'It's only a matter of time before someone dies' - medics warn of SouthDoc crisis in West Cork

Beara Peninsula has no regular after-hours GP and you could be waiting two hours for an ambulance in an emergency

Dr Fiona Kelly in Castletownbere, West Cork, Ireland. Picture: Andy Gibson.

Yet again, healthcare provision - and the lack of it - in west Cork is headline news.

This time it’s SouthDoc and the fact the Beara Peninsula has no regular after-hours GP.

That’s about 6,000 people left to - for the most part - fend for themselves in one of the most remote parts of Ireland from 6pm until 8am at least five nights a week.

This is in an area where you could easily be waiting up to two hours for an ambulance to get to you before it then takes at least another hour to get to the nearest acute unit, which is at Bantry General Hospital.

However, this is mainly used for certain medical emergencies like strokes, heart attacks, fractures, and minor injuries, meaning that you'd need to go to Cork University Hospital for more serious trauma, pregnancies, and surgical emergencies.

And you’d need at least another hour to get there - and that’s on a dry night.

That is a stark reality, especially for anybody who suffers a heart attack or a stroke, and doesn’t get treated within the so-called Golden Hour.

Any doctor will tell you that heart muscle starts to die within 90 minutes.

And research on recovery from strokes all points to the same thing: time lost is brain lost.

So, the chances of you surviving or having a successful recovery from either of these potentially catastrophic medical events are debatable.

It’s all the more reason why Castletownbere GP Dr Fiona Kelly is concerned that it is just a matter of time before somebody dies due to the absence of essential supporting medical services.

Some might suggest she is being alarmist but she’d be the first to hope her fears are proven wrong.

“I’m not the only GP in west Cork having problems,” said Dr Kelly, who runs the town’s Bank Place Clinic with her part-time near-retirement colleague Dr Colin Gleeson.

“What is happening in Castletownbere is a microcosm of what is happening in West Cork.

Hundreds of GPs are not only retiring but many of those are retiring long beyond when they should have retired.

“And a lot of them are not being replaced because nobody wants to work the sort of hours we work in a rural practice like this.”

Dr Kelly, whose mother Mary still runs the town’s Millbrook Bar where the 42-year-old grew up, routinely works up to 70 hours a week.

The mother-of-two hasn’t had a whole week’s holiday off since 2019 and the last time she had a two-week holiday was in 2009, a few months before she joined what was then Dr Gleeson’s practice.

He himself has been a GP in the town for nearly 40 years and is trying to retire, but doesn’t to leave Dr Kelly in the lurch.

As well as not having much time for holidays, she doesn't have much time for maternity leave.

When she had her son Jack in 2012, she was only able to take five weeks of maternity leave because she couldn’t get a locum.

And when she had her daughter Lizzie in 2014, she had the same problem trying to source a locum and was only able to take four weeks off.

The pressure didn’t ease three years later, on June 7, 2017, when Lizzie was diagnosed with Acute Lymphoblastic Leukaemia.

She is now in remission but Dr Kelly had to keep up the hours at what is a very busy clinic, with Dr Gleeson’s help, in between travelling to and from Cork city and Dublin for Lizzie’s treatment.

Indeed, her clinic is now so busy that many of her colleagues elsewhere in general practice say she should close her list to new patients but she refuses to.

Dr. Fiona Kelly in her surgery in Castletownbere, West Cork, Ireland. Picture: Andy Gibson.

Her patient list includes people from no less than 38 different countries, many of whom are employed in the fishing industry.

“I just can’t say ‘no’ to people I know,” she admits.

“I grew up in the town, and I know a lot of people.

“As a result, we just seem to be getting busier and busier and it gets to be quite stressful.

“Don’t get me wrong, I am not complaining.

“I love my job, I love where I work and I love where I live.

“But the bit that really gets me is the constant number of obstacles that keep being put in my way.”

It doesn’t take her long to list some of the main obstacles that have affected not just her but GPs and patients all over west Cork.

In 2011, people had to fight against HSE plans to reduce the number of ambulances serving the area from four to two.

It was a move the West Cork Faculty of the Irish College of General Practitioners slammed as “flawed and fraught with danger”.

At the time, the ratio of service nationwide was one ambulance for every 37,000 people.

If the HSE proposals had succeeded, the ratio would have jumped to one ambulance for every 58,000 people for west Cork.

Then the decision was taken in 2013 to close the emergency department at Bantry General Hospital from 8pm to 8am daily.

It was replaced with a local injury unit, and the Acute Medical Assessment Unit (AMAU).

This was then forced to close in the summer because it didn’t have enough staff.

The closure, which was temporary and led to a large protest in Bantry by around 1,000 people, revived fears locally about the future of the hospital.

The unit, which was closed for just over two weeks, had been forced to shut because a consultant had to take sick leave, and it emerged that consultants that had retired had not been replaced.

Two new consultants have since arrived from Portugal.

The temporary closure of the AMAU led to a bizarre situation.

Because the unit was closed, people were asked not to go to Bantry.

Instead, they were directed to consider other care options, including going to CUH.

But then a few days later, due to overcrowding issues at CUH, management at that hospital were forced to tell people not to go there and instead to consider other care options.

Picture: Denis Minihane.

With the AMAU still closed at Bantry, it left an area - with a catchment of around 86,000 people - with a limited range of options.

Dr Denis McCauley, chairman of the GP Committee of the Irish Medical Organisation, warned at the time this was an example of what is increasingly going to happen in West Cork and other parts of rural Ireland.

He described what happened as a “perfect storm” and warned: “You are going to see more of them.”

Dr Kelly has noticed a marked increase in the amount of time some of her more seriously ill patients are having to wait for an ambulance.

These include a man with severe chest pains who had to be driven to Bantry General Hospital by a family member who had no medical training.

This was because the nearest ambulance was 75 minutes away in Skibbereen and Dr Kelly was seriously concerned they were having a heart attack.

They also include a person with a severe heart condition who had to wait two hours for an ambulance, which eventually arrived from Killarney.

And she also had a patient who had to wait six hours in excruciating abdominal pain for an ambulance the National Ambulance Service said would be there in two hours.

Such delays are nothing new for Dr Kelly.

She once had to wait three hours for an ambulance with a patient who had broken their neck, and a member of her own family once had to wait four hours for an ambulance after they broke their hip.

“At least these situations happened when I was on duty during daylight hours where pre-hospital care was administered,” says Dr Kelly.

“However medical emergencies also happen at night and now with no regular out-of-hours GP cover, it is only a matter of time before somebody dies.”

Independent TD Michael Collins said West Cork is seemingly lurching from one healthcare crisis to another. 

I can’t see how anybody seriously thinks the situation can keep going on without there being serious consequences to patient care in the area.

“The health minister needs to come down and see it first hand.

“He probably doesn’t even understand the sheer geographical spread of the area, for a start.”

When the deputy saw what he later said looked like “something out of a war zone” on the night of August 7 just outside Schull in West Cork, others have warned it could soon be a more commonplace sight.

As he waited to pass on the narrow road at about 11.15pm, he saw a fire crew and gardaí tending to three people lying on the ground around the mangled wreck of a car just outside Schull, West Cork.

There were bits of debris everywhere, he recalled, but what later struck the Cork South-West TD was the fact that the injured were waiting, he estimates, two hours for an ambulance.

“They were waiting so long, a lady who lives nearby came out and gave them blankets to keep them warm as they lay there on the ground," he said.

A leading paramedic told the Irish Examiner at the time: "You are going to see more people lying on the sides of roads waiting for ambulances.

"The system is getting to the stage where it just can't cope with demand."

Although the HSE says an arrangement is now in place to provide locum cover in Castletownbere this weekend, Dr Kelly sighs wearily down the phone.

After a short silence, she says: “All I do know is that we had no cover on Wednesday night and Thursday night.

“And of the cover, we are getting for this weekend, it’s only until 6pm Sunday.

“And we don’t know what’s happening next week, and the weeks after that.

“If we could just get some consistency and continuity for the patients, that would be better for everybody.”