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Don Moloney/Noteworthy

'The belief that being a doctor is a vocation and all else must be sacrificed… that mentality is waning'

Non-consultant hospital doctors are currently balloting on whether to take industrial action over their working conditions.

LIKE MOST JUNIOR doctors, Rachel McNamara is no stranger to the exhaustion of ultra-long shifts.

She’s worked through more nights than she can remember, but the hardest ones are still seared in her memory.

There was the 64-hour shift, for example, that ran from 4pm on a Friday until 8am on a Monday. She managed to get home for a few hours’ sleep during the daytime, but she knew the phone could ring at any point with a question or update requiring her to get back on site.

Then there are the nights with no let-up at all. On one of her first 24-hour shifts, calls and admissions poured in until around 4.45am. She walked through the wards that night feeling “pretty much comatose”, as if her body had shut down.

“I eventually got into bed but then the phone went off again after about 15 minutes – another sick patient. It was painful having to get up, but there was no one else to call.”

McNamara says the tiredness felt by doctors working in these conditions is hard to explain. “You work through the day and the adrenaline will take you through until eight or nine in the evening, but then you just have to keep going and going. If you’re needed on the wards, you can’t really stop.

“By the time it gets to the early hours of the morning, you’re operating on a much lower level. You’re not thinking as clearly as you should be, and you start to doubt yourself.”

She tells The Journal of the guilt felt by doctors stretched beyond their limits. “People can be upset or distressed right in front of you, and you don’t have the energy to properly empathise or give them the care they deserve.

“You end up not being able to derive any sort of satisfaction from the job because you’re so chronically fatigued. It’s not something you can do to yourself long term.”

The Limerick woman knows several colleagues who’ve recently left the profession. “These were great doctors, but there comes a time when you see it’s taking too much from you.”

She herself has considered choosing another specialty. “There are weeks where you might work 12 days in a row, and you can see the impact it has on your relationships. You can’t keep up with family and friends, and your house is a mess. Whatever time you have away from work, you’re sleeping.”

Problems across the system 

McNamara’s frustrations are shared by many in hospitals across the country. In a recent survey by the Irish Medical Organisation (IMO), 78% of junior doctors said they were at high risk of burnout.

The research identified widespread breaches of the European working time directive, under which non-consultant hospital doctors (NCHDs) are supposed to work no more than 48 hours a week, or 24 consecutive hours. Doctors are also “routinely not paid for all hours worked”, according to the IMO.

NCHDs are now being balloted on industrial action, with junior doctor representatives warning that a nationwide strike will be considered if these issues continue. A result will be announced after balloting closes on 9 June. 

It’s been nine years since the last junior doctor strike, when 51 hospitals were hit by a one-day walkout over working hours.

Aidan Coffey, who’s on the IMO NCHD committee, says no junior doctor would take the decision lightly.

“I hate the idea of not going into work, but I also hate the idea of being ten years down the line and seeing that nothing has changed. I don’t want to be working as a consultant in the future and wondering why NCHDs are still facing these conditions – and wondering whether we could have done more to improve things.”

Coffey worries about the future of the health service given the growing number of junior doctors moving abroad. He himself had a stint in New Zealand before returning home at the start of the pandemic. The differences between the two healthcare systems are stark, he says.

“In New Zealand, you were given a roster, and that roster was respected. If a change needed to be made, it was up to the hospital to find cover, whereas here so much of that responsibility is put on the doctor.

“There was more flexibility and more of an understanding of the need for a work-life balance, which just doesn’t seem to exist at all in Irish hospitals.”

Expectations 

Like McNamara, Coffey has seen friends and colleagues leave hospital work because of the impact it’s had on their mental health and wellbeing. The Cork man counts himself lucky to have “a somewhat tolerable” roster, with 50 to 60 hours a week being the average.

Pressures are being felt across the system, though. He and others point to the increase in patient numbers and complexities due to our ageing population, as well as the workload caused by new interventions and guidelines.

NCHD advocates say that while contractual breaches have to be addressed, a cultural change is needed as well.

“There’s often been this expectation that the doctor goes home when the work is done,” says McNamara. “I think there’s a greater appreciation now with Covid that life is short.

“The belief that being a doctor is a vocation and that all else must be sacrificed in order to carry out the role … I think that mentality is waning. People are asking why we can’t do this job but also maintain some of ourselves in the process.”

This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here

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    Mute Ed Redbird
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    May 18th 2012, 8:11 AM

    Yet we contribute millions to the bottomless pit known as Africa for years without result. Would it not make sense to spend this money on our own hungry kids?

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    Mute Tony Groome
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    May 18th 2012, 8:25 AM

    The pc bridage won’t like that comment, the oul racist card will come out to show its ugly head!

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    Mute Gavin Yore
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    May 18th 2012, 9:25 AM

    Charity starts at home and I don’t include the “career” Romanian beggars you see sitting on their new backpacks with their coat, jewlery and phone inside. Met two female ones walking away from Dublin city centre at the Mater, obviously after a days begging. They were all chat while putting back on their necklaces, bracelets and rings! Sickens me to see it happening when there are genuine people in need of a few euros to get them through to the next day.

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    Mute Laura Marie Purcell
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    May 18th 2012, 10:35 AM

    ed, i contributed for years to poor nations, unless one day my partner pointed out to me, money goes to his country, to the poorest part…it doesnt feed kids, nor build wells…it helps to continue a war that raging between muslims and catholics…most of the money contributed to africa, asia etc go to corrupt leaders, and processing fees for charities here, not to feeding the kids at all :(

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    Mute Gavin Yore
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    May 18th 2012, 10:58 AM

    Very true Laura. My old primary school teacher retired and went out to Uganda to teach there for 2 years with Concern or Trocra. He recently came home last Christmas on holiday and said we were only wasting our money giving it to them cause at least 75 percent of what we give is swallowed up by administration. You just have to look on Camden St in Dublin, the main shop for Dublins Simon community is a tiny little shop on a corner and 50 yards up from it is Concerns main office,a huge modern 3 story building with dozens of people working on computers inside(no expense spared). The financial scale difference between the two charities is huge but with the Simon community,everything you give gets to where you intended it to go.

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    Mute Susie Chester
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    May 18th 2012, 1:21 PM

    Gavin Yore
    Well said . Before last Christmas I knit and crocheted ,hats scarves and gloves and sent them in to SIMON ,for who ever they needed to give them to. I have seen my creations around Dublin and felt quite proud. It was a small gesture but it benefitted someone and my ego was puffed up a bit . I live on a pension ! (No one knows I did that )

    14
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    Mute Dan Delaney
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    May 18th 2012, 7:44 AM

    “…while making well-off families carry more of the burden…”

    Practise what you preach…have you ever seen a destitute priest or nun? Try opening the doors of your big convents and monastries to the less well-off. Then I might listen!!

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    Mute David Sheridan
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    May 18th 2012, 7:53 AM

    Will You practice what You preach Dan and open your doors to the less well off? Then I might listen…

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    Mute Celly O'Brien
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    May 18th 2012, 7:59 AM

    How shameful can you be you ignoramus? Sr Stan has worked tirelessly for the poor of Ireland for over 50 years starting Focus Ireland when no one else cared about the homeless Go listen to one of her lectures or be more informed Before making such a comment in public

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    Mute Conor Oneill
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    May 18th 2012, 8:04 AM

    The church is loaded! Christ said give your money to the poor. There not following his message

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    Mute Mary o Shea
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    May 18th 2012, 8:44 AM

    Disgraceful comment! Sr Stan has worked tirelessly over many years for the most poor and marginalised in our society. She has always been incredibly modest (both personally and financially).

    I have worked with a local homeless unit in Tallaght in the past. It was only through the financial support given to us through a local catholic church in our area that we were able to survive and deliver crucial services. They gave in excess of 40k per year and never asked for recognition in any way – it was done quietly and in a dignified manner.

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    Mute Irelands Owen
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    May 18th 2012, 8:49 AM

    Same anti church idiots seem to pop up on every story. Give it a rest!

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    Mute franco
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    May 18th 2012, 9:01 AM

    Have you ever seen a nun driving a BMW , don’t think so , sr stan does great work she practises what she preaches .

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    Mute Garry Whelan
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    May 18th 2012, 10:05 AM

    Dan you are a moron. Sister Stan has done more good for the vunerable in Ireland than most .It is easy to be trite when it is not you that is affected.Have you ever being homeless? have you ever had to sleep in a doorway in winter?. I have and it is no picnic. It is not the responsibility of releigious instuitions to look after thewefare ,of the citizens of this country.

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    Mute Tom Shine
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    May 18th 2012, 7:54 AM

    Good article, the unfortunate in our society often have no voice, are treated badly and largely ignored.

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    Mute Susie Chester
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    May 18th 2012, 9:21 AM

    That is why the rest of us should speak up . When you are desperate, depressed, hungry, afraid, tired, stressed, worried…..it is like wearing a strait jacket, and shackles, We all must say NO WAY should anyone be hungry.If we all did something small today to help someone we believe is struggling ,buy groceries, pay a small bill ,buy a bag of coal, Make a meal ann give it to them, bake a cake or bread…. anything ,It is a start….It will boost your own sense of worth also. Please think about it :) :)

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    Mute Laura Marie Purcell
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    May 18th 2012, 12:47 PM

    i think this is the main problem that the celtic tiger caused, we all seem less likely to notice anyone else who is struggling, we have all lost community spirit, and expect to get something for everytjing we give…it really isnt that hard to go and check on an elderly neighbour, or to invite a family you know is struggling for a meal etc…if we all just help each other a little more, we may regain a lot of what we lost, and we will all be richer for it

    i met with my inlaws for the first time last year, and while some of the poverty i seen was scary, i seen an amazing scence of family and community spirit…

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    Mute kingstown
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    May 18th 2012, 8:07 AM

    I wonder when the last time certain bankers and ‘simple farmer’ types went to bed hungry? Thank god we’re bailing them out

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    Mute Norman Hunter
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    May 18th 2012, 8:24 AM

    I trust your not forgetting Politicians,i’d imagine none of them or their children are going hungry either don’t you think?

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    Mute Doc Benway
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    May 18th 2012, 8:43 AM

    What’s particularly sad is the waste and dereliction of partially finished houses under N.A.M.A. control. Considering the absolute failure of the “rent allowance scheme”. This scheme under it’s current form is an absolute disgrace. It takes months to realise that no help is coming, while during that time applicants are asked to jump through hoops. Obtain this document from that agency, obtain that document from this agency and so on. Why a citizens claim for social welfare should depend on so many other parties co-operation I’ll never understand. A Vogon would be proud of the ridiculous bureaucracy. Willie Penrose resigned when he failed as Minister for housing yet Joan Burton is happy to continue in her nice warm comfortable office. Shame on all of us for allowing this to happen.

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    Mute Micí Mulcreevy
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    May 19th 2012, 2:50 AM

    Following on what you say Doc, is that changes in policy now require any recipient of Rent Supplement wishing to return to the jobs market must now be living in houses contracted to the Rental Accommodation Scheme run by the local authorities; as they will be deemed to have a long-term housing need. This would be a reasonable idea except there are very few property-owners interested in signing a RAS contract, viewing it as a mechanism to reduce rents. The upshot of this, given the high cost of rent in Ireland, is that all 96 000 families in receipt of RS must choose between having a home or having a job; it is not possible to have both under the current regulatory framework.

    Good article Sr. Stan – keep up the great work

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    Mute Sasha Musgrave
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    May 18th 2012, 8:55 AM

    If we could get the balance right, between helping our own, and helping the people out in Africa, we would be better off, but think we have to help our own homeless first as they are our priority.

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    Mute Lou Martin
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    May 18th 2012, 8:10 AM

    After 26 years of the Combat Poverty Agency,and the situation is worse ? Would that not tell you something ?

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    Mute Continent Simian
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    May 18th 2012, 8:31 AM

    We need to restart the CPA and finance it properly this time?

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    Mute Susie Chester
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    May 18th 2012, 9:25 AM

    Another expensive quango while kids go hungry . Why can’t we all just DO SOMETHING good and positive for anyone we meet today and ease their burden even for just a few minutes. It does not always need to be the grand show…. There are lots of Charities doing fantastic work ,it is us ordinary people who need to make small efforts.

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    Mute The Burning bush
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    May 18th 2012, 10:59 AM

    Always nice to know that our tiny little economy can continue to pay those decision makers €150,000+ p.a. to strip the services to those earning not even the equivalent of a public representatives selection of allowances and associated tax breaks.

    A 20,000 long waiting list for orthodontic work, five years for a speech therapist. Thats a five year wait for everyone without private health insurance or the benefit of 150,000 p.a.

    How many of your decision makers have children on any one of those waiting lists? how many of those who advocate the rollback of services are affected by same?

    Then theres the old reliable and altogether predictable response, “we have no money…..we are where we are”. Reliable nuggets of bullshit Irish argument from our venerable leaders.

    They found billions somehow to give the banks, they found billions more to give unsecured punters on the Bond market, and they will give billions more before they’re done, but dental services for your kids? A speech therapist for your child who is deaf in one ear and has 35% hearing in the other?

    They go on the scrap heap, they go there because those that make these decisions have never and will never experience the consequences of that which they are so very keen to implement.

    You ask the question, “What are the government doing?”. They rob Peter to pay paul, they continue to collect on a bill created by those at the top end and paid for in full by every living soul residing at the bottom. Peter had f+u+c+k+ all to commence with, Paul has more than he needs, but in this fairytale Peter will continue to pay Paul. He will pay because we continue to elect useless bastards earning enough to insulate them from those decisions they make and will continue evermore to advocate this approach.

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    Mute Glyn Carragher
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    May 18th 2012, 11:33 AM

    Kinda sums it all up. Well said

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    Mute Susie Chester
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    May 18th 2012, 1:58 PM

    Brilliant ! Well said .

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    Mute rcorrigan
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    May 18th 2012, 9:16 AM

    In the interests of balance let’s do a straw poll; how many of us commenting here went to bed hungry last night? It’s not just politicians, bankers and farmers you know!

    22
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    Mute Damocles
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    May 18th 2012, 9:44 AM

    Is there or is there not an excess of houses in this country?

    21
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    Mute Deirdre Bennett
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    May 18th 2012, 9:23 AM

    Sister Stan seems to be a lady who has dedicated her life to helping out the less fortunate and giving them a voice. She is to be commended for that. Religion has no part in this topic. We all see the poverty around us daily. How can we make the government do more when they tell us there hands are tied due to the economy. They hold the country’s cheque books. Sister Stan is a voice for the poverty stricken, how do we make the government listen. No child in this country should ever go hungry.

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    Mute Caroline Hughes
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    May 18th 2012, 9:16 AM

    This is not an accident-it is a policy-it is all part of the agenda to bring back Dickensian poverty as a social norm. The banking elitists want this and their puppets, useful idiots-er’hmmm sorry-politicians want it because their bosses want it. We have to stop being conned into thinking these are ‘just the results of a bad idea’, on the contrary, it is planned and it is agenda driven. Sr Stan would do well to start researching this aspect of the new ‘governance’ that is being foisted on us, an comment on what is happening so that people have a chance to hear the truth from someone who actually gives and damn!

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    Mute Susie Chester
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    May 18th 2012, 9:28 AM

    Caroline Hughes
    Much and all as it frightens me to admit it , you are quite right . This is policy !
    People shoyuld wake up NOW and start looking after each other AND in that way we garner strength against the people and groups who are pushing us down.

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    Mute Susie Chester
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    May 18th 2012, 9:12 AM

    …. Poverty = lack of sufficent good food, lack of heat,lack of warm clothes, lack of shelter , lack of electricity.
    Dan , you are quite correct , priests, nuns, brothers are not in poverty.
    There is poverty here , Particularly among some children. I have been thinking that maybe some schools should introduce a scheme along with the local shops , pubs, church , to introduce soup and brown bread or rolls to children . It could be done cheaply and without much fuss .
    Food parcels too are a way of ensuring that children get good warm food, convenient and nourishing.
    We have fallen a long way from the tiger days !!! And it is taking some people longer to adjust to their newly forced poverty status. And no way have we reached the bottom yet !!! (If the gov,have their way )

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    Mute Ciara Ní Mhurchú
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    May 18th 2012, 10:32 AM

    Why did we let the Roma into this country? They are beggars and thieves. The money should go to genuinely homeless people and not those who moved here to milk the system,who live by different rules to the rest of us and who intimidate people in town on a regular basis.

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    Mute Deirdre Keohane
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    May 18th 2012, 11:16 AM

    Lunches in schools is a brilliant idea..I wonder how we do it… The cuts to lone parents and our (the nations)children will soon have an impact… I waited 10 years for housing and that was in the boom and even with rent allowance..it was shit hard..can’t imagine how difficult it must be for moms and kids in rentals now. god help them..:-( i was told last night it was a “life choice”…he’s lucky he’s still breathing today!

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    Mute Susie Chester
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    May 18th 2012, 2:23 PM

    What an arrogant phucker to say that about any one who finds themselves alone rearing children , regardless of the why ‘s or how’s ….
    I reckon it should be done as a first contact with the school principal to get permission, ….to ascertain numbers ( not all kids will need assistance) Then approach sponsors … It need not cost much as the kids themselves can provide a bowl and spoon each or do a random collection amongfriends and family for utensils…… I t can be done with a bit of proactive like minded people.

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    Mute Damocles
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    May 18th 2012, 9:44 AM

    You appear to be advocating murder.

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    Mute Darren Englishby
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    May 18th 2012, 11:22 AM

    We are the most unpatriotic people in the world which sickens me we give to foreign bankers , foreign governments yet we let our own starve and our bloody government won’t stand up for us at european level .
    People really need to think next time they vote …… Stand up for Ireland !!!!!

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    Mute Deirdre Bennett
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    May 18th 2012, 9:32 AM

    Is there an Irish Ideas Forum? We have so many brilliant minds in this country. Could we not gather ideas on how we might solve the countries problems. Let the decision makers dip into it to investigate the merits of each. Have a prize for the most successful ones (incentive). I know it would probably end up full of weird random stuff as well but couldn’t hurt.

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    Mute Marc Mac Eo
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    May 18th 2012, 10:24 AM

    aye, i almost am, i almost am.

    self-preservation has been noted throughout history to be an amazing motivator for even the most base amongst us to consider the repercussions of their actions, however indirect, and to correct their actions accordingly.

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    Mute raymelody
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    May 18th 2012, 10:30 AM

    At least stanislous Kennedy is showing us the real face of this austerity and asking a question the government just swan around from company to company saying look another 20jobs we are turning a corner while they kill the vital quangos like cba and leave the fat cat ones for their buddies to pillage

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    Mute John Conniffe
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    May 18th 2012, 12:41 PM

    Hmmm. Bring up poverty, a very real issue. Cue the fingerprinting. There’s a problem, but you can be sure to find a “them” to blame; so far we’ve had the church, the government, the Roma, undefined fat cats, African nations and Charity administrators. I’m not saying there isn’t some truth to these, but it smacks of a knee-jerk reaction. There’s a law of finishing returns on this website; the more comments, the less factual argument and realistic options.

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    Mute The Burning bush
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    May 18th 2012, 1:54 PM

    See your point but what more can you expect from people who find themselves at the receiving end of what is the greatest mismanagement of funds and/or resources in the history of the state. People are pissed off and comments here and nearly everywhere else on the net reflect that fact.

    Rage at times can be a rather difficult variable to manage when one endeavors to communicate how they feel about the complete and utter lunacy of what has and continues to take place. The system has consciously left hundreds of thousands in a deep dark hole and expressions coming from such a place are not often moderate.

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    Mute The Burning bush
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    May 18th 2012, 1:55 PM

    …..or constructive.

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    Mute John Conniffe
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    May 19th 2012, 2:09 AM

    @ burning bush – I get what you’re saying, I agree. Or rather, I did. But there’s a fair few people who seem to have made a fetish out of outrage. Righteous anger is valid, but a constant stream of bile and negativity from the same people, day after day, month after month, at best it’s a journey from anger to bitterness, which is unhealthy. At worst it’s simply fake. I don’t believe it’s honest. Sorry.

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    Mute Alan Rouge
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    May 18th 2012, 6:15 PM

    “It is imperative that the Government tells us what it is doing – and what it intends doing – to protect the vulnerable and poor against austerity measures.”

    The austerity measures are directed at “the vulnerable and poor”. Anyone who is dispossessed of their own private resources is in a sense vulnerable and thus dependent. We are dependent on each another for all sorts of reasons not least for maintaining human life but also for a degree of dignity and civilty hence the point of a welfare state which is being dismantled at the behest of vulturous bankers and those who command an incredible amount of wealth and resources.

    Govt. are well aware of this.

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    Mute raymelody
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    May 18th 2012, 6:55 PM

    I didn’t see any of this on the rte news like other journal articles this one wouldn’t suit the government at this time the real face of austerity could cost them and rte knows what side their bread is buttered

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    Mute Mark John O'Reardon
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    May 18th 2012, 3:20 PM

    Can Somebody Please Tell Me How People, anywhere in the world, become Poor?? Is that not the real issue here?

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    Mute William John Hannan
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    May 18th 2012, 11:11 PM

    Shall set up a Charity called SOS Ireland!

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    Mute InkTonicMelvin
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    May 18th 2012, 2:23 PM

    Food waste Smithfield Dublin not far from Capuchin Monks on Bow St. http://www.totalproduce.com http://www.flickr.com/photos/inktonic/7221258954/in/photostream

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    Mute mrnobody
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    May 18th 2012, 3:22 PM

    I read a comment here the other day which turned out to be fairly accurate… It said 7euros out of 10 goes on wages in the public sector. Maybe if we had the facilities, we could get the less fortunate back on their feet again.

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