DEAR MADAM - I came to Fermanagh in 1991 when I was 37 years old and I found work as a GP and made my home here.

I was a GP in practice for 13 years in Enniskillen and latterly have worked in Palliative Care for 10 years where you might say my heart is! (Both in Tyrone and Fermanagh and in the Republic).

When I started out as a doctor 36 years ago there was no talk of palliative and end of life care.

I emigrated after qualifying as a doctor from Dublin to London and found work in a hospice in Hackney - St. Joseph’s Hospice.

I heard that a woman called Cecily Saunders had worked there and had gone on to start her own hospice, St. Christopher’s, and I went to interview her for a magazine that I was involved with at the time. She looked very old to me then (a colleague who worked with her said she was in her prime!) She did the interview and served me coffee in a polystyrene cup. As we washed up the two cups she looked at me and said, “You think it odd that we would drink out of polystyrene cups - but money is hard to come by!” Now I think Dr. Saunders knew about that, as she used her own money to get St. Christopher’s up and running.

When I started in Fermanagh in 1991 there was no palliative care service, no Consultant and no Palliative Care Unit in Omagh.

I can promise you I was well aware of the fact. Maybe I am a particularly sensitive soul but I recall the conversations I have had with the dying like no other conversations I have had. What I now understand is that one professional cannot do for the sick and dying what a collective of trained and caring professionals can do. There is no simpler way to express it. You need a dedicated team and by that I mean dedicated specifically to the palliative care needs of the sick and the dying.

To maintain the skills and to transfer them on to the next generation of doctors and nurses you need a place where palliative and end of life care is concentrated. If this were not true we would have developed the skills without hospices and palliative care units years ago. The facts of the matter are without “the concentrate” the skills become diluted and then they go!

I support hospices and palliative care units because they remind us what our best can be. Our professional hearts which get burned out and weary with too much exposure to stress and distress get a new lease of life.

They come at a cost. I have no illusions. They cost in money and in commitment.

We are living now in times where we have to make savings.

I am fearful that changes proposed to the status of the palliative care unit in Omagh are a retrograde step.

Let me remind us all of the reality of the situation.

There is a hospice in Derry, a palliative care unit in Antrim, two hospices in Belfast, one in Newry.

The Tyrone County Hospital has for five years (!) had a palliative care unit on Ward 5 (TCH) and it is now proposed to amalgamate it with the Rehabilitation Unit (involving a physical move from one purpose built ward currently used for palliative and end of life care).

How would Belfast, Derry, Newry or Antrim feel if their hospice was to be amalgamated with another facility?

Don’t tell me that when the going gets tough we start to deny reality and pretend there is not a need. The landscape is not the same out there as it was when I came to Fermanagh in 1991.

I have a short period left on my medical clock, I will be 60 soon. I have interviewed over 150,000 patients over my lifetime. What I know is that maintaining solidarity with the sick also means having the institutions that safeguard what is a vulnerable group of people who cannot speak on their own behalf.

I repeat; it is a backward step to dilute the presence of a dedicated palliative unit in Tyrone and Fermanagh and I base this on my 36 years both as a GP and as a palliative care doctor.

Yours faithfully, DR. RACHEL LONG Rigg Road, Enniskillen, Co. Fermanagh