Modest Expectations – Twenty of dark chocolate

Neale Daniher

Neale Daniher is a very brave man. I admire him greatly as the epitome of all that is great about being an Australian. He fully deserves the Order of Australia recently bestowed on him; he also deserves to be invested with it as soon as practical while he can still walk.

For seven years his health has progressively deteriorated. He has motor neurone disease (MND), yet he has maintained a defiance against this progressively incurable disease.  Today, he has almost lost his ability to speak. It is a terrible disease, and I know that when I developed my own disease one of the differential diagnoses, soon discounted thankfully, was MND.

The symbol for what Daniher describes as “The Beast”, with inadvertently or not its Biblical imagery, has been the ice bucket, the ice bath, the ice pool – a plunge in order to raise funds for research.

The problem is that research into the cure for motor neurone disease is at the same level as it was when I was born. Getting nowhere substantially is not restricted to MND.  I have known researchers who have spent their lives trying to develop a malaria vaccine or find a cure for Duchenne’s muscular dystrophy – to no effect. Honourable failures – the dilemma for those seeking more money for such research. That is problem personally I have in contributing money for research into this disease – poor return on investment.

Lou Gehrig

Around the time I was born, a famous baseball player died of amyotrophic lateral sclerosis (ALS), the most common form of motor neurone disease. The disease was given his name, Lou Gehrig. He too was a brave man; a film starring Gary Cooper was made of his life. Lou Gehrig died about three years after the onset when he was only 37 years old in 1941.

Now 80 years on Neale Daniher, in his time a very gifted footballer whose playing days were foreshortened by knee injuries, is dying of the same disease. The onset of his disease was when he was 53. Over seven years survival is testimony to something innate.

Increasingly, auto-immunity is being ascribed as the culprit. Auto-immunity, the tendency of the body to destroy itself when the immune system goes rogue, is the battlefield. It is an area where the disease has been victorious up to now, particularly in the case of this disease, which causes the destruction of the nerve cells that control voluntary muscular movement.

There are a few inconclusive drugs and conservative measures which may prolong life; and as long as Neale Daniher remains optimistic, then his will to live deserves every support. After all, more than 2,000 people have the disease in Australia, and the total cost of therapeutic support per person averages out as $1m. Two are diagnosed every day; two die every day of the disease.

When there is no longer Neale Daniher around fighting against destiny, let us make sure those with this terrible disease do not die alone, paralysed, slowly suffocating. In other words, strengthen palliation, help strengthen family support but do not – I repeat – do not raise false hopes of a cure.

A muddy Saturday

This is a very simple story about a group of University students who, in 1958, won the Juniors Premiership in the Victorian Amateur Football League. It was a time when there was only one university in Victoria and therefore most of the teams that we played reflected the division between “town” and “gown”, even though the diversity of the team list reflected the normal cross-section of society. The only bond between us was a desire to play football and being under 19 we were consigned to the Juniors.

The two adult teams were the University Blacks and Blues, which were in the top grade and produced a number of players for the pinnacle, the then Victorian Football League (VFL) where you got paid. The other University team for those who just wanted a game was the University Reds.

There was a hierarchy; even as 18 year olds there were a few university students who just played VFL. which, in those days, had an Under 19 nursery as well. They were just too good to play amateur football. Many were in fact champions, not just making up the then “twenty”.

There also was the Victorian Football Association which headed a cascade of suburban and country teams where footballers who had had enough of the paltry returns from playing under the then Coulter Law in the VFL, left to play and/or coach a country team. These players would receive a generous wage and were often set up as the licensee of the local pub.

Then there were the “lily-whites” – the amateurs. In the University hierarchy, this was the place where the cohort of youngsters who were not drafted into the Blues and Blacks played. Some went straight into the top teams; some oscillated between the top teams and the Juniors.

Nevertheless, the Juniors won the Grand Final, and three members of our winning team climbed onto the roof of the University Union Building. They were said to be in a jolly state when they climbed up and affixed the Premiership flag. As one said later, they did not know how they managed to climb onto the roof given the ethanol haze that surrounded them. The flag was returned early the next week neatly folded and nothing more was said.

After that year, the team went their various ways, but one person stuck in my mind and obviously the minds of many of the others, who had known him better. He was a few years older than us and had played for the University team. He was always immaculately dressed, with his signature furled umbrella, given the grounds we played on barely afforded any shelter from the Melbourne winter. He was in direct contrast to the coach, Peter Kelliher, who was a knockabout fellow who acted, as all coaches do, with a mixture of encouragement and invective.

Ian Hamilton Munro was different. He was almost the pastoral adviser to the team – a very kind and compassionate man who was always around when you were injured, when you were having a lousy game. He was a counterpoint to the coach – one person I could always picture on the side lines – often a solitary spectator on a windswept oval.

Somebody suggested that, as we approached the 50th anniversary of the Premiership, the survivors of that year should meet annually for lunch. The first, in 2005, was deemed such a success that it was decided we would have one every year, so that has occurred every year, including 2020. This cohort, then in their youthful sixties when the lunches started are now in their eighties. Our coach, having had a stroke a decade before, was an infrequent participant from early into the lunch cycle.  The immaculate Ian Munro was a regular attender, until he fell victim to old age several years ago – and then he too was gone.

Such a small group, men now who are bonded by a football premiership gained so long ago and all accepting their mortality, has now decided to establish the immortality of their achievement and to honour their paterfamilias by donating a cup in his name for annual presentation by the Melbourne University Football Club for an annual match between the now two Melbourne University Juniors teams.

The cup is made from spun brass, silver-plated. It sits on a dark tallowwood plinth around which is collar of silver-plated nickel with enough space to engrave the annual winners for the next 80 years. It was made by the silversmiths and goldsmiths that make the solid gold Melbourne Cup each year for “that race which stops a nation” – the first Tuesday in November; these same trophy makers also create the trophies for the Australian Tennis Open; they are the last such company in existence in Australia.

Munners Cup

Ian Munro might have been embarrassed, like all good generous persons who give much, but never expect recognition. However, he would have liked the enamelled crossed furled umbrellas – one black, one blue – under his name on the trophy – the Munners Cup.

Even to us well aged, he was still always Munners – not Ian Hamilton Munro. However, that name is the cup’s pseudonym inscribed on the reverse side of the plinth. A simple story with hopefully a long nostalgic tail.

Morrison – A Description in One Word

What struck me was the stony-faced Prime Minister who had been persuaded by his Mate, Mat Cormann, to attend a West Coast Eagles match. The boos around the ground when he was introduced were universal. As part of a meet and greet in the morning, he had been persuaded by one of his consigliere, the irrepressible Mr Forrest, to partake in morning PT. It was a more typical photo-opportunity to show off his eminently “daggy” self.

He does not like to be booed. I notice that he has not turned up at any of the football matches in Victoria.

The other fact about the Prime Minister is that he is not that intelligent; yes, smart in the ways of the Molonglo swamp but not particularly well read or thoughtful. Like all people not blessed with any real sense of personal identity, he is totally versed in public relations, and therefore takes the temperature of his quarry – be it Liberal Party pre-selection or Australia before doing anything; hence he leads from the rear.

His problem, and his is not unique in this regard, is to have as the rule of thumb that you never have any Ministers and advisers more intelligent than he is.  The Prime Minister has succeeded in that endeavour, with one exception. That is the recently departed German-Belgian-West Australian, a chameleon of great skill, Mathias Cormann. There is a genus of politician who, when the master rings a bell, will argue without any shame but on cue that black is white – and too many do it persuasively, all the time knowing where the career escalator is located. Cormann has shown himself to be such an engaging man.

Morrison does not brook dissent; he just cannot take it. Part of this is explained by his reliance on a Christian belief system that does not take criticism easily. Much of the Pentecostal beliefs are couched in uncompromising, simple terms, which require no thought but a belief in a literal interpretation of the Bible. This is a Book where the ambiguities of the authors have been reduced to cartoons. His father was one such believer, and here is a person who has been coached in what some would say is a heretical belief system.

Morrison’s trip overseas has been not unexpectedly revealing. The Prime Minister of Singapore, Lee Hsien Loong, gently chided him about his aggression in relation to China; and even in the matter of mask wearing he seemed to guide our uncertain Prime Minister.

The Prime Minister has been hoping to amble the world stage but having been relegated to a landing slot at an airport distant from the G7 meeting it should have warned him at the start. There are no better people than the Poms in insulting one and then being able to smooth it over once everybody recognises that the insult was deliberate, if nuanced.  The perfect word for British diplomacy – nuance!

The daggy “Scomo” image which he believes is the basis of his rural popularity – in Queensland and New South Wales – seems not to have translated as well into International Prime Minister. Here is a guy who not only threw himself at the feet of Trump but has an old friend with connections with the dark side of the web – one of those peddling those conspiratorial beliefs, which are so much of the Trump madness.

If he were to have someone close who is visionary, with ideas that he could sample, then he may not be in his current predicament – and if he did not have an adviser called Stewart.

Biden has proved not to be the doddering front man that some of us wrongly feared, but at the centre of some hard-nosed advisers, who probably worry that Morrison is a security risk – hence the intrusion of Johnson into the Biden-Morrison meeting. It would be a problem for our relations if his words “ritual sex abuse” get wide currency in the corridors of the White House. Can Biden trust that anything he says to Morrison will not appear somewhere as an unacceptable comment?

When Howard extracted special treatment in the Kyoto Protocols for our fossil emissions, the United States owed us for our support in the Bush War Coalition of the Willing; Biden owes Morrison nothing.

In relation to the domestic scene, obviously if your Government’s handout to Big Business is essentially little more than to further enrich, then the recipients of such largesse have every reason to support the current regime. It is not an unusual situation when both sides of politics are compromised, but there is a limit which the community, however rendered compliant by the Virus, will tolerate. Australia sliding into plutocracy is not a pleasant sight.

It is also helpful for Morrison that the Murdoch newspapers’ unceasingly support him, bolstering him in a constituency of flag wavers for fossil fuels and where the environment is being progressively degraded by climate denialists.  For the moment these Murdocistas are spooking the rest of the community.

However, this strange remnant from the Trump days has found the world stage somewhat guarded. As one would have expected, he was greeted in France with all the warmth that the appalling submarine contract with the French can muster. Whatever he may think privately, Macron has been polite; it will be interesting to see if he speaks to Morrison through an interpreter – or in English.  If the first, and from afar hard to know, Macron is maintaining distance so that any communications between the two can be properly interpreted, n’est-ce pas.

Another problem for Morrison is that not all the electorates in Australia are obsessed with maintaining coal mining. There are certain electorates in Queensland and NSW where urgent steps must be taken to transfer the workforce to other industries, not to bolster coal which has to be phased out if the world is to survive beyond the end of this century.

Unfortunately, Australia has a Prime Minister who is only concerned with his re-election, and his only response to climate change and the need to reduce carbon emissions is an underlined word “technology” – as if Technology is a God like Baal to be worshipped not defined. Here a throng of happy clapping followers with arms outstretched towards this Solution and repeating over and over again, “Technology. For thine is the Answer.”

Maybe I’ll wake up and blame all this on something I ate.

Aduhelm 

“I had no sense of where to turn for help, support, or even how to express the diagnosis with family, friends or co-workers. I was lost and crept further inward. There is no single handbook one can read to prepare; each journey is different, each course of the disease takes different, meandering turns—no two are alike, the experts will tell you, an observation that is clearly numbing in so many ways.”

The drug is called Aduhelm. It has just been given the all-clear by America’s Food & Drug Administration (FDA) to be prescribed for people with early Alzheimer’s dementia. As one correspondent said, for many people Alzheimer’s disease has passed through the early stage of memory loss and is not recognised until the cognitive abilities have declined significantly.

The quote above is from Mary, the wife of a journalist, Greg O’Brien who has written On Pluto: Inside the Mind of Alzheimer’s, which follows his own decline from the early onset of the disease. Her cry is clear; and there is no wonder that those families where there is Alzheimer’s disease in their midst want a cure. No wonder that news of a drug with any prospect for improvement will generate clamour for its availability – now.

Much of the excitement generated by this drug is that it is the first since 2003 to show any promise and it has cleared a path through the FDA, not without controversy, which resulted in some members of the committee overseeing its approval resigning in protest. The method of approval has also instilled a feeling of uneasiness in this blogger.

The drug is supposed to attack amyloid-beta, the protein which appears in the nerve tangle of the Alzheimer brain. However, nobody really can say whether it is the amyloid deposits which cause the disease or whether they are waste, the result of a process which leaves this protein functionally inert in the brain. Amyloid disease is one of those differential diagnoses for unexplained disease which my generation of doctors grew to know about and recognised with its distinct histological appearance on staining.

The problem is this drug, which is defined as an amyloid-beta-directed antibody reducing the number of plaques of amyloid, is that the benefits are minimal against its downside.

This is where the drug company, Biogen, which is set to make a “motza”, begins what I call the drug company gavotte. Immaculately arrayed in elaborate steps the gavotte dancers move around in intricate steps, a spectacle of elegant circles, arms waving, legs crossing, all to produce a mannered tableau.

Even the drug company’s paid expert, in a beautifully executed twirl, said the drug “potentially prolongs patients’ independence by several months, even a few years, as demonstrated in long-term study”. She said it is a “stepping stone for our next advances” gracefully executing a series of fluttering steps.

The consumer is transported into a trance, ignoring any side-effects, asking the government to make it universally available. Biogen proposes a charge of USD4,312 per infusion “for a patient of average weight”, or USD56,000 per year.

The Institute for Clinical and Economic Review, in a somewhat bizarre statement, has said Aduhelm should cost no more than USD8,300 per year, given the “insufficient” evidence supporting its benefits in clinical trials.

Dancing the gavotte …

Biogen has defended its pricing strategy, noting that the U.S. dishes out about USD600 billion in direct and indirect costs for the disease that affects roughly six million Americans. Now that is a beautiful sideways gavotte movement by the drug company.

Biogen plans to target between one to two million patients with early onset symptoms, executives said last week. The company, generous to a fault, says it won’t raise the price over the next four years.

It should be noted that this drug can only be given as an infusion in a healthcare facility; and then there are the side effects of brain swelling and bleeding, all factors to be integrated into the patient’s health status, a patient status which is directed only one way – down.

When the gavotte is transferred to Australia, it will be greeted by a solid history of successful lobbying for drugs of questionable benefits. First, there is the special pleading, which is always highly personal as one would expect. Ron Walker, the flamboyant businessman, was an influential example of this in his quest to have an experimental drug, Keytruda included for the treatment of melanoma, of which he was a sufferer. His influence on the then Minister saw the placement of this drug on the Pharmaceutical Benefits Scheme (PBS) for his particular indication at a per patient cost of $4,500 every three weeks for two years.

He achieved his goal; he died in 2018 with the benefit of an average life expectancy increase of 12 months over the cheaper chemotherapy. Not sure about the quality of that life extension. Nevertheless, the drug can now be prescribed to other cancer patients following the largesse of the current Minister, who provides a taxpayer subsidy of $120,000 annually per patient so entitled. Has Ron Walker’s intervention been cost-effective – or just costly?

The drug companies and their shareholders have a different requirement – profit at all costs. Lobbyists hang round drug companies like flies round questionable food, as one of my less than kind associates has said, ever ready to help with selling the product whatever its effectiveness; whatever its cost to the community.

Objectivity is the casualty. Hopefully, the Aduhelm saga will not get to his level, but sometimes I wonder whether governments have lost their sense of smell.

However, the cry from the wife still echoes. Yet will her husband, the author of On Pluto: Inside the Mind of Alzheimer’s, take Aduhelm?

My mind drifts back to Neale Daniher, and the need to ensure that while we wait for a cure the palliative services are not ignored, nor the family, and most importantly, that even the person with lowest profile dies with someone holding his or her hand.

Mouse Whisper

In recognition of my friend from Dalarna, Kyrkomus, I am reminded of Carl Linnaeus, the great Swedish botanist, who sometimes got it wrong. He said that potatoes were poisonous, because he noted that the vegetable was related to deadly nightshade. However, the first woman inducted in 1748 into the Swedish Academy in Sciences, Countess Eva Ekeblad, was so recognised by showing that potatoes were essential in the manufacture of wig powder, and more importantly that cool liquor, aquavit.

Skol!

Countess Eva Ekeblad

Modest Expectations – A Range of Lemon

In 2011, shortly before he became governor of the European Central Bank, Mario Draghi warned fellow Italians that Venice in the 17th century and Amsterdam in the 18th century planted the seeds of their collapse by putting elite privilege ahead of innovation. Corporate Italy can hang on to what is left of its sheen.

To which I would also ask, do you smell the gum leaves of Canberra in that quote?

Draghi then goes on with a quote from “The Leopard”, where Prince Trancedi Falconeri says to his uncle Dom Fabrizio, “If you want things to stay as they are, things will have to change.”

This is the last paragraph from an article published in the October 24th 2020 issue of The Economist about corporate decline in Italy. The article starts with an acknowledgement of that novel by saying, “Few works of literature capture the challenges of managing [societal] decay.

If you read very slowly you might be able to detect that we too have a leopard who has learnt to change his spots at the next leap of leopards passing through the spin of his mind. 

Waiting for Bliss

Last week I came across the word “bliss” – a word little used in these pandemic times, but once linked very firmly with “ignorance”. It is an old English word, and I would ask the readers, when could you genuinely say you had experienced a state of bliss?

What is a state of bliss? The definition varies from person to person. It is not wandering round in a trance; and it is not squatting on the floor and being told to meditate. It is not a set of rosary beads nor a set of bells – some may relate bliss to one or more of the senses – sitting in front of a log fire toasting marshmallows having come in from the icy cold and relaxing in a deep armchair drinking a suitably warmed glass of wine while listening to a the Tallis Singers’ recording of the Allegri’s Miserere. To me that is a suitable caricature of the meaning of bliss. This scenario can be explained in a conscious appeal to all the senses – extreme sensuality on a forgiving cliff face.

For me, bliss has always been unexpected. I was racking my brains trying to overcome the mist of ignorance to work through how many times in my life I have experienced bliss. Twice. Both were unexpected, and one instance came after a night in the Royal Women’s hospital student quarters in Melbourne back in the summer of 1962, and the other in 2002 all’aperto in Vancouver.

In one case I had experienced; and in the other I was waiting – in expectation. In both cases there was a woman involved – one in the past tense, the other in the future.

The summer of 1962 was the year when I just become engaged and where I used to sleep illicitly in the Hospital where my fiancé was doing her obstetrics term as a student. I used to leave the hospital a tick before six am and went over the road to a friend’s flat where he had a spare bed that I could “crash” on before going off for my job. For some reason, my friend was away. He had just finished an architecture degree and maybe it was a job out of town; I don’t remember but I would occasionally run into his cheerful flatmate over Vegemite toast and cup of tea.

This particular morning the sun was streaming into the room in his rented terrace,  a comfortable bed and the record player with George Shearing playing “Folks who live on the Hill”. The album with a young woman with her black dress spread around her, demure smile, looking upwards. Drifting into sleep with this environment, this was bliss, a sense that it could never get better – the recent times provided that core requirement of optimism – the security of such optimism in the past, present and future tense which leads into that bliss, which you want to last forever.

Vancouver

The second time, I was in Vancouver sitting outside, the weather was mild and I could gaze up at the mountains hidden partially by a scarf of sea mist. I was waiting for her to arrive, and the expectation of her arrival gave me that same sense of bliss. I did not sleep or even doze off, but had a very good Coho salmon. The wine was Washington State. That I remember, and unlike my normal approach, I ate very slowly and sipped rather than gulped. The mild temperature, open air, the food, the solitude among a late afternoon drinking mob provided the setting, but overall the expectation of seeing her that sealed the bliss. She was arriving later in evening from the other side of Canada.

Both were in good times, but this very juxtaposition of these two occurrences only has meaning when I paste them with those other vignettes which constitute life, so many of which do not have the same muted delicate colours which bliss has. Bliss is thus rare – at least for myself. I hope that in my last view of human experience I will be able to be full of bliss listening to Shearing playing Kern and Hammerstein, and with that expectation of seeing Her. 

Another time; another Trek

A pool of lotuses

A few weeks ago, my blog charted our eventful course to China in the summer of 1973. The weather was foul in Beijing. There were floods and we were unable to go to the Great Wall as a result, but it was interesting times to be there, given the turbulent period China was going through at the time.  I intend reviewing notes of the visit which are in one of my numerous archive boxes. As with our difficult journey to get there, leaving Beijing was no pool of lotuses either.

Our leaving Beijing when we did, produced one of the great regrets of my life. Unlike Gough, we did not meet Mao Tse Tung, but even though the Gang of Four were then in the ascendency and he was not, Chou en-lai was still a significant figure. The then Maltese Ambassador to China and also the High Commissioner in Australia – he was a shadowy figure but he kept popping up elsewhere – said that if we stayed another day he could arrange for us to see the great man. On reflection, there may have been a discussion with Stephen Fitzgerald, the Australian Ambassador, but my lasting impression was that it was a done deal but for one thing – we were on a tight schedule and on that schedule was a meeting with the Japanese Prime Minister Tanaka. In the scheme of things at the time, the meeting with Chou En-lai could not be fitted in. As I say, I still harbour that regret, to have missed meeting with one of the greatest men of the 20th century.

There was no direct flight from Beijing to Tokyo in 1973. The route would take us in a Chinese Ilyushin, as it turned out to be, to Guangzhou and then by train to Hong Kong, where we would fly to Tokyo. That was the plan, but this trip was one of the unexpected. The fellow travellers included the Chinese women’s volleyball team. That was unexpected; to see all these 1.8 metres tall Chinese women strolling down the aisle of the plane. As I reflected, I had lived in a world of stereotypes, and these young Chinese women were not that.

Then the fun and games started. We were forced to land at the then Henchow, and we were emptied out of the planes. Initially here was no information, and efforts to find out, even trying to contact the Australian Embassy in Beijing were unfruitful. So, all we had to do was wait. The flight crew parked themselves under the wing of the plane to get out of the sun.

The airport was on the outskirts of a village, which makes me think that although they gave us a name, it was not a major hub where we landed. The facilities were rudimentary and after a fruitless endeavour to get through to Beijing, I went for a stroll down to the village. After all, there seemed to be no security, and I had reached its outskirts, when I looked back and there was a soldier carrying a rifle running down the hill. It was clear from his gesturing that I was out of bounds. Although, he was smiling and his demeanour was surprisingly sympathetic to my venture, there were rules; and he escorted me back.

Otherwise, Geoff produced a football from somewhere, so the three of us entertained the few airport staff, the volleyball team who were standing at a distance from us on the tarmac and the aircrew under the wing. There seemed to be a cone of isolation around us.  Nobody ventured near us. Not surprising when we could not speak Mandarin, and there was no Chinese minder travelling with us.

When the ball rolled over to them, it was treated as if it were a bomb. Nevertheless, these three Australians cavorting around in the sun with a strange looking ball had an audience. Geoff had been a champion schoolboy footballer, and Bill Snedden had played competitive football, as I had. Mine had been curtailed not only because of lack of skill but by my need for glasses, and the fact that contact lens technology was very primitive during my playing years. In a tussle to get the ball, Geoff showed the benefit of wide hips when he easily brushed me aside in competing for the ball. Playing on a hot airstrip losing one’s balance on such a surface reminded of the times I used to play sock football in the school’s brick quadrangle. The hands suffered as they hit the bricks.

Eventually three hot, mildly sunburnt blokes were motioned to join the plane. In retrospect, the Leader of Her Majesty’s Opposition, lost in Central China playing kick to kick on a distant tarmac, was a mildly amusing incident but today, a major political figure uncontactable in the wilds of China…well…

As we found later when we arrived in Guangzhou, the delay was due to a storm described as “monsoonal” passing through the city at that time. The air navigation instrumentation then was not equipped to enable any plane to land safely during such a storm.

Being completely “stuffed’, I have very little recollection of the city, except we were parked in a fine old hotel and the climate was subtropical. I remember the chintz curtains, looking out over lush tropical growth – the normal collection of monstera deliciosa and other undergrowth to which I could not put a name.

The next morning we were on the train to Hong Kong, and there were rice fields all along the rail line and the ubiquitous lychee trees in the middle of the fields.

Then we were across the border into Hong Kong, where we met up with Snedden’s wife, Joy, and had a relaxing time there.

I was left with the task of booking the flight to Tokyo. There were three alternatives BOAC, Alitalia and Air India. Given that forelock touching was the order of the day and there were people watching for aberrant republican behaviour, I chose BOAC. When guess what? Alitalia departed on time; BOAC was indefinitely delayed and Air India was about to leave. It was already taxiing out to take off when it was told to come back and pick up four Australians – travelling first class. Well, the revenue boost would have doubled that of the paying customers; there were only about ten others in economy, and it was the time before business class.  Also, it was a time when a country to have its own national airline was all important. Prestige before profit in those days.

We were not late for the meeting with Prime Minister Tanaka.

Backroad out of Ceduna … Where next?

Given my love of Strahan, for many years we have owned a blackwood pole house there; if it were not for the trees we would have a view of Macquarie Harbour. We once had such a view but that has now vanished in an entanglement of blackberry and tea trees. Strangely this tangle disappears down the Esplanade where there is an uninterrupted water view from the ex-mayor’s house.

I have only watched the Backroads show once, when it visited the small Victorian town of Beaufort, so much part of my family life. I thought the program strange, focussing on quirky periphery. This must make good television because the ratings are said to be high and the program receives substantial support from the ABC. It plays to a belief system of the viewers, it doesn’t shock and it gave a view of Beaufort uncluttered by any relevance. Nevertheless, those pictured obviously loved their half-hour of exposure.

At the same time a substantial film, television and book stream about the Australian bush country provides a different picture – a dark foreboding scene, deeply crime-ridden country towns, where there is always some secret which the townsfolk know but won’t tell and where a serial killer stalks the unsuspecting city-slicker. This is a country, the background to horror stories, of empty houses, banging doors, and where you only see the feet and the flashing knife.

I have had the benefit of seeing much of Australia and, looking through the schedule of past episodes of Backroads, I’ve been to most of the towns featured, not just as a tourist but to work, and that has included spending time in Aboriginal communities. Hence, for instance when I watched that extraordinary portrayal of the Aboriginal relationship in the film Samson and Delilah, it was reality, slightly “doctored” but essentially reality – it rang true, not from what I had read or had been told, but what I have seen.

 

Strahan

One of the challenges of being from “aways” is that it is important to blend in while realising that you are a “blow-in” and like all “blow-ins” you know it, they know it and, unlike the Backroads crew, when they pack away the camera, you from “aways” still have to live with the long time residents, and not be there just when the Macquarie Harbour is sparkling and the ocean is calm. The plaques around the foreshore remind of those alive how dangerous the seas are, but that was the risk of earning a living out in the Ocean.

The cinematography of Macquarie Harbour, the Southern Ocean and the accompanying rugged temperate rain forest with encircling mountains is brilliant. North barely seen are the two mountains, Heemskerk and Zeehan, the first 721 metes high, the second 684 metres. Both were seen by Abel Tasman when he sailed these two ships past the mountains in 1642. The mountains bear the names of those two ships; named by Bass and Flinders 1802 while circumnavigating Tasmania.

The Backroads episode provides this glorious perspective of the Wilderness, the Harbour, the Rivers and the Ocean. I agree, fantastic.  I have flown with a mate in his twin-engined Cessna on such a day – from Strahan over the Gordon and Franklin Rivers to the Southeast Cape and then back over the Walls of Jerusalem. Let me say there are not many days which provide the perfect uninterrupted vista without being buffeted around the sky by the powerful winds, because these are the “Roaring Forties” where the storms roll in with the greatest intensity.

“Backroads” has essentially a tourist view of Macquarie Harbour, two of the major rivers the Gordon and the Franklin, and the Southern Ocean. The King River, flowing as it does from Queenstown, being cleansed from metal pollution gets very little mention – maybe 12 years ago when the powerboat was taking people on adrenalin leaching trips up the river, it may have got a mention. But then the seaplane has gone too and the train which runs on the Abt railway gets not a mention, presumably because the engines were being overhauled. Yet that railway among others is essential to the Strahan narrative, otherwise if it were running why ignore the original lifeline after the convict settlement had gone.

Heather Ewart, the presenter, is pictured on the steel ketch “Stormbreaker”, drifting down the Gordon river; Heather Ewart on Sarah Island, a ruined convict settlement full of gore where the tourists are dropped off for a quick exposure to the horror that was; Heather Ewart as a walk-on participant in “The Ship that Was”, a long running sketch about adventurous escaped convicts, staged in a theatre setup on the wharf.

She is there interviewing a couple of young Aboriginal women from “aways” picking up shells on the beach. Mate, there are middens on the West Coast but not there where the full fury of the Ocean storms would have washed them away eons ago. Eventually, the show ends up in the woodworks, but not before we see Bob Brown, the Saviour of the West Coast wilderness and the film clips from that campaign so many years ago; the whales more recently stranded on the Ocean beach, and then for a piece of trivia, a waterskiing event to break some concocted world record for the most water skiers at any one time.  May I say I have never seen waterskiing on the Harbour as a regular activity. It is just too rough.

Picture postcard maybe; emphasis on the Wilderness, the magnificent scenery but except for a short reference to huon piners, not much about Strahan. Strahan does not exist because it is perched on a large, picturesque harbour. It was a port for the mines of Queenstown, on the other side of the West Coast Range – an isolated settlement set in the most beautiful part of Australia. People did not go there to admire the beauty; they went there to work. And the question is why – and why have they stayed?

While the background may be beautiful, the living conditions are harsh – but not the day that Heather Ewart blew in with her entourage. The opportunity missed of how a town has reconciled itself to the need to conserve when the genesis of the township was to exploit Australia. Isn’t that more the dilemma of modern Australia rather than the extent of the line of water skiers on the Harbour?

A hardy, resourceful community which has adapted – that has been my privilege of being a person from “aways” to know Strahan – to experience more than one sunset.

Somebody told me the week before Backroads was about the towns of the Dunmunkle Shire in the Wimmera. Now that is a place I know very well, particularly Minyip. Maybe I will look at what they have done with those townships.

St John’s Lutheran Church, Minyip

Special Pleading?

Let me give this person privacy. However, I have heard of a woman who was in remission from her disease of polymyalgia rheumatica and, having submitted to the AstraZeneca vaccine, promptly got an exacerbation of the disease, which has persisted.

The problem with polymyalgia rheumatica, nobody knows what causes it, whether it is a vasculitis or myopathy. What is known is that it occurs in older age groups and is associated with osteoarthritis and, in a number of cases, with another autoimmune condition, called temporal arteritis – a condition of the artery supplying the temple region. If not treated temporal arteritis can lead to blindness. This is patently a disease of a blood vessel.

Polymyalgia generally resolves by two years after diagnosis, which is complicated by the stealthy onset of the disease. Therefore, the onset is difficult to pinpoint. However, with me it burst out into a florid state of muscle pain, extreme weakness and stiffness of joints. In its untreated state one has the premonition of death, holding onto the basin in the bathroom and seeing the world disappearing from view – but trying not to let go. That is what occurred to me. After seven years the disease is chronic – I shall die with or because of the disease. The more the disease is stimulated by outside influences, the more it will shorten my life.

Treatment is cortisone, and it is in this titration of the amount of cortisone that provides symptomatic relief.  Methotrexate did nothing. Without cortisone, it is simple. I would be dead by now.

In the initial fulminant state, there is in addition to the indicators of infection, an indication that platelet function has been disturbed. In this particular case there was a marked thrombocytosis. Platelet problems are at the heart of the AstraZeneca side effects.

Being on cortisone therapy for over seven years means that adrenal function becomes compromised, well demonstrated when the replacement cortisone  was at point where it could be expected for the home grown cortisone to kick in if there was stress.  My adrenals did not kick in, and I experienced symptoms of hypoadrenalism.

Therefore, living on the edge should not be challenged by a vaccine which has its own problems, even if they are downplayed. Yes, I have had my influenza inoculation for 2021; yes I had my shingles inoculation several years ago. None provide 100 per cent protection; and indeed I have a mild reaction to the influenza inoculation; no pain at the site but a slight feeling of unwellness with upper respiratory symptomatology for several days. Symptomatically, my polymyalgia has got worse.

But then I am a doctor once a medical researcher and public health physician. The soothing words saying “do not worry” are not here crashing on a shore devoid of information. The case can be argued that it would be better to avoid the risk. However, in a country where choice is limited to who you know, well why not ask that I be given the Pfizer vaccine by my public health physician peers.

However, if my request is refused, maybe I will have to consign myself to the line of AstraZeneca injectees, with all the hollow assurances, but knowing that I am especially vulnerable to admittedly rare significant side effects.

If this insistence on AstraZeneca occurs, then I will post a daily message on social media telling everybody 24 hour by 24 hour how well I am going – and for Government “come in spinner.”

The coins are about to be tossed. The chances are of (a) no complications; (b) side-effects with the ultimate government prize of my death; or (c) putting the kip down and allowing me to have the Pfizer vaccine and of course my daily diary of how that vaccine is treating me.

Then of course I could not have the vaccine and die of that wonderful phrase “natural causes”; better than “misadventure”.

Mouse Whisper

I am entering into the world of invention. This invention threatens to take over the world, so they say. It is an American invention. It is a new type of pasta that is sweeping the trattorie of New York. There are 300 different types of pasta and yet for this new one, people have to wait for 12 weeks to get a packet of the new pasta, and then it costs USD18.00 plus postage. It is called “cascatelli” in reference to the Italian word for waterfall.

To me, the ravenous mouse, the pasta resembles a caterpillar, but this pasta is said to be able to capture ragu or vongole jetsam which may be drifting by in the sauce, flooding the pasta dish. This is the secret, opening up the tube and having pincer pasta pseudopodia able to clutch and not to let go of the tidbit onto your shirt (or in my case my mousling bib) but finding the safety of your mouth.

In Australia you can buy similar pasta, where the tube is closed, called creste di gallo – “coxscomb”. This pasta sells for about AUD$5.00.

As The Washington Post reports:

But it is the technology of opening the tube and having the right template that has the culinary world agog.

There’s no wrong sauce for this pasta. Every kind clings like Velcro.

It’s like a Venus fly trap. Anything that goes in there can’t get out.”

The pasta’s marketing materials refer to that grippy-ness as “sauceability.” Alongside “forkability” and “toothsinkability,” these goofy, made-up terms form the inventor, Dan Pashman’s trifecta of ideal pasta characteristics.

Ugh, that is sufficient mangling of the English language – bit like pasta.

 

Modest Expectation – An Apple Once in Paris

Just to put Australia’s lack of flexibility into context, where the AstraZeneca vaccine has been prioritised for vaccinating the population Moderna, as reported below, seems to be leading the pack. Where are we, Mr Morrison? Are you across what is happening, and if you have recently done a deal with Moderna has this advance been factored into the deal? AstraZeneca technology is apparently increasingly obsolete in the face of such coronavirus vaccines.

I remember a different time, when the polio vaccines first came to Australia. I was first injected with the Salk vaccine and then, when the Sabin vaccine arrived, it was able to be administered easily orally because it was a live attenuated virus; the Salk vaccine was quickly jettisoned. But then Australia avoided  political furore; we relied on the medical evidence not the share portfolios of various people in influential places .

Also, Prime Minister there is one statistic which you use to justify the continued use of hotels for quarantine – your “99.99 per cent effective at protecting the community against COVID-19” mantra. However, when the air flows are mixed and internal, the problem of cross infection exists, whereas in the case of the Howard Springs facility the air flow is to the outside, with little or no chance of a compromised airflow. Thank God it is only that tiny percentage, Prime Minister. That causes enough chaos as we are now seeing in Victoria, without tempting Fate any further. This is where the use of data only shows what a catastrophic situation it would be if the effectiveness was any lower.

But let’s hear what the CEO of Moderna, based as it is in the Boston area, had to say about its advance, as reported in The Boston Globe, and draw your own conclusions.

Moderna’s chief executive on Wednesday discussed the biotech’s progress in developing a booster shot against COVID-19 variants, saying the company hopes to have authorization from the Food and Drug Administration on one of three booster strategies by the end of the summer or early fall.

Stéphane Bancel said Moderna is working on three different options for a single-dose booster shot against variants of concern: the current vaccine, a new variant-specific vaccine, and a 50/50 mix of the two.

Moderna last week shared early study results that showed its first two options — the current vaccine at half the dosage and a shot of its reworked vaccine — both appeared to raise antibody levels against variants that first emerged in South Africa and Brazil. Bancel said the company is expecting to receive data on the third booster strategy in the coming weeks.

“And then we’ll work with the FDA to get the safe and effective variant-specific booster to the American people as fast as we can,” he added.

The data showed that Moderna’s current vaccine “looks good” in protecting against variants, Bancel said, but the reworked vaccine tailored to fight off newer strains of the virus “looks stronger” against the B.1.351 variant first identified in South Africa.

Bancel said it’s “not impossible” that a booster could be ready for the fall for people who were vaccinated against COVID-19 in December 2020 or early January, especially for high-risk groups.

“When we have that data [on the third booster strategy] in the clinic, we will pick which one we’ll take for authorization,” Bancel said. “We’re hoping that toward the end of the summer or early fall, we should be able, if the data is good, to have authorization for a boost to be used in the fall to protect all of us so that we can have a good fall and a next good winter.”

Bancel also said the company is working with federal officials to test “the mixing of vaccines,” ensuring that regardless of which vaccine a person initially received, it will be safe for them to get Moderna’s booster shot.

“We shared last Wednesday news that the Moderna vaccine in the 12 to 17 years of age has 96 percent efficacy,” Bancel said. “The safety profile is like what we saw for the adults, and we’re working with the FDA to get the vaccine authorized as soon as we can.”

Moderna is continuing to study its vaccine for children 6 months to 11 years old, Bancel said, and that data is expected to take a few more months.

“We have to go very slow down in age to ensure the safety of the children,” Bancel said. “And we’re also starting at the lower dose, because given their lower weight, we might need to lower the dose for children. But for the teens, it will be the exact same dose, which will help the distribution of a vaccine.”

And also….

Under the heading “Breaking Alert”, The Boston Globe publishes the ongoing COVID-19 situation. An example is reprinted below.

The death toll from confirmed coronavirus cases in Massachusetts rose by 19 to 17,413, the Department of Public Health reported Monday. The number of confirmed cases climbed by 281, bringing the total to 657,119.

The number of coronavirus vaccinations administered rose by 25,904 to 7,168,399, state officials reported.

As the population of Massachusetts is about 6.3 million, and about 20 per cent are under 15, it means that many of the residents are being given their second injection of an mRNA vaccine.

Every day, the NYT has a comprehensive list of the data down to county level. Where can you obtain such data published daily in Australia, in relation to vaccination?

Casey Briggs, Master of Clarity

When the pandemic was rife in Australia we could follow its course every day with the ABC’s Casey Briggs, whose clear informative manner showed Mr Briggs as The Master of Mathematics; to which he could as well have added The Master of Clarity.

He could report vaccination levels in the same manner on a daily manner if the data were available.

Only criminal idiots would want to the fiddle the supply demand relationship by manipulating the data for so-called political advantage.

You may never recover

This is the only comment I shall make about the Princes. I sympathise deeply and know that probably their relationship, in whichever way it existed after their mother was killed, may one day be repaired to the extent that they do remain civil towards one another.  I suspect the attitudes of their wives in this is vitally important.

A loving mother taken from teenage sons in the presence of an inadequate father – undoubtedly a good man but because of his own stunted upbringing with an inability to show compassion – is very familiar.

Genuine compassion is something one recognises when you yourself lack it. People may try and manufacture compassion, but fail because it is an inherent attribute, just like a sense of humour. Most of those who are afflicted with the combination of loss of a loving mother, the inability to ever come to terms with the wakening nightmare of your last glimpse of her, coupled with the attempts by the remaining father to fill the void and failing, who then eventually gives up, marries again and gradually become to you an irrelevance.  Onwards into an adulthood for which you are ill prepared and then you have to muddle through life in a cloud of unforgiveness, episodic self-pity and destructive fury.

A Sisyphean existence?

Occasionally, in among the circumstance of life with a variable dollop of pomp added, you may do something worthwhile. But for what? Your other life upon which the flashlight is never dimmed, wherever you try to escape, always haunts. For those for whom compassion does not pay, there is a delight in having all your trespasses laid bare, yet as those who trespass against you seek justification in hypocritical comment only, which encourages you to further trespass. A Sisyphean existence?

Alas, poor Harry, I knew him well.

Is anybody listening?

The three articles on China published last week in the AFR are almost like the last hurrah from one of the most insightful and level-headed journalists still living. Max Suich is one of those people who has lived a long and varied life; and his reflections on the current state of play in China draws upon his own views and those of a number of his contemporaries, and their apprehension about the course of current Sino-Australian relations.

This trilogy commences with reference to the world conditions when the AFR was started 70 years ago. It was not long after that I was on a cargo boat in the South China Sea in sight of one of the disputed islands of Matsu and Quemoy, tiny National Chinese outposts close to the mainland and Communist China. It was a time when the Chiang Kai-shek regime in the island of Formosa was seen as the legitimate representative of China in the United Nations.  How fanciful that appears now, but then as we crossed the South China Sea, we were buzzed by American Starfighters which swooped out of the clouds and came over the ship just above mast height – twice.

Bloody hell, was it necessary to demonstrate to a small ship carrying wool and grain to Japan how powerful America was? The power equation certainly has shifted over the past decades in the Southern China Sea. American planes intimidating ships close to the Chinese shore in 2021 – I don’t think so – unless America was on war footing.

As for Australia: The conclusion is that while we dramatically changed our approach, we did not define a policy objective for the new relationship with China or a strategy to achieve it. Nor did we thoroughly review alternative options. We elevated anger about Chinese activities in Australia and latent ministerial hostility towards China, turning threadbare slogans into policy. Traditional measured, thoughtful policy-making in an area of such great importance is lost.

Thus spake Suich. He sets out his conclusion succinctly and directly on the first page of his trilogy. He then spends much of the rest justifying the conclusion, which is more a thesis. He had come to that conclusion as the anti-Chinese forces in this country were emboldened by Trump’s antics. No matter how Turnbull may want to re-write history he should share the opprobrium which Max dishes out.

We have no hedge – we are “all the way with the USA” but what if the USA is not there? How does our military, naval and air force stack up, in the face of an aggressive China? Not much, is his assessment. Australia is vulnerable especially, as he pointed out, Pine Gap would be an early target for any Sino-American conflict. Therefore, whether or not America proved to be a steadfast ally, part of any war strategy in this part of the World would be to knock out Pine Gap, inevitably leading Australia being locked into the conflict.

Max Suich has dissected the Australian government approach into three phases, “push back, call out, out in front”. The three stage approach typifies a crude approach to the reality where the right wing infiltrate in the intelligence always inflates the danger in order to maintain their relevance to government. Max quoted one still serving official – “without Trump the hawks would not have the mode to develop their own insane line that we had no choice but to divert trade flows and supply chains.”

As he goes on to write, the John Howard approach twenty years ago “we don’t have to choose” between America and China has been dumped, but echoing experienced advice there was no way that Australia, with its limited defence forces, could possibly back up its bellicose rhetoric. In fact, as Turnbull has written in his recent opus, Australia has to be careful where its warships sail in Asian waters because there is no doubt that the Chinese are watching. The Americans may have the power to extricate a ship which ventures too close, but Australia by itself does not.

Nevertheless, paranoia is fanned by the idea that the Chinese government is penetrating the Australia community and in particular the Chinese diaspora. Such investigation of this has only yielded Sam Dastyari who, despite his indiscretion, still seems to be involved in the sensitive vaccine rollout. There was all that flurry around Gladys Liu, the Coalition member for Chisholm, because of her apparent ties in China, but that seems to have dropped off the intelligence schedule and is not mentioned by Max anywhere in the article.

The Government seems not to be bothered by the experience of South Korea where, earlier in the last decade, it experienced a Chinese trade freeze. Yet for all the bravado, the articles note three forces operating currently in our dealings with China. The alienation from China has been aggravated, as he points out, by the circumstances of the COVID-19 virus first being seen in Wuhan and the subsequent lack of co-operation by the Chinese in the investigation of its genesis, where one of the major cheerleaders for the investigation has been Australia.

The first force is the feeling of being abandoned, and if one delves into the history of the ANZUS pact, it was constructed originally against the wishes of the State Department in Washington – the nightmare of “Washington not picking up the phone.”   Then the rise of Xi Jin Ping, who has disturbed the comfortable trading arrangement that some Australians had built up with various Chinese businesses. The impression of a free enterprise economy able to exist under a one-party system was brought to a halt by Xi .

Max recognises that Xi’s assertiveness and his expansionary vision for China as a truly Pacific maritime power was another impetus for the rise  in Australia of the intelligence community influence and their political hawks on both sides of the parliamentary aisles. Any moderating influence of DFAT is seemingly ignored and Max quotes Foreign Minister Payne going it alone on the Wuhan inspectors seeking answers on the Wuhan connection with the virus, and particularly whether the virus escaped from a laboratory there.

He doesn’t attempt to analyse Xi’s character, because being pragmatic, Max recognises Xi is what he is, and nothing will change him. However, this is not to say that defining his strengths and weaknesses is not more than a parlour game. Remember XI was a princeling forced to eat dirt – he understands how the game “Go” unravels. In this game, there is a need to understand its length. Xi does not intend losing; he has tasted the soil. As someone said to me, he doesn’t care about the niceties.

Max says that the breakdown of our government’s foreign policy development process and its supplanting by the security and intelligence services and their vociferous supported is a main driver of Australian government attitude.

I know there is a younger brigade of Australians who have repeatedly dealt with the Chinese and who believe that Obama’s soft position towards China would have been reflected in the present Biden administration. However, free of Obama, these so-called liberals have adopted a hard line almost indistinguishable from that of the Trumpers. In this narrative, Obama is the villain.

As Max said, we took more risks than we should; we could have been adroit. This is the position of “former senior officials who lament the lack, still, of policy making and disciplined public language about China, that weighs up options and employs some subtlety and seriously considers the risks of war.”

One source, Paul Dib, compares the situation to the 1930s where the risks set off by territorial confrontation were ever present, in Europe, Africa, and Asia. In the meantime, Australia then lived in bliss, ostensibly under the wing of the British Empire. Now it is the USA to continue to shield us, but the hawks are everywhere so that his conclusion of this need to follow the USA is “a bleak but realistic view…if the hawks of Washington and Beijing are not stifled, if compromise is rebuffed, war will be the consequence, a disaster for Taiwan and the combatants and a disaster for the rich and growing economies of our region.”

China is not complicated as suggested in the article – the World exists at the whim of Xi Jin Ping.

His adversaries are varied; have we ever really looked into the eyes of these hawks of ours – these eyes exhibiting uncertain bravado and fear?

These are not the fanatics which drove the agenda of the 1930s but more the muddle-headed wombats who took us into the Vietnam war. This time, the War will not be an away game.

I do not want the prospect, if I survive, of stumbling through the rubble which was once Sydney. Everybody, look carefully at Gaza and that was only an 11 day’s conflict.

Thank you, Max for encouraging me to write this critique.

 A Prickly Situation

My eye was caught by an article in the NYT this week. It concerned the poaching of rare species of cacti from the Atacama Desert in Northern Chile and them being found smuggled into Italy.

The Atacama Desert is not particularly large compared to other deserts, but it is a remarkable ecological structure. There is an area where it has not rained for about 500 years; there is another part where the largest copper mine in the world is located.

Licancabùr

As we looked out from our hotel in San Pedro de Atacama in this patch of green, the dominant view rising high from the desert was Licancabùr, the volcanic cone rising high above the desert. The volcano is very close straddling the Bolivian and Chilean border, and as you near it, sulphur is mined on its slopes. Sulphur – ah, the whiff of hell, but here the winds tend to cart the smell away.

This desert has historically been an area of dispute between Chile, Bolivia and Peru. It was called the Saltpetre War, and ostensibly it was about Bolivia retaining access to the Pacific Ocean but, as the name implies, it was a battle over the nitrite deposits used in both fertilisers and explosives. Chile won that war, which has enabled that country to exploit the mineral rich Atacama and, since discovered, also the site of substantial lithium deposits.

San Pedro de Atacama is in an altiplano pocket of the desert, the remnants of the Andes, which mean one is strolling and riding around at 2, 408 metres. The highest point we reached were the Geysers del Tatio which lie at 4,330 metres, a large cauldron of boiling water where there are signs in English and Spanish warning for you not to get too close to the edge of the multiple pools. The sudden spurts of boiling waters and steam at such an altitude are very impressive. There are no fences; you are able to freely wander. At least one tourist did step too close apparently and ended up boiled in one of the pools.

Even though we were only 14 kilometres from the Bolivian border we skipped walking up the volcano which tops 5,920 m. For comparison, Mount Kosciuszko is 2,200 m high.

This area of the Atacama altiplano is very diverse. What with the geysers, and flamingos standing in salt water at an alkaline PH of 10 and eating the crustacea out of the brine. These tiny marine life determine the flamingoes’ colour. Every desert has “bad lands” of rocks and gulches. Here Atacama has its red rock folded into buttes and jagged cliffs. They were thought to mimic valleys on the moon rather than a scenario from a Hollywood Western.

Here I found myself rooted, unable to move, halfway up one of these hills, on a goat track not one-person wide, winding itself to the peak. I have always suffered from vertigo, and stupidly I looked back and down. The cheerful chatter ceased. There is nothing more debilitating than being stuck like that, with feet in the shifting sand unable to move. Here, feminine resolve came to the forefront to uproot the fear – women on either side of me giving me their hands, encouraging me onwards.

We stop on the way in stone cottage villages where the construction of the houses would not have changed since Inca times. One of these villages called Machuca had about ten houses, was situated at 4,000 metres but still had its church perched on the hill above the houses. This is subsistence living. Guanacos can live at that high altitude and like their relatives, camels, will drink salty water, but like the vicuñas are not domesticated. The flightless rheas dot the landscape, not venturing close.

It was an enthralling landscape and the hospitality overall was great, the only blemish being locked in a poorly ventilated minibus with an English family for three hours as we went back to Antofagasta to catch the plane back to Santiago, but they probably had the same feelings towards us – a little more Albion disdain. Having sprawled across the front rows they objected to us wanting the windows being open. Not even my wife’s imitation of Shrek’s donkey colleague amused them.

But you see what is pointed out to you or what you are looking for, and in the desert, on this trip I failed to appreciate the flora.  In the Atacama are some of the rarest and most intricate cacti. I suppose I should have been interested given the use of cactus wood to make the doors of the cottages.

Now there is an increasing market for those unnoticed cacti.  The cacti of the Atacama are special. A year after the robbery from the Atacama happened, the NYT has reported on a cactus “heist”. This had been uncovered in Northern Italy.  Most of the stolen plants, many over a hundred years old, had been taken from the Atacama.

As the NYT said in the article:

Cactuses and other succulents are hot business today. They have become the darlings of social media, promoted by indoor plant influencers for their outlandish looks and minimal care requirements. The pandemic only increased their popularity, with shops struggling to keep some species in stock.

The average hipster’s cactus collection will include only common species propagated in nurseries. But for some specialist collectors — who tend to be middle-aged or older men — the hobby is much more serious.

“A lot of what drives the interest and passion for these plants is their uniqueness and rarity.”

Atacama cacti

Of course, that is the problem. People with too much money, bored by their hedonism, looking for something different and in this instance, something requiring little maintenance. Perfect!

There is a line to be drawn between appreciation and acquisition. I have never been a xerophile, and in fact cacti watching has always been low on my attention span. Having written that, cacti can be striking. I wrote a piece one winter in Arizona called “Snow on the Saguaro”. Seeing those majestic cacti, their branches smothered in white, reflects how severe the winter was we were then traversing.  While we marvelled and I wrote this, there was no passion to dig up all these cacti and transport them Los Angeles to become a prop for silver tinsel and light. A silly notion, but no more silly than digging up the cacti in the Atacama for them to be festooned on balconies of the palazzi of Milan.

One wonders how many of those who buy plants illicitly taken, really appreciate them, or do they just want to have something nobody else has.

Anyway, this story had a better end than most of these robberies. As has been reported:

844 cactuses made the return journey to Chile. Around 100 others had died, and 84 stayed in Milan for study.

Mr. Cattabriga (responsible for apprehending the shipments which had first passed through easier EU custom controls in Romania and Greece) has been making daily video calls to try to ensure the plants are being properly cared for while they are in quarantine. According to Bernardo Martínez Aguilera, head of the forest inspection department at Chile’s National Forest Corporation, the final goal “is that the majority of these individuals return to their natural environment, which they never should have left.”

Rules have been introduced among cacti lovers not to purchase the seeds for such exotica, on the grounds that if these cacti are allegedly propagated, it provides a cover for the poachers’ lack of provenance. A worldwide problem but this is a salutary tale. The answer is always the same – curbing the poor attracted by the cash, harvesting the cacti and a cohort of wealthy humans who always vote for subsidy, tax breaks and entitlement with rapacious middlemen who always vote for subsidy, tax breaks and entitlement with greasy paws.

Mouse Whisper

Is it an unnoticed cultural cringe? The Swans are a Sydney Australian Football team, which was transplanted from Melbourne where they were known as the South Melbourne Football Club. The colours are red and white which earned them the early nickname of “The Bloods’. But somehow, presumably because South Melbourne was originally a marsh from which the Albert Park Lake was carved, the idea of calling the team by the name “Swans” was floated. But the white swan, whether cob or pen, is not an Australian; it’s a Pom!

Black swans are as Australians as Vegemite. If the club wanted to call itself the Swans, it should have adopted black. I am surprised that my indigenous brothers played with colours and name which reflected colonial attitudes. Especially as there are only black swans on the Albert Park Lake.

Imagine the Sydney Swans changing to a black and red strip. What would they say at Essendon?

And don’t me started on the St George Illawarra Rugby League colours taken from the St George Cross which I believe has some relationship to an island off Europe.

Dragons – yes, they have relation to Australia – water dragons can be seen all over Sydney in nurseries.

By the way, the native animal of NSW is the platypus and the bird kookaburra, but a Major Mitchell cockatoo has all the elements of red (if actually pink) and white. But barracking for the platypi, the Kookas (or Burras or the Cockatoos) – could be very authentic like the Eels.

My preference. Come on The Majors.

 

 

Modest Expectations – Cheers Bar

Cheers Bar

The actual address of Cheers Bar was 112½A Beacon Street, Boston – in other words I have resorted to an approximation for this week’s blog.

One of my former partners, who was a very good mathematician, said that he always judged his peers by knowing whether they knew when to approximate. I have never been numerical, but I know you can vanish along the decimal value of π and end up in a different world where sanity evaporates in the pursuit of such accuracy in this relationship of circumference to diameter of a circle. Endless fun.

One of the matters that used to irritate me was when I was seeking certain data, I was told it was unavailable because 100 per cent of the data had not been collected. In other words, the data publication had been delayed by over-zealous statisticians when 95 per cent would have been adequate – if the distribution is normal then approximation of data around the mean of the distribution is mostly likely to be good enough for policy considerations.

But this wise mathematician also told me that when coming to conclusions make sure your assumptions are clear and transparent; something unfortunately becoming less and less evident in public policy. Then, your approximations could be assessed as to validity in the pursuit of making the particular decision.

The excellent Dr Paul Kelly, the Chief Health Officer, clearly outlined the government assumptions in his critique (let us not say criticism) of the government’s reasoning in invoking the provisions of the Biosecurity Act to keep Australians in India from returning. His was calm, measured, sensible advice, which the Government, now scrambling to save face, will follow. Within this prediction, it shall become clear how accurate is the approximation of 9,000 Australians in India who require repatriation.

And so it was, when the COVID-19 infected Dutton emerged in their midst, it was fortunate that Kelly was there to quell the Cabinet hysteria.

I do not know just how the Government have guessed, estimated, approximated and predicted the number of Australians who have visited our near neighbours. After all, the assumption is that each of the verbs in the previous sentences mean approximately the same thing, but with an ascending order of assuredness in their use in media releases.

With most of Asia plunged into pandemic considerations has Mr Coates, in that tattered remnant of his imperial cloak – the Olympic Games, issued an approximation of the number of athletes that will become infected during this festival. My assumption is that he will say “none”. Just an approximation after all!

The Divine Light of the Gods

One of the interesting aspects of the spread of COVID-19 in India is the reaction it has generated in those who, one way or another, are driven to comment. The threat to put Australian citizens in prison because they want to come home and escape the virus was hysterical. The fact that some of our best cricketers were caught up in this catastrophe only complicated the situation.

Now I am not one of those who believe that the Government’s immediate midnight reaction would have not been approved by a strong segment of the population. These have remained quiet while megaphones from both left and right have given Morrison a roasting, to coin a phrase. However, what has been most confronting here has been the sight of the funeral pyres night after night on television. As somebody said, it is a vision of hell.

In India, fire is a very important symbol. Yet India was associated with the flower generation where there was always some swami in some ashram somewhere in India where mostly privileged Europeans were drawn to seek “enlightenment”, and lotus flower symbolism was everywhere.

I first had the privilege of traveling the length and breadth of India when it was a secular state. Then the Nehru-Gandhi hegemony was strong.

With the ascension of the charismatic Modi, India has been converted into a Hindu state, despite the fact that India’s Muslim population is the World’s third largest, close behind two avowed Muslim nations, Indonesia and Pakistan. Hindu intolerance is confronting. I have entered a Kali temple, one of the few not prohibited to non-Hindu people. To me Kali was a black doll monster, at the centre of a dark incense-ridden foreign place where I was both fascinated and yet repelled.

Contrast that with the elephant head Ganesh, where the myth of his head being chopped off by an enraged Shiva and that of an elephant sown on to replace the human head is just one of tales which surround the religion. Yet we have a figure of Ganesh in our home. Ganesh is a symbol of good fortune; and it gives a clue as to how pervasive Indian culture becomes once you have been and seen.

The COVID-19 pandemic was never going to bypass India, because wherever you go in India there are crowds, pressing in upon one another. Modi loves the theatre of the large crowd and given that Varanasi is his electorate we are constantly confronted with the spectacle of the crowded river Ganges. When I was first exposed to this crush of humanity, it was as overwhelming as the smell of India, which never leaves you. There is an axiom which tests the strength of any union, association or whatever you call two foreigners abroad. “One watches the bags, while the other creates the space.” It always seemed to work no matter where we were in India – and crowds.

It is easy to ascribe a national identity to India, and there is no doubt the Hindu caste system has embedded in itself a sense of entitlement – at least with some. This is pronounced whenever you deal with Indians as at some stage a sense of entitlement will bob up.

Again, as an example, I remember giving a talk to a group of health professionals, predominantly doctors. There were both male and female doctors at this meeting in a town in the very South of India. My talk was given over dinner in which we ate our curry served on banana leaves. The whole atmosphere was so authentic – down to the separation of the male and female doctors onto separate tables, including my partner.

This often overbearing regard for the place of women was one of the problems I have encountered, not only in India but also with some Indian-trained doctors here. Yet Indian men have a great reverence for their parents, and one of the most obvious examples of this are reports of the number of older Indian women in wheelchairs at airports; sons are very concerned to ensure the mother does not have to walk from the plane, but they clearly show their wonderful ability to walk when greeted by family and leaping from the wheelchair to run to the family. This atavistic reverence is reflected in the number of stories of the Indian-born Australian now caught in India.

The other is the number of small children who seemingly have been lodged in India. It is very difficult to see an infant apparently helpless against the encroaching Virus and to not elicit the reaction for someone “to get them out of there”. What is the reason for this? Could it be that the couple working full-time in Australia want a safe haven for their child’s care, and grandparents are an obvious place to park the children, even if it means leaving them in India for extended periods. Up until now that practice has gone unnoticed or unsanctioned.

The Indian-born population in Australia amounts to 455,389 or 1.9 per cent of the Australian population. The affinity for the country of birth, especially when there are close relatives in India, remains strong. However, one of the prices of being a citizen is that you also accept that some of your personal risks clash with public policy considerations. However, if one knows the risk, then one must also accept the consequence if risk translates into liability for the wrong choice.

The fact is that the Australian government has not factored in the need for a more long term sustainable quarantine capacity will inevitably mean hardship will occur to those waiting to return from overseas. Just as it is trying to contain the Virus where up to 50 per cent of incoming travellers may be infected throws this policy stumble into letters writ large. Larger and more custom-made quarantine facilities, where it is an accepted fact that when coming from most places worldwide there will be an invariable 14-day hiatus during which everyone will quarantine and be tested multiple times, with designated exceptions such as New Zealand and the island dependencies of our two countries. The volume of people needing to come here will increase with an impatient tourist industry scratching at the Government’s door.

Politicians try to fill the vacuum of uncertainty with unsubstantiated optimism (remember the vacuous Trump assertions as America died), which in this case is trying to predict the future of a disease in which the vaccine remains unproven in its long term efficacy – and long term in this situation means “a year”.

Does that prediction alter when our young politicians realise that their contemporaries in both Brazil and India are dying from the mutant strains stealthily and rapidly causing them to die unpleasantly; and be under no illusions this chameleon virus can mutate at the drop of a tartan rug.

Australia has achieved an enviable record in quarantine, even though there are obvious blemishes. Parenthetically, rabbits were one example. Eradication has been so successful that rabbits are now a luxury item on the dinner table. Nowhere else in a major country except New Zealand has achieved suppression of the Covid-19 virus to the same extent we have. However, you can never relax, as shown by our pursuit of the rabbit plague.  (I consider Taiwan a special situation being more an armed camp than a nation.)

But after the Indian tide, the biggest test will be to see how the Government handles the anticipated 1,000 travellers returning from the Toyko Games, without assuming that any will become COVID-19 positive while out of Australia. Now where will be the holding pen? Even if the team members don’t all return at the same time, there will be a significant number to be managed at any one time in quarantine.

An expanded permanent human quarantine capacity that is not a “make do” in willing hotels clearly is essential. This sector will require staffing. That means more staffing and where does that staffing come from? I have worked in rural health encompassing inter alia assuring workforce for many years.  To achieve sustainability in the workforce in a country such as ours is very difficult, especially when the policy makers are blissfully ignorant of what works because there is no readily available corporate memory nor empirical evidence of what works – just opinion and opinionation.

Ganesh

Here we Go Again

I have worked in rural health policy for a considerable time and it sticks in the craw when a doctor reveals his ignorance by hailing the modest injection of a rural element into the Medicare benefit for eligible patients as if it is something new. Since there has been no rebuttal, this statement just confirms that the profession has no realisation of what has occurred in the past, what has worked and what has not.

Throwing money at medical workforce problems has never worked.

Repeatedly I have outlined the challenges that face the provision of rural health, and the problem is that the structural change I assisted in bringing in through the University Departments of Rural Heath, the Rural Clinical Schools and the Rural Intern Training Program in Victoria can easily disappear if there are no champions for its continuance. This requires advocacy, not lazy policy makers, who do not care a “tuppenny tart”, as long as they seem to be doing something, even if it is a discredited strategy.  This reminds me of that New York wit, Ida Downer, who wrote “Maybe some consultant provided advice at an appropriate price in order to maintain their expensive watch vice.

There are four challenges which should be addressed in the development of any rural health policy.

  • Social dislocation – by which I mean that the spouse does not want to go there or where you have to send the children away to school. The concept of a young graduate going to a rural location and staying there for his or her professional life is increasingly a myth. The sensible response to this challenge is to accept that five years is a reasonable stint in one place.
  • Isolation – this occurs in a variety of forms, but professional isolation is one danger, even with the myriad professional development programs including online options, coupled with the availability of registrars and other doctors employed in subsidised training schemes. The sole doctor risks burnout, and one of the aims of the programs I promoted was to reduce the possibility of professional isolation.
  • Community tolerance – in country towns, especially if you are the only one, you have no privacy. Therefore, there are two options – immerse yourself and your family in the life of the town or get away from the town at weekends which, in a single doctor town, leads to all sorts of antagonisms. In other words, the way the community views its medical workforce is critical for retention.
  • Succession planning – often the hardest, because there is a push me/pull me syndrome in many country doctors. When the media spotlight is focussed on the local doctor, then if the request is not for money it is a plea for more doctors. The doctor should be planning for succession, but how many do that? Often, when the doctor is offered a doctor to assist, then the resident doctor changes direction because the fear is of another doctor impairing the incumbent’s income, which is generally a nonsensical fear unless there is deeper pathology than just basic insecurity. The successful country practices involve succession planning so there is a gradual ageing of the workforce and a balanced practice with each doctor having the general skills to provide emergency treatment but having a special skill required in the practice, such as anaesthesia and obstetrics.

Money is always an important component and I was involved in a number of Inquiries in which the level of Medicare (and before that Medibank) patient benefits was the focus. One of the misunderstandings is that doctors’ fees are set by government; the Federal governments sets the level of the patient medical benefit and when I had direct involvement generally the benefit and actual fee charged by the doctor did not have a substantial gap. That does not hold any longer, except for general practitioners for whom different policies have been implemented, such as those that encourage bulk billing. The rural doctor, whether general practitioner or specialist, nevertheless have other sources of income to supplement the income derived from Medicare Benefits.

If I were conducting a review again of the rural workforce, flying from place to place as I did in the late 1990s, I would ask the same questions to find out what was happening in relation to those four challenges outlined above. You need to stay overnight as I did, and not fly in and fly out the same day. This overnight stay can reveal the tension and the stratagems of avoidance when the simple question of more money and more resources are not automatically accepted as incontrovertible fact.

As a person who engineered one solution to rural workforce and see it being trashed after you have “left the room”, it is very sad, but as someone once said about me, my epitaph should be “He tried!” 

A Woman Scorned

I never liked her father, Vice President under Bush Junior. Not that he was unintelligent. He was, but dangerously so.  I’m sure that I do not like her politics, but then Liz Cheney is a determined woman, who has a set of principles and Trump in his disregard of such principles should be challenged and defeated.

Liz Cheney

She is the sole representative from the State with the smallest population, Wyoming. It is the one State that has one representative in Congress and two in the Senate.

Wyoming is a rich State, and the inhabitants pay no State income taxes because this is fossil fuel territory – oil, gas, and coal. To see the kilometre long coal trains traversing the Wyoming prairie is a sight not easily forgotten. Cheyenne is the capital in the southern part of the State two hours from the Colorado border and one hour from Laramie, where the University of Wyoming is located. Both lie on this altoplano dry area, and travelling across the country just after the snow melts, it is easy to see how the vegetation struggles.

But six hours away in the northern part of the State is Jackson situated at the southern end of the Jackson Hole Valley. Here the scenery is some of the most spectacular, with the Tetons jaggedly thrusting their snow-capped peaks more than 4,000 metres in the cærulean sky. Jackson epitomises the tax haven for the ultra-rich, with an average annual income of the residents being US$16 million, a place with which her father was heavily identified.  One commentator has encapsulated the Jackson conundrum.

This form of “gilded green philanthropy,” widens even further the ugly socio-economic divide, hollowing out the community and making it harder for workers to live nearby. Unable to find affordable housing in town, they are pushed all the way into the neighbouring state of Idaho, on the other side of the treacherous and steep 8,431-foot-high Teton Pass. These workers told many a harrowing story about just making up — and then down — to work in the dead of Wyoming winter.

Close by to the Tetons is the Yellowstone Park with his surface covering the subterranean turbulence, which manifests itself in bubbling pools and geysers spreading across and into both Idaho and Montana. Some have said this is where the destruction of continental America will occur with a massive explosion.

In the meantime, there is Liz Cheney, at the prime of her working life being repudiated on voices by her Republican colleagues yet receiving a standing ovation at the end of her speech to the Caucus yesterday. The explosion which she is engineering under Trump will come, if death or gaol do not supervene. Trump who requires a cosmetic shield to conceal his vacuity, his seditious behaviour and mental deterioration must maintain his profile for another four years. During that time, his support among his own age group will winnow with inevitable death.

Liz Cheney’s march to leadership of the Republican Party is now unconstrained by any faux-loyalty. I shudder though if Wyoming becomes the model for USA. Ironically, Trump tried, but his criminal streak and his narcissism saw him come up short.

Liz Cheney may succeed. In the short term I applaud her unyielding opposition to Trump, but I also remember she is the daughter of Dick Cheney, who was de facto President for eight long years.

Mouse Whisper

There is an entrancing book published recently called “Entangled Life”. Before anyone thinks this is one of those morbid novels about self-discovery, may I interject and say it is a very entertaining exploration of the world of the fungi. One insight into the truffle makes one realise that its smell has to compete against “the olfactory racket of the forest”. As the author, Merlin Sheldrake, writes “every visual disadvantage that truffles face -being entombed in the soil, difficult to spot once unearthed and visually unappealing once spotted – they make up with their smell”.

Elsewhere in the book, Merlin (how appropriate for a mycologist) describes one of the truffle experts as having olfactory flashbacks how powerful is the memory aroma of the top truffles.  But even so he admits there is still so little known about the fungus, including Truffle Mice! Boy, can we smell!

Modest Expectations – Arthur Phillip

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

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

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

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

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

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

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

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

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

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

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

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

Charlie Perkins

Charlie Perkins

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

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

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

Hermannsberg Mission

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

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

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

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

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

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

Aboriginal tent embassy

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

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

However, he was also fighting renal failure.

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

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

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

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

John Kitzhaber Concludes – A New Model for the Nation

Dr John Kitzhaber

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

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

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

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

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

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

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

COVID-19 and the Urgency of Now  

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

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

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

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

The Role of Unions

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

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

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

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

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

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

Let’s Begin Now!

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

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

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

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

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

Mouse Whisper

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

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

She’s from Minnesota!

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

Modest Expectations – Derby Day in Walla Walla

State Capital West Virginia

It was late in the day some years ago and we had just driven past the capital of West Virginia, Charleston. The golden capital strikingly stood above the low-level smog which was layered over the city itself. Here we were in the Alleghenies, a 640 kms portion of the Appalachia, a rich source of coal. Here pitched battles were once fought between the miners and the mine owners – called the coal wars. The reason lay in the fact that during this period more miners were killed here in accidents than were lost by the US armed forces in World War 1.

West Virginia had been carved from Virginia in 1863 during the American Civil War, partially because the West Virginians did not follow most of Virginia which seceded at the outbreak of the American Civil War. Yet the electoral base and its Democrat traditions lay in its workers, radical by American unionism standards, reinforced by the memories of the coal wars.

I wondered, as we approached the entrance to this property with its imposing edifice, whether it was a hotel where we could stay for the night. I drove in and the colonnaded entrance suggested that perhaps I had inadvertently driven into a private estate. However, I got out of the car, in jeans and all, and entered the building in all innocence to enquire what was this place.

The Greenbrier

The man behind the reception desk looked me up and down and said, “Sir, this is The Greenbrier.”

As I learnt very quickly, The Greenbrier was the place where Presidents stayed, and I found out there were references to them as far back as Polk and Tyler. I thought the car parking space for the resident golf professional at the time, Sam Snead, said it all. This was a comfortable Republican enclave in the heart of what was a poverty-stricken mining area. I remembered once, on a flight north in Australia, there was a dishevelled guy sitting next to me. We got talking, although I had difficulty understanding him; he turned out to be a miner going up to the coal mines in Queensland. He was from West Virginia, and his mumbled English was full of archaic constructions and words that meant nothing – it was a dialect probably based on 17th or 18th century English. In the end, in the light aircraft, the noise of the plane made it impossible to talk and we lapsed into silence.

But back to The Greenbrier. The Government had built a huge bunker at the hotel during the height of the Cold War, which had the capacity to house the whole of the Congress in the event of a nuclear attack. The facility had long been decommissioned by the time we had stayed. I believe I was punished for my disrespectful comment as the room assigned was so far from the main building that it almost collided with the fence and was well behind the bunker. Still, they allowed us into the dining room.

However, before that could occur, the reception desk clerk had said, “If you wish to dine in, sir, you will need a jacket.”

“No worries.” I had a jacket – a blazer in fact.

A key was pushed towards me. The Greenbrier had welcomed us, after a fashion. Menofregismo as the Italians would say.

West Virginia has always been reliably Democrat, but now no more.  The three Congress members are all Republicans; only one of the two senators is a Democrat and over 50 per cent of the time he voted with or for Trump, even in the impeachment he was only one who crossed over from his Democrats for Trump.

From being reliably Democrat, now West Virginia is almost the most Republican State if judged by the vote for Trump here recently – all changed in a decade! Biden received less than 30 per cent.

The use of coal is rapidly dying, so it would be a useful exercise for the Biden Government to determine how to restructure the West Virginian economy to phase out coal. It is more difficult than just bribing the mine owners to provide the semblance of work by keeping uneconomic mines open. However, it probably would be just as cheap for the Government to bypass the owners and pay the miners a living wage disguised as a redundancy package or employ them to resuscitate the once pristine landscape mined over the past 150 years.

After all, the wealthy and influential were prepared to invest in an opulent playground here, including the Congress shelter bunker. Notwithstanding that it had been decommissioned well before we stayed, here was further evidence of the very essence of privilege in one of the poorest parts of the country.

The latter part of the last century and into this, first as governor and then as Senator, Jay Rockefeller, the great-grandson of John D Rockefeller, as a Democrat (unusual because the rest of the family were solidly Republican) won most of his elections by huge margins. There is little doubt that during his long association with West Virginia he and the coal industry were on very good terms – for most of the time. However, towards his retirement, he began to realise the impact of coal on climate. Two years before his retirement, in 2012, he made in the following statement:

Scare tactics are a cynical waste of time, money and worst of all coal miners’ hopes. But sadly, these coal operators have closed themselves off from any other opposing voices and few dared to speak out for change – even though it’s been staring them in the face for years.

This reminds me of the auto industry, which also resisted change for decades. Coal operators should learn from both the mistakes and recent success of the auto industry. I passionately believe coal miners deserve better than they are getting from operators and West Virginia certainly deserves better too. 

Here in Australia the problem is that fear has gripped Joel Fitzgibbon, not any constructive thought. His livelihood lounging on the plush red seats of Parliament House is threatened. Forget about climate, but then there are unions agitating for retention of coal mining, and the power of the unions depends on these miners coughing up subscriptions – but for what? As with the car industry, government subsidy for the uneconomic only ends up improving the bottom line of the big foreign-owned companies.

The slick Monsieur Perrottet wants to restore his stained escutcheon by expanding the coal industry in NSW to pay off a short-term debt and in so doing leaving an incalculable environmental debt for generations of Australians; the feathery Premier just keeps talking to see if she can break the world record for not taking a breath. There is some in government with a contrary idea of how to lessen the coal dependency, despite export prices for both coking and thermal coal are being maintained.

Yet there is fear of divesting away from coal. This has been aggravated by the electoral results in Queensland, and by the “near-death experience” of Fitzgibbon in his seat of Hunter. The other NSW coal seats did not seem to mirror the same extreme behaviour.

There is another problem, and that is the Fly-in-Fly-Out miners. This expanding cohort should not be confused in the arguments over the hearts and minds of the local coal miners.

As one local Mount Isa correspondent has written:

The issue of Fly In Fly Out did not get much of a look-in in the federal election, perhaps because it is mainly seen as a state issue.

FIFO is convenient for workers who want to live by the coast but still enjoy high-paid jobs in remote locations.

It is also convenient for companies who have better control over their staff and their movements whether it be on chartered flights, mining camps or buses.

But it is a terrible deal for places like Mount Isa and the towns of North West Queensland which get all of the downsides of a large mining operation on their doorstep but few of the benefits.

Yes I understand that airports, motels, pubs and clubs, and the like do well out of a transient workforce but other businesses not so well.

The wear and tear of mining operations on roads and other facilities is a cost borne by those communities. And only this morning did I hear a speaker at a MineX breakfast talk about the need for a local work force because without that “we have no social licence to operate”.

The Queensland government recognised the issue with the Strong and Sustainable Resource Communities Act introduced last year to ban 100% FIFO mining near towns like Mount Isa and Cloncurry.

However, companies can get around this simply by posting one staff member locally which meets the wording of the act but not the intent.”

Balmain coal miners

Great is it not; with one selfish self-centred politician intent on contaminating the narrative of moving away from coal.  A leader, if one can term Albanese that, should have called him out immediately.  Or do I do Mr Albanese a disservice. Maybe he really wants to see the Balmain coal mines re-opened in his electorate.  Fitzgibbon can’t have it all his own way. After all, my late neighbour used to tell me that, as a boy, he would go around the corner to the coal dump and bring coal home for the stove and the fire. It was said that Balmain was then quite a sooty turn to behold.

As a 40-year resident, I remember seeing the entrance to the mine.   After all, to that smooth genius, Monsieur Perrottet, reopening the mine shafts under the Harbour would bring lots of “coal hard cash” and so convenient – or not. And what a jape – reopening a coal mine in a Green electorate. Problem is that is where Perrottet and his fellow travellers want to scar Australia, the wildlife do not vote. However, in Balmain, I am assured that Monsieur would find a different form of wildlife – one that rumbles around the suburb in their Land Cruisers looking for anybody with a lump coal in their political pocket. After all, Monsieur wants to demolish the White Bay Power Station – perhaps a new location for an underground coal mine.

But I stray from my West Virginian narrative – at least I have a narrative.

While America looks away.

I was rummaging through my old magazines and I came across a copy of a Harper’s dated August 1999, in which there is an article where two journalists were assigned to report on Cyprus – flipping a coin to determine which of them travelled to the Turkish Republic of Northern Cyprus and the other to the Republic of Cyprus. As the lead-in to that article, it was stated; “Cyprus remains partitioned, a case study in how ethnic hatred perpetuates itself but perhaps also a manual on how peace can be sustained in places like Kosovo”.

It was nearly 20 years later that my friend and I walked across the Green Zone that separated the two sides of the divided Nicosia, the major city of Cyprus.

There is something strange walking across what is essentially the line where battle formally ended.  A few peacekeepers wearing blue berets are moving around inside the buildings and the only sound is a radio blaring out modern pop. There is nobody to block our crossing through the rubble strewn street, only a strange sense of abandonment, although you know eyes are watching you in the CCTV cameras slung along your pathway. Passing from one side to the other met with little interference from the Cypriot or Turkish side.

Once we were across then there was the question of transport. We did not have to wait long before a taxi pulled up and took us to Kyrenia, a seaside town on the Turkish side where we had a pleasant seafood lunch. The taxi driver said he would return, and he did, punctually. The only noticeable difference from one side to the other was the appearance of mosques; the cars still drive on the left, irrespective of which side of the green lines one drives.

Cyprus is the only place outside the British Isles and the Republic of Ireland in Europe where there is a remnant link to the previous British occupation – driving on the left hand side of the road.

In 1878 Cyprus entered the British Empire under rather unusual circumstances. The Ottoman Empire had just been at war with Russia and were very much in danger of losing control of their capital Constantinople. The British intervened in the crisis on the side of the Ottoman Turks by sending a fleet to intimidate the Russians. The Ottoman Sultan was so thankful for the British intervention that he granted the control of the island of Cyprus to Queen Victoria. This lasted until 1960 when independence was gained. Throughout the 1950s a Greek terrorist group EOKA, under a former Nazi collaborator George Grivas, exacted a price on British occupation, a killing spree of British soldiers and Turkish Cypriots in the main.

The British still retain armed forces bases there on territory that was ceded to the United Kingdom on independence. That means that slivers of Cyprus remain British soil.

While there was a myth abroad that the Turkish and Greek Cypriot relations had been harmonious before the invasion but after Independence, that was far from the truth. The Green Zone actually began a line drawn by the British in 1963 because of strife between the two.

By 1974, the treatment of the Turkish Cypriots was bad enough for Turkey to intervene, and it did not take that long for the Greek Cypriots to quickly sue for peace. This led to fragmented jurisdictions, separated by a UN peace force which have, since the ceasefire, patrolled the Green Zone that extends across the island, cutting through Nicosia as mentioned above.

There the line has remained intact despite regular exchange of obscenities, rock throwing, and the more serious “cocking and pointing”.

When the Harper’s article was written there was very limited access across the border. The two journalists met once, face to face, for coffee in Pyla, a small fishing village within the Green Zone.

There may have been calm when we visited, but there was residual bitterness. We were there at a time before Erdogan came on the scene with all his populist fury. However, he probably recognises what one Greek Cypriot soldier said when asked whether he would retaliate: “No,” he said smiling, “We are careful not to provoke them, because we are the weaker side.” 

Erdogan must know that and after the defeat of Armenia recently, he may be tempted to have a “go” at Cyprus.

Apart from the increased access across the Green Zone, since the 1999 Harper’s article was written, another phenomenon has occurred. It was first evident when I picked up the menu at the hotel in Limassol where we were staying. The menu was not only in Greek and English but also in Russian. The Russians have made a large investment in Cyprus – either with or without Putin’s collusion. Who would know the extent of each?

Now there is a cohort of Russians who have not only invested in property but also have bought Cyprus passports, a practice contrary to EU rules. Under pressure from the EU, Cyprus has now withdrawn that permission to buy into the Republic. Unlike Armenia, Cyprus is a member of the EU, but the Russian passports have not been cancelled.

However, would that matter given that America is now  distracted and if the Turkish Cypriot grievances are inflamed by Erdogan, how would the Republic respond? Seek Greek support? It was not there in 1974.   Would it be now?

The European Union?  Does the EU want to go to war with Turkey, a member of NATO? After all, it was NATO bombing of Serbian held positions and a USA-brokered peace which, in the 1990s, ended that perennial obsession of the Serbs to dominate the Balkans.

This is different political chemistry, and one without a strong America, with a lame-duck President with Russian connections still at the helm. Cyprus has inhospitable mountainous areas. Don’t we know it? We got lost in the wilds of Cyprus, and only worked our way out by pointing the car down the mountains, but at least there was a track to follow.

So military conquest of Cyprus is not just a case of rolling up to seaside resorts like Limassol and Paphos in Turkish tanks. The mountains are perfect for guerrilla warfare.

So-called Russian peacekeepers could already be there to help – and themselves – as they have done in Armenia. They might be there to welcome the invading Turks.

As for the sovereign British bases, maybe Boris would let the Russians have them. After all, he could say it is part of his Brexit plan. Hopefully no one would write, as Queen Mary did with “Calais”, that Cyprus will be written on his heart.

Nevertheless, it should not be ignored that the Russians doing the Trump

Presidency have built up a seasoned defence force, which has honed its skills in Syria and elsewhere. Why not Cyprus? Why not indeed!

John Kitzhaber continues his analysis of the US health system…

Dr John Kitzhaber

Public Resources

We need to understand the central role of public dollars in our healthcare system. Healthcare is the only economic sector that produces goods and services which none of its customers can afford. This system only works because the cost of medical care for individuals is heavily subsidized with public resources. This happens directly through public programs like Medicare and Medicaid. It also happens indirectly through the tax exclusion for employer-sponsored health insurance and through the public subsidies in the individual insurance market established through the Affordable Care Act (ACA).

As a result, about 90 percent of Americans depend on public subsidies to help them cover the cost of their care—all except the 28 million Americans who remain uninsured. These people are not eligible for a public subsidy themselves, but through their taxes they help subsidize the cost of healthcare for everyone else. This egregious situation reflects the systemic inequality that exists not only in our healthcare system but also across our whole society.

Thus, the central issue in the healthcare debate involves the allocation of public resources, which represent a kind of fiscal commons. They are shared resources raised from society as a whole—and they should be allocated in a way that benefits all of us, not just some of us.

The National Debt

We also need to recognize that our healthcare system is increasingly financed with debt. Why? Because public resources are finite and Congress is borrowing ever more money to pay for existing programs and services—including health care. This fact is reflected in the congressional budget deficit and in our national debt. The national debt is the accumulation of years of budget deficits and represents the amount of money that has been borrowed to cover the difference between congressional spending and the tax revenue available to pay for it. Since healthcare now accounts for over 28 percent of the federal budget not spent on interest—and is projected to grow to 33 percent by 2028—it has become a major driver of the national debt.

This means that as the population ages and the cost of care continues to rise, the economic viability of the healthcare system will increasingly depend on borrowing money—and on the capacity of the federal government to absorb more debt. If the capacity to borrow is constrained, the financial underpinnings of the healthcare system begin to unravel. Since COVID-19 has created exactly this constraint on borrowing, a healthcare financing crisis that was on the horizon is now at our door.

Income Inequality

Furthermore, a growing share of the money borrowed to prop up our medical system is not being used to expand coverage. Instead, it is enriching the profits of large corporations and wealthy individuals. Let me be very clear: our current healthcare system is increasing income inequality through a process called rent seeking. This occurs when powerful stakeholders manipulate public policy to increase their own wealth without the creation of new wealth (i.e. they take more of the pie without making the pie bigger). For example, when the pharmaceutical industry convinced Congress to prohibit the government from negotiating drug prices for the 60 million Americans on Medicare, it distorted the market by putting the power in the sellers’ hands to set whatever prices they wish. After many news stories about “big pharma”, more people have become aware of concerns with drug prices. What seems to be less well known is just how profitable medical insurance is: in 2019, the seven largest for-profit insurers had combined revenue of over $900 billion and profits of $35.6 billion, a 66 percent increase over 2018.The result of the rent seeking that is evident throughout the health care industry is lower disposable income for the individuals who have to pay those inflated prices, increased profits for the companies, and wider income inequality.

Health versus Health Care

Finally, we need to recognize that the goal of the healthcare system should be to keep people healthy, not just to finance medical care. In other words, it needs to address the social determinants of health—access to healthy food and clean water, safe housing, a reliable living wage, family and community stability, and more—which have a far greater impact than medical care on the health of both individuals and communities. Yet the ever-increasing cost of care compromises our ability to invest in these things.

Today, healthcare providers and the system have different goals. While most care providers are trying to enhance people’s health, they nevertheless work in a system where the incentives are to increase profits and redistribute more wealth to the wealthy.

Confronting the Total Cost of Care

Improving health requires a financially sustainable system that ensures that all Americans have timely access to effective medical care

and

that makes long-term investments in the social determinants of health. To achieve these dual goals requires five core elements:

  1. Universal coverage;
  2. A defined set of benefits;
  3. A delivery system that assumes risk and accountability for quality and outcomes;
  4. A global budget indexed to a sustainable rate of growth; and
  5. A cost prevention strategy that allocates some of the savings to addressing the social determinants of health. A system that incorporates these elements can take many forms, but without all five we cannot achieve our goal of improving health in a financially sustainable way.

There are two primary obstacles keeping us from moving toward a new system focused on value and health: the way the debate has been framed, and the cost-shifting strategies that—until the pandemic—allowed us to avoid the growing discrepancy between the cost of the system and our ability to pay for it.

How the Debate Is Framed

For decades, the national healthcare debate has been paralysed largely because neither Democrats nor Republicans have seriously challenged the underlying healthcare business model—the debate has been over what level of funding to provide. The current business model is built around fee-for-service reimbursement. The more they do, the more they get paid. Since the fees paid for medical services usually are not linked in a meaningful way to a positive health outcome for the person receiving the care, the system incentives are aligned with maximizing revenue rather than maximizing health.

The Affordable Care Act (ACA) attempted to move away from this model with incentives to participate in accountable care organizations (ACOs), which are networks of providers that shared in savings if they delivered care more efficiently (called upside risk). The problem is that the ACOs were not required to assume any significant degree of downside risk, in which they had to refund a payer if the actual costs of care exceeded a financial benchmark. Furthermore, the ACA did not take on the rent seeking (transferring wealth to the wealthy) that accounts for so much of the cost in the system. As a consequence, the cost of health care grew from $2.6 trillion in 2010 to $3.6 trillion in 2019.

In the wake of the ACA, both major political parties have continued to debate only the extent to which we should fund the system, creating a false choice between cost and access. This false choice is reflected in the Republican view that the cost of health care is unsustainable and must be constrained, and in the Democrat view that any reduction in spending will reduce access. Both sides are right, if they remain wedded to the current business model.

Republican proposals to “repeal and replace” the ACA would simply reduce the public subsidies in the current business model, increasing the number of uninsured Americans and exacerbating the inequity that already exists. Democrat efforts to expand coverage through proposals like “Medicare for All” would significantly increase public subsidies but within the same inflationary fee-for-service business model, adding to the burden of debt that future generations will have to pay. To put it another way, Republican proposals increase inequity and harm people today; Democrat proposals increase the debt and harm people tomorrow.

Cost-Shifting Strategies

Framing the debate in this way allows legislative bodies to avoid directly addressing the cost of care by simply shifting that cost somewhere else, a strategy used by other third-party payers (insurance companies and employers). As the total cost of care increases, instead of seeking to reduce it, these payers take actions that shift the cost to individuals, who cannot afford it, or to future generations. Here are the most common cost-shifting strategies:

  • Reducing eligibility, cutting benefits, and/or raising co-payments and deductibles—all of which shift costs to individuals;
  • Reducing provider reimbursement, which may result in efforts by providers to avoid caring for those who cannot pay and/or lead to increased fees by providers when they are caring for people who are insured; and
  • Increasing debt-financed public subsidies, which shifts the burden to our children and grandchildren.

Importantly, none of these cost-shifting strategies reduce the total cost of care, which is the central structural problem in our system. Before COVID-19, we were able to rely on these strategies, particularly debt-financed public subsidies, to avoid the difficult choices necessary for a solution. But given the economic crisis we face now, we must directly confront the total cost of care. Fortunately, this gives us the opportunity to pursue new strategies that both redesign the current hyperinflationary business model and invest in those things that have the greatest impact on health and well-being.

To be concluded

Mouse Whisper

Out of an abundance of caution

ex abundanti cautela

In law, describes someone taking precautions against a very remote contingency. “One might wear a belt in addition to braces ex abundanti cautela”. In banking, a loan in which the collateral is more than the loan itself. Also, the basis for the term “an abundance of caution” employed by United States President Barack Obama to explain why the Chief Justice of the US Supreme Court John Roberts had to re-administer the Presidential oath of office, and again in reference to terrorist threats.

In reference to Chief Justice Roberts, who flubbed it the first time, Obama recognised the deep conspiracy and made him do it again – correctly. Our authority is the impeccable, Il pagliacco Guiliani.

Just a quote dripping with irony, it has become the favourite phrase of the month, and it seems that is how one formally approaches the Virus, but you must be in full evening dress with all medals displayed (sic).

For we mice it is more that we’re “Out of our barn dance our Cat’s in”.

Modest Expectations – The Hawke has Landed

After managing the responses to the Christchurch terrorist attacks, the White Island volcano and a pandemic — not to mention the birth of her first child — (Jacinda Ardern) has become a global standard-bearer for a progressive politics that defines itself as compassionate and competent in crisis.

So spoke the New York Times after Jacinda Ahern’s landslide election win last Saturday. Let’s face it, she was a refreshing breeze at a time when there had been some dodgy females hogging the headlines in Australia.  I get sick and tired of the mantra that women do not get a fair go. These women have demonstrated that they are no different from men. The one qualification is that I have never seen women politicians flogging stuff out of their parliamentary office. However, Darryl Maguire is not on his pat as a male if the species in running a two-dollar store out of his parliamentary office

The current problem is that having convenient attacks of amnesia seems to be the most valued commodity in public life whether it be female or male.

In my first blog, which I wrote 83 weeks ago before all that was recounted above occurred, I wrote: “Yet Jacinda Ardern gives me hope. Her words – her demeanour of grace, compassion, resolve, her ability to call out the bully – the courage of making herself a target for all the “unspeakables”. She is indeed a paragon.”

However, there is a squad of chaps who do not like her. I was criticised for blind adoration. Yet one of her great assets is a supportive partner, a person with presumably “selective” adoration.

The brutality of politics is reflected in that her hapless opponent was nick-named “Crusher”, and yet the woman seemed to revel in being called that.

Now the New Zealand election is out of the way, there is the opportunity for our horse-drawn politicians to recognise – as the rest of the world has done – what a contemporary and significant stateswoman she is. She has been the equivalent of a wartime leader in her approach to disasters which would have defeated a lesser person.

The laughable attacks on her last week by an alleged apologist for the Australian security service and the political remnant of Mary Knoll makes one ashamed to admit to the same nationality as those other elderly jokers.

Now, Ardern can get down to work to try and transfer her qualities into the deeply corrupt Australian society. I thought I would never say that we could ever learn from a Kiwi.

As one commentator has written, the liquidity has caused a surge in real estate market prices in New Zealand, particularly Auckland.  Hopefully, this will encourage her to abandon the KiwiBuild scheme, which seems to be a remnant of “Rogernomics”, and spend the money directly on much-needed social housing.

Improved contact, whatever you call it, with Australia is also essential. How the two countries deal with the South Pacific and the incursions from the Northern Hemisphere countries will be a critical test. However, before that there will be wool.

All that superficial crap highlighting tearful family reunions around “the bubble” hides the fact, which I noticed driving around NSW this week, that there are a lot of sheep that need to be shorn. With a shortfall in our shearing workforce, Australia needs shearers. The shortfall is generally made up by 500 New Zealand shearers. Until the TransTasman bubble was developed in the last couple of weeks, there was a deterrent in the high price New Zealand shearers had to pay for working in Australia, with their own fares and quarantine arrangements estimated at A$10,000.

A gun shearer can earn $150,000 in Australia if they average 200 sheep a day. New Zealand shearers are considered high quality and readily employed by shearing contractors so it should be attractive for them to work in Australia, especially now they are able to enter Australia freely.

Let’s hope that we adapt now to developing a better collective arrangement, instead of a perpetual Bledisloe Cup attitude between the two countries. It is time in the aftermath of COVID-19 to lay down our scrums and get to work. I am sure Ardern is up for the challenge. Not sure about the Australian Prime Minister, but then November 3 may change him – or not.

It Could be a Lot of Rot

There is extensive fruit and vegetable picking work available in Australia. The Australian Bureau of Statistics estimates about 140,000 people are employed in this industry every year. In fact, many people travel the country working the ‘harvest trail’ which sees them in employment all year round. This is because they know when and where the harvests are and move from one harvest to the next.  

For many years, I worked in North-east Victoria right in the heart of the orchards and fruit picking. I witnessed changes in the industry during my time.

There is no doubt one of the most tranquil moments is walking along the lines of pear and apple tree with the emerging fruit. There is a calmness in the ordered lines of greenery and the rilled earth and grass along which you walk.

It was sad to see the tree pulling, which left that Acadian stroll of my first years an empty paddock.

During that time there were changes in the industry. The rise of the farmers’ market meant that there was a new appreciation of fresh fruit. The decline of canned fruit as a major component of the Australian diet meant that apricots had already fallen out of favour with the orchardists before I arrived there. The cling peaches beloved of the canners are far from being the best eating variety.

The then chair of the local health service came from a line of orchardists and the family enterprise was a major economic driver in the town, together with tourism and the now defunct milk processor. His view of the workforce was that he had the itinerant pickers who worked from harvest to harvest. They came year after year – fruit picking generally commenced in November with cherries and apricots, but the major fruit were first, the stone fruit – nectarines and peaches followed by pears and apples until late April to early May.

This was a separate cohort from those employed to pick grapes as the region is a substantial wine producer with the grape picking reaching a peak in February.

My expert friend was not particularly positive about backpackers, because they would come and leave after a few days. The problem is that the media generally turn up on day one rather than, say, day 70 to photograph the “happy campers”. The attrition rate was high, he said. The orchardists need a steady work force not a group of young people flitting from place to place.

When I was young I myself did a variety of vacation jobs – working in a wool store, reading electric light meters, working as a storeman, a guard on armoured cars, gardening, pathology laboratory assistant, working as a clerk among first and second war veterans in the then Repatriation department, spotlight worker. There may be others that I forget, but I know I never went fruit picking, which I regret.

One of the strengths of working in these jobs is you learned the vernacular of being an Australian worker, essentially at a time when unionism was strong. This was important when you were a doctor and your patients were essentially working class, as those of my father were.

There is a growing complexity in the horticultural industry, because one business model does not necessarily encompass the whole of horticultural harvesting.

Some politicians who undertook compulsory national service (or more likely received an exemption) in a different era now champion putting “these young blighters” to work in some sort of revived “Nasho”. However, there will be some smart young person, who will see a place for a scheme which harnesses the workforce in the gig economy to perform this kind of work.  Yet the politicians have allowed a generation of young workers to be pushed into the gig economy, whether they wanted to be there or not, and now may be the time for those in the gig economy to organise themselves – they have the means to do so.

It is a fallacy to believe that the young are not entrepreneurs.

Given the appropriate incentives they could develop business models for efficient fruit picking or for that matter the whole area of horticulture.

In forming the business plan, there are a number of hurdles to address. How do you marshal a workforce with tertiary aspirations, yet where the vacation coincides in substantial part with the fruit-picking season; and yet where the delights of the flesh and the necessity to work are in conflict.

Fruit picking as a business exercise should not be left to the labour contract companies, which the COVID-19 pandemic has shown to be both predatory and incompetent.

Fruit picking as a youthful enterprise, with the instincts of a co-operative work force, requires consideration in that balance between government subsidy and impost on one’s future career. Therefore, the business must ask the question of how much and whether in the end it fills the gap between the two.

The female and male workforce, price, availability, reliability, capacity needs to be assessed and negotiated. In the end are there enough young people prepared to pick fruit effectively and efficiently?

There are a number of reservations, and that is the sustainability of the industry, and because it is so varied and seasonal to develop the flexibility. I remember my orchardist friend pulled a substantial number of trees and replaced them with freezing storage units, because there was a significant demand for such facilities. That was business.

Tastes change.

When I was young, one of the treats was having snow apples. They grew in cold climates and I last had them about 15 years ago; they were growing in a vineyard in the Victorian Pyrenees. Once grown commercially, they suffered from a lack of reliability and resilience, which gave them a short season and besides, they did not store well.

For the growers, profitability is aided if the need for manual harvesting is removed. One industry which has completely removed the need for manual labour is the sugar cane industry. That has occurred in my lifetime.

Almond Trees

As another instance, the number of almond trees that have appeared where once there was only a dried fruit industry along the Murray river has meant that with the rise of the almond and with mechanisation of their harvesting there is no need for a labour force. Similarly, just outside Leeton there is huge acreage being given over to walnut trees. Again, no manual harvesting.  It highlights the need for a workforce that is both agile and responsive.

I know if I were younger and had lived in a “horticulture”, I may have tackled this task, but I am not. Still, it is a challenge because, as I said, tastes change. I remember when I was reviewing a small health service on the Victorian border, I innocently mentioned that I was growing pomegranates. The response I elicited was somewhat comical. The man was about to invest in “serious” pomegranate tree planting. It was a time when Australia had just discovered the delights of the pomegranate, and he immediately thought I was there to “case” the place for pomegranate investment rather than reviewing the health service. When I said I was only planting a couple in my back garden in Sydney, he visibly relaxed.

As an epilogue, pomegranates must be removed from the tree using clippers or secateurs, from March to May. The stem of the tree is strong and thick; fruit cannot be pulled from the tree without damaging the fruit and/or tree. There are no mechanical harvesters. Some of the growers have small acreage and have banded together to form de facto co-operatives to avoid employing pickers. However, as the southern hemisphere only supplies one per cent of the world’s production, the potential should be large for out-of-season export to the northern hemisphere. Ramping up production will require a workforce to pick the pomegranates as they are not the easiest to harvest.

Over to you guys.

մոգ pronounced mog

Armenia

Armenians, it was once said to me, are the shrewdest business people after the Bengalis. Armenians can weave beautiful intricate carpets. Armenians have been Turkish punching bags. Armenians, if nothing else, are survivors. One of my favourite songs is linked to that great Armenian troubadour Charles Aznavour. The song? “She”.

She, Gladys Berejiklian, also has strong and proud Armenian heritage, clear in the retention of her surname. She has cultivated an image of saintliness trying to emulate the many Armenian saints within the Armenian Orthodox Church that as reported she attends regularly.

My encounter with Gladys was when she was the newly-elected member for Willoughby. She came to a dinner where I was the guest of honour. She was late and was brought along by the host of the dinner to be introduced to me. Before that could occur, she saw somebody who must have been so important that she was totally discourteous and totally ignored me, despite being brought to specifically meet me.

I was surprised but then the Italian have a word for it –menefregismo. The barista not looking at you as he pushes the coffee in your direction while talking to a mate at the bar is an example. When it is combined with furbo, which has many interpretations but suggests a person on the make, then it perfectly described Berekjikian that night – except she is a furba to acknowledge her gender. After all – fare la furba – is to jump the queue.

Despite that first impression, if I thought about her which was not often in the intervening period, she seemed superficially to be assiduous and competent.

This year, however, you could not get away from her, because of the series of incidents. I noticed a characteristic, which underpins her authority. She can talk for long periods without saying: “um” or “ah” or any hint of hesitation. It was a trait that I remember a certain English teacher trying to instil into us boys, and for years, there was a BBC radio show called “Just a Minute” where the panellists were given a subject and had to talk for a minute without hesitation, repetition – a variation of not saying “um or “ah”.

It became clear that even when she was very wrong, as with the Ruby Princess, this ability to talk without hesitation gave her an air of authority and her escape hatch from admitting error.

It is amazing how a one trick pony has gone so far, but it may be argued when coupled with that of her immaculate conceived persona that she has been very important to her Party when underneath her feet is a swamp of indeterminate depth inhabited by all sorts of creatures, those that grate and those that appal.

The immaculate sparkle has gone. Yet one of her Ministers, in a stumbling defence, said she was married to NSW. Needless to say, how that could be interpreted in the current soap opera obviously escaped him.

At least, NSW has been spared that agonisingly ambiguous statement of the politician under stress: “I am going nowhere.”

I await the first hint of hesitation in her voice, but maybe that occurred with Kyle Sandilands. Then some may be said to have standards which do not include parsing his utterances and her replies.

I have to admit she did sign the gift I received at the dinner and still treasure – a magnificent book on Aboriginal Art.

Chloroquine studies are alive and well in Parkville

There is still one study in Australia into whether taking hydroxychloroquine can help prevent health care workers getting COVID-19 in the first place. And the jury is still out on that one.

What an interesting take by the intrepid Paul Barry. He had spent extensive time in his “Media Watch” two weeks ago bagging that comedy duo, Bolt and Dean, for their advocacy of the use of hydroxychloroquine in the treatment of COVID-19.

I expressed concerns months ago that funding had been provided to the Walter and Eliza Hall Institute of Medical Research (WEHI) to test the prophylactic use of this drug for health workers. The hypothesis I thought threadbare, and subsequently, the evidence against its use has become overwhelming. Barry interviewed Steven Tong from The Doherty Institute who had stopped a trial on the drug’s usage, and used the word “rubbish” in defining the further investigation in the use of the drug.

Even Donald Trump has disavowed its usage, and Barry played an excerpt of recent footage of the President to back up that contention.

So why his curious form of words suggesting that health workers are a separate entity, otherwise why in Barry’s words is the jury out, when he had just demonstrated that the jury had well and truly delivered the verdict of it having not only no effect but also potentially dangerous.

I sent an email to Mr Barry, but he seems to have learnt from his usual quarry of spivs. Just ignore and hope I would go away. However, over my long life in which I have been exposed to many journalists – their worse outcome is to lose objectivity and begin to be believe in their self-beatification.

For the record, I’ve published below my last letter to WEHI, after I had a very swift response to my first letter. Note that I have had no response in the interim 3 months plus, when much has happened to further discredit the use of the drug.

The problem is this drug can potentially kill, for what? WEHI had assembled a cheer squad asserting the worthiness of this study. I was assured that the funding was totally derived from government, although WEHI had admitted accepting money for COVID-19 from a Chinese company, which has been under governmental investigation for business malfeasance.

I made sure that copies of my correspondence were sent to both Brendan Murphy and Anne Kelso, the Chief Executive Officer (CEO) of NHMRC. Needless to say, they have shown no interest.

I have published that letter, unabridged below. I hope that community and peer pressure will stop this pointless exercise. I canvassed the study with certain sources outside the WEHI claque, and one comment was telling – how concerned he was in the decay of a once great Institute. Not my view as yet.

Perhaps, Mr Barry, you could clarify further why you made that comment, when you were so definite in criticising it elsewhere in you program. Have you an undeclared link with WEHI? Unfortunately I don’t have my own “Media Watch” to keep you up to the mark.

I’m sorry, but at this stage, I am disappointed. Below, my last letter of 27 June 2020 to Prof Doug Hilton AO, Director, WEHI:

Dear Professor Hilton,

Thank you for your very prompt email. Your direct response in relation to the source of funding for the study is instructional for those who obfuscate, however unintentional.

I am very sympathetic to the plight of research institutions in raising funds, but raising expectations, as you would realise, is two-edged. I am somewhat concerned by some of the reports emanating about putative cures because there is already a scepticism in the community about science, which has led the dark fringes of society exploiting anti-science attitudes in the community. This situation is always aggravated when expectations fall short.

You are very disappointed by my linking the Trump support for hydroxychloroquine, but the message received is as equally important as that sent. I do not question that Pellegrini and Wicks had constructed a hypothesis, but its construction when there is already controversy as to its use obviously raises question of whether the publicity created did not play a part in the government making available funding.

I’m alarmed, as you must be, by the apparent renewed support by Trump for its usage even after the FDA’s July warning on its safe use, on the advice provided by Dr Stella Immanuel, whose other ideas are bizarre to give the most generous interpretation. Given how increasingly difficult the situation is becoming you may wish to reconsider the WEHI position, given any association with this Dr Immanuel’s idea would not benefit WEHI.

It is for you as Director to determine its priority in the overall research program if MRFF funding had not been made available. That the availability of funding was not influenced by political considerations, at the time when hydroxychloroquine as a cure was being so widely promoted, was at the tie partially answered in your response.

I note that the study is subject to interim analysis and look forward to its release.

I note that the study has rheumatologists and other lines of support, I am not sure whether my requests have been answered so that I am not personally reassured, in particular concerning the safety of the study. However, for the time being I shall accept your assurances.

In relation to your final paragraph, I have read your annual reports and periodic bulletins – and I understand you have had some spectacular results that have resulted in profitable collaboration with the private sector. However, may I make a couple of points: you refer to my being a medical doctor, but I also suffer from a chronic autoimmune disease, and therefore mine is not a detached interest.

Also in relation to the therapeutic effect of hydroxychloroquine, as I have written elsewhere, the drug was essential in treating the malaria that I contracted in Madagascar over 30 years ago. It was a nasty experience; fortunately I have never had a second attack. But that was malaria, a recognised use for hydroxychloroquine!

From your response you are far from the “the simple protein chemist” as you describe yourself. Your response is impeccably drafted, apart from your use of “principle”. My principal committee I assure you was principled.

My kind regards

Jack Best

As someone said, the first death of a health worker in this study will see a scattering of support for the study, which would test even the best “Outback ringer” to catch.

Watch this space.

Mouse Whisper

Hickory Dickory Dock

The way he kisses dictators’ butts. I mean, the way he ignores the Uighurs, our literal concentration camps in Xinjiang. Right now, he hasn’t lifted a finger on behalf of the Hong-Kongers,”.

“The United States now regularly sells out our allies under his leadership, the way he treats women, spends like a drunken sailor. The ways I criticize President Obama for that kind of spending; I’ve criticized President Trump for as well. He mocks evangelicals behind closed doors. His family has treated the presidency like a business opportunity. He’s flirted with white supremacists.” …

“But the reality is that the President careened from curb to curb. First, he ignored Covid. And then he went into full economic shutdown mode. He was the one who said 10 to 14 days of shutdown would fix this. And that was always wrong. I mean, and so I don’t think the way he’s led through Covid has been reasonable or responsible, or right.”

The author of these statements?  Senator Bernie Sanders? Any other Democrat?

No, it was the junior Republican senator for Nebraska, the anti-abortion, anti-Affordable Care Act, pro-gun, anti-impeachment Senator Bill Sasse.

Yes, he may have said it in a whisper, but let me say it was a courageous whisper across the Pawnee National Grasslands of Nebraska.

Senator Bill Sasse

Modest Expectations – Round & Round

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

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

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

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

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

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

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

Thick as a Plantain

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

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

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

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

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

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

Dr Young is unyielding – to a point.

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

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

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

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

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

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

The little sparrow 

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

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

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

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

Scabies

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

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

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

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

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

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

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

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

Letter from Victoria

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

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

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

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

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

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

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

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

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

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

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

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

Federally-Operated Quarantine Facilities

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

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

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

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

Howard Springs quarantine facility

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

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

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

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

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

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

The model exists in the successful evacuation from Wuhan.

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

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

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

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

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

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

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

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

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

Well, let’s see!

O Panda Alaranjado

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

So has been written to me by an American lawmaker.

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

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

Burning the White House, 1814

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

Mouse whisper

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

Is Julian the Lesser suggesting that:

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

All in all, a rum statement.

Out of breath

 

Modest Expectations – Vince Gair

What I wrote about Biden in May holds in my view, but but for one thing…

The most disturbing vision of Biden is his rear view – essentially that of an old doddering man. Then turn him around and there is that ever-engaging smile – as if he has a giant axon inside his skull that is connected to all the facial muscles, which make him smile on cue when somebody rings the metaphorical bell. 

Biden is a plagiarist, discovery of which aborted his 1988 Presidential campaign. Plagiarism is a mixture of deceit and intellectual laziness – or underlying dumbness. This flaw resurfaced in certain dealings last year.

… Nevertheless, one positive sign that he is a good man is how he has handled grief and he has much to grieve about in his life.

America is in a mess; no matter when the change is made there is a White House reduced to the political nursery of the Baby Trump, and there will need to be someone very focused to clear out the rattles, the dolls, the bucket and spade, and other geegaws fondled and thrown around in the past four years.

I fear Biden just doesn’t have the ability – no fire, only embers. My earlier comments about him have not changed, and my support for Bloomberg would still hold had it not been for this entry of Obama into the frame.

Kamala Harris

He is still a fake, but fortunately Kamala Harris is authentic. I had not been paying enough attention to this very smart lawyer from California because I thought Biden would choose from the talented pool of Democratic women from the Midwestern States, even given that he was colour conscious. The residual influence of the Clintons would have been tested; the accident-prone Susan Rice in the forefront of Hilary’s list.

However, the Obama imago prevailed.

Biden is not adventurous and at 78 he has the habits of a lifetime printed in his electrical circuits. Prejudices such as showed in relation to Anita Hill bubble below the surface, despite all the meae culpae he has given. I never trust a plagiarist – it shows a level  of dishonesty, subterranean it may be.

However, that pales before Trump, a person whose inability to tell the truth is well documented.

When Trump immediately attacked Kamala Harris and called her “nasty” (how pathetic can you be), he starts on the eligibility nonsense that he tried to perpetuate with Barack Obama. He is now repeating the same with Kamala Harris. In so doing, he emphasises the essential similarity between the two. One is the son of a Kenyan and white American union; the other the daughter of a Jamaican and Indian union. Coincidentally both unions broke up soon after the children were born and both had an absent father.

Trump would have preferred the traditional Tobacco Road Afro-American upon which it is easier to spew racial division and hatred.

He has a pathological antipathy to Barack. He cannot stand being mocked, his inferior intellect put to the test, his demonstrable cowardice – all in all, a vicious, corrupt guttersnipe. To put it in simple terms, he cannot bully either Harris or Obama – unlike Biden whom he has shown that he can.

There are two reasons that could be conjectured as to why Biden delayed his choice. One is that he is a natural ditherer (not a good sign in a President with so much to rectify) and the second is that he simply did not want Ms Harris. One may suspect that she is the Obama surrogate. That is not to denigrate her, but it will not be too much trouble for her to “clean up” Pence – and then unleashed she will so clearly become the President-in-waiting.

Two Vice-Presidential reactions when the President became “infirm” are relevant contrasts.

Eisenhower was 67 when he had a stroke in 1957; Woodrow Wilson was 63 when he too had a stroke in 1919. Eisenhower had nearly three years to go; Wilson the best part of two years. Richard Nixon, whom Eisenhower had foisted on him and whom really did not like much, became more prominent directly in policy decisions after 1957.

Trump is 74 and has been rushed to Walter Reed Hospital at least once; Biden is 78. Both probably are testimony to the availability of health care now in modern America, for the affluent at least, particularly in the treatment of cardiac disease and high blood pressure.

Thomas Marshall, Wilson’s Vice-President and who somewhat eerily had been the 27th Governor of Indiana (the current Vice-President Pence was the 50th), followed a different path. Again, although as with Nixon he served two terms, Marshall was disliked by Wilson and particularly by Wilson’s wife so that he was blocked from much of the day-to-day management. However, Marshall was very much his own man with seemingly a misplaced sense of noblesse oblige in refusing to take over as acting President because he feared the precedent that this action would have created.

In other words, even at an age when infirmity can strike suddenly, Biden can be tolerated because (a) Trump is so bad, probably more senile and (b) Biden has a strong deputy. However even the sight of the indecisive Biden face to face with Trump still fills me with trepidation, whereas Harris I suspect could eat Trump for breakfast and still ask for more waffles.

Is Australia prepared for the next Pandemic?

The above is the title of a paper published in April 2017 that had, as one of its authors, Brendan Murphy, whose address was given as Office of Health Protection, Australian Department of Health, Canberra.

It was published in the MJA under Perspectives and begins with the statement “infectious diseases continue to threaten global health security, despite decades of advances in hygiene, vaccination and antimicrobial therapies”. How very true!

It was a paper, which has a table of four Committees with very long names, and because they are labelled current NHMRC Centres of Excellence the assumption is that they are just that. The problem is that much of health research is encased in the gossamer of self-congratulation.

Angels dancing on a pinhead?

Much of medical research is somewhat like exquisite Chinese ceramics in the seventeenth century, refining the tools of the past to render more and complicated dexterity, but not advancing the human condition – defining how many angels you can fit on a pinhead – wonderful feats but of what utilitarian value?

The Murphy paper does not explicitly mention three people who have provided Australia with a buffer in the battle against infectious diseases.

The first was the emphasis by Michael Wooldridge, when he was Minister of Health, on raising the vaccination rates of Australia in the face of criminal behaviour by the anti-vaxxer brigade. Wooldridge had a strong base being close to Prime Minister Howard and being a member of the Expenditure Review Committee. Wooldridge retired and since then Federal Ministers for Health excluding Hunt have been an indifferent bunch in relation to their influence and interest (although at times Abbott showed he was across the portfolio).

The second was Dr Brian McNamee who, on assuming the role of CEO of the Commonwealth Serum Laboratories (CSL) in 1990, turned it from being a “basket case” into a world leader in the development of vaccines and blood product. As a bonus CSL is now very profitable. In so doing, McNamee cultivated Australia’s research capacity. He had a keen eye for the very best.

The third is Lindsay Grayson, whose crusade for people to wash their hands has provided a springboard for the community campaign to wash their hands. Men in particular are grubs and Grayson, first in hospitals then elsewhere, demonstrated how important hand washing is in minimising cross infection. His work has resulted in modification of health professional contact with patients.

On the flip side, governments had believed infectious disease hospitals were a thing of the past, and while HIV inpatients gave some of them a prolonged life, these hospitals dedicated to what was believed to be a relic of a past age were progressively closed down.

Fairfield Hospital

As I have written elsewhere I remember in the 1950s being admitted to Fairfield Hospital in Melbourne for a week for an unspecified infection, and as was the wont of the senior doctor at the time I was prescribed chloramphenicol, which was shown to have disastrous side effects. I was in isolation – quarantined – in a dedicated infectious diseases hospital, and did not escape being dosed with chloramphenicol. Nevertheless, I was well treated by a trained staff and still alive.

The New Zealand Chief Medical Officer has used the word “bespoke” in relation to quarantine facilities, especially tailored for the individual circumstance. Fairfield Hospital was just that, until it was closed by the then Premier Kennett in 1996 as a cost cutting measure, a familiar tune when it comes to public health expenditure.

The dilemma for Government now – as part of the grand exit strategy – is whether to invest in the construction of quarantine facilities. Those opposed, generally identified as central agencies, may argue there are quarantine facilities available, which were convenient when the early evacuations from China were occurring, but Christmas Island and Darwin are not the most convenient. Far more troubling for these bureaucrats is the prospect of a vaccine at a time when there is substantial hype about its prospect of success.

There are two points to keep in mind: the vaccine is far from a done deal, and there are plenty of other viruses at a time when the Climate is changing and when technology has conditioned the mood of the population to care only about Self, surrounded by Instagram or Facebook or Twitter or Tik Tok or Facetime or IsolationXbox.

However, investment in facilities now may be the price that needs to be paid to reassure Australians that our status of being a country with a low COVID-19 infection rate is preserved. It may be that the price to be paid from coming from a place of high infectivity to Australia means automatic isolation.

The paper by Murphy and his co-authors sets outs a number of Committees. Despite all the apparent impressive panoply of intellectual input set out in the paper, Australia was woefully underprepared when the Virus struck and was fortunate that our distance from the source of the original infection provided a buffer. Perhaps in hindsight, what was done there is the template for quarantine facilities to be established.

For Murphy the pamphlet of 2017 becomes the reality of 2020.

Australia just cannot be placed in permanent lockdown on the whim of some set of politicians. There is a need for a finer sieve than group punishment. If there is a lesson from this Victorian debacle it is that nobody should be allowed to visit a nursing home (or a prison) for 40 days or least a significant period after returning from abroad and not developing signs of infectious disease, then so be it. That is an obvious restriction to be put on the table, but there will be others.

The development of quarantine facilities to house the infected or those potentially infected should be near airports, and the further the airport is away from a high concentration of the people the better. There are those who wish for a vaccine, but given that viruses are coming in waves – and until this Virus struck, Australia has dodged the metaphorical bullet.

To get this whole response right is not just a case of consulting laboratory scientists whose ruminations have been effectively ignored by the community until the Virus struck. I have always taken issue with the Fabian approach of pamphleteering for change. As has been clearly demonstrated by Murphy et al in their paper, until the pandemic struck, there was no impact of these matters on the politicians. Now of course the airwaves are full of these same scientists unleashed, some able to communicate well, others not. They remain background noise while those in charge of containing the pandemic continue to work on in a social Darwinian bubble shedding the useless people whilst retaining the useful.

Wartime does not have the luxury of maintaining the idiots, just because they look good in suits. In other words, even though the cacophony of those who love show-boating remains, it is refreshing to see the “survivors”, who an observer thought from the start were competent and see some that you thought were initially incompetent improving. Hence Australia is still one of the best places to live in this Time of the Virus, even with the mistakes.

The danger is that some of the Premiers who have closed borders are caught in a competition to see who can close the longest. Closing borders becomes a mindless and sadly cruel obsession.

Now setting up, in the words of the New Zealander, a bespoke set of quarantine facilities may require less money being tossed to the other politicians-needs-a-legacy projects. I am sure the War Memorial renovations could be put on hold; and the sports stadia.

An evening looking down from the loggia

Just imagine in the Second World War John Curtin advocating for Parliament House to be transformed into the Palace of Versailles. To suggest that is so ridiculous, but Australia is in a similar crisis. The above point is to make everybody think of what is more important than the long-term health of the country – a football stadium for the inheritors of Versailles looking down from their exclusive loggia quaffing champagne and eating truffled lobster – or quarantine facilities where all the components of public health and infectious disease can be concentrated. I say again, this Virus will not be the last the infectious assault. 

The solution I propose is unashamedly simple in conception but difficult in the details of implementation. I know that; unlike the following, which is barely intelligible but it is not the only vapid advice which has been published: And we might do well to remember that the wisest and most effective course of action will more often be forged in the contest of ideas than distilled from unilateral decisions untested by scrutiny and tempered by no real debate.

However, one must not get angry, rather listen to that wise local florist who noted: “when my ability to smell the rose and the eucalypt return, so will I then contemplate the frivolous.” 

Once upon a time in Lithuania

In an earlier blog, I have written in some detail about our visit to the Baltic countries. However, a few comments may be relevant now that the hidden country of Belarus has emerged from behind its curtain. What is surprising is that when we drove from Estonia to Latvia and then to Lithuania we noted that there were no mountain ranges or marshes between the three countries – just nondescript borders. Yet, there are three distinct cultures, three distinct countries. All have struggled to maintain their independence, but with the breakdown of the old Soviet Union they all achieved their independence.

In 1989, to celebrate the independence from Russia on the 50th anniversary of the Molotov-Ribbentrop Pact, the people of those three countries formed a human chain stretching across all three countries from the Tikk Herman, a mediaeval Estonian fort in Tallinn, to the square in front of the Lithuanian cathedral in Vilnius.

In Vilnius, we were told that we would no longer need a visa to go to Belarus. Vilnius is close to the border and it was only a couple of hours drive to Minsk if it were not for the stringent border controls, which reflected that Belarus had never moved from its Soviet past. That was correct, we did not need a visa, but only if you flew into Minsk. It did not apply to land borders.

Belarus was once a client state of the Soviet Union and a founder member in 1945 of the United Nations as Byelorussia. Nobody talked about it and because it was translated as “White Russia” it was confused with the white Russians of the 1917 Revolution – those who opposed the Communist red Russians. So anybody who encountered the name shrugged their shoulders, “too complicated; little relevance” and turned to other matters. For Australia, there were very few migrants from there fleeing Soviet domination, unlike the Baltic Countries.

Protests in Belorussia

To most people Belarus (once Byelorussia) has meant nothing – a small landlocked nation of peat and farmlands, iron works and overflow Soviet manufacturing. To those who knew little, it was just a part of the Soviet Union, carved off, given a name, just to be another convenient rubber stamp, to provide another vote in the UN – to jump when the Soviets said so.

The Republic was not retained when the Soviet split up, and it was given its independence. However for Belarus, unlike their neighbours, this did not bring democracy.

So there was little surprise when a burly young former collective farm manager named Alexander Lukashenko seized power in 1994 and then, over time, consolidated his power over the population of nine million. While Yeltsin was there and in the early years of Putin, Lukashenko wanted to have his country re-absorbed into the new Russia, with himself as the Vice-President; that dream faded as Putin consolidated his personal power.

However, Byelorussia has its own language and while most people speak Russian, the country has certain differences. It is Slavic, but it has more than a pinch of Balt. It was an area, once Lithuanian as part of its empire with fortified towns. The Swedish army has tramped across it, as had the Poles. The people suffered greatly under the Soviet Union and in an article in the February 2000 Harper’s Magazine the author, who had decided to visit the Kurapaty Forest just North of Minsk, said:

“Shadows throughout the grove resolve themselves into crosses; the farther in you look the more crosses you see. Here lie the bodies of tens of thousands of Belarusians (estimates run from 30,000 to 900,000) who were executed by the Soviet authorities.” In the psyche of the Belarus people, this Soviet brutality has not been forgotten.

In 2000 Lukashenko, who had some pretensions to being an ice hockey player, was only 35 and had the support of the elderly and rural communities. His approach to government was well-defined as during that year (2000) four opposition leaders had simply disappeared.

But now in 2020 the population seems to have had enough. There is always a tipping point and Putin, if he invades, would be well aware of the cost of not only fighting but also garrisoning a hostile country, especially one where the President-in-exile is lodged in Lithuania. Furthermore, much of the countryside in the South and East has been contaminated by the Chernobyl nuclear power plant accident. Radioactive caesium is lodged in the soil.

Then there is the Russian exclave of Kaliningrad Oblast for Putin to think long and hard about if he moves on Belarus.

Kaliningrad

Kaliningrad, named after one of Stalin’s cronies, was formerly Konigsberg, the capital of Prussia. The oblast, the size of Northern Ireland, was annexed in the aftermath of World War II as a base at Baltiysk for the Russian navy, being its only ice-free port. The area is also essential for Russia’s ability to intercept and interfere with Allied communication networks – Russia’s spoiler.

Putin could move fast and send troops in to rescue Lukashenko, reckoning that his influence over Trump would stymie any Allied response involving Kaliningrad Oblast which, despite being heavily fortified, could be a risky proposition.

Currently Russia is separated from its exclave by both Belarus and Lithuania. An invasion of Belarus, unimpeded by Trump, could tempt Putin to demand a corridor across Lithuania in much the same way that Hitler demanded a corridor across Poland to the then Baltic free-port of Danzig, one of the precipitants for World War II in 1939. Lithuania is a member of the EU, and yet…there is this Manchurian candidate factor redux.

Fanciful? Better to call it out?

However, drawing breath and not wanting to wander into a nightmare more fitting of a video game, in which I am no expert; equally I am no expert in how to destroy the world to save a despot or two.

Mouse Whisper

Geraldine Ferraro was Walter Mondale’s Vice-Presidential choice in 1984. At the time, there were many ugly rumours about the Democratic New York congresswoman relating to unpaid taxes and family links to organised crime. After all, she was of Italian extraction and from Queens at a time when the Godfather series had stereotyped Italian America – guilt by association is a favourite ploy of the media.

She decided to confront the media and answer each and every question for as long as it took – by 80 minutes she had exhausted the media and when she had finished, according to a report in the Washington Post, many of the cameramen filming applauded her.

As the Washington Post recalled this week:

There was just one critic left to deal with — the conservative columnist George Will. He had sent her roses as a sort of apology, writing in a card that, “Has anyone told you that you are cute when you’re mad?”

Ferraro called Will to thank him for the roses… But there was something she needed to say. 

“Vice-Presidents aren’t cute,” Ferraro told him. And then she hung up.

Modest Expectations – Natasha Nuora

Given what has been happening this week and I have been on the road in areas suggested as potential hotspots, I am starting this week’s blog with a few jottings. The radio has been the constant companion and television ever present in motel rooms, wherever you stop to socially distance.

I jotted down “self important politicians pontificating about how bad everything is – all on fat salaries and perks”.

I have never been a great fan of Tony Abbott, but when he was engaged as a firefighter or as surf lifesaver, he may have attracted some media attention, but unless it was all spin he continues to provide a real tangible service to the community.

So what of the current batch of politicians? What are they doing? Now in the time of the Virus where are all these well paid politicians and their side kicks – on the ground helping out rather than buried in spin – helping out with food deliveries – helping their constituents get through the crisis and not inflaming it.

For instance, those people in the high rise have two local parliamentary members – one Federal; one State. Both are Green.

Their names are Adam Bandt and Ellen Sandell. The photo-op outside the high rise apartments – of course. What else, running around picking up scraps of paper at the foot of the apartment blocks setting down the grievances of the locked down residents – and there is more – they are complaining to the government or in the political terms “ making representations”.

Now given that they represent comparatively small geographical areas, I would expect that these two would know what resources can be rapidly mobilised and instead of uselessly fluttering around be working to assure the “care element” for the tower residents.

Now if I were the local parliamentary member, given so many people have isolated in a series of high rise building, I would be seeking answers to questions of resident safety in the case of fire. Simple questions as to assure the smoke alarms in each of the flat are in working orders and nothing is blocking the emergency exits.

As I jot, in this fast moving scenario, comprehensive testing has  concentrated the Virus  in one of the towers. The Government has seemingly restored some order here.

I sympathise with Premier Andrews. He has the cattle he has been left with – often elected through branch stacking and factional deals. Obviously, a few able colleagues will have escaped the net of incompetence. One of these is Richard Wynne, who is the Housing Minister and the State member for Richmond who is very much acquainted with public high rise towers and what’s more effective.

The Victoria Opposition? I’m sorry I suffer from coulrophobia, which makes me having difficulty commenting further.

However, there is one person who overcomes my coulrophobia, and that is Premier Gladys. Obviously the spectre of the Ruby and Newmarch keeps her awake at night.

As soon as the pandemic flared up, she was into border lockdown without any contingency plans. Then a COVID-19 positive teenager turns up in Merimbula -after all, if the spread is going to happen, school holidays is a perfect time as Victorians flee winter.

However, had she anticipated border lockdown and was there a contingency plan? Well, apparently no. However, next day, she is encouraging NSW border townspeople not to travel and may have to lock down that area.

I bet there is no contingency plan in place to withdraw her troops in the face of the advancing Virus to the Murrumbidgee River, and yet she stigmatises her NSW border constituents and reinforces what has been said for years – that the NSW border should be reset at the Murrumbidgee River, so little the NSW government is concerned about its Riverina population welfare.

Day 1 of border closure – 6.00am – 4 degrees C

Data, Gladys, data – 10 cases across Albury-Wodonga and not one for 92 days until a couple of Melburnians were caught escaping Melbourne. The Victorians have locked down metropolitan Melbourne – that should be sufficient in any case.

It also raises the question of why isn’t the Government coming down hard on the appalling behaviour in Sydney, where social distancing appears to be reduced to about 30 cms if you’re one of the massive pack of people lining up to enter a hotel in Double Bay. Callers to ABC’s breakfast program discussed strategies for avoiding unwanted hugs – there seems to be a pandemic of short memories about how to avoid catching COVID-19 if that discussion is anything to go by.

Then Gladys’ nightmare continued, JetStar slipped a plane through the NSW cordon, emphasising the inherent fragility of policy being as strong as the weakest link.

Now two of the 48 passengers refused to be COVID-19 tested. If that one percentage of “refuseniks” is considered representative of those who are probably the same cohort as the anti-vaxxers, then there is a need for quarantine space not being a plush hotel to accommodate them.

No doubt, NSW has done an excellent job in relation to hotel quarantine, but that does not diminished the argument for designated quarantine facilities. The new and immediate challenge is a government intent on providing a refuge for an unspecified number of Hong Kongers at the same time as the States are showing hotel fatigue by pleading for fewer overseas flights.

Then, there must be a plan to cater for expanding travel given that for a long period into the future, the world will have reverted to the nineteenth century quarantine situation given the differential effect of the Virus on nations – and not wanting to completely stifle international travel yet not wanting travellers to be isolated for quaranta giorni, the basis for the word “Quarantine”.

The Greater Green Triangle

I have spent a lot of time in the Greater Green Triangle over the years. From the time I was responsible for some community health projects in Western Victoria and more recently when I was Director of Medical Services at Edenhope Hospital for a couple of years. If you asked 100 people in Victoria or in South Australia (outside the GGT) where is Edenhope, I would guess the number who knew where it was in each State would run into single digit figures.

However, Edenhope exemplifies a border town and the interdependence of border settlements with one another. Their ability to accommodate to different governments with different legislation is one of the qualities that I love about such towns. I have worked in many.

The problem is that being at the extremes of the State, unless in Queensland where the border is close to the capital, the border residents tend to be forgotten. And this is so, even in Queensland! At the Post Office Hotel in Camooweal on the Queensland-Northern Territory border, you can get the best steak sandwich in Australia – but who would know.

However, let’s return to the Greater Green Triangle. The Victorian-South Australian border was set in 1836 to run along the 141st meridian. Although there is some discrepancy between the then and now measurement, what distinguishes the area east and west of the line is the limestone South Australian coast and hinterland; and this is reflected in the buildings. Mount Gambier stone is a distinctive limestone. One of the ways community in rural Australia has traditionally defined itself is through its football leagues. In this area traditionally there has been a strong Australian Rules tradition; all the border leagues are organised around perceived communities, and these do not seem to recognise borders as a barrier.

The Greater Green Triangle has its base along the coast from Apollo Bay in Victoria to Kingston in South Australia, and as it goes north, where the major population centres are Horsham and Keith, before it runs against the Mallee, an area that also crosses the border.

The point is, as I found out when I assisted in the establishment of the cross-border Greater Green Triangle University Department of Rural Health, that it proved a viable size to deliver an area where medical students could gain enough clinical experience. It showed that the region had both the intellectual capital to provide tertiary education for the population locally and also a population to support clinical training. Both Flinders and Deakin University have had a significant investment in this putative region.

Working at Edenhope demonstrated how clearly important Naracoorte (known locally as Nazza) was to those living on the other side of the South Australian border. This was emphasised by the 2011 floods, which closed the road between Edenhope and Horsham. This meant that services in South Australia were crucial.

Look at the data. Regional Victoria has been virtually free of the Virus for a long time. Therefore, the case is clear for a more sensible approach to border closure in the south-west of Victoria and the south-east of South Australia.

The recent cross-border exemption of 50 kilometres recognises the importance of Mount Gambier and Naracoorte to Western Victoria. However, it dose not recognise the importance of Portland, Hamilton, Warrnambool and even Horsham to South Australians living along the border. As I write this, there is apparently a substantial backlog of people seeking to gain the requisite permits to cross the border

Recognition of the Greater Green Triangle – a long-established and recognised area by three governments – is now being undermined under the current COVID-19 restrictions. The tri-governmental decision to close the Victorian border with NSW fails to recognise that this economic, educational, health and community zone should not be undermined during the COVID-19 pandemic.

East of Eden

The Victorian border south of Eden suddenly looms as a small notice and a bigger notice further on announces the East Gippsland Shire. There is one mobile neon sign saying that those from some undefined hotspots are not allowed into NSW. The cars that whiz past, including several towing caravans – all with Victorian number plates. There is no sign of any active policing of the border.

However, that was before the NSW decision to close the border from Tuesday midnight.

There is no doubt that this border crossing will present a logistics problem. It is going to be interesting to see how the NSW police will arrange their supervision of the Princes Highway border for an extended period, given that it very sparsely populated in an area of bush regeneration, with lots of tracks and not much population until Eden 50 kilometres up the Highway. The ADF may be very useful here. Presumably for completeness, the NSW water police or the Navy will be patrolling the 31 nautical miles between Mallacoota and Eden.

This past weekend we decamped to Merimbula. We were curious to see how the devastated region, after the ghastly summer bushfires, was regenerating. We had watched, as did so much of Australia, with horror and helplessness the destruction being wrought. We contributed to the bushfire relief, but it seemed a pittance. We were then ashamed at the politicians’ response, many of who were overseas, even though there was forewarning of the disaster afoot, much in the same way this border closure has been handled. Many warning signs; then the white stick panic.

Our visit coincided with the weekend of the Eden-Monaro by-election, and although some equated the electorate with the bushfire, the actual area of the electorate burnt was comparatively small and unpopulated. However, that statement is little comfort to hamlets like Cobargo or Mogo where the devastation was numbing. In Australia loss of property is like losing your mind – your memory.

Yet in Merimbula there are few signs of the bushfire. The trees grow tall in the gullies and onto the rises of this hilly settlement with its glorious views of the water stretching out into the Pacific Ocean. Here is a world of the best rock oysters and great fish cuisine. And that emblem of middle class – the golf course – that has been unaffected. The trees are majestic and the fairways green.

Here is the remnant temperate rain forest, which stretches out onto the slopes of the Great Dividing Range. Yet here is an electorate, where a climate denier whose only bush fire policy seems to be fuel reduction, nearly got elected. I would like to see how she would go about man-contrived bush fuel reduction on Brown Mountain. Fortunately, she received a huge thumping by the Merimbula voters.

South of Eden where the devastation was so pronounced there is a very small population – tiny settlements such Kiah are littered with the graveyards of houses, although the local store stoutly displays a “bottle shop” sign.

 

Princes Highway, south of Eden

I remember the reports from Eden, which saw people congregating at the wharf. The flames across Twofold Bay must have been a terrifying sight.

The sturdiness of the bush has been shown by the way the new green leafy growth has been shinnying up the black trunks – to announce its new arrival. However, death is beige, trees whose beige foliage hangs forlornly. The trademark colour of emerging wattle is noticeably absent. Yet there are banksia and grevillea in flower – small numbers but as with the grass, and the ferns and wildflowers, exhibiting regeneration. Nature does not wait for government assistance. Will the thousands of eucalypts across NSW and Victoria that now have epicormic growth gradually recover? Time will tell, but the intensity of the fires was such that we are unlikely to see recovery any time soon, if ever.

There are areas of clear felling and trees scorched beyond immediate redemption. There are no sounds – no bird sounds, no evidence of wildlife, no animals skittled on the roadway. It is not yet Spring but this is a silent world, apart from diminishing noise of the highway.

Yet the two government bush fire inquiries are meandering down bureaucratic gravel roads. The NSW Inquiry finished its community consultation in May, and the Federal Inquiry is due to finish on August 31. When will there be recommendations; when will there be action?

The governmental inertia is appalling and, as has been shown by the Berejiklian approach to government, it gives no idea of whether she knows what she’s doing – apart from kicking the can down the highway and trying to find it in a white stick panic. The NSW bushfire report is due “before the next fire season” (policy by length of the string principle) and presented to her (policy by ceremonial burial)

However, get ready for her response in 2021 when the remaining South Coast bush may have been subject to fuel reduction, but not in the way she meant – only it was not her fault. Nature had just misinterpreted her message.

Stabilising our “Arc of Instability”

Neil Baird – Guest blogger

Celebrated American travel writer Paul Theroux describes his impressions of our neighbouring Pacific islands in “The Happy Isles of Oceania”. It is an ironic title for a book that others have described as “The Arc of Instability” – the chain of islands extending from the Cook Islands in the east to Indonesia in the west.

Cook Islands

While the latter epithet was originally applied to geological instability, it now much more accurately applies to geopolitical instability. The Chinese “dragon” has awakened and is blowing its hot, corrosive and corrupting breath in the direction of our archipelagic neighbours.

That makes it high time that Australia and New Zealand wake up to the threat that accompanies China’s interest. We should be doing much more to counter that threat while we still can. Instead of our benign neglect of the region during the past 75 years Australia and New Zealand need to become very proactive and pragmatic. It is far too late for idealism – the light on the hill burns low. 

Anyone sceptical of the danger that the Xi Jinping-led China presents to Australia should be reminded that his approach shares the hallmarks of a number of pre-World War 2 dictators.

Inter alia, Winston Churchill’s “The Gathering Storm” and Willard Price’s “Japan’s Islands of Mystery” and “Japan Rides the Tiger” very perceptively and accurately predicted the likely outcomes arising from the behaviour of such “Imperialist” dictators.

Willard Price’s books are most relevant to Australia’s current situation with respect to our neighbouring archipelagic nations. His description of the Japanese strategy and actions in regard its League of Nations Mandate of the Micronesian territories north of the Equator are particularly apposite in our current situation. President Xi’s China is closely following General Tojo’s playbook, albeit a little less brutally; so far.

Xi Jinping has demonstrated his imperialist credentials in the South China Sea. They have since spread rapidly with his “Belt and Road Initiative” which, as well as many Pacific and Indian Ocean states, now even encompasses the satirically characterised “Democratic Socialist Republic of Victoria”.

A serious and rapidly worsening problem in Australia’s immediate neighbourhood has emerged. While many of our neighbouring nations have been described as “failed states”, it is probably more accurate to class them as “unviable states”. In hindsight, it would have been better if they had formed a federation giving them some critical mass when they gained independence from their former colonisers.

They are, apart from Indonesia and Papua New Guinea, mostly too small, in terms of land area and population, let alone resources, to be economically viable individual nations. All are, to be bluntly honest, seriously deficient administratively. That makes them unusually mendicant and, therefore, vulnerable to external influences.

This reality must be allowed for in any approaches Australia makes to our neighbouring nations in an effort to counter the influence of the Chinese government. These countries need help and, to preserve its own future, Australia needs to help them.

However, to effectively help protect our neighbours from Chinese hegemony, Australia must be much more realistic and practical in its approach than has been the in the past. The paternalistic, diffident approach of Australia has created a vacuum that China is rapidly filling.

Australia must help protect these “Pacific paradises” from the detrimental effects of Chinese “colonisation”. This will require a very different diplomatic approach that to challenge the capabilities of both Australian and New Zealand bureaucrats – be they diplomats, trade representatives or “aid” consultants. They will need to be very incorrect politically.

That will require a much more culturally sensitive and realistic approach than has ever been demonstrated by current employees of Australia’s Department of Foreign Affairs and Trade and flies in the face of their education and departmental acculturation.

The simple fact is, as any senior island nation bureaucrat will privately confirm, their biggest problem is “political interference”. Read “corruption” from elected representatives from ministers downwards. The Chinese government panders to this. Australia does not. This policy puts us at a great disadvantage. Australia must learn to work around and overcome that distasteful reality.

With that reality firmly in mind, Australia needs to much better plan its approach to those tiny nation states. We have to accept that they are not really “democracies” in the way that most Australians and New Zealanders understand that word.

Apart from brown paper bags of cash, diplomacy has a long tradition of purchasing influence. Scholarships, similar to those offered by the successful Australian Indigenous Education Foundation, provided to the bright – they’re always bright – children of politicians would be a start.

So would appropriate venture capital funding for business start-ups. “Educational” tours for politicians are always popular. There are numerous examples of what could be done in that line without having to go so far as the old German trick of “limitless” credit cards.

Australia could do much more in the areas of health, education, transport, agricultural, forestry and fisheries development, disaster relief and even defence. Australia could provide these island nations with safe, efficient and comfortable Australian designed and built ferries for inter-island transport. Importantly, Australia should train them to operate and maintain those ferries safely.

In contrast Australia should not be:

(a) building “Taj Mahal” financially unviable convention centres, or

(b) providing fleets of fancy cars to transport the delegates to non-existent conferences.

Above all, unlike our Chinese rivals, Australia should not be pushing debt onto the islanders, which only serves to reinforce their mendicant status.

The aid provided should be practical, sensible, conspicuous and culturally sensitive. There is no point in providing aid in any circumstances where someone else gets the credit for our generosity. Importantly, rather than handing over cash that inevitably would be spent on Toyotas, Yamahas, Hyundais or Maseratis, Australia should promote purchase of Australian goods or services.

We have plenty of desirable home grown goodies to offer,” as one reliable source said to me.

Not To Know What Happened Before One Was Born Is Always To Be A Child

I once had dinner with the essayist, author and sometime editor of Harper’s, Lewis Lapham, in New York. It was very cordial, entertaining dinner. I was trying to entice him to Australia to give a talk, but somewhere, sometime he slipped out of the net and did not come.

Later he did come to Australia and Bob Carr hosted him. The meeting of those minds is not surprising because although Lapham was a gifted essayist with a very astute mind, he could not resist writing such words: “I first met him at a New York dinner party in 1962, among the company then traveling in the entourage of President John Kennedy, and over the next half century I ran across him at least once or twice a year – in a Broadway theater, on a lawn an Newport, Rhode Island, in the Century Club dining room, on the stage of an university auditorium.” However, he carried his self-importance more easily than Carr, probably because he was a true intellectual.

In any case he was talking about Arthur Schlesinger. Schlesinger was a historian, a very good historian, who saw the world in which he lived, as Lapham recalls, as a place “to construe history as a means rather than the end, the constant making and remaking of the past intended to revise the present to better imagine the future.”

Schlesinger, although he died in 2007 at the age of 89, had witnessed the growth of the information revolution, without watching it explode. He noted that it was associated with “an attitude of mind which accommodated the floating world of the timeless fantasy, impatient and easily bored, less at ease with a stable storyline than with the flow of brand names images in which nothing necessarily follows from anything else”.

The problem with eloquence is that those mentioned above are listening to a different beat and hence the comment is lost in that floating world. Further, eloquence may mask thoughts that may be too personal, too generalised or just too loquacious.

“The problem is if the population do not recognise that history captures the past then the populace may be presented with solutions where there is no link between cause and effect. To be told what is right without any evidence, without the benefit of history is to caught up in the whirlwind of fake news, fascist politics and quack religions.”

Schlesinger was talking about Bush The Younger’s legacy in dumbing down American educational standards. Such a statement retains its relevance 13 years later, when the barbarian is no longer at the gate – he is within the gate. Now educational standards are reduced to slogans and chants of invective repeated.

Lapham compares Schlesinger’s analysis of history with that of a man who “forged the strength of Roman history into a weapon”. According to Lapham, both this man and Schlesinger recognised history was not a nursery rhyme. The name of the Roman was Cicero.

Marcus Tullius Cicero

Cicero paid a mortal price for his defence of the integrity of the republic against vanities of would be Emperors; and by the way, the quote at the head of this article was written by Cicero; how prescient a description of the current American President.

Mouse Whisper Primo

Overheard in the executive office of an unnamed casino: “Of course we have bought a vat of sanitiser – how else are going to launder all the money we are getting?

Mouse Whisper Secondo

Premier Gladys, my whisper from the floor, may I give you a tip about salt and pepper shakers – use them first, then hand sanitise. Then everybody can share or else wipe the shakers down before you use them.