Modest Expectations – Going Around with the Dog

Treacherous implies readiness to betray trust or confidence. perfidious adds to faithless the implication of an incapacity for fidelity or reliability.

One must admire in one way the gall of Qantas. Presumably with the spiv who walked Gall Way home set the tone. Qantas want the customers to pay for the compensation for the bastardry committed by itself on the same customers. Higher prices, projected introduction of a true cattle class confined to strap hanging on aircraft. Who knows what further pain would Joyce have inflicted on us for years, as he looted the airline.

His successors seem not to have learnt.

No, you miserable sods, reduce the dividend to those shareholders, who have basked in your bastardry, earning gross financial returns generated by this unmitigated bastardry, engineered by the little Irish-Australian now skulking in some mansion, perhaps in the aptly-named Dublin suburb of Goatstown. Funnily enough, he does not want return to face the music – the Moonflit Concerto being a favourite piece of his.

I have confined myself to so few uses of “bastardry”! There seems to be no corresponding word for it in Gaelic.

Nothing has changed because the government we voted for has allowed them to develop a complete monopoly. Time to nationalise this disreputable embarrassment which fell twelve places in the rankings from 5 to 17 this year. But then Virgin Airlines fell from 43 to 46. This coming year, watch the free fall continue. 

Brat is a Brat is a Brat

There is an acquaintance of ours, a former teacher who decided to volunteer at a local school as a teacher’s aide.She was faced with a brat, a common manifestation of the male growing up. She went to encourage him to behave, by calmly admonishing and telling him, “c’mon, do some work.”

To which this man-child responded “Step back. You are making me feel unsafe”.

This sense of entitlement in one so young!

Oh, for National Service.

But then who am I to talk! A life speckled with entitlement. Nevertheless, from experience, if you keep saying that Ponsonby Minor, I assure you that you will soon learn the meaning of “unsafe”.

Olive Oil 

Homer called it liquid gold. To Hippocrates it was “the great healer”. These days olive oil is used to sauté vegetables or dress salads—but it is once again becoming a luxury. In September prices reached their highest level since records began, rising by 117% year-on-year according to the International Monetary Fund. Olive oil is seventeen times as valuable as crude oil weight for weight; in 2019 it was seven times cheaper. Why has the price shot up? – The Economist 13 December 2023.

The price has shot up because the crops have failed in Europe, or rather, not lived up to expectations. There is the matter of climate change and even though Australia does not rank in the top ten olive producers, our crops do not seem to have the same problems as Europe is experiencing. We should not get too smug, because Australia is the seventh biggest importer of olive oil in the world. The Mediterranean diet certainly has a hold here. Australia has come a long way since my first experience of the rancid oil that Spain used to dump here.

Spain produces about 40 to 50 per cent of the world’s olive oil, and together with other major producers, Italy and Greece have experienced extreme drought and heat, even beyond the tolerance of this tree which grows prolifically, as I thought, in less arable land enjoying the climate, “baking summers and mild winters”.

The impact of Xylella fastidiosa

Compounding the crisis, as reported in the Economist, in Italy, Xylella fastidiosa, a bacterium, has ravaged trees. The disease, which is spread by insects, is thought to have been introduced by an ornamental plant from Costa Rica in 2008. It has since killed an estimated 21 million trees. The bacterium is transmitted exclusively by xylem sap-feeding insects such as  grass sharpshooters and spittlebugs. These are unknown in Australia – at present.

Other factors contributing to the shortages, beside the overall increased costs, has been that Turkey has kept its whole production to itself, thus exporting nothing.

In our household we only use Australian grown olive oil, and because I worked there for many years, we almost always use Cobram olive oil, grown in the Murray Valley not far from the township of Cobram. My wife used to buy the extra virgin olive oil in the 3 litre cans, but now buys it by the 750ml bottle, since she is more likely to be able to buy it on “special” in the bottle.

The point that I recently made in the blog is that we planted a tree outside the front gate. Sometimes we were able to harvest it before some thief would strip the tree. One year we harvested five kilograms, but olive trees have minds of their own, and sulk if you don’t look after them, and they do grow old as ours has, given it will be 40 years old this coming year.

But I have always thought, and talked about it often, if we, brown fingers can grow an olive producing tree, why can’t the local council convert the whole street into an olive grove and at harvest time, close the street off and have an Olive Harvest Festival.  From there it would be up to us to arrange for our batch of olive oil to be produced. After all, this would be a start, and who knows!

Perhaps even Popeye would come.

Ian Taylor

You normally casually flip through the school magazine, scan the uplifting editorials, look at the photographs of smiling success, glance at the obituaries, and bin what some may think is an absurdly expensive magazine of gloss and colour.

Prof Ian Taylor

Then there was this article on Ian Taylor, who was in my year of Medicine at the University of Melbourne. When we enrolled in Medicine, it was the only medical course available in Victoria. Moreover, the University of Melbourne was then the only university in Victoria.

From my year 12 at school, including Taylor and myself, about 20 went into Medicine, which was about ten per cent of the first year. There were many very smart fellows and women, although our year had about 25 per cent women. It was 1958 after all.

In my opinion, and I have voiced it privately, Ian Taylor has made the greatest positive contribution of any student in my year of Medicine. I would go further and say that he was among the greatest Australians of his generation. A nomination for a Nobel Prize has been mooted.

Why? The article puts it clearly and simply. His work on being able to transplant whole segments of the skin, subcutaneous tissue, muscle and bone where there was a common blood supply was revolutionary. It enabled the operations where a flap was needed when there had been loss of tissue because of cancer surgery or extensive trauma to have a shortened time of recovery. Nevertheless, I feel that anything further I write about his many skills would be an inadequate acknowledgement of this great man.

“Benny” Rank scrubs up at the Heidelberg Military Hospital

But then Melbourne was the place to be if you wanted to become a plastic surgeon. This was because of the presence of “Benny” Rank. Sir Benjamin Rank, as he was to become, was the doyen of plastic surgeons, having earned his reputation during WWII. His appointment to the Royal Melbourne Hospital (later at a specially designed unit at the Preston & Northcote Community Hospital {PANCH}) enabled him to establish a facility whereby a succession of highly skilled plastic surgeons, such as Taylor, was trained. They were also a group of innovative surgeons.

Rank did not suffer fools, co-wrote a definitive text on hand surgery and emerged from WWII as the father of plastic and reconstructive surgery in Australia, in particular Melbourne. It was Rank who inspired Taylor. We were in many ways a very lucky generation of doctors, who were taught by men and women (although women doctors were thin on the ground). There were some very impressive nurses whom we came in contact with who all saw war service. One of the distinguishing features about this group was their teaching prowess, with us gaining the benefit of their experience. Yet I can’t remember any of them talking about the War, even though many of them had been prisoners of war of the Japanese in Changi.

From my point of view, I have benefited from the skill of these trained surgeons. I sustained a car accident in 1981 where my chin sustained an implosion injury, and this injury required multiple operations. I ‘ve also had multiple skin cancers removed, including on face and ears. My current plastic surgeon was trained by Ian Taylor. He is highly skilled and before commencing practice, Nick Houseman obtained a Doctor of Medicine at the University of Melbourne – then a higher degree – gained by defining a particular vascular supply to a part of the body, being the first to do it. He was supervised by Taylor in this research endeavour.

The problem is that the reputation of plastic surgery has been compromised by a bunch of doctors who essentially dabble in cosmetic procedures without the training. Belatedly, as usual, AHPRA have now recognised that cosmetic surgery has been full of not only untrained incompetent medical practitioners, who have done a course set out on the back of a cereal packet, but also the fraudulent. All this dross should have been wiped off the medical map long ago.

Under the then current law, anyone with a basic medical degree or a GP or dermatologist could call themselves a cosmetic surgeon, even though not registered specialist surgeons, who receive eight to 12 years of postgraduate surgical training, unlike this mob with “cereal packet diplomas”.

For exposing this malfeasance, Mark Ashton, a prominent plastic surgeon was raided by unspecified “health department officials” following a spurious anonymous smear.

The problem with AHPRA is that it is about as tough as a bowl of cucumber soup. It tries to be palatable for everybody; but we shall see its ability in tackling the resulting recommendations from the Review.

This country is privileged to have high standards of plastic and reconstructive surgery, as epitomised by Ian Taylor.  The article written in the school magazine should be amplified and used to reinforce the need for the imposition of strict standards and to expose the backdoor influencers who would want to water down any of the conditions imposed by the reputable plastic and reconstructive surgeons.


We have spent many Christmases outside Australia. I have mentioned some of them, where the Christmases were more traditional.

The most different Christmas away from the holly and the ivy and decorated Christmas tree was when we were staying in Little Governor’s camp in the Masai Mara.

The highlight of Christmas morning was a visit to a Maasai village, and because there had been substantial rain, the ground was a swill of mud and animal excrement.  The tall slender Maasai women performed their traditional dancing  but with the women ululating.

Christmas cheer as they offered us their bead jewellery, at a price.

And then it was over. Maybe when I hear the processional hymn “Once in Royal David’s City”, who knows whether this applied to the Maasai village as much as anywhere else more conventionally Biblical, given how happy and joyous was the atmosphere engendered by these remarkable dancing women.


I have been to Argentina several times, but every time it has been when the country has been relatively stable, and not under the rule of the military.

In the late 80s, the Argentinian national airline started offering trips between Australia via New Zealand to Buenos Aires. I was lucky to be offered a trip there on one of the early flights, in exchange for a few articles that I would write for the medical press.

In those days, you could not reliably fly between Sydney and Buenos Aires without stopping. Returning to make the ocean crossing, one first had to fly south to Ushuaia, located between the Beagle Channel, glaciers and eternally snow-capped peaks on Tierra del Fuego, to take account of the prevailing Westerly winds.

In those days the Chilean airline flew as far as French Polynesia in clapped out Boeing 707s. Anyway, it was the time of Pinochet and I would have nothing to do with anything Chilean while he was in power.  Today Lan Chile flies to Australia, the planes are relatively new, and there is the added attraction of being able to visit Easter Island. I have visited Chile on several occasions since Pinochet’s demise, but not Easter Island.

To me, Patagonia is as synonymous with Argentina as the tango and Evita Peron. It is one of the places where Charles Darwin explored, temporarily leaving the “Beagle”, where he received some of those intense insights which led him to the Origin of the Species. Disappointingly, tango was a tawdry tourist show in San Telmo, near the centre of Buenos Aires, and Peron was the tomb of Evita in the extraordinary cemetery at Recoleta, where I felt that de Chirico may be round the corner of the next street of mausoleums, painting. To gawk at the dance or at the Peron bier was tourist grist, but the drive from the airport at Bariloche was not quite what the tourist expected.


Bariloche is approached from the windswept Patagonian plain. You come in through the shacks of the Chilean Indian refugees. Perhaps “refugees” is too harsh a word since Bariloche lies near the Chilean border and there were few jobs at home in Chile for these Indians. It is somewhat ironic that the only Indians in Argentina are of Chilean stock.

It confirms what our companion murmurs when we see a black man singing on the Florida, one of the main streets in Buenos Aires. He is probably Uruguayan. Argentinian history’s heritage is exclusively on the European white side.

There is a mass of undistinguished light industrial factories, and then suddenly the lake can be seen and there is Bariloche – a German mountain village, complete with excellent chocolate, fine porcelain, and a hotel called Edelweiss, our room with a balcony lined with flowerboxes and overlooking the lake – Nahuel Huapi.

Arrayan (bambi) trees

Across the lake was an island where one finds the arrayan trees -the so-called bambi trees because of their cinnamon-coloured trunks, dappled like the Disney fawn, Bambi. Hence these trees create groves of magical trees, which brings out for a moment that sense of wonderment I once had as a child.

Even though we arrive in mid-summer, the nights are cool enough to enjoy both raclette and fondue – and it is evident that there is also a strong German Swiss influence in this resort.

Some of the brochures say the town reminds one of Bavaria – there, predominantly German settlers had settled from the last part of the 19th century onwards.  And that word “onwards” had dark connotations.

It is reputed to be one of the places where prominent Nazis fled to avoid the retribution. It is alleged that the mastermind for this movement was a Vatican bishop, an Austrian named Alois Hudal.  He was reputed to have gained from President Peron around 5,000 Argentinian visas, which he used in his ratlines to enable these war criminals to flee to Argentina, where they fashioned themselves as in the main German settlers. It was here that the Israelis apprehended Adolph Eichmann, took him back to Israel for trial and subsequent execution.

Bariloche is where we took our first look at the Andes. We hire a car and driver to make the trip to Mount Tronador, where one of its peaks is in Chile and one in Argentina. We can see the peak this day, free from the clouds which often cloak it. We fumble around on the moraine at the end of the glacier and climb the rocks beside a mountain stream which cascades from the side of the mountain, but we do not make any serious endeavour to climb onto the glacier or attempt to follow the stream to its source. Yet the trip has taken away that uncomfortable feeling of a village, which we might have been sharing with war criminals.

We would never know because we left Bariloche soon after.

Mouse Whisper 

According to the Energy Information Association (EIA), Venezuela, with 304 billion barrels of oil reserves, is in first place, followed by Saudi Arabia (259 billion), Iran (209 billion), Canada (170 billion) and Iraq (145 billion). By comparison, the United States has proven crude oil reserves of 44 billion barrels, that puts the country in 10th place.

And Venezuela wants to invade Guyana next door to get more oil reserves. We need another war around the globe like we need a cerebral gulch.

Yet Guyana only has reserves of eleven billion barrels.

Maduro, the proliferately spending Venezuelan President apparently has not heard of the Micawber Principle. “Annual income twenty pounds, annual expenditure nineteen pounds nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.”

Modest Expectations – Buenos Aires 1972

Defence Minister Richard Marles summed up the situation well on Wednesday by saying we live in the most strategically complex and threatening period to exist since the end of World War II – Red Alert publisher Mr Shield

Their Lordships of the Admiralty, with their hierarchy of Admirals under the First Sea Lord; the War Office with its Secretary of State and Army Council; even the later-created Air Ministry again with its Secretary of State—it was in these historic bodies that rested the real, practical control. Moreover, the responsibility of their political heads to Parliament had scarcely been altered by the emergence of the Minister of Defence.  Harold MacMillan, quoted by Arthur Tange

Approaching the lunch table I was accosted by the formidable and testy Admiral Hyman G. Rickover, creator and guardian of America’s devastatingly powerful sub-surface nuclear strike capability, and notoriously defiant of control by his nominal superior, Chief of Naval Operations Admiral Elmo R. Zumwalt. The Admiral abruptly dismissed my explanation about the need to satisfy Parliament in our democracy saying that, if we did not want the US Navy to defend Australia that was fine by him and, as a coup de grace, after listening to us he saw no reason why they should be shouting us lunch – Arthur Tange

The prudent planning of defence preparation requires genuine intellectual rigour. Instead, all that is evident in the submarine announcement is intellectual rigor mortis, and the realisation of an idea of a former prime minister who was more famous for marketing than substance. -David Livingstone – one time graduate, Australian Naval College, in SMH opinion piece 15 March 2023

Now, thanks to AUKUS, Australia’s manufacturing will be built on a foundation of defence, specifically buying and making nuclear submarines. But there is likely to be an opportunity cost in that. Given the amount of money involved there won’t be much, if any, left for anything else, such as the global energy transition, health care and agriculture – Alan Kohler New Daily 20 March 2023

Paul Keating is an old man and many of his gestures are those of an old man. His brain is still sharp; he speaks with a verbal brutality that nobody can challenge publicly because of the immensity of his achievements in nation building. This has left his successors their only pathetic defence that the world has moved on and somehow he and his views are irrelevant. It is a new world, so they say. What utter rubbish! Why take his phone calls? He’ll just slag off if we do not agree – after all, he does it in public anyway.

Wong, Marles, Albanese are saying that he is of a different age; and have become a public chorus – with a variation of the “more sorrow than in anger” theme. Wong has perfected the low affect style of the Delphic oracle. She is measured; she weathers criticism with or without abuse by corridor whispering. A perfect foreign minister of whom Talleyrand and Metternich would be proud.

Defence Minister Marles

Marles is the classic politician captured by the Defence establishment. He fits the succinct description which former British Prime Minister, Harold MacMillan, himself a former Minister of Defence, warned of the capture by the “top Brass” of the defence forces. Marles grew up in Geelong Grammar School, where his father was a teacher for many years, and even with his Left credentials there’s no way he would not have been exposed as a schoolboy to those of the same ilk as those now in command of the defence forces. He is obviously comfortable being with his own class, although there are nominal differences theoretically in his political views.

There is no doubt that like so many of his predecessors as Minister, whether Labor or Coalition, whether it be “Bomber” Beazley or Peter Dutton, he has just dutifully spouted the American and or British line.  And what of Bevan Shields’ description of the profundity of Richard Marles? Yes, I read it, but where is it?

Now for the Prime Minister. Here was the man who on the first day of the last Federal campaign did not know the simplest of facts, stumbled, simpered, tongue poked out for some reason. David Crowe, the SMH political writer, in a recent by line identified him as the “trippy” Prime Minister. “Trippy” is a slang term for a person under the influence of a hallucinogen, and sometimes the accidental trip up contains a modicum of truth.

Albanese does not seem to want to offend, and his antics in India where his obsequious dealings with the current Prime Minister Modi suggest that he does not quite get it. Modi is a dangerous figure, whose politics lie at the extreme edge of Hinduism, whose embrace of Putin is well known, but where the prospect of an alliance against the Chinese seems to have lured Albanese into an uncritical acceptance of a man whose abuse of civil rights rivals that of Xi Jinping. Such a contradiction did not go unnoticed by Keating – nor should it by us.

When Morrison unveiled AUKUS, it was thought that this was the dying lunge of a discredited government waving the flag of jingoism; that it would die with his demise. But that has not occurred. Morrison had dumped the French, who still have a substantial presence in the South Pacific, for an alliance with a nation which has Pitcairn Island as its last remaining possession in the Pacific. It no longer has any strategic place in the Pacific Ocean. British Prime Minister Sunak, in his AUKUS speech at San Diego on 13 March, referenced Barrow-in-Furness and Derby as places in Great Britain which would benefit from Australian nuclear submarine construction.

As reported, on 10 March 2023 the U.K. Prime Minister Rishi Sunak and the French President Emmanuel Macron held the two countries’ first bilateral summit in five years. They inter alia pledged to aim for a permanent European maritime presence in the Indo-Pacific, notably by coordinating deployment to the region of France’s Charles de Gaulle and the UK’s Queen Elizabeth and Prince of Wales aircraft carriers. No mention of submarines.

Two days later, Sunak met with Albanese prior to the photo-opportunity the next day. In the Australian Prime Minister’s words: “We discussed our shared commitment to bringing the Australia-UK Free Trade Agreement into effect to benefit businesses in both our countries.” Anything else?

As reported in the San Diego Union Tribune, Biden said Australian sailors will embed with the navies of both countries and study at schools specialising in nuclear-powered subs. In 2027, the U.S. and U.K. will begin placing their own submarines at Australian ports on a rotating basis. Now the USA has 275 vessels, 71 of which are submarines; Britain has a total fleet of 72 ships, 11 of which are nuclear submarines and, as the Union Tribune reported further, Australia has just under 50 ships, less than the Americans have docked in San Diego.

The paper dismisses the Collins class submarines as if they were some sort of ancient craft, an underwater galleon methinks. However, given all the aggressive talk about the defence capability of submarines, only two submarines have sunk enemy warships since WWII, which may say something about the deterrent capacity of having submarines. Nevertheless as Rex Patrick has  noted, American and British nuclear submarines have been involved in offshore bombardment of Iraq, Afghanistan and Libya.

Did the President stick round to talk to Albanese after such a momentous decision? No, he headed off to San Diego International Airport to board Marine One to fly him to a fundraiser in Rancho Santa Fe. Albanese was off to Fiji.

In simple terms, (a) the USA, by transferring its ageing nuclear submarines to us, also transfers the responsibility of nuclear waste disposal – if nothing else. The rumblings of “not in my backyard” have already started here in Australia.

(b) The British just want to flog off their nuclear submarines, thus supporting BAE ship building in Barrow-in-Furniss and the Rolls Royce nuclear expertise facilities in Derby.

(c) Australia pays a great deal of money, essentially for some very expensive toys.

What Keating did was to draw attention to the fact that the whole business seems to have been transferred from a regime known for its stunts to a new regime which had promised political sobriety. Yet nothing had changed; no real debate was entered into as the media mostly tried to smother any such discussion. The new Government was committing Australia to this enormous expenditure which frankly, on the face of it, does not make sense.

I do not follow the Keating assertion that increasing the number of Collins submarines will provide the defensive cover which his scenario projected. Nobody seems to have explored the workforce requirement, which is an important factor given that, at different periods of time, Australia has not been able to crew the Collins class submarines and apparently currently several don’t even have commanding officers. Thus, for a time, the submarines were unable to be deployed anyway. The new submarines need more crew, and while the suggestion of blended crews superficially seems reasonable, that is only if you do not accept the current Government’s banging on about “sovereignty”.

Currently the pay for an Australian submariner is about $167,000 a year, plus various other allowances, but being crew on nuclear submarines means coping with months on end beneath the waves, working six hour shifts and where night and day no longer have relevance. Blended crews mean being able to cope for long periods of having two cultures working alongside, even if they do speak the same language. There are differences that need to be addressed in sharing facilities. For instance, US naval warships are traditionally dry. It is easy to say that potential Australian submariners will be trained offshore; but what of social costs, including the attrition rate.

Then, in the world of technology advances, the prospect of unmanned submarines looms – unmanned underwater drones. The Russians evidently have that technology and it would be inconceivable that the major submarine manufacturers are not developing these as well.  Given the projected time surrounding the acquisition of Australia’s nuclear submarines, our purchases almost certainly will be dwarfed by these developments. The problem with the government propaganda is the assumption that everything else remains the same, and if they ever were, will remain on the cutting edge of technology.

David Livingstone’s opinion piece is like an antique Gatling gun deliberately mowing down the paper-thin justifications for this enormous transfer of “Australian sovereigns” from Australia to its colonial reliquary, Great Britain and the USA, whose reliability as an ally has been an article of faith adopted by both sides of Australian politics with only occasional inconvenient questioning – but certainly not by our current bunch of politicians.

The following is taken from an article published last year in an international investigative journal, Insider.

In 2005, the USS Ronald Reagan, a newly constructed $6.2 billion aircraft carrier, sank after being hit by torpedoes.

Fortunately, this did not occur in actual combat but was simulated as part of a war game pitting a carrier task force including numerous antisubmarine escorts against HSMS Gotland, a small Swedish diesel-powered submarine displacing 1,600 tons. Yet despite making multiple attacks runs on the Reagan, the Gotland was never detected.

This outcome was replicated time and time again over two years of war games, with opposing destroyers and nuclear attack submarines succumbing to the stealthy Swedish submarine.

With the Stirling engines, a Gotland-class submarine can remain undersea for up to two weeks sustaining an average speed of 6 mph — or it can expend its battery power to surge up to 23 mph. A conventional diesel engine is used for operation on the surface or while employing the snorkel.

Gotland-class submarine

The Stirling-powered Gotland runs more quietly than a nuclear-powered submarine, which must employ noise-producing coolant pumps in their reactors.

The Gotland class does possess many other features that make it adept at evading detection.

It mounts 27 electromagnets designed to counteract its magnetic signature to Magnetic Anomaly Detectors. Its hull benefits from sonar-resistant coatings, while the tower is made of radar-absorbent materials. Machinery on the interior is coated with rubber acoustic-deadening buffers to minimize detectability by sonar.

The Gotland is also exceedingly manoeuvrable thanks to the combined six manoeuvring surfaces on its X-shaped rudder and sail, allowing it to operate close to the sea floor and pull off tight turns.

The article then went on to say:

Because the stealthy boat proved the ultimate challenge to US antisubmarine ships in international exercises, the US Navy leased the Gotland and its crew for two years to conduct antisubmarine exercises. The results convinced the US Navy its undersea sensors simply were not up to dealing with the stealthy AIP boats.

However, the Gotland was merely the first of many AIP-powered submarine designs — some with twice the underwater endurance. And Sweden is by no means the only country to be fielding them.

China has two diesel submarine types using Stirling engines. Fifteen of the earlier Type 039A Yuan class have been built in four variants, with more than 20 more planned or already under construction.

Beijing also has a single Type 032 Qing-class vessel that can remain underwater for 30 days. It believed to be the largest operational diesel submarine in the world and boasts seven Vertical Launch System cells capable of firing off cruise missiles and ballistic missiles.

Diesel powered submarines are apparently particularly useful in assisting in maintaining littoral integrity if one is able to crew them. The Americans have determined to only have nuclear submarines so they can roam the world underwater – an international police force. Why else would a nation commit itself to such a program? The British want to join in if Australia will help to pay for their ailing submarine building industry– why else would the British want to use Perth as a base unless they want to join the USA in this role as a police force. Really, do we want to be part of this folly – “the final link in the chain” as Keating so bluntly put it, of nuclear submarines lurking in the Pacific Ocean.

There is another incidental fact I have learnt trying to fathom why we are committing ourselves to such enormous expenditure. The Collins class submarine was taken from a Swedish design. The Swedes have a fleet of five diesel-powered submarines, but under the auspice of Saab Kockum have committed themselves to building the new A-26 Blekinge submarine by next year, constantly advancing the technology and have ordered two more.

Finally, more than anything, Australia needs a debate on these matters – and outside the wardroom. I would like to know what we are defending and who really is the enemy, apart from the cost being committed for the next generations of Australians who will be forced to pay.

Mud by Name; but not by Taste

Continuing my occasional reminiscences of the most memorable seafood meals that I have experienced, this one concerns the giant mud crab, I thought wrongly to be solely an Australian delicacy. The crabs are caught in sheltered estuaries and mangrove areas, favouring the soft mud below low tide levels in Northern Australian waters. The flavours are distinctive; some say sweet; but like so many tastes which stick in the memory – mud crabs caught in the wild are distinctive. I first remember a large tray of these crabs on a VIP flight back in the 1970s when I first realised what I had been missing. Lobster was relegated to second place from that day on until many years later when I ate farmed mud crab fed on chicken meal. That unique taste had been lost. It was quite a disappointment.

On this night, after working in Mackay all day, we were recommended this place to eat on the outskirts of the city. Unprepossessing, the premises resembled a hut, and it was called The Hut or some such. It was 1988. As it so happened the British Lions Rugby League Team was in town and following them was a large entourage of British journalists because the whole trip was more of a jaunt than a tight schedule of Tests.

When we entered this establishment, it was somewhat basic; “homely” would have been a good epithet if the place had not been swarming with middle-aged Poms, who seemed to have done with any formal activity.  The alcoholic hubbub swirled around us, outsiders in our own country. Nevertheless, we secured a table in a corner facing the kitchen, so when the owner/chef emerged with this large mud crab, and asked whether anybody would care to have it for a meal, we responded with alacrity, such that the deal was done before the Fourth Estate had time to turn around, let alone react. Perhaps they would have enthused more over it, although there was a ripple of “got another one, guv?”

This mud crab had just been caught and dropped off at the café. I don’t know whether it was the only one, but I doubt whether I have ever seen one bigger. Even though I had actually cooked my own earlier in the decade, there was something about this mud crab feast which made it special. Unfortunately, with time, the wild crustacea and fish are increasingly a product of farming rather than being gathered from the wild. Mud crab farming is very popular in some Asian countries – Bangladesh, India, Thailand, Philippines. Mud crab is in huge demand, with equally huge prices in the international market, and thus they have mostly lost that uniqueness which we experienced one night in Mackay.

Dr Lee Gruner

Entering Bacchus Marsh

Dr Lee Gruner has just been banned from medical practice for 10 years. She is 74, and at that age, she would probably be retired or be living off the fruits of her labour, irrespective of the Medical Board’s finding. She has been punished for her actions at the Bacchus Marsh Health Service (Djerriwarrh Health) which occurred over a decade ago. It was evident to me well before that time that Dr Gruner was a smooth talker without much substance. The Medical Board’s finding about her behaviour even astounded me, although I was well aware of the dysfunctional nature of the Bacchus Marsh health service even then.

Gruner had always projected herself as an expert in quality assurance (QA), which is almost a Medusa in the number of jargon-laden interpretations to describe a very simple concept – the actual improvement of health care achieved against projected proposed improvement over a specified period. My association with managing improvement of health care first occurred with involvement in a successful “management by objectives” project in 1971-73 at the Royal Melbourne Hospital.

In 1975, the then Federal Minister of Health, Ralph Hunt, challenged the medical profession to formally assure quality in health care.  As a result, the Australian Medical Association (AMA) together with the then Australian Council on Hospital Standards (ACHS) set up the ACHS/AMA Peer Review Resource Centre and the then AMA President challenged me to take on the portfolio of quality assurance and peer review. Within a decade I found myself as President of the International Society of Quality Assurance. During this time, it gave me a wide perspective of those involved in the various “players”, both in Australia and overseas.

While there was a cohort of health professionals genuinely interested in improving the quality of health care, I found there were many flim-flam persons, hucksters and grifters who drifted around drawing flow diagrams and pie charts, writing monographs telling the clinicians what they should do, speaking in the distinctive “quality assurance creole” and holding seminars and workshops purporting to be fonts of learning. Much of this QA movement was translated into more bureaucracy, which led to the creation every three years of shelves of folders containing rules and requirements, which were neatly stacked in the administrative section of the hospitals, but to which the clinicians in general were impervious.

Effective interplay between management and clinicians is essential if true quality improvement can occur and be maintained. In addition, the quality assurance movement flourished until the central agencies started extracting “efficiency dividends” from the health sector, and the hospitals were the most vulnerable as targets for such “efficiencies”. Costs were paramount.

Dr Gruner with her gush, winning smile and line of blarney, fitted in well with this scene. She became Censor and then President of the Royal Australasian College of Medical Administrators (RACMA), being good mates with the then Chief Executive Officer. Yes, Dr Gruner constructed an impressive façade.

This façade crumbled before the findings of the Medical Board of Australia. Her behaviour, as set out in the Board’s findings, was truly appalling, given that under her medical management, neonatal management was wanting.

In 2021, Dr Surindar Parhar, who had been chief of obstetrics and women’s health between 2008 and 2015 at Bacchus Marsh Health Service, was formally reprimanded and disqualified from applying to practise medicine for 12 years after a finding of professional misconduct related to his time at the Service. But the doctor had surrendered his medical registration seven years previously, so the sanction was very much post hoc. The following is the finding, six years after he stopped practising; it happened under Dr Gruner’s watch and is equally appalling as her reprehensible neglect. (sic)

Dr Parhar was found by the Tribunal to have failed in almost every aspect of his role. The Tribunal found that he failed to conduct formal reviews in nine cases of perinatal death, and where reviews were conducted, he had failed to give sufficient clinical input and adequate processes were not used. Further, between 2009 – 2015, he failed to engage an external reviewer for cases involving foetal and neonatal deaths, failed to communicate important information and failed to supervise or assess junior practitioners who he was directly responsible for. Additionally, the Tribunal found that Dr Parhar failed to improve or maintain his own professional performance, did not keep accurate or legible clinical records, and inadequately investigated, diagnosed and managed a patient’s care.

Incidentally, the former nursing director and the maternity services manager were both banned for 10 years. Several other healthcare workers including senior midwives, junior doctors, a clinical support director and a physiotherapist were also disciplined.

Gruner now has no credibility and her neglect was allowed to continue for far too long. Nevertheless, the RACMA and the level of remuneration its Fellows attract has also gone too long without scrutiny. Some years ago, I offered to assist the College after a decade’s stint during which I was able to refine the role of Director of Medical Services (DMS) of small health services. I had a formal contract with each service at which I worked, and I had a modest base at one of the health services with shared secretarial services. From personal experience, I believe that the findings in relation to Dr Gruner’s position are sufficient reason to investigate the whole state of medical administration, where there are a number of aberrant practices, which Dr Gruner’s action highlighted. She just got caught. In Victoria there apparently is a tool to assist hospitals in appointing a DMS, and having read it, this tool is one of the theoretical “flannelling” documents that people like Gruner were adept in constructing to give the appearance of activity.

The task of a DMS is to work with and have the respect of the local doctors and visiting medical specialists; to ensure that the credentialing, scope of practice and privileging of these doctors is aligned with their knowledge and skills; to participate in the hospital management as required; and, as I showed, to extending the DMS role to being director of clinical training, as evidenced by the creation of the Murray to Mountains Intern Training Program. Removing a doctor’s privileging rights is difficult and requires a skillset not immediately obvious in medical administrator training. Moreover, the DMS must be a visible presence, not hidden away in the administrative suite of offices well away from the clinical action.

The other worrying matter shown by this Gruner episode is how long it takes for the Australian Health Practitioner Regulation Agency (AHPRA) to do anything. The Agency publicly displays its satisfaction rating, 1.6 out of 5. It is time the Chief Executive Officer, Martin Fletcher, is put under active scrutiny. An English bureaucrat imported to do a similar job he was employed to do in Great Britain, Fletcher has been in the role for 13 years, so he would know all the steps in the political foxtrot.

The current Federal Health Minister Butler had ordered a rapid review of AHPRA, which seems like a handball rather than “rapid review”.  “I am writing to the chair of the Health Ministers’ Meeting to put this issue on the agenda at our next meeting, including a rapid review of the response by jurisdictions to previous reviews.”

Martin Fletcher

I would say the AHPRA obfuscation is less “flannelling’ but rather a “whole suite of blanketing”. As such, Martin Fletcher may tuck in the last “blanket” in rejecting allegations that AHPRA had resisted government engagement and was slow to implement reforms, saying the leadership team was rolling out a “huge” program of work to improve procedures. That “blanket” sure has a lot of fluff.

Much more of this and it will be media suffocation so thick is the “blanket”. Gruner is just one of the cases to serve as a reason for a comprehensive review of AHPRA.

Time for action, and restoration of the integrity of AHPRA, shorn of excessive bureaucracy, but that is the ultimate goal, training quality staff and ensuring the agency does not have the opportunity to hide behind overly restrictive legislation – a matter for urgent Government review – and that the multiple agencies involved don’t allow cases to fall between the cracks. This will require close attention to the profile of those supposed to uphold the standards and in so doing recognise dysfunctional situations such as the one which allowed Gruner to flourish. One missive received yesterday from the current President trying to justify continuing trust in the College credentials, I’m afraid is far from enough.

Mouse Whisper

Will the Floridean Goldenlocks weather yet another Storm? Remember Shakespeare’s The Tempest?  The jester Trinculo, on hearing the Storm is coming, utters words perhaps relevant to a forthcoming New York Courtroom appearance:

Alas, the Storm is come again! My best way is to
creep under my gaberdine: there is no other
shelter hereabout. Misery acquaints a man with
strange bed-fellows. I will here shroud till the
dregs of the Storm be past

The golden mask of Trinculo