Modest Expectations – My God, not Des Clarke’s Son

There is one thing about the configuration of hotel/motel rooms. Much is made of the fact that “accessible” rooms are routinely part of a hotel’s room complement – but what does this really mean? When people think of disabled, they recognise that the signage for disability is the wheelchair. However, there is another level of disability which, on occasions, may require a wheelchair – it now tends to be described as “ambulant”, although that seems to only apply to bathroom doors.  When I need a wheelchair, I use one that can be borrowed. This is sufficient. I can manage on two sticks, even with my balance problems.

But back to those accessible rooms. Bathroom/toilet facilities need to be user friendly. Wheelchair friendly facilities must have sufficient space and most disabled facilities recognise the need to eliminate steps.  Nevertheless, many of these are not appropriately designed for the disabled who use sticks or crutches unless there are sufficient railings to assist navigating a wet floor, where sticks are liable to slip as one tries to walk on the cracks between the tiles to avoid sliding The criteria for accessible rooms definitely need to include non-slip-when-wet tiles.

What is also not factored in are the beds, which need to provide a safe place to site and reasonable ability to get out the bed. I use carer help, or else a chair located next to the bed to wrestle myself up. The mechanics are deceptively simple to assist sitting up and swinging legs over. The height of the bed should be related to the height of the person so ideally the height should be adjustable, particularly as modern beds seem designed for an accompanying ladder. The modern hospital may be the template. Hospital beds have a feature that makes them more appropriate, high-low functionality. The user can raise and lower the bed vertically, making a hospital bed ideal for people like myself, who need more assistance when getting in or out of bed.

The other issue is the inappropriateness of the chairs provided in most hotel/motel rooms – often rickety hard backed chairs or ludicrously low armchairs. Even rooms that purport to have a work desk rarely have a suitable chair on wheels. From my point of view, a decent office chair makes life much easier and I suspect for others, avoiding having to push a normal chair back and forth from a desk would be welcome.

It may be said that I am speaking from the viewpoint of a rara avis, but does anyone know? An ideal disabled room should incorporate some of the suggestions discussed above, and it would be useful to convene a working party to set the standard.

Considerations of Some Matters

Some years ago, we visited the first ghetto in the world which is located in Venice. When it was constructed to house the city’s Jews, the gates were locked at night, emphasising its quasi-prison conditions. The ghetto is far from the centre of Venice. Apart from a gaggle of Chinese tourists, the ghetto square was empty save for a Jewish family enjoying the balmy sunny day, sitting under a tree. The only jarring note was the bulletproof door to The Holocaust Museum. We did not go in. I had seen the gruesome museum in the old Gestapo headquarters in Berlin. One Holocaust Museum is enough. Pity, the Israeli government seems not to have seen it lately.

In any event we had eaten a delightful kosher lunch marred by the officious surliness of the staff. Quite obviously, non-Jews were not particularly welcome, even if we did have an inkling of the food taboos.

Reflecting on that I wonder when the world will be able to bask on the shores of the Gaza Riviera. Maybe without gates to lock the Israelis out.

The above were just a few introductory thoughts if you wish to read on.

Avraham Stern – who split from the Irgun to form the Lehi (also known as Stern Gang) in 1940 – had suggested securing support from the Third Reich.

Haaretz adds that Lehi representatives met with an official from the German Foreign Ministry in Beirut at the end of 1940.

“The establishment of the historical Jewish state on a totalitarian national basis, in an alliance relationship with the German Reich, is compatible with the preservation of German power,” the newspaper cites the Israeli document as saying. The Cradle, June 2023 (a journalist-driven American publication founded in 2021 covering “West Asia voices not heard in the world’s English-language media. That’s not the only differentiator. Not owned by any donors, and so they have no say over what is written or not.”)

Q: True or False? 

On April 19, 1943, the Warsaw ghetto uprising began after German troops and police entered the ghetto to deport its surviving inhabitants. About 700 young Jewish fighters fought the heavily armed and well-trained Germans. The ghetto fighters were able to hold out for nearly a month, but on May 16, 1943, the revolt ended. The Germans had slowly crushed the resistance. 

The SS and police captured approximately 42,000 Warsaw ghetto survivors during the uprising. They sent these people to forced labor camps and the Majdanek concentration camps. The SS and police sent another 7,000 people to the Treblinka killing center. At least 7,000 Jews died while fighting or in hiding in the ghetto. Only a few of the resistance fighters succeeded in escaping from the ghetto. – Holocaust Encyclopaedia.

Q: Tell me why the current Gaza situation is different from Warsaw?

The attendees hadn’t expected a policy shift from the meeting, according to the accounts, but felt confident that their concerns would be conveyed to Biden, to be taken into consideration in his public remarks about Palestinians. Two days later, the President made the comments questioning the accuracy of Palestinian casualties at a time when Arabic-language TV channels were showing nonstop footage of lifeless, dust-covered children being pulled from the rubble after Israeli strikes. –Washington Post

Could someone tell me why Israelis are viewed as more truthful than the Palestinians?

The Venetian Ghetto was the first ghetto instituted in 1516 by decree of the then Doge Leonardo Loredan and the Venetian Senate. It would be ironic if, by his actions in Gaza, Netanyahu emulates the Doge, albeit for a different reason, reviving the ghetto so that every Jew, whether Zionist or not, is worldwide forced to live in armed enclaves for their own protection.

When the Gunman Comes to Town

The following is from the Boston Globe response to an edited account of the mass shooting in Maine. I have spent some glorious times in Maine, although I have never been to Lewiston as far as I can remember.

Mass shootings are a rarity in Australia although I well remember the Port Arthur massacre in 1996 when 35 people were killed. I was one of the few who saw the police film of the horrific aftermath, a coloured grainy film. It was a time when I had just stepped down as President of the Australasian Faculty of Public Medicine, and my successor strongly supported our Prime Minister’s response, which inter alia resulted in banning semi-automatic and pump action shotguns, without good reason. While there were concessions to the rural lobby, there were restrictions which, despite some high-profile shootings since, have seen deaths due to firearms decrease.

Nevertheless, what is interesting about this Boston Globe article is the description of the emergency medical response, given most of the shooting victims were dead. Those injured are not as newsworthy, given the concentration on the event and the number dead. How much of the response of Maine health professionals is applicable to the Australian situation?

Dr. Sheldon Stevenson was at home hosting 10 fellow emergency physicians when the call came in Wednesday night around 7:30. Colleagues at his hospital, Central Maine Medical Center in Lewiston, were resuscitating a gunshot victim. More were on the way.

Stevenson, the hospital’s chief of emergency medicine, had been expecting this call to come one day; mass shootings had grown far too common.

With scarcely a word, the doctors stood up and decided who would stay behind and take over for the others the next morning. The rest sped the roughly 35 miles from his Portland home to the hospital.

Meanwhile, chief executive Steven G. Littleson and chief nursing officer Kris Chaisson had already fielded similar calls. There was an active shooter, and the local emergency dispatch center had activated “code triage,” alerting everyone at the medical center that a disaster was unfolding.

As the hospital braced for what would prove to be its worst disaster ever, the staff knew what they had to do, but knew little of what they might face. Ambulance crews were reporting possibly 15 to 20 victims from two shooting sites. But the gunman was at large, and there was talk of as many as five or six additional sites, possibly waves of patients streaming in all night.

Alerted by the code triage, doctors, nurses, respiratory therapists, support personnel, about 20 to 30 people in all, assembled in the ER within minutes. As word spread throughout the medical community, the emergency room filled with 100 people ready to help. Blood supplies arrived from other hospitals. Five helicopters were parked outside, ready to transport victims across the region.

The first gunshot patient arrived at 7:24 p.m. Thirteen more would stream in over the next 45 minutes — many more severely injured patients than the hospital had ever seen at once.

By the time Chaisson, the nursing chief, got to the emergency department, four shooting victims were being assessed in the trauma bays and the ER was filled with “a sea of people.”

“It was an organized chaos,” she said. “There were so many people but they knew exactly what they needed to get done … It was like a work of magic.”

Littleson, the CEO role would coordinate everything that happened next. The hospital was full Wednesday night, its 170 beds occupied, and the emergency room was already busy with the usual crush of 25 to 30 sick patients, including some who were waiting for beds. The staff would have to somehow make room for an untold number of casualties. Patients were moved into holding areas and other available spaces.

“We knew that the patients coming out of the operating room would need critical care. We had to mobilize some of our less critical care patients to other floors, to free up the ICU to take care of these patients,” Chaisson said.

Nine gunshot victims went swiftly to operating rooms — their awful wounds an urgent and obvious diagnosis. Privacy rules prevent a discussion of individual injuries, but Dr. John Alexander, the chief medical officer, named the types of surgeons who worked on them to give an idea: four trauma surgeons, four orthopedic surgeons, a vascular surgeon, a cardiothoracic surgeon, and a urologist.

Stevenson, the emergency chief, said the hospital treats gunshot wounds at least every month. But typically they are from handguns and hunting rifles, involving a single bullet wound.

The wounds he saw this time were an order of magnitude more severe, because the automatic weapon the shooter used sprays people with multiple bullets and shrapnel that rips the flesh. “They’re devastating wounds. Lots of soft tissue injuries, vascular injuries,” he said.

Because patients had been rushed to the hospital, and then into surgery, some were still unidentified two hours later. “That was a very difficult time for the families and for us as well,” he said, but eventually family members were brought inside and the patients identified.

In all, 15 gunshot casualties were taken to hospitals: 14 to Central Maine, and one to St. Mary’s Regional Medical Center, also in Lewiston.

Central Maine discharged two less severely injured patients after treatment on Wednesday night. Another patient was transferred to Maine Medical Center in Portland because the Lewiston hospital didn’t have enough operating rooms. Two died in the emergency department, and one died after surgery at Central Maine.

On Thursday, one surgical patient was discharged to home and another was transferred to Massachusetts General Hospital because of the nature of his injuries. The patients cared for at St. Mary’s and Maine Medical Center were also discharged. Late Friday two more patients were discharged from Central Maine.

That means that, of the 12 injured survivors, five remained hospitalized on Saturday — four at Central Maine (three of them in critical condition) and one in stable condition at Mass General. Staff members had prepared for such an emergency many times, in drills and exercises. Just a month earlier, they’d done a tabletop simulation involving mass casualties.

“People have assigned roles,” said Alexander, who is an emergency physician. “They understood what their roles were. They stepped into those roles and they acted accordingly. They are just incredibly heroic.”

Once it became clear there were no more gunshot patients, the challenge was convincing day-shift nurses to go home, because they would be needed the next day. They took comfort huddling with their teams, and feared leaving the hospital.

“We had to almost push them: ‘You’re still safe. … Let’s get a security escort to your car and let’s try and get you home. You’re safe at home.’”

The next day the hospital was eerily quiet. With the shelter-in-place order in effect, the hospital cancelled surgeries and the emergency room saw just 35 patients all day, compared with 120 on a typical day. By Friday, as the hospital resumed normal operation, clinicians and workers who had been stunned and shocked started processing what had happened. Counsellors were made available throughout the hospital.

“Their training and their skills take over during the event. Emotions and feelings take over afterward,” Littleson said. “The grieving process will now unfold over the next couple of weeks. In some respects, the hard part has just begun.”

Littleson, who used to work at a hospital in New Jersey not far from Manhattan, recalls preparing to receive an influx of patients on 9/11. None arrived because there were so few survivors.

He thought of that when he realized that in Wednesday’s mass shooting, the 18 dead outnumbered the 12 injured survivors.

“The tragedy of this event,” Littleson said, “is that there weren’t more patients to care for.”

I think I know what he meant, but it could have been better said.

It’s Just Dust

When you actually successfully regulate something, so that nobody sees it anymore, your very success is the thing that causes it to emerge again. Because it’s just lost in people’s minds.” Dr Frances Kinnear 

Bernie Banton

Who remembers Bernie Banton? Do you remember David Martin? What did they have in common. They both died of asbestos-induced disease. One, Bernie Banton worked for the industry villain in asbestos – James Hardie – in the 1960s and 1970s.

David Martin

The other was a naval officer who was Governor of NSW until a couple of days before his death from mesothelioma in 1990. He had been exposed to asbestos in the ships on which he served in his long career. The navy was his life, commencing as a midshipman and rising to the rank of rear admiral.

Asbestosis was a vertically integrated disease. By this I mean from the workers in the Colonial Sugar Refinery (CSR) blue asbestos Wittenoom mine, which operated between 1943 and 1965. Here in the Hamersley Ranges, Lang Hancock started his career, in an environment where asbestos fibres are carried by wind and water everywhere, and disturbed by human activities such as walking or driving around the area. 7,000 workers and their wives and children succumbed.

This was the same story with asbestos with its cottonlike appearance, easily pulled apart or packed as insulation throughout buildings until 1984, when the dangers of the material became apparent, and the community gradually come to realise a deadly material lay in the walls of so many buildings built post-war. James Hardie was the major distributor where Banton and his two brothers worked for 20 years.

Then there were the people who worked in an asbestos-riddled environment, as the rear admiral did.

The problem is many employers, in response to public health problems, have sought to obfuscate, refuse to accept responsibility, lobby parliamentarians about loss of jobs and social catastrophe if the use of material is curtailed. Just muddy the waters, bugger the toxicity, until the community pressure through legal redress catches up with the employer’s venality. As was written a decade ago: “The banning of asbestos in 2003 was the culmination of a three-decades long process that got underway in the 1970s through the efforts of workers and their families, health professionals, and researchers” – note the absence of the employers, the big mining companies seemingly doing nothing to improve the situation.

The current furore about the silica-based material, which has become fashionable for kitchen countertops, but in the process of cutting the material to size, creates a silica-laden atmosphere. When I was entering my career as a doctor, silicosis was a major occupational health disease, contracted then by miners and quarry workers. It received so much attention and publicity as a cause of respiratory disease there was no controversy within the health profession as to this association. A major associated problem was that most of workers then were also cigarette smokers; the danger of cigarette smoking was comprehensively exposed by the work of Doll in the 1970s.

In this current scenario, where the culprit is a fashionable kitchen countertop product that is silica held together by resin, one would think that it was a no brainer to ban the product.

As the SMH editorialised this week, The (Safe Work Australia) report (recommending a ban on this stone) was handed to the governments on August 16 but not released until last Friday. Despite the delay, the Minister for Workplace Relations Tony Burke then skirted the issue of a national blanket ban saying it was not reasonable to make a final decision without the public knowing the Safe Work Australian’s recommendations. Burke said a meeting of federal and state work, health and safety ministers would be convened by year’s end to consider the next step.

Mr Burke, who have you been talking to, when the dangers of silica are so well known even before you were a boy? Your response in the media is laughable. Why the delay? Who has been in your ear?

A Fashion Plate at the White House 

At a dinner at the White House on Tuesday, Mr. Biden and first lady Jill Biden presented the Prime Minister with an antique writing desk, designed by an American company in Michigan, the White House said. The first lady gave (Jodie) Haydon a hand-crafted green enamel and diamond necklace.

The NYT covered the Albanese visit by sending its fashion editor.

In amongst all the plaudits, the visit fulfilled all the expectations outlined in my last blog. The Americans laid on the treacly flattery, and characteristically Albanese responded to his swain in the audience while talking at the dinner, by saying it will be all downhill from now on. He may be right, but not for the reason stated.

Biden treated Albanese as anybody would treat a fawning vassal. Let me indicate, as I have before, I am not a great fan of Biden, but watching him in government he gets it right most of the time. Hooded eyes, which mean it is difficult to assess his mood, a flawed man who has spent most of his life in Washington, a man who has grieved far more than most of us, Biden has a residual advantage – that “Pepsodent” smile. I would imagine that if I were in the Albanese shoes, how seductive that would be, especially if I needed a father figure.

The treatment: “Don’t be a naughty boy and play with that kid across the road without telling us. Otherwise, I’ll send you to bed without your banquet.”

Thus, Albanese is lucky – slap on the back, not on the wrist – yet. Depends now on how he navigates China. The removal of tariffs is probably more important than some hypothecated underwater war toy (if ever launched at a time when “AUKUS” has replaced “obsolete” in the Australian vocabulary.)

Albanese is lucky. I surmise this US administration cannot countenance Dutton, especially following the Morrison debacle. However, Trump would be another matter. Yes, it is Halloween this week.

Mouse Whisper

Ever heard about my Andean cousin, the leaf eared mouse. They have been called “extremophiles” Why? Well let the current issue of Science set the scene:

Few places are as inhospitable as the top of Llullaillaco, a 6700-meter volcano on the border between Chile and Argentina.Winds howl nonstop and no plants live there; daytime temperatures never get above freezing and plummet even more come nightfall. Oxygen levels are just 40% of those at sea level, too low for mammals to live there —or so biologists thought until 3 years ago when a research team captured a live leaf-eared mouse at its summit.  

That has proved not to be a fluke as climbers in the high Andes have seen the mouse scurrying across the snow searching for lichens to feed upon.

There you are!  Mice on top of the world.

Modest Expectations – Song of Joy

We are sailing on Le Lapérouse, one of Ponant’s cruise ships, which is on an eight day cruise up the Vietnamese coast, commencing from Ho Chi Minh City. The weather reflects the fact that it is still the rainy season. This Ponant ship was constructed in two parts by VARD, one of the major global designers and shipbuilders of specialised vessels. Headquartered in Ålesund in Norway and with approximately 8,000 employees, VARD operates seven shipbuilding facilities, three in Norway, two in Romania, one in Brazil and one in Vietnam. VARD also develops power and automation systems, deck handling equipment, vessel accommodation, and provides design and engineering services to the global maritime industry.

The hull was constructed in the Romanian city of Tulcea, which is the major settlement on the edge of the Danube Delta, but the ship was outfitted in Norway, and the Scandinavian influence is shown in the clean lines and the light airy fittings which seem to be beech or pine. The trip between Tulcea, through the Danube Delta (predominantly Romania but including the Ukraine and Moldova) to Norway takes three weeks and it was towed by tugboat the whole way. It must be an interesting journey these days to enter the Black Sea towing a partially finished ship. Unless you have been there, you do not appreciate the Delta’s immense size, and stopping off on one the many settlements in the Delta, as I had done on a previous trip down the lower Danube, I learnt that the villagers spoke Ukrainian not Romanian. There is much cultural intermingling.

Le Lapérouse hull, under tow

The ship, as its name suggests, is determinedly French, although curiously it is registered in Mata’Utu, the largest settlement in the Wallis and Futuna Islands, a French territory north of Fiji and west of Samoa.

On the bow of the boat, flutters the Breton flag – nine alternating black and white stripes in the upper left canton of which, in serried rows, there are what look like eleven scarecrows – not the stated description impenetrable in my heraldic illiteracy. The captain of the ship is a Breton.

Before we embarked, we all had to be tested for COVID-19 in Vietnam. I might add it cost around $22 for two of us, whereas when we were tested earlier in the year prior to going to New Zealand, it cost in the region of $120 from one of those “cut-price” pharmacies. Thus, all the passengers who boarded the ship were RAT negative, but on the first day one of the crew was reported to have tested COVID positive and from then on, all the crew wore masks. There were no more positives reported.

The food is mostly French, the wine is French, the chefs are French, the waiters are mostly Filipinos or Indonesian and the sommelier comes from Djibouti. The service is superb, but still there are gangplanks to be negotiated, and tours are for those who can walk over uneven streets and for three nights, there was weather, with “pitching and rolling” in a three metre swell. Nature is there to test not cuddle one. Fortunately, the typhoon in the Philippines was tracking away, but we were still left with strong winds from the north.

Nevertheless, the two cabins for disabled passengers have been outfitted well, with quasi-timber floors, not tiles which are notoriously slippery, irrespective of the vigour of the boat movement. The cabin is spacious, and the shower space has been cleverly designed to accommodate a wheelchair, but not so large that the ambulatory disabled cannot grasp a hand rail.

The passengers are mainly French; there is a smattering of Americans, 18 Russians – and about seven Australians, including a retired nurse from Canberra, who classifies herself a seasoned Ponant traveller having been on four cruises including this one, although this one was more courtesy of an enforced COVID confinement on the previous cruise resulting in credited days on a future cruise.

The large cruise ships have emerged from a period where they were seen as villains in the spread of COVID-19 and that there was something squalid about this form of leisure – the love boat, excessive drinking, a casino and theme park on the water with variety shows, games and boorishness admixed into some forced jolliness.

Ponant is none of these. Perhaps the price deters some and these boats have much smaller numbers of passengers and promises of French chic, personalised service, no herd-driven demand to participate in onboard activities, sensible flexibility in the rules and exotic locations. To what was promised: I would say “yes” to the first four.

The problem with the places where this ship berthed is that they were working ports, and to see the historic and natural sites one had to go well away from the dock for whole day excursions. Perhaps some time in the future Vietnam will have more “cruise ship docks” given the country is looking to develop this area of tourism, together with the massive resort developments taking place along the coastline with its palm fringed beaches. Vietnam has been a preferred holiday destination for both Russians and Chinese tourists, and while the Chinese have developed their own casino resorts they are probably empty at present while China remains effectively locked down. Nevertheless, the long bus excursions from cruise boats would still remain.

Ha Long Bay

I contemplated several and paid for the Ha Long boat excursion, but in the end I suspected the boat transfers may prove too difficult and didn’t go – reports of unstable portable steps more suited to giants and small, rocking boats confirmed it was the right choice. No doubt the huge limestone rocks which dot the Ha Long Bay justify recognition by UNESCO as one of its spectacular World Heritage sites, but not if venturing to see them is more ordeal than being able to appreciate their uniqueness. Fortunately, the view from the “main channel” when you enter the Bay provides sufficient exposure.

To me the challenge was to take a cruise to compensate for several cancelled because of The Virus in 2020. In the intervening two years my level of disability has increased so choice of cabin and activities requires planning.

Among the 94 cabins there were two for the disabled. As I said above, they are so well appointed that they should serve as models for all ships setting aside space for the disabled, so different from the airlines.

However, let me be frank and it may be my own experience, but Asia does not yet do disability well. That is not to say that people do not try and be unfailingly helpful, but they are untrained and nobody in many cases has thought about access nor the needs for showers, toilets and beds to be disabled-friendly. Rooms provided with rails, nonslip floors, chairs – firm enough so that one can get up unaided – a feature that equally applies to the bed.

This is increasingly going to be a challenge to the tourist industry as the number of not only wheelchair bound, but the ambulatory disabled increase – a very fertile ground for the entrepreneur prepared to challenge this whole area of Aids to Daily Living, even on holiday.

Fraser and the Fishing Boats

Fraser was right to claim successive governments did not withstand similar pressures as he had experienced, but he sees these as pressures of hostile and xenophobic anti-refugee community sentiment: the long-term agenda of immigration officials was of greater weight in Australian politics, expressing itself as an insistence on governments and Immigration Ministers. The “mandarins at the border” did not abandon the templates they had developed, and eventually they found future governments who would progressively implement their agenda. During 2010, former Prime Minister John Howard’s Immigration Minister Philip Ruddock would boast about ‘his’ “interlocking suite of measures”.. Philip Ruddock  was referring to policies he brought to the Parliament; yet another view might argue he merely claimed for himself the proposals first tabled at Fraser’s 1979 Cabinet meetings.

(From James Smit, “Malcolm Fraser’s response to ‘commercial’ refugee voyages” p 103) 

Colourful Vietnamese fishing boats ply their trade along the coast. They are the same vessels that sailed with refugees to Australia. Seeing them, I was reminded of the first time I went to Broome. I had booked into the Mangrove Motel which was located on a sandy knoll and from my window I looked onto a forest of mangroves and beyond out to that distinctive azure sea which is the Indian Ocean. The difference between low and high tides can be much as 10 metres. Perched in the mangroves was a beached Vietnamese fishing boat. It was 1979. Over the years whenever I returned the boat was more decayed until there was only a remnant of the keel left.

Yet despite the conclusion reached in a review of Fraser’s contribution, between 1975 and 1982 when he was Prime Minister, 60,000 Vietnamese came to Australia, but only 2,000 who came were identified as “boat people” or “queue jumpers”, as Minister McPhee called them at the time. Most of the refugees came from South Vietnam, some were opponents of the incoming communist regime or had worked for the foreign forces. Those fleeing in the fishing boats still had to negotiate the Indonesian and Philippines archipelago, where they were attacked by pirates, the women raped, and all those on the boat including children murdered. Those who did reach Australia were allowed to stay and were not inhumanely towed out to sea.

The acceptance of these Vietnamese owed much to Whitlam’s ditching of the “White Australia” policy, which had underpinned much of our community attitudes, particularly to non-Europeans, since settlement in 1788.

The end of the 1970s found Vietnam still in turmoil; the concurrent rise of the Khmer Rouge and their Killing fields in Cambodia just aggravated the strife in Indochina in the aftermath of the “American War”. Arising from the criminality of the use of carpet bombing, napalm on villagers, inhumanity spread like fertilizer over the Indochinese countryside. Retribution was often brutal. Yet in Australia, with a blind eye to what was happening in the World, Government has maintained a policy of obstruction of those trying to reach their perceived safe haven, Australia, unless “they played the game”.

The use of the term “queue-jumpers” exemplified this response akin to “chaps, play the game.” Despite all, Australia has a vibrant Vietnamese population, the older generation having given way to a generation born in Australia.

Just like the election of 1966, the conservative party in Australia has been unerring in pushing the “yellow peril” button when in electoral strife. John Howard was, to me, the epitome of the curate’s egg, hard boiled.  The various exercises under his stewardship designed to prevent asylum seekers coming by boat, demonised the people smugglers, and then imprisoned those trying to escape conflict. Their crime? “Not playing the game” was added to the charge sheet.

It was an expensive solution. One source has it that in 2021 the annual cost, per person, to the Australian government of detaining and/or processing refugees and asylum seekers was estimated as follows: almost A$3.4m to hold someone offshore in Nauru or Papua New Guinea; A$362,000 to hold someone in detention in Australia. The deal struck between Cambodia and Australia to take refugees, which was brokered by Morrison, then Immigration Minister, in 2014, ended four years later after the Cambodian government had pocketed A$40m for ten asylum seekers, only one of whom stayed in Cambodia. He was last heard of in 2019 without assistance, a Muslim in a Buddhist country, no access to Cambodian citizenship and forgotten by Australia.

It is easy to tolerate inhumanity when you are shielded from its excesses. The demon is the people smuggler, and so it goes, there is something morally wrong in endeavouring to use whatever means at hand to reach Australia. However, given that Australia was up to doing questionable deals in response to getting rid of asylum seekers at great cost, it would have made more sense to locate an immigration department presence on one of the Indonesian islands and cut the middleman out. Then, perhaps the public disgrace where the Tamil family were treated so appallingly could have been avoided.

At several stages, given that we have an apartment in what was Frydenberg‘s electorate, I contemplated a hunger strike, but given my general health, it would have been futile, but then standing up for something you believe in is essentially an exercise in futility.

I always think of the IRA soldier, Bobby Sands, who died in 1981 aged 27 in the Maze prison, maybe an urban terrorist but a man who believed passionately in a cause for which he was prepared to die. After all, the litany of beatified persons, who died for their belief, forms one of the Christian Church’s traditions. Their images are cast across Christendom and they live on as labels of churches, cathedrals and basilicas.  Plus, you have a particular day in the calendar where people may worship your hallowed name.

But not Bobby Sands.  Misguided … depends on whose perspective – a person who faced his own mortality, but yet has no church in his name. I could not do what he did, with the walls of rationalisation I had constructed to reassure myself.

Anyway, the Tamil family are now happily ensconced back in Biloela, and my gesture perhaps would just have been recorded on a sheet of newspaper in the recycling bin.

Cosmetic or Not

Typically reserved for the rich and famous, cosmetic surgery was, and still is, desired by many women and men, regardless of financial constraints. In today’s world with numerous financing options available, it becomes just a matter of “what would you like to do first?” 

I grew up in an era when plastic surgeons were highly respected. The advances they had made during the World Wars in fact defined the specialty. By definition a plastic surgeon needs to be very skilful, and given the level of disfigurement of some of the war casualties, the surgeons had to be patient, knowing where they were going with each procedure – facing challenges which were then thought insurmountable. Through experience the surgeons improved the outcomes for their patients while also gradually defining the specialty.

Sir Benjamin Rank

Sir Benjamin Rank was the doyen and because of him and his team, Melbourne became respected worldwide as a centre for plastic surgery. I was fortunate in many ways to have known so many of these highly skilled surgeons; one I classified as a friend, another two were in my year of medicine, one made an outstanding contribution in determining the blood supplies to skin and underlying tissue of various parts of the body; the second combined plastic surgery with ophthalmology, a sub-specialty which, even now, is increasingly directed towards improving appearance rather than correcting deformity and extirpation of tumours.

I had a bad car accident in 1981 and among my myriad injuries was one where my chin struck the steering wheel. It had previously been shown when I had any dental work that my bone is very dense. When my chin struck the steering wheel, I sustained a cruciform lesion, suggesting my tissue between steering wheel and jaw imploded. My jaw was not fractured, so although sore, no wiring was required, but my chin was damaged far beyond just stitching up a complicated laceration. It needed plastic surgery.  The tissue which had sagged around my jaw line had to be fixed. Multiple operations and bandaging to help to hold the repaired tissue followed. Meticulous it was; now what remains is a meandering scar on my chin, hardly visible. But it is 41 years since the accident and cosmetically it has stood the test of time.

Thus, cosmetic surgery is not standalone expertise, conjured up without regard to the rules of mainstream plastic surgery. Why these so-called aesthetic surgeons, essentially general practitioners who have created their own tribe, are allowed to practice is probably due to the fact that much of the work lies outside Medicare.

The other myth that these aesthetic surgeons hide behind is that any medically qualified practitioner should be able to undertake the practice of medicine. Is that a full stop? It may have been so, even at the time I graduated, since it was assumed that as a student we were exposed to all aspects of medical practice – here was the leap of logic – and thus were competent. That mantra of see one; do one; teach one …

Prof Mark Ashton

It was a fallacy then and it is a fallacy now. It is appalling that Mark Ashton was harassed by the Health Department after he blew the whistle on the shonky practices, which passed as “cosmetic surgery”. Plastic surgery is all about outcomes. Cosmetic results – yes important, but in the hands of a competent surgeon what would you otherwise expect? At the simplest level this may be just removing a tumour from the skin. However, it is vital to remove all the tumour otherwise more surgery will be required to determine the tumour edge. A competent surgeon gets this right first time to avoid trauma to the patient and additional cost – to either the patient or the taxpayer (and this depends on the results of pathology and whether the lesion proves malignant or not). In my case once, the plastic surgeon did not get the edge, but he was quick to realise that he had not done so, and the additional operation was done efficiently with an excellent result- it has not recurred in 30 years.

I‘m very much a believer that all plastic surgery should be under one set of best practice rules. Those cosmetic surgeons who have learnt the practice involved in creating a temporary illusion that the ageing process can be combatted should abide by the same standards that I would expect from a plastic surgeon undertaking lifesaving rather than lifestyle operations. To me it is so obvious. The dark side of this area of surgery was caught on camera, where the supposed surgeons were engaging in disgusting antics, while performing liposuction. Unbelievable.

The area has been subject to multiple investigations by the media, but the prime response has been the lawyers threatening a class action. However, what of the government and organised medicine?  Most of these cosmetic cowboys join the Australia Medical Association knowing how loath it is to criticise its constituency – or rather to call for a total revamping of the regulating and disciplining agencies.

The scandal of the raid on Professor Ashton shortly after the 60 Minutes TV exposé, by Federal Government regulators, made me think of dark corridors or coffee bars where scuttlebutt is devised, and shock-horror – money can change hands.

If I were Government, I would initiate an investigation into how the raid came about, and just who was the whistleblower. Or was there one?

In the meantime, I would bring the whole practice of plastic surgery including cosmetic surgery under the one regulating body, offer the chair of such a body to Mark Ashton for five years, together with staff including a panel of qualified plastic surgeons to review the competence of all those practising and generally fix this appalling mess. If this means obtaining the Kabuki doll appearance has to be carved out in another country, so be it.

I wonder what Sir Benjamin Rank would have done; but then we live in different times. That does not mean Australia should be inflicted with a class of people – that of incompetent practitioners – in their case laughingly called cosmetic surgeons, should be able to display their incompetence and general disregard for their patients and leave it to the reputable area of the Australian health system to repair. Furthermore, those cosmetic surgeons who are providing competent, quality procedures should welcome such a move.

A good story

The following report appeared this week in the Boston Globe. Why it is a good story is evident, and I realised how little I know. But this article I’m glad I read.

Explorers Bradford Washburn and Robert Bates travelled to the remote Yukon wilderness in 1937 to climb Mount Lucania, but a month of bad weather that preceded their trip had left the Walsh Glacier, the starting point of their expedition, covered in “fathomless” slush and “cut to ribbons by dozens of new crevasses.”

The poor conditions made it impossible to get a flight off the glacier after their climb, so the men hiked more than 100 miles to safety, shedding supplies that would have been too heavy to carry. It was one of the more remarkable survival stories of the past century.

Nestled in the cache they left behind were cameras that Washburn, a renowned photographer, had planned to retrieve a year later but never did.

Instead, a seven-person expedition team recovered the cameras in August, 85 years later and more than 12 miles from where they had been left. The team of explorers announced their discovery last week.

Washburn, who died in 2007, would become one of the world’s top mountaineers, in addition to his work as one of its foremost cartographers. In Boston, he would be known as the man who built the Museum of Science into one of the premier institutions in New England.

The explorers found a portion of one of Washburn’s aerial shutter cameras, a Fairchild F-8. They also recovered two motion-picture cameras with the film loaded, a DeVry “Lunchbox” camera model, and a Bell & Howell Eyemo 71, as well as mountaineering equipment.

Conservators at Parks Canada, which oversees national parks in Canada, are treating the cameras to see if any images can be recovered.

The idea to recover the cameras came from Griffin Post, a professional skier who had learned about the cache while reading a 2002 book about the explorers’ harrowing journey, “Escape from Lucania” by David Roberts.

Post read Washburn’s journals, enlisted the help of scientists, and this year led two expeditions to the glacier in Kluane National Park and Reserve in the northwest corner of Canada in search of the cameras.

“You do all this research, you have all this science-based reasoning, and you think it’s totally possible: We’re going to go in there and look in this certain area, and it’s going to be there,” Post said Saturday. “And then the first time you actually see the valley of the Walsh Glacier and how massive it is and how many crevasses there are, how rugged the terrain is, your heart kind of sinks and you’re kind of like, no way, there’s just so much terrain.”

To find the items, the team enlisted Dorota Medrzycka, a glaciologist who interpreted maps and historical observations of the glacier’s flow to determine where the cache might be. But she could only provide estimates, and the group spent days searching the glacier.

“It would take us the whole day to walk 10 kilometers up glacier and come back to camp,” Medrzycka said. “And going up, there was quite a bit of crevasses, so there was a lot of zigzagging to try to find spots to jump over them.”

The group could not simply return to the spot where Washburn and Bates had left the cameras, because the glacier’s flow had changed the landscape.

Glaciers move at a constant speed from one year to the next, but not the Walsh Glacier, Medrzycka said. Unlike most, it is a surging glacier, which means that every few decades it moves more quickly for a period of a year or two.

In a normal year, the Walsh Glacier typically flows less than 1 meter per day. During the surge, it moves more than 10 meters, or about 32 feet, per day. Since the 1930s, there have been two surges.

Toward the end of the team’s weeklong trip in August, Medrzycka noticed two anomalies in the pattern of the ice, which she guessed had been caused by the surges, and was able to calculate a new estimate about where the items might be.

The revised estimate ended up sending the team to the items the next day.

“Knowing that the educated guess I made actually paid off and was right, it’s a very incredible feeling,” Medrzycka said.

Her findings also provided a new data point about the glacier that will be helpful for researchers.

“We can now better understand the change in the dynamics on Walsh Glacier and potentially be able to better predict how this specific glacier might change in the future,” Medrzycka said.

Whether the surging was tied to climate change was unclear, she said.

Climbers Bradford Washburn (right) and Robert N.H. Bates near the summit of Mount Lucania around July 1937. Until their summiting, Lucania had been the highest unscaled peak in North America.

“This irregular flow, that means that they are not behaving like other glaciers in the region,” Medrzycka said. “It’s difficult to say how much of what happens on Walsh Glacier is related to anything climatic or if it’s just internal behaviour.

The team was backed by Teton Gravity Research, a company that creates media showcasing extreme sports and plans to release a film about the item recovery.

Post said that though it seemed unlikely, he was cautiously optimistic that researchers would be able to recover images from the cameras.

“It was so unlikely to find the cache in the first place after 85 years,” he said. “Yes, it’s unlikely that some of that film is salvageable — but maybe it is.”

Mouse Whisper

The Italians have a phrase “come un ghiro” as in “ho dormito come un ghiro” – I slept like a dormouse, meaning I slept well, which is not surprising given that our dormouse cousins spend up to six months in hibernation. Like the T-Model Ford which could be any colour as long as it was black, dormice are any colour as long as it is Hazel; unless they are of the edible dormouse variety which was a delicacy favoured by the Romans and still persists as a delicacy among the countryfolk of Croatia and Slovenia, where their fat little bodies cooked are supposed to rival squirrel in their greasiness.

Oh, and you can tell a dormouse from a rat because the dormouse has a furry tail whereas the rat has a scaly tail. Just thought you’d like to know, if you’re looking to put one in your teapot to cook and mistaking cousin rat for one of them … just joking.

The dormouse’s head may have been in the teapot, but John Tenniel ensured the furry tail remained visible.

Modest Expectations – Lionel Messi

The recent visit of the Prime Minister to Makassar in the Sulawesi, reminded us of the links of the Makassan traders with the northern Aboriginal people well before European discovery. It is a neglected area in the study of the cultural influence of these people.  Thus, I thought it interesting to reproduce below a bark painting which I bought some years ago on Mornington Island in the Gulf of Carpentaria. You be the judge of the cultural influences at play in this painting. 

In a tortuous vein

I had a pleasant surprise the other day. This is a lesson in clinging onto a view of what you think you know, and what is in fact reality. You may be dying, but you think tomorrow you will be better. I was reminded of the time leading up to the diagnosis of my underlying disease nine years ago. There was a delay in instituting therapy, and I was largely to blame – but not totally.

This time, my legs have been beset by increasing peripheral oedema, two swollen angry red calves and feet, compounded by the sub-fascial swelling on the soles of my feet.

Overnight, the swelling has always decreased, but the level of that reduction in oedema has slowed since the start of the pandemic because of weight increase and closure of hydrotherapy facilities. I dislike exercise especially if it is painful. Hydrotherapy provided a relief from the pain. My legs began to become more and more oedematous. Nobody offered the panacea I was looking for.

Over this period, there had been mention of vascular specialists and compression stockings but, as I now realise, I need for those who advise me to be assertive and not be ambivalent. The latter gives me an excuse for inaction.

I visit a plastic surgeon, who regularly checks me for skin lesions. I mentioned my legs; and once he saw how bad my legs apparently were, he said he had a vascular surgeon colleague whom I should see urgently.

Nearly ten years ago, it was an orthopaedic surgeon who looked at me, ordered tests, and by the next Monday, due to a fortuitous cancellation, I was able to see a consultant rheumatologist, who immediately confirmed the diagnosis the orthopaedic surgeon had considered, but which had been missed by a variety of other doctors. I might add I had seen another orthopaedic surgeon a week or so before and he offered to replace my knee joint almost immediately without any tests. That is the danger of being referred to a specialist, who may be technically brilliant but would have most certainly have ensured a very stormy post-operative passage for myself.

On this second occasion, it was a Thursday afternoon, and by Monday morning first thing, I had an appointment to see the vascular surgeon.

Now this vascular surgeon is young. He shares a clinic with three others. To the best of my knowledge he is not owned by an American hedge fund. He is actually into the business of helping people, not trading a commodity for financial gain.

Vascular ultrasound image

Under one roof, I had an ultrasound of my lower limbs’ vascular system, a consultation where the specialist did not expect to sit across a desk in a consulting room – inspected, interacted with the allied health professionals, recommended compression stockings. These and the applicator were on hand and my wife was taught the optimal way the stockings should be applied. As she said, looking at me meaningfully, she did read the instructions and watched the video in addition to the initial demonstration.

All in less than two hours – a one-stop shop. We had the compression stockings and the applicator.

Here was a local product where any Medicare benefits paid remained onshore, able to be reinvested. How different to those diagnostic imaging and pathology companies allegedly repatriating Medicare payments overseas.

Over 20 years ago, the Australia Institute in a discussion paper analysed the growth of corporate medicine foreshadowing the decline in standards as the profit motive became the prime driver in health care.

As the growth of corporate medicine grew so did Medicare become the ATM, not only for private entrepreneurs but also for the States, which were up to their filing cabinets in cost-shifting. As many of the purchasers were underwritten by overseas investors, the consequence increasingly will be that Medicare funding, which should remain in Australia, ends up in overseas tax havens.

The problem is that the medical profession has ceded control and hence independence to its corporate masters. As somebody who was involved in the various Inquiries in the regulation of the Medicare Benefits Schedule, I have always regretted that the AMA gave up this privilege, which meant that there was not any regular mechanism to alter the Medicare benefit, which was constantly misrepresented as a fee rather than a financial patient benefit the government provided for payment to the doctor.

During my time at the AMA, the discrepancy between the Medibank (then Medicare) benefit and the fee charged was symbolised by the AMA annual recommended list of medical fees. This was a guide, not an instruction by the AMA. Nevertheless, it maintained a relevance, which has only persisted after the introduction of gap insurance when the private health funds, initially prohibited, were able to re-enter the medical insurance market.

John Deeble, Medicare pioneer

After 1984, when the AMA abandoned the regular fee for Medicare benefit Inquiries, it became a matter for every medical specialty to negotiate for themselves. The problem for some of the medical specialties was a function of what happened following the Nimmo Inquiry in 1969 into health insurance which was that benefit relativities were based on what were the fees charged by each specialty; and these relativities naturally created distortions in the market as technology made a number of items of service much cheaper to perform. In 1977 it was clear that technology advances with automaton replacing manual testing was enabling pathologists to make a bonanza from Medicare payments. This Inquiry into the Pathology Medibank Benefits was the first instance of government intervention into these relativities.

The AMA, through the Inquiries, had effectively maintained control over relativities. It provided a form of “flawed order” even though some of the Medicare benefits were well in excess of the underlying cost of the service while some other areas of the profession had done badly.

Thus, from an exercise where the AMA and the Government were in an edgy if not directly confrontational relationship, then there was none.

As I found out henceforth from the AMA relinquishing its position, it became a matter of having a good cost accountant to negotiate with government. With the growth of technology, while the value of the professional component of the medical service remained important, in some areas of the service there were both a substantial technical and a capital component. The “technical” component includes the cost of the scientists, the technicians, the allied health professionals including nurses required to provide services which were not medical, and “capital”, such as the cost of linear accelerators, MRI facilities and so forth.

Not all capital costs are covered. For instance, disposables were inherent in the delivery of the professional component, and not differentiated into any of the other Medicare benefit components. In fact, most of the cost of these has been borne by the hospital. Even now re-usable devices and prostheses lie outside the cost of the service.

Enter the world of the entrepreneurs, more interested in cash flows and profit rather than patient care. Some of the first were medical graduates, like the criminal, the late Geoffrey Edelsten, who gave the whole area a bad name; but it is the multinational companies that have moved behind a wall of cost accounting to dissect the Medicare schedule to exact the greatest profits, and in so doing, to enable Medicare funding to be sent to tax havens overseas.

Some may say how outrageous such a comment is; but the easiest way to deal with Medicare funding is to prohibit any profits that those companies who benefit in any way from exporting those profits.

This vascular surgeon, whose expertise spreads far wider that just advising on varicosities, demonstrated the one-stop shop advantages, which I frankly did not expect, and another fact – you don’t need to run late if you are a doctor.  And you do not need to be a multinational corporation; his rooms were modern and located within a religious hospital.  Good God, on second thoughts, located in a multinational corporation!

Such a thought in no way diminished my satisfaction with the service.

I, the Cryptosexton

I read about this complicated thing called Cryptocurrency. After riding the Algorithm Hobbyhorse around in my Virtual Nursery, I realised that cryptocurrency must be like a bit of barter behind the tog room at school. Hidden from the authority, a packet of Senior Service for two packets of brown Capstan; but not requiring the electrical power requirements of a small city to accompany the transaction.

But this cryptocurrency surely must be more complicated than that, and thus have more benefits.

Apart from plugging cryptocurrency into the cyptocharger, I decided to call it Tulipcoin. I was tempted to use “Lillionarcissus-coin”, which was the name for “tulip” before this Turkish corruption of a Persian word for “turban” was adopted. But that name was too long, would use too much power.

I thought by calling my cryptocurrency after such a famous flower, irrespective of the corruption implicit in the name, I would honour a previous occasion which may have arisen in a crypt.

Jan Breughel the Younger’s view of tulipomania

The whole saga of the tulip bubble was well expressed years ago in the 1999 book “Tulipomania”. The basic cause of the exorbitant prices which the tulip bulb reached in sixteenth century Netherlands was somewhat eccentric. A Flemish merchant found tulip bulbs in a cargo of cloth from Istanbul, thought they were onions, ate most of them and planted the rest.

The resultant blooms were overwhelmingly beautiful and attracted the eye of wealthy Dutch burghers.

The tulip is thus the most captivating of flowers, and like so many products of the Levant, this was the favourite flower of Süleyman the Great, who not only cultivated the wild variety but also initiated the science of breeding hybrids.

Thus when the tulips bloomed, the Dutch, who had the time and were a very wealthy nation due to their trade in the East (the Dutch had a monopoly on nutmeg for instance), were intoxicated by the flower; and the tulip became the signature of these prosperous people.

As was written in Tulipomania: “In 1633, the flowers served no economic purpose other than relieve the cold wet spring with petals that promised a change from the grey mist”.

Initially they were not only desirable but scarce. They attracted gardeners and the few connoisseurs, where scarcity was compounded by the search for perfection. At one stage when a skilled worker could expect 250 guilders in a year, a single tulip bulb was traded for over 5,000 guilders. A small basket was worth more than an Amsterdam mansion. It took three years for the bubble to burst, which it did in a spectacular fashion in 1637.

One of the reasons for this was that many of the tulips had been infected with a virus, which did not necessarily diminish the spectacular colours but certainly lessened the life of each infected bulb. What’s more by that time trading in bulbs had spread throughout the community into every tavern across the country. One of the supposed benefits of cryptocurrency is to be able to bypass “stodgy banks”. Just like being able to buy a cheap TV at the local pub.  But here it was the tulip bulb.

The value of the bulb during this hectic three period provided a way to extricate oneself from, if not poverty, at least to being able to afford a decent house -only if you sold early.  However, given where many of the transactions took place as the author of Tulipomania wrote: “The trade was conducted for the most part in a haze of inebriation.

How appropriate! My Tulipcoin placed into such a market – drunk with power but where the mist has yet to lift?

Reprise

I wrote the following italicised in my blog on 15 January 2021 in a vain attempt to promote Craig Reucassel to stand against Falinski. My sentiments yet have been reflected in the deserved dumping of this Morrison sycophant, despite all the protestations.  Subtly, my choice reveals my deep-seated prejudice, born of over 80 years in a male-dominant world. I suggested that a high-profile male with a formidable record in climate change and waste management should mount the challenge. I discounted the fact that he lived far away in the Sydney inner west.

Dr Sophie Scamps MP

I congratulate Dr Scamps (pronounced Scomps), who has been a high-achieving, very well qualified general practitioner who both lived and practised in the electorate, before successfully challenging Mr Falinski in the recent Federal election. My sense of his vulnerability was correct, but I got the gender of the new Member for MacKellar wrong.

I would suggest one of the New South Wales’ seats held by one of the Trump neophytes would be perfect for him, given that upending Abbott showed the way to do it. Maybe Falinski, whose seat is MacKellar, would be the way to go. Falinski is the typical Liberal Party hack toeing the party line.

As Falinski said in his maiden speech full of the pieties expected:

And so a politician is accountable to their community – I am accountable to you.

Mr Jason Falinski

Wrong, he is beholden to his masters, never voted against any government.  He has a voting record which would please Donald Trump – he should be vulnerable to somebody with the Reucassel values. I would love to see them debate why, for instance, Falinski has inter alia disagreed recently with the proposition:

“The Prime Minister to attend the House by 2 pm Tuesday 8 December to make a statement to advise the House whether Australia is speaking at the Climate Ambition Summit and table any correspondence with the summit organisers relating to whether Australia is speaking at the summit.”

This is but one example, but Falinski’s voting record is reprehensible to any person who is genuinely Liberal.

Reucassel is genuinely concerned with climate change and the world becoming a rubbish dump. He should be elected to Parliament to pursue this goal and hold the government to account.  Falinski seems unwilling to do so. Is it Mitch* Falinski, or is that your second name?

*Mitch stands for that annoying Kentucky Senator, who pleads propriety but unquestionably has supported Trump. Dr Scamps reminded the electorate of the false nature of the so-called moderate Falinski’s voting record.

Janus was an EU Politician with the head of Boris Johnson

As an impotent observer of world affairs, I fret over the ambivalent attitudes of politicians over the fate of Ukraine. Angela Merkel defends her legacy in stalling the entry of Ukraine into NATO by saying that, at the time in 2008, the Ukraine was controlled by a pro-Soviet Government.

The root problem was that most governments wanted Zelensky to disappear into some hedonist exile, and he has proved to be very inconvenient.  He wanted to defend the sovereignty of his nation. Suddenly, the Ukrainians had a leader, an uncompromising charismatic leader who, in a matter of 100 days, has differentiated a country from the neighbouring Russians. The ferocity with which the Ukrainians have responded to the Russian invasion contrasts with the bloodless coup where Russia took Crimea back from the Ukraine eight years ago, and have defined a country, which no matter the outcome will never again be just a “Little Russia”.

Zelensky has thus created that which most Ukrainians have always believed; and that is Ukraine as an independent nation. He has ensured this affirmation occurred in the full glare of the World spotlight.

Putin has been revealed as a primitive hominid intent on destroying the world’s energy and food supply as he dresses up as Peter the Great, an absurd travesty of the human condition.

The New York Review of Books provide a comparison of sorts in critiquing yet another book about Anne Frank. The contention is that if only the same courage epitomised by Zelensky had been on display during the time leading up to Anne Frank’s death in a Nazi concentration camp, she may have survived. As has been pointed out, because of the lack of any ongoing focus on Dutch Jews in particular, she was always in peril.

Anne and her Diary

As part of the analysis, a harsh judgement was made about Queen Wilhelmina in that she failed to stand up to the Nazis and fled to Great Britain. She had maintained Dutch neutrality during WW1; but the only indication of her attitude to the plight of Jews was she insisted a Jewish refugee camp prior to WWII be moved further away from her summer palace than it was originally planned.

The American Government declined to give the Frank family a visa to travel to New York via Cuba in 1941. It provides an unsettling view of a country, with a quick trigger for invading non-European countries, and yet basically ambivalent against European aggressors. President Biden’s halting support of Ukraine could be the USA in early 1941. The Allies did not bomb the railway lines to Auschwitz. A matter of unimportance in the scheme of things!

Russia seemed to have infiltrated the top levels of government, politically, socially, financially, corruptly – a passage facilitated by Trump and scattered within the Conservative Party, those that worship the Infantis Johnson. However, there would not be a country in Europe where the malign Putin influence has not infiltrated.

As a result, maybe NATO could imprint the head of Janus as an emblem in acknowledgement of this influence given the way they have responded to the Russo-Ukrainian War.

Mouse Whisper

I was on a field visit when I heard a regional ABC reporter talking to a local farmer about the cost of a box of cauliflowers. He was selling them for $80 a box.

“What was the usual cost?” she asked.

“About $20 a box.”

“Oh, they’re double the cost then.”

Good to see the ABC is maintaining its standards.

Great value at twice the price, or is that four times?

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 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?