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Tuberculosis in Ireland — a lesson from history

What Irish history shows is that governments can improve public health when the will is there to do it, writes HELEN O’CONNOR

THE Covid-19 crisis is not the very first time that contagious disease has existed and lessons can be learned from how the Irish government got to grips with a tuberculosis crisis in 1940s Ireland.

Tuberculosis is a highly infectious disease that ravaged Ireland at the beginning of this century.

Tuberculosis used to kill more than 10,000 people per year in Dublin alone. There was a stigma around getting tuberculosis in those days and it was known as a “poor person’s disease.”

Even though the disease did not just affect the poor, lack of sanitation, overcrowded conditions, poor food-hygiene and the widespread practice of spitting in the street enabled it to spread like wildfire throughout the population.

The coughing followed by bright-red blood on a handkerchief was the classic sign that someone had contracted the deadly disease.

Tuberculosis was so feared in Ireland that it got to a point where people couldn’t get appointed to a job in a bank or in the Irish civil service unless they had a clear chest X-ray first.

Furthermore, the Irish health service was inaccessible to the poorest as doctors charged fees for seeing and treating patients.

Fresh air, sometimes in freezing conditions and life-threatening experimental chest surgery were the few treatments available for tuberculosis and the poorer you were the more likely you were to suffer a horrible and agonising death in your own home.

Dr Noel Browne was born into those conditions and he saw his parents and siblings all die from tuberculosis.

He contracted it himself and his experiences of childhood loss, hardship and insecurity shaped his politics and he became powerfully motivated to change the Irish health system.

Against the odds and by the sheer luck of being financed by acquaintances of his family, Browne managed to train as a doctor specialising in the care and treatment of tuberculosis patients.

Rather than accept a comfortable career as a doctor in Britain he made a conscious decision to return to Ireland to try to set up a socialised health service of the type he had experienced while working in the British NHS.

Browne spoke of the inertia that was commonplace in the management of tuberculosis before he was actively involved in driving anti-tuberculosis campaigning in Ireland.

Browne was elected as a Teachta Dala (TD — a member of Dail Eireann, the lower house of the the Irish Parliament) as part of a coalition government in 1948 aged just 33, for Clann na Poblachta, a left-wing republican party founded in 1946 by Sean MacBride, a former chief of staff in the IRA. On his very first day as a TD, Browne was appointed minister for health.

There was a lot of hard work ahead as one of the mainstream political parties, Fianna Fail, had delayed acting on making improvements to the Irish health service in spite of repeatedly promising to do this prior to elections.

There was still no medications that were effective in treating tuberculosis but Browne knew that Denmark had succeeded in containing tuberculosis by diagnosing it effectively and then isolating patients.

A free mass-screening programme was introduced. Preventative measures were recognised as very important and a programme of public education was rapidly rolled out.

A clean food code was launched to educate the public in food hygiene and the importance of respiratory hygiene was widely promoted.

Leaflets were produced and there were even posters in train stations warning the public about the dangers of droplet infection spreading from spitting in the streets.

Radio, TV and film were all utilised to give clear and consistent public health messages to the Irish people.

The aim of the new government was to create 7,000 additional hospital beds throughout Ireland over 10 years and an ambitious hospital building programme was embarked upon which cost in excess of 20 million.

Government assets and resources were used in a highly organised way to establish the hospital building programme and Browne took personal responsibility for overseeing the hospital building projects.

Public buildings were also acquisitioned in this drive to set up a world-class health service and increase hospital bed capacity.

Led by Browne the state and the civil service mobilised buildings, people and equipment creatively in their ambitious plan to improve the Irish health service.

A national blood transfusion service was eventually created, effective national BCG inoculation service and diphtheria vaccination scheme were also set up when vaccinations became available.

By 1950 Ireland had 2,000 more hospital beds and the rate of tuberculosis infection dropped from 123 per 100,000 in 1947 to 73 per 100,000 by 1951.

Even though Browne did not achieve his dream of an Irish NHS that was free at the point of use, there can be no doubt that he was a key leader throughout the drive to eradicate tuberculosis in Ireland.

What was achieved in a relatively poor and underdeveloped country in the 1940s was very impressive, even by today’s standards.

This work to increase the number of hospital beds and drive down the rates of tuberculosis in Ireland was started off and ultimately achieved without all of the medical and technological advances of the modern era.

What Ireland did have was a health minister who cared about public health and who had the courage of his convictions. He inspired an army of civil servants and others to mobilise radical and groundbreaking improvements in the Irish health service.

The hospitals that were built during that period in Cork, Limerick and Galway still stand today.

Hospital beds were not reduced in 1940s Ireland as tuberculosis had a grip on the nation and instead provision was massively increased.

The reverse is happening in Britain as plans to move, merge and reduce hospital-bed provision are rolling on as the Covid-19 pandemic is raging.

Unlike the present day, preventative measures were recognised as being vitally important then in the drive to eradicate a contagious disease.

Our government doesn’t even listen to the scientists or the unions but Browne worked in a collaborative way with many others — and he also involved trade unionists in the drive to create better public health in Ireland.

The Irish state and local government played the key role in setting up and fully controlling the infrastructure and the services to improve public health and get to grips with tuberculosis.

When commenting on the role of the Irish state in the drive to improve the Irish health system Browne made the following key observation many years later in his book Against The Tide.

“The immediacy and spontaneity of the response, its versatility, originality and creativity made it hard for me to understand the adverse criticisms so frequently made about the rigidity and the lack of imaginative planning of the civil service and the state bodies.

“Would that our politicians, industrialists and farmers had the dynamic qualities of many of our state services as shown at that time.”

There can be little doubt that legacy of Browne and the others who supported the public health drive saved many lives in Ireland and continue to do so to this day.

The state and its resources were mobilised for the good of the many and not for private profit.

What Browne’s tenure as a government health minister shows is that political leadership can and does make a significant difference to public health outcomes.

The mass of the Irish people responded positively to the public education programme and to the clear and unambiguous public health advice and guidance which made a significant difference in bringing the infection rates down before the BCG inoculation programme took hold in Ireland through the course of the 1950s.

This is the kind of knowledgeable, committed and decisive leadership that is called for during the coronavirus pandemic before many thousands more die unnecessarily.

Helen O’Connor is GMB Southern Region organiser.

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