Modest Expectations – Sudan

It was a modest dilemma, but a dilemma nevertheless. We had stopped in Genoa, a small sliver of civilisation which had nearly been razed to the ground two years ago by the 2019-2020 bushfires which had burnt through the far east of Gippsland. It resembled a ghost town. The late autumn day was beautiful, and we noted that there was a new bridge over the river which flowed through the hamlet. So even though there seemed to be no one around, someone had spent money on the bridge.

We stopped in front of a very shabby building. The sign on the front of the building indicated that it was once a hotel/motel. It seemed to me to be disused; my wife disagreed. She thought there were people living there. There was no fence around the front of the motel.

However, in the front of the building was a tree loaded with lemons. There was only one windfall, and that was on the wrong side of ripe.

As we were contemplating a guy riding on a tractor rode up to the north wall of the motel, but did not stop. That was the only person we saw.

I looked at the lemons. They were many beautiful ripe yellow lemons.

I was tempted; my wife said no.

The dilemma:  Would you pick lemons off the tree or not?

We were only 45 minutes by taxi from Eden. Could not see any apple tree though.

Wistful in Werriwa

Werriwa (Lake George)

My eye was caught by a small piece which said that Morrison was contemplating winning Whitlam’s old seat of Werriwa. He had descended on that electorate to start the day with a group of locals, or so it was reported. Now Werriwa is the Aboriginal name for Lake George, which mysteriously periodically fills up with water and then empties, with no river flowing in and out to explain its fluctuation. Werriwa was one of the original electorates at the time of Federation.  As the population has grown, the electorate has moved closer to the southern outer suburbs of Sydney, and thus has been a stronghold of the Labor Party since 1934.

Morrison believed such a seat was winnable, as he cast himself as the Everyman battling the Political Elites. He was encouraged by a media machine that we have endured for a long time, particularly after the accession of Rudd, biased to the Coalition. Morrison was also buoyed by his surprise victory in 2019, with a major swing in Queensland. He made the assumption that he could cast himself as the champion of the working man. “Man” was the operative word. Werriwa has a woman member, and with a very “Anglo” name, Anne Stanley.

Added to that were migrant communities where you could sow the divisive wedge politics, particularly playing upon conservative religious practices. Here, sexuality and general relaxation of patriarchal family relationships, admixed with spurious declamation about religious freedoms, were perceived by Morrison and his advisers to be fertile ground for playing on prejudice to gain votes. The Liberal Party candidate was Sam Kayal, the surname Lebanese; and obviously he seems to be very friendly with the Mayor of Liverpool, who is also of Lebanese heritage, presumably Christian.

When you reviewed the first preferences in the recent Federal election, the Liberal Democrats, the One Nation Party and United Australia Party collected about 23 per cent of these. The Greens received a modest increase of just over one per cent to 6.6 per cent.

Both the major Parties in the allocation of first preferences lost ground – Labor lost eight per cent and the Liberals four per cent. After the allocation of preferences, the swing against the Labor Party had been reduced to 0.3 per cent. If the three right wing splinters had been solid for the Coalition, the seat would probably have fallen to the Liberals.

When I first read the piece about Morrison, I scoffed. Now it is food for thought; maybe it was a lockdown reaction, where each side received electoral contumely. Certainly, how the votes flow in the NSW election next year will be more interesting, because the antipathy to the enforced “lockdowns” should have faded by then.

Enter Dr Ryan

Let me say, as I have said before, that my health care has been very good, considering my co-morbidities. Yet I do not have one health professional who can provide all my ongoing care. Why? Because the world of medicine is so sub-specialised that having all the information in one place is impossible. As I have been a medical practitioner, I have navigated the system with varying degrees of success. This has meant that for probably six months my auto-immune disease was undiagnosed; but I knew when I was fibrillating and not reverting to sinus rhythm.

Take for instance, because of arthritic changes in both my cervical and lumbar spine, coupled with some symptomatology which suggested impairment of neural function, a spinal surgeon that he would operate. I found his clinical approach puzzling and consulted a colleague of mine – a neurologist – who said that, in his opinion, the operations were unnecessary. That was six years ago, and the disability caused by these changes has not progressed.

He retired but referred me to a neurologist in Sydney. The cost for the initial consultation was announced by the practice to be $800, more than three times the appropriate Medicare benefit. I would have thought that outrageous, especially so given that he would have my notes passed on by my previous neurologist who had settled for the Medicare benefit as full payment for a consultation.

Ironically, through the consultant physician professional association of which I was vice-president at the time, I had negotiated with the Commonwealth Health Department in 2006 to create the Medicare item which reflected recognition of significant complexity in consultations.

Let me say that the neurologist whom I consulted was understated, yet had an eye for detail; more importantly, he had wide clinical experience and a great modicum of common sense.

Talking of neurology, Professor Monique Ryan, a prominent paediatric neurologist has been elected to the Federal Parliament. As a member of a small sub-specialty, her natural health constituency is one of the “elitist” areas of the profession – small patient load given there are about 120 paediatric neurologists; yet, irrespective of needs, the sub-specialities keep on expanding. There is also a tendency in these small specialties for the doctors to become researchers or even more sub-specialised. In a review of the field, 250 neurological disorders have been isolated, but most are very rare diseases.

Yet reflexly the tendency continues to also train more and more, despite smaller and smaller patient load per neurologist.

As a result, they tend to “keep” their patients rather than “returning” them back to the referring doctor. The other way to expand the clinical base of the paediatric neurology sub-specialty is by moving into the mental disability field, where rehabilitation is the aim, or areas such as attention deficit disorders and autism, which have become very “popular” diagnoses.

Whenever I watch reports on these spectrum disorders, I am reminded of the successful long distance swimmer, who was concurrently being treated for chronic fatigue syndrome.

While many of my medical colleagues would bristle and dismiss my comments, it’s very difficult to get any medical sub-specialty to objectively review what has been achieved as against that which was promised over a given period – and to agree on when is “enough is enough”.

Monique Ryan may now represent the electorate of Kooyong; she also represents by her professional attainment and experience, a rather narrow tranche of the health system. That is not to decry its importance; it is a matter of the allocation of scarce resources. Now she has Parliamentary standing, her utterances will be interesting; especially as the ego lurks very close to the surface in most maiden speeches to Parliament. I will read hers with very great interest, given my own experience, and see where her priorities lie, once you strip away the comments of the generalities.

The dangers of  rampant sub-specialisation in medicine and elsewhere in the health system is just one potential dysfunction which needs to be rebalanced in the health system after the COVID-19 experience, an indifferent series of Federal Ministers and the unfortunate influence of a number of public servants,  some of whom should be ashamed to take their pensions let alone the consultant work they fouled up – and that is before Australia has a decent Integrity Commission to investigate whether there are shenanigans and rorts to attract any action.

If the aim is to get a more equitable spread of health professionals, then as one whose nationwide Rural Stocktake in 1999 led to the creation of the rural clinical schools and university departments of rural health among other changes and who introduced a successful intern training program and opposed lengthening the post-graduate training in the name of professional “slavery” rather than education, I have been disappointed that its success has been seemingly ignored and structures dismantled. Yet there is a crescendo of complaints about the lack of rural health professionals. I shall define the systemic pathology and suggest what has to be done in a number of my following blogs.

I just hope that the incoming Health Minister can think outside and beyond the normal temptation to just get the matter off his desk and onto the States, with resumption of the “blame game”.

The Fall of Globalisation – How inconvenient.

Danube Delta

In the years just before COVID-19 struck, I travelled widely, and in doing so visited Finland, the Baltic countries, and the countries on the lower Danube (Romania, Bulgaria, Serbia and Hungary), the boat on which I was travelling ending up nosing into the Black Sea before turning around; also Croatia, Bosnia & Herzegovina, Montenegro; Slovenia. I had been to Russia and Poland on earlier trips. Although it did not occur to me at the time, I was able to do this under the mantle of Globalisation; in fact, as long as you flew there you could also then visit Belarus from Lithuania. Belarus, together with Russian exclave of Kaliningrad, were the only two places where entry was not automatic in these European wanderings.

All the time Russians were seething; or rather Putin was seething with his Peter the Great complex. Plotting – planning for his dystopian world is just the end product of the authoritarian narcissist who gazes at their image in the world; the Chaplinesque caricature now widely spread across the world.

In the USA, it is unbelievable that the Republican Party, which ostensibly believes in free enterprise, has been complicit through the Vandal Trump in the Putin destruction of globalisation.

Trump was not the only one. For instance, the narcissist Rumsfeld cajoled a group of politicians into a “coalition of the willing” on the grounds that Iraq would be easy pickings for the American oil industry. Others may nuance it to share the blame around and saying pillorying one person is never the reason. However, George W. Bush’s famous assessment of Putin: “I looked the man in the eye. I found him to be very straightforward and trustworthy. We had a very good dialogue. I was able to get a sense of his soul; a man deeply committed to his country and the best interests of his country.” needs no commentary.

It seems that remains the belief of that great meddler, Henry Kissinger, who was so important in Hanoi winning the Vietnam war. Kissinger turned 99 a week ago; and his wrongheadedness is still being reported.

Nevertheless, the greatest win for Putin was to have his Manchurian candidate, Donald Trump, in the White House. Thus, while America slept or was “tarbabied” in Afghanistan, Putin consolidated his power base. If Hilary Clinton had been voted in as President instead of Trump in 2016, this current situation would not have arisen. She would have kicked the All European cocktail circuit which for years has gone under the name of NATO, in the backside. At the same time, Putin was meddling with a British Isles polity befuddled by one Nigel Farage who may well have been on the Soviet payroll in order to play wazir to the aspirant sultan Boris.

After all, in a prescient speech 12 years ago, Clinton stated inter alia: NATO Headquarters is bulging with over three hundred committees, many with overlapping responsibilities. Too often, our budgets – military and civilian – are divorced from Alliance priorities, and the most important priorities have been under-resourced for years. Our secretary general has not been invested with the power he needs to truly manage the organization. This must change – and we must agree to that change in parallel with the new Strategic Concept. A new Concept with old structures will not be transformational. In fact, it may not change much of anything at all.

But that did not happen. Hilary Clinton was a casualty at a time when the world was reaching a crescendo of dystopian behaviour.

Now, it has taken a young man, unencumbered by the cocktail circuit and with the true insight of the comedian, to stand up and fight. As he said, he does not need martini glasses, he needs the armaments to vaccinate Europe against this particularly virulent Russian variant of Monkey Pox. But old habits die hard; the clinking of glasses still resonate around the palaces of Brussels.

Old Age

“It is a giant labyrinth that you walk into, they lock the door behind you, and there is no exit,” she said. “I can’t keep doing this. I’m falling apart.”

I have been concerned with care of the aged since not long after I graduated in medicine in 1963. It is now 2022. During this time, there has been a huge change in the technology surrounding care of the aged.

Yet is this reflected in the care?

People are living longer, and hence the gap between ceasing employment and death is growing. I have joined the throng.

There is this myth that looking after old people is more about care rather than medicine. When I was in practice, I was less concerned with “fast rehabilitation”, typically treatment of the sporting injury, but more with so-called “slow rehabilitation”, the staff, including the doctors, employed all the expertise available to assures each person attains his or her highest level of capability, and then maintains it. While most are old; that is not necessarily the case.

The projected Labor Party policy is to have a registered nurse on duty 24/7 in every aged care facility, which equates to employing six registered nurses to cover the one position. This is very difficult to achieve given that government has allowed the nursing home to be separated from mainstream health care with different rules – and for aged care to be largely private. The more you diffuse the expertise of a group of professionals, especially with an absentee landlord, the more you undermine the staff morale which, in turn, leads to increased staff turnover.

When almost 20 years ago I started working as Director of Medical Services in a country hospital, to which was attached a nursing home, the first thing I did was a drug audit for each of the residents with the local pharmacist. I then asked each of the general practitioners how often they reviewed each resident’s medication charts, which most did with varying degrees of reluctance.

There was a visiting geriatrician at the time. “Visiting” was a joke. He would not visit the nursing home; insisting each patient be brought to the rooms from which he worked. Incredible. In the end I secured a mate of mine, a city geriatrician to periodically visit to not only see the nursing home residents but to also provide tutorials to the local doctors and other health professionals. The problem with any program which involves visiting staff is its sustainability.

When the policy makers – divorced from reality – say “train more staff”, it is far from a magic solution.

There are basically three ways of training staff

  • In dedicated training institutions,
  • On the job – apprenticeship style,
  • Importing staff trained in other countries,

coupled with:

  • Periodic in-service training programs.

To me, what is important is to reduce the attrition levels and minimise the spread of disease. Simple to say; hard to accomplish.

There has been a shift from people suffering stroke to those suffering dementia. The incidence of stroke has fallen because of improvement in cardiac treatment, in particular in the treatment of high blood pressure. With stroke, the hope is that the patient will improve; once improvement is stabilised, then the level of independent living ability can be assessed. The problem with dementia is to slow the rate of deterioration; but in both cases, redemption is a limited commodity.

Care of the aged as I have found out is care and competence. One of the most frustrating aspects to exercise even the basic function of getting out of a chair, which once was automatic, is having to wait for someone. The horrors of not being able to undertake normal bodily functions without soiling yourself is ever present. If many of the population are like me, impatient, then learning to wait becomes one of the challenges. This is compounded everywhere by the challenge of the furniture: once it was great to be able to sink into an armchair. Now the softness becomes a giant jellyfish from which you alone cannot escape.

The giant jellyfish

When I was involved with a nursing home attached to a country hospital, the key to its success was that the manager was very competent. Competency is being able to utilise the resources allocated to achieve that no patient is neglected – falls, hygiene, bed sores, nutrition, compliance with treatment being uppermost in those items monitored continually. She had an eye on how everyone was performing, which is what is needed in developing a coherent happy team and thus reducing the turnover of staff. This is important if employment is continually being disrupted by the pandemic.

I am one who believes that in community health structures you build from the bottom, not with great fanfare spray funding from the seat of government and the assumption it will work. There are packages of care everywhere, but who is monitoring the implementation rather than just the distribution of these government initiatives, which are often encased in impressive language, but of what meaning?

One may suggest a number of ways to improve the quality of care of the aged. I believe that there are indicators which denote good care. I also believe that there should be a credentialling, definition of practice and privileging system across the whole sector. When I tried to implement this process in aged care, despite it being the norm for hospitals, the Commonwealth Department of Health protested. Gives you an idea of the appalling track record of the Commonwealth Health Department in that sector. after all, has the sector improved since the kerosene bath era when Bronwyn Bishop was the Minister at the turn of the century? I have viewed hapless Federal Ministers, but the antics of Richard Colbeck in this sector shows how little the Coalition continue to view this sector of human existence.

As a result, a bad situation has festered.

Nursing homes should not be an area where the output is conspicuous consumption, as shown in the media by the acquisition of a yellow Lamborghini because of the apparent profitability embedded in the current aged care arrangements. As can be seen in the media, or in expensive church vestments (as we saw during the first year of COVID-19 when deaths in nursing homes were rampant), the residents of these facilities, many without comprehension, are in need of care, compassion and dignity. However, then give some thought to all the marvellous medical technology which has enabled lives to be extended in this way.

I am well aware that any system which seeks to monitor behaviour in all its forms will receive resistance; however, over a long period of time I have found that it works if you have the will to make it so. I am also a believer in hands-on management, not of the individual interaction between patient and health professional, but of the system. This has enabled me to pick up when inevitably, even with the best of intention, events go “pear-shaped”.

Also accept the blame for such situation where you are ultimately responsible. Then review when this happens – and one of the results of credentialing, defining the appropriate clinical practice and then privileging is that the staff members can learn from others – both the right and the wrong – with recriminations as a last resort.

Unfortunately, most systemic failures have an individual implicated; and that is often the hardest part – to get rid of that individual or individuals. A well constituted system under the new government, where all the parties are bought together in perhaps an electorate-based arrangement, so that each elected member can follow the monitoring of aged care in their electorate – and, as I said above, credentialing, definition of clinical practice and privileging would be one way of attracting attention to an area of past government neglect.

Perhaps a Prime Minister faced with the care of the aged will find out sooner than he thinks that he may need to enter its portals. Therefore he may like to receive periodic factual reports of what is currently occurring in his electorate of Grayndler and aim to visit each over the lifetime of the Parliament. After all, across Australia 151 committees should not be too much of a burden to assure better care of the aged, providing  insurance for that time which each of us will eventually reach, if we live long enough. To face being placed in a nursing home, and knowing that I will be cared for in the best way possible; not left to wallow and nobody comes.

After all, as I found out, 70 may be the new 50 years; but I assure you 80 is still 80.

I am not alone. However, even though there has been an extensive review of this area recently, who of us has been consulted? Who among us aged is the protector of that increasing group of people alongside me who are demented? You see in your contemporaries the slow decline in cognitive function, the irrational behaviour, and unless each one of them has a carer who truly cares for them and has the resilience to battle the many hurdles to getting an acceptable aged care situation, they end up on a scrap heap which, for administrative purposes, is called a nursing home.

The nursing home nightmare is when I cry out, but nobody comes.

Mouse Whisper

Serious Mouse! 

Since 1982, 123 mass shootings have been carried out in the USA by male gunmen. In contrast, only three mass shootings (defined by the source as a single attack in a public place in which four or more victims were killed) have been carried out by women.

Mass shooter

Modest Expectations – In the blowing snow was that a gun report I heard?

I am not a very good gardener. I once killed the grass on the terrace with what I thought was loving care when I overused the fertiliser. The aim when we moved into our house over 30 years ago was to remove the weeds which dominated the garden, and it took about 20 years for the last of the wisteria to go, but asthma weed has defiantly resisted all efforts. There was the vain aim to install a Port Jackson garden, which would have only plants which may have been there at the time Arthur Philip landed at Farm Cove in 1788. The pittosporum, the blueberry ash and the lilli pilli, together with some of  the native grasses survive.  Anyway there was never a true Port Jackson Garden because of resistance by one party to remove the gracefully gnarled exotic frangipani – the survival of which in the end negated that proposal.

I do not have the patience nor the leisured and measured existence to enjoy one anyway. In many ways I envy the apparently sybaritic existence of the author’s “Elizabeth and her German Garden”. Elizabeth Von Antrim, a cousin of Katherine Mansfield, was born in Sydney in 1866. Both were Beauchamps, and Elizabeth only lived in Australia for her first three years before leaving, never to return.

This book recounts her life married to a Prussian aristocrat 15 years her senior, whom she describes throughout as the Man of Wrath. They lived on a vast Pomeranian property in what is now Poland. There she bred  five children and found satisfaction with organising the garden in this vast property.  Her tussle with the gardeners reflects her observation that women were considered inferior, particularly among the workers, and where the women were also often subject to violence. These observations counterpoint the description of her careful design of her plantings and the descriptions of her results. One of these was a bed where plants in every shade of yellow from the fieriest orange to the palest yellow were represented. The book was a spectacular success on publication, having 21 reprints in the first year.

A yellow garden

Her insight is that interest in gardening makes for a satisfied society. The promotion of gardening has, at times, been subject to controversy, but the very best of presenters induce a hard-to-explain serenity; and yet so much of the content is repetition – the vegetable garden, the horizontal wall, the internal garden, the obsessional manicured country garden, build your own hen house, and so on.

Yet as you drive through the newer suburbs of our cities today, the houses consume the whole block with a few pebbles strewn around with a few forlorn plants, labelled drought tolerant. I have named these suburbs “testudines”. In Latin, this means “tortoises”. The word was also used to describe the layered way the Roman legion infantry went into battles with the shields interlocked above their heads. Our modern suburban rooflines seem to be aligned in a manner reminiscent, swathes of grey seen from above.  Barely is there any green in these suburbs except thin green verges with the despondent saplings left to their own devices to shrivel in the summer heat with minimal attention. The sunburnt country… need I recite more.

And as for Elizabeth and her German Garden, gardening is a such a telling metaphor – a brilliant insight.

“Nature has Given me Love”

Adriana Elisabeth Hoffmann Jacoby has died.

Who? You may ask.

She was somebody special – a Chilean cog in the wheel of climate activists.

As the Boston Globe noted:  The presence of two Chilean Cabinet ministers at her funeral made clear the importance of her legacy to the country, where scientists-turned-politicians are helping to make a new constitution shaped by the climate crisis.

Above in the title are her last words recorded.

The Boston Globe went onto say that: “she was born in Santiago on Jan. 29, 1940, the daughter of a renowned Chilean doctor and scientist, Franz Hoffmann, and pioneering psychiatrist and spiritual guide Lola Hoffmann (born Helena Jacoby). Ms. Hoffmann went on to study agronomy at the University of Chile before dropping out. She later switched to studying botany when she spent some time in Germany with her mother.

She credited her parents with nurturing her love for nature. “I have pictures of myself, very little, always with flowers and plants,” she said.

In the early 1990s, she met Douglas Tompkins, a conservationist and the founder of the North Face and Esprit clothing brands, and his wife, Kristine Tompkins, who together bought about 1 million acres of Chile’s forests to protect them.

Yendegaia National Park

Ms. Hoffmann advised and supported the Tompkins’ conservation efforts, Kristine Tompkins said in a phone interview, and once joined other conservationists in obtaining the couple’s help in preserving a vast stretch of precious but threatened land on the border of Chile and Argentina. In 2014, the area became the mountainous Yendegaia National Park.”

This National Park lies in the very southern end of the country on Tierra del Fuego, but Chile is a ribbon which winds its way along the Pacific Coast of South America from ice to desert; it was a perfect site for this determined botanist to work.

In 1992, two years after the fall of Pinochet, she headed a non-profit organisation, Defensores del Bosque Chileno, dedicated to protecting Chile’s native forests documenting how Chile’s extractive industries were destroying the country’s forests.

Her activism was seen by many as an attack on economic development, especially in a country whose economy heavily depended on exporting commodities.

In 1993 Chile created the Comisión Nacional del Medio Ambiente (Conama) an agency that would later profoundly change her life and legacy.

In a way, in the reflections on this great activist botanist, I find it ironic that Chile inherited Easter Island where religion, manifest in the construction of the moai, led to extreme deforestation with the destruction of three species of trees which grew to 15 metres or more, including the Chilean tree palm, often thought to be the largest palm tree at the time. It is difficult now to conceive of Easter Island in 1022 as an island as thickly forested as Lord Howe Island is today with, in both cases, their distinctive palms and accompanying fauna and flora.

Easter Island Moai

Fast forward 300 years and Lord Howe lies deforested because climate change and now, cut off by rising seas, the population are searching for deities, imploring them to reverse the calamity. The Lord Howe islanders have cut down all their palms and replaced them with basalt figures of Malcom Fraser and Shane Warne to attempt to appease the Gods.

As my companion said, even such a great botanist as Jacoby was unable to recreate the old Easter Island. Maybe nobody would want to do it anyway. The man made figures are such an attraction, more so than any palm trees, however tall they grow – whether we like it or not.

Finland

 

 

 

 

 

 

Finland, behold, thy daylight now is dawning,
the threat of night has now been driven away.
The skylark calls across the light of morning,
the blue of heaven lets it have its way,
and now the day the powers of night is scorning: thy daylight dawns,

O Finland of ours!

Finland, arise, and raise towards the highest
thy head now crowned with mighty memory.
Finland, arise, for to the world thou criest
that thou hast thrown off thy slavery,
beneath oppression´s yoke thou never liest.
Thy mornings come,

O Finland of ours!

Jean Sibelius is one of my favourite composers. Finlandia, composed by him while Finland was under Russian rule as the Grand Duchy of Finland, has become a hymn to Finland independence. A group of Finns in the early part of the Russo-Ukraine War sang it in front of the Russian embassy, changing “Finland” to “Ukraine.”

The Finns have lived in the shadow of Russians. The country survived the 1939-44 conflict with Russia, having put up strong resistance, but diminished in size while forced to pay reparations. Thus it was very  wary of offending the Russians in the years following. Yet Finland recovered sufficiently to successfully hold the 1952 Olympic games and its 72 metre tower stands as memorial to the superb architectural design of Yrjö Lorenzo Lindegren, who had worked closely within this Finnish functionalist school which included Alvar Aalto, who inter alia defined the architecture of the modern hospital.

The Finns are impatient with fripperies; yet they are creative and hardy – especially important when you live next to Russia and the beautiful summer is lost in harsh winters.

I remember the Finnish lecturer in Semitic Studies who met his smaller professor coming up a narrow set of stairs. There was no standing aside. The Finnish lecturer picked the professor up, swivelled and placed him on a higher stair tread. Efficient, unorthodox, and without a word the Finnish lecturer proceeded down the stairs into the street.

I have been to Finland several times and recently mentioned in my blog my pilgrimage to Turku where John Landy broke the world mile record in 1954.

We have taken the Finnish train to Saint Petersburg, as it was suggested not to take the Russian version. The Finnish train was cleaner and more comfortable

Communal garden / meadow

We were once invited to lunch with a public health specialist in one of the Helsinki suburbs some years ago. There was this deep sense of communal living here.  There was a simple order about the way the houses were built and how clean the streets were. The houses backed onto a communal field, alive with vast swathes of summer flowers. Everybody could participate in picking flowers. Communal sharing was encouraged.

As an epidemiologist, she was interested in population health studies. As such she was able to freely go across the border into Russian East Karelia where the ethnicity of the people are essentially Finnish.  This region was once part of the Swedish-Finnish Kingdom from 1323 to 1617 and again between 1721 and 1743, then part of the Grand Duchy of Finland between 1809 and 1918 and of independent Finland between 1918 and 1939 and finally from 1941 to 1944. Not exactly a serene existence.

The Finns, with some support from Germany, with a population of about 5.5 million were able at times to more than match it with the Russians. The Finns knew their country. It helped as the troops used the cover of pine forests and snow which covers the terrain along a long border as far north as Lapland far better than the Russians until the inevitable power of the Allied Forces prevailed.

The Finns paid the price of alliance with the Germans during this period both in reparations and loss of territory.  Following World War II, most of what Finnish people define as Karelia was incorporated into Soviet Russia. The Finns were forced into a pro-Soviet neutrality.

After the fall of Soviet Russia, the social movement of both Russians and Finns across the borders has progressively increased. In 2011 for instance, around the time we were in the Helsinki suburbs, Russian tourists constituted 31 per cent of the total.

However, life has changed significantly recently and Finland has thus far not been caught up in Putin’s web; that of attacking smaller neighbouring States searching for his Peter the Greatness.

Sweden has been neutral throughout the 20th and, thus far, the 21st centuries. As people know, Finland has a cohort of Finn-speaking Swedes in the population. Both countries have been members of the EU since 1995; in fact Finland was one of the first countries to adopt the euro, replacing the markka. For the Russians, who had controlled Finnish neutrality, the Finns joining the EU was one blow, but until the onset of the Russo-Ukrainian War, there was no incentive for either Finland or Sweden to join NATO. This has all changed. The Finns  want to join NATO.  Once implacably opposed, the Swedish government is softening its approach, although there is still opposition from the Left.

Does Russia want a repeat of the intermittent war which occurred between 1939 and 1944 on a vastly different field? Does Putin really want a re-run of this conflict to stop the incorporation of these two technologically advanced countries into NATO? St Petersburg is 250 kms from the Finnish border but Helsinki is over 1,000 km from the Russian border. I doubt it; and yet the Russians have engaged in another war with a far more populated opponent and the outcome of this conflict will ultimately determine whether Putin turns his attention to Scandinavia.

Exercise – the Bane of Existence

At one stage, I used to go for a run every day around the suburb, which contained many hills. Given that I instinctively loathed exercise, the surge of endorphins countered so effectively this loathing, that many times during a year I would engage what were laughingly caused “Fun Runs”. As I aged, the runs became long early morning walks; and then disease caught up and exercise became biweekly hydrotherapy sessions; and then with COVID causing the closure of the pools, desultory infrequent rambles – the walking restricted to climbing stairs, back stretches.  This article in the NYT gave me some hope. I have edited the original article, but have noted the contribution from a University of Sydney expert.

For years, exercise scientists tried to quantify the ideal “dose” of exercise for most people. They finally reached a broad consensus in 2008 with the Physical Activity Guidelines for Americans, which were updated in 2018. In both versions, the guidelines advised anyone who was physically able to accumulate 150 minutes of moderate exercise every week, and half as much if it is intense.

But what’s the best way to space out those weekly minutes? And what does “moderate” mean? Here’s what some of the leading researchers in exercise science had to say about step counts, stairwells, weekend warriors, greater longevity and why the healthiest step we can take is the one that gets us off the couch.

For practical purposes, exercise scientists often recommend breaking that 150 minutes into 30-minute sessions of speedy walking or a similar activity five times a week. “

Moderate exercise means “activities that increase your breathing and heart rate, so the exertion feels like a five or six on a scale between one and 10.” In other words, pick up the pace a bit if your inclination is to stroll, but do not feel compelled to sprint, according to Emmanuel Stamatakis, an exercise scientist at the University of Sydney in Australia who studies physical activity and health.

We can accumulate our 150 weekly minutes of moderate exercise in whatever way works best for us. “Many people may find it easier and more sustainable to squeeze in a few dozen one-minute or two-minute walks between work tasks” or other commitments. “There is no special magic to a sustained 30-minute session of exercise” for most health benefits.

Think of these bite-size workouts as exercise snacks, he said. “Activities like bursts of very fast walking, stair climbing and carrying shopping bags provide excellent opportunities for movement snacks.” To concentrate the health benefits of these workout nuggets, he added, keep the intensity relatively high, so you feel somewhat winded.

Conceivably, you also could cram all of your exercise into long Saturday and Sunday workouts. In a 2017 study by Dr Stamatakis and colleagues, people who reported exercising almost entirely on weekends were less likely to die prematurely than those who said they rarely exercised at all. But being a weekend warrior has drawbacks. “It is certainly not ideal to spend the workweek totally sedentary and then try to compensate” over the weekend, Dr. Stamatakis said. You miss many of the health benefits of regular exercise, such as improved blood-sugar control and better moods, on the days you do not work out, he said. You also increase your risk of exercise-related injuries.

For most people, “150 minutes of exercise a week would translate into about 7,000 to 8,000 steps a day,”

The recommended 150 minutes a week also may be too little to stave off weight gain with age. In a 2010 study of almost 35,000 women only those who walked or otherwise exercised moderately for about an hour a day during middle age maintained their weight as they became older.

But any activity is better than none. “Every single minute counts “Walking up the stairs has health benefits, even if it only lasts for one or two minutes, if you repeat it regularly.”

Tell me it is not so

I always watched Sam Waterston and his off sider played by Angie Harmon in Law and Order in the 1990s. There was something taut about their relationship, giving a certain authenticity, if you accept the underlying morality of “Crime does not pay”. Angie Harmon left and reappeared in the crime series Rizzoli and Isles, which I admit I watched very infrequently.

When I heard Sam Waterston was returning to the series even though, after so many years on, he may appear somewhat hoary. However, this comment from The Boston Globe is suddenly a blow to progress. It is a bit like the “auto-correct” when you use an unusual word or one that has been made up to create a sense of the original. Watching a program created by a computer program, maybe the nightmare of the future.

Law and Order in the ’90s

Well-oiled machines are great, except when they’re TV shows. The best of scripted TV has a human touch, a sense of the risks and variations and flourishes that come with inspiration. This season, the “Law & Order” scripts seem like they’ve been auto-written by a computer program, the same program that was writing them back when the show had already hit a creative wall back in 2010 after 450 something episodes.

I don’t think it’s the cast, including newcomers Camryn Manheim and Jeffrey Donovan and returnees Anthony Anderson and Sam Waterston. They’re given very little character development. They’re also given story lines, some of them feebly ripped from the headlines, that are half-baked at best. Watching this new season, I keep finishing episodes and wondering, “Is that it?” There is very little there, when the denouement rolls around; the writers aren’t sneaking in any of the twists that left you thinking a bit about the justice system, or human nature. There’s almost none of the wit from the show’s prime, too, when the cops’ and lawyers’ little sharp asides added both irony — something many of the spinoffs, notably “SVU,” do not have — and bits of character.

Mouse Whisper

“Oh, my dear, relations are like drugs, – useful sometimes, and even pleasant, if taken in small quantities and seldom, but dreadfully pernicious on the whole, and the truly wise avoid them.”

From Elizabeth and her German Garden. Never thought about relatives that way, they always seemed so “mice”.

Modest Expectations – Jeffrey O’Brien

We had a bushfire the other day up the road at Tullah. It seems not to have been deliberately started, but a stray cigarette or a spark from an exhaust would suffice as explanation.

Tullah

Next minute, fire crews were working on the outskirt of the Tullah village through the night and had the blaze on the nearby Mackintosh Dam Road contained by Sunday morning. In the meantime it burnt down one vacant property and a number of sheds. It was contained, but the resources that were thrown at the fire early were spectacular, drawn from all over Tasmania. The fear was that it would get in the pine forests and then it would have rivalled the mainland fires of two years ago. The other danger was fire getting into the peat, which lies at the base of the button grass meadows that constitute so much of the West Coast. Then it could burn for a very long time.

Tullah, by way of explanation, describes itself as a village on Lake Rosebery. It was a settlement built by the Hydroelectric Commission when one of their schemes was to dam the Tasmanian West Coast (or was it damn?). It would have culminated in the Franklin River being dammed, which would have had a great impact on the region.

Returning to Tullah, the older part of this township lies directly on the Murchison Highway. An old silver lead mining area, it consists of a pub and a few houses and displays one of those famous locomotives now cast onto an Australian coin – Wee Georgie Wood. It was used to transport the ore before there were any roads and was in that part of the township threatened by the fire.

Having had experience some years ago of a fire initiated as a “burning-off” exercise by the Department of Parks and Wildlife (laughingly referred to then as that of Sparks and Wildfire) on the ridge behind our house in which we lost a shed containing most of our stored linen, it was great to read how much the fire fighting service has picked up its game.

One of the newer residents of Tullah, who runs a microscopically-sized café with excellent coffee (and a resident alpaca), was obviously relieved when the fire was halted on the outskirts.

Tullah is on the edge of the West Coast wilderness area, which has some of the most undefiled temperate rain forest in the world. Because of the high   rainfall, an average of 240cm a year, it has been thought of as somewhat protected from fires.  Ironically the wettest place is actually Tullah, with an average annual rainfall of 280cm. So this recent blaze serves as a warning. Climate change is coming – I’m not clever enough to calculate how quickly and how selective will be the change. Yet the forests of the West Coast and South-west are vulnerable. Whether one believes that the forested wilderness is little changed since the time when the dinosaurs walked the earth, it becomes all so academic if this part of Australia catches alight as has occurred periodically in NSW and Victoria.

Ubertas et Fidelitas

An interesting datum. The state which has the highest identification of its inhabitants as Aboriginal people is Tasmania (close to five per cent). As a person who grew up believing the last Tasmanian was Truganini, as I have grown older, I have been surprised by the number of Tasmanian Aborigines who emerged from “among the Huon pine”.

A Dulcie Greeno maireener shell necklace

We have purchased several traditional Aboriginal Maireener shell necklaces, with their characteristic iridescence. Much of this art form is concentrated on the Flinders Island in Bass Strait. We have other cleverly executed pieces of Aboriginal art with a Tasmanian tag – but seemingly made in the last 20 years. My problem is connecting them to a tradition that shows areas of petroglyphs and middens on the shore which have survived the often violent storms which characterised that part of Tasmania for millennia.

To celebrate Tasmania Day in 1986, a collection of papers from the early days of Tasmania was published, including that of Captain James Kelly’s voyage, which commenced on 27 December 1815.

Then James Kelly sailed out of Hobart in a five-oared whale boat, with four men, John Griffiths and George Briggs, who were described as native to the colony and two others described as “European” William Jones and Thomas Toombs, the last named’s previous occupation being listed as“bushranger”.  King’s aim was to circumnavigate Tasmania and, as part of this voyage, he discovered Macquarie Harbour. This harbour, the third largest in Australia, has a treacherous entrance, which was later christened Hell’s Gate. The weather was very compliant as they came into the Harbour under the smokescreen from the Aboriginal fires at the Heads. They reckoned that enabled them not to be seen initially.  They spent some time and made contact with a number of Aborigines, warriors with whom they developed an uneasy relationship.

However, when leaving the newly discovered Harbour, which Kelly named after the then Governor Lachlan Macquarie, (whose territory then incorporated both NSW and Tasmania), the fury of Hell’s Gate kicked in and they were lucky to survive.

The insights into Aboriginal life and the interaction with the whitefellas is expressly discussed under the heading of “female sealing”. Seeing how they went about harvesting the seals obviously astonished the diarist. The women showed a distinctive methodology, as though they had to commune before killing the seals. It shows how important the description of Aboriginal life, when the only chroniclers of the day-to-day activity came from these early reported interactions, at a time before extermination became government policy with the inevitable destruction of the social fabric.

The recent literature trying to show that the Aboriginal tradition progressed from the hunter-gatherer society to one of adopting the tenets of the agricultural revolution as its origin is promoted by a number of Australians who claim Aboriginal descent and are clustered around the University of Melbourne. From what I have read, I do not believe it to be so. Take this excerpt.

The description of female sealing in the Bass Strait islands is a prime example. No mention of herbs and spices in cooking the young seal. Having personally been one of those who have tasted seal, I would suggest it is not among my top ten gustatory phenomena.

“We gave, says the journal of the exploring party, the women each a club that we had used to kill the seals with. They went to the water’s edge and wet themselves all over their heads and bodies, which operation they said would keep the seals from smelling them as they walked along the rocks. They were very cautious not to go to windward of them, as they said “a seal would sooner believe his nose than his eyes when a man or woman came near him.” The women all were about nine or ten seals upon each rock. Lying apparently asleep. Two women went to each rock with their clubs in hand, crept closely up to a seal each, and lay down with their clubs alongside. Some of the seals lifted their heads up to inspect their new visitors and smell them. The seals scratched themselves and lay down again.

The women went through the same motions as the seal, holding up their left elbow and scratching themselves with their left hand, taking and keeping the club firm in their right ready for the attack. The seals seemed very cautious, now and then lifting up their heads and looking round, scratching themselves as before and lying down again; the women still imitating every movement as nearly as possible. After they had lain upon the rocks for nearly an hour, the sea occasionally washing over them (as they were quite naked, we could not tell the meaning of their remaining so long) all of a sudden the women rose up on their seats, their clubs lifted up at arms length, each struck a seal on the nose and killed him; in an instant they all jumped up as if by magic and killed one more each. After giving the seals several blows on the head, and securing them, they commenced laughing aloud and began dancing. They each dragged a seal into the water and swam with it to the rock upon which we were standing, and then went back and brought another each, making twelve seals, the skins of which were worth one pound each in Hobart Town. This was not a bad beginning for the black lakes (sic), who now ascended to the top of a small hill, and made smokes as signals to the natives on the main that they had taken some seals. The smokes were soon answered by smokes on the beach. We skinned the seals and pegged them out to dry. The women then commenced to cook their supper, each cutting a shoulder off the young seals weighing three or four pounds. They simply threw them on the fire to cook, and when about half done commenced devouring them, and rubbed the oil on their skins, remarking that they had a glorious meal.

As I said above, food for thought! 

Reflection in the Pool of the Land of the Anziani

I suspect that the aged care portfolio has caught up with the politicians because when it is part of the health portfolio, it tends to be cast into “the too hard basket”.  Yet with the increase in longevity and the growth of the private nursing home sector as a lucrative business for the owners, government responsibility should have increased not lessened in maintaining our aged through the time of life when a person becomes increasingly dependent on others. Once into the nursing home it is very much one way, but it should not be a nightmare.

When I had my 70th birthday, I half believed the axiom “that 70 was the new 50”. Three years later and that concept went into the rubbish bin.

For myself, the acute phase of the disease took a long time to settle into a chronic burn, and as the years have passed the co-morbidities have accumulated until now I can no longer live independently. In previous times, there may have been an array or servants, but in the modern world this not feasible without wealth.

I had two aunts who entered nursing homes in their nineties, wealthy women who were able to afford a nursing home where all the “creature comforts” were available and provided. What struck me was the number of Filipino and Nepalese nurses, both male and female, and feeling of optimism in this establishment. But it was at the high end. They were both dead before the Virus struck and surveying the conditions in that nursing home gave no reason for me to worry about their care, even as one increasingly succumbed to fronto-temporal dementia.

The Virus has taken a toll in other ways. I used to go to hydrotherapy twice a week. The hydrotherapy pools where there are supervised programs have vanished, as the pools have closed because of the Virus. This gets no coverage, but when one depends essentially on allied health professional services, the Virus has curtailed them, and with any such program, once they cease so too do the levels of personal fitness and social interaction decline.  Gyms get all the publicity, but circumstances for the aged are probably worse once you lock people in their rooms with staff barely having the requisite nursing skills let alone those of allied health professionals.

Some of the drugs required for my treatment, such as the corticosteroids are essential but impose complications. I had the rapid development of drug induced cataracts, both of which have resulted in new improved lens (no longer any astigmatism). Otherwise I have eschewed operative intervention. Some of the operations had the potential to make life worse, and I value the fact that I can still communicate.  The bottom line is that if I did not have my wife, who is a very caring individual, I would be facing institutionalisation and all the uncertainty that entails.

My sleeping arrangements have been modified, so I am close  to the toilets.  I still have been negotiating stairs.  My fall a few months ago emphasised the line between having my immediate daily care and then having to wait face down for someone to come after nearly two hours. I have learnt to curb my impetuosity, since change is now a one way trek, but the nursing home looms as a prison, with the likelihood of solitary confinement.

And a Minister in charge of this crisis who goes to the cricket for three days! He has either given up, or else needs a cognitive test to assess whether he needs the pity for a person with early dementia. Or is he just callously insensitive? I cannot believe that this man is functioning normally; but then the last people who are considered to have such pathology are those with the public relations machinery of denial. Morrison has demonstrated himself to be a Prime Minister with zero human relations skills but with a formidable expenditure on public relations.

Having experienced Bronwyn Bishop’s hair-raising approach to any portfolio in which she was put, I thought that disclosure of kerosene baths in nursing homes under her watch would have elicited a positive reaction for reform. There was the predictable furore and then nothing. Even Royal Commissions do not move the dial, because the people trapped in nursing homes have virtually no say.

The idea of little children mingling with the elderly as gleaned from the ABC TV program has long since been suspended because of the Virus, but it is ironic to see a photograph of myself at two years of age with the wide gait; and realise that I am not that much different now because of loss of proprioception.

I remember a child staring at me from a stroller; I was in a wheelchair.

“Don’t worry son, you’ll be here soon enough.” He was too young to understand, but it certainly brought home to me the irony of existence. His parents did hear me, and laughed. Vulnerability is the product of the child in the stroller and the guy in the wheelchair.

The role of government intervention in both areas has demonstrated the difficulty, because childcare and care of the aged have both been exploited, and over a long period. The failure of the religious institutions in these areas has been shown, and in many areas, disgraceful exploitation has emerged – yet these institutions keep their charitable status in regard to taxation

The whole failure of government intervention has been compounded by the laissez-faire approach to looking after the elderly – maximising profits by exploiting the elderly is a spreading stain on the Australian community.

I can only watch the stain come closer because I have no confidence in the area being afforded the priority it needs and which one only realises as 80 is the new 80.

Yet during my professional life I have sought solutions, but many of the schemes in which I have invested myself have reverted after I have gone. Some have survived.

Is there a solution?

Over my professional life, one way or another, I have had considerable contact with care for the aged in its various forms. The problem with being old as described above is that nevertheless it is not a homogeneous product. People age with different disabilities and hence needs.

The problem with age is that it comes at a point when nothing more can be done for you, but to ensure you are comfortable, pain free, not isolated, able to use the toilet facilities, and that your medications are regularly reviewed, and you have enough to eat and drink and to operate at the higher end of your residual competency.

To accomplish this properly requires both a high level of management skills and continuity of these skills; thus the competency of a clinical manager of each facility should be recognised and rewarded appropriately and succession planning encouraged.

I am a great believer that credentialing and privileging should be undertaken not only in health services but also in nursing homes. I am a purist as I have retained “credentialing and privileging”, whereas others have replaced “privileging” with “scope of practice”. In fact, the process has four stages –

(a)   Credentialing is self-evident as it is based around the qualification.

(b)   “The scope of practice” is what is requested by the health professional, but

(c)    privileging depends on the capability of the health service and confidence of the director of clinical services (or equivalent) that the requested scope of practice is appropriate and safe given the resources of the health service.

(d)   approval of the board on the recommendation of the credentialing and privileging Committee

All recommendations to the Board must involve the director of clinical services and if the terminology is correct, the nursing home manager who should be a nurse.

To me that is a very simple statement of intent, and I was able to successfully implement such a process among a number of small health services over a decade. To me, it satisfied the requirement of the clinician and the administrator and it made those involved take it seriously. In the private sector, that includes the owner (or representative).  In my health service experience the hospital board was very visible, but in the nursing home sector, who knows in the tangled web of business resulting in the lack of oversight in this sector. And with the obscenity of some of the owners with more concern with having the latest Lamborghini, it is a massive task to permanently change the culture when the government is basically uninterested.

When I suggested that the nursing homes be included in the regional credentialing and privileging scheme, the pushback from the Commonwealth Department of Health was fierce. The nursing home was the person’s home; it was not a quasi-health institution, it was said. The residents could have whomsoever they wanted as carers, without interference from government, and certainly by such a scheme which attempted to codify standards. God, no.

Yet there is an unfortunate strain of authoritarian behaviour which I have seen in the transition stage between hospital and nursing home. In the acute hospital, for some of the staff, an old person admitted is an old person to be get rid of, because of his or her occupancy of an expensive acute bed.

As the hospitals move from metropolitan teaching hospitals, the pressure on the bed is not as great. Nevertheless I once was faced with an officious nurse who was attempting to threaten me because I believed my father-in-law needed more time in the acute bed before being sent to a so-called “sub-acute care” environment. She attempted to stand over me by threatening to have him placed in a nursing home in a far-off town where he would have no-one able to visit him easily. After a strong word, that option was removed and he stayed in the hospital for some further period until he was well enough to be transferred. Nevertheless influence, like information, is asymmetric.

The fiction that a nursing home is a domestic situation is nonsense, because of the nature of the residents, who need personalised care but which is often left wanting because staff levels are squeezed for a number of reasons – profit margins, COVID-19 restrictions, poor pay and conditions.

Some nursing homes are attached to the public hospital. Therefore, I was in a position to influence the rules for visiting doctors. My initial approach was to look at the drug charts of each resident as this gives one an idea of how often the resident is reviewed by a doctor. The need for documentation is as essential as regular visits by the local general practitioner, and each nursing home should have access to a consultant geriatrician or specialist in rehabilitation medicine (and ensure one or the other visits regularly).

The requirement for allied health cascades from this overall need to ensure that in a world of specialisation and constantly improving technology, the aged are not deprived of the benefits of these advances.

In the health area where there is increasing specialisation, the pool of generalists in all fields becomes limited. The concept of nursing staff in rural areas acquiring some of the basic skills of allied health professionals has been regularly canvassed. Whatever the current state of this move to develop generalists should accommodate that some of the generalists will develop special area on interest and hence expertise.

The suggestion of “care finders” adds another layer without any improvement. To establish a new professional group is to establish a new bureaucracy, not necessarily improve care of the aged.

I well remember the country hospital which was converted from a general practice procedural hospital to one concentrating on geriatric treatment. The “driver” was a doctor who persuaded the staff to re-train from the theatre to treating the aged. He was successful and well-liked but did not want any limelight – and presumably this pilot program died with him.

However, successful models abound. The problem is each requires a certain discipline, dedication and time to implement and maintain. To change the culture is not just taking a pill. Governments, when pressed, can be reasonable at getting the input right through the multitude of ways enquiries can be organised.

Government falls down in the implementation. Many of the ministers and the bureaucrats think that fussing over the nature of enquiry is enough, and unfortunately too much of the intellectual capital is invested in the initial enquiry and its report. In fact, the report is only the start; but too often it is the end point, gathering dust with so many others.

In the end it is the clinical management standard that counts.

One question, what is the best private nursing home in Australia; and what is the best public nursing home?

In such a search, the common feature I postulate will be the ongoing standard of the clinical management team. Appropriate credentialling and privileging should be able to validate that approach.

In the end I want to know what works; and what has worked over a generation at least. Imprecise, but once you see success, you know what it is. To achieve this insight, experience helps.

Mouse Whisper

Just two items for Trivial Squeaksuit (obviously in a cat-free environment – pur is a palavra proibida).

  • Who is Dorothy Gale?
  • Who is Barbara Millicent Roberts?

Dorothy, the heroine in the Wizard of Oz.

Barbie doll.

Simple really.

Modest Expectations – Stumps

After another 100 days I hope the world will have the same hope in Biden that it does now after the first 100 days.  Having survived the four years of President Trump with all his mimicry of Batman’s enemies, it is good to have Bruce Wayne alias Joe Biden back.  Sorry, so sorry I mistook your disguise as the doddering anziano, but your treatment of Anita Hill can never be disguised or forgiven because you begat Clarence Thomas, one of the great catastrophes of modern America.

Sometimes He gets it Right

Anonymouse

It was May and then June last year that this Blog started to advocate for custom built quarantine facilities. One of the Blog’s mates thought it would be too expensive, and in any event the hotel industry had near empty facilities desperately in search of customers, so hotel quarantine was born. People returning from overseas fitted the bill for the missing customers, but viral outbreaks from these hotels have sporadically occurred. However, use of such facilities has also produced lessons – all of which can be applied to the adaptation of or construction of bespoke quarantine facilities in each State near ports of entry.

The Federal Government seems to be able to wrap its collective mind around all sorts of spending needs – defence spending seems to be a bottomless pit with an endless time frame.  However, when the matter of defence is against an invisible foe, with so many tricks in its RNA, then Government seems not able to grasp the enormity of the problem and has sat on its hands for 12 months now apparently wishing it would all go away. COVID-19 will persist, with no idea when it will be conquered. At the same time, the social links between countries will be irrevocably changed.

Quarantine facilities require their own expertise and one of the various expertises needed is to ensure the rapid construction with best practice observed. That is why hard-nosed visionaries such as the Wagners in Queensland who were asked by that Government to prepare a plan, should be taken seriously; their Toowoomba airport venture should be sufficient proof as to their competence and ingenuity.

But in true Australian style, Government asks for a report. Jane Halton’s report was adequate in that she articulated the obvious – a national quarantine capacity – although it’s hard to see that recommendation, together with a collection of documentation, to be worth the alleged $118,000 it cost. The Report nevertheless provides the weasel words for the Government to ignore the positive parts of the report.  For instance, the Halton pronouncement set out such a situation for the “Commonwealth Weasel”.

States and Territories should now consider their hotel quarantine operations in line with the features of good practice and make adjustments where necessary to meet these baselines. Noting issues about scalability and the specialised nature of the workforce required to implement hotel quarantine, States and Territories should also investigate establishing standing arrangements with AUSMAT in the event of the need to scale up operations quickly.

Stripping out the verbiage, of which there is plenty, the recommendation is to get a national system of quarantine, with agreed standards and scalable capacity.  Too much to ask that our Federal and State Governments behave like grownups and just do this? The Federal Government’s admissions about quarantine in relation to returnees from India demonstrate the scale of the problem.

How long ago did Halton write her report? 

Concept village – mining, quarantine …

The Inglenooks of Age

When I was a young doctor, elderly patients who presented in hospital, with apparently uninteresting symptoms and signs, besides being old, were called “old sloughs”. Now I have reached that “old slough” age, it just confirms how offensive that description was. Even then I recoiled from the dismissive way hospitals were places where these patients were admitted. Care was a secondary consideration. Therefore, old people when there was considered nothing more could be done, were left in a bed with minimal attention until they could be moved to a geriatric hospital, which was one step before the nursing home.

One case stood out when I was reviewing some of these older people in hospital. It was at a time before the specialty of geriatrics had been carved away from general medicine and general practice. In Victoria there were geriatric hospitals; later I received a more detailed insight into such care when I had to run the rehabilitation unit at one of the large teaching hospitals in Melbourne and later still spent time reviewing facilities when I was responsible for certain sectors of community aged care.

I stopped at the bed of an elderly lady who had been classified as suffering from dementia. I reviewed her charts and there, on her drug charts, was a nightly dose of Relaxa-tabs. She had been taking these for years and the order seemed not to have been changed. Naturally, with the dose prescribed, she would sleep, but I was taken aback by the quantity.

Relaxa-tabs contained bromine and so, out of curiosity, I ordered a serum bromine. When the result came back it showed her serum bromine was at toxic levels and clearly explained her apparent dementia.

The tablets were stopped at the time of the test, and once the serum level was known treatment was instituted to flush the bromine out of her system. Over the next fortnight her mental state improved to such an extent that I cannot remember whether she went home directly or had a staged return to a more normal living. The demented state cleared – I know that much.

To me it was a salutary lesson in labels, especially now I am of that age. Bromine in not the problem it was in the past as it has been removed from reputable pharmaceuticals. I have read that in the USA it is licensed to be added to the water supply of naval ships and oil rigs, as in addition to having sedative properties, it also allegedly dampens the male libido. I grew up, myth or not, believing that bromine was added to the tea of soldiers for such an effect.

You can have as many government inquiries into aged care as you like, but society has passed you by when you strike 80. The elderly with money can have their care softened by the cushioning effect of their money. I had an aunt who lived for her last years in a very plush nursing home, but even in that home, it was evident how many of the staff were recent immigrants, particularly from the Philippines and Nepal.

Yet neglect remains the headline for much that goes on in the aged care sector. The stories on the one hand of the Greek Orthodox Church demanding its nursing homes pay a tithe so the archbishop can have a wardrobe of fancy raiment or, on the other hand, of nursing home owners who live lavish lifestyles, complete with the signature matching yellow Lamborghinis, running nursing homes with minimum standards of care. I well remember the whole fiasco of Bronwyn Bishop’s stewardship 20 years ago when she was the Minister responsible for defending the use of kerosene baths in nursing homes Nothing much has changed, except perhaps the kerosene.

The exploitative areas of the nursing home industry should be shut down. When Governments crab away from such a drastic solution, they tacitly agree that the immensity of the problem of nursing home care requires not only more but also better trained resources in a coordinated environment and regulatory unification between the sectors – and Governments keep saying that, but effectively do nothing about solving the problem. It is ridiculous for the Commonwealth to be running the aged care sector and the States the public hospitals, when it should be the one sector.

As indicated above, I have been involved at various times of my professional career with the aged care sector, and it is a no brainer. There should be a single system, because age is a continual wave eventually crashing on the shores of death.  At present, the method of distribution of health care is via aged care packages, depending on the funding source floating on the top of the wave. Quality is incidental.

There is a philosophy with certain government sources of shovelling out the cash – job done – but what about quality and outcome? To some bureaucrats that requires actual work, collection of data and, given the reigning politicians suppress as much information as possible, they may argue what is the point?

Political announcements are all about input and the immeasurable glorious future where the recipients of such input are chewing lotus leaves – or their gums. Who needs data, especially when this is the third or fourth time the same announcement of government largesse has been made? To make the point, sometimes irony is the best way to highlight the problem, especially when the government itself is the very epitome of irony when it says, “We are taking the matter very seriously.”

The other public problem is the lack of an articulate advocate for reform on behalf of aged care residents. If you look at the vast array of those who appear on the media, there are none who regularly appear when the topic moves onto the way to actually improve the lot of the aged. The last woman of consequence to appear regularly on a panel show and make an impact by clearly showing that age was not automatically the gateway to dementia was Margaret Scott, the Tasmanian poet, who was a regular guest on Good News Week in the 1990s.

It is mainly a variety of social workers and health professionals who are some way away from being aged, often well skilled in the vocabulary of “shock and horror show”, but stopping short of doing anything.

There is the vaudeville act that the ABC has twice arranged by mixing the very old with the very young. This concept was aired first on the BBC and, given the COVID-19 pandemic, the ABC have been venturing into perilous territory, but it is assumed everybody involved has been “dry cleaned”. The concept is very interesting, but not just as sporadic entertainment. After all, grandparents looking after their grandchildren has been around for a long time, just ask the Indigenous community. I am just not aware of any program which seriously looks at the benefit of those arrangements long term and whether a program such as the ABC is airing is demonstrating anything sustainable or generalisable.

There is also that myth about 70 being the new 50. However, it is illusionary. The general improvement in the welfare of the community has improved. Too many in the years after the “new 50” start to die in a manner not befitting of a reborn generation 20 years younger.

The problem with age is invalidism and the daily humiliations that accompany it. I am reminded of the words of a young woman with motor neurone disease who said she most feared the time she could not wipe her bottom – to her this represented a turning point. Don’t just be appalled about the frail and elderly dealing with such daily humiliations. Demand that every politician spend a week or two in community service looking after the aged and contemplating their own probable destination before they can pontificate about the problems of aged care. Although perhaps their pensions will be such that their choices will be much easier in the future.

The Drums are beating

This past weekend, Essential Quality came fourth in the Kentucky Derby at Churchill Downs. Louisville is the city in the middle of this blue grass country and Bourbon distilleries.

Essential Quality

As the NYT has reported, pre-race talk among the racing fraternity was all about what Sheikh Mohammed’ al-Maktoum’s money has accomplished, and the fact that the same group completely ignored the international human rights scandal over the Sheikh’s role in the disappearance of Sheikha Latifa, one of his daughters.

But others are speaking up. A group of human rights lawyers and students at the University of Louisville filed a complaint with the Kentucky Horse Racing Commission, asking it to bar Sheikh Mohammed and thus Essential Quality from the Derby.

“The Horse Racing Commission must also use its authority to end his involvement in Kentucky horse racing, at least until Princess Latifa is free of captivity,” the complaint document insisted. The Kentucky Racing Commission went for the long blue grass; after all, the pervasive influence of the UAE ruler who pays the wages of a large segment of the racing industry not only in Kentucky but also across the world. In Australia where the racing industry has a disproportionate influence, one can only cringe when one hears our equine commentators falling over themselves to address “His Highness”.

Two weeks ago a panel of United Nations human rights experts, including members of a panel that deal with forced disappearances and violence against women, asked Dubai for proof that Sheikha Latifa was still alive and called for her immediate release.

Evidence of life and assurances regarding her well-being are urgently required,” the U.N. analysts said. In recent years, videos have of Sheikha Latifa, saying she was imprisoned in a Dubai palace and afraid for her life. In a 2018 video she said, “her father only cares about himself and his ego.” In an ominous premonition, “I’m making this video because it could be the last video I make,” she said. She was last seen at a meal hosted by her father that the former Irish President and erstwhile defender of human rights, Mrs Mary Robinson attended. She later said she had been tricked into attending. Yet her excuses sounded lame in a report of the matter in the Irish Examiner when, in her attempt to rationalise the woman’s dire situation, she was reported to have said Sheika Latifa was said to have a bipolar disorder. I would say it was the least of the Sheika’s worries.

As widely reported, Sheikha Latifa hasn’t been seen in public since an attempt to escape in March 2018, when her Finnish personal trainer and a former French soldier joined forces to smuggle the Sheika aboard a boat, which was later boarded by armed Emirati commandos in Indian waters. Sheikha Latifa and her personal trainer, Tiina Jauhiainen, were captured at gunpoint, sedated and returned to Dubai, with Ms Jauhiainen released after a fortnight. No mention is made of the French soldier’s fate.

This is not the first time Sheikh Mohammed’s treatment of female family members generated outrage. Last year in Britain a judge found that he had abducted another daughter, Shamsa, off the streets of Cambridge in the UK in 2000, flew her by helicopter to France and then returned her to Dubai.

In addition, his youngest wife, Princess Haya, Mrs Robinson’s mate, has also left Dubai fearing for her life after she was subjected to a campaign of intimidation and harassment.

But then the Sheikh has 30 children from six wives. Given the attention being shown to women’s right in Australia, who will be the first to issue an invitation for Princess Latifa to visit Australia – if she hasn’t been killed already by Godolphin Blue.

Godolphin Blue

Tasmania – the place where it counts

Each of five electorates are called divisions. Each division has approximately the same number of electors. Voting for the House of Assembly is by a form of proportional representation using the single transferable vote (STV), known as the Hare-Clark electoral system. By having multiple members for each division, the voting intentions of the electors are more closely represented in the House of Assembly.

Since 1998, the quota for election in each division, after distribution of preferences, has been 16.7% (one-sixth). Under the preferential proportional voting system in place, the lowest-polling candidates are eliminated, and their votes distributed as preferences to the remaining candidates. If a candidate achieves a quota, their surplus votes are redistributed as preferences.

I was once elected to office by a similar system.

In this election Premier Gutwein in his Bass division nearly achieved three quotas. That is the way to do it, because once you reach the required number of votes, the surplus cascades to your fellow party members. If the level of this popularity for Gutwein had been translated across the other four division, he would have won in a landslide.

That is not how Tasmania works. Like Gaul, Tasmania is divided into three parts. Hobart in the south, Launceston in the north, and a conglomerate of towns on the north-west and west coast.

Hobart spreads westwards along the Derwent is a different constituency to Bass. Divided into Clark, where the Liberals struggled to gain a second seat and Franklin, where the Liberal and Labor Party gained two seats and Greens one, the electoral picture is far different in the other three constituencies of Lyons, Braddon and the Gutwein fortress of Bass.

Launceston, the overwhelming population centre of Bass, in fact is a much smaller electorate in geographical terms than the other two northern electorates.  Yet it does include Flinders Island, where the Islanders are the closest living remnant of an Aboriginal race despite some residual controversy, where its purity left with the death of Truganini in 1878.

Devonport is the largest town in the north-west electorate of Braddon, but this electorate has a number of settlements ranging along the coast (plus King Island) and then extending down the Murchison Highway to the “mineral shield” settlements of Rosebery, Zeehan and Queenstown and the fishing and tourist settlement of Strahan lying as it does on Macquarie Harbour, the third largest in Australia, larger than Sydney Harbour.

Within Braddon are some of most extraordinary examples of untouched temperate rain forests, despite the efforts of successive Governments to destroy it in the name of jobs. Here, in one the most magnificent wilderness areas, despite a strong working class population the electorate is strongly Liberal – the heartland of Morrison populism. The Greens are the foe. Yet the south-west is the State’s unique flora and fauna Treasury.

South-west wilderness

Lyons, also a Liberal State electorally, is an amoeboid electorate which spreads its pseudopods from the east coast through the Midlands into  Sheffield, a trendy watering hole just 22 kilometres south of Devonport which lies within Braddon on the north coast. Federally it has a Labor party member but in this State election it voted for the Liberal Party, a crossover trend which occurs in Tasmania; as does the number of Independent members of both State and Federal Parliament, which is not difficult to understand given how strong private politics are in Tasmania.

Last Saturday was the first time I had been in Tasmania when the State election had been held. The gracious concession speech of the Labor leader and the gruff laconic acceptance speech of the Premier contrasted with the predictable loquacity of the Greens leader given a post-election microphone. She unfortunately provided a strident tirade, and before turning her off, I had thought politics at the top here was refreshingly different. Not so.

For a population of about 550,000 with one in four of the population living in Hobart, it has 57 Federal and State politicians; and between 200 and 300 local councillors in the 29 municipalities (it was 79 when I first visited Tasmania).

Tasmania is grossly over-governed. Under the Australian constitution it is guaranteed five seats in the House of Representatives; and as with the US Senate each State has the same number, apart from the ACT and the Northern Territory.

Comparing Wyoming with a population slightly larger than Tasmania’s, it sends only one elected representative to Congress (out of 535). By contrast, Tasmania sends five elected members to the House of Representatives (out of 151).

Therefore, Federal Government policy towards Tasmania has traditionally been to fill the begging bowl and a tree not chopped down or a river not dammed or native species not exterminated have dogged policy considerations to the detriment of the State. It is private politics in its purest form. Take the health system: if Hobart gets A, Launceston and Burnie will want A too.  It is the root cause of so much of Tasmanian problems – the inability to live with one another.

I was just perusing The Advocate, the paper of the north west. The number of football teams in the area is extraordinary, and as I have written elsewhere the antagonism between towns is often reflected on the football field and the closer the towns are to one another, the greater the antagonism and failure to work together. Thus, in terms of rationalising resources, this part of the State presents a problem in getting agreement to any public policy.

My contribution to this private politics, since I am a ratepayer, is the following ; first the gorse along the Zeehan-Strahan road needs to be eradicated before it consumes Tasmania, just as Queensland was threatened by the prickly pear infestation before the introduction of cactoblastis beetle. The other problem with gorse is that below its impenetrable prickly greenery it stores all its dead wood which can act as a fire accelerant.

Peruvian goat herder

Peruvian goat herders have been used in the USA to oversee goats which eat noxious weeds. Paradoxically if you do burn the gorse, then four to five years’ worth of goats feeding on it will eliminate gorse. Andean Peruvians are said to be the most reliable goat herders; apart from which, having a goat herd in the area will provide an industry and something for tourism. However, don’t let the goats become feral otherwise it’s another cane toad.

Secondly is to upgrade the Strahan airport to a level where it can receive planes as big as a 737. The latter is unlikely in the short term even thought it could be used for tourism in the south-west and would certainly open up the tourist market, especially with a rental car franchise. The longer term consideration is with climate change – inevitably the forests will dry out, and therefore there is a need on the west coast of Tasmania for the airstrip to be upgraded so water tankers can land instead of being based in Launceston or Hobart. For those with short memories, no one seriously believed the rainforest of the south coast of New South Wales could burn the way it did.

Then thirdly, more a suggestion than a demand, there is another industry which I find it strange that the Liberal Government has not promoted and that is dedicated quarantine facilities. I would not advocate Sarah Island in Macquarie Harbour, once a prison, but a properly constructed quarantine facility in Tasmania is certainly closer to Australia than Christmas Island.

Sarah Island, Macquarie Harbour

But then the success of private politics depends on how determined and how committed one is for the long game. I wonder how well this is translated into the future administration of Tasmania.

Mouse Whisper

An unguarded comment?

As one of his colleagues recently remembered:

“30 years ago today, the wonderful C… H… died. Fabulous economist & mentor with unlimited time to talk. Friday drinks in his office often included Pichon Lalande, Lynch Bages & Chateau Talbot as he mulled over the next additions to his cellar. Great man; greatly missed.”

Different time – wrong look. Yet the connoisseur of lotus cuisine continues to be the role model for the current Canberra Elite.

Modest Expectations – Geneva & Adelaide

The sight of our Prime Minister flailing around, without the wit and with deep-seated prejudices inherited in his childhood, reflects the fact that he is increasingly paralysed by the culture over which he presides. The problem with cultural change is that it takes time, and frequently depends on brutal decisions, not the least of which is to confront the problem head-on and cut away the diseased part.

Taking a medical analogy, once the doctor finds the abscess, it is drained. If the abscesses are miliary, then a general remedy is needed, and even then the disease may overwhelm the system.

All I know is the diseased process of our parliamentary government is not going to be solved by a laying on of hands or an outburst of political glossolalia.

The immediate response of sections of the Liberal Party is to introduce female quotas into the preselection process. Does the preselection procedures in the past give you reason to believe that this system will produce candidates that live within the Bell curve of normal women? And if you decide to select women who lie at least at the extremities of that curve are you sure that their idiosyncratic ways will benefit the community at large and not the tiny, skewed population that preselected them?

Extraordinary women may add colour and may play an important role, but the expectation for all women parliamentarians is that they will generally care and have an innate compassion and respect for other women. The current crop of female Liberal Party politicians (or for that matter National Party) in Canberra do not seem to have these qualities.

Catherine Cusack

There is one female politician in the Liberal Party who has seemed an exception. She is a NSW State politician, Catherine Cusack. She and her husband Chris Crawford represent that remnant of the Liberal Party that used to participate in the then Australian Institute of Political Science, in its latter glory days when it ran a summer school in Canberra and its Board had members from both major political parties. Gough Whitlam unveiled his Medibank initiative at one of the Summer schools, such was their influence. They were able to discuss policy in terms of the financial and social implications.  However, whenever Catherine Cusack has put forward genuinely liberal solutions, particularly in relation to conservation issues, she has been demoted, slapped down and unsupported by her colleagues, especially when attacked by the National Party.

Now she has called out the Prime Minister for his behaviour. Is this a single utterance of frustration and will she vanish back into the background of women who wear shapeless clothing, and have a bow in their hair to recognise their traditional inferiority at the time of the “rapture” – their role being in actually tending the hearth?

Cusack has issued herself with a challenge – that is to maintain her very important confrontational position. Otherwise, she will be dismissed as a remnant of a Liberal Party that, in the eyes of the current crop of her colleagues, never existed.

Meanwhile, Morrison recycles his bevy of outliers under the wing of Marise Payne, herself the invisible woman.

I was only 22

Rico Marley walked into a grocery store in midtown Atlanta on Wednesday afternoon carrying a guitar bag.

He headed for the men’s room, the authorities said, where he strapped on a bulletproof vest. He then donned a jacket, its pockets full of ammunition, and placed two loaded handguns in a left front pocket and two other loaded handguns in a right front pocket. In the guitar bag, he carried a 12-gauge shotgun, an AR-15 military-style rifle and a black ski mask.

Rico Marley’s weapons

Then he walked out into the store.

Police, tipped off by an alarmed shopper in the bathroom, soon stopped him. But the incident, just three miles from the site of one of the shootings last week that left eight people dead and coming two days after a man stormed a grocery store in Boulder, Colo, and killed 10, sent new waves of unease throughout greater Atlanta and also raised nationwide fears of copycat crimes.

It is stated that when the mass shooting season starts, then there is generally a series of massacres, and increasingly it seems that the supermarkets are the killing venues, whereas in the past it was schools.

This report in the NYT is unusual, instead of reporting a massacre, it provided details of the disturbed man before he could kill the innocents – his activities being seen by an observant guy who legitimately wanted to use the toilet; no, not a security guard, not a police officer, not anybody employed to guard the community. One can surmise that the alert was raised early in that the armed gunman was apprehended before he was able to effect mayhem.

In isolation, the 22 year old coloured, poorly educated gunman had a criminal record with relatively minor petty theft – a young man with a troubled mind.  It is only newsworthy in that the potential killer was apprehended before the shooting, given that in Georgia, one does not have to conceal one’s weapons. In other words, a casual passerby in a country inured to gun violence may have shrugged seeing a fellow men’s room user donning a flak jacket as just a “normal” incident. In fact, when the observer informed the store attendant of what he had seen, the attendant was initially indeed very casual, but fortunately the vital call for police was made.

Last year in the USA there were about 20,000 gun-related murders and an almost equal number of individuals who committed suicide using a firearm. This was an increase overall, and the rise was attributed to being one endpoint of domestic violence.

On the other hand, mass shootings were absent, even though they constitute only about one per cent in most years. The reason for this is attributed to the COVID-19 pandemic. Schools were closed, there were fewer public gatherings.  The whole nation was plunged into collective misery so that those potentially homicidal aggrieved were absorbed into the wider community or, as stated above, violence was absorbed within domestic situations.

When the gun control advocates try to define solutions, they rely on the few small-scale attempts to ameliorate the situation, but unless Americans believe that their gun culture is unacceptable and women at all levels of society are considered equal in mutual respect, everything is for nought.

In other words, we are all powerless unless those who make the laws, makes the law. For me, if I were in power in Australia, I would limit the arms being made available to police forces. They are not a militia – not a paramilitary force. When did the police change from a “service” to a “force”? They do not need armoured vehicles and tear gas to protect the community. All police forces should be restricted in the colour they use, so they do not resemble a posh group of “bikies”. Try pink as the colour for their uniforms – why do they have to dress in black or midnight blue?  Get rid of the “aviators”. Be more selective in the range of ironmongery with which they adorn their uniforms. It would be such a change to see police showing compassion, on a regular basis, rather than presented as a novelty.

Another consideration would be to extend the principles of averment to all cases involving crimes of a sexual nature. I would turn the whole matter of proof over to the alleged assailant to prove he or she did not do it. Presumption of innocence in these cases does not work, first because of the trauma of the episode being cast out of the memory bank and then the unappetising prospect of ongoing harassment, being carried out in a court of law by an essentially misogynistic legal profession. Well, Gentlemen you only have to disprove that which has been so averred.

A consumer’s view of vaccination – albeit with the disadvantage of a medical degree

But infectious-disease experts are worried the pace needs to be faster to reach the high levels of immunity needed to slow the virus, especially as more transmissible variants spread throughout the country. To reach the level of protection needed, about 80 percent of the population has to be immunised, meaning that about 260 million people need to get vaccinated. That would require 3 million to 3.5 million shots being administered each day until April 30.

The Washington Post concludes an optimistic article about the efficacy of the Pfizer and Moderna vaccines in health workers with a muted warning. America has not embraced the Astra-Zeneca vaccine, which has been the subject of a number of caveats resulting in the temporary halt to its use in a number of countries. When these questions are answered and the world-wide juggernaut resumes, with the difficulties that entails to get momentum, another caveat is issued, currently surrounding some of the mutant strains of the virus and the ineffectiveness of that vaccine against these strains.

At the same time in Australia a great number of people who are not doctors are spruiking the virus vaccines, as if there were no doubt about their efficacy, their availability and the “Jab Program” being on time. As a result, there is the unedifying spectacle of political squabbling, and I as a customer has given up trying to make an appointment. The general practice phones are always busy; in fact, the general practitioners are not geared for mass vaccinations.

Again, I am told that the Pfizer vaccine needs to be stored at -70 degrees Centigrade, and given the shemozzle for a consumer, how can I be assured that the cold chain integrity has been assured? The questions then begin to flood out – for instance, how long will immunity last?

Clinical trials suggest that vaccine-induced protection should last a minimum of about three months. That does not mean protective immunity will expire after 90 days; it may last longer. However, that is still one unanswered question.

The other one, given the problems with the rollout, if I was able to secure a first dose, how long shall I have to wait for the second dose, and then more importantly, for the booster? It does not seem clear to me, whether (or more optimistically, when that will occur). That is why the J&J vaccine appeals to me more because it is single dose; but will it ever be registered in Australia? Questions, questions everywhere, but only opinions to imbibe. That is my reaction as an elderly consumer eligible for the injection. I am confused, and so will hold back. In the Australian climate it seems the best option is to wait and see.

I am very pro-vaccination, and unless it is caught up in this COVID mess I intend to get my inoculation against the flu as soon as possible My only worry is that the puerile political agendas will get in the way of the program, lending ammunition for the anti-vaxxers.

And a final question. Who was the bright spark who suggested “Jab”, with all the violent connotations of the word? It is more correctly “inoculation” or “vaccination” – injected into the muscle. “Jab” is variously to poke or thrust abruptly as jabbing a knife into a body; to stab or pierce as in jabbed the steak with a fork; or lastly to punch somebody with short straight blows.

I, the frightened old person, seeing a uniformed person with a syringe saying that “I am going to jab you – just a little jab – it won’t hurt you.” Violence follows me at the point of a needle.

I thus remain a watcher. There are just too many unknowns.

It may be raining here, but this just came from the Boston Globe

Workers at a Baltimore plant manufacturing two coronavirus vaccines accidentally conflated the vaccines’ ingredients several weeks ago, ruining about 15 million doses of Johnson & Johnson’s vaccine and forcing regulators to delay authorization of the plant’s production lines.

It does not affect Johnson & Johnson doses that are currently being delivered and used nationwide. All those doses were produced in the Netherlands, where operations have been fully approved by federal regulators.

But all further shipments of the Johnson & Johnson vaccine — projected to total tens of millions of doses in the next month — were supposed to come from the massive Baltimore plant.

Those shipments are now in question while the quality control issues are sorted out, according to people familiar with the matter.

Federal officials still expect to have enough doses to meet President Biden’s commitment to provide enough vaccine by the end of May to immunize every adult. The two other federally authorized manufacturers, Pfizer-BioNTech and Moderna, are continuing to deliver as expected.

Pfizer is shipping its doses ahead of schedule, and Moderna is on the verge of winning approval to deliver vials of vaccine packed with up to 15 doses instead of 10, further boosting the nation’s stock.

It is a pity Biden was not President a year earlier – when I was at my most skeptical – he seemed so ill equipped. But that is the nature of pontificatory error. It can be lost in the cushions of mea cathedra.  I shall wait until his Presidency reaches 100 days before deciding the nature of my humble pie.

Food and Drink for the Memory

This past week has been a time of eating out in Melbourne – almost the first indulgence as such since the Virus struck last year.

There were two occasions during the week, when I experienced two tastes that reminded me of a couple of meals – one about a decade ago in New York and one in Manaus in 2019.

The first was when I asked for a gin martini in this restaurant near the Jolimont station. The best martini I have ever drunk was in the Morgan Library and Museum on Madison Ave on the west side. We had ambled into this place, not knowing that it originally housed Pierpont Morgan’s and found that there was a restaurant situated in the middle of a library.

The ornate chamber was lined with bookcases and the filtered light gave us a gauze covering. Now I thought this is going to be one of those tea cake places with delicate cups of Assam tea and dainty neatly-shaved cucumber sandwiches. No way, the only cucumber was infused into the martini. Cucumber and martini when balanced is a superb drink. It is still my benchmark as the best martini I have ever tasted. It helps if you have a cucumber infused gin at the outset.

Some years ago I managed to corner the only remaining bottles of Gordon’s cucumber gin in the distinctive green-labelled bottles available in Australia. It seems that the only gin now available with a passing nuance of cucumber is the Scottish gin, Hendricks. So was I surprised when I ordered the martini last week, and the only gin I recognised was Hendricks, not being familiar with all these boutique gins popping up all over the place.

I was thus pleasantly surprised when the Hendrick’s martini was presented to me with a generous ribbon of cucumber in what could have passed for a sherry glass. Immediately I thought I was being short changed, and yet the martini was brilliantly balanced to highlight the cucumber infusion. There was one shortcoming, with which I confronted the martinista, and that was water in the martini. It is a bit of a conceit to pour you a gin straight from the freezer in the glass wetted with dry vermouth, in so doing limiting the water content and in a commercial world increasing the cost. The other problem is that gin watered down or inferior gin coming out of the freezer half frozen is not a good look for the martinista.

But back to the Morgan – we had the meal, but as we knew nothing about the place, we left without looking around this ornate building. It was just another place to have a feed. Pity we missed the Gutenberg Bible and the only remaining first edition of Paradise Lost. Mr Morgan had a great deal of money.

The other memory last week was when ordering kingfish ceviche at a Spanish restaurant in Richmond. It brought back memories of that morning in Manaus two years ago when I remembered the ceviche I had ordered. As background, we had arrived there around 2am after a five-hour flight from Rio de Janeiro and gone straight to bed.

In the mid morning, we had woken up to one of those overcast tropical humid days. It had been raining. Food was being served on the same level as our room in an open eating area overlooking the courtyard. It is somewhat disconcerting arriving into a city so far up the Amazon, knowing that we had to board the ship to take us up the river in a few hours, but not knowing quite when.

The only option was to have a meal, before being scheduled to be picked up. There was a tropical fruit collection to start. Ceviche was on the menu, in big white chunks marinated in a lemon marinade with red onions. The fish used in Manaus was tambaqui, an Amazon freshwater fish with a passing resemblance to the piranha; tambaqui has been overfished, and its future depends now on aquaculture.

It was a very memorable feast upon the ceviche. Nevertheless, we have moved on, as we do, even though this blog is somewhat wistful for a world that has gone.

Maundy Thursday – The Lavage of Feet

As I finish this blog in preparation for it being published, tomorrow is Good Friday. Now, it is the night that Judas Betrayed Jesus in the Garden of Gethsemane. When I was younger, attending a midnight vigil, where the whole church is draped in black, was one of my most compelling involvements. As a Christian, I was brought up with a belief that this was the one day of the year that we should collectively mourn with the day completely closed. However, this religious quirk has been the victim of multi-culturalism; it is no longer a national expression. However, for someone who was brought up to believe in the sanctity of this day, I cannot help being uncomfortable with this change.

Maundy Thursday as the name is thus described, is the day when Jesus after the Passover supper washed his disciples’ feet as a sign of his humility.  The British Monarchy has its own interpretation of acknowledgement of the poor. Rather than washing feet, the Queen hands out Maundy money, with the number of coin sets equal by gender; the actual number determined by the age of the monarch – in 2021, 94 sets for women and 94 sets for men.

1902 Maundy money

I have a 1902 Maundy money set featuring Edward VII – a silver one penny, twopenny, threepence and fourpence laid out on blue velvet in a small red box. Given the size of the coins, it literally is a miracle that this small box given to my mother, who had nursed this very widely-travelled lady who gave her these coins, has survived intact.  I remember seeing it first as a very small boy.

As my Cypriot doctor friend said: “Jesus is the reason for the season”. Especially appropriate comment, given I don’t remember any rabbits hopping around the Cross with baskets of eggs.

Mouse Whisper

President Biden pledged to have 200 million doses of COVID-19 vaccines administered by the end of his first 100 days in office. That’s double the goal he set in December and reached earlier this month before his 60th day in office. 

The mausmeister, who was so critical of Biden in the lead up to the election, grudgingly backing him to win, is holding back judgement, but has been pleasantly surprised. However, he was worried when the President stumbled three times on Air Force One stairs. He will have to realise rather than trying to appear decades younger by jauntily approaching the red carpet, that his behaviour will need to be modified. Fortunately, the last steps up to the plane entrance showed no evidence of a barked shin – no sign of limping. Good sign, but as my mausmeister found out, never be ashamed to use a cane – or hold onto the railing.

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