Modest Expectation – Hiroshi Mikitani

I was sitting at the table writing. It was about midnight. No, the candle was not guttering in the fireplace, nor were the shadows sending their long indigo fingers across the room towards me.

And then there was this almighty crash against the window. Looking around the cause was not immediately obvious; however, there she was, crouched on the top of the bars on the window outside just below the curved head jamb – this tiny ringtail possum. She was peering in. This jill has been a frequent nocturnal visitor and generally likes to perch on the balcony rail, but tonight she had been attracted by the light. There are no food scraps left out nor is there a grease trap. However, there is large clump of bamboo below the balcony, and thus there must be a feast of insects in the bamboo, including cockroaches. Cockroaches infest the suburb where we live, and if this adopted Jill as she is called, can contain them, well Jill you can crash into the window any time, as long as you don’t bring a Passel, and break the pane.

Anyway, we now know when she arrives…

Just like John Elliot 

The late John Elliot and I were contemporaries at the University of Melbourne, but he did commerce and played billiards; I did medicine and played politics. I can’t remember him; he was younger than I was.

Our paths crossed in the seventies; sometimes amicably; sometimes less so as he went on his merry way building his Empire and meddling in politics.

One encounter sticks in my mind. It was about 1980, and he had been a guest speaker at an Australian Institute of Political Science Summer School.

We happened to be walking back from one of the sessions, or maybe after his speech.

He turned to me suddenly and said, “You know, Jack, the difference between you and me? I’m a success and you’re not. “

What could I say? At that point of time, these two specks trudging through the Universe, he was probably right then. Not sure that was necessarily so later, until he butted his last fag, and trudged further on from me up to that Jam Factory in the sky.

It’s a funny thing. He was lucky not to be gaoled. Yet, I really didn’t mind Elliot. A friend of mine thought of him as charismatic despite his fondness for ordering culo di maiale with his Fosters. Increasingly transmogrified into a latter-day Mr Punch, he was a creature of our time, not of this time.

Known for Potatoes and not Necessarily those in the Ground

Idaho is one of many states where GOP lawmakers have responded to early-pandemic restrictions with moves to limit public health powers, arguing that the measures paved the way for alarming incursions on people’s rights. A state law passed this March gave county leaders veto power over some orders from health boards — like the mask mandate that drew fury and demonstrations in Ada County last year. 

Former Ada County commissioner Diana Lachiondo (D) said she was used to “working quietly in the background” as a member of the region’s Central District Health Board. They monitored West Nile virus and made sure toxic algae blooms didn’t grow in lakes. Then, she said, the pandemic made public health explosively political.

Opponents of mask mandates showed up outside her home with air horns and audio clips from the movie “Scarface,” in which actor Al Pacino famously says, “say hello to my little friend”, as he uses a grenade launcher and fires a barrage from an assault rifle. At least one person was armed – from The Washington Post. 

In explanation, Ada County is located in the southwestern part of the U.S. state of Idaho. As of the 2010 United States Census, the county had a population of 392,365,  making it the state’s most populous county, with 23.3% of the state’s 2010 population. In this county, its seat and largest city is Boise, which is also the State capital. -Wikipedia

When I was undertaking the Rural Stocktake for the Commonwealth Department of Health, I visited WWAMI which were medical schools, organised under the rubric of “rural”. The University of Washington, including the main medical school, is highly rated. To get that statement into some perspective, the University of Washington is ranked 16th in the world and third among U.S. public universities according to 2020 Academic Ranking of World Universities.

At that time this University ran the Medical School for Wyoming, Alaska, Montana and Idaho, in addition to Washington, hence the acronym. Given these states have sparse populations there was an avowed intention for them to concentrate on rural health. The problem, as I found out later, is that educating well-trained doctors in rural areas just makes them attractive to city hospitals looking to recruit skilled young health professionals. This hardly solves the dearth of these professionals in rural areas.

Sandpoint, Idaho

However during my visit, which started out in the very urban coastal Seattle, I ended up seeing some parts of Idaho. It is a state which gets very little attention unless one skis or enjoys the “amenities-rich” areas of the northern part of Idaho extending up to the Canadian border. The town I visited, which exhibited this “amenities rich” profile, was Sandpoint.

The doctors here were well served by students from the University whom they taught. It was a great environment for those wanting a conventional conservative community framed by ski slopes and mountain trails. Nevertheless, it was prosperous and undeniably rural with a population of just under 9,000 and intensely conservative.

There is a division between the northern part where the picturesque forested area is; what one expects of the Pacific North-West.  The southern portion, essentially altiplano and much drier, is where the capital Boise is located. The transition from north to south seemed to be Coeur d’Alene, a large undistinguished town, where I visited an Indian community medical service. I use an ordinary general practice as a yardstick for effectiveness. I grew up in an era of busy general practices and even though I never practised as a general practitioner, I did many locums, including for my father. Later I was associated with many rural general practices in establishing rural intern training. There were very few indigenous medical services which measured up to that yardstick, and a casual view of that one at Coeur d’Alene then would have needed a longer visit, given I visited when there seemed not to be many patients.

The amount of money allocated between Washington and Idaho was starkly demonstrated when I visited the two WWAMI campuses. It was clear that Washington State puts far more resources into education than does Idaho. Buildings, staff, programs – adjoining but so different.  They are in Pullman in Washington and Moscow in Idaho- only the border separates these two campuses.

Boise at that time was a small city, like so many of the state capitals. Unlike Sandpoint, which is at a forested 639m, Boise is on the altiplano at 832 m. So different in rainfall. At that time over 20 years ago, the guys I had lunch with were already talking about Boise becoming the new Silicon Valley; but it took almost the intervening time till now for the concept to stir into reality.  Nevertheless, from a business point of view, Idaho is on the move. On the basis of cumulative GDP and domestic migration plus non-farm employment growth, Idaho ranks 8th in the nation, and yet it lags badly in social expenditure, including that spent on public health.

This has been brought into relief by the COVID-19 crisis. Here is a State still rooted emotionally in a conservative agricultural and mining past of rugged individualism, yet paradoxically dependent on neighbouring Washington State to soak up those that it cannot treat because of the lack of health facilities.

I visited Spokane from where a member of the WWAMI faculty, who accompanied me around Idaho, was based. Spokane is a city of 230,000 in Eastern Washington, only 29 km from the Idaho border and 55 kms from Coeur d’Alene.

Spokane county itself is 53 per cent fully vaccinated (overall 63% Washington State) and across the border the corresponding Idaho county is 39 per cent fully vaccinated (overall 45% Idaho).

The current death rate from COVID-19 in Spokane County is far higher than anywhere else in Washington, being 5 a day based on a 7-day average. Spokane is bearing much of the Idaho caseload. In other words, Washington, where outdoor masking is mandatory, is having to treat the consequences of a State that discourages vaccination, masking, social distancing.  The problem is the area incorporating both States is uniform geographically and unsurprisingly attracted the same people with whom each hence shares much of the cultural heritage and attitudes. The only difference is how each State is coping with the Virus.

The Palouse

Individualism and pig-headedness are cut from the same cloth. As we drove back from Boise, we crossed the fertile Palouse, wheatlands where the differentiation between the two States was lost. I always thought that education with dispersal of the health knowledge capital into such areas would produce a more rational view of health. Yet Idaho still ranks 37th and Washington 14th in public health measures; but does that apply where the WWAMI campuses intersect at Pullman and Moscow?

In terms of its economic development Idaho is said to be a progressive state. But COVID-19 has questioned its worth, given the macabre report that so great have been the Idaho COVID-19 related deaths lately that the funeral homes are running out of space, being forced to hire mobile morgue facilities and admitting that cremations are running two weeks behind schedule. As the deaths are among the unvaccinated, someone opined darkly that no further government action in this State – where the Lieutenant Governor, Janice K. McGeachin wants to ban mask wearing – may be needed.

Yes, reinforcing the report at the head of this piece, Idaho is the State where some joker threatened to kill the doctor if he did not treat his father with ivermectin for his COVID-19. Is it really the Gem State?

And by the way, it does say something about border closures.

Plat de jour – Tehan-boned stake

While France’s military is dwarfed by that of the United States or China, it remains one of the world’s strongest and is backed by a world-class domestic military industry.

With 5,000-7,000 soldiers in the Pacific region, 20-40 military aircraft, and seven naval ships, France is the only European nation with genuine military strength in the region. The French air force has also carried out exercises deploying Rafale fighters from France, halfway across the world, to the Pacific as a show of strength.

France also has a seat on the United Nations Security Council, giving it a measure of hard power around the world. But for the great power that France once was, it is sometimes just not enough.

“The decline of France is a theme that emerges often, especially during electoral periods, and is popular among the right and far right. It’s the idea that France used to be extremely powerful and influential, and that the France of today is insignificant and contemptible. It’s obviously a narrative that can be questioned for a number of reasons.”

This is a very sober analysis. Having been against the intrusion by the French into the South Pacific with their nuclear testing program in the 1990’s, I worked to try and improve the co-operation throughout the South Pacific between the public health services. This cooperation was also forthcoming in relation to the nuclear testing.

Understandably, at that time there was complete silence shown by the Francophone area. Nevertheless, the problem went away, with the French buckling and ceasing nuclear testing. Language differences remain one of the difficulties, but even at that time the South Pacific Commission, as it was then called, was based in New Caledonia and the recently-appointed Director General at that time was an Australian. This situation is currently ironically the same, with another Australian now heading up the now South Pacific Community – another time of crisis.

When I headed the Australasian Faculty of Public Health Physicians (AFPHM) as President for three years, I made a point of visiting New Zealand at least twice a year, and with the assistance of the then Minister for Development Cooperation and Pacific Island Affairs from 1993 to 1996 was developing a strategy for public health in the South Pacific. My last act, despite my prominent anti-nuclear testing stance, was a meeting in New Caledonia of the then Commission. It was supposed to herald further co-operation.

Unfortunately, two things changed, the Labor Party was voted out. Bilney lost his seat – and the interest from the incoming Government was zilch -and it was also near the end of my fixed term in office. My successor showed no interest in pursuing the matter. He had achieved his standing by being an expert on the anatomy of the rat brain – says it all really.

French nuclear testing, Bikini Atoll

The French could have been interested and it is important if you want to meaningly communicate with the French to speak the language and know more about them, apart from their cuisine. In the original makeup of the South Pacific Commission, both Great Britain and the Netherlands were members, but they relinquished their seats with the loss of colonies (the Brits did a “Melba” but that was short-lived). However, the French have held onto New Caledonia, the Wallis & Futuna Islands and French Polynesia, and maintained a strong presence. They reluctantly agreed to the creation of Vanuatu in 1980 out of that strange condominium arrangement with Great Britain then called New Hebrides.

There are 26 members of the community incorporating Polynesia, Melanesia and Micronesia. So, although its title is “South Pacific Community,” the Micronesian nation members are in the Northern Pacific.

And when Pitcairn Island is incorporated, then the members are guardians over great amounts of the Pacific Ocean.

Thus, the recent clumsiness of Australia has yet to be worked through. I wonder if Morrison even knows we have Our Man in Noumea. Yet I’m sure Morrison would be having regular conversations with His Man in the OECD. At least Corman speaks French fluently – I do not know about the new Australian Ambassador to the OECD, Brendan Pearson, or whether he speaks fluent French.

Morrison has managed to tie himself up in a number of showboats, because of his desire to hold a megaphone. One of the latest, the QUAD– where the quid pro quad is not immediately evident – hope it won’t end up in a Quad wrangle. Now, it’s AUKUS (if you introduced Canada, it would be CAUKUS and Russia, it would RAUKUS). I also thought Mirage was only a fighter airplane; not a nuclear submarine fleet.

Now the South Pacific Community is one of the only landlines with a French connection left to Morrison. Here there is a common interest, protection of the Pacific Ocean in all aspects for all the nations within the South Pacific Community. Who knows how valuable they will be in the future?

Before WW11 the Japanese had sampans all over the South Pacific, doing a bit of pillaging, fishing and gathering intelligence. The Chinese now have what are euphemistically called “fishing boats” roaming all over the Pacific, doing much the same but in a more sophisticated way. As with Afghanistan and Iraq, we are being dragged away from our base. It is not the South China Sea where our interests lie. There is great deal of ocean for the Community to patrol, let alone the waters of China. At least the French have naval bases in New Caledonia and Tahiti if justification for their interest in the Pacific was needed.

Then, with all this breathless collection of acronyms that Morrison has brought back in his Gladstone bag, why snub New Zealand? After all, New Zealand more than Australia shares a heritage with Polynesia and the South Pacific. Wait a minute, there is another alliance where New Zealand does have a monocle in common with us – Five Eyes. Is that a true sharing arrangement?

Five Eyes

But then the cold sixth eye – that of Dawn comes. Australia wakes in a sea of acronyms triumphant, but for what purpose?

At dawn, China remains our major export market (42%) followed by Japan (13%) then the South Koreans (7%), USA (5.5%) and UK and Singapore (4% each) India and New Zealand (3% each). France ranks 22nd; not Asterix but not that much, predominantly coal.

Now didn’t Paul Keating question the Australian policy of cutting off our noses…

So which of our alliances incorporates China? Or do we have a Backdoor Alliance somewhere, maybe CAOZ?

I would get confused if I did not know Morrison was a marketing man, and the author of “Where the Bloody Hell are You?” Perhaps you can answer that, Prime Minister. You know you never ask a question without knowing the answer.

The Fragrance of France

I still cannot let go of our crass behaviour in regard to French sensitivity, even though I personally am very ambivalent about the French. That ambivalence is encased in some of my poetry, but I do love my memories.

Vanilla flower

Coming out of that reverie, I have to say I have journeyed across French Polynesia, as well as visiting, with a dose of malaria, one of the French Indian Ocean Département, Réunion, where grows much of the vanilla, ylang-ylang and vetiver, and also has produced a French Prime Minister, Raymond Barre. There is a French naval base there and last year France and India held sea exercises around the Mascarene Islands.

Turning to the South Pacific Ocean, before Bali became the Australian tourist destination de choix, New Caledonia and Tahiti were popular with Australians. This was not because of a love of the Melanesian and Polynesian populations necessarily, but it was a taste of French life in the South Pacific. The lure of Club Med was everywhere. That is the problem. The island population are the backdrop, only incorporated as far as women in shimmying in grass skirts and smiling faces proffering coconut or some other tropical delicacy, or booze.

The myth of the South Pacific was embodied in a popular musical “South Pacific”, based on the American, JM Mitchener’s novel, Bali Ha’i. The French colonies escaped the barbarity of the War in the South Pacific, it was nevertheless very important to the Americans. Australia was in French Polynesia in the espionage business there when there had been a battle for control between Vichy and Gaullist forces and particularly before the Americans arrived in 1942 and took over control.

During WWII, the American presence in the French Pacific was significant. Noumea was the main US base with 22,000 troops, but it had air bases at Efate and Espiritu Santo in the then New Hebrides where there were 4,300 stationed.  There were 2,600 on Wallis Island, and 4,000 at a refuelling base at Bora Bora and the Raiatea meteorological station in French Polynesia. An uninhabited French possession, Clipperton, served as a meteorological and radio base.

It has been said that the American interlude enhanced the way the French handled these areas post-war as distinct from Vietnam or North Africa. The French were poor colonists in terms of their treatment of the indigenous people, and if one discounts Corsica, the only other remaining overseas territories are in the Caribbean and, uneasily, French Guiana. The French hate giving up their overseas possessions as witnessed by the difficulty in the achievement of Vanuatu’s independence, which only occurred because of the unique condominium relationship with Great Britain; this is worthy of a standalone blog.

When I first visited New Caledonia and sought to buy an artefact which typified the culture, the shopkeeper laughed and said the genuine old stuff had all been taken by the Americans during the War – and then in Noumea, the indigenous people were backdrops to colonial French life.

Fortunately, I have been acquainted, through the diaries of a young man who worked on the island of Eromanga in the 30s, of the New Hebrides, then  jointly administered by the French and British. His diaries provided a tantalising insight.

In Vanuatu where I stayed with my friend on his island off Efate in the lagoon, there was more contact with the local indigenous people.

While staying there, we did fly to Tanna. Standing on the edge of an active volcano Yasur on that island was one of those experiences that is hard to forget – no railings, just the hot lava spurting out and upwards  – the trade winds blowing the sulphurous smoke away.

Yet the Americans left a quasi-spiritual legacy in the John Frum movement, but this nation in all its diversity exemplifies the challenge the whole of Melanesia presents, whether being colonised by France, Great Britain and in the past Germany and The Netherlands – and not forgetting now Indonesia.

French Polynesia is where I did have direct contact with the local people when in the Marquesas far out on the edge of French Polynesia. Perhaps of all the places I have ever visited in the South Pacific, this is where I became more immersed and able to observe the interaction between the French colonists and the Islanders. It is said that the Marquesans are the closest to the New Zealand Maoris in both their customs and language.

At the time we visited, very little English was spoken, but we got by. However, French Polynesia is spread over a large area of the Pacific Ocean, and therefore strategically it remans important; but even more so now at a time where there are social disturbances whether due to climate change or from disease. Even given French aloofness, it is important not to gratuitously insult the French.

So where does that leave us in relation to the South Pacific Community. Great Britain left in 2004, and the direct American interest is through American Samoa (if one discounts the nations north of the Equator). Apart from the all-pervasive influence of USA, what is the relevance of the albatross called AUKUS?  Especially as I repeat the following from one of my blogs written in May last year by a person far smarter than most, certainly Morrison, i.e. if manned submarines are really needed, Australia should buy nuclear, reducing the number to six and buy them completely constructed and fitted out in France.

I was not aware of any major investment by India in the South Pacific, and Japan certainly was a pest before WWII especially with continuing harassment over the Australian mandate over New Guinea. More recently, trade between Japan and the South Pacific nations is uneven. The largest exporter to Japan from the region is Papua New Guinea, mainly liquefied natural gas (LNG) while other countries export a variety of primary products. More than 95% of exports to Japan from these countries are based largely on mining and fishing-based products. Not particularly useful in terms of either COVID-19 or climate change.

As for India, it has a great facility for getting involved in all sorts of relationships and talking a great deal; but as far as can be discerned, its contribution to the South Pacific in tangible terms has been minimal, and only the ethnicity of Fiji provides any Indian footprint. So much for the QUAD being relevant.

China is a different matter. I could not say this better. While China is by no means the dominant donor in the Pacific, the way in which it delivers its aid — large infrastructure projects funded by concessional loans — makes these projects stand out. Chinese lending has also been used as a vehicle to get Chinese state-owned enterprises into the region. These companies are now competing in commercial activity across the board. According to China’s own investment statistics, Chinese construction activity in the region was $958 million as of 2017, almost six times greater than its foreign aid activities.

For instance, China owns Tonga (unless it can reschedule the debt) and it is only recently that Samoa has ditched the proposal for China to build a port. Vanuatu continues to flirt with the Dragon.

But the Chinese own neither French Melanesia nor Polynesia. Not yet anyway; and Australia with its heightened sense of Sinophobia snubs the French. Incroyable!

Willow is not Necessarily Shallow

This push for ridding the language of gender differentiation has reached another closing of the fork, in this case that of between batsman and batswoman. The resultant of closing this fork is “batter”.

“Batter” is a word of violence. “The batter battered the bowling.” or

“Bumper battered, the batter succumbed.”

“Batter” is also that mixture of flour and liquid. There are three types – “drop batter” as in he was “the first drop batter”; “pour batter’ obvious but get your spelling right, and “coated batter” which you find on a village pitch in Yorkshire on a mid-summer day.

There you go, for the sake of gender anonymity, “Going out to open the innings is a violent mixture of flour and water.”

My solution is to call them Willow.  The bats are willow. Calling the bat handlers “willow” is environmentally conscious. Notwithstanding “Out for a duck, the weeping willow trudged back to the pavilion”, the name is more euphonious, and instead of “bumpers”, we could have “wind in the willows.”

However, as you go out to the crease, would you prefer to be called, “the batter coming to the wicked” or “these willow have the wood on these bowlers”.

Some blogs ago, I also questioned…

Mass General Brigham, the state’s largest health care provider, said Tuesday that it will not administer Biogen’s controversial new Alzheimer’s drug to patients, dealing another setback to the Cambridge company and its expensive treatment.

The network, which includes the flagships Massachusetts General Hospital and Brigham and Women’s Hospital, is the latest major US health care system to opt against offering monthly infusions of the drug, called Aduhelm, over concerns about its safety and effectiveness. – from The Boston Globe

Mouse whisper

The matter has been raised by the cartoonists already. However, my New Zealand friend Kioreann has a taken this idea for protestors to a far more serious level. The police should be armed with specially designed dart rifles where they fire syringes full of vaccine into each of the protesters. These rifles would fire very penetrative darts since the hides of these protesters are particularly thick.

As compensation, these protesters will be able to collect their “Freedom from COVID-19” certificates as they are driven away in those comfortable vans and the protest date when they will receive their second dart.

Modest Expectations – Dominican Republic

“Ladies and gentlemen: the story you are about to hear is true. Only the names have been changed to protect the guilty.”

Strike me lucky, Blue, did you hear that? They are at it again – the Coalition of the Willing has now changed its name to a self-preened great Aukus. Yes, I know the Great Auk has joined the Dodo, but the word here is Aukus. Remember the name! And no cracks about Noah’s Aukus.

The great AUK – now extinct

I’ve a friend who has been associated with the Senior Service since he was 19 years old. I asked him a simple question – why does Australia need submarines? He thought it was a good question, and he answered in conventional terms, that he thought Xi had the same expansionist propensity that the Japanese military had before the Second World War. I said to him it sounded like a version of the yellow peril coming from the North.

My friend made the observation that the French contract was rubbish, and the Adelaide shipyards were just not up to the requirements. From my point of view, having heard from a variety of sources, Master Pyne will have a lot to answer for this in relation to his involvement, apart from any fiduciary gain, just to shore up a few South Australian Parliamentary seats for the Liberal Party! Any objective assessment would have concluded how poor were the underlying assumptions, an impression reinforced by knowing of the recent involvement of Jane Halton as a consultant.

Yet five years ago Australia had entered into a contract – ill-formed, ill-thought through – but did the Australian Government confront the French with its concerns? Probably not. If so, why now go behind the back of the French government?

Nevertheless, the cackhanded way in which Morrison has responded to being hoodwinked into the nuclear submarine imbroglio is par for the course. That was compounded by the gratuitous insult by an American President, who knows of Morrison’s failed bet on Trump. Biden seems unable to bring himself to utter his name.

Despised by Biden. Morrison has also pissed off the French (and probably the EU as well) and the Chinese. The rest of Asia is looking askance, especially when they also see Boris, the dishevelled spectre of the playing fields of Eton College, in the mix. The question may rightly be asked – why are the British meddling in the Pacific since they do not even have any British Overseas Territory tax havens in the Pacific to defend?

Nevertheless, Morrison is following in the traditions of the recent past Australian Prime Ministers where, despite the trumpet blast about the number of members of the Coalition of the Willing (apart from a Danish contingent of about 50 troops), only Australia and Great Britain made any sizeable military contribution to America’s ill-starred invasion of Afghanistan.

The French refused to join, although it had previously committed 17,000 troops to the Gulf War in 1991.  And who can forget Menzies’ embarrassing involvement in the Suez Crisis in 1956 where, by Jove, those “gyppos” needed to be taught a thing or two. At that time the French joined the British in tickling Menzies’ vanity.

According to my source, the Americans will probably flog Australia the Virginia class nuclear submarine.  At what cost? A lot is the best estimate, and just re-emphasises the non-answer to my initial question, when Australia has a small navy, minuscular compared to both China and the USA.

This Virginia class submarine, with a crew of about 135 sailors, can carry up to 24 torpedoes and Tomahawk cruise missiles. The boat’s top underwater speed is about 25 knots (46km) per hour. The submarine has an advantage, namely the reactor plant will not require refuelling during the ship’s lifetime. But the question remains of what will the life time look like if it takes 20 years to build this fleet. It does not make sense.

Just look at the logistics. From laying down plans to final commissioning seems to take about six to seven years; but General Dynamics already has a backlog, with the boondoggle being a tasty supplement to maintain the money flow to the American armaments industry in, say, 20 years’ time. Needless to say, these submarines will be built in the USA, not Australia. There are just so many subsidiary suppliers of equipment to make Australian involvement in the manufacture impossible.

There are a few other queries, especially as the life of a submariner is not one which is immensely popular with the younger generation. Long periods of time next to a nuclear reactor underwater is not the most enticing job prospect, given the amount of time needed to ensure that the person recruited has the ability to remain sane in a closed underwater environment. So how is this to be answered?

The alternative is to invest in smaller unmanned submarines, more suitable for our shallow coastal waters. These are being built by Boeing and, according to my source, may be the future. They are cheaper; and nobody cries over the sinking of an unmanned drone.

The observations from my friend seem very sound, especially as he is concerned with our defence; not some vain manoeuvre to spend a great amount of funding on a project where the competition is already set between the two heavyweights. The Chinese are investing in more and more nuclear submarines.

Deployment of nuclear submarines confronting the Chinese in the South China sea should be left to the Americans – and the Japanese. In the undersea domain, the increase in Japan’s submarine force is highly regarded throughout Asia, and even America’s anti-submarine warfare operators struggle to track Japan’s modern fleet of super-quiet non-nuclear submarines. Note the comment about the stealthiness. This was a major criticism of the French submarines ordered by Australia, which apparently are so noisy one can hear La Marseillaise anywhere if the enemy wishes to tune in.

Even Taiwan is building new submarines. Paradoxically, there are some suggestions, one of which is that the Americans are seeking to reduce their nuclear submarine fleet. This may give some clue as to the US interest; and hence sloughing a few off to Australia – obviously at the right price whether for outright sale or some form of lend-lease – to shorten the period from 20 years to a much more “acceptable” timeframe. These alternatives may have more currency now the possibility of such has been denied by a former US Secretary for the Navy.

Sometime in the future there may be six nuclear submarines under an Australian ensign; an expenditure which could have been spent on a more mobile unmanned underwater navy, able to have quick deployment around the vulnerable coast of north-west Australia demonstrated so clearly when the Japanese attacked there, as well as Darwin in 1942. I wonder still whether this “sometime in the future” scenario will ever eventuate, but I certainly won’t be around to see it.

I do not weep for the French. In the 1990s, when President of the Faculty of Public Health Medicine within The Royal Australasian College of Physicians, I coordinated with Saatchi a protest against the French nuclear tests in the South Pacific at Mururoa Atoll. This protest involved colleagues from New Zealand and other South Pacific constituencies. I also well remember the callous bombing of the Rainbow Warrior by the French in Auckland Harbour in 1985. It should be noted that the French last withdrew its ambassador from Canberra in 1995, after Australia had withdrawn our ambassador from France two months earlier.

Given all this, I am sure that Malaysia, Indonesia and the Philippines will be unhappy about Australia gratuitously poking around underwater in the archipelago, knowing that there are already a number of nuclear submarines close by, if not in disputed territorial waters.

The other diplomatic problem for Australia is that the last thing the South Pacific nations will want is a nuclear reactor with a boxing kangaroo motif berthed in their harbours, which reinforces that point about the unattractiveness of the submariner’s life.

But then, will this whole extravaganza ever occur?

To boost or not to boost 

An advisory panel, independent of the Food & Drug Administration (FDA), has voted to recommend administering Pfizer vaccine booster doses to people over 65 and those at high risk of severe COVID-19. The shots would be given at least six months after the original two shots.

The panel had earlier voted against a broader proposal from Pfizer to make booster shots available for people 16 and older. However, the FDA is not bound to accept the recommendation.

What is important is that Israel and USA have evidence for the efficacy of boosters, and it seems that six months is an indicative time for a booster dose of both Pfizer and Moderna vaccines. The need for a booster for AZ vaccine is less clear. What is known is that the AZ vaccine is a “slow burner”, and immunity levels build over time, especially when the dosing period is stretched. Currently the gap between first and second doses is between eight and 12 weeks which gives an optimal immune response.

For the third booster dose, it may be preferable to give a different brand of vaccine than the one used for the first two shots. This is specifically mentioned for the AZ vaccine. This would be positive news for those Australians over 65, who have been denied access to the Pfizer vaccine for their initial inoculation.

Booster shots are subject to speculation as to efficacy, but both Moderna and Johnson & Johnson are lined up seeking FDA approval. There is a suggestion that the Moderna booster requirement may be half the initial inoculation shot and, given the arrival of Moderna vaccine into this country, such information is relevant.

What is important is for the Government to develop a national approach to boosters, assuming that Australia will follow the FDA decisions, and moreover Israeli experience. In other words, let us not get caught up in the no man’s land of indecision; the Government failed comprehensively in relation to vaccines – they cannot afford to fail again.

The debate still centres on the level of vaccination and applauding the great response of Australians to be vaccinated once the vaccine hesitancy was  overcome. I for one, was in that cohort, and masked my hesitancy by taking the advice to space the influenza and COVID-19 vaccines. As I wrote in an April blog:

The other one, given the problems with the rollout, if I was able to secure a first dose, how long shall I have to wait for the second dose, and then more importantly, for the booster? It does not seem clear to me, whether (or more optimistically, when that will occur). That is why the J&J vaccine appeals to me more because it is single dose; but will it ever be registered in Australia? Questions, questions everywhere, but only opinions to imbibe. That is my reaction as an elderly consumer eligible for the injection. I am confused, and so will hold back. In the Australian climate it seems the best option is to wait and see.

I hope that same indecision does not dog mixed vaccine boosters, but at least if Pfizer is approved for boosters it can be used potentially across all of those over the age of 65 years. In retrospect, my comment in relation to the J&J vaccine seems have been a good bet. Although there were production difficulties, it is said that the second injection provides near to 100 per cent protection.

In any event, the matter of boosters should not be let slip in the way other matters have been mismanaged, because if boosters prove successful, then a six-monthly cycle hopefully can be converted to a minimum one year with further tweaking of the vaccine. This would then cement the booster added into the influenza vaccination cycle, with the possibility of a combined flu-COVID vaccine. This is in the future, but the matter of boosters must be part of the conversation now.

There is one distraction, if it can be called that. Why should Australia be applying for boosters when the undeveloped world is largely unvaccinated? Australia cannot take responsibility for the world. Yet if Australia accepts public health responsibility for our neighbours, the level should be clearly defined; and once it is clearly defined then these nations should be incorporated so their level of access is the same as ours.Yet at the same time those nations should accept the same level of responsibility as us.  Every society has got its “whack jobs”, every society has its level of ignorance, but public health responsibility is universal just as taboos are universal. It is all about the acceptable mix of persuasion and coercion.

Sweden Calling

I read the article by James Baillieu in Crikey extolling the virtues of the Swedish approach to the COVID-19 pandemic.  After reading it, I am sorry to miss articles on the benefits of the “English moat usage in repelling the Virus” or the “Cumulative benefit of monocle use when taking ivermectin.”

But I joke, my Lord, when such an authoritative source as yourself waxes lyrical on Sweden and its approach to the Virus. I appreciate you attribute your expertise on Sweden to your genetic pool.

My Swedish friend, a distinguished doctor from the Karolinska, who unhappily has not had been afforded the wisdom of working for seven years for McKinseys, which has been so much on show in its advice to that other McKinsey genius, Master of the Hunt, Greg.

I took the liberty, my lord, of forwarding your Epistle to The Nation of Crikey to my Swedish friend.

My friend, having read the Epistle has replied (sic):

Outcome measures obviously differ vastly whether you are a potential pub client locked (at home) or a frail elderly  person with the sword of Damocles sharpened above you. 

Australia is to be congratulated having saved so far ca 50,000 lives (compared to similar countries including Sweden)

It is somewhat callous to imply that a 0.1% death rate is negligible. The figure is also off by a factor of 10 in developed countries.  I strongly disagree.  

However there are other costs, lives not lived, children not schooled, economic problems to evaluate also before a total score can be tallied. 

To me it seems that Australia 

  1. Was lucky to be able to close borders
  2. Enforce lockdowns that saved many lives
  3.  School closures may not have been evidenced (i.e not been objectively assessed).
  4. Lockdowns only work for short times during which extensive vaccination must occur lest the disease take hold again savagely which is now occurring (in Sweden). 

We are now in Sweden following Denmark in repealing nearly all Covid restrictions, hoping fervently that our vaccination rate is ultimately sufficient.

(Consider) that there are groups in society both more exposed and sadly neither accepting vaccination nor being reached by the information, which is also as clear as it was more than a year ago when the typical Covid patient(in Sweden) was an immigrant taxi driver.  

Subsequently, he informed me that the architect of the Swedish approach, Tegnall is showing signs of stress. Baillieu labels Tegnall as independent; no he’s not – he is a civil servant. Baillieu maybe means “maverick”. Perhaps if Tegnall resigns, “maverick” becomes “martyr” in Baillieu language.

Baillieu trumpets zero deaths from COVID-19 in Sweden. On 17 September alone, there were 22 new reported deaths and 1,009 new reported cases; then on 22 September, 19 deaths. What a callous statement by Baillieu saying “Sweden’s COVID death toll of 0.14% of the population was nearly all people who had a short time to live.” 14,000 people about to die on his say-so. As my friend wrote: It is somewhat callous to imply that a 0.1%(sic) death rate is negligible.

While its economy may be showing signs of recovery, Swedish sources still say there is significant uncertainty. It’s possible that restrictions to curb the spread of infection will tighten again in autumn if cases rise, and this would impact economic growth.

Over the course of next year, employment growth is predicted to slow down further as GDP increases more slowly, but the number of employed people will still increase. Many businesses are looking for skilled workers again. A total of 190,000 people in Sweden have now been without a job for over a year. It seems a sober assessment of the current Swedish situation complementing my friend’s comments. Not a small hit, as Baillieu asserts.

Demonstrators on the steps of the Shrine, Melbourne

I don’t like what is occurring with the Virus unsuppressed in both Melbourne and Sydney, but when an over-privileged graduate of the Melbourne Establishment has a childish tantrum disguised as an objective assessment then I too, a product of the same environment, feel deeply ashamed.

What nonsense his final words: “Restore our rights and freedoms. Stop harming our children and instead protect them.”

I hope he was not wandering along the Westgate Freeway protesting this lack of Freedoms with all the irresponsible.

My great grandfather did not lose his money in the Depression of the 1890s in which the Baillieu family was a prominent player; the consequences of the Depression still affect Melbourne to this day. My great grandfather did not have much time for the Baillieus either.

John Shelby Spong

Spong sounds as if came from the world of Spike Milligan.

Bishop John Spong

Yet John Shelby Spong was a very, very serious influence. Some may say that Spong flaunted once-controversial views, but now many have become mainstream.  At times I wonder why I retain my Anglicanism, until I am reminded of Spong. I have been fortunate in knowing some great Anglican priests, but it is hard to live in the Sydney diocese which has all but abandoned people like Spong in its literal Bible interpretation and acquired intolerance of anybody not in its own image – seemingly not that of the Trinity anyway.

Yet one statement in the obituary prompted me to seek further information, and that was the statement about Judas Iscariot. He is so vilified, and yet in an excellent article on the iconography by Dr Felicity Harley relating to Judas, the early church was much more forgiving of Judas and his suicide. The reader is explicitly told that he had remorse; and there is no condemnation of Judas in his choice to take his own life in the way that he does. Rather, in recording the suicide Matthew allows guilt to pass from Judas to the Jewish leaders who ignore Judas’s confession and his atoning gesture and are thereby rendered guilty.

Later he was further vilified for that act in addition to his betrayal of Christ, and by the time of the medieval church the Hanged Judas had been consigned to the darkest parts the Inferno.

It is testimony to Spong that even in death, his obituary has made me think, in any areas I thought very much cut and dried.

I am indebted to this lightly edited obituary from The Washington Post, which I doubt will get much currency in Australia.

Long one of the most liberal voices among the nation’s Episcopalians, Bishop Spong has died at the age of 90.

In 1989, while he was bishop in Newark, N.J., he ordained the first openly gay male priest in the Episcopal Church, the Rev. Robert Williams.

Though the Rev. Ellen Barrett, an openly lesbian priest, had been ordained a decade earlier, Bishop Spong drew national attention by sending letters inviting all the church’s bishops — many of whom opposed his actions — to attend the ordination of Williams that December.

“Christian moral standards have changed quite dramatically,” Bishop Spong told The New York Times before the ordination. “We had slavery in a Christian nation. We had oppressed women. I think that our world is more Christ-like when it’s open to all of God’s children.”

And he added: “We believe that the Church needs to be honest. We have gay priests in every diocese.”

The author of more than two dozen books, Bishop Spong questioned some of Christianity’s fundamental doctrines while over the years he had often taught and lectured at Harvard Divinity School.

“He was trying to find the kernel and sweep away the husk of what it meant to follow Jesus. He was always seeking after that truth,” the Rev. Canon Kelly Brown Douglas, canon theologian at Washington National Cathedral and dean of the Episcopal Divinity School at Union Theological Seminary, said; “What he truly came to understand is doctrine and dogma doesn’t make us Christian. Doctrine and dogma doesn’t make us church. What makes us church is respecting the sacredness of every single human being and creating a world that does that and making sure the church is leading the world in doing so.”

“In so many ways,” she added, “he was ahead of the church.”

Nine months after Bishop Spong ordained Williams, the Episcopal Church’s House of Bishops voted to pass a resolution affirming that it is “inappropriate” to ordain a practicing homosexual.

“The way the church treats its gay and lesbian members,” Bishop Spong said afterward, “strains the very fabric of my life by tearing it between my loyalty to Jesus Christ, who made a habit of embracing the outcast, and my loyalty to a church that historically has rejected Blacks, women and gays.”

Born in Charlotte, N.C., on June 16, 1931, John Shelby Spong was raised in fundamentalist churches amid those whose values were racist, sexist, and homophobic.

When he was young, he was taught that gay people were sinful, women were subordinate to men, and whites were superior to people of color.

His father, a salesman who struggled with alcoholism and died when John was 12, told him he should always say “sir” and “ma’am” to his elders, so long as they were not Black.

Bishop Spong later said the greatest influence on his upbringing was his mother, who was part of a strict Presbyterian sect that refused to play hymns because the lyrics were not “God’s words.” He later targeted that kind of biblical literalism in his books and sermons.

In 1998, for example, he criticized LGBTQ opponents as “uninformed religious people who buttress their attitude with appeals to a literal understanding of the Bible. This same mentality has marked every debate about every new insight that has arisen in the Western world over the last 600 years. It is a tired, threadbare argument that has become one of embarrassment to the cause of Christ.”

He graduated from the University of North Carolina in 1952 and received a master’s in divinity from Virginia Theological Seminary in 1955. That same year, he was ordained to the priesthood and married Joan Lydia Ketner, who died in 1988. In 1990, he married Christine Mary Bridger, an administrator in the Newark archdiocese who went on to edit his work.  He was survived by his wife, five children and six grandchildren. He had a sister, who also has outlived him.

Before he became a bishop in New Jersey, he served for 20 years as a priest in North Carolina and Virginia. As rector of St. Paul’s Episcopal Church in Richmond, known as the Cathedral of the Confederacy because it was where Robert E. Lee and Jefferson Davis had worshiped, he took down the Confederate flag that flew above the building.

As the civil rights movement progressed, Bishop Spong found himself preaching to Black and white congregations alike, and said he worked to shed what he called the “residual racism” of his upbringing.

“I happen to believe that God’s image is in every human being, and that every human being must [be treated] with ultimate respect … And the Black people in America were the first people who made this very clear to me,” he said in a 2001 interview with the ABC, Australia’s national broadcaster.

He later expanded his ministry to encompass the fights for gender equality and LGBTQ rights. Soon after he arrived at the Diocese of Newark in the mid-1970s, the diocese became one of the first to ordain women to the priesthood.

The Rev. V. Gene Robinson, who in 2003 was consecrated as the church’s first openly gay bishop, has recently called Bishop Spong “a prophet”, using the term in the sense of “someone who speaks truth to power, who says those things that people don’t want to hear because it calls their morality and their lives into question.”

“I stand on his shoulders,” Robinson added. “Were it not for the work that he did and the ministry that he did and the advocacy on behalf of LGBTQ people that he did, I wouldn’t be a bishop. He did it long before it was popular or politically correct — he did it because he believed it was the Gospel.”

After publishing “Resurrection: Myth or Reality? A Bishop’s Search for the Origins of Christianity,” Spong spoke with the Globe in 1994 about parts of Christianity he was challenging.

Neither Judas Iscariot nor a betrayal by one of the 12 apostles was mentioned in early parts of the New Testament, he said.

“Judas was a creation of the Christian Church, which sought to shift blame for Jesus’s death from the Romans to the Jews,” he said.

In his 2005 book “The Sins of Scripture: Exposing the Bible’s Texts of Hate to Reveal the God of Love,” Bishop Spong wrote:

“I am now convinced that institutional Christianity has become so consumed by its quest for power and authority, most of which is rooted in the excessive claims for the Bible, that the authentic voice of God can no longer be heard within it.”

He did not say Amen. Others may.

There’s a Tree in the House

I was looking at an old repeat of Grand Designs in Australia where the owners erected a huge tree trunk as a centrepiece of their house in the tropical bush south of Darwin. It was a huge endeavour.

Trees, in the house …

By chance, at the same time, we received a short message from a renter of our property in Tasmania, which read in part; “Thank you so much for a wonderful stay in your holiday house. Our young boys absolutely loved the trees in the house.”

I had watched this installation of the tree trunk in the Northern Territory house, and yet did not immediately associate with the three massive blackwood trunks which support our house together with the trunk of a King Billy pine, which was the only old wood.

The blackwood poles were green at the time of construction and this is shown by some splitting in the poles , but the house is nearly 30 years old and seemingly that is now stabilised. The simple observation of children entering the property for the first time, full of wonderment at something we just take for granted; for them the house may be a fugue of interwoven wood. But from ageing eyes like mine, you only see what you don’t see.

Mouse Whisper

In Italy, May 1 is known is “Festa dei Lavatori”. It is a day of little work, also known in Italian as “la toiletta”. In southern England on the same day, there is a little known ceremony heralding the harvest of the first honeycomb. It is known as “Bee Day”.

Modest Expectations – Shakespeare in Love

Testudo

Our jolly duo and their retinue have been in Washington for the normal annual discussions on reintroducing the testudo as a secret weapon in the invasion of the Chinese consulate in Sydney and whether oars for the Australian quinqueremes are suitable for a long blockade of the Sino-Territorian harbour in Darwin. Their visit coincides with the national security adviser in the White House testing positive to COVID-19.

In a more serious vein, it seems a long way to go to give the Yanks a gentle slap.

The question remains as to whether a custom-made suite is being created in one of the defence establishments to test how comfortably these stalking horses can be accommodated for 14 full days after they return. Facilities so plush as to make even the Ministers blush?

By “stalking horses”, would the Commonwealth be setting up such a facility so that all the Ministers can assure us mug punters that they can freely travel overseas and say that “all measures will be taken to protect the Australian community” on their return from overseas where “fruitful and productive talks” were undertaken.

The basic cancer in this country is that the politicians and their mates are sealing themselves off from the rest of the country, so they retain all the healthy remuneration and the perks of office and beyond – irrespective of the party. A special quarantine facility would just serve to emphasise this separation. This whole situation is only going to be cured by some deep electoral cleaning, a very difficult task given the way the media’s saprophytic existence supports the status quo.

Nevertheless, it may be interesting to see if an obscure single line item appears in the coming Budget. 

Growing Old 

* Residential aged care or nursing home. I grew up with the nursing home nomenclature and feel comfortable in it describing what should be emphasis on the “nursing” rather than the “residential”.

It was a revealing article. On a day when the pandemic was raging through Victorian nursing homes*, a report appeared in the Property Section of the AFR (28 July), headed “Estia Health can’t quantify pandemic hit to earnings”. Says it all.

Estia Health is one of the largest residential aged care providers in Australia with 69 homes, 6,180 beds and more than 7,500 employees across Victoria, South Australia, New South Wales and Queensland. Its chair and board have nobody with any clinical health expertise. Gary Weiss, the Chair, Doctor of Juridical Science (JSD) from Cornell, is the very model of the modern business tycoon, “legendary corporate raider”, asset stripper, draining the demand side to maximise profit.

His responsibility portfolio also includes Ardent Leisure; so he is a very busy person. Yet he appears to have no expertise in the central issue – containing pandemic in nursing homes, given that two of the Estia homes have well over 100 COVID-19 sufferers. Doesn’t fit your business model, Dr Weiss? What are doing to improve the situation about the rest of your Empire?

For many years I was involved in the management a number of public nursing home facilities in rural Victoria as the both Director of Medical Services and also later as Director of Clinical Training. When I came into one of those positions the first thing was to undertake a review of the nursing home residents’ medications with the local pharmacist. It is one measure of a doctor’s involvement in nursing homes because one gets a sense of how often the residents receive medical attention by such a review.

There were always stories of medical practitioners, who did visit private nursing homes waving to the resident and then moving on and billing Medicare. The fact that such stories had currency was disturbing enough, but I certainly found in some areas a reluctance of doctors to visit nursing homes on a regular basis.

I was fortunate that the nursing homes I was involved in were attached to the hospital and worked under the rules of the particular health service. I was able to thus monitor and encourage the local doctors to see the residents regularly. May I also say that there are some general practitioners who are interested in geriatrics and they should be identified as future role models for their less involved colleagues. At that time there was a country health service that had completed the transition from being an acute care facility to one which concentrated on care of the elderly, and the nursing staff re-trained accordingly.

The problem was that this model needed a “champion”, but the doctor, who initiated this change was too self-effacing to promote his model widely. It was regrettably a lost opportunity.

These public nursing homes exist as a function of the health care system. It is ridiculous to maintain the fiction that they are a home in the conventional sense. Health care is superimposed on a residential environment. It should be noted that the public sector has 10 per cent of these nursing home “beds” in Victoria and yet only 0.6 per cent of the COVID-19 sufferers.

Private nursing homes and the local health care services are under different jurisdictions. There is thus a situation when a facility for the elderly, the most vulnerable people in the community, has no formal link to the local hospital. This has been the case before the advent of the Virus and the early responses to this situation showed so clearly this dysfunctional aspect of the health care system, even to the extent of a private nursing home initially refusing to cooperate.

Let us consider the “Before Virus” situation, when an individual resident needed urgent medical attention in a private nursing home, the immediate conventional response was to send them to hospital, often without informing the hospital in advance – or ever. If there is an agency aged care worker, or just a very understaffed nursing home at night, it is just a natural response for the patient to be sent off to hospital regardless.

On arrival by ambulance the resident waits, often in the ambulance, is admitted to the hospital or left in the emergency department and sent back to their “home” often without any communication between hospital and aged care facility. If admitted they are either discharged back to the home or to the mortuary.

So much for coordinated action! The lack of same has led to mutual resentment between nursing home and hospital.

However before the pandemic arose, establishing a Royal Commission to take the heat out of the sector seemed the best choice.

The Aged Care Quality and Safety Commission has been, as I said before during the Time of Newmarch, one of the most useless neo-government bodies I can remember. The Royal Commission seems to be an irrelevancy as it grinds on, with Lynelle Briggs and Tony Pagano only reporting in October; personally I have a high regard for Lynelle Briggs.

Significantly the Commonwealth now with a medically qualified Departmental Secretary, Brendan Murphy, with a broad knowledge and contacts with Victoria, his Department has been able to move relatively quickly to mobilise the hospital workforce, bolstered by AUSMAT, to fill in the deficient work force in the private nursing home sector. How different from the uncooperative, often confrontational scenario described above!

The Victorian government is developing a strategy on the run. The question remains of whether NSW should have recast their policy after Newmarch rather than having it been bogged down by one of those face-saving useless inquiries. On the other hand by early response using AUSMAT, the North-western Tasmanian infection of a number of nursing homes was nipped in the bud. That was a lesson Tasmania seems to have learnt. The essence is that the States assume responsibility for the private nursing home sector. What is happening in the other States in the wake of the above disasters – nothing? One only can presume that the private nursing home industry is fighting back, and of course seeking government support rather than asking their shareholders to assume extra financial responsibility.

The nursing homes are not generating the Virus; it is being brought in from outside. However, once it is in the nursing home, it has the sort of chaotic environment in which the Virus loves. Nursing homes thus will require extensive structural updating, and not the least in this time of the Virus, the most effective air conditioning. AUSMAT brings that order to curtail the Virus.

However, the staffing, the qualifications, the required skills, the discipline required are the critical element. I find it somewhat baffling that the AMA have called for a Royal Commission, while there ostensibly is one due to report before the end of 2020.

However, in this area where there is a lack of objective data because in reality government oversight is minimal; then the various politicians fall back on anecdote. In so doing, it only serves to emphasise the disparate quality of the private nursing home sector; one politician has a good experience and therefore it is only natural to generalise from this one case in the absence of systematic data; a second politician has a bad experience … It is another matter for the politician to use his experience to defend the whole sector.

Having had a long association with this sector, it has been clear to me that it is important the industry should be recognised as part of the health sector – and therefore management should be devolved to the States so the possibility of co-ordination can exist, particularly in times of emergency. For instance, it was almost nigh on impossible to get nursing homes accredited and staff credentialed – as occurs with hospitals, because private nursing homes exist under Commonwealth rules. Those with shoddy practices are always resistant to such oversight, and unfortunately my experience is that the Commonwealth effectively goes along with that.

The problem is the all the health services concentrate on the services for which they are directly funded; and any regional co-operation is personality dependent. If there is a lazy or incompetent manager, the system is such that it protects them, because conflicting anecdotes and personal prejudice tends to thwart the solution – competent management.

Public/private health services have tended not to work because the mix stumbles over the financial imperative. The question boils down to how much am I, or my family, willing to pay for me to be placed in a nursing home environment. For the family without contacts in the health sector, the lack of objective information is a major problem when families are faced with making a choice and thus fall back on affordability and public relation handout where every private nursing home is “an invitation to Paradise”.

The better the nursing the less the knee-jerk reflex to bundle the patient off to hospital when ill. The more a doctor visits the better the preventative measures. The presence of a competent specialist geriatrician, especially those with psycho-geriatric experience who has a regional role in not only reviewing the difficult resident but educating the local general practitioners and nursing staff, the better the care. The whole matter of medical training in geriatrics and its ongoing turf dispute with medical rehabilitation specialists is another issue, which needs resolution in the longer term. However, “turf issues” are not helpful.

The last thing that is needed when the AUSMAT bring order and control of the Virus and then leave, its immediate task completed; yet there appears to be no national plan follow up. You know the normal mantra, “we have to wait until the Royal Commission reports.”

I would accept what Murphy and his mob decide rather than wait for a Report encased in governmental aspic, even one with the redoubtable Ms Briggs.

By the way, it is unfortunate comparison of AUSMAT with the SAS, AUSMAT do not, to my knowledge, kill innocent bystanders.

To Dr Weiss and all of your fellow owners of nursing homes, nursing home care should be a different vehicle – one shorn of the primacy of the dollar, one where you realise irrespective of how wealthy you are, old age approaches.

If one of the outcomes of this pandemic is to improve overall standards, improve co-ordination with the nursing home sector, enhance mutual respect, have a regular interchange of data and engage in all the rules of good management that the text books provide, then Australia should be satisfied. I for one want to be assured that I will not die in a bed of soiled sheets, where nobody comes and death arrives as a massive relief.

Fr Don Edgar OGS

Don Edgar died last week. Don was a country boy; his parents ran the newsagency in Wangaratta at the time I entered his life. Don and I met in College. Don was a theology student and I a medical student. There was nothing memorable about our meeting, which is often the case when you run into somebody and although you may immediately have nothing in common, you have an instant mutual regard – and form a friendship.

One person we both admired was the College Chaplain, Barry Marshall.

The Reverend Dr Barry Marshall

Following Barry Marshall, Don had a lifelong association with the Oratory of the Good Shepherd, in which he was appointed Companion, which brought a set of obligations where “piety” had a real meaning.

Barry Marshall was a charismatic figure. He influenced Don immensely. Marshall grew up near Coolah, north of Dubbo. His father was a grazier. It was unsurprising that after a stint in the RAF during the war and then ordination he became a “bush brother” based in Bourke. It is a funny thing but if my friends and acquaintances were a typical cross-section of Australian professionals, then there must have been a rite of passage to pass through either Bourke or Broken Hill on their way to their future career.

Both Marshall and Edgar were committed Christians, and Trinity College at the time of Marshall’s chaplaincy had a balance of spiritual guidance and robust secular behaviour. Marshall had a twinkle in his eye and reminded me of Father Brown with his kindness, his ability to listen, to have an easy relationship with the “Jocks” and possessing disciplined firmness. There were boundaries that he would not cross, and Don inherited much of this sturdiness. It was a tragedy that Marshall prematurely died as the result of an accident in Oxford, when he still had much to fulfil.

Don’s religious discipline I suspect had its seeds in his early time from the age of 13 being a naval cadet, with an eventual career beckoning at the end of his teenage years. He was a model cadet, midshipman and at the time of his resignation to pursue his religious vocation, a sub-lieutenant. Many of his fellow naval officers were in College at the same time but studying electrical engineering. Generally, aspiring naval engineers were sent to the UK for graduate education. Electrical engineering was the exception because graduates could study under Charles Moorhouse, who was Professor at University of Melbourne and regarded internationally as the doyen of this discipline.

There was one memorable night after we had both graduated and he was a curate in a country parish near the Victorian border in the North-east in the lee of the snow-capped mountains. My then wife and I were invited to stay with him, but the weekend was one of filthy weather that only Victoria can produce, windy, sleety rain – and the drive north in a car, far from waterproof. The heater gave up early early in the trip.

It was miserable, but eventually we were able to find the vicarage. We were almost completely frozen. However when we entered, the transformation was miraculous. The building was small and hardly imposing, but inside the fire had turned the rooms into a welcoming environment; the claret was at room temperature, the soup was simple – and Don was an easy-going welcoming host.

We had arrived long after the time we hoped to get there, but the fact that Don had provided such a comfortable destination is a memory that has been indelibly imprinted ever since. Never then and since had I felt such a welcoming environment – there is an element of magic – or is that another word for a unique spiritual experience?

Such was the nature of this extraordinary man who spent many years emulating the Abbé Pierre dicta – as a worker priest in railways yards in France, where he always said he was cold-shouldered by his co-workers until they found out he was an Australian not a Pom. On his return to Australia he continued to work in the railway yards in Darwin, he got married, had four sons.

During this period he re-entered the mainstream to the extent that for a time he was the vicar in Tongala, a dairy community in northern Victoria. It was another wintry night in 1981 when I was on my way to see him and his family, when my car aquaplaned on the flooded road, and the car ended up against a post and burst in flames. Maybe, it was an intercession, which caused the miracle of my escape from the car before it caught fire and  burned. My injuries caused by the accident prevented me from moving for weeks afterwards, and I was shuttled from hospital to hospital. Don visited me in hospital, but it was another six months before I visited Tongala and met the family.

Over the years we would see one another periodically as his domestic circumstances and calling changed, but when he finally landed in the western suburbs of Melbourne working among recent arrivals, in particular the Southern Sudanese community, it was almost impossible to find out what he was achieving so self-effacing he was. He just would not talk about himself. It was only listening to the sons talking about their father at his funeral that I knew what I had missed.

We had seen him last in February when we shared a Candlemas cake. He was then hampered by bilateral carpal tunnel operations, which ironically left him not only with stigmata but also dependent, which he hated.

This year has made communication separated by borders difficult, and it was only several days before he died that his stepdaughter asked that he was moved to palliative care and he specifically had asked her to let me know. As I said, I thought he was indestructible and he would bury me, but that was not to be. When he heard an audio message I sent to him, he responded with: “Good old, Besty.”

He died two days later.

The Eucharist was held at All Saints Footscray, from where he was farewelled by ten family members and an impressive array of the Church hierarchy. There were over 200 sites watching via online streaming. Modern technology had enabled us to be involved from 900 kilometres away.

Given the simplicity of his life, I wonder what he would have said if he realised that he was being borne away to his Destination in a Rolls Royce hearse. “Good old, Besty, trust him for noticing” and I can hear that laughter as he said it. 

The Day the Mormon came calling

It was just an ordinary day in Parkville some years when looking through the window of his terrace house, he saw two young clean cut men in dark suits, white shirts, thin ties and close clipped hair walking down the street. The boys had arrived from the Ark of Mormonism, he thought. It was an affluent neighbourhood so the two Mormons took the chance of separating. They stopped in front of our hero’s house. Next moment there was a knock on the door and the young watcher answered the door. The normal response to tell them to politely to go away was replaced by another stratagem. There being only one chap was just too tempting.

The young man was invited in and seated in the front room. Before he could get a word out, our hero asked directly “Are you a Christian?” looking intensely into the eyes of the young man. “I am a Mormon,” he commenced as he fingered what was probably the Book of Mormon. The Book of Mormon occasionally joins the ubiquitous Gideon Bible in motel rooms. Once our hero had flipped through the Book with all its underlying basic dogma, which could be construed as a derivative of American values. Pity about the polygamy, white supremacy with a Palestinian tan, and so on. It was not by chance that it was a Moroni who passed the tablets or was it cactus juice to jolly old Joseph Smith. Bit of intolerance in our hero, (which can be ascribed to youth) when he burst forth with “You are heretic. You need to be saved. You need to repent. You need to embrace Anglicanism.”

This conversional diatribe continued; our hero was now out of his chair stalking around stabbing the air with his finger calling out: “Hallelulah’ let this infidel be saved.” The voice rang out. The Mormon was now on his feet backing around the room trying to get away from the intense yet beatific expression.

“Repent ye, and be saved from this work of Satan. Become an Anglican.”

At this juncture, a young woman entered the room. She looked at the chap with his back to the wall. She laughed at the sight as much as that young woman ever did.

“For God’s sake, would you stop yelling, you’ll wake the children. Let him go. You’ve had your fun.”

“Nearly had him converted when you interrupted. Fire and brimstone. Good for the soul. He just about ready to change your gear that of the Anglican – sports coat, leather elbows, college tie and cords.”

“Don’t mind my husband, you can go whenever you would like.” She had ignored her husband, moved out of the front room and opened the front door, there being little distance between the room and the front door. The terrace house was one of those with the front door is almost on the footpath.

If you have never seen a “scuttle”, then you had to see that one, eyes to the ground, clutching his Briefcase and Book, and into the arms of his partner who had come back to see what had happened.

The young woman gave her husband one of those looks and went back to the kitchen or wherever.

Never been troubled by Mormons since though. Whether the Anglican converter’s transmission matured as he aged is a moot point.

Putin Nyet

As an addendum, Sydney Russians were one of the groups that voted against Putin. A shirtfront? At least a tug on the coat tails.

Mouse Whisper 

The John Travolta of the Australian Parliament, Furbo Wilson has set up a ginger group called The Wolverines (given the colour of wolverines perhaps it should be more appropriately called the “umber” or perhaps “melena” group.)

Now for Mr Wilson, a few facts:

  • wolverines stink like skunks
  • they feed off other animals’ kill – the animal equivalent of rent-seeking.
  • wolverines are snowy relatives of the weasel

So your group of jolly jape-ridden parliamentarians could be called the Wolverine Skunk Weasels.

Beware also if the Labor Party ever set up a Grey Wolves group. Grey Wolves are the biggest killers of your WSW. Take your pick Tibetan, Eurasian, Caspian Sea or Tundra Wolves -all Grey.

We rodentia know stuff!

One of the wolverines

Modest Expectations Ate

Bob Hawke has died. A cricketer, he would have been proud of making 89. Unlike Whitlam, he had a very good first XI. Some were brilliant. He did not make the same mistakes as Whitlam. He was not divisive; as with all good captains, he gauged the strengths and weaknesses of the opposition, and that of his own side. He had at least one dictum – he exerted attitude change in his own party such that the old time union collective thinking in which he had grown up, was changed.

However, when you go against your normal working person constituency, no matter how beneficial that might be for the Australian community, paradoxically you increase the power and influence of those elements which remain emphatically opposed to your reforms and who, over time, would seek to distort or destroy those reforms.

In time others may pore over the Hawke legacy and I for one wonder what he would have done for Australia if he were of the current generation and waiting for Saturday.

A Surfeit of Coke

Talking of mortality, one option that has not been widely canvassed about the current US Presidency is that Trump may die suddenly in office. If it is true that he drinks 12 cans of Diet Coke a day, has a diet of fast food and is so obviously overweight suggests that he is a walking health disaster waiting to happen.

In his latest medical history his height is recorded as 6ft 3in, but on his medical record when was being drafted into the US Army the record says 6ft 2in. Has he grown an inch as an adult? Really? Look at his shoe heels. Already obese at his recorded 243 pounds, how does anyone know what his real weight actually is? That missing inch plunges him further into the Obese.

Of course we do not know about his health status any more than we know about his tax returns. He obfuscates from his sandpit. It is his whole strategy to create sandstorms.

However, the one thing that Trump cannot make a deal about is his physical health.   He can only hope that the drugs will deal with his atheroma, not to mention what appears to be a cancer-prone diet.

Judging by the media reports there is a chorus of learned doctors or psychologists who obviously believe he is mentally impaired despite the protestations. His bizarre behaviour is just a quirk of his personality – a legacy of his early childhood his apologists say.

Trump prefers Diet Coke, and his daily consumption of it is extreme. According to the pundits, the excess drinking is linked to mood swings and dementia. As we all know, because he tells us, he is a cohort where n=1. He may be thus unaffected and the mood swings may be due to other factors, but the world ought to know. It is reasonable to know the mental state of a person who has control of the nuclear button, and what has caused it.

Is he mad? It is a question that publically the world would not answer through its current beige array of politicians. There are those politicians who prefer the Trump flamboyance – a man of many mental colours. There is that state of Munich delusion that one can cuddle up to Trump, know this man’s mind, and get him to sign a promise to be a “good, predictable boy”. Some have tried to put a political straitjacket on him – to be his great friend and mentor – to their cost. That is his art of the Deal. It costs you, not him!

Well, his handlers could deprive him of Diet Coke and see what happened, and see if the twitter finger stops twitching and rationality prevails.

However he is well past satisfying Koch’s postulates. The Diet Coke could have replaced his blood and no longer would he be like any of us mortals …

He is the Child Trump caught up in The Rapture. The Rapture is quoted as a doctrine that at the return of Christ, all believers will be caught up, “raptured”, to meet the Lord in the air. The bodies of dead believers will be resurrected, and all believers, living and dead, will be glorified. To the believers, it is a passport to immortality. That is the Child Trump constituency, who may call him not King but at least Duke.

The problem as with Mr L Ron Hubbard, whose disappearance galvanised a whole generation of charlatans, if he dies now as a demonstrably unhealthy Old Trump, his followers may believe the Child Trump is not dead. He may become a cult for the Enraptured, setting up shrines with figurines of the dear little child with golden hair and red baseball cap along the highways of America waiting for him to come again.

However, that is probably better than that of him never accepting the American people’s verdict saying at the end of 2020 “You’re fired!”

Shoulder replacement – The Anatomy of Medical Advance

I have a worn-out body. A major road accident over 30 years ago did not help.

So I was attracted to an advertisement in a major metropolitan daily for complete shoulder replacement. The advertisement is cast in a way that suggests it is just the thing for a worn out shoulder. Out with the old; in with the new. Like repairing a car, but with a car you at least can get a written guarantee.

However, when one is embarking on a major operation, such as a shoulder replacement, it may go well. You, the patient, if it is a new procedure, may become the poster person for the operation, the one the hospital and surgeon wheels out when boasting how great you, the Result is. You are the Positive Result and are allowed to say a few words, the surgeon performs the benediction, interviewer sums up from the media handout – and the camera is turned off.

The problem is that what the advertisement lacks is setting out the complications, which are rapidly becoming the small type to protect the surgeon and which frankly most patients do not want to hear. There it is in small type at the bottom of the advertisement: “any surgical or invasive procedure carries risk. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.”

However, if you get a complication with such a complex operation as a shoulder joint replacement, you are looking down a long corridor of pain and disability.

I consulted a shoulder surgeon some time ago, because that is how specialised orthopaedics is. This bloke was very frank. Shoulder surgery was difficult; unpredictable results; the surgeon he would recommend is “very good”. However, in the end it is how much knowledge I, the patient, have in making an informed decision. I weighed the evidence up, and said I had decided against an operation on either shoulder.

Outcome is one matter for making an informed decision, especially as increasingly surgery is leaving foreign material in your body. Some is fine; some is not and when a technique is new, how do you know the likely outcome? The answer is you, the patient, do not. Trust in the integrity and skills of the operator are paramount.

But not quite! What was absent from the advertisement was the cost.

Let’s list them.

There is the cost of the hospital stay – everything down to the nametag. The cost of the surgeon – the enquiry about whether there was an assistant and why – and then the anaesthetist. That person is often forgotten in determining the cost, because he or she is the person the patient sees fleetingly.

Then there is the cost of rehabilitation. Because there is a belief that the surgery has a magical effect similar to laying on of hands, the need for rehabilitation may be underestimated. Try to take a middle course and ask, even if it means flattering your particular surgeon that “it could not possibly happen with him or her at the ready”, get a price which includes a contingency item for the costs of complications.

The solution – make it mandatory for prices to be displayed, including the guaranteed consumer floor price – that is, the Medicare benefit. This makes the shortfall starkly obvious.

Then given the notorious asymmetry of information, it is suggestive that there may be a case of brokerage – where those with knowledge negotiate for the customer, without the emotional stress of having the condition. Needless to say, there is a business model to be developed where, through brokerage, the asymmetry in health information can be corrected – as long as the process is uncontaminated, as the mortgage brokerage system recently was shown to be.

It’s Time – The Bubble rhymes with Trouble

One has the feeling that Victorians are going to go after Morrison and his crew with cricket bats. Morrison is not the right fit for Victorian voters. The hillbilly persona does not wash well in Victoria especially as he so clearly identifies himself as a New South Welshman, and the fact that Frydenburg is the only Victorian of note left standing says a great deal about the state of the Liberal party. The problem is the myth of a liberal Victorian has been blown away with the rise of the populist far right in Victorian Liberal politics, since the Kennett accession in 1990s.

The situation uncannily resembles 1972 – a NSW Prime Minister and a Victorian Treasurer. However, the Leader of the Opposition was Whitlam in 1972 – New South Welshman, secured six seats in NSW, the greatest number. His “It’s time” introduced the charismatic presidential-style campaign. Despite everything, Whitlam did not win in a landslide. In fact, Labor lost four seats in Victoria, one in South Australia and two in West Australia. However, it picked up seats in Victoria (net two), Queensland and Tasmania.

Snedden was never in any danger of losing his seat of Bruce in 1972 and Frydenburg should be in the same position. But is he? The bellwether seat is Corangamite, long a Liberal stronghold but for some time marginal with the spread of Geelong to the west counterbalanced by the shift of affluent retirees to places like Torquay and Barwon heads. If Corangamite is lost, so is Australia to the Government.

And tellingly Shorten is a Victorian.

If the Labor party wins big in Victoria, and takes seats in New South Wales and South Australia, what happens in Queensland, Northern Territory and Tasmania becomes irrelevant in the numbers game, except in perpetuating the cleavage in Australian society. This cleavage is not more starkly demonstrated than by the Green and Labor advance in the northern coastal regions of NSW. However, go across the border into the Gold Coast and one is in solid Liberal Party territory.

One has to realise that love of a member in Queensland is inversely proportional to the despisal in the “Mexican” States. Listening to a highly intelligent North Queensland academic referring to the member for Dawson as “good ol’ George” is confronting for those of equal intelligence without the privilege of being baked in the tropical sun.

However, there are several differences in the political scene now and in 1972 and that is the rise of the Independents. The Independents are fashioning themselves into a party of the Centre, freed from the constraints of the Creationists, Falangists and Rural Socialists, that coalition within the Coalition. One of the important features of this election is to see how well the Independents perform – one observation is that they seem to do well when the incumbent member is so appalling that anyone somewhere decent becomes electable.

The bellwether here is Kerryn Phelps. She profited from the clumsy dumping of Malcolm Turnbull and the fact that she had a high profile. However, the problem with her high profile is that she has a great deal of baggage and given her time as President of the AMA and the nature of her support base at that time, it would be a surprise if she has maintained that support base. Considering that her opponent has had more time to assess her, is a former DFAT charmer, is as likely to be as smooth as Dr Phelps is spiky, then she has a challenge. If she holds the seat, then again one can guarantee the swing is on against the Government.

However, the lessons for the government are undoubtedly how this country goes about climate change, how it participates in the Coalition of nations in the South Pacific, how New Zealand and ourselves become outspoken on the matter – just as I would remind the reader that 20 years ago we were outspoken about getting nuclear testing by the French out of our backyard swimming pool.

So I can predict, but I am notoriously bad at it. However, irrespective of whether Morrison or Shorten is Prime Minister after this weekend, any future government worth its reputation should realise that Australia is the joint Guardian of the South Pacific and Southern Ocean and Antarctica – and that is only the start. Trade and jobs become irrelevant if the Earth becomes uninhabitable.

And that, Mr Morrison, is not a Canberra bubble!

The Curse of Pre-polling – The Loss of the Democracy Sausage

I have voted. It was very convenient. It was easy to park the car near the hall. No waiting time. I met both the Greens and Liberal candidates – both nice guys. However as it is a safe Labor seat, you are more likely to meet Elvis Presley than the Member.

Pre-polling is so popular, since most Australians view voting on the Day as one step from having to go to the dentist. Having to run the gauntlet of those trying to shove a piece of paper into your hand and then having to queue, in the end, everybody will have exerted their preference and have voted by Election Day. In several elections’ time, if this trend continues, Election Day may become the Day that nobody came. So there you are, with the picture of politicians with a heavy countenance as they have when they are voting for an increase of their entitlements, in bilateral solemnity agreeing to now decrease the pre-polling time in the future. After all, one has to protect the “democracy sausage”.

Mouse Whisper

Heard in the Louis Vuitton emporium in Pooncarie as one stockman said to the Vuittoneur as he was looking through the range of outback portmanteaux:

“Why is it that politicians are always having Visions? Who do they expect to see? And why – if you can have a Vision of the Future – is it not acceptable to have a Hallucination of the future? Makes as much sense.”

 

Modest Expectations Too

Ron Lord

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

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

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

Can I jump puddles alone?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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