MEDICAL MATTERS: The population of Ireland is increasing. The 2002 census predicts considerable increases in the next 20 years. Children under 14 years will increase in Dublin by a quarter, in the mid-east by almost half and in the west by a third. The over-65-year age group will increase by 133 per cent. Dublin's population will increase by 75 per cent.
The numbers of community medical doctors are decreasing - we should have 150 but we are down to over 30 doctors, a fall of 20 per cent.
Community medical doctors are very worried about children who are missing out on health screening because there are not enough doctors to carry out clinics. They are desperately trying to prioritise the work they are legally obliged to do under the Health Acts.
All children are entitled to a free check by the community doctor who has considerable expertise and experience in the area of child health and development screening. Children get the benefit of at least a half-hour check with a community doctor and public health nurse.
If referred to HSE services for vision, hearing or problems needing referral to a physiotherapist, occupational therapist, speech therapist or to hospital-based services, they are all free.
Waiting lists have developed for children, with 30,800 waiting for or having never received a developmental check. Children grow and develop rapidly and any delay in picking up and referring on a problem is potentially disastrous.
A range of problems can be missed. For example, developmental dysplasia of the hip was previously known as congenital dislocation of the hip. Now, we know that dislocation can develop later and the first sign may be a child who starts walking and has a limp. If picked up late, this may lead to surgery. In some cases, the child is left with a limp and the risk of arthritis in the hip in later life.
Another problem that can be missed is developmental delay. Some 5-10 per cent of children have some degree of delay and the earlier this is noticed the better. Every month missed out is vital. Early intervention by specialists can allow every child to reach his or her potential and offer parents the support they need in caring for their child.
Community doctors also work in the areas of immunisation, adults and children with disabilities and care of the elderly.
Immunisation protects against diseases like TB, mumps, measles and rubella and also tetanus and diphtheria. World travel and the increase in immigration to Ireland means that immunisation is more important than ever. There were six cases of TB meningitis in 2004, with eight in 2003. TB meningitis can be fatal or cause devastating disability. Young children, especially under a year, are the worst affected.
Migrant workers are coming to Ireland from the Balkan states where the incidence of multi-drug resistant TB is 20 per cent. MDR TB has a mortality rate of 50 per cent. We must ensure that all children get the opportunity to have BCG after birth. Not all areas of the HSE can do this because of doctor shortages.
We know that measles and mumps can cause serious illness and even death. Congenital rubella can leave a child with visual, hearing or learning disability. Tetanus is rare but can be fatal. Diphtheria still occurs in some East European countries and could arrive in Ireland.
Anyone old enough to remember children having to have a throat tube to assist breathing having contracted diphtheria would dread its return.
We have a statutory obligation to provide medical assessment for a range of allowances relating to disability in adults and children.
There are now 3,000 patients awaiting assessment because of the reduction in area medical officers. The waiting time is two-seven months. This is causing undue financial hardship to the patients involved.
Area medical officers are involved in nursing home inspections and in the care of the elderly in the community. They play a valuable role in the detection and prevention of elder abuse, nutrition and in advising on home-care packages to enable a older person stay at home.
With the increasingly ageing population and 25 per cent of those over 75 years of age living alone, there will be an increased need to provide community-based services.
There are over 500 private nursing homes nationally. New nursing homes are opening every month. All must have input at pre-registration, first registration and re-registration every three years. By law, all must be visited at least twice a year.
Complaints need to be dealt with promptly and extra visits out of hours may happen to follow up a complaint such as no heating in bedrooms. Community medical doctors are currently prioritising nursing home inspections but can you see our problem? All our work is important - do one and neglect the other?
In conclusion, the Community Medical Service offered is delivered by dedicated, highly experienced doctors. We have always acted as advocates for our patients and their families. We know our communities.
We can make our way through the public service system and link in with all agencies to get our patients what they need to keep them healthy. But we cannot do it without sufficient numbers of community doctors.
• Paula Gilvarry is the vice-president of the Irish Medical Organisation.