Karl Marx famously claimed that everything in history happens twice – the first time as tragedy, the second time as farce. But when it comes to women’s health, Ireland seems to have developed its own variant on this theme: the first time as tragedy and the second time as tragedy – and the fourth and the fifth.
Here, for example, is the opening line of an Irish Times editorial from November 6th, 2008, almost a decade ago: "The publication of another report into cancer misdiagnosis is a further indictment of our health system." When something bad happens once, it is a scandal; when it happens repeatedly, it is a system.
In all the justifiable outrage about the large scale failures of the State’s cervical cancer screening programme brought to light by Vicky Phelan’s legal action, we must not lose sight of the brutal truth that unnecessary death is a systemic question. She and other women will die because of attitudes so deeply seated that outrage after outrage has failed to shift them.
The American baseball coach Yogi Berra was notorious for his linguistic solecisms. One of the best was "It's deja vu all over again." But if you've worked as a journalist in Ireland for a few decades, deja vu does indeed keep happening all over again. When I hear Vicky Phelan's story and the subsequent revelations, I have flashbacks. I remember the then minister for health Mary Harney, choosing the day of the US presidential election in that same month of November 2008, when the world's attention was riveted on the phenomenon of Barack Obama, to slip out the announcement that she was cancelling plans to introduce a programme of vaccination against cervical cancer.
‘Utterly irresponsible’
The mind reels back, too, to the same year and the then head of the National Cancer Screening Service, Tony O'Brien (now outgoing head of the HSE), denouncing everyone who raised concerns about the management of the cervical screening programme as being engaged in a "calculated effort to undermine confidence in the National Cervical Screening Programme for narrow political gain". Or Mary Harney, in May 2008, raging against the temerity of the then opposition health spokesman, James Reilly, in raising questions about the efficacy of that screening programme: "I regard that as an utterly irresponsible statement made for no reason other than to scaremonger. Women have huge faith in the screening service and we want their faith in it to continue."
The unconscious instinct is that it is better for a few women to die than for confidence in the system to be undermined
This is one of the fatal attitudes: women’s health is a matter of faith and the medical and political authorities must be believed without question, just as the bishops had been in the past. But the sense of deja vu is even stronger if we go back a little further. In the mid-1990s, I wrote a lot about the appalling treatment of women who had been infected with hepatitis C by blood products supplied by the State’s own Blood Transfusion Service Board (BTSB). And in that horror story there was an even deeper attitudinal distortion: since the greatest need of the State is for women’s faith to continue, it is okay not to tell women when the State knows they have life-threatening conditions. The unconscious instinct is that it is better for a few women to die than for confidence in the system to be undermined.
Eerily familiar
It may now seem staggering, even inexplicable, that doctors were arguing for more than a year about whether to tell women that CervicalCheck had failed to pick up on early signs that they had cancer. But the mentality at work is eerily familiar. In 1991, the BTSB received definitive confirmation that a blood product it had been administering to thousands of Irish women had been contaminated with hepatitis C since 1976. The doctor who received the fax with these lab results did nothing to inform the women or their GPs because, as she later told the Finlay inquiry, it “just totally slipped my memory”.
And in 1989, the BTSB went on to create a whole new strain of blood plasma which again infected hundreds of women with hepatitis C. Again, when this became clear internally, the women were not told. Even when, in April 1994, the then minister for health, Brendan Howlin, was told about the 1989 contamination of blood products, this crucial information was kept from the women, their doctors and the general public. Breathtakingly, the Finlay tribunal, when it reported, made little criticism of this decision to keep the women in the dark: “The balance seems to be appropriately one of caution rather than of risking alarming a greater number of people.”
Toxic condescension
Keep the faith, do not be alarmed, trust us, we know best, calm down dear. This toxic condescension is not directed only towards women, but there is a consistent pattern of applying it especially towards anything to do with female health. It is wrapped up in what Miriam Lord brilliantly summarises as "this State's disordered relationship with women from the waist down". Even when there is a great deal to be alarmed about, even when confidence is misplaced and faith is being abused, the facade of authority must not be undermined. Women cannot be trusted with their own literally vital statistics. This systemic arrogance will always lead to systemic incompetence. Women will go on dying for the faith.