Modest Expectations – David Owen and Norman Cowper

For those who want to follow the sordid details of the former Member for Wagga Wagga, Mr Darryl Maguire’s shenanigans while he was a Liberal Party member of the NSW Parliament there is plenty in the media about his questioning before the ICAC that I need not repeat, including his close relationship with the Premier.

However, when his conduct forced his resignation from Parliament, at the 2018 by-election, Joe McGirr was elected. Joe was then easily re-elected at the 2019 poll. Joe is an Independent, and first challenged Maguire in 2011 with his major policy to upgrade the local hospital. He achieved a swing against the entrenched member Maguire who was, at that stage, the Liberal Party Whip; the miasma had yet to rise and cloud his parliamentary career.  Joe had not stood in 2015.

Joe McGirr

Joe McGirr has a strong ALP connection and his great-uncle was Premier of NSW. His grandfather was Minister of Health in NSW when James Dooley was Premier. Joe is resolutely independent and has resisted blandishments to join any Party.

Joe McGirr came to Wagga Wagga as a junior doctor and remained there, undertaking a number of roles. He is married to Kerin Fielding, the first female orthopaedic surgeon in NSW (and only the third in Australia in what is very much a male club). They have four adult children.

Dr Fielding is a cordon bleu cook, and she and Joe have a retreat in the south of France, which unfortunately I have not savoured.

Over a period of time I have had contact with Joe, as I undertook a number of jobs in Wagga Wagga, and I encountered him from the time he was a young doctor on the way up. During the time when the first rural clinical school was being planned in Albury and Wagga Wagga, which had its moments because of the traditional rivalry between the two cities, Joe was always eager to assist. It was unsurprising when he became Associate Dean of the then new Notre Dame Medical School.

Joe has been reported as saying that: “My views on social justice were formed by the Jesuits during my education, with the Jesuit approach linking justice to action and love. I have seen through my work, many areas of rural disadvantage that create problems for the whole of society as well as those directly affected. Social justice is an important part of our medical program and should be a part of every doctors calling.”

This view on social justice has been translated across into his diligence in parliamentary life.

With Joe, you know what you’ll get.  Brutally honest, in a sea where there so much parliamentary squalor, just look at whom he replaced. A premier swain, no less – and high on the Dodge.

The problem with anybody who runs as an independent for parliament in a country electorate, it helps if you have local “cred”; for Joe it counted for a little at the first tilt, but not enough.

He persisted.

When I have advocated for an Integrity Party, sometimes you wonder if you talking to an empty stadium. However, Joe McGirr is a very useful role model for future candidates, even if he is an avowed Independent.

Oh, by the way, his first major electoral policy has been accomplished.  And there is more – the local Wagga Wagga hospital has reached stage 3 of its redevelopment.

A Casual Comment which the Conservatives will probably ignore – for the time being

Barry Goldwater

In 1995, Barry Goldwater warned the GOP that they would rue the day they welcomed the religious right into the party.

It is a pity it took him until he was 85 years old to say that.

However, maybe an Australian somebody of a similar age in the appropriate part of the Australian spectrum will have the guts to say that – because in the end ignoring the Goldwater axiom will savage the credibility of genuine conservatives.

David Owen visits

In 1982, the Australian Institute of Political Science (AIPS) reached its fiftieth anniversary. The Institute published the Australian Quarterly and held annual Summer Schools where people from all sides of the political spectrum used to gather to mingle socially and discuss matters politic.

The pioneering Cowper Family crest

Norman Cowper was one of the founders of the Institute. Of the pioneer families five – the Cowpers (arrived 1809), the Streets (1822), the Stephens (1824), the Windeyers (1828) and the Fairfaxes (1838) have produced representatives, prominent in public life, over the succeeding four or five generations.

Thus Norman Cowper, a lawyer in one of the biggest Sydney law firms, was hardly a radical. However, in the 1930s he was very concerned with the rise of fascism, as he was of communism. In founding the AIPS in 1932, he saw it as a bastion for the political centre where the reasonable left and right could converse across the policy divide. Therefore, the Board and contributors represented both sides of the political spectrum – then United Australia Party and the Australian Labor Party. Gough Whitlam used the Summer School to test some of his policies in the years running up to the 1972 election.

While the AIPS was Sydney-centric, it had a Melbourne Committee. However, it was not until I moved to Sydney that I was asked to join the AIPS Board. The Institute survived on modest grants from some of the large companies and the proceeds of the Summer School. However, by the 1980s as politics became more ideologically driven and coverage of politics in the media expanded, the influence of the AIPS began to decline.

Although we did not know it at the time, the fiftieth celebration was the last hurrah for the bipartisan flavour that the Institute had attempted to inject into public debate. I was entrusted with organising the anniversary.

Norman Cowper was 86 at the time, and everybody wanted him to be there. The family was enthusiastic and so it was important that the anniversary honoured him. However, I had the disadvantage of being a newcomer to the Board, essentially an outsider who had to work around the sensitivity of a Board that had known better times. The sun was setting on what the Institute had been constructed to be, a bulwark against the extremes in politics.

David Owen

At the time of the celebration it was before the Falklands war, Thatcher was on the nose and Reagan was still to make his impact. I thought that it would be an idea to have speakers from each of the decades. David Owen, as co-founder of the newly-created Social Democratic Party, provided a model of the centre. He was a doctor, and he was friendly with a prominent English surgeon who I had met the previous year. I was able to enlist his support in having David Owen accept the invitation.

Unlike speakers today, David Owen did not charge for his attendance and through my contacts, a first-class airfare was arranged gratis; that left the Institute to pay for his accommodation.

I had the idea of having a relevant speaker for each of the decades from the foundation of the AIPS to describe what was happening in terms of the politics and policy.

The speakers were Nugget Coombs, Bill Snedden, John Button, Anne Summers and Patrick Cook, with Max Walsh as the Master of Ceremonies. The talks, including the inaugural Cowper Oration given by David Owen, were scattered across the dinner which was held at the University of Sydney.

In addition, I persuaded the guys at Movietone, who had their archives in Balmain at the time, to put together a traditional newsreel, together with the highlights of 50 years. So it was a jampacked evening. Anne Summers was a great help in getting the program together, particularly persuading Nuggets Coombs to reminisce on the 30s and Patrick Cook to round up the speakers’ list.

I remember asking Paul Keating whether he would attend, but anybody – no matter who they were who deserted the Labor Party – was a “rat”. David Owen had been elected as Labor Party member for Plymouth Devonport and was part of the “Gang of Four” that had broken away from the Labor Party in 1981, and at the time of the Oration he was very much the flavour.

We were both doctors. We spent an interesting week together, and he told me that he had not had a better “minder”, but I said I had done it before – and had learnt a great deal about being the essential shadow. He gave me one piece of advice which has been imprinted in my memory ever since – never be caught in the soggy political centre.

I’m not sure whether he followed his own advice.  My view is that the centre is not definable; it shifts around like the Magnetic Poles.

Later I was to become the Chair of the AIPS and suffered an attack from the right to take it over. This time, the Centre proved not to be soggy, and the attack from the Victorian right was defeated. I learnt a lesson – if you naively believe that a centrist political position has a future you need resilience and deep pockets – and wait until the stench from the political miasma becomes too much, even for the most complacent, and the community pleads for a climate change.

Re-setting the cuckoo clock

Guest Blogger:  Janine Sargeant AM Master of Public Health

“No general penalty, pecuniary or otherwise, shall be inflicted upon the population on account of the acts of individuals for which they cannot be regarded as jointly and severally responsible.” So says the 1949 Geneva Convention.

No wonder Victorians, and Melburnians in particular, are sick of both lockdowns and being treated as pariahs judging by the statements from the smaller States. This is particularly the case for the border communities. NSW fares little better when it comes to treatment by these other states, but at least has avoided the harsh Melbourne lockdown. Yes, group punishment is alive and well here in “good ol’ democratic Australia”.

Premier Palaszczuk is the stand-out serial offender here. Anxious to present herself to her electorate as the defender of Queensland against the “marauding plague” from the south, her offensive comments about locked down Melburnians have just added to their misery.

When the Queensland border opens up to the plague-ridden southerners they could be forgiven for rejecting her blandishments to come and spend their hard-earned money in this Mendicant State of the North. Opening day: likely to be just after the election. Surprise; surprise. The fact that her fellow Queenslander, Pauline Hanson is the prime practitioner of xenophobia, she as the inheritor of the Barcaldine tradition should be bloody well ashamed of following the Hanson line. The Deputy Premier, Stephen Miles has exhibited arrogance verging on boorishness in his contempt for the southerners.

Palaszczuk and Miles shouldn’t underestimate the extent to which their endless ill-considered commentary about not wanting those “diseased” southerners in Queensland has made the past three months even worse (apart from the purveyors of football games and others she has exempted). Don’t underestimate the impact of the longest, toughest shutdown in the world on the mental health of those in its midst.

And what is the latest advice from those who apparently encouraged hoarding of food to combat the swine flu epidemic? There is a rumour about gunships on the Brisbane River to repel invaders from the south although this one is difficult to confirm.

28 days of no community acquired cases and then, after a couple of weeks, NSW has three cases of unknown origin, 48 hours to find the origin or else!  Or else what?

Queensland re-sets its cuckoo clock on the border re-opening. Now it seems it is community transmission of unknown origin; talk about moving the AFL goalposts.

The current outbreak in Shepparton again demonstrates the challenges this country is facing, particularly when individuals think guidelines don’t apply to them.  It highlights again that public health in every state must have strong contact tracing and clear directions in relation to targeted testing and expanded self-isolation. There is no excuse for this not to be the case; the health departments have had months to get this right. Contact tracing will allow all states to keep outbreaks suppressed – and there will be outbreaks.

But not to cynically use disease for a blatantly political exercise.

Thus, memo to you Premier (for the moment) Palaszczuk – having no COVID cases when your State is hermetically sealed doesn’t get you any prize; the real test is when the country opens up, which it must do. So, where is the agreed national plan to safely open Australia’s open borders in which you are participating? Where is the plan for affordable quarantine to bring business travellers and tourists back? Or do you plan to lock out the world until it can demonstrate 28 days without community transmission?  Good luck with that one.

Memo to those other Premiers, Gutwein, Marshall and McGowan, read the memo to Palaszczuk and take a memo yourselves; the fact that you might be keeping your borders closed, or you dream up bizarre rules like the current one about not lingering in Mildura for petrol or taking a comfort stop at the side of the road as you drive through from NSW to SA (via the main road at the north west of Victoria) if you want to avoid 14 days quarantine, your actions are seriously dividing a country that is struggling and needs to be pulling together.

A bit of advice to the fiefdoms, look up “mendicant state” and remember that Australia is one economy but the larger State economies support the smaller ones. It is about time the Prime Minister rounds up the Premiers and directs some mature thought about Australia behaving like an adult nation – not a collection of infants in the playpen they rule for the moment.

Bud Wiser

Driving along we had just crossed the Lachlan River on the road through Darby Falls, beyond a line of trees there it was in a field behind a gate sardonically labelled “Railway Crossing.”

It was a Budd railcar – still recognisable – a silver cigar-shaped carriage sitting out in the middle of this field.

In 1950, the first of three Budd diesel powered rail cars was bought by Commonwealth Railways for use in the Iron triangle of South Australia.  I remember being on one of its first trips between Port Pirie and Port Augusta. For a young boy, this gleaming motor train with its rippling silver stainless steel frame shouted “I’m American” and resembled the Pullman cars that were featured in American films and magazines at the time, albeit without a locomotive. It was very exciting. I almost thought I would see a man in a peaked cap and appropriate livery there to assist us onto the car. In the American films of the time they were always black men. This was well before Afro-American replaced the subservient descriptions of the slave state.

Three rail cars were shipped to South Australia, manufactured by the Budd Rail Company in Philadelphia. The rail cars were said to be able to attain speeds of 90 mph, and I remember that day in May 1951 climbing aboard, and finding myself hit by cold air. Air conditioning is taken as a given in today’s world, but not in 1951.

There were two compartments, originally with the luxury of padded seating for forty-nine and forty-one respectively, buffet facilities being fitted still enabled 70 people to be accommodated.

The reason I was on this train was that it was the link service which enabled us to join the “Ghan”, the train originally named after Afghan camel drivers that worked across the Territory. The train travelled between Port Augusta and Alice Springs. The contrast between the slick Budd railcar and the venerable steam train labelled the “Ghan” was amazing as though one was climbing back into a past century. In those days, the “Ghan” wended its way through the Flinders Ranges and then North through the desert, but through that part of the Simpson desert which was liable to flash flooding.

The rail cars because they were swift and relatively noiseless and ran on the unfenced railway also had a propensity of striking wildlife, in particular kangaroos.  Twice on level crossings the rail car tangled with trucks, and on one of these occasions the rail car driver was killed.

Four of the cars were built under licence in Australia for NSW railways later, but by the 1990s all the rail cars had been retired.

One obviously ended up on this property, but it only shows there is always something around to remind you that you have been on this planet far too long.

Roger Dunn

He was my oldest friend, but our pathways deviated far away from one another. It was in the past few years when these now old men re-started the relationship we had at school. Some of the magic which is deep friendship remained. Roger was a successful scriptwriter for shows like Bellbird, The Sullivans, Homicide. He was a great watcher of human frailty, even though probably a bit too much was seen through the bottom of a wine glass.

He was not a bad artist and learnt part of his trade from John Brack who, for a time, was our art teacher. The ever-alert Roger noted that Brack had a separate room into which he would vanish, often with a young lady; in the romantic parlance of Dunn at the time this room was dedicated to our teacher’s trysts. I was too naïve to notice. After all, ours was a boys’ school.

Anyway, Brack found time to do a pen and ink caricature of Roger which now has pride of place at the school.

I penned this piece below which Roger’s eldest son, Lachlan read at his funeral last week.

Name?

Roger McLeod Dunn, Sir

Two small boys stand forever captured in navy blue shorts and butcher blue shirts, unbuttoned blazers; but not forgetting the cap on head. From home to school and cheering events, the cap jammed on head was the essential ingredient for everyday living.

Two small boys living close to the same railway line. Trains thundering past – a mutual lifeline to wild distant lands of Kooyong, Darling and Jordanville.

Two small boys joined by their love of words. Once they both entered a competition at school – one with delicate touch described the feathery fairy penguin; the other wrote about the awkward grumpy cassowary. The boy with the light touch won, the youngest ever winner of that prize.

The two boys endured that school; had a friendship held together by that love of literature where even in daytime they both could see the stars.

Vale good friend. The fairy penguins will be dancing with you.

And you? John Barton Best, Sir.

Mouse Whisper

The guy from Old Man Gunyah Creek said as the vehicle passed by the hill, the afternoon sun casting a sheen on its purplish-blue colour: “You know,” gesturing towards the hill, “It is always a matter of perspective. Some call it the Riverina bluebell, while others – Paterson’s curse.”

Having been in England in early spring where bluebells dot the country often in the dappled shade of trees with their new foliage, it is a sight immortalised on many a painted teacup. From a distance, you might gain a similar impression as you drive through the Australian countryside, especially where the weed may be seen growing in gullies shaded by gum trees.

Obviously, Jane Paterson thought so when she bought cuttings back from Blighty in the 1880s to plant in her garden on the family property. She did not think it a weed.

Then the weed escaped. Mrs Paterson’s name is not recorded among our female pioneer heroines.

For Australian farmers who have experienced the spread through much of the East Coast and Tasmania, it is Paterson’s curse. It can be used as fodder, by animals with a rumen, but it caused consternation by those driving by when they saw a number of horses in a large patch seemingly feeding on it. It can kill horses.

However, as a footnote there is a suggestion it was not her fault -well not totally. The number of phenotypes found here are greater than found in Blighty; but sorry that does not let her off the hook.

Somebody had to be the first. Oh, I remember it is success which has many authors, but then I remember – the weed has another name. Salvation Jane.

Jane, Paterson or Bluebell

Modest Expectations – Telephone Pole on Ardmona

Fillet of a fenny snake;
In the cauldron boil and bake;
Eye of newt and toe of frog,
Wool of bat and tongue of dog,
Adder's fork and blind-worm’s sting,
Lizard's leg and howlet's wing,
For a charm of powerful trouble,
Like a hell-broth boil and bubble.

I must be living in a parallel universe.  Nobody has commented how much like Wonderland it all is. Illness with Trump becomes a circus act.

Two lines of people in white coats troop down the stairs of the Walter Reed Hospital. In my many years I have never seen doctors emerge from a hospital as if they are members of a marching band who have forgotten their high stepping band major twirling a baton.

At that stage, I wondered who was looking after the President – he was conducting a photo-op to convince everybody he was working; yet he looked ill. So, I presume the crew of that little masterpiece he was filming were physicians who doubled as camera crew.

Then he is out on the streets, denying every protocol relating to the Virus, bar one, he appeared to have his lower face covered. But he is a bag of contagion, for God’s sake.  He is being driven by men in masks and white coats, but the strait jacket is nowhere to be seen.

Back in the hospital, he has a tantrum. “I wanna go home” is the insistent refrain. Back at the White House, it is plain that he is short of breath, struggling to maintain his posture. Next frame in this farce: Trump has seized the narrative from his medical staff and is now reporting his own condition. The cameras do not switch to the White House lawns to show his staff playing croquet with flamingos as mallets with Virus balls.

The head of Trump’s medical retinue is an osteopath. Sure he was titled an emergency physician, but what does that mean in the term of this guy’s experience? He demonstrated a level of inexperience, which could be attributed to nervousness or incompetence.  As has been observed, “There are innumerable examples of sycophants rising to a level of incompetence where they are finally ‘revealed’. When that happens, the kissing up no longer matters – now reality demands competence.”

The question remains: what does his osteopath know about infectious diseases? Not much.

The President is being given a weird concoction of drugs, and one of the ironies is that if this unpredictable infant negotiates the illness, then the cult worship will intensify.

Is Trump taking a calculated risk in leaving hospital and returning to the White Burrow, whilst ensuring a screen of twitters? Or have the hinges completely come away from the door?

Zigzagging all across the landscape, he knows that the media are fascinated by his serpentine movements. The media is the helpless rodent in front of the snake, mesmerised by these movements.  Perhaps more the Komodo dragon rather than snake, given that saliva is the medium for contagion, and that saliva is an ooze coating his White Burrow. So beware the Kiss of the Komodo, Ivanka.

But then young Komodos climb trees to get away from the cannibalistic adult Komodo – they, like Donald, are too heavy to climb trees.

And as a postscript question to the hapless Dr Conley, can the King Komodo still smell the hamburger and chips he is gobbling?  Or would that be too much like being a clinician to answer that? 

A future President of the USA writes to the incumbent…

It is ostensibly January 31, 1829. Martin Van Buren picks up his quill in New York and writes to President Jackson. He is alarmed. 

“The canal system of this country is being threatened by the spread of a new form of transportation known as ‘railroads’. The federal government must preserve the canals for the following reasons:

One. If canal boats are supplanted by ‘railroads’, serious unemployment will result. Captains, cooks, drivers, hostlers, repairmen and lock tenders will be left without means of livelihood, not to mention the numerous farmers now employed in growing hay for the horses.

Two. Boat builders would suffer, and towline, whip and harness makers would be left destitute.

Three. Canal boats are absolutely essential to the defense of the United States. In the event of the expected trouble with England, the Erie Canal would be the only means by which we could ever move the supplies so vital to waging modern war.

As you may well know, Mr. President,’railroad’ carriages are pulled at the enormous speed of fifteen miles per hour by ‘engines’ which, in addition to endangering life and limb of passengers, roar and snort their way through the countryside, setting fire to crops, scaring the livestock and frightening women and children. The Almighty certainly never intended that people should travel at such breakneck speed.”

The problem with the letter was that it was a (in Trumpian Capitals) HOAX. Jackson had yet to be sworn in when the letter was purportedly written and no original of this letter has ever been found. Yet this example of absurdly protectionist fears, written in such a manner that it would be greeted by outrage and derision, is still given currency.  I remember hearing about the supposed letter when I was a teenager. It had been shown to me in all seriousness. I was duped. This hoax letter is still doing the rounds. How many are still duped?

I wonder whether any of the Trump sputacchiere will have currency in 200 years from now. But then, as those reading about the climate hoax on the parchment of the Murdoch past, it just may be a remnant of civilisation living in a world resembling the remains of a Texan barbecue in an ocean of blue-green algae learning to love aloes, hemlock and bitter melon by then.

An Australian Centre for Disease Control Thought Bubble

A mate of mine received this ALP splurge from the Shadow Minister of Health Bowen.

Australia went into COVID-19 unprepared. We are the only OECD country without a Centre for Disease Control. Our nation went into the coronavirus pandemic with less than one mask for every Australian in the National Medical Stockpile, an overreliance on global supply chains, and badly stretched aged and health care systems.

Future pandemics are a certainty and we can’t be left playing catch-up again. We can’t afford another Ruby Princess, or another tragic disaster in aged care. Our health, our lives and our economy depend on us getting our response to future pandemics right.

That’s why this morning, Anthony Albanese and I announced that, if elected, a future Labor Government will strengthen Australia’s response to future pandemics by establishing an Australian Centre for Disease Control.

Establishing an Australian Centre for Disease Control would mean that Australia will be better prepared to avoid the mistakes we’ve seen from this government so far.

This is one of the most contestable announcements that has emerged from the Opposition. I always remember one Government staffer deriding Opposition policies as “Policy by Penguin Book”. In other words, somebody thinks he has a bright idea, and then reads stuff which supports his claim without discussing it with anyone with experience for confirmation of the assertions.

What the ALP are advocating is that Australia centralise the public health to one centre, as the Centres for Disease Control (CDC) in the USA which, over the years because of good leadership up until Trump interfered with its succession planning, enabled its high academic reputation to be maintained. Now the CDC lies wounded, maybe mortally. There is no back up.

The media release says Australia went into the COVID-19 pandemic unprepared. Yet theoretically perched on a board of an international organisation dedicated to epidemic preparedness was a former head of the Federal Department of Health. This person watched while a number of abortive epidemics denoted by colourful acronyms rolled across our country.

What did she do not only heading Health but also then Finance? Emulated Sir Humphrey, if her performance on the “4 Corners” program was any guide. The “4 Corners” program seemingly was supposed to remind everybody of her grasp of the subject but instead showed how content-free she actually is.

There was no significant increase in the funding for public health under her stewardship and, at the end of her reign as the Government might have said, “we were shovel-ready to cop the Virus”.

However not to be diverted, back to the ALP announcement. Nothing wrong with that first sentence! This writer plunges on.

However, how are the OECD countries travelling? The media release says that Australia is the only OECD country out of 36 members without a Centre for Disease Control. That is a stretch. I am unaware of New Zealand having such a centre. USA with its CDC has 7.3 million COVID-19 cases, whereas the Australian total without a CDC is 27,200 and New Zealand 1,858. How does the author regard the use of the particular statistic to bolster his case for an Australian CDC?

Then the non-sequiter in the release – “few masks, an over-reliance of supply chains and a vulnerable aged care sector”. So? That is not a responsibility of a CDC.

The success of the Australian health system, despite being starved of funds for public health over the past 20 years, coinciding as it did with the Halton stewardship, was that NSW had set up a decentralised contact tracing system in the early 1990s as part of a generalised devolution of public health responsibility regionally. Hence in NSW, disasters in nursing homes and the Ruby Princess were resolved, messily but nevertheless resolved without huge numbers of cases and deaths compared to the later Victorian experience.

Even though I advocated that in NSW heads should roll because of these disasters, the basic strength of the public health system saved them. The Premier has never fully acknowledged the authors of that program – and it was certainly not Dr Chant, as she has herself acknowledged.

The Parkville Precinct

Victoria on the other hand never had an organised public health system, and the reason was that public health funding, beyond the training programs, was sacrificed on the altar of Parkville aggrandisement.

The result was that Victoria was completely ill-prepared to be able to handle the contact tracing requirements of this epidemic. What has saved Victoria is not some esoteric centre in Canberra, but a realisation by Andrews and some of the public health specialists that something had to be done to save the situation. Let’s face it – he closed down Victoria to allow the public health system to be upgraded and a de facto regional approach created.

By shutting Victoria down he enabled the street fighting with the virus to be undertaken with minimum street casualties, and the hand-to-hand combat in nursing homes where the Virus had sheltered to be contained and then has been steadily rooting it out, even though innocent people unfortunately have been caught in the “crossfire” without any protection.

A regionalised public health system has many heads and, unlike in America where CDC relevance and responsibility has been decapitated, thus is harder to destroy.

Ergo, mark for Master Bowen: D-…  A poorly thought-out essay.  Please resubmit after getting advice from somebody who knows.

Appointment with a Telegraph Pole

I was badly injured. Yet as the car which I had been driving a few minutes previously was being incinerated, I found myself laughing. I had got out of the car. I remember releasing my seatbelt and opening the door. Now I was watching the car – a rented Holden Calais burning. In the distance but coming closer I could hear bells ringing.

Charon and the River Styx

Then blank. The next picture imprinted on my memory was of opening my eyes and looking upwards into a hairy face. I did not care, if this was introduction to a hirsute Hell then so be it.

Then I heard my name being called – distant but distinct. Since I was not wearing glasses as I usually did, I had to focus. No, it was not the representative from Hades customs seeing if I was bringing anything illegal to burn, but my cousin’s son Owen.

My cousin, Margaret, and her husband Bill, lived in Shepparton at the time, and that evening I had intended to go to her 50th birthday party there. Bill was the city engineer at the time. Owen had a sister, Jill, who I do not remember playing any role in the drama.

It had been an ordinary Saturday, and I had had an uproarious lunch, with a few drinks. I assessed myself able to drive the three hours to Shepparton. The problem being June, the weather was foul, but I arrived in Shepparton at about five o’clock in the evening. Given that the party was not going to start until after eight, instead of going to the motel, I decided to go and see another mate who had a parish in a nearby town. No matter that this was the eve of the shortest day of the year and the sun had set. The rain had come again.

I did not get far, and fleetingly remembered the car aquaplaning and sliding off the road up a narrow muddy pathway.

So much for any more festivities.

Then blackness before the image of fumbling for the door handle.

Having got out of the car, I could not walk for two weeks. While I had considerable soft tissue damage, the only fracture was a rib broken by the seatbelt as I went from 100 kph to zero in a second or so.

It took me a long time to recover so I could return to work. I needed plastic surgery on my face, where my chin had imploded on the steering wheel. Fortunately, that was skilfully done, but then if you need plastic surgery for disfigurement rather than vanity, Melbourne has traditionally been the best place in Australia. So I was fortunate in more ways than one.

Now 40 years later I have extensive osteoarthritis in spine, knees and shoulders. That is the price of the impact. It is unsurprising that until I developed an autoimmune disease related to the arthritis, I coped. In the years after the accident I competed in many misnamed “fun runs”, and while finishing in the ruck, it convinced me that I had enough mobility to do so.

That I have described elsewhere.

There was one major change that I noticed about six months after the accident, but have I never talked much about it.  Probably because it is so subjective. As background, I had extensive head injuries, and the area between skull surface and the thin muscle layer, the galeal aponeurosis, was a lake of blood. This fluctuant spongy mass stayed for several weeks, but I did not have any intracranial bleeding.

I went back to work. The Italians call it garbo – it is an untranslatable Italian word, but it is the way I was treated – trying to suggest I had come back prematurely but not telling me directly; garbo. Courteous pitying, you might translate it.

My insight was such that I was oblivious to hints for a longer time in convalescence. I was never sat down by my peers and specifically challenged – and even if I had been there is always someone prepared to make allowances, and in split decisions, the benefit of the doubt generally prevails. I presume that occurred in my case, and I solved the problem by being perceived as eventually returning to “normal”.

Yet there was one  change in my personality that, unless you had followed me as a boy, adolescent and young man, you may have missed.  Before the accident, I had been prone to periods of dark depression; yet not despairing enough to be suicidal.

After that head injury, I have never again had these episodes of deep depression. At that time, there was not the same attention being paid to head injury – particularly on the sporting field.

Yet there is now an increasing reportage of traumatic injury of combat, although it has been around since Cain punched Abel.

Having mental infirmity was just a hidden phenomenon, and in an era of “stiff upper lips” as the shorthand for not showing any weakness, you did not talk about mental frailty. If you were laid out, you shook your head, got back on your feet and went back into the fray. There was never any talk about head injury, unless there was obvious loss of function.

In my case, whatever happened to my brain circuits in the crash, I emerged with a change of which I gradually became aware. I was able to cope better with setbacks. The dark moods were largely gone. Had the accident changed my circuitry? The obvious answer subjectively was “yes”. However, there was no one able to judge whether I had changed.

I am not advocating for people to improve their lot by banging their heads against walls, but what I am saying is traumatic injury is very much a lottery, and never should be ignored. Concussion is one thing, but is important in having someone who is able to detect any long-term change from head trauma, especially repeated. The problem is it takes time (and in this world who has the time or the level of care) to stop the episode ending up as a death against a telephone pole on a country road in the middle of a tempest. Some survive; some do not.

Putting Meaning into ExHume

Conditions not complied with or enforced (currently under review). State government approval conditions require 80% of ‘reservoir gas’ emissions (3.4-4 million tonnes each year) from the Gorgon facility to be captured and pumped underground (geosequestration or CCS) delivering a 40% reduction in the project’s total emissions.

Chevron received $60m in federal funding for the geosequestration project. It announced geosequestration had begun on August 8th, 2019, more than two years after production commenced. Delays were due to ‘ongoing technical problems’ and Chevron has also been accused of deliberately mismanaging the geosequestration project. No penalties were imposed by the WA government for emissions not sequestered over this period, and alternative offsets were not provided by Chevron despite State conditions requiring them in the event the geosequestration is not successful.

A review is currently underway by the WA Environmental Protection Authority to examine and clarify the intended start-date for the geosequestration condition at the request of the WA Minister for the Environment. There is no federal requirement for sequestration ….

Chevron geosequestration project

Australia has had a Carbon Capture and Storage Development Fund since 2009. These carbon technologies are supposed to trap the carbon dioxide produced by factories or fossil fuel power plants before they are emitted into the atmosphere where they contribute to global heating.

Once trapped, the greenhouse gas can then be piped into permanent underground storage facilities or sold to buyers who can use the carbon to manufacture plastics, boost greenhouse crops and as one boosting media release said even “help make fizzy drinks”.

As one insider has written, when the Australian fund was established for carbon capture in 2009, crude oil prices were just recovering from a sharp but very brief decline. Then Chevron decided on the final investment decision (FID) for Gorgon. The world was awash in natural gas then as it is now. Chevron made a decision on a projected $30bn LNG facility with a cost model in which high hydrocarbon prices would bail them out.

The cost overruns made Gorgon the most expensive LNG facility per unit cost ever of more than $50bn and the raw gas stream from the field already contains 15% CO2.

Today, carbon capture (CCUS) facilities around the world are capturing more than 35 million tonnes of CO2 per year. Apparently that is equivalent to the annual CO2 emissions of Ireland, whatever relevance that may be. Recent announcements and commitments have the potential to more than double current global CO2 capture capacity. But the International Energy Agency’s Sustainable Development Scenario, which charts a path towards achieving the world’s stated climate ambitions, calls for a 20-fold increase in annual CO2 capture rates from power and industrial facilities in the next decade.

Most activity seems to be taking place in Norway and the adjoining fields in the North Sea. Norway built the first large scale carbon-capture project at the Sleipner gas field in 1996, and since has been storing nearly 1 million metric tons of CO2 each year.

Against the above estimated optimal requirements, that seems small, and Norway is where carbon capture is reckoned to be the most advanced. The current situation is a long way away from the ideal, and despite government investment in the technology,

For someone trying to find out what is going on, the area is full of obfuscation. The quote from the WA Conservation Council at the head of this blog segment has not been denied. The problem is that Government uses “carbon capture” in its recent policy announcement as though it is being shown to be a settled solution. There is one facility in Australia where carbon capture is supposed to work. It is a long way away from scrutiny – the Gorgon LNG project on Barrow Island in the middle of a nature reserve.

At least one matter is to be settled and that is that this natural gas field contributes more carbon pollution than any other facility in Australia.  In addition, the fate of the Gorgon CCUS plant has been racked with problems and even now it is not fully operational while the parent Chevron facility spews out pollution.

So there is a price. Now if the technology is going somewhere, fine, but if it is just a disguised handout to help a business mate or mates, then it should classify as assisting new technologies

It is difficult to work out how much has been wasted as distinct from being spent wisely. The Morrison government has indicated it will contribute another $50 million into carbon capture and storage technology, following more than $1 billion in taxpayer subsidies and investment from the fossil fuel sector since the early 2000s. Teasing out how much has been contributed by either sector may provide a different figure but in the end, we mug punters foot the bill. For what?

Back in Canberra, there is a major structural problem in policy direction, and that is the country is run by a public relations man. He is spin, not substance. It has been an unfortunate trait in Australia in recent times that major political roles have been filled by people of his ilk – journalists – more interested in feeding the news cycle than doing anything to improve the lives of Australians and more generally the world.

NSW suffered from Carr; South Austalia from Rann and Australia, Abbott – although the Abbott is more an aberration and thus harder to classify as a giornalista. Wistfully we may look back when journalists who became Prime Ministers were men of substance – John Curtin and Alfred Deakin.

Added to this mix is Minister Angus Taylor who leaves a dubious trail of politics mixed with self-interest rather than any real commitment to what is one of the greatest challenges – climate change. Frankly, he is not up to the challenge. That is why I suggest that the Minister, the member of Hume should exit, lending himself to a slogan – Taylor to ExHume. In fact, he should be dismissed – no longer be in any equation.

If carbon capture was the only energy boondoggle, perhaps I would be less vehement…but it is not!

I worry about a country where policy is predicated on being generous to your mates. Still, there is always a day of reckoning.

Finally, a pertinent comment from an insider made in relation to those executives in the oil and gas industry, who form a Praetorian Guard of Mates around the Prime Minister:

“They are stuck in their ways, which worked for the past decades and made them and their shareholders very rich. Now they can’t do anything else.

According to API the average age of an employee in the oil and gas industry is 51 years, only surpassed by the average age of employees in funeral homes. The average age of the managers and decision makers in the industry is even higher. 

Right there lies the problem, in plain sight for everyone to see. The decision makers in O&G are all solid, hard-working and amply educated individuals. Sternly conservative due to a lifelong paradigm of analogous thinking such as ‘proven design’ in this once wonderful adventurous industry.”

In ten years, the current lot will mostly be dead, dripping with honours and never having to pay the price they may have inflicted. So shall I be, but is not going to deter me from encouraging Australia to sleep only when the moon is no longer red with pollution.

Mouse Whisper

The Lewis chessmen are about my size. I sat in the back stalls watching a program on this extraordinary cache of figurines, which was a Viking hoard found in the sand dunes of the Outer Hebridean Isle of Lewis in 1831. Most of the 93 artifacts are in the British or Scottish National Museums. When the hoard was deposited, the Outer Hebrides were colonised by Norwegian Vikings.

The figurine which attracted my attention was one of a Bishop, with his right hand administering benediction. With the thumb opened, in the early church, the three open digits came to represent the Trinity (The Father, Son, and Holy Spirit), while the two closed digits represented the dual nature of Christ as both man and God.

However, the Bishop’s hand in one of the figurines resembled Duputyrens contracture, which is a disease predominantly of the palmar fascia, the connective tissue beneath the skin which, as it thickens, pulls the fingers into a flexed position. The disease generally affects the little and ring fingers first.

Further, it is a disease which originated in the Vikings, it is a disease which affects males and is associated – among other things – with a love of alcoholic beverages.

Just an observation, but an interesting one?

Modest Expectations – Spitzbergen

It is high time for me to put an end to your sitting in this place, which you have dishonored by your contempt of all virtue, and defiled by your practice of every vice. 

Ye are a factious crew, and enemies to all good government.

Ye are a pack of mercenary wretches, and would like Esau sell your country for a mess of pottage, and like Judas betray your God for a few pieces of money.

Is there a single virtue now remaining amongst you? Is there one vice you do not possess?

Oliver Cromwell on getting rid of the Rump Parliament

Cromwell

In the first weeks of working for Bill Snedden in 1973, I remember the office in Canberra was visited by a delegation of Myall Lakes’ miners. At the time, Myall Lakes was a major source of mineral sands, the source of the then new wonder metal – titanium. They were concerned with the intention to close the mining. It seemed genuine and that they were not proxies for the mine owners since they had a union representative with them.

In their minds there was no consideration of the need to preserve the beaches and dunes that constituted part of the landscape. It was understandably all about their jobs, a familiar theme. A very relevant theme now that there is an intention to close some coal mines in the region.

Hawks Nest

I knew about the Myall Lakes at close quarters because a decade later, after the mining had been closed down, I and three others walked the colourfully named trail between Mungo Brush and Hawks Nest. It was a very varied walk through coastal rainforest before emerging upon dunes and then back into scrubland and wetlands. It was a superb if challenging walk, the last part of which was through a marsh where there were supposed to be blocks of wood forming a boardwalk. This had collapsed in places and we were forced to wade through water up to our waists, and then at the end of the walk to rid ourselves of the leeches. However, on that day, I was very much a conservationist.

The miners thus had come to Snedden as a last resort, because they had been told that even the union was not supporting the sand mining being retained. Yet this was not far from Newcastle, where the ALP is electorally entrenched.

What could we do about it?

Snedden chose to be publicly sympathetic. He realised very clearly that there is a political divide in this country, where one side saw representing its task of protecting labour, including here the role of the State, as paramount. Any support in any case would have been seen as opportunistic and fleeting, while alienating traditional supporters.

On the Liberal side, which Snedden led at the time, essentially the policies were around encouraging individual enterprise and the development of wealth, independent of the State, yet not entirely disregarding that the State had a crucial role. It provided certain services, which had been shown or were deemed better to be public enterprises. The problem with such a separation is that in a democracy, such attempts at differentiation are riddled with inconsistencies, paradox not to mention conundra.

Disaffected union members thus do not easily fit with the so-called Liberal side of politics when a basic two-party adversarial system forms the basis of this country’s democracy. The adversarial system has been distorted by the alliance of the protectors of free enterprises with the agrarian socialists who, in their purist ideological form, have been known to ally themselves with the ALP briefly.

There are other elements. The sectarian division in the ALP, which has resulted in once defenders of worker rights, albeit with more than a tincture of Roman Catholicism, separating themselves into the DLP. They crossed the political divide, were regarded as renegades by the ALP and eventually were destroyed as a Party. Elements remain as a core reactionary Falangist rump now embedded in the conservative side of politics far away from their traditional roots. Their ideological basis aligns more easily into the “new liberalism” which has evolved.

The other political party, which probably has progressed beyond the charismatic individual, is the Greens party, but there is no discounting the effect of Bob Brown on promotion of environment protection in Tasmania.

However, a proto-anarchic party, which paradoxically has blind beliefs as a substitute for reasoned policy, is doomed to irrelevance. As was shown in Western Australia hugging trees wearing a twinset and pearls does not win a constituency.

In the end, political parties which do not progress beyond the individual who sets them up or the individual who works the Senate system, primarily but not exclusively a Tasmanian phenomenon, exists so long as they exist. Who still remembers Brian Harradine and the antics he inflicted on this country to secure largesse for Tasmania? So in your lifetime, you were influential, but that Life of Brian, your legacy?

I believe very much in the definition of conservatism that to change your view can be done by persuasive evidence-based reasoning. However, such logic seems to be in short supply these days.

The problem with politics in Australia as I have written elsewhere, is that vested interests typified by the urgers, rent seekers and mercantilists on both sides of the political spectrum have emerged to distort and compromise the political process. They have one basic belief, irrespective of what side of politics they profess, and that is: “Government is an ATM. All I need to have is a password; that is a politician in my wallet”.

Vested interests squeeze out those who have a belief that the political party of choice will take account of your views, if you are a member.

It was salutary watching the 2010 documentary of the GFC debacle and how Wall Street and an array of “respected” academia were involved in almost destroying the world’s financial structures. What happened to them? Many of the perpetrators ended up not only with handsome dividends but also as faces among Obama’s trusted advisers.

Was anybody prosecuted as a result of the Wall Street shenanigans? Nope. No wonder Obama paved the way among the deprived for the ascension of a “saviour” who has avowed to clean the swamp with a broom, he himself infected by fake news and conspiratorial theories.

The Haynes Banking enquiry in this country showed the extent of our diseased society, but already the Government are unravelling the structural cures so recently put in place. Symptomatic?

Don Chipp had the right idea when he used the slogan “Keep the Bastards Honest” as his party’s brand. Unfortunately, Chipp did not have the intellectual capacity to articulate policy arising from what was a strong call for change and, most importantly, integrity.

However, 40 plus years on, with ongoing corruption so evident across the political spectrum, the demand for a “National Integrity Commission” is the perfect way in which what seemingly is a simple issue could become the centrepiece and rallying call for a national party. The issue should be attractive to most of the independent members in the House of Representatives. It seems a single issue, but it is not.

A simple single issue upon which to campaign has the potential to focus the electorate – an Integrity Commission – so much to say about how to promote such a body; so many reminders of integrity lacking in the current crop. Contemplate a party with a pristine white banner with a blue “I” one way-intersecting at right angles with a blue “I”. Maybe throw in a few stars as well.

Eureka may at last have a long term meaning.

The problem with any centrist party is that it has to have a structure, funding, and a strategy attuned to that. In an earlier blog, I suggested a Haircut Party aimed at reducing the entitlements, perks, and the overstaffing which politicians are afforded – something which would test those already within the “parliamentary tent”.

Being a member of Parliament as I identified in articles I wrote years ago when the entitlements and perks were far from what they are today had a number of challenges and bogeys. Staffers then had legitimate policy roles, rather than just harassing bureaucrats and playing puerile undergraduate one-upmanship scherzi. The individual targets such as the choleric Craig Kelly are many, but need to be franked in terms of lack of integrity.

I mention this just to assure those who do glance at this blog, that the two notions are not incompatible – a good haircut gives one a good view of integrity.

However, I am also mindful that after Cromwell died, five years after he uttered the above exhortation, the Rump resumed and needless to say, they exhumed Cromwell’s body and hanged him.

Says something for cremation – but also about embedding policy so that it has no single author.

The Spectre of Parkinsonism

The discussion about post-infective sequelae to viral infections should not surprise anybody. However, those people who carelessly disregard history should at least take notice that the possibility exists.

I had an uncle. He was a very active, successful businessman who built his father’s agency into a profitable business. He was closely involved in attracting Roger de Stoop and his Belgian enterprise in high-end fabric weaving to set up a factory in Melbourne.

However, during the 1930s as a young man my uncle contracted encephalitis lethargica, the aetiology of which has never been worked out beyond an influenza-type pathogenesis being suspected. It was also known as “sleeping sickness” because of the severe alterations in sleep patterns. Within the family, I was told that my mother helped nurse him.

In any event he seemingly recovered and was fit enough to serve in World War 2. However, in the late 1960s, he began to show neuro-psychiatric symptoms, which were initially diagnosed as “anxiety attacks” for which he was prescribed chlorpromazine. That just made him worse, and soon after he was diagnosed as having Parkinsonism, which rapidly progressed – the trembling hands, the mask face, the rigidity. It was the time that levodopa had just been introduced and to that was added the then experimental dopa decarboxylase inhibitors to try and dampen down his movement fluctuations. In hindsight, once his prior medical history was disclosed, the association with his prior disease was made.

The disease progressed and he eventually died, not the death that such a previously active man would have wanted. Nevertheless, even though I was never close to him, I have two strong contrasting memories of him. One was the uncompromising man with a fierce expression in his late forties telling me off in no uncertain terms when I was barely twenty-one – and rightly so; and the man 12 years later in a wheelchair barely able to talk. We two were alone briefly then. I got up to leave, shook his trembling hand and said good-bye. It was the only time I have ever touched anybody on the cheek; his brother, my father, had died years earlier when I was not allowed to see him until he was dead, cotton wool already stuffed in his mouth. But that needs more explanation at another time.

However, the spectre of Parkinsonism is real, especially if theoretically there was a long life ahead of you before the Virus came. I wonder whether it will be associated with a loss of smell, one of the symptoms of the Virus infection, because that may suggest an entry point into the brain along the olfactory cranial nerve, which is not only the shortest cranial nerve but also originates in the brain itself (rather than the brain stem, unlike all the other cranial nerves, except the optic nerve).

We shall see.

There is always a solution

It was a Saturday morning. The phone rang. It was my son. I was working in Broken Hill at the time and coming to visit me, he was in Mildura. He had been booked and had a ticket to travel on the Eastern Airlines Cessna 402 flight. However, he arrived in Mildura at the same time as the camera crew, with its baggage, which was about to film a Coca-Cola commercial outside Broken Hill.

The tiny settlement of Silverton outside Broken Hill had served as the image of the Australian Outback in multiple films, and the road out to the Mundi Mundi plains was the backdrop for the early Mad Max movies. The Mundi Mundi Plains are flat land stretching to the South Australian border, and sitting on a rock overlooking the plains watching the sunset makes one realise how lucky you are to be an Australian as long as it was not a set for Mad Max.

Mundi Mundi Plains

Coca-Cola was rumoured to have a set somewhere on the plains where they shot commercials, and who was this young man with a ticket to stand in the way of a commercial eulogising dark fluid which looks like haemolysed blood but a tried beloved method of stacking on calories for many generations of the world’s youth.

Anyway, son was bumped, and when he rang he presented me with the problem. There was one fight on Saturday; none on Sunday. He enquired whether there was anybody flying to Mildura that day who could pick him up for free. There wasn’t. We quickly dismissed the idea of him hiring a car to drive the 300 kilometres between the two cities. The cost would have been prohibitive for someone of his then age hiring a car under “remote” conditions. Hitchhiking: forget it.

However, there was one outfit from whom I could charter a plane and pilot. They said they could accommodate me – at a price. The pilot had to be roused and when he arrived unshaven, I ignored the fact that he drank a whole bottle of milk immediately.

All systems go.

I phoned the Mildura airport and let them know to tell my son that I was coming down to get him. I went with the pilot, who still stank of alcohol. Despite all the signs, it was uneventful; an hour down and an hour back. I cannot remember the type of small plane, but it was adequate to fit at least four. Flying to Mildura and back on a clear morning as this was before the thermals made their presence felt was diverting. It was a time when the waterholes were filled after substantial rain. When that occurs, it took about a year or more for them to dry out, if there was no more rain – and the farmers used to sow them – it was a harvest of pocket money. Generally, two harvests could be obtained. A tremendous sight.

Yes, I remember clearly this morning and these vivid spots of green, distinct from the unending blue grey of the saltbush, blending as it does into the ochre of the desert.

I always remembered this morning as one in which a potential disaster was so quickly solved – at a price. My son was given a taste of why Broken Hill is what it is – a place that everyone should see before they die. It is the essential Australian whitefella legendary Outback.

My son met Pro Hart while he was there, said he was broke, and did Pro Hart have anything he might have for free. Pro Hart probably thought he was an urger, but generously remembered he was probably the same when he was my son’s then age. The son still has the purse with the Hart dragonfly painted on one corner.

In a way, it was a variation on that wonderful “The Gods Must be Crazy”. Here the Coke bottle stayed in the plane, and bumped my son onto the tarmac. Never thought that I was a bushman or my son was a surrogate for the Coke bottle.

Andrews – a Career going North?

The future is not about his response to COVID-19. Andrews made the wrong decision, just as he narrowly avoided a similar debacle had he allowed the Grand Prix to go ahead in March. If he had done that, and it must have been a close call, Melbourne’s “first wave” may have been as bad as the second. So I hope he remembers who gave him that advice to pull out. Otherwise he would have been cactus.

The Health Minister, Jenny Mikakos, recently resigned and conveniently, being a member of the Upper House, her resignation will require no by-election to fill her vacancy and thus few ripples. Depending on the media, she will become a footnote and then forgotten like so many. However, the parliamentary election of her successor may generate a platform for some of the more infantile in the Opposition.

Ultimately no matter how softened, Andrews will be tainted with the decision to hire the private contractors. Whether it was out of contempt for a Department over which he once ruled or not, Victoria was ill-prepared for a major public health emergency. The problem with Victoria, and Melbourne in particular, is that the politicians are continually being told how wonderful medicine and medical research is in Victoria and thus there is a belief that Victoria can weather all ills because of the Parkville precinct. It is more the Parkville rather than the Stockholm Syndrome. Generation after generation of politicians and business leaders have been lulled into believing this.

In this sea of self-congratulation, public health was a casualty. Now public health is very central, and what is happening clearly has been painful for those within Melbourne in particular; but are we witnessing what has to be done when the Virus calls. It is obviously shambolic elsewhere in the world where the Virus is rampaging. Does it need politicians with the resolve of Andrews and his tactical skill to control the outbreak?

Andrews tried the carrot but needed the stick to bludgeon the Virus out of the community. Victoria has surely seen a winter of discontent, but Australia faces a summer far better placed than elsewhere in the World, where the Virus has already conquered and colonised. Here the Virus is being forced into the underground – a terrorist force nevertheless, which will break out. Think ISIS; think Virus – a smaller form, but nevertheless terrorist.

Thus, the challenge for Andrews is to know when his anti-terrorist support is strong and reliable, able enough to be maintained, so that he can “declare a peace” and free his people, who are now knowing the anguish of wartime.

Are the lessons learnt in Victoria generalisable? What time is required to suppress the Virus once it is rampant? What is important is that Andrews has overseen a bungle, responded decisively, and did not cave in despite some attempts, particularly by some elements of the media intent on giving him a permanent pariah status. The legacy of these decisions is yet to be known in full; the Virus has been suppressed – but at what cost?

Reponsibility has been handpassed from Department to Department. But we all know. Of course, who caused the stuff up was the Channel-9 cameraman.

Penitents in Holy Week

In the end, scherzi aside, let’s face it, if you stand out there as the Premier has done, enduring all the slings and arrows day after day, recognise that this is an act of penance. Soon, the penitent can remove the purple drapes, forgiveness has been given? Who knows whether the electorate will give absolution. In the meantime, Victorians, you should move on. There will be no Pallas Revolution.

Mouse Whisper

“Thanks be to God,” Father Ted was breasting the bar of the Balaclava pub in Whroo when he heard.

He remembers when his mate from school, George Pell, could not travel back to Australia because of health problems.

In 2016, supported by a two page medical Report, “Cardinal Pell’s office in Rome issued a statement at the time saying his heart condition had worsened, making it unsafe for him to travel.”

In 2020, glory be, miracle of miracles, a medical report unnecessary because of such a miracle, Cardinal Pell did not issue a statement that his heart condition four years later has improved to such an extent, he was able to scuttle back to Rome on Qatar Airways.

Or perhaps the clouds of civil cases have begun to gather.

Modest Expectations – It’s Time

Two weeks ago, it was horror stories coming from Victoria about people being locked up in tower public housing blocks, and I expressed a concern as to whether locking people up in tower blocks should not be accompanied by a warning about the risk of fires and how this would be managed if the buildings were to go into lockdown. In fact a number of residents were evacuated to hotel quarantine.

It seems that threat has abated in the public mind in the face of the rising horror stories of the private nursing homes and the circumstances whereby the residents are caught up in the rising tide of community transmission.

This involved families, staff and “persons unknown” unwittingly spreading the virus to a group of our elderly population incarcerated in a system where financial profit is paramount and the operational arrangements seem far from being able to combat a pandemic. However the problem, while systemic, is not only rampant in certain postcodes and not in others but also completely contained within the private sector.

The Premier, Daniel Andrews, tries to be measured, never raising his voice and refusing to apportion blame to any sector of the population when it is probably plain to himself when reviewing the data that certain sections of the population are more susceptible to “amoral familism”, which I have mention previously. That one of the biggest outbreaks is in an aged care facility linked to the Greek Orthodox community has not elicited as yet any finger pointing in the community is testimony to his control of the situation.

The problem with “amoral familism”, which is not limited to a Greek village upbringing, is that it promotes the mindless protection of the family unit above all – the State can go hang. It is the product of an upbringing where the education levels are low and unfortunately the society in which many of the people have grown up is male-dominated and authoritarian, and often where sanctions are not enforced by the gentle remonstrations of the reasonable man, as Andrews is. Ignorance of English does not help.

Therefore, when it seems nobody is watching this group, even when COVID-19 positive, it is unsurprising if these people do not heed warnings. If I were isolated in a foreign village with no knowledge of the language, could or would I heed any warning?

Hence not having the language would be an excuse if the individual were an isolate. However, it would be rare for this to occur. Spokespersons for particular communities bob up all the time. Instead of ensuring that these potential “purveyors of death” are quarantined, these spokespersons seem just to offer a variety of excuses; they did not understand, they did know that what they were doing was criminal and the excuses flow on and on.

Andrews has a difficult job, because if he names the miscreants then he runs the problem of stigmatising whole communities for the sins of the few. Andrews also knows that these “hotspots” are in his electoral bailiwick, but given that many of the Labor parliamentarians in these electorates have migrant backgrounds, you would think that the Premier should not have to bear the full load. Some of the political actions are somewhat like those gossamer Green parliamentarians posturing in front of the locked-down housing towers, full of sound and fury, as is common with Greens, signifying nothing.

So it is easier to implement rules that disadvantage the Victorian community, moving to the second-highest category of restrictions – Stage 4. Unlike America, most Victorians know more about the Virus than they did in March when it first came to notice and are thus better able to run relatively normal lives, while appreciating the need for social distancing, hand washing and now masks. Most people have shown that they are prepared to work within increasing limits – as shown by the imposition of masks, which has been almost universally accepted.

The percentage of self-serving exhibitionists and just plain “wackos” seem to be mercifully small, but having identified themselves they could form a nucleus of inmates of the quarantine facilities that I have advocated should be constructed where those who are invited in serve a true “quarantine” period – that is, 40 days and nights. They would be joined by those deliberately flouting the government directives. After all, each of those COVID-19 positive individuals roaming the streets in a wilful manner is a “potential murderer”. Harsh words, but think about the logic. Who actually killed grandpa and grandma in the nursing home?

The other problem with Victoria is that it has always lagged behind NSW in its investment in public health, particularly in contact tracing. Victoria has been known to have under-resourced public health training for years.

That advance goes back to the work of Dr Sue Morey who, under the Head of the NSW Department of Health the late Bernie Amos, set up a comprehensive program in the late 80’s and early 90’s. Many of the current senior cohort of the NSW public heath physicians, as does the State of NSW, benefited from the program Morey established and owes her a very great debt.

The inability to find out the source of all the cases occurring in Melbourne also relies on people telling the truth and not incriminating themselves for whatever reason. Having said that, the present inquiry presumably is expected to reveal the chain of infection from case zero.

Those three young women flaunting and flouting through three States, refusing to co-operate, destroying their mobile phones and probably denying they are Nigerian are just extreme examples.

However, as with criminal activity the more the rest of the community is law-abiding, the more time there is for policing the extreme cases. As with vaccination, there is a reliance on having a high proportion of the community vaccinated – the vaccinated group provide a buffer for the unvaccinated.

There is also another “wee” problem that may be overlooked when the pandemic is distracting attention. The Ministerial retinue has returned from America. Like those who have flouted the pandemic in Melbourne, the government has not offered any advice on their whereabouts. However, the “cat may be out of the bag” when a so-called “consular officer” returning from overseas turned up in Maroochydore and then Toowoomba yesterday with a dose of COVID-19. Coincidence?

Apparently, “not actually a Consular officer” quibbled DFAT, but he was still carrying a diplomatic passport or the equivalent. The arrogance of holders of red and green passports knows no bounds, but at least the Queensland Premier has called this exemption out; however there is no mention of the whereabouts of the two Ministers. Again, there are exemptions for the few.

Clive Palmer – The Rose of Bulgaria or a Dangerous Furbo? 

I think that this son of Bulgaria, alleged owner of property in Sofia, and expert in its national sport of Split Squat has been wrongly characterised. Here in the damask fields of the Rose Valley of northern Bulgaria they talk of nothing else – but Clive.

He is up to all his Bulgarian tricks again. He has a case before the High Court challenging the Western Australian Government’s right to the close its borders.

His arguments are based around section 102 of the Australian Constitution, which states:

On the imposition of uniform duties of customs, trade, commerce, and intercourse among the States, whether by means of internal carriage or ocean navigation, shall be absolutely free. But notwithstanding anything in this Constitution, goods imported before the imposition of uniform duties of customs into any State, or into any Colony which, whilst the goods remain therein, becomes a State, shall, on thence passing into another State within two years after the imposition of such duties, be liable to any duty chargeable on the importation of such goods into the Commonwealth, less any duty paid in respect of the goods on their importation.

Most of the words in this section relate to the immediate transitional arrangement following the enactment of the Constitution in 1901 but the key clause has centred on what States can or cannot do about imposing barriers between themselves. Legal arguments have waged about what it all means and many lawyers have had their waistcoats filigreed in gold as a result.

The Attorney-General, Christian Porter, probably as a proper lawyer had the normal reflex. Since there is a challenge to the Constitution, therefore the Australian Government must take an interest. This is such a fundamental issue. Does State border closure present a challenge to the Federation if unilateral action is taken by a State to close the borders? Does Clive Palmer provide a challenge to the Australian Constitution?

The Federal Government was emboldened by the initial encouragement of the Prime Minister to keep supporting the Palmer initiative. There, in the background, would be the normal cheer group that thinks supporting Clive’s challenge a “jolly jape”. These are parliamentarians gathered together under the standard of a skunk-like animal with adolescent behavior rituals and bearing aloft an icon of Christopher Pyne. They can’t help irritating the Australian community from their seats of privileged opulence.

The Prime Minister has had second thoughts, hopefully not only because of the backlash in Western Australia to the Palmer challenge. It should be remembered that Palmer was born in Victoria and spent most of his formative years on the Gold Coast, where he made his first fortune in real estate. So he is not a genuine Western Australian – “he just ain’t one of them”.

If Clive wants to stir up the Sandgropers over this issue of secession, of which border closure is a subsection, then they might just take it out on the Liberal party at the next Federal election. Hence, Morrison backing away may have been because he realised that Palmer was trying to “tar baby” him.

One obvious solution is to form a pro-tem barrier away from the accepted geographical boundary. Cross-border regional arrangements are everywhere. To me, working in the Victorian border town of Cobram on the Murray River, meant that I had to cross to the NSW river town of Barooga more than once a day.

One has only to live in a border area to know that indiscriminately shutting borders is group punishment, unnecessarily unfair and at times unwittingly dangerous.

These are communities of interest, which have grown up over a century or more, where the border is just irrelevant to normal social and economic intercourse.

Therefore when this Virus is eventually contained there is work to be done in this area of “communities of interest”, so that if borders have to be closed then there is a fully developed plan that minimises the disruption and can be put into immediate effect. As has been said on more than one occasion, cross-border arrangements have diverse benefits and opportunities for managing a shared resource.

In any event should the adopted son of Bulgaria win his case in the High Court, I am sure that Western Australia could move its lockdown zone един метър inside its actual border with South Australia and Northern Territory. Clive, with your solid knowledge of Bulgarian, you would know what that means.

After all, Clive you are not the only gander in the “Gooserie”.

Hafnium (Hf)

I was browsing through an old New Scientist and came across a world map, which indicated that among a series of metals, Australia had over 50 per cent of the world’s hafnium.

According to the map legend, it was estimated that Australia had the biggest deposit of hafnium in the World. Hafnium does not occur independently in nature.

Even though predicted by Mendeleev it was not discovered until 1923 by two chemists Dirk Coster, a Dane, and George Charles de Hevesy, a Hungarian. The Dane prevailed. Hafn was the mediaeval name for Copenhagen. The Hungarian just shared the glory of having isolated this last natural occurring element.

Apparently, one of the major problems is that hafnium is tightly linked to zirconium in a ratio of 1:50, and exists in a group of three naturally occurring elements with titanium the lightest and hafnium the heaviest with an atomic number of 72. Lying between is zirconium. However, as far as can be obtained, the amount of hafnium produced is small, and until recently it was a considered a waste product, removed in the purification of zirconium. Zircons are renown as jewellery substitutes for diamonds, but zirconium has a multitude of uses, and put simply it is everywhere – its industrial use is in hardening alloys and ceramics. It is also anti-corrosive.

Recently, Hafnium has been found to have a number of amazing properties and it can be used in almost any industries where the word “advanced” is the prefix.

The special properties of Hafnium oxide have recently permitted further miniaturisation of microprocessors, enhancing processing speed while eradicating overheating problems.

Resistant to corrosion, the metal its oxide forms extreme temperatures. Consequently, hafnium is used in plasma cutting tips for welding, and is essential to the advancement of the aerospace industry. 

Added to this, hafnium carbide is one of the highest temperature resistant and hardest materials with melting point of 3,900 degrees Centigrade which potentially suitable in a nuclear thermal rocket (NTR) for faster spacecraft propulsion.

So writes the hafnium enthusiast linked to the company proposing to mine a deposit south of Dubbo when extolling the element’s virtues.

Despite its global market being about 70 tonnes annually, this enthusiast predicts the demand will double by 2025, and Australia could produce 200 tonnes a year. So far I am following the trail to Hafnium.

This is a small amount given that the Dubbo mine is proposed to be an open cut operation that will extract 19.5Mt of ore a year from a 32m-deep open cut mine.

The extracted ore is crushed and further reduced in size by grinding circuit. Sulphuric acid will be used to convert the material into sulphated ore, will be leached in water and sent for solvent extraction and precipitation, and onwards the final product.

Extraction of these elements and the associated pollution is increasingly being factored into political considerations when the mining spruikers are abroad. However, there are further chemical processes to separate the hafnium from zirconium.

The technological description states it is “a liquid–liquid extractive separation between hafnium and zirconium from thiocyanic acid medium using the mixtures of diisobutyl ketone (DIBK) and di (2-ethylhexyl) phosphoric acid (P204) as the extractant was developed.”

A metallurgist could answer the question of how much this extraction method damages the environment. 

It is almost as an afterthought, that process residues are treated before dumping them into storage facilities. The disposal of residue when there is a potentially such a big hole in the Dubbo landscape is far from a throwaway line.

Water will be taken from the Macquarie River, but the amount proposed is nowhere stated. In the description of the extraction of ore no amount of water is mentioned and the description hurries onto the marvels of the proposed mine.

OPAL’s lightwater pool

There is another problem with zirconium mining – the deposits often exist with radioactive elements – thorium and uranium. Small problem with an open cut mine only a few kilometres from a regional city! I find it interesting that there has been an experimental extraction plant at Australia’s Nuclear Science and Technology Organisation (ANSTO) since 2009. Hafnium is used in control rods in the nuclear reactor core.

Currently, China produces 75% of the world’s zirconium supply and hence hafnium. “China’s stranglehold on the supply chain of this material essential for advanced technology weakens the economic and political security of other nations”.

Metallurgy is one of the professions that, from the outside, smells of alchemy – there is a magical aspect to the extraction of these uncommon elements and their increasing relevance with advancing technology demanding these metallic elements with their special qualities. Then it is promoted to an essential component of our lives. Lithium has been one such metal.

However, the “green lobby” faces the whole “strategic development” lobby, where self sufficiency is increasingly important, and moving rare elements around the political game board are important chips in being able to game, with more strategic element chips than other nations. At present, China seems to have the greatest variety of these chips in the greatest quantity.

Australia has quantity in two particular chips – iron ore and coal. But that is a different game board. Given the amount of these being mined, then the impact on climate change is a constant.

However, too often the question from the local politicians when confronted with the prospect of a mine in their electorate is concern about how many jobs will be created. The Dubbo project bosses does not explicitly answer that question.

As far as one can gauge prices, the price of hafnium is in the region of USD6million a tonne; whereas zirconium is priced at USD10,000 a tonne.

To get a comparison, Australia produces 900 million tons of iron ore at about USD110 a tonne.

What progress has been made on the Dubbo mine project? In February 2020: Alkane noted that Export Finance Agency’s (EFA’s) financial support would be subject to finalisation of due diligence, acceptable financing structure and eligibility and credit requirements. As Australia’s export credit agency, EFA is mandated to support businesses, which are seeking to develop new export market. 

I have been one of those converted to the climate change lobby and I am particularly worried about the wasteful use of water in what, apart from Antarctica, is the driest continent.

I read about hafnium; the notion of there being the greatest percentage of the world’s supply in Australia has intrigued me. I have searched to find out what is its proper place in the Australian economy. Political leaders are often confronted with such decisions when they have little intrinsic knowledge of the subject.

The giraffes are watching …

However, if I were in a position to make a decision, I would be immediately worried by the massive water requirement and the fact that there would be an open cut mine where radioactive minerals are being mined close to a major regional city, the Western Plains Zoo and the Dubbo Observatory. However the dilemma is, as with all mineral extraction, how can the metal be purified with the least pollution. Unfortunately, when in doubt the large powers with a monopoly of the chips kick the game board over – and everybody loses.

Paraphrasing Einstein, who never said a truer word when he said the fourth world war will be fought with rocks, some of which may contain hafnium.

All Souls

All Souls, Oxford

I suppose being invited to dinner by Max Beloff with the academic Fellows at All Souls was an honour. Great Britain that year was sunny, and when that occurs the summer is always beautiful. Off to Oxford the three of us went one evening to have dinner.

Max Beloff was an eminent modern historian who, at that stage of his life, was tramping from one side of the political spectrum to the other. The young socialist Beloff, now in middle-age having marked time as a Liberal, was moving determinedly to the right at the time, when he invited us to dinner.

Beloff had been a Fellow since 1957, ensconced as he was in this group “at the pinnacle of British academic hierarchy”. He had attained this position much earlier than when he had pursued this neo-liberal journey, in the process setting up a private university and then later absorbing imperial honours that were piled on him by Thatcher.

When we arrived we were ushered into a reception room where pre-dinner drinks were served; I had the obligatory dry sherry as the clever repartee started. The problem with clever repartee is that it is essentially hierarchial; if the young man (it was not until 1979 that women were admitted as Fellows of All Souls) wanted to announce his presence in such exchanges, it seems dressing flamboyantly helps. The “look at me” mien serves as an entrée card.

I was well versed in the social rules of these establishments, having been an undergraduate in a residential College, which replicated much of its social mores from those of Oxford. Therefore, I shut up and only replied when spoken to by some Fellow who had not the slightest interest in whom I was.

However, the call to dinner came and there is nothing like a College refectory – long high table, paneled walls, high-backed mahogany chairs. Beloff welcomed us – the Boss thanked him. It was all so polite, but it was an experience – probably once in a lifetime. Although for them not; just three Australians to be humoured in exchange for a meal.

I was seated next to Michael Howard, the military historian and we chatted about his topic. My contribution when the Franco-Prussian War was mentioned was that I had inherited a full set of skeletal bones from my father. It was widely thought that many of the skeletons used by aspiring doctors pre-war had come from soldiers who had died in that War. They were highly prized for the muscle markings, which were very distinct on these bones. However, apart from that I cannot remember the other Fellows beside and across the table. The talk was just that – inconsequential chatter as the Fellows on either side of the table carefully updated themselves on one another, given that there was a young foreigner in their midst.

Dinner was traditional English fare, which was better than the College roast to which I been subject every night more than a decade earlier.

Once dinner was finished it was off to another room for fruit, nuts, digestive biscuits and the central cheese. The obligatory Stilton round had pride of place, and the port was passed. Then it was off to the terrace for coffee and brandy.

The night was absolutely still and balmy, the sky a curious lavender grey. Across the terrace was the impressive Codrington Library building, built in the early 18th century on the back of slavery and a sugar cane fortune amassed by a Christopher Codrington.

It highlights the problem of applying 21st century values to the funding of a building like that. The Christopher Wren sundial installed over the entrance is a spectacular reminder of the versatility of the man, and Wren himself was a Fellow.

Oh, so different from the environment of the All Souls College of Christopher Wren, outwardly becoming more sensitive to its survival after the radicalism of 1968 which threatened its existence, when it was sneered at as “a weekend home for port-drinking members of the London Establishment, grown fat on the rent of farms it owned since the Middle Ages”.

Had we had dinner in an Anachronism?

Then it was back to London. I still remember the golden glow drenching the car, and my thoughts drifted to the recently-released Joe Losey film “The Go-between” and I, projecting myself as the young man in search of a romantic interlude in the same rural saffron softness of the film.

I have often visited Oxford since, but never again had a brandy with the 42 Fellows outside on the terrace.

But then again I would have preferred to meet Julie Christie. 

Mouse whisper

A scrap of paper plastered against my mousehole. That is the problem about my mausmeister. He is always cutting out what he considers wise sayings and leaving them on sticky pieces of paper. When I scraped the piece off my “hole way”, it read:

There is nothing more difficult to take in hand or more perilous to conduct or more uncertain in its success than to take the lead in the introduction of a new order of things.

Very sage advice; but I was thinking of putting in a new entrance to my mousehaus to make a closer access to the pantry. I’ll have to think about it now.

Modest Expectations – Barry Marshall & Obey

Pauline has parked her grandstand in the News Ltd car park, where she is advocating a High Court challenge to border closure. This is a normal Pauline stunt, unsurprising given that the Queensland elections are imminent -and there is nothing like a confected confrontation magnified by that shrill tone of hers.

One concession you have to give to this lady, she plays “victim” very well. One of the ploys when I used to be an official visitor to psychiatric hospitals in New South Wales was the way the inpatients could produce someone who had been “victimised” and ask me to help “save”, usually, a “her”.

My companion visitor was a wise woman, who unlike myself had long practical experience as a psychiatric nurse. She warned me not to be “sucked in’’, but listen to the complaint and investigate. However, she said – maintain rationality –don’t be get caught up emotionally as these people are very clever, since it was a practised scenario, and they try you out.

Whenever I watch Pauline, I am reminded of this advice, since whenever she is pushed into a corner the voice becomes quavery and the tears well up.

The one hand clap, Pauline.

But back to reality.

How much is this High Court challenge going to cost, Pauline? $300,00? More? For what, Pauline? A failed challenge? Of course, the victim.

However, who is going to pay? You, Pauline? No way. I’m afraid it is going to be us mug punters, of course; the real victims.

Telehealth – Look Mother! No hands

I was brought up as a medical student to believe that the essence of being a doctor was to take a full history from the patient and then to do a full examination.

That was a message. The face-to-face consultation was the basis of consultative medicine and the skill was to make the correct diagnosis – or if unsure, to provide a set of differential diagnoses based on what you had elicited as symptoms and signs of the patient’s condition.

However over the course of my medical career technology has intruded upon the “maestro” doctor able to diagnose the patient before he or she sat down. Observation to me remains a very important element as it was to Dr Arthur Conan Doyle, who invested his sleuth, Sherlock Holmes, with the same or enhanced degree of observation he had as a doctor.

The astonishing array of technology and increasing differentiation of care has been something I have witnessed through my long career. Sometimes I have watched and sometimes I have been closely involved, for example with the introduction of Magnetic Resonance Imaging (MRI) into the private sector and its recognition by Government – not always the most tranquil moment of my career.

There has always been agitation from the medical profession for reimbursement for non-face-to-face consultations. With the corporatisation of medicine, where the bottom line is everything, this agitation has not lessened. “Money for jam”, as the old saying goes, many jars of which will inevitably be transferred offshore.

Having watched telehealth progress through phone conversations to uncertain video links through to more reliable technologies such as Zoom has meant that technology has challenged traditional ways of medicine.

My only hope is that the government, which is increasingly strapped for cash, monitors it use.

I have used telehealth as a patient, and for a person with limited mobility it has been particularly beneficial. I have found that the doctors have been more punctual, but that anyway may be because of the lower volume. Telehealth acts as a screen. For the plastic surgeon, you can send a picture of the lesion, and get an opinion over the phone and in my case, yes it looked as though it needed to be removed; then a regular check up with the rheumatologist reviewing my pathology, a critical aspect in my ongoing chronic disease. More importantly in talking to my neurologist, he listened to my history, and said yes, it was important to see me, but I should have a cervical spine MRI first.

Two of the three telehealth consultations required subsequent face-to-face consultation. My general practitioners friend said that with the modern video technology, it is possible to diagnose simple conditions, such as a strained muscle, by observation and prescribe a treatment without seeing the patient in the rooms.

My appointments to see specialists could only be undertaken by face to face consultations – removal of a lesion from the face, assessment for cataract removal, neurological examination for the particular set of signs.

As someone who developed an auto-immune disease insidiously, after my diagnosis it was apparent that I needed not only a good general practitioner but also one who would provide continuity of care.

Being a doctor myself, I am in the worst category in regard to regularly seeing a doctor. I can do all that general practitioner stuff – but of course I cannot. It is impossible to have an objective view of yourself until, as I found out one night, I knew that I was dying. Hypochondria is one thing; a sense of impending death is another.

I survived the night, and because of the pain and stiffness and overall weakness, I went back to my orthopaedic surgeon whom I had consulted a dozen years earlier for my acute painful knee.

At this time, I had no regular general practitioner although most days I was surrounded by them at work. However, the orthopaedic surgeon knew what it was, but orthopaedic surgeons treat by operation and not by drugs and so he flicked me over to his trusted rheumatologist. Now rheumatologists are gentle ruminative folk, but have long lists of patients; so waiting for up to six weeks is not uncommon for an appointment.

Miraculously I saw the doctor that afternoon. He prescribed tests and drugs, but I was not to take the drugs until the test results came back.

The starting line could not have come sooner; within 24 hours after taking the first tablets, my condition improved dramatically.

Unfortunately dramatic improvement didn’t equate to immediate cure, but that’s another story.

What is interesting however, in a story about telehealth, is how do you diagnose this sort of disease. As one of my general practitioner colleagues said to me that this is a GP diagnosis – you ask: “Can you roll over in bed?”

This was very much after the fact. I had already been diagnosed and was being treated. However, I had not noticed it before; he was right, I could not roll over in bed.

Theoretically, if the doctor had been as astute as this Scot, who had seen cases before, a telehealth diagnosis might have been made.

But then again I still would have had to see him in a face-to-face consultation. Telehealth is not a panacea and I would caution government and suggest once the COVID-19 pandemic is controlled, to review its application closely, especially the biggest users and then ask why? As I know too well, governments are reluctant to wind back largesse for fear of vested interests squawking about compromising people’s health.

Telehealth is a bonanza for the corporate health business, where throughput is everything, and health care a by-product.

Nevertheless, far more insidious is the large health conglomerates where the owners are dependent on government payments to profit, inevitably providing donations to political parties to keep the tap turned on. Donations after all have a wonderful effect of assisting politicians to roll over – not necessarily in bed.

Hey, Pellegrini, whatcha doing with that test tube?

A new study shows coronavirus patients who took hydroxychloroquine to treat COVID-19 had a higher risk of death than those who weren’t given the drug.  

The study, published Friday in the medical journal The Lancet (22 May), also found that COVID-19 patients were more likely to develop serious heart arrhythmias if treated with hydroxychloroquine, or its closely related cousin chloroquine.  

Arrhythmias can lead to a sudden cardiac death, the report said, but researchers did not associate the study’s fatalities with adverse cardiac affects. 

Even though it’s only an observational study – not the gold standard double-blind, randomized, controlled trials – experts say the enormous sample size makes it compelling.

The study comprises of 96,000 coronavirus patients from six different countries who were hospitalized between Dec. 20, 2019 and April 14, 2020. Nearly 15,000 patients were treated with hydroxychloroquine or chloroquine alone or in combination with an antibiotic.

When I heard that the Walter & Eliza Hall Institute for Medical Research (WEHI) were about to embark on a trial to enlist 2200 health workers into a trial to test the efficacy of the drug being a preventative agent against the virus, I checked the date. No, it was not April 1st.

Professor Marc Pellegrini is employed at the WEHI with one of those expansive titles, which suggest he is important. On television, his justification for the trial is that the drug kills the virus in the test tube. So, I might add, does bleach.

I wondered how this experiment has come about.

This modern day Lancelot has given his project a grandiose title – COVID-19 Shield. Here I wonder whether you need a diploma in public relations rather than a science degree in this modern world purporting to be medical research.

I have not the seen the protocol except it seems to be a randomised controlled trial; but one important report I would like to see is that of WEHI Ethics Committee on the proposed study and the reasons for approval.

In the latest bulletin of WEHI, there is a coy mention of this trial without naming the drug and the brief comment that it is being funded by the Australian Government. There does not seem to have been the award of a peer-reviewed grant as one would expect for such a potentially dangerous activity.

The problem for the Australian government is that there is pressure coming from the non-medically qualified – especially from such a medical expert as Clive Palmer.

In response to the above Lancet article, the WHO is reported to have put on hold the hydoxychloroquine arm of review. However, the report has all the hallmarks of the WHO walking away (or should I say “crabbing” away), without losing face.

But WEHI seems defiant. At least Professor Pellegrini is. May I suggest it is time you retire the Shield, Sir Lancelot.

Finally, as The Washington Post noted – as I have – who says Trump has been taking the drug. Has anybody seen him take it? This person who lies, lies and lies. Why would his statement of putative self-administration be any different? In any event, he now says that he has stopped taking the drug. Come on, Donald, which is the lie?

The time I under-dosed with Chloroquine (Plaquenil)

It was about 30 years ago and we went on a tour of Africa. Among measures to be taken were the mandatory yellow fever vaccination and a prophylactic antimalarial, then hydroxychloroquine, which was marketed under the name plaquenil.

It was a wide-ranging trip, which excluded South Africa, then in the grip of the apartheid Afrikaans. However, in many ways it was defining as it led to us, especially my wife, returning almost yearly to the continent.

We had previously been to North Africa – Morocco and Tunisia – but this was a month long roam through Southern and Eastern Africa. The trip incorporated the island of Madagascar, the French Département of La Réunion and then finally the Seychelles. 

We spent some time in Madagascar, both in the jungle near Antananarivo, the capital, and the island of Nosy Bé looking for lemurs and indris. After leaving there, we flew to Saint-Denis, the capital of La Réunion, where the intention was to climb La Fournaise, the volcano at the end of the island. The year previously we had reached the summit of Yasur, on the island of Tanna in Vanuatu. This is one of the only active volcanoes in the world where you can stand and look down into its fiery cauldron. La Fournaise presented another opportunity to do so.

Le Piton de la Fournaise, Reunion Island

However, while having a drink at the bar of the hotel on arrival, I started to feel unwell. I went to bed, and then passed out. As described to me I began to get very hot, and my temperature was apparently swiftly rising, and as my wife said I became quickly delirious. She did not know quite what to do except keeping sponging me to try and reduce my temperature. She told me that her plan was to phone a public health physician acquaintance in Paris, in the event that I needed to be admitted to hospital because, as she said, her French wasn’t up to an emergency admission. However, about one in the morning, suddenly I was a bundle of sweat. I woke up; my temperature was dropping. My pyjamas were absolutely soaked with perspiration

How could this be; I was taking the plaquenil regularly, but then I reviewed my dosage – it was below the prophylactic dose. God knows even to this day how this happened, but it was obviously my mistake. Fortunately, my wife did not succumb. So even though I felt lousy and confused, I increased the dose to therapeutic. The worst residual symptom was a terrible headache behind the eyes. I have never had one like it before or since.

That was it, except I felt lousy for over a week, but I did not have another crisis – nor have I had a recurrence since that day.

However, I always take Malarone, the current anti-malarial drug of choice whenever there is the prospect of contact with a malaria-bearing mosquito overseas.

But back to La Réunion, we did see around the island, including the Cirques, tropical remnant of extinct volcanoes but we never did climb La Fournaise.

No, I did not have a test to confirm – not malaria – confirm my anserine status.

But at least after that experience I can swear by hydroxychloroquine – for malaria!

Just a lurk

COVID-19 causes massive inflammation boosting cytokines, which increase the liver’s production of clotting factors, explains Beverley Hunt, medical director of Thrombosis UK and a practising clinician. For example, fibrinogen levels in a severely ill COVID-19 patient are 10-14 g/L, compared with 2-4 g/L normally and 5-6 g/L in a pregnant woman. “A COVID patient’s blood is enormously sticky,” she told The BMJ.

“All patients in critical care are at increased risk from clots because they are immobile, and when you are sick you have sticky blood,” says Hunt. Studies of venous thromboembolism rates among non-COVID patients in critical care show that rates of thrombosis can be as high as 28% if patients are not given any prophylaxis. Among patients given prophylaxis the rates are halved. So, we seem to be seeing significantly higher rates of thrombosis in COVID patients. 

“Thrombosis is definitely contributing to the high mortality rate from COVID,” says Hunt. “Not only can it lead to a pulmonary embolism, which can be fatal, but there are also higher rates of strokes and heart attacks.”

In this report in the British Medical Journal, a United Kingdom medical specialist is musing on COVID-19. Now at the outset one would have thought that the only experts interested (or consulted) would be emergency physicians, anaesthetists and respiratory specialists. However, this is a doctor expert in blood clotting which has arisen as a major COVID-19 complication, especially as the amount of anti-coagulant to be given seems to be unsettled. Moreover, there there are reports of late onset deep vein thrombosis. My Swedish correspondent mentioned COVID-19 toes, which appear to be a severe form of chilblains, pointing to this being the virus being an instigator of widespread disturbance in blood clotting.

What is further intriguing and indicates the widespread effect of the virus is loss of the sense of smell as an early sign. In humans, the olfactory cell location measures 9 cm2 and lies on the roof of the nasal cavity.

With the common cold when there is swelling of the nasal epithelium non-specifically, sense of smell is impaired. However there are reports that this COVID-19 virus infiltrates the sustentacular (supporting) cells which, together with olfactory cells, constitute the pseudocolumnar epithelium underpinning the nasal cilia and microvilli. Among other functions these cells have an effect on how odours are perceived by the olfactory cranial nerve.

It was interesting looking at the histology of the nasal lining, and its complexity. The olfactory nerve and its connections are one of the most neglected areas in medicine, because the sense of smell is more related to lifestyle rather than considered a major marker of disease. However, if it is indeed an early marker of COVID-19, attention should be paid to the way the nasal swab is taken to assist early detection, especially if the olfactory area of the nose is where the virus may lurk first.  This infiltration indicates how profound this virus may be in invading the body.

This virus is not going away soon and while Australia has, up until now, done an excellent job in suppression, “lurk” is probably the most concise way to describe it.

The Hungerford Games

We camped on the Queensland side of the fence, and after tea had a yarn with an old man who was minding a mixed flock of goats and sheep; and we asked him whether he thought Queensland was better than New South Wales, or the other way about. 

He scratched the back of his head, and thought awhile, and hesitated like a stranger who is going to do you a favour at some personal inconvenience. 

At last, with the bored air of a man who has gone through the same performance too often before, he stepped deliberately up to the fence and spat over it into New South Wales. After which he got leisurely through and spat back on Queensland.

Henry Lawson wrote thus about his experiences in Hungerford in 1893, when he had walked there with his swag from Bourke. The expectorating man’s name was Clancy, that familiar ‘loveable larrikin” character alienated from officialdom. Sorry, that is my ironic interpolation, and on the contrary Henry Lawson was not impressed by him.

There was no Pauline Hanson around in those days, and anyway she would not have been able to vote or stand for any of the colonial Parliaments in Australia at that time.

The Royal Flying Doctor Service (RFDS) periodically does medical clinics in Hungerford – this population speck, which straddles the border of New South Wales. This settlement is about a three hour drive along the Dowling Track from Bourke. I have always hankered to go there since I worked with the RFDS, for no other reason that it is there and like so much of western Queensland it epitomises my image of the laconic yet irreverent stoicism of the Outback.

We have years ago thought to drive there, but there had been heavy rains and the road beyond Bourke was impassable. The road is still unmade, but even though it is not the first place one would think to cross the border, my hankering is still strong. So I thought I would find out more.

The problem is that the Royal Mail Hotel is on the Queensland side of the Queensland-New South Wales border, which is defined by the wild dog fence. There is a border gate at Hungerford.

To get more intelligence on the current situation, I rang the publican at the Hotel. The news was grim. The gate is locked; the coppers have the key and even if I could he said it would inadvisable to try and climb over the gate. Anyway we would be aliens from New South Wales – waratah cockroaches invading the land of Cooktown orchid cane toads. So we could not stay at the inn.

So Premier Palazczuk, I promise I won’t make a High Court challenge if you open the Hungerford gate and allow us to stay in the pub. I’m not sure about the High Court challenge – however I believe there is a class action being mounted by a consortium of wild dogs to remove the fence between the two States. And it is only an unsubstantiated rumour that Clive Palmer is funding their challenge.

Muri Succursus

Mus Virgilis “destillat ab inguine virus”

We mouselings, as you know, pay homage to our celestial creator, Rodentia Nora. So we have knowledge of Latin – one of the greatest bard being one Mus Virgilis.

Given how much used the word “virus” is, we had a peep at its derivation.

“Virus” is a rare second declension neuter word for “poison” or “slime” and that attracted me to see if there was a plural form, “vira”. But the word has never been found in a plural form in Latin literature. Thus “viruses” is acceptable – even though the “es” suffix is generally associated with third or fifth declension Latin words.

And certainly do not say “viri”, which is Latin for “men”.

Modest Expectations – Kennedy

When I wrote about Sweden in my blog on 27 March, Australia was paralleling Sweden in numbers of COVID-19 cases – well sort of.

2,016 people have been reported infected with COVID-19 in Sweden (20 cases per 100,000 inhabitants). Nationally, 25 of the cases have died.

Australia had 3,047 cases with 14 deaths at the time (12 cases per 100,000 inhabitants). Of that total then, 300 infected were attributed to the Ruby Princess circus.

Reviewing the figures as of 20 May, the current Swedish figures are 31,523 cases (315 per 100,000 population and projected to be the highest per capita death rate in the world) with 3,831 deaths and 4,971 recovering. Australia by contrast has 7,081 (29 per 100,000 inhabitants) with 100 deaths.

My friend who is a senior radiologist, who once ran the department at the Karolinska Institute in Stockholm, has written to me last week (sic):

… In Sweden a large proportion of elderly who died from COVID-19 were not only old but in special care facilities …

Our experts seem to view yours and New Zealand’s very successful containment effort with scepticism, thinking that in the end, spreading is inevitable. However, the alternative that we are experiencing with many dead elderly is really also very painful indeed. Hopefully you will be better prepared when (if) the virus spreads again. We have had to put much of ordinary health care on hold and reports are that many who should seek care are not, ie transient ischaemic attacks (TIA,) coronary disease patients, symptomatic cancers.  

The much increased ICU capacity, fourfold increase, takes a toll on all other activity. 

… Life is not as normal as reported in international media, all shows and theatres are cancelled, very few travel by Metro compared to normal. Largely the restaurants are complying with rules of sparsely seated customers, with no waiting lines… However many are enjoying the outdoors and our small wood next door sees many visitors, keeping prescribed distances…

We are hoping for restrictions to ease so that we can at least visit Öland.

Lutheran church, Öland

Öland is an island four hours drive from Stockholm connected by a bridge across the Kalmar Sound and we had hoped to spend some part of the Northern summer there. Not now unfortunately.

My friend continued:

I have worked for some time, and noted the high proportion of pulmonary emboli in our COVID patients, as well as other interesting things with this baffling infection. Rashes, COVID toes, white lungs (usually associated with widespread asbestosis – Ed), cerebral complications, abdominal symptoms.  The list is endless.”

My friend mentioned a smorgasbord of diseases arising from COVID-19. This infection is neither the flu nor just a bad cold. And my friend does not even mention Kawasaki disease; there is much more in the COVID-19 malignant store to sample.

His comments were backed up in a report in the NY Times (May 16).

In essence, the report agreed that the Swedish mortality was very high among the elderly but unlike Italy where there was a high concentration of multi-generational families, Sweden lives in a far less cramped space with many more single person households.

The average Swede has less diabetes, obesity and heart disease than in the other countries with a high infection rate.

Even so the Swedish economy has not emerged unscathed –and a contraction of the GDP by seven to ten per cent is predicted by the Central Bank.

Therefore, for those idiot Australian Borises who want to open Australia tomorrow, think Sweden – and not as an Ikea panacea.

Thank God for our senior health people who said don’t go to see the “Sharkies” and hug each of the players in turn, but shut down Australia.

Sweden provides a salutary lesson as Australia re-opens its leisure activities.

Non dimentica

When you author a blog, you open yourself up to being wrong publicly. So I trawled back through my blogs to see when I first mentioned the coronavirus. It was late February, and at that time I was somewhat Thomasine, because a large group of our nationals had been airlifted back to Australia from Wuhan. None of them had tested positive before or after the quarantine.

Yet there was something I was unaware of at the time I wrote the piece and that was how many Chinese were working in sweatshops in Northern Italy. The Chicago Tribune as far back as 2009 reported an estimated 30,000 Chinese are legal immigrants in this city (Prato) of 180,000. Another 30,000 illegal immigrants are also suspected to live here. Many among the Chinese work in small hidden factories for as long as 14 hours a day.

One of our informants recently confirmed that there have been regular flights from Wuhan to Milan, with up to 100,000 Chinese“guest workers”. making shoes there. Once out of the wild meat market, the virus thus had a saloon passage to the delights of Lombardy and Emilio-Romagna. There here were the crowded conditions both at work and domestically to spread the virus.

Despite there being no positive cases among the Wuhan evacuees, Australia had closed its borders to China and then selectively to other countries – but not to the United States, which we should have.

Yes, I was skeptical – and the question remains in my mind why were there no positive cases detected in the people being flown out of Wuhan. If there were none, what was the major reason? I know, the plane air conditioning had been bolstered – what else? Social distancing? Masks? Hand washing? Repeated cleaning of the airplane toilets and no moving from the one seat unless going to the toilet? In the end no-one was infected – in 400 people out of Wuhan.

As for what I wrote, I think I overused the word “hysterical”, which I now regret. 

Abiden with me, fast falls the eventide …

 the New Yorker’s Adam Gopnik decided that this was the night that changed everything. “Not only, as we did not know then, was President Obama in the midst of the operation that would lead shortly to Osama bin Laden’s killing,” he wrote last fall, “it was also the night when, despite that preoccupation, the President took apart Donald Trump, plastic piece by orange part, and then refused to put him back together again.” Report in the Washington Post concerning the White House correspondents’ dinner in 2011.

It is about time that the Democratic Party in America prepares for its Peregrine moment. A Peregrine moment? Bob Hawke. The Labor party, which has always been gentle on its leaders up to that time, vanquished Bill Hayden and replaced him with a more formidable challenger to the then Australian Government – Bob Hawke. Not that Bill Hayden was any slouch and certainly in his long-term influence he has been much better than Joseph Robinette Biden Jnr.

In November this year, this man who served 35 years as a senator for Delaware will reach his 78th birthday and he is asking America to elect him to serve a period of time, which will see him leave office at 82 years of age, or perhaps at 86 years.

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.

As I abhor hugging and extravagant shows of affection (one of the only positive outcomes from this virus), it is unfair to criticise his “touchy-feely” approach, unless it degenerates into the “creepy-gropey”.

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.

Wilmington Railway Station

He seems popular, and although I did not see him on the railway platform of Wilmington, that city is an Afro-American with old patrician heritage veneer – it is this cultural gap that Biden has been able to span his whole professional life. After all, he has spent his life in politics with an early daub of lawyer on his escutcheon.

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.

it struck me this week listening to Obama– is perhaps Biden only the shill? A cleverly-concocted shill for Obama. Maybe there is a residual something behind the Delaware smile.

There has not been a contested convention requiring multiple ballots since Eisenhower won the Republican nomination for President in 1952.

Only one President has served two non-consecutive terms – Grover Cleveland, a New York Democrat who was both the 22nd and 24th president.

Yet Obama may be the next to do so. After all, he is only 59 years of age and even another two terms would make him only 67, much younger than either Trump or Biden.

Will there be a contested Democrat convention? I would doubt it if Obama continues to surge. Biden probably may even nominate him.

Obama’s recent entry into the political debate is that of the man of stealth with disarming ruthlessness, just the needed antidote for Trump. Here was a man at a dinner, the master of the lampoon without any sign that at that same moment he was supervising the killing of Osama Bin Laden.

America is in a crisis, in a way that it has not been since the outbreak of the Civil War. Trump just has no sense of national leadership. His genius has been in dividing and ruling a circle of sycophants and chancers in a building on Pennsylvania Avenue and then darting off to rally to and sustain “his apprentices” – a hate-filled armed militia in the event that he does not get elected democratically.

Trump has a pathological fear of Obama – there is something deep in his twisted psyche, which no amount of ranting can exorcise. There is no doubt that if Obama wins and the Democrats get control of both the House of Representatives and the Senate, there would be no more the mister-nice-guy of his first term of 2008. Obama may very well push through an agenda not that much different from the one promoted by Elizabeth Warren. At the same time, he would be the focused commander in chief commissioned to slay the coronavirus by putting America on a war footing. Bringing order to chaos.

Nevertheless, I would speculate that one significant force who would not like to see Obama contest the election is his wife, Michelle. Why? Because as he exposes and humiliates Trump on the election trail with an increasingly unhinged Trump, then with all the fomented madness in America, Obama would be a prime target for assassination. That is the American way.

But as I have said often, what would I know? But then I cried when Kennedy died.

Just a Footnote – talking of Presidents

Once when a young doctor wanted to become a consultant physician, one pathway led to a year in the pathology department doing post mortems. Just as if one was training to be a surgeon, time in the anatomy department was one tried and tested way to that career.

One Friday morning, the Department boss came to me with his mischievous smile and said that he would like me to undertake an interesting task. The person on the slab had been born with Peutz-Jegher syndrome, which is an inherited disease where part of the syndrome involves multiple polyposis in the bowel. These polyps, usually benign, nevertheless could be very distressing and require multiple operative interventions.

In this case, they had been multiple with resultant adhesions all through the abdomen. The question of my boss when the post-mortem had been requested was to see if this particular person had had an undetected cancer in the large bowel.

It is a somewhat ironic situation that whereas I could do up to three postmortems in a morning then, post mortems even in the large hospitals today are rare. However, they are rampant on current television. Admittedly, there is still a swathe of forensic post mortems, and having been someone who was actively involved undertaking post-mortems it is sometimes hilarious to glimpse the portrayal on television.

When I was presented with this body, it was so scrunched up and distorted, it was hard to determine the age, but I do remember that there were remnant spots on his lips and face, which are part of the syndrome. The eyes were open and even after all the post mortems that I had undertaken, I had an immediate sense of pity – even in death the eyes showed the pain.

One of the ways I coped with post mortems was to put on a metaphorical mask for any emotions as I donned my apron and gown over what are now defined as scrubs (but then called boiler suit) and never take a memory of the post mortem away from the department.

Not in this case; I can still see this person in my mind’s eye. Of all the post mortems I have ever done, he did leave an impact, because he was the epitome of misfortune. Why had he been afflicted so – to live for what?

But you cannot have the luxury of thinking much about the meaning of life when you are doing post-mortems.

However, the task at hand was the congealed mass of intestine – seemingly an amorphous matted lump – and I had to open the bowel from duodenum to rectum without losing continuity in my dissection.

How the hell did he survive for so long? It was laborious work to dissect. The body had been stitched up and removed. All my colleagues had finished their post mortems and left. There I was; left on my own to dissect the bowel.

The complication was that I was supposed to be groomsman at a wedding at 6, and as the day progressed, I began looking at the clock. Eventually I finished, sometime around 5 o’clock. I had found no cancerous growth. However, I had finished and I knew I had done a good job.

I was fortunate that the mortuary attendants were still there and after having a shower, they helped me don my evening dress – white tie and tails which, when you are in a hurry, can be excruciatingly fiddly. An incongruous sight. In a hospital morgue.

Mortuary attendants are a genus of their own – in this case one was a large lump of a man with a funereal voice, who obviously enjoyed the work; the other a smaller man, whom I remember always swore by Cooper’s sheep dip as a great hair restorer. He used it daily. He had a thin wispy comb-over. The two of them were a somewhat quixotic pair.

Dressed, I dashed across the hospital car park and into my car. It was a short drive to the chapel where my friend was being married. I did not have time to see my wife, who on the previous Saturday had given birth to our second son, Marcus. In those days, life post-partum was a more leisurely affair, as Sister Fabian insisted that the mothers needed rest, but of course I could have my evening meal with my wife – just pop across the road after work, doctor.

But tonight was different and when I emerged from the hospital replete in white tie and tails, I remembered it was the day LBJ was coming to town and all the streets around where I was going would be blocked off.

Bugger! However, I was able to take a circuitous route and fortunately found a place to park – at least walking distance from my destination.

I took my umbrella because it was about to rain. There were numerous people along my route down Toorak Road. I really did not notice them as I was walking as fast as I could. I thought of running, but when you are like a stuffed white cockatoo, I thought it unwise.

So concentrated was I that it was not until it hovered directly over me that I looked up and saw the helicopter. Suddenly I felt I was the target. I stopped and waved gingerly. The helicopter crew having seen that it was only a strange young guy in fancy dress with a furled umbrella, rose and left me after a few whirring minutes.

At that moment, the big dark limousine whipped past. There they were – President Johnson with Prime Minister Holt – a brief glimpse of them through a bulletproof window.

Then they too had gone. I reached the chapel before the bride.

Quite a day.

Can I call you Belford?

Two mildly proptosed eyes peer through a crack in the closet door – then the perfumed polished head emerges looking around and then it is out – darting around the space – a twirling gossamer-haired Titania.

Then satisfied that the stable remains groomed, it retreats into the closet, more a cupboard where this remarkable beast has a number of instruments – the microphone, the megaphone, the semaphore flags, a euphonium, even a full set of drums. Here it changes into a different mode – no longer queen but king. And if we had penetrated the closet there would have been a number of jolly mates, who spent more time in the light, but in this cupboard they prove what religion is without devotees.

Belford, I am truly sorry about your departure. Such an ornament of darkness is irreplaceable because such perfection – a rugby coaching Titania, even if Balmain never benefited from your trail of tauric stardust.

However, away with sarcasm and irony; a lamentable trait which is stimulated by the very thought of you, Belford.

What a disheartening performance, Mr Albanese, your obsequies to Belford. Moreover, you are now the inheritor of the Labour tradition-the traditions of Curtain and Chifley.

What would they have said about this creature, who has said the vilest things about Jacinda Ardern and Julia Gillard? They are women. Belford seems to have a deep hatred of the successful woman – none are allowed into his closet wardrobe, no way.

So why on earth would you, Albanese, join Abbott and Howard (and predictably Morrison) in their obsequies? Do you intend joining them in losing your seat at the next election? I just happen to have a vote in your electorate as does my wife – and our friends. After all, you are not too young to remember that even Belford lost the safe Liberal seat of Eastwood at a by-election, never to be pre-selected again.

I believe that Belford has had a breakfast audience of 17 per cent. Perhaps we can ensure you get the same vote in the next Federal election – perhaps a few more per cent.

The electorate just has to find its Zali Steggall – willing to challenge your antediluvian views – the electorate has a bit of time to find someone, Mr Albanese, someone who can continually provide a reminder for your praise of Belford, the misogynist.

And remember, Mr Albanese, Belford was in all probability shafted by the Melbourne establishment. Your potential nemesis, Mr Albanese, is Victorian. I am unsure but perhaps then you would get more than 17 per cent of the caucus vote once your praise of Belford sinks into your colleagues.

The Sutherland Reds and Campsie Green factional mates of yore may have excused this behavior but they are almost extinct – and your hero, Belford is about to fall off the wall – enclosed in his own green bottle.

And as you may realise, although he was a good unionist and a Sydney boy, Ted Grayndler is buried in Melbourne – admittedly not “by”.

Mouse Whisper

A colleague of my mausmeister, Professor Leeder, has suggested that a uniformed public health service should be created here as in the United States. There is some value in this idea as it would make public health much more easily identifiable as part of the emergency response team. While it has blended in so well at present, being a uniformed service would provide both a discipline and continuity. However like all uniformed services there is always the danger of attracting the characters, who prefer vestments and braid to activity.

Nevertheless, my mausmeister thought that the comment below (as reported by The Economist) of a current Prior of a Camaldoli order was very relevant. This order is a Tuscan offshoot of the Benedictines, who have an excellent tradition of teaching yet within the monastery are encouraged to keep their own company, in prayer and reflection – without loquacity.

Still, liberalism has its limits. The liturgy, the scripture, the ritual, the tradition, is the container that holds this life together. You start losing that, it’s a free-for-all.”

Think about it. Wise words. It has a relevance in all sorts of way at the current time, not just to public health, or to a putative uniformed service, and also not only to Christianity.

Benedictine monastery, Tuscany

Modest Expectations – Pike’s Peak or Bust

The Cook / Covid-19 comparison highlights a problem with a cohort of young doctors who go into public health medicine. Generally they are very intelligent, but some, unlike Sue Morey or Nick Coatsworth for example, have lived a professional life in cotton wool. Among them, you get a few smartarses, where the ready availability of Twitter and one more glass of red than should be imbibed leads to a misstep. The higher up the career ladder, the more the misstep becomes obvious. If the misstepper ends up on the ground, the question arises whether the person is mortally injured or will just bear a stigma on his or her professional life.

There are no real excuses for such a puerile tweet, where superficially it may be seen as a clever expression of a belief. However, despite the predictable blustering from the Liberal political cognoscenti pazzi, they should rest assured that the good doctor would have been given a verbal flogging by the Premier.

Yet he would recognise that she is a hard worker in a stressful position, and one who would definitely be against premature opening up Victoria and having to combat the “joy boys”, jocks and the Murdoch publications braying for sport to be reintroduced for solely financial benefits with a slight simpering regard for the community health.

Andrews learnt a lesson at the last minute, pulling back from the Grand Prix. With the potential of a cohort of infected Europeans mingling with the crowd, Australia may well have been plunged into a crisis. It has been bad enough with the antics of the NSW government in regard to the Ruby Princess. I do not underestimate the involvement of this good doctor given the reckless behaviour in the neighbouring State with Victoria not locking its borders against NSW.

Just a word of advice to you Dr Van Diemen, if you want to say what you like publicly, wait until you get to my age, and then it does not matter. You will recover from this glitch and hopefully have a successful career. But ditch Twitter and leave your wisecracks to spaces where the walls are not listening. Everybody in stressful positions needs to sound off occasionally, but go find a few like-minded galahs to share your frustrations. I mean the fluffy grey and pink ones.

A little known encounter of Jimmy Cook

Since everybody is getting into Cook, I thought reviving a relevant part of my novel “Sheep of Erromanga” would enliven the discussion about of the impact of this Yorkshireman on one small island in the South Seas. The story centres around a young Australian called Philip Morey who spent two years on the then New Hebrides island of Erromanga in the1930s, and this describes the end of a trek across the island.

At last, Philip had emerged from the dark jungle through the line of giant tamanu trees. Through the foliage he was met with a vista of huts along the water’s edge. To his left, the dancing silvery shards of the river Ounpontdi made him stop. 

So this was Potnarvin, lying under the lee of a mountain called Traitor’s Head. He shaded his eyes as he looked upwards. The mountain appeared to rise to what he estimated to be about 3000 feet. Its height was hard to gauge as clouds obscured the peak. As Philip was to find out over the three days of his stay, Traitor’s Head was almost perpetually covered in cloud. The clouds concealed the fact that Traitor’s Head was a volcano. It had not erupted for nearly two hundred years, but had done so twenty-five years after Captain Cook had been there on an exploratory voyage. 

The mountain had received its name from Cook who, on landing on the beach, wondered why such apparently friendly people were armed to the teeth. One of Cook’s muskets had misfired and the friendliness had vanished in an instant. A battle had followed and, before Cook was able to get back to the ship, one of his sailors had been mortally wounded and at least two of the Erromangans lay dead. Philip thought the “Traitor” was an odd choice by Cook, given that he had a meticulous way of naming his discoveries. The Captain was probably just annoyed. “Traitor” did not seem to be the right word, although the incident was certainly prescient of Cook’s future.

The villagers, unlike their ancestors, had welcomed Philip. They seemed to appreciate the quiet tall young white man, who came out onto the beach stopping to look around and unbuckle his rucksack.

Cook’s response was predictable – confrontation with bloodshed. At the time of Cook’s visit, the Erromangans were cannibals, with a strict etiquette concerning where the white man could move around on the beaches where they landed. These rules were transgressed as they were later with the arrival of Presbyterian missionaries. When they crossed this line they were killed. In addition the natives developed quite a taste for Scottish missionaries – haggis?

Purchase a copy of The Sheep of Erromanga! Email enquiry to: SheepofErromanga@gmail.com

The recidivist Carnival

On February 27 this year, a cheery ABC reporter noted:

… the effects of swine flu in the grip of the 2009 pandemic was confronting. This disease affected people who don’t often get the flu, afflicting young adults whose previously healthy lungs became white and cloudy with pneumonia. While most recovered, many did not. By the end of 2009, more than 37,000 Australians had been diagnosed with swine flu. 

More than 190 people were dead. 

Worldwide, the US Centres for Disease Control estimate swine flu killed as many as 575,000 people. Eighty per cent of them were under 65. 

Let’s contrast the swine flu epidemic with the spread of the novel coronavirus — or COVID-19 as it is now known.

The new virus is sweeping through parts of China and infecting small numbers all over the world…

I will not detail some of the learned academic predictions that were criticising our draconian measures e.g. close our borders to China. Their expert advice was just wrong.

Now just what was being reported in the media in the autumn of 2009?

As suspected swine flu cases in the Hunter New England health area jumped to 72 yesterday, a Hunter family quarantined at home after a cruise on virus ship Pacific Dawn slammed the handling of the outbreak. 

The Exxxxxxo family of Thornton was ordered into quarantine on Tuesday, a day after they arrived home from a 10-day cruise on the Pacific Dawn, and only after Mrs Chris Exxxxxxo contacted health authorities.

“There were 2000 or so passengers wandering around who had no idea that they should be avoiding contact with other people.” Mrs Exxxxxxo contacted NSW Health who confirmed the family should be quarantined and was later contacted by P&O Cruises.

As the flu emergency escalates, the Federal Government has ordered enough doses of swine flu vaccine for 10 million Australians. The Exxxxxxo family has spent the past week in lockdown in their home and will not be allowed out until they receive the all-clear on Sunday… 

…When the Pacific Dawn cruise ship docks in Brisbane today, after cutting short its cruise because of the flu threat, the Queensland Government will invoke tough quarantine powers to stop interstate passengers disembarking. Three crew members have tested positive to the virus, but have recovered with treatment. Five passengers await test results. Health officials will screen the ship’s 2000 passengers and 700 crew. Only Queensland residents will be allowed to disembark and will be asked to quarantine themselves for seven days.    

“We are being extremely cautious in our testing arrangements for anybody who presents themselves with flu-like symptoms” Carnival Australia chief executive Ann Sherry said.

Of course, that is what you would say, Ms Sherry, with your winning smile. It is however understood that people with swine flu contracted on Carnival ships may not have agreed.

And then about the same time there was another media release…

Minister for Health, John Della Bosca, today announced NSW would upgrade its Swine Flu protocols for cruise liners who arrived in NSW waters. 

The NSW approach to arriving cruise ships has been developed in consultation with the Commonwealth. 

“When the Pacific Dawn arrived this week, its passengers had not been to any jurisdiction where Swine Flu was present and it was considered unlikely the virus was on the ship,” Mr Della Bosca said. 

“The two children from the Pacific Dawn who have since tested positive for Swine Flu had not travelled overseas before boarding the ship, had no contact with affected countries, and were not considered to be at risk. 

“An additional 16 people from the ship have since been confirmed to have Swine Flu. Six of these people are currently in Queensland. 

“These people have been assessed by public health staff and placed into isolation. 

“Further public health assessment of contacts of these passengers is now underway.”

Similar pattern. Let them all off the boat – she’ll be “jake”. The NSW Chief Health Officer then – the incomparable Kerry Chant.

Unlike COVID-19, a vaccine was rapidly developed for swine flu, (the existing influenza vaccine was partially effective) which then helped contain the viral spread. Nevertheless, on a population basis Australia had the third highest number of cases worldwide. The virus affected the elderly, young children and pregnant women particularly, and spread so rapidly that contact tracing was well nigh impossible. Fortunately, it was not as deadly as initially believed, unlike COVID-19.

In the case of Victoria, it was bought there by a well-to-do Australian family returning from the USA by air. Their children spread it in the two well-known private schools they attended and the spread was accelerated by a “social” dance. Later, its spread was tracked along certain tramlines passing through Bolli-wood a.k.a. Toorak.

It is interesting that although it was first berthed in Victoria, the cruise ship made sure it spread the virus to NSW where the normal laissez-faire attitude (see Chant) predominated. However, in Queensland the Pacific Dawn was refused permission to berth, and the following may be apocryphal but nevertheless it is a good story. A highly-placed Queensland official threatened to order gunboats, a.k.a. whatever Dutton inherited, into the Brisbane River to make sure it did not happen – bit of a wimp the current Premier – only closing the borders.

The Office – viruses thrive on randomness

Some time ago, as I reported previously, well before the COVID-19 outbreak, I was sitting in the foyer of the Alfred Hospital in Melbourne where there was a hand sanitiser predominantly displayed. Virtually everybody entering and leaving the hospital ignored the instructions to clean their hands.

Last week I was waiting in the foyer of Cabrini Hospital in Malvern and next to where I was sitting, near the hospital exit, there was a hand sanitiser. Despite the hospital foyer having all the trappings of virus prevention, this sanitiser was mostly ignored. Yet on the other side of the foyer not five metres away all the preventative measures were in place – maintaining a safe distance in defined queues, temperature and verbal screening, hand sanitiser use being required.

The difference – one side of the foyer was supervised; on the other, no supervision.

The problem with any loosening of the COVID-19 chains is that the new concepts of hygiene are yet to be embedded in the nation. As I have said, the standard of public toilets gives a clue as to how seriously hygiene has been embraced by this country. Driving between the two capital cities this past week for medical appointments, I observed that the toilets along the Hume Highway are just as bad or as average as they have always been. There has been no change except toilet paper has disappeared for various reasons from some of the dispensers.

Having issued this caveat, there is no doubt the underlying strength of the Australian health system has been shown even given some of the dills, often influential, who have tried to disrupt the public health protocols, because that is what they are – dills with a deep-seated sense of entitlement and self-importance – the essence of “Do you know who I am?”

As I wrote last week, there is a good case for the re-opening of schools, and paradoxically Premier Andrews being so hardline means that the other politicians have to be more measured.

Viruses love disorder

The more that you contain the natural community Brownian movement into more laminar flow then the more order you bring to contain the enemy. However, at the same time it must be recognised that open plan and activity-based work spaces designed 20 years ago to maximise the number of occupants were also designed to maximise “random” contact between staff members who were moving around in the workspace. The post-COVID-19 office has to contend with minimising disorder while dealing with now-outdated office planning that maximised apparent randomness.

While the concept of working from home has seemed to solve the problem of halting the viral spread, the evidence of long term efficacy of working from home is mixed. Some may praise its “flexibility” and claim that efficiency has improved, while others use the word “chaos”.

In my mind’s eye I have a hospital operating theatre. Here people are gathered together for hours on end to perform operations and in so doing assuring the patient does not acquire an infection attributable to the operation. The air conditioning must be maintained at such a standard that the air circulating is pure enough for the most complex operation – such as a joint replacement – to be undertaken with the least risk.

In the end, the assumption must be that the post-virus office must be big enough to provide sufficient space for people to congregate while maintaining a certain distance from one another without shouting. Street clothing does not seem to be a major factor in viral spread, but the operating theatre staff do not go into an operating theatre in their street clothes as the nineteenth century surgeons did. They change into their green or blue scrubs, their head covered and mask at hand. And at the operation a further gowning with all the appropriate obedience to the rules takes place, and this ritual is repeated for each patient.

Professor Lindsay Grayson

Professor Lindsay Grayson, the Australian doyen of hand hygiene succinctly summarised the national hand hygiene study after eight years observation in 2017 – The National Hand Hygiene Initiative (NHH) has been associated with significant sustained improvement in hand hygiene compliance and a decline in the incidence of staphylococcus aureus bacteremia (HA-SAB). Key features include sustained central coordination of a standardised approach and incorporation into hospital accreditation standards. The NHHI could be emulated in other national culture-change programmes.”

The challenge to community cleanliness is to accept the challenge for its offices as set down by Professor Grayson.

The new office order

The elements of the new order now are being tested everywhere, have they penetrated into every individual’s brain … at least not yet.

The elements include:

  • Social distancing and limiting the time spent in face-to-fact contact or in a closed space with others
  • Lift etiquette and disinfecting
  • Masks (understanding how and when they should be worn and by whom)
  • Air conditioning
  • Hand hygiene and not touching the face
  • Temperature checks
  • Responsibility for the regular cleaning of one’s designated work area, including equipment such as computer keyboards and phones
  • Regular cleaning of the office, reception, kitchen areas and the toilets
  • Quarantining anybody who shows the slightest sign of a respiratory infection
  • Viral testing
  • Being able to plug into a internal form of contact tracing to identify if employees are not generally within their designated areas (that is, for the purposes of maximum numbers to ensure social distancing)
  • Food outlets
  • Making provision for workers who are at a higher risk

This is part of the equation – the other major element is how to get employees to and from work safely when public transport is designed around maximising the number of passengers and when work hours are not staggered, but that is a future blog.

One of the theoretical advantages has been the advance in communication over the past decade. This has meant that isolated people can see one another – good reliable images of the people. How far that improvement in this distant communication can supplant actual face-to-face contact will give researchers a great deal of time to seek answers. Online meeting platforms will be an essential part of the response to this pandemic.

It is up to those who head the large firms to enforce social distancing – not sitting huge distances away, although appropriate spacing of work areas will be important, but being careful of exchanges – the hand shake, the hug, the kiss on the cheek, borrowing somebody’s pen. It is these social gestures, essentially random, upon which the virus thrives.

There must be an etiquette in the use of lifts, as is occurring in hospitals already, with the maximum number of people prominently displayed. Again this demands discipline.

The meeting room should contain a round table of appropriate size, and the air conditioning should be such that a joint replacement could be performed on the table with little chance of airborne infection. Time spent in closed meeting rooms should be minimised.

This leads to the discussion about planning an office to be open plan or not. As the NYT reported this week: “Some companies have begun mentioning a return to one of history’s more derided office-design concepts: the cubicle. There is talk also of the cubicle’s see-through cousin, known as the sneeze guard.

“Cough and Sneeze Protection Screens,” is how they are being marketed…

Earlier in the article “Soon, there may be a new must-have perk: the sneeze guard. This plexiglass barrier that can be mounted on a desk is one of many ideas being mulled by employers as they contemplate a return to the workplace after coronavirus lockdowns. Their post-pandemic makeovers may include hand sanitizers built into desks that are positioned at 90-degree angles or that are enclosed by translucent plastic partitions; air filters that push air down and not up; outdoor gathering space to allow collaboration without viral transmission; and windows that actually open, for freer air flow. 

All very good, and some of these changes are evident in our hospitals and retail outlets, but it is imperative that offices have a structure to ensure that all the changes are effected. In other words there is a team of enforcers, from the time the person enters the office area initially to use the hand sanitiser to the odd time he or she may use the toilet. You see that sign in the aeroplane toilets to respect the next user by cleaning up after yourself. One can believe that some who use the toilet are blind. After a few hours in the air the said toilet can become unclean because of lax enforcement. The new office will ensure that cleanliness is maintained

Then there is consideration of the material that you use to outfit the office anew. In a NEJM article and combined with another source, it was shown that the virus persisted up to four hours on copper, eight hours on aluminum, 24 hours on cardboard and two to three days on plastic and stainless steel. Elsewhere it has been shown that on glass or wood surfaces, the virus will remain present for up to 4 days.

Reassuringly it has been shown that Covid-19 can be eradicated within one minute by disinfecting surfaces with alcohol, 0.5% hydrogen peroxide, or bleach containing 0.1% sodium hypochlorite.

Watching the thermographic camera in operation while I waited at Cabrini Hospital was an impressive demonstration of its capability, and the question is the number needed and their positioning. Having temperature taken manually is probably more consuming of staff time. Nevertheless the receptionist or however he or she is described must be someone who understands the basic requirements of public health, and it should not be too difficult to arrange an instruction in this. After all, the responsibility extends to ensuring clean toilets, that there is form of “contact tracing” of anybody in the building, with the current chunky badges of identification need to be reviewed.

One of the other matters which follows is how food and drink is dispensed. Bringing your own coffee cup and lunch is an obvious solution. Trialing take-away has been happening in the community, and therefore how the workers obtain their coffee and lunch needs to be mapped. When food and drink is raised, then the spectre of alcohol is also raised. I have some doubt that those affected by drink respect social distance. Then what does the office do with those who smoke, coffee in hand outside the building. As I walked around the outskirts of the Royal Melbourne Hospital last week, even there were numerous staff members in their scrubs outside smoking in corners away from the elements.

Thus in the end someone in the office must be the arbiter deciding who needs to be tested or sent home. There is a certain unrealistic optimism about a vaccine, and clearly the anti-viral drugs do not work on coronavirus. If they did, the cure for the common cold would have been had long ago. As for hydroxychloroquine … be careful Palmer, what is your pitch when the first person dies using that drug rather than killing the virus – go green rather yellow?

Those in business must take a pessimistic view and not believe the vaccine is just around the corner. However, in equal measure they must take an optimist view that careful planning and implementation of a rearranged COVID-19 office space will support both the reopening of business in 2020, but also recognise this will be the “new norm” for the foreseeable future.

As for masks, they may be obligatory in the operating theatres where the operating team are kitted up with sterile gowns and gloves, however in the community I have this image of the Italian smoking, his mask limp around his chin. Masks are ideal to irritate, to touch – as are gloves when the gloved hands are moving from one potentially infected surface to another. Masks thus can be a definition of false security as are latex gloves – only as clean as the last touch.

In the end, the broader community has to come to an understanding of what is needed to provide a safe working environment because the changes that are needed cannot be achieved without everyone giving up some personal “freedoms”. At the same time reliance on pre-COVID-19 legislation to direct the ways things were done won’t cut it any more. Governments have to review all their relevant legislation to make sure they don’t allow sloppy hygiene to continue.

This is whither I have arrived – a personal exercise calling on what seems to be a reasonable allotment of information in turn to provide a reasonable allotment of advice.

Mouse Whisper

I was self-isolating outside my mousehole when I looked up at my mausmeister’s television and saw a man called Nev who turned up on the screen. He seems to reflect this economic imperative, which is taking over from the lingering pandemic, as his mates are getting restless. Doctors should stick to the hospitals was the secondary unvoiced agenda.

Pardon my meek mousiness by addressing you as Nev. I thought I heard it correctly that you said there will not be another pandemic – you will make sure it does not happen again? (see above). Hope the viruses are listening.

You know Nev, you, the bloke who maybe can’t see the trees for the Forrest.

Danse Macabre

Modest expectations – Tom Waits

From the Carnival playbook as reported by The Washington Post:

More than 20 passengers were still too ill to leave the ship (Coral Princess), along with 38 crew.

Of the 1,020 passengers on board, about 993 were expected to be declared fit to fly, he said. They will be taken by bus straight to Miami International Airport, where most will avoid terminals and take charter flights. A minority of the passengers, he said, would take commercial flights; those passengers would be brought to a terminal that is not being used until they board.

As with the above Washington Post report, it is now 4 April and the number of COVID-19 cases has just reached 5,548 in Australia. If it had not been for the cruise ships, it would be considerably less than 5,000, and fortunately not the 10,000 Dr Greg Kelly and his fellow petitioners prophesised for 4 April.

Fortunately, at the centre of this activity federally we have a cohort of knowledgeable, calm public health specialists that you need in a crisis and obviously they are not going to release the models if the assumptions are wrong. The world is not a TV reality show. It is a planet at war. Therefore getting the strategy right is everything.

The Carnival is over?

As the Ruby Princess saga grows, my recommendation to sack Dr Chant appears mild now that all of the NSW Government seems to be in a state of self-preservation or that of hazard reduction. It was so obvious from the start that people being hurried off the boat meant something was afoot. Only too true – 10 per cent of the positive cases in Australia and 11 deaths as of 6 April.

However, the media were dozing – but not now. The Australian Financial Review at last discovered the media demure Ann Sherry. The Australian is calling for governmental scalps.

Now three weeks later, it is the NSW Government trying to weasel out of its responsibility. Carnival is the culprit shipping line that has the dubious honour of having two firms in Miami that specialise in launching legal actions against it – that includes all the shipping lines owned by the Miami-based Arison family. Mr Sture Myrnell is their local head and has sparingly fronted the media. Mr Myrnell, born in Bergen, was once the sommelier on the QE2 and although he has been promoted to dizzying heights, he has probably not lost his taste for a good sherry.

Which reminds me.

Now Ann Sherry was replaced by Mr Myrnell as CEO in 2018, but is still the Executive Chair and it was pointed out that she was responsible for external relations – aka lobbying.

Once Ms Sherry was not afraid to front the media. In an interview, she made the point that thinking big was crucial. She was quoted as saying in this 2018 interview:

I think it’s important not to lose touch with what’s happening in your organisation. One of the great challenges of leadership is that you’re busy and there’s a million things people demand from your time. So, it’s easy not to know what’s happening on the frontline of your business, and just let people tell you. My view, though, is that it’s better to find things out yourself rather than rely on layers of organisational filtering to tell you what’s going on. I think this is especially important in a customer-centric business. It’s crucial to be visible and to communicate to people on the frontline that you understand how important their jobs are.”

After all the above interview started with the following “Coming off a high-profile, extremely successful tenure as CEO of Westpac New Zealand…”

The report in the NZ Herald 5 December 2008 begged to differ somewhat:

Sherry was chief executive for four-and-a-half years and resigned from Westpac after she was moved sideways to head up the group’s Pacific banking division on the back of poor performance from the New Zealand division.

She earned more than $3 million per year in the position.

Maybe the word was not “profile” but “profitable” – and an interesting definition of “extremely successful”.

The situation is serious – very serious – not just because of the number of additional COVID-19 cases and deaths directly attributable to the Ruby Princess, but because the NSW Government somehow lost control of its public health measures during a worldwide pandemic when cruise ships had been identified as one of the most effective vectors for the virus. That is unforgivable.  

Therefore every link in the communication chain needs to be examined. I believe that Ms Sherry’s role as Executive Chair, irrespective of her belated attempt to escape the title, in influencing the decision-making process now and over the time of her stewardship should be critically examined as part of this review.

Now that there is a full police enquiry underway, in the end there may be the prospect of criminal charges. This review must be comprehensive and nobody should be shielded; equally, innuendo should be confirmed as fact or any particular person exonerated.

And finally Prime Minister this cruise ship behaviour has not been an isolated example to flick away. It has been happening for years.

Hibernation

I have been chipped for not looking forward to predict what we might look like after the virus has passed.

My predictions on the future are based on the proposition that there will no vaccine against this virus in the near future. The second is that immunity to COVID-19 is not life long. In other words, one infection will not guarantee that the individual will not be susceptible to other attacks. The same applies to a vaccine; some common colds are due to coronavirus and come back in a different form year after year. There is no vaccine that works.

The problem with the hibernation analogy is that the animal sleeps through its time of food deprivation. Its life is about foraging for food to be converted, and here the brown fat accumulation is an important factor up over many generations – not an immediate fix, but one essential to sustain the slumbering animal.

However, when the bear emerges from hibernation, the external factors have been at work providing the bear with sustenance from the very time it comes out of its den. The hibernation cycle does not factor in a continuing winter because spring always comes.

When the government uses hibernation as a metaphor it should realise hibernation it is not a one-off aberration of nature. It is not for everyone. However for some creatures, it occurs year in year out – the word itself is derived from the Latin word for wintry – hiemalis. Thus Prime Minister, you are not the head bear, although many of your sloth of bears may be somewhat grizzly.

Australia must emerge into a new world, which prizes personal and public hygiene. It is a world where everyone including the police force carries hand sanitisers. It is a world where coughing without shielding your mouth becomes as unacceptable as spitting. Every restaurant has pepper, salt and sanitiser on the table, and before food is served the patrons are politely asked whether they have used sanitiser.

At home as I was in the days before antibiotics lulled the community into a false sense of security, children always washed their hands before a meal – but then we said grace. As we grew up, with the advent of the fast food industry with the disposable society, washing hands before meals then lapsed.

Meanwhile, hygiene in hospital has improved immensely, and that is largely because it has been recognised that washing one’s hands between examining each patient is essential. It was a simple manoeuvre as was the abandoning of wearing ties and the improvement of the attire of staff – particularly those archaic nursing outfits. It is now as different a world as the time when surgeons operated in their frock coats in the nineteenth century and more recently when I was a junior doctor, when the anaesthetist’s monocle fell into the sterile neurosurgical site. Why, because this particular gentleman was peering over the neurosurgeon’s shoulder. Bad form old boy.

It is time to transfer these hospital lessons to the community. One measure of this is the standard of public toilets. As I have written before about how these are diminished in number in the major city centres. However, the technology is evident to establish a clean safe environment in those facilities.

Thus, when the virus passes for the moment Australia needs investment in hygiene – in public health – so that it is the aim to generally reach hospital grade level. In so doing this should evoke a cultural change in this country where nobody is exempt – and that means settlements like Utopia or Soapy Bore, Toorak or Byron Bay – yes you! Not singling you out, just reminding everybody that we are a nation with mutual obligation – it applies equally to you as it does to the smallest outstation.

One Labor Minister in Whitlam’s government once made the astounding observation “Australia is an island surrounded by water.”

The Terra Australis face that was turned towards the original adventurers and buccaneers was very unappealing and they left and those who were shipwrecked died in the harsh climate or were absorbed into the local aboriginal people.

Then our border control need be mindful of the unseen, not spend time hounding the vulnerable and looking in the mirror of this nation and seeing Pauline Hanson.

However the underlying premise is that the Federal government should take the original power allotted in the original Australian constitution – that of quarantine and thus assume national control of public health.

Australia has emphasised biosecurity in relation to fauna and flora, which has been moderately successful, but in terms of spread of human disease less well.

After this last episode it is not the poor unfortunates awash in the Timor Sea, but cruise ships with their crowded cabins and archaic air conditioning. Huge floating cesspools no longer should be allowed to berth in Australian ports. It is an industry that needs urgent review. As one correspondent has written:

Long ignored by cruise lines seeking to sell older tonnage are air conditioning and plumbing issues.

Ships built after 2000 are suspected of having air conditioning and plumbing and sewerage problems, some of which problems are major. 

The older ships will not survive nor are resaleable as they’ll be seen as potential health problems. Why? Breathing the same recycled air in every cabin or room will no longer be acceptable to paying passengers.  

The cruise industry must be re-evaluated, and Carnival and all its affiliates banned indefinitely – or should it be said that any ship owned by the Arison family. In other words, nobody begrudges a well-run shipping line, one that does not evade taxes, does not fly flags of convenience, does not use underpaid staff – and if the arcane Maritime Law needs to be repurposed for Australian conditions let the government assure that is so.

The other major area of potential infection and violation of the borders are the airlines. However, biosecurity in relation to plane passengers has always been lax – handing out pieces of paper is no substitute for targeted testing.

The question must arise as to the level of hygiene on planes where people are packed together and the air conditioning is dodgy at best. Should the passengers be handed sanitiser along with bottles of water; should passengers be handed out masks at the same time as headsets.

Once the country had quarantine stations; once Australians going overseas carried yellow books to assure that we had been inoculated (or vaccinated in the case of small pox) against typhoid and cholera and, if we were going to endemic areas, yellow fever. Until this pandemic, only the latter has survived as mandatory. However, given there is no vaccine for COVID-19 then having a yellow booklet does not apply except for yellow fever.

However, there are past measures that worked, but reminding the passengers of basic hygiene becomes as important in the training of cabin staff as being able to serve meals. Toilets on planes are a potential source of infection given how poorly the hygiene is policed and on long flights used to change into sleep wear.

However, it is also air conditioning that needs to be assured at “hospital grade”, not continually recycling stale air but providing clean air at all times. As one source with more knowledge in the air ambulance sector where there is liable to be more exposure to infection has written … It has not yet been disproven that exhaled droplets are not aerosolised by the cabin conditioned air flow, and some planes may not recycle enough air to effectively dilute aerosol pathogens, or they don’t pass recycled air through HEPA (high efficiency particulate air) filters.

Therefore, the future Australia as it emerges must have a different approach to hygiene. Once this is assured then it must have a continuing impact on the economy, and not be forgotten by government with a strangled budget.

The Long White Shroud

In this time of COVID-19 crisis, a farce is being played out within the Royal Australasian College of Physicians. Once a prestigious body responsible for overseeing the qualifications and hence the quality of consultant physicians and paediatricians it is rapidly becoming the Ruby Princess of the medical profession.

The Royal Australasian College of Physicians (RACP) was founded in 1936 as the Australian College aping its British counterpart, because our medical traditions have always been linked to the Old Country, fob watch and chain. Two years later, the New Zealanders accepted the invitation to join. Between that time and 2010 there had been only three Presidents from New Zealand.

Then Dr John Kolbe emerged. A respiratory specialist at Auckland Hospital, his wife a prominent surgeon who had been President of the counterpart surgical Australasian College and one who has publicly listed herself as a consultant for Siggins and Miller, a consultant firm based in Brisbane which is entangled in the current college mess. This is a slightly complicated situation since one of the principals of which, Ian Siggins died two years ago, but Mel Miller is still lurking around. Her role and ongoing involvement, if any, is for others to investigate further.

And indirectly, another Queensland connection lingers around as the Commissioner of the Australian Charities and Not-for-Profit Commission (ACNC) which is the middle of this imbroglio has as its Commissioner, Garry Johns, a former Labor member for the Brisbane seat of Petrie but now a darling of the right. He has been, as reported, experiencing his own internal problems within the Commission. His original appointment in 2017 was described as bizarre by certain of those familiar with the charities field, especially in regard to statements ascribed to him about indigenous people.

Following Kolbe there has been another New Zealander, currently the incumbent, Mark Lane. Two of three aspirants in the current election for President-elect are New Zealanders. There is thus this select pack of All Blacks. There were three New Zealand Presidents over 72 years; now the prospect of three within 15 years. It suggests that there is now enough confidence among the New Zealand physicians to form their own College; never tell a New Zealander that they should be a State of Australia. Let us guarantee a fond farewell.

The next problem is that with time, the active elements of the consultant physician workforce have formed their own specific societies based on subspecialist skills and technology.

Some of them drifted completely away and formed their own collegiate enclaves, such as the psychiatrists and dermatologists. At the same time, the paediatricians, whose governing body had been separate although existing under the same certification, rejoined the College.  Faculties were created in public health, occupational and rehabilitation medicine, and the consultant physician element in the college was further diluted by the creation of College Chapters.

While this dilution effect was progressing, the College undertook a review of the “collegiate relationship” with the then “specialty societies of the RACP”; the upshot has been that the relationship was effectively severed. The societies were relegated to distant cousin status, while at the same time the College took all their existing curricula as part of upgrading its own responses to AMC requirements. The specialty societies were left delivering training within an increasingly bureaucratic and unresponsive college structure that, in the view of the societies, was unwilling to provide resources to those societies for their contribution.

If it were not for the fact that the letters FRACP certify their members a meal ticket, many sub-specialties would have broken away, but government unwittingly, through regulation and connivance, have allowed this monopoly to continue. Therefore the College, irrespective of its current intrinsic hollowness, has been allowed to continue in its current unchallenged form.

Over the past 20 years since the time that the ill-starred late Craig Paterson was appointed the CEO the internal troubles have grown. However concurrently the level of farce has grown, fuelled by the presence of another New Zealander and would be physician rangatira, Dr John O’Donnell.

I was once on the Council of the College in a saner time when its impact on the community, apart from being a certification mill, was evident. However, what has stirred me to write this was a ridiculous set of propositions put to an extraordinary general meeting (EGM) held fittingly in New Zealand in 2019. The intent of the propositions was to create a select group to be known as “respected Fellows” whose role was to create a quasi-theocratic model superseding the current College democratic elections.  One young female college Fellow asked whether passage of these motions meant that all other Fellows would not be respected. Enough said. This takeover attempt by a small cabal was soundly defeated.

But now they are at it again. Presumably the same crowd with the same would-be rangatira is leading this pack of All Blacks. They want to convene an EGM at a time when this country and New Zealand are locked down in crisis. There is no valid reason given for this action, but apparently they have the numbers to pursue this self-serving, totally unnecessary course of action.

Perhaps it is linked to a document produced by a Brisbane-based firm Effective Governance. Their review purported to describe what is wrong with the College, but the endless list of recommendations revive some of the very problems identified in 2019 – e.g. a nominations committee to select Board candidates to ensure they have the “right set of skills” for the Board and essentially to remove the concept of popular election by Fellows of candidates who don’t necessarily have such skills. At the same time the proposed number of Board members is 6-8; that, combined with the “required skill sets” will make it increasingly difficult for a College Fellow to be elected to this Board. Is this what the College Fellows really want? On reading the document I raise the question of whether the report should have been consigned to the garbage can long ago, and incidentally what did this Review cost?

If I were a conspiracy theorist, I would be asking how much of this advice on governance over the years has emanated from a limited number of sources in Queensland. What of the direct Kolbe connection to Siggins Miller?

And why are certain people so seemingly keen to cover up about those who have requisitioned the EGM? And as for this EGM, especially at such a perilous time with COVID-19 and both countries effectively isolated, why are the usual suspects pushing such a destructive line?

However, I am not such a theorist, but I do like Kolbe to Bolitho to Talley to Yelland to Lane – what a sparkling daisy chain of “respected fellows. Once they were Presidents, and now…?

Last year I wrote to the RACP President, the New Zealander Dr Lane, asking for the release of the list of signatories to the 2019 EGM request. His dismissive reply relies more on legal smartness rather than common sense. Why was the list of signatories withheld? What did Dr Lane, as the President of the College, want to hide – a preponderance of NZ signatories?

The problem presented by this year’s EGM is that it ultimately will become an exercise in unexpected consequences, which may lead to a totally new organisation to guide the training and ongoing guidance of consultant physicians and paediatricians.

Maybe it is about time for consultant physicians to dispense with the current structure altogether with its over-regulation and expensive payments to a band of rent-seekers.

Maybe it is the right time to let the New Zealanders go and we revert to a purely Australian college. Our health systems are so different, our training is different; we may speak the same language but our cultures separate. Yes it is a good time to flag – once we are on the other side of the current health crisis – that we need a debate about this College of ours being purely Australian; after all, such a proposition is based on a purely utilitarian approach. It is totally ridiculous that this College could be run by a NZ rump.

And further, what about a breakaway College prepared to look after the interests of Australian consultant physicians and paediatricians, and not be burdened by the vestments of yesterday?

And as a footnote, almost as an afterthought, does having New Zealand Fellows compromise the charity status of the College in Australia. I cannot see the College’s New Zealand element being ascribed charity status in its own country. Just asking for clarification. Nothing more.

But first, in the interests of decency, those behind the resolution should withdraw their request for an EGM immediately. Otherwise every politician in Australia will know about this unnecessary distraction in this time of coronavirus. 

Mouse Whisper 

From a riverine relative, I am indebted for the following

Hydroxychloroquine costs around USD90 per 50x200mg tablets in the US for those who have insurance, or USD650 for those who don’t.

By contrast 100x200mg tablets cost AUD16.50 on a private script in Australia – a 40-fold difference before taking account of currency differences.

Make America Rich Again!!!

Modest expectations – Carthaginian Vanilla

How appalling is Mr Albanese suggesting that the Parliament adjourn for a whole day as a part of respect and condolences admixed with confected piety.

All that does is delay what he then said is vital – that is, the passage of urgent legislation.

Otherwise such a gesture is symbolic of Parliament – hypocrisy and inaction.

By all means apologise that you did nothing about preventing the bushfires but spare us the crocodile tears – and get on with the business of government. In fact you should be meeting earlier.

And incidentally get away from this Albo and Scomo nonsense. It sounds as if they are clowns.

No caption required

Fell or Fall

I have written about clearing the trees around the house surrounded by bush. That’s fine if your land does not abut land where the owners can’t be found. The chap who cleared parts of the block and the boundaries asked Council about the absent owner. The Council were not particularly interested; so we went ahead and took down the trees on the boundary and in so doing, cleared the scrub from a large section of the block. This was last year. There were several trees that required a specialist arborist to fell them safely so that they did not fall on the house – a possibility if you do not have the specialist knowledge. In addition the insurance companies take a dim view of those who are literally “cutting corners”.

Even with gutter guard to prevent the accumulation of leaves in the gutters, these trees were a fire risk. We have a celery pine growing close to the back door. That was spared but pruned, as was the leatherwood, so essential for the bees to make honey with its distinctive flavour.

The detritus of forest clearing

However the mass of fallen trees if left present a problem. It was bought to mind by the allegation that the NSW Forestry Corporation leaves what is called “slash” after they have cut down trees. This outcome should be remembered anytime the foresters say we need “to thin the trees”. As you drive through areas which have recently been harvested, there is always a lot of residual wood left in the cleared coup. Around settlements, some trees when they are cleared by Councils are wood chipped, but these wood chipping enterprises seem to be carried out alongside roads where bringing in the appropriate machinery requires clear access.

But back to our block – left with a large pile of wood, there were several ways to go. We could have a controlled burn – a “pile fire” – with the local volunteer fire brigade using it as a training exercise. That proved not to be feasible. The pile of wood was on the absent landowner’s property. Then there was the problem that there was never suitable weather for such a burn to be organised safely, or so the local fire chief said.

In the end, we had the pile of wood removed, some of it would be used as firewood as many of the houses still have open fireplaces, but the rest moved to garden waste – still flammable but away from the property.

There is still a way to go, but bushfire prevention needs a concerted approach if the community is not to end in charred regrets.

Next to our property is a deserted miners cottage, which was illegally moved on site many years ago. It had been lived in, but now the empty land is covered in blackberries. Blackberries have also threaded their way along the foreshore and there has been no attempt to remove the bushes; the trees have been allowed to increase in number, because some eucalypts and melaleucas proliferate at a great rate. There is now a thick line of bush between the foreshore and the heritage footpath – so much so that visitors walk on the road at night because the footpath is too dark. The only clear line of sight to the harbour along this foreshore is in front of the former mayor’s property.

In the end in this over-governed country, we the ratepayers depend on the competency of local government and its finances are dependent on the ratepayers and the amount of money that trickles down from the State and Federal governments. So, can I ask what is being done about those people who buy a bush block and then do nothing to clear vegetation?

In our case on each side that is the situation. We have taken unilateral action, as we prefer prevention to “re-embering” a once pristine countryside.

Tasmania is here to burn. This is a serial problem, a new ABC soapie called “Burnt Hills”?

Postscript

I bought my wife a chainsaw for her birthday. No, we shall not destroy the habitat of the New Holland Honeyeaters or the wrens, who of course love a pile of rotting timber as a habitat. Then perched in the trees are the yellow-tailed black cockatoos. Green rosellas come calling once in a while – they are particularly fond of stripping fern fronds. There is still plenty of bush, but as the local fire captain said, keep it at least 30 metres back from your house. Enter the chain saw.

However, there are still those melaleucas, which are constantly sprouting. We cut them down. What next? The wood has few commercial usages, beyond a brush fence which was constructed years ago when the Council accidentally cleared a piece of our property and we needed a temporary fence while the undergrowth grew back.

Here on the west coast of Tasmania I thought we would be free of the bushfire smoke. However silly me – the population and wildlife of the West Coast are enshrouded in smoke. I worry that my grandchildren will show photographs of what their grandchildren will never have seen as they splutter with their chronic respiratory disease – blue skies.

A small question

One of the intriguing facts of the recent bush fires, which came to light in the fire started in Ebor, a self-styled village in the northern tablelands of NSW, is the impact of illicit crops. Here some guy tried to “back burn” to save his marijuana crop and in doing so set the bush alight with horrendous effect. I have been through Ebor some years ago, and chose not to stop. It is duelling banjoes country.

Even more dangerous are “meth labs”? A large one of those turned up as well. The bush has a way of hiding all manner of things, but the production facilities are flammable.

I have tried to find out whether growing marijuana in the bush leads to small isolated communities resistant to bushfire evacuation for obvious reasons. If marijuana growing in isolated communities can be substantiated, then such horticultural endeavour presents a hazard to human life, if nothing else. The answers don’t lie in intensifying police action, which in turn leads to hiding cultivation in more and more remote inaccessible bush.

However, it is a vexed situation as was tobacco cultivation in the Ovens Valley – the last place in Australia where it was commercially grown. I was working in Myrtleford in the years of the last tobacco crops grown there; we watched the whole farce of growers, “standover merchants” and various government agencies chasing one another around the district at harvest time which was enough for the government to enact their own variety of “chop-chop”.

Tobacco at Myrtleford

The crop is no longer grown in the Ovens Valley, and it is not a crop that is easily able to be illicitly grown there. The kilns for drying the tobacco leaf are a giveaway although many have now been re-purposed as stylish Airbnb accommodation. Anyway Australian tobacco leaf was never rated as much good, and until the early 1980s it was one of, if not the most heavily subsidised crop grown in Australia because of its inferior quality. I remember being a party before the Industry Assistance Commission Inquiry, on behalf of the medical profession, to argue the case for the subsidy to be withdrawn.

Therefore, given the changing attitudes to marijuana cultivation, would it not be better grown in controlled conditions away from the bush? After all, it would be one way to enhance tourism if they could visit a legal greenhouse and see the crop under cultivation and sample … just a thought.

I have a bone to pick with you

An interesting emergency occurred last week when we were having a meal of fish and chips. A fish bone lodged in my wife’s throat. This once happened to me when I was having a meal in Derby in the Kimberley. It was probably barramundi, and fortunately I was having the meal with the legendary outback doctor, Randy Spargo. The spectre of being evacuated to Perth, a distance of 1800 kilometres, confronted me if the bone could not be dislodged. Water and bread was Randy’s solution, and after the initial trial, we went to the local hospital to pursue his cure. Randy was extraordinary – it was as though he talked the bread down – a “bone whisperer”. Randy had worked for a long time among Aboriginal people and at one point had an Aboriginal partner. Randy had a very calming way of handling a situation that could have turned awkward. In the end, the bone cleared my throat, whether “talked down” or not.

We went back to the café and finished our meal. Next to the restaurant was a meeting of Pentecostalists, complete with glossolalia and very audible groaning, which created a fraught atmosphere when we left for the hospital. When we returned after the bone had “gone South”, all was silent.

So last week we embarked on the bread and water exercise. It was unsuccessful, as was the banana; so we called an ambulance and with the expectation of there being at least an hour’s delay then dialled a general practitioner friend for any other suggestions to try in the meantime. He suggested that the bone might be caught up in a tonsillar crypt, and reassured us that if it was not causing breathing problems we could leave it until the morning and via a referral from the general practitioner to an ear, nose and throat specialist the bone could probably be removed under local anaesthesia. This would be a two-stage procedure, potentially drawn out, dependent on the availability of the doctors.

We were about to accept our friend’s advice, and cancel the call to the ambulance when two paramedics turned up after an hour. The situation explained, Rocco, one of the paramedics asked if we had any Coca-Cola or lemonade – something both carbonated and acidic. As we had Coca-Cola he suggested my wife gargle with it. She went out to the kitchen, gargled and Eureka, it worked almost immediately. A few gulps and all’s well. So we learnt something, because as Rocco said the first response if they had taken her to the Accident & Emergency Department would be to purchase some Coca Cola from a vending machine and see if that shifted the bone.

As there were a few minutes while the fish bone was moving its way down the gullet, I asked how they had found their education. It was nearly 30 years since I undertook a review of the NSW Ambulance Service, and one of my recommendations had been to establish a formal tertiary education course for ambulance officer training, not only to introduce a reproducible training program, but also to assure reciprocity for Ambulance officer recognition between State services. At the time, training was internal and there was no reciprocity between the States. Learning was robotic and one of the teachers was reputed to carry a baseball bat to establish what passed as a learning environment.

It was a time when the NSW Ambulance had more ranks than the British Army such was the promotional system based on seniority rather than qualification. Behind this system was “the Brotherhood”, in which the power of the ambulance service rested at the time. Not a particularly enticing prospect for someone entrusted with review. However the NSW Ambulance Board at the time was progressive. Changes came. It seemed that the education recommendation has survived with these two paramedics being graduates of this system that had its genesis in the early 90s.

As Rebecca, the other paramedic there at the “Fishbone incident” said, looking at me just as they were leaving; “Thanks for the HECS debt!” I think she was joking.

Barramundi

When I have had the best seafood meal, I record it – not the exact date or time as they are immaterial except in a general sort of way. I am too impatient to be an angler and the complexity of the fly fisherman is well beyond my ken. However, I remember inter alia my very best barramundi meal.

It was Good Friday about 20 years ago and the temperature in the shade was in excess of 40oc by mid morning. We had pulled up at a nondescript store outside Wyndham. There was a sign advertising fish and chips, but given the time and place there was no expectation of there being any tucker available. No fish apparent. One of the young Aboriginal guys there looked at the other and said could we wait a half an hour or so. We agreed to wait.

Sure enough – a freshly caught barramundi appeared. One of the guys had gone down to the Gut and speared one. We didn’t mind waiting and then sitting in the shade, the sublime enjoyment of consuming this most notable meal of barramundi. When you are not expecting excellence, you appreciate it so much more. Legally caught? Of course, with a wink.

And one more thing…

I was a bit taken back by the army chief, Angus Campbell, jumping out of a helicopter onto the deck of the “Adelaide” to be surrounded by many cheering troops and saying what a good job they had done. I thought it would be better if this claque were out working in the community rather than giving the General a rousing cheer on a boat moored off Eden.

I wonder what would have happened if the head of the firefighters had called them in for a rousing reception while there were still bushfires all around. Condemnation I suspect.

Irrespective of the motive, with all due respects it was a bad look, redolent of George Bush declaiming on the Abraham Lincoln under a banner “Mission Accomplished.”

The fact is that the defence force was caught unprepared, and while they are obviously learning lessons with them increasingly visible in helping with bushfires, your self-congratulatory action, Angus Campbell, was a poor, unnecessary image which hopefully will not be repeated.

It is the problem with public relations staff trying to justify their existence.

Mouse whisper

The local vicar on the Tasmanian West Coast also owns the earth moving business. One feels very safe in the hands of someone who can move both heaven and earth.

Modest expectations – Montana

This is a story about the unexpected – an unremarkable story on the face of it, but like many stories of its ilk, instructive.

In August, as I have recounted several times in my blog, I was in Chile and in particular Valparaiso. As I was hobbling down a flight of stairs and across a doorway in the restaurant, my hand caught on something sharp. Whether metal or wood, it created a spectacular gash over my fifth metatarsal right hand. It as not particularly long, but it bled. My canes clattered to the floor. As I had nothing immediately at hand except paper serviettes to staunch the bleeding, and rudimentary Spanish to say “Ayuda”, it continued to bleed profusely. It took some time for my companion, who was sitting by the window in this upstairs-downstairs configuration, to come and put order into stopping the bleeding, by pressure.

Eventually Chilean band-aids were produced and these reduced the bleeding to an ooze. The wound was not stitched, but there was a bit of debridement and the edges of the wound were roughly opposed – without seeking outside medical help. I thought that was one reason it took a long time to apparently heal, but the skin remained pink as the scar tissue started to form.

One day about a month after I had returned home a lump appeared at the site of the scar. It grew relatively quickly, but the skin did not ulcerate. I went to my long time plastic surgeon in Melbourne. I thought there must have been some retained fragment – a foreign body that had been missed. The surgeon who has operated on me on a number of occasions said nothing except after a little hesitation, that he would take it off immediately.

Jean-Nicolas Marjolin

I was surprised by the length of the incision and its depth; I should not have been so surprised when the pathology came back – squamous cell carcinoma. Sometimes in wound tissue an aggressive skin cancer can erupt. That had occurred in my case – Marjolin’s is the eponymous name for it – normally these cancers appear as an ulcer, and this would probably have occurred in a few days if it had not been removed.

That was a month or so ago, but now the area has healed and the scar from the incision is barely visible.

A very good astute surgeon, now onto my next experience…

The Surgeon Never Replied

Below is a letter I wrote to a surgeon just prior to a proposed operation three years ago. I have still not had the operations, and although I have a few mild symptoms I have not had to endure the morbidity or my family the funeral costs which could easily have resulted from operative intervention. I am writing this blog to provide an informed consumer perspective on my doubts about spinal surgery.

The other problem with surgery, especially with severe osteoarthritis in the shoulder joints, is that when you are being moved about during cervical surgery the anaesthesia will mask any incidental damage being done in the shoulder. One does not feel the pain of tearing a ligament or muscles or the rotator cuff of the shoulder joint until one comes out of the anaesthesia, and suddenly there is another centre of pain. In the aftermath of proposed surgery, pain relief for me is always going to be tricky because of my sensitivity to opioids. That does not matter to the orthopaedic surgeon – the surgery itself is the centrepiece, not the subsequent morbidity nor the rehabilitation. After all, I was facing three major orthopaedic operations in short order – nearing the end of my eighth decade.

The following is my letter to the surgeon appropriately de-identified sent in the days before the operation.

I thought I would explain the reasons for deferring my operation. I am sure you respect that the choice I have made has not been undertaken without much deep consideration of balancing the risks and benefits. My response was largely generated from our last consultation and your subsequent letter to Dr A. 

I note you made a comment that if I stressed my spine that there was a possibility of worsening the condition but I recently spent nine days in Malawi on a number of extremely rough terrains in a four-wheel drive without any apparent change.

Currently I have very mild numbness in my little and ring fingers intermittently in the morning on waking – not every day!

If one reads my latest MRI report it demonstrates that I have significant pathology in my cervical spine, yet I am virtually symptom free. You list the risks associated with the procedure without setting out the probability of any them occurring. Hence I take the paragraph in your letter to Dr A to mean that they are considerable risks. I thought it preferable to have the MRI at JHospital well before the operation rather than the day before – and there is no doubt that JHospital runs a very professional operation. However, so does the Diagnostic Imaging Department at IH, with which there appears to have been an unfortunate failure in communication (with yourself. I am sure you did not meant to criticise the IH nor the fact that at that time it was more convenient for me to have my imaging undertaken there.  

In addition you intend to take iliac crest bone which, as you rightly point out, is better than cadaveric bone for the putative operation on my cervical spine

However I have chronic polymyalgia rheumatica, the aetiology of which condition remains obscure, but there is one observation I would make which is that any shift in the dose of cortisone (currently 4 mgs a day) has a far more marked clinical effect than would be expected – manifested as stiffness and muscle weakness. There is no mention of the possible impact of operative trauma on such a condition, but you would have more information than I do. Therefore, that is one matter that needs to be resolved. The other of course is the effect that the cortisone has had on my bone given that I have been on the drug for three years, despite taking Vitamin D regularly.

I am nearly 77 years old, which is a factor, and the fact is that my cervical spine has significant pathology. The question that is raised is whether there is any guarantee that intervention would not have a cascading effect requiring more operative intervention for diminishing returns.

In relation to my lumbar spine, I do have symptomatology of mild spinal claudication as you have noted as 5/10, but as one senior physician said to me the other day, the major problem is my right knee – and knowing the success of such an operation would it not be preferable to do any operative intervention starting with the knee?

The question then arises of whether the operative schedule should be in reverse, and would a laminectomy guarantee relief of my symptomatology – particularly my ataxia and loss of proprioception? Your letter would seem to suggest otherwise. Is the fact that even if I had a lumbar spine operation I would not be helped? What are the odds of improvement given my age and lumbar pathology. 

I walk with two sticks for social reasons not because I need them invariably. For instance, I challenged myself the other day to walk without sticks but accompanied for three blocks to the coffee shop. There was some pain in my knee, minimal pain in my back and no symptomatology referable to my neck. The pain did not stop me at any stage, there and back.

I continue to do hydrotherapy twice a week and find it very helpful and, so as to clarify your comments in the letter concerning “Panadol Osteo” dosage, I am taking 4 tablets of Panadol (625mg) a day in divided doses and not six as previously. Do you think that a significant observation?

There are a number of other matters in your letter to Dr A, which could be better put. The comment concerning my heavy smoking history is totally ambiguous given that I have not smoked for 36 years, and it was taken not from any direct interrogation but lifted from my “confidential note”. The fact that I produced those notes to inform you so that it saved time and helped you to take a comprehensive history. I am sorry to have to make that point, but in providing such information it should be attributed and not just “noted”.

A copy of the letter was sent to Dr P who retired at the end of June and my doctor is now Dr Q locally. Given that the letter was sent to Dr A, who made the initial referral I am at a loss to understand how that occurred. The copy to Dr P has been archived at NHospital with certain agreed caveats. I believe that any copies of correspondence should not only be sent to Dr Q but also to Dr R, who has been the rheumatologist responsible for my treatment for PMR since 2013, when Dr A referred me to him, Dr A having made the initial diagnosis.

You have not referenced my severe shoulder osteoarthritis, which would be a consideration in any cervical spine surgery? (Here a confidential matter relating to another person has been excised from my letter.)

There are there other matters that puzzle me and that, given all the potential complications set out, I understand you will be away the week after the proposed date of surgery – and if that is true who would undertake my post-operative care, should any of the dire consequences set out in your letter occur. 

The second source of my puzzlement is an initial comment you made that you would be prepared to operate on my back four days after my cervical spine operation. Does that still hold true? 

The third matter is your comment that “ agreed with your need to alter the plan on the day before”. I must have misheard but I do not remember agreeing to a change in plan –especially as it would appear that a substantial part of my cervical spine is affected and yet I am virtually asymptomatic. My cervical symptomatology is better than it has ever been given the problems I had with it 20 years ago, and which were relieved by some excellent physiotherapy.  

Those cervical symptoms were resolved a long time before I first presented to Dr A. It is certainly not a decision I would take the day before the operation, given the seriousness of the complications you have listed. Hence this was my reason for undertaking the imaging a substantial time before the proposed operation.  

The underlying question is would it not be better to reverse the operative schedule on the basis of relief of symptomatology and enabling me to walk pain free, with a reasonable gait and with an improved ability to negotiate stairs, reverting to what I could do in early 2013 before the onset of the PMR, which seems to have acted as the tipping point for all this? 

As you foreshadowed in your letter you have awaited my further advice –and my basic response is the question above couched against the previous consultation, but not with the benefit of you reviewing the MRI and spinal X-rays

I asked for a number of second opinions. The average elderly person who is suffering from degenerative disease does not have that option because information in the health sector is so asymmetric.

To me the non-response to the letter reflects on the person. Here there is an arrogance characteristic of some of the medical profession. They do not see it, especially when they have only patient contact and are acting like a high paid tradesman, who comes in does his job, gets paid and moves on. From my experience very few tradesmen ever come back to view their work. Unfortunately, I was brought up to be a doctor and now as a consumer my perspective has only shifted to the other side of the desk. There should be debate, including this doctor who has remained silent for over three years. 

Boeing Sub-Max

In a investigative piece on Boeing at the time that it was amalgamating with McDonnell Douglas to monopolise the American plane construction in 1997, Boeing’s warts were well and truly revealed. McDonnell Douglas had some very good planes, but inter alia fell over because of its failure to build economic wide-bodied airliners, despite in 1995 receiving US$334m in rebates from kindly Uncle Sam.

Meanwhile the Pentagon was awarding Boeing US$1bn for “restructuring costs” and so eager was Export-Import Bank to ease any problems that Boeing might have, was renamed by some in Congress as the “Bank of Boeing”.

If you want to blame the Republicans for allowing this monopoly to occur, well that’s just not true. Increasingly when the truth of this has emerged, since there in the centre of these appalling decision, smoking a cigar in his Oval office was Mr Teflon – Bill Clinton.

He agreed with the advice that the Boeing position was legal because of the pressure it faced from Airbus. As the1997 correspondent said: “Using this logic all the US automakers could merge because the ‘Big One’ would still face foreign competition. Too bad the Detroit lobbyists can’t figure out a way to hide price hikes in the airline tickets and Pentagon procurements.”

Now Boeing is being confronted with a major problem – its latest airliners appear to be duds – and dangerous duds at that.

I have flown on most types of Boeing: 707 through to 747 internationally, 727 and 767 domestically, and even the 717 and 757 although not as commonly as the workhorse, the 737. They have all been good aircraft, although the Qantas 747s are becoming creaky and by preference I try to avoid them.

A former retired Boeing engineer and policy analyst has been reported recently as saying: “(There has been) a shift in the culture at Boeing from one which strove for engineering excellence to one focused on cost cutting. This deliberate strategy from the very top of the company led to massive, ill-thought-out outsourcing and the discarding of engineering talent as work was moved out of the Puget Sound region…(and in turn) has led to major failures on Boeing’s latest two major airplane development programs — first the heavily outsourced 787 Dreamliner and then the minimally upgraded 737 MAX. Both planes had to be grounded over safety issues.”

This failure has left companies in the supply chain in tatters. Fiddling and tweaking has not worked. Other airlines are running out of patience and are ordering planes from Airbus. As the airline fleets age then attention turns to maintenance; and if cost cutting takes over there as at Boeing, then air travel becomes not just an atmospheric pollutant but also a health hazard.

As has also been reported locally in the Seattle media “Boeing hopes for its first good-news event: the long-delayed first flight of the new 777X, with its massive composite wings. In late January, Boeing’s new leadership will reveal the latest tally of the cost of the MAX grounding, updating the $9.2 billion estimate through October. The rest of the year is likely to be a long slog, getting the MAX program restarted and slowly ramping back up again. No one can yet foresee the long-term impact.”

Boeing 737 Max engine

It sounds forlorn, since many of the mistakes Boeing has made in the 20 years interval have been glossed over by Government not holding them to account and the accompanying high profitability of the 737 until the MAX version came on line.

There have been failures such as not exploiting the 717, which, as one our own Alan’s choices, was particularly shrewd. There is now an increasing requirement for jet airliners with 100-150 seat capacity to run on regional services. The 717 fulfilled that need, but it was given the cold shoulder at Boeing because it was essentially a McDonnell Douglas enterprise and Boeing stopped making them. Only Delta, Hawaiian and Qantas have the plane in any numbers, and they are not selling them. Now through its Bombadier subsidiary, Airbus is filling the need. In the end the 717 will suffer as we all do – it will need spare parts that are no longer there.

However, all is not lost on the bottom line. There are the cost-plus projects where the Defence force chiefs inflate their budgets with expensive projects. Because they are seen as symbols of military might, it is interesting to reflect on the giant transport plane, built by Boeing, the C-17. With a budget of between USD200-300m a year for each one, one official labeled it the Golden Turkey because of its cost and its vulnerability to being blown apart by $22 mortar shell. Perhaps it has been made less vulnerable, especially after one crashed into an Alaskan forest in 2010.

Nevertheless more recently than that, someone who had experienced the joys of travelling in a C-17 said despite all the hype of being long range and being able to be refuelled in midair, it was more like a “stopping all stations conveyance” between the United States and Afghanistan, even including a stop for repairs.

Despite all the rending of garments, the Defence establishment continues to pour money into Boeing. In 2018, Boeing won contracts to build a new pilot training jet for the Air Force, an in-flight refueling drone for the Navy, and a fleet of the Airforce security helicopters.

As reported, Boeing’s “Defence revenues” had fallen by more than one-third over the timeline of a decade: from USD32.1 billion in 2007 to USD21.1 billion in 2017. But, President Donald Trump’s higher defence spending and three new military contracts put Boeing back in the game in 2018.

Still, to put all of the boondoggle in perspective, the Boeing commercial division in 2018 before the Supermax crisis billed USD60bn by airlines around the World.

Cap in hand to the Government you would think can go only so far, but Boeing has shown it has a capacious chapeau.

Mouse whisper

Just a message for the Nimbin anti-vaxxers …

Your child about two years old gets chicken pox; has a high fever – starts fitting – you prescribe one of those herbal remedies that incidentally has aspirin hidden away in it. Child severely incapacitated mentally – or dies.

Remember the name Reye, who first described the mixed brain and liver symptoms and signs as a syndrome in small kids.

Chicken pox plus aspirin; vaccinate against chicken pox. Reyes Syndrome no longer. QED.

Ralph Reye incidentally was an Australian pathologist – normally they are the doctors who deal with the dead.

Like polio, Reye’s syndrome was nearly eliminated until your mob came along.

Reye’s Syndrome