunately in suspension since October 2002. It makes eminent good sense that opportunities for practical cross-border co-operation should be sought out and pursued between the Health Departments, North and South. Their ability to work towards this principle would undoubtedly be much enhanced by an early resumption of the North South institutions, in particular, the North South Ministerial Council. I sincerely hope that progress can be made to bring the current round of political negotiations to a successful conclusion for so many things can be accomplished in a climate of political stability and we have yet to have fully revealed to us the many good things that will evolve when we work with one another.
In the meantime, initiatives such as the Telesynergy project for cancer care which connects St Luke’s Hospital in Dublin, Belfast City Hospital and the National Cancer Institute in the USA are very encouraging. I am also very encouraged by the good work of the various nurse-led minor injuries centres developed in Northern Ireland which rely on advice by telemedicine links from major hospitals to treat unfamiliar injuries, obviating the need for the patient to travel. This is an area which has been specifically identified for cooperation by the British-Irish Council and I have little doubt that much good will come from it.
As the Ulster Surgical Club approaches its half-century, it has seen an enormous change in surgical practice. It has seen demands placed on its members that could not have been possibly anticipated when it was founded. We owe you its present and past members a debt of gratitude for all that you have done and all that you will do to make life better for people. If I might borrow and paraphrase the words of George Eliot “the effect of your being on those around you is incalculably diffusive, for the growing good of the world is partly dependent on unhistoric acts, and that things are not so ill with you and me as they might have been is half owing to the number who lived faithfully a hidden life and rest in unvisited tombs.”
I salute tonight the work of all those past and present members of the Ulster Surgical Club, those especially who had the vision to found such a Club and those whose efforts sustain it from generation to generation. I hope that each and every one has known the deepest personal and professional fulfilment from a career that above all others takes you deep into the lives of strangers and puts their fears, their hopes, their futures in your trusted hands. Few professions enjoy such trust, such respect. Few generate such practical hope. These precious gifts were hard-earned, especially here in Northern Ireland.
Thank you for choosing this life and this place and for the powerful witnesses you have ever been to all that is decent and good in human nature.
I congratulate you and wish the Ulster Surgical Club every continued success in the years ahead.
Go raibh maith agaibh.