HEARTBEAT: A colleague sent me an advertisement that appeared in a provincial newspaper. It was placed by a firm of solicitors and was seeking a doctor who would advise them in their "commitment to people affected by the MRSA superbug".
To take liberties with the old nursery rhyme, "Fe fi fo fum, I smell a suing coming on". It really made my day to know that there were such altruistic folk out there willing to take up the cudgels on behalf of these unfortunate patients.
I would be even more impressed if I learned they were giving their services free. I suppose there are the usual two chances of that.
I do not propose to give a medical lecture on MRSA, save to say that is a complex problem and I am not qualified to explain it in detail. It is not of course the "superbug" of the popular press, but it can cause difficulties, profound illness and even death. So also can many other infections.
MRSA has been increasing in frequency and spreading in distribution since the early 1960s. The initial problem here was that some families of staphylococci acquired resistance to the drugs used to treat them. This resistance made the treatment of infections with this organism more difficult to treat but certainly not impossible.
The development of antibiotic drugs to deal with the wide variety of infection, has always had to contend with the development of resistance on behalf of the organism, and indeed is hard pressed to keep ahead in this ongoing process. There is also the problem that some antibiotics, pivotal in these treatments, have serious side effects particularly if used over a prolonged period. Many are no longer used for this reason.
Research thus far has provided replacements, but these newer drugs are not free from side effects and moreover in their price reflect the vast expenditure in their development.
So MRSA developed because of the development of resistance. It did not develop because people did not wash their hands. Its development was due to mutations in the structure of the bacterium. The wide and possibly inappropriate use of antibiotics in both medicine and animal husbandry may have played a part by hastening the process. However it happened it is with us today.
This poses a problem for some patients, and is like all infections most serious in patients whose general resistance is low or whose immune system is not functioning properly. Hence MRSA and its remote cousin VRE are more threatening to the debilitated adult or child. Those most at risk are post surgical and intensive care patients.
Irish doctors, principally microbiologists and infection control nurses have been dealing with this problem for years. Like other areas of the service they are undermanned and underfunded.
Their dedication and expertise are unquestioned even when working in the most unfavourable conditions. This is not an attempt to sweep the problem under the carpet, far from it. It is rather a call to provide the staff and funding necessary to improve the situation.
We will not eradicate MRSA, nor cure everybody. We could allocate the entire health budget and not achieve this. Like in every aspect of the health service we can only do our best.
Maybe 40 per cent of the population carry this organism, but in the absence of serious illness it does no harm. The danger is that it may be transmitted to those seriously ill or post surgery.
Every effort is made to avoid this in every hospital in the land. Doctors and nurses are well aware of this and have been since the days of Lister and Semmelweiss. Things could be better, they always can be.
To maintain however that this is a problem created by unhygienic medical staff is a gross over simplification and indeed a gratuitous insult. MRSA propagation has been documented in prisons, schools, sports facilities and wherever people gather and are in contact.
Apart from people, tables, door knobs, walls etc. can harbour the organism. Other facets of this problem have been conveniently overlooked. MRSA is more prevalent and more difficult to control in overcrowded conditions. Most of our hospitals fit this bill. Yet our Minister tells us as a response to overcrowding in A&E, to put up more beds in the wards despite resistance from the infection control teams.
Another salient and overlooked fact is that our hospital stock is old and more difficult to maintain and clean. Bathroom and sluice facilities are often inadequate, as are kitchens and general areas. Cleaning suffers from lack of funding as does nearly every clinical area in the service. However it must be pointed out that even in the newest super hospital there is no guarantee against this problem.
It is more prevalent in southern rather than in northern Europe, rates in Ireland and the UK are broadly similar. However at present there is little point in trotting out largely meaningless statistics, as reporting of incidence varies from place to place and hospital to hospital.
Litigation in this situation will only make it worse. Fewer patients will be treated and more defensive medicine, with its inherent costs practised. Whom do you sue? The doctor, the nurse, the cleaner, the porter, the walls, the beds, the administrators, possibly you might even sue the State itself?
Let's get real here. To you noble lawyers dedicated to the plight of the MRSA patients; I have one piece of advice. Go dance on someone else's grave.
Maurice Neligan is a cardiac surgeon.