67

TABLE C

Babies

Lungs and heart . . . . . . . . . . . . . . . . . . 174 Barium meal . . . . . . . . . . . . . . . . . . 16 Barium enema . . . . . . . . . . . . . . . . . . 3 Long bones . . . . . . . . . . . . . . . . . . . . . 33 Plain abdomen . . . . . . . . . . . . . . . . . . 10 Shoulder girdle . . . . . . . . . . . . . . . . . . 7 Skull . . . . . . . . . . . . . . . . . . . . . . . . 87 I.V.P . . . . . . . . . . . ,. 2 ? Congenital abnormaiity (mainly h'ips) . . . . . . . . . 263 Miscellaneous . . . . . . . . . . . . . . . . . . 9

604

SOCIAL W O R K D E P A R T M E N T

Miss ELEANOR HOLMES

Five thousand six hund red and fifteen new pa t ien ts were in terv iewed dur ing 1966, and 2,248 were found to be in need of some form of social help. Of these 2,041 (1,991 publ ic pat ients , 50 semi-pr ivate p a t i e n t s ) w e r e re- gistered for stat ist ical analysis and inc luded : - -

Maternity . . . . . . . . . . . . . . . . . . . . . 1,816 Gynaecological . . . . . . . . . . . . . . . . . . 205 Paediatric . . . . . . . . . . . . . . . . . . . . . 11 Social (not actually under the care of the Hospital) ... 9

These pa t ients wcre r e fened to us as follows:-

By Hospital Staff . . . . . . . . . . . . . . . . . . 439 Made application themselves . . . . . . . . . ... 512 By individuals and agencies outside the Hospital ... 287 During routine interview . . . . . . . . . . . . . . . 82~

Their needs should be classified as : -

Material . . . . . . . . . . . . . . . . . . . . . 365 Personal . . . . . . . . . . . . . . . . . . . . . 408 Family . . . . . . . . . . . . . . . . . . . . . 146 Emotional . . . . . . . . . . . . . . . . . . . . . 39 Combination of two or more of these factors . . . . . . 1,063

I n in te rpre t ing these figures i t is necessary to be aware that , whereas mater ia l and personal needs f requent ly occurred separately, family and emot ional problems most of ten occurred in associat ion wi th other needs, hence the ra ther low figures for these two categories, which could be mis- leading; for example, 39 pa t ients had purely emotional problems, never the- less emot ional difficulties arose for 408 other pa t ien ts inc luded in the "com- b i n a t i o n of two or more factors."

Trends in the commun i ty in 1966 have resulted in no marked changes in the problems found.

Material needs have been fairly static. We con t inued to have a very approximate 10% of our pa t ients requir ing mater ia l help.

8

Statutory Benefits increased on 31st October 1966. There was considerable confusion regarding the implementation of the 10th Round of wage increases; eventually in July, an increase of £1 weekly for male workers and 15/- weekly for female workers, earning under £1,200 per annum, was put into operation. The Government's pay policy was less successful in State Compan- ies, some of which gave salary increases to employees earning more than £1,200.

Strikes took place in a few concerns, and most of these were aimed at securing the 5 day, 40 hour week. The progressive increase in the cost of living well nigh obviated any real gain from these Statutory and wage benefits.

The housing situation continued to cause very serious concern. Fewer local authvrity houses were built, due to financial stringencies. Many patients with three children, riving in one room, or in grossly overcrowded houses and flats, still awaited rehousing. Some lived in inadequate flats with many restrictions and having most exorbitant rents. A number of pregnant patients were in constant fear of eviction for landlords were often averse to the arrival of more children. In certain cases, overcrowding made hygiene very difficult. One can attribute the number of upper respiratory infections and gastro- enteritis in infants to these unsatisfactory conditions. We found ourselves powerless to help the great majority of patients. We made strong repre- sentations to the Municipal Housing Authorities in 42 cases, and for the remaining 343 patients requesting help, we had to spend much time giving supportive and casework help to them, and frequently to their husbands and relatives as well. A few patients rented caravans, but their chances of being rehoused from these were very poor, for the Local Authority does not receive a Government Grant for rehousing caravan tenants; also, there is no control on the reletting of a caravan once the tenant moves from it. For those with the initiative and eligibility to purchase their homes, loan facilities remained difficult to obtain, due to restrictions on credit. This situation was caused by the depressed state of the economy, this had discouraged investment. Furthermore, the cost of houses increased, due to various factors, notably the high cost of sites.

Of the emotional, personal and family difficulties that we encountered, marital troubles figured high. Immaturity, irresponsibility and inadequacy were primary and dominant reasons for many breakdowns in marriage. Overprotection of children by their mothers was a causative factor. Historic- ally, due to emigration, many Irish mothers have had to take tremendous responsibility for the upbringing of their children, and in many instances, even when the father was at home, this trend has operated and mothers have continued to bear the brunt of rearing their families often to a point of overprotection, and frequently deriving considerable maternal satis- faction from this. The father has taken the line of least resistance, parti- cipating little in the discipline and upbringing of the family. Children from such a background, when they reach adulthood are at a marked disadvantage in building contented marriages, for ia their immaturity they are too de- pendent on their families and on society. Only exceptional children from such a family setting make satisfactory and happy marriages.

Alcoholism, poor management, inability to integrate into a new commun- ity have caused great marital unhappiness. Proper sex education, too, has been almost entirely lacking in all strata of society.

A Marriage Guidance CerLtre for Roman Catholics is a most pressing need. It is significant to note that none of the patients with marital difficulties, who we saw, had attended the very excellent Pre-Maniage Classes, which have been operated since 1955 by the Jesuit Fathers and the Catholic Social Welfare Bureau. We are glad to note that the Church of Ireland Marriage

69

Counselling Service commenced a Marriage Preparation Course in April. The large Corporation Housing Estates leave much to be desired in their

lack of community amenities. Such vast areas as Finglas, which is rife with problem families, need recreational, more educational and cultural facilities for all age groups, especially the young. The provision of properly designed community centres should be given urgent priority. Creches are needed to ease the burden of over-worked mothers; school dinners should be avail- able. In areas such as this, professionally trained caseworkers and community workers combined with voluntary effort could do much preventive and con- structive work. The Housing Welfare Officers of Dublin Corporation are doing a tremendous job, but each officer has a district comprising about 7,000-8,000 dwellings, and it is quite impossible to cope adequately in those areas where the problem rate is high.

Illegitimate pregnancies have increased and we dealt with 91 patients in the Out-Patient Department, and 80 such patieI~ts were delivered in the Hospital.

Extern Department: Of the 91 illegitimate pregnancies, 82 were single, 2 were married, 5 were married and separated, and 2 were widows. Forty- four were delivered in Hospital in 1966 (20 were not due until 1967), 3 were tmbooked District deliveries, 10 were referred elsewhere (special homes, etc.) for delivery, tile remaining 17 patients did not return to the clinic. Fif ty of these patients came from Dublin city, the remainder from provincial areas and other countries. The average age was 22½ years. Teenagers numbered 34.

Intern Department: Of the 80 illegitimate pregnancies, there were 73 single girls, 2 married women, 3 married and separated, 1 divorced, 1 widowed. Fifty-one were booked, 29 unbooked. Sixty were primiparae; 12 were gravida 2; 8 were gravida 3 and over. Thirty-seven came from Dublin city, the remain- ing 43 were from rural areas and other countries. Twenty-five patients were teenage and the average age was 23½. One patient got married before delivery, but not to tile putative father, and 3 patients married the putative father after delivery. Sixty-one babies were born alive, 3 were stillborn, 3 were neonatal deaths, 9 were abortions, 2 were "no labours", 1 was Hydatidiform Mole, 1 was a pseudo pregnancy. Twenty-two patients kept their babies, and 39 babies were placed.

Patients, who have had illegitimate infants, need a sensitive understanding. Their difficulties, their feelings about their babies, their relations' att i tude (if they knew the situation) and the family relationships, if the patient was living at home, are all important facets of tile situation; indeed sometimes the parents needed more help than the patient. Many of the patients who came ilxto Hospital unbooked had not been prepared to admit before- hand, even to themselves, tha t they were pregnaaxt. Some, often through sheer terror, had demanded instant placement of the baby, and this may be something that is greatly regretted in later years. With the unbooked patient the task of helping her constructively and wisely llas often been difficult, due to the very brief period that she is in hospital. During the puerperium the patient canllot be in a fit state to make momentous decisions about herself and her baby, and it is extremely difficult to get to know her fully in such a brief time. Outsiders who know the situation can be a tremendous help, if, on account of expediency, they do not t ry to impose their views and advice on the patient. We have had enormous help and cooperation from our Roman Catholic Chaplaiu, Father Geaney, from the Church of Ireland Social Service, and other agencies, as well as from the various Special Homes and Nursing Homes which we use for these patients.

Our work has been aimed at the easing of, or the eliminating of social problems that would prevent patients carrying out medical recommendations. The Pre-Natal Department has a concentration of such difficulties. For ex-

70

ample, domestic arrangements at home, care of children, and the finartcial worry for those who have made Semi-Private bookings, not anticipating complications and a prolonged stay in Hospital. Supportive help has oftelx been required to enable patients to accept certain situations, especially when a baby has died or when there is physical or mental handicap, with the latter, especially, many parents have ambivalent feelings about the baby. When a mongol or other mentally handicapped infant is ready for discharge, almost always it must be taken home by the parents, most of them require help in acceptance of the situation. From the various Associations of Parents and Friends of the Mentally Handicapped, if they will agree to join, the parents can derive tremendous support in meeting other parents with similar difficult- ies. It is important to make provisional plans for the training and care of such ckildre~x at the earliest possible stage, for the waiting lists for all institutions for the mentally defective are long and the turnover is slow. We have met with patients who did not apply soon enough and who with succeeding pregnancies became physical and mental wrecks trying to cope with the unabating demands made by a severely handicapped child.

The numbers of patients having home confinements continued to fall. The main practical causes being lack of Home Help, overcrowding or in- adequate housing facilities. Certain patients, who were obstetrically and medically suitable for domiciliary delivery, and some husbands, have on emotional grounds needed the security that hospital delivery offers. Our repeated and unanswered pleas for a properly organised Home Help Service could help those who preferred home delivery, but could not have it on account of absence of domestic assistance. It would also mean that the family could remain together and prevent the painful experience of separation for young children. The pressure on hospital beds would be eased and the cost to the State would be considerably less.

We particularly welcomed the setting up of a Family Planning Clinic in January 1966. The guidance it gave was much sought for and needed by patients with severe social problems, as well as on medical and obstetric grounds.

In the Gynaecological Department we have tried, in conjunction with other members of staff, to deal with the anxieties and fears so commonly met with, for there appears to be no doubt but that examination and treat- ment frightens most of these patients more than their disabilities. Some have a fear of Hospital, of operations, of anaesthetics, of medical students. To reassure is of little value, but to help such patients to voice and discuss their fears, and to try to rationalise them, has beelz of therapeutic value. In seeing patients who are to be admitted, reducing the unknown and explaining routine has made acceptance of the Doctors' advice easier. Too few have availed of convalescence in their auxiety to get home to their families. Some patients, especially from certain rural areas, have had to return home following major gyaaecological surgery, to conditions which could well cause relapse. Many have come from houses devoid of auy modern conveniences, and their housework was hard alxd heavy. Home helps for a short period following discharge would seem to be the immediate, if partial, answer.

Teaching: During the year lectures were given to student midwives and to theological students from the Trinity College Divinity Hostel. A tutorial was held for student priests from Clonliffe College. Although tutorials can embrace fewer students, there is no doubt in my mind that they are of much more value than lectures in social work teaching. Three social science students from Trinity College and University College came for field work training.

The serious lack of professional social workers is a matter for deep concern. Many emigrate following graduation and some employing authorities in Great Britian and Northern Ireland will second them, and pay for the neces-

71

sary year's post-graduate training. This and the more attractive salaries a r e

amongst the reasons for the scarcity in this country. Whilst the shortage of trained social workers in Dublin is serious and causes great difficulties in filling posts and in procuring locum tenens, the position in provincial areas where professional social workers are almost non-existent is considerably worse. When country patients have social problems needing casework help and follow up, liaison is difficult and often impossible.

In September 1966, Miss Margaret Home, who had worked with us for fourteen years, resigned in order to read for a Master's degree in Birmingham University. Her decision to undertake further study was in keeping with her pioneering spirit. Miss Home gave loyal, devoted and talented service to the Hospital, and we wish her great success in her new venture. We welcomed Miss Eibhlin O Briain, B. Soc. Sc., as temporary Social Worker. To her and to my two clerks go my thanks for their ready and cheerful help.

Dr. A. D. H. Browne's term of office as Master came to an end on 31st December 1966. We have greatly valued his understanding, help and con- sideration.

It was with great regret that we learnt of Mr. E. W. Tomlinson's resigna- tion as Secretary. Throughout the years his courteous and wise counsel has meant much to us. We are glad that as a Govemor of the Hospital he will still maintain contact with us.

It was with great sorrow that we learnt of the death of Dr. Percy Seager in January. His kindness to patients and his generous help to our Department was further borne out by his wish that those desiring to remember him should not send flowers, but instead make donations to our Samaritan Fund.

Our thanks are due to the many statutory and voluntary agencies and individuals for their continued help and co-operation. We contacted 43 different statutory agencies and 64 voluntary agencies, and individuals (e g. solicitors, landlords and employers) during the year. Without their help the social service for our patients would be very incomplete. We had reason to contact the Garda Sfoch~na on several occasions, and have greatly appre- ciated their discretion and understanding at all times. The Rotary Club, the Religious Society of Friends, and Messrs. NichoU's, Exchequer Street, provided us with toys and sweets for the children of some of our very needy mothers at Christmas. The St. Martin in the Fields Christmas Appeal Com- mittee sent us a generous grant of £60 for distribution to those reticent people, who through some exigency, were in straitened circumstances and who would never dream of seeking charitable help.

The Linen Guild and Samaritan Fund Committee continued their essential help in operating a Library Service, as well as supplying money for use in constructive aid for patients, and together with the Infant Clothing Com- mittee provided baby garments and clothing for needy patients. A word of appreciation goes to Mrs. A. D. H. Browne, Hon. Secretary of both these Committees, for her unfailing help to us. We are greatly indebted to the Rotunda Dance Committee for raising yet another large contribution for the Samaritan Fund. A few ladies outside the Hospital have knitted baby rugs and matin6e coats for our patients and we greatly appreciate their kindness.

Through the enlightened press and television media, muck has been done to focus attention on social requirements, stressing the need for adequate planning and the appointment of more skilled personnel in this country. Our patients, too, have benefited greatly from certain instructive sound and television programmes, notably "Home Truths." There has been a great widening of horizons, and much of the passivity regarding many matters is fast disappearing.

Finally, thanks are due to members of the Hospital Staff for their help and co-operation throughout the year.