Today I am going to tell you about something that happened to me in a not very rich European country, which got me thinking about our health system.
Before I start, there will be no moral to this story. There will be no “We should do this” or “We should do that” and no finger-pointing at possible culprits. I’ll just tell you what happened.
I brought a child – a good friend of my son’s – to an A&E in a small city called Sibenik in Croatia. You may remember the name Sibenik because it was under siege during the opening months of the war in Yugoslavia. It’s a provincial town of maybe 25,000 people with one public hospital.
We had left Ireland earlier that day and the boy initially complained of a sore knee in Dublin Airport. On the flight his knee had swollen and by the time we had landed in Croatia, the knee looked like a balloon.
We thought it was a ligament or similar problem maybe picked up playing football. But during the evening it continued to swell so we thought we’d better see a doctor in the morning.
We headed to the A&E in the local hospital. Given my experience with children in Irish hospitals, I braced myself for a long wait.
But something quite shocking happened. We didn’t wait at all.
We arrived into a new wing of the hospital into a spotless A&E ward. Just to put things in context, Croatian GDP is half of Ireland’s with a similar population.
There were lots of patients milling about but there were also five nurses on standby. One spoke English. She immediately started with the paperwork and told us not to worry.
She produced a wheelchair and whisked us in to the doctor. He diagnosed an infection and said that they’d operate without any delay, to drain and clean out the wound. The doctor reckoned there was about two litres of fluid on the knee and this had to be sorted. On establishing the boy had eaten something just before we headed to the hospital, he postponed the operation for five hours to make sure the general anaesthetic would work. The surgery time was set. We had been in the hospital for 10 minutes at this stage.
Just in case there could be some underlying damage to the knee itself, he suggested an X-ray and ultrasound. An orderly appeared immediately.
If you are getting the impression that we were the only people there, we weren’t. The hospital was extremely busy, with nurses and doctors bustling around. They explained to us that this was, in fact, the busiest time of the year because the local population doubles with all the tourists. They joked that drunk tourists are much more likely to end up in hospital than the locals. We waited 16 minutes for the four X-rays to be carried out.
The radiographer told us to wait for the radiologist. We waited on the trolley in the corridor, which I suppose to an Irish person was a pretty familiar experience. About ten minutes later, the radiographer came out with the photos and reassured us that there was no knee damage but that he’d still need surgery. He also explained in perfect English that he was thinking of moving to Ireland because a colleague had moved to Limerick and was getting what he described as “good money”. He walked with us and chatted for a while about the World Cup, how Croatia had been awful and how we now needed to get the boy some blood tests, which were also done immediately.
We had been in the hospital for about 40 minutes and we’d seen three nurses, three doctors, had had four X-rays and ultrasound, blood tests and had already had a bed allocated in the surgical ward. The nurse asked for our EU blue card to cover the costs of the operation. We (typically) didn’t have it but she said an EU passport would suffice.
At no stage did they ask for money. Within the hour of arriving through the door, we were in a children’s ward in bed with a big TV in the room, showing the tennis. The nurses were extremely kind and said we’d be seen by the consultant surgeon who’d be doing the operation.
Before we had settled in, he’d arrived and straight way asked who was better, Messi or Neymar?
Sitting on the bed, he explained to the 12-year-old exactly what he was going to do, why and how long it would take. As he spoke the nurse hooked up the boy to an intravenous drip and chatted away about how she dreamt of visiting Ireland some day but it was unlikely on her Croatian salary. By the way, the hospital uses generic not branded drugs. The consultant announced he was a big Pogues fan and explained that Shane MacGowan was a genius. They then offered me lunch. A few minutes later, the paperwork was done. They’d have to get a parent’s permission to operate. So they phoned Dublin and then emailed the necessary consent forms. All this was done without any delay. They said the operation would be at 4pm and told us to kick back and watch Wimbledon.
The consultant anaesthetist came around, explained what she’d do and said the kid would be out cold for about an hour. The surgeon came back a few times and smiled, told us not to worry because he’d personally take out, what he called, the “garbage” in the knee.
At 4pm on the dot, they operated.
The boy stayed in hospital for five nights. We could visit at any time of the day or evening. He will head back tomorrow at 8am to get the stitches out. The entire patient experience was simple, straightforward, pleasant and remarkably efficient. There was no waiting at all, no charge at all and the boy will be swimming by Friday.
I have no idea why it worked so well. Maybe we were just lucky. But I’ve taken kids to Irish hospitals and I’ve waited hours for two stitches. This Croatian episode was a totally different patient experience in a hospital that can’t even afford branded drugs. I don’t understand how hospitals work, why they get clogged up and why Irish patients end up waiting for hours on end. But it is clear that it doesn’t have to be that way. I have just seen, in a country with half the income per head of Ireland, a patient experience that is in a different league. You have to wonder why.
Adam tut tut
A publicly funded health system, free at the point of use, based on the criteria of need alone? I’d say that’s your answer…..
A left-right divide in the political system? A distinct lack of all things to all people/whatever you’re having yourself politics of FF? Or the alternative of a ridiculous left-right divide in an FG-Labour coalition?
We should either go the American/German insurance based model of private health care (I am virulently opposed) or the British/Croatian publicly funded model. Either way, we should vote for parties that represent one or the other model, not for parties that want to cater for both
PS generic drugs produced in Ireland are often more expensive than branded drugs…..the well paid jobs that domestic generic pharma companies maintain in places like Clonmel and Bantry are largely sustained through hospitals purchasing these drugs and political interference making sure that they do so…….
Nah, ‘It’s your consultants!’ as a Swedish nurse, who’d once worked in Irish hospitals, told me when I’d a similar experience in Stockholm. People who think they’ll ‘waste’ high Leaving Cert points if they don’t take up medicine, find themselves entirely unsuited for such a vocation. So they compensate by seeking high salaries and control of the system to ensure it works best for them, rather than patients. Our fault for not taking them on.
The huge disparity of input and experience is worth spelling out like this as often as possible, and studied to identify and then tackle what’s causing it, which stakeholders, system processes, unexpected influences etc need to be repaired.
Positive experience in the Irish Health Service. I recently had to call an ambulance for my father who was ill in rural Ireland. I was in Dublin at the time. Within 20 minutes of calling them they were in the house with my father. They called me to tell me all was fairly OK but he would be taken to Sligo A&E.I prepared for the worst given all I have heard in the media. However within 20 minutes of him being admitted he had CT scans and X-rays and blood tests. The results of these were back in an hour.… Read more »
I have an intermittent Achillees Heel situation that’s preventing me from living life to the max, ie: Dancing all night. Thankfully, doesn’t stop me shagging. I’ve carried crutches everywhere for the last few months in case I’m stranded by tendonitis. I’ve done the ice pack/painkiller stuff, so now we’re on to the physio/tests/x-ray route to a possible operation. When I presented as ‘acute but not urgent’ I was told there was a 6 week waiting list for an English NHS appointment BUT! If I could pay privately, I could be seen in the next day or so… The pitch was… Read more »
It has always been my observation that we Irish are a right-brained people, hence our thriving culture and renowned ‘craic’. Irrespective of what system is put in place the Irish psyche will render it shambolic, it’s just not in our make-up. I know seasoned travellers who have settled in Ireland because they find the Irish to be truly unique while accepting our lack of left-brain efficiency as a price to pay. A stranger to Ireland will quickly realise after a few days that the Irish lack standards, any standards when compared to most developed countries, but they’ll still return for… Read more »
The spirit of this story I think raises a question to “The Irish Way” of doing things. This comment is written in the middle of the Garth Brooks debacle, it is now tipping back towards happening, we’ll see. But we have seen it all before, with both the Nice and Lisbon treaties. Something needs to be done, the system pushes back and the answer is no, then what happens we try it again until the desired result is achieved. Then, after all the ructions and twisting of law and Second Slane concerts for U2, do we try and fix the… Read more »
Foreign Virus is the Cure
If the Mexican Ambassador can brink Garth Brooks to Dublin we should ask him to change our Health System.
Does the Croatian health system have to deal with the same amount of drunks in ‘craic-filled’ Ireland who fight each other every night when rolling out of the pub / drinking den? Does it have the same amount of heroin addicts who demand to be cared for when things go wrong for them? Do Croatian teenagers drive at speed around our city streets and country roads without wearing seatbelts, wrapping their cars around trees, lamposts and whatever else you’re having yourself including ditches? Do Croatian women working in delis slip on vomit on the floor then call an ambulance, and… Read more »
Hi, Excellent article. My two pence worth is there isn’t a scumbag of a charted accountant with the final say. For example; A nurse in the maternity in Limerick pointed out to me that when she started her career over 30 years ago the wards were all shining but now were shabby and worn. This is because the nurses that time had the responsibility and pride of profession to ensure the wards were spotless. Their salaries were also capable of ensuring they could provide an adequate standard of living for their families. Then she went on to point out that… Read more »
David , As much as I am glad about your good expirience with the hospital , I as a Croatian could tell you whole different story about Croatian hospitals . But I am not much of a storry teller , so I sudgest you read about some 600 croatian doctors that are waiting for the papers to leave Croatia . Or you could investigate the recent debacle of our leftist (sic!) government , when they tried to impose a new system of shifts on medical workers , which monumentously failed , so it was simply stopped . Withouth regard to… Read more »
I’m a foreigner living in Zagreb, Croatia for 8 years and I’ve also had only positive experiences with the A and E here. The same as you, we’ve always been seen very quickly, got the x-rays and any lab tests done immediately and no payment was needed (only had to show our Croatia health insurance card). Although I speak Croatian, I mostly use English when it comes to medical things here and almost all the Drs/specialists speak English (some German and Italian too!). I can’t speak highly enough of that part of the Croatian health system here. Outside of the… Read more »
Healthcare systems are classic bureaucracies – they have all the features of the East German industrial planning ministry. To slightly misquote someone or other: “A bureaucracy cannot exist as a permanent form of institution. It can only exist until the managers discovers it can effectively vote itself largess out of the public treasury. ” This is what has happened in many countries, over the past 30 years. It is always the same: a. The healthcare managers announce that without a significant increase in budget, they’ll have to cut beds, doctors, and operations. b. So they get the money. c. More… Read more »
On the subject of East German planning I was in Magdeburg yesterday which is in the heartland of what was the old East Germany. I wouldn’t be thrilled about the Stalinist architecture and it didn’t seem like party central but the city centre looked prosperous with a good transport system(mostly trams) and modern industrial estates. I travelled throughout the old Eastern Bloc in the early eighties which was largely a dull grey boring mess. Almost twenty five years after the wall came down these people have got their act together and risen from the ashes again. I prefer Ireland over… Read more »
What’s fascinating about social and economic structures is how easy it is for them to operate against the interests of those involved, and especially against those who they are designed to benefit. This occurs even on the occasions that the majority of their staff involved believe that they are trying to do the beneficial things they claim. This isn’t about conspiracies and smoke filled rooms of enemy agents planing the downfall of civilisation, or about capitalist running dogs. This is about the alignment, or misalignment, of interests. Health Services are good example: Staff get pay rises for working hard and… Read more »
David, I had the opposite experience in a Dublin Hospital.
The main reason for the chaos is organisation – a complete lack of it and the protagonists want it that way.
I would echo Db4545 comments about the substance abusers choking the system.
Also I was in Croatia recently too.
The people, scenery, food and general stress free atmosphere are joyous.
I never felt in Danger or the ominous presence of scumbags, I once left the car unlocked overnight with the GPS on view. The car was not touched.
Ireland is a tough place to come back to.
Also I was in Croatia recently too (Zadar).
The people, scenery, food and general stress free atmosphere are joyous.
I never felt in Danger or the ominous presence of scumbags, I once left the car unlocked overnight with the GPS on view. The car was not touched.
Ireland is a tough place to come back to.
The Ireland/Croatia comparison is analogous to the quip I once read about the difference between Argentina and Japan – How is it that the Japanese can do so much with so little yet the Argentinians can do so little with so much?
This situation reflects strongly some ideas which Sen talks about when looking at development, etc. He says that while income can lead to better outcomes in health, it is not usually the main way to achieve the best outcome. He talks more about the expansion of entitlements and freedoms of individuals. It is a fantastic concept and one that has lead to indicators such as the Human Development Index(HDI). In looking at health he talks about support-led and growth-led policies. Support led are the ones that are entailed in entitlements. These would probably be conducive with Croatia. This type of… Read more »