In praise of the tenacity of our public health teams

I can’t help feeling that the disappointment era is finally over

This week marks one year since I returned from Australia to work in Ireland. I’ve often stared out at the rain since, reflecting on the fact that, not so long ago, I was living in idyllic Queensland. Surrounded by sunshine and dolphins, I had a permanent consultant job, and I loved it. But, as many who have made the journey before me know, the lure of home and the pull of family are like an elastic band. The further you go away, the harder you feel the tug. The prevailing view tends to be that the move home is a bit of a demotion. A bump back to reality for those of us who can’t hack life away from loved ones. But, while some elements of the healthcare system in Ireland will always bemuse me, it’s perhaps more functional than people give it credit for.

There are downsides, no doubt. I’ve never felt so institutionally infantilised as I have in Ireland. For example, continuing professional development (CPD) allowances for consultants here are similar to those in the Antipodes. But in Queensland, it was given to me in my wage packet as a fortnightly payment. We were trusted to manage our own education, and we did. Anyone who has tried to use their CPD fund in Ireland knows the multiple layers of approvals needed to just get reimbursed months later for a basic life support course. It’s the feeling that someone has to keep an eye on us. It’s everywhere. And it adds a huge human resource burden where none is needed.

CPD is just one example of “Things that are hard to do in Ireland, for no good reason.”™ Progress is difficult in the operational sphere, too. Health protection work often involves managing infectious diseases among populations not well served by the medical machine. Try vaccinating residents of a homeless facility in an emergency. In Australia, I’d click my fingers and it would happen. In Ireland, it’s not impossible. But it’s a challenge that relies on goodwill from other agencies. The same goes for getting serology done, or administering post-exposure prophylaxis to a large group. It can and does happen, but it’s not easy. And after decades of doing this, it should be.

It’s news to nobody that healthcare in Ireland is difficult. But what surprised me most about the health protection service is that it actually keeps ticking over. That may seem like faint praise. But when I say the service keeps going, I mean six regional departments of public health, with minimal staff, keep the worst infectious diseases at bay, while each covering a population of up to a million people. In recent times, colleagues have dealt with a pandemic, managed almost 100,000 refugees from Ukraine, and kept pace with a variety of uncooperative emerging diseases. 

There’s a notifiable disease for every letter of the alphabet. And they’re all kept under control

iGAS, MPOX, avian flu, diphtheria, and muti-drug resistant shigella. These terms roll off the tongues of anyone working in health protection. But the public is largely shielded from the worst of these maladies because of the relentless tenacity of our public health teams. We have the highest rates of the dangerous verotoxigenic E.coli in Europe, yet we contain it so well that most people don’t know it exists. Our enviable record of bathing water safety is often down to health protection teams and environmental health colleagues painstakingly analysing water surveillance results seven days a week. Yet, like most of our work, almost nobody knows it happens.

All the above is in addition to the routine stuff. Meningococcal disease, salmonella, tuberculosis, mumps, influenza. There’s a notifiable disease for every letter of the alphabet. And they’re all kept under control. But until Covid-19, most politicians didn’t know there was a public health department in their constituency. There’s still no computer system to manage outbreaks, so our teams rely on whiteboards or Excel spreadsheets to manage and visualise complex chains of transmission. In short, public health has, until recently, been invisible.

It’s no small praise to say that public health’s biggest achievement over the last few decades has been to just keep going. When I think what my colleagues accomplished while operating in absolute obscurity, I can’t not feel excited about what can be done now that we have a profile that’s more in line with other medical specialties. Martin Luther King once urged us to accept finite disappointment, and to never lose infinite hope. While our hopes for the specialty are perhaps not infinite, I can’t help feeling that the disappointment era is finally over.