Modest Expectations – Earthquake in Hunter Street

I arrived at the Melbourne apartment having come down from Sydney on Wednesday 25th November. The desk calendar said May. I had not been here since then?

The Virus has wreaked havoc and it is time to reflect given that I have been writing my blog continuously during this time. Hence, once written, always there.

There have been two major disasters – one was the Ruby Princess. Some say the targets to whom I assigned blame were wrong. There is always the fall guy, and people have told me who it is.

Given the Premier seems to be wrestling with disclosing her misdemeanours, she is trying to deflect an increasing number of embarrassing disclosures by filibustering. The “poor little me” melodrama is becoming increasingly tiresome, but people should listen to her fellow Armenian, Mr Aznavourian sing “She”:

She may be the face I can’t forget

A trace of pleasure or regret

May be my Treasurer

The price I have to pay.

Increasingly her NSW constituents may begin to agree with her fellow Armenian’s summation. Obviously, the Queensland Premier may agree as she has used poor Gladys as a punching bag; the State of Origin biff has extended to the two government leaders.

Anyway, the Queensland Premier has her own idiosyncrasies, apart from Jeanette Young, including her insistence on being called “Palashay” and not the original Ukrainian “Palastchuk”. Perhaps it was this Slavonic heritage that loved the sound of Dr Young’s continual “nyet”. Who would know?

Border closures were initially effective as was confining people’s movements, but after a while it became a symbol of secession – even puerile schoolyard spats. It should be noted that if Andrews had not given it credibility by supporting Morrison’s “National Cabinet”, it would have floundered. In any event Morrison has shown little trustworthiness.

Lockdown had a novelty value as Insiders showed with their amusing washing troubadours way back in March and Daniel Emmet continued the fun with his banishment of the Virus to the sound of “Nessun Dorma”.

However, it progressed from a romp when Peter Dutton came back from the USA with the Virus and it was reported that his senior colleagues immediately panicked until they were quietened down by Dr Paul Kelly. However, the lavage jolliness had given away to a sense of vulnerability, albeit fear.

What has happened is that the State governments took the matter very seriously and closed the borders. It is a difficult area to manage because not opening borders can lead to two outcomes, as has been shown over the succeeding months. The first is that despite the Commonwealth having the quarantine power it was virtually ignored by the State Governments – except in one area – the actual meaning of “pandemic”.

However, in one way, the Commonwealth listened to the health experts, and those like Brendan Murphy, who was appointed Head of the Federal Health Department, listened to the health experts in his own team – Paul Kelly and Nick Coatsworth. There were myriad others with varying levels of health expertise, but apart from a number of superficial missteps, Murphy listened to the right voices and the distilled Health advice prevailed over Murdoch and his fellow Ignorants, most of whom could understood the share market but not much else.

In the end, apart from the tourist industry and interference with social communication, the real effect of border closure was magnified by the closure of the NSW / Victorian border. One of the worst happenings is to continually go into lockdowns, then open the borders, then go into lock down again – on and on heightening confusion. I am not a fan of hotels being used as quarantine facilities because in the end all are porous. This is the nature of the beast, especially when you impose imprisonment without accompanying health expertise, and then find out you did not have the expertise anyway. This occurred in Victoria and Daniel Andrews assumed control, locked the State down, imported the contact tracing expertise from NSW, where it had saved the Armenian bacon, and while all about were behaving badly Andrews gradually, over 112 days, bullied Victoria into compliance. It was a terrible time for those in the State but demonstration of the discipline needed to eliminate the virus that is raging everywhere else in the world, apart from selected areas in the South Pacific.

In the end, the strategy had its effect. It suppressed the Virus, and in the case of Victoria probably eliminated it. As a result, woe betide any tennis player who comes to Australia with a cavalier attitude. He or she will be faced with a battle-hardened population who are not going to allow a set of “celebrities” to import the Virus. The message is plain.  Get it into your heads, nobody is going to breach security again and bring in your own tidal wave of infection.

What Andrews showed was courage under fire from the Murdoch media and an Opposition who, if their actions were seditious rather than serious criticism, should be facing charges. He showed that once a lockdown is imposed, and his State embarked on a recovery plan, he had to get it right and not backtrack. That drifting in the political breezes is happening all over the world, in and out of lockdown with political rather than the resolute application of health priorities being uppermost . Under the recklessness of the Mad Trump or the hubris of the Swede “Turnip” Tegnall, people die, people clog up the health system and, as with any arterial blockage, the end result is death to the blocked area.  Andrews showed the way by eliminating the blockage and should be overwhelmingly elected Australian of the Year.

South Australia has since had a similar outbreak in hotel quarantine, and the lockdown was far shorter and the epidemiological weapons used had been improved across Australia since March. As this blog goes to posting, NSW has just had a breach in hotel quarantine.

Underlying all the political action is that there will be a viable vaccine available soon. There seem to be plans upon plans for distribution of an untested product.

There are two questions that seem to be consumed by the cacophony of the public relations spin. What are the side effects and can I die from the cure? How long does the immunity last? You see, I grew up in a world where we had injections before we went overseas, and they did not grant life-long immunity. You had to get injected for cholera and typhoid each time you went overseas – and the latter gave me a nasty local reaction. I’d been through it at that time, bearing my vaccination card, when overseas travel was a far smaller sector than in the modern world.

This whole area is complicated by the Head of Qantas saying that you would not be able to board an aircraft unvaccinated. Forced to take an unproven vaccine? Where is the duty of care? The world of business is treading a perilous pathway.

Finally, one thing I would say is that the media is braying about how well our political leaders have stood up in the recent polls. Did the polls award Morrison the Lodge in 2019?  Did the polls accurately reflect the votes in the recent US elections. Let’s face it. Polls stink.

Ah yes, but this is the poll I like. It says I am popular. The politician preens. It says that people think of me as a perfumed gardenia. Beware, gardenias die very quickly and leave a stench not a perfume. But then I am given another gardenia, and it’s alright, isn’t it?

Why not a Summit at ShaTin?

The Chinese are insulting us. The Prime Minister armed with his Pentecostal shield fights back. The Chinese are trying to strangle our industries. The Chinese have taken over Hong Kong completely. Dissidents are being locked up.

Sha Tin race course

But it is not all bad. There is still horse racing in Hong Kong – whether at Happy Valley on the Island or Sha Tin in the New Territories with Australian-bred horses, Australian-bred trainers, Australian-bred jockeys and even Australian-bred stewards. All their antics are broadcast by Channel 7 in the interests of Sino-Australian recognition of our long association with the Hong Kong Jockey Club.

The Chair of the Club is Phillip Chen Nan-Tok. He seems to be well connected, having been a senior executive of the Swire Group and of various property developments in Hong Kong and on the Mainland.

It is all unreal. Munchkin-like barrier attendants. The race commentary and in between race commentary is all very English, although the race-caller is obviously Antipodean; he does not have the languid style of the British race-caller or the unintelligible brogue of an Irish counterpart. There he is describing Australian horses galloping around these racetracks with not a whiff of tear gas or the young rioting against Mainland repression.

The betting brings Hong Kong plenty of money – and not an Australian boycott in sight. I wonder therefore if the Chinese will be at the Australian horse sales in the New Year.

Bliss

My son gave me “Abraham Lincoln” – which coincidentally was reprinted in 1939, the year of my birth. This book was written by William Thayer, an American educator, who was born during the American Civil War.

Lincoln

The book details a mob response to the death of President Lincoln in very graphic terms:

“In some localities the grief expressed itself in the form of vengeance. It assumed that form early on Saturday morning in the city of New York. Armed men gathered in the streets threatening speedy death to disloyal citizens. Their numbers rapidly increased, until fifty thousand assembled in Wall Street Exchange, bearing aloft a portable gallows, and swearing summary vengeance upon the first rebel sympathizer who dared to speak. One thoughtless fellow remarked that ‘Lincoln ought to have been shot long ago’; and he was struck dead instantly. The grieved and vengeful crowd seethed towards the office of the World, a disloyal paper, with mutterings of violence on their lips. It seemed scarcely possible to prevent violent demonstration. A bloody scene appeared to be imminent. At that critical moment a portly man, of commanding physique and voice, appeared upon the balcony of the City Hall, from which telegrams were read to the people, and raising his right hand to invoke silence, he exclaimed, in clear and sonorous tones:-

‘Fellow-citizens, – Clouds and darkness are round about Him! His pavilion is dark waters and thick clouds of the skies! Justice and judgement are the habitation of His throne! Mercy and truth shall go before His face! Fellow-citizens! God reigns, and the government at Washington still lives!’

The effect of this serious address was magical. The raging populace subsided into repose. A hushed silence pervaded the vast assembly, when the voice of the speaker ceased, as if they had listened to a messenger from the skies. The change was marvellous. The speaker was General James A. Garfield, who became President sixteen years afterwards, and was shot by an assassin four months later! How strange that the inhabitants of that metropolis, who listened to the gifted statesman so gladly, April 14th, 1865, should be shocked by the news of his assassination on July 2nd, 1881!”

There are two stories in this excerpt from the book. The one directly showing that in times of crisis America always seems to unearth a saviour. Garfield’s ability to quell the mob reaction restored a degree of order into what was one of the most provocative acts imaginable to incite mob revenge – the assassination of Abraham Lincoln.

James Garfield had been a major-general in the Union forces while still in his 30s and had seen action in some of the major American Civil War battles such as Shiloh while still a young man. He may have been described as portly in the above excerpt, but he was only 34, and “portly” is not a word I would normally associate with a person of that age.

Garfield

Moreover, as with Lincoln, Garfield was born in a log cabin – Lincoln in Kentucky, Garfield in Ohio – both Republicans, both with progressive social agendas.

When Garfield was shot, he had a doctor called “Doctor Willard Bliss” foisted on him. Doctor was actually his first name and in most of the description of this man, he is known as “D W Bliss”. Bliss was a rogue, in that he ran away under fire at the Battle of Bull Run, and then claimed that he participated in a great victory. He faced prison for stealing Army equipment but was helped to evade conviction by his political contacts.  He took the opportunity of an association with Lincoln’s son to spruik a false cancer cure.

Notwithstanding that, he bobbed up as Garfield’s personal physician again on Lincoln’s son’s recommendation. He was completely disdainful of Listerian concepts in mitigating infection. It is not reported whether he ever uttered something like “fake news” or “hoax’. However, it was his complete repudiation of infection control including shoving unsterilised instruments into the President’s body in a vain attempt to find the bullet that accelerated the President’s ultimate demise.

Despite a welter of optimistic reports on the progress of the President’s condition, completely fake, Garfield died on September 16 – two months after the assassination attempt. A long pus-laden sinus was found in the President’s body at post-mortem – the track outlined where Bliss’s probe had gone.

At trial, Charles Guiteau, the would-be assassin,  said in his defence that he did not kill the President, Bliss did. Nevertheless, it was Guiteau who was convicted and hanged in January 1882.

In fact, Bliss billed the US Government for an outrageous sum for services rendered, but in the end received nothing.

Real gallows humour, because with Bliss, quackery and fake news clashed with scientific evidence. Scientific evidence and the life of a President were the victim of the Bliss cocktail.

Ambulant recognition

Simple things are often lost in the grand sweep of the disabled. One of the problems with being disabled is the lack of uniformity of public toilets, those in restaurants and also those within service stations which are the most easily accessible, unless the service station has a sign which says “Express”, which stands for “no toilets”.

The problem:

There are four essentials.

  • The toilet seat must be about 50 cm from the floor.
  • There should be a rail to hold on to when standing up.
  • There should be a handle on the inside of the door; just try getting the door open if you have only a small bolt handle and you are too weak to use it.
  • There is a need to have an ambulant toilet, the use of which should be enforced with appropriate signage in each of the male and female toilets, so the first stall can double as the ambulant toilet with appropriate adjustment in size.

I am going to name one toilet. The one at the Pheasant’s Nest Service Station which is one of last on the Hume Highway before Sydney, and therefore has a strategic importance if you do not want to be caught short on the freeway, caught in an unexpected gridlock.

The disabled toilet has been converted into a shower for interstate truck drivers and was locked. You can hold all the Royal Commissions in the World, but the recommendations often float away.

It would be very useful if there was an enforceable guide for toilets – then there may be an attempt to get uniformity, to conform to the standards, which are clearly set out if one can be bothered to read them.

In Namibia, I once flew for more than three hours in a light aircraft with a bottle for use in the emergency. The flight was from Windhoek to the Hartmann Valley in the north-west of the country, close to the Angolan border. There, alongside the airstrip in magnificent solitude, was one the cleanest flush toilets I have ever used.  That was a very good definition of “relief”. I called the toilet – Mafeking.

Hartmann Valley

Dial M for Misnomer

I had one of those “Four Weddings and a Funeral” moments recently. You know when:

Charles:  How do you do, my name is Charles.

Old man: Don’t be ridiculous, Charles died 20 years ago!

Charles: Must be a different Charles, I think.

Old man: Are you telling me I don’t know my own brother?

This day, I was in a hurry and I thought I had transcribed the phone number correctly.

I rang. A familiar voice, as I thought, answered.

“Marcus, this is father.”

“Don’t be ridiculous. My father died 40 years ago,” followed by a piece of unnecessary invective.

The receiver was slammed down.

I checked the phone number. It was that of one of my cousins who was born grumpy. His name started with “Michael” but although I see him infrequently, I know he is deaf. I could not be bothered ringing him back.

Mouse Whisper

At last, the Trapdoor has been removed and I have been able to visit Melbourne and all my mouse mates who went to Murine Grammar School. I was with a wise friend, Melchior who travels every year here with his two friends, Balthazar and Caspar. Melchior in not Australian but apparently COVID-19 immune.  As we ran along a Melbourne street, we saw this newspaper poster on the newsstand:

SMITH

BLASTS

TON

Melchior was at once fascinated since Melchior is familiar with gold. So he pondered; “Goldsmith?”

“Blasts?” explosives –

“Ton” – unusual for a goldsmith to mine his own gold?

Melchior said such was the rarity no wonder it had made news.

“Good try but not quite right, Melchior!” was all I whispered.

Modest Expectations – Windy Bears

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

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

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

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

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

 

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

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

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

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

The Big Tree, Orrooroo

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

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

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

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

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

Adam Goodes mob – The Adnyamathanha

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

Adnyamathanha flag

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

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

We purchased both the book and the flag.

John Kitzhaber – His Thoughts

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

Dr John Kitzhaber

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

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

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

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

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

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

From Cost and Coverage to Value and Health

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

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

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

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

COVID-19 and Our Legacy of Inequity

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

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

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

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

To be continued next week.

 What a Village

After such an above sober analysis…

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

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

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

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

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

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

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

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

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

Mouse Whisper

Not Anywhere

            Not Delaware

                          But Somewhere

                                     Wilmington South Australia

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

Respectfully

Wilmington, South Australia

Modest Expectations – Christmas at Bethany

One of the books I dipped into when I was younger was Oblomov, an 1859 novel by Ivan Goncharov. However, I found the concept of a rich, self-indulgent slob not getting out of bed such an anathema to me that I threw the book aside.

Oblomov

Some years later I again ran across this excerpt from the novel; it is the one which is most often quoted: 

“When you don’t know what you’re living for, you don’t care how you live from one day to the next. You’re happy the day has passed and the night has come, and in your sleep you bury the tedious question of what you lived for that day and what you’re going to live for tomorrow.”

As a doctor, I became aware of the Oblomov syndrome. Oblomov’s syndrome has been formally defined as a mental disorder characterised by low cognitive function, low emotional response, flat affect, or “emotional apathy” and a generally ambivalent approach to life or when reacting to people, events, thoughts, or feelings.

A more personal comment from some character in search of identity labeled himself as a typical “Oblomov” – a weak-willed neurotic who is apathetic, lazy and parasitic, unable to work”, with those characteristics culminating in self-loathing.

The recurring metaphor is a “refusal to get out of bed”. The metaphor may be extended to remaining in pyjamas for the whole day, except for making allowance for personal hygiene. It can become a way of life as Hugh Hefner clearly and very publicly showed, but I believe this outward Oblomovian indulgence covered serious neuro-pathology in the case with Hefner.

During the last months when the country has been in various levels of “lock-down”, I found myself constantly wanting to go back to bed and remain in my pyjamas. That is my reaction, but I wonder how many others, especially those without support – and here my hypothesis says that it is a male condition and not for poor people – have been faced with this situation. However, in nursing homes does it become a less voluntary condition?

The key to combating this condition is to get out of bed, have a shower, get dressed and have breakfast. Gluttony was an obvious refuge for Oblomov so I conjure up and then dismiss the picture of myself sitting in pyjamas consuming a breakfast of thick French toast dripping with butter and maple syrup, with a side dish of bacon and a gallon of orange juice laced with champagne. This context is definitely Oblomov.

Modern technology has provided excuses for staying in bed. Television, iPhones, ubiquitous apps, the introduction of Zoom, somebody to fetch and carry – paradoxically all have made one more Oblomovian. The latter day Oblomov emotes: “Why stir out of my room? Why go outside? Why travel anywhere? Why exercise?” A torrent of questions poured forth until COVID-19 imprisoned us.

As one writer has said: “Throughout many hours Oblomov tries to overcome his passivity but without result. This part of the book is deeply disturbing. After many sad events, over a couple of years, Oblomov dies of cerebral hemorrhage.”

After all, in the book Oblomov stays in bed until page 131; sometimes I have wondered what page I am on.

In the final chapter, Andrei Schtoltz, Oblomov’s friend is talking:

“He came to rack and ruin—though for no apparent reason.” As he spoke Schtoltz sighed heavily. Then he added: “His intellect was equal to that of his fellow’s, his soul was as clear and as bright as glass, his disposition was kindly, and he was a gentleman to the core. Yet he—he fell.”

“Wherefore? What was the cause?”

“The cause?” re-echoed Schtoltz. “The cause was—the disease of Oblomovka.”

“The disease of Oblomovka?” queried the literary gentleman in some perplexity. “What is that?”

“Some day I will tell you. For the moment leave me to my thoughts and memories. Hereafter you shall write them down, for they might prove of value to some one.”

Is the blog after all only a symptom of modern Oblomovism – or is it therapy?

Hijacking the Narrative

John Kitzhaber

Governor John Kitzhaber is a longstanding friend of mine and a former three-term Democratic Governor of Oregon. An emergency physician by training, he was responsible for the Oregon Health Plan. He has kindly allowed me to reproduce his recent blog – which I do in part.

Portland, Oregon

… The arrival in Portland of Federal agents on the pretext of protecting Federal property – in this case the federal building which has, in fact, been defaced and damaged in recent weeks. The damage to federal property, while perpetrated by only a small subset of the protesters, provided the Trump Administration with the opening it needed to direct Acting Secretary Wolf to deploy Federal agents to Oregon, citing the Homeland Security Act as the legal justification for this action. 

A provision in this Act gives the secretary the power to deputize other Federal agents to assist the Federal Protective Service in protecting federal property, such as the courthouse in Portland. Those agents can carry firearms, and arrest, without a warrant, those they perceive as committing a crime. This action, not surprisingly, has heightened tension and increased violent confrontations in the streets. In the process, the protest movement’s emphasis on racism and injustice has been effectively replaced by a manufactured narrative of “law and order”—playing directly into the hands of the President’s re-election strategy. 

To further complicate matters, millions of Americans and tens of thousands of Oregonians will most likely lose Federal support payments next week because of inaction by Senate Republicans to extend unemployment benefits before the current support lapses. Adding to the current environment of protest and frustration, the potentially dark social consequences of panic, blame and desperation that haunt those who cannot meet their most basic needs of food and shelter and see no hope for tomorrow creates an unstable and increasingly dangerous situation. This has been made even more dangerous by increasing inflammatory rhetoric from all quarters. 

What kind of plan could help de-escalate the situation before it spirals out of control? If the protests in our state since the murder of Mr Floyd are about social justice—about putting an end to police brutality and increasing accountability and transparency in law enforcement; about ending institutional racism and addressing the inequities that exist in our state and our nation—then what we are doing right now is not working. The peaceful protest movement in Portland has been drawn into a reactive position, a defensive position, and is at risk of losing the true narrative and putting in jeopardy the very goals for which it has been so courageously fighting.

What kind of strategy can reclaim the justice narrative that holds the moral high ground, and connect the energy of the protest to tangible and measurable actions that can redress the legitimate and long-standing grievances from which that energy flows?

Possible steps in that direction could be:

1. Leaders of the peaceful protest movement—Black leaders in Portland, religious leaders, and those who love courageous but peaceful advocacy for change—call for a short moratorium on the protests for five to seven days and urge their followers and those who seek only to exercise their right to peacefully protest, not to congregate in downtown Portland during this time. This is not a call to end the protests, which must continue. It is an intentional tactical decision to separate, for a time, peaceful protesters from those who seek violence and anarchy and from increasingly provocative and confrontational actions by federal agents. This moratorium would pause the momentum of escalating violence, and stop playing into the hands of those who want to mask the racism and inequality in America with an authoritarian narrative about law and order.

2. During this moratorium, call for a summit that would include Black leaders, protest leaders committed to peaceful change, business and labor leaders, Oregon’s governor, Portland’s mayor, members of the city council, legislative leaders of both parties, the attorney general, and the U.S. attorney for the District of Oregon. Given that the summit will necessarily be virtual, former President Obama might be invited to moderate. Considering the importance of this issue, and the amount of national coverage Portland has received over the past few weeks, the president would be likely to accept. This summit would seek two goals. 

First, develop an action plan for short and long-term steps and commitments to address, in intangible and measurable ways, the issues of transparency and accountability in law enforcement, and the conditions of injustice that have marred our state and our nation for far too long. Second, develop a strategy for how to resume the protests at the end of the moratorium in a way that will (a) keep the narrative focused on the conditions of injustice we are seeking to address and the actions, outcomes, and commitments developed in the summit; and (b) minimize, to the greatest extent possible, the likelihood that peaceful protests will be hijacked again by those who seek violence and anarchy.

  1. Also during the moratorium, secure a wide perimeter around the Federal buildings, perhaps deploying the Oregon National Guard for this purpose, to make it very clear that the state of Oregon is capable of and intends to protect federal property—just as it intends to protect state property and private property—thus eliminating the only legal justification the Department of Homeland Security has for sending these agents to our state in the first place. Not only would this perimeter protect Federal property, but it would also create a buffer, once the moratorium has ended, to protect peaceful protesters from violent and provocative actions taken by federal authorities—a task that should not be left solely to the courage of the “Wall of Moms”. 

The course we are now following puts control of the narrative into the hands of those who seek to further divide our state and our nation. We should not facilitate that, we should not allow it, we must take steps to prevent it. It is important not to lose sight of the fact that the focus of the protest is not on the legitimacy of laws that protect public buildings and private property from vandalism and damage. The protest is and should remain, focused on racism, injustice, and inequality. We cannot allow that focus and that narrative to be co-opted by either a handful of violent protesters in Oregon or by a national strategy that seeks to fuel and exploit violence and confrontation for political gain. 

The protests of the past two months are set against the backdrop of perhaps the most challenging set of problems in our state’s history: high unemployment, a daunting budget deficit, and a public health crisis. We are only six weeks away from when Oregon public schools have traditionally opened and the uncertainly about how that will be managed has put huge additional stress on parents, children, teachers, and other school employees. The ongoing, but necessary steps to bring COVID 19 under control, including the closure of many businesses and childcare centers, has added another layer of stress and uncertainty.

At this point in time, the combined leadership of Oregon’s public, private and civic sectors—and the energy, talent, and creativity of each and every Oregonian—must be engaged, with single-minded determination, to hold our state and our communities together. Now is the time to develop and implement a five-year strategy to create the kind of change rooted in social justice that we have been unwilling or unable to make in the past; a strategy to put Oregon back on its feet and lead us—all of us—through to a brighter time. By taking back the narrative, as well as the tone and focus of the important protests going on in Portland, protest leaders can help ensure that social justice, equity, and opportunity are built into the foundation of that strategy.

Somewhere in America, during this difficult time, a state needs to demonstrate that we can weather this storm without losing our sense of community, without losing our commitment to one another, and to emerge stronger and more unified than when we began. Let’s make that state Oregon.

Since this posting, Kitzhaber has followed up. Shortly after I posted it the State negotiated a removal of the Federal agents and the Oregon State Police took over.  There was a significant easing of tensions until a few days ago but there has been violence the last two nights, not at the Federal courthouse but at the headquarters of the Portland Police Association”…

The outbreak we had to have

Some may argue, to put it in the words of the Maestro, the Victorian outbreak of the Virus is the Outbreak Australia needed to have.

NSW had been the State where incompetence and carelessness were well on display but from June, Victoria has assumed the mantle and usurped that crown well and truly.

How the Premier handles the crisis could be the template for handling any pandemic – or not. He has a dreadful set of Ministers, the product of union factionalism. His public service, which has been stripped of most of its talent, is not much help. There are exceptions such the Chief Health Officer Brett Sutton and his deputy Allen Cheng.

Otherwise, the amount of intellectual integrity underpinning the Victorian approach has been woeful, and Andrews has moved, essentially groping in a policy blackness, on how best to move against a nasty hidden foe. The stress he is absorbing, particular given how weak his Health Minister is, has been extraordinary.

The lesson from the breakdown in the hotel quarantine should be clear – unvarnished or even if “coated”. This “stuff up” is just an example of giving work to your mates rather than assuring experience, trustworthiness, competence and responsibility in the contractors.

Australia is in danger of becoming a country of sunburnt baksheesh and wide brown paper bags. The sense of entitlement in some quarters of this country has grown under the guise of neoliberal narcissism – and its mantra is “only mugs work.”

The disaster is concentrated in the private nursing homes. Brendan Murphy has generally done a good job, but still remains somebody with a “tin ear”, talking about “reputational damage” that the proprietors of nursing homes have suffered, which frankly is irrelevant. There he was, presenting to a Senate Committee while the pages of the newspapers showed the owners of one or more of the affected nursing homes flaunting their yellow lamborghinis and bronzed buffness.

The problem is that the Commonwealth Government has shirked its responsibility. It has yielded to the shibboleth of “business knows best, Government should get out of people’s lives” and hence allowing self-regulation to be overseen by a group of bureaucrats waving warm lettuce leaves.

The training of the lowest level of health carers in the nursing homes is the benchmark level for adequacy and knowledge of health care. The simplest element of this knowledge and care is hygiene and hence infection control – theirs and those for whom they are caring, whether they be labelled patients, clients, customers, residents – or just people. Let us not descend to calling them “mum and pops” or “kiddies”.

However, it is not only the “lowest” levels of health carers that do not wash their hands. There are many surveys that show doctors and medical students do not routinely wash their hands – and to a lesser degree, even nurses. It would be interesting to know if the increased availability of hand sanitisers in the community may have changed habits and if there is any objective evidence that shows this is so.

The Commonwealth Government should at least be obtaining draft recommendations from its Royal Commissioners now, because the Victorian misadventure is a case study in progress and enables the Government to see what works. The Victorian misadventure is just such a fertile ground.  The Commissioners are realising that that one does not often have the opportunity to see what works or does not work “in real time”. Bugger the ivory tower – this is better than any self-serving submission. The Victorian situation is a case study in progress!

Andrews is in survival mode. However, he is all Victoria has. The predictable antics and hectoring for the sake of point scoring by a woeful set of politicians is more than unhelpful. Yet the Coates report is likely to be ugly. Already, the media watering can is nurturing the rumours.

If this next six weeks doesn’t work and with the numbers of infected people in Victoria being driven down, Andrews may be gone, subject to a Pallas coup.

Nursing home owners’ conference?

And what of the other States? What are they doing preventatively to rein in the operators of the private nursing home industry – to put a cap on the purchase of yellow Lamborghinis. Or are they behaving like “normal” governments – alternatively piously self-satisfied, sitting on their hands or putting “it on the long finger” until the community pressure becomes too great, all the while wishing the problem of the aged just disappears. Imminent elections as will be occurring in a number of states colour every policy decision.

One little measure, Commissioners Briggs and Pagono, presumably your Report will contain the amount of money the nursing home owners and shareholders contribute to the various political parties. No, of course not, not in the Terms of Reference.

All my problems come at once 

My son was on the same flight from America as Dr Higgins, in the Precovidassic era when the political dinosaurs stalked the World.

That week on March 8, CNN reported that there were more than 550 cases of the “novel coronavirus” in the USA. According to CNN at that time “around the globe, the novel coronavirus has killed more than 3,800 people and infected more than 108,000, the majority in Mainland China.”

Both men had independently acquired the then novel virus in the USA or on the flight. My son was actually No. 13 in Victoria. He went off to Box Hill Hospital when he felt mildly ill but had to battle the staff to get tested; eventually he prevailed. Despite being a journalist, he resisted publicising his plight, and went home, self isolated, tested positive and then stayed with his family in isolation for two weeks. No fuss.

Dr Higgins received more publicity, possibly because he has a famous daughter. As with my son, he had a minor upper respiratory infection and was tested. He however went back to work pending disclosure the test results for this “novel virus”. He also tested positive. Minister Mikakos weighed in and gave Dr Higgins a totally unreasonable “spray”, especially as he did not transmit the Virus! True to form, did she apologise? No, the lady was not for civilised responding.

However now Mikakos is on limited release, such has been her effect on containing the COVID-19 spread. That she is tweeting in the middle of the night is bit of a worry. I am afraid she gets no sympathy from me.

I suspect she and a number of other Ministers will resign.

She cannot be blamed for destroying the Health Department’s corporate memory and limiting the medical input in favour of advice that condemns “the medical model” (whatever that is) and fuels an environment where nobody with medical expertise would want to work. That’s the history of the Victorian Department of Health over the past decade. However, the attitude started many years before, with John Paterson and his contempt for the medical profession.

However, reviewing the Kennett legacy is not part of the current review. Kennett promoted gambling, including poker machines, as a significant contributor to the Victorian Government’s coffers. I am old enough to remember some of his disparaging comments about old people. There is no review of the spread of organised gambling and the harvest being reaped by overseas betting agencies, often at the expense of the elderly.

Although I used to like to punt and especially loved watching Winx, I question why racing has been given an exemption. City and country racing persists in Victoria and the industry seems to move seamlessly between Stages 3 and 4 Lockdowns. As one Victorian put it, “Would be a great feeling when your business is going down the toilet to turn the TV on and watch the essential horsies go around”.

However, an erudite friend of mine said: “what else is there to watch on afternoon television”. It should be noted that racing in Victoria, whether dog or horse is in the Ministerial portfolio of one Martin Pakula, who also has direct oversight of Disasters and Catastrophes.

However, the whole question of preference for sport pandering to the jocks, the whole reliance of government on gambling revenue at a time when, paradoxically, the same crowd that own the horses are often those who are wanting taxation cuts – presumably to buy more horses.

Overlaying this jock anti-intellectual climate is the cosy relationship between government and big unions (Victoria), big business (Federal) and big accounting/consulting firms (New South Wales). Queensland, with its long history of political corruption being an irritant, will have its day of reckoning as well.

The day of reckoning for the smaller States will be in the lifting of the State of Lockdown. This will be a test of shared responsibility in the face of inflammatory media that uses words like “carnage, deadliest, surge, tsunami” – any word that evokes anxiety in the community. Victoria has “stuffed up” because of a number of people, whose metaphorical heads should soon be gracing Spring Street gutters.

It is unfortunate that it is election time in various States so there is a propensity to blindly apply border restrictions, which flies in the face of Australia being a nation. Has anybody given a thought to Australia being balkanised, with Tasmania the Montenegro and the Northern Territory Kosovo?

Been there, chaps! As we headed towards the Albanian border a couple of years ago, the driver turned to me and said: “Have you got a gun?”

Having heightened the level of anxiety to a feverish level for political reasons, what will be the nationally agreed acceptable Virus levels to allow all borders to re-open, and moreover New Zealand? Elimination – that is, insisting on zero cases before opening borders is political nonsense, even in the face of there being no vaccine. Restlessness in the community increasingly will only require a minor incident before the restlessness and restrictions spills out onto the streets with the targets, the perceived virus spreaders.

Thus, agreement over what level of infection constitutes “suppression” is a priority. Once that is agreed then appropriate resources can be assigned so that Australia (and hopefully New Zealand) has one system of public health to maintain that suppression across Australia and New Zealand.

Once this relationship is tested at a government level then expansion of the initiative can be offered to other South Pacific countries. It is important in opening up trading and tourist links. As a former President of the Australasian (Australian and New Zealand) Faculty of Public Health Medicine, who advocated closer links with Pacific nations over 20 year ago working with the then Minister for Development Cooperation and Pacific Island Affairs Gordon Bilney, I feel reasonably assured of my credentials to offer this suggestion.

As the historian Humphrey McQueen has written: “In 1915 an external menace had driven Australians together; by 1919, an internal danger revealed yet again how easy it was for Australians to stand apart. If national unity involved loyalty to the Commonwealth as an administrative machine, the Pandemic showed how little of it there was.”

McQueen is somewhat harsh on Australia since New Zealand suffered more because of the laxness of its quarantine arrangements compared to those mandated by each of the Australian States. However, the pandemic varied widely. Tasmania did not have one recorded case. Yet one major consequence was the establishment of the Department of Health in 1922 and the assumption by the Commonwealth of the quarantine power, which had lain fallow in the Constitution.

In 1936, the National Health & Medical Research Council was set up so the Chief Medical Officer had a public health forum. Early on they were faced with the 1937 polio epidemic. “The prevalence of the disease in Victoria caused concern in other States, particularly New South Wales and South Australia. Up to twenty crossings into NSW were patrolled by police. Special police were stationed at railway stations, aerodromes, bridges over the Murray River and at the wharves in Sydney to control the possibility of the infection being spread from Victoria to New South Wales. Vehicles were stopped and checked.” 

Sound familiar?

Mouse Whisper

I have always wonderd why they use the word “shrewd” to define the astute mouse, rather than just say moused mouse. I have always thought of these vagabonds sleeping or digging tunnels under hedges as our country cousins. Apparently not, even though they are characterised as “shrewd”. I find that us mice are closer to the Porcupine family than to the Shrews.

Just as well I have made that point. Some shrews have salivary poison which they inject when they bite unsuspecting prey. Thus the derivation of “shrew” can be reflected in the Swedish, Danish and Icelandic words for “cut”.

While it is a shrewdness of apes, it is a caravan of shrews. As they tunnel, shrews navigate like bats: they emit ultrasonic clicks that reflect back to their ears to create an aural picture of the surroundings up to about a metre away. So the nursery rhyme caravan of three blind mice may be in fact “shrews” – talk about giving a mouse a bad name. We mice would never run up a clock in that way.

Modest Expectations – The Spine

In an advertisement for the MD Anderson Cancer Center in a 2009 issue of Harper’s, a healthy triathlete smiles. His name is Bill Crews and under his name is the word “lymphoma” with a red line through the word. It is five years since he had been diagnosed and now following “an individual treatment plan”, he was in remission attested to which was completion of 14 triathlons at that point.

To celebrate his achievement a Bill Crews Remission Run was organised annually to provide funding for this Houston- based Cancer Center. Then there is a brief note in 2014 to say the website advertising the run is “inactive”. There is no record of Bill Crews dying – just that one word “inactive”.

It got me thinking, since my closest male friend also succumbed to lymphoma some years ago, although his course between diagnosis and death was far shorter. Once you get cancer, except for some skin cancers, you know your life will be limited. We all will die, but there is no need to face it until the doctor across the desk signals your mortality. You can of course avoid this confrontation by suiciding, being murdered, killed in an accident or sacrificed deliberately by those who would wage war.

What if I responded to the doctor after the sentencing: “I want you to tell me the exact day I am going to die.” What would be the response?

“Unfair question. Impossible to know.”

“OK, then will it be next week, week after… and this year, next year, sometime, never?”

We can be very precise with the input when we are provided with an individual treatment plan. Therefore, if you can give me such a plan, then it is reasonable to know the outcome, or what to expect. After all, infallibility is a power that some health professionals like to assume – well doctor, how long will I live? But then nobody writes on a funeral notice – he lasted x time longer than the doctors predicted or that the doctor got it so horribly wrong, he died well before the predicted date – perhaps in the middle of some surgical procedure, where the euphemism for “surgical vanity” is “heroic”.

The problem is that what I have written above is so foreign to how society is ordered. Most of us try and live in a predictable world. We expect that if we go to the gym in the morning it will be open at a certain hour. We know that lunch follows breakfast and we have a mid-morning coffee break.

Bill Crews probably had such a regimen. Cancer came; cancer went; but it never does. It marks time. How much of that time was consumed by unpleasant morbidity; how much did life become unbearable; and in the end, how much did he wish to live – all unanswerable now.

In fact, we live in a world of uncertainty. The flow of information from so many portals means that life is like traversing an Arabian souk. We never know what will happen next, but we always have the option of wanting or not wanting to know what we have bought – without it being varnished with fakery.

What does that all mean? Government, despite the various inputs, has to make the most cost effective allocation of resources in the face of all the individual treatment plans. There is no incentive for those manufacturing, distributing and prescribing the various medications to be less than optimistic. The cost of development of a drug is always stated as being so expensive so that the end product mirrors this expenditure. However, in the World of Optimism, who is going to undertake the rationing on behalf of community affordability. The plea, the crowd funding, the picture of the cancer sufferer, the hoped for remission mistaken for cure are all part of the emotional appeal. However, what price does one pay for a small addition to life of variable quality – what is an average of six months worth?

Policy should not be predicated on the outliers. Bill Crews had non-Hodgkins lymphoma. Through all the obfuscation surrounding survival rates, maybe his ten-year survival rate was about average when the last mention of Bill Crews was made.

Therefore, assessing the cost of Bill Crews’ treatment may be a useful indication of the individual cost for the condition. That statistic is just as important as knowing the relative success of the individual management plan and generalising from that one example.

But my whole case is predicated on two assumptions: the first is that the lack of mention of the poster boy by MC Anderson Cancer Center (now also with a red slash through the word “Cancer”) public relations, and the inactivity of the Remission Run from 2013 onwards means that Bill Crews is now cycling on a higher plane. In line with MD Anderson Center publications, I have not mentioned the word “death”.

The second is what Bill Crews’ individual management plan cost when everything was tallied, its figure would be useful enough to be used as a guide to cost – assuming that those costs could be found and adjusted for current prices.

Hopefully the responses, outraged or not by such reductionism, would be a welter of data trying to disprove my assumption. However, that could lead to a good controversy if the policy makers were listening, and cost could be determined with all the accompanying arguments laid out. Then tell the taxpayers!

The Senile Trail

Listening to the Health Minister, he talks about “self stigma” and that we should reach out for help. Well, may I tell you, if you bother to listen, Minister, self-stigma is a meaningless term, when you are crying spontaneously for no reason, when your body is at a point where you cannot undertake the activities you were once able to do; and you are alone. You reach out for what? The phone lines are always busy in the daytime. Trying reaching out at 3am in the morning wherever you are for help. About all that is left is the late night / early morning radio programs that provide an outlet to the old, the sick, the lonely who can’t sleep and who communicate with fellow callers from across the state or the country, through the radio: “How is Beryl from Cooma, we haven’t heard her on the show for quite a while, does anyone know?”

There is a great deal of breast-beating going on, because despite all the expense spent on input, nobody has a solution to care of the aged. I have been associated with nursing homes that work well, because there is a continuity in management and the constant positive is that those in charge worry and care for their nursing home community.

Being dependent implies that I have a carer, which fortunately I have “in spades”. I can no longer live independently unable to have shower, cook, dress and generally manage any housework efficiently – without help. It is frustrating knowing that when you are dependent, you have to wait – you have to learn patience without surrendering yourself to outright submission.

However, being in a wheelchair and then suddenly left facing a blank wall in an airport adds another dimension. The person responsible who leaves you without saying anything just adds that element of being ignored. It is no longer just waiting, you are being ignored and that adds a new reality. It is a sign that you a bit of garbage to be swept when the mood takes the handler. In the end, you lose your self-respect unless dementia beats you to that realisation.

Such are elements of growing old – such are the elements of being in care, where the rules are such that you – the resident – are governed by regulations engineered by government bureaucrats far away from your bedside. They call it compliance or accreditation – a meaningless term to indicate everything is under control. Unless you have a family, whether natural or manufactured, to act as the antidote, then every day is one day nearer to death, and increasingly you wish that day will come. Those words like “accreditation” have a meaning to those who love making paperwork look like an illuminated manuscript.

Are there any solutions beyond having a caring carer not an impersonal person – a shift worker with an inadequate handover when they come on duty, their measly remuneration ultimately dependent on some distant hedge fund?

All solutions are just a variation on that fact of individual care without the negative embellishment.

For instance, I mentioned in a previous blog the series shown on the ABC where four year olds visited an aged care facility over a seven-week period. Then the series finished, with an elaborate farewell antic. I wrote in my blog* at the time:

However, if the attempt of mixing the groups is just voyeuristic – “been there; done that”; then I believe the makers of this series have probably done a disservice to all involved if nothing further eventuates.

Old age is an increasing societal challenge. It should not be just a case of waste management. Yet I fear that is happening – and David Attenborough-like explorations of human foibles and cuteness should not replace serious consideration of what can be done.

The clue is in the series – get the elderly to tell their stories, whether they have a four year old audience or not. After all, it gives you a sense of relevance, even when you may be the only one listening. However even one child listening and responding with questions is a bonus. After all, I believe we are all storytellers.

My argument was not against the idea; my concern was it being generalised – the implication being that infant schools be co-located with nursing homes, so there is ongoing integration of experience – not just a one-off “gooey-eyed” curiosity but as part of a conscious government policy.

After all, each group’s experiences are transitory – the children grow up hopefully socialised to understand what it is to be old; and one of the aged care participants died between filming and release of the documentary. Such is life, as Mr Kelly is reported to have said.

It was ironic when the aged care report was released recently there was no mention of the documentary as one remedy – even seemingly by the ABC.

* Modest Expectations – Duckworth 30/8/19

Mount Augustus

 Uluru has been closed at last. To me, there has never been any question. The traditional owners should have the right to invite strangers to climb this extraordinary monolith. I have walked around the base which is measured at 10.6 kilometres and to me it felt ‘right”. Being a “whitefella” does not exclude you from being in touch with this extraordinary country. One of the things I have learnt from my association with the Aboriginal people is to know when the Land is accepting your presence.

The idea that climbing the Rock is akin to climbing a cathedral may satisfy some people as an excuse. However, the analogy does not hold. Tourists are like ants on the roofs and spires of famous cathedrals and churches; and prohibition to climb churches is more related to safety or privacy rather than it being a spiritual taboo.

The bogan chant of why can’t I go anywhere because this is Australia and I am Australian is OK if you are a self-absorbed narcissist who does not believe that any restrictions apply to yourself. There is a high-falutin’ word for this – “libertarian” and a more macho term – “individual”, its anthem: “I am what I am”.

Well, Mount Augustus may be just what you are looking for, to express your feeling and being what you are. Mount Augustus is technically a monocline but then for you guys, it is a “humongous Rock”. It is not red and bald like Uluru – it is covered by bush and it is still called by the “whitefella” name rather than its Wadjari name of Burringurrah.

Burringurrah / Mount Augustus

However, it is the largest rock in the world and I went there 20 years ago; so it exists and has not shifted. It is a bit inconvenient being 500 kilometres inland from Carnarvon. Uluru is tiny compared to Burringurrah. There is an eponymous Aboriginal settlement close to the monocline.

Rather than walking around the base, we were carted around the 43 kilometres in a minivan at a hair-raising speed by a male nurse then living in the outstation. The trip ended back near the settlement, when the van hit a large pothole and lost its wheel. Fortunately the sand provided a cushion and we were all uninjured and trudged back to the settlement. It just emphasised how huge this Rock is.

Currently, the local Wadjari people allow visitors to climb Burringurrah but unlike Uluru, there is scrub and a trail, which takes around five hours to climb and return.

Watch this space! I remember when Uluru was Ayers Rock and was hard to get there.

Burringurrah speedway

Sydney Ferries Fiasco – A form of naval gazing

Guest Blogger: Neil Baird#

It could be said that the only thing keeping the New South Wales Liberal/National Coalition state government in power is the even greater incompetence of the State Opposition. If the latest controversy over the renewal of the Sydney Ferries fleet is any indication, the Gladys Berejiklian led coalition is certainly not an exponent of open government. The Opposition has only now awakened to an announcement that was made nine months ago in February.

Unusually, the announcement about Sydney’s ferry renewal was made from Liberal Party headquarters and not from the Minister for Transport’s office. Sure, the party was in election mode but what were they doing issuing a press release announcing a $1.3 billion project in such an underhand way? What was the government trying to conceal? Why will just 13 comparatively simple and small ferries cost $ 1.3 billion? That figure appears grossly excessive. Or does that include running and maintenance costs for nine years as mentioned in one report? Why would the government not be more transparent?

Given their other shenanigans with the Northern Beaches and Mona Vale hospital projects, for example, taxpayers have every right to be suspicious. For the record, the three larger ferries are to be built in Indonesia, presumably by Penguin Marine; the 10 smaller ones are being built by Jianglong in Zhuhai, China. The local firms mentioned below Ross Roberts/Harwood Marine were never invited to tender. Nor was anyone else apparently.

It has since been fully revealed, in an 23 October 2019 press release from Opposition Leader, Jodi McKay, that the fleet replacement was a “done deal” by 27 February 2019 when the Liberal Party announcement was made.

The story goes that in early February this year a couple of Australia’s leading ferry builders had been approached with a vague invitation to tender for the ferries. Apparently they didn’t respond to the approach. So did at least one leading firm of naval architects. None could be bothered to respond as they had such bad previous experience in dealing with Sydney Ferries, apart from being very busy anyway.

The subject went quiet for a few months and has only now been revived by Ms McKay who seems to have confused the facts.

Simply put, after endless problems, mainly with the maritime union, the operations, but not the ownership, of Sydney Ferries has not officially been privatised. It is a public-private arrangement, which avoids the need to go out to tender. The French-owned transport conglomerate, Transdev have contracted to operate the ferries, and seem to have eliminated most of the problems when it was run by the NSW Government.

Yet the curious way the ferries were ordered remains, with virtual concealment of the nature and cost of project from the taxpayers of NSW.

While Ms McKay has revealed some of facts, other parts of the story are off-beam. While the Trade Unions have been one of the major reasons for the problems at Sydney Ferries, the relative absence of shipbuilders in NSW has not helped.

However, she is partly correct. The ferries could have been built locally, as she advocates, but the only company in the NSW with experience in building ferries of the size ordered is Harwood Marine of Yamba in Northern NSW.

Strangely, Harwood was not even approached or invited to tender. Indeed, the managing director of Harwood was unaware of the government’s intentions until very recently. Harwood has been busy with a major expansion of its company’s facilities including, ironically, a 60 metre shed in which large aluminium ferries could be built. Equally ironically, those who could have benefitted – the local youth workforce in a town where unemployment stands at 23 per cent – didn’t get a look in.

Apart from Transdev, which is expected to correct Sydney Ferries’ inadequacies, one major local firm will benefit from the association with Transdev. That is the Port Macquarie-based company, Birdon, which moreover has been contracted to build ferries in China and Indonesia for Transdev.

Birdon is a highly reputable company, as is Transdev. This fiasco is no reflection on either. The government may well get a good deal in the end. However, the problem is the opaque process that the government followed. The State Opposition has been unaware of such a major project, until the belated statement from Ms McKay. It is also a major problem that Harwood, a significant employer and highly reputable local shipbuilder was not even asked to express interest in the project.

The taxpayers of New South Wales have not been well served by its politicians.

We have not heard the end of this.

# Neil Baird is non-executive Chairman of Baird Maritime, a global maritime trade publisher. Among his other positions, Neil is a long-serving director of the Australian Shipbuilders Association.

Mouse Whisper

Once I heard the confession of a poker-faced mouse whisperer despite it being difficult to squeeze into a murine confessional box.

In January 2004, I was in grade 12 of high school and about to graduate. I operated a profitable web design business as a part time job for some spending money. Seeing as my legal name is Mike Rowe, I created the domain MikeRoweSoft.com for my portfolio. The Canadian lawyers of Microsoft didn’t like this (I really don’t know how they found my site, I had 2 visitors a day. One was me (sic), one was my mom). They sent me a couple of emails and a large legal document telling me to give up my domain name. I asked for $10k. They said no. I went to the media. Hilarity ensued.

Since then I’ve been a full time professional poker player for the last 3 years. I’ve made enough to buy a condo and live very comfortably in that time. I have finished 5th in the PokerStars Sunday Million for $97,500 as well as 31st at the PokerStars Caribbean Adventure earlier this year for $40,000. So I guess you can ask about the poker stuff as well if anyone wants to.

And no, I didn’t sell out for an XBox.”

The site was still active in 2017, but not now.

Modest expectations – Mali

In my heyday

Young men wrote to me

Everybody seemed to have time to devote to me

Everyone I saw all swore they knew me

Once upon a song

Main attraction, couldn’t buy a seat

The celebrity, celebrities were dying to meet

I’ve had every accolade bestowed on me

And so you see

If I never sing another song

It wouldn’t bother me

I had my share of fame

You know my name

This was the last recorded song of Matt Monro when he was dying of cancer. Matt who? Frank Sinatra recognised him as his equal in voice and ability to connect with his audience. However, there is a plaintive quality – you know my name. Really, you, Mr Monro have been a long time dead – and there is limited space in a nation’s collective memory for anyone, even if a superb crooner such as yourself.

The problem is that you may know my name but the passage of time will dull and obliterate it.

That is unless you make sure that there is a memorial, where its message is relevant to an ongoing generation, and not just to remember “my name”.

For me, the muffled sound and grainy sight of Salvatore Allende crying out “Larga vida a Chile”, and the fact that his cousin, Isabel has been such a prominent author, has meant the name has stuck around, as a romantic standard bearer for the oppressed – something South America has in droves.

Museum of Memories and Human Rights, Chile

I have recently returned from Santiago where I made a point of visiting the Museum of Memories and Human Rights. This was the brainchild of President Michelle Bachelet, to ensure that one memory sticks in the mind of the Chilean people. On a wall on the first floor are myriad photographs of Chileans murdered by the Pinochet regime – 130,000, probably more.

People who are just an anonymous as Mr Monro may be now, but they exist, not by names but as a powerful dark photographic reminder of the cruelty of Chilean to Chilean; in other words, you may be nameless, but collectively you are not forgotten and that is due to the overarching forgiveness led by this remarkable woman. After all, her father was killed by Pinochet’s thugs and she and her mother tortured.

Perhaps this memorial will serve the people of Chile and remind them to never abandon democracy again. Never, never. Ask Chileans of the age what they were doing on the 11 September 1973, when the military forces were unleashed on the democratic institution and they know, as well as those of my age know what they were doing when we heard John Kennedy was assassinated.

On the surface, Chile is now a stable country with a reasonable economy, the most robust in South America. Some may say its economy is built on copper, but Chile is increasingly diversified. Santiago could even be a Spanish speaking Australia city if it was not for the appalling slums that litter its outskirts.

But what of the forces behind the public face of the Chilean coup and the lugubrious Augusto Pinochet on 11 September 1973, during which the legitimate President, Salvatore Allende, was probably assassinated? That ghastly horn-rimmed Kissinger and his President Nixon, who also gave us the Killing Fields of Cambodia; only worth remembering for the cold-blooded approach to their fellow humans.

Unlike Michelle Bachelet who has gone some way towards rectifying one of the injustices they perpetrated.

Pain 

Opium poppies, northern Tasmania

One of the most unexpected sights is driving around northern Tasmania in early summer is seeing field after field of opium poppies with their delicate pale mauve flowers giving such an innocent touch to the sinister drug industry which is dependent on its supply from this one of few legal areas for opium cultivation.

I am not one to unnecessarily applaud anyone, but I do applaud the Chief Medical Officer, Brendan Murphy, for sending out 5,000 letters to doctors who have a profile of high prescription of opioids. That letter elicited the usual aggrieved response, particularly as it was sent to so many doctors. The problem with many doctors, even in a climate of increasing peer review, is this natural reaction to being questioned on “infallibility”.

Even if the letters implicate those who have a legitimate excuse, it should flush out those who are just drug dealers with a medical degree. Let us get one matter straight, this letter relates to chronic usage – not acute usage. There are times when complaints have been made of the under usage of such drugs where the need is acute.

I well remember the country doctor who was well known to government for over-servicing which, among other misdemeanours, involved handing out opioid prescriptions. When this particular doctor died, his funeral procession through the town streets was lined by grateful dependent patients. It was an ironic way to end one’s days, with a town, which had become addicted to this one doctor.

I hope that the Murphy initiative ends with a marked decline in the chronic prescription of opioids – it is a strange state of affairs that doctors are reportedly suddenly afraid to prescribe opioids because of the letter rather than fearlessly continue to exert their clinical judgement as to whether opioid use in a patient are justified.

For my part I have an auto-immune disease in which pain has figured so prominently that I was taking the maximum dose of paracetamol each day and counting the hours until my next dose. However, I eschewed opioids because of the fact that I feared addiction, given how long I would gave to take them. Just hankering for my next paracetamol tablets was warning enough. I survived the time without resorting to opioid, and fortunately my need for analgesia has abated.

It was interesting to note that the recommended maximum dose of paracetamol in the USA is lower than in Australia. I wonder whether this had any effect on its use and the substitution to opioids.

The other problem is exemplified by the woman who claims to have been prescribed opioids for 25 years for pain and now her prescription base has dried up. I make no judgement on any individual case but it is not difficult to hypothesise that there is a cohort of people who have become addicted because of doctors, who act as drug dealers rather than as medical practitioners.

I do hope that Dr Murphy’s action will lead to this cohort of medical practitioners being exposed and appropriate action taken. The medical profession will be well rid of them.

In the USA, as usual with the vigilante approach long after the wrong has happened, they are lynching the drug companies without solving the problem. The drug addicts are there; the overdoses are there. Making the drug companies pay does not solve the problem. However, when combined with an initiative such as being prosecuted by Murphy, it just may work. Keep it up, Doctor so that its success will be celebrated as part of Murphy’s lore.

Where do we go from here?

The ABC has produced a four part series Old People’s Home for 4 Year Olds; it is modeled in some degree on a BBC series of the same name.

Lucy Mangan wrote in the Guardian about the BBC version (sic):  The show continues to tread the fine line between heart and sentimentality, between reporting on measures involving vulnerable groups without patronising them … and that at the very least the sociological gubbins should be let fade into the background instead of the makers trying to paint a scientific gloss on the commonsense appreciation that anyone’s mood, mobility and memory will improve if you throw activities, new experiences, a few highly supervised hours with some charming infants and the money to pay for it all at them.

I am somewhat uneasy at the sight of four year olds being led into an old people’s home to play with the residents. To me, the children could just as well be going to the zoo. These are strange creatures to the very young; and the carefully depicted interaction predictably elicited parental clucks by the commentariat at the wonder of it all. Annabel Crabbe is the ideal presenter.

However, where is it all leading after the cameras are turned off and the academics drift away to write their papers? The numbers participating are few and given that the camera cannot be a continuous record but one determined by the selectivity of the director, then the temptation is to have the cutest cuts and leave out the scenes that do not correspond to the producer’s definition of bliss.

There have been other experiments, such as the Seattle one where a preschool was placed in an old people’s home. It has been locally successful if one can believe the reports. However, it is just one example; but what does a policy maker do with such a project to make it generalisable? The other factor is the enthusiasm of those who initiated the transfer of concept to action. They have a vested interest in making it work, but times change, enthusiasm wanes. These sort of projects need a wider support base not only to be sustainable but more importantly generalisable.

The actual conduct of the operation probably requires a high level of supervision, because one is dealing with the interaction of two groups where there is both dependence and yet a high level of unpredictability. One group will soon move to another age group and perhaps will be left with a positive view, while the other group are about to die and leave their trace on a filmed archive only.

I remember when I was a small boy and following my father as he went around a ward full of war veterans. At one bed while my father saw other patients I got talking to a patient – a soldier. He was friendly and he talked so that I understood what his life had been, without any sense of self-pity. I remember saying I would see him next week. He smiled, called me “Blue” and patted my arm.

Later, (I cannot remember the time gap) I came back with my father and went straight to his bed. I don’t remember whether it was empty or if there was another person in the bed. However when I asked about “my friend”, the reply came back that he had died. I could not believe it. I think it was my first experience of loss. Whether this was experienced by any of the children in this “experiment”, coming back to see one of the old people only to find they have died. For me the memory has stayed tucked away for years.

Why do you tell stories as you get older? Nostalgia is the province of the elderly and the benefit of this type of interaction is that the elderly have an audience – admittedly a very fleeting, easily distracted audience to which to tell your tale. Perhaps in the end the ability of old people to tell a tale where the audience still has the flush of wonderment is a good thing. But loneliness is a 24-hour experience.

However, if the attempt of mixing the groups is just voyeuristic – “been there; done that”; then I believe the makers of this series have probably done a disservice to all involved if nothing further eventuates.

Old age is an increasing societal challenge. It should not be just a case of waste management. Yet I fear that is happening – and David Attenborough-like explorations of human foibles and cuteness should not replace serious consideration of what can be done.

The clue is in the series – get the elderly to tell their stories, whether they have a four year old audience or not. After all, it gives you a sense of relevance, even when you may be the only one listening. However even one child listening and responding with questions is a bonus. After all, I believe we are all storytellers.

Mouse whisper

I don’t know what I will be able to squeal and the Press to write once they silence Trump, but this quote from the New York Times has a degree of murine richness. And I thus thank Mr Krugman for the quote.

At that point you might expect an intervention from the grown ups in the room – but there aren’t any. In any other administration the Treasury Secretary Steven Mnuchin, a.k.a. the Lego Batman guy, would be considered a ridiculous figure; these days, however, he’s as close as we get to a voice of economic rationality. But whenever he tries to talk sense, as he apparently did over the issue of currency manipulation by the Chinese, he gets overruled.

Protectionism is bad; erratic protectionism, imposed by an unstable leader with an insecure ego, is worse. But that’s what we’ll have as long as Trump remains in office.

Modest Expectations Too

Ron Lord

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

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

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

Can I jump puddles alone?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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