Month: April 2019

Modest Expectations V

The Roman V for five reminded me of this anecdote which some may find trivial and others may see as something more profound.

It was the time when Vic Garland, the then Opposition whip, was giving the second reading speech in reply to the legislation on the Australia Council Bill. Bill Snedden, then the Leader of the Opposition, was to have given the speech but his wife’s unexpected illness precipitated his early departure from the House that day.

It was an impressive speech, and Vic Garland had an equally convincing delivery. However, there are always pitfalls when the speaker, no matter how impressive his diction, has a basic unfamiliarity with the topic. In referencing the costly purchases of Jackson Pollock’s “Blue Poles” and of de Kooning’s “Woman V”, he said “Vee” instead of five. In Hansard it stays correct, and a mispronunciation was a zephyr wisp drifting across a somnolent chamber. Like Vic Garland, a zephyr comes from the West.

Perhaps Vic would have been somewhat surprised that the speech had been written by Jack Hibberd, the playwright of “Dimboola”, and John Timlin, who was the administrator of the Melbourne based anarchic Australian Performing Group with their outlet the Pram Factory in Carlton. Snedden had read the speech and given it the “thumbs up”. He did not care how either of them had voted. He just agreed with the sentiments in the speech.

Vic might also have been somewhat surprised had he known who the authors were. The words that Vic uttered inter alia may have been seen to be somewhat radical:

I have pointed out that less than 5 per cent of ACA funds have been directed to community arts by the Whitlam Government – a so-called populist crew which rows its fiscal boat to the already well-endowed shores of those few cultural monoliths who have for years fed well on the subsidy cake.

And further on: “To spread available funds widely through the community seems now to be a shared aim of both the Government and the Opposition. A basic requisite then is close consultation with the State directors since these are the people closest in touch with regional local groups. We reject totally the notion that the Council should consist of itinerant and possibly ignorant friends of whatever government happens to be in power.

All parties want our culture preserved and developed. We wish to see diversity of the culture maintained. We wish to see Aboriginal cultural efforts expanded without destroying the intrinsic requirements and tenets of that culture.”

 Vic had delivered it well apart from the “Vee”. Hibberd and Timlin, watching on, may have shuddered but in the long term what did it matter? In any event, a month later, Snedden was gone.

Trying to establish policy where the aim is to seek views from all sides of the political spectrum is a tough task, and you lay yourself open to yon Cassius. After all, being the centre should be purple – the place where blue and red mix.

I remember well the judgment by the Coalition backbencher of the Snedden staffer who was seen talking to the young Charlie Perkins around a campfire outside Parliament. “Who is that bloody communist working for Snedden?” Talking to Charlie Perkins. Shock … horror.

Trolls always have difficulty with the concept that my adversary may only be as close as my policy neighbour. Their angst, alienation and ethnic hatred is a bar to anything.

Later Snedden would be a good friend of the Pram Factory in assisting its survival. He was very loyal.

The Triennial Comedy Festival

It is strange that when there is a national election, I always think what would it be like if Australia were a Republic. I am a republican, and have been since I was very young. Even though I had a privileged Anglican education, it was always my Irish roots that called me to the Republican cause. I was comforted by the fact that the early great Irish revolutionaries like Robert Emmet and Wolf Tone were Church of Ireland and not Roman Catholic.

I may say I am “committed” but I never joined the Turnbull caravan nor the current Red Bandana Brigade. One reason is that with Elizabeth on the British throne, it is an exercise in futility.

For no reason other than most of the population have known no other monarch and she is such a closed, controlled individual – a metaphor for a colonial lounge room, comfortable, cream coloured walls with flashes of colour in the curtains. The flashes of colour signal how good the British Royals are at pomp. However at the same time, monarchy is a symbol of nostalgic stagnation glossed over as “certainty” – and who expects her to die?

Yet there is a second reason for going easy on my republican stance and that is the Australian election cycle.

The current Australian election campaigns are run as if they are Presidential, but only in style. Presidential substance, however, comes against constitutional barriers, which are impossible to avoid.

We have to ride the carousel every three years to elect a new government. The community finds it hard to keep up the interest at the best of times when elections are so frequent, hence the media attention on the bizarre array of peripheral political buskers.

However, if we removed all the trappings of a foreign monarchy, most politicians would be comfortable with a system where the end point would be “me” as President. Australians would now have a flexible “Republican” constitution, the Presidential hand would be on patronage, the bizarre fringe would be in the government or in an asylum depending on Presidential whim, and I nearly forgot: “pesky” elections would be held once every ten years.

Currently the autocratic President is the fashionable model, a person who alters the constitution to remain in power with a series of coercive institutions to maintain that power. Trump yearns for this power; democracy is a hindrance. When one looks back on the Trump legacy, the end point will have led to the destruction of trust and paralysis in rational policy formation. Government decision-making becomes a game of dice for the rent seekers and mercantilists.

Now if we got rid of Elizabeth, then elections could become real American vaudeville. Roll up, roll up and see the Screaming Circus Strong Man. We sober people are shocked; we avert our eyes from this grease-painted figure.

However, this behaviour does not seem to affect his following any more than stage performers shed their audience. That is a republic!

Trump has an audience. It is only that Trump has an unusual spiel for a politician – he insults and his audience squeal with delight. It is a well known trick of the comic. However, remember, beware the mob that in the end invariably pulls down the figure that it has created.

Maybe our election campaigns freed from our Constitution would become festivals of the absurd – after all, the Italians have Beppe Grillo, a comic who is the eminence grise of the Five Star Movement in Italy; the Ukrainians have just elected a comic, Volodymyr Zelenskiy, as President for the next five years.

Of course nothing like this would happen in Australia, proclaimed the Best Country in the World. Our politicians are serious people. They are not comics; desist, you with your hand on the voting paper, desist from saying anything. Let us not have cheap irony; and anyway the “word” is comical.

So let the republican idea lie for the present.

In three years time when this campaign is all repeated and when the climate is teetering on the edge of the irreversible, when rent seekers and short-term carpet baggers seem to have retained their ascendency, it is only a hope that the electorate as a whole will have at last awakened – listening to the sounds of our descendants, pawns sizzling on the barbecue of climate change. Hopefully Australia would have stopped drawing the Joker from the pack of policy options!

Then in six years, there will be only two words on the election campaign trail – “Water” and “Climate “. Nevertheless, all may not have changed. Hannah Gadsby may be leading the new Social Democrats. Then we can think of a Republic – when it is a necessity.

A magnificent obsession

Tim Fischer is a great Australian. When he looks at you, you feel as though he is peeling away the layers of crap that you pick up in a lifetime of being in the System and seeing whether there is something underneath. He speaks in his own unique argot, but he does not need a translator. You know perfectly well what he is about.

Sir John Monash

One of his obsessions over at least the past decade is Sir John Monash posthumously being raised to the rank of Field Marshal. Many have attributed this not happening in his lifetime to the fact that he was Jewish at a time when being Jewish excluded you from such institutions as the Melbourne Club and when the Roman Catholic Good Friday liturgy made mention of “perfidious Jews”. In fact Monash had been sent to Scotch College over Melbourne Grammar School because Scotch taught Hebrew.

Another reason was that Monash was “militia” and not “regular army”. After all, “the traditional” Haig insisted on sending the cavalry in to the last stages of the War, notwithstanding that Monash the engineer, because of his technical superiority, had virtually won the War already.

Monash was loved by his troops; to him one Australian casualty was one too many – and in the final offensive which defeated the German army, some of the feats performed by Australian soldiers were extraordinary – frighteningly murderous to Germans in their own way but building upon the stuff of the Australian legend.

I know that Tim Fischer wanted to see the posthumous award of Field Marshal in 2018. He asked Turnbull and Turnbull, as was his wont, deferred the request to the armed forces hierarchy. They said no; Turnbull said “no”.

Fortunately, Bill Shorten was a proponent of recognising Monash. All the obfuscation about not doing so is at the feet of academics and of course Brendan Nelson. Chattering about precedent, one hears the voices: “You know, he never commanded enough men to be a field-marshal; he was only a lieutenant general at the outset of the final campaign” – and on it goes.

The Digger, emerging from the shadows of war, can be heard saying: Mate, he won the War. Don’t give me this stuff about a posthumous award being a dangerous precedent for others to be promoted after they have died. There was only one Monash.

And by the way, there is only one Tim Fischer.

Mouse Whisper

“No matter how rational, logical and ingenious Monash was, there was nowhere to escape the insanity of war. “

Roland Perry the author of these words is a remarkable wordsmith – first published in 1979; 7th book 1994; 17th book 2007; 28th book 2014.

Modest Expectations Fore

Golf puzzles me. However, I do enjoy fluttering around the Masters Golf Course in Augusta on the YouTube bird. A floral pilgrim arboretum with quaint names like Amen Corner and Flowering Crab apple; kaolin coloured bunkers; water courses and ponds interwoven with trees and bushes which seemed to be groomed rather than planted. The spring flowering dogwood, azaleas and magnolias provide a regimented colouration – red, pink yellow and white. The annual Master’s tournament is testimony to that Brownian movement which is America. The winner this year – an epithet for Trumpian America – tiger woods.

In contrast, every time I pass the Rosebery golf course on the West coast of Tasmania, against the mountainside away from the local zinc mine there are abundant green fairways dotted with a mixture of exotic and native trees – just varieties of green. Perfectly groomed but lacking bunkers. Never have I seen anybody playing golf there – not even a Tasmanian devil stirring – it seems a golfing Marie Celeste -an epithet for Canberra at election time.

Lessons from the Memorial Sloan-Kettering Malfeasance

The whole political spectrum is awash with promises of funding for cancer but it is nigh impossible to predict the expected outcome from the actual outcome. The ALP seems to want to provide money for patients whereas the commitment on the Coalition side seems to favour research.

Except for certain localised cancers, mainly of the skin, the cancer patient become a statistic in the survival rate – in other words the cancer patient always hopes to be at the far end of the survival curve. Increased research funding is equated to increased survival.

The current Australian election campaign is awash with promises to tackle cancer. The time-honoured political response is to promise more money for research – however it is dressed up. Politicians have always seen cancer funding as a vote winner – they can provide funding without strings and bask in the immediate kudos.

Therefore, the recent Memorial Sloan Kettering Institute disclosure is something to make everyone pause. This institute is prestigious, shorthand for “above reproach”. I have actually visited this sprawling but unremarkable bastion of cancer treatment and research on the East Side of Manhattan.

The New York Times has been progressively reporting what one may describe as “malfeasance” – corruption seeping through the upper echelons of the Institute.

The heart of the matter as reported by the NYT is that fact that “scrutiny of researchers’ stakes in start-ups has intensified at a time when venture capitalists are betting millions of dollars on the next potential cure for cancer and when expensive treatments like immunotherapy have fueled public concern over rising drug prices.”

As reported in the NYT, a review, conducted by the law firm Debevoise & Plimpton presented a week or so ago concluded: “that officials frequently violated or skirted their own policies; that hospital leaders’ ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies”.

There has been a great amount of public soul searching, but it seems that despite the list of questionable activities at the Institute most if not all those with fingers in pie have survived and the cosmetic changes and promises to do better have not been matched by deeds. The excuse is that culture change takes time, but when the direction of research becomes a branch of a hedge fund, then in the long term the effect is that of a “warm lettuce leaf” sanction.

However, when the scandal emerges in a leading institution in USA, it is reasonable to assume it is not an isolated example. The problem is that anything to do with health is now a business and health is just one commodity on the sprawling profit and loss sheet. Aiming to save lives in the most effective manner – an incidental – is met with guffaws by this coterie. So let the policy makers shed the faux Pollyanna approach to research funding, knowing how difficult it is to remove emotion from any decisions – hence this is an area where any policy makers worth their salt should follow the money trail – and hopefully not end up finding a Memorial Sloane Kettering Institute at the end of the trail.

Howard Florey, our greatest Australian, the man who gave penicillin to the world would have shaken his head in disbelief. He never benefited from the discovery; never made a buck out of a drug which saved millions of lives but ironically changed the fortunes of the pharmaceutical companies who picked up the patent.

After all, infectious diseases were the cancer equivalent of the day. Lest we forget. 

The Out-of-Pocket Expenses

Cancer is multifactorial; it is an expression of everyone’s mortality.

We, the patients have to bear the brunt; and given the mortality surrounding cancer that brunt is so often deadly.

Pancreatic cancer in particular has a five-year survival rate of 7-8 per cent; and that is survival not quality of life.

Some unfortunate people get multiple cancers – just not metastatic spread. Many cancers are terminal. Treatment is surgical, radiation, or chemotherapy – cut, irradiate, poison. There is nothing pleasant about cancer; and if you emerge from this experience and are presented with a huge bill then it adds to the unpleasantness.

One approach to alleviating the burden of cancer is to improve the funding of the actual care, and that seems to be at the heart of Shorten’s stance. Minimise or eliminate the out-of-pocket expenses. However, apart from waving a few figures around, the implementation is just that – short on detail.

There are number of matters which need to be balanced – the Medicare benefit the government is prepared to pay and the fee the doctors charge. The figure of $150 has been mentioned as some extra payment. What does that mean?

Inevitably as one grows older, one is faced with the prospect of surgery. As a privately insured patient, I always ask what will the whole business arrangement known as “operation” cost.

What is the price? How much will that vary from (a) the MBS benefit (b) the amount guaranteed by my level of health insurance? The surgeon is responsible for the whole episode including post-operative management no matter to whom he or she may delegate it.

There is the anaesthetist – the person who suddenly appears before the operation at the behest of the surgeon. Since the surgeon hires the anaesthetist, it is reasonable for his or her price to be disclosed.

Then there is the surgical assistant – often a supernumerary – but who has to be costed in and someone the patient probably never sees. “Is that person necessary?” is the obvious question.

The same occurs with pathology – the pathologist is rarely seen – and diagnostic imaging, where the patient may see somebody vaguely resembling a radiologist.

Then there is always the matter of complications to be factored in and therefore the total cost before anything else needs to be agreed. The patient should not have to bear all the risks.

Similarly there needs to be a price put on the radiotherapy or chemotherapy, with may occur in association with surgery or independently.

Then there is the unknown – the cost of palliative care. Unless, you the patient are demonstratively terminal, it is not something the average cancer patient wants to think about. But nevertheless it entails a price; dying from cancer is not cheap.

When you buy a house, you don’t buy it room by room. Therefore, for that purchase knowing what you do, what your entitlements are and then negotiating from a solid basis breeds a degree of certainty. If you as the buyer feel this task is all too daunting you get someone you trust with the appropriate knowledge to do it for you.

Buying a property and assuring health are no different in needing a broker than any other commodity.

Now try and translate that into what the political parties are suggesting as health policy. This area is complicated by the current review of the Medicare Benefits Schedule, which has been going along for four years but with an end point in creating a new MBS schedule without putting any value on any of the items. Alice may well be asking where is the tea party.

Yet the ALP has a proposal putting finite values on patient reimbursements and injecting them into health care financing. Pluck a figure from the policy teapot to give to the patient as an added benefit, and the market may absorb that benefit and the price for the service commensurately rises.

The current state of affairs is not the best situation in which this policy initiative is being put forward – private insurers put up their premiums, doctors charge what they believe their services are worth or what they think the market will bear, the central agencies of government hover to squeeze the value of the benefits.

Let us set out a premise. Once diagnosed, cancer treatment in our affluent society should be cost free to all. Having made this statement it is tempting to think that premise too fanciful. However that is the challenge and just throwing a consultation benefit or subsidising one piece of equipment to the exclusion of others does nothing to solve the problem.

It would be useful if the patient could choose a one-year or five year survival package with named participating doctors, health facilities and health insurers who would accept the package based on the mean expected survival. The actual projected expectations should balance out the assumptions underpinning the package. The assumptions should be made clear. Work on the basis that whatever figure, however fair and reasonable will be inevitably wrong; so err on the side of generosity.

This is not fanciful – there are arrangements where surgeons label them selves as “no gap” when linked to particular hospitals with arrangements with health insurance, but it is patchwork – sometimes quite attractive patchwork.

However, it does not absolve government, and when politicians enter funding for cancer, there should be a plan to give the cancer sufferer a non-transferable amount of funding either in a one or five year package according to the expected price of such service – realising that currently MBS benefits provide a de facto floor price – the public hospital provides a guaranteed government funded place. Private hospital insurance premiums and the AMA list of recommended fees provide the other end of the price spectrum. Work between those two limits and determine the fund holder. In the end if information were symmetrical it should be the patient and his or her family, however defined.

The resultant cost accounting exercise should not be beyond the wit of a smart bureaucracy. Absolve oneself from the clutches of the external consultants to do the work. Have a team dedicated to the task – not as happens all the time continually shift the bureaucrats around to destroy any continuity and thus disrupt the timetable.

Do not let the work of this well-intentioned attack on cancer meander for years. Have a very concise timetable – three to six months. There is enough information. It is a matter of distilling the options. Go to it.

Mouse Whisper

Overheard on Big Rat Island:

“Whose idea was it to change the Island’s name? Totally inappropriate! Kerr was not big.”

“But you forget the top hat, mate.”

Modest Expectations Hiru

“This is a serious horse, Mary Lou!”

These slightly reproachful words were uttered by a Spanish dressage instructor on a property west of Theodore in Queensland, where he was conducting a dressage training weekend. The owner had dared to turn away from watching him put her elegant black horse through its paces to chat to her friend. She should have been closely watching the intricacies of what the rider was doing, hence the sharpness of the tone. I was just an onlooker, but these words have entered my lexicon as words when you want to concentrate the mind.

I have followed Winx since her first win as a two year old in 2014. She has grown in stature since that time – a serious horse in every meaning of the word.

As she faces her last race, I note that the Liberal party are having difficulty pre-selecting candidates in some seats.

Just a silly thought to believe that you could put Winx on any of those ballot papers, now when politicians are so much on the nose. I would wager she would get more than just the “donkey” vote.

After all, the Emperor Caligula made his horse a consul. And they thought he was mad. However, I believe that horse won his election in a canter.

(Painting of Bowman and Winx by Garry Higgin)

The Protoplasm that is Politics

The Coalition Government in 1972 was a remarkable beast. It was caught up in Menzian aspic in a culture of internecine strife, which had been plated during the Holt days as Prime Minister. While John McEwen was around, this protoplasmic mess was controllable. However, he retired in 1971, and McMahon was let loose.

At the apogee of Australian civilisation as we knew it then was Prime Minister William McMahon, a prissy spiteful destabiliser, whose contest with the truth was in most cases found wanting. He had married late in life, and used his wife as a fashion plate accessory – remind one of someone? His government had difficulty in disentangling itself from the Vietnam War – and remember China was then indeed the Yellow Peril – a place for Australians to be quarantined against. Policy considerations were neglected by a Government exercised by whim and patronage spiced with payback.

Gough Whitlam by contrast provided an articulate alternative, offering Australia a new way. His election campaign was vigorous and enthusiastic. He had vanquished the Old Guard and promised so much – his clarion call being “It’s Time.”

Yet even with support of Rupert Murdoch, Whitlam ended up with a majority of only nine seats – and five of the ALP gains were in NSW.

Morrison – compared to McMahon? Time will tell. The Liberal party in 1972 had the DLP albatross, but now the continuing DLP cohort is embedded in the Falangist arm of the Liberal party. The Liberal party branches, once conceived to provide policy advice – “listening to the people mythology” – in reality are the vehicle for partisan pre-selection. It is thus unsurprising the so-called Liberal party has the crop of politicians it now has, seemingly out-of-step with the electorate.

That seemed so true in Victoria; but does it matter what candidates you have when one ignores the yearning for centrist politics where the art of negotiation is preferred to the strident megaphone?

In Victoria at last year’s State election, Daniel Andrews achieved an electoral landslide. In NSW Gladys Berejiklian has held the line for the Liberal party. Each has been pouring money into infrastructure, in a way that Whitlam promised to do in 1972 – into cities, regional centres, health and education. You can imagine Andrews and Berejiklian preferring the first way rather than yelling at one another, especially now they have both been re-elected for four years.

Morrison clings on, his hand on the megaphone. He should look at the 1972 and get some comfort, where in the end the overall swing was 2.5 per cent and even with McMahon, the Liberal Party still won four seats from the Labor party. At that time there were three Liberal and one National party premiers, including NSW, Victoria and Queensland. Today there are three Liberal party premiers in NSW, South Australia and Tasmania.

And Shorten is no Whitlam. He does not have the charisma. Unlike Whitlam, he has two strong lieutenants, Wong and Plibersek who, as the election nears, may become more prominent. However, with the media concentration on the two leaders, because the imagery of the prize fight is much more easy to convey in an election, emphasise the ‘may’. Therefore with all the talk about gender equality will these powerful women resonate – or be allowed to do so – in rural and regional Australia.

Even if the players are different, the scenario is reminiscent of 1972.

The long term lesson for what should follow as could have occurred from 1973 onwards? Defining and constructing the hard centre of politics, combatting this tiresome fearmongering, remembering what David Owen, the British politician, once said to me – never get caught in the soggy centre of politics. One might say that his is a re-interpretation of that familiar mantra – drain the swamp.

But that is only the start … hard… please define!

A few thoughts on the first salvos in health policy – Chris Brook comments

The budget and budget reply 2019 are now completed and no one could mistake that each was effectively a campaign launch for a Federal election – ending up as six weeks after the Budget.

Both have committed to expansion of funding for MRI and imaging more generally, (well done whoever lobbied this through both parties because there has been longstanding underinvestment in this technology). However, the ALP proposes to invest in greatly reducing out of pocket costs for cancer care, most of which is non-inpatient.

It seems ironic that the ALP is prepared to pay to repair a problem that is partly due to withdrawal by States of public oncology clinics. Thus, patients cannot access free care. The end result of the ALP’s plan hopefully will restore free care in public hospitals. It will be interesting to see if the Commonwealth chooses to claw back funding from the States for this, in effect exacting a punishment.

The Coalition has committed $450 million on chronic disease payments, especially for diabetes. Missing so far is the detail of what is new funding as opposed to just altering MBS descriptors.

The literature suggests such programs improve patient perception of care, which is a positive, but neither reduce cost nor hospitalisation rates.

Mental health funding is boosted in the Budget, though spending more on Headspace where its evaluation has given at best tepid endorsement. Nevertheless, any money directed to early psychosis is welcome.

Both sides promote their resumption of indexation for GP attendances, and not before time. It was always a cruel means to cut outlays.

The Coalition commitment to fund new drugs is welcome, though I note that the cost of the PBS is rapidly becoming the major cost driver in health , approaching $14 billion per annum. However, since “Big Pharma” makes a number of concessions and discounts from the list price, the real cost is closer to $9bn.

The rest is snippets and bits although the absolutely uninspired changes to Aged Care and Disability will have a strong indirect impact. If patients cannot access care, the putative expansion of care lends an air of unreality. By default the aged and infirm are forced to attend local general practitioner clinics or hospital emergency departments.

From my objective standpoint, the ALP wins this round, but it is early days in the campaign, so keep alert for further comment.

Mouse Whisper

Heard in the back of the Melbourne Club Caboose: “These three blokes born in December were given a portrait of Winx, each with Hugh Bowman atop. Why? Because a Sagittarius is half horse, half bowman.”

Modest Expectations Too

Ron Lord

Ron Lord died at the weekend. Ron was a journalist who grew up in the days of “concrete-foot-in-the door journalism”. This was the accepted muscular journalism of the Norton and Packer era in the late 50s. I met Ron when he was the resident journalist at the Australian Medical Association. He was never the high flyer that some of his fellow journalists who moved in the upper echelons of political influence were, but he was one of the first to recognise that there was a niche in health journalism beyond the learned medical journals.

He may not have been the first but publishing and editing Healthcover, a journal devoted to health policy in the 1990s was a bellwether for journalists who have trod the same pathway since. Ron was an edgy character, loyal to his employers but with a honed critical faculty, a person who knew his limits. He had a rare shorthand ability to rival that of a Hansard reporter, which enabled him to accurately and precisely record what people said rather than just printing the media handouts. Thus his was a refreshing approach to which I was privileged to assist.

His passing is a time for appreciating Ron’s contribution to health journalism and then moving on.

Can I jump puddles alone?

I wrote this first when I was severely disabled with pain, stiffness and weakness – the result of a presumed autoimmune disease. Mr McGuire’s recent ill chosen words reminded me that some able-bodied, articulate people can demonstrate insensitivity and in turn need to be reminded – although he seems to be awash with contrition.

Four years after first writing this reflection, although my health is much better, I am still dependent but with flashes of independence and thus hope.

When you go from independence to dependence in a relatively short period, it is bad enough.

But consider the case of this man, when the change was instantaneous – the result of trauma on a rugby field – and persistent. My condition pales by comparison

This young man was determined to walk at his graduation ceremony. His was a high profile accident and the media were there in spades.

The background to the television news report was that the young man had been severely disabled – the word paraplegic was not mentioned – only his determination to walk to receive his degree and, almost incidentally mentioned in the report, he had a wife. When the picture came on the screen he rose out of his wheelchair and with his wife supporting him as though he were a statue, he tottered a few steps across the stage. No, he had not walked – his carer had borne his weight and even though she was half his size, held onto him while he made the small distance across the stage. Then the news item was over – no attention to the wife’s efforts – no watching him struggle back to the wheelchair or more probably the wheelchair moved into position to avoid the need. He had said he would walk to receive his graduation certificate. It was the gritty devotion of his wife – his carer – that enabled him to do so. Good luck – his family could only wish that he would improve; but what struck me was the essential importance of the carer and how little reference was made to her in the news item.

Likewise, had it not been for me having my wife and others to care for me I would not have been able to continue to work at that stage and full time.

I hate being in a wheelchair. Not that I am in a wheelchair that much, but when I have to move more than 100 metres it becomes very difficult without one. What is wrong with the wheelchair? Nothing. I have been surprised by the comfort the modern wheelchair affords.

However, you become a different human being in a wheelchair. Until you make it clear that being in a wheelchair does not mean that your IQ is automatically halved, you tend to be ignored or treated as a child. I remember sitting in a wheelchair and being confronted by a small boy in a stroller. We were at a similar eye level and he with the ingenuousness of a child stared at me. To which I responded “ Son, see what awaits you.” His parents laughed but I wondered whether they continue to deny the five year old the use of his legs.

The other is that you exist in a forest of legs belonging to the able-bodied. You become acutely aware of that facility to walk, which you considered as an automatic right of homo sapiens. It is compelling to watch the easy facility of movement that you have lost. It brings home the sheer complexity of the evolutionary trail watching the striding young man or woman clasping the iPhone to the ear. There is plenty of time to observe when you are waiting in a wheelchair.

This waiting time is emphasised if you happen to be one of those people who has been both impatient and fidgety. In a wheelchair, impatience is not a wise strategy. Gesturing irritably – especially with a walking stick – is counterproductive!

Likewise, you cannot act on impulse – jump up and do something. Getting to your feet is a considered exercise. In other words, it is the carers who count in such an environment. Their understanding of the level of background support required is crucial.

This was brought home to me when I decided to walk along the Seattle waterfront from the ferry terminal to my hotel. At the time the Seattle waterfront was undergoing massive reconstruction and therefore hailing a cab was difficult and I misjudged both the distance and my capacity. “The little boy” had decided to get out of his stroller. For about 50 metres with two sticks it was bearable. However, as I moved forward the uneven asphalt became jolting potholes; walking down improvised inclines, minor to the able-bodied, become challenging ski runs. I struggled, and my carer kept watch for an hour, hovering and supporting, without saying how stupid I was. This was my “puddle” moment.

The occasional person, invariably a young woman, stopped to ask whether I needed help. For an hour I moved along, away from the dusty, sulphurous fumes and clanging steel of the waterfront, onto quiet civilised pavement. The hotel was in sight, and as you do when you walk with sticks, your eyes are mostly directed towards the terrain. What made this segment better was the line of copper beeches, which I could count as I passed each one. I remember when I ran those inaptly named “fun runs” and I was getting tired, it was the next telegraph pole in the street or on the highway, which was the marker of achievement.

My carer who had been ever present suddenly asked whether she could go and get the wheelchair from the hotel since the footpath was paved and the hotel was not more than two hundred metres away. She had picked the right moment. I agreed and she disappeared as I slogged on with the vain hope that I would get there before she could bring back the wheelchair. The definition of bliss is being propelled in a wheelchair up and through the hotel foyer to the bar for a cold ale.

Caring, as I have found out, and the interaction with the person in care is something you see, but unless you are in the situation, you will never feel the importance of that interaction.

However, caring is not the exclusive preserve of some professional group or a financial benefit enshrouded in impenetrable regulation. It is a basic tenet of our society.

It is up to those disabled but articulate, to continually advocate for a better deal, not only for the disabled, but also for the carers. Neither the carer nor the person being cared for live in parallel. However, the challenge remains of how best to translate that interaction between those who have the interpersonal skills intuitively and those who need to learn the skills to improve the interaction. The internet seems to be full of exhortation as to what is best for the disabled, but there does not seem to be much room for interactive comment.

Yet 272,000 carers are under 25 years. I have grandson who was then 14 and who, without prompting, brought me a chair when I needed to sit down. He knew without any words being exchanged what was wanted, because he was paying attention to his environment rather than a piece of technology.

As against this was a young girl of similar age, head down, concentrating on her texting who pushed past me into the lift. Suddenly there was a scream of anguish as the door closed on her inattentive self. It was fortunate that it was not a railway crossing – or a puddle, which turned into a fathom-deep pond.

The allusion in the title is to the Australian author, Alan Marshall, a useful text for us all. He did learn to negotiate that fathomless puddle. Has government with this recent budget done the same thing?

Mouse Whisper

Heard in the Louis Vuitton emporium in Tibooburra: What is better, a retail politician or a wholesale disaster?