I love what I do as a single-handed rural practitioner. I’m dealing with ‘salt of the earth’ people who appreciate what little I do for them.  I’ve had many opportunities to move to more central locations, but after my arrival in Mulranny I met my better half purely by chance at a wedding in Malin Head, thanks to a potential locum walking in the door to visit my landlady that very morning.
I am still in Mulranny 41 years later and I doubt very much I would still be here were it not for Teresa wanting to look out across Clew Bay at her native Lecanvey at the butt of Croagh Patrick. She is also the mother of my five children, three boys and two girls, the latter being the oldest and the youngest, both of whom have followed me into medicine.
I am proud like any father would be of all my children and particularly so of those who would follow me into medicine, after seeing the major commitment needed, particularly in the earlier years of my practice. My better half and my daughter Caroline have assisted me in delivering seven babies over the years whose mothers did not make the hospital in time. Thank God all are all well.        
I quickly discovered why my surgery was called a practice. Although I was fully vocationally-trained, I have been on a learning curve ever since I arrived here (I did a law degree and also became a barrister after I qualified in medicine, but it was not a patch on rural practice). There’s not a day I don’t learn something new and the day I don’t is the day I feel I should hang up my boots.
From the get-go, the clinical exposure was 100% with the minimum of back-up. I must have been a slow learner as it’s only now, years later, do I feel fully competent with enhanced diagnostic ability, based on many decades of my growing knowledge of each family history.

A social service

In the early days of my practice it was not very long before I discovered that a lot of older folk needed to see me more as someone to talk to rather than for anything I could offer them as a doctor (there were very few telephones in these days). This came as a terrible shock I can tell you; most disappointing indeed to a young graduate after long years of medical school learning and vocational training.
All most patients needed was for me to sit down and spend time talking with them. So that I would have time to do my many calls, I felt obliged to set up a voluntary day centre in association with the local community to help tackle people’s isolation and loneliness. I found that many vulnerable older people lived alone in isolated areas in temporary accommodation which was invariably too hot or too cold, draughty and damp. When those older folk could no longer live alone, even with the support of our voluntary day centre, they had to go to a faraway place in Castlebar or Westport where they knew no one and I reckoned, they just lost heart and sadly, died.
I eventually got involved in setting up a 16-house sheltered housing development and a 36-bed high support unit so that older people would have the chance to stay locally, whatever their need. I was approached by many people looking for houses for their relatives abroad who yearned to come home and had sent more money home than we ever got from the EU.
Many of these long-term Irish emigrants who wanted to come home were now elderly, had fallen on hard times and were in poor health. They applied for housing from the local authority but to no avail. Our St Brendan’s Village not only stopped the sad silent migration of older people to faraway institutions but actually reversed it, and setting up the Safe Home Programme in Mulranny has allowed 2,200 long term Irish emigrants, mainly from the UK, to be repatriated permanently to secure housing all over this State with the support of the Irish Government.

Depopulation

It is difficult to live in an area where there are no services such as Garda stations, post offices, schools, or a local GP. When these services go the population goes with them. The vicious circle of depopulation and loss of services could be broken by new services such as housing and high support care, giving that care incrementally as needed. These services proved to be the saving of our village as the biggest local employer 365 days of the year, with people coming here to find work even from the big population centres.  
It is hard not to get involved when the community you serve and love is in trouble. I know GP colleagues get roped in all the time into doing more for their local community than dishing out medicines or being a judge at the fancy dress competition. Last week our local undertaker, as well as the parish priest, myself and others had our legs waxed in the local pub to raise funds for a local charity!
Us GPs find it hard to stand idly by when our communities are being unfairly criticised.  I do a branch surgery in Ballycroy (‘Ballroom of Romance’ country) where I discovered that the water coming out of the taps was not fit for drinking. The community was criticised by the local authority in the Dail, and even at EU level, for this state of affairs. This led to us setting up the national federation of group water schemes with the support of rural communities all over Ireland and the result now is that the parish of Ballycroy holds the quality mark for the best water in Ireland.
To me, being a rural GP is about being able to identify problems and needs and treat illness at an early stage, often before it can progress to serious harm. This can be as simple as treating an infection early with antibiotics or halting the dying process with timely IV fluids on the side of the road in an accident. Being a dispensing GP and providing a ‘one stop shop’ for essential medicines is also a most valuable service where it’s not economically viable for a pharmacy to set up shop.
GPs servicing older people’s long stay units like our local unit, be it public or private, contributes enormously to keeping people out of hospital and facilitates earlier discharge. Both dispensing and local nursing units help support the viability of the rural GP. 

First port of call

Being a rural GP means you end up being the first port of call in every rural storm. There is commonly no colleague to lean on and no ED close at hand, so you just get on with it. Rural GP colleagues are often not replaced once they retire. The need for their services may be as great as ever in the place they may have served for a lifetime, and ambulance calls, hospital admissions and ED attendances will go through the roof as a result of the loss of their services.
This crisis is growing. Recent reports detail swathes of practices without permanent doctors. Where dozens of doctors would apply a few years ago for a GP practice, we now hear there is often only one candidate applying for six positions. This is a shame.
There is great satisfaction in serving a local community and a privilege to share patients’ life journeys. I regret that younger GPs may not get this enriching experience of bonding with a community, and as a result many more rural communities will be deprived of a very valuable service.
Abolishing the distance code payment system for a stated saving of €5 million was a senseless exercise by government  and a massive disincentive which essentially threatened the future of rural practice overnight. Research must be done to expose the fiasco of ending a fair payment system based on demographics and distance from the doctor and replacing it with chaos.  I would have loved to make the case for the restoration of the distance codes system to give back a future to rural Ireland once again.
I love rural practice and I regret I have not had the time to do a lot more. I remember my school days in Ballina when we were asked by our teacher “What would you like to be when you grow up?” The class in its entirety were falling on the floor laughing  (much to my surprise) when I declared I wanted to be a doctor.
Everyone was highly amused as they thought I was a bit ‘wild’ for that profession, but I wanted to help people. To me being a doctor was foremost about being a GP, where I could render immediate useful assistance to my fellow humans no matter what their condition. Being in rural practice allows me to do that best, and is very fulfilling.