Medical Alumni and Faculty Newsletter 10

January 2012

Contents P2 Introduction / Welcome Diary in Pictures

P3 Head on the Couch UCC Medical Alumni Scienti c Conference 2011 - Professor John Higgins P4 UCC Alumni Achievement Award 2011 P5 New Chair Appointments - Anatomy / Physiology

P6 Those were the days ... UCC, Physiology and Professor Jack Sheehan Dr Mary Bukley and Dr Nell Crushell Dr Paddy Crowley and Dr Dermot Long P7 AUCMS Twinning Programme P8 Connecting the Dots P10 Medical Grand Rounds

P11 Memoir of the Plague Year

P12 What Makes a Doctor?

Dr Eamonn McCoy, Dr Eamon Shannahan and Dr Mary Dr Helen Hynes and Dr Deirdre Rafferty P13 Charles Sugrue MD of Cork (1775 - 1816) Favier - A name that deserves to be better known

P14 Twenty Years of War and Disaster - The Story of IDEALS P16 A Short History of Anaesthesia

P17 John Woodroffe and the Cork Professor Cillian Twomey, Dr. Niamh Lynch and Dr Ronan Boland and Professor David Kerins Anatomists Professor Barry Ferriss

P18 Dr Len Amow (A Personal View of an Aortic Dissection)

P19 Medical Alumni Annual Scientific Conference 2011 P22 UCC Medical Research Centres

Professor Peter Kearney, Dr. Pat Cogan Tangney, Professor Eamon Quigley and Dr Noel Tangney P24 Appreciations Dr Michael Hyland and Professor Cillian Twomey Dr Will Fennell

Introduction

Welcome to the 10th Medical School Alumni Newsletter.

We are coming earlier this time in order It has also been decided that the UCC or overseas. As the highest earning to alert alumni to the next annual Alumni Medical Alumni Association should be- graduate group in UCC I think you will agree Scientific Conference on September 13th come the UCC Medical Associa- we should lead by example in supporting 2012 to be held in Brookfield Health tion (incorporating Alumni and Faculty). our Alma Mater. Sciences Complex, UCC. We are hoping With the development of the College to facilitate class reunions at the time and of Medicine and Health, the faculty has I am also appealing for contributions to we wish to invite representatives from become much more diverse than before. Up our next Newsletter and Annual Conference the reuniting classes to present their to now, many UCC faculty have shied away on September 13th 2012. The feedback experiences. Details of the volunteer class from alumni functions to our loss. from graduates far and wide remains very organisers for the 2012 reunions are listed strong, brings back happy memories and on the back page. You will see below a brief summary of frequently renews contacts. five outstanding Research Centres in The 2011 Scientific Conference was an UCC. I would encourage you to consider We will look forward to welcoming Dr outstanding success in terms of quality and supporting the centres in any way. Giving Madoline O’Connell & Dr Bill Navin (1939 diversity of presentations and a number any sum no matter how small is welcome graduates) as guests of honour at the of the presentations are summarised and there are tax benefits for sums over conference. in the newsletter. €250 in a year, whether paid from Ireland

Professor George Shorten

Welcome

UCC has become a progressively more The pace of life seems quicker and is outward looking University over the past quicker than before. The answer may be decade and has benefitted from a strategy a catchphrase, slogan, headline or, best of internationalisation. The School of Medicine of all, a ranking. As I write, several university positioned to carry the reputation of UCC is keen to identify a small number (perhaps ranking systems have recently recognised School of Medicine to our international four) Alumni currently working at excellent UCC as a university that is improving, at least colleagues and to prospective students. training institutions which would be interested relative to its peers. The Shanghai Jiao Tong in developing formal links with UCC. World University Ranking, the QS World There will also be opportunities to These links might take the form of undergrad- University Ranking and the Sunday Times formalise our links with your new “home” uate student electives, postgraduate training have all reported on the improved standing institutions. These may occur in the form fellowships, PhD studentships, or exchange of UCC. We bravely opted to undergo of student electives and placements, programmes for staff or students. specific evaluation by QS and were rewarded exchange programmes for staff or students, with five stars. For all the acknowledged fellowships, PhD or scholars programmes, Although informal arrangements currently failings of the university ranking systems, they or collaborative research projects. In 2012, exist with several individuals and institutions, are important determinants of how we are the School of Medicine will approach it is the School’s intention to build on perceived worldwide. In 2011/12 this many of you with specific proposals; these. This will serve to enhance UCC’s perception is of a first class university which more importantly we will welcome and reputation internationally and to increase knows where it’s going and is getting there. respond to your suggestions. valuable diversity in the classroom, clinic and Any visitor to the newly occupied facilities lab. You may express interest in contributing in the Western Gateway Building would agree. Enjoy the newsletter and we will look forward in this way by contacting Ms Connie to welcoming you to the 2012 Annual Mulcahy, Manager, School of Medicine One of the categories on which the university Scientific Meeting of the Medical Alumni ([email protected]). rankings are based is “internationalisation”. Association. The Medical Alumni Association has a We want the answer right now and with tradition of bringing together old friends as little padding as possible. There simply with shared memories of Cork and UCC. is no time to consider the “ifs” or “maybes” The annual meetings are invariably because the next question is not far behind. stimulating and good fun. It is ideally

2

Dr Bridget Maher

Head on the Couch - Professor John Higgins

Dr Bridget Maher interviews Professor with the philosophy of the College of John Higgins, Head of College Medicine and Health. In the past, universities of Medicine and Health, University drew a line in the sand when students hospitals out of College Cork and Professor of graduated. “That’s it, we’ve finished with you, the HSE and set up Obstetrics and Gynaecology at UCC. off you go”. But the world is changing locally autonomous rapidly. What’s now happening, especially institutions. We have real opportunity right There has been considerable expansion of with the Medical Practioners’ Act, and now to influence thinking nationally. student numbers at Brookfield Health Sciences what is also happening in other professions, Complex. What do you think of the student is that Society is telling us that while And now to a bit further afield. You worked in facilities at the College of Medicine and Health? university may have given health professionals Australia - what are your views on the Australian their educational foundations, they have got Healthcare System? People work better when their work to keep reinventing themselves as information In many respects, the Australian healthcare environment is good and students here at changes more and more rapidly. The system is very similar to Ireland. Most people the College of Medicine and Health at UCC university is ideally placed to take on this have a GP even if the primary care system is have state-of-the-art facilities. The micro- role. not quite the same. Hospital care is free and environment that is the Brookfield Complex yet 40% of the population voluntarily take and the recently-developed Western Gateway The third big agenda for us is one of the out private health insurance. What struck me Building is brand new and beautifully strategic goals in the University’s 5 year plan most about the Australian system was that designed. We should be grateful - it has to deliver an Academic Healthcare Centre they got much better value for money. They given us top-class facilities and we really for this region. What does that mean? It means were more cost conscious and the system was don’t want for anything in terms of facilities. that you link the delivery of clinical care better run and better organised than here. In Western Gateway is a huge building, with which is the prime focus for any healthcare all parameters, from childhood vaccination lots of extra space that is now being utilised. system, with teaching, training, research and to high-tech hospital procedures, Australia If you invest wisely, it will always be worth- innovation and commercialisation. Up to now, does better than us even though they don’t while and the extra space in the Western those agendas have been running in parallel, spend much more than we do on healthcare. Gateway Building is now proving very useful. but around the world, particularly Northern We should ask why? America and some Nordic countries and more I think they define issues better. They are very What are your goals and your vision for the recently, the UK, they have found that running straight, what they say is what they mean and College of Medicine and Health? these agendas in parallel and separately, is they tell you as it is. In fact, they bring that trait The College of Medicine and Health is a not the best way to do it. The best healthcare to everything, from how they run the clinic to relatively new creation, initially bringing systems in the world are actually bringing how they run the healthcare system. Medical together medicine, nursing, dentistry, followed the various strands together and finding training is very well organised and they put by pharmacy and the clinical therapies. It takes innovative governance mechanisms. These a huge emphasis on training. They have a time for a project of this nature to become a healthcare systems believe that, while delivery ‘can do’ culture, they look at something reality but our key objective is to make the of clinical care is central, their remit also pragmatically and don’t cite the fifty College of Medicine and Health the epicentre includes teaching, training, research and reasons you can’t do something. We could for healthcare innovation and care for all innovation. learn a lot from this attitude. healthcare professionals in the region. This approach helps change the culture within Has the economic downturn had an adverse We have identified three main objectives the healthcare organisation in that there is effect on your plans? that we will persue. The first one, and a very an emphasis on change and on excellence On the contrary. The economic downturn has important one, is to identify major research and innovation. Healthcare is the world’s been the single biggest driver of reform, it themes that we actively and strategically biggest business. Ireland is highly reliant on has brought realism to how we all think, and support so that it just doesn’t depend on an healthcare as a business and we are very made us all more practical and more willing to individual’s enthusiasm (which is important, successful in the healthcare business. We are change. of course). Five research themes will be the phenomenally successful in the manufacturing focus for the next five years – “Five in Five”. of medical devices. We are phenomenally The types of things I am talking about - an That’s our number one priority - to invest in successful at manufacturing pharmaceuticals. academic healthcare centre for example, research infrastructure in the broader sense, When you consider healthcare in this way, these are generational changes and it requires not just the space, but the people. when you look at the big picture, Ireland does significant momentum to deliver changes extremely well. Of course, in Cork and Kerry, as fundamental as these. But it’s not just the The second objective is to make the College we should aim to do better than anywhere College of Medicine and Health at UCC that of Medicine and Health a centre for lifelong else! is calling for these changes - other medical learning for all health professions in the schools around the country are pursuing the region. We train the undergraduates in all What’s first on the agenda? same agenda. It may well be that a whole set the different disciplines and there is nothing In the next few months, we’re going to put of circumcumstances are coming together - inconsistent with our continuing to do this. shape on these plans and include them in the where Ireland is today, a new Government, We have the skill-sets among the faculty, we University’s strategic plan. We will feed this the need for a radical revamp, the need to have the organisational resources and we agenda into the Department of Health as they reform the public sector. All of these things have the buildings and the facilities to deliver consider how they are going to reform the happening together may make this just post-graduate education. It’s very important healthcare system. There is a real opportunity the right time for the changes we suggest. for UCC to say that it wants to take on here and the timing is good - the current that agenda and I think it’s wholly in keeping Programme for Government aims to take

3 What did you learn from your experiences in harder as I get older though! But this 24 hour The Art of Medicine bringing together the Maternity Services in Cork? commitment defi nes Obstetrics. There are What attracts me to the inclusion of I learned almost everything I consider certain specialities with a lot of “on-call” and Humanities in Healthcare Education is the important in terms of management and Obstetrics is one of them. If you fi nd “on-call” importance of tapping into our imagination leadership from this project. I learned a lot about easy as a trainee, Obstetrics is one of the and unlocking the full potential of individuals. people and their concerns and the need to specialities that you may fi nd attractive - it The perfect organisation doesn’t exist, but bring people along with you. I hope I learned a self-selects in that regard. if it did, it would be one where people look lot about myself and that I’m a wiser person for it. forward to coming to work and feel that the One of the key things I’ve learned from the Is Cork home now? organisation supports them personally and CUMH project is to identify the things you are Cork is home. Three of our children were wants them to be great, an organisation that not good at and fi ll those gaps fi rst – you need born in Ireland, one in Australia and the cherishes them personally for their contribution. people and partners working with you who youngest two are citizens of the Republic I think that in Ireland sometimes we put have the particular strengths you don’t have. of Cork! Cork is a fantastic place. At a time too much emphasis on form rather than I think I’m stronger on outlining the vision when the world is changing to bringing function and on process rather than results. rather than necessarily delivering the fi ne more balance back in to our lives, Cork The healthcare world is changing rapidly. The details that underpin the process. provides that balance and off ers a huge countries that can tap into their staff ’s innovation I also learned the importance and advantage amount in terms of lifestyle and quality of life. and imagination are the countries that will of being close to clinical services and being Recently I was listening to an external group invent new medical devices and develop new a practicising clinician when trying to reform talking about University College Cork. They said treatments. These are the countries that will healthcare. that if you look at the top universities in the prosper. Fortunately, Ireland is a naturally world, the overwhelming majority are not innovative, creative country and this will be How important is clinical practice to you? found in capital cities but are located in what to our benefi t. I look forward to the future. If I were to choose what I consider the single you might loosely call second cities - Harvard, most important thing that I do, I would say that Yale, Oxford, MIT, Cambridge. I think that this is a it is that I am a practicing Obstetrician. I would most useful observation. Cork is the right place. admit that getting out of bed at 3.00 am gets

UCC Alumni Achievement Award 2011

Sr Miriam Duggan

Limerick native, Sr. Miriam Duggan, graduated behaviour, drugs, self-esteem and constructive She was elected Congregational from UCC with a degree in Medicine in 1964. life choices by providing members with a Leader of the Franciscan Missionary After graduation, she went on to study strong sense of belonging and the necessary Sisters for Africa, a position she still holds. She Obstetrics in Birmingham, receiving her MRCOG support that they need to oppose the negative was President of the Irish Missionary in 1969 and FRCOG in 1982. Sr. Miriam is a forces and pressures all around them. This Union from 2004 -2009. member of the Franciscan Missionary Sisters for prevention programme was very successful Africa and has dedicated her life to combating in Uganda in reducing the prevalence rate the HIV/AIDS epidemic in Africa. She is and it has now been adopted in 21 African aff ectionately called ‘The Mother Teresa of countries. In 1998 she transferred to Southern Africa’. Africa where she continued to establish care and prevention programmes in South Sr. Miriam went to Uganda in East Africa, Zambia and Zimbabwe. Africa in 1969 to work fi rst as Head of Department at St Francis’ Hospital, Nsambya, Sr. Miriam has received numerous accolades Kampala and, in later years, as Medical and awards for her work in HIV/AIDS care Superintendent where she was also involved and prevention. She was honoured by in the training of midwives and doctors. Harvard University, Church of Uganda and the Templeton Foundation for pioneering In response to the HIV/AIDS pandemic, which behaviour-based HIV prevention in 2006. became manifest in 1987, she helped establish In 2008 she was presented with a clinics, mobile and home based care recognition award from the President programmes to care for the sick and to help and Parliament of Uganda. the orphans. She founded Youth Alive in an eff ort to address the root causes for the As well as her medical work, Sr. Miriam spread of HIV and to help young people to has been involved in the Catholic make responsible choices and avoid getting Charismatic Renewal and the Christian AIDS. The Youth Alive programme provides Doctors Guild. ongoing education regarding sexual

4 New Chair Appointments

John F. Cryan is the newly appointed Prior to his recent appointment, John was a and behavioural approaches. Other interests Professor Senior Lecturer in Pharmacology in the School include understanding the interaction of Anatomy of Pharmacy and in the Dept. of Pharmacology between brain and gut and how it in UCC. His & Therapeutics. He received a B.Sc. (Hons) in applies to stress and immune-related disorders, mission for Biochemistry and a PhD in Pharmacology including irritable bowel syndrome, obesity the Anatomy from the National University of Ireland, and sepsis. He is also interested in department Galway, Ireland. He was a visiting fellow at the applying novel approaches to facilitate is to enable Dept. of Psychiatry, University of Melbourne, drug/siRNA delivery to the brain in vivo. John high-quality Australia (1997-1998), which was followed by has an H-Index of 35 having published over innovative postdoctoral stints at the University of 130 peer-reviewed articles, including articles teaching and Pennsylvania, Philadelphia, USA and in high-impact journals such as PNAS, Neuron, assessment of The Scripps Research Institute, La Jolla, Nature Reviews Drug Discovery, Molecular anatomy at California. He spent four years at the Psychiatry, Biological Psychiatry, Progress in both undergraduate and postgraduate Novartis Institutes for BioMedical Research Neurobiology, Gastroenterology, Gut and level within a context that is clinically in Basel Switzerland, as a Head of Laboratory in Journal of Neuroscience. John is an Editor meaningful and related to the competencies Behavioural Pharmacology prior to joining of The British Journal of Pharmacology and required by health professionals. From a research UCC in 2005. John is a Principal Investigator in Senior Editor of Neuropharmacology and perspective the Anatomy Department has the Neurogastroenterolgy Core of the APC is on the editorial board of 7 other journals. a long-standing focus on neuroscience (http://apc.ucc.ie) and also a Principal John has been honoured with the European research and John is hoping to develop an Investigator in Food for Health Ireland College of Neuropsychopharmacology internationally recognised research unit in (http://www.fhi.ie) (ECNP) Fellowship Award, the Wyeth the neurosciences to advance knowledge, Psychopharmacology Award from British and to educate both students and society of One of the major focuses of John’s research Association of Psychopharmacology and the mechanisms and potential treatments for group is to understand the neurobiology the Young Scientist Award from the brain disorders. The name of the Department of stress-related neuropsychiatric disorders European Behavioural Pharmacology Society. will change in coming months to refl ect the including depression, anxiety and drug dual disciplines of Anatomy & Neuroscience. dependence using molecular, cellular

Ken D. O’Halloran was recently appointed his decision to return to his alma mater. links between the basic sciences and Professor The Department of Physiology at UCC clinical medicine in both education and and Head of teaches more than 1,000 students annually research. Researchers in the Department of Physiology across a broad and demanding range Physiology are engaged in interdisciplinary at University of programmes in the College of projects with research groups in Ireland and College Medicine and Health and the College further afi eld and there is great potential Cork. Ken is of Science, Engineering and Food Science to link research in Physiology at UCC with a native of at UCC supported by excellent technical and industrial partners. Ken’s primary research Cork city and administrative staff . The Department has interest is the control of breathing in health and was educated the largest undergraduate BSc in Physiology disease. His research group utilise experimental at Coláiste programme in the country. Coupled with this models of common human respiratory Chríost Rí and is a diverse array of research activity in the diseases to explore the physiological and University Department supporting undergraduates, pathophysiological eff ects of hypoxia on College postgraduates (M.D., M.Sc. and Ph.D degrees) the respiratory control system. Working with Cork. He read Physiology for the BSc (Hons.) and post-doctoral fellows engaged in studies scientists, clinicians and colleagues in industry, degree at UCC graduating in 1992. Thereafter, that range from cell and molecular physiology, the group are engaged in studies that may he completed his doctoral studies at the through integrative systems physiology inform therapeutic strategies in the treatment Royal College of Surgeons in Ireland (1995) to experimental models of human disease of devastating respiratory diseases. Outside and undertook postdoctoral training in the www.ucc.ie/en/physiology/. Current projects of UCC, Ken has active roles in the USA at the University of North Carolina - are funded by SFI, HRB, IRCSET, EU, Wellcome Physiological Society (UK and Ireland) Chapel Hill (1995-6) and the University of Trust, and other charitable organisations. and the Royal Academy of Medicine Wisconsin – Madison (1996-2000). Ken joined Principal Investigators in the Department in Ireland. the Faculty of Medicine at University College lead research labs in two key sites on campus Dublin in 2000 and spent 11 years as an – the BioSciences Institute and the Western academic in UCD. The opportunity to lead a Gateway Building. Ken is keen to build on the Department with a strong commitment to legacy of his predecessor Prof. Edward Johns teaching and research at undergraduate and and he points to the important role that postgraduate levels was a major factor in the Department can play in strengthening

5 Dr Denis McCarthy

Those were the days ... UCC, Physiology and Professor Jack Sheehan As a former graduate in biological sciences, and frequently questioned them, or challenged and its emerging now of advancing years I feel strongly moved to faculty to produce data in support of the basis in scien- acknowledge publicly the major contributions theories or hypotheses they had expressed. tific research. of UCC to my personal development and to my While their (to us hilarious) contributions often His forward and professional career. I feel especially indebted shocked us, and were not on the whole well objective think- to John D. “Jack” Sheehan, Professor of received by faculty, they opened my eyes ing was extremely valuable to his students, Physiology, for the strong influence he not only to the to the great local popularity to UCC, and ultimately to all Irish Medicine. exercised on myself and several other young of uncritical thinking, but also to the physicians who, from the late 1950s on, sought rapidly-growing body of scientific discoveries But all was not work. When I came in 1963, insight into the then nascent field of modern that might be brought to bear on exciting new I joined classmates Eoin Casey and Jim scientific medicine. As background, I had biomedical research and ultimately patient Finnucane, who later went on to successful studied medicine in UCD from 1956 to1962, care. careers in Rheumatology and Endocrinology, at a time when Irish Medicine in general while I pursued Gastroenterology and was more or less dominated by the influences But where was a young doctor to obtain the Hepatology, with occasional excursions and opinions of a handful of prominent mentorship and training to prepare for this into Biochemistry and Nuclear Medicine. Professors, Consultants and Specialists, often emerging world of medical science? In UCD All of these careers developed from our linked to each other by dynastic, marital and at the time, outside of Pathology and Pharma- Physiology studies in UCC. But we also had social connections. Very few of them were cology, there were few opportunities to study lots of fun and great camaraderie year engaged in, or in close touch with, basic sciences e.g. Physiology, Biochemistry, round. We shared interests in history, literature, contemporary scientific research of any kind. Cell Biology, Genetics or any of the more music, drinking pints, and pursuing many Nevertheless, from this core group of quantitative aspects of biology. Looking at of the “fine halfs” that wandered the quad. opinion leaders emanated the modeling the careers of medical graduates ahead of me But, with Jack’s encouragement, we also and advice that directed the post-graduate in UCD, doctors such as Barry Flanagan and learned to work as a team, in studying some training of most young physicians towards Andy Heffernan, who had managed to secure of the more difficult intellectual concepts essentially clinical careers. As a result, first class academic training abroad, the spring- posed by the assigned course materials. the care delivered even in teaching board to such success often seemed to be hospitals, could mostly be described as spending a year in Cork, doing a B.Sc. degree After finishing my B.Sc., I stayed on for another “eminence-based” rather than evidence-based, in Physiology. The additional components 15 months and finished the M.Sc. degree with students and junior doctors uncritically of this training included degree-level in Physiology, while lecturing to medical learning medicine largely based on the Biochemistry, with lesser amounts of students. I had to develop from scratch the unchallenged views of their mentors. pharmacology, microscopy, photography, methodology for the experiments which were statistics and, above all, compulsory the basis of my thesis, a task I found very hard. I had always been interested in science and reading and analyses of the original published But, when the going got tough, Jack was always had reached UCD on an entrance scholarship reports of ground-breaking experiments in there with support and encouragement, in mathematics. My medical education was physiology. In UCD I had had no training of and taught me a lifetime lesson in the value “touched by the light of science”, in that any kind in data analysis or critical thinking, of persistence. This work gained me the NUI we certainly had exposure to various basic but in the Physiology Department at UCC, Travelling Studentship in Physiology in 1965, sciences as we progressed through the such training was an on-going daily activity. and helped open doors in both London and pre-clinical years, but the content was the USA. Another warm and supportive rudimentary, relatively superficial, and gleaned Behind the organisation and execution of colleague from this time was Prof. Dan from text-books, with course contents all this, and completely committed to the O’Mahony in Pharmacology. Week-ends often that changed little from year to year. Notes enlightenment of his students, was the found Jack, Dan, various other faculty members taken from our teachers in class were rounded tough and sometimes gruff, but ultimately and I, hiking in the mountains of West Cork off with knowledge gained from text-books, and kind, witty, and good-humored figure of Jack and Kerry, to the great enjoyment of all. I recall these sources generally guided what we re- Sheehan, a Cork man returned from England, with affection many other faculty colleagues gurgitated in examinations, largely undigested. Africa, and God Knows Where. Like Florence from that time, including the late Seamus We did not read journals or engage in critical Nightingale, he neither gave nor accepted Kavanagh, John Murphy, Denis O’Sullivan, discussions: we thought everything was an excuse, but his door, heart and mind were Sean O’Riada, and many others. I also found known, just not by us. always open to anyone needing help or time to be an occasional performer at Cork’s guidance. He was possessed of great personal Southern Group Theatre, with my friends My eyes began to be opened to the integrity: the constant reflection of this in his James N. Healy and Fergus Cahill, and we limitations of this educational process by a behaviour left a lasting impression on me. also broadcast a regular folk music program, group of Americans in my class, veterans of He had a strong work ethic, always seeking “Ballads at Night”, from RTE’s Cork Studios. the Korean War, who came to study medicine excellence in himself and in those he served in Ireland, where the costs of a medical or directed. He also brought to us awareness But throughout this rich and happy interlude education that was widely accepted in the of a world beyond our shores, and tried to in my life, the one who contributed most to USA, were easily covered by their benefits prepare us for it. Out there, beyond the horizon, my growth and development was my good under the “GI Bill”. They were all older than their was a new and exciting world, and there were friend, Prof. John “Jack” Sheehan. I am just one Irish classmates, more mature, tougher real doctors who carried out research for a of many young doctors who were privileged intellectually, and in many cases had living. Today, with UCC in the forefront of and fortunate enough to spend some time completed undergraduate degrees in the world centres of excellence in biomedi- under his wise direction that greatly benefited sciences in good universities, before beginning cal research, these comments may seem all of our careers. Both UCC and his students their military service and medical education. to border on the absurd, but in 1963- are much in his debt, and owe him our They had limited tolerance for the often poorly- 64 this awareness greatly expanded my profound gratitude and deep respect. supported opinions of their Irish professors, consciousness of the scope of medicine, Thank you, Jack. 6 Dr Anne Marie Harris

Introducing the UCC/NUIG/AUCMS Twinning Medical Programme

In September 2011, UCC welcomed the first that all facilities are in place for the return of clinical attachments in Fundamentals intake of 51 medical students from Malaysia to of the first students in Spring 2014. of Integrated Clinical Practice (which will a new Twinning programme. This programme The Twinning Programme partners have a include Cardiovascular Studies, Gastro- involves a three way partnership between staffing plan for the development of academic intestinal, Respiratory and Critical Care, Care UCC, NUIG, and The Allianze University College units in all of the major clinical disciplines, of the Elderly, and Acute Medicine). of Medical Sciences (AUCMS), based in Kepala which will be based around the training sites. Batas, Penang State, Malaysia. AUCMS was In order to provide a pattern of clinical training The students will augment their hospital and introduced to the Irish partners in 2005 by the in Malaysia equivalent to that delivered community based experience with ongoing Malaysian Government, with a Memorandum in Ireland, there will (in addition to Clinical Skills training in the facilities provided of Agreement signed by all partners in January the appointment of the Pro-Dean) be by the partners at the purpose built medical 2009 at a ceremony in Penang. appointments at Professor, Senior Lecturer, school near to Taiping Hospital, and at other and Tutor level in the disciplines of Medicine, primary care health centres and hospitals in The students are recruited from the AUCMS Surgery, Paediatrics, Obstetrics, Psychiatry, Malaysia. Clinical Skills sessions will continue Foundation course or from Mara Banting Primary Care, Medical Imaging and throughout their clinical studies, adapted College in Kuala Lumpur following interview Anaesthesia. These professorial staff will be appropriately to the stage of their training. by the Irish partners and successful completion jointly recruited by UCC and NUIG. of the Foundation year or IB examinations. Where are the students to undertake their Eventually, the intake will consist of 60 In addition to involvement in the appointments clinical training ? students per year in UCC and 60 in NUIG. The of the academic staff in Malaysia, the Irish Malaysian students make a great contribution partners will provide mentoring and advice to the life of the medical school, and a true in course delivery and assessment. Staff ‘learning together’ atmosphere prevails. development for the new Malaysian staff will include Medical Education courses which High-quality school-leavers have been will be provided by the partner institutions in recruited to UCC from Malaysia, beginning Ireland by distance learning. in 1978, but in the past, the students have remained in Ireland for the full five years of Investment by the partners in the programme the course. UCC is still recruiting students will ensure that the students are provided for the five year programme, but in this new with excellent library facilities, IT laboratories, Twinning programme, the students will video conference facilities, clinical skills View of one of the ward blocks in Taiping Hospital experience slightly more than half their laboratories, simulation rooms, seminar training in Ireland, returning to do their clinical and tutorial rooms, lecture rooms, student Taiping Hospital studies in Malaysia, where they will be based common room, prayer rooms, lockers, and Yong Wah Hospital, or the Chinese Pauper at Taiping hospital in Perak state. The clinical staff offices. These will be provided at all Hospital, was the first established hospital in studies will follow the curriculum and exam hospital sites, and in a specially built student the Federated Malay States. It was founded in structure of UCC/NUIG, with the students medical school building close to the main 1880 to treat the Chinese coolies and tin-miners rotating to other hospitals and primary Taiping hospital base. This will also include who were often sick and suffered from various health care centres for parts of their training. student residential accommodation. Planning diseases, such as diarrhea, cholera, malaria, The clinical curriculum will be delivered for this is advanced and will be completed beriberi, dysentry, and pulmonary diseases. using a mixture of conventional lectures well ahead of the students’ return to Malaysia. Its establishment was developed in parallel and small group teaching, supported by with the town’s significant economic growth. distance learning facilities. By the time of transfer to Taiping, the students will have completed (both in Cork and Galway) The hospital has continued to expand, The students will remain registered students an intensive clinical preparation and particularly in recent times, and it is now the of UCC (or NUIG) for the duration of their orientation course in January – March on second largest hospital in Perak province. course, taking UCC/NUIG moderated aspects of Health Management and Health The hospital currently has 608 beds and serves examinations, and upon successful completion Care Delivery specific to Malaysia, Global as the major hospital for northern Perak of the course, will be conferred with a UCC Health and Infectious Diseases, ALS and province. There are 44,000 admissions or NUIG medical degree. Extern examiners Advanced Clinical Skills courses, patient safety, annually; 70% bed occupancy; 6,200 will be appointed by the Irish Ethics and Medical Law, and completion deliveries; and 202,000 OPD attendances. partners. of Pathology and Pharmacology exams. Taiping has a complement of 400 medical Satisfactory completion of this course is staff, of whom 51 are specialists, 120 are A representative of UCC/NUIG, Professor Paul mandatory prior to transfer to Malaysia, Medical Officers, and 140 are Housemen. Fletcher, has been established in Penang with all assessments completed by March. New ward blocks and outpatient departments since October 2008, providing ongoing liason. A member of the Malaysian based faculty will are currently under construction, and this Professor E.J. Johns has recently been have a role in this preparation for transfer to will further increase the bed complement. appointed as Pro-Dean and will be based in Malaysia. Taiping Hospital has recently been Taiping, to take on responsibility for designated as a centre of excellence for organising the academic staff recruitment Following transfer in the second part of third research, and collaborative research with the and infrastructure developments in Taiping year, the students will reinforce their clinical Irish partners will follow. and at the other hospitals, to ensure knowledge and skills through the completion

7 the wettest town in Peninsular Malaysia. The public gardens established during British rule average annual rainfall is about 4,000mm in Malaysia. These gardens, which contain ten in Taiping, while the peninsula’s average is scenic lakes, are located near Bukit Larut within 2,000mm – 2,500mm. An umbrella is not the Taiping town centre, and are adjacent to needed though as most of the time it is just the Taiping Zoo. There is a large country club a drizzle. Locals do not wonder whether it will and golf resort adjacent to the Lake Gardens rain on a particular day; they wonder what and Zoo. time it will rain. Taiping was on the route south for the The unusual rainfall has also led to a fertile Japanese forces invading Malaysia in WW2, collection of flora and century-old rain trees in and there is a War Graves cemetery which is Aerial view of Taiping from peak of the Taiping Lake Gardens, which were the first maintained to this day, with separate areas for Maxwell Hill looking west the Christian, Muslim, and Hindu fallen.

Taiping is a large town located in northern Perak, Malaysia, about 100km south of Penang on the main North-South highway. Taiping derives the name from two Chinese characters (tai - ‘great’) and (ping - ‘peace’). It has a population of almost 200,000 and is the second largest town in Perak after Ipoh, the state capital. The discovery of tin deposits in the area in the 19th century attracted Taiping Lake Gardens with Maxwell Hill in settlers from China, who were organised into the background two feuding groups around the Cantonese Ghee Hin ( ) society and the Hakka Hai San ( ) society. British intervention in the early 1870’s put an end to the feuding and the town, which used to be known as Klian Pauh, acquired its present name. The British made Taiping the administrative centre for the state of Perak in 1875. The town served this function until 1937 when the state capital was moved to Ipoh. The town contains many old colonial buildings, typical Chinese Main Street in Taiping with Maxwell Hill in buildings and temples and a large state prison background Map of Taiping Taiping also receives some limelight for being

Dr Kevin Horgan

Connecting the Dots North America. One of the Ottawa cardiologists were not to be ventilated because of concern was Johns Hopkins trained and strongly that they would become ventilator dependent. A request to write for the Graduates Newsletter encouraged me to go there. My discovery I saw multiple patients with hypothermia prompts a reflection on the decisions that there was a strong connection between during the severe winter of 1984. I became underlying one’s career path. Connecting Hopkins and UCC amplified my interest. friendly with Malegapuru Makgoba, the dots can only be done in retrospect, an opinionated South African endocrinologist and that can create an erroneous illusion After internship in CUH, I returned to the and immunologist, who would later inspire that the path followed was planned. physiology department thinking a firmer me to do immunologic research. Also, another grounding in physiology under the challenging My decision to attend UCC to do medicine colleague was David Adams with whom I mentorship of Prof Sheehan and Prof Hall in 1976 was somewhat predictable as shared multiple interests. The most memorable would be an excellent foundation for my desired my father was a UCC medical graduate. clinical experience I had in Birmingham career in academic medicine. It was! The road from Crescent College in Limerick was in the Liver Unit which had a rapidly to UCC was well travelled. I then spent a hectic year as a Senior House growing transplant unit and that kindled Officer in Birmingham, prior to going to an interest in applied immunology. Physiology and Pharmacology were my Baltimore. I worked at the General Hospital and favorite subjects. It was only later when I I then moved to Baltimore where Paul and the Queen Elizabeth Hospital where Richard was involved in teaching at other medical Andrew Whelton were on the Johns Fitzgerald was a revered member of the schools that I realised just how good the Hopkins faculty. There was a distinctive sense radiology departments. There was a strong clinical education was at UCC with the superb of cohesion and collegiality at Hopkins: tradition of UCC graduates working there, with cornerstone of the clinic system. the esprit de corps was particularly strong Prof Denis O’Sullivan and Paule Cotter two and welcoming with a mindful awareness My interest in internal medicine was fortified notable predecessors. Medical practice was of the historical legacy of William Osler by electives in surgery and cardiology in Ottawa, predictably very similar to Cork though the and his philosophy of “Aequanimitas”. The Canada in the summer prior to final med. volume of patients and their ethnic diversity generous hospitality of Donal and Alma I learned there that I wasn’t going to be a was a novelty. There was reticence about Nyhan was very welcome when I arrived. surgeon! The structured post-graduate training aggressive therapy that contrasted with my I witnessed was very appealing and I decided I subsequent experience in North America: The hospital was more generously staffed would try and pursue post-graduate training in elderly patients with chronic respiratory disease and the hospital stays tended to be shorter 8 than in Birmingham and Cork. All inpatients apply my insights into human immunology Vioxx as a marketed drug, when a colon were seen daily at consultant level. to a clinical problem, then gastrointestinal polyp prevention trial, that I had assumed There was a formal signing out process disease seemed a logical focus. The University responsibility for, produced unequivocal to ensure that colleagues, covering your gastroenterology department with numerous evidence of a cardiovascular risk. It was patients when you were off, were aware of “opinion leaders” on the staff includ- established soon after that other COX-2 potential issues that might arise. Patients ing Fergus Shanahan. Jared Diamond the inhibitors shared this risk. Though the COX-2 were zealously “worked up” with little physiologist and ornithologist was also a inhibitors reduced the recurrence of polyps, regard to cost and investigations member. Since “retirement” Diamond has this benefit was negated by the cardiovascular were easily arranged. I did more lumbar become a geographer and writer of effect. It was my Philadelphia neighbor, punctures in one week at Hopkins than I had provocative and influential books that attempt Dubliner Garret FitzGerald, who had done in a year in either Birmingham or to explain the rise and fall of civilisations: predicted previously that there might be Cork. Elderly patients with chronic respiratory “Guns, Germs and Steel” & “Collapse”. cardiovascular issues in some patients when disease were frequently and briefly ventilated he had discovered that COX-2 inhibition and to my surprise generally did well. There The UCLA medical school was founded in 1951, reduced prostacyclin production. were many teaching conferences. I recall vividly interestingly, the year of my father’s graduation a presentation on hypothermia where it was from UCC, illustrating the youth of California. Given the increasing importance of biologic commented that all the relevant literature was My endeavors at applying my immunologic therapies and my background in immunology, I curiously from the UK, provoking an interesting insights to inflammatory bowel disease were was keen to acquire some biologics experience discussion! My aspiration in pursuing a 3 year somewhat frustrating. Pursuing what is now which was not possible at Merck. A dividend of medical residency was to try and assume called translational research, I impatiently felt living in the Philadelphia area is the proximity some mastery of internal medicine! However, the work I was most interested in would be to many of the major pharma companies and as much as I learned and the more experience more effectively pursued in the setting of a I joined Centocor, a subsidiary of Johnson and I got, the more I appreciated the degree of my pharmaceutical or biotechnology company. Johnson, the developer of Remicade. For 2 ignorance in comparison to the multitudes I also felt there was too much of a rift between years I worked on Remicade and several novel of surrounding expert subspecialists. patient care and the laboratory based research I anti - inflammatory drugs before I became was trying to pursue: I didn’t feel comfortable as restless and moved to General Electric Unlike most of my colleagues, I didn’t feel a part time clinician treating complex patients. Healthcare to work on molecular diagnostics. a compelling attraction to any clinical The diagnostics were imaging based and were subspecialty. Inspired by my friend I was lucky to get a position at Merck in a logical extension of my prior experience Malegapuru, who was now at the National their GI group – which had a very strong with PET at Merck. GE had acquired the Cancer Institute in Bethesda, Maryland in record of successfully developing drugs diagnostic group as a result of the acquisition of suburban Washington DC working in the such as Pepcid and Losec. Merck, at that the Amersham company. This was a fascinating laboratory of Stephen Shaw, I applied to do time, had an exceptional reputation among experience and I thoroughly enjoyed immunology research in Steve’s lab. I thought pharmaceutical companies for its academic working on molecular imaging agents related this would be an excellent opportunity to rigour and ethical approach to business. to the diagnosis of Alzheimer’s disease, learn about research in a small laboratory Parkinson’s disease and cancer with a focus that was publishing in high impact journals My assigned project was to lead the clinical on angiogenesis. Developing a novel such as Nature. I joined Steve’s group in 1988. development of a neurokinin 1 (NK1) receptor diagnostic is more complex than is frequently Steve had made the observation that antigen antagonist. The NK1 receptor is the dominant appreciated – the key question is whether independent T cell interactions result from receptor for the neuropeptide substance P, a novel diagnostic provides additional adhesion mediated by specific molecular originally discovered in 1931 and believed information that influences patient interactions and identified the first molecular originally to have a crucial role in pain management/outcomes positively. Many receptor ligand interactions between different perception. Many companies had been trying diagnostic evaluations provide information cell types: CD2 with LFA3 and LFA1 with ICAM1. to develop NK1 antagonists but progress had that is not likely to alter management: I extended this by characterising subsets of been slow. When clinical trials were done, reimbursement based rather than evidence T cell defined by differential expression of surprisingly the compounds were not effective based medicine! isoforms of the CD45 molecule. Unlike much at relieving pain, but they were effective at immunology research, we only used human preventing nausea and vomiting associated Having spent more than 12 years in very large samples. My main finding related to the with cancer chemotherapy. My job was to companies, I was keen to try working for a much a4b7 integrin molecule which mediates the design and supervise the execution of the smaller enterprise where I could attempt to migration of T cells to the gastrointestinal clinical trials that would enable approval of the leverage my experience. The company I tract. This molecule has subsequently Merck NK1 receptor antagonist throughout joined in February 2011, Soligenix, has an emerged as an important factor in mediating the world for alleviation of nausea and inflammation focus and is trying to repurpose HIV infection and also as a therapeutic target vomiting. The drug’s site of action was existing drugs for novel indications where there for inflammatory bowel disease. When I in the brainstem and it had a complex is unmet medical need. So far, I’m enjoying the left Steve’s lab, my former colleague from metabolic and drug interaction profile. We more informal atmosphere of a small enterprise Birmingham David Adams took my place. UCC used positron emission tomography (PET) and we are working on some very interesting classmate Frank Sullivan was also in Bethesda, to help select the dose in a way that has projects with potentially large impact. training in oncology and subsequently remarkably become a model for subsequent radiation oncology. I interacted with research development of brain penetrant drugs. I have been very lucky to have such a varied fellows from all over the world and it was career thus far. Certainly, my UCC clinical and enthralling to learn about their research. The drug was approved in both the US and physiology training gave me an excellent I particularly enjoyed learning about advances Europe in 2003 as Emend. An especially foundation and it is gratifying to see how the in brain imaging from Declan Murphy, a gratifying aspect of the program was the medical school has developed and flourished psychiatrist from London, who regularly number of letters received from patients who in recent years. Please get in touch via linkedin updates me on his latest findings at had found chemotherapy to be very distressing if you are passing through Philadelphia and Kings College. without Emend and easily tolerable with it. I look forward to seeeing my classmates in October 2012 at our 30th year reunion. My immunologic research experience In 2004, I was also belatedly and peripherally prompted my choice of specialty. If I were to involved in the final days of the COX-2 inhibitor

9 Dr Sean F. Dinneen

Medical Grand Rounds: feeling the pulse of an institution

Introduction Walking along the main corridor in Cork When invited by Will Fennell to write a piece University Hospital after an absence from the for the UCC Medical Alumni newsletter I building of more than 15 years, I was surprised thought a reflection on my own experience of at the multitude of memories that came MGR in the various institutions in which I have flooding back from my days as a student and worked would be of interest to the readership. junior doctor in UCC and “the Regional”. Just It has certainly been interesting to write! as a piece of music can bring back memories of a time and place that is long forgotten so, I Cork in the 1980’s realised, can the return to an institution that My recollection of MGR in Cork during my was once a nurturing environment for those NCHD days consists mainly of the weekly case of us assigned to learn the medical profession presentation mentioned above. These were within its walls. During the course of an typically SHO-led and involved two separate afternoon spent visiting an ailing relative, 30 minute reviews of a case (or cases) including I enjoyed taking time out to explore discussion and key learning points. In those some of my old haunts and to trigger pre-powerpoint days we used acetates and the return of additional memories. an overhead projector to deliver the message. The venue (main lecture theatre) and the Passing the ward sister’s office on ward 2A audience (senior members of the medical reminded me of the post-ward round cup consultant staff and your NCHD peers) meant of tea that was part and parcel of Denis that there was a formality and an edge to O’Sullivan’s professorial ward round. Because the event. Added to this was the fact that of the size of the room all but the senior you were competing for a prize and your members of the team were excluded. I had name on the board! Derry Murnaghan stands a real sense of “arrival” when, as Prof Sull’s out in my memory as being an interrogator of the Mayo logo represent clinical practice, registrar, I was finally invited in to the china of fine detail. Michael Brady, Professor of research and education, and the not-for-profit tea set inner circle. I was surprised to see a Surgery, was also a regular attender. While model calls for revenue from the practice to be photograph of the professorial team from those very few of us mere mortals would ever dare fed back into the teaching and research efforts. days still adorning the wall of the main ward compete with the likes of Liam Plant on the corridor. Another “wall decoration” that I had floor of the UCC “Philosoph” the MGR forum Medical Grand Rounds at Mayo were held forgotten about was the board (prominently was a more even playing field. The case itself at lunchtime on Wednesdays in the ground displayed near the hospital entrance) listing often carried the day and the presenter floor of the Siebens building, a multi-storey the winners of the best NCHD presentation did not need to have world class public building dedicated to medical education. The from the mid-1980’s to the present time. speaking ability to engage the audience. venue was an impressive several hundred I don’t know where the idea for that “board The meeting was held on Fridays at 4pm and seater auditorium with large wall hangings of honour” came from (it may have been the was followed by tea and biscuits which in turn reminding people of the traditions of Mayo aforementioned tea room) but it represents was often followed by adjournment to the including images of the founders of the a good example of the promotion of a Bishopstown Bar. The cut and thrust of the institution (the Mayo brothers) and of Nobel (competitive) learning environment in the Cork MGR forum and the collegiality that it prize-winning clinical investigators (Kendall hospital. engendered among the medical staff was good and Hench). The MGR session was chaired preparation for future endeavours overseas. by the Chair of the Department of Medicine Medical Grand Rounds (MGR) is a fundamental or in his absence, a senior member of the Mayo part of any academic medical centre but one Mayo Clinic MGR Foundation (responsible for postgraduate that can easily be taken for granted. Since I moved to the States in 1989 and spent several education). Presenters included external returning to NUI Galway as a Senior Lecturer years in training and on staff at the Mayo and (mainly) internal consultants from a range in 2005 I have been responsible (along with Clinic. Mayo amounts to an enormous medical of medical specialties. The main speaker my colleague Tim O’Brien) for the organisation enterprise with the main facility in Rochester, was often preceded by a brief vignette of the Galway University Hospitals MGR MN and satellite clinics in Jacksonville, FL and or image in clinical medicine presented by programme. I have come to realise that while Scottsdale, AZ. It was a remarkable place to an internal medicine resident. effort has to be put in by the organisers to learn and to practice medicine. The scale of ensure that talented and informative speakers the enterprise was hard to fathom coming My early recollections from attending those get invited to deliver MGR, the real success of as we did from an under-resourced health sessions include a sense of amazement at the programme is dependent on the degree service in Ireland. In the year I left Rochester the self-confidence of the American medical of engagement by the staff of the institution. (1999), Mayo Foundation employed 32,531 student. It would not be unusual for a student If asked to assess the health of an academic staff consisting of approximately 2,000 to ask a question or even speak of their own medical centre anywhere in the world, I would consultants, 1,500 trainees and over 28,000 “experience” with a certain condition in front have no hesitation in asking to sit in on that administrative and allied health personnel. of an audience of several hundred clinicians. week’s MGR. While HIQA, the Medical Council The annual expenditure on research in 1998 Later on I came to appreciate the meritocracy and the HEA have a legislative role in ensuring was over 200 million dollars and on education of the US system. If someone has a good idea (and accrediting) the standard of care delivery, over 100 million dollars. There were 1,820,000 (regardless of their seniority) the system teaching and research within an Irish teaching outpatient visits and 108,054 surgical cases wants to hear about it and (generally) will hospital the weekly MGR is where all of these which generated over 100 million dollars in do what it can to encourage and promote its elements should (ideally) come together. net patient care revenue. The three shields development.

10 The MGR session at Mayo was strong on the Cambridge. I was very busy clinically during my during their appointment as a way of letting clinical aspects of medicine and (like many time in Addenbrooke’s and often missed the people know their interests and encouraging other aspects of the work there) interpreted weekly MGR which was held on Wednesdays interaction. The programme is generally well scientific breakthroughs in the context of at lunchtime (a particularly busy day for me). attended although we have had disappointing what they meant for clinical practice. This was The venue was the William Harvey lecture turnout on occasion, particularly if the true of my one and only presentation at Mayo theatre in the Clinical School building. The time of the meeting is changed to facilitate MGR when (along with my mentor) I spoke meeting was chaired by the Regius Professor a visitor’s travel arrangements. of the clinical relevance of new diagnostic of Physic, Professor Sir Keith Peters, or by one criteria for diabetes (see illustration). of the Professors of Medicine. The format What lessons have we learned from other MGR involved two 30 minute presentations by experiences and how have these lessons been McMaster CE&B Rounds consultants or senior trainees on a sub-spe- incorporated into our Galway programme? After completing my internal medicine and cialty topic of interest to the general audience. The venue is really important and should reflect sub-specialty training at Mayo I spent a year The meeting was always well attended by the importance placed on the meeting by the doing a Masters in Clinical Epidemiology at students and clinicians from all ranks within institution. Although we have more modern McMaster University in Hamilton, Ontario. I the hospital. On the 2 occasions that I delivered facilities on the main University campus we studied in the Department where the term MGR in Addenbrooke’s I included patients as continue to hold MGR in the Clinical Science “Evidenced Based Medicine” was defined co-presenters. This was not commonly done Institute because it is adjacent to the hospital and put into operation by people like David but was very well received. The first patient and makes it easier for busy clinicians to attend. Sackett and Brian Haynes. Because the year was a retired banker who developed a true Buy-in (and attendance) from senior clinicians is involved no clinical practice I did not attend allergy to insulin, a once-in-a-career event, critical. If juniors see that their consultant does the hospital MGR but instead was a regular even for a diabetologist. The second was a not attend MGR then they are very unlikely attender at the weekly “Clinical Epidemiol- patient with diabetic gastroparesis who was to do so themselves. Attendance cannot be ogy and Biostatistics” or CE&B rounds. This the second person in the UK to receive a insisted upon by the organisers however the was a remarkable forum in which clinicians gastric pacemaker to treat his condition. Both recent introduction of competence assurance from many different backgrounds combined patients were very confident at discussing their by the Medical Council is likely to help with “methodologists” (including statisticians, condition in front of a large medical audience. attendance at all organised medical education health economists, clinical trialists and others) events. Preparation of a proper introduction to interrogate protocols, preliminary data, or Galway in 2011: bringing it all back home! by the chairperson helps set the scene for a final results of clinical practice research. There Our MGR programme in Galway is held on good MGR. Ease of use of the audiovisual was a real excitement to the presentations Fridays at lunchtime and is supported by an supports also helps avoid the unanticipated and discussions with a sense of “making it up unrestricted educational grant from a number during a talk. The dream scenario for the editor as you go along”. This was the environment of pharmaceutical companies. Because we of a medical journal is a readership that tears that gave birth to the concept of the number have separate postgraduate education sessions the journal out of its wrapping as soon as needed to treat (NNT) which has now become geared towards SHOs and Registrars the MGR it arrives and sits down to read the content a widely used method for presenting the programme is consultant led. We aim to have cover to cover. The equivalent for the organiser results of a randomised controlled trial in a internal speakers approximately twice per of a MGR forum is a large attendance with full way that is relevant to the practicing clinician. month and external speakers (from within participation in the Q&A session following As a mere MSc student I did not get to present Ireland or from further afield) twice per an enlightened talk. While we may not yet at CE&B rounds and I don’t think I would have month. If possible we invite external speakers be at that point in Galway we’re working been brave enough to do so even if invited! to meet colleagues from their specialty at a on it! Let us know if you are passing through Visiting Faculty dinner on Thursday evening and you want to feel the pulse! Addenbrooke’s Hospital MGR and/or during the course of Friday morning. After 10 years in North America I moved to The MGR programme is a good way of work in the NHS and took up a consultant promoting the hospital and the university to post in Addenbrooke’s Hospital, the main influential people from abroad. We encourage teaching hospital of the University of new consultants to present as early as possible

Dr Paul O’Brien

Memoir of the Plague Year

LONG TERM FOLLOW-UP little sister Margo Flynn from my description. I contacted what far-flung survivors of I spoke with Carmel and, sure enough, she those long- ago days I could find, including Following on my ‘Memoir of the Plague Year’ was right. She told me that Margo had lived Nancy O’Connell SRN, (nee Riordan), in South article in the Medical Alumni Newsletter 7 on in the bosom of her family until she died Carolina, who also spoke with Margo’s describing how some other students and age 19 of complications of chronic respiratory mother and sister, and fellow volunteers I during the Cork polio epidemic of 1956 insufficiency. She had led a happy if Raymond Hegarty (Nova Scotia), John A. Kelly volunteered to manually ventilate a little 4 compromised life. I had the pleasure of (Pennsylvania), Michael O’Sullivan (Arizona) year-old girl with respiratory paralysis also talking with Margo’s ninety year-old and of course my wife Elizabeth Healy. They who couldn’t be mechanically ventilated, mother, who was very happy her brave little were pleased and intrigued to hear such the Cork Holly Bough 2009 picked up on girl was remembered after all the years. positive follow-up on their efforts after 54 the story. Shortly after it appeared editor Subsequently Margo’s full tragic but uplifting years. John Dolan got a call from Carmel story appeared in the 2010 Holly Bough. Daly who thought she recognised her

11 Dr Deirdre Bennett and Dr Martina Kelly

What Makes A Doctor? The Teaching and Assessment of Medical Professionalism “To me the ideal doctor would be a man of things” in medical practice. The uncritical endowed with profound knowledge of life and absorption of unprofessional attitudes and I saw how important this patient relationship of the soul, intuitively divining any suffering behaviours is a risk of this approach. It is now is and how patient trust in their doctor is so or disorder of whatever kind, and restoring recognised that such an important aspect of important. I saw people with both acute and peace by his mere presence“ Henri Amiel students’ development shouldn’t be left to chronic illness during my three weeks in general chance. Regulatory bodies require that we practice and it helped me to understand better The aim of modern medical education is to teach and assess our students’ professionalism. the affect that illness has on people’s lives. produce a good doctor rather than a perfect So how do we go about teaching students one. But what does a good doctor look like? Therefore, we teach medical professionalism about medical professionalism in the clinical How do they feel, think and behave? Our in a way that is grounded in students’ own setting in UCC in 2011? Before students come professional bodies attempt to capture these experiences and contextualised in real life to clinical attachments they are taught the elements in definitions and frameworks for practice. But how do we judge what our cognitive base of medical professionalism. medical professionalism but in practice the students have learned? Assessment of There is a gap, however, between the theory issues are complex and poorly defined. Most professionalism remains problematic. What of medical professionalism and its practice. doctors are aware of these guidelines but day is the rationale behind trying to assess It is in the clinical setting that students come to to day employ an internal barometer in relation professionalism? To encourage students to understand the complexities and uncertainties to professionalism. We all have an image of the take it seriously? Perhaps. To provide formative of professional practice. Students are good doctor, a composite created over years feedback? Certainly. Most importantly encouraged to be aware of professionalism of undergraduate and postgraduate training, however, it is about identifying the issues that arise on clinical attachments. based on other doctors we have met and unprofessional doctors of the future. The They write reflective pieces on their experiences from our own practice. We may link between undergraduate unprofessional experiences which are then discussed in small not find it easy to define professionalism but behaviour and later breaches is well established. we know when it is missing, in others at least. group sessions with their peers and a tutor. Reflection requires the students to look at the No single assessment method can capture Professional behaviour in doctors is important attitudes and beliefs that they bring to the to patients. In 2010, 52.6% of complaints to the complexity of professionalism. Surveys of clinical setting. They return to an event and professional attitudes have not been demon- the Medical Council related to breaches of view it from a distance. They consider how professional standards or poor communication strated to translate to clinical practice. At UCC they and others behaved and felt at the time, we have added a professionalism dimension /rudeness. In 2006, a Medical Council survey they are able to analyse how events unfolded revealed that 25% of people had reason to be to many of our clinical assessments, OSCE, and how they can use this understanding clinical attachment evaluations, workplace dissatisfied with a doctor over the previous in their future practice. By discussing their 5 years. In 30% of cases this related to doctors’ based clinical examinations eg. MiniCEX. thoughts with peers they gain alternative Behaviour in such artificial situations, with an inter-personal skills including rudeness, perspectives and the beliefs and attitudes poor communication and a lack of empathy. examiner standing by, may not reflect which they hold may be challenged. The tutor behaviour in practice however. Nor do such The need to ensure that medical graduates do guides students to an understanding of better in the future is clear. assessments address the thinking that lies professionalism in practice. behind behaviour. In this regard assessment of Guiding medical students as they develop Students often reflect on the professional written reflections seems attractive but there their professional identity is challenging for skills of role models. “She never once appeared are problems here also. Is it ethical to assess teachers. Diverse in every aspect, medical to lose composure, particularly when the story students’ inner thoughts and will doing so school classes no longer look like a typical of the patient’s family history was unfolding. lead to gamesmanship? Students might Irish Leaving Certificate cohort. In 2011, across She was able to express an appropriate level of fabricate their reflection in order to gain a programs at UCC, more than half of our first empathy and compassion towards him while better mark. The educational literature has year students are North American or Malaysian. he was telling his story...... she patiently eased some suggestions, however these focus on They may be in their teens or their thirties, the patient’s worries and concerns, as well as reflective writing ability rather than linking just out of school or married with families. ensuring that he understood the approach to understanding of the concept of medical They come to medical education with vastly he was to take in managing his condition”. professionalism, which is surely our goal. differing experiences of life and of education. New knowledge and understanding is built They examine their own feelings and Medical Professionalism is an emerging area on the foundations of what students already those of their patients. “She started talking within Medical Education. Our research, here in know and understand. The challenge for us is about her daughter who was born with con- the Medical Education Unit at UCC, examines to support the development of professional genital neural tube defect. I felt very emotional both how students learn about professionalism identity in a way that connects who our and disabled, I didn’t know what to do, or say and how we might effectively assess their students are with the requirements of patients, because I fear if I changed the subject she would learning. In an era when there is heavy emphasis colleagues and wider society. feel rejected but if I interact and ask further she on biomedical research and technological would get more emotional so I was in a awkward advances, we must not forget what separates The traditional medical education, which position but I expressed sorrow many times and us from the bio-scientists and bio-engineers. most of us experienced, did not address showed empathy because I think that this is what What makes us doctors? It is our relationships Medical Professionalism as a discrete entity. she wants.....after a few seconds I was able to re- with patients. Research into teaching and Domains within professionalism, ethics and spond to the patient’s body and verbal language assessing Medical Professionalism is key to the jurisprudence, were taught but other aspects to make her feel important and listened to”. future of our profession and must be supported were left to the informal and hidden curricula. by the same investment of effort and funds as The informal curriculum is the ad hoc learning They gain insight into how trust develops research in biomedical domains. To conclude that takes place in clinical settings, discussing between doctor and patient. “The GP has “One of the essential qualities of the clinician cases in corridors and over coffee. The hidden time to build up a relationship with his patients is interest in humanity, for the secret of the curriculum is made up of powerful messages that you do not often see in the hospital setting. care of the patient is in caring for the patient” communicated to students about “the nature During my three weeks in general practice 12 Dr Neil Cronin

There were recurrent epidemics in Ireland Charles Sugrue M.D. of Cork (1775-1816) of typhus fever throughout the eighteenth and nineteenth centuries, with a particularly - A Name That Deserves To Be Better Known virulent outbreak in Cork in 1800 and 1801. Mortan’s Medical Bibliography is a side also considerably enlarged; it resembled in John Milner Barry was the most prominent comprehensive listing of the most important appearance that of the right side … The capsula doctor in early nineteenth century Cork, contributions to the world literature of renalis of the left side, together with the kidney, particularly in the field of public health. medicine. The only citation with a Cork which was of the natural size, weighed 3¼ lb. Despite much opposition, he succeeded in connection appears to be that of Charles opening the Cork Fever Hospital and House Donovan, honoured for his contributions The symptoms and signs of weight loss despite of Recovery on the Old Youghal Road in to the pathogenesis of leishmaniasis. a voracious appetite, recurrent abdominal 1802. Sugrue was a member of the founding Hopefully, Cork doctors of the future will pain, hectic flushing, perspiration and committee of the Fever Hospital. Sugrue continue to significantly contribute to tachycardia, taken together with the presence and Milner Barry were close associates, but medical science. One Cork doctor whose of bilateral adrenal tumours are highly seem to have had a falling out at this time. name deserves inclusion in any bibliography suggestive of phaeochromocytoma. No other of medical science is that of Charles Sugrue. diagnosis would account for this combination Medical issues and politics can be closely of findings. Hitherto, the first description of intertwined. An anonymous Cork writer On the June 26 1800, Sugrue sent a letter from phaeochromocytoma was thought to be declared that the vaccinators “are with few the city of Corke to the London Medical and by Dr Felix Frankel in 1886. He described the exceptions, if not downright Jacobins, at Physical Journal, describing the case of Rich- case of 18 year old woman, who suffered from least jacobinacally inclined”. Sugrue was ard Mountjoy, who was eight years old when intermittent attacks of palpitations, anxiety, politically active and was indeed also he first came under Sugrue’s care in 1796.“[A] headache and vomiting. An autopsy showed “jacobinacally inclined“. Coming from the thin sprightly boy of a fair complexion with blue bilateral adrenal tumours which however were increasingly confident and upwardly mobile eyes delicate skin and fair hair was attacked … thought to be incidental to her illness which Catholic professional middle class, he would with a severe pain under the stomach.” Treatment was attributed to nephritis. have been acutely aware of the continuing for worms and all other therapies then discrimination of the Penal Laws. Education available were of no avail, except large doses Born in 1775, Charles Sugrue was a medical in revolutionary Paris and in Enlightenment of laudanum. The pain persisted for some student in Paris and in Edinburgh, then the Edinburgh must have influenced the young months until he underwent a spontaneous leading centres for medical education. When in student. Cork itself was politically radicalised remission. The child remained well until the Edinburgh, he translated from the Latin Robert in the 1790’s. Arthur O’Connor, a senior United summer of 1799, when his illness relapsed, Menzies’ A Dissertation on Respiration, which Irishman, visited the city in 1796. O’Connor had with pain similar to before, increasing in contains the first description of a method recently been in France and knew an invasion severity. “Though during the last three or four of measuring tidal volume of breathing. was imminent. A “select few was summoned” months of his illness, he took a considerable Sugrue graduated at the age of 21 years from to meet him. Sugrue was a member of the quantity of nourishment, he visibly became more Glasgow University and came to Cork after Directory of the United Irishmen then formed. emaciated and feeble. His pulse was during this qualifying. There, the institution with which he The French invasion at Bantry Bay in the winter time about 120. His countenance resembled that was most associated was the Cork Dispensary. of 1796 was a failure but raised the political of a person in the last stage of a pulmonary con- Dispensary doctors were often those who by temperature even higher. Even greater sumption; it was pale, and the hectic flush was virtue of their religion or who for other reasons numbers of the medical profession were distinctly marked on each cheek; he had con- were excluded from the more lucrative hospital however loyalist, most prominent among stant profuse and universal perspiration.” Young positions. Patients (“the sick poor”) were treated whom was Dr Robert Harding, physician Mountjoy’s progress was inexorably downhill. in their homes and doctors were for the first in the North Infirmary. Harding was sheriff He died in May 1800. time exposed to the full effects of the extreme of Cork in 1798 and was the leading figure poverty then prevalent. Sugrue also had a in suppressing local radicalism and revolution. At the parents’ request, a post-mortem was connection with the Cork Lying-In Hospital. In his house searches and other activities, performed. Reflecting the wasting nature he did not spare his medical colleagues. of the illness, no omentum or adipose tissue Edward Jenner, noting the protection against Sugrue remained sufficiently prominent in was found. There was no evidence of smallpox conferred by previous cowpox radical circles that he was arrested at the time tuberculosis or of worms. A tumour was found infection, introduced vaccination in 1798. The of Robert Emmet’s uprising in 1803. attached to the right kidney: success of the procedure ensured its rapid dissemination. According to John Milner Barry, It is possible to follow his career until 1804 but The tumour was of an oblong shape, about to whom credit is usually given for thereafter we lose track of Charles Sugrue. He six inches long, and from two and a half to introducing vaccination to Ireland, the may have continued practicing without public three in its largest diameter; it was of the same protective effect of cowpox infection had been activity or he may have left Cork. He died in colour as the intestines externally; it was of a firm long known in west Cork - the native Irish calling Genoa on 30th March, 1816 after a short illness consistence and on cutting into it, we found it it shinach. Sugrue was Milner Barry’s closest contracted on a journey from Marseilles. composed of a yellowish-coloured substance, associate in introducing vaccination to Cork. with a shade of brown, not unlike the remains Sugrue undertook experiments, presumably Sugrue was an active participant in the vibrant of beef-suet, after it has been melted and the to understand the mechanism of protection medical culture of early nineteenth century tallow squeezed out of it. After been separated conferred by vaccination. Obviously not Cork. From the case report, we can deduce from the kidney, it weighed 2¾ lbs. We now had hindered by ethical considerations, he he was an acute observer and an empathetic no hesitation in pronouncing this tumour to inoculated with smallpox two children who and astute clinician. A product of his be a considerable enlargement of the capsula had already been vaccinated, and noted the background, he was also socially and politically renalis [adrenal gland]. … On raising up the failure of a smallpox pustule to develop; in active. Sugrue deserves recognition and stomach and spleen, a similar tumour was another experiment, Sugrue simultaneously honour. When Cork clinicians consider phaeo- perceived on the left side, which on examination inoculated a child with both cowpox chromocytoma, we should remember Charles was found to be the capsula renalis of that and smallpox. Sugrue, who provided its first description.

13 Dr Éamon McCoy

Twenty Years of War and Disaster - The Story of IDEALS

This is the story of a medical charity. Although set up. One of the busier stations was with continuous shelling and heavy machine it is a very small charity, it is one that has been hit more than 3,500 times in six months. gun fire. Just like the local medical staff, we were realistic in ambition, highly cost effective and all tired. We had arrived to do a specific job, has punched well above it weight during the Hospital care in Sarajevo was provided by two but had been able to accomplish little as day last two decades. It has changed the lives of centres - The University Clinical Centre and and night we had been forced into providing those of us involved. It has also changed the the State Hospital. The Clinical Centre suffered emergency care to casualties that were lives of many others in Europe, Asia and now irreversible damage to its children’s and pouring into the hospital day and night. in the Middle East. It has done so at minimal maternity sections and lost 20% of its beds costs in travel or miscellaneous expenses or and significant numbers of medical staff. What we were only beginning to experience overheads. More importantly, it is a medical Therefore many doctors and nurses were was another emotion that the local staff had charity that doesn’t just firefight but sees that, moved from destroyed community health been feeling for more than 12 months, frustra- though its acute projects must be completed centres and clinics to these two facilities. tion. What we were seeing was a sophisticated in a short a time as possible, long term support The State Hospital was located in the central society and well resourced medical system is critical. Finally, it is a charity that realises that part of Sarajevo close to the university and experience a sudden and prolonged conflict. medical assistance alone is sometimes not 400m from the city’s first defence perimeter. The close quarters warfare resulted in a the priority. This charity is called IDEALS and By the middle of 1994 staff here estimated significant loss of physical resources and it has been in formal existence for more than that over 500 rounds of artillery shells had hit the massive numbers of military and civilian 17 years. the hospital. The aggressor had an accurate casualties placed an enormous pressure on knowledge of the layout of the hospital and medical personnel. Finally there was totally The story begins in June 1994 in the Sarajevo, aimed to knock out the casualty department, inappropriate and inadequate assistance. the capital of Bosnia and Hertzogovnia, which central sterile store, operating theatres, had been under siege of almost a year - a siege radiology department, generator, water supply, That evening our group set up a charity that that would last for a total of 42 months. At least pharmacy, blood bank and kitchens. They became known as IDEALS (International 142,000 people, of a population of 4.3 million succeeded to a large degree. All floors from the Disaster and Emergency Aid with Long-term are known to have been killed, 16,000 of these 4th to the 12th were rendered unusable, and Support - www.IDEALS.org.uk) which has children under the age of 12. However these from the 7th to the 12th destroyed. However 6 trustees that include three for medical are United Nations figures and probably a gross even some of the intact wards had to remain expertise, a business expert (who provided underestimation. It is believed that almost unoccupied as they were exposed to sniper substantial initial funding), an influential 400 physicians were killed or imprisoned. fire. A red cross was placed on the hospital politician and an accountant. In the city of Sarajevo alone with a population early in the siege in accordance with the of 380,000 (pre war 550,000) nearly 11,000 Geneva Convention. Unfortunately the During the last 17 years, IDEALS has been were killed, 80% of these civilian, including surrounding forces used the cross as an aiming involved in projects in Bosnia, Pakistan, 1,500 children. In addition more than 50,000 point and it was soon removed. From some Sri Lanka and Gaza and at first glance these were wounded, 15,000 under 18 years-of- of the higher floors of the hospital you could projects may seem quite disparate. But what age. But what these figures hide is the sheer have had a perfect view of the fighting except they have in common is that they fit our eight savagery of the attacks on the population, the that, like previous untrained observers, we fundamental rules for giving aid. These are; systematic murder and rape, the deliberate found that there was usually very little to 1. Have a particular skill (or get it), 2. Get local wounding in the pelvis and lower limbs in see. High-powered weapons and high speed information from locals, 3. Plan small and order to sap medical resources, the targeting fire, camouflage and smokeless explosives in specific projects, 4. Have a limited time-scale of children in order to draw adults into firing modern warfare render soldiers invisible. Now (months not years), 5. Bring added value range and the precise shelling of hospitals. and then a puff of dust would rise in the city, (teaching, equipment, drugs), 6. Avoid They also neatly disguise many thousands of but with the sound of the impact so delayed dependency (Governmental agencies, NGOs), deaths from malnutrition and infection. that cause and effect seem to be disconnected. 7. Be a minimal burden on the local facilities (bring all equipment and personnel), and At the time I was doing my anaestheic training The shelling and constant stream of casualties 8. Always maintain close contact. The reason in Belfast and had seen a fair share of bomb and took their toll resulting in patients lying in that rules such as these are important is that gunshot injuries. But Sarajevo was on another beds jammed side-byside with no space the effects of war and disaster are not just level. Early in the siege almost all of the between them in corridors and storage rooms. from physical and psychological damage ambulances were destroyed, together with Operations were frequently performed on but also a breakdown of civic life (education, the buses, trams and the telephone system. stretchers in the emergency department. law and order, commerce, health service) Indeed red cross-marked vehicles and their Despite back-up generators and other and a loss of education, food, water, heat crews were specific targets of sniper and emergency provisions, the hospital still and medicine. These effects are too great mortar fire. In the first few months, 93% of lost electricity for months at a time. No fuel for even the largest organisations and in casualties received some form of basic first aid meant no heating in an area where midday any case are often beyond our control. by relatives, friends or others. This percentage temperatures were still less than zero in fell as the rescuers themselves became targets, winter. Needless to say an intact window In Bosnia, centred on Sarajevo, and to a lesser as were the few remaining private vehicles and was unusual. Little water meant no laundry extent Mostar, we had 4 main projects. The taxis used for transport to hospital. Accurate facilities and that bed clothes, theatre gowns first 4 years focused on fracture non-union, sniper and mortar fire necessitated a change and drapes had to be eventually burned as chronic wound infection and anaesthesia from the policies of “stay and play” or they eventually posed an infection risk. development. The years from 1998-2000 “resuscitate while transporting” to the simple concentrated on long-term development of “scoop and run”. In addition, due to the danger I was part of a medical team working in The medical education and sustainable equipment of transporting the wounded in daylight, State Hospital at the time. One particular planning. However it is important that a front-line casualty clearing stations were evening the noise was intense but not unusual dependency culture does not develop 14 and towards 2003 we knew that our role crash in railroad history when The Samudra population into a temporary tent village. should reduce and in any event we were Devi (Queen of the Sea) was hit by 2 waves This was of high quality and allowed them asked to repeat our formula far further away. resulting in somewhere between 1,500 and to survive the succeeding winter with a 2,500 deaths. The infrastructure was wrecked. high standard of living that was disease A military historian was asked in a radio The human cost was extraordinary with at free. The children’s education was also interview were there fundamental rules of least 40,000 dead or missing. However most attended to with a temporary school. war. Slightly tongue-in-cheek he replied that casualties died immediately and, though the there were only three; never meddle in Ireland, survivors suffered mainly long bone and soft In September 2006 IDEALS paid for the never ever invade Russia and never ever, ever tissue injuries, local medical facilities could purchase of new land for the Bedadi families go near “The Stans” (Afghanistan, Pakistan, cope. It was apparent that the major problem that freed them from a feudal dependence Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan was damage to social infrastructure. on corrupt landlords. This permament and Uzbekistan). “The Stans” have proven resettlement has been described by the United the graveyard for many a military adventure Infrastructure was not our area of expertise Nations High Commission for Refugees in history by Alexander the Great , Genghis but we knew that doing nothing was not (UNHCR) as a unique venture. They moved in Khan, the British (twice), the Soviet Union an option. We could get the funds, the time on October 17th 2006 and the New Bedadi and now the United States led coalition. In and professional assistance. In a very short Village was completed in Autumn 2009. 2003, due to our experience and reputation time we put together a project team to The families now own their houses and in Bosnia, we were asked to become tackle problems in shelter, water and sewage cannot be prey to unscrupulous landlords. involved in the frontier region of Peshawar, in and to make these projects sustainable. In Skills, which were learned during the the federally administered tribal areas (FATA) Tangalle the Tamils had been resettled in a building of the village, are now used of Pakistan on the border with Afghanistan. camp, which was really just a warehouse full to gain employment and support the of tents. With little or no sanitary or other community. The total cost was only £200,000. The problems in this wild and war torn area are facilities, malnutrition and disease were rife. legion. From our perspective our charity could The local School for Blind and Deaf Children, On the morning of 27th December 2008, assist the reduction in the extraordinarily essentially an orphanage, was even worse. in response to persistent rocket attacks on high mortality rate from major, or sometimes Israel, the Gaza Strip was attacked by F16 relatively minor, injuries. This results from the They benefited from a large donation of food fighters and Apache helicopters. The initial distances to medical facilities, the absence of and assistance with a new clean water supply attack lasted only 220 seconds but killed 230 training in pre-hospital and immediate hospital and kitchens. In addition some essential and injured 700. The subsequent invasion care and the lack of even basic equipment. local businesses were given professional and lasted 3 weeks resulting in at least 1,166 financial assistance to return to normal activity deaths including 936 civilians, 313 of We funded Primary Trauma Care (PTC) including the supply of cattle, fishing nets and whom were children. instruction in the area. For those not familiar building materials. A deep-sea trawler was with PTC – it is a system of Acute Trauma Life purchased to replace one that was destroyed The invasion and subsequent siege has Support that is free, appropriate to poorly in the Tsunami. This allowed the crew of resulted in massive destruction of livelihoods, equipped locations and can be cascaded ten to be employed and for their families to agriculture, infrastructure and basic rapidly once a cohort of enthusiastic instructors be supported - up to one hundred people services and has created a culture of have been created. We realised that confining in total. The supply of this boat included a dependency. Huge numbers of homes, this training to the Peshawar region would contract guaranteeing free fish and income government buildings and facilities were be suboptimal and now have thousands to the Blind and Deaf Childrens’ school. destroyed. Health facilities were damaged or of medical staff trained in Karachi, Lahore destroyed including half the hospitals, and Quetta, who have formed a supporting Our charity learned a lot of new skills in Sri primary health care centres and many fellowship across Pakistan. We didn’t know it at Lanka but never envisaged that they might ambulances. Most drinking water is unfit for the time but this fellowship would prove very again prove so useful, so soon. In October 2005 consumption (hepatitis is rife) and electricity useful, very soon. a devastating earthquake hit Pakistan close to unreliable resulting in the use of small the area where we had based our projects. generators which cause burn and blast Like the rest of the world we watched the Ironically, it was caused by movement of the injuries daily. Asian tsunami in horror on the 26th December same tectonic plate as that had caused the Asian tsunami. The roughly 70,000 killed and In 2009 an organisation called Medical Aid 2004. We all had a sense of helplessness. 100,000 injured proved once more that it’s to Palestinians (MAP) asked us to go to Gaza. Reports from the vast area affected revealed building collapse that kills, not the earthquake. We were initially very reluctant to do so, not that the aid priorities were fresh water, food, Most survivors lived in inaccessible sites, were because of danger but because the very act shelter, logisticians and engineers. We, as a small already impoverished and their rotten buildings of turning up in Gaza is often interpreted as medical aid organisation, would have little had immediately collapsed. More than 19,000 a political statement. This area is a tinderbox to offer. However in February 2005 we were children had died and 50% of the survivors and any charity has a lot to lose by association. given a significant donation and asked to see if had multiple injuries. In addition numerous But we went, we are still there and delighted we could assist in a particular area. We ended up patients were found weeks later having had to be so. Now we are using our core skills in in Tangalle on the southern coast of Sri Lanka. very poor medical treatment by inexperienced five projects in complex fracture management, Almost 80% of the coastline had been severely overseas volunteers resulting in problems limb reconstruction, anaesthesia and affected. Because of the rapid international such as septic ulceration and malrotation. pain management and a large program in the management of chronic disability. response and financial aid there was great IDEALS trained doctors from the PTC fellowship hope. Though phase 1 of the recovery process moved to the area to care for the immediate During most of the last 20 years our charity was complete – everything else was falling needs of the injured survivors and IDEALS has ended up in several regions that apart due to political wrangling and corruption, appropriate medical equipment was provided. continue to suffer the effects of war and poor communication and coordination. However it was obvious that the most disaster. We have learned a lot during that important aid would be shelter. time but some things have never changed. In Tangalle there was total destruction at The eight principles we wrote down in June the coast and for at least 100m inland. This We targeted a small village called Bedadi and 1994 in the State Hospital, Sarajevo still hold was highlighted by the nearby greatest train paid for the resettlement of the destitute true. But they don’t negate the problems 1515 you will encounter over and over again. We have found that it is worth remembering never even hint at the possibility of delivery In areas of disaster you will encounter many some basic rules. The fi rst concerns safety and as this will be taken as a promise. war tourists, enthusiastic amateurs and personal safety is usually just common sense. dangerous criminals. You must identify them However the only truism is that most Finally there is the question of trust. Many early and steer clear. Governmental and reassurance is pointless. Despite all the books victims recognise that above all you are giving non-governmental organisations (NGOs) and documents published and reassurances them that most precious of commodities, are usually doing their best. It is fashionable given there is no pattern to those who live or time. But they usually place an enormous to criticise them, particularly those working die in war. In war people die because they do. trust in you, especially as a doctor. Victims of with or for the United Nations. Most There is nothing more to it than that. war and disaster are often victims because criticism is unfair. However it is true that of the trust they place in those who, by they frequently don’t know what others are The second rule concerns promises. Even for commission or omission, actually caused doing, they have no chain of information a medical charity, medical assistance is often their problems in the fi rst place. They and you sharing, they cannot leverage off each other, not the fi rst priority. Safety, water, food should be wary. As Machiavelli said “Put not cannot synergize their activities, cannot resolve and shelter are often of more immediate confl ict and often have no sustainability. importance. Therefore never make a promise your trust in princes , bureaucrats or Some of these organisations seem to defi ne unless you are certain you can deliver in a generals – they will lead ex pedience success as the ability to go from one failure reasonable time frame. To the desperate  ile spilling your blood fr om a to another with no loss of enthusiasm. safe dist ance”

Dr Carol Dundon

A Short History of Anaesthesia

In 1796, James Moore, Member of the Surgeons “Whatever removes the exhausting pains School, in the Ether Dome, Massachusetts Company, London published a small book arising from the Surgeon’s knife adds greatly General Hospital (MGH), Boston. Ether was thirty pages long entitled “A method of to the chances of the patient’s recovery. administered by a dentist – William Thomas diminishing pain in Surgery”. James Moore Strongly impressed with this belief, for many Green Morton. The date was 16th October had devised a nerve compression appara- years, I sought some method of preventing 1846. Less than four months later, the following tus. It was rather like a curved carpenter’s the pain of a surgical operation.” notice appeared in the medical press. clamp with a screw adjustment. He showed it to the renowned surgeon John Hunter of Jackson describes some of the methods used St. George’s Hospital, London who obligingly by preceding generations in attempts to produced a patient who needed a below- relieve pain. Opium was ineffi cient and PAINLESS OPERATION knee amputation. The patient had lost all dangerous because its systemic eff ects TO THE EDITORS OF THE MEDICAL PRESS. his toes and had a large ulcer on his foot. were too great before it produced any real anaesthesia. A freezing technique with GENTLEMEN – I think it right to add my On the morning of the operation, at a quarter ice could be eff ective, but could lead to testimony to that of others in favour of the to eleven, Moore began the nerve gangrene and pneumonia. Alcohol, causing inhalation of ether vapour, (when properly compression. The limb became numb after stupor, had been successful in isolated cases administered) as a preventive of pain in surgi- half an hour. At a quarter to twelve, Moore but it was not suitable for routine use. cal operations. gave the patient one grain of opium. A few Mesmerism (a form of hypnosis) sometimes minutes after twelve, the tourniquet was worked well but was unreliable. I yesterday amputated the thigh of a patient applied and Hunter performed the (by circular incision) for incurable disease amputation. Dr. Jackson’s book shows that the time of the knee-joint, who did not evince the lapse between the discovery of new agents slightest appearance of pain. It is needless for This trial was considered a success by Moore. and their use in practice is incredibly long. me to state more than the fact of its wonder- There was evidence of a most remarkable Humphrey Davy’s suggestion of nitrous ox- ful effi cacy. The vapour was administered by diminution of pain, particularly during the fi rst ide as an anaesthetic in 1800 was not used Surgeon Grattan, dentist, of this city, with an incisions through the skin and muscles, which clinically for another forty six years! Chloroform apparatus constructed by himself. I may add, are generally by far the most severe parts of was discovered in 1831 but was not used in its success astonished me, and I believe all the operation. The exact date of the trial is not practice until sixteen years later – and Ether was those gentleman present. – I remain, gentle- known, but Hunter was surgeon to St George’s the most neglected of all, known for 306 years, men, your obedient servant, Hospital from 1768 to 1793. it had to wait till the year 1846! However, when GEO. S. COTTER M.D., &c. these last three agents did fi nally make it into Cork, 56, South Mall, January 31st, 1847 “A Brief History of Anaesthesia” by Charles the unique and powerful world of anaesthesia, T. Jackson M.D. was published in Boston in they revolutionised surgical practice forever. 1861. It contained a comprehensive account of anaesthesia as it was then practiced. It is The fi rst public demonstration of the effi cacy Editor’s note: 127 pages long and at the beginning, Jackson of ether as an anaesthetic was performed by Cotter and Cork OTB - On the Ball puts forward his case: John Collins Warren, Dean of Harvard Medical

16 Mr Michael Hanna

John Woodroffe and the Cork Anatomists

History, when you least expect it, has a the giddy season of boyhood is over, when the star among the Classes at the University and at the charming ability to throw up characters. of Science has illumined the darkened chamber College of Surgeons for some years, are those who One such is John Woodroffe who established of the mind, when, by persevering study and well commenced their careers of study in this City.” Cork’s first stand-alone School of Anatomy directed application, the rudiments of the healing in 1811. A recent exhibition on Woodroffe in Art are fairly acquired, when the memory is stored This exhibition, which uncovered this the Jennings Gallery in UCC’s Health Sciences with fundamental principles of Medical science, previously unknown portrait of John Woodroffe building presented a vivid picture of his life when the soil is cultured and the seed is sown, a (courtesy of his living descendants), does much and times and included an erudite tribute warmer sun will ripen the intellectual fruits, and to bring back a tough and rather appealing by Professor John Fraher, Professor Emeritus more large opportunities and extended practice character from 150 years of relative oblivion. of Anatomy at UCC, to some famous Cork will mature judgment and teach experience— anatomists whose early years must surely have but without such preparatory acquirements been influenced by Woodroffe’s presence. The what manifold risks and dangers do you run.” trouble is that the records don’t always yield information on the first steps in a famous For nearly 20 years he had the field to himself career. and in that time a number of pupils passed through his school who went on to fame, if Woodroffe provided a thorough grounding in not fortune, in the Victorian era – artists such basic medical sciences and gave his students as Daniel Maclise, Samuel Forde, William Fisher, a zeal for study and a hunger for learning. He George Russell Dartnell, the great sculptor came to Cork in his mid 20s around the time John Hogan and surgeons and anatomists when Nelson was approaching immortality such as Joseph Maclise, Richard Butcher and at Trafalgar. Probably nobody noticed this possibly one or more of the Quains. The link young Dubliner arriving in Cork to claim his between anatomy and art is not surprising inheritance. His great, great, great grandfather for Anatomy has always been a visual science. had been Provost of Bandon in 1641 and Joseph Maclise produced some truly stunning had three sons who were granted land by images of dissections, drawn from life on Charles II, probably for losses suffered in the stone in a new process called lithography. 1641 Rebellion. John’s portion of the family inheritance was about 700 acres in East Woodroffe was not just an inspiring teacher. Carbery around the town of Ballyneen. He was a hard working surgeon in the South He joined the Military Hospital in Cork as a Infirmary – the proceeds of his public lectures junior surgeon where he was regarded by at all went to the Infirmary – and a tough least one leading Cork physician as “one of the opponent when crossed. In 1820 he fought very lowest rank”. He seems to have had two “a furious paper war” with William Bullen for things going for him – a passion for anatomy his reputation and won. In 1829 he and other and a magical way with words. medical men (for they were all men in those days) fought a campaign to combine the Before starting his school, he sought advice County Infirmary at Mallow and the North among the medical profession in Cork – mixed and South Infirmaries in Cork into one General to say the least but it was enough. In 1811, he Infirmary and lost. In the course of that leased a building in Margaret Street in the South campaign he penned this letter in defence Parish and offered a course of “Anatomical of his school: “I am well aware that to obtain a and Surgical Lectures”. He seems to have knowledge of Medicine requires years of serious been an overnight success. He welcomed all application, and if I sought by my Lectures to – aspiring art students or medical students or abridge a single day of pupilage or members of the military. He even offered his undergraduate study, I should feel myself introductory lectures to the general public, amenable to Doctor Galwey’s censures. I even “specially adapted to a female auditory”. think the prolonged period now insisted upon at In 1815, the war with France having conclud- Colleges and Universities, far too limited for the ed, a doughty reporter of the Cork Mercantile acquirement of the great mass of knowledge Chronicle dropped into Margaret Street to necessary to be obtained. I do not then pretend listen. He begins his report thus: “Criticism is to any shortcut, to any Royal road to Medical not intended to form any part of our notice of Science. Of all acquirements, Anatomy is Dr Woodroffe’s Lecture. Upon its matter it would the most essential, and to the student the be presumption in any other less acquainted with most difficult and repulsive, and if he can be the subject to offer a contending remark; and as accomplished in this necessary rudiment of to the manner, we are disposed to pass over his professional education, previous to his entering peculiarities and slight defects, and lose them in a University, the heavy obstacle to his progress the recollections of the beauty of his language, is removed, and he can at once apply himself and the irresistible truths he impresses on us.” to all the elegancies and refinements of Medical Whatever his mannerisms may have been, literature. That the Cork school is of essential John Woodroffe could inspire with words. value in this way has been acknowledge by Imagine being a 15 year old with all life ahead almost every pupil I ever had; and it is an admitted of you and hearing this? “I will admit that, when fact that the most expert Anatomists to be found 17 Dr Len Amow (A Personal View of an Aortic Dissection)

A surgical experience in Buenos Aires, During the first post surgery hours the ground. The attendant nurses and staff Argentina – while attending the International patient experienced auricular and ventricular made sure that such an event never happened Society of Orthopaedic Surgery and fibrillation requiring defibrillation. The patient’s again. From then on I had supervised physio- Traumatology. vital signs were normalised in the following therapy and occupational therapy. hours and his urine output recovered and Extracted from “Present Medical Condition” didn’t require dialysis. For 5 days a week and on Saturday morning, (Argerich Hospital, Buenos Aires, October I was at first exposed to physiotherapy 2006). The patient became hemodynamically with passive movements of the joints of my stable on the following days, showing an upper and lower limbs. Then they proceeded “Lennox Amow is a male patient born in the improvement in his language skills, despite to my trunk and neck to loosen out these joints Republic of Trinidad and Tobago. While visiting suffering from quadriparesis with muscular which had also stiffened up. In the afternoons the country for professional purposes, he hypotonia and requiring assisted ventilation. it was occupational therapy for about 2 hours. suffered syncope and was taken to Fernandez (He was believed to have Hospital, where global aphasia and right-side polyneuromyopathy of patients in critical I had noticed that I had more power in my left hemi paresis were established. By means of condition.) The patient experienced some hand as I could almost clutch all the fingers imaging studies (CAT with contrast MRI) he complications due to his condition, such as in a closed fist. My right hand was definitely was diagnosed as having DeBakey type A late pneumonia associated with ventilation weak and the IT-P, P-I-P and TIP joints were aortic dissection involving aortic arch, (NAR), bacteremia, urine infection and only half closed and the rest of my fingers ascendant-descendant aorta and the prolonged assisted ventilation, because of remained pointed out. dissection reaching up to right primitive iliac which tracheostomy was performed on artery. A brain CAT showed neither September 11. It was only when I returned to Trinidad at the hemorrhagic injuries nor early signs of end of January 2007 that I began my own ischemia. The patient was urgently taken to At present, the patient is lucid, tracheost- therapy. I started by holding onto the bed Argerich Hospital, being hypertensive on omised, without assisted ventilation and with and walking around the bed, holding arrival and having severe language disorders partially preserved verbal comprehension. onto the bed edge or rail. Then I obtained regarding production, naming, repetition He is unable to move suffering from a walking cane and started going away and comprehension as well as serious motor quadriparesis with right-sided predominance. from the bed and into the outside areas. disorders in the right half of the body. The He is undergoing motor and respiratory By then the fingers of my right hand were patient’s diagnosis was confirmed and by rehabilitation, he is under no antibiotic closing more, but not still quite enough. means of subtraction angiography it was treatment and he may be taken to a shown that the ascent aorta had been affected rehabilitation centre.” It was only on my refresher course in from its root to the infrarenal abdominal driving a vehicle and driving out on my own aorta with moderate valvular insufficiency and that I realised I could hold the steering wheel extension of dissection up to the left carotid Letter received from Dr Amow – July 2011 with my right hand and that I could make a artery and right carotid occlusion. firm fist with all the fingers on my right hand. After successful surgery, (I say this It was decided that urgent surgery was tongue in cheek), and a period of time in All this while my personal assistant was required. In such surgery the placement of Intensive Care, Intermediate Care, I was teaching me how to write again with a vascular endo-prosthesis at the root of the considered fit enough to be transferred to my right hand. ascendant aorta with valvular resuspension rehabilitation medicine at a special physio and the placement of a seond vascular and occupational centre in the vicinity of Editors note: prosthesis at the arch with closure of the false Buenos Aires. I had to travel for about 3 hours. Len - Well done and thank you - great fighting spirit. lumen at the aorta and at both carotid arteries Once there I assessed my environment. Locked were performed with the use of extracorporeal away in a private area, I thought I could circulation for 226 minutes, continuous move about just as easily as before surgery. cerebral perfusion by means of cannula insertion of both carotid arteries and controlled And so, I rolled over my body closer and hypothermia for brain protection. The patient closer to the edge of the bed. Then I put my was taken to ICU with assisted ventilation, feet over the edge and there was a crashing marked hemodynamic instability and noise when the rest of my body hit the metabolic acidosis, requiring vasopressors. floor as gravity forced me to fall to the

18 Medical Alumni Annual Scientific Conference 2011

Ten years in a functional and, while it is still early days, evidence is I planned to calculate the number of seizures beginning to gather to suggest the presence of in newborns with encephalopathy, using bowel clinic: making subtle changes in these bacterial populations continuous video EEG, and to perform MR in IBS. Are any of these findings of any clinical spectroscopy in addition to the routine MRI some sense of the significance? Firstly, we believe that there is of brain that is performed in the first two weeks the potential to develop a biomarker for IBS, of life in these newborns. MR spectroscopy complaints that just will something that has been sorely lacking and, provides data on biochemical derangement secondly, we already have evidence that within the brain. It gives an indication not go away - Professor some therapeutic agents, such as certain of the ongoing effect of seizures on the Eamonn M M Quigley probiotics, may owe their efficacy to an anti- brain, and whether or not the seizures inflammatory mechanism. Parallel studies are injurious to the developing brain. Gastrointestinal complaints that are not readily in a number of animal models attempt to Establishing if this is the case would lead to explained on the basis of a defined radiological, dissect the neuro-gastroenterolgical pathways greater emphasis on effective seizure control pathological or biochemical abnormality that may mediate the physical and biological in newborns with encephalopathy. have been conveniently lumped together as impacts of these microbiota-host interactions. “functional gastrointestinal disorders” (FGIDs) Challenges and their sufferers largely dismissed as We believe that these are exciting days in MR spectroscopy was not available in CUH, “functional”, beyond help and unworthy of what were previously neglected areas, IBS although at the time of my proposal it was serious scientific consideration. Over the past and other FGIDs, and that there is hope for envisaged that the software could be acquired ten years or more a group of clinicians and real diagnostic and therapeutic progress. quickly. However, in these difficult economic scientists at the Alimentary Pharmabiotic To get to this stage would have been times, obtaining funding for this expensive Centre (APC) in Cork have attempted to swim impossible without the hard work of the software was challenging, and the process against this tide and sought, at a clinical level, students, trainees, and research colleagues was protracted. I persisted in writing grant to provide some support for those who suffer who actually do the work, the doctors who applications for funding and negotiating with from these complaints and, at a scientific level, refer the patients, the nurses, doctors and the suppliers and my endeavours paid off, but to unravel the complex biology of the FGIDs. other health professionals who care for it took several months, and in the meantime, I While our primary focus has been on irritable them and, above all, the patients themselves decided to modify my research focus. bowel syndrome (IBS), our clinical data-base for their patience and cooperation. includes the full range of these complaints/ Modified Proposal syndromes and has been able to document Work is currently underway to identify an their impact on clinical and diagnostic services. effective anti epileptic agent for newborn Outcomes of the latter have included the seizures, which are notoriously difficult to recognition, firstly, that diagnostic algorithms control. It has long been recognised that are poorly developed for these disorders Baby Steps: Towards a clinically evident seizures evolve in severity and, secondly, and as a consequence, that Better Understanding of over time in newborns with HIE. Seizures have some of these patients are overexposed to been described as beginning at about 24 hours radiation emanating from diagnostic studies. Neonatal Brain Injury of age, and reaching a peak before declining in severity and ceasing by about 72 hours of IBS-type symptoms are not only common but - Dr Niamh Lynch age. However, it is now realised that clinically also non-specific and one of the challenges evident seizures are only the tip of the iceberg faced by gastroenterologists on a daily basis - Professor Denis O’Sullivan in terms of true seizure burden in newborns is to attempt to interpret the significance of with encephalopathy. This is because many these symptoms when they occur in a patient Fellow (2010 - 2011) seizures in newborns are very subtle, or with a known “organic” disorder such as coeliac Neonatal Encephalopathy subclinical. The only way to truly measure disease or inflammatory bowel disease (IBD); The area of neonatal neurology is challenging the seizure burden in this population is by our own research would suggest that such and rewarding, particularly when one continuous long term video EEG monitoring. symptoms in these contexts should always remembers that an effective neuroprotective be regarded as indicative of ongoing activity intervention following neonatal brain injury Recently, a new intervention called therapeutic of the primary disease process, until proven may result in 60 to 70 years or more of improved hypothermia, or ‘cooling’, has been shown to be otherwise. Such observations, suggesting that quality of life following that intervention. effective in improving outcome in newborns inflammatory processes can produce IBS-type Premature and full term infants are with HIE. The reason for its effectiveness symptoms led to the elaboration of a research vulnerable to brain injury. The focus of my is not entirely clear, but it may be partly due question that we have been pursuing in the work was to examine the population of to reduction of seizure burden. However, clinic and in the laboratory for the past several infants with neonatal encephalopathy. it is only possible to ascertain this if we truly years: could a low grade of inflammation or Encephalopathy can develop in the context understand how seizures evolve in newborns immune activation (and much lower than of infection, neonatal stroke, or hypoxic who have not been cooled. would qualify as IBD) be operative in IBS, in ischemic encephalopathy (HIE). Hypoxic general? ischemic brain injury affects 3-5 infants per Benefits 1000 live births. Of these, 0.5-1 per 1000 infants Analysing the evolution of seizures over time in What we have found is that this is indeed the develop symptoms of moderate to severe HIE. newborns with HIE has three potential benefits. case; not only are immunological changes It may identify a therapeutic window detectable in the mucosa in IBS, but “spill over” Denis O’Sullivan Fellowship Proposal during which intervention would have an into the systemic circulation is also evident My original proposal for the Denis O’Sullivan optimal impact on reduction of seizure burden. through the detection of pro-inflammatory fellowship aimed to address the question of It would allow us to avoid incorrectly cytokines in serum. The obvious question then whether a high number of seizures (seizure attributing efficacy to new interventions in arises: what is driving this immune response? burden) contributed further to brain injury the case where the intervention took place The gut flora (microbiota) is a prime suspect in newborns with neonatal encephalopathy. at a time when seizure burden may begin

19 to decrease regardless of therapy. Finally, I would like to thank my team mates and when he recognised that the coordinated it provides a benchmark against which we fellow researches, Dr Evonne Low, Dr Brian physiological reactions maintaining these can assess the effect of new and innovative Walsh and Dr Irina Korotchikova. steady states in the body are complex and forms of neuroprotection and anti-epileptic Special thanks to Dr Vicki Livingstone and Dr peculiar to living organisms. He designated medication on evolution of seizure burden Nathan Stevenson who were instrumental in the underlying mechanisms as the process in newborns with HIE. In particular, we would helping me bring this study to completion. of homeostasis. The principle of homeostatic like to assess the impact of therapeutic Finally, thank you to Professor Denis O’Sullivan, equilibrium has underpinned biological hypothermia on the evolution of seizure and his colleagues who set up the Denis theory and grounded medical advances in the burden. O’Sullivan Fellowship and UCC Alumni who twentieth century. An eminently successful funded the Denis O’Sullivan Fellowship. theory in biology easily generalised to Methods adjacent disciplines such as psychology and The Neonatal Brain Research Group is uniquely ethology, so that homeostasis was understood placed to ascertain whether there is evolution as the goal of all animal behaviour. Put in of seizure burden over time as we have EEG another way, the homeostatic proposition data on over 300 infants, born between suggested that the most important fact 2003 and 2011, who have exhibited signs Sociology of Health in about living things is that they remain alive. of neonatal encephalopathy or seizures. Contemporary health practitioners still rely From this extensive database we identified Childhood - Professor Peter on the principle of homeostasis because it infants from the period prior to the J. Kearney enables them to interpret various laboratory introduction of therapeutic hypothermia tests. Deviations from established biochemical (2003-2006) with HIE and seizures who had Sociology has a reputation of being an norms are then a failure of homeostasis a minimum of 48 hours of continuous video eccentric discipline that harbours intellectual indicating some kind of malfunction. EEG monitoring. We then analysed the malcontents. The malcontent is probably The result of the homeostatic inquiry is a evolution of seizure burden over time more in society than the discipline. Sociology dichotomy – it is either normal or abnormal. and calculated the distribution of seizure is interesting because it explores how we Homeostasis is the principal that underpins burden using the skewness coefficient. relate to ourselves and the world and how the pathogenic mode of assessment. the world relates to us. It explores what we The pathogenic paradigm dominates clinical Results normally take for granted. The discipline practice and health research in the first world. 15 infants were eligible for this study. The of Sociology became necessary when the The paradigm worked for scientific medicine, results showed that seizure burden evolved grand narratives of religion and politics but leaves a sense of disappointment when over time and that seizures were not evenly lost their purchase in the Western world. applied to research about quality of life. distributed over the seizure period. Seizure Christendom was challenged by violent burden was positively skewed, meaning revolutions and the discovery of alternative Pathogenesis and Salutogenesis that there was an accumulation of seizure ways of living in the new world. The sociology In the Faculty of Medicine, the problems of burden near the beginning of the seizure of health explores how society impacts on pathogenic disease are solved in an orderly period. Further statistical analysis showed a our health, and the place of health in the way through eliciting symptoms and signs, short period of high seizure burden followed political agenda. Sociology is important in interpreting these with the aid of biological by a longer period of lower seizure burden. the Faculty of Medicine and perhaps most samples and images, arriving at a diagnosis so at the extremes of life in Paediatrics and prescribing appropriate therapies. Conclusions and Geriatrics. It is a reactive process that combats pathogens. This study has successfully identified a Reliance on pathology has been very pattern of temporal evolution of seizure Social Wellbeing, Equlibrium and Homeostasis successful in solving problems of ill health, but burden in newborn infants with HIE. There Social wellbeing is part of the WHO definition does not work well when researching quality is a short period of high seizure burden, of health and is written into the WHO of life. Salutogenesis is an alternative way of followed by a longer period of lower seizure constitution. Most definitions of health conceptualising health and was first described burden. This is the first time that this has been require a harmony or a sense of equilibrium as by Antonovsky. Aaron Antonovsky (1922- described, and provides important information expressed by H.G. Gadamer, the German 1994) was an American medical sociologist that will help guide the development and philosopher who stated that “the doctor’s who spent most of his academic life in Israel. understanding of new forms of treatment and contribution consummates itself by He introduced the concept of salutogenesis, neuroprotection in this fragile population. disappearing as soon as the equilibrium of because he found that some female survivors health is restored”. In the early seventies there of the holocaust could still enjoy life to the Acknowledgements was a minor revolution in paediatrics when full. He conceived salutogenesis as a proac- I would like to thank Dr Brendan Murphy there was evidence that childhood cancer tive process of meaningful engagement with and Professor Geraldine Boylan for their and leukaemia could be cured. It came at a the world, which promoted a holistic sense support and guidance during my year cost as it often disrupted whole families and of coherence even in the face of unspeakable as Denis O’ Sullivan Fellow. I am grateful to the their quality of life. This was an era prior to suffering. He noted that disease and stress are infants and their parents who have over the portacaths and effective antiemetics. Harsh so ubiquitous that a risk free ideal of health years agreed to take part in the research studies treatments were justified by the real prospect was a hopeless ambition. His key insight was conducted by the Neonatal Brain Research of a cure. Quality of life was initially measured that the causes of health are independent Group. by side effects of treatment, and then by of and separate from the causes of disease. questionnaires that were deemed valid and Pathology and its classifications depend on the Thanks also to the Children’s Medical and reliable through repeated testing. principle of homeostasis, so that the existence Research Foundation in Crumlin and the Irish The emphasis was on methodology rather of pathology can be defined in terms of Institute of Clinical Neurosciences for the grants than theory but the results were unconvincing. deviation from the norm when the self which facilitated the purchase of MRS software. Gadamer’s concept of equilibrium is the nearest correcting constancy of the milieu intérieur Many thanks to the Baby Ava Foundation and theory we have to quality of life. Equilibrium cannot be maintained. Pathology is a failure their generous donation towards the purchase links to Claude Bernard’s description of the of homeostasis. Antonovsky understood that of the MRS software. body’s constant internal environment, which there was more to life than biological he called the milieu intérieur. Walter Cannon equilibrium. further developed the concept in 1929,

20 Health as a Continuous Variable task in hand that blinkers self awareness. The pathogenic mode of thought is to Life repeatedly throws up challenges that can dichotomise. It is divisive in the social domain be interpreted as an opportunity or a threat. and causes trouble. The doctor’s note has to A strong sense of coherence tilts engagement declare that the worker is either sick or healthy. with the challenge towards an opportunity The salutogenic perspective is holistic. It sees for flow, whilst experiences of flow in turn MPS - Medical Protection health as a continuous variable that vacillates strengthen a sense of coherence – a virtuous between health-ease and dis-ease. Health is circle. Flow is a sense of mastery when Society - Dr Mary Favier not one or the other. It is more like the Irish word challenges are overcome despite stretching As a board member of the Medical Protection cuibheasach, that implies so-so, or somewhere participants to the limits of their capability. Society for the last six years I have been in between complete health and fatally ill. There Lutz envisages flow on a vertical axis and time privileged to gain an insight in to the area is a modicum of health present even when one on a horizontal axis as repeated experiences of medical indemnity both in Ireland and is at death’s door. Salutogenesis is founded on of flow graph a personal sense of coherence. worldwide. MPS is a not-for-profit mutual the principle of heterostasis that seeks optimal A sense of coherence then is both a product owned by the membership, and as the largest experiences which promote joie de vivre. and a resource for meeting challenges. Lutz’s Irish and international provider of indemnity It is an exuberance rather than an equilibrium. proposal to integrate flow and a sense of cover, it has a wealth of experience in dealing A heterostatic understanding of health is coherence resolves the issue into a reciprocal with litigation and complaints against therefore not an ideal, unlike the ideal norms of relationship. A strong sense of coherence doctors and dentists. The board of MPS homeostasis, which apply to basic physiology. enables flow experiences in the future. Flow oversees all of the company’s operations Antonovsky placed salutogenesis under the may happen spontaneously, but it is much and exercises discretion so to offer the best second law of thermodynamics – the idea of more likely that it will happen in a structured protection and support to both individual entropic doom – disruption and dissolution activity. The etymology of flow comes from doctors and the membership in general. are our fate; but a salutogenic approach the German meaning flood and suggests to life counters entropy and directs us towards an abundant supply. The experience is often The MPS issue I am most commonly asked order rather than disorder. It accepts that referred to as a natural high and athletes refer about is ‘how not to get sued?’ MPS continually there are risk factors whether lifestyle or to it as being in the zone. Flow is a pleasant examines how and why doctors get sued and pathogens, which have to be encountered; state of reduced self awareness to the point aims through its educational programmes to but in salutogenesis the focus is on resources of self forgetfulness. Flow can be an individual address the important issues. In a nutshell that tilt the vacillating continuum of health experience but research has suggested that it prevention is about maintaining good towards quality of life. The problems of is more satisfying when experienced as a social communication with patients, addressing suffering and stress are omnipresent, but in a event. According to Csikszentmihalyi flow is mistakes when they occur and documenting salutogenic frame, they are challenges to be an experience of timeless self forgetfulness, the high standard of practice that is so often overcome. The salutogenic frame prompts associated with total involvement and fo- delivered but not recorded. As a general rule, a response that strengthens rather than cussed attention on the task in hand which doctors who keep themselves up to date weakens the affected. There are situations demands a balanced challenge-skill load. with developments in their field, are open to when a pathogenic response is appropriate but There is anxiety if the challenge is too great comparison with colleagues and encourage it is subordinate to and part of salutogenesis. and boredom when the challenge is trivial. their own work to be audited, are substantially His research identified flow in both work and less likely to be sued than those who don’t. Sense of Coherence recreation and gave examples of surgeons Open, honest communication with patients Professor Antonovsky did not dismiss the accomplishing difficult operations, Roger that doesn’t disappear when an adverse event effects of pathogenesis and the consequent Federer playing in Wimbledon and rock occurs is fundamental to litigation prevention. need for the correction of deficits and the climbers on the North face of the Eiger. Acknowledging mistakes or standards that treatments of dis-ease; but suggested that were not met and making a commitment to a it was more important for social life to seek Barretstown patient and their family that every effort will be health-ease through a meaningful appraisal The lifestyle behaviour of adult survivors of made to prevent it happening to somebody of present circumstances that could lead to childhood cancer has been found to be more else, is very much part of why some doctors a better understanding and management of conservative than their peers. They smoke and services do not get sued when comparable problems. He suggested that the intertwining and drink less. They have less risk taking ones do. However sometimes medical errors of comprehensibility, meaningfulness and behaviour, marriage and employment even occur in circumstances where there is no manageability can lead to a sense of coherence though their education is on par with their putting it right. Whatever the cause, MPS offers that orientates engagement with life. The peers. At first glance the lifestyle of survivors ongoing professional medico-legal support process of understanding the situation and appears to be good and healthy, but most to individual doctors and dentists. This is accepting challenges as meaningful could observers think that it represents non professional support that is available even if it is prompt active management of resources. participation in normal risk behaviour – a many, many years after the event. A reassurance Antonovsky described generalised resistance type of self imposed social exclusion. Children we all need but hope never to have to avail of. resources that embrace personal, social and attending the leukaemia clinic at the Mercy cultural factors to enhance the development University Hospital appeared changed after of a sense of coherence in a lifetime. Our sense ten days in Barretstown. The change was of coherence uses our resources to visible to parents, Paediatric Oncology Nurses overcome life’s challenges. and Paediatricians. Interviews with alumni of holiday camps for seriously ill children Flow (Barretstown and the Painted Turtle) suggest A sense of coherence is the key concept of that participation in these camps is a salutogenesis. Csikszentmihalyi’s concept salutogenic experience that may reverse of flow may assist elaboration of a sense of the social exclusion of chronic severe coherence. Lutz suggests that flow and a sense childhood illnesses. of coherence are different dimensions of the same phenomenon. Both flow and a sense of coherence are matters of focused attention – a tunnel vision of engagement with the

21 UCC Medical Research Centres

Alumni support for medical research enables ongoing investigation and discovery.

Alimentary Pharmabiotic Centre (APC) are two very signifi cant industry partners involved in the APC research programme – Established 2003 - Professor Fergus Shanahan Alimentary Health Ltd., an Irish biotech www.ucc.ie/research/apc company, and GlaxoSmithKline, a With a cohort of range of infl ammatory, infectious and other multinational pharmaceutical company, both 120 microbiologists, disorders within and beyond the gut, as well of which collaborate in a very signifi cant immunologists as to health maintenance. In addition, the way, including having staff embedded in food scientists, intestinal microbiota represents a rich the APC research teams. Among the key gastroenterologists, repository of biologically active material from achievements of the APC are the licensing psychiatrists and which bioactives can be mined for novel of Thuricin CD, a novel naturally occurring pharmacologists, drug discovery or for use as functional food antibiotic, to Irish biotechnology company the Alimentary ingredients. Alimentary Health Ltd and the launch of Pharmabiotic Centre Align® (bifantis) in the USA. This year Pro- (APC) has a University College Cork is ranked number fessor Shanahan was invited to deliver the unique blend 2 in the global Thomson Reuters Science AGA distinguished Mort Grossman lecture. of clinicians, clinician-scientists and Watch for probiotics research, primarily due to basic scientists working together to publications from researchers in the APC. The “The Alimentary Pharmabiotic Centre (APC) is understand the complex environment of APC aims to deliver innovative research that about people. It is about shared minds, shared the gastrointestinal tract and its microbial establishes Ireland as a centre of excellence resources and multidisciplinary teams. It is community. Six research themes are led in GI health, to help the development of about the creation of an environment conducive by 22 Principal Investigators, internationally indigenous industry and to attract to learning, research and innovation. The APC recognised in their areas of expertise, who multi-national companies to Ireland to instigate is also keen to embrace potential new industry create an exceptional collaborative working collaborative research programmes. The collaborators, where research synergies and environment. APC postgraduate and work of the APC is of tangible importance to complementary strengths exist, and sees this postdoctoral training is also central to the several industries, including human health as a means to develop Ireland’s industrial R&D development of the scientifi c leaders of maintenance, agriculture, and animal base. The APC aspires to being an agent of tomorrow. The scope of the research on husbandry, and is pitched at the interface of change and a contributor to the development host-microbe interactions has relevance to a the food and pharmaceutical sectors. There of a knowledge-based economy in Ireland”

Cork Cancer Research Centre (CCRC) College, UCLA, Brigham and Women’s Hospital Boston and Harvard Medical School and the Established 1999 - Professor Gerald O’Sullivan Marsden Clinic London. The research work www.ccrc.ie carried out at the Centre has already translated into fi ve unique clinical studies with three Cork Cancer • Cell Death and Survival Mechanisms and further trials due to commence this year. Research their role in Cancer Drug Resistance From our modest beginnings with Centre • Development of Novel Therapeutics and only two employees, the Centre has (CCRC) is a related Delivery Devices rapidly expanded in both size and signifi cance, multi- • Immuno-gene Therapy of Cancer – approaching while still remembering the central tenet of disciplinary clinical application our task: “To advance new cancer treatments organisation • Oncolytic Viral Therapy of Cancer particularly through research”. CCRC staff are located in that investigates involving Head and Neck and Lung laboratories and offi ces at the Mercy University major issues – Clinical Trial Stage Hospital, Cork University Hospital and the concerning • Leukaemia – Treatment Resistance Leslie C. Quick Jr. Laboratory, Biosciences the genesis, progression and ultimately the – Mechanism and Therapeutic Targeting Institute, UCC. Funds for the Centre are treatment of cancer. Founded twelve years Critical to the success of CCRC is the depth and generated through research grants, voluntary ago it is a partnership between the relevance of the research, the strength of our fundraising eff orts and private donations. University and the Teaching Hospitals that doctorate programmes for basic science and provides a research continuum from labo- clinical graduate students, together with the “While we are very successful in securing ratory studies through to clinical investi- engagement of collaborating clinical investi- competitive grant funding our work is heavily gation and application. Our research en- gators at multiple teaching hospitals in Ireland dependent on voluntary support from deavours extend from discovery science and abroad including; Beaumont Hospital, charitable and philanthropic sources and through to design of new treatments and to St. Vincent’s University Hospital, Mercy directly from the public. We cannot continue clinical delivery, where we study treatment University Hospital, Cork University Hospital, this work without external support. This year effi cacy and mechanism. Our eff orts are University College Cork, Uni- after his visit to our laboratory, Nobel Laureate predominantly directed towards control versity College Dublin, National Dr. James Watson himself made a personal of incurable cancer. We are very gratifi ed University of Ireland Galway, Royal College of donation to our research. It is humbling by the progress that has been made in the Surgeons in Ireland, Trinity College Dublin, and motivating to think someone of his Centre and are very optimistic about some Queens University Belfast, Tyndall Institute, calibre recognises the contribution that we of the current programmes which include: New York University, Weill Cornell Medical are making from our Centre here in Cork.”

22 Centre for Research in Vascular Biology (CRVB) The CRVB basic research lab at UCC develops bench concepts for clinical translation and Established 2005 - Professor Noel Caplice www.crvb.eu has generated multiple patent fi lings and At the Centre The state-of-the-art Centre was established invention disclosures over the past 5 years. for Research with the assistance of more than €15 million Novel devices in stenting and tissue re- in Vascular in international peer-reviewed funding. pair have been developed and novel small Biology (CRVB) molecule and protein approaches to myo- A recent extramural review of the lab by leading a multi-disci- cardial infarct repair have been translated world experts in cardiovascular stem cell plinary team from proof of concept to commencement research placed the CRVB amongst a handful of 20 basic of clinical trials at Cork University Hospital. of comparable centres with the capability scientists, to translate on site from bench to bedside animal “We look forward to building on our fi rst 5 years novel concepts in vascular progenitor biology. physiologists of success at UCC and hope to consolidate over Researchers at the Centre have been awarded and clinical researchers address fundamental the next 5 years these gains integrating more Young Investigator Awards at the Irish Cardiac questions in vascular stem cell biology, eff ectively with our local clinical colleagues and Society and the American College of atherosclerosis and vascular remodelling. with national and international translational Cardiology meetings. The Centre has also Emphasis is placed on the translation trends in convergence device and small molecule published a large number of papers in of ideas to the clinical cardiovascular technology development in the cardiovascular prestigious journals including Circulation, space in areas of novel diagnostics fi eld.” Circulation Research, ATVB, JACC and and therapeutics in the fi eld of vascular FASEB journal. biology, stem cells, and tissue engineering. National Perinatal Epidemiology Centre (NPEC) Additionally, the Centre is collaborating with the Self-Employed Community Midwives to Established 2007 - Professor Richard Greene develop a perinatal surveillance system for www.ucc.ie/en/ npec impacts of maternal experiences on perinatal home birth deliveries. Furthermore, the NPEC The National (pertaining to the period immediately holds the license for access to the Vermont Perinatal before and after birth) health outcomes; Oxford Network in Ireland, a collaboration Epidemiology as well as formulating and implementing of healthcare professionals dedicated to Centre (NPEC) is systems for the reporting of all perinatal improving the medical care of new-born based in Cork mortalities and maternal morbidities infants.The NPEC is committed to expanding University Mate- occurring in Ireland’s 20 maternity units. expertise in perinatal health, and is therefore rnity Hospital and hosting two Health Research Board PhD To date, the NPEC has set up three special- is under the scholars in Health Services Research. Through ist groups in order to examine, on a national directorship of Prof. appropriate training and supervision, the NPEC basis, specifi c subjects in fi ne detail. These Richard A. Greene. hopes to secure high-calibre research in include the Perinatal Mortality Group, which Established in maternal and child health. 2007 and funded collects and reports information on all babies by the HSE, its overall objective is to translate greater than 500g delivering without life, “Each year, an estimated 70,000 women give outcome data from Irish maternity hospitals and and any live born baby dying within 28 birth in Ireland. Funding is vital in order that the evidence-based best practice into improved days after delivery. The Maternal Morbidity NPEC can proceed with its mission to improve the clinical services for Irish mothers and babies. Group looks at cases of severe maternal health and well-being of all Irish mothers and morbidity; and the NPEC Advisory Group babies, by translating epidemiological data and Currently, the staff at the NPEC are working advises and supports the NPEC in the testing new treatments to enable well-informed on projects concerning maternal morbidity; achievement of its defi ned mission and decisions about reproduction and perinatal neonatal morbidity and survival; and the objectives. health.” Neonatal Brain Research Group (NBRG) Also in development is a web based tool for remote diagnosis so that the physiological data Established 2003 - Professor Geraldine Boylan from new-born babies can be sent to the expert www.ucc.ie/en/neonatalbrain Seizures in new-born babies, commonly for interpretation regardless of their location. The Neonatal caused by problems such as lack of oxygen, The group are also integrating this technology Brain haemorrhage, meningitis, infection and into mobile phone applications. The NBRG is Research strokes, are often missed because babies currently co-directing the NEMO study, the Group (NBRG) do not always exhibit obvious clinical signs largest multicentre European clinical trial of at University during seizures. The neonatal brain is neonatal seizures and their treatment which is College Cork particularly vulnerable to seizures which funded by the European Union under the FP7 and Cork can lead to life-long neuro-developmental programme (http://www.nemo-europe.com). University defi cits. The best tool for diagnosing seizures is “Seizures are the most common neurological Maternity the electroencephalogram (EEG), a test which problem in new-born babies worldwide and Hospital in uses electrodes placed on the surface of the are a very worrying sign for parents and Ireland aims to improve the long term scalp to measure the electrical activity of the clinicians. Urgent diagnosis and treatment health outcomes of new-born babies through brain. Neonatal EEG provides a sensitive, real is essential to prevent lifelong neurological early and accurate detection of neurological time, continuous measure of brain function. problems. Our research is vital in helping us problems. Established in 2003, the NBRG is led EEG recordings must be interpreted by understand the new-born brain and to recog- by neurophysiologist Professor Geraldine neurophysiologists who are expert in nise problems early so that appropriate Boylan and includes scientists, clinicians, neonatal EEG analysis. A worldwide shortage treatments can be instigated quickly. As nurses, computer scientists and engineers. of this expertise currently exists. Through babies can be born at any time of day or night we The group works to develop technology research the NBRG has patented an automated strive to maintain a 24/7 rota so that a member of that will have a very direct and tangible seizure detection algorithm and aims to staff can always be available to monitor new-born impact on the diagnosis and treatment of integrate this algorithm into common neonatal babies at Cork University Maternity Hospital. We ur- new-born babies suff ering from neonatal cot side monitors so that problems in new-borns gently need your help to raise funds to provide this seizures and other neurological conditions. can be detected as soon as possible. service and the necessary monitoring equipment.” 23 on, or level with the window fitting and the game from New York, where he was advanc- Appreciations remaining shards of glass. ing his medical studies at the time. He scored two second-half points that were to turn the Mr John Blake (1932-2011) He wrote a definitive paper “Road Blindness” classic game against Dublin in Kerry’s favour. John Blake, who died recently, was one of on the subject which was published in the the most brilliant medical professionals of British Medical Journal in 1983 and lobbied He also held three national league medals, our time and someone who, through tireless extensively to change the law. The Irish three inter-varsity Sigerson Cup medals, two campaigning, saved the sight of many road government eventually relented. with UCC and one with UCD, and was named crash survivors. He was, for many years, on the Sigerson Cup Team of the Century. one of Ireland’s most eminent consultant Prior to 1986, more than a hundred eye ophthalmic surgeons. perforations from road traffic accidents were seen every year. Nowadays, with many His brother Michael, also a doctor, who died His campaigning for the outlawing more accidents, that figure has fallen to in London last December aged 79, captained of toughened glass in car windscreens about three per year. the Kerry minor team to All-Ireland success in Ireland in the Eighties led to a dramatic in 1950 and won a Sigerson Cup medal in decrease in eye perforations. He was President of the Irish Ophthalmological 1952 and an All-Ireland senior medal in 1953. Society when it amalgamated with the Faculty Along with their brother Jerry, the Brosnans John Blake, who was described as “one of the of Ophthalmology to form the Irish College were the backbone of the Moyvane team. true scholars and gentlemen of Irish medicine” of Ophthalmologists and was at the forefront by Professor Barry O’Donnell in his book on the of diplomacy in those negotiations. Their father, the legendary Con Brosnan, was Royal College of Surgeons in Ireland, was born an outstanding footballer with six senior in Cork in 1932 into a medical family. His father, John Blake was everything you wanted in All-Ireland medals to his name between 1923 a GP, died when John was 11 and the family a consultant surgeon: extremely well read, and 1932. Significantly, although an officer struggled financially for some time. With money professional, courteous and competent at in the Free State Army, he co-operated with in short supply, only a scholarship could ensure nearly everything he turned his hand to. former internee Joe Barrett, regarded as Kerry’s his third level education and this proved to be He worked tirelessly, loved helping patients greatest full-back, in ironing out simmering no difficulty to the dedicated student. and they loved him. Always helpful to his colleagues, his opinion was highly respected Civil War animosities in the county. Educated at Presentation Brothers College by them. Privately, he was a warm and devoted in Cork, he attained first place in Ireland in family man He loved the company of Having blended rival factions from both sides Mathematics in the Leaving Certificate and others but family always took priority. of the political spectrum into a united and won a scholarship to UCC’s medical school. It isn’t any great surprise that all five Blake winning Kerry team, Barrett ceded his He also won the Cork Corporation scholarship, children should join the medical profession. captaincy to Brosnan in 1931, leading the Honan scholarship and later the Ainsworth to a life-long friendship. scholarship for young surgeons. A member of Elm Park and Woodenbridge Golf Clubs and Donnybrook and Fitzwilliam Tennis Making the virtually unheard of move While studying in UCC, John met Eithne Power Clubs, John’s other passions were architecture from Moyvane to Dingle, Dr Jim, as he was from Kiltealy in Co Wexford. Eithne was every and opera. He was a regular on the golf course known locally, served as a GP in the west bit a match for him as she also topped her on a Sunday morning with his friend and Kerry Gaeltacht where football is called class in medicine in the year behind him. colleague Joe Walsh, and it was the routine “caid” and he became a fluent Irish speaker. They were in their 52nd year of a very happy games of tennis that kept him fit into his later marriage when John died on January 9. years. A man who spoke his mind, he could be direct, even brusque, but is remembered John did his ophthalmology training in He suffered Alzheimer’s towards the end of by former patients as an excellent and much Nottingham Eye & Ear Hospital, studied in his life, but was supported greatly by his loved doctor. He also served as medical officer the Royal Eye Hospital and later worked in family and friends. Moorfields Eye Hospital in London. at St Elisabeth’s Hospital. John Blake is survived by his wife Eithne, Returning to Dublin, he succeeded Professor children Alison, Richard, Patricia, Michael and A story that he liked to tell, with a touch of Lavery in Our Lady’s Hospital for Sick Children Gavin and his brother Tom, as well as Gaeltacht humour, involves an elderly patient in Crumlin and the Royal Victoria Eye and Ear 14 grandchildren. who brought him two forms to sign: one was Hospital where he would later become RE an eyesight certificate for renewal of his driving chairman of the medical board. In 1971 he licence and the other was for the blind joined the staff of St Vincent’s hospital, at the Dr Jim Brosnan (1930-2011) pension. He never divulged the outcome. time the hospital moved to Elm Park Dr Jim Brosnan, who has died aged 81, played in Donnybrook. Gaelic football with Kerry, a county where After retiring as a player, Dr Jim became While working as an eye surgeon in the UK players are measured in terms of All-Ireland chairman of the county board and proved and Ireland, he was disturbed at the number medals. By that exacting yardstick, he was a superb administrator. He played a pivotal of serious eye injuries arising from sometimes revered for his immense contribution to role in creating a county league system for minor car accidents compared with the US the game both on and off the playing field. the Kerry clubs, giving the players a chance and Canada. Laminated glass was used in to play football throughout the year. American cars whereas Europe continued to In the annals of Kerry football, the Brosnans of use toughened glass that shattered on impact. Moyvane, at the northern end of the county, The envy of other counties, it has been a were a family to be reckoned with, and he cornerstone of Kerry’s development as the John continued to research this problem and was a powerful, direct and fearless player. Built most successful football county in the pointed out to the Irish government that like a tank, men hopped off him on the field. history of the GAA. the natural progression of a sudden impact virtually assured that the head of a front-seat The holder of two All-Ireland senior medals with He also coached All-Ireland-winning Kerry car passenger would hit the windscreen, Kerry, he won the first in 1953 and the second minor teams in 1962 and 1963 and was smash through it and end up with their eyes in 1955 when he was flown home for the instrumental in setting up Bord na nÓg

24 to bring players at a young age into the world. We met twice a year in Cork for many included coach Ronnie Dawson, Dave county setting. He was also involved in the years. John was responsible for setting up CME’s O’Leary and Noel Henderson. He served as development of Austin Stack Park in Tralee. with the help of his UCC counterparts. He also president of the UCC club from 1975 to 1977. was instrumental in raising money to begin In the mid-1970s he became involved in A man before his time, he believed players the Denis O’Sullivan Fellowship, a successful medical politics. In 1976 he was a member were paramount to the success of the GAA program to help those doing research in a of an Irish Medical Association delegation and saw to it that their interests should not be scientific program. John had a great admiration to China, and he was elected president neglected. Aptly, some of the greatest players for his fellow classmates. He was the glue of the Association in 1977. of all time, among them Kerry’s Mick O’Connell that kept them all together for all those and Seán O’Neill of Down, attended his funeral. years after graduation, right up to his death. Elected to the Medical Council in 1979,

he was vice-chairman from 1984 to John is survived by his wife, Betty, and their three Having served the people of the Corcha 1989 during which time he also served children. Myla, born at the Bon Secour Hospital, Dhuibhne peninsula as a doctor for more than as chairman of the ethics council. Cork, Ian and David and seven grandchildren. 40 years, he retired at the age of 75 in 2005. BOD A member of the Cork and Waterville golf He is survived by his wife Kitty, their sons clubs, he had a wide range of friends and Dr Derry Gleeson (1922-2011) Conor, Barry and Seán and his brother Jerry. enjoyed a nightly pint in his local hostelry. Derry Gleeson, who has died aged 88, was a past president of the Irish Medical Association, Predeceased by his wife Margaret Dr John Danis (1930-2010) a former vice-chairman of the Irish Medical (née O’Gorman) in 2004, he is survived Dr. John Danis (M.B. 1962) was well known Council and an Ireland and Munster rugby by his sons Dermot, John and Colin for his contributions to UCC and especially selector. and daughter Fiona. All three sons to the Medical College. Because of this, followed him into the medical profession. he was well known and loved by the Born in 1922 in Nenagh, Co Tipperary, he administration, teachers and fellow was the son of Jeremiah Gleeson and his Mr John Kenefick (1937-2011) students. wife Mary (née Murphy). His father was a John was born on 10th February 1937 and local government inspector and was John was born September 17, 1930 in Chelsea, died on 14th September 2011 in Great Billing, subsequently posted to Kilkenny and Massachusetts, a suburb of Boston. He Northamptonshire. Clonmel. entered Brandeis University in 1950 where he He was educated in Presentation Brothers earned his B.S. degree. After graduation he When he was nine, the family moved to College and University College Cork entered the United States Army. In 1957 John Cork. He attended Presentation College, where he qualified in medicine in 1960. entered Medical School at UCC. He knew making the senior cup team and matriculating little about Ireland at that time, but took the in his final year. The latter was a remarkable He did his intern year in the Mercy Hospital opportunity to come to Cork to begin his achievement as he was only 15 at the time. and worked under Mr. John Kelly, Mr. John medical career. He went back home in 1959 Kiely and Mr. Kevin Kearney. They were to marry his sweetheart, Betty, and they both He entered University College Cork medical excellent surgeons and soon stimulated sailed for Cork. They lived in Bishopstown until school without sitting the Leaving Certificate. John to take up a surgical career. John’s graduation in 1962. Their door was There he was President of the students’ council and active in the medical society and rugby He then went to London to work at the age never locked and their home was often visited of 25. He worked as an SHO first in the North by fellow students and many Corkonians. club. Middlesex Hospital for 3 years under Mr. Following his graduation in 1962, John returned He played for Munster against an Army XV Tom Henerby. John thought an awful lot of to the Boston area to begin his residency in during the Emergency. Mr. Henerby who was a general surgeon in the wonderful North Middlesex Hospital. Family Practice. In 1964 John opened his Graduating in 1944, he became an intern at He learned a lot of general surgery practice of family medicine which continued Sheffield Royal Infirmary and gained further from him. Mr. Henerby was Irish and until his retirement. John was also active at hospital experience in the area in preparation originally came from Waterford. his hospital where he was Chief of Staff and for a career in general practice. He returned to head of the Department of Family Practice. Ireland to take up an appointment as a senior Next he got a job in the Royal Free Hospital John was very active in Continuing Medical house officer in obstetrics at the National as a Registrar and Senior Registrar and Education in both Cork and North America. Maternity Hospital, during which time he became a Consultant in Barnet General John and Betty’s house was always open to played rugby with Clontarf FC. Hospital in North London in 1974. He also had rooms in Harley Street. He was lucky to visitors and if you were from Cork, you were Following locum and public health build up a very good practice in both places well received. For several years medical appointments in Ennis, Co Clare, he was until he was taken ill in 1994. students would spend their summers with appointed dispensary doctor in Labesheeda, John and Betty while they did externships Kildysart, Co Clare, in 1952. He played Gaelic To sum up his career in London I think I will that John had arranged for them at Boston football with the local club. In 1955, he was read a letter which I got from Lionel Gracey area hospitals. appointed dispensary doctor in Ballylinan, who was John’s Chief in the Royal Free Hospital. John always had a deep desire to give Co Laois, and played rugby with Athy FC. He, like Mr. Henerby, was a wonderful surgeon and teacher of whom John thought the world. something back to UCC for giving him the In 1958, he returned to Cork as dispensary quality education he received, John initiated doctor in the Grattan Street area. He also Mr. Gracie said that Johnny came to us at the the development of the Medical School opened surgeries in St Mary’s Road and Royal Free Hospital in London, first as a Registrar Alumni, along with North American physicians Bishopstown. On his return to Cork he and then as our Senior Registrar in Surgery. who graduated from UCC. “Friends of UCC” joined UCC rugby club and was coach/ From the start it was clear that he possessed was formed for the purpose of raising funds for selector of the first and second teams. He an exceptional surgical talent. This was based the Medical School and to begin a Continuing was a Munster selector for most of the 1960s, not only on his surgical, diagnostic and Medical Education program. The core group when his fellow selectors included Paddy technical skills but also on his warm humanity besides John was Dr. Charles O’Connell, O’Callaghan, Jim Kiernan and Tom Clifford. and rock like integrity. This drove him to work Dr. Chris Walsh, Dr. Jim O’Brien and myself. with a devotion to the welfare of his patients He was an Irish selector from 1969 to 1972, A group of UCC graduates in Cork was formed which went far beyond the call of duty. to solicit funds from graduates all over the and his fellow members of the “Big Five”

25 He carried all these virtues into his work as a grades with whom he worked. have been reinstated and appealed the Consultant Surgeon at the Barnet General judgment. He lost his case and here ended John was returned to Ireland on 29th Hospital where he inaugurated a much needed his formal relationship with Maynooth. September and requiem Mass was but intensely demanding Vascular service. concelebrated by Archdeacon Murphy Nevertheless, he retained many lasting I have no doubt that the exhausting O’Connor and the Parish Priest of The friendships with his clerical ex-colleagues nature of this extremely branch of Surgery Descent of the Holy Ghost Fr. Twomey. from Maynooth, from the diocese of Kildare contributed to his tragic and premature Leighlin, and from further afield, who supported Even though John had not lived on a stroke and subsequent incapacity. him in his difficult time, and many of whom permanent basis in Ireland for up to 50 years, were present at his obsequies. John was proud of his alma mater in U.C.C. there was a large turn out at his funeral and he kept in touch with it during his which gave his family great solace. The significance of these events in the 1970s active Surgical career. He had medical CK is noteworthy. This was a time when attitudes students over every summer to learn clinical to the power of the Catholic Church in skills. Dr PJ McGrath (1935 - 2011) Ireland, and the ways in which it was wielded, PJ McGrath came from a farming background were very different from those of today. I know from word of mouth that they loved in Killerig, Co Carlow. He was educated at The stance he adopted showed outstanding going there and that they were treated Knockbeg College. A brilliant undergraduate courage, underlining his very clear, reasoned exceptionally well by him. career ensued at Maynooth, where he was and principled view of what was just and He was also the London Representative ordained in 1961. Postgraduate studies unjust. His refusal to defer unconditionally to of the U.C.C. Medical Alumni and chaired followed at Louvain and Oxford. its authority was a landmark in the evolution the meeting they had there in early 1990. of the standing of the church in Ireland. His doctorate was obtained from Louvain John was a keen sportsman. He played senior avec grande distinction in 1964. In the same His academic difficulties continued in an rugby for PBC and UCC senior team year he became professor of philosophy at Ireland with this ethos. Despite his exceptional where he got his colours. St Patrick’s College, Carlow, and went on to scholarly standing, he did not find it easy hold the chair of metaphysics at St Patrick’s to obtain another appointment in Ireland. He was a scrum half and his out half was his College, Maynooth, from 1968 to 1977. His academic exile finally ended in 1980, great friend for life Noel Buckley. A philosopher of high distinction, his research largely due to the initiative and determination was mainly concerned with moral philosophy, He was a single handicap golfer and was of University College Cork’s professor of ethics and the philosophy of religion. an active member of South Herts Golf Club philosophy. The university appointed him His books include The Nature of Moral opposite his home in Totteridge in North to a statutory (senior) lectureship in Judgement, The Objectiv- London. philosophy, a post he held until his ity of Morals (both on moral retirement in 2000. I had the pleasure of playing many enjoyable philosophy) and, on the philosophy of rounds of golf with Johnny there and religion, Believing in God and The Justification In Cork he met Paule Cotter, a consultant also down in Devon. of Religious Belief. His published articles haematologist, whom he married in 1984 Shooting and fishing were also great interests appeared in Mind, The Philosophical Quarterly, and with whom he shared a deep empathy. of his. In his school days he was a great Analysis, Logica, The Furrow and Religious Studies . His studies were characterised by PJ McGrath was a man of unwavering high friend of Jim and Tommy Kiernan and I principle and an astute reader of character. remember him going shooting and fishing logical rigour, lucidity and clarity of exposition. Conciseness and clarity of thought, combined with Jim and Tommy Kiernan and with with a wry sense of humour, were highlights of Mr. Kiernan senior. He enjoyed those A number of his articles from the late 1960s and his personality. He had a lifelong, profound love times very much. the 1970s, including one on the papal encyclical of reading, with an encyclopaedic memory for Among his very close friends and class mates Humanae Vitae, were critical of the Catholic everything he had read. He had a profound in UCC were P.E. Kiely, Jim McKenna, Barry Church’s teaching and were seen as prejudicial knowledge of history and was immersed in Keane the world famous Paediatric Cardiologist to ecclesiastical authority and to the interests of European culture. He had a deep appreciation in Boston, Frank Golden who became a the church. These brought him into prolonged of wine, with a superbly developed palate and world expert in the treatment of confrontation with the Maynooth authorities. an impeccable cellar to match. He and his wife gave celebrated parties in their Bantry home hypothermia and Terry O’Callaghan. He was laicised in 1977, and was asked to for the musicians on the opening night of resign his chair. He refused on the basis he He also became a great friend of Richard (Dick) every West Cork Chamber Music Festival. did not understand the reasoning behind Walsh the Anaesthetist in the Mercy during his These contributed in no small degree to the the request. He continued to resist relentless Intern year there and he went shooting with spirit of close camaraderie that binds together pressure, but was eventually dismissed. him at least once a week. He loved this as well. the performers at the Bantry festival each He bore his long illness with great forbearance The request to resign, the reasons behind it and summer. and he managed a further 10 years of good the eventual dismissal became a cause célèbre He is survived by his wife Paule, his brothers quality life. His death is deeply mourned by since they raised fundamental questions Séamus and Peter, and sister Mona. patients and colleagues alike. regarding academic freedom and tenure. The family attended a requiem Mass in the Widespread concern was expressed in the Dr Tom O’Callaghan (1928-2011) lovely church in Great Billing on the Wednesday national press and elsewhere regarding the “A gentleman, a wonderful doctor and before we received John home. Both Frank implications of the actions of the Maynooth a good friend” these were just some Golden and Sean Corkery, who is a Paediatric authorities for him and for the academic of the words used to describe Dr Tom Surgeon in Birmingham, were at the ceremony community. The matter came before the O’Callaghan Snr, who died on Friday, June 24. and it was great to see them there. They both High Court, which held that he had been Dr O’Callaghan was born in 1928 and grew up live in England. wrongly dismissed and that his removal on a farm between Knocklong and Hospital from the chair had been invalid. However, he We also had the opportunity to meet many in Co Limerick. After studying medicine at was not reinstated. Instead he was awarded of Johnny’s great friends from both London University College Cork (UCC) Dr O’Callaghan damages against the college trustees, but and Northampton including his old surgical started his working life at the Mercy colleagues, the theatre sisters and staff of all only 60 per cent of his costs. He felt he should

26 Hospital in Cork cit and then having academic atmosphere there, he maintained However, while totally supportive of her worked in hospitals across the UK set the connection with Cambridge all his life. decision to take up acting, he was also acutely up his practice in Mitchestown in 1956. aware of the uncertainties of life in the theatre After a stint teaching at Leeds University, and insisted she first do a degree at UCC, Never one to sit still, Dr O’Callaghan worked Teegan, who was by then published in scientific thereby ensuring she had an academic tirelessly for his patients and his community. journals, was appointed lecturer in physical background before going on to study at Rada. He was involved in many of the early chemistry at UCC in 1951. He became professor developments of medical standards and of chemical spectroscopy in 1962. Though quietly reserved at those Montenotte supported his colleagues in Irish general soirees, he was a fine raconteur with a hearty In the late 1950s, Teegan held a research practice through his work with the Irish laugh and a fund of entertaining stories about fellowship with the US Atomic Energy Medical Union, where he served as President. his boyhood days in Cobh. Educated at the local Commission at the University of Notre Presentation College he went on to study “My father was also a founder and fellow of the Dame. In the early 1960s he was a visit- medicine at UCC. He played rugby for UCC faculty of Occupational Medicine, chairman ing professor at Florida State University. and for the Combined Universities, and was of both the North Cork and south Tipperary He was elected to membership of the Royal capped for Munster. He subsequently worked Clinical Societies, area medical director Irish Academy in 1968 and, in retirement, for a short time as a GP in London and later of the Red Cross and founder president remained active in the academy’s affairs. back in Cobh before qualifying as an of the Mitchelstown Lions Club.” ophthalmologist at the Manchester Royal Dr O’Callaghan’s son and director of the Centrally involved in the reforming Eye Infirmary in 1960. Livinghealth Centre in Mitchelstown, administration of the then UCC president Dr Tom O’Callaghan Jnr told The Avondhu MD McCarthy in the 1970s, Teegan served Returning to Cork, he was appointed as UCC governor and NUI senator and filled With a well-known love of rural Ireland, to the Eye Ear and Throat Hospital the new office of Dean of student affairs Dr O’Callaghan had many friends from The as a consultant, and worked there until from 1974 to 1983. He was warden of the Shorthorn Cattle Breeders who he joined his retirement at 65, which coincided with Honan Hostel residence from 1963 to 1970. every year at the ploughing championship the transfer of the unit to Cork University He retired from UCC in 1984. and from the boating and fishing community Hospital. Constantly keeping abreast with in Ardmore and the pilgrims of the Extramurally, Teegan’s greatest voluntary developments in eye surgery, he was awarded Cloyne Lourdes pilgrimage. “My father work was with the Cope Foundation, which an honorary fellowship in ophthalmology by had a deep love of rural Ireland, its towns developed out of the Cork Poliomyelitis his peers in London. He also taught at UCC and and villages, its countryside and wildlife, Aftercare Association. A Cope director, at the Royal College of Surgeons in Dublin. and its conversation, music and sport. he researched and wrote its history, As a doctor he had a way of putting He was a keen follower of horse racing and An Ill Wind Blowing Good (2003). patients at their ease and built up a a ruthless 45 player.” Dr O’Callaghan Jnr said. Music was a passion and his friendship with substantial practice in Cork down the years. Classical music was another important part of composer Aloys Fleischmann began at the In retirement, he continued working as Dr O’Callaghan’s life and as a special tribute, Cork Gramophone Society. He also relished a consultant at CUH and also had a busy soprano Cara O’Sullivan joined all those who foreign travel and recently put the final private consultancy practice for many years. came to say farewell at the Church of Our touches to The Way That We Went, a chronicle After retiring he wrote De Iron Trote, an Lady Conceived Without Sin in Mitchelstown. of the trips he took with his wife Maura. excellent history of the old Cork Eye, Ear and “My father had a great love of classical His extensive knowledge of his native Throat Hospital on the Western Road. Turning music and especially Cara O’Sullivan. I would county is reflected inTwenty-Five Scenic his interest in the arts to good effect, he also like to thank all those who were involved Roads Walks in West Cork (1993) and Scenic studied for a Diploma in Art History at UCC. in his physical, medical and pastoral care Walks in Cork (1998). As well as giving An enthusiastic golfer he played in a regular during his recent illness.” Dr O’Callaghan Jnr practical information on scenic walks, four-ball at Cork Golf Club. Three years ago said. they are affectionate discourses on the he suffered a stroke. He is survived by his lore and antiquities of inland west Cork. Dr Tom O’Callaghan Snr is survived by his wife, Mary, daughter Fiona, sons John and wife Mary, his brother Paddy, his daughter Teegan was a fellow of the Royal Society of Mark, grandson Jim, and sister Kathleen. Marie, Sons Ger, Tom and Barry and his 13 Chemistry and a member of the Irish Federation He was predeceased by his son Peter. grandchildren, nieces and nephews. of Chemical Industries. He also served on BM – Reproduced with the kind permission the Irish Commission for Justice and Peace. Some of the above appreciations are of “The Avondhu” reproduced with the kind permission A cherished paterfamilias, he is mourned by his of the Irish Times. Professor Seán Teegan (1923-2011) beloved Maura, children and grandchildren, Sean Teegan, who has died aged 87, was and a wide circle of friends. professor of spectroscopy at University Dr Denis Wilson (1922-2011) College Cork and the author of several highly Denis Wilson, who has died aged 89, was regarded walking guides to his native county. an ophthalmic surgeon who practised An only child of John Teegan and his wife in Cork for more than four decades and Mary (née Mooney), he was reared by his was the father of Fiona Shaw, one of maternal grandparents following the untimely the leading classical actors of our time. death of his father when he was still a A highly cultured and courteous man of the boy. A brilliant pupil at St Patrick’s national old Cork school, Dr Wilson (FRC Ophthal) school and North Monastery CBS, he won shared with his wife Mary a lifelong interest a scholarship to study science at UCC. in the arts, music and theatre. Their home Graduating in first place in chemistry in 1945, at Montenotte, overlooking the city, was a Teegan did an MSc the following year and venue for private poetry readings, operatic then went on a science research scholarship evenings and musical recitals, pursuits that to the University of Cambridge, where he was were to have a significant bearing on Fiona’s awarded a PhD in 1950. Having relished the decision to embark on a career on the stage.

27 UCC Annual Scientific Conference 2012 Would you like to support Medical Research at UCC? September 13, 2012

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http://conferencing.ucc.ie/conference Tax relief available for all Tax relief available for Tax relief available for Tax relief is not available or contact Rachel Hyland types of donations. cheque donations only. cheque donations only. outside Ireland, the UK or 021 4901587 / [email protected] for details the USA. Cheques must be made payable to Cork Cheques must be made Cheques must be made Cheques must be made University Foundation to payable to UCC payable to Irish payable to Cork qualify for tax relief. Educational Foundation Educational Foundation University Foundation. to qualify for tax relief. to qualify for tax relief.

Cork University Foundation is UCC Educational Foundation is Irish Educational Foundation is Class Reunions: a registered charity in Ireland a registered charity with the a registered charity with 501 (c) and gifts of €250 or more, Charity Commission for 3 status in the USA. given by Irish residents, may England and Wales. qualify for tax relief. 1967 Will Fennell: [email protected]

1977 Barry Lordon Contact Details: Ms. Rachel Hyland, 1982 Medical Alumni Association, Brendan Mullins: [email protected] Brookf ield Health Sciences Complex, College Rd, Cork. Marie Murphy: [email protected]

1987 Tel: +353 (0)21 4901 587 Paula O’Leary: [email protected] Email: [email protected] http://www.ucc.ie/medschool 1992 Please send us your email address to update our files. Deirdre Bennett: [email protected] Helen Hynes: [email protected] UCC Medical Alumni News is intended for circulation among UCC Medical Alumni & Faculty. The opinions and views in the publication are those of the contributors and are not necessarily shared by the UCC Medical Alumni Association.