the politics of health

The Limerick Leader posted an interesting article online this week.

University Hospital Limerick’s ‘colossal spend’ on hiring ambulances

Limerick Leader 6 July 2017

The growth in spend quoted in this article makes for good politics but it doesn’t get to the bottom of the story. What kind of private ambulances were hired? Staffed by what level of clinical qualification?

TD Quinlivan says four fully equipped ambulances could have been bought with the spend since 2012 – I assume he means emergency ambulances with fully qualified paramedics or EMTs on board.

But it’s far more likely than non-emergency patient transport is needed in Limerick far more than emergency ambulances. Managed well, this is a good clinical decision and good business too. And this is very likely what this private ambulance spend was used on.

Non-emergency patient transport is staffed by people with lower clinical qualifications using a vehicle with far fewer pieces of expensive equipment and little or no drugs on board. The majority of people requiring ambulance transport in any country need it not because they are a critical emergency case requiring high-speed transport by highly qualified (and relatively expensive) paramedics. They are the chronically ill or injured who cannot make their own way to hospital for regular appointments – chemotherapy, dialysis, rehab – because of the nature of their illness. They need a certain level of assistance and perhaps monitoring en route. And there are far, far more of these journeys needed every day in every city than people needing an emergency ambulance.

Funding four new emergency ambulances will not get these people to their hospital appointments on time and safely, but it would make a good political headline.

Investigating the need for this spend – the real people behind the headline – would have been a good piece of investigative journalism for writer Fintan Walsh, but I suppose that takes time and he probably doesn’t have the luxury of delivering that kind of good journalism these days.


total eclipse of the heart

Last time I witnessed a full solar eclipse was back in Ireland. It was August 1999 and it was billed as “the astronomical event of the Millennium”: probably the most-viewed eclipse event in human history.

I was back from my world travels, temping in Dublin, analysing market research documentation for a chain of Irish sandwich bars. My “favourite” suggestion was for a sandwich with sausage, cheese, Bovril and crisps.

The 11th of August was a Wednesday. I have no clue how I managed to be in my parents’ back garden at eleven in the morning, but I was. My Dad, who had been very ill that year, was not long out of hospital. Now and again it’s handy to have a structural steel welder in the family, and today was one of those days.

It was a beautiful summer’s day, with the flowers bursting from the ground and the birds singing from every tree. I was looking every inch the professional woman-about-town in my cream Chanel-style bouclé suit and Executive Heels. We stood in the back garden with Daddy’s welding mask and waited. We would not have been aware that the eclipse had even started if it had not been for that welding mask.


Dad and I were beside ourselves with excitement, doing the whole countdown thing. Mum was a bit nonplussed about it all, but like all Doyle women she loves an “event” and this was one. Also, that’s one of my favourite photos of my mother, ever.


Near eleven o’clock on the eleventh of August, the sunshine began to dim. It was eerie. It was different to a cloud going in front of the sun: we shivered as the very heat of the sun was blocked. Irish sunsets and dusks go on for literally hours in the height of summer, but that day we experienced a fast-forward sunset. The cat was seriously unimpressed. The birds fell silent. The sun went out.

We imagined how shocking it must have been when the solar eclipse (allegedly) occurred just after Jesus Christ died on Good Friday. Even weeks from the beginning of the twenty-first century, with all our scientific knowledge, there was something mysterious and sinister about those few minutes when the world went dark and the birds fell silent at the very height of the day.

Moments later, the sun started to emerge and the spell was broken.

Fast-forward again fifteen years and more. I sit on the other side of the world, jealously watching the countdown as the northern hemisphere awaits the next total solar eclipse. I remember that summer’s day back in Dublin, sharing a moment in earth’s history with my parents, my father the armchair explorer so excited to witness something of such magnitude from the comfort of his back garden.

This one’s for you, Daddy.

Cruise Daddy 1

diving dos ojos

It was eleven years ago almost to the day that I first discovered the limestone caves of Dos Ojos (“Two Eyes”). On an organised Trek America trip with a dozen or so others, we visited Dos Ojos for a snorkelling trip on our way to the ancient Mayan ruins of Tulum. Since its discovery in the mid-eighties, this 68 kilometre long cave system is one of the most accessible in the world for divers and snorkelers. One of my strongest memories of this first Mexico trip was snorkelling along the surface of the crystal-clear water of the entrance cavern, watching three of my travelling companions diving ten or so metres beneath me, knowing I was not getting to see the best part of this amazing location. It was at that moment I knew I was going to learn how to scuba dive, and one day I would come back to Dos Ojos and explore it properly. Today I delivered on that eleven-year-old promise to myself.

We parked the van and wandered down to “Eye One” – one of the two limestone sinkholes or cenotes that give the cavern system its name. The mosquitoes in this patch of Yucatán jungle were enormous: I could swear we could see the whites of their eyes as they came hunting us down. At the entrance to the cenote were a dozen or so divers getting ready to enter the water. Plenty of serious dive equipment here: nitrox tanks, full dry suits, customised octopuses, full body gear, space age torches. With our rented half-suits and kit, we could not compete with this mob.

Back at the van we geared up and made our way slowly down the long stairs, being careful not to lose our balance with the full weight of the tanks on our backs. It is amazing to me every time how ungainly I feel outside the water, compared to how freely and smoothly I can move along underwater.

One giant leap and the cool fresh water of the cenote hit me. A familiar feeling of serenity enveloped me as I turned amphibian for the second time in four days. People who know me well will find it hard to believe that I am at my happiest under water where I cannot speak. I let the silence become my world, eyeballed Orlando my dive buddy, then descended effortlessly a few metres and slipped noiselessly through the cool fresh water of the lake.

Quetzal our divemaster got us into line – Raquel the novice up front with him, Orlando and me towards the back. We followed a guide line through a wide flooded tunnel where the air from previous divers glistened like mercury on the roof above us.

This was not the warm, rich tropical waters of Barbados, our previous dive of the holiday. Around us was not the usual richly-colour marine life of other dive trips, rather the other-worldly forms of limestone eroded by thousands of years of flowing water, then re-formed drip by drip into majestic stalactites, stalagmites and limestone columns.

Now and again a mystical blue glow above indicated a smaller entrance to the cave system. Occasionally another diver would appear silhouetted dramatically against this glowing backdrop, like the entrance to Diver Heaven.

We followed the dive master further and further in, as far as a clumsily-rigged diorama of a Barbie Doll being eaten by a plastic crocodile. This dubious marker is what gives the Barbie Cave its name. Divers have a weird sense of humour sometimes.

Retracing our steps using the guide line, we headed back through the eerie paleness of the tunnel system until a larger blue light and lots of legs with fins attached materialised in the distance above us. We were back at our entrance point. The first part of the dive was complete.

Half an hour on the surface to relax and change air tanks while another couple were taken by our dive master on the same adventure. Another giant leap into the same cenote, then Quetzal led us into a different cavern system towards the Bat Cave. I wondered if there would be plastic bats at the far reaches of this trip, or real ones.

We followed the guide line again through the gloom, Quetzal’s strong torchlight cutting through the dark water to spotlight a particular point of interest, or making slow circles and waiting for each of us to reply in kind: yes, we’re still OK. Victor from Scuba Cancun followed with his underwater video camera – our dive paparazzo – buzzing around the edge of the group like an insect.

In time we surfaced in a small cave, and there were indeed real bats to be seen, nesting in little micro-caves in the roof. Definitely a better end-point than a plastic Barbie-Croc combination.

At some point in the previous few minutes my ear had started to hurt, and I had tried repeatedly to equalise the pressure in my ears and sinuses to no avail. Once back underwater in the bat cave, the pain really began to build. The deeper I got, the worse it became. Worried, I signalled at Quetzal, moving my own torch rapidly back and forth in a horizontal movement. Using impressive sign language, he signalled to me that it was likely a tooth and not a pressure equalisation problem. He instructed me not to descend any further, then took my arm and brought me to the head of the group near him. My face still throbbed dangerously but as long as I stayed high enough at ten metres or less, I could manage.

And then it was over – two dives in the location that gave me the scuba bug all those years ago. Back at the van we took out the log books to record the dive stats from Quetzal. As I wrote the location in my book, “Dos Ojos”, I stopped and savoured the moment of another life’s ambition realised. I agreed a price with Victor the Paparazzo for his DVD of the trip – not only did I get to dive Dos Ojos, but somebody had filmed it for me!

Back in downtown Cancun we did some supermarket shopping, ready for our long bus ride in the morning: bananas, muesli bars and crisps (“fuego” flavoured of course, chosen by Orlando). The fruit and vegetables area was fantastic: bananas of all sizes, tiny, regular and enormous; oranges and tanjelos (a hybrid between a tangerine and a grapefruit); piles of dark red dried hibiscus flowers for making agua jamaica or imparting a delicate flavour and colour to cooked food; about seven or eight types of dried chilli.

The butcher counter had fresh “chorizo verde”, a bright-green spicy pork sausage coloured and flavoured with fresh herbs such as oregano or coriander. The deli counter had three types of mole, a local sauce often using chocolate and chilli in generous quantities.

Later, wandering down the street near the hotel on the way back from the internet place, I heard my (Mexican) name being hollered behind us: “Margarita! MARGARITA!!”. It was Victor who had just dropped off my dive DVD. We joined himself and Quetzal in a little local place called Pescaditos for a bite to eat. I happily received my first – enormous – frozen margarita of the Mexico trip, and then a second. How lovely to have a cocktail named after me. Quetzal recommended the pescadillas as a house speciality and he was right. Sort of like a fish empanada or a quesadilla using fish instead of cheese, it was served with an excellent habanero sauce that we couldn’t get enough of. We put the world to rights with Victor and Quetzal, before heading back to the hotel to pack our bags ready for our trip to Tulum early the next morning. An excellent end to an excellent day.