“Stronger Together” the motto of Pacific Rugby Players Welfare, one that aptly ties in with the sentiment behind the World Rugby statement that the “sport is built upon the principles of camaraderie, fair play, respect and teamwork.”
Rugby is undeniably the epitome of a true team game with every club or team enveloped by a network of volunteers, employees, players and supporters. The spirit of rugby is seen in the bonds not just between team mates but in the friendships and relationships created in the rugby community. For players from the Pacific Islands the communal spirit of the game replicates the emphasis on community which is paramount in their culture. These are men and women for whom community and family are the team to whom they will always belong.
With the globalisation of the game Pacific Islanders have, in particular, been drawn to the lucrative opportunities of professional and semi-professional contracts which have taken them away from their communities and placed them in every conceivable corner of the world. With the increases in the number of Pacific Islanders embarking on professional contracts in Europe the Pacific Rugby Players Welfare (“PRPW”) was established to provide a support network for these players and to speak out on behalf of the players who, despite appearances, are often slow to push their own agenda or admit they are struggling away from home.
Daniel Leo, former Samoan international and CEO of PRPW, similar to his own performances on the field is certainly not shying away from the issues and is very candid in detailing some of the inherent difficulties which players from the region experience when they find themselves separated from family, friends and the communal lifestyle. He admits the societal problems rife in Fiji, Tonga and Samoa, such as the worryingly high instances of alcohol abuse and domestic violence, follow players across the globe and it would be “naïve to believe they weren’t echoed in the rugby community”. Faced with isolation in a foreign country and the pressure of often financially supporting family, friends and indeed entire communities at home players are often under immense pressure, unbeknownst to teammates and coaches. PRPW aims to connect these players and to provide them with that sense of community which is integral to their home environment.
Isolation is a huge issue for the players PRPW supports and their often imposing physiques can often conceal the difficulties being face when thrust into the limelight of the professional game with the additional responsibilities of supporting family at home without their support in your everyday life owing to distance. In a dressing room situation team mates can be unaware of the fact that whilst appearing to be on lucrative deals a player may in fact be sending the vast majority of his earnings home. The reality is that a player under such strains is unlikely to speak up about injuries, particularly head injuries, if it may impact their ability to provide for their families and communities.
When it comes the issue of head injuries and concussion Leo is equally direct, another trait that replicates his on-field career, “the writing is on the wall about concussion”. The information is out there for those of us in the developed world, and in particular Europe, to read, see and hear. There can be no denying concussion is a problem in the game but whilst Pacific Island players are exposed to this information when they arrive on our shores it is often the first time they are fully aware of the level of potential risks. When it comes to concussion awareness and the general attitude to head injuries in the Pacific Islands Leo gives the example of Samoa where there are few, if any, specialists with most doctors being general practitioners. There is little medical presence at games. Leo reminds me that the Pacific Islands are third world countries where resources are limited and certainly there is an information deficit in terms of players full comprehension of the impact of head injuries.
For many rugby is the opportunity to provide not only for themselves and their families but for their community en masse and players will not risk losing a potential professional contract through injury, although perhaps if better educated as to the risks they may be taking in failing to do so this would differ. Leo points not only to the lack of education on the possible ramifications of head injuries but to the way in which the game is viewed particularly in the Pacific Island region. The sport is often not equated with the skill of finding space, which many now associate with the expansive play of the New Zealand teams, but moreso with the “confrontation” and the “war” which takes place on the field of play. This culture is changing with time but it is still apparent in the game and he himself recalls a game in his youth where despite an average overall performance in the game a “big hit” rendering another player practically unconscious was worthy of praise. For a culture where status was confirmed through displays of bravery and strength it is easy to see why the brute force and physical prowess required by rugby is a popular choice. Leo humbly suggests that he was not the most skilful of players but “I knew my aggression would get me through”, those of us who watched his performances would no doubt quickly disagree with that summary as a very modest underselling of his own talent.
We discuss how rugby will tackle the issue of head injuries and concussions and in particular how it will deal with countries, such as the Pacific Islands, where the wealth of resources and supports are not as readily available as in other rugby playing nations and the answer clearly lies in education. Players, Leo says, must be educated not just to ramifications of head injuries but also down to the fundamental aspects of learning how to tackle correctly from the outset. He welcomes the changes in the laws of the game but agrees with my contention that rule changes are only as good as their enforcement.
For PRPW the two main focuses are on replicating the communities players are accustomed to in their new homes and to seeking to have some form of regulation of agents introduced to ensure that when players are making the move abroad their interests are safeguarded from the outset. Through a series of educational initiatives with Pacific Island Players PRPW is striving to prepare players for their life in Europe from the cultural changes to the day to day financial and other considerations they need to adapt to.
Where players like Daniel Leo have made the hard yards in building lives for themselves in Europe as the number of Pacific Island Players in Europe and further afield continues to grow the work of PRPW takes on further significance and players, such as Charles Piutau, Manu Tuilagi and Sene Naoupu, to name but a few, are adding themselves to the drive to put player welfare issues to the fore whilst giving even more back to their communities.
John Donne’s poem opens with the statement “No man is an island entire of itself, every man is a piece of the continent, a part of the main” and that line rings even truer for the Pacific Island Players, separated from their communities, isolated from friends and family rugby becomes the epicentre of their world and their new community, their home away from home, becomes centred in the sport of rugby. In supporting player welfare in every aspect, both on and off the field, the game continues to grow and the community bonds which are built are strengthened. As the game grows it is of paramount importance that rugby does not lose that community which it has always built around it or forget that players are people first and athletes second, PRPW is ensuring that for Pacific Island players they are not just stronger together but continuing to get even stronger.
BY Iseult Cody, a collaboration with Dan Leo, CEO of PRPW
A Parental Diagnosis
“Frustrating” and “lamentable” not two words I expected to hear used to describe his son’s experiences with head injuries but as I spoke with Dr Richard Cudmore I continued to be surprised with how he spoke about rugby and head injuries not with the clinical matter-of-factness one would expect of a medical professional but with equal passion and enthusiasm for the game and player welfare. No matter what age your child is there is never a time when you will not watch them with the same concern for their safety, the same apprehension when they hit the ground and the same lump in your throat when they see them injured. It doesn’t matter if you are a doctor or not you are a parent first and foremost.
Dr Cudmore has the unenviable advantage of having watched his son’s return to the field of play in the 2015 Champions Cup semi-final against Saracens in Twickenham through the eyes of not only a concerned parent but a medical practitioner particularly au fait with head injuries. He watched with “surprise” as his son returned to the field of play still displaying the tell-tale signs of a disorientated and concussed player. Whilst Jamie would continue to play professionally following a difficult rehabilitation with little support from his club his playing career was undoubtedly shortened by the incident. Dr Cudmore would see his youngest son Luke’s rugby career also cut short by injury. Despite all of the reasons to justifiably have a gripe with rugby he is remarkably pragmatic and undeniably still a rugby fan, he himself being a former player it wouldn’t take a detective to figure out where his sons’ love of rugby was cultivated.
In Europe head injuries and concussion are growing topics of discussion, taking on greater significance with the additional worldwide coverage of games and with the increased knowledge emanating, by in large, from the states. In Northern America head injuries, concussion and CTE have “blown up”, to quote Dr Cudmore, in the last few years. NFL and NHL in particular have become sports where head injuries are now becoming as topical as the games themselves. The term “CTE” no longer requires explanation, if you have even the slightest interest in contact sports you know about concussion, you may not know enough to fully appreciate the risks or what is at stake but you still know concussion is a risk.
Dr Cudmore has noticed the significant increase in the number of reported concussion related injuries in recent years in his own practice and goes so far as to note in the last two years he has probably treated more patients for such injuries than he had in the previous twenty. He is not suggesting that concussion is a recent phenomenon of course, far from it, but the knock on effect (pardon the pun) of great knowledge is increased diagnosis. Concussions have always happens in contact sports and indeed outside the field of play in day to day life however as people learn more about the risks and symptoms they present more regularly and are diagnosed.
Undoubtedly with greater knowledge comes greater responsibility, as the risks become more apparent the onus is on those involved in all contact sports to take the appropriate action to safeguard player welfare. This is admittedly a moving feat, as the research emerges and evolves so too must the treatment, the tests, the precautions. Dr Cudmore is somewhat pragmatic about the situation and acknowledges that World Rugby are working within the accepted parameters, the SCAT5 being the acknowledged most up to date recognition tool for concussion, but that being said he agrees with my contention that rules are only as good as their enforcement. Using the available research to put in place the accepted best practices is the first step but ensuring their consistent and universal application is the equally important next part of the process.
When we discuss the diagnostic tools available to medics during the course of a game Dr Cudmore is quick to point out that diagnosis is a clinical judgment, a medic makes the judgment call based on the symptoms a player is displaying and there are the tell-tale “red flags”, such as vomiting, which would serve as further clear indications that a player should not return to the field. Dr Cudmore recalls his surprise at seeing Jamie returning to the field in Twickenham given how he had appeared when leaving the field but it would be after the game that he would find out in the intervening period off the field Jamie had been vomiting. There weren’t just red flags waving in the changing room as the decision was made to put Jamie back on the field, there were fireworks going off!
He reminds me that concussion is too often associated with a blow to the head with the attitude being that if there isn’t head contact a player couldn’t be concussed. The opposite is true however, a player can be concussed without any impact to the head and that is where it is key for players, coaches and medics to be live to the visual cues. In the professional game the hits get harder, the players get bigger but the risk doesn’t diminish, in fact it grows. The brain doesn’t learn to protect itself any better than it could 20 years ago but the tools for recognising the symptoms are better. The potential to educate players how to minimise risks through education not only on injury management but on risk prevention. Prevention is always better than the cure, even if it may cut down on a doctors’ workload.
The phrase “recognise and remove” is to the fore of the World Rugby’s concussion guidelines. Three simple words that, if adhered to, can make all the difference. You see a player displaying any of the signs of concussion and you remove him or her from the field, end of story. The reality is that players will not always instantly display the symptoms of concussion and this is where the HIA protocols come into effect but this is the only time they should be used, when there is a need to ask the question. Dr Cudmore assets that we should always “err on the side of caution” when it comes to concussion and where there is any doubt get the player off the field.
The overriding theme of our discussion isn’t one of attributing blame or looking to change the game but to improve how the game of rugby reacts to increased knowledge and research, to injuries as they happen and to players in their rehabilitation. Clubs need to take a compassionate approach to player recover. Head injuries will happen, they are inevitable in sports and eradicating the risk isn’t a possibility or Dr Cudmore reminds me of the most important consideration in concussion management, that there can’t be a “cookie-cutter approach”, no two brains are the same, no two players will recover identically or at the same rate of progress.
The take home message from him is clear, whatever the procedures and protocols we put in place they must follow evidence based research. He cites the lack of proper awareness of the risks and signs of concussion in the “trenches” of the game as of particular concern and it is only on reflection that the aptness of his turn of phrase fully strikes me, trenches conjures up images of a war being fought and for those of us who love the game of rugby the fight to ensure the highest standards are met to protect our players is well and truly underway with the cost of not pursuing that fight too high to risk.
- Iseult Cody, 2017
Collision coach isn’t exactly the job title one would expect of someone whose career was brought to an end as a result of concussion. It would be akin to a stunt man deciding to retire and take up BASE jumping as a relaxing pastime. Then again they say reformed addicts make the best counsellors and on that logic who would be better placed to teach players how to take a hit than a man who knows the perils of the game. It was in that capacity, of collision coach, that Bernard Jackman would return to the professional game with Grenoble in France.
When the final whistle blew on Bernard Jackman’s professional playing career it would have been easy for him to walk away from the game but the title of his autobiography, Blue Blood, says it all, Bernard is a rugby man through and through. Speaking to Bernard about concussion, and indeed about rugby in general, his love and enthusiasm for the game is evident in every word. He knows what it is like to be a player at club, provincial and international level and to be a coach at school boys, club and elite level. He has seen both sides, he knows the risks and he knows the rewards.
Bernard retired at a time when concussions in rugby weren’t topical, they happened but people didn’t delve further into the issue but Bernard, understandably, wanted to delve deeper. It lead him to the NFL and the beginning of murmurings there of the long term effects of taking constant hits to the head, of changed men physically and mentally, of CTE. These were consequences no one thought about for contact sports, they may spring to mind for boxing but not others.
Asking Bernard about his own retirement I expect some level of bitterness or maybe perhaps regret that a game he loved had been ended so cruelly by injury. Bernard spent his career in the front row, taking and making the big hits, pressing forward with his head into the waiting shoulder of an opponent in the scrum, before the days when scrums had been “modified” with player welfare in mind. Is it little wonder a career of colliding ended in this manner. Despite my expectation Bernard is pragmatic in his recollection of his retirement. He didn’t pursue an insurance claim citing the “stigma” which, at the time, he felt would have been there if he had done so, the perception being that you were somehow “pulling a fast one”. When I liken head injuries to being the “new mental illness”, and by that I explain it is the condition no one wants to talk about, no one wants to admit to, an attitude of if you can’t see it then it doesn’t exist he agrees. “When you’ve your arm in a sling you don’t feel guilty on the sidelines”. He compares the open acknowledgment of being concussed, of needing to sit out a game or games because of concussion to showing weakness, we both know this is not the case but it is easy to see how a player could have that impression. The fear of being an “outcast” for a man or woman whose life revolves around a team game can be crippling and can breed a culture of mafiosa like omerta when it comes to concussion.
Our discussion moves to Jamie Cudmore and his pending litigation against ASM Clermont Auvergne. Bernard praises Jamie’s “bravery”, it isn’t easy speaking out especially when you continue to be actively involved in the game, with Jamie this being as a professional player initially and now as a coach. Bernard points to this as adding credence to Jamie’s claim and I readily agree. Here is a man who loves rugby. Similar to Bernard he has taken the hits, made the tackles all for the love of the game, pride in the many jerseys and enjoyment of others and he has been injured in doing so. Again, akin to Bernard, he has not walked away from the game in fact mirroring Bernard’s own retirement he has embraced a coaching career and no doubt will be consciously making an effort to ensure history does not repeat itself with his own crop of players.
Bernard became an ambassador for Acquired Brain Injury Ireland and has been vocal in his calls for reform in the game, for the need to be cognisant of head injuries. He admits his own failings as a player, his attempts and successes at “beating the system” when (under the former rules) a low enough base line score at the start of a season would allow you to pass tests. He would “buy time” in which to recompose himself and be able to pass a test somewhat re-orientated and return to or inevitably stay on the field. The effects of concussion being initially only momentary like the blows which caused them. It was after the games when the adrenaline went and team mates were alongside you, fans cheering, coaches yelling instructions, when you had the time to catch your breath and think about it that you noticed you may not be as quick to run into the next tackle in training or to recall the call. I acknowledge my appreciation of the fact players will always want to play, if that wasn’t in their mentality then they wouldn’t be the elite. They need that edge, that grit, that determined resilience otherwise but someone needs to call time, someone needs to take it out of their hands surely and Bernard agrees. Towards the end of his own career he knew he “couldn’t keep taking the hits” constantly and whilst in games, presumably with adrenaline racing and a game mentality firmly in place he would never shy away from any tackle, he knew in training how to better position himself in a scrum or how to tackle to minimise the impact to his head. He knew something was wrong and the sense of self-preservation was kicking in.
I recalled a podcast some years ago when in the wake of a Top 14 player Florian Flitz returning to the field bloodied and concussed Bernard, in almost exasperated tones, calling for the end to the farcical use of a “head bin”. He called for independent doctors to take the lead whilst opining that the French player union, which was a force to be reckoned with in itself, may strike if the matter wasn’t dealt with. At the time listening to his interview my own instant thoughts were that with the French love of a strike it wasn’t beyond the realms of possibility. Needless to say no such strike ever materialised.
I pose the question what, if anything, has changed in Top 14 during Bernard’s time coaching. He points to Jamie’s litigation as somewhat of a turning point with the publicity it drew resulting in all Top 14 medics being summoned by La Ligue Nationale de Rugby (“LNR”) to reinforce the message that protocols needed to be adhered to. Bernard reports he was fortunate at Grenoble to have a young and, as he puts it “eagle eyed” doctor and medical team who were proactive in their approach resulting in training sessions being interrupted by the ebb and flow of players on and off the field for HIAs. He admits this may be partly attributable to youthful exuberance or fear of risking the wrath of the LNR where doctors longer in the tooth may not be so quick to change the practices and habits of a lifetime. Bernard certainly isn’t backward about coming forward, to use an appropriately Irish phase, and knows that doctors will look the other way and decisions can sway on the day when a player in needed on the field, when a coach is calling for his return, when the player insists he is fit to return. Doctors differ and patients die may be too stark a comment but perhaps it is the most appropriate.
What would he do if he was in charge? His answer is simple, he would “take it out of players’ hands”, when I throw in (a very apt analogy when referring to anything dealing with a man who spent his like as a hooker) the suggestion of the blue card system being trialled in New Zealand, Australia and South Africa he is particularly receptive to the idea. He maligns the fact that World Rugby “don’t have a proper handle” on the issue.
As I enquire as to the difference in attitudes to head injury at elite level between Ireland and France Bernard points to the IRFU central contraction of all at provincial level as a cause in the disparity of treatment. He explains that in Ireland if the Irish management are attending a provincial game, which they invariably are, and see a player with a suspected head injury remain on the field they will understandably be on a collision course of their own with the IRFU who in turn will tackle the issue with the provincial set up. In contrast the league in France is a commercial entity, they are answerable to the Union but rules without enforcement are simply empty words.
When we discuss the recent Lions Tour Bernard has yet to watch the final test owing to his relocation, such is the life of a professional sports coach. He is aware of the incident involving Alun Wynn Jones and I give my untrained musings on it. He will watch the game when schedule permits, I expect he will reach a similar conclusion as mine.
Would he want his own children to play the game? Yes, absolutely with the caveat that as a parent you should be aware of and fully informed of the risks and then make the decision. . He agrees with me that children will emulate what they see at the top, so if they see players at elite level, the Wynn Jones’ of this world, return to the field when some would question the appropriateness of the return that is what they will replicate.
Bernard recently participated in a debate held in the Royal College of Surgeons in Dublin on the subject of head injury. Bernard was joined on the panel by a representative from the IRFU and Dr Bennet Omalu, the man who quite literally brought concussion to the big screen and the main stage in terms of sports issues. Bernard, unsurprisingly, was passionate in his defence of a game he loves and while he clearly respects the immense work of Dr Omalu he disagrees with his overly cautious approach, “he doesn’t let his kids go on a trampoline”. With everything in life there is a risk but without risk there is no reward and the rewards of sports to my mind, and clearly Bernard’s, are worth the chance but what needs to change is the level of risk being taken.
We both agree that the changes need to come from the top and having listened to the enthusiasm and passion with which Bernard speaks about all things rugby, and indeed sports related, I wonder if perhaps he may person to someday be the person ensuring the changes are made. One thing is clear Grenoble’s loss in most definitely the Dragon’s gain and hopefully someday he will return to the emerald isle to write the sequel to Blue Bloods with the Leinster team.
County Dublin, Ireland, Eoghan P. Clear Solicitors