Cleft Situation in 1987

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Situation in Ireland in 1987 - A look back.

This is the full-text of an article by Padraig Yeates, then Health Correspondent,that appeared in the Irish Times on Tuesday, 27th October 1987:

Last week the Minister for Health, Doctor O Hanlon, received a report on the� exceptionally long waiting list at the mouth and plastic surgery unit in Dublin s� Steevens Hospital. Padraig Yeates reports on the plight of one group who figure�

prominently on it: children suffering from cleft palates.

How the cuts hurt the cleft palate kids.

Children with cleft palates or the milder condition of hare lip are not entitledto a medical card. The treatment can be painful, slow and expensive. Timing can becrucial. as certain operations need to be carried out at specific stages in achild s development. The present cutbacks have not made the burden facing parents� any easier. In at least one case over the past month a parent has emigrated toLondon to ensure that her child receives the necessary treatment.

We are not attacking the professional and paramedical staff who treat our� children, says Mister Anthony O Connor, secretary of the Cleft Lip and Palate� �

Association of Ireland. He describes their service as sterling . It is the� � Government s cutbacks which have made the situation unbearable for his members,� their 400 children and the many other families in Ireland whose children sufferfrom this distressing, disfiguring, but ultimately fully treatable complaint.

A cleft mouth condition is still socially taboo in Ireland. None of the familiesinterviewed for this article wished to be identified. Their discreet form oflobbying has encouraged official neglect, even though the families of three formerhealth ministers and a Taoiseach have had children born with the handicap.

Lack of recognition for the complaint hits hardest at those families whose incomeis too high for a medical card and too low to make private medicine an easilyaccessible commodity. One mother I spoke to, with two children suffering from

cleft palates, aged 13 and four, said that she had never applied for VHI coverbecause, up until a few years ago, there was absolutely no waiting list .� �

Then we were told that suddenly, due to cutbacks, they couldn t finish my oldest� � boy s mouth, even though three quarters of the work was done. A small piece of� equipment, worth 20 pounds, was holding up the work, she went on.�

Another mother told how the first seven operations on her daughter s mouth were� covered by free school dental treatment - now she is too old and the nextoperation will cost 1000 pounds. We inquired about the new VHI scheme but� discovered our income was too high.�

Even for those wishing to subscribe to the VHI, there are major obstacles inobtaining benefit. Most people are very upset when the baby is born. It's a�

disaster and usually there is nobody they can turn to, says Mister O Connor.� � Unless they receive advice quickly, they will probably fail to insure the babyunder the VHI. For while the company will usually accept children admitted withina short period of birth, in many cases the Cleft Lip and Palate Association hasfound that its two-month limit is passed.

After that any child entered for the scheme will not become eligible for cover forfive years. Another VHI condition is that all the children in a family must beinsured, not just those with known medical problem.

The squeeze on public dental services has been a slow one. As long ago as 1982,



the then Minister for Health, Doctor Woods, in response to the Cleft PalateAssociation, announced that five new consultant orthodontists would be appointedto ease the demand for treatment. This never happened. The salaries on offer weretoo low, compared with private practice.

In Steeven s Hospital today there is only one part-time orthodontist on secondment� from the dental hospital, assisted by two trainees. They have a nurse who mustdouble up as a secretary/receptionist. During the six hours of treatment per week,

around 50 to 60 patients are seen. The fact that there is only one set ofinstruments, most of which don t work, does not help.�

Cleft palates produce related defects in hearing and speech, which can seriouslyhinder the intellectual and psychological development of children. While Steeven s� Hospital has evolved by default, as a national centre to treat sufferers, fourother hospitals - Crumlin, the Ear, Nose and Throat, and Temple Street Children s� Hospital in Dublin, and a new unit in Cork - also provide services.

These too, are under threat. In Temple Street, one of three overworked speechtherapists is being let go under the cutbacks. Ironically the therapist has 11years service but is a temporary employee and therefore expendable under thenegotiated redundancy deal with the unions. Already it has taken children with

cleft mouth conditions six months to be assessed at Temple Street and anotherthree to six months to begin therapy sessions. These delays will now increase andfor children with less severe speech defects, the waiting lists will grow evenlonger.

In the surgical area, the pressure on services is also severe. One mother who wastold her child would receive a bone transplant operation last February, has nowbeen told it will only be possible after Steeven s mouth and plastic surgery unit� is moved to Saint James s Hospital. No one is sure yet when that will be, but it� should happen before Christmas. The operation, she has been told, could be carriedout by February, 1988. Meanwhile her daughter must suffer the pain and socialembarrassment that 16-year olds are particularly susceptible to, suffering fromsuch a disfiguring complaint.

For parents living outside Dublin, the unpredictability of the delays can be evenmore wearing, and expensive. Some, but not all health boards, provide transport.

Deputy Michael D Higgins, of the Labour Party, says that the situation ofsufferers in Galway has been totally ignored . He says it took seven years to� � persuade the Western Health Board to advertise for an orthodontist.

When they did only two people applied and only one turned up for interview; eventhough the salary on offer was 27,000 pounds and allowed time for privatepractice. The one and only successful applicant declined the post.

Dentistry is expensive and we spend only two per cent of our health budget on it

compared with an average of seven per cent in other EEC states. Not surprisingly,only ten per cent of medical card holders seeking dental treatment actuallyreceive it.

The Cleft Palate Association has gone the usual round of sponsored events andother fund-raising events to raise money for essential equipment. It has alsosubsidized training courses for health board staff.

The uncertainty over the future of the unit in Steevens led the Association toseek representation on the group investigating the huge waiting list at thehospital which reported to the Minister last week. The request was ignored. So



will the Association s call for Doctor Steevens to remain open.� �

Some senior surgical staff at Steevens insist that once facilities are moved to� Saint James s Hospital, the present backlog can be cleared, and at this stage they� do not question the inevitability of the move.

Wherever the service is based, nothing short of a dramatic improvement inorthodontal resources is going to meet the dental needs of the population in

general and those of its worst sufferers in particular.

The Cleft Palate Association says that it will be increasing pressure for adequateresources. They are not looking for confrontation, insists Mister O Connor, but� � this can t be treated as a book balancing problem. The Minister has to carry the� can. If no one else does it he must show compassion.

(Reproduced by permission of Padraig Yeates).

This information is available from www.cleft.ie

Cleft Situation in 1987

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