Modest Expectations – Arthur Phillip

This is my 88th blog. I have not missed a week – and the sequential naming of the Modest Expectations to reflect that number in some way. 1988 – the Bicentenary of this Nation was quite a year. I received funding from the Commonwealth Department of Health to write a book where I asked a number of health professionals how and why they were there in Australia in 1988, at the time of the Bicentenary. It was called “Portraits in Australian Health” – not a particularly riveting title.

However, what I wanted to see in their recounting of their lives was why at that point of Australia’s history, they were where they were. The backdrop to each of the lives of those interviewed was Australia.

This idea was expanded by the BBC in 2004 where they identified celebrities and took them through their genealogical paces with a predictable chorus of “gosh” and “unbelievable” and “who would know?” as each of the atavistic eggs was unscrambled. All beautifully orchestrated.  By and large the people chosen were performers, who could act the part of the stunned inheritors of their family helix.

I suspect that the budget for these TV shows is generous, because it showed that people are curious about other people. “Celebrity” gossip is the fare of the magazines which concentrate on a vague representation of the truth. The BBC, as did I, actually did research!

My concept was relatively simple: sit the person down and let him or her talk. Some I had known before; others only by reputation and I tried to achieve some sort of balance. A few I regret using; others were incredibly important in tracing the path of the reason for their being health professionals and providing “a tapestry” for the 200 years.

However, in retrospect there were at least two major omissions in people from certain categories. There is no dentist in the book; the person I had singled out, because of his long family association with the profession declined to be interviewed; he died not so long after of cancer. That was the only rejection that I remember.

The other omission which, if I could I would rectify, was an Aboriginal person with a health background. On reflection, I should have asked Naomi Mayers, who was the Chief Executive Officer of the Redfern Aboriginal Service. Much later I had lunch with her and a number of Aboriginal people in Redfern and even then I had no inkling of her link to the Aboriginal singing group, the Sapphires. But I didn’t identify her and I regret it.

However, as I found as I met more and more Aboriginals, there was a rich cultural heritage, much of which was hidden from whitefellas. I have always been sceptical of the historical importance of bush tucker, which has acquired a following among well-heeled whitefellas. Much of the tucker available would hardly merit a feed, so tiny are the individual berry, fruit and the other flavouring agents.

However, what I have found very interesting and have met on various occasions were ngangkeri, the medicine men. When I was often visiting Wilcannia in the early 90s, I heard about the kadaitcha men who were still around. However, that was all, and after all “the feathered foot” left no trace; so how would a whitefella find out more. It was all intriguing and the more I was accepted the less I knew.

The Aboriginal society is “many nations” – after all, look at the difference in the culture across the nation. The problem is that in the confected restoration of Aboriginal culture, the diverse nature of the culture has been increasingly homogenised. That cannot be criticised as it recognises that the Aboriginal culture is not static; and given the improvement in communication and educational opportunities it is unsurprising that the Aboriginal is becoming less and less regionally distinctive. Having said this there will always be nests of such traditional culture.

The conundrum for such communities is how to preserve culture against the predatory nature of a culture of booze, fast foods , “black milk” and all the churning of this faddish instant googled-eyed Facebook age – yet not denying progress.

It would be a challenge now to find the Aboriginal health professional who would fit easily into a portrait of Australian health. In 1988, it was only four years since the first Aboriginal doctor graduated.

Charlie Perkins

Charlie Perkins

I was thinking about the first time I met Charlie. It was obviously in 1973, and up until that time, all I had heard about him was that he participated in the Freedom Ride to confront rural NSW concerning Aboriginal rights. To the urban Australian living in comfortable suburbia, Aboriginals were invisible.

As I child I remember receiving Church Missionary Society pamphlets about all those nice little Aboriginal children running around in Roper River Mission – so happy to be one of God’s lambkins. It was all so foreign, and the first time I saw real, live Aboriginal children was years later when I went with my parents to Central Australia. Part of the tour was a visit to the then Lutheran Hermannsberg Mission. We white children eyed off the Aboriginal children, who did likewise and giggled at this awkward bunch of kids from down south.  Nobody encouraged us to mix and eventually we got back on the bus and left. There were also the blackfella children in the settlements along the old Ghan route which then wound through the floodplain country and terminated in Alice Springs.

I remember I insisted in Alice Springs that my parents buy me a black ten-gallon stockman’s hat, and even though I have a large “scone”, the hat came down over my ears. My other purchase caused all sorts of bother, and when it was brought home it had its own “cordon sanitaire” because the ochre covering this large bowl was very thick and had never been fixed, so if you touched it, the ochre always stained your hands. Eventually the bowl disappeared from the house – as did the hat.

Hermannsberg Mission

However, there were several episodes of the ABC lunchtime serial “Blue Hills”, which have remained with me. These concerned a storyline where Aboriginal Heritage would lead to “a throwback” situation which meant that apparently white parents with Aboriginal blood could be confronted with a “piccaninny” child. Then, as the serial progressed, what relief – Aboriginal heritage was diluted – absorbed – assimilated – and joy of joy – no return to the noble savage. Well, that was the gist of the serial story and reflected the attitude of Australian suburbia superficially encased by a white picket fence of normality.

There were three films that I remember in my early childhood leading into teenage years. All had a variable effect on the development of my attitudes towards Aboriginal people. After all, I grew up in a world dismissive of our landlords. The 1947 film Bush Christmas starred a 12 year old Aboriginal boy from Woorabinda in Queensland, Neza Saunders, who showed how to eat a witchetty grub. At that moment, I wanted one to eat. A gourmet meal of witchetty grubs sadly still remains on my to do list.

The film Pinky explored the plight of the light-coloured black American in a 1949 film of the same name. I remember in the context of a society which, despite the pious comments of my schoolteacher, remained at its base racist. We, as children because we grew up in a homogeneous culture, did not have the basic experience to question. However, for me, it instilled in me a sense of unease, the word “miscegenation” still unknown to me.

This unease was reinforced by Jedda, a film where the central tragedy of the Aboriginal was played out in Charles Chauvel melodrama. Jedda was such a beautiful young image for myself, a teenage boy. Years later I went to Utopia, an Alyawarre settlement on the Andover Highway. As an Alyawarre woman, she had grown up there and later had a troubled relationship with the community.  I did speak to her on the telephone but she was away when I stayed in Utopia.

It was still a long time from Jedda before I was to run across Charlie Perkins. I do not know why but we had an immediate empathy. One problem I had noted was that Aboriginal reticence meant that you had to learn to speak through the silences. As one of my Aboriginal brothers would say, the non-verbal conversations with the various vocal clicks was difficult for whitefellas so used to voice communications. The other manifestation that was clear from a growing association with Aboriginal people was if a particular government meeting was thought irrelevant, the Aboriginal representative just did not turn up, but as the Aboriginals have come in from the fringe that dynamic changed. Aboriginal people can recognise tokenism.

In 1973 in Parliament House it was demonstrated very clearly that here was a nation wrestling with the Menzies’ legacy and in particular the engagement in Vietnam. Whitlam terminated Australian involvement, and both he and the Leader of the Opposition, Bill Snedden visited China that year. Snedden was privately concerned with the lack of involvement with Aboriginal People, since even though the 1967 referendum was an overwhelming affirmation of Aboriginal rights that was not easily translated into a workable outcome for our society.

Aboriginal tent embassy

Charlie Perkins, when he was young, had this busy enthusiasm about him. Snedden suggested that I might try and talk to him. The easiest way to talk to him was around the campfire which the Aboriginals had started outside Parliament House. We got on well from the start and spent a lot of time yarning around the fire. To me it was symbolic of establishing an understanding, and Charlie was appreciative that somebody from the Opposition had bothered to brave the fireside. It did not take long for the message to come back from one of the Nats who had seen me with Charlie around the fire saying: “Who’s that Communist working for Snedden?” The other occasion that I well remember was walking with Charlie across King’s Hall one evening, when Mick Young with Eric Walsh came up and said to Charlie without acknowledging me, “You coming to dinner, Charlie?” Charlie shot back, “No, I’m going to have a meal with Jack Best.” These are in the order of things inconsequential. Both Charlie and I wanted a better world and we threw out ideas, most of which drifted off in the camp fire smoke.

So did we, drifted away from one another. Much later when I met him when he was a senior public servant, he seemed to have lost much of this zest for life, but then that happens when you become a fully-fledged bureaucrat.

However, he was also fighting renal failure.

I read Pat Turner’s Charlie Perkins Oration this year, and even though I am not sure I agree with everything she said, she was right in saying that Charlie – the Charlie I knew – never backed down. Yet he showed a willingness to engage in all sides of politics. Later I was to have quite a bit to do with Congress, the Aboriginal Health Service which grew out his early activity in Alice Springs. It is a pity Charlie died while still a relatively young man, succumbing to one of the sequelae of that most deadly infections to Aboriginal people – the streptococcal bacteria.

Conquering that scourge of Aboriginal people still remains. It is not the only one.

Charlie to my mind was the first person who taught me the etiquette of equality of the whitefella in the eyes of the Aboriginal person.  I never attained the level that we could have called each other “brother”, but he enriched my life. Aboriginals were not a cute fringe eating witchety grubs, playing in mission dirt or conforming to a stereotype imposed on them.

Thanks, Charlie for being around when you were – brief as it was. However, you opened up a new perspective for me, and in so doing enriched my life in so many ways.

John Kitzhaber Concludes – A New Model for the Nation

Dr John Kitzhaber

A financially sustainable system designed for value and health can take many forms, but it must include five core elements:

  1. Universal coverage;
  2. Defined benefits;
  3. Assumption of risk by providers and accountability for quality and outcomes;
  4. Capped total cost of care through a global budget indexed to a sustainable growth rate; and
  5. Cost prevention by addressing the social determinants of health.

Here is one example. Starting with our current public-private financing structure, modify the three large insurance pools that currently define the US healthcare system.

  • Pool 1: To achieve universal coverage (element 1), restore the ACA individual mandate but ensure that people have affordable health plans in which to enrol. Expand Medicaid eligibility to include the 28 million people who are currently uninsured or create a new, affordable, publicly subsidized option to offer them. At the same time, move Pool 1 to a CCO-like capitated model that encompasses elements 2 through 5. If coverage in the individual market is unaffordable, those below a certain income level (e.g. 450 percent of the federal poverty level) could buy into Pool 1 with income-based cost sharing, which would make universal coverage more feasible. This is particularly important today as millions of people are losing their employment-based coverage and moving to Medicaid or the individual market.
  • Pool 2: Because Original Medicare is still paid through fee-for-service, the program must be moved to a capitated model. One approach would be to create incentives to enrol in a Medicare Advantage Plan (most of which are already capitated) and change the Medicare Advantage Plans that are still fee-for-service to capitated models that meet elements 2 through 4. Because reimbursement would now be based on managing cost and improving health, Medicare Advantage Plans would better incentivize providers to view their patients as a whole through, for example, nutrition counselling or working with social services for safe housing, thereby meeting element 5.
  • Pool 3: Allow the remaining markets—employer-sponsored medium and large group and self-insured markets—to operate as they do today, negotiating prices with health plans and using their market power to insist on capitated risk contracts with provider networks. The public sector price negotiations outlined below would provide a benchmark, giving employers additional leverage in negotiating prices in the commercial market. This advantage should be amplified by forming new partnerships with Unions

Continue the transformation by using the consolidated purchasing power of Pools 1 and 2 to negotiate one set of prices for both pools. This would include not only what providers are paid per beneficiary (risk-adjusted according to each beneficiary’s expected care needs) but also prescription drugs, medical devices, laboratory services, imaging, and all the other niche business models that have been established under the fee-for-service model to maximize revenue. This kind of price negotiation is what most large private employers (making up the majority of Pool 3) do today. Public payers should follow suit by using the consolidated purchasing power of the public sector—which is footing an ever-larger part of the bill—to get the best price and value for the United States of America community. If the public sector were so inclined, it would also be possible to both negotiate limits on individuals’ out-of-pocket expenses and ensure there are no caps on annual or lifetime benefits.

The result would be a new system of universal coverage built on our current public-private financing structure. With the majority of Americans in some form of capitated risk model, this new system (1) reduces the total cost of care through price negotiations, a global budget indexed to a sustainable growth rate, and provider accountability for quality outcomes; (2) preserves consumer choice and allows current insurers to compete for Pools 1 and 2 in a restructured market; and (3) delivers more and more value and health because it requires strategic, long-term, effective investments in the social determinants of health.

This is merely one way to design a new, health-focused, financially sustainable system. There are others. My objective here is not to advocate for the example I have just outlined here, but rather to spark a new debate that will lead to a better system. Instead of being constrained by what currently exists, we need to start with our objective, agree on essential elements, and then let the contours of the new system emerge. Long-term, this will serve us better than starting with a plan that may not meet the criteria needed to achieve our goal. For example, while both Medicare for All and a public option are ways to achieve universal coverage (element 1), neither directly addresses the total cost of care (elements 3 and 4) or focuses on increasing investment in the social determinants of health (element 5). Surely, we can imagine linking the total cost of medical care to a sustainable growth rate within the next few years. Then we can work backward to create a health system that meets the objectives of Democrats by expanding coverage and improving health and meets the objectives of Republicans by reducing the rate of medical inflation through fiscal discipline and responsibility.

COVID-19 and the Urgency of Now  

As the healthcare system has become ever more dependent on public debt, its financial underpinnings have become inexorably linked to the capacity of the government to borrow. That capacity has been suddenly and dramatically diminished by COVID-19 and by the business closures and high unemployment resulting from efforts to slow the spread of the coronavirus.

To prevent a complete collapse of the economy, there has been a massive federal intervention to keep credit flowing and to provide loan guarantees and direct payments to businesses and individuals. America will have to spend at least $5 trillion this year alone to sustain our economic infrastructure and to support its unemployed. This will leave us with an unprecedented budget deficit and a national debt approaching $28 trillion—with little or no capacity to absorb the 60 percent growth in health care spending that is projected by 2028 (from $3.7 to $6.2 trillion), especially when prices for medical goods and services are projected to account for 43 percent of that growth.

The pandemic is forcing us into an era of dramatic constraints on the public resources allocated to the healthcare system. Neither the government nor private-sector employers can afford the current system anymore, given the economic losses that both employers and individuals have experienced since February and the massive amount of public debt that has been accumulated just to hold our economy together. At the same time, those parts of the healthcare system that have been hit the hardest by COVID-19 are those most dependent on fee-for-service reimbursement, which exposes the basic flaw in a business model that depends on volume, regardless of the value of the services rendered.

This economic crisis means that, for the first time, the economic interests of workers, employers, the government, and many parts of the healthcare sector are aligned. The time to transform the system is now. We have crossed the Rubicon, and there is no going back. We can either watch our current system unravel, with millions more losing coverage and ever-widening income inequality, or we can work together to design a system that helps stabilize our economy and better serves the needs of the American people.

The Role of Unions

This is the moment for more states, facing huge general fund shortfalls, to move to a CCO-like care model for Medicaid, and for Congress, facing staggering debt, to create incentives for Medicare beneficiaries to enrol in a Medicare Advantage Plan and to move that program to a fully capitated model in which providers assume risk for quality and outcomes. Health professionals should be vocal advocates for both of these changes—and that advocacy should be backed up by the strength of the union movement to bring this model to the commercial market. This will require forging new alliances at the bargaining table between Unions and payers—both public and private.

Coverage of the cost of healthcare is, of course, part of the total compensation package, which means that in collective bargaining, wages are often pitted against health benefits. For public employees, general fund appropriations for healthcare compete not only with general funds for wages but also for essentials like increasing nurse staffing ratios, reducing class sizes, and investing in housing and other social determinants of health. The traditional goal in bargaining over healthcare is to reduce, to the greatest extent possible, out-of-pocket costs for Union members (which is very important).

The problem is that focusing only on this aspect of the total compensation package—without questioning the cost structure, quality, or efficiency of the care being purchased—suppresses wage growth. Without aggressively challenging the cost structure and value of the healthcare being purchased, the dollars spent on rising premiums flow into a system that redistributes them upward, taking money from the pockets of working Americans to enrich the profits of large corporations and wealthy individuals (further exacerbating income inequality).

A CCO-like model would be better because it caps the total cost of care without sacrificing quality and it realizes savings to invest in the social determinants of health—including wages. Particularly for workers making minimum wage or close to it, income is a primary driver of health.

Employees and employers have a shared economic interest in reducing the rate of medical inflation and in focusing on value and health. Providers, for the first time, now have an economic interest in changing the payment model from fee-for-service to capitated because this is the only way they can survive in an era that no longer can sustain debt financing. From the standpoint of the Labour movement, CCO-like models could result in increased wages, better staffing ratios, and more funding for education and other services that are critical to making our society more just.

This need for greater social investment must  emphasized. Reducing the total cost of care will assist all working Americans (not just those with union representation) because it will make not only their wages go further but also relieve them of the anxiety of not knowing whether the next illness will push them into bankruptcy. And it will give us, at last, the ability to address the conditions of injustice that underlie disease.

Let’s Begin Now!

Creating a new system with the five core elements will take time. But there is much we must do quickly. Because the economic consequences of the pandemic—particularly the increase in unemployment, with its associated loss of workplace-based coverage—are driving us toward Pool 1 (Medicaid, the uninsured, and the ACA marketplace), this is the logical place to start.

The most urgent coverage problem is for those who are not offered or have lost workplace-based coverage and whose income is too high for Medicaid (above 138 percent of the federal poverty level) but too low to afford the individual market. These struggling individuals are joined by a growing number of underinsured Americans who are technically covered by employer-sponsored plans but face copayments and deductibles so high that for all practical purposes they are uninsured. People of color—particularly Black, Hispanic, and Native American people—make up disproportionate numbers of both of these groups.

The state of Oregon offers an illustration of both the problem and the opportunity. By the end of April, 266,600 Oregonians had lost their jobs (an unemployment rate of 14.2 percent). An estimated 215,800 of these people will be eligible for Medicaid, 20,500 will move to the ACA exchanges, and 30,300 will remain uninsured.20 Because Medicaid is entirely financed with public resources and the ACA exchanges are heavily subsidized with public dollars, this amounts to a dramatic increase in public sector financing of healthcare. In terms of the healthcare model proposed in this essay, Oregon’s Pool 1 is expected to increase from 34.9 percent to 41.3 percent of the state’s population over a few months.

Furthermore, if 80 percent of those who lack health coverage in Oregon made use of coverage for which they are currently eligible—Medicaid or the subsidies available through the ACA marketplace—the number of Oregonians who are uninsured would drop from almost 250,000 to 34,000 (from 6.2 percent to < 1 percent). The only obstacle is the total cost of care.

Since states are facing enormous budget deficits and the federal government is facing a looming debt crisis, it is imperative that shifts toward public financing be accompanied by effective mechanisms to reduce the total cost of care through global budgets (indexed to a sustainable growth rate, with providers at risk for quality and outcomes). At the same time, such global budgets are now more appealing to many hospitals and primary care practices because of the sharp loss of revenue among those with fee-for-service models.

Mouse Whisper

I know we were all keen on Amy Klobucher, when she seemed to be the most articulate candidate back in those days when the Democratic race was like the first at Rosehill. She dropped out, and although considered as Biden’s running mate, she missed out here also to Kamala Harris.

However, the most final reason for her not getting the nod was:

She’s from Minnesota!

In explanation, no Minnesotan has ever made President, and such a judgement tends to stick once voiced. At least Barcelona is not in Minnesota.

Modest Expectations – Windy Bears

Blinman is the highest settlement in South Australia at 610metres. It has a pub and one of the distinguishing features of this area is that it sells locally-made ice cream – well, not actually made in the Flinders Ranges but in a little town in this mid north area of the State – in Laura.

The Flinders Ranges were named after Matthew Flinders who, together with his cat Trim, were the first Europeans to see the Range when he anchored his boat in Spencer Gulf near present day Port Augusta, and his name was given to the Range by Governor Gawler in 1839.

Wilpena Pound is an ancient caldera in the Southern part of the Flinders Ranges. It is one of the few places which was still on my bucket list of places I hadn’t been in this vast country. The name had stuck in my mind since I read that the famous New Zealand soprano, Kiri Te Kanawa had performed here in an open-air concert – with the all kit and caboodle of an accompanying symphony orchestra.

Within the National Park now owned by the local indigenous people, the resort is surrounded by hills and the bush crowds in upon you. Ring throated green parrots are cavorting on the terrace as I am setting down my thoughts.

Six weeks earlier the area had been flooded and there is still evidence of water damaged roads. Most of the bush that had been washed along with the floodwaters had been cleared away, but the road signs still warned of flood damage and the unmade roads into the interior of the range had yet to be graded. There are plenty of hikes, which I could have done in the past, but there is still much to see.

 

The Flinders Ranges themselves are not that high, but they have a certain majesty. There is the huge Arkaroola Rock; there are the hills which are swirls of pink accentuated in the afternoon sun. A hill pokes out from the pink diorama as though it is a sand dune not rock. There is the Great Wall of China atop, in American usage, a butte. Nature had constructed what appears to be a dry-stone wall, which meanders up and across these flat-topped hills. Other peaks are jagged, saw toothed. This has been a playground for Mother Nature to experiment in form and texture. After all, to the local Aboriginal people this is the land of the Rainbow Serpent.

Throughout the ranges on the road north to Blinman, the dominant tree is the native cypress and, because of the recent rain, they are growing amid a greenery which has coalesced with the salt bush. There is also the mauve of Paterson’s Curse, which has been let loose by the rain and, as I have written before, it can look beautiful. However, as Baudelaire once wrote, at the heart of great beauty resides evil. I always think of those words when I see this imported weed coating the landscape.

Tiny Blinman has a general store, which was closed, but fortunately the pub offered the ice cream. There was once copper mining here, and the woman at the door informs us that the tour of the mine is full. She gives me some tiny pieces of malachite as compensation. I tell her my great-grandfather, when he first came to Australia, took his family south of the Flinders Range to Kapunda, where the first commercial mine in Australia had been opened in 1842. This mine also yielded copper but has long been closed. I had been there many years ago and already gathered pieces of souvenir ore from the mine tailings.

The view from Stoke’s Hill Lookout is of a red ochre expanse dotted with salt bush. Here the greenery has not penetrated and my whole vision was one that Fred Williams may have seen and painted. After all, the Flinders Ranges was inspiration for Hans Heysen also. He painted many a vibrant gum tree landscape. Although the native cypress are dominant, there are stands of several major eucalypts throughout the Ranges. There is the Southern Flinders Mallee, which grow on the rocky slopes, but along the river-beds are the imposing river red gums beloved of Heysen.

The Big Tree, Orrooroo

The largest of these eucalypts is celebrated in the small settlement of Orroroo, south of the Flinders Ranges, where the eponymously named tree is said to be over 500 years old. It has a trunk circumference of 10 metres and no fork in the trunk until six metres up.  It is a very healthy tree, but it is by no means the only tree of similar size and in the forecourt of our accommodation, there is a tree that is not much smaller. In the reception is a huge red gum counter made from a tree that had fallen over. Part of the massive trunk had been salvaged but the rest, despite protests, was cut up into firewood, the desecration often perpetuated by government-paid foresters.

Hawker is at the southern apex of the Flinders Range, a small settlement but with an enormous tyre service. This is an ominous warning of travel on the unmade roads that penetrate the Range. While we refuelled there, we were surrounded by an exhaust of leather clad motorcycle riders, most of whom were old enough to be directly inspired by Peter Fonda and Denis Hopper in Easy Rider. This is “easy riding” in the Outback, even though the sense of hair flowing the wind is now “kerbed” by a helmet.

The road to the west of the range proceeds north to Parachilna, with a pub and an official population of three. The pub is managed by a young couple who have fled there to escape the Virus, and here gained employment. This Prairie Hotel is a well-known watering spot to where once a railway ran, but no more.

The hotel is deceptive. From the outside it is a normal pub with the corrugated iron roof slung over the walls to provide protection from the sun. However, it is different from the normal desert hostelry in not being a reservoir for stubbie holders, fridge magnets, car stickers, and sexist T-shirts in a dungeon-like public bar. Inside it is tastefully decorated, light and airy.  There is a wide array of quality, mostly Aboriginal, art on display for sale. It is also the general store, sells other Aboriginal-designed artefacts, has good accommodation, the place for a good feed at breakfast and dinner; and being a pub, a wide range of grog. A bottle of my favourite Hendricks gin peeps out of a well-stocked spirits selection. Over the road from the hotel there is the budget accommodation in the form of dongas, ship containers with a portal of entry. Without air conditioning in the middle of summer, they would be like being in a microwave.

The paved road now goes a long way north and last year was extended to Marree (once the cattle railhead) to try and help those “grey nomads” dragging their caravans. Thus, Parachilna is now not a terminus but a welcome stop on the way north into the desert. For us, given how late in the day it is, this was our turning point from where we drove back, bathed in the late afternoon sun.

Adam Goodes mob – The Adnyamathanha

Terence and Josephine Coulthard, in the words of the front cover, compiled a Culture and Language Book on the Adnyamathanha people. These are local Indigenous Guardians of the Flinders Range – the long title means Rock (Adnya) People (Mathanha). The book runs to 450 pages and serves as a dictionary – the written form of the oral language – painstakingly described.

Adnyamathanha flag

These people have a flag (pictured) which combines the blue diagonal canton as representing sky and the Blue Rock people. The brown represents the land and the Red Rock people. The saucepan star formation is the men’s story line; the seven sisters the women’s story line. The circle with the radiating white lines is Ikara (Wilpena Pound) and the symbol for the whole Adnyamathanha community. Thinking about the complexity in the cultural attachments to the land we now recognise as Australia, such a flag should be looked at in a national context. It is a proud flag; this is not the flag of the downtrodden.

This strength was exemplified by us being invited to come to the launch of the book under the river red gums, where Terence sang and played the guitar, where the mob had come  and now sat under the trees and the children ran free the aboriginal kids weren’t running around, they sat with their parents. There was a lot of talk, everybody seemed to have a word to say, including the local member for Stuart with a long Dutch name.

We purchased both the book and the flag.

John Kitzhaber – His Thoughts

Below is a the first of a multipart series by Dr John Kitzhaber, former Democratic Governor of Oregon and the author of the Oregon Health Plan. I have known Dr Kitzhaber for a long time and he has agreed to his essay being reprinted in my blog. It provides an insight into the thinking of someone whom President-elect Biden may tap for ideas. Over to Governor Kitzhaber…

Dr John Kitzhaber

“I started practicing emergency medicine when I was 27 years old, and I still remember the vulnerability of the people who came to see me. They were sick or injured, frightened, and asking for help. They didn’t know me, and yet they put their trust in me. I did everything in my power to help them and yet, even then, I sometimes failed.

As an emergency doctor, being unable to save a life was devastating. The walk across the hall to the small room where family and friends waited always felt like a long hopeless journey. Yet while this poignant intersection of compassion and mortality is difficult, it is that very compassion, and the humility and caring involved, that drew many of us into healthcare in the first place.

Today, much of that compassion is being stripped away. Early in my career, in the 1970s, we had time to build the kind of personal relationships with our patients that often contributed as much to their health and well-being as the medical treatments we prescribed. Sadly, the space in which to cultivate these deeper relationships seems to be slipping away—lost to an electronic medical record that is as much about billing as about caring, and to an impersonal corporate structure that prioritizes revenue generation over a deeper understanding of the social and economic circumstances that contribute to illness.

I became a doctor to improve people’s health and well-being, not just to treat their medical conditions. I soon realized, however, that in many cases I was treating the medical complications of social problems. I was trained to treat the medical conditions, which I did to the best of my ability; but afterwards, my patients returned to the same social conditions that had brought them into the hospital in the first place. I eventually realized that our healthcare system is designed not to support wellness but rather to profit from illness. While most healthcare providers certainly don’t approach caring for people that way, the underlying business model does.

Serving in public office while still practicing medicine gave me another insight: the realization that the more money we spend on healthcare, the less is available for housing, nutrition, education, or other things that are critical to health and well-being. Since first running for the Oregon legislature in 1978, I have spent 26 years as a representative, as a senator, and as governor trying to develop a new model—one built on the recognition that health is the product of many factors, only one of which is medical care.

In 2012, in the depths of the Great Recession, Oregon established such a model: coordinated care organizations (CCOs) for our Medicaid recipients. The CCOs don’t just treat illness; they cultivate health by addressing not only physical, mental, and dental care but also related needs such as safe housing, transportation, and fresh, affordable food. CCOs have also demonstrated that it is possible to expand coverage and reduce the rate of medical inflation while improving quality and health outcomes. Now, with the deep recession triggered by the coronavirus pandemic, it is time to scale this kind of model up for the whole nation. My primary aim with this article is to offer one way in which we might achieve that goal.

From Cost and Coverage to Value and Health

For decades, the healthcare debate throughout the United States has focused almost entirely on coverage—on how to pay for access to the current system—rather than on health. What is missing is a consideration of value, which in this context means that the purpose of the system is not simply to finance and deliver medical care but rather to improve and maintain health. Indeed, the things that have the greatest impact on health across the lifespan are healthy pregnancies, decent housing, good nutrition, stable families, education, steady jobs with adequate wages, safe communities, and other “social determinants of health”; in contrast, the healthcare system itself plays a relatively minor part.

Ironically, since the cost of medical care consumes 18 per cent of our gross domestic product (GDP), our current healthcare system actually undermines our ability to invest in children, families, housing, economic opportunity, and the many other key social factors important to health and well-being. This is a primary reason why the United States does not compare favourably in terms of health statistics with nations that choose to spend far more on the social determinants and far less on the healthcare system.

If we could reduce our healthcare spending from 18 to 12 percent of GDP (which is the average spent by most other industrialized nations), we would free up over one trillion dollars a year to invest in the things that contribute more to health. Such a reduction in spending might seem impossible, but successful examples of how to bring down the total cost of care do exist, including Oregon’s CCOs. Under these care models, providers receive a global budget to provide quality care with good outcomes for a defined population; if the global budget is exceeded in any given year, the providers are at financial risk for the difference. These care models change the system’s incentives from rewarding sickness to rewarding wellness—and they work. Because they focus on improving health, they prevent illnesses and thereby reduce costs without sacrificing quality.

Effectively addressing the access, value, and cost issues in our healthcare system is one of the most important domestic challenges we face as a nation. Doing so, however, requires both a clear-eyed assessment of what this system has become and the courage to challenge that system. The global pandemic, with its profound economic and social consequences, has brought into clear focus the urgent need for a new model more aligned with caring, compassion, and the goal of improving the health of our nation. And no one is more qualified to lead that effort than the people who have dedicated their lives to the healthcare profession.

COVID-19 and Our Legacy of Inequity

In 1882, the newly formed Populist Party wrote in its platform, “The fruits of the toil of millions are boldly stolen to build up colossal fortunes for a few, unprecedented in the history of mankind.” Now, over 125 years later, these words aptly describe our current social and economic conditions and how little progress we have made in terms of social justice and equal opportunity. The novel coronavirus has exposed anew the inequities and the linked class and race divisions within our society, problems that have been with us since before our nation’s founding, almost always churning just below the surface, visible only indirectly when we examine disparities like disproportionately lagging health and education outcomes for chronically under-resourced— often racially or ethnically segregated—communities. Especially in the past few decades, these inequities have been masked by debt-financed economic growth that has prevented us from mustering the political will and societal solidarity necessary to address them.

Perhaps nothing better illustrates the depth of these disparities, or the extent to which social justice has been eroded, than the US healthcare system. It is a massive corporate enterprise that now consumes nearly one-fifth of our GDP, a huge employer that is increasingly dependent on public debt for its financial stability, and a major driver of income inequality. The pandemic has cast these inequities and contradictions into stark relief.

We see the difficulty nonmedical essential workers have had in obtaining adequate health protections, often resulting in significantly higher rates of infection. These are people in low-wage positions—often with minimal or no sick leave or insurance—working in grocery stores, warehouses, factories, and food and agricultural production sites. We also see that Black Americans are dying from Covid-19 in dramatically disproportionate numbers—deaths attributable to the structural inequities in our society that make Black people and other people of colour more likely to have diabetes, heart disease, and high blood pressure, and to live near major sources of health-endangering pollutants and far from health facilities and grocery stores. These are issues we urgently need to address.

At the same time, the pandemic has for the first time brought the economic interests of those who pay for, consume, and provide healthcare into clear alignment. This gives us a once-in-a-generation opportunity to transform the current system by demanding value as well as universal coverage and by constraining the total cost of care.”

To be continued next week.

 What a Village

After such an above sober analysis…

The votes for the US President have been counted and, as predicted, Trump is behaving as he always has, and in so doing disgracing all American democratic traditions.

Joe Biden has won. I have not thought much of him, but now that he is on the brink of Presidency, he needs his critics – of which I am not even a speck in importance of one of these – to give him a chance.

Trump is exhibiting the sure signs of dementia. People are now openly saying he is lying and the media is by and large turning him off. The pathetic lies are obvious, but is he confabulating? There are these long blanks in his mental processes which he fills with babble. This is associated with early dementia. Therefore, with his face the colour of a tomato, which even make up cannot hide suggests a visit to an independent medical panel would be wise.

Nancy Pelosi is 80; Joe Biden is on the cusp of 78; Mitch McConnell is 78 and unquestionably the most unhealthy seems to be Donald Trump, who is only is 74. He has had a dose of the Virus and refused to heed its danger.  Instead of convalescence he embarked on a frantic schedule in which he encouraged his adoring crowd to gather into a feed lot for the Virus. He demonstrated how the President’s power must be reviewed, as the Senate has done in the past, to clip presidential authority. Trump has shown how susceptible a nation can be to bullying, even when this is limited to four years.

There is an increasing adage that 70 years is the new 50, but believe me, 80 is the new 80. Something happens between 70 and 80 in many people, and that is why it is hard to detect how well they would handle the “next four years”. Retention of physical and mental health in individuals begins to become more of a lottery. Therefore, both Pelosi and McConnell should be watched for any slippage, but in politics that is an inconvenient comment.

I do not fear of being called ageist, because I am in the same age group. Biden still shows he can jog to the President-elect’s podium, but he called upon Obama to assist in maintaining a sense of mental resilience. I had made the comment earlier that Biden would give away to an Obama restoration. I made the comment that this may be stopped in its tracks by Michelle Obama. Obama’s oratory over the last few weeks helped solidify African-American voting intentions in these closing weeks.

Kamala Harris is 56 years old and Mike Pence is 61. Whether having endured years of Trump, Pence might retire in Indiana to try and cure the PTSD engendered by four years at “Don’s Party”, with any thoughts of a future Presidency probably snuffed out. However, the future of Kamala Harris will determine whether that divide in America painted red will ever accept under any circumstances a woman, especially if Biden should die or be incapacitated over the next four years.

In short, there is much that could be added without rehashing that which has already been said. What in the end were the most significant conclusions for me?

  • America elected a woman Vice-President.
  • Trump scored 72 million votes.
  • COVID-19 has affected three per cent of the population and O.8 per cent of the population have died up to this point. Does anybody out of that 72 million in the imitation of a self-obsessed narcissistic ex-President really care about such a small group of “losers”? Is America that callous?

Mouse Whisper

Not Anywhere

            Not Delaware

                          But Somewhere

                                     Wilmington South Australia

The Worshipful Company of South Australian Field Mouse Grain Handlers have asked me to invite you Sir to open the Wilmington Night Rodeo on January 23 next. I understand to perform this important role you will have re-schedule a minor ceremony in Washington to be with us. However how could you afford to miss having the finest tucker at Rusti Kate’s Feed Lot after a trip through the Puppet Museum, which I understand as a fine array of your predecessor’s marionettes.

Respectfully

Wilmington, South Australia

Modest Expectations – Round & Round

There was much hype surrounding the 20th anniversary of the Sydney Olympic Games with the spruiking by the ABC of their biopic, Freeman. Given the cloying, hagiographic way many of these biopics are constructed around sporting celebrities, one might have anticipated a certain predictability with a treacly voiceover. Therefore, I planned to give it a miss.

However, the television was tuned to the ABC during the Sunday night meal and it was just left on. I started watching with the eye of the sceptic prepared to switch it off. I did not. It was a fine depiction of an extraordinary woman.

I must say that at a time where the world is devoid of genuine heroes and heroines (if that word is still allowed) Cathy Freeman stands out. Running 400 metres faster than anybody else in the world was the centrepiece, but in relation to the woman herself it is, in the end, incidental.

Yet without this extraordinary talent, she would have been yet another unrecognised good person, one of those who form the spine that anchors this country. She is Indigenous. It marks her out. She provides that sense of grace that was so well emphasised by the beautiful unnamed Bangarra dancer, and as with Cathy Freeman, grace is so natural – more than just a physical attribute.

This artistic portrayal, far from complicating the vision of Freeman winning and thus being a source of distraction, made me realise that this was more than just an expression of the filmmaker’s sensitivity, it demonstrated something rare in the Australian psyche – a genuine unsentimental view of what grace under pressure is all about.

Freeman engendered on that night a sense of optimism in a country which wallows in its veneration of failure – Burke and Wills, Gallipoli and Fromelles immediately springing to mind.

Now, two decades on, she has remained the same determined person dedicated to doing good without constantly reminding us of it – that was one message that I took from this biopic.

Thick as a Plantain

Queensland is a different world, to a point. When I was first exposed to the public service in Queensland, I was amazed to see and feel how centralised the system is. It so closely approximated attitudes in the Victorian public service, which I experienced when I had worked there, that I felt quite at home.

The authoritarian personality dominates the centralised mentality of Queensland public servants. It was almost to a level that paper clip distribution in a Camooweal government office depends on the signature of the Departmental head in Brisbane.

When the authoritarian personality is combined with a healthy dose of xenophobia and lack of intellectual integrity it perfectly describes Pauline Hansen. Yet such a perception of her underpins a preparedness of Queenslanders to elect her – time and again.

Her tearful retreat whenever she is under political fire relies on a cynical appeal to an undercurrent of paternalism. If she were a man, she could not hide behind a veil of crocodile tears. The extraordinary performance of the Queensland Premier last week accusing the Prime Minister of bullying when he was making a perfectly reasonable request shows that in Queensland the Hansen playbook is very adaptable – in this case by the Premier herself.

Then there is her chief health officer, Dr Jeanette Young who, according to the Premier, apparently is running the State – at least in health and in border exemption. She does not have any public health qualifications despite having been in the job for 15 years.

This is the same Jeanette Young who, during the swine flu scare of 2009, advocated for Queenslanders to stock up on food – in essence stirring up panic buying. Well, Queenslanders, there has been another outbreak of swine flu in China, which has been kept quiet. China has just banned pork imports from Germany because also has been the emergence of swine flu there.

Dr Young is unyielding – to a point.

The Premier and her minions may want to blame Peter Dutton for everything, and the Hanks imbroglio allows the State government to spread some of the topsoil, but Dutton cannot be blamed for allowing the polo-playing McLachlan with his flock from descending on Queensland (and a variety of other well-shod Victorians) to serve out their quarantine in the comfort of a resort. If the Premier is to be believed, this is the handiwork of Jeanette Young, who makes the decisions to allow special access. However, in so allowing it, this seems to contravene everything the resolute Jeanette Young says she stands for.

Yet Jeanette Young is not averse to the quavering voice when under media scrutiny. After all the health plausibility of many of her decisions is inversely related to the political expediency. At least with Daniel Andrews, he has now learned that public health considerations must have a scientific basis; and is following a course. He is in for the long term. Sounds familiar. Perhaps he has observed the Chinese devotion to the long term solution at close quarters.

Dr Young has recently acquired a deputy, Dr Sonya Bennett, who has worked in the Royal Australian Navy before joining the Queensland Department of Health to oversee public health three years ago. Given the propensity of professionals in the armed forces to collect post-graduate certificates and diplomas, Dr Bennett has acquired appropriate public health qualifications. She has the credibility of sitting on a government committee to oversee communicable diseases, and presumably is assisting in the flow of exemptions.

However, in the end Queensland with in all its authoritarian rigidity has to find a way out of its completely illogical stance of border closure that demands a rate of community transmission that is absurdly low before the drawbridge is lowered. In a population of 8.129 million, NSW is reporting around five cases a day – that’s 1 per 1,625,800. Maybe the election will do the trick – one way or the other, if Australia can wait that long.

But, Jeanette, batten down the hatches, swine flu may be coming again and Australia needs a unified strategy to deal with a new swine flu outbreak – apart from advocacy of panic buying. Time to start behaving like a country.

But, you know, it is Queensland and do they know how to bend a banana!

The little sparrow 

Having discussed Cathy Freeman, this vignette of another inspiring woman may help ease reaction to the writings immediately above. Sarah L. was a young English doctor when she met me in the corridor of the hospital. She looked so small; even childlike and yet when I met her at Doomadgee, I soon found out her resilience belied her appearance.

Doomadgee is mainly an Aboriginal settlement in the Queensland Gulf country and has had its moments with a police station under siege and Aboriginal riots. The problem with this settlement is that it is the meeting place of various mobs, and in such clusters, there are always underlying tensions, even when there is no violence between rival mobs.

When she greeted me, she apologised for saying she was a little tired. The previous evening, she had been called out to triage a serious vehicle roll-over, and given that nobody wears seat belts, there was a variety of serious injuries. She had to work out the priority in treatment and who needed to be evacuated to Mount Isa or to the coast. They had all survived.

She also wanted to set up an evidence-based treatment for scabies, which was endemic in the community. Scabies is caused by mites (Sarcoptes scabiei), which burrow into folds of skin, are found in children’s hair – and often, in the severest form, the scabies lesions are inter alia infected by streptococcus pyogenes. Scabies spread by contact and older people tend to be “super-spreaders”. There are a number of treatments that work, but they require compliance. She wanted to test ivermectin, which can be administered orally and used topically.

Scabies

Ivermectin’s parent drug was discovered in Japan in the 1970s and was first used in1981. It is the essential agent for two global disease elimination campaigns that will hopefully rid the world of both onchocerciasis and filariasis. These diseases affect the lives of many millions of poor and disadvantaged throughout the tropics. Ivermectin is also effective against mite (scabies) and lice (crabs or pubic lice) infestation. It has a very wide use against parasitic infestation, but for the use proposed by this young doctor there were still unknown elements.

The attack on scabies means ridding the home of the mites and, for instance, the habit of sleeping with dogs, which occurs in Aboriginal communities, can facilitate the spread. The young doctor, who had paediatric training, wanted to clear the children in the community of scabies.

I was impressed by her enthusiasm, and her approach reflected my ideal public health physician – able to have clinical expertise and yet wanting to set up a trial to see what would best suit her community.

This week, I tracked her down to see what happened. Yes, she successfully eradicated scabies, but that was so long ago.

She was pregnant at the time I met her in Doomadgee, and subsequently she had a second child. They all moved to the Coast. Her professional career was interrupted by a couple of major car accidents – one on Magnetic Island and one in Townsville – after she left Doomadgee. She took a long time to recover, and has been left with residual loss of vision in her left eye. She is now practising at Townsville Aboriginal Health Service.

To me, she was an exemplar of a doctor working in a remote community who was able to cope with emergencies but yet with the curiosity and determination of the public health physician. She epitomised the very best of medical practice, but her experience also demonstrated the lack of sustainability of a health system built on the individual worth without there being succession planning. That is a major problem that has bedevilled medical practice, particularly in rural and remote areas.

Before I made contact with her this week, while reflecting on Doomadgee, it reminded me of looking out of the train window and seeing two women tending a colourful beautiful garden alongside the train platform. Then the train moved on, and I did not have a return ticket.

However, on this occasion, I knew the name of the woman and when she rang me back, the voice was still so familiar. It was still the bright, breezy Sarah.

Letter from Victoria

I was talking to a friend of mine in Victoria. He is a consultant geriatrician, one of the best. He is also a member of a nursing home board.

In this State of unmitigated residential care disaster, in this nursing home there have been no cases of the coronavirus, in either residents or staff. He prefaces his comments by saying that luck is always a factor. Nevertheless, what they did from the outset was to ban visitors, allow only essential trades people into the facility and ensured that on arrival the staff had a temperature check and were quizzed on whether there was any sign of COVID-19 disease. Then, all staff appropriately attired themselves, and strict protocols were observed.

I asked how the residents coped with this degree of lock up – and he said they hated it, one saying she preferred to be dead rather than endure such conditions. So it is not just a case of expressions of pious statements about “loved ones” whenever a person in their nineties dies, but perhaps in the eyes of the departed, death was a joyous event. The problem is that it is one technology we have not mastered, that of polling the dead.

Apropos, I asked about Zoom and other means of distanced face-to-face communication. His view was that for the elderly it was no substitute for physical contact.

He made a further comment that it seems that in these institutionalised care environments, aerosol rather droplet spread is the major means of transmission. He cited a case where a particular residential facility was coronavirus free in the morning and by the evening two-thirds of the people were coronavirus positive.

After talking to him, I re-read the Newmarch Report, which shows that if you bring in a competent team that knows what it is doing then you get to the same situation that my friend describes. But it is far from a perfect situation.

I wonder whether the central agencies or the private operators have worked out how much it would cost to comply with the 20 recommendations of that Report.

The Commonwealth government, with an incompetent Minister, is still relying on the private sector, with its record of putting profit before care increasingly being shown to be scandalous. The fact that some Victorian aged care facilities delayed the release of dozens of deaths which were then added to the daily tallies has not been adequately explained, but hopefully the answer is not deceit .

My friend said that government-run and not-for-profit facilities were better in his view. Yet Newmarch is operated by Anglicare, an offshoot of the Anglican Church, and seems to have belied that generalisation as does the apparent gouging of the contaminated St Basil’s Home in Fawkner, a northern suburb of Melbourne, by the Greek Orthodox Diocese.

However, mimicking the home environment but being able to maintain infection control at a level where the coronavirus will be repelled at the door remains a challenge, organisationally and financially.

I know that if and when the time came for me to go into a nursing home, it will be a one-way street. Thus I want to go into a place where my family at least has the choice of visiting me. I do not want to go into an institution, which is kitted out as an intensive care unit, so that I become a delayed statistic dying in a labyrinth of tubes, with a card on my big toe labelled “a loved one”. “Loved One” is becoming the modern day substitute for the black rimmed Hallmark bereavement card.

Coronavirus is an accelerant, and if you are old and contract the Virus, but survive the buggery of being on a ventilator in an actual intensive care unit, you can then become a photo opportunity for the evening news, before dying unnoticed a few weeks later. Is that what I would want – is it anything anybody wants?

Federally-Operated Quarantine Facilities

The comment has been made to me that government building a series of quarantine facilities would very expensive. The problem is that there is no evidence of long term thinking beyond the immediate combat with the current coronavirus. We have the spectacle of the President of the United States denying climate change, a feeling echoed by members of the Australian Government. There is a suggestion that swine flu outbreaks are now reappearing in China and Germany complicating the world disease profile.

Coronavirus infections are out of control in many places throughout the world, where incidence and number of deaths are the indices to measure spread and severity. Yet, unexpressed is the level of morbidity, which at present can be classified at short to medium term. I have yet to see whether the impact of morbidity on the world economy and burden of disease has been assessed. Probably, it could be argued that we are only seeing six-month data.

Our ancestors recognised the need for quarantine facilities but often located them in harsh settings. However, being in a necessarily isolated environment need not be harsh.

It seems that both the Northern Territory and Kristina Keneally among an increasing number of others, myself included, are advocating for discrete quarantine facilities. However the Australian government, with its attachment to private enterprise, appears to prefer to maintain the fiction that hotel quarantine can work in the long term. Frankly as the economy improves and the hotels are required, planning for these facilities should occur now rather than in the usual ad hoc manner. More importantly, we need to get quarantine out of the major population centres, and we need to find an affordable quarantine solution if Australia is to re-enter the international community and not completely destroy tourism for the foreseeable future, particularly if a successful vaccine is not found in the next 12 months.

Howard Springs quarantine facility

In relation to a particular operational Northern Territory facility, the comment is that to get to it “…drive south-east from Darwin Airport for 30 minutes and you will arrive at an old mining camp – the Manigurr-ma Village for fly-in, fly-out natural gas workers. Until recently, this complex was abandoned. Today, it is perhaps the most popular travel destination for Melbourne escapees.”

In other words, facilities do already exist, and it seems a tolerable spot to spend 14 days, especially if the facility is airconditioned. In my last blog, I suggested the Northern Territory as the site for quarantine and singled out Katherine. Creating a so-called bubble around Katherine would allow the possibility of visits to Katherine Gorge, increasing the tolerance levels for incarceration. However, creativity is never a recognised expertise of public service.

Now the Northern Territory First Minister has been re-elected, he can act with more freedom, notwithstanding section 49 of the Northern Territory Self Government Act. This mirrors terms of Section 92 of the Constitution in protecting movement across border. As one constitutional expert has said: “It means the NT is in the same position as a state.” However, the Northern Territory exists under law enacted by the Australian parliament, and is not recognised in the Constitution as a State.

The experience with the repatriation of Australians from Wuhan should have given the few long term planners in government a clue of how to handle quarantine. The Northern Territory is an ideal place. Over time, flight schedules can accommodate the need for incoming quarantine.

The other destination for the Wuhan evacuees, Christmas Island, is to Australia what French Guiana is to France – a place to send people to be forgotten at a great cost, but inconvenient for large scale quarantine.

Kristina Keneally took a direct stance recently when she suggested that the Federal government could provide a set of quarantine resources if they are establish any form of international tourism. Repatriating the clamouring Australians provides a pool of people to test how best to allow people coming from COVID-19 endemic areas to return – or come to Australia.

The model exists in the successful evacuation from Wuhan.

Build or adapt facilities in Northern Australia to enable people to be quarantined for 14 days.

Gradually close down hotel quarantine, as international restrictions are eased but, in the light of the Government’s announcement this week that incoming passenger numbers will be increased, those states and territories that have taken a back seat in hosting quarantine can take some of the load – the ACT is a case in point, with its newly-constructed international airport; there are suitable sites in the ACT – much land around the Fairbairn RAAF base.

However, long term it is undesirable to use hotel facilities, which are not dedicated health facilities, for such a purpose. Thus there is a reason to establish a health-tourism forum so that people in each sector are brought together to develop a common language.

As with any facility designed to attract tourists to this country, each person presenting at a border should have the equivalent of the yellow card – when we needed to show evidence of smallpox vaccination, inoculation against typhoid, cholera – and still yellow fever.

Remember that yellow, even in this world of digital communication, remains the colour of the letter Q – hence quarantine. Data should provide evidence of the time of testing, a temperature check at departure and arrival and a checklist of symptomatology. As a parenthetic comment, the ability to test olfaction may become an important additional marker.

The longer there are no organised quarantine facilities the more policy will be at the mercy of ad hoc arrangements. Quarantine facilities that are recognised and organised with appropriate staff will provide a Security Blanket for the politicians, who are increasingly terrified of opening their borders – and in general Australia.

When we wanted to deal with those poor benighted asylum seekers, we were not at a loss for ingenious methods of inflicting as much misery on them without descending into actual torture. Also, can anybody realise how much hilarity and champagne cork popping there was in the Cambodian government when we wanted to “rehome” some of these asylum seekers.

However, the asylum seekers were at the end of a line of misery, and despite the compassionate cohort of advocates their plight means little to the vast majority of Australians.

By contrast, quarantine, well organised with a border force replete with replacement masks of compassion and a health work force working in conjunction with the tourist industry in all its manifestations would seem to be a simple concept to put an end to the ad hoc actions and the unmitigated xenophobia that some of our governments have developed.

Well, let’s see!

O Panda Alaranjado

I don’t see how we get through to the January 20, 2021 inauguration day without bloodshed.  Ever since James Adams succeeded George Washington in 1797, there has been a peaceful transition of power in this country from one president to the next. I fear that after 223 years we are about to tarnish that record.

So has been written to me by an American lawmaker.

Everybody has been setting out a scenario that this increasingly unhinged person with his band of acolytes could inflict on the USA if he loses.

The following is one is taken from the playbook of the Bavarian house painter, he could contrive to see the White House burnt down, and then invoke the Insurrection Act of 1807. “In all cases of insurrection, or obstruction to the laws, either of the United States, or of any individual state or territory, where it is lawful for the President of the United States to call forth the militia for the purpose of suppressing such insurrection, or of causing the laws to be duly executed, it shall be lawful for him to employ, for the same purposes, such part of the land or naval force of the United States, as shall be judged necessary, having first observed all the pre-requisites of the law in all respect.”

Burning the White House, 1814

Not that it was an insurrection but British troops did burn down the White House in 1814. So there is a precedent, if not a president.

Mouse whisper

One Australian politician who answers to Julian the Lesser has made a statement that more Australian have seen Berlin than Bundaberg. Bundaberg has 93,000 people.

Is Julian the Lesser suggesting that:

  • people who live in Bundaberg are blind
  • there are more people than that to take our breath away.

All in all, a rum statement.

Out of breath

 

Modest Expectations – Biblical Trivia

The Orange Toddler she calls him. She, our American friend, agrees that the vaccine should be tested, but the chosen vaccine should first be provided to the Great Leader. He has spruiked it – he must be made invincible. To mark the occasion in the Oval Office he must be surrounded by adoring people wearing white coats, but definitely without masks, unless made by his beloved daughter. There will be commemorative syringes for all.

That will give the American people confidence; he to bare his arm for America; the test as no other test has been seen by anybody; and then to cap it off, perhaps a couple of days, maybe a week later, who knows – the flock of white coats will be reassembled while COVID-19 is directly injected into the OT. Then he will turn, give the syringe with the Presidential seal to an adoring fan, saying that there has not been anybody ever, perhaps with the exception of Jesus Christ himself, who has done so much for America, to make it great.

No, you’re dreaming. That won’t happen because he says he has a deformity of his body, which precludes injection – too much Ancient Orange.

Maybe Sarah Cooper will be a suitable surrogate.

Hunted? Not quite

How predictable, the sanctimonious Hunt, the Minister for Health egged on by the Prime Minister, trying to blame Premier Andrews for the ills of Victoria, including the failed nursing home system. Nevertheless, a small history lesson is probably useful to dispel some of  the information about Daniel Andrews.

The problem with Victoria is that for years now it has not had a Department of Health but a “Department of Social Reform”, reflecting a social service bias at the expense of public health. Health is hospitals – full stop. That was the conventional wisdom.

The Heads of the Department have traditionally not been medically qualified. The structure of the Health Department was separated into Health, Hospitals and Mental Health, then unified for a time under a doctor, Gad Trevaks, when he chaired the then Health Commission.

That was the last time, and the real source of the decline in public health was due to Premier Kennett and his agent John Paterson, who effectively destroyed any remnant of public health considerations in the State. At the same time regulations have been loosened and, as one insider has said, food regulation and the lack of public health surveillance of food safety will be another problem that Premier Andrews will have to confront at some time.

Thus public health was in a woeful state even before the minions in the Victorian Treasury insisted on so-called “efficiency gains”, which is just a way of reducing public funding.

Then there was the case of a former chief health officer who was largely invisible during the time of his appointment and nobody seemed to care. Raina McIntyre, an outspoken epidemiologist, has commented wryly: “… such a minimalist system can get by during the good times but will be exposed in the pandemic”.

As Andrews has emphasised, this is an area where political point scoring is pernicious. It is more laughable than pernicious to hear the NSW Premier saying that she has a public health department, which “was second to none”, when the Chief Health Officer, Dr Kerry Chant, who is responsible for public health, was lucky to keep her job after the Ruby Princess and Newmarch House debacles.

After all, she has been in the job for 12 years, and was an inheritor, as were her public health colleagues, of the work done by Dr Sue Morey when she was Chief Health Officer. Dr Morey not only supervised the introduction of the contact tracing system but also enabled the public health medical officers to be recognised as medical specialists. As a result, in relationship to Victoria the public health doctors in NSW are far better remunerated. Many of those NSW public health doctors were trained by Dr Morey, who had gained formal public health training, resulting in a Master of Public Health from the Harvard School of Public Health in 1980. She set in place the public health system that is now being described as the Australian “gold standard”; it did not appear overnight. It is after all only a tool and it demands competence in its usage.

Strangled by a Thread of Cotton

Birdlife in the marshes

To me the Macquarie Marshes have always been one of the important bellwethers as to the health of the Murray Darling region. I have read much about them, but until this week had never visited. The marshes are located on the Macquarie River and lie some two hundred kilometres north-west of Dubbo, between Warren and Carinda.

To put them into context, the Marshes are an extensive wetland system covering more than 150,000 hectares, and the nature reserve covers 18,500 hectares of it. It is recognised as a Wetland of International Importance (but not by the NSW government). Most of the Marshes are in fact on private land.

The Marshes are arbitrarily subdivided into the northern and southern segment. There is more water in the latter. Importantly at present there is water in the marshes and there is abundant bird life. Black and white magpie geese swoop low as coots, ducks and a swan glide across one of the many lakes. The signs of the Marshes having periodically dried up are evident in the dead reeds where fires have wrought irreparable damage when there was no water. Across the water cormorants perch on the dead trunk, silent witnesses to the dying marshes.

Yet another sign of the degradation of the Marshes is the yellow rape mustard weed growing wild throughout the marsh areas that still are more or less dry.

The ultimate sustainability of these Marshes, even now after heavy rains have returned water there, is dictated by the cotton industry. The huge broad acres of black soil being prepared for planting near Warren attest to the nature of the enemy.

Originally it was the building of the Burrendong and Windamere Dams in the 1960s and 1880s respectively, which had diverted the wetland water to irrigation, and in so doing challenged the future of the Marshes.

That sets the picture for this almost lost resource.

We stop where the water is running across the track – 100 metres wide and from the flood post at a level of about 0.4 metres. A large 4WD lurching into a hole and then struggling out only to sink again in the running water before blundering through set the tone for the crossing. We did not attempt to cross, but had lunch at the edge of the stream. Another 4WD stopped on the other side had released a bunch of kids who set out their beach towels on the track and took advantage of a swimming opportunity.

A couple of ATVs containing a number of boisterous teenagers went by, charging into the water. They knew where to go, they clung to the right side next to the fence line. There were no holes on that side – no problems – across and gone with all round waves to those of us left behind. “Local kids”, the weathered face who appeared at the car window said.

He was a seasoned farmer who had stopped with his family, and came across to see who “these foreigners” were. He ran shorthorn Hereford cattle on a property north of Carinda – a place where he said the best cotton in the world could be grown. He was on an afternoon drive with his daughter who had brought visitors from Norway to see the Marshes.

However, the problem is that Warren always took the bulk of the water, and thus Carinda – 140kms further north – hardly received enough water to sow a crop – maybe once in ten years, despite its capacity to produce premium cotton.

His attitude is a microcosm of the problem of Murray Darling River planning. Nobody agrees. It is a free for all, with each person, each municipality, having no consideration for the people of the catchment as a whole. Why should they? Their role model – their various governments seem hell bent on fracturing the Federation. Why not add compromising the nation’s water to a deteriorating concern for country?

The Pub in the Scrub

It is but a speck on the map between Condobolin and Tullamore. Here there is a typical two-storied, corrugated iron roofed country hotel, with a bright orange tiled façade. It luxuriates in the soubriquet of The Pub in the Scrub. Its name, which also is the name of this hamlet, is Fifield. The hamlet is empty, apart from a murder of crows having a convention in the main street and a ute parked against the kerb in front of the pub.

Near the geographic centre of NSW, Fifield is surrounded by blazing yellow broad acres of canola. It was once the site for alluvial exploration for platinum and there is a sign nearby pointing to a place called Platina.

Fifield’s car graveyards

However, Fifield is a graveyard for car bodies. They are everywhere. There is an old barn, unusually with a chimney but now ramshackle, despite the incongruous new solar panels on the roof. Acres of car bodies behind the building are spread on the other side of the main road, the whole extent of which is hidden by trees. The fact there was a newish bright yellow Ford in front of the barn seems to confirm that the building was occupied.

The oval was covered in cape weed; there was once a tennis court, now overgrown, but with its net still in place and the rusted gate still visible. A disused wooden church on the corner with a handwritten sign which says “St Dymphna”, who can identified as the Lily of Ireland, the patron saint of mental illness.

However, on the road as you enter town there is a bright black and yellow sign exhorting the passing motorist not to dump rubbish – or else. Unless of course, it’s your car.

Ah, the wonderful irony of Australia.

Yuranigh

When I used to walk close to my old home among the trees which dotted the sloping land that had been preserved around the Melbourne Cricket Ground, I would come across a canoe tree where, before whitefella settlement, the Wurrundjeri people had carved a canoe from the bark.

Canoe trees were probably more common than have been found, but civilisation has a way of destroying heritage. Maybe many trees so used for canoes, shields, coolamons and other artefacts just did not survive. After all, before the whitefella came with his tree-felling prowess, there would have been open forest where the city now stands. Not surprisingly the river red gum with its stout trunk was a favourite source of bark. Bark was plentiful. Bark was the only resource they had for their canoes as there is no evidence that the dugout canoe of their Northern Australian brothers ever percolated south.

Yet the bark canoe was obviously important given the number of rivers and watercourses that flowed around and through the land which whitefellas labelled Melbourne. It is surprising so many of the trees survived so close to the centre of Melbourne

Aboriginal carved tree trunk

This reflection on tree carving was at the forefront of my mind when we visited the grave of Yuranigh. His grave lies a few kilometres east of Molong, a central west NSW town just off the highway to Orange.

The directions are well marked, the track is stony clay, there is a gate and a cattle grid, and then a short drive where old gnarled yellow box gums hold sway over a weed infested paddock. This is where Yuranigh is buried. Little is known about this Wiradjeri man except that he accompanied Thomas Mitchell to the Gulf of Carpentaria on one of Mitchell’s explorations.

Mitchell thought so much of this man that when Yuranigh died when still a young man, Mitchell paid for his grave and a marble headstone commemorating Yuranigh. It is apparently recognised as the one site in Australia where European and Aboriginal burial traditions coincide.

Around the area where Yuranigh is buried are carved trees, sinuous dendroglyphs etched into the heart of the trees – complex cuts given the tools that would have been used. The most prominent one of these is a stump protected from the weather, an extraordinary example of Wiradjeri art. It had lain for years on the ground, before being raised and now supported in a concrete base

There is another tree close by where the artwork can be viewed through a slit in the tree – the carving lying within the tree. There are four trees that define the corners of the gravesite, but some have defiantly repaired themselves and in so doing smothered the artwork.

We were alone at the site. Despite the complexity of what we were witnessing – an intertwined image where we could see original Wiradjeri work in all its complexity but only guessing as to meaning not only of the carving but also its placement in relation to Yuranigh’s burial place, I realise I know so very little.

Yuranigh grave site

Yes, I understand Mitchell’s tribute. That’s how we whitefellas celebrate dying in a world of grey – the compromise between white and black in our monuments and headstones. But the trees are not confected – they are real. In blackfella eyes Yuranigh obviously was a great Aboriginal man; the carvings denote respect. Otherwise who would take such care? “Sorry business” is such an important part of Aboriginal life.

John is not the Name

When I go to a bank or any other place where the interaction is usually with a younger generation, far younger than my “silent generation”, I find being addressed by my Christian name jarring to say the least. I quickly correct them on most occasions.

After all we have a surname for a reason, whether derived by being the “son of “, colour (white, black, brown), profession (fletcher, butcher, smith), location (London, Birmingham, Kent).

I come from a generation when every male at least addressed each other by “surname”. However, within the family and friends circle, we were called by our Christian names.

I find calling elderly people by their first name, as if they are children, unsettling. I would object to a stray carer that I have never seen before, calling me by first name. Using “John” jars just because they have seen that on some of my documentation, because those who know me call me “Jack”. Address me by my surname please.

Having thus aggressively put my point of view, my cousin told me a salutary story about his uncle. His uncle Jack went to get a job on the wharves.

He was asked his name.

“Jack,” his uncle replied.

“Look, feller, on these wharves we deal in surnames. What’s your surname?”

“Honey.”

“Well, Jack, it is …!” came the immediate reply.

One against me.

Mudgee Mud

It is about 40 years since we were in Mudgee. We came to the inaugural Mudgee Wine Festival. It was a spur of the moment decision. I asked her. She said yes. Now years later, the trip was not so romantic; you know, she said as we were driving there, “We came here in 1980. Have you been to Mudgee since?” I had travelled widely around this part of NSW and for a time I often visited Dubbo, spent time at Bathurst, found some delightful antiques at Molong and had been to Glen Davis on more than one occasion – but Mudgee?

Forty years ago, Mudgee wines were dismissed with the label “Mudgee Mud.” Give something a bad name and I doubt whether even after exposure of the wine at the Festival was sufficient for me to ever buy some. It was still very indifferent wine.

Ulan coal mine

The dinner was an uproarious affair, as one of the guys who was a geologist had mapped the coal deposits around Ulan and was making or had made a financial bonanza out of his assiduous tracking of the coal deposits around those areas. At the time of the dinner he had secured the lease over the tail of the deposit. Forty years ago, coal as they said was king, and who had heard of climate change effects!

At the end of the night, we blokes had all got along so well, and there was so much bonhomie, that everybody was shickered. Out in the car park all the blokes got into the driver’s seats and the wives, who were by and large sober, were consigned to the passenger seats. There was one exception – the young lady whom I eventually was to marry years later – insisted on driving. Just as well.

The next morning I awoke, nursing a damaged head. We had stayed down the road at Kandos, famous for its limestone quarrying. Mudgee had been booked out. As we were leaving the motel owner noted that I was a doctor.

“Oh”, she cooed, “ We would love to have a young white doctor here in Kandos.”

Different times then, different times.

Mouse whisper

On the menu at the Italian restaurant in Griffith, it was stated that one could dine “al fresco”. Sounds authentic – just as the names of any the pastas or “il cotoletta Milanese” were authentic italiano.

The term al fresco is unknown in Italy. If you want to dine outside (fuori) or in the open (all’aperto”), you will be directed to that leafy courtyard.

Thus, il cameriere will scratch il sua testa if you say “al fresco”. He may misunderstand and instead bring you acqua fresca – cold water.

all’aperto!

Modest expectations – Route Marcus John

I was born on the west coast of Ireland many year ago & up to now I thought I had a hard life as a young boy picking potatoes for farmers, plucking turkeys for meat exporters, caddying for rich golfers wishing for a bag of clubs on each shoulder. But after seeing (how the Blasket people lived) I now I know I lived the life of a prince. The Blasket people were made of granite. I now live the life of a softie in England compared to what they endured …

Blasket Island

This stray Twitter comment from some guy who had watched a video on the Blasket islands off the coast of Kerry typifies many of us with West coast Irish heritage. There is something about really returning to one’s Celtic roots if you travel to one of the islands.

The Blasket islands have not been inhabited since 1953 when the then Taioseach Eamon De Valera moved the last 22 inhabitants off the island and onto the mainland. Nevertheless, this group of islands has much Gaelic literature written about them.

Sometimes, especially as you grow older, you like to relax in your heritage. Mine is partially rooted in Co Clare and off the coast are the Aran Islands; an intrinsic part of the Gaeltacht.

I remember the day I went to Inishmore, the largest of the three islands. I took the ferry from Doolin. The ferry was delayed until the tide came in, and if you get impatient, remember the Irish nostrum: “A watched kettle never boils”. So we all waited and waited. However, the day was one of those days when you thought you were going to a Greek Island rather than to an island in the Atlantic Ocean.

Rowing your curragh

The 1934 documentary called Man of Aran that I watched recently, made and remade the point that the seas around the island were very rough and perilous, and not a good place to be out rowing your curragh. It is a dark film.

The island seems to be enveloped in gloom – dragging the curragh from the surf, gathering seaweed to provide nutrition for the soil, breaking stones to uncover that precious soil in which to plant potatoes, cliff fishing – a hazardous exercise of throwing a long line down the cliff wall into the sea. Conversing in Gaelic – hard to hear with words drifting the waves and wind.

Overall, men, woman, boy – these are the toilers of the seas, to borrow from Victor Hugo. Light is provided when the figures are set against the backdrop of grey skies hacking at rocks or looking out to sea. Or else light is the white spume of the dark tempestuous sea crashing against the rocks and cliff face.

The film uses black and white imagery, which has been so over-used, to define an Ireland deprived of its emerald hue – sunless and poor.

Contrast it against the unexpected experience of being on the Aran Islands when the sun shone and you could be in the Mediterranean. Here was an optimistic panorama and not a cloud in the sky; the ocean a millpond. An island where you could take off your heavy fisherman’s jacket and sweater and go bare-sleeved.

I trekked across the limestone and grass and over stone walls to the ancient Neolithic fort which sits on the edge of cliff overlooking the Atlantic Ocean. It has the appearance of half being there, and the other half having broken away and fallen in the water. The Legend of Atlantis often gets a run when you see the ruin, especially from above. But it is an illusion; it was just built that way, as if to defy the elements.

In the progress of the trudge across the island, I was sunburnt – for God’s sake in Ireland. Twice that has happened. And that was before I could blame it on climate change.

The Man of Aran, however authentic it may have been when it was a pathfinding documentary of a vanishing Ireland, now can be portrayed as a caricature of an impoverished land.

But that day on the island aroused in the emotion of an ancestral intrusion. The landscape is a limestone continuation of the Burren, an extraordinary pavement that appears to have the hand of my ancestors in its creation. Yet it is where Nature has brought together Arctic and Mediterranean flora in the nooks and crannies of this pavement. It is a place where I have had the sensation, walking across it, of having been there before – was that chance or was it predetermined that I had placed feet on where one of my ancestors had trodden.

I have always been fascinated by the concept of the Celtic twilight.

Therefore, one of the privileges of an Irish heritage is that it has provided me with a sense of that past, which has shaped who I am – both my insignificance and my significance. That day on Inishmore I was tempted to buy a stone cottage and live surrounded by dry stonewalls and green fields. The life of an ascetic lingered for a moment.

That urge passed because in the end you are one person no matter where your heritage may lie, and I am Australian not Irish, not someone who repeatedly says that my mob have been here for 40,000 years but nevertheless proud of my mob who have been in Australia for 170 years.

I hope I have added value to the nation of many nations brought together under the Southern Cross even as the twilight gathers. In the end, it is what you do with the privilege of being here, be it one year or 40,000.

I disagree with the Twitter who escaped from the West Coast to become a softie in England.   Migration does mean being, as he terms, “a softie”. It was not a soft option for my ancestors to leave, after all it is a long way from Tipperary, let alone County Clare.

The Cylcon

I first saw them in a roadhouse at Little Topar, lying alongside the emu eggs in a dusty display case. I asked whether I could buy one of them. The guy behind the counter said no. He was only minding them for the owner. Same reply each time, I asked. The owner was elusive. Stone walls are stone walling and I did not stop at Little Topar often enough to nag.

So there it rested, until I saw one advertised on e-Bay. I am not one of those people who regularly trawls e-Bay, but I was attracted to a couple of Aboriginal artefacts, which looked ridiculously cheap. However, they became part of a bidding war – and I have never bought anything at auction. In any case, I am a tyro when bidding against skilled operators, who have so much better timing of their bids (to say nothing of the automated bidding programs).

Anyway, once on the e-Bay site, I had a further look for anything else that that might be interesting. Then there it was – one of those items that had been displayed at the Little Topar roadhouse.

It was a cylcon and it was for sale.

To put Little Topar into context, it is a roadhouse about 100 kilometres from Broken Hill. Nothing else. Cylcons, as the name implies, are conicocylindrical stones. They are said to be found across Australia, but were often picked up by those working on properties in Western NSW and South-West Queensland. Markings are not uniform and it is said that the local Aboriginal Barkinji knew nothing of them.

However, then you read elsewhere about a mob around Lake Eyre who were still using stones that resemble cylcons at least 50 years ago.

Tchuringas are often mentioned alongside cylcons as having magical powers. I know what authentic tchuringas look like as I was shown several when I was travelling around the Kimberley in the late 1970s. An elder of the local mob, who thought I was important enough to unwrap this valuable legacy showed them to me as we sat alone. As I worked out later, this was one of the most sacred possessions. That’s all I will say recognising that anything I could say about it would be strictly men’s business and remains so.

So now I have a hard sandstone cylcon. I can talk about it, still not knowing what its significance is – it remains unfinished business.

The messages are getting mixed again

A couple of recalcitrant families have tested positive for the Virus in Victoria and the postal address of these families suggests they are not “white anglo-saxon protestants”. Anyway there is no mention of heritage, and there was only passing reference to the fact that last month it was Cedar Meat abattoir at Brooklyn in one of the targeted local government areas (LGA), which was associated with an outbreak resulting in 111 workers testing positive. Do we really want to punish the whole of Victoria because of one group? Let us not be coy about where the problem lies.

The fact is Victoria has used the first lockdown in March to refine contact tracing to a very comprehensive level. However, there is need to develop a strategy to selectively isolate those groups who persist in flouting the rules, without disrupting everybody’s lives.

An Essendon football player has tested positive for COVID-19 virus. He has been found guilty of flouting the very tough guidelines, which have tried to isolate these gladiators in some sort of safe house environment. Then they show the image of this player on the field with his teammates. First, he spits on the ground and then he blows his nose so the droplets spray everywhere.

So the AFL says that they take every precaution to ensure that the behaviour of players is hygienic; so is this player as pictured the only one spitting and blowing his nose without a tissue? No evidence of hand sanitiser here. No evidence that he was disciplined for those disgusting pieces of behaviour. The game must go on, the tills must keep jingling – metaphorically.

There is confusion about whether he has tested positively or not; and anyway Essendon say he only had contact with a marginal player who would not have been selected.

That seems to be the first mixed message; just like the scurry before the Grand Prix in March. Essendon player contact vs a large Keilor Downs family contact – different approach?

Then there is the matter of quarantine facilities.

One topic that has not received much attention is the need for permanent quarantine facilities.

Sydney quarantine station

Australia has been quick to lock up asylum seekers. They are clearly different from those who flout – accidently or intentionally – the rules laid down in one major respect, the latter group vote. The way the Biloela Four have been treated is nothing short of disgraceful.

This situation is more than regrettable if an ignorant populist tries to bend public health discipline for short-term electoral gain. One of the problems with the Victorian outbreak is that it is within Labour-voting electorates. However, the Premier seems imperturbable.

That is no reason for the current Government adopting a different reaction to one where the outbreak is in Liberal- voting electorates

In the past, where there was a need to quarantine people, quarantine facilities were located close to the shipping. However, while cruise ships have been shown to be a very real source of infection, it is air travel where the major problem of ongoing infection will arise. Therefore, as quarantine is now becoming an ongoing issue, it is now important to rapidly develop facilities close to airports, where those to be quarantined can go.

Using hotels in the centre of the city with obviously unskilled staff is not an ideal long-term solution. Hotels are not constructed to quarantine people – quarantine facilities must be secure.

As has been shown in Sweden, believing people will take seriously a foe that they cannot see, hear or touch has not worked. This Virus may show its presence through smell and debatably taste, but they are not the primary senses to stimulate a “viral defence policy”.

The second mixed message is thus that politicians think quarantining the asylum seekers is OK; but not those fleeing the Virus.

The Prime Minister is keen to have a building /renovation program. Constructing appropriate quarantine facilities would be an important way to consolidate in more ways than one on the governments’ achievements; rather than fritter the sense of unity away on acrimony over the borders or fritter away money on some renovation scheme accessible to a few well-heeled homeowners. Some would say a return to the primitivism of politics rather than a rational way of devising a sustainable quarantine program.

In doing so, the government must realise that this situation is not a three month wonder since it seems that some countries, notably the USA have given up, irrespective of what they say, and just wish for a vaccine or that the Virus will go away.

Therefore, such construction recognises that this situation is not going away any time soon. One of the dozens of facilities currently seeking a vaccine might be lucky, but inescapably the most recent vaccines for HPV and chicken pox took 15 and 20 years respectively to develop.

When government wants to, it can use its own land to construct anything.

Those that are sick go to hospital. There used to be infectious disease hospitals – the last one being Fairfield Hospital in Melbourne, which was closed in 1996. I once had a week in Fairfield as a teenager when I had a severe respiratory infection for which there was no obvious reason. In another time, I could have been the first in a line of pandemic victims with an unusual set of symptoms.

COVID-19 has shown that it is preferable to have the capacity to treat an infectious disease for which there is no cure and but importantly to have the skills to treat patients without the disease being let loose in the general hospital environment.   After all, warnings of recent epidemics have been largely ignored; but now the pandemic has come upon a World which has been shown as hopelessly unprepared.

The third mixed message follows on and involves border closures. With the Victorian outbreak, the hysteria is rising again. “Victoria is the Lazaret State”. Australia has suppressed the Virus to such an extent that it can be isolated to specific areas. So you can lock down particular areas; not the whole State. You prohibit movement outside that area until the virus is suppressed; those who don’t obey go to the quarantine facilities and join the overseas arrivals.

The bluntness of this message may act as a deterrent. We have not worried about the niceties of language for the asylum seekers; so why not those that flout the COVID-19 regulations. No exceptions, not even for the rich and infamous. However, there must be designated quarantine facilities that are run as such. Once you have defined quarantine facilities and the staff requirements you bring certainty into the process.

My son came back from the United States in early March and was case 13 in Victoria. It was uncertain times as knowledge of the behaviour of the Virus was not as well known as it is now. His spread was contained. That meant inter alia that the whole family stayed at home without any direct contact with anybody until all were virus-negative. However he and his wife have defined antibody titres, as presumably have all those who have recovered in Australia.

Before we have more mixed messages – of having some recognition of their status, what does it mean? Can such people travel freely around the country or internationally? Around the world there are a growing number of such people. Do they get the equivalent of a diplomatic passport to travel? What is the ideal threshold titre for immunity required? And the questions mount up because there is still so much unknown. To avoid a fourth mixed message, does Australia just subscribe to the WHO conservative dictum on this subject – especially the immunity passport as suggested by Chilean sources have superficial appeal to some?

George V Salle à Manger

After all, there will be a graduated requirement for return to travel. Some places will be safer than others. This one area where a fifth mixed message is liable to arise as the “politician itch” to go overseas becomes unbearable. This pandemic has questioned the need to have all the junket paraphernalia – sister-cities, inter-parliamentary delegations, most conferences and even business travel – let alone ministers and their staff spending vast sums of money for nothing much more than say, having lobster bisque at the George V in Paris.

Been there; done that. Time to suppress the virus of Self Indulgence, which also selectively affects tastebuds. However, for others it has been a fascination – the overseas all-expenses paid junket. What is the government’s advice in relation to this? What twisting and turning will Australia see to make sure the lobster bisque does not go to waste?

And of course there is the sixth mixed message to end all mixed messages, Ann Sherry. She has, as recently as February this year, been applauded for all the good works she did for the Carnival organisation. She has now bobbed up co-chairing some Australia-New Zealand outfit to promote, among other things, tourism. Given her propensity to flog ships can we expect Carnival, her old ahoy, to be plying between their ships between Australia and New Zealand?

I understand there is no foundation to the rumour that Carnival is renaming its ships: the Rabies Princess, the Diarrhoea Princess, the Plague Princess and the Leprosy Princess. 

Five Characters in Search of a Disease

We were having lunch in the neighbourhood restaurant that serves freshly shucked rock oysters mostly from the south Coast.

Nearby, in retrospect far too close to us, a table was set for five.

They straggled in and sat down at the table with their bottles of wine. They were five men, well into their sixties and beyond, and typical of men when they gather together, loud talking, joking, passing the booze – as they have probably done whenever they’ve gathered.

The problem is that these are not normal times. Were they social distancing themselves? Well, no. Their bodies were touching. Was there any evidence of hand sanitiser? Well, no

In fact in retrospect, given that the courtyard was virtually empty, they could have located there.

However, suddenly one of them sneezed and coughed extravagantly. No tissue – he at least belatedly put his hand in front of his mouth. I told him off – told him to cough into his sleeve. I said a few more words. The table shut up for a short time.

Who was this other old codger telling off one of their number? They were stunned, as though being pulled up for a transgression outside the confessional box was itself a venal sin. Then they said no more and went back to their crowded space – except nobody coughed.

It emphasises how tenuous this whole community regulation as been on any long-term change of behaviour, even attitudes. Here was a group of men in the target age for serious trouble if they were unfortunate enough to catch the Virus.

However that is not the imagery that is projected on the screens; rather it is of old people being the victims. In some cases this is true, but there is a problem. It is being able to tell old people what to do – especially when they are not culturally attuned to change, except by extreme coercion.

In this case, I remember these guys as young men – not this particular quintet. They nevertheless represent that chap who limped into the surgery 50 years before with a severely infected leg following a seemingly minor injury a week before. If they have come earlier they would not have had such drastic treatment. Now these men have aged but their attitudes have not changed. In their minds they are disease-proof – that is until the Virus comes calling. They are the most vulnerable age group.

When we left, one of them muttered something that was obviously in the same literate genius sense of “What are ya?”, given the others guffawed. Sometimes the larrikin in the Australian persona is seductive; at other times, not so much.

My dining companion who is a well-known public health physician said to me afterwards that we should have told the proprietor to ask them to comply. We did not. That is our fault. It poses the dilemma of calling people out, especially the elderly who always know best (you know the guy who smokes heavily and boasts that he has never had a day off work in is life), when you only have the authority of your voice to make them comply.

Premier, you who presided over a government that gave us the Ruby Princess, should recognise that the situation occurring in Melbourne is only a cigarette paper thin barrier away from occurring in Sydney suburbs in NSW that have similar ethnic demographics where large family gatherings are the regular occurrences – let alone among the men who lunched next to us last Friday.

So may I respectfully suggest that you get your competent Health people to look at the potentially vulnerable local government areas and the level of compliance within each with the COVID-19 guidelines?

Mouse Whisper

Sometimes I come out of my mousehole, and there is this sleek lizard skink sunning himself in the morning rays. He cavorts around my mausmeister’s kitchen, and has done so for a long time.

My mausmeister decided then that he would call my industrious friend Dyson, because of his ability to vacuum – clean the floor of pesky insects.

However with the revelations in this week’s papers, it asked me why would any self-respecting lizard (and it emphasised the self-respecting) call himself Dyson?

He is petitioning to change his name to Hoover.

Dyson

Modest Expectations – Paul Egan

I was reading Rupert Brooke’s Letters from America, which he wrote about his 1913 journey, but which wasn’t published until 1916 with a foreword by Henry James – apparently his last piece of writing. Brooke had died in 1915 in Greece, and is known for his romantic view of dying for one’s country.

The flag of German-occupied Samoa

The book is a set of well-written notes about Brooke’s 1913 travels which, despite the title, included a visit to Samoa, then under the German flag. Brooke is very sympathetic to the German rule saying it was better than that of British rule in Fiji. Nevertheless, a Samoan princess did not agree with this assessment. Climbing the flagpole she removed the German flag and, having torn it into pieces, danced on the remnants. Brooke does not report any retribution.

He describes Samoa as Heaven and although it was ruled for a time by a tripartite administration of Germany, United Kingdom and USA, in 1900 the western islands were ceded to Germany while the Americans kept the islands east of the 171st degree meridian. This latter information was not gleaned from Brooke’s writing, but his book did draw my attention to the fact that New Zealand invaded Samoa at the outbreak of war, rounding up the 50 or so Germans and native auxiliaries. New Zealand did not let go of its conquest until 1962. The League of Nations bequeathed it as a territory and other post-war finagling ensured the long time to independence.

Rupert Brooke’s account was certainly not first hand of the invasion but it is a wonder nobody has made a film of the story – with Sam Neil at the head of the expeditionary force wandering the Pacific before mounting the invasion. The Germans had a couple of large ships in the area but they were told by Berlin not to attack. A film would suit Neil’s wry humour.

Anyway Brooke wrote the following: “They must have landed at noon, I see. How hot they got. I know that Apia noon! Didn’t they rush to The Tivoli bar – but I forget, New Zealanders are teetotallers. So, perhaps, the Samoans gave them the coolest of all drinks, kava; and they scored. At what dances in their honour, that night! – but, again, I’m afraid the houla-houla would shock a New Zealander. I suppose they left a garrison, and went away. I can very vividly see them steaming out in the evening; and the crowd onshore would be singing them that sweetest and best-known of South Sea songs, which begins ‘Goodbye, my Flenni’ (Friend, you’d pronounce it), and goes on in Samoan, a very beautiful tongue. I hope they rule Samoa well.”

New Zealand Troops in Samoa NZ Archives*

Overlooking this invasion was Tusitala, the great bard of the South Seas, also known as Robert Louis Stevenson, who now lies atop Mount Vaea in Apia. I still shake my head at the thought of the Kiwis invading Samoa.

This is a Knife

That is the famous line uttered by Crocodile Dundee when threatened not by a white, but a big black man – dinkum white Aussie threatened by a stereotype. We whitefellas felt comfortable; great sight joke and the sub-title – a smart Aussie will always outwit the dopey Yank.

This is a knife …

Last week newly-minted young white constable faces a taller black teenager in Sydney, who is alleged to have said that he will break the constable’s jaw, “bro”. The young man in the hoodie knows his street talk! The young constable, instead of inviting the young alleged thug to have a cup of coffee to discus the immense psychological pressure the young man was experiencing, moves across, turns him around and trips him – one might think that reasonable if someone says he is going to break your jaw.

He did not: (a) draw a baton, (b) use tear gas, pepper or mace, (c) use a taser or stun grenade, or (d) shoot him.

That is the problem I have with police forces. They are clothed in ominous dark uniforms and dehumanising headgear with all the armaments of the military. Yet the police force is not meant to be a killing force. The more the toys of destruction are supplied to an increasingly poorly-adjusted police force, then working as an agent for Trumpian cancer metastasising across America, then who is going to halt their spread?

The solution to violence is not providing more weapons – the reverse should be true. A police force should be more concerned with each police officer being given the confidence to settle disputes with the minimum of violence. For instance, at this time of pandemic widespread use of agents designed to compromise the cardio-respiratory system such as the irritant sprays should be banned. The problem is that politicians wring their hands over domestic violence, send mixed messages when violence is rife in the community. Politicians yield to the slightest demand of police associations, where the megaphone is the loudest.

There is ambivalence when police are involved.

At the outset of the piece, I related the instance of a young policeman threatened with violence. He tackled the young aggressor, one on one – it was not a gang tackle. He was responding as he was trained to do in a potentially violent situation.

Contrast it with the images of multiple law enforcement officials, be they men or women, tackling the one individual. The sight sickens me. I am sure that there is almost always provocation and prisons, for example, are dehumanising violent environments. Drugs are dehumanising.

However, the wolf pack response is descent to the same primitive level. Just look at the all-white police officers at Central station last Saturday let off the leash, the officer in braid visible behind – not trying to restrain his men with their eyes full of hate. Not trying to lead! Not trying to maintain his police force in social distancing. Except for himself, the senior officer “looking good in a uniform”, as they say, is pictured generously social distancing himself from the fray – leading from behind.

Yet one episode after another of alleged police brutality tumbles through the media. I can never forget the images of Ron Levi, an unfortunate man having a psychotic episode in the surf at Bondi who was shot four times by two drug dealers who at the time happened to be members of the NSW police force. Shooting someone, even one carrying a knife, when presumably every policemen is taught how to disarm with the minimum of violence, destroys community confidence, shakes one’s confidence. No charges were laid against these men, despite this young guy being murdered in full sight.

Instead of questioning whether police are competent to have the paraphernalia of aptly named “assault weapons”, why doesn’t the debate start about when the distribution of weaponry should be curtailed?

Death in custody is like domestic violence; it has circled in earnest discussion ever since I can remember. The number of Aboriginals in custody has not reduced. Violence has been endemic in Aboriginal communities; to say it is not is to deny reality, irrespective of whether it is fuelled by alcohol or other drugs.

Yet there is an increasingly articulate group of Aboriginals – lawyers, public servants, Parliamentarians. The grievance rightly exists; obviously the solutions are not there for change despite the increasing number of these Aboriginal advocates. How many years are needed for you articulate people to effect change, not just to leave it someone else; not just to complain – blaming government is a way of doing nothing.

One of the advantages of modern society is that everything is recorded; just as that young constable’s action was. Instead of saying that he had had a bad day, the police commissioner should tell us what he would have done; probably nothing different. A bruised ego for an aggressive youth; but what does the young constable learn? Just exhorted not “to have a bad day” again?

Meanwhile the weaponry lobby rolls along, getting its inspiration from the brutal obscenity that masquerades as policing in the United States. Democracy dies when the police force, shorn of accountability, becomes the means of its destruction not its defence. The more weaponry a police force has the more it is likely that you or I will become the next Ronny Levi.

As they said when they came back from Bondi after killing Levi,

“That was a knife!” And the man with the braided cap responded: “We have just the carpet under which you can put the knife, and we won’t tell anybody. Probably need to replace the carpet – we burn them after five years. They become too stained.”

The Third Pole

I had not thought of the Tibetan Plateau as the Third Pole. Joel Berger’s book “Extreme Conservation” with its subtitle about “Life at the edges of the World”, in which he describes his extraordinary life, draws attention to the Third Pole. By and large, his experiences are in the snowbound parts of the planet in the depths of winter.

The Third Pole

The author has spent a considerable part of his working life trying to assess the state of endangered species, including the musk ox. The musk ox is an extraordinary animal able to survive the harshest of winters; it was hunted to extinction in Alaska, but revitalised by the re-introduction of animals there from Greenland.

Musk ox

There is a musk ox farm just north of Anchorage in a place called Palmer, on the way to Mount Denali. Incredible was my response when I first saw a live musk ox – sturdy and solid with a skirt of hair reaching its feet and with horns Berger describes as “piercing armaments”. Their closest relative is the wild yak that lives high in the Tibetan plateau, itself a different beast from the domesticated yak – and considerably bigger than the musk ox.

The musk ox is beautifully adapted having spiralling nasal turbinates so that freezing air has been warmed sufficiently by the time it reaches the lungs so they don’t become snap frozen. I have adopted two of the calves, which has maintained my status as a herd associate and bought a scarf made from the combed wool. It is woven into an extraordinary light fabric, called qiviut, which is remarkably warm and as long as you like a brown scarf, everyone should travel with one in a cold climate.

Wild yak – very difficult to tag

However, this interest in the musk ox is a prologue to the matter of the Tibetan plateau where the wild yak roams, admittedly in decreasing numbers. The problem is in the assessment of numbers, it is important to tag a beast – and wild yaks are very difficult to tag. This is the Berger expertise – tagging and tracking – and being heroically mad and brave.

However, that was the task facing the author where wild yaks are seen nearing 6,000 metres above the plateau. The Tibetan Plateau occupies an area of around 1,000 by 2,500 kilometres, at an average elevation of over 4,500 metres.

As Berger says, this plateau is the “water tower” of Asia. All the major rivers of south-east Asia – the Indus, the Mekong, the Brahmaputra, the Kangali, a major tributary of the Ganges, as well as the Yellow and Yangtze rivers all rise on the Tibetan plateau. Even Burma’s major Irrawaddy River is not immune from the effect of the Tibetan plateau.

Berger describes camping in the shadow of the Bukubada glacier, “a massive vault covering 170 square miles” (44,000 hectares) is vital to be preserved, monitoe. He describes other glaciers – the Yuxu and Yuzhu with the giant Muztag Ata glacier, located on the far western margin of China and east of the Pamirs Plateau, at a summit elevation of 7,546 m. So much water locked up and yet climate change has reached the plateau. Berger observes in the ice, the vegetation, the movements to higher ground of the indigenous wildlife, so many of which through indiscriminate slaughter are going the way of the bison on the North American prairie.

Belatedly the Chinese have recognised this, but as with so many authoritarian regimes they believe they can beat Nature into submission. Because we humans all live close to sea level, few give much thought to the dams being built on the Tibetan plateau. Thus this plateau, which provides Asia with much of its river water, is too precious to be left to one country with its selective concern about the World Order.

With climate warming and the glacial water storage thinning on the Plateau, water becomes scarce and this process will not be accelerated by the Chinese – given their form, who is not to say that they will divert most, if not all, of the water into their own river system. The planet despoilers are hard at it, and without any real checks and balances. The Mekong is particularly at risk, as Cambodia found out in the last dry season.

The world knows the Amazon is at risk – but so is the Tibetan Plateau. The problem with Tibet is clear.

However, in the minds of the West, Tibet is the Dalai Lama, once a hero but now increasingly shunned, soon to be a footnote in history. The successor will be appointed by a supervised Chinese process; Tibetans lose the links to their last traditional living god chosen by traditional mumbo jumbo.

What has to be avoided is to miss the importance of Tibet. Joel Berger gives us an intimate glimpse of what we will miss once the short term imperative of`progress ends up with the Tibetan Plateau a ruined wasteland deprived of wild life and water.

It’s somewhat ironic that the Chinese President, Xi Jinping, is reported to have cited the following Chinese proverb in a recent speech: “The ceaseless inflow of rivers makes the oceans deep.”

The problem is there is red ink seeping across the map of the world and it is not British.

If the world were brave enough it would face down China over the Tibetan Plateau – it should have the same status as Antarctica. Look, my grandchildren’s generation (and onwards). Witness the World at War over water, and remember your parents and grandparents should have read what Berger has written, taken heed, stopped wringing their hands over the Tibetan Plateau and acted. But don’t worry – there is not any moisture left on your hands. It all left with your ancestors.

Christ stopped on his way to Wilmington Station

Biden is a dud. His advocacy of the appointment of one, if not the biggest, dud on the Supreme Court, Clarence Thomas, shows that one dud knows another. At the Senate confirmation hearings in 1991, it was Biden who pilloried Anita Hall. She had accused Thomas of sexual harassment. Biden denied her the chance to present corroborative evidence. Then he came crawling back after 28 years after the Brett Kavanaugh disgrace, trying to apologise to Professor Hall – he received no dice.

This senator from Delaware, with his own problems in this area, has so many strikes against his name – and his gaffes are continuing although he has barely been out of his home for the past three months. Whether this means these gaffes are the first signs of mental decline, only his closest medical advisers know. If there is any indication of cognitive decline, he should just immediately withdraw, full stop.

I have mentioned that he looks old, covered up by a sunbeam smile, but even if he goes forward, he must resist a Sandra Palin, whether male or female, of the left. Palin helped do John McCain in. McCain was seemingly more astute than Biden and only a “chicken” – 71 at the time. If the Democrats nominate this aged “rooster”, they have to make sure that perception of his inherent weakness is not further compromised by a Vice-Presidential nominee who is already campaigning for the White House succession. It is not hard to do the numbers on Biden’s age.

So the Democrats nominate a younger active assertive person with the “smarts”, who only serves to accentuate Biden’s weakness. On the other side Trump needs a tough image now that people are beginning to laugh at him – now, after the stories of him huddling in the White House bunker and then walking behind his Praetorian Guard as they gassed the innocents. Sound familiar?

Trump recognises this need for “toughness” and in this context having a pliant poodle as a Vice-President gives him that air – at least to his fan base.

The wrestle for the Presidency

Trump is also well versed in the theatre of professional wrestling, where there is the Bad Guy against the Good Guy. Just simplify the rhetoric and make Biden look weak and confused. Violence. Pile into him; mock his weakness; back-slam him; put him in a headlock – a crusher hold perhaps. Let’s turn Presidential debates into “Ringside with the Wrestlers”.

Trump has little else left. He is the Bad Guy with the devoted fan base. The Biden insipidity gives him a chance.

Thus Biden may be caught between two “shouty” forces, which continually emphasise his inherent weakness.

Is the electorate going to be won over in November? Think carefully, you Democrats, don’t become real donkeys. 

Mouse Reflection

I decided the pool was deep enough to reflect a mouse whispering.

In the Feb 28 blog, my mausmeister under the heading: “The Price of Never Being Wrong”, wrote the following, which has been reproduced abridged…

The problem with epidemics is they thrive on ignorant national leaders, who have no idea of public health, suppressing inconvenient information. This increasing government secrecy is coupled with the modern version of the courtier castrati, people without ideas but with perfumed phrases whispering into the ear of national leaders who have lost the ability to apologise.

… I once wrote a small monograph entitled “The Dilemma of the Public Health Physician” in which I attempted, as I said, “to help public health physicians to work through the situation which confronts many professionals when they are in possession of information which others perceive as ‘sensitive’ or valuable in any respect.” 

… I went on to argue that all public health information should be freely available. Even over 20 years ago I wrote; “there is an increasing tendency for the political walls to be daubed with the graffiti of misinformation”.

On reflection am I just succumbing to daubing those political walls? Well, that is the point – public health expertise is being allowed not only to languish but also ignored as an inconvenience. But as many politicians have found out in the past, “wishing an inconvenience would go away” is not a solution.

Having said that it seems we are fortunate in Australia not only to have the calming influence of Brendan Murphy, but also his unheralded deputy Paul Kelly who, unlike his boss, is a public health physician. Their influence on the government where there is a high level of ignorance is, and will continue to be, important…

On the same day in February 2020, the Australia Health Protection Principal Committee (why do the Government give committees such indigestible titles) published one of its reports, an excerpt of which is printed below. This Committee is chaired by the Chief Health Officer, Brendan Murphy and has as its membership all his counterparts in the States.

… More than 60 per cent reduction in travellers and no cases detected in more than 30,000 Australians returning from mainland China since 1 February 2020. This has been assisted by travel restrictions imposed by China. In addition, a significant number of students from China have spent 14 or more days in third countries and have arrived in Australia to commence or continue their studies, again with no cases detected in this group. The only new COVID-19 detections in Australia in the last two weeks are eight cases in Australian passengers repatriated from the Diamond Princess cruise ship. There remains no evidence of community transmission in Australia, with thousands of negative tests for COVID-19 in the last week alone.

Much can happen in four months, and in the end as my mausmeister prophesised, they got it right, despite the Committee’s crystal ball being somewhat clouded at the end of February.

 

 

*By Archives New Zealand from New Zealand – New Zealand troops in Samoa, c.1914-15, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=51248178

Modest Expectations – A Girl called Sue

Scotty the marketer cannot help himself. Trump had to find somebody to blame on one particular day – the WHO was a convenient target. As with so many organisations of that ilk, they are inefficient but located in a nice part of the world as multiple senior Australian bureaucrats such as Jane Halton have demonstrated by visiting repeatedly at government expense. In other words whatever the WHO is Australia has been complicit in how the organisation is managed. Presumably senior bureaucrats like Jane Halton, now a member of the Power brigade, could have given an insight into the WHO and her role in recommending efficiencies, given how frequently she visited Geneva.

Prime Minister Morrison, as distinct from his instinctual marketing Scotty persona, is inexperienced in the world and, being surrounded by his clapperati, he has decided to play the international role, flush from our apparent success in containing the virus.

Evidently he has been contacting a number of seasoned political leaders, still up to their necks in death and destruction, to enlist them to his cause. Now, if there was one thing I found out when I was reforming an international organisation it was the negative reaction of the Europeans in senior positions to an Australian running the show; and the more you demonstrate your QED, the more quickly you can alienate the European audience. However, once committed Prime Minister, you must know precisely what you want to do in reforming the organisation – and then make sure you let somebody else share the credit. Hopefully you have a clear idea for a course of action and it was not just an instinctive Scotty-from-marketing bubble.

Trump does matter in the short term because if you become one of the emissaries, then you are also in his line of sight. After all, there are a great many tweets to go before November; many and much to blame.

I am sure that you are not going to crow, but remember the Chinese are fuming. Marise Payne is shrewd; but please put Dutton back in the shed. One fact is that like the poor, the Chinese will always be with you, whereas Trump is an old man with deteriorating faculties.

Reform of the WHO may yield to tactical Australian influence, especially with people like Kelly and Coatsworth as an impressive vanguard for this to be achieved; but political bluster won’t cut it.

However, because this is an era of instant gratification the clamour to return to the ancien regime grows louder in Australia. Neoliberalism – how has that benefitted the ordinary Australian?

Before this cohort upsets the careful public health response, please look at the recent Singapore experience, and do not accept at face value the Taiwan experience. It knows how to regulate information as well as the Mainland – just better attuned to occidental sensitivities.

I was once an aperitif

Years ago I was in a Carlton restaurant to hear Peter Sarstedt. I enjoyed his droll songs, and there was one song speculating about the career of a lady. The voice has remained in the brain, getting louder and louder with a slight change in the wording:

So look into our face Ann-sherry

Remember just who you are

Then go and forget Ruby forever

‘Cause I know you still bear the scar, deep inside,

Yes, you do…

When prologue and epilogue collide

The researchers enrolled two groups of COVID-19 patients in a public hospital in (the Brazilian city of) Manaus; the high-dose group was assigned a total dose of 12 grams of chloroquine over 10 days, while the low-dose group took a total dose of 2.7 grams over 5 days. All participants also received the antibiotics ceftriaxone and azithromycin.

After 11 patients died across both dosage groups, the team halted the high-dose arm of the trial on day six, citing more heart rhythm problems in the high-dose group, and “a trend toward higher lethality”.

“Preliminary findings suggest that the higher chloroquine dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards. Such results forced us to prematurely halt patient recruitment to this arm,” as reported by the “researchers”.

In a later update, the “researchers” noted that they experienced even more deaths in the high-dose group than were documented on day six. And it doesn’t mean the low-dose group is safe, either.

“The major difference between the high-dose and the low-dose group occurred during the first three days and the actual toxicity – two patients in the high-dose chloroquine arm developed ventricular tachycardia before death…”

This is the price the world will pay for having to deal with Trump’s thought dysfunction. Chloroquine and its less toxic analogue, hydrochloroquine have been spruiked by Donald the Quack. So what is the Doherty Institute doing wasting money on experimenting with this drug? Because a couple of Trump friends are providing funding?

After all, the drugs had been tried in the MERS outbreak and found not to work. A trial in France was also aborted because of the fact that it killed the patients. The Manaus experiment has elements of Dr Mengele – but then he did die in Brazil.

As a portent of the future, if you go up the Amazon from Manaus, there a number of abandoned luxury resorts on along the River – a Trumpian portent?

Manaus Opera House

Yet Manaus does retain a beautiful opera house, where listening to its orchestra from high in the “gods” in this ornate house, itself the legacy of the rubber barons, was a sublime experience.

A well-regulated militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

While I agree that there are many law enforcement officers who could be considered good there are an awful lot of them who abuse their authority. I live in a particularly red area of Michigan and since our sheriffs are elected, here they landed to what is clearly the base. Laws up here are selectively enforced on a routine basis as it is, and since the stay at home order has been in effect it seems worse. I agree we need them, but we also need them to not take the law into their own hands.  

This was a post among the twitterati which, unlike so much of the bird song that emanates from cyberspace, was sensible and caught my eye.

This tweet was prompted by an onlooker. To her, a Michigander, members of the Trumpian “lumpenproletariat” egged on by his inflammatory tweets were threatening the Michigan governor, Gretchen Witmer. What this response alleged was that Trumpian supporters were being elected as law enforcement officials at the local level. The tweet cited a number of places in Michigan where this has occurred. It is unsurprising given the attention paid by Trump in subverting the whole legal process, as typified by his approach to judicial appointment at all levels.

Trump mischievously sends these tweets invoking the Second Amendment and then, like all instinctive cowards, backtracks and obfuscates. The Trump strategy is to be consistently inconsistent; but it becomes easier and easier to work through. I presume the Democrats have now got someone studying the Trump persona as honed through “The Apprentice”.

Like all grifters, the fact that he does not want his taxation returns released suggests he is treading water; that he is in fact broke, with the Presidency providing his négligée. His strategy depends on a booming economy where, under cover, he could pillage sufficient sustenance from the American people by the end of his second four-year term to maintain the fiction of business success.

However, this virus has been somewhat inconvenient, and it will be interesting to see what next bit of quackery Trump invokes to keep the public interested; if not the public interest. After all, the virus spread across the United States has disobeyed Trump at every turn. How dare it disobey the President. Build the Virus Wall, he screams.

I wrote about a month ago:

Social media has been a godsend to Trump, enabling him to perfect the tactics he employed in “The Apprentice”. It is a medium that is understood and accessible to his constituency.

However, Trump is an old man, and his dissolute lifestyle has challenged the resilience of his gene pool. While he has hinted at a dynastic succession, this is one of the few themes that he seems to have dropped. Yet if he is elected he would be 78 at the end of a second term. The question is, can The Planet afford it, whether he is elected or especially if the electoral college does not return him? One scenario has the Old Man brandishing the Second Amendment calling up a militia drawn from his alienated constituency energised by ethnocentric hatred.

Nevertheless, Trump wants to use the tweet-executive order combo to keep the attention on him. He knows that legality and enforceability does not matter in his new order, because legal processes move so slowly and ergo he tries to do what he likes; and if the media do not cower then he brings out his lumpenproletariat. If one reads the Federalist Papers, I do not believe the Founding Fathers envisaged such a lumpenproletariat as a “well regulated militia”.

Globally we live in very dangerous times, especially as the pervasive senses of immediate solution, entitlement and me-tooism echo around the community.

The main point of anything Trump does now “to make America great” in his own image is to outlast the virus or create the illusion that the virus “has left the house” leaving him triumphant, having saved the world from a “Chinese” virus.

Where did you come from, smallpox?

I have been reading a monograph about an alleged occurrence of a smallpox pandemic among Aboriginal people. The author was South Australian doctor and anthropologist, Ted Stirling, and it was published in1911. Interpolated in his discourse was an account of her land by a Narranyeri woman (Köntinyeri), born before “whitefella” invasion.

Stirling’s review of smallpox in Australia must be cast against Jenner’s vaccine against smallpox being available from 1798. So this vaccine, or at least its variolation predecessor was known to the first white settlers. In his review the author goes to great length to indicate that none of the First Fleet or the French ships under La Perouse, which turned up five days later, had any smallpox sufferers on any of the ships.

However, according to Stirling, over a year later four Aboriginal people turned up in the Port Jackson settlement with smallpox. The two adults recovered; the two children died. Stirling then mentions the NSW epidemic among Aboriginal people occurred in the central west in the 1830s and continued spreading to Victoria up to 1845.

Stirling came upon the Narrinyeri woman called Köntinyeri, who had been born about 1830, but remembered stories of the great wind that had come and which had then been followed by the outbreak of this disease which killed many and left those who recovered severely pockmarked. This epidemic’s start is disputed. To Köntinyeri the disease appeared around the time of her birth, but there was the suggestion that the epidemic began as far back to 1814. Whatever the actual date, there had been so many deaths that the traditional burial procedures were modified – they normally would put the body on a platform until all the soft tissue was gone and then bury the bones.

Köntinyeri believed that epidemic advanced from the East down the Murray River almost depopulating the banks of the river for 1,000 miles. The Narrinyeri nation inhabit the lower reaches of the Murray River and along the Coorong, but there was a neighbouring tribe very adept in the use of the mungo, the bark canoe. So the virus would have moved swiftly along the river.

Trepangs

Yet Stirling, in tracing this smallpox epidemic, suggests that it had originated in Malay Koepangs who first visited northern Australia to harvest sea cucumbers (trepangs) – an Asian culinary delicacy. They had visited annually for the harvest since 1783. The Malays were certainly the source of an epidemic of smallpox among aboriginal people in the north-west between 1860-1870. Your acceptance of the wider implication of these Malay “trepangers” being the source of other epidemics depends on whether you believe the evidence of the First Fleet and the French squadron being free of the virus.

Much of the controversy of “when and why” has gone, not just because there was a pre-existing vaccine that has proved remarkably effective, given that smallpox has been eradicated from the planet.

The Koepang “trepangers” serve as a reminder that an infected Indonesia is an ongoing challenge to border security. Over the past few years publicity given to people smugglers means that the Timor Sea remains a tenuous barrier, especially given that Australians are wedded to Indonesian travel, especially Bali. In other words there is a two-way flow both by sea and air which inevitably will present Australia with a problem. Indonesia will not like to be stigmatised and a great many Australians will not like having to abandon Bali as a holiday destination.

In this regard, it would help if Australia’s border security restructured to have less emphasis on the direct police role. The police are there in this context to enforce the quarantine power. The whole Department needs an injection of health expertise into its future role. Ted Stirling may have drawn too long a bow in relation to solely attributing the genesis of smallpox among Aboriginal people to the Malays. However, who knows how far the Malays ventured.

Nevertheless it is a lesson in what can happen, even considering that in the NSW colony vaccination must have been available by 1830 – for whitefellas. Variola material, derived from smallpox scrapings, was brought on the First Fleet, but there is no record of its use in “variolation”.

Overall the challenge to Australia now, without allowing Indonesians to unnecessarily lose face, is assuring what is potentially an ugly and untidy viral situation in Indonesia does not spill over into Australia. Therefore, important to get the narrative right now.

Nico Louw

Now there is a name to contemplate

Lion of the Northern Cape

Senior adviser to the Prime Minister

Of a country under threat from COVID-19

Kids in queues lining the streets

Unemployment rising

Louw, close to the beating heart of Authority

A Hillsong chorister

Response to crisis?

Distributing pirated copies of Turnbull’s memoir

You’re kidding

No for real!

So what does this joker get?

Nearly 200 grand plus expenses

Now I know you’re joking

No mate, that’s what you get for distributing pirated copies.

His expenses? Barely enough for the odd bottle of single malt while with furrowed brouw Master Nico constructs yet another “gotcha”.

Which got me thinking. Most people around Australia are doing it tough, but what about the politicians and their flunkeys like Louw? Why haven’t they taken a cut in their entitlements, given that the feather-bedding they get in the way of contributions to their superannuation and then their ability, after they have left Parliament, to rort the system as “consultants” may be construed as a sense of entitlement rather than enlightenment.

The national cabinet, this ad hoc response to the virus, is confronted by a number of serious questions but there is one matter that seems to have slipped its notice. This is the question of their income; yet it does not seem to rate a mention in the talks. While the unemployment queue grows and the masses of people on struggle street grow, the New Zealand Prime Minister Ardern has taken the lead by reducing her annual salary from NZ$470,000 to NZ$376,000. This 20 per cent salary cut extends to Opposition leader Simon Bridges, Deputy Prime Minister Winston Peters, all 25 cabinet ministers and 34 key public service chief executives, including the Director-General of Health.

We know that Prime Minister Morrison has dismissed the idea of a pay cut for government ministers in Australia. In a radio interview, “We’ve already said there won’t be any pay rises right across the public service and this is not something that’s currently before us … it’s not something that’s being considered.”

Well, Prime Minister, that constituency you ostensibly run is locked down and struggling to pay its way; kids with poor prospects may beg to differ when they see what your senior adviser, Mr Louw gets for being un furbo. Do these qualities fostered in the bosom of the politician’s office deserve him being paid such a salary, which inevitably cascades upward to yours?

What is the value in a politician?

Let’s test that question with the electorate. At the next election let it consider voting for a Haircut Party devoted to recommending a 50 per cent cut in all politicians’ salaries and a serious pair of shears to pare back all the entitlements, including those of staffers. Instead there would be the abolition of the remuneration tribunals and linking of all future increases in politicians’ salaries to the unemployment benefit.

The policy is a bit rough about the edges – but this is not just a one-trick pony Party. The savings achieved by the Haircut would be put towards paying for a National social housing policy.

Morrison, mate, in the interim there is one aphorism for you to consider “Austerity begins in your parliamentary office.”

Maybe these officers in their sancta of the various parliament basilicae should wonder whether they should continue to stoop so Louw.

Join the Haircut party – look out for our barber poles!

In the prosperous time, the outrageously bloated political staffers can go unnoticed, but not now. Roy Masters, with whom I vie in the longevity stakes, made a serious comment about the bloat in the NRL administration, with some mediocre pie-eater, now terminated, getting over a million dollars as salary. Sport like politics has this similar sense of insensitive greed.

In some ways, the description of the Mafia condottieri as 95 per cent hanging out and 5 per cent ultimate brutality has relevance. Members of the Bloat can fill in their particular 5 per cent like distributing pirated copies of other person’s property any which way.

La cucaracha; la cucaracha

One the challenges I have enjoyed is turning on the light and being confronted on the floor by a cockroach – you know one of those robust cockroaches. It stands still, and then the battle begins. I am indebted to a study undertaken in the Hebrew University in Jerusalem for the information.

I advance to squash it. The cockroach can generate a speed of a metre per second, or 3.6 kilometres an hour. Seeing it scurrying away from my vengeful shoe, it seems faster than that. However it has the ability to turn and twist at 25 times a second, which improves its chances of evasion. It does this because of its antennae, which are very sensitive to changes in the environment. Cockroaches are guided by a superb nervous system of giant neurons, ready and prepared for leg muscle action with an equally efficient sensory system. As has been said, cockroaches have had several million years in which to hone their reflexes. Makes it very much more satisfying when you win the battle and the cockroach lies squashed. Adieu, mon cafard. Arrivederci il scarofaggio.

Mouse whisper

I love the aptly named Queensland Minister Dick who has labelled Queenslanders the Bazookas and the New South Welsh the Pea Shooters in the wake of the wrestle over Virgin. Better than Cane Toads and Cockroaches? But given that I live in Mousehole NSW, I do love the Italian word for cockroach – Scarafaggio. It has a certain swaggering mouseketeer ring about it.

I believe my mice relatives over the border resent being mocked as cane toads at the best of times. A mouse has a certain dignity, and Rospi di Canna? Really, I ask you.

However, I know that among them there is quite a dispute about being relabelled Dick bazookas. However the squeakeratti are still debating Bazooke with or without the Dick.

Watch this tap.

Signor Scarafaggio

Modest expectations – J.J. Lyons

The problem is that, over the years, the community has become inured to the laughing mother in the advertisement with a gaggle of inanely smiling children showing how some disinfectant or other has rid the kitchen countertop of 99 per cent of germs.

If we lived in a sterile world devoid of all viruses and bacteria then like them we would all be dead.

Therefore we have to be reasonable, but when we have a media fuelling the hysteria that is not easy. There is a talk about the “surge” in infection and highlighting the number of deaths from the “killer virus”, rather than highlighting those who have recovered. The basic fact is that in a population of 25 million there have been less than 200 reported cases – i.e. as of today, an infinitesimal percentage of the population. The number is small, and it is important to maintain perspective. This is a prime function of government in the face of the irrational community response. Such a reaction dwarfs the other responsible response, which is building an evidence base as to what this coronavirus actually does.

Thus currently the rate of increase has hardly been a “surge” despite its attraction as a media headline – or even the milder use of “tide”. And if you use “surge” as a faux-dramatic metaphor then eventually the metaphor will “abate” as a tide will ebb.

Take Dr Higgins: how is the contact tracing going? It would useful if we were told how many of the people, including patients, with whom he came in contact have returned a positive test. However what we have is some State Health Minister attacking him and the AMA responding, rather than getting together and using this case to obtain useful information about the spread or otherwise of COVID-19.

Dr Higgins was on a United Airlines flight from San Francisco. I know somebody who was on the same flight who has the “sniffles”, all very mild. However, when my acquaintance’s partner became ill with a fever, an attempt to see the local general practitioner, resulted in an immediately referral to the relevant Hot Line which, having established my acquaintance as a resident of that State, then referred my acquaintance back to the general practitioner.

So much for consulting your local general practitioner as the front line defence, as the AMA have been telling the community. My acquaintance went off to a newly-designated centre for coronavirus testing. It was so new that the staff provided a good imitation of not knowing what to do. Waiting, my acquaintance and partner were alone, but it took an hour and a half for my acquaintance to be seen.

Despite my acquaintance’s history, the hospital-based centre was reluctant to undertake a test. Initially, the triage nurse wanted to send them away. Eventually my acquaintance was tested, but not the partner because at that time there was no proven contact with a confirmed virus carrier.

Ultimately they both tested positive and my acquaintance’s partner’s substantial workplace has been locked down for a week. They have children at school and university. The children tested negative.

It should be appreciated that the coronavirus tests for virus RNA being excreted at the time of the tests. There is no serology test to tell whether the person has had the coronavirus. Young people clear their system very quickly because in the main their immune response is very strong, a fact having being confirmed elsewhere. So it is quite possible that the children had been infected but have been asymptomatic and were no longer excreting the virus.

My acquaintance and partner no longer have to fight for attention. They have their own personal doctor contact available and visiting nurses. That is fine when there are so few cases, but this is a government that tends towards engendering fear rather than soothing concerns, when the number of cases are primed to increase.

Already the reluctant-to-test-centre of a week or so ago has a queue of the mostly worried well.

When winter comes is everybody going to receive such personal service? The answer is in the ability of general practice to develop a more hygienic environment this winter – not having waiting rooms filled with coughing adults and children would be a good start.

And what about the United Airlines flight? My acquaintance wasn’t sitting anywhere near Dr Higgins. So what is the evidence basis for the “same row plus two rows in front and two rows behind” exclusion zone? Almost everybody goes into the bathroom on a long flight, and from observation the level of hygiene in the bathroom is generally appalling. Tissues everywhere, an unclean basin and taps, water left in the bowl, used hand towels poking out of the waste bin, handrail and door locks not cleaned between usage.

In the meantime the United Airlines flight had been merrily going everywhere presumably continuing on with the scant hygiene measures which have been characteristic of  airlines.

It may well be that America may prove to be the biggest problem and the irrational behaviour of the President, most recently in a blanket ban on flights coming from “Europe” (senza the UK) and at the same time a reluctance to be tested himself, does not help.  Will America be added to the Australian exclusion list? After all, viruses do not respond to ideology.

I suspect that this scenario which is going on all over America with an unprepared and totally under-resourced public health system. As I’ve just said, Trump’s measures are irrational, and hard to follow, but that is nothing new.

Yet here, summer has been and gone; summer is not conducive for coronavirus spread and a containment strategy based on excluding nationals from an ever expanding list of other countries is in place. So currently it is a good time to be in Australia, and if the medium term strategy is based on a belief that with summer in the Northern Hemisphere the coronavirus epidemic will abate, then the current strategy has a modicum of sense.

The underlying problem is whether the political declamations are actually being carried out. Some of the state governments websites giving advice are very good, but why not consolidate this information into one web site – this is where the federal Government should be the single voice.

One of the problems highlighted by the 1918-1920 influenza pandemic was the destructive effect of the lack of public health co-ordination between States. Ostensibly, the Commonwealth is in control, but with each State seemingly disseminating its own information, it calls into question what is the actual level of coordination.

However, the tipping point is to know how far the government’s policies can go to effectively close the country down before wrecking the whole societal fabric and not just the economy. Having everyone in two-week isolation is ultimately unsustainable.

So a greater number of people who have to work will ignore the ban or not be tested; or the government will relax the ban. The evidence is that the older population are disproportionately affected, not school children or young adults. So why close the schools? We don’t do that if children catch the common cold, a coronavirus relative.

Look at the mixed messages. No wonder the community is perplexed.

Mixed message one: There are the media appearances of politicians elbow bumping and contorting themselves. However, what does the Prime Minister do in a forum where the spread of coronavirus is being discussed? He shakes hands with the guy who introduced him, does not use any hand sanitiser and goes to a lectern where there is no indication that it is to be cleaned between speakers. As far as we could see it certainly was not cleaned in this case.

Mixed Message two: There is a full house at the women’s cricket final – so much for the empty stadium scare that some of the muppets in the football codes seem to be mouthing.

Mixed Message three: There is the spectacle of the women cricketers jumping all other one another, high-fiving, potentially contaminating one another.

Mixed Message four: The Victorian Premier is threatening to close down the education system while at the same time giving an exemption to Ferrari for the Formula One exercise in air and noise pollution. No crowds, Mr Premier, after all it is school but of a different sort.

It was wonderful to see the publicity-shy Dr Mukesh Haikerwal in his medical practice car park collecting specimens for testing in a strapped pathology system. Presumably he continued to do this once the cameras stopped and continued to flood the local pathology laboratories with specimens. But what was his protocol for offering testing? Close contact with a person with who was confirmed positive? Or the worried well? Not clear. But the next day, having put on the show for the TV, his clinic was overwhelmed.

Now pop-up clinics; I suggest the government consider using the expertise of Dr Haikerwal with his car park technique to ensure that the Health Minister’s promise of the having all these clinics popped up by the end of May can be met. After all, he looks good in a suit.

Then as Australia enters the winter unless there is reliable health surveillance, it may be expected the pop up clinics are going to be inundated by people with that other coronavirus, the common cold, or those who are suffering influenza.

It is always disappointing that the first thought of governments is the authoritarian solution. Australia has always been quick to press that button. Such a solution resulted in the misguided lock hospitals of the past on Dorre and Bernier Islands in Sharkes Bay. Aboriginal men and women suffering from venereal disease were sent there. Australia has a dark history of isolation of people with disease and community panic attacks.

It seems at this time the greatest risk group is the elderly. However, they are not all congregated in nursing homes. On the other hand, they are not, by and large, in the workforce. Many roam in the freedom of being child-free and comparatively well off. One has to know where the mobile “grey nomads” will congregate in the coming months, and where they will roam in remote Australia. Perhaps that is why there is a run on toilet paper and disinfectant.

For the sedentary aged care population and their housing, just assure hygiene and that someone is checking on them to ensure they have supplies. Places for the aged should conform to the level of hospital hygiene. After all, we are the vulnerable group, and let me say that this raises very strong questions about the workforce’s ability to communicate with an increasingly deaf population and with its significant demented cohort.

In the end, China may be able to impose Draconian provisions in the short term but will it effect the cultural changes vital to prevent this sort of disease outbreak happening again? And the experts still don’t know whether this infection confers life long immunity. The common cold recurs and it is contained in a set of coronaviruses.

As somebody very wise said to me, the aim of all the actions taken in the public and private sector should be directed to creating a new appreciation and behaviour in relationship to personal and community hygiene. Conceivably then we may be able to blunt the inevitable winter season coming up where we are beset with the common cold and influenza, as well as this COVID-19.

We are already seeing this with the proliferation of hand sanitiser stations in public places, offices, banks and shops. I hope it continues to grow so, for instance, washing your hands before eating which I was taught to do as a child, becomes the accepted norm again.

Rollin’, rollin’ rollin’ – Raw Hide

The problem with toilet paper is that, while it is considered an essential, it is a topic we normally do not discuss.

The picture of three ladies wrestling over toilet paper in the Chullora Woolworths may be appalling for the pious commentators, but there would be a sizeable populace who found the spectacle as mildly diverting as watching mud wrestling.

This toilet paper imbroglio reminded me that a number of celebrities including Magda Szubanski, Merv Hughes and Ita Buttrose, all making fun of themselves, have appeared in toilet paper commercials. However, the prize paper seller was Lleyton Hewitt in his memorable commercials.

Perhaps Government could use these toilet paper spruikers to use their talents in calming the hysteria induced by a country afraid of being quarantined with dirty bottoms.

By the way, when we were young, there were always squares of newspaper hanging on the hook beside the dunny door. Even then we favoured the Daily Telegraph as the paper most worthy of use because we knew that it had been pre-tested.

Nevertheless, we did a trial this week – 15 minutes in tap water at ambient temperature (a) toilet paper, (b) ordinary tissue, (c) paper towel and (d) newspaper of same size – at this time that water agitated to simulate flush. The result, toilet paper and tissue disintegrated, the paper towel dehisced and the newspaper was unchanged and still readable; so much for newspaper and paper towels.

Mount Quilton, a new Tasmanian landmark

Leprosy

Leprosy is endemic in the Kimberley. When I first went to the Kimberley in the 1970s there were obvious signs of past leprosy in elderly aboriginal people, particularly men. This was characterised by loss and deformity of both fingers and toes, and the leprous discolouration of the skin.

Randy Spargo, whom I have mentioned in a previous blog, has also commented on the destruction of cheek bones and the nasal septum as a characteristic Randy remembered – the so-called “lion face”.

The Aboriginals in the early days of the 20th century who were found to have leprosy were rounded up in an appalling manner, put in chains, taken away and confined. Originally there was a leprosarium at Cossack, now a ghost town near Roebourne which, when the patients were moved to the new Derby facility in 1935, was burnt to the ground as a public health measure – such was the fear of the disease.

Bungurun

The was managed by an Irish order, St John of God nuns from the mid 1930s, and the conditions improved so much so that the leprosarium had outlived its usefulness by the time I visited Derby. In the 1940s a treatment had been found, and the public health measures of contact tracing for those with the disease was well in place. I remember one of the nurses saying that they had only one whitefella on their list; all the others were Aboriginals allowed to move around – but their movements were traceable, which was no mean feat.

I met some of the last nuns. They were caring, admirable women who had worked much of their life bringing a more humane way of caring for lepers. Soon the leprosarium would be closed. Contact tracing was maintaining oversight and facilitating care for a diminishing population of lepers.

The Kimberley is strongly Roman Catholic and there were tales of the then Bishop of Broome, John Jobst, who was reputed to have been a panzer commander in World War 2, terrifying everybody with his fierce approach to flying – tales of Aboriginals scattering as he unexpectedly would come into land.

However, the 1970s in the Kimberley was a time of great change there. Its Wild West characteristics as described above began to fade.

For those suffering from leprosy thankfully change had started earlier.

However, there are lessons to be learned. The mere mention of the word “leprosy” incites fear in the average person. Leprosy is a mycobacteria like tuberculosis. Both are contagious diseases.

Tuberculosis was particularly common before antibiotics became available, but in the Western world it was realised that there was a “herd immunity” – in other words we, as a white race, had a better immune response than other people, such as Aboriginals.

The first response of the community is to isolate the infectious ones, these days in more humane ways than in the past. However, a person is isolated, how long is the sentence – and when these poor people try to break out from their isolation our first reaction is to punish them.

Punitive powers exist under current State legislation, but true to form when you have a government such as ours that tends to prey on community fear it’s not unexpected to turn public health into incarceration. After all, the other name for this is “border control”.

We don’t want to end up with armed police patrolling the street to stop people coming out of their houses – and why not a curfew for good measure?

Before the Attorney General, who seems to be a reasonable character, goes further into this murky Duttonian world, he should see what his West Australian forbears did to the Aboriginal population in the name of public health.

After all, recommending 14 days in isolation from an indeterminate starting point when the coronavirus infection possibly occurred is just an informed guess. Why not 40 days as the Bible exhorts, Mr Morrison.

And why this stupid term “self-isolate”? In those days before the Age of Fear” I just stayed away from work when I had the flu and thought it inconsiderate to go out while coughing and presumably infective. Why not retitle the play “Self-isolating for Godot”?

Mouse Whisper

When Marie Curie visited the United States in 1921, interest in radium surged as reported some years ago in one of those journals hoarded by mausmeister. “Americans were flocking in their thousands to buy bottles of radioactive water, believing it would cure their aches and pains.”

Never fear, there is a spa in an old uranium mining area on the border of Germany and the Czech Republic, which advertises the anti-inflammatory effects of radon-infused water. How many, Topollino wonders, are fruitlessly flocking to this spa to escape the virus?

Radium Palace

Modest Expectations – The Dark Blue

When you read this I shall be far away, floating down the Amazon where the piranhas are actually fish. One of the diseases of the Americas that gets very little airplay is Chagas disease, named for the Brazilian doctor, Carlos Justiniano Ribeiro Chagas. With the globalisation of disease, which is impervious to political shenanigans, cases are turning up in Australia. However, while it has the acute manifestation of any infectious diseases, it is the long-term insidious effects on the cardiovascular system.

Trypanosoma cruzi

It is said that Charles Darwin picked up Chagas disease as a young man when he was “Beagling” his way around South America. It would explain why an outgoing young adventurer increasingly became a reclusive invalid as he grew older, never again venturing from Great Britain.

Chagas disease is caused by Trypanosoma cruzi, a protozoa which is carried by a particular bug, commonly called the ‘kissing bug’, so called because of how it cuddles up to you, sucking your blood and letting the protozoa bug into the blood stream. There are drugs to treat the trypanosoma but the course is long and hazardous as one may be strewn with complications.

However, given its insidious nature and that the fact that when backpacking it is romantic to sleep under thatch or in adobe, remember to have that mosquito net, however inconvenient it may be, and a good amount of insect repellent.

The Lancet has said in a sobering statement: “Chagas disease has been considered a neglected disease, without fully effective drug treatment to avoid the chronic stage.

Australian figures on its prevalence are scanty, but undoubtedly it is there as I noted above. After all, disease is a free market.

I shall keep reminding myself of that as the Amazon drifts by. 

Setting down Bores

Charlie McMahon continues his reminisces …

We took the smoothest route via Papunya but that was still a rough corrugated dirt road for 600 of the 750 km drive. There was one lane of good tarred bitumen up the middle of the road so that you drove half on the dirt shoulder when either overtaking or accommodating oncoming traffic.

Near the Mount Zeil plain we came up to overtake a fully loaded “3 dog” road train doing about 90 kmph to our 100. I reckoned it looked safe enough to overtake with the road ahead dead straight. The truckie was not likely to go half on the shoulder to ease our passage and I indicated my intention to pass with high beam flashes and came up beside the road train driving entirely on the shoulder, which slowed us a bit. I was going OK till about a quarter away from passing the road train, a huge hump appeared on the edge of the shoulder, a blasted drainage gully that the dust swirled up by the road train had obscured. I slowed but still hit it at speed. Up and over we went with the load and fellas on the back bounced around. Danger barked, shouts of dismay and Henry with me in the front woke from his snooze looked back and “oh-ho jingiles, lucky one, Murra Hook. They all there still” was all he said. We barrelled on and made to pass the road train again. The truckie congratulated us with the road train horn blaring. “More better I drive ilta” (true questioningly) Henry said. So he took over at the Papunya turn off. Had Henry been driving he would have seen the bump long before I did and we drove on into the night without incident to camp at the halfway point west of Mt Liebig.

On the way the next day we found Freddy West and his family of six camped 100 km before Kiwirrkurra at the Moying Bore near Tjiterong. They were there as an expression of his eagerness to move to Kiwirrkurra, his traditional land. He waved us over, offering a billy of warm sweet tea and put his son Nicholas on board telling him ‘work karriantjku’ (go work with them). Nicholas had been in a lot of trouble sniffing petrol, breaking into places at Kintore – his ability with locks astonished everyone for a child with zero formal education.

On arrival our Kiwirrkurra camp appeared pretty much as we had left it, though the Vinnie’s bag of clothes had been dragged about. “Lotta myall dog been here”, Charlie reckoned and there was much discussion about tracks the crew saw as they gave the place the once over and the first timers showed elation at being on ancestral ground, old hands pointing to and naming places near and distant.

Danger, the dog, got a good sniff of some scent and bolted off not to be seen again till dark. I took a quick shower and said to Henry “you’re next” as well as suggesting to Charlie that since he had been sitting next to Henry for two days he would do well to have one too. I dried off beside the fire as the crew had started. I got out the scabies oil for Henry. As Aboriginals do, he showers with his clothes on. Whether he was shy or just efficient I didn’t bother to ask but handed him fresh clothes from the Vinnie’s bag.

August was perfect work weather. After about two weeks we were well into the job with the four 1x2sq metre-footing holes for the windmill tower legs dug with crowbar and shovel. The John Deer tractor had a bucket and ripper, good for pipeline trenching, and a trailer for carting water and aggregate but without a backhoe for deep holes. The fairly soft soil of Kiwirrkurra made digging easier, which was one of the reasons for choosing the place, so the proper job pit dunny was finished in three days. It was a design called the Blair Ventilated Pit Toilet, shown to me by Steve Pattman at the Centre for Appropriate Technology.

To briefly describe it, a 2 x 2 meter mesh reinforced concrete slab is poured with an off centre “crap hole”, another near the edge for a vent pipe and left to set while the hole is dug 1.8 metres or more deep. The slab is dragged over the hole and the shelter fastened to it with the vent pipe painted dark running up the exterior of the sunny sidewall. An insect mesh cap goes on top of the vent pipe. The dunny building has a hall type entrance to darken the inside so that when you look down into the “crap hole” there’s a circle of light on the bottom of the pit from the vent pipe. Any flies that enter invariably seek the light to leave and drawn by the draft up the sun warmed vent pipe, get stopped at the mesh. Walla! An odourless fly trap and having a proper dunny was a treat for in two years work at Kintore I had to do with a shallow trench – there was always too much to do and the quartz rock subsoil would have been a very hard dunny pit to dig.

We did not listen to the radio so the outside world mattered little. We worked every day and no one bothered with the time or names of days. Sometimes in the evening we turned on the Codan SSB radio tuned into a frequency used by locals, so that the crew would have great fun telling other clans away of the new place they were building. I heard amazing tales of doings in life out there in the days they laughingly called ‘before trouser time’. They would mix up dreaming stories with actual ones and I gave up asking ‘ilta’ (true) ‘did it really happen’ after realising they were often unsure themselves of what was myth and what wasn’t. The young fellas liked to hear Henry’s take on things and looking at the moon one night he asked me to confirm the moon trips “Tjpangarti (my skin name) true int it, some white fella been longa moon, been leave house and car there too”. We cooked and ate together. A coil of black one-inch pipe on the roof of the half walled shed we had built gave us the luxury of warm showers. It pleased me to see the crew (except for Charlie) use them fully dressed so body and clothes got washed in one go. Bathing was not an option for desert people and living around a fire tends to cure or cover their bodies with smoke.

The missing Horse

One reads brochures about Slovenia and they all say you can get horse and foal meat in some of the restaurants. Intriguing, I thought.

Slovenia is a tiny country nestling between Croatia, Italy and Austria, with the Alps forming a crescentic barrier in the north. In the south, Slovenia has a narrow coastline on the Adriatic Sea, with Trieste nearby.

We travelled to Slovenia by car from Venice headed for Ljubljana, the capital of Slovenia. We were told to get a vinjete before the border. This is the only way to pay the road toll in Slovenia (15 euros for a week). We were warned that the Slovenian police wait just across the border, and the fine for not having the vinjete is substantial, 300 euros.

Otherwise the passage across the border is seamless. One moment the signs are in Italian, the next in Slovene – transition from the Romantic to the Slavic.

However we are travelling in a more north-easterly direction towards the capital of Slovenia. Ljubljana is a trap for the new arrival because of its central hill; the tunnel through it, the shortcut to the north but not to the city centre, can fool even the GPS. Ljubljana is one tricky place to navigate, to coin a phrase.

The Antiq Palace Hotel turns out to be a rambling allegedly 16th century building. We are piloted to the room up stairs, via a lift, along a series of corridors bending and twisting until we are on a landing overlooking an internal courtyard. Here we are greeted with music, its source unseen. There is singing, then a horn; a violin struggling to escape; a cacophony of variable quality. Apparently there is a music school in the building on the other side of the courtyard.

The room turns out to be a suite. There is a huge dining room, a lounge area, a bedroom and a bathroom dominated by a huge spa bath. Over the bed in this white painted room was a painting which seemed to indicate that if you had difficulty with nightmares this would ensure you would get one – a weird sylvan scene.

The centre of Ljubljana has been preserved in its pre-World War One architectural attire. Its Austro-Hungarian past is evident in the two-storey houses with gabled roofs, stuccoed walls and large windows lining Ljubljanica River. One early evening when the sky was still blue and the streetlights were lit, you could be forgiven for thinking that this city was the inspiration for Magritte’s series of Dominion of Light paintings.

The problem with the food started on the first night after a meal of kranski and sauerkraut. Whether it was that or a roll I had earlier bought from a motorway food barn, I had a generous bout of food poisoning. I could not blame the horse. My first day in Slovenia thus was spent recovering, but she roamed the streets far and wide, photographing the Triple bridge and beyond.

The narrow Ključavničarska (The Locksmith) Street in the medieval part of the town, connecting Cankarjevo nabrežje (Cankar Quay) with the Mestni Trg (Town Square), contained a surprise. The central gutter was full of bronze heads about the size of billiard balls, most looking at you, as the water trickles over them. Oddball does not do them justice. These are the work of Jacov Brdar, whose work is scattered around the city. It has a Tolkien feel – with the heads looking like members of the Gollum family. They are featured above in the heading of this Blog.

In many ways, walking from bridge to bridge is a reminder of walking along the Seine in Paris, but without the cars streaking alongside.

Ljubljana and the Ljubljanica River – Photo: Janine Sargeant

The river lies just down the hill from the Antiq Hotel and acts as a magnet – so much so that until the last day we did not use the green coloured electric cars, which circle the inner city and are reserved for the disabled and the elderly and their carers. They are called “cavalier”, the name being adapted from the Slovenian for “gentleman”.

On our last night in Ljubljana we used the transport to a traditional restaurant on the outskirts of the old city – the Taverna Tatyana. It was away from the tourists and the bar was full of locals quaffing their beer. It was all brown beams and low ceilings and homely hosts, who spoke passable English. It allegedly had horse and foal on the menu. Not so. Instead they provided a Dalmatian stew and grilled pork with wild mushrooms and after the main course, the magnificent strudel. Slovenian wine is a cheap and good accompaniment as is the complimentary glass of the local honey brandy called medica.

The electric car was there promptly to take us back to the hotel – I wished I had used it more given that my ability to walk was limited –no longer able to roam far and wide. However, the bridge near the hotel was always a site of “a happening” – tonight there was a pumpkin-shaped carriage, which fitted in well with this fairy tale backdrop.

On another night the bridge provided the dance floor for a group of young people elegantly executing the tango. We watched the precisely executed movements while sitting on a granite bench, consuming a cornet of freshly roasted chestnuts.

Yet for all these fairy tale qualities, Ljubljana is a university city. Those walking past are predominantly young and fashionable. The restaurant in the riverfront, overflowing with young people, labelled itself Mexican but the food was “pancake parlour” and the service was poor; yet nobody seemed to care as they oscillated between conversation and iPhone – or just sat, concentrating on their screens, tapping away ensuring future thumb disorders as they decoded life.

The lack of transport and reliance on foot and bicycles accentuates that this is a place for youth. The elderly lady dressed all in white struggling with her bicycle was an exception. She stood out in this world where it was the young who cycled.

We did travel elsewhere – but a full description of our “Cook’s Tour” could well become a Clog. But not a sign of horse on the menu.

When I asked my adviser on Slovenian food about the “missing horse”, he looked at me and asked me whether we had gone to the Tivoli Gardens as he had suggested. Apparently horse burgers are available in the Tivoli Gardens – at least I can confront my vegetarian friends with somewhat of a clear conscience.

But as for the survival of Slovenia, a tiny remnant of the Austro-Hungarian Empire which survived Tito and the break up of Yugoslavia with which it, I am reminded of what that wise observer of human nature, whose writing appears above, Charlie McMahon has said about small countries and survival of language: “Learning a language from a culture where the core practices are gone is really only good for that.” The Slovenes have never let their culture be destroyed, and hence they have a vibrant language with all the blossoms that that will bring.

Still, there is this matter of konjsko meso. 

Mouse Whisper

To further annoy the occasional reader of a vegan persuasion, overheard in a restaurant in Swakopmund in Namibia, after perusing the menu she was heard to say, “I think I’ll try the zebra.”

Not a laughing matter …         Photo: Janine Sargeant

To which the waiter impeccably replied ‘Black or white stripes, madam?”

No, it was not an exchange of hoarse whispers, but in fact it was true, (with apologies to Mr Brydon).

Modest expectations – Tennessee Ernie Ford

We were having lunch at the weekend and were discussing the penalty of age and what happens when you grow old. “Yes”, he reflected. “You may have a point. Once, my phone calls were returned immediately; now it may take four days or longer.”

I immediately thought of a time I was at a function in Dubbo and a number of politicians mentioned my name in glowing terms. One guy came up to me and said he had not heard of me, but I must be influential because of the things being said about me. “No, I replied, “Influence is ephemeral – it can disappear as quickly as it appears.’’

Not that some people do not retain influence for a long time – but there is a price to pay. You have to mix with a crowd of the same types grasping at the ephemera until, like Citizen Kane, they have only “rosebud” to murmur; some don’t even have that.

The comment that summarises much of what occurs was from the defeated member of parliament who said what he noticed most was that the telephones stopped ringing. Obviously that image needs to be updated in social media terms, but it summarises the ephemeral nature of influence and the intellectual laziness that surrounds it and which is epitomised by the growth in each politician’s office of the number of consigliere.

Traditionally, the more senior the ex-pollie the more important the government sinecure away from Canberra; some ex-Ministers have became chancellors of universities all the way down the ephemeral rungs to that of teaching politics part-time. Using their retirement or ousting, some are able to undertake pro bono or voluntary work, underpinned by their generous pensions and their contacts.

The problem is that politicians over the past 40 years have become outrageously well paid, with generous perks that seem to be never-ending. However, the stories of excess are not met any more by community outrage when reported but by clamours for more of the gravy train tickets.

“Jobs for the boys” have been replaced by the scourge of “rent seeking” – essentially jobs for doing nothing while wrapped in the gossamer of influence.

The hoary excuse for such greed is “I have sacrificed so much.” To which is added the lachrymose sacrifice my family has made for my increased prancing around in the Ephemera.

To put it bluntly, a rent-seeker is just a metastasis. A cancerous excrescence away from the main tumour, but still reflecting the nature of the tumour as it destroys the framework of the body. Doing no good but draining the life from the body for a price.

Yes, a metaphor, but the metaphor is obvious. And the metastases, male and female, let’s mention no names but they know who they are.

Mr Unaipon – My modest acknowledgement of NAIDOC week

Of all the Aboriginal people, I would have most liked to have met David Unaipon.

He died when I was in my mid-twenties. I had never heard of him then.

But what had been my exposure at that time to Aboriginal people? Virtually none. I had been to the Hermansburg mission as a child and seen Albert Namatjira and Rex Batterbee, the white fella associated with encouraging Namatjira’s talent in watercolours and that of the Western Arrernte people.

I was a rabid Essendon supporter from a young age. Norm McDonald played on the half back flank for Essendon. I never thought of him being Aboriginal, a Dhauwurd Wurrung man from around Lake Condah; just a magical footballer – boy was he fast!

Then, if an Aboriginal person was mentioned with the word “footballer” it seemed always to be Doug Nicholls.

It was a world where I could have met David Unaipon but there was no $50 note to tell me he even existed.

David Unaipon died in 1967, and the closest I have got to him is his grave overlooking Lake Alexandrina, Victoria’s name before she became queen.

One of my fondest memories of when I used to go around the bush was seeing the Ngarrindjeri land near the mouth of the Murray river at Raukkan. Its Lutheran church is pictured on the $50 note. For some reason, it has some of my best memories.

One of my clearest memories of Raukkan was going into the Aboriginal office and seeing the number of portraits of their late elders lining the wall – mug shots as you would see in a whitefella boardroom. There was no concern about showing the faces or mention of the dead among the Ngarrindjeri, so I was told.

I happen to have a wonderfully annotated copy of David Unaipon’s slim volume “Native Legends” which he wrote in 1929. It is said to be the first volume actually written by an Aboriginal person. He is succinct.

For instance, Pah Kowie – The Creature cell of Life and Intelligence is just one page and concludes:

Thus many of the ideas formulated by my ancient fathers may seem absurd to an enlightened age fantastic and absurd, but to us these ideas are the foundation of a structure and edifice of knowledge under whose shadow we live today.”

I wonder what Mr Unaipon would have said today.

However, I am a bit surprised that this early work has not been reprinted, at least as far as I know, given that most of us are reminded of him everyday.

The Bruce Robinson New World Odyssey

I remember the Independent Enquiry into the Repatriation System under the wonderfully named Justice Paul Toose. It was set up in 1971 and did not report until February 1976 – three elections and three Prime Ministers later. As people in government joked, this “plodding” inquiry lasted longer than the First World War and ran to 800 pages and 300 recommendations, one of which seems to have been changing the name of the repatriation department to the department of veteran affairs.

Not that I would like to see the Review of the Medicare Benefits Schedule break the Toose record, but Professor Robinson is giving it a red hot go. The review has been going for four years – for what? Any review that takes that amount of time becomes problematical.

As a comparison, while this Robinson Review with its 30 committees has been meandering along, the Review into Australian banking practices under Mr Justice Haynes has been [2017-2019] and reported in 1,137 pages ; in the USA the Mueller investigation has also been [2017-2019], and reported in 472 pages.

They were somewhat significant inquiries.

Yet here we have Bruce Robinson and his crew backed by McKinsey just like the Mississippi River, “it just keeps rollin’ along”. I have heard the time 2023 mentioned as the new end point. Well, that would break the record – a formidable feat. Probably we could have a plaque to celebrate the finish of this Homeric epic.

Perhaps getting a sharper Shadow Minister for Health in Chris Bowen will see if we can dam the Robinson and his multiple tributaries.

The subsidiary question is how much has McKinsey cost the Government for no noticeable impact – you know McKinsey, the firm that is in a running feud with the NYT about its methods and clients. It is an unedifying backdrop.

It is interesting that the latest round of Ministerial adjustments to the Medicare Benefits Schedule by Minister Hunt did not seem to mention the Review. As one senior politician said to me once, governments use these inquiries as a means of maintaining a freeze on patient benefits. I wonder if the patients themselves know of this stratagem.

Unlike the original Nimmo Inquiry which reported in 1969, which had the knowledgeable advice and expertise of John Deeble and Bruce Scotton, subsequent reviews since the breakdown of the periodic Enquiries conducted by Government and the AMA have not achieved very much – but at a great cost in time and the employment of outside consultants.

I should know. Medibank and Medicare have been central to the life of most doctors, including myself and it should not be left to slowly decay, because of an interminable uncertainty, which is the other side effect of an unending wander through the Medicare Benefits Schedule.

Knock before Entering

My wife loves photographing doors. Front doors, that is. Front doors opening on streets; front doors not hidden by a pathway, a garden, a porch or verandah and a flyscreen.

In it simplest form she believes the front door defines the place, the thoroughfare, the relationship of one place to another, the people behind the door in the space, working and living there.

I am not so sure. I see the front door as an identifier of the place but not necessarily those behind the door. Many of us merely inherit our front doors. Many front doors do not identify anything. There may be nothing behind that door but an empty space.

The doorway is Ianua in Latin, named for the god with two faces and from where the word “January” is derived – and janitor as well. January is the doorway to the year. We cannot prevent anybody from passing through the doorway. February always comes.

We, however, may have a janitor to maintain the upkeep of door and passageways. That person may have many names and interpretations in many languages.

We invented the door and then locks to keep people away from the space behind the door, for whatever reason. The door becomes the vehicle for the lock and for maintaining permission to use that space. The door can become a massive contraption to secure that space or as occurs in rural areas in my country just a way of keeping the dust and the animals out. The houses meanwhile are left unlocked. The unlocked door can be a measure of trust, but also a measure of carelessness.

Once I could turn the handle on any church door in any out of the way place, and I could enter and stand in this church with all its furnishings and stained glass intact. This is not carelessness, but an act of trust by those who have the key to the door.

The front door as an inanimate piece of wood or metal is an obstruction to that passage, and so may be an identifier. My wife may be right. How we regard the front door in fact may define the civilisation in which we tread.

Mouse Whisper

I decided to try my hand at shrew taming. I sent for an application form and received the following questions. Well, not actually.

I have inserted the word “shrew taming” to protect the names of the drongos who manufactured these questions. My reflection is the same as it has always been, except my fur is bit greyer and the lines on my faces are deeper than when I was a pinkie.

But see if you can interpret this set of Parts into English. Good Luck!

Part 1: Tell us about yourself and your role 

Objective: Understand the individual’s overall role and interactions with shrew taming

Part 2: Tell me about your experience with shrew tamers

Objective: to understand individuals touch points with shrew tamers and their overall end to end experience

Part 3: What is your overall reflection based on these experiences? 

Objective: to understand shrew tamer’s strengths and pain points to identify future areas of focus for the end to end experience 

Part 4: What would you like to see more of in future? 

Objective: focus on the future experience and how we can orchestrate touch points in the future to ensure a seamless experience.”