Neuro-rehab dillemma, Ireland

Guest Blogger: Claire Fastner

There are so many “ifs” when it comes to an accident, such as Declan's.

If we hadn’t decided to get coffee that morning before going on the boat.

If we had left seconds later.

If I had been ahead of Declan (I would have likely been propelled many more meters through the air and died).

If we had still been living in Dublin at the time.

The last “if” is interesting. As I can genuinely say, luckily, we weren’t. If something like that happened to me, I would insist on being solely a German citizen and would ask for a fighter jet to fly me out of “third world Ireland”.

Before comparing what's available to people with severe traumatic brain injury in Ireland and Germany, I need to state (due to the inability of many to look beyond nationalist ideas), that I do not hold any nationalistic views. I  believe states are arbitrarily drawn lines, resulting from history that have influenced culture and the idea of identity. To me, the state is a useful entity: I pay taxes and I expect services in return; one of them being healthcare.

In Germany, neurological cases like Declan's are handled through a phase model.

Phase A provides acute treatment to ensure survival and prevent further brain insult.

Phase B provides early rehabilitation (basics such as breathing, swallowing, talking) and can provide for intensive medical treatment (hence Phase B is often offered in hospitals).

Phase C is the beginning of rehabilitation. It's all about getting someone to live an independent life again. This is measured by the Barthel Index that rates the performance of activities of daily living. Basics skills such as getting up, dressing etc. are trained. Everything that makes a person; walking ability and speaking is emphasised.

Phase D is for those that can manage their day to day life without much help, yet still require rehabilitation. Declan's Barthel Index is higher than 80, he wakes himself, rolls to the shower, dresses himself and rolls on to breakfast.

Phase E is a phase that allows individuals, depending on prognosis to phase back into work (if possible) and to ensure ongoing therapy.

Phase F  ensures that the afflicted gets the care and therapies to ensure their condition doesn’t worsen. Basic human decency (in the developed world, where this can be provided)! Yes, you might not get better BUT we will try to give you hope, a bed and will reduce your suffering

In sum, a very good system. There is one problem, the extensions are up for renewal every three weeks. If progress isn’t good enough, you are out, and that can be quite unjust. A patient can get sick, have an operation or simply not make huge gains. We have seen plenty of less afflicted stroke victims who left without walking ability in spite of their potential. They will continue to get physio and occupational therapy prescribed by their GP, but inpatient rehab is finished. Of course, Declan may find himself some time in a position, not fully fit to work but not within the sheltered world of rehabilitation. The real world is likely to pose challenges, but he is now equipped to seek help and to face this mess he is in, himself.

And what's available in Ireland?

There is the National Rehabilitation Hospital in Dun Laoghaire with a month-long waiting list and 56 beds for inpatients with head injuries. There is Headway, a charity that provides rehabilitative services. At the time of Declan's accident, I spoke to a very nice lady at Dun Laoghaire and she told me that Declan would most likely have to wait nine months.

Of course, if you find yourself in a hospital post brain insult, there will be some physiotherapy, speech therapy and occupational therapy – but that’s not enough for someone with a severe head injury. There are many people, who can afford it, that have fled Ireland (see  Padraig's dad's story). In fact, I would recommend it to anyone. I receive Declan's bills for the hospital and can only recommend that instead of buying a new BMW, you might want to send your afflicted relative to Germany for rehabilitation. Rehabilitation doesn’t do wonders, doesn’t reverse the brain damage but there is so much a person can relearn by being put into a situation where this is his main objective over the coming months.

I cannot solve the many problems that states face. But, frankly, many problems stem from people not seeing the state as what it is, a legal entity, a corporation that manages our communities. If we continue seeing the state as an identity, we run danger of letting the state do whatever they want. The community, your neighbour, masses and paddy-whackery doesn’t make brain damage bearable. It's healthcare that makes it bearable. I call myself lucky to have been born in a country that rebuilt a modern (not perfect) system after World War II, where the state can no longer be an identity, where being “proud” means being “glad” to be born into a country where irrationality and belief systems do not rule. Danke Vater Staat!