Medicine Archives - The Best Mouse Tap

Modest Expectations – All aboard for Wakefield

I last had lunch with Tom Reeve and a few people at the Mixing Pot in Glebe about 16 years ago to thank him for all the support he had provided us in the consolidation of the Broken Hill University Department of Rural Health and his general interest and leadership in improving and maintaining health care.

The Mixing Pot has been closed for years and Tom Reeve died at the end of last week, just short of his centenary. Others are better qualified to write about his life, but the progression from being a doctor in the mining town of Collinsville in Queensland (about which he wrote) to be the leading thyroid and oncology surgeon in NSW and Executive Officer of the Australian Cancer Society demonstrated the breadth of Tom Reeve’s experience and influence.

One memory I have of Tom and Ross Webster (then recently retired from the University of Melbourne but acting as part-time Director of Medical Services at the Broken Hill Hospital) was them sitting in the garden of the Menindee Hotel having a beer. It was in the mid 90s. This was before the hotel burnt down and therefore the backdrop was still the old hotel where Burke and Wills stayed on their journey up North.

Reeve and Webster made a different mark on Australia, when they worked together in Broken Hill for that all to0 brief a time.

There was one flower in that courtyard – a lone red hibiscus. Strange what you remember. As the hibiscus and all flowers are fragile, so is human life. The beauty of flowers, like the enjoyments of life, is fleeting. This quote with its link sums up that privilege of working with Tom. Fleeting – yes; but also so very substantial.

The Problem with having only one Joyce

My real worry in flying Qantas is that it is now an unsafe airline. An irrational fear, but it is embedded in my psyche.

I fuss over the number of frequent flyer points I have accumulated. At present I have over 700,000 points but I doubt the value of the Qantas program. I seem to be bombarded with emails wanting to sell me a whole raft of goods in which I have little interest. Yet try to use them for flights, especially business or first – squeezing through the eye of the needle by comparison would be a doddle.

I once preferred to fly British Airways and their customer service, including its rewards for loyalty program set a standard. I remember the rewards, a touch of luxury with a stay at the Hôtel de Crillon in Paris and a weekend at Belltrees in the Hunter Valley. In those days, British Airways even offered an upgrade on Concorde. Days that have long vanished.

I had always travelled domestically with Ansett, and I found their service was very good. I travelled thousands of kilometres around Australia and abroad with Ansett, until it went broke, leaving me with over 600,000 unusable frequent flyer points. I switched to Qantas for domestic flights. I did not harbour any resentment for the Ansett loss.

What has happened?

Ansett collapsing was inconvenient and I had to build a new frequent flyer profile with Qantas, which I did, rapidly reaching platinum status. All this suggests that I wanted to be pampered. No, I just want efficiency and certainty. I have paid for flights with Qantas with that expectation.

The six years before the COVID-19 epidemic arrived, I developed a different insight. I contracted an auto-immune disease, which became chronic and with the chronicity I have become increasingly disabled.

This meant that every time I fly, I need a wheelchair. Distances in airports became just too great to walk. This has meant that for me to board a plane, assistance needed to be co-ordinated. I have experienced other airlines and other airports in a variety of countries as well as across Australia as a comparison. Depending on other people to get you to and from the plane and the uncertainty that entails does not sit well in one’s psyche when the airline that you are used to coincidentally reduces the level of its services. Part of that is the policy of cramming more and more into economy class. Disabled people need more space not less. Qantas seems not to have given this much consideration.

Qantas has been run by a CEO whose culture is the budget airline reducing customer service, aggressive treatment of his workers, while he panders to his Board and the shareholders. To him, the plane is no better than a bus, but the cost of a ticket is anything but.

How will his legacy be judged – not now, but say in five years?

But there are even limits to Joyce, the Scrooge. He also has a touch of the Heeps, the sycophant. The Chairman’s Lounge system with an associated concierge service is a cheap way to pander to those persons of influence including, so it seems, their children. This has been a Joyce discretionary power, providing a perfumed screen shielding the politicians from the stench of Qantas’ decline in service for the masses. He can manipulate access to the flights using earned frequent flights for his coterie. It is all distasteful, but then the Australian bunyip aristocracy laps it up.

Maybe I am melodramatic, but the level of complacency and non-concern about the overall deterioration, even with the pitchforks at the gate clamouring for change, is mind blowing.

“Prime Minister, don’t you t’ink the livery on the plane advocating “yes” shows how well our airline is appropriately politically correct?”

Maybe. I’m afraid that what Joyce substitutes for an airline, is now a hollowed out advertising hoarding, and hardly a suitable vehicle for carrying passengers in comfort.

Stress and The Emergency Department

I spent nearly seven hours in the emergency department one day last week. I had an uncontrolled nosebleed for 36 hours. The bleeding would stop with pressure on the affected area, but then would start again once pressure removed. I had stopped the anticoagulant immediately. Still, it takes time for the anti-coagulant effect to wear off.

I went to the emergency department at 11.30am and was home for the evening news at 7.00 pm. I had only gone to emergency department with one clear objective, to have an ENT specialist cauterise the nasal bleeding point as I had been bleeding since late Sunday evening. At times, as I have written above, I thought the bleeding had stopped since I had stopped taking my anti-coagulants and was applying considerable pressure as well as placing gauze plugs up into the nasal canal.

When I arrived the promptness of a nurse getting me a wheelchair and showing concern was interrupted by the receptionist clerk who seemed to have lost something, fussing around, while I sat in the wheelchair. All the time I was glad that the blood was not gushing out as it had been earlier. Eventually, he found what he was looking for and I was allowed to proceed. I passed through the first set of doors and was wheeled into what was labelled hilariously RAFT (Rapid Assessment of First Treatment).

It took me over three hours to see a doctor, and then in the meantime the nurse-driven protocols started annoying me. When I was shown to have high blood pressure – which was already known – I was given a tablet without any reference to my current drug regimen, nor was there any instruction about further treatment. Then another nurse bobbed up wanting to take a blood sample, which I worked out was an INR test, which has been shown to be useless for the “novel” oral anticoagulant measurement that I had been taking. I pointed that out, and the nurse beat his retreat.

The protocol enforcers were ever present and had to be beaten off. I came in with a nosebleed, and yet they wanted to take blood for various pathology tests, and fortunately I had the results of blood tests done a few days before. ECG. Why? Chest X-ray. Why?

I was told my refusal of blood tests (the results of which apparently would take two hours) would further delay any prospect of treatment. At that point I spat the dummy well and truly, and no blood test was taken. I had my complete pathology profile which had been obtained the previous week.

There was no questioning about whom my local doctor was – no sense of referral back to my local doctor. They seemed not to notice I had compression stockings and leaving me in a wheelchair for such a long period was not a good strategy. Fortunately I had a sheepskin, but even sitting on it there was still prolonged compression of my thighs. It was not optimal.

Eventually I was examined by an emergency physician and an emergency physician registrar, and they discovered a small, ulcerated nasal area anteriorly. However, they then admitted that they did not have the equipment to cauterise the area from where I was bleeding. Thus, I had to go up to the ENT outpatient clinic, where I waited for a further hour, the last patient for the day; a lonely sight sitting in the vast outpatient area. Why I could not have been sent there hours earlier is totally due to this protocol driven bulk handling of patients.

I remember when I was responsible for the Casualty aka Emergency Department at the Royal Melbourne Hospital, we reduced the waiting time to an average of fifteen minutes. It was before the advent of emergency physicians. Some of my colleagues have wondered about the long term value of having this intermediate specialty lengthening the time for patients being seen in order to justify it being a separate specialty rather than a salaried hospital practitioner with common sense.

The Emergency Department is stressful enough without having a person like myself being kept there because of the requirement to be examined by a doctor labelled “emergency physician”, when they didn’t have the equipment to treat me anyway. Simple common sense would have referred me direct to ENT outpatients, and saved hours waiting – but as I was reminded more than once, priority is determined on clinical need, notwithstanding most of those presenting can be quickly triaged out of the Emergency Department to a more appropriate clinical setting.

Here the ENT registrar was a young doctor training to be a specialist. She fixed me up in half an hour, to be reviewed in a week, when I can go directly to the ENT Outpatient Clinic without having to be checked through “The Hospital Customs”, once known again hilariously as the Emergency Department. She also prescribed me oxymetazoline HCL nasal spray to be used three times a day for five days.

Finally, after all this stress, I could not be discharged until I was given the “green light” by a clerk attached to the emergency department. Mercifully, the ENT registrar intervened so that she had permission to discharge me. Otherwise, as my wife observed, we would have to stage a prison break.

I was once a doctor, then I was listened to by government; now I am a customer with the added experience of being a patient to complement the knowledge I’ve built up in years of practice. Am I now listened to by the next generation of policy determiners? No way – I’m just a mug emergency department statistic in a wheelchair, my knowledge of my medical condition not taken into consideration.

You see, when I ran the Emergency Department, I would have looked at the presenting complaint, and quickly confirmed the provisional diagnosis and sent the patient to the appropriate specialist unit or to be seen. I have never had any time for collecting patients.

Epistasis – An Addendum

There were ambulances parked outside the hospital. We had contemplated calling an ambulance at one stage when my nose bleed was particularly acute, and we were unable to bring it under control. In conversation with the paramedics, my wife found out that ambulance officers, including the paramedics, have no special training in stopping a nosebleed, apart by compression for up to 30 minutes. Let me say that compression for that length of time is difficult to sustain, as I found out when my nose was bleeding, seemingly uncontrollably.

Added to the fact that ambulance officers or emergency physicians are unable to staunch the blood except by pressure, it is appropriate for treatment of this condition to be reconsidered. I have since read the NSW Health sheet on nosebleed, and none of the protocol recommendations were used by those in the emergency department. I did it myself (well until eventually the emergency department registrar removed the gauze plug I had inserted).

I was bleeding anteriorly, but as I read on through the material on nose bleed, postnasal bleed may be a far more serious condition requiring specialist attention without delay. One can lose blood very quickly as the postnasal space is the terminus for a vascular plexus to which two arteries contribute.

Finally, it was also incidentally discovered that I have a deviated septum. I remember I sustained a heavy blow as a child boxing in an inter-house final. A deviated septum, means that one of your nasal airways is smaller than the other and more likely to bleed. You live and learn.

Truth-telling

Each year for more than 15 years now, we benchmark the gap between Indigenous and non-Indigenous Australians. The point is, what will we do about this gap? Truth is important, but it must be followed by action. Identifying the problem is only a start. The next question is what do we do? And this is why we need a Voice. That’s why the Voice is our first priority. We must change the process to ensure governments and bureaucrats respond to the voices of ordinary Aboriginal and Torres Strait Islander peoples, people who truly represent their communities from the grassroots up to the decision-makers in Canberra.

The Voice will be an authoritative representative body elected by Aboriginal and Torres Strait Islander peoples. It will be a committee, in a sense, an advisory committee, to make representations on behalf of First Nations peoples. No special legal powers to write or implement policy, but the moral power of representing the true Indigenous population of this country. Representation that is consistent. – Rachel Perkins.

The fondest memory of many I had of her father, Charlie Perkins, was the time I was walking across King’s Hall during the dinner break, when Mick Young and Eric Walsh approached us and addressed Charlie: “You coming to dinner with us, Charlie?” It was an invitation designed to publicly humiliate me as I was pointedly excluded. Charlie turned to them and said quietly, “I’m going to dinner with Jack Best.” It was recognition the Aboriginal people were not unquestionably beholden to the Australian Labor Party. It was also recognition that, once he determined a course of action however trivial this gesture may appear, Charlie would follow through.

I knew Charlie at the height of his power. I believed he was too much constrained by the bureaucracy. He was too much of a free-flowing spirit.

Now we have his daughter on the “truth-telling” bandwagon. This is a Marcia Langton ploy to shut down discussion. Truth is what Marcia determines; whereas the stories incorporating the myths and legends belong to each tribe, as it was how they may be interpreted in terms of natural phenomena. We constantly hear that the Aboriginal people have been here for 60,000 years. Then there are thousands of years of silence broken by secondary sources and much speculation. No truth here.

Here, storytelling is important to fill the gap, especially where such tradition is in the main oral. But that is not truth. Truth is something that is accepted – such as the dark side involving the complicity of Aboriginal troopers in the massacre of other Aboriginals and the fact that Aboriginals collected Aboriginal skulls now being repatriated back to their ancestral burial grounds alongside the more commonly stated “truths” about whitefella actions. This is one of my aims – to remove the sense of whitefella guilt and expunge this insidious so-called “truth telling” as if “truth” only exists on one side of the ledger.

Once we admit that we all live an imperfect world, which will always remain so, then there will arise a Voice which, for a brief time, I shared with Charlie as we sat around a campfire outside Old Parliament House 40 years ago. Surely there are other examples that could give meaning to the Voice, as a call for mutual respect in which sins of the past are cleansed rather than weaponised.

My Favourite Gourd

One of my favourite reminders of times we spent in Maine near the Canadian border overlooking the Bay of Fundy is a gourd. My wife had bought it in Maine. I had always associated gourds as water containers that Mexicans lugged around the desert strapped to the sides of their burros.

Yet gourds were found growing all through the New England area from pre-historic times. The earliest gourd carving was found on an archaeological site in Maine and has been carbon-dated to 6,500 years ago.

As one authority has written, growing gourds may have been spread initially in conjunction with improvements in fishing techniques, with small gourds used primarily as net floats. In this scenario, gourd growing spread northward from the coastal plains of the Southeast into river valleys of the Midwest and Northeast as fishing became more significant. The growing of gourds was fully compatible with a fisher-gatherer-hunter lifestyle.

Gourds have been grown worldwide for thousands of years. They have little food value but their strong, hard-shelled fruit, in addition to being used as fishing floats, have been long prized as containers and musical instruments.

This lightweight “container crop” would have been particularly useful to human societies before the advent of pottery and settled village life and were grown before there was any systematic horticulture.

Thus, gourd harvesting was not an impetus for widespread horticulture nor did it necessarily trigger a transition to the Agricultural Revolution.

Women may have grown gourds, but the possible role of women in fishing activities as noted above is more ambiguous than is their role in gathering and eventually domesticating the food plants along the eastern seaboard of Northern America, well prior to white settlement.

Gourds being used for folk art has a long history in south-west USA among the Indian tribes such as the Apache, Hopi, Zuni and in Central and South America among Indian tribes, particularly those of Guatemala and Peru. But I had no idea that gourd carving occurred in Maine. Some of the carvers are the descendants of the local indigenous people.

The gourd my wife purchased has the patina of leather and is unexpectedly light. It is easy to see why the gourd was used as a bag. But our gourd with a narrow opening with a rim of pine needles would be an inconvenient vessel.

Pine needles are only one such decoration; porcupine needles are also used. The needles are usually baked in glycerine water (and dye, if colouring them) for four hours and then dried for 3-4 days. This preserves the needles from breaking.

Our gourd seems polished amber in colour with its circular walls etched with figures of prehistoric horses which seem to have been transferred from the cave paintings of Altamira.

Overall, a piece of art which attracts the eye, and carved in Maine!

Mouse Whisper

The F-16 offers Ukraine the ability to safely strike targets hundreds of km away, deep in Russian-controlled territory. That’s vital if any ground offensive is to succeed.

An American declaration about the refusal to send the latest F-16s to the Ukraine because they might fall into Russian hands is a ludicrous excuse. This implies that you would be using your worst equipment (or at least equipment no better than the inferior equipment of the other side) in all warfare. War is not fought that way, and we all know that. Just imagine the RAF, in the Battle of Britain, saying that the boffins advocated they use Sopwith Camels instead of Spitfires for that same reason.

Really you American squirrels should stop treating us Australian mice as though we are drongos.

Australian speckled drongo named Barnaby

Modest Expectations – Southern Sudan

In 2006, my younger son and I went to Munich to see Australia play Brazil at football. It was World Cup time. I still have the scarf. As I remarked to the chap sitting next to me in the stadium, it would probably be the first and only time that I would be watching Australia play Brazil in anything. Australia was in a navy blue strip; the Brazilians the traditional yellow and blue. The similarity of our colours threw a golden ring around the field. Brazil was too good for us (2-0), but it was a competitive match just in the same way the recent encounter with Argentina was. Soccer or football (as it’s more universally called) was to us Australians very much a fringe sport, basically imported after the war to Australia, initially clubs being formed around particular migrant groups.

Australia had imported rugby and cricket from England and was playing test matches against them in the nineteenth and early twentieth century. But not football. Football was a working class sport; a winter niche filled in Australia by Australian Rules football and Rugby League. The latter was also a sport of the coal mining areas in Northern England. Then there was Rugby Union, the sport of the public schools in England and predominantly NSW and Queensland. Not much room for football in schools.

In 1956, at the Melbourne Olympic Games, Australia fielded a team when there were only eleven teams. Australia reached the quarter finals after beating Japan, only to be comprehensively beaten by India in the quarter final. The Soviet Union won the gold medal. On either side of the Olympic Games in 1954 and 1958 saw West Germany and Brazil win the World Cup; neither bothered to send teams to Australia. In 2000, as host nation for the Olympics, Australia received a free pass, but this was a genuine test among modified national sides. The Cameroons won; Australia came 15^th.

I was in a taxi in New York when I learnt that Australia had qualified for the round of 16 for the 2006 Cup, when Australia later lost unluckily to Italy which then went on to win the title. However, this was a “golden” team with plenty of players in the top flight European leagues and their coach was one of the acclaimed Dutch coaches, Guus Hiddink – a very talented gun for hire but not in any way close to being an Australian by adoption, despite the media hype.

Graham Arnold, the current Australian coach is a knock-about Australian, who fits within the description of a typical “Aussie bloke”. His zone? An abusive father; mother who dies of cancer when he’s 20; lives in straitened circumstances as a teenager, soccer journeyman who has pushed his innate abilities to its limits; underestimated; a chip on his shoulder compounded by his rumpled appearance. Moreover, he drinks at the Sackville Hotel in Rozelle (renamed for the Cup Sacky-roos), which I know well also. Rozelle – now gentrified – a long way from his childhood yet with identifiable parts to which he could relate, like his Sackville patron mates.

He has been around a long time, spent a lot of time playing second violin. Where does the Australian Football team go from here, after this run of magic – does Arnold know when the trail of gossamer ends? Next year, when the Woman’s World Cup will be played out in the Antipodes it may go a long way towards answering that question.

Pity about Argentina.

Chenozem, indeed

I sent an e-mail to a friend in Sweden after Australia beat Denmark, commenting this win was like Sweden beating Australia at cricket.

In response, after congratulating the Australian achievement, he mused over the state of Northern Europe – “Weather impacts will be great, we suffer high energy bills and Ukranians freeze and buy simple wood ovens to compensate. Last week a full foot of heavy snow fell here, resulting in fallen trees and much shovelling. The area is littered with fallen fir branches.”

I sent him a poem entitled Black Soil, which I have written about the Russian Invasion of Ukraine and which will be published as part of an anthology in the New Year.

BLACK SOIL


Saffron the sun emergent

Caerulean a sky beginning to dawn

Trees wintry tracery on the light

A flag limp in a flowerpot

Blood dripping in the terracotta


Black soil 


A footprint; a lonely shoe

A carved track; a burnt out tank

A sunflower once tall; now bent 

Sap dripping from its torn stem

But still life lives in this sap
 

Black soil
 

Once a feathery highway

Of fun and laughter

Where children ran 

Where parents chided 

Where bicycles slowed and 

Everyone as sunflowers were waving in the gentle breeze.


Black soil


Now mud 

Where chilled men and women lie

Twisted and burnt

In tatters and shreds

In graves 

In plastic body bags

Alone with company
 

Black soil

 
A way beside a church

Where once Putin prayed 

Where Oligarchs prayed

Where a Muscovite Prayed

A Patriarch with heavy braid

Prayed

To God


Black soiled.

My friend’s response was brief:

“Chenozem” indeed.

Well, here was an unfamiliar word, which I found out is derived from the Russian word for “black soil”. Nearly a quarter of the world’s most fertile soil, known as chernozem, is located in Ukraine.Chernozem is black soil -rich in organic matter made up of decomposed plants – “humus” in fact. I live and try to learn.

Who suggested this?

Under the Higher Education Loans Program, commonly known as HECS, the government covers the cost of students’ contributions until such a time as they earn a minimum salary of $48,361 and repayments of one per cent a year kick in. Repayments are staggered to $141,848, at which point graduates repay at a rate of ten per cent through the Australian Tax Office.

While the loans are indexed to CPI, no interest is paid on them. Legislation passed in the Federal Parliament this month will wipe more than $70,000 from university debt accrued by doctors and nurse practitioners who spend three years working and living in a rural or remote area after they graduate. The policy will apply to students enrolled from January 1 this year and is designed to attract an estimated 850 additional doctors and nurse practitioners to hard-to-staff areas. In the AFR, the education editor stated this initiative to encourage graduate medicos to go bush is unlikely to achieve its aims. She went on to say experts believe is unlikely to succeed. Dozens of attempts over the past 40 years to influence student course choice by lowering tuition fees have largely failed.

I would agree.

I was involved directly in the national establishment of university departments of rural health, rural clinical schools, regional university medical schools (James Cook University and later Deakin) and in Victoria the Murray to Mountains Program directed at training interns totally in rural areas of Victoria. All were successful, at the time I retired to join the ranks of the aged and infirm. So, what the hell is going on.

Money is one incentive, but not in isolation.

The problem with attracting doctors to rural practice is that it is not about money, it is about providing the right non-monetary incentives and from the latest initiatives, it looks as though the Government has learnt nothing.

I have seen what does not work. It is somewhat depressing when you devise policies that have been shown to work and you see in your retirement 20 years later the policy jesters and theory purveyors without field experience write their formulaic repetition of what does not work, and which I discarded long ago.

One of the initiatives that did not work was providing funding to retain doctors in the country, just as bursary systems don’t work if there are no linked career prospects. The idea that you dragoon recent graduates to work in the country for two years is not only bad policy it is damaging to medical practice across Australia.

My view, which was vindicated, was that if you present an opportunity for medical students to train in rural areas, not just a brief “holiday” visit, but a full-time living and learning experience with committed staff co-ordinated by a director of clinical training, good outcomes are achieved. The student is in effect being socialised into rural practice. It has been said that if one grows up in the country, one is liable to go back there for a career – as long as your memories are positive. When the rural clinical schools were first funded, there was considerable resistance until those who went through the program found they both enjoyed themselves and learnt the important skills to enable a doctor to resuscitate a patient and look after that patient until they are transferred, get better under your watch or die – all up significant clinical experience.

The problem with training in the rural areas is that it is completely foreign to most of the deans of medicine and their ilk who have grown up on a diet of research with an elitist view of teaching hospital training as the only legitimate pathway. To them, training in the country is second class. These people unfortunately have the ear of government because research laboratories are embroidered with toys to suck in the politicians who have no idea of what they are seeing but are glitzy. Medical education should be primarily about developing the majority of students to work as medical practitioners from the day they graduate, not research scientists. Rural clinical schools were funded independently from the Department of Health not Education to protect the funding from being “skimmed” by the universities for administrative costs.

As I have written extensively, certain matters must be satisfied for rural practice to succeed, and the overall assumption is that time as a rural general practitioner should be around five years. Social dislocation, professional isolation, community tolerance and over all succession planning. In explanation, social dislocation recognises that one’s partner needs to be accommodated and, in the longer term, factor in the education of the offspring. Professional isolation recognises that single person practice without a backup program is undesirable. Community tolerance means that in a rural community one sacrifices the anonymity of the big city and the level of social acceptance not only by the community at large but also by fellow professionals is essential for a good experience.

The simple fact is there is need for a system that can provide long term solution; succession planning is an integral part of the policy.

The Murray to the Mountains Intern Training Program showed clearly that by the end of the intern year, the doctors were capable of independent practice, able to handle emergencies and having had the benefit of an ongoing comprehensive professional development program – organised for maximum attendance of the interns and where feedback was actively encouraged. The appointment of a Director of Clinical Training able to co-ordinate the professional education component and provide a degree of pastoral care is important. For a successful program, dumping young doctors in rural areas of which they know little is doomed to failure. Then there will be the cohort who seek exemption or release from the program, often by way of legal action, and the program will be quietly dumped without fanfare.

This is a precis. As I have said, mine is the perspective of somebody who spent 30 years involved in rural health policy development, not flying a desk in Canberra but working in the field, and seeing what worked. Needless to say, I had my fair share of unproductive policy cul-de-sacs.

From an economist’s point of view, Richard Holden has been reported as saying “Writing off student debt for doctors who practice in the bush is an unfair and inefficient use of taxpayer dollars that amounts to bus drivers subsidising wealthy kids to get medical degrees.” Professor Holden went on to say that the decision to wipe out student debt for doctors and highly trained nurses was inefficient, unfair and would shift the cost of educating rich kids who become doctors onto the working poor.

Students from rich families tend to be over-represented in medical programs because of the established link between wealth and academic performance, particularly on the Australian Tertiary Academic Rank. They also can pay off HECS and thus exchange of compulsory rural placement is not much of an incentive.

As further reported in the AFR, Andrew Norton, a higher education policy expert from Australian National University, said the repayment of debt would turn into a bureaucratic nightmare as the Australian Taxation Office and education departments try to sort out the debts of about 850 graduates if the target is reached. The US-based think tank, The Brookings Institute, recently described student loan forgiveness as “regressive whether measured by income, education or wealth. Student debt is concentrated among high-wealth households and loan forgiveness is regressive whether measured by income, educational attainment or wealth.” That position was backed up by a recent Productivity Commission report. The October report was disdainful of free places in TAFEs and universities, saying such policies come at a huge cost to taxpayers, which is largely borne by people who don’t directly benefit from them.

Overall, dreadful policy, which will go nowhere – but who will ever say so?

Who do you think you are?

Halima Begum, director of Runnymede, a race equality think tank, said: “The courtier in question was born in the 1930s and is the product of a time and place defined by British imperialism. However, this does not excuse racism, whether or not it occurs inside the king’s London home.”

As background, Begum has been the boss of this Trust since 2020, itself set up in 1968. She represents “the organisation across national and international forums and has led major research, development and policy programmes spanning education, equality, human rights, public health, the environment and post-conflict reconstruction”. It is best for it to wallow in its self-defined worthiness. Great Britain is the home to so many of these worthy organisations.

There is something vaguely offensive in her italicised statement heading the article. I suppose because I am nearly 83, I find some woman who runs one of those worthy organisations dismissing us as the product of own time, as though that has any particular meaning, patronising. I was born into a Commonwealth Dominion that may have been defined by British imperialism, even though we followed Great Britain into a destructive WW11. In fact, looking at her background enmeshed in Bengali heritage with a tough early life to understand, I suppose I should cut her some slack, but reading it slowly suggests some degree of the very thing she has committed herself to eliminate – racism.

Yet, the object of this contumely is an easy target. Lady Susan Hussey, the aggressive confidant of the late Queen, served as her enforcer. I just imagine the late Queen asking her to deal with “those difficult hussies” and then her unappreciated way of dealing with Princess Diana and more recently the Duchess of Sussex. Once her patron was gone, then it was only a matter of time before Lady Hussey with all her hoar frost would follow. The exchange with an equally aggressive black woman with an African themed persona who took umbrage at being asked where she was from, certainly made the most of the exchange

Unfortunately, one could deduce from this report that all people born in 1930s should shut up and drink their cocoa. One of the ways I have always learnt is to ask people about themselves. After all, that is what makes you interesting. The taxi driver from Bangladesh is amazed that I even know where Bangladesh is and then tells me he comes from a hilly area there and dispels in my mind that the country is totally deltaic and floats around in the Bay of Bengal. He tells me about his family, but before he can produce the family photos, we have reached home – and I have learnt about a middle-aged man who I’ll probably never see again – but I was enriched by the conversation.

Perhaps Lady Hussey looking at the Ms Fulani expressed herself insensitively, but then if I pranced into a garden party dressed as a harlequin in a fur coat and Roman galea and an 83 year old woman asked where I was really from, then perhaps I might understand if she repeated the question, confused by my heterogeneous garb. But as reported, seven times! I think not.

In any event, the nobility knows when the execution block beckons, and this fifth daughter of the 12^th Earl Waldegrave descended from the union of James 11 and his mistress, Arabella Churchill has played the game and stepped down. I’m sure the crocodile tears have been mopped up.

Ngozi Fulani, born Marlene Headley, has a scalp in Lady Hussey and publicity for her charity – for the moment. “Ngozi” is “skin” in Swahili, the lingua franca of the East Africans, but Fulani are a West African people. As I wrote above, a heterogeneous lady. I just hope that these publicity hounds don’t use the elderly, less able to cope, as targets for confected outrage. One problem is having written the above I’m likely to find Nigel Farage on the same side as myself.

Mouse Whisper

Since it is round ball and hands off time, some majestic trivia:

King Charles is a Burnley supporter. Camilla undisclosed, possibly Plumpton Athletic.

His mother, clue is the only team she ever hosted at Buck House was Arsenal. His father – rumour hath it he supported Leeds.

Prince William very Aston Villa, whereas wife Kate supports Chelsea. Prince Harry is Arsenal. Duchess of Sussex? Not stated.

And Princess Diana? Philadelphia Eagles.

Modest Expectations – Marcus Aurelius

How depressing to see the Prime Minster spending “quality time” with Lachlan Murdoch, at a time when Murdoch is trying to bully the newsletter publisher, Crikey into submission. The description of Crikey as a minnow is to underestimate its clout and the intention of Eric Beecher to confront what he perceives as the malign influence of the Murdochs.

It is important to place Beecher in context, and while his own bio is scant, this quote from the Public Interest Journalism Initiative provides a summary of his early achievements. Beecher started in newspapers as a journalist on The Age in Melbourne and later worked at The Sunday Times and The Observer in London and The Washington Post in the US. In 1984, at age 33, he became the youngest-ever editor of the Sydney Morning Herald and in 1987 was appointed Editor-in-Chief of the Herald and Weekly Times newspaper group.

He has spent a large part of his later life as the pamphleteer, railing against the privileged plutocracy, which has grown under cover of globalisation and the so-called information revolution. He has explored alliances with other writers with a like attitude.

Lachlan Murdoch is targeting him in the defamation jurisdiction on Earth most sympathetic to the complainant – namely NSW. Nevertheless, Beecher has taken the decision after initially retracting the offending comment to challenge the Murdoch Empire of “alternative facts”. As Beecher has commented, any morality in journalism has been sacrificed in the pursuit of financial profit, and Murdoch, once the supporter of Whitlam and the Republic, has given over to a son without any connection to Australia, apart from a father who has long deserted his citizenship, again in the pursuit of profit.

Thus, it is tedious to see the Prime Minister giving the Murdochs the normal vassal symbolism of going cap in hand to them. When will they learn? Remember, Rudd was entrapped by a Murdoch operative in a New York strip club. Prime Minister, have you forgotten the disgusting behaviour of Murdoch in Great Britain, where yon Rupert almost apologised by closing down the “News of the World”? But then it was the other son James in the firing line, rather than Lachlan.

I’m not surprised that Marles joined in the pilgrimage to Compostela de St Rupert, given his common Geelong Grammar School heritage with Rupert. Marles, as with Murdoch, had an elderly father, and both his parents were high achievers. So, both “slumming” in a working class electorate and rubbing shoulder with the establishment is a recurrent behavioural pattern among some of the Victorian Labor party private school elite.

But really, Penny Wong! Or were you just practising dealing with some of the unsavoury types lurking around the world in some of the foreign affairs portfolios?

Presumably to demonstrate neutrality in the ongoing stoush, the Prime Minister should visit Crikey and break bread with Eric Beecher and his crew in a less plush setting but in keeping with his electorate’s wish.

Finally, yes, we have contributed to Crikey’s defence.

St Kilda

I have been reading about St Kilda.

Not the beach suburb of Melbourne, although I must admit that I was surprised of an association; I’ll come back to this later.

St Kilda was a few rocks stranded in the Northern Atlantic Ocean about 60 km from the Outer Hebrides and where, for centuries, a small group of hardy settlers subsisted. Until the nineteenth century, they lived a very isolated existence with the occasional ship calling carrying salt, iron and timber for which they traded cows, sheep, feathers and grain.

It was a hard life, living in such a state without money, where the whole population gathered as their local council, with strict observance of the Sabbath with Christianity interwoven with pagan practices, where the infant death rate was greater than 50 per cent because of neonatal tetanus, which is terrifyingly described.

The islanders raised sheep and cattle and grew some crops, barley and potatoes. They did not fish, but rather raided the bird nests which were clustered in the steep cliffs which ringed the islands.

The largest and inhabited island was Hirta and thus the inhabitants were more commonly called Hirtans rather than Kildans. The link with Melbourne is that some of the islanders apparently found their way to Melbourne. St Kilda beach in Melbourne may have sea birds on its sands, but that was the only similarity. The immigrants would have missed their roasted puffin, but surely cooking a puffin reminds one of the old recipes about cooking a galah with a stone.

Collecting eggs and birds from the cliff face was a Hirtan skill, which even to today’s rock climbers would have presented a challenge, as the ropes they used were very rudimentary, with much jollification while this hazardous operation was happening.

In the nineteenth century, St Kilda became a tourist spot, even though landing on the island presented problems, especially when the weather was bad. There was a post office where postcards could be stamped. Photographs of the islanders became popular. Paradoxically, the standard of living rose, as shown in contemporary photographs of the improvement in the housing, but the attrition of a population, now exposed to the mainland “delights” increasingly losing their previous self-sufficiency, accelerated.

The final paragraph of the description of the Hirtans in Shadowlands is evocative. By 1930, the population was reduced to 36.

“…in the dying days of August 1930, the final postcard was sent. Its message, from a tourist called Freda, said, just “Last Greetings from St Kilda.” Then the post office was shut forever. The final service was held in the church and bowed by sorrow, the islanders rounded up their dogs, those indomitable hunters and guardians, tied weights around their necks, placed them in sacks, and dropped them from the pier, looking sorrowfully on as the yelping bundles sank beneath the waves. They returned to their houses and waited for HMS Harebell.

And up on the stacks of Boreray, from their nests in the cliffs, the birds rejoiced.”

It is an example of the problem of civilisation intruding on a community which has achieved a fragile ecological balance and then, over time, from being endangered they are rendered extinct. Our forefathers characterised the Australian Aboriginal people as remnants of the Stone Age whereas they had developed a very complex hunter/gatherer society, but unlike the Hirtans they had a far bigger canvas upon which to work. Nevertheless, what have we learnt from the Hirtans, especially as with the Australian Aboriginals, there was no written language – not even an ogham?

Same Old Rubbish?

I have been a supporter of the Essendon Football Club for most of my life. It was because of the Doust family, who lived on the corner; and then after WWII they went back to Britain, leaving me with a black and red scarf. We lived nowhere near Essendon, and so it was quite a trip across the city to watch them play. The Victorian Football League (VFL) then was essentially composed of inner suburbs extending west and north. The only team in the eastern suburbs was Hawthorn, and when I was small, its team was a “basket case”.

Essendon did not conform to the original teams when in 1897 the VFL was formed. Essendon was not an inner working class suburb. Yet Australian Rules was essentially a working person’s game, despite having a posh beginning as a game between an Anglican and a Presbyterian private school.

Many of the clubs were both Irish and Roman Catholic, none more so than Collingwood in the era when John Wren virtually owned the club. Essendon was not Roman Catholic – far from it. But the nuances of this history were lost on one small boy, even the fact that Essendon once played their games in East Melbourne where the railway yards now stand and they were nicknamed “the Same Old”.

By the time I became a supporter, the team was located at Windy Hill, high on the hill in Essendon where the gales blew. In winter it was a place for the frozen spectator, even rugged up and with the obligatory Thermos in hand; and because the suburb Essendon had become the location of Melbourne’s airport, the football club adopted the nickname of the “Bombers” in 1940.

It was a different time with the VFL progenitor, Victorian Football Association (VFA), having many of its teams in the eastern, south-eastern and southern Clubs still active. Oakleigh, nicknamed the Devils even though they wore gold and purple colours, just down the road was my club, but I was never as addicted to Oakleigh in the same way as I was to Essendon.

This long introduction is to say that most of my life has been consumed in my support of Essendon, even at one time being a paid-up Essendonian. However, that changed when the game became an exercise in keepings-off and Essendon relinquished its Windy Hill home.

Sport at the top level is now a moneyed game driven by TV rights. There is also a stadium fetish, to ensure that the pampered few are spared the rigours of winter with access to glass boxes awash with alcohol. The players from teenage years are moved around as well-paid commodities without, in most cases, any deep-seated loyalties. After all, being doled out in a draft means that these players are separated from their hearth and home. And that gnaws away at the special nature of the Game loyalties.

Curiously, the game is reverting to the original game where there seemed to be limitless players, running on and off in a blur, to maintain the momentum of the game, keepings off, scragging; little men in yellow running around making arbitrary decisions so they can keep up with a game, which is driven by the manic desire of those who run the game to make it faster and faster. The only difference between the original game in 1958, which perhaps should be introduced, is running among the gum trees in Yarra Park and the length of the playing arena when rules as today were arbitrary or non-existent – and of course the little yellow officials.

However, there is a veneer of corporate civilisation. As somebody wrote about the Essendon worship of bright and shiny baubles “Walking up the concrete steps, Essendon’s headquarters feels like a corporation. The generic nature of the massive building continues inside where it becomes immediately clear the home of this historically great football club – which has not been anywhere near great since it moved to Tullamarine – has no heart.

That is my problem – once a fanatical supporter who imparted the same spirit to my sons and then they to most of the grandchildren. But then only one of these six was alive – just – when Essendon won its last premiership in 2000. My heart has gone – I no longer care.

Maybe a flicker of nostalgia when I read about Michael Hurley’s complete loyalty to the club. (pictured)

The AFL has a heritage round, but what is meant by heritage? True heritage would be playing twenty a side – eighteen on the field with two emergencies, which came on as replacements and were not interchangeable. Yet that rule only operated from 1946 until 1978 when the interchange rule was introduced. The longest time the rules of the game have not been changed was nine years between 1877 and 1886. Now, there is more year-to-year fiddling with the rules than in a Bullamakanka bush band.

Then see how the spectators would enjoy it. The grounds are more uniform than in the past. When playing at Hawthorn, you were on a compressed ground wedged against the railway lines – and with the right conditions the full back kicking out, if accurate enough, could kick a goal at the other. I repeat “if the conditions were right”. Oh, for the suburban grounds that had character.

Now, what an exercise in sterility, but the AFL is now politically correct. Gillon McLachlan, scion of the South Australian Establishment, you have left your legacy – you have pasteurised the game behind pay walls. Well done.

What the Butler saw

The Strengthening Medicare Taskforce is bringing together Australia’s health policy leaders. The diverse membership has been drawn from across the health professions, and includes consumer, rural and regional and Aboriginal and Torres Strait Islander representatives.

The Taskforce will work to deliver concrete results through its recommendations, including:

Improved patient access to general practice, including after-hours.
Improved patient access to GP-led multidisciplinary team care, including nursing and allied health.
Greater patient affordability.
Better management of ongoing health conditions including chronic conditions.
Decreased pressure on hospitals.

Here we go again. The Same Old!

Mark Butler, a lawyer and union official prior to being elected to Parliament, under Rudd had an exposure to matters relating to Health, in various parliamentary secretary and ministerial positions between 2009 and 2013. He had been Shadow Minister for Health since January 2021

Unlike another South Australian, Neil Blewett, who maintained continuity in the portfolio whether in Opposition or Government to became one of the best Ministers of Health, when the Labor Party went into Opposition, Butler was handed the shadow environmental portfolio by the then Opposition Leader, Bill Shorten. The Health shadow portfolio was passed to Catherine King. After the 2019 election, the shadow Health Ministry was held by Chris Bowen, until it was passed back to Mark Butler. The Health portfolio seems to have been in the “pass the parcel” category among the Labor gentry.

One of the prerequisites for the Health portfolio incumbent is that unless one learns the language of Health, it condemns you to being at the whim of translators. Blewett as a linguist was fluent in Health, and he also had a bunch of public servants who had served in health matters for a considerable period, and while they were not necessarily health professionals, they were more or less fluent in Health. Guys like Alan Bansemer and Bernie MacKay.

A 17 member committee is doomed to failure as anything but a megaphone, given that allows every member an average of 3.5 minutes an hour to speak. Also the bigger the Committee the more unwieldly, although technology allows for everybody not to be in same room for a meeting; however, that introduces the trickiness of the membership being in isolated cells, without any meaningful interaction. But maybe that is a deliberate ploy. I have faced public service running interference and have dealt with it mostly – without winning any popularity polls.

Scanning the list of Butler’s Committee, the only one with any decent corporate memory is Stephen Duckett; like all of us who have been in the health sector for as long or, in my case, longer than him we have our own set of biases. Duckett sure has his, and his bias against private practice is well-known. He is sure to raise salaried practice and capitation as alternatives; but Medicare has served Australia well, even under conservative governments where it is always allowed to decay. Added to this the central agencies hate uncapped programs as Medicare has been.

My problem with the medical representation is that each is there because they have been elected as distinguished members of one of the many tribes of medical graduates, not as experts in health economics and policy. To them, reforming the health system is not a full time pursuit, but a task force gives them all the opportunity to whinge, and in a couple of years these office holders are gone.

The only medical graduate on the committee, a former President of the AMA with some experience of the vicissitudes of Medicare, is Hambleton. He does not fill me with any confidence because once when I asked why the AMA had ceased being deeply involved in establishing doctor’s incomes, he seemed confused about the value of the bilateral Medicare Enquiries between the AMA and the Federal Government last held in 1984.

Looking down the list it seems that the aim is to include every player in the provision of primary care and a wish list of aims without any means of achieving it. Thus presumably, the Department will prepare a series of working papers – a variation on the Jenny Macklin National Health Strategy Initiative where she was asked to review Australia’s existing system, which produced a series of discussion papers of varying quality. That task force was disbanded in 1993, without any discernible effect on the health system. My involvement goes back to listening to Gough Whitlam expounding on health reform in 1969 at the time of the Nimmo inquiry, when the genius of John Deeble and, to a lesser extent, Dick Scotton provided the intellectual capital for both Medibank and Medicare.

The crux of the primary care problem is that despite all the talk about professions working together, it just does not happen spontaneously. I am a patient in a very good general practice, with very competent medical and nursing staff. They have their tasks and they don’t spend their time in formal training in how to get along. As a patient, I want to be able to converse with my general practitioner and yet realise I have a limited time to do so. Yet despite its caring profile, this long term traditional suburban general practice has been absorbed into the corporate world, and if it were not profitable, you could bet your bottom dollar that this world would not be there. This presents a bit of a paradox. Substantial investment on the one hand; crying poor on the other.

The other variable is general practices now closing off appointments for new patients, which effectively caps throughput. Given that Medicare is uncapped – and the rule of thumb is to maximum daily limits for doctor – namely seeing 80 patients a day for 20 days a year or 30 telehealth consultations for the same period a year, otherwise any more will attract a reference to the Professional Services Review Committee. That is the only comment on optimal throughput – two extreme positions. The Committee should address optimal throughput.

Given that the public has been used to bulk billing in general practice, I can now ask a question: “What is general practice?” and then ask, “what is the most cost-effective way to deliver general practice?”

My premise is that general practice is heterogeneous. Yet it conforms to certain rules. For instance, at least three doctors are required if the practice provides a 24-hour service. Yet how many practices exist as standalone services providing such a service? In rural areas in the small towns such a service is problematic, but general practitioners there do have a local hospital to back them up. I have no idea what the “urgent centre” proposed by NSW and Victoria is; and where does the staff come from – Mongolia?

In any question of general practice, one must ask the question of what level of coverage by general practice yields the most effective return. The fact that the so-called 24 hours clinic or general practice attached to urban hospitals has not become standard suggests this is a work pattern unacceptable to the majority of the general practice workforce, notwithstanding that its income is underwritten by government.

From a question of what is general practice, and the most cost effective organisation of same, then it becomes a cost accounting exercise. The best cost accounting depends on ensuring that all the assumptions underpinning the process are clear. There are times when approximations will be made; and it is the test of any good cost accountant to know when to approximate. After all, if one waits for a complete census of any population when 90 per cent will provide a useful approximation and if the information can be obtained in a reasonable time, then delays are avoided that otherwise can render the data of limited use.

The problem is that the advice provided by cost accounting is ignored by government, because it is often inconvenient. We once showed that the most effective radiation oncology practice was one based on three linear accelerators at any one site. What happened was the States bent to political pressure and scattered one machine facilities across its jurisdiction; as well as being uneconomic, these facilities had difficulty maintaining staff.

In the end, once the true costs are known, then it can be discussed what should be the professional cost of the practice, the expected income of the general practitioner, which is subsidised through fee for Medicare benefit and what can be gained by additional charges that the patient has to find. This figure is complicated by the corporatisation of general practice. After all, general practitioners can charge what they believe is fair and reasonable. What does their corporate boss want to charge?

The Federal government provides a patient benefit not a doctor’s fee. The patient benefit is constitutionally valid; but setting fees is not. The Australian voters in the 1973 referendum rejected Federal control on prices and income.

And there you are. Answers are gained, and the 17 member committee can deal in facts adorned by assumption rather than opinion warped by bias and, I hesitate to say, “enlightened self interest”.

Where fantasy meets reality

In the Boston Globe, Stephanie Ebert runs a regular opinion piece chronicling what is happening due to the Supreme Court ruling, overturning Roe v Wade. This is her latest update I’ve edited hopefully without affecting the original content.

The consequences of withholding reproductive choice were expressed in stark and varied terms, by a Republican state legislator in South Carolina, by voters in New York, by political pundits balling up their midterm predictions, and by HBO viewers shocked by the premiere of the “Game of Thrones” prequel “House of the Dragon.”

But before we get to Westeros, let’s stop in the Palmetto State (South Carolina), where a Republican state lawmaker’s abortion regret clearly struck a chord.

Rep. Neal Collins told an emotional story about the real-life fallout of the “Foetal Heartbeat Bill” he had supported, which prevented a 19-year-old whose water broke at 15 weeks from terminating a pregnancy that was not viable. She was sent home from the hospital with a greater than 50 percent chance of losing her uterus, he said, and a 10 percent chance of developing sepsis and dying.

“That weighs on me. I voted for that bill,” Collins said in a video clip that circulated on social media. “These are affecting people.”

The clip was picked up by CNN Politics, where commentator and former Trump aide Alyssa Farah Griffin said that in some states, the GOP was going too far with abortion restrictions.

“This very extreme position will backfire on Republicans — not having exceptions for rape, incest and life of the mother — and I absolutely think we need to course-correct,” she said.

That’s the view of many political observers who are rewriting their predicted narratives for the midterm elections since voters began having their say at actual ballot boxes. A special election victory by Congressional candidate Pat Ryan — a New York Democrat who campaigned on abortion rights after the Supreme Court struck down Roe v. Wade — is a sign that Democrats are now more competitive in the midterms than anticipated.

Anger over the abortion ruling is translating into new voter registration and could fuel a pushback at the ballot box, several new analyses suggested.

Tom Bonier, CEO of the political data firm TargetSmart, dug deep into Ohio voter registration and reported that women out-registered men by an 11 percentage-point margin since the Supreme Court’s Dobbs decision on June 24 — a huge change from the 2018 midterms.

Bonier documented the surge of women who registered to vote in Kansas after the leak of the Supreme Court’s draft ruling in early May before Kansans voted overwhelmingly to preserve abortion rights in the state’s first-in-the-nation referendum on the issue.

Not to be outdone, the New York Times’ The Upshot examined new voter registration in 10 states and found the number of women registering to vote rose by about 35 percent after the decision was leaked, while men had an uptick of 9 percent.

Meanwhile, abortion bans have taken effect in 12 states. But in one of those, Idaho, the Justice Department prevailed in a legal challenge that partially blocked criminal prosecution of doctors who perform abortions. A federal judge agreed with the Justice Department that Idaho’s abortion ban conflicts with the federal Emergency Medical Treatment and Labor Act, which requires hospitals that receive federal funding to provide treatment in medical emergencies.

In Texas, the decision was the exact opposite. A federal judge agreed with Attorney General Ken Paxton that the state can’t be compelled by the federal government to save a pregnant woman’s life with an abortion.

In other news

Once vulnerable, N.H. Senator Maggie Hassan is suddenly benefiting from abortion ruling, other Democratic breaks – The Boston Globe.

Google, criticized for steering those search for abortion to anti-abortion crisis pregnancy centres, takes steps toward clarity – Bloomberg

The aforementioned HBO series “House of the Dragon,” which requires both trigger and spoiler alerts for a brutal childbirth scene that was upsetting to many women.

Still, one of the showrunners told the L.A. Times that the women consulted during production offered positive feedback. “Some felt it wasn’t violent enough,” he said.

Was it gratuitous – as was often said about its patriarchal forebear “Game of Thrones?” Was it transparent in its intentions, like a latter-season “Handmaid’s Tale”? I was surprised to discover it was written and filmed well before the Supreme Court ruling.

Mouse whisper

Appalling taste. According to The Economist, there are those Brits who are promoting Larry the Cat as the next British Prime Minister. Extraordinary how the Brits have embraced this serial murine killer. But then Larry has had to deal with Boris Knotgudonov, who has tried to portray himself as a cool cat, but turned out to be an appalling mouser.

Modest Expectations – SXM

Here we are in Mungo National Park. The power is off. My computer needs re-charging. Thus, after this sentence, there will be a lull. Transmission will resume after we get to Balranald.

When you write something as disconnected as that, there must be what they call in the trade a prequel, and there must be a postscript as well.

But first, the scene should be set for both.

Mungo National Park was the site of an ancient lake, Lake Willandra, dry saltbush expanse disappearing into the horizon. On one side of this lake is a long stretch of dunes caused by the winds blowing the sand and grit into have termed “The Walls of China”. There has been differential erosion across these dunes leaving a series of obelisks in the sand. They are a small version of the famous Pinnacles in Western Australia.

I first drove around Mungo National Park 30 years ago. The Park had been given WHO Heritage status in 1981, the remains of the modern Indigenous Australian man, at least 40,000 years old, were discovered in the Willandra Lakes in 1974, with the remains of a perhaps equally ancient female having been discovered in 1968. They were labelled Mungo Man and Mungo Lady.

The bones have languished in Canberra, until Mungo Lady was returned “to country”, and is kept under lock and key in the Visitor Centre while a suitable burial site could be designated. Thirty years have passed. The then Minister of the Environment in May this year gave permission for reburial. Having been given the gravedigger role, the NSW Government has baulked.

Meanwhile Mungo Man’s remains await, to be interred in an ancient river red gum box.

The Paakantji, Mutthi Mutthi and Ngiyampaa share the land, saying their people have effectively been there forever – well for at least 40,000 years, but when I first went to Mungo, there was not much evidence of their occupation. One could freely drive around the Walls of China; you could walk around the ancient site without the benefit of an Aboriginal guide. Sensitivity towards these lands did not require a boardwalk. The country was full of kangaroos; this time there was not one to be seen.

Then there was a seasonal Lodge at the entry to the Park, where you could stay, except during the summer months, and water was at a premium. Today, there is a renovated Lodge, well set up with cabins clustered around the administrative and dining facilities. The highlight of the evening meal was the rack of lamb; after all, in the land of sheep in the saltbush, how glorious was the taste of a very generous serving. We agreed that it was the best lamb we had eaten since one memorable meal at Wanaka in the altoplano area of the South Island of New Zealand, where Canterbury lamb is raised, and until this Mungo experience was the most succulent lamb meal.

Strange, in search of an Aboriginal masterpiece, it was the product of imported fauna which provided the most memorable experience, apart from the cold which, although not unexpected, when combined with a wind chill factor pushed the thermometer well below zero.

As the reader may discern, I was disappointed being locked out of the self-drive tour, and there were suggestions that a sunset tour with two adults and two children at $200 was expensive, but then life is not cheap when you stay in the Park.

Although it is stated that there is no need for a four-wheel drive, some parts of the road to Balranald were, as they say, challenging, especially as it seemed not to have been graded after the floods, and deep dried ruts dotted the roads and in the sandy areas, the bull dust concealed potholes in the road. On the other side of the coin, the asphalt roads are creeping outwards, especially where mining interests are concerned. On reaching the junction with the Balranald-Ivanhoe road, I was surprised by this newly sealed road.

Why? Mining means improved access.

Mineral sands mines had been opened 175km south–west of Ivanhoe. The heavy mineral concentrate (HMC) from the mine is trucked to a new rail siding just outside of Ivanhoe, then transported to Broken Hill for further processing. Unsealed roads used to go in all directions from Ivanhoe, which existed as a place where the rail fettlers lived and where once the Indian Pacific stopped at 3am to let me get off. If you want to emulate that feat just remember the station is approximately a mile from town – and there are no taxis.

There you are, the future of the NSW Far West, tourism and mining, not forgetting the traditional overlay of cattle and sheep. Just setting the scene.

The Prequel

We had been invited to a farewell of Professor David Lyle who, for the past 27 years, has headed the first University Department of Rural Health (URDH) created in Broken Hill. The concept was bitterly opposed at first by some elements of the Federal Department of Health and certain then influential general practitioners. The brainchild of these university departments of rural health was Dr Sue Morey, then the NSW Chief Health Officer, who believed that teaching of medical students should be available in a structured rural facility and should have a strong public health component with equally robust community involvement. Sue delegated me to sort out the structural barriers and importantly secure local involvement. As it turned out, Clyde Thomson, the remarkable CEO of the local Royal Flying Doctor Service, was that person. I have written extensively about Clyde elsewhere and it is about time that his status of being a “national treasure” is fully recognised.

Clyde trained as a pilot, but he grasped very clearly what we were about and how an air transport facility, an almost untouchable icon delivering emergency medical care to the outback, could be further broadened to be an integral part of the clinical life of the community, including most tellingly of the Aboriginal people. Clyde embraced the ideas and demonstrated very clearly the essential need for a “local champion” to work in the planning and implementation.

Although Clyde was Chair of the Hospital Board at the time and a university department of rural health being attached to the local hospital seemed an attractive option – in this case we avoided the danger of parochialism in that even if it were considered successful, there would always be a number of reasons advanced that a “Broken Hill Department of Rural Health” would not be a generalisable model.

Also, medical education at an undergraduate level is the preserve of universities in Australia. We decided that despite a locational problem, the University of Sydney should be invited to participate in the project. At the time university medical school thinking about having a rural component was to have it located on a campus on the outskirts of Sydney, not 1,200 kilometres away in a mining town which was closer to Adelaide.

Crucially, Broken Hill was located in NSW. As time went by, the rural involvement of the University of Sydney moved towards Sydney to Dubbo, then to Orange, over a number of years. This would have been impossible if Broken Hill had been linked to one of South Australian Medical schools, which initially appeared to be the easy option given Broken Hill’s medical relationship with Adelaide, but would have assured failure. There was some academic resistance in University of Sydney Medical School; it was overcome. The Dean, Steve Leeder, helped – a crucial ally.

I was asked to do a Rural Stocktake across Australia by the Department of Health in 1999, and I reported early in 2000.

There is no doubt that Minister Michael Wooldridge’s dedication to rural health improvement drove implementation, in particular securing funding for the program in the 2000 Federal Budget, which was distributed to universities with medical schools, with the proviso that the Universities could not skim any of the funding for “administrative expenses”. All the funding went to the various programs.

The final keystone for this Broken Hill project was David Lyle. He is a public health physician who had been involved, even before his appointment, in determining the extent of lead poisoning in the children of Broken Hill. He has always had a reputation as a great teacher, and ensured that his URDH was expanded to embrace other health professionals, including Aboriginal Health workers.

He oversaw the conversion of disused wards at the back of the hospital into a tangible Department and attracted a significant amount of research funding. There are now 19 UDRHs across the country, and the fact that David, until now, has been the unmovable champion and therefore crucial in the growth of rural training of health professionals, including public health.

His replacement has yet to be named and the University of Sydney advertisement suggested that the office would be based in Camden, where apparently the university has some agricultural facility, such is the systemic idiocy in the university bureaucracy. There is a problem among medical deans where there is an obsession about ranking, largely determined by research citations. Most of the medical deans have had professional careers within academic cloisters where the sun of rural Australia doesn’t shine. It is alleged that rural health money is taken and strewn around the city campuses.

This response by the University of Sydney indicates the bane on any program – lack of corporate memory without a record of the genesis of the program.

David Lyle must leave a written legacy or podcasts to ensure that 27 years of experience is not lost, given he is the last of the original heads of the URDHs.

The Postscript – What’s in a Name!

Years ago, I was asked to review an alleged problem in the delivery of medical care at Hopetoun. Hopetoun is a small township just South of Wyperfield National Park – an area of mallee desert country which lies in the far north-west of Victoria. During my time there, a case of a pregnant woman with no access to ante-natal care, was raised with me.

It was an anecdote raised in passing as an example of the general lack of access to medical care. Strangely over the years the name of this tiny place, Lascelles, has stuck in my mind.

This week we were returning from Broken Hill and decided to go across to Victorian border to visit the pink lake, Lake Tyrrell. Because of its colour, it has become a destination for Chinese tourists because of their association of pink with luck. When we visited the wind was blowing and sun was reflected from the water against a cloudless sky. You could pick out fragmentary pink colours in the shaded areas of the lake, but there is a far better pink lake in the South Australian Coorong. Anyway, Lake Tyrrell has put the Mallee town of Sea Lake on the map, but also on the map has been inserted the Silo Art Trail. Many of the silos in the district have murals painted on them. One of these silos was at Lascelles and at Sea Lake there was a signpost to Lascelles.

The signpost evoked my memory of the name. I thought that it was a speck even further into the bush than Hopetoun, but for the first time I could put a face on this hamlet, where the major medical centres of Mildura and Bendigo were about two hours away. Lascelles is a pub and a few homes and on the silo wall there were beautifully painted, in sepia tones, portraits of a farming couple, the Hormans.

That is the endemic problem of small settlements, so small they do not merit any shops, but most do have a pub, a hangover from the time the trains stopped there and now a place for the locals to come and have a drink. The pub is often the only community resource and would be a perfect place for regular clinic by a visiting medical team. As a model, the flying doctor provides the excitement in community by arriving by air. I remember in the 90s flying with the RFDS when they provided medical care at the Noccundra rodeo; and boy is Noccundra remote! Yet a plane on a gibber plain air strip indicates that the doctors and flight nurses have arrived.

Noccundra in Far West Queensland had a permanent population of four, but there was a pub made of stone. The RFDS provides a model for a visiting service, with provision of a regular clinical schedule and being available for outback events such as the rodeos where inevitably there will be injuries, some of which may require evacuation, either to Broken Hill or Adelaide.

There is much discussion about the lack of doctors in the bush. I believe the root cause is that there is no coherent succession planning, but for such planning there needs to be a facility which can appropriately both monitor and supply a regular flow of doctors.

To me all programs of clinical care must have a teaching component to assure the flow, as occurs in teaching hospitals.

Therefore a university facility, whether it be a university department of rural health, rural clinical school or a rural medical school, could provide a regular means of servicing the small communities with clinicians and providing two elements – one: clinical experience and two: continuity.

Much of these ideas have sprung from my own personal experience of providing a visiting medical service. For a number of years when I was newly graduated I would do evening consultations by visiting patients who, for one reason or another, could not present at the rooms for ongoing care. I did it twice a week, and if I encountered any deterioration, I would let the general practitioner know. Here the General practitioner was my educational resource and I went out on my visits -five or six patients generally had to be seen each evening.

The principle is simple – a travelling medical team connected to a teaching centre, where public health is an essential ingredient. As I have found out, if you provide a mixture of collegiality, teaching, recognition and succession planning, then you can build a coherent team of health workers.

Such a concept where you use colourful cars in lieu of aircraft to attract attention as the means of providing a regular service to remote settlements need to have a David Lyle to implement such a simple but obvious concept. But make sure that the travelling band arrives in each township with panache and always come when they said they would -punctually.

Incidentally, there was no problem with the medical care in Hopetoun, but that is another story, but instructive in trusting your on-site observations to strip away the hearsay and gossip.

Sarah Jane Halton and her Stomach Knot

Jane Halton has bobbed up again. The incoming Health Minister, Mark Butler, has asked her to review the existing vaccine contracts and whether the country had a regular source of vaccine supply – a guaranteed pipeline.

The background is the dilemma being posed by the surge in the number of cases of the virus and the fact that the new variants seem to be more contagious. The fact that the level of vaccination including boosters has declined and there seems to be a growing complacency in the community with the removal of public health safeguards presumably is driving the review.

His action follows on from a national surge in case numbers, with health department estimates showing around 200,000 people are actively infected. He also confirmed that COVID-19 vaccines for children aged between six months and five years, which have already been approved in the United States, are progressing towards approval in Australia. Pfizer has been granted provisional approval to put in an application to provide a paediatric COVID-19 vaccine.

At the same time the impact of the transmissibility of the new variants BA.4 and BA.5 has introduced another variable, because of the unknown factor around the virulence and the effectiveness of current mRNA vaccines against these variants. That is the problem with mRNA viruses – they are fickle, mutating regularly.

Reading between the lines, Butler wants a “quick and dirty”. Despite what has been provided in the media release, and a comment that he was only interested in the future, the lessons come from the past.

Butler’s appointment of Halton is a shrewd one. She is a Howard-Abbott warrior. Therefore, her appointment has a “Teflon” quality. As a Deputy Secretary in the Department of the Prime Minister and Cabinet, Halton was convener of the People Smuggling Taskforce in the Children Overboard Affair. This was a convenient vehicle for Howard’s scare tactics in relation to the “Boat People”. She was the dummy in believing false claims, but she was rewarded with the post of Department of Health Secretary, where the then Minister, Abbott obviously saw her as a person in his own image and when he became Prime Minister Halton moved upwards into a central agency – that of Finance.

She became a member of the ill-fated Executive Board of the Australian National COVID-19 Coordination Commission in March 2020. That would suggest that she was engaged in the whole sorry process from the start, the entrails of which she has been asked to examine. Maybe she will be able to airbrush any involvement of Sarah Jane Halton from her report to Minister Butler.

After all, the Chair of the Commission, Neville Powers was convicted of breaches of COVID-19 rules. Maybe the activities of this Commission will figure in her solution. So far, the only public contribution by Halton as a result of this association was an indifferent report on hotel quarantine.

However, there is no doubt that Halton is an expert on integrity having been a member of the Board of the Crown Casino which presided over a raft of corrupt practices, the criminality of which has not been tested in the Courts. Nevertheless, the former judge Patricia “Paddy” Bergin, who ran the Inquiry on Crown, noted that despite her involvement in some of the deceptive practices, her integrity emerged intact.

James Packer had a business model which relied on an ongoing river of Chinese money replete with all the attendant malfeasance connected with the movement of large amounts of money, including junket tours and money laundering. It seems that ASIC is not prepared to take the matter further – “too big to fail” is the mantra.

Halton is a beneficiary in that the level of her involvement in the shenanigans will not be tested in court. Nor unsurprisingly, this involvement was not mentioned in the Butler media release, where she is described as “a vaccine expert” and Chair of an international organisation – the Coalition for Epidemic Preparedness (CEPI) based in Oslo, which is the brainchild of the Bill & Melinda Gates Foundation and the Government of India. Given the generous description of her as a vaccine expert by the Minister, the published description of the CEPI Board, acknowledges her starkly by a single word “Chair”, a position to which she was re-appointed last year for a further five years. Yet others on the Board are clearly defined as vaccine experts. It is as though the authors of the CEPI Report were unsure why she was there.

I therefore was surprised with the Ministerial comment: “I make no judgment about the existing arrangements. I think it’s entirely appropriate for us to have some independent advice about incredibly important arrangements that we have inherited.”

Excuse me for gagging on “independent”.

Now that ex-Minister Hunt has retired, also excuse me by speculating if there is now one remaining person with a target on his chest. Also let’s hope that she does not get that knot in her stomach – her own shorthand for the times she has stuffed up.

Climate Change

Ravenserodd – site of sunken Medieval town

The worst manifestation of this deteriorating climate was the Grote Mandrenke (Great Drowning of Men) of 1362, the greatest North Sea disaster in history which saw up to thirty thousand dead and almost half the population of the marshland districts along the Jutland coast drowned, not to mention the inundation of substantial chunks of the city of Dunwich and the port of Ravenserodd on the North Sea coast of England.

This above excerpt from a newly-published examination of ancient Britain settlement, Shadowlands by Matthew Green describes the changes in the British coastline because of climate change in the early part of the last Millennium. There is the description of Old Winchelsea where, over a period of a hundred years, this settlement – an important port on the Kent coast – was washed away. The intervention of King Edward 1 in acquiring land in the hills above Winchelsea was not without controversy because it meant a shift of Winchelsea being superimposed on existing settlements on this higher land.

These were turbulent times as the Northern Hemisphere moved from a calm Mediaeval Warm Period (c. 900-1200) into the turbulent Little Ice Age (c.1300-1900). During this time, hundreds of settlements on both sides of the Channel were inundated with extensive loss of life.

As Green says, this period was instructive for our time, when climate change is very much in the hands of manmade intervention, which as he says, it is probably much worse than the thirteenth or fourteenth century “ever dreamed up.”

May I suggest that the inhabitants of Lismore and other places that were once ports and which are now being repeatedly flooded, read what happened to this mediaeval port of Winchelsea. It took time but, in the end, the once thriving port of Winchelsea was no more, death from repeated flooding.

Mouse Whisper

My Bushrat relative, Rafferty, turned up the other day. He had hitched a ride on a number of trucks around the southern part of the Far West of NSW with a mate, Jack Kerourat. Anyway, he said that the Hay Plain was so flat you could see the curvature of the Earth’s surface.

The other thing he mentioned was in the bar of the Penarie pub where he heard one of locals say, “Look mate, you know what a remote place is in Australia. It’s where there’s no TAB betting agency.”

Modest Expectations – Stereo on the Mountain

I have written this story before, but the proposal to increase the travel allowances of patients living in country areas of NSW reminds me of a story which appeared in my 1988 book “Portraits in Australian Health” released in the Bicentenary year, to my knowledge the only book which the Federal Department of Community Services and Health sponsored to honour this occasion.

It related to a long time general practitioner in a northern country town in NSW who, among his diverse interests and skills, was an expert in diseases of the eyes. On one occasion, one of his patients came to see him for advice. Apparently, the advice did not suit this person, and so he sought a second opinion. This meant travelling to Sydney by train, which took about eight hours, in order to consult the eye specialist. This meant no mean effort.

Days later, he arrives at the specialist’s rooms in Macquarie Street only to find, as he entered the consulting room, there was his own country doctor who, at the time, was undertaking a locum for the specialist.

This is highly unlikely to happen today, but emphasised that just because one may prefer to practise medicine in a rural setting it is in any way different from practising in the city, apart from the technology. It just means getting the skill sets and the incentives right. But I admit that technology has in some areas supplanted a need for the same level of clinical skills, but that generality hides a much deeper discussion on its truth.

The doctor in the anecdote never lost his links with the city. When a doctor practises in a country town, he or she does so as an everyday member of the community and as the repository of the knowledge of the community’s health status, each person by person. In attracting a doctor to country practice, the community must realise that the doctor must have his or her own space, his or her own privacy – the interaction between the doctor and community, which I once termed “tolerance” – a recognition of the importance of both sides of this interaction played out beyond the doctor’s rooms.

In so doing, another element of potential dysfunction is broached – that of professional isolation. Post graduate education is offered but availability is not the same as uptake. What worried me when I served as Director of Clinical Training was to get the professionals to interact with one another, even within the one practice. I have found collegiality helps in diminishing isolation, because sometimes I think many of my colleagues would prefer a sub-specialty of one.

Over years working in rural areas, it is tragic that I have seen the same mistakes being repeated over and over again. The classic conundrum is that of the doctor who complains about his workload, but when offered another doctor, recoils because of an unsubstantiated threat to income and as a threat to the power structure these long term doctors have created in their town. As a result there is a dearth of succession planning.

The other cultural problem, for which doctors are not to blame, is that the closer one town is to another the greater the rivalry and animosity, often demonstrated in the regional sporting rivalries

Awareness of the dysfunctions of rural life is papered over by the vision of an Acadian life, but despite the attempts at regionalisation, it is always the major regional city which collects the spoils and the rest of the region is left to its own devices. There are success stories; but always it seems there is a time when former patterns of dysfunctional behaviour re-emerge.

Having the will of successive generations of administration to maintain an open co-operative system requires the steely resolve of people like the Mayo Brothers, and how they achieved their success should be studied in every institution where health administration is taught.

“Tasting the winds, that are footless,
Waist-deep in history.”

I love trees as obviously does Sylvia Plath from this above quote.

One of my most enjoyable times was driving between Bourke and Goodooga in Northern NSW with Stuart Gordon and Nick Mersiades. Stuart Gordon then was moving from growing cotton into the community services sector. He asked whether he could cadge a lift to Brewarrina, as Nick and I were going onto Goodooga to stay the night before proceeding to Hebel just over the NSW border in Queensland the next day.

What was unforgettable about this drive was the level of knowledge of the countryside those two blokes had. The bush was varied. At one point we would be driving through predominantly brigalow scrub but at other times gidgee scrub.

Gidgee trees are stockier than brigalow and have dark trunks, which, when they are cut, yield a yellow sapwood corona surrounding an umber core. Brigalow trees are taller. In the dry area, the green brigalow foliage becomes increasingly silvery, and in a breeze I thought it to be almost feathery like giant dowager boas.

Interspersed among these stands of acacia were mallee eucalypts, and the incredibly beautiful leopard and salmon gum trees. The trunks of the latter were smooth salmon in colour and the leopard gum mimicked the spotted hide of the eponymous carnivore.

To me, crushing a gum leaf and smelling the eucalyptus oil is the most tangible reminder of who I am. Although I have been eligible for both British and Irish citizenship, however tempted, I can only be loyal to one country – Australia. Sometimes over the past decade it has been very difficult to assert such loyalty, but the sun always rises.

Some years ago, Thomas Pakenham, who is incidentally the 8^th Earl of Longford, a disestablished Irish peerage, authored a number of books, among them extravagant pictorials highlighting the trees of greatest significance to the author. In the first of these, “Remarkable Trees” was an impressive arboreal array, including the oldest tree in the world, a bristlecone pine about 4,600 years old growing at an altitude of 3,000 metres in the White Mountains in California among other aged trunks in the aptly named Methuselah Grove.

Apparently there was an even older tree in which an enthusiastic geography student inserted and then broke a tree corer in trying to ascertain the age of a similar tree. The corer was valuable enough for the tree to be cut down to rescue the corer. The tree turned out to be 4,900 years old at the time of its axing. It could be said that these trees have been dying for two thousand years, but none had been beheaded in search of an instrument. Two thousand dollars for the oldest tree – a question of priorities.

Yet there were Australian trees among his remarkable trees. One was the famous prison baobab near Derby in the Kimberley. Another was the bunya pine next to a grand castle in Northern Portugal. The height of this pine is comparable to the castle’s campanile tower. In our garden here in Sydney we have had a number of bunya pines which we once bought in the Bunya Mountains south-west of the Queensland town of Kingaroy.

Fortunately the remaining one still grows in a pot, saving us from worrying about a putative 45 metre tree overshadowing the whole of our front garden. Australia is thought of as being gum and wattle trees, but Australia is also home to many of the Araucaria relatives of the bunya pine, the most recent member of this genus being the Wollemi pine, named for the wilderness area in the Blue Mountains where it was first discovered.

This book was followed by “Australia’s Remarkable Trees” – another impressive pictorial. I once wrote to its authors Richard Allen and Kimbal Baker, pointing out that there was this remarkable tree at the corner of Punt Road and Alexandra Avenue in Melbourne. It is a huge golden elm at the intersection of these two very busy roads on the banks of the Yarra River.

The amazing element which I found as I entered the dense canopy, seeking an unmarked specimen of leaf, at a time when I was collecting the various glabrous leaves of these trees, was that when you were under the canopy your vision was only of the foliage. The outside world was blotted out. Branches nearly touch the ground, and others are propped up. Here, there was a tranquillity, and even though close by, the traffic noise was muted, although the smell of the dusty, dirty city does penetrate through the foliage.

Most of the foliage bore the scars of insects – it was mid-summer and cool under the foliage. Close up the imperfections in the leaves were very evident. But that is life. The tree appears in the book, and the authors suggest the best time to view the tree is in spring when the foliage is unmarked, a lighter shade of green than its companion elms. Given in Europe that the English elm has been almost wiped out by Dutch elm disease, Melbourne and also other places like Ballarat are major remaining strongholds on Earth of this remarkable tree.

All such books as I describe are based on informed subjectivity. However there is one thing binding all these trees and that is of a deep appreciation, if not awe, of the permanent diverse planet upon which we move about. Thus, when one hears of destruction, it is often a time when I mourn for this lost heritage, as if one has lost a member of the family.

Fire is an ever-present risk to our forests. For some slow growing trees like snow gums it is a ghastly fate, but for others such as banksia it is important for the generation of new stock. The greater danger is overlogging, which has dogged Australia throughout our history. It seems that if you are born Tasmanian, you are born an instinctive forester. A forester is OK; but an indiscriminate logger is a vandal. The stories abound of such destruction in Tasmania, which continually change the undoubted resilience of trees such as the trio of its indigenous pines – the Huon, king billy and celery.

Trees deserve our attention. They are part of us. The introduction of the deciduous exotica, which provide Australia with all the autumnal colour, is probably one of the positive contributions from the colonial Heritage.

Thus, many of us take trees for granted, and when we talk about trees, the appreciation of diversity is unfortunately limited to whether the tree is obstructing my view or not.

A Virus in the Sand

At a time when the rise in the number of cases of Covid in Australia has been dramatic, the following article from the NYR shows a thoughtful perspective as it describes what the new medical graduate must expect. Much of the clinical experience of all these young health professional graduates would have been in a period when the COVID-19 pandemic dominated health care and the resultant priorities arising. I have read these thoughts, and the stark manner in which ICU practice has been affected in modern medical practice with the advent of a contagious disease dominating the acute patient load.

At the same time, there are the challenges presented by its persistence as the chronic disease in all its manifestations; such as the phenomena of active long COVID or dormant COVID reappearing decades later.

This is a virus which is both deadly and seemingly innocuous, depending on the particular individual response. Whether it creates a deep ravine in medical practice, between infectious and non-infectious disease will ultimately depend on how the organisation of the health care system changes both now and after the pandemic has waned– the resurrection of infectious disease hospitals for instance.

An illustration of the growth in COVID cases

Paradoxically, Australia has spent a considerable amount of money on health institutions, often driven by clever marketing of sub-specialities, with an advocacy group of those affected by the particular condition and their relatives, especially if the affected person has a strong public profile.

The level of sub-specialisation and the disproportionate incentives for this to occur only serves to magnify the cost of health care. Children are an irresistible magnet for funding; and beware any attempt to interfere. Try a review of funding for childhood cancer – impossible to review objectively as to cost effectiveness because of the emotional halo.

A subspecialty exists because, through skill or advocacy, it has carved itself away from a perceived drudgery of general practice. This view has been increasingly encouraged by the various deans of health sciences in universities, where excellence is determined by the amount of research funding and by the number of citations, notoriously subject to gaming.

This obsession with rankings based on the alleged quality of research has been increasingly dissociated from the prime reason for universities to exist – and that is to teach each generation of students in the best available environment. Plus, may I add, not to have half the Faculty away on overseas conferences, on sabbaticals and/or time spent in private practice and outside consultancy work. This state of affairs is hardly conducive to healthy pedagogy.

The doctors who are finishing residency now have completed most of their training in a world without robust family presence. They learned to become doctors to patients who are intubated and under deep sedation, behind closed doors, in a world of masks and alongside the fear that if they are not careful, their patients could make them sick.

Back in my own training, we used deep sedation and paralysing medications infrequently, as we knew that these decisions came with a cost: delirium, long-term brain dysfunction, profound weakness. But today’s doctors in training have learned on Covid patients. When we were uncertain what to do, particularly early on, we reflexively jumped to deep sedation as the answer for them. These are patterns that are hard to unlearn.

And beneath it all is the continued spectre of the virus. Though I did not have a single patient with Covid-19 during my recent weeks in the unit, from time to time, we would receive a message alerting us that one of our patients had a Covid exposure from a staff member who had tested positive and would have to be on precautions as a result. Patients and families were once terrified by this news, but now they are largely used to it and seem reassured that the staff are masked and so any meaningful exposure is unlikely. This is another aspect of our new reality.

To think that a possible Covid exposure would not cause panic is itself a sign of great progress. But at the same time, we are so far from where we thought we might be by now. When I walked through the halls of the Covid intensive care unit back in the spring of 2020, I told myself, as did so many of us in health care, that we would improve care for those who were disproportionately impacted by this virus. The systems to which we had become accustomed would be dismantled, and we would find ourselves somewhere better.

But those sorts of promises are naïve and empty without a plan for how to make and sustain real change to protect the vulnerable among us. So here I am, back in the unit, caring for a patient with severe cerebral palsy, who had aspirated his own secretions and developed a life-threatening pneumonia. His aging parents had done the best they could despite limited resources, making sure to turn their adult son on his side multiple times a day to help him cough, but his muscles were too weak. And now he would require a tracheotomy tube for the rest of his life. I know, talking to his parents, that it is possible that their adult son will not go home, that they will not be able to afford the kinds of services he needs. When and if another virus comes, the son they cared for at home for three decades might be living in precisely the kind of nursing facility that will be decimated by it. It’s easy to feel that the tragedy only repeats.

But then again, in just a few weeks, a group of newly minted doctors begin their internships. Medicine is strange like that, a new generation every three years, and with it a chance for reinvention. They will find themselves in a hospital in transition, in a country that has suffered more than a million deaths. We will teach them about all of it, about how to manage sepsis and heart failure and trauma, about the pandemic and how it was before. And for a moment, maybe, we can step back and see it all through their eyes — the nervousness and the excitement and, more than anything, the hope for what is to come.

Oolong or Earl Grey?

In a previous blog, I worried about the many deficiencies in our approach to the other nations of the South Pacific.

The Chinese might have the money, but Australia has the advantage of Foreign Minister, Senator Penny Wong, who has turned disdain to genuine respect for our South Pacific community. This has been coupled with a change in the Government’s attitude to climate change, to make it easier for the Australian government to adopt a primus inter pares role in the South Pacific area.

Every nation in the South Pacific has been victim of colonisation. China in its entry into the South Pacific is just another coloniser, although the gunboat may be muted, the offered funding comes clutched in a mailed fist.

Therefore, the European countries have been a major factor in the sometimes idiotic distribution of their colonies. Does it make sense that the Western part of New Guinea has been hived off into Indonesia just because it was once the furthest outpost of Dutch colonisation.

One remnant of Portugal’s worldwide speckled colonisation is the Republic of Timor-Leste, whose isolation in a region of muted hostility makes it not unexpectedly seek a powerful ally, such as China. Previously East Timor, as it was before Independence, has always presented an anomaly. Whitlam was worried that East Timor, if it received such independence, would present a risk of an Arafura Cuba.

However any hidden intervention then has been well and truly trumped by the disgraceful behaviour of the Australian Government, as described in the Crikey newsletter namely the bugging of the Timor-Leste cabinet, the motives of the Howard government in its tactics towards the fledgling state, the subsequent decisions of the then foreign minister and then DFAT secretary to take jobs with the biggest beneficiary, the abuse of intelligence agencies for corporate espionage, the attempts to cover up the truth of the bugging and the vexatious attempts to punish those who exposed that truth, amount to the greatest scandal of recent decades.

Successive Australian governments have concealed such chicanery that will make any long term relationship between the Republic and ourselves very shaky. Australia has a substantial Timorese population in Darwin, and having been there just before the pandemic, it was to me clear how much the Chinese were investing in the Timor-Leste infrastructure. While the Republic shares the island with Indonesia, it is also a short boat ride from Dili across to the Indonesian island of Alor, part of the extended archipelago of the Southern Sunda islands, one of which Bali is 1,600 kilometres to the west of Alor.

Setting Timor-Leste aside for a moment is not to ignore its importance in a cohesive Australian South Pacific strategy lacking up to now.

Apart from a perception of the Chinese being a new colonial power, one of the points of differentiation is for Australian government ministers to cease to act as colonial masters. The Chinese have difficulty in hiding their sense of superiority, which grates, and in the end makes their presence in the South Pacific unpalatable. Nevertheless, mate, money takes away any distaste.

As I wrote about Andrew Peacock’s actions when he inherited the Ministry of External Territories, he immediately treated the New Guineans as equals, so evident in his relationship with Michael Somare. His predecessor was an old school Country Party politician, who viewed coloured people as inferior. After all, we’ve lived through a long term White Australia policy, and it is testimony to countervailing factors which have assured our role among out neighbours – not the least of which was our generation in speaking out against such a policy.

One of these factors binding us together undoubtedly is rugby; and with that New Zealand and its indigenous Maori population provide a vital bridge to Polynesia. This the Chinese do not have,

Our mutual Anglo-Celtic background provides a deceptive similarity of Australia with New Zealand. Yet it is in part mirage. As one who has headed a hybrid Australian and New Zealand organisation, I found the countries to be very different; the two nations respond differently to external stimuli. As with all neighbours, there is an accumulation of negative factors, which will intrude into all the positive aspects, unless we both recognise and deal with the differences immediately. Recently in her new role, Penny Wong has ably demonstrated with her embrace of the NZ Foreign Minister, Nanaia Mahuta, with her facial moko, her ability to confront the cultural differences. Whatever may be unstated, facial tattoos are confrontational for a country not steeped in Polynesian culture as New Zealand is.

Melanesia, as shown by the Solomon Islands treaty with China, exhibits our vulnerability; this is intertwined in our relationship with Papua New Guinea. Papua New Guinea is a nation borne out of strong colonial links with Australia, both direct with Papua and by the acquisition of a mandate of the German colony of New Guinea after WW1.

Our indigenous Aboriginal people are represented in some of the Southern Sunda islands but more as an anthropological curiosity than as any cohesive force.

There are the Torres Strait People and here the Australian border with PNG provides a problematic divide. Then there is the collection of South Seas islanders – the descendants from the nineteenth century kanaka trade. Predominantly men from Vanuatu, they were press-ganged to work the cane fields of Northern Queensland, and Mackay is where many of the descendants remain. They have their identity, their flag but are not recognised in the same way Torres Strait Islanders are recognised. Only a small fraction of white Australia has ever met a Torres Strait islander. Yet some of the greatest rugby league players have come from both Torres Strait and South Seas Islanders.

On the other hand, the Solomon Islands were always a British colony before independence in 1978; and the Republic of Vanuatu was born from the New Hebrides condominium arrangement between Britain and France in 1980.

France remains the only European power left in the South Pacific and there is no indication that it will leave soon. One of the lessons was our ability to mobilise against the common enemy – this was the French when they were conducting nuclear testing in the South Pacific. We ran a meticulous campaign against the French and, given its modest funding, was very successful if judged by its impact among some of the South Pacific nations, remembering I was fronting an Australian and New Zealand organisation.

One area of which both our nations are guilty is still the magnetism of Great Britain, even though despite some Whitehall protestations, Britain has long since vacated the South Pacific. The AUKUS arrangement is redolent of a backward looking, nostalgic stream of thought.

Hopefully as an early priority Wong will not rush over to the “old Country” to tug the forelock or have tea at Windsor. Fortunately, she seems to have left that to the emissary of the old huntin’ and shootin’ brigade, garbed as an Edwardian remnant of Albion humankind, a man whose name conveniently rhymes with dandy. Leave the UK to these people and let’s get on with dealing with the actual challenges of our region.

We marshalled the forces against one form of climate change 25 years ago. The challenge presented by climate change is far more serious and instead of AUKUS, how about a South Pacific alliance against the great polluter, China. Unfair characterisation? Fairness is not a major constituent in Chinese foreign policy. I am sure that matter is foremost in the Penny Wong mind.

Some are advocating Australia enact a form of the Monroe Doctrine. Next blog I shall discuss this proposal, given it seems to have some currency.

Mouse Whisper

Have you noted those advertisements, where the dentist has his back to the viewer, brandishing what is ostensibly a tooth brush. If you look in the mirror, there is no reflection of the dentist.

Now what a subtle advertisement. Toothbrushes and garlic toothpaste?

As some other rodent has said: “Real vampires do exist – they are life sucking people that are narcissistic, greedy, selfish and vain. They take from you as much as they can. They “seem” to be friends and offer you pleasure and beauty but they take your life. They cannot see their reflections because they portray someone other than their true self.”

In the end, as they say, this is no reflection on anybody.

Modest Expectations – At Last Michael Bowlby

Have you heard the name Kizzmeika Corbett? Well, this 35-year old immunologist is a very significant person. A leading researcher on coronavirus spike proteins and mRNA vaccine technology long before the COVID-19 pandemic emerged, Corbett’s work proved critical to developing a coronavirus vaccine in record time. For a year and a half, she worked around-the-clock alongside her team at the National Institutes of Health (NIH), where they developed the vaccine in collaboration with Moderna.

A native of North Carolina, she early showed her innovative scientific mind. It should be added that although it is very rural, part of the tobacco road mythology where the leaf was king, North Carolina is a powerhouse in medical and health-related research, particularly at the University of North Carolina in Chapel Hill and Duke University in Durham.

After a period working on dengue fever at Chapel Hill (with field work in Sri Lanka) and her PhD having distilled immunology research into that virus in 2014, she went to work at the NIH.

Here she attracted the attention of the Head of Faculty, Barney Graham, and was appointed to lead the coronavirus research team, meaning that years before the Virus became a pandemic, Corbett was laying the foundation that would one day allow immunologists, herself among them, to quickly formulate a vaccine against the ever-changing coronavirus.

She has become one of just a handful of scientists around the world with expertise in the viruses’ distinctive spike proteins and antibody responses — knowledge that made it possible to quickly develop and deploy vaccines.

It should be noted that the use of mRNA in making vaccines had been around for 40 years, but the breakthrough came when a protective coating for the mRNA was discovered, since injected mRNA without such protection was destroyed in the body.

In her matter of fact way, Dr Corbett describes her work.

My contribution was helping to design the vaccine, leading the preclinical studies that informed the Phase I clinical trial and designing assays used for testing of clinical trial samples.

The quest in early January 2020 was to gear up. We started ordering all the things that we needed around animal experiments. We mapped out a plan. I started assigning roles to team members.

If you want to go fast in a pandemic, then messenger RNA (mRNA) is a shoo-in. It can be manufactured very quickly in very vast quantities, and you can essentially just swap out the protein once you have the system down. We collaborated with Moderna so we could get the system down pat.

Recently she decamped to Harvard as an assistant professor at T.H. Chan School of Public Health. “Assistant” is not far up the academic ladder, but like many who wish not to be overburdened with administration nor become what we used to call in Australia “Qantas professors” because they flew from conference to conference wringing as much as they could from their research.

She is therefore still the epitome of the researcher working long hours with a partner who is the assistant dean in the same school. It is not an uncommon set up, with two people intensely committed to research developing deep personal relationships to compensate for the long hours in the laboratory which research imposes. Having a partner able to share the language in which your research is couched – to understand what drives you, in this case someone who is really changing “the shopfront of society”, and not just moving the manikins around to provide an appearance, rather than effecting true change.

A year ago or more, who of the general public had heard of mRNA technology. On December 8 last year, the first dose of a COVID-19 vaccine outside a clinical trial was given. We’ve moved a long way scientifically in combatting the Virus but it is clear that our social structures have not been so successful.

Dr Corbett had already tried to change that situation, and in so doing, she fell foul of former President Trump. However, it is clear that within Dr Corbett there is more than one messenger RNA.

Such a little disease…

Once, rubella was a scourge of pregnant women. It was a very mild disease. In fact, rubella wreaked havoc in the first trimester of pregnancy. It was very transmissible . It was also known as “German measles”, because of its fascination for German physicians in the 19^th century, and measles because it caused a rash. Measles comes unremarkably from the Old English, meaning “many spots”.

An Australian ophthalmologist, Norman Gregg, first described the association between rubella and birth defects. As reported in the Australian Dictionary of Biography: His alert clinical observations and inquiring mind enabled him to make his outstanding discovery about rubella. On 15 October 1941 in Melbourne he delivered a paper on ‘Congenital Cataract following German Measles in the Mother’ to the Ophthalmological Society of Australia which was published in its Transactions.

My clash with the Virus came twice, in 1964 and 1966. I cannot remember having had rubella, but as happens when you least want it to happen (sound familiar), I was exposed each time to a patient with rubella.

It was a time when a rubella epidemic was sweeping Europe and the United States. During that short period in the USA there were 12.5 million cases of rubella. In the USA, 20,000 children were born with congenital rubella syndrome (CRS)). Of these 11,000 were deaf, 3,500 blind, and 1,800 intellectually disabled. There were 2,100 neonatal deaths and more than 11,000 abortions – some spontaneous miscarriages, and others “performed surgically” after women were informed of “the serious risks of rubella exposure during their pregnancy”.

It so happened that in each of the years, 1964 and 1966, I was exposed to rubella in the course of my medical practice – as a first year intern and then as a pathology registrar. I also did a number of locums during those years.

Prophylaxis against rubella was injection of gamma-globulin. In the case of rubella, one was not spared – 10 mls into each buttock and five into the right arm. Being injected with a needle of a gauge that you could probably run a train through, left me with a painful legacy. However, two boys born normal was a no-brainer in terms of receiving the gamma-globulin injection during my wife’s first trimester.

The rubella virus had been isolated in 1962, and a vaccine followed in 1969, which was incorporated in the vaccination schedule a year later; and the virus has all but vanished now.

I do remember that one of the members of the Students’ Representative Council Executive probably had been a victim of CRS. Her sight was compromised, but we never talked about it, and although she fell into what some would say, the FLK basket, in retrospect her sheer ability, her doggedness in getting things done, yet her innate kindness belied her disability. In retrospect, with all my other colleagues on the Executive, I was a medical student. The other males were law, engineering and architectural students, in those days when men were kings and women were not, she earned respect. And for God’s sake, she was a social studies student!

I lost contact with her after university. She has long since died. Yet when I starting writing this piece, I suddenly realised how much we took for granted about this remarkable women. But then I muse alone. All the other members of that Executive, whose memory I treasure, are dead also.

However, my sons, I still remember the injections, well worth it, but hardly a treasured memory.

Snottites

As I probably mentioned in a previous blog, I accumulated New Scientist magazines, even though I never had time to read them. After I started writing the blog, as the magazines were conveniently stacked in the office, they served as a source of some of my material, even though some were 20 or more years old. Most of the issues came in an era before the modern technologies, and therefore there was a certain quaintness. Having fulfilled this purpose of providing source material, I broke the link which bound me in this state of habituation and threw them out.

Now I am down to my last few. One of which highlights the snottite. If there were a word which immediately disgusts, “snottite” would be a major contender.

Let me put it in context: This place stinks. The rotten-egg smell of hydrogen sulphide hits before you even enter the mouth of the cave. Acid drips from the walls and ceiling. Slime coats the rock with coloured blotches like ghastly gelatinous wallpaper. And then there are the “snottites”, white, wobbling versions of stalactites with the consistency of phlegm.

The snottite is a mixture of gypsum and sulphur, with bacterial activity within them which ensures a stalactite appearance stretching as far as half a metre from the ceiling of these caves. This is the sulphurous environment of the underground where even Orpheus and Eurydice wore gas masks.

The bacteria cause a coating of slime to develop over these calcareous formations. The slime forms curtains and loops that some liken to mozzarella cheese. Some slime is red in colour; some white or black. At the tip of these snottites drops sulphuric acid with a pH of 0.5. This is a hazard for cavers, where a drip on the t-shirt can burn a hole, not to mention the damage if a drip directly hits one in the eye. The skin is bad enough. Just as a comparison, battery acid is 0.8 pH; thus, snottite sulphuric acid is twice as strong.

These snottites exist in a set of caves where life is perpetuated through the metabolism of sulphur. The original cave where they were discovered in the Mexican State of Tabasco was the Cueva de Villa Luz (The Lighthouse Cave). Its name came from holes in the roof of this cave which let the light in; it was a traditional place for religious ceremonies, at least at the mouth of cave.

Then a guy called Jim Pisarowicz, a caver from South Dakota, explored deep into the cave in 1987 and found the snottites. That cave system is two kilometres long. However, the simultaneous discovery of the Lechuguila Cave in New Mexico, stretching 140 kilometres in length and at a depth of 500 metres, in one word dwarfed the original discovery of life in a cauldron of sulphur. Recently these sulphurous caves have also been found in Wales and elsewhere.

Under the microscope a snottite contains a dense mesh of fine bacterial filaments embedded in a mess of sticky polysaccharides that form sulphur crystals. Many of the bacteria oxidise the sulphur, but others devour these organic compounds. There are also higher organisms which consume the bacteria. One researcher has distilled the observations into a “consortium based on sulphur metabolism”.

There are fish called mollies which survive in this extremely acidic environment, even though the mollies deep in the cave were somewhat different from those at the mouth of the cave.

What does it all mean? One supposition is that if there is such subterranean activity on Earth, why not on Mars. Not sure where it gets you – except to make sure your t-shirt on Mars can withstand acid burns.

What I find amazing is that we humans co-exist with a world where sulphur is the essential ingredient. But then, what is Hell?

Personal Irresponsibility

Janine Sargeant MPH

“Just off phone to Aussie friend who visited Germany. Testing station on every corner: takes five minutes, walk in, no line, results in 3 hours at the most. And they can do 80 million daily. A twitter observation

On December 12^th I wrote the following email. I didn’t send it and have just found it saved in my “drafts” folder:

Did you see today’s numbers by the way – bloody awful – 800 in NSW? Perrottet better get onto this PDQ or we’ll have thousands of cases a day and be locked out of the rest of Australia again.

I looked at this draft email on the 26^th, just two weeks later. On the 26^th, the case numbers were 6,310. What happened in those two weeks? It was two weeks of Perrottet’s Christmas gift to NSW; throwing public health caution in the bin along with the used Christmas wrappings. No abundance of caution, just an abundance of Omicron, although he can’t sheet home all the blame to that variant. Masks off, QR codes gone, social distancing ditched – packed nightclubs, parties and raves in!

Today is the 30^th, there are 70,928 active cases in NSW and the new cases up to 8.00 pm on the 29^th are 12,226. That’s exponential growth in anyone’s book.

However, the Premier has told us not to worry about case numbers anymore; worry about hospitalisations instead (and those numbers are also now increasing exponentially). Sure, but what about all those people linked to cases who are now in isolation. If you assume a ludicrously low average of one per case, that’s over 140,000 in isolation; assume half a dozen, that’s getting up towards half a million people in isolation; where do you stop? That’s a lot of people who can’t leave their houses, who can’t work – perhaps in one of those hospitals with burgeoning numbers of COVID cases – and a lot of people sitting at home and wondering just what happened in the past two weeks.

Further, the time now taken to be advised of proximity to a “case”, courtesy the recently ceased and more recently-partly reinstated QR code, has blown out to 4-5 days. By which time you may have been out and about with COVID, given that omicron has a median incubation period of 3 days.

The “testing debacle” means that people in isolation who have needed tests on day 1 or 2 and then day 6, were likely to end up having their day 6 test before they even got the results from their first test. What a waste of time and resources. The most modest of Christmas arrangements were thrown into disarray with hosts packing up the Christmas fare and taking to the road to deliver “care packages” around the city to isolating family members. One of our family members recently turned up to a testing centre at 7.30 am and was told there was already a six hour wait – and that was in Melbourne, not Sydney. Have we demonstrated that with 6,000 plus daily cases (and who knows how many people wanting a test so they can go to Queensland), we have effectively broken the NSW Government’s testing capacity? All we can say now is thank heavens Queensland and Tasmania have just announced the removal of the PCR requirement from 1 January otherwise testing in NSW would be completely crippled. Although replacing these tests with Rapid Antigen Tests (RATs) is presenting its own difficulties with supply.

At 6,000 cases a day and with State border crossing PCR requirements, the collection centres have been overrun and pathology labs are days behind despite working round the clock; inevitably, errors have crept in. Positive results require double checking which significantly slows down the test processing so as case numbers grow, the pathology response inexorably slows down. No matter how meticulous a laboratory’s quality control, systems and people under extreme pressure inevitably result in human error. So nearly 1,500 people have received wrong results in the past week; of these around 900 have now had their negative results rescinded, having been out in the community for days.

Did anyone foresee this? Where are our public health experts? Go forth and multiply the cases, says the Premier; go on holidays, go to your parties, and that’s exactly what has happened. The younger citizens have partied and raved into the night on the back of their vaxxed status and we’ve seen some spectacular superspreader events. Next, we have New Year’s Eve and then an Ashes Test; mercifully, if the Melbourne test is anything to go by, that game will be mercifully short, but just long enough to fill the new year’s COVID coffers to overflowing.

Twenty thousand cases a day and half a million in isolation in NSW by New Year’s Eve? Not beyond the realms of possibility. Happy New Year from the NSW Government. According to Premier Perrottet “it’s all going according to plan” as long as you don’t disappear into the shifting quicksand of Government COVID policy. Plans are meant to prevent chaos, not create it.

On the 30th we have now seen a change in the rules of isolation and the Prime Minister telling us we have no right to line up for a COVID test if we don’t have symptoms. Hopefully all those industries requiring employees who have been in isolation to have negative PCRs are changing their policies now as well.

And what about those RATs that you can’t find for love nor money? It’s the only time in my life I’ve gone into a pharmacy and asked if they have any RATs for sale. COVID – a whole new world.

Hazzard with two “Z” – The Alchemist from Wakehurst

Unlike the previous writer, I had been going to let the stupidity of the NSW government in relation to the Virus go through to the keeper. There are enough satirists, with an eye to the ridiculous – the antics of the Premier Pirouette. Coupled with those of Morrison, Australia potentially has a marvellous export – the Fountainhead Circus.

Thinking through what Minister Hazzard had said, what would have happened if a State Health Minister had said during the polio pandemic – “It’s inevitable that everybody’s going to get it?” You could barely hear this Metaphor through the swishing of iron lungs and the clanking of braces attached to children’s limbs.

What do you think vaccination is for, you chump?

The idea that it is a good idea to let epidemics “rip” so we can get the illusory herd immunity, is arrant nonsense. The one thing you and I share, Minister Hazzard, is that our ancestors survived among other things the Black Death. However, there were many other perils our forebears weathered so that you and I could walk on this dry and dusty land.

Even in the time of our forebears, they went to the country from the city to evade the plague bacteria that lived in the flea that lived on the rat that the sailor jacks bought from the city seaports. As you sat on that estate balcony, oh God that dreadful Pirouette is coming up the drive, fresh from sailing back from the Levant. He calls out – “no worries, I have perfumed the air in which I travelled to rid us all of the miasma.”

“Must not stand in the way of unlimited travel”, he adds.

Our parents dodged the Spanish flu, and even the worst estimate at a time when there was no vaccine defence against the Virus but people wore masks was only 5 per cent of the population. The influenza virus comes and goes as a pandemic, and I know I have had it. But according to the Hazzard dictum, why bother vaccinating – we’ll all get it. Nevertheless, there is a new vaccine annually tailored to the particular influenza strain which provides partial immunity. I will take it anytime to avoid the Hazzard spread.

So, Minister Hazzard, let us also dismiss that little reported diphtheria epidemic that your parents dodged in the twenties, to be saved by the arrival of a vaccine in the early 1930s. Of course, your parents were lucky to dodge Spanish flu. Both Spanish flu and diphtheria wreaked havoc, especially among children, as your parents were probably then.

But they are different (diphtheria caused by bacteria and flu a virus), even though both have vaccines to control their spread and hence confound the Hazzard Rule of “everybody will get it”. Diphtheria is caused by a bacterium, and the arrival of antibiotics in the 1940s has curbed a bacterial pandemic taking hold.

The population gave up on flu pandemic measures because they were “tired of them”, and paid a heavy price

Influenza continues to present a hazard, as I suspect coronavirus will be, also requiring a new vaccine variant annually, although frequency for such vaccine administration remains unclear.

And there is also the matter of “long COVID”. If I had lost my sense of smell and taste, if I were young, I would be looking at my future with trepidation, because the nerve fibres of the olfactory cranial nerve enters the olfactory part of the brain near the optic chiasma. Therefore, the virus is very close to the brain when it infects the olfactory nerve, and the course of post-viral brain syndromes is well recorded. I have personally had a family member with such a syndrome with devastating, life shortening effects.

I shudder when Hazzard’s comments echo down his corridor of ignorance.

Thus, the voice of Minister Hazzard may also reflect a politician overwhelmed by bad news and in effect surrendering. Time for you to do the right thing and take a rest, murmuring herd immunity as you drift off into stress-related sleep.

I’m sorry, but you are just not capable for whichever of the above reasons, but then some politicians never get it! I suspect you are one of them.

On the other hand, this seems sensible…

Reprinted from the Boston Globe with thanks.

With cases of Omicron surging nationwide, you may be wondering if that runny nose or aching throat is a dreaded case of COVID-19 that’s finally tracked you down, or if it’s merely a symptom of the common cold.

On top of that, the flu virus, which had all but vanished last year as the pandemic gripped the nation, appears to be making a comeback, according to the latest data from the Centers for Disease Control and Prevention.

Distinguishing between it all can be hard, and finding a COVID-19 test can be harder. Here we try to break down what we know about Omicron symptoms so far (remember, much is unknown this early in the outbreak) and how they may differ from the common cold and flu, or even from the previous variant, Delta.

Omicron is now the dominant variant in the USA and is spreading at a rapid rate, with cases rising about 23 percent in the past two weeks or so alone, according to data from the CDC. The variant has an unusually high number of mutations, some of which may be enabling it to evade immune protection. And early data has demonstrated that it is about two to three times more transmissible than the Delta variant. As a result, many, including those who are vaccinated, are likely to test positive for the virus.

Because the variant is a relatively new discovery, scientists are still studying the severity of illness and what symptoms it will bring — and if they vary from other strains. Some hopeful news arrived this week, with three teams of scientists, who studied the course Omicron took in South Africa, Scotland, and England, releasing preliminary results that showed infections more often resulted in mild illness compared to those from the Delta variant before it. The findings suggested those infected were less likely to be hospitalised, but there were caveats.

Preliminary reports indicate that those infected with the variant generally display similar symptoms to those who have been infected with either Delta or the original coronavirus.

Data scientists with the health company Zoe used the most recent data from London, where the prevalence of Omicron is higher than in other regions throughout the United Kingdom, to analyse symptom data and compare it with data recorded in early October when Delta was dominant. The analysis found no clear difference between the two — and only about half of people experienced “the classic three symptoms of fever, cough, or loss of sense of smell or taste.” The top five recorded symptoms in both periods were a runny nose, headache, fatigue, sneezing, and sore throat. They tended to be “mostly mild” and “cold-like.”

In the United States, possible symptoms of the coronavirus listed by the CDC include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, the new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhoea.

When Delta became the dominant variant and led to an uptick in cases, cold-like symptoms became more common, as the lead scientist in the ZOE COVID Study noted last week. It appears to be the same case with Omicron, and some of the key symptoms first seen earlier in the pandemic — namely a loss of taste and smell — are not as typical.

An analysis published by researchers in Norway following a small Omicron outbreak among “fully vaccinated” people found that only 23 percent of patients reported a loss of taste, and only 12 percent reported a loss of smell. Meanwhile, a runny or stuffy nose, fatigue, cough, and a sore throat were the most common symptoms.

Early evidence also suggests that Omicron is less likely to spread deep into the lung tissue, despite it replicating in the upper airway quickly, which could help to explain why infections may appear milder. A study undertaken by Hong Kong University researchers found that replication of the variant in deeper lung tissue was more than ten times lower than the original of the virus.

It should also be noted that, according to data collected by ZOE, the symptoms one experiences can vary depending on vaccination status.

Both the flu and the common cold are contagious respiratory illnesses that share similar symptoms despite being caused by different viruses, according to the CDC. In general, flu symptoms are more intense and begin more abruptly, while colds are usually milder and do not typically result in serious health problems.

The symptoms of the flu, according to the health protection agency, can include muscle or body aches and “fever or feeling feverish/chills.” It can have associated complications. Meanwhile, people who have a cold tend to have a runny or stuffy nose.

Compared to the flu, COVID-19 can cause more serious illnesses in some people, according to the CDC. It can also take longer for people to experience symptoms and they can be contagious for a greater period of time.

The CDC also stressed that because some of the symptoms of both the flu, the coronavirus, and other respiratory illnesses are so similar, testing is required to “tell what the illness is and to confirm a diagnosis,” especially because people can be infected with both the flu and COVID-19 at the same time.

In short, for those looking to determine what they are sick with for travel or planning purposes, public health experts recommend getting tested for the coronavirus beforehand.

Mouse Whisper

As I was slouching towards Mousehole these words came out of the ether and flattened my nose.

I think we are well advised to keep on nodding terms with the people we used to be, whether we find them attractive company or not. Otherwise they turn up unannounced and surprise us, come hammering on the mind’s door at 4 a.m. of a bad night and demand to know who deserted them, who betrayed them, who is going to make amends.”

Rest in peace, Joan Didion. For there will be no more 4.00 am calls, but I know what you meant. Life is indeed complicated.

Modest expectations – The Physical Basis of Personality

Friday, April 13, 2029, will be a showtime for asteroid Apophis, for the general public and astronomers alike. Apophis will come so close that it’ll be visible to the unaided eye alone; something that almost never happens with asteroids. It will appear first in the Southern skies and seem to streak across the Pacific Ocean and America before orbiting off to outer space. During this time the Earth’s motion will cause the asteroid to shake if not stir.

Apophis is 320 metres across and if it struck the Earth it would have a circumferential destructive effect of several hundred kilometres from where it hit. Instead, it is predicted to miss by the predicted 13,000 kilometres.

The asteroid first attracted community attention in 2004 when its orbit, in relation that of Earth, became a matter of controversy. It should be noted that Easter day in 2029 falls on April 1.

Endangered Elements

The idea that there are endangered elements that could face a severe shortage in 100 years does not warrant the interest of other “endangered species”. There are nine listed as “endangered”, which sounds quaint when the world is failing because of the atmospheric pollution due to other elements – notably the products of the ubiquitous carbon and nitrogen.

In any event, the “endangered” nine are arsenic, gallium, germanium, gold, hafnium, helium, indium, tellurium and zinc.

Indium was an elusive element and it was not separated from other metals until 1863. It was named indium because examination of it spectroscopically showed a very prominent indigo spectral line.

In May 2007, the New Scientist reported that a material chemist at the University of Augsberg in Germany reported that the world would run out of indium within ten years. The price was over $1000 per kg at the time.

Fourteen years on, and the world has not run out of indium. Most of the indium is stored in China. Its price does not appear on most stock markets as only about 800 tonnes is produced each year. A particular platform underwritten by the Chinese government tried to corner the market, by stockpiling tons of the stuff – and then despite an artificially created shortage found that the price which had soared to its highest level in 2005, fell which is not what it was supposed to do.

Indium is alloyed with tin and oxygen to form the transparent, conductive oxide that coats the screens of TVs, mobiles and laptops. The element is also used in infrared lasers that transmit data down optical fibres that enable the Internet. In combination with gallium, it is used to make the LEDs that backlight screens and are increasingly used for domestic lighting.

Indium (atomic no 49) has the unusual property when molten of clinging to (wetting) clean glass and other surfaces; this makes it valuable for producing hermetic seals between glass, metals, quartz, ceramics and marble. Its use has given it an aura of indispensability, but as with the 1972 MIT thesis adopted by the Club of Rome that the world would soon run out of crucial resources, this did not eventuate. The world is now more concerned not with quantity but with the quality of the output. Indium as the elemental metal is toxic if ingested; left in the ground it remains locked up, even if it is becoming an “endangered species”.

Predictions of it becoming an extinct species have been revised upwards and the new prediction is now 2025. However, indium is being recycled and even other elements such as silver which are more plentiful have been substituted in manufacturing. Thus, all the world can breathe a collective sigh (at least among the cognoscenti). Indium may remain endangered but is not a metallic dodo.

I should hasten to add that does not imply that the endangered elements will disappear from the Earth completely. It means that there will come a point when the supply of these elements will be limited or when it is no longer economically viable to extract or use these elements. At such a juncture, we will have to seek alternatives, as has occurred with indium.

Arsenic always gets a bad press. A beloved poison of the mystery writers, yet once used as a medication for syphilis, it is also a contaminant of waterways because it is used in the production of gold. I find it somewhat surprising that arsenic which has been used as a pesticide, especially in treating wood in particular – rather than rats – is endangered. Arsenic is very toxic, yet I find it difficult to believe it is considered an endangered element, given how many rivers and wells are contaminated around the world – just ask those living in rural Bangladesh and Taiwan.

Arsenic is often used as a doping agent for solid-state devices such as transistors. Doping is the intentional introduction of impurities into an intrinsic semiconductor for the purpose of modifying its electrical, optical and structural properties. It seems to me the new alchemy, but it seems also that there is a degree of elemental interchangeability. It is not the inflexibility of turning lead into gold.

Some time ago, I wrote a blog on another endangered element, hafnium. Australia has some of the biggest deposits of this rare element, which is found as the junior partner in zirconium ore. Purification is very costly and, by its nature, potentially detrimental to the environment. As I have written, hafnium is used in the manufacture of nuclear reactor rods, and a pilot project employing hafnium was set up over a decade ago at the Australian Nuclear Science and Technology Organisation (ANSTO).

Where is this all going? It’s elementary, dear Watson. But only if the world lasts another century in its current form with just so many cowboys and indiums.

Remembering Latvia

I have previously written about touring the Baltic countries, and at this time when there is disturbance in the region again, Latvia has a special significance. It has more Russian-speaking inhabitants than the other two Baltic countries. Hence, it is regarded with some caution by the other two – the object of the sidelong glance.

The whole area again has attracted attention because of the current confrontation on a Byelorussian border and Poland in particular, but also Lithuania.

Latvia sits on the sidelines. Prior to COVID-19 we travelled to the Baltic countries. Below is a snapshot of Latvia, pre-COVID-19.

We arrived in Latvia and headed for the capital, Riga. One of the most noticeable aspects of this whole drive is the fact that the border changes everything. Estonia does not blend with Latvia nor does Lithuania blend with Latvia; nor Estonia with Lithuania. It is as though there is a cultural crevasse between the three countries. The Estonians relate to the Finns; the Lithuanians to the Poles. And the Latvians? They sit between the two with, as I have noted above, a significant proportion of the population Russian-speaking.

The hotel where we stay in Riga lies at the confluence of roads and away from the city.

In the park across from the hotel are tearooms. My companion looks over the variety of teas. Exotic teas? No, she will have coffee. I order a cute bowl of “rabbit food” – everything including the beans are in miniature in an appropriately small bowl. What a healthy lunch for a dwarf. As we walked away, I am reminded of the true meaning of “famished”.

There are several areas of Riga where these old wooden houses also survive. The wooden house is a characteristic feature of Latvia and I wonder how they survived the wars. They would be so easy to torch, but there are streets of wooden houses, with various degrees of decoration –mostly in brown, but blue is a favourite alternative colour – sky blue to steely blue to presumably match the changing climate.

Latvia is the home of amber, and from the selection in a shop inside the wonderfully named House of Blackheads, I purchased a couple of pieces of yellow amber. Amber has always attracted me from the time I was a small boy on first seeing an insect caught in the fossilised pine resin. I remember my mother had a necklace of red amber; amber is always so warm and my mother showed me that after rubbing amber with fur, the amber could attract tiny scraps of paper. It was magic to a small boy. Later I would learn that stroking amber with cloth provided for human curiosity the earliest demonstration of an electrical charge.

One interesting impression of the Baltic countries is even as their existence is threatened by Russian invasion, the whole feeling is one of a fantastical past – a surrogate home for the Pre-Raphaelite movement, where Arthurian Knights would be invited for a guest appearance at some Baltic Armageddon in a joust with a company of Blackheads.

Everywhere there seems to be evidence of mediaeval valour, varlets and knaves, clattering armour, and unmerciful treatment of the vanquished. The House of Blackheads, with its huge façade, draws on all sorts of architecture. It has its curlicues and statues on a bright terracotta coloured façade; and to honour the Blackhead name – an effigy of Saint Maurice, the black saint revered by this coterie of Knights, stands on one side of the front doorway.

The building has been razed several times, the last after the Russians destroyed what the Nazis had missed. The rebuilding program is a tribute to Latvian doggedness. Yet Latvia remains vulnerable to invasion, even though its border with Russia is not as long as the Estonian-Russian border, the latter has a better defence being mostly swamp and marshes. Even so the Estonians are threatening to build a 110 kilometres long fence.

However, Russian influence remains in Latvia. Yet the Riga Cathedral epitomised the strong Lutheran influence and the informality of a kindergarten being located in its precincts.

One morning we journeyed to Jurmala, a seaside resort near Riga, recommended not to be missed.

Our guide pays the toll to reach this littoral enclave. Here is the Russian embassy, a quietly luxurious residence set back from the road. My companion jumps out of the car to photograph it. Our guide looks concerned. But she is back without any fusillade of bullets. It is only the camera that winks at us.

During the Russian occupation, Jurmala was a popular resort with senior officials from the Kremlin. Even now our guide says much of the property in Jurmala is owned by Russian oligarchs.

Our guide, who has an uncanny resemblance to Radar in M.A.S.H., steers us into a wooded area known as the Ragakapa nature park. Here in this reclaimed dune area, we peer through the wire fence at a fishing village which has been created complete with long boats. The exhibit is closed –and that was that. Jurmala was yet to wake up from its winter hibernation. It is a summer resort on the Baltic with a beach, 33 kilometres long –and there are sanatoria, spas, buckets and spades.

Radar is a multi-faceted personality. He talks with the high-pitched voice of his TV twin. He tells he does this job part-time. He is Jewish and he spends his time researching the genealogy of Latvian families, Jews in particular. It keeps him busy particular at the times of the year when there are no tourists. He also claims other ancestors – a very defined group with a long history but now in serious decline.

They are the pure Livonians who are a small group now, but he like many Latvians is proud to claim Livonian heritage, given their long history as Teutonic knights. Its language is akin to Estonian and is classified as “dormant” since the last fluent speaker died two years ago. The Livonians suffered badly under the Russian occupation. Their land is where the Germans made their last stand in Latvia at the end of World War II. Retribution followed.

The Baltic States have been the stage for almost continuous conflict. Yet what cannot be denied is the beauty of the Jurmala setting with its beach, its dunes, its forested environment. And there is something both romantic and nostalgic about places where there are wooden houses.

Yet there, in all this quaintness back in the capital, there is Restorans 3. This restaurant is in Old Riga, itself a convolution of narrow cobbled streets where negotiating them is only for the expert – but eventually the taxi driver finds his way around the tangle of one-way streets and drops us off at this restaurant with its wide picture windows and a kitchen open for customers to see the virtuoso preparation.

We sit by the window. There is only one other customer, a nattily dressed Chinese man, who seems only to be drinking coffee, and soon leaves. For a time we are the only diners as we face the formidable gustatory menu. She avoids the tongue and the ox heart items. She hates tongue; and ox heart is a meat too far. While ostensibly there were five or seven on the tasting menu, by the time we have worked our way through the meal, there were three other courses –including a sorbet intermission.

As with all Baltic countries, Latvians love beer. However, there is a Riga drink – balzam. It is a black liqueur. Having been required on a few occasions when as a post-graduate research scholar to take iodine after inadvertently labelling myself with radioactive iodine, I taste the balzam. I am transported back to my heady iodine days. It tastes just as bitter and unpalatable as iodine.

End of story: my first and last drink of balzam. Extreme bitterness is not that quaint. Radar is back next morning; time to move on to Lithuania.

A Road past Gundagai

I first drove to Sydney at Christmas 1957. My mother had died the previous year and my father had a one-off job as a ship’s doctor on the SS Lakemba going to America. I had recently got my driver’s licence, and thus with nothing to keep me in Melbourne, I decided to go and see my cousins in Sydney. I took the old man’s Peugeot and my dog, the wonderfully frisky blue roan pedigreed springer spaniel called Smokey and a few other essentials. We made good time stopping off only for petrol and Smokey to have a No 2. He was a well-disciplined dog, nonetheless, and once was enough, he assured me.

We left early and made very good time out of Melbourne. The problem was once you got to Goulburn it was still a four-hour drive over the Razorback to Sydney no matter how many chances you took. The Hume Highway then was two lanes, and as a result of it being the busiest country road in Australia, it was where there were numerous horrendous accidents inciting lurid newspaper coverage.

Since then, I have travelled back and forth innumerable times.

I was reminded of an incident much later, when I was driving along the highway, which was still largely two-way, with still a number of difficult sections to negotiate on the way to Sydney. It was 1968 or 1969, my wife alongside me in the front and our two young children were in the back of the car. There were no seat belts then.

On a rise some 20 kms from Gundagai, there had been an accident. A car had left the road and struck a tree. There were several people clustered around something. When we got out of the car, we saw that there was a young woman lying on the verge. She was deeply unconscious, with terminal Cheyne Stoke breathing, and moreover there was brain visible through the fractured skull. She was near death, but there was also a child, restless and crying out, obviously cerebrally irritated. An ambulance had come and taken away somebody who one of the onlookers said to us appeared dead. The other two had been left, God knows why!

There was nothing much one could do for the woman, but the child was another matter. There was a guy who volunteered his station wagon, and so we lifted the child into the back, and my wife who was also a doctor climbed in to look after the child. We left the dying woman. There was nothing we could do for her, but we hoped that at some stage another ambulance would turn up. Out on the highway, we had no means of communication then.

The old wooden railway bridge from the 19th century in Gundagai

So, there we were. I was in the car with the boys; my wife in the back of a Good Samaritan’s station wagon with the unconscious child. It was raining but I took a robust approach in speeding towards Gundagai. Then we came to the long wooden bridge across the Murrumbidgee River and flood plain. For some reason there was a long line of cars queuing to cross the bridge. I took a chance and with horn blaring dashed down the wrong side. For some reason there were no cars daring to cross, but right near the end of the bridge my car skidded on the slippery wooden surface. It is a situation where the sub-cerebral instincts kick in, and for some miraculous reason I did not fly off the bridge. It is a long way down to the Murrumbidgee River flood plain.

Anyway, we arrived at the hospital. Gundagai, at that time, had a strong procedural base, and our appearance caused the general practitioners at the hospital preparing for their operating theatre list to pause.

The child was bought in, and we handed his care over to the Gundagai practice. To them it seemed all in the day’s work – no fuss – just a slight annoyance of having their routine upset – we were waved away. As for me, irresponsible, driving as I did with two unrestrained children. It was a sign of the times; I do not sweat when I remember the incident.

In any event, that was the last we heard of it, apart from me telephoning the hospital next day and being told that the child was still there, and there were no concerns. For a while I scanned the papers for a coroner’s report. There was nothing, or I missed it.

Twenty-five years later, when I was reviewing the NSW Ambulance Service, the transition from ambulance driver to allied health care professional had begun. Change is a slow process, especially in inward-looking uniformed services.

I was reminded of that escapade this week when I saw images of this 800 metre long wooden Prince Alfred bridge being dismantled, its boarded heritage clattering to the ground with a promise to retain the section which actually crossed the river. The extensive flood plain now has not only a sweeping four lane highway bypassing the town, but also, for some reason, a large dead gum tree poking above the road parapet, painted in a garish blue. Why?

By the way, I picked up my first speeding fine on my way back from Sydney in early 1958. Five pounds for fanging through Albury. The police motor cyclist caught me after I had entered Victoria. Those were the days. I did not protest, Smokey said I deserved it.

The Use of the Car as a Weapon

Iowa is one of three states, along with Oklahoma and Florida, to enact laws this year giving drivers some degree of legal immunity if they use their vehicles to hurt protesters, part of a wave of “hit and kill” bills introduced in 13 other states by Republican legislators since 2017 (as shown in the figure below). Most of those proposals came after one of the most sustained periods of demonstrations in US history following George Floyd’s murder, and the effort to crack down on protesters has sent a chilling message to activists, who believe it will encourage violence against them. – Boston Globe.

Yet another example of the reversion of America to the glorification of violence – the staple diet of American fantasy.

Marching along streets and roads has been a characteristic of protests in particular of African-Americans but not exclusively.

In the year after the George Floyd incident, The Boston Globe found across America 139 cases of cars being deliberately rammed into people. Only 65 of these have been taken to court, with only four convicted of a felony. One hundred people have been injured and four killed. Not a huge number, some would say; but wait a minute, deliberately using the car as a weapon!

Yet the legislators in essentially very Republican states run the line of driver being surrounded by violent rioters and in trying to get away, some of the pedestrians may be hit by the car, where the driver at risk feels his or her life in danger. The thesis plays the white audience which spawned a person like James Field who, well before the George Floyd murder, in 2017 ploughed his Dodge Challenger into a crowd of demonstrators in Charlottesville, South Carolina, only stopping when he struck a white Camry, which was pushed in turn into a maroon minivan.

As was described, this young man had driven nine hours from his home south of Toledo in Ohio to be there to kill – this person was described by one of the victims, as she lay half under the car with a smashed leg, as having lifeless eyes. Fields was later convicted and given two life sentences. Would legislation to protect the driver have made any difference to the outcome for the victims? I doubt it.

Yet despite this crime, these States are endeavouring to twist the narrative to the protesters not the driver being the villains. As such, it would be somewhat ironic if such a law protected protesters at a far right rally with its pronounced anti-vaccination bias, such as those who surrounded vehicles on the Bolte Bridge in Melbourne and deliberately caused damage to them.

The problem with this legislation is perspective and from any perspective this legislation is wrong-headed.

Mouse whisper

As recounted in Harper’s Magazine February 2005

A story headlined “Syria seeks our help to woo U.S.” in Saturday’s Weekend Australian misquoted National Party senator Sandy Macdonald. The quote stated, “Syria is a country that has been a bastard state for nearly forty years,” but should have read, “Syria is a country that has been a Baathist state for nearly forty years.”

The Australian regrets any embarrassment caused by the error.

I doubt there would be any apology forthcoming now – defence in truth.

Modest Expectations – Vile Bodies

If you are writing a sermon, it is good to have a text, in this case from The Gospel of The Boston Globe.

At a time when climate change and those who fight it demand that coal be treated like tobacco, as a danger everywhere it is burned, Australia is increasingly seen as the guy at the end of the bar selling cheap cigarettes and promising to bring more tomorrow.

Along with koalas, kangaroos, and beaches, the country — the world’s third-largest exporter of fossil fuels — is becoming known for refusing to clean up its act.

With just days to go before a major UN climate conference in Scotland, Australia is one of the last holdouts among developed nations in committing to net-zero emissions by 2050, and it has refused to strengthen its 2030 target or make plans for transitioning away from its deep commitment.

The country’s prime minister, Scott Morrison, only recently agreed to attend the climate summit after criticism from Queen Elizabeth II and a crowdfunded billboard in Times Square that mocked his reluctance to address climate change, calling him “Coal-o-phile Dundee.”

Australia’s inertia points to a pressing challenge for the world: how to get places that profit from a dangerous product to transition before it becomes too late. With the threat of even more damaging storms and fires looming if temperatures keep rising, a combine-and-conquer approach is required — fossil fuel users and producers both need to kick the habit.

The kings of carbon are not in a rush. A UN report recently released found that coal, oil, and gas production will keep growing at least until 2040, reaching levels more than double what is needed to prevent a catastrophic rise in global temperatures.

Australia is a major contributor to the problem. In energy terms, the continent is essentially a bigger version of West Virginia: Coal is still king, natural gas is celebrated, and the conservative government has a lot in common with Senator Joe Manchin, a West Virginia Democrat, who has blocked President Biden’s sweeping plan to shift the country toward renewable energy.

In May, the International Energy Agency released a detailed overview of what it would take to cut carbon dioxide emissions to net-zero by 2050 and keep the average global temperature from increasing by 1.5 degrees Celsius over preindustrial levels — the threshold beyond which the Earth faces irreversible damage.

Near the top of the list: end investment in new sources of fossil fuels.

Australia’s response? Yeah, nah.

The federal government still revels in Australia’s role as the world’s largest coal exporter. A report from the Department of Industry, Science, Energy and Resources last month used a medal icon in denoting the country’s status as the world’s coal leader, expected to ship out 439 million tons this year, up from 400 million tons last year.

In the last month alone, three new coal mining projects have been approved. In New South Wales, a production hub for the thermal coal burned in power plants — some of the biggest contributors to global emissions — proposals for 20 new coal mines are under review. And that does not include a giant project in the state of Queensland, where the Indian industrial giant Adani is trying to build the largest coal mine in the world.

Nor does it include Australia’s expansion of natural gas. The government plans to open at least five new gas fields, including the giant Beetaloo Basin project in the Northern Territory, which has been granted subsidies of around $170 million. The tax breaks given to the fossil fuel industry last year alone were worth more than what Australia spends on its army — and the federal resources minister, Keith Pitt, said this month that the government should spend even more to protect coal and gas.

Critics argue that it is all the product of a warped political and media culture that has spent decades doing the industry’s bidding while deceiving the public, exaggerating coal employment, and understating the need to reverse course. Federal elections are often won or lost in the coal areas of Queensland, and with another contest due next year, the coalition government’s junior partner, the National Party, which represents regional areas, is playing a familiar hand.

“For at least 10 years, they’ve been telling people that climate change is rubbish, that it doesn’t exist, that we can continue digging up and burning coal forever and a day,” said Zali Steggall, an independent member of Parliament who unseated a former prime minister, Tony Abbott, in 2019 with a campaign focused on climate. “They have a difficult job now in turning around to those communities and saying we were wrong or misleading you and we need to do this.”

Until the devastating bush fires of two years ago, Australians might not have blinked at their government’s continued support for fossil fuels. The country is responsible for less than 2% of the world’s carbon dioxide emissions.

But the Australian public has become increasingly concerned. Polls show that a strong majority of Australians want climate action even if the costs are significant and want the government to stop approving new coal mines.

There is some momentum at the local level. Several states, including New South Wales, have committed to net-zero by 2050 and more immediate emission reductions that go beyond the 26%-28% cut that Australia promised with the Paris climate agreement.

Thanks also to changes in farming practices and solar panels on people’s homes, Australia’s emissions are now projected to fall by around 34% by the end of this decade compared to 2005 levels. But that decline is still weak by international standards, with the United States promising cuts of 50%-52% by 2030, Britain agreeing to a 78% decline by 2035, and Japan pledging a reduction of 46% by 2030.

I remember the first weeks of Whitlam’s reign. I also remember the treachery and traducery of McMahon’s last year where the Government refused to confront the obvious reforms needed. And with the decay, the government leaked continually rather than made a splash, with McMahon himself the master of the watering can.

When Whitlam won the 1972 election, there was no leisurely transfer of power. He brushed the inept McMahon aside and, with Lance Barnard, with the blessing of the then Governor General Paul Hasluck, set up a temporary duumvirate.

This enabled Whitlam to immediately abolish conscription, end Australian military participation in South Vietnam and release Vietnam draft resisters from prison. He recognised Communist China and warned the United States against renewed bombing in North Vietnam.

Whitlam had a degree of courage, which I have found in only one other major politician in my experience.

I only hope that when the next Government comes to power, the person who becomes the Prime Minister acknowledges the matters relating to climate, as so clearly set out above, and sets about a clear remedy.

It should be possible through those who have paid the Porter legal bills to identify the biggest polluters in this country, not only in terms of climate change but also of the social fabric of the nation …

… and stop this disgraceful persecution of people, who are universally of colour as the modern version of non-white is now called, by releasing them from the various concentration camps, if you want to be brutally frank, imprisoning these persecuted refugees who have come by sea.

And finally, let us judge those who would loot the Treasury, and release their names. Strip away the black tape of redaction and coverup.

The overriding lesson for Australia at this very difficult time for the future of not only ourselves but also the planet – those determining the nation’s policy are just not up to the challenge. Brown nosing is no substitute for policy.

An Eloquent Statement on leaving Kinross Wolaroi School, Orange

… I believe that each and every one of us in the graduating class of 2020 has something special to offer to our friends, our family and to our community so long as we persevere. After 13 years of schooling, we will finally enter into the wider world and go our separate ways. They say that smooth seas do not make skilful sailors. This year has been anything but smooth sailing and I know that wherever we end up, we will all be well equipped to face and overcome the challenges that life throws at us. I hope that you find happiness wherever you may go in life and I wish you all the best for the future. – Edward Taylor Year 12.

In explanation, I was looking for something else and came across the magazine of this hybrid Presbyterian/Methodist co-educational boarding school located in Orange New South Wales. I don’t know whether I had ever heard of the school, but casually reading it, I came upon the valedictory address given by this young man. I wished I had been able to articulate my future at his age as well he did at the end of a difficult year. He will need all that resilience while the present clowns of climate change control his generation’s destiny and will be headstones by the time this young man will fulfill his own expectations.

George Repin

George died a week ago at 3.30pm. He was 93, and thus he had a life well lived. He was a Russian émigré from Shanghai, whose family started Repin’s coffee inns in Sydney in 1930. These were very successful, and the name Repin became a household name for a place to have a cup of tea as well as coffee. During the Depression, hard-up businessmen used the coffee shops to run their ailing businesses. American servicemen during WWII, unused to tea, found access to coffee through Repin’s – a boon. Repin’s in the fifties were the places the Push literati frequented in the afternoon to discuss how many angels were on certain pinheads.

George Repin’s father died suddenly in 1949 and George, recently graduated doctor, was midway through his residency at the Royal Prince Alfred Hospital. He abandoned his medical career for the moment and took control of the family business.

Despite being a household name in Sydney, the name Repin meant nothing to me because I was born in Melbourne, and there was a large social gulf between the two cities. I cannot remember any Sydneysider who holidayed in Melbourne. We had family in Sydney, but although we were frequent visitors, my father loving Manly and my mother having a close friend who lived in Point Piper, I can never remember Repin being mentioned. It would have been easier if I had known this when I moved to Sydney in 1979.

After the family coffee business closed in 1966, George joined the AMA and after a period became Secretary General, just in time for the negotiations to commence on the shape of the health care system following the report of the Nimmo Inquiry in 1969. The Ludecke Inquiry was where George became blooded in dealing with the Federal Government. Then the Whitlam government came to power in 1972, with its stated intent of introducing a universal health scheme.

George was an avowed opponent of governmental control of medical practice. He was also very skilled in preserving the interests of doctors, including medical incomes, while ensuring that he never confused the Federal government’s constitutional power to provide a range of health patient benefits – but not doctor’s fees. The word “fee for medical benefit” was the mantra one used when discussing medical benefits and beware the glittering eye if you strayed into saying that the Commonwealth government had the power to set doctors’ fees.

It was not riveting stuff, but the meticulous way that George controlled such syntax meant the AMA countered the Commonwealth Health Department from implying it determined doctors’ fees. Yet I believe it was a deliberate ploy to imply, falsely, that if doctors did not charge a fee equivalent to the patient benefit, they were flouting the law.

Doctors could charge what they considered to be fair and reasonable. Incomes and prices were the responsibility of the States and I was closely associated with the referendum that Whitlam initiated late in 1973 where the intent of a “yes” vote was to transfer these State powers over incomes and prices to the Commonwealth. The referendum was soundly defeated, but it meant I was well acquainted with this division in Commonwealth powers.

The disciplined Repin approach meant that, for a long period until the destructive Shepherd influence, the power of the AMA over medical incomes was due to this one man, paradoxically through the way he handled the periodic government-initiated reviews of the patient fees for medical benefits.

As such he had a major stabilising influence on the profession at a time when there was a diffusion of medical specialties into subspecialist groups. Much of this could be attributed to the adherence to the relativities which had been built into the medical benefits system but owed somewhat to the way the various existing specialties in 1970 valued themselves. This resulted in distortions of the actual value, but it was the genius of Repin that maintained acceptance of relativities – in one word some of the profession were more knowledgeable and skilled than others in the initial phase. This self-valuation created distortions. Yet George always maintained that a doctor could do anything, given circumstances, and somehow he was able to assure the relativities in the fees for medical benefit – no mean feat.

His resilience was tested by a severe bout of Guillain-Barre syndrome, but in true Repin style he overcame this disease, which almost paralysed him for a time, and went back to full-time work..

For most of the time during the Repin stewardship, government accepted the AMA as the sole legitimate representative of the profession. George had to juggle differences, such as between the NSW Branch, which was essentially an employer’s organisation, and the Victorian branch with very much an industrial approach negotiating terms and conditions with the Victorian State in a number of landmark cases.

For five years from 1979 I was his Deputy at the Australian Medical Association. We were two very different individuals; he did not support my appointment, but just after I commenced, George went overseas and on return he seemed satisfied with the way I handled the preparation of the AMA submission to government, where I had the opportunity to work with one of the most highly respected and able Sydney lawyers of the time, Bob Stephens.

This gave me an early insight into how organised and meticulous George Repin was. Despite his distaste for government control, his strength in negotiation and ability to coalesce the profession around the importance of medical benefits (whether Medibank or Medicare) paradoxically ensured that his legacy was woven into both schemes. In turn, this has assured the ongoing system Australia has today, despite it having become somewhat tattered over the past decades.

Not long after I started, in early 1980, he agreed that I should take the lead secretariat role in the preparation of the AMA submission to the Jamison Inquiry (the Commission of Inquiry into the Efficiency and Administration of Hospitals). This enabled me to travel around the AMA branches and receive an early valuable lesson on how organised medicine worked around Australia. The AMA agreed to the appointment of Robert Wilson, an excellent economist and cost accountant, to assist me.

The submission was highly regarded by the bulk of the AMA grandees and more importantly for myself was that I achieved an independence within the organisation, which forged the basis of our ongoing relationship.

My relationship with George was totally professional. I do not remember having any social interaction with him. I was never invited to his home; I never even had a social drink in his office or elsewhere. He only told me one thing about his boyhood. It has stuck with me. On one occasion when at Scot’s College, after being bullied, he hid behind a fence and threw rocks at his tormentors. I bet he was accurate, but I didn’t quiz him.

Always combative though our relationship was, he imposed a way of handling circumstances which proved very valuable. I wish I had had him as a tutor as a young man as he would have imposed an intellectual discipline, foreign to my instincts but I suspect very Russian. Our politics were so far apart, but only rarely did they disturb our relationship, and as someone commented if we happened to be on the one side, which occasionally happened, nobody could stop us.

At the outset I said I would work there for at least five years, as the superannuation arrangements were second best only to Qantas then. In five years and one month after beginning the job, I left to set up a consultancy business. I remember George firmly shaking my hand as his last gesture. George was to work for another three years before relinquishing the post. Having negotiated the move, understandably he himself did not want to move to Canberra.

The one thing I did wonder about was why, after 1984, the periodic reviews between the Government and the AMA were abandoned with his say-so; that was George’s source of power and authority. It may be that, after supporting their abandonment, he missed them. Maybe he just got tired of Bruce Shepherd.

As for me, I had experienced one of the most productive five year periods of my life; George taught me a lot; yet I never asked his advice. After I left the AMA I never talked more than a dozen words to him.

It was a pity because reading his regular column in the “Pittwater News” only after his death, I realised what an underlying affinity I had for George. As with everything he did, he did not waste a word.

When I heard he was terminally ill, I sent a short message thanking him. I hope he read it. I meant what I wrote.

Monterey

The challenge came. What about canneries? You’ve spent enough time in northern Victoria to know all about them. Mentioning canneries reminded me of what has been one of my favourite places to visit in the world. Previously, in one of my earlier blogs, I had mentioned the junction of the Darling and Murray Rivers as my favourite place in Australia.

After my blog, last week, on tanneries and stannaries, she had said “What about canneries and for that matter granaries!” Monterey, an easy choice!

Lying south of San Francisco, Monterey was written about by John Steinbeck. The canneries that line the waterfront are now stylish reminders of an era long gone when the run of sardines was such down the Pacific coast that catching and canning sardines became the sustenance living of many, especially during the Depression. But like so many profitable fishing industries, it died when the fish were no more – overfished in an era where the notion of conservation did not exist.

We amble down Cannery Row, made famous by Steinbeck. It retains some of the old atmosphere, if not the smells of what it was. Monterey has its own “rialto”, structures bridging the road now announcing that this is Monterey Canning Row, but yet prosaically this “rialto” was only a place for offices rather than being vibrant walkways above the street.

This was one of Steinbeck’s haunts and he was very friendly with Ed Ricketts, the pioneering marine biologist whose work, particularly on tidal flows, established his reputation. Ricketts was not unlike Steinbeck in appearance, politics and living a full life, whatever that means. He was killed on the edge of Cannery Row in 1948 when hit by a train. He was only 50.

The cannery façade thus still exists, punctuated by hotels and stores selling memorabilia, but what is the most memorable at the end of the Row is the three-storied Hewlett Packard Aquarium, with the three-storied kelp forest as the first sight of this structure.

The one area where the child in me emerged was the interactive pond where one could handle the various sea creatures, the starfish and the gooey sea anemones. I don’t remember any sea urchins, but given their spikes and the care taken to ensure kids like me still had a hand after removing my arm from the water, there probably weren’t any; yet it was a tactile experience so important in tuning the senses.

Staying at the Monterey Plaza Hotel enabled us to see the sea otters, frolicking in the sea in the lee of the hotel, with its deck acting as a viewing platform. The sea otter’s fur, unlike that of the seals is not waterproof. Therefore, the otters have to eat a large amount of fish and shellfish daily. One’s sleep can be disturbed by the sound of those animals cracking open the shellfish as they float on their backs in the sea. One of the reasons for them becoming an endangered series was that their voracious appetites provided competition for the fishermen – and the otter pelts could also command a good price.

Like many of the places I have visited, I suspect Monterey has become one of those tourist destinations, and therefore I probably will never go back, if only to retain memories of a less tourist-infested age.

The Age of Confusion

The advent of vaccination has shown a course of action where there have been both positive and negative aspects, but moreover it has provided a window on what works and what does not.

One of the prime movers in vaccination, when the national levels of vaccination had started lagging in the mid 1990s, was Michael Wooldridge when he became the Federal Minister of Health in 1996. One of the most vocal advocates of the campaign was the late Gay Davidson, whose daughter, Kiri, had died of a complication of measles. Gay was both an influential Canberra journalist and a mother who had first hand experience of the horrific decline of her daughter from a beautiful vibrant child to a helpless vegetative state because of this rare late complication of measles.

The message was clear. Vaccinate! Now another campaign. What has been encouraging, after a very hesitant start, is how vaccination against COVID-19 has progressed. The problem is that the early ambivalence, aided by the social media, allowed all the misinformation to gather momentum. Fortunately, the momentum for universal vaccination that may have been slower at the outset has at last been far greater recently. The rare complications from the vaccine administration, which fuelled the initial hesitancy seem now to have been mostly cast aside as witness the successful introduction of vaccination in school children above the age of 11.

The other complication of the early hesitancy was the failure of the Commonwealth government to effectively lead the response, because it had not ordered enough of the mRNA vaccines , banking on both the Queensland version and the licensed AZ vaccine to do the job. The Queensland vaccine was a flop, and those academics who promoted it so vigorously should have been more roundly condemned than they were for their flagrant self-publicity. As for the AZ vaccine, once the production line was sorted it has been effective, if less popular than Pfizer and now Moderna.

What has been done in NSW and Victoria emphasises the desire of people to get out of prison – to be paroled – except each Premier has a huge number on parole, including a substantial number who should continue to be locked up because of their flagrant disregard of the rules. Separating this unvaccinated group for re-incarceration would be a challenge, and currently the appetite for any such action is not strong.

It is time to change reporting the number vaccinated to a more correct number by incorporating the 12 years plus age group. Presumably this is not being done because of the lesser level of vaccination of this age group. This number has been increasing rapidly and will soon not be different from the adult population.

This will be further complicated by the extension of vaccination to children aged five to 11. The White House announced (and since confirmed by the FDA) that they will soon be able to get a COVID-19 shot from paediatricians, the local pharmacy and potentially even from their schools. The detailed plans for the expected authorisation of the Pfizer shot for these younger children are expected shortly, after lengthy studies to test vaccine safety. The recommended dose will be about one-third of the adult dose. It will be interesting to see whether the TGA delays approval in Australia until just before the school year starts next year.

United States regulators have also signed off on extending COVID-19 boosters to Americans who received the Moderna or Johnson & Johnson vaccines and anyone eligible for an extra dose can now receive a brand different from the one they received initially.

From our point of view, there is a need to assure the same level of vaccination in every State (and that includes Western Australia); and the challenge of assuring the first double dose vaccination, monitoring the teenage vaccination, introduction into children and assuring an ordered booster regime needs to be answered – as does the need to factor in additional variants, such as the emerging new Delta AY.4.2 variant identified in the UK and USA. It would be useful to obtain details of the vaccination program – the assumption being we have enough vaccines and identification of recipients nationally is assured, and I mean assured, not waved away into some contract deal among mates.

May I suggest somebody think of Jeroen Weimar for the task, even if he doesn’t bob up in a general’s uniform (but look out for the coffee cups).

Congratulations, Minister Hunt, you seem to be adopting aphorisms from The Prince, in particular when the news is good: release it unto the multitude in small amounts deliberately and progressively. Apparently this ploy helps maintain the applause.

Mouse Whisper

I was talking the other day to my one of bandicoot cousins, Bullum, and the topic turned to this Virus, the one we are hopping to avoid. I thought it was a good test of the efficacy for each of the Commonwealth funded Aboriginal Medical Services (AMS) to see how well they vaccinated their particular mob. Bandicoot Bullum said he was a bit nonplussed by those who seemed to speak for the various AMS complaining about the Government not vaccinating their mob.

He thought that it would be one of the key jobs for each AMS to get to as close to 100 per cent vaccination as possible, and only complain if they were not supplied with enough vaccine. He thought there was no shortage of supply; yet doses have been reported as going to waste. But maybe the bush telegraph would tell him something else.

He seemed to have a good point. This is now a time when the strength of the AMS can be tested, rather just being at the mercy of our brother rhetorical advocates.

Modest Expectations – Twenty of dark chocolate

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

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

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

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

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

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

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

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

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

A muddy Saturday

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

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

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

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

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

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

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

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

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

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

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

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

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

Morrison – A Description in One Word

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Aduhelm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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

Skol!

Modest Expectations – A Range of Lemon

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

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

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

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

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

Waiting for Bliss

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

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

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

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

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

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

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

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

Another time; another Trek

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Backroad out of Ceduna … Where next?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Special Pleading?

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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

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

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

As The Washington Post reports:

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

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

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

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

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

The Problem with having only one Joyce

Stress and The Emergency Department

Epistasis – An Addendum

Truth-telling

My Favourite Gourd

Mouse Whisper

Chenozem, indeed

Who suggested this?

Who do you think you are?

Mouse Whisper

St Kilda

Same Old Rubbish?

What the Butler saw

Where fantasy meets reality

Mouse whisper

The Prequel

The Postscript – What’s in a Name!

Sarah Jane Halton and her Stomach Knot

Climate Change

Mouse Whisper

“Tasting the winds, that are footless, Waist-deep in history.”

A Virus in the Sand

Oolong or Earl Grey?

Mouse Whisper

Such a little disease…

Snottites

Personal Irresponsibility

Hazzard with two “Z” – The Alchemist from Wakehurst

On the other hand, this seems sensible…

Mouse Whisper

Endangered Elements

Remembering Latvia

A Road past Gundagai

The Use of the Car as a Weapon

Mouse whisper

An Eloquent Statement on leaving Kinross Wolaroi School, Orange

George Repin

Monterey

The Age of Confusion

Mouse Whisper

A muddy Saturday

Morrison – A Description in One Word

Aduhelm

Mouse Whisper

Waiting for Bliss

Another time; another Trek

Backroad out of Ceduna … Where next?

Special Pleading?

Mouse Whisper

“Tasting the winds, that are footless,
Waist-deep in history.”