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'Country Practice'

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'The Photographer`s Story'

Barry Lewis photographed Dr Arthur Mitchell, in practice in Kilkeel, County Down, and the doctors of Willowbank Surgery, Keady, Armagh.

"I photographed two country practices in northern Ireland. Both were small communities where doctors and patients knew each other well. I stayed in the doctors' homes and was introduced to patients as a friend.

"The doctors are incredibly busy. In Keady, they have open surgery each morning, with packed waiting rooms. At lunchtime they have a bit of toast and see the drug company representatives. They give their spiel while the doctors are signing prescriptions and taking calls from patients. Then the doctors rush off to home visits. From 2.30, it's surgery again until 6.00.

"Until a few years ago doctors in one-person practices had no life of their own. People could be knocking on the door 24 hours a day, seven days a week. Now, doctors are working together to avoid the pressure on their own families. At Keady they have a co-operative system to share call-outs at night and at weekends, which works brilliantly.

"Until the mid-60s, all the doctors were involved with 'birthing', at the cottage hospital. They really miss that, now it's done in the general hospital. They say that when you're there at the birth, you have that patient for life.

"The family continuity for them is being there at the death, and sharing the grieving process. The doctors are almost the secular equivalent of the priests. In Keady, the doctors are mainly Protestant and 95 per cent of patients are Catholic. But it's non-sectarian. It's always been people first.

"They've got to be able to listen to what the patient has to say. Older people especially will come in and talk about anything but what's bothering them. The doctor has to be able to listen between the lines."

Life expectancy at birth is 75 for a male born in East Anglia, but 73 for those born in Merseyside.

Rural parts of Britain have the lowest proportion of babies born underweight (a risk factor for health) but one of the highest rates of death from injury and poisoning. Rural areas have higher suicides than other parts of the country.

The UK shows significant regional variations in health. On average, the heaviest smokers are in Scotland and Northern Ireland. Hearing difficulties are most prevalent in the North East and Wales. Lung cancer registration rates are highest in Scotland and lowest in the South West.

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