The right thing must be done at right time

ONE line defined the tragic death of Savita Halappanavar, when the story emerged last November. “This is a Catholic country,” a midwife, later identified as Anne Maria Burke, had told Ms Halappanavar when explaining why a termination of her pregnancy wasn’t possible.

A more appropriate line might have been: “This is a shoddy country, where the right thing only ever gets done in the wake of public outrage.”

The tragedy of Ms Halappanavar’s death was used by groups that have strong opinions on abortion. For the pro-choice side, it was an example of how the country was barbaric towards women. The ‘pro-life’ movement protested that the death was an aberration, that this country was among the safest in which to give birth, that there was no requirement for a law to protect women in peril.

Last week’s report from the Health Information and Quality Authority (HIQA) will have provided little comfort to either point of view.

HIQA has not addressed the failure to grant Ms Halappanavar a termination when she requested, after learning that her child would not live, and her heath was deteriorating.

But HIQA has illustrated that the tragedy was informed by more than a grey area in legislation.

The report also blew out of the water the notion that this country was one of the safest in which to give birth. It showed that once complications set in, all bets are off. HIQA identified 13 junctures, during Ms Halappanavar’s deterioration, at which a different course of action might have saved her life.

More pertinently, the report placed last November’s tragedy in the context of another death, that of Tania McCabe. In March 2007, 34-year-old Ms McCabe died of sepsis in Our Lady of Lourdes maternity hospital, in Co Louth, when six months pregnant with twins. Zac, one of her twin sons, also died. The tragedy made the news. Ms McCabe was a garda sergeant, was highly regarded, and was survived by Adam, the other twin, Ben, her two-year-old son, and Aidan, her husband.

The story was tragic, but, without any other specific element, it faded from the headlines after a few days. Behind the scenes, the HSE investigated the tragedy and issued a report, complete with recommendations.

One would have thought that such recommendations would have been taken seriously. Not so, according to the HIQA report into the Halappanavar case. The report drew a number of parallels between the two cases, pointing out there was “a disturbing resemblance”.

Only five of the country’s 19 maternity hospitals provided a detailed status update on the implementation of recommendations from the report into McCabe’s death.

Why is that so? How could something as important as the safe delivery of babies be treated in such a cavalier manner within the health system?

The horrible truth goes to the heart of much that ails public life in this country. Unless major pressure is exerted, nothing gets done. Who, for instance, could remember Ms McCabe’s name a year after she died in such tragic circumstances?

The case retreated from the forefront of public consciousness. After a few days, it didn’t make the headlines of broadcast or print or online news. It didn’t feature in leader’s questions in the Dáil. No members of parliament were confronted in clinics about the tragedy, nor berated to get things right. There were no speeches, on major occasions, that included reference to the tragedy.

And so, behind the scenes, precious little got done. Quite obviously, 14 of the 19 maternity units in the State didn’t mobilise to ensure standards were applied. Without pressure, most reverted to coping with the immediate struggles of the system.

None of this is unusual in the health service. When matters such as A&E overcrowding are dragged out into the public square, everybody clicks into action. Suddenly, the problem is alleviated, until such time as it again hits the headlines.

The standard of care in some nursing homes was long a scandal before the Leas Cross facility was exposed on RTÉ’s Prime Time Investigates in 2005. There had been numerous reports of poor, sometimes shocking, standards. Yet, the reports showing how elderly people were being treated in a sub-standard manner wasn’t enough for action. It took headlines, outrage in the public square, righteous indignation on the floor of the Dáil, before anything got done.

So it went with the recent investigation into the standards of crèches, earlier this year. On Mar 20, 2006, the bold front page headline on the Irish Examiner read: “Every Parent’s Nightmare’. Underneath, the strap line read: ‘Revealed: the disturbing details of neglect and abuse in our nation’s creches’. Yet, after a few days of passing comment, the story faded.

The power of TV, and a legal attempt to stop the programme, ensured that the matter hit home.

The right thing is only done to get the media and political agendas to move on.

Is this any way to run a country?

The HIQA report didn’t deal with Ms Halappanavar’s request for a termination. However, it is now obvious that her death was attributable to far more than that.

It is still unclear as to whether or not she would have survived if the law had been clarified.

Ultimately, the abortion issue is symptomatic of the same malaise. For 20 years, the law was in abeyance. Then, on the basis of a public outcry over the Halappanavar tragedy, there was a mad rush to legislate.

The urgency was based not on what had befallen Ms Halappanavar, but on the public perception of it.

The imperative was to make the whole story go away. In a grown-up country, the legislation would long ago have been enacted.

But, here, without a story to drive it, we had to wait for somebody to die, and a storm to blow up.

What if Ms Halappanavar had died without her tragedy touching on the abortion issue?

There would have been a report detailing shortcomings. It would have made the news for a day or two. The failure to have implemented the recommendations from Ms McCabe’s tragedy would have generated some comment.

And then the caravan would have moved on. Little would have changed in the standards of maternity care provided when complications set in. There would have been no urgency to legislate for the X case.

Real change would have been placed on the never, never, until such time as another tragedy hit the public imagination and sparked outrage.

That’s how public life is lived here. The political culture lends itself to reacting to events rather than pro-actively tackling issues. It would be easy, but wrong, to blame politicians exclusively for this culture.

It is far more embedded than that, and needs urgent addressing, if the shoddiness that informs so much of public life is to be tackled.