A brief little discussion on slavery

As we head into a long weekend – which hopefully will include glorious sunshine and carefree days of no responsibilities and stress, it seems opportune to talk about the crime of slavery.

Slavery – the practice of owning slaves, or ‘the condition of having to work very hard without proper remuneration or appreciation’ is still practised in Ireland. And in the main, it is practised in a manner that has been used over the centuries – the vast majority of slaves are generally not of the same race as the slave-owners.

These slaves are not kept at the plough by the whip or the lash – indeed they need very little or no supervision. What keeps them in slavery is what they see as their own responsibility to other human beings – in many cases, the very human beings who are responsible for their slavery.

I am referring, of course, to doctors. These slaves are a peculiar subset of doctors – variously called by awkward names precisely because of the embarrassment of their position. They are certainly not ‘junior’ doctors.

That word itself was a calculated insult, rightly confined to the dustbin of history. And they are not doctors who can be defined by others – such as consultants.

But if you are going to perpetrate an injustice, you have to use all sorts of nomenclature to disguise and justify it. I’m sure the Russian soldiers who fire the missiles in Ukraine are told they are hitting ‘enemy insurgents’ when they attack schools and hospitals. Similarly, we use the term ‘Non-Consultant’ to describe the doctors who are the backbone of the Irish hospital service.

That tells you two things at once – the incredible power consultants have wielded over various Ministers for Health for many decades, and how invisible our hospital doctors are in a system that would collapse without them.

There is no question that hospital doctors are entitled to strike. One could say that the union heads who are calling this strike could well be judged as negligent in their duty of care to their members if they didn’t strike – such has been their working conditions for decades.

Again, we are not talking about months or years – this is a problem that has run on for decades. And again, one has to wonder if it weren’t for the browner and blacker skin tones of a good proportion of these hospital doctors whether they would be in this situation at all.

Racism in Irish medicine, however, is a subject for another day.

But today the issue is the fact that hospital doctors have been enslaved in the chains of human conscience and have had to forgo their own human rights while the government, Minister, and society in general has used the threat of the neglect of patients as a check – on their right to strike – mate.

This tactic has been one of the lowest, disgusting and vile things any Irish government has done, but the public have failed to come to the aid of the doctors. Every marginalised group, it would seem, has access to government sympathy, but hospital doctors can become suicidal, burnt-out or broken by their impossible hours – their virtual ‘slavery’ – and no-one cares. Because ‘doctors’ are supposedly rich and comfortable, impervious to pain, poverty or prejudice.

We are now in a very real triage situation. Hospital doctors must go on strike and must stay on strike (unlike 2013) until substantial changes are made in their working conditions, education and training. It’s a situation where patients either die now or later. Yes, a strike would remove care from people who need it, but without a strike, there simply won’t be the doctors there in the future to take care of future patients. And the doctors who are there may be so exhausted, burned-out or stressed out that they will inevitable make the wrong decisions on occasions. Let’s hope it’s not your mother or brother when that happens. We need to stop this now.

The reason for this is primarily that the government knows that doctors are suckers for caring. I have sat with doctors complaining about how they are never ‘off’, and then seen them react to an emergency because they can’t help themselves. They didn’t work all the way through school to get into medical school because they only cared about money. They didn’t work all the way through medical school because they wanted to make money. These people care. And that is their fatal flaw in negotiations – everyone knows that 99% of doctors are decent, caring people.

Politicians, on the other hand…
There is nothing intrinsically wrong with politicians. They are, after all, people who race to the front of a torch-lit mob and shout ‘Follow me’. Irish politicians stand for very little – except popularity and virtue. How hard would it be to get an Irish politician to go on television or radio to express ‘support’ for patients? The whole cynical, money-draining pointlessness of elected representatives is revealed in those moments – they would support almost any cause that would bring them votes.

You don’t get votes by carefully explaining the complexity of medicine to the public, or the history of the changing roles and demands on the worldwide labour market for doctors. You don’t even get the time. You get (at best) a few minutes on TV with ‘Gotcha’ journalists who like nothing more than a tragic death CAUSED by someone – preferably a professional that they can then ‘take down’ and thereby signal their own virtue. And all you can say or do in that time are words along the lines of ‘I support the patients’ or ‘Patients must be cared for’ – meaningless platitudes for which no-one will hold you to account.

The doctors must strike, and must stay struck. There can be no compromise or deal until the government accepts the need for huge change, and huge change now. There should be no talk of Ukraine or Covid or the struggles of turf-cutters or why this can’t be done now. Of course this can be done now. If there’s a will there’s a way. But if there’s a will, there’s a bill.

Any reasonable solution is going to cost a lot of money. That’s because this problem has been left to fester, and like any problem that has been ignored, it has gotten worse. The scratch has become a wound, has become a life-threatening wound. We are now at breaking point. It’s life or death.

Literally. Doctors’ lives. Patients’ lives. We can’t simply deal with the currently sick at the expense of the future sick.

As a boy, I attended many road accidents with my GP Dad. He would get me to ‘help’ – as you do in isolated areas. Even if it was only talking to the person and reassuring them that help would come soon. On one occasion I asked him to help a man who was bleeding badly and looked to be in a very bad way. He refused, and I thought it was very cold, and even morally wrong. How could this be? My father was a great and kind man – the greatest exemplar of those values I have ever known.

But he told me later (the man subsequently died) that he had a duty to save those who could be saved, and not waste time on those who were already gone, or soon to go. He was a doctor, not a priest.

And that’s what triage is – you leave those that can’t be saved to go to someone who can. You save the most lives. Without saving our doctors, we are going to lose more lives. And sick doctors are not going to save anyone.

We have to accept that even if lives are lost in this strike, it will save more lives ultimately in the future.

This is a just strike, called for good and humane reasons, and it should continue until there is a proper working life for our hospital doctors.  We wish these doctors well. They are striking ultimately for better care for everyone.

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