Category: Politics

Modest Expectations – Siatonta

Grisons, Switzerland – where they say siatonta

Harry Cain sounds as if he should be a shamus in a Raymond Chandler novel, but he was an amusing health bureaucrat whom I met in the early 1970s in Washington. We were both characterised as “bright young men of promise” and interested in improving the health care in each country – in fact we would be in the vanguard of such improvements, so our conversation went.

When we first met it was the Nixon administration in the USA, and the Gorton-McMahon carousel in Australia, but like many smart bureaucrats he was advancing upwards through the Department of Health, Education and Welfare. We saw one another whenever I visited the United States. Harry, with his sardonic manner, was popular and knew which buttons to push. He and I got along as well as any two could when we were a Pacific Ocean apart.

I have been going through my files and I came across a news article about Harry in the Los Angles Times of 14 April 1978.

Harry Cain had an intermittent stutter and it apparently manifested itself when he had to address an audience. This day when he started to address an audience of 200 fellow federal bureaucrats, his stutter got the better of him and his boss had to read his statement:

“I have totally lost my tolerance for the bureaucratic swamp through which a bureau like this must wade … old bureaucrats never die, they just grow obsolete and get transferred to another agency which can’t use their skills and can’t fire them.”

With those words he quit and it was reported that: “bemused bureaucrats came up to shake his hand (and) a woman threw her arms around him and asked, ‘what are you going to do now?’”

His reply was that he was going to climb out of that swamp and dry out for a while.

To my knowledge, having dried out, he remained within the Beltway – running for a time the American Health Planning Association, getting quoted, and arguing that there was a need for a less centralised control under Obamacare –reduced government intrusiveness which he characterised as “the micro-management of Medicare. The scale and complexity of the health care industry (which) are beyond the grasp of 500 politicians sitting in Washington.”

Swamp life

But nowhere does Harry appear to say he ever wanted to drain the swamp. However, there still remains the problem of how to co-ordinate an American health care sector when there are so many interpretations and so many unresolved prejudices; unfortunately his time has passed.

Strong as Your Weakest Link

In 1666, a fire started in Fish Yard off Pudding Lane, spreading from the king’s baker’s oven. Thomas Farynor, the baker, could not contain it and off down the lane the fire sprinted. The fire spread rapidly through the pitch and thatch of the crowded buildings until it was stopped four days later by the military blowing up houses at the edge of the inferno. Very few people died directly, although many buildings, including the Guildhall and churches including the Gothic Old St Paul’s, were destroyed. Spot fires persisted for many months in London.

Pudding Lane, London

Unfortunately, a French watchmaker was hanged after a false confession to starting the fire. Thomas Farynor was one who signed the petition accusing the watchmaker of starting the fire, then rebuilt his bakery and died four years later.

In 2020, the fire was a COVID-19 virus phoenix arising from its suppression in Melbourne. The strong rumour in need of rebuttal, if untrue, is that the recent spread of the coronavirus in Victoria was started by one of the ladies who had returned from overseas and in whom being confined rankled, or so the story goes, so much so that she started imparting sexual favours to her custodians in return for “day leave” as it were. The security detail was unskilled and untrained in the ethics which are implicit in being able to distinguish not only what is legal and what is not – but also the difference between right or wrong, even if these particular individuals escape prosecution.

The endemic problem is that the security industry is rife with undertrained part-time staff. It is not a new problem. When I was a medical student, I used to ride in the back of the Mayne Nickless security van, as the third guard. I was provided with a loaded pistol although I had no training. I worked in that job part-time for years. However the lack of training is never a problem until something goes wrong, as has happened with the spread of COVID-19 from the Melbourne quarantine hotel when the security was laughable. And somebody, Mr Premier, sanctioned its use, didn’t he?

As I write, the COVID fire is still not under control in the two largest States. We await the outcome of the enquiry and wonder how close to the truth the above rumour is and how many truckloads of whitewash will be brought in to expunge the stain. Presumably the perpetrators will be deluged with some of the wash.

However, there is another potential ember attack on the horizon, the jolly ministerial pair of Payne and Reynolds are slated to fly to Washington with a retinue of braided officers and presumably the “usual suspects” which accompany such people of renown. However, as a concession, limiting the number of the flacks limits the number of potential exporters of the COVID -19 to Australia, I presume they will have a trained medical team to ensure they will all be abiding by Australian requirements. They are going into an environment where the Boss is in flagrant denial. Are all these travellers going to abide by our rules or by the lax American requirements?

I presume social contact will be constrained and I would hope that all travellers are vetted for their history of alcohol consumption. Actually I would hope that all will be on the wagon for the duration given the propensity for alcohol to reduce adherence to anti-COVID rules.

And what are they going for anyway, except for huff and puff – apart from the fact that it will make the Chinese dragon even more infuriated. As I am writing this I am also watching Midnight Oil with that political dud, Peter Garret singing US Forces at a 1985 concert on Goat Island:

“US forces give the nod

It’s a setback for your country

Bombs and trenches all in rows

Bombs and threats still ask for more” … and onwards.

Easy to protest. I am surprised that the ALP is so acquiescent to the US trip. Richard Marles is its spokesperson. Richard Marles, the Geelong Grammarian who loves his toast buttered on both sides, is encouraging the jolly catch-up. Marles is not stupid and he is not endangering either himself physically or the nation by being a COVID carrier. However, it was the week when it was revealed that overseas forces in 1975 had rid themselves of a “troublesome Prime Minister”, and Marles knows that the shadowy forces mark down any Labor politician who does not bend the knee to overseas authority.

Being a boy used to the light blue trimmed blazer, he would well know the bounds of being a radical chap. He may have read about Whitlam’s sacking when he was a boy in Glamorgan knickerbockers – and somebody may tell him about a Mr Marshall Green whose successors are still abound.

The last recorded time an Australian Minister went to Washington was Peter Dutton and, as reported, his infected return elicited an almost hysterical reaction among his colleagues, who were were taken in hand and reassured by Dr Paul Kelly.

You know, small details about those who are going need to be considered in meeting these Americans. How many of the travellers are susceptible: over the age of 60, obese, suffering from cardiac or respiratory problems and having diabetes? Then there are the cigarette smokers.

Enough said. Sounds as if it’s not worth the risk, especially as Trump and his regime may be a footnote in history after November – and sanity begins to prevail again. After all, one is only as strong as the weakest link.

Peril at Buck House

Given I’m actually old enough to have participated in the prequel of the Whitlam sacking, to me it was always clear that it was a put-up job.

I must congratulate Jenny Hocking in having the fortitude to have the letters released. Strangely, Whitlam never maintained the rage, because what made him both great and yet vulnerable was his basic generosity.

This was the story of the three fops. One was Whitlam, but all his other positive characteristics overshadowed this vainness. The other two were also Sydney lawyers, one became a Senator; the other, Governor-General. They were James McClelland and John Kerr respectively. Both were very careful about their appearance – one exquisitely flamboyant and tasteful, exciting the sobriquet of “Diamond Jim” and the other embarrassingly boorish and tasteless, caricatured as an Irish squire with top hat and frock coat.

Whitlam was the son of a senior public servant. His education was a mixture of the public and the private with a taste of the early Canberra. McClelland, the son of a paperhanger and signwriter, was educated at St Patrick’s Ballarat and St Kevin’s in Melbourne, where he and B.A. Santamaria were mates. Kerr, whose father was a boilermaker who worked in the Sydney dockyards, went to Fort Street School.

All were very bright scholarship boys; all became lawyers – the second world war interrupted their careers. Whitlam and McClelland were in the RAAF. Whitlam was a navigator so he flew, whereas McClelland was a leading aircraftman and stayed on the ground. However, Kerr was the star; he was one of Alf Conlan’s bright young men – and a colonel by the end of the War. With Alf, he probably absorbed the dark arts of the double agent.

After the War they came to know one another well and, if it is to be believed, Whitlam was persuaded by McClelland to appoint Kerr as Governor-General on the retirement of Paul Hasluck. The die was cast, as Kerr’s boilermaker father may have said.

The constitutional crisis was played out, demonstrating Kerr as duplicitous egged on inter alia by Buckingham Palace. If the letters had been released earlier – say in 1999 when Turnbull was heading the push for a Republic, Australia may have been in a totally different state now. The longer the release was delayed, the more the response would be who cares? The major players, except the Queen, are all dead.

Undoubtedly the Queen knew about the coup. Her private secretary Martin Charteris was showered with imperial honours, most noticeably an escalating array of those that are reserved for personal gift from the queen. It is doubtful if a displeased sovereign would have been so bountiful.

However what I find instructive is that some years later when Charteris had retired to polish his escutcheon, the Queen was placed in a similar spot in relation to a constitutional crisis which occurred in Saint Kitts and Nevis in 1981, when the Governor, Sir Probyn Inniss, used his reserve powers to refuse assent to a bill passed by the government of Sir Kennedy Simmonds, the country’s premier. Inniss believed that the bill was unconstitutional. The situation was resolved when Queen Elizabeth II, at the request of Simmonds, terminated Inniss’s commission as governor.

The problem when retracing history is that in the end what has been done has been done. I, together with a number of other players who had roles akin to those of Rosencrantz and Guildenstern, may speculate on what could have been.

Fraser was a lousy Prime Minister and it may been argued that what Hawke wrought may have occurred six years earlier if Whitlam had belatedly brought in a new crew headed by Hayden and Keating and then had been allowed to manage economic policy until the scheduled election in 1978. But in the end Hawke did take over in 1983, and changed economic direction.

Many changes have occurred since 1975. The Melbourne establishment’s power is now vestigial and while the demise of these Whigs masquerading as Tories may have occurred, there has risen a very powerful plutocracy, with Sydney at its epicentre; but with Perth as a powerful outstation.

The reserve powers exist as long as the links to the British monarchy exist. Therefore, the Kerr situation could be used as a precedent for a repeat, if the plutocracy did not like the government. When you review the Governors-General since Kerr, one would have been confident that Cowan, Hayden, Stephens and Deane had the strength, integrity and wisdom in using the reserve powers in a way so as not to compromise the Australian democracy.

I would not have been so sure about the last lot of Governors-general, but the “reserve powers” situation should be addressed. It is a totally unacceptable situation that one unelected person is able to connive with a distant monarch, with increasingly tenuous links to Australia, to sack the elected Government – and to call that ability “reserve powers”.

What a joke!

The Australian propensity to change its Prime Ministers – seven in 13 years – equally may be a joke.  Thus it has been a basically unstable time and fortunately Australia has not been confronted with a Governor-General such as Kerr, using at whim the so-called “reserve powers”. Therefore, I would be wary of any merchant being appointed as Governor-General in the future. However, “reserve powers” remain the joker in the Canberra pack.

Codification of the reserve powers – just a jumble of words. I wouldn’t hold my breath that anything would occur, unless both political parties think clearly about what it means. Self-interest may drive the thoughtful on both sides of politics. Conservatives should wake up in a sweat about the spectre of a Jack Lang as Governor-General invoking “reserve powers”.

And the Australian Republic? I am an avowed Republican – but so what? I know what I would want. Given the social and economic instability of the current situation in this year of the Virus, the matter of a Republic seems somewhat of a sideshow. However, at such time as the Queen abdicates or dies, that will be the time for a serious thrust from the Republican forces.

In the meantime, the Republican movement should plan that the sideshow is ready to become the main event. Then the matter of any “reserve powers” may become irrelevant – or would it?

Putin and His Kosher kitchen

In 2001, Putin was still feeling his way amongst the leaders of the World. In January of that year he dined with the then President of Israel, Moshe Katsav. As reported in the NYT, the meal was kosher, “making the occasion a first for a Russian leader in a thousand years.”

Putin with his matzah bread

The food was kosher – mushroom soup, vegetable stuffed veal, roast turkey with fruits; even the caviar was from red salmon rather than from the scaled sturgeon.

As distinct from the White House which still ordered-in kosher when the Israeli leader came calling to Washington, Putin created an entire kosher kitchen that, as reported, required “among other things, an army of rabbis, all-new utensils and a blowtorch.”

A kosher blowtorch?

Yes, the blowtorch can help make a kosher crème brulee.

Putin has tried to dampen down the anti-semitism that has been a feature of Russia social policy – pogroms being the centrepiece. However, after briefly trying to implicate Jews in the 2016 anti-Hilary campaign, Putin has aligned Russian sacrifice in WW2 with the Holocaust. It is a way of emphasising the history of anti-semitism among the Slavonic people, but extracting Russia from the general contumely.

As reported during a recent January speech at the dedication of a monument to the siege of Leningrad, Putin indicated his latest thinking on the Holocaust and anti-Semitism. The Kremlin now sees the distinct and separate story of the Jewish wartime suffering as supportive of its broader campaign to improve the image of the Putinic Russia.

After all, Putin has had an easy time of it facing a divided opposition where clearly, for whatever reason, he has an ally in Trump. Putin very clearly realises that Russia can only achieve limited goals with military force. It is ironic that he seems to be using a similar tactic to that used by the USA to destroy the Soviet Union in Afghanistan. His support of Syria and the continuing military action in the Ukraine after his annexation of Crimea are targeted, and it could be argued that these could have been stopped if Trump were not his ally. However, the whole Trump association may have to wait until Trump’s finances are disclosed – if ever.

Putin, despite his spoiling tactics and his annoying misuse of cyberspace where it is inconceivable that he has any technological advantages, has looming problems. His is not a wealthy country as judged by its GDP, especially with its reliance on oil and the need to manage a vast country, made particularly vulnerable by both climate change and his own disdain for the environment – and the Virus.

It is always unwise to underestimate the Russians, as distinct from Putin. They have this habit of producing excellent strategists. This ability is manifest in their overall supremacy in chess. Russians are remembered mostly for their WW2 exploits against Germany and by their defeat of Napoleon.

Capturing Moscow has been a mirage for many invaders.

In 1709 there was the less well-known Battle of Poltava in what is now Ukraine. In a long term but initially successful campaign against Russia under a very competent leader in Charles XII, the Swedes against the Russians had the high hopes of taking Moscow.

Instead, the Swedish empire was effectively destroyed at that Battle and the Russians, under the generals of Peter the Great, not only gained Ukraine but also the Baltic states, giving Russia unimpeded access to the Baltic Sea. This access was consolidated by the concurrent construction of St Petersburg by Tsar Peter on what was swampland on the Baltic shore along the banks of the Neva River.

If you want to experience both Russian power and grandeur, St Petersburg should not be missed. As a parenthetic comment, the reconstructed Amber Room in the Summer Palace is one the wonders of the modern world.

Yet with his keen sense of history, Putin would know that Russian leaders have thrived on governing with the use of often unspeakable brutality. Putin has recently won a vote for him to govern until he is 83 years old. His desire for alliances, his disruptive tactics, his hold over Trump, the American floundering in Iraq and Afghanistan, his drive to maintain and expand access to seaports have served him well, as he has climbed the rungs of power from his unheralded anointment as Yeltsin’s successor in 1999.

Nevertheless, especially once the Virus has extracted its toll, when Trump has gone, when the Chinese have assessed his true value to them and Russia is again exhausted financially, the coming decade will certainly be a test of whether the blowtorch will only be used for the crème brulee.

Mouse Whisper

I have actually seen the newspaper cutting from The Age sometime in mid 1981 under Missing Friends, personal:

“Would anyone knowing the whereabouts of GUY FAWKES please tell him we have an urgent job for him in Canberra.”

H.B. (Marlo)

Would anyone knowing the whereabouts of H.B. from Marlo…

Guy Fawkes

Modest Expectations – Maria A Nona

Just a brief acknowledgement of Prof Brendan Murphy becoming the first medically qualified head of the Commonwealth Health department since Gwynn Howells was Director-General from 1973 to 1982. Murphy has a certain quality, which can survive the neo-liberal/ Canberra mandarin doubt. You know, doctors should stick to their knitting – and not mix it with the “big boys”.

I must say I have been always sceptical of that mantra which inter alia the late John Paterson promoted – namely you could be content free and run a Health department with minimal knowledge of the portfolio. To Paterson, health was only an unadorned matter of cost accounting. 

Another view of the Endurance

There is one piece of COVID-19 information about the South American situation that does not get much coverage. The rate of infection in Uruguay is very low, currently being less than 1,000 infected, with 27 deaths.

Now Uruguay has only 3.5 million people and while the death rate on a population basis is higher than ours, the number of cases is very respectable given that it has borders with Brazil and Argentina.

In an earlier blog I have written of my experiences about Uruguay last year. It has the characteristic of a Spanish-speaking culture but one I found, as an Australian, a very comfortable one. Maybe it was because we had two fantastic guides with an appreciation of Australians.

If we look at attenuated tourist bubbles of countries that have suppressed the virus, Uruguay should not be left off the list.

Montevideo

Two matters stand out. The first is that a third of the population lives in high-rise condominia along the Montevideo waterfront. In some parts Uruguay may be sparsely settled, but it has one substantial city, Montevideo, with a crowded population that seems to have avoided the CoVid-19 occurrence of other cities with substantial high-rise populations.

The second relates to the MV Greg Mortimer, with a substantial number of Australians on board. There could have been a complete disaster without the intervention of the Uruguayan Health authorities.

The World Health Organisation had declared COVID-19 a pandemic three days before the brand new, luxury MV Greg Mortimer (which despite its illustrious name is registered in the Bahamas), with a crew of 85 and 132 passengers, set sail from Ushuaia on March 15 on a 21-day cruise following a similar route to that of the Antarctic explorer Ernest Shackleton.

During the next 13 days the virus struck, although everybody tested negative for the virus before they boarded. Progressively more and more tested positive until 81 of the crew and passengers had contracted COVID-19.

Both Argentina and the Falkland Islands would have nothing to do with them, even though the passengers had embarked in Argentina at Ushuaia. The Uruguay government allowed the ship to anchor 16 kms off shore and then sent in a medical team to assess the COVID-19 status of those on the ship

Uruguayan physicians who boarded the MS Greg Mortimer to assess the passengers and crew

This story has been told recently by a respiratory physician, who was on the ship. He highlighted how careful and ordered the Uruguayan authorities were in handling the situation. They provided a “sanitary corridor” which allowed for repatriation, where those who were sick, including one of the ship’s doctors, were taken from the ship. Eight were hospitalised and one person unfortunately died.

As described in a recent issue of the Macquarie University journal, the way the matter was handled was in stark contrast to the Ruby Princess fiasco.

To his credit our Prime Minister was very generous in thanking Uruguay, a fact that should not be forgotten in the Year of the Virus.

The Presidential position had just changed back to the Conservative coalition, with Lacalle Pau, the surf-loving scion of an old Uruguayan family winning the runoff from his Socialist rival by only 30,000 votes. The maturity of this change in government reflects well on the state of democracy in Uruguay and on the successful approach of containing the virus even with a change of government.

Remember also Uruguay has a 1,000 kms border with Brazil and while there are nine border crossings, in one instance between two of the border towns, it is virtually just a line on the ground, little if any spread of the virus has occurred across the Brazilian border.

Yet according to The Guardian, Uruguay is fourth in the world for success against the Virus with New Zealand first and Australia second.

The discipline shown in handling the Greg Mortimer is an exemplar, and explains the current success. While it is not stated when you are moving people from an unsafe environment to a sanctuary, nobody wants to be last off, and yet the Uruguayans were able to maintain the discipline and co-operation for 19 days before the last person was evacuated from the MV Greg Mortimer.

In Uruguay, the current Minister of Public Health is Dr Daniel Salinas, a medical graduate but it seems that five years is a long time as Health Minister. He has only been in the position since March this year.

Talk about a baptism of fire and he has already been “outed” for going where he should not have gone during the lock-down. The words were harsh, but for now he has kept his job. 

In the Year of the Virus

In the Year of the Virus, what is written at the beginning of the week may be superseded at the weekend by the way the virus is driving the government agenda, both the economy and social intercourse. How something so small can change the way we go about our life tests our ability to maintain order and not succumb to the chaos of the individual ignorance – whether wilful or not.

Chaos is epitomised by the image of the two old guys in a street in one of the infested suburbs culturally kissing one another on the cheeks and then when they knew they were being photographed grinned like idiots into the camera. As I pointed out last week, the active elderly are potentially great Virus spreaders, especially as the niceties of the reasons for testing seem beyond them.

Premier Andrews is very adroit in being prepared to call out the Aspen skiers as “persons of interest” who brought the Virus into Australia. “Bad people”. However, his adroitness is in not blaming but at the same time blaming his Labor-voting constituency.

Andrews recognises it is pointless to call out the peasant mentality that the Florentine Leon Alberti identified 500 years ago as “amoral familism” – an inability to think beyond the extended family. Panic buying is one symptom, and disregard of any appeal to community values is another. Hence the Andrews adroitness is the gentle appeal to particular community leaders in public; and then giving them a stronger message in private.

The message has changed abruptly about those in quarantine who refuse to be tested. It turns out that the resistance has occurred among children – or rather their parents for testing their offspring.

For adults, there is no excuse; the sanction should be unyielding. The other means are either the addition of another ten days to the quarantine period, or else use the new saliva test for children. The reasons for these changes rest with the experts’ assurance that the extra ten days are sufficient and that the saliva test has a comparable degree of sensitivity and specificity to those of the current procedures.

However, it does not change the need to have designated quarantine facilities near all the international airports. One of the successes occurred early with the efficient evacuation of people from Wuhan to Christmas Island and the Darwin Howard Springs facility.

That is one good reason to have permanent quarantine facilities, if for no other reason than to streamline the process of quarantining returning citizens and permanent residents to Australia and to provide space so people are not cooped up in hotels with untrained supervision, as instanced in this case. The short-term objective of improving the bottom-line of the hotels should give way to planning for a long term recognition that inevitably we will have another raft of diseases without vaccines, and thus need designated, properly designed facilities.

Whereas a ship used to raise the yellow flag to denote Infection, so must a community flag be raised to indicate a suppression of pandemics, for which the only defence is suppression through isolation. What does Australia want – worrying about cultural sensitivity and spurious privacy issues or protection against the disruption caused by a pandemic?

Andrews invoked Bentham’s utilitarianism in his media conference last Sunday; his government must work for the greatest good for the greatest number. Here he is so right, but the refusal of a substantial number of people to be tested will challenge how consistent his resolve is, or whether he considers them as “conscientious objectors”.

Governments have a number of precedents for such a group, but he seems to believe that locking down certain suburbs until the end of July may suffice. It is a difficult policy to police.

On the other hand, the vested interests remain. There is a serious one that will lurk well beyond the end of July.

Quoting from the Sunday Age, “questions have been raised this week over when health authorities contacted Cedar Meats about the positive cases and over the government’s decision not to initially name the abattoir, whose owner was a long-time member of the Labor Party.”  

Meat processing facilities – in my language, abattoirs – because of the working environment are perfect areas for the virus to re-gather its strength. This Cedar Meats facility owned by the Kairouz family has previously been subject to questions about its occupational health and safety, and now by definition it is a “hot spot” until proved otherwise.

However, rather than pursuing the Lebanese connection, would it not be better to set up a preventative strategy in regard to all the meat processing facilities throughout Australia? Maybe that is in process, and as a casual observer, all I can say is that it is an obvious matter to consider, given it is an international problem even threatening to compromise the food supply chain. Therefore, who is working on the uniformity of rules here that recognise the seriousness of the situation?

Quarantine facilities are not holiday camps. They are facilities to isolate for a period for the few whose freedoms are temporarily sacrificed for the greater good. The government has become expert in building such facilities for asylum seekers. Maybe with the media spotlight on them and staffed by trained health professionals rather than guards of dubious experience, there will be more humanity in the construction of quarantine facilities. The Olympic village model springs to mind, with all subject to social distancing and hand washing “between events”.

The promise of a COVID-19 vaccine

The history of vaccines, and especially one against a coronavirus would suggest that it is nonsense to expect a solution in the near future – if ever. There may never be a vaccine and therefore the world must work around suppression of the Virus.

It is somewhat like 1938 and Neville Chamberlain waving a piece of paper and talking about “peace in our time” – it could easily be any of our current political leaders substituting “vaccine” for “peace”. The world has found out that it cannot eliminate war – it devises mechanisms to try and suppress it – not very successfully as there are hot spots breaking out everywhere as countries lose respect for borders read “social distancing”; for “hand washing and sanitisers” read “defence”.

The corpus of research scientists has the same quota of flimflam chancers as the rest of the population. Labelling someone a “research scientist” is not equivalent to beatification. As a somewhat mediocre medical researcher I was fortunate to work among some brilliant medical scientists. I sympathise with Brendan Murphy and his obvious unsuitability for research. Mine was a forgiving research environment, but then I never wore a tie in the laboratory.

I learnt the hard way, but because I was in a laboratory where the technical standards were high to complement some of the best scientific thinkers of my generation I was very privileged. I learnt enough to achieve two doctorates in a time when one could do that without being consigned to the debtors’ prison for unpaid HECS fees.

However, I learnt one lesson from two distinguished scientists, Ian Clunies Ross and Frank Fenner. When the myxomatosis virus was developed to infect and kill rabbits, both these men were the first to have themselves injected with the virus to show that the virus did not harm humans.

I remember one of my experiments demanded taking arterial blood. First person for this study to have that procedure done on himself was me. As the responsible researcher, if I expected others to take part, then I should be the first volunteer. Arterial puncture is no big deal now, but it was different 50+ years ago.

These days the whole process has been made more complicated as the ethicists have moved in. These days Clunies Ross and Fenner probably would be surrounded by reams and reams of paper seeking justification for their research.

However, the principle remains the same.

As one psychologist has expressed it: “The golden rule – do unto others as you would have them do unto you, is about as basic as morality gets. It’s the bridge between empathy and sympathy, between putting yourself in someone else’s shoes and making some accommodation to them as a result.”

That simple statement does not need a synod of ethicists to ratify. After all the 1978 Belmont Report said much the same in a great many more words. Among the reasons for this Report were revelations in regard to the Tuskegee experiments. The Tuskegee Study of Untreated Syphilis in the African American Male was a clinical study conducted between 1932 and 1972 by the United States Public Health Service. The purpose of this study was to observe the natural history of untreated syphilis; the African-American men in the study were only told they were receiving free health care from the Federal government of the United States.

Dr Cutler referred to below was complicit in a substantial way.

Naturally there are now researchers tripping over themselves in the search for a vaccine for COVID-19 as if this whole research exercise is less about research and more of a gold rush. The issue of how to fast track this process has inevitably lead to the question of challenge trials.

Descendents of the victims of the Tuskagee experiment

The nature of a challenge trial involves giving healthy subjects a prospective vaccine and, in this case, then infecting them with a coronavirus. As the Tuskagee and Guatemala experiences show, it can be totally unethical, and while these quoted may be extremes, there are many shades of grey.

An article in a recent issue of the New York Review of Books commented on a new book on Adverse Events: Race Inequality and the Testing of New Pharmaceuticals by Jill Fisher, a social scientist at UNC-Chapel Hill.  The reviewer, Carl Elliot, a Professor at the University of Minnesota, notes 38 members of the US House of Representatives have called for COVID-19 challenge studies to be put in place. Perfect – they can be among the first cohort to be challenged with the Virus but protected by The Vaccine.

Carl Elliot is concentrating his literary endeavours on whistle blowing and unethical research. He makes the point that in these often dangerous challenges, the “volunteers” come from the bottom of society: the poorest, the most easily exploitable, prisoners, people in impoverished countries like Guatemala or Alabama.

A challenge study on Guatemala poor in 1946-48 mimicked those carried out by the Nazis. These US researchers:

  • intentionally infected victims with syphilis and gonococcus without informed consent
  • failed to provide victims with treatment or compensation
  • covered up and did not publish or disclose the experiments, including the intentional infections and failure to provide treatment.

It was not until after his death that the person who led the study, John Cutler, a public health luminary, was revealed as the monster he was – but there were accomplices. After all, for every Dr Jekyll there potentially lurks a Mr Hyde.

Challenge studies may be integral to testing of particular research protocols, but the researchers should be prepared to be the first to be challenged. The organisation 1DaySooner promotes challenge trials and allows individuals to volunteer, or to be advocates for such trials. The website notes there are currently (as at 2 July 2020) 30,108 volunteers “interested in being exposed to the coronavirus to speed up vaccine development”. Volunteers implies they will not be paid or expect to be paid.

Still, if I were the lead researcher I would expect to be the first one infected. How many of the myriad researchers will volunteer to be the first one tested with their own challenge protocol if and when it gets to that point?

Let Him Sleep

In a question on notice on 28 October 1982 from Barry Jones, the then Minister for Foreign Affairs, Tony Street responded with the following. In so doing, between the two, they encapsulated much of the story of Raoul Wallenberg:

(1)       Is he (Street) able to say whether Raoul Wallenberg was First Secretary of the Swedish Embassy in Budapest from July 1944 to approximately February 1945 and was he described as the ‘hero of the holocaust’ for his work in saving Hungarian Jews during the Nazi occupation?

(2)       Is it a fact that he was last seen in Hungary in or about February 1945 when he set off for an appointment with officers of the Red Army?

(3)       Is it a fact that reports have been received in Sweden that he was being held in a Soviet prison since that time, that he was last sighted in the late 1970s and that, at the age of 70 years, he may still be alive and that he has been seen in Soviet prisons?

To which Minister Street replied in part:

… the Government is aware of reports that Mr Wallenberg is alive and that he has been seen in Soviet prisons. Sweden continues to pursue the Wallenberg case with the Soviet authorities, who so far have done no more than repeat their claim that Mr Wallenberg died in prison in 1947.

The Australian Government fully supports the efforts of Sweden to have the case re-examined by the Soviet authorities. Because the Australian Government has no direct standing in the matter, however, there has been little opportunity for us to make an effective intervention. The matter is basically the concern of the Swedish and Soviet Governments and for the time being it is felt that Sweden is best placed to press for a more satisfactory response from the Soviet authorities…

There is no doubt that Wallenberg was a very brave man. What he did for Hungarian Jews in trying to save as many as possible from the gas chambers was extraordinary. One of his strongest promoters in the Australian community is Dr Frank Vajda. Wallenberg saved him, at the age of nine, together with his mother, from the firing squad – a direct intervention. Everybody interprets miracles differently, and there is no wonder that Vajda, who later became a noted Melbourne neurologist, views Wallenberg as his personal saviour.

Kew

Wallenberg was made Australia’s first and only honorary citizen in 2013. An exhibition honoring him was shown around Australia between 2015 and 2019. In his brief time in Hungary, he saved many Jews. Some, as with Professor Vajda, came to Australia. There are around Australia many Wallenberg monuments. In Melbourne, I have always acknowledged the bust of him when driving past, if it was safe to do so, since the bust is perched near a busy intersection in Kew.

It is inconceivable that the Russians would not have known that the Wallenberg family not only enabled German industrialists to hide their assets but also ironically helped the Nazis, though their bank, to dispose of Dutch Jewish assets. The Russians tend not to differentiate; once a Wallenberg, always a target.

Whenever or whatever the Russians did to Raoul Wallenberg just highlights the corkscrew of the Russian mentality. In 1982 the possibility, however tenuous, existed that he was still alive. Now 108 years after his birth, non acceptance of his death makes his memory a pointless hagiographic conceit.

On 26 October 2016 the Swedish tax authorities (responsible for death certificates) finally pronounced Wallenberg dead and to be considered having died 31 July 1952. “Han ska anses ha dött den 31 juli 1952”, skriver Skatteverket i sitt beslut.”

Given those words, it is surprising the Swedish embassy allowed the question mark over his death to remain on the information sheet advertising the Wallenberg exhibition last year in NSW. The Swedish Government has done so. When Tony Street replied to Barry Jones’ question nearly 40 years ago, and there may have been a reason not to bring closure.

The Swedish Government has now recognised one of its national heroes has died. He should no longer exist in some limbo. To dismiss the recognition as a Swedish administrative mechanism is to not accord Wallenberg the recognition that he died in Russian custody.

Also, I know that some people who were directly saved by his intervention believe he should be revered as a giant of the spirit, but he was made our only honorary citizen of Australia in 2013. Why? He did not have the chance to accept; did the proposer, having refused to assign a date of death, seek to ask his advice on the matter?

I wonder whether being made an honorary citizen of another country would have been significant to him and whether he himself, having been described as being a diffident person, would have accepted? One of the problems is that people who often indulge themselves in the pursuit of vestments and honours just assume that the object of their esteem would agree.

There is a touch of arrogance in making such assumptions, particularly in the case of affording people nationality. And if you think about it, why “honorary”? Either you are a citizen or you are not.

Then Prime Minister Julia Gillard, in her eulogy when Wallenberg was awarded his honorary title, said: “Some of the individuals whose lives he redeemed became part of our first great transforming wave of post-war immigration; among the first to pledge themselves to their new home after Australian nationality was formalised in 1949.

Surely that was testament enough to his ongoing legacy – those who were spared and then were able to make such contributions as Frank Vajda. What does Honorary citizenship add and in 120 years of Australian Federation, why one?

I think Wallenberg was one of the greatest men of the twentieth century, even though he had such a short life. After all, he was the same age as Jesus when he disappeared.

Jesus left a spectacular legacy, one that has been transformative for our country as with others. Do we then make Christ an honorary citizen of the country? And of course we do not have a death certificate for Him either. But does anybody believe that Wallenberg rose from the dead? Allow him closure.

Mouse Whisper

Ever thought why it is mice but not hice? Well it is all because in the Saxon language hus was a neuter noun whereas mus was feminine. So in the plural it is still hus but for mus, which becomes mys to the plural (as was lus).

But it is more probable that in the future there will be “three blind mouses” before it becomes “as safe as hice”. After all, those little gadgets that are pushed around computers are mouses not mice. It just illustrates there is a tendency in all language usage towards homogeneity and simplicity.

So as my Aussie quoll friend would say, it’ll be grouse, mate – and grouse is grouse never grouses nor grice.

Or because we mouse love devouring literature, will it become a case of “eatymology”?

Modest Expectations – Paul Egan

I was reading Rupert Brooke’s Letters from America, which he wrote about his 1913 journey, but which wasn’t published until 1916 with a foreword by Henry James – apparently his last piece of writing. Brooke had died in 1915 in Greece, and is known for his romantic view of dying for one’s country.

The flag of German-occupied Samoa

The book is a set of well-written notes about Brooke’s 1913 travels which, despite the title, included a visit to Samoa, then under the German flag. Brooke is very sympathetic to the German rule saying it was better than that of British rule in Fiji. Nevertheless, a Samoan princess did not agree with this assessment. Climbing the flagpole she removed the German flag and, having torn it into pieces, danced on the remnants. Brooke does not report any retribution.

He describes Samoa as Heaven and although it was ruled for a time by a tripartite administration of Germany, United Kingdom and USA, in 1900 the western islands were ceded to Germany while the Americans kept the islands east of the 171st degree meridian. This latter information was not gleaned from Brooke’s writing, but his book did draw my attention to the fact that New Zealand invaded Samoa at the outbreak of war, rounding up the 50 or so Germans and native auxiliaries. New Zealand did not let go of its conquest until 1962. The League of Nations bequeathed it as a territory and other post-war finagling ensured the long time to independence.

Rupert Brooke’s account was certainly not first hand of the invasion but it is a wonder nobody has made a film of the story – with Sam Neil at the head of the expeditionary force wandering the Pacific before mounting the invasion. The Germans had a couple of large ships in the area but they were told by Berlin not to attack. A film would suit Neil’s wry humour.

Anyway Brooke wrote the following: “They must have landed at noon, I see. How hot they got. I know that Apia noon! Didn’t they rush to The Tivoli bar – but I forget, New Zealanders are teetotallers. So, perhaps, the Samoans gave them the coolest of all drinks, kava; and they scored. At what dances in their honour, that night! – but, again, I’m afraid the houla-houla would shock a New Zealander. I suppose they left a garrison, and went away. I can very vividly see them steaming out in the evening; and the crowd onshore would be singing them that sweetest and best-known of South Sea songs, which begins ‘Goodbye, my Flenni’ (Friend, you’d pronounce it), and goes on in Samoan, a very beautiful tongue. I hope they rule Samoa well.”

New Zealand Troops in Samoa NZ Archives*

Overlooking this invasion was Tusitala, the great bard of the South Seas, also known as Robert Louis Stevenson, who now lies atop Mount Vaea in Apia. I still shake my head at the thought of the Kiwis invading Samoa.

This is a Knife

That is the famous line uttered by Crocodile Dundee when threatened not by a white, but a big black man – dinkum white Aussie threatened by a stereotype. We whitefellas felt comfortable; great sight joke and the sub-title – a smart Aussie will always outwit the dopey Yank.

This is a knife …

Last week newly-minted young white constable faces a taller black teenager in Sydney, who is alleged to have said that he will break the constable’s jaw, “bro”. The young man in the hoodie knows his street talk! The young constable, instead of inviting the young alleged thug to have a cup of coffee to discus the immense psychological pressure the young man was experiencing, moves across, turns him around and trips him – one might think that reasonable if someone says he is going to break your jaw.

He did not: (a) draw a baton, (b) use tear gas, pepper or mace, (c) use a taser or stun grenade, or (d) shoot him.

That is the problem I have with police forces. They are clothed in ominous dark uniforms and dehumanising headgear with all the armaments of the military. Yet the police force is not meant to be a killing force. The more the toys of destruction are supplied to an increasingly poorly-adjusted police force, then working as an agent for Trumpian cancer metastasising across America, then who is going to halt their spread?

The solution to violence is not providing more weapons – the reverse should be true. A police force should be more concerned with each police officer being given the confidence to settle disputes with the minimum of violence. For instance, at this time of pandemic widespread use of agents designed to compromise the cardio-respiratory system such as the irritant sprays should be banned. The problem is that politicians wring their hands over domestic violence, send mixed messages when violence is rife in the community. Politicians yield to the slightest demand of police associations, where the megaphone is the loudest.

There is ambivalence when police are involved.

At the outset of the piece, I related the instance of a young policeman threatened with violence. He tackled the young aggressor, one on one – it was not a gang tackle. He was responding as he was trained to do in a potentially violent situation.

Contrast it with the images of multiple law enforcement officials, be they men or women, tackling the one individual. The sight sickens me. I am sure that there is almost always provocation and prisons, for example, are dehumanising violent environments. Drugs are dehumanising.

However, the wolf pack response is descent to the same primitive level. Just look at the all-white police officers at Central station last Saturday let off the leash, the officer in braid visible behind – not trying to restrain his men with their eyes full of hate. Not trying to lead! Not trying to maintain his police force in social distancing. Except for himself, the senior officer “looking good in a uniform”, as they say, is pictured generously social distancing himself from the fray – leading from behind.

Yet one episode after another of alleged police brutality tumbles through the media. I can never forget the images of Ron Levi, an unfortunate man having a psychotic episode in the surf at Bondi who was shot four times by two drug dealers who at the time happened to be members of the NSW police force. Shooting someone, even one carrying a knife, when presumably every policemen is taught how to disarm with the minimum of violence, destroys community confidence, shakes one’s confidence. No charges were laid against these men, despite this young guy being murdered in full sight.

Instead of questioning whether police are competent to have the paraphernalia of aptly named “assault weapons”, why doesn’t the debate start about when the distribution of weaponry should be curtailed?

Death in custody is like domestic violence; it has circled in earnest discussion ever since I can remember. The number of Aboriginals in custody has not reduced. Violence has been endemic in Aboriginal communities; to say it is not is to deny reality, irrespective of whether it is fuelled by alcohol or other drugs.

Yet there is an increasingly articulate group of Aboriginals – lawyers, public servants, Parliamentarians. The grievance rightly exists; obviously the solutions are not there for change despite the increasing number of these Aboriginal advocates. How many years are needed for you articulate people to effect change, not just to leave it someone else; not just to complain – blaming government is a way of doing nothing.

One of the advantages of modern society is that everything is recorded; just as that young constable’s action was. Instead of saying that he had had a bad day, the police commissioner should tell us what he would have done; probably nothing different. A bruised ego for an aggressive youth; but what does the young constable learn? Just exhorted not “to have a bad day” again?

Meanwhile the weaponry lobby rolls along, getting its inspiration from the brutal obscenity that masquerades as policing in the United States. Democracy dies when the police force, shorn of accountability, becomes the means of its destruction not its defence. The more weaponry a police force has the more it is likely that you or I will become the next Ronny Levi.

As they said when they came back from Bondi after killing Levi,

“That was a knife!” And the man with the braided cap responded: “We have just the carpet under which you can put the knife, and we won’t tell anybody. Probably need to replace the carpet – we burn them after five years. They become too stained.”

The Third Pole

I had not thought of the Tibetan Plateau as the Third Pole. Joel Berger’s book “Extreme Conservation” with its subtitle about “Life at the edges of the World”, in which he describes his extraordinary life, draws attention to the Third Pole. By and large, his experiences are in the snowbound parts of the planet in the depths of winter.

The Third Pole

The author has spent a considerable part of his working life trying to assess the state of endangered species, including the musk ox. The musk ox is an extraordinary animal able to survive the harshest of winters; it was hunted to extinction in Alaska, but revitalised by the re-introduction of animals there from Greenland.

Musk ox

There is a musk ox farm just north of Anchorage in a place called Palmer, on the way to Mount Denali. Incredible was my response when I first saw a live musk ox – sturdy and solid with a skirt of hair reaching its feet and with horns Berger describes as “piercing armaments”. Their closest relative is the wild yak that lives high in the Tibetan plateau, itself a different beast from the domesticated yak – and considerably bigger than the musk ox.

The musk ox is beautifully adapted having spiralling nasal turbinates so that freezing air has been warmed sufficiently by the time it reaches the lungs so they don’t become snap frozen. I have adopted two of the calves, which has maintained my status as a herd associate and bought a scarf made from the combed wool. It is woven into an extraordinary light fabric, called qiviut, which is remarkably warm and as long as you like a brown scarf, everyone should travel with one in a cold climate.

Wild yak – very difficult to tag

However, this interest in the musk ox is a prologue to the matter of the Tibetan plateau where the wild yak roams, admittedly in decreasing numbers. The problem is in the assessment of numbers, it is important to tag a beast – and wild yaks are very difficult to tag. This is the Berger expertise – tagging and tracking – and being heroically mad and brave.

However, that was the task facing the author where wild yaks are seen nearing 6,000 metres above the plateau. The Tibetan Plateau occupies an area of around 1,000 by 2,500 kilometres, at an average elevation of over 4,500 metres.

As Berger says, this plateau is the “water tower” of Asia. All the major rivers of south-east Asia – the Indus, the Mekong, the Brahmaputra, the Kangali, a major tributary of the Ganges, as well as the Yellow and Yangtze rivers all rise on the Tibetan plateau. Even Burma’s major Irrawaddy River is not immune from the effect of the Tibetan plateau.

Berger describes camping in the shadow of the Bukubada glacier, “a massive vault covering 170 square miles” (44,000 hectares) is vital to be preserved, monitoe. He describes other glaciers – the Yuxu and Yuzhu with the giant Muztag Ata glacier, located on the far western margin of China and east of the Pamirs Plateau, at a summit elevation of 7,546 m. So much water locked up and yet climate change has reached the plateau. Berger observes in the ice, the vegetation, the movements to higher ground of the indigenous wildlife, so many of which through indiscriminate slaughter are going the way of the bison on the North American prairie.

Belatedly the Chinese have recognised this, but as with so many authoritarian regimes they believe they can beat Nature into submission. Because we humans all live close to sea level, few give much thought to the dams being built on the Tibetan plateau. Thus this plateau, which provides Asia with much of its river water, is too precious to be left to one country with its selective concern about the World Order.

With climate warming and the glacial water storage thinning on the Plateau, water becomes scarce and this process will not be accelerated by the Chinese – given their form, who is not to say that they will divert most, if not all, of the water into their own river system. The planet despoilers are hard at it, and without any real checks and balances. The Mekong is particularly at risk, as Cambodia found out in the last dry season.

The world knows the Amazon is at risk – but so is the Tibetan Plateau. The problem with Tibet is clear.

However, in the minds of the West, Tibet is the Dalai Lama, once a hero but now increasingly shunned, soon to be a footnote in history. The successor will be appointed by a supervised Chinese process; Tibetans lose the links to their last traditional living god chosen by traditional mumbo jumbo.

What has to be avoided is to miss the importance of Tibet. Joel Berger gives us an intimate glimpse of what we will miss once the short term imperative of`progress ends up with the Tibetan Plateau a ruined wasteland deprived of wild life and water.

It’s somewhat ironic that the Chinese President, Xi Jinping, is reported to have cited the following Chinese proverb in a recent speech: “The ceaseless inflow of rivers makes the oceans deep.”

The problem is there is red ink seeping across the map of the world and it is not British.

If the world were brave enough it would face down China over the Tibetan Plateau – it should have the same status as Antarctica. Look, my grandchildren’s generation (and onwards). Witness the World at War over water, and remember your parents and grandparents should have read what Berger has written, taken heed, stopped wringing their hands over the Tibetan Plateau and acted. But don’t worry – there is not any moisture left on your hands. It all left with your ancestors.

Christ stopped on his way to Wilmington Station

Biden is a dud. His advocacy of the appointment of one, if not the biggest, dud on the Supreme Court, Clarence Thomas, shows that one dud knows another. At the Senate confirmation hearings in 1991, it was Biden who pilloried Anita Hall. She had accused Thomas of sexual harassment. Biden denied her the chance to present corroborative evidence. Then he came crawling back after 28 years after the Brett Kavanaugh disgrace, trying to apologise to Professor Hall – he received no dice.

This senator from Delaware, with his own problems in this area, has so many strikes against his name – and his gaffes are continuing although he has barely been out of his home for the past three months. Whether this means these gaffes are the first signs of mental decline, only his closest medical advisers know. If there is any indication of cognitive decline, he should just immediately withdraw, full stop.

I have mentioned that he looks old, covered up by a sunbeam smile, but even if he goes forward, he must resist a Sandra Palin, whether male or female, of the left. Palin helped do John McCain in. McCain was seemingly more astute than Biden and only a “chicken” – 71 at the time. If the Democrats nominate this aged “rooster”, they have to make sure that perception of his inherent weakness is not further compromised by a Vice-Presidential nominee who is already campaigning for the White House succession. It is not hard to do the numbers on Biden’s age.

So the Democrats nominate a younger active assertive person with the “smarts”, who only serves to accentuate Biden’s weakness. On the other side Trump needs a tough image now that people are beginning to laugh at him – now, after the stories of him huddling in the White House bunker and then walking behind his Praetorian Guard as they gassed the innocents. Sound familiar?

Trump recognises this need for “toughness” and in this context having a pliant poodle as a Vice-President gives him that air – at least to his fan base.

The wrestle for the Presidency

Trump is also well versed in the theatre of professional wrestling, where there is the Bad Guy against the Good Guy. Just simplify the rhetoric and make Biden look weak and confused. Violence. Pile into him; mock his weakness; back-slam him; put him in a headlock – a crusher hold perhaps. Let’s turn Presidential debates into “Ringside with the Wrestlers”.

Trump has little else left. He is the Bad Guy with the devoted fan base. The Biden insipidity gives him a chance.

Thus Biden may be caught between two “shouty” forces, which continually emphasise his inherent weakness.

Is the electorate going to be won over in November? Think carefully, you Democrats, don’t become real donkeys. 

Mouse Reflection

I decided the pool was deep enough to reflect a mouse whispering.

In the Feb 28 blog, my mausmeister under the heading: “The Price of Never Being Wrong”, wrote the following, which has been reproduced abridged…

The problem with epidemics is they thrive on ignorant national leaders, who have no idea of public health, suppressing inconvenient information. This increasing government secrecy is coupled with the modern version of the courtier castrati, people without ideas but with perfumed phrases whispering into the ear of national leaders who have lost the ability to apologise.

… I once wrote a small monograph entitled “The Dilemma of the Public Health Physician” in which I attempted, as I said, “to help public health physicians to work through the situation which confronts many professionals when they are in possession of information which others perceive as ‘sensitive’ or valuable in any respect.” 

… I went on to argue that all public health information should be freely available. Even over 20 years ago I wrote; “there is an increasing tendency for the political walls to be daubed with the graffiti of misinformation”.

On reflection am I just succumbing to daubing those political walls? Well, that is the point – public health expertise is being allowed not only to languish but also ignored as an inconvenience. But as many politicians have found out in the past, “wishing an inconvenience would go away” is not a solution.

Having said that it seems we are fortunate in Australia not only to have the calming influence of Brendan Murphy, but also his unheralded deputy Paul Kelly who, unlike his boss, is a public health physician. Their influence on the government where there is a high level of ignorance is, and will continue to be, important…

On the same day in February 2020, the Australia Health Protection Principal Committee (why do the Government give committees such indigestible titles) published one of its reports, an excerpt of which is printed below. This Committee is chaired by the Chief Health Officer, Brendan Murphy and has as its membership all his counterparts in the States.

… More than 60 per cent reduction in travellers and no cases detected in more than 30,000 Australians returning from mainland China since 1 February 2020. This has been assisted by travel restrictions imposed by China. In addition, a significant number of students from China have spent 14 or more days in third countries and have arrived in Australia to commence or continue their studies, again with no cases detected in this group. The only new COVID-19 detections in Australia in the last two weeks are eight cases in Australian passengers repatriated from the Diamond Princess cruise ship. There remains no evidence of community transmission in Australia, with thousands of negative tests for COVID-19 in the last week alone.

Much can happen in four months, and in the end as my mausmeister prophesised, they got it right, despite the Committee’s crystal ball being somewhat clouded at the end of February.

 

 

*By Archives New Zealand from New Zealand – New Zealand troops in Samoa, c.1914-15, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=51248178

Modest expectations – On viewing a Gun Carriage November 1963

A weeping blackness

But           

Refusal to enshroud

A memory

In a haze

         Of

What you were to do

                           Yet what would you be

                                             As man

                                                      Of seventy-two

                                             You when the flames of youth

                                                      Have died

                                             How promising can a man

                                                      Of seventy-two

                                                               Superannuated

                                             With a watch

                                                      A gold watch

                                             A great gold watch which ticks

                                             And tells that time is time

Who grieves

         For your greatness

         For your back

         Which now relieved

         Stands straight

For mourners lift

         Their candles high

For who knows you

         Who knows

The emptiness of the tomb

For who but you

         Can deride

The greatness that might have been

         For you – at seventy-two

 

John Fitzgerald Kennedy was 46 years old when he was assassinated. He would have been 103 this year.

It was my tribute, the tribute of 24 year old about to graduate as a doctor, still raw; still disbelieving that this man who could have inspired our generation was dead – assassinated. My first reaction was that it was some mad right-wing Southern racist.

Kennedy was a courageous thoughtful man inured to disability. However, there he was – distant but resonant to the young idealist. Staring down the Russians, learning from the ill-advised Bay of Pigs, and probably about to dump the Texan anachronism from the Vice-President position for someone who would face not only the massive change in American society but understand the nuances of post-colonial Asia.

How he would have handled the Vietnam conflict would have been instructive, because the cancerous growth of American exceptionalism – as culminating in this present Trumpian farce – may never have happened.

How different a time it was when Kennedy recommended appointments to the Supreme Court based on talent not ideology – both swiftly ratified. One was Abe Goldberg, the eminent jurist with his opposition to capital punishment that led to its long moratorium in America; the other was Byron White who, despite his strong Democratic party links, became the “swing” vote until his retirement in 1993. Funny how good sense and rational thought have flown away from Pennsylvania Avenue.

Strange when I re-read this poem after many years, that I picked the age of 72. Trump is 74 this week. Only time is ticking for him. 

The “Free-City State” of Hong Kong

Nowhere is that sense of selective self-righteousness more apparent than the extreme sensitivity in Beijing towards Australia’s criticism of China’s behaviour in the South China Sea. There is strong public support for the official view that China’s claim to historic territorial rights is totally justified, along with indignation that this could be even questioned.

Foreign Minister Julie Bishop’s statement about the need to respect the ruling of the International Court of Arbitration in The Hague last July as binding and final is regarded as particularly egregious.

Jennifer Hewett was travelling in China this month as a guest of the Chinese government.

I note that it is the same Jennifer Hewett who wrote that piece in October 2016 who referred last Friday in the Australian Financial Review to the people’s republic of Victoria.

This sly comment in an otherwise unremarkable piece of journalism stood out, because amid reasoned argument there was no justification for the statement.

“The people’s republic of Victoria” is just the same as a label of “Junket journalism” pinned to a journalist called Jennifer when discussing her guest experience in China at their expense.

After all, the paper she writes for has been prepared to the take Chinese Government money for China Watch – a propaganda instrument of that Government. Nevertheless, some of the articles are interesting when stripped of their cocô de touro covering.

Hong Kong is due to be returned to China in 2047. The Chinese Government has accelerated the process. The Chinese government doles out the rope so that the dissidents can protest for a time. Once the government has had time to assure itself that it has identified all the ringleaders, then it will move in, and use its overwhelming force to quell the dissent. At the same time, the ringleaders will be targeted so that unlike Mao, these dissidents cannot set up a guerrilla force.

The dissidents have done a very good job up to this point in harassment, but a guerrilla movement needs strong leadership to resist the inevitable imprisonment.

The aim now of the Chinese government is to arrest all of them with or without murdering some of them. Once imprisoned, then choose the instrument of torture.

In the face of this, the options for the dissidents are: be a political penitent; melt into the background; leave Hong Kong or fight on to an irrelevant death or remembered martyrdom. After all, Tiananmen Square provides the blueprint.

First, the Chinese Government clears the streets of the dissidents. There will be little forewarning before the invasion. Big business can pull down the shades and high up in their skyscrapers the noise of rioters being killed can be drowned by Vivaldi being piped through the system.

Horse racing can still proceed so we Australians can be reassured that nothing untoward has happened. You can still see Hong Kong on the TV racing channel.

However I shall concentrate on those images of empty streets bristling with of the People’s Armed Forces on street corners – men who do not speak the local Cantonese. It is the Hong Kong oxymoron for all those foreign journalists to digest searching for a catchy 32-second “grab”; an empty street full of men with guns and tear gas and heavy metal.

It is a small step for the legislature to meet in secret, not in accord with the agreement with the British – no negative votes now.

The transition is complete. The dissidents are somewhere in China, far from our eyes. The Hong Kong legislature now reborn becomes a sheet of red with applauding figurines

With time everybody in Hong Kong is encouraged to develop a convenient amnesia to what has gone on. The dissidents never existed. Business as usual nods in agreement. Eyes are averted not to see evidence of more People’s Armed Forces on street corners – men who do not speak the local Cantonese.

All the trappings of the legislative process agreed with the British may be maintained with Carrie Lam, but she will pass and eventually the fiction will fade away – and Hong Kong will now be “One China – One System”.

The Chinese Government seems to have a tricky decision about maintaining a Hong Kong with an open trade policy, but now under a Chinese rule of law. Given the mainland experience of an increasingly intrusive government, a Hong Kong shorn of the pretence of democracy has to reassure Europeans that the remnants of colonialism do provide a safe enclave for business. If the judicial system completely loses its independence, then business only belongs to the Chinese government and its concessional treatment of us Guizi.

Anyway, as one reliable source said, China always takes a long view and there is already a visible transition of importance from Hong Kong to Shanghai.

Given how the Chinese Government is playing Australia on a break, what is our attitude to all the potential Hong Kong refugees; and do you not think that the Chinese will test Australia out further in the Government’s nascent “White Australia” policy?

This whole business is complicated by the 350,000 Hong Kongers who have British Overseas National passports. These allow for one year’s access without the need for a visa; more ominously another 2.5 million are eligible but have let their passports lapse. Given how immigration-averse Boris’ government is, one can rest assure that the Brits will start putting pressure on both us and Canada to share the “pain”.

You know old boy, the Commonwealth and all that. Watch this space.

However, clinging to Mike and Donald may not be the best solution either. Perhaps we should adopt a modified Belt and Braces policy, making sure we do not rely totally on China – but something has to hold our trousers up. At present it is a lovely rusted ferric belt.

Maybe a more self-reliant by ourselves with a little help from who?

It is time for some lateral thinking, because the name
“China” keeps popping up as the answer.

After all, due to the strength of our public health response Australia has a comparative health advantage over those countries that have not recognised that the Virus breeds and feeds on Chaos.

Turning this public health advantage into an economic advantage is not helped if Australia prioritises frippery, turning this country into a circus fuelled by a shallow media and even shallower politicians.

As for Hong Kong, remember 100 years ago there was another city-state dependent on Great Britain for control over its foreign relations. This state lasted, until its invasion by Germany in 1939, for nearly 20 years – the Free City of Danzig.

Does anybody remember Danzig now?

In the meantime, what will Jennifer say?

Muscular Judaism

Some years ago when Magnetic Resonance Imaging (MRI) was a new modality I had been able, despite some government opposition, to facilitate its use attracting a Medicare benefit for the patient, I received a phone call from some guy who said he represented an Israeli technology firm. He was interested in selling MRI equipment, and he mentioned that his firm was interested in the low Tesla end of the MRI equipment spectrum. However, he wondered whether he could meet me when I was in Melbourne.

I agreed and was somewhat surprised by the address as it was essentially a residential suburb where I once owned a property.

Nevertheless the address where we were to meet was in North Fitzroy. As I anticipated, I arrived at a rather nondescript brick villa. One of the first things I noted was that all the windows were barred and the blinds were drawn. As I walked up to the front door, the light above the door winked at me.

I remember being ushered into a tiled floor entrance where a small flight of stairs led to an open living area, where three other men were lounging around. My hosts were all of medium height, with cropped hair, and what struck me was how supremely fit they appeared. They were all dressed in expensive casual attire but despite the seeming relaxed informality, the atmosphere in the room was far from that.

I remember being introduced, but names meant nothing and probably when I thought about it later, the names were likely manufactured. The only item in the room that sticks in my memory was a model of an El Al airliner, but the room had comfortable chairs where I was invited to sit, and offered coffee or tea. I chose coffee. It was instant. I hate instant.

The problem was that suddenly I did not know why I was here. Everybody spoke perfect yet accented English. The discussion started about the MRI technology and the fact that in this area Israel had developed a great number of interesting products. However, the discussion increasingly became general.

I felt trapped – there was an unspoken menace in the air. It was obvious that the MRI was the bait. All of them were very courteous and amiable. I really did not know what this encounter was about. I generally tend to deviate from the script and play with words in meetings. Not this morning – I have never stuck more carefully to the “script” and measured my replies than I did during that hour. I had never felt under such scrutiny – random seemingly innocuous questions kept coming in this seemingly friendly fashion from each of them. Their seating meant that I had to shift round to answer; I was not always facing in the same direction because of the way they had dispersed themselves.

I still had no idea what this was all about. They were searching me for some information, but what? At the end of our hour, they all got up and said how good it had been to meet me, and they would be touch.

When I was outside, I had this immense sense of relief.

I did not look back. I never tried to find the house again. Presumably they got what they wanted or thought that they had wasted an hour, because I never heard from them again. Laughingly, I related that I had had morning coffee with Mossad. Nobody smiled.

Some years later, I did go to Jerusalem when Yitzhak Rabin was Prime Minister. It was a time that one could jump into a taxi in Jerusalem and ten minutes later you were in Bethlehem in Palestine. I am glad I went there at that time, but I did not meet up with anyone who resembled the guys whom I had met in Melbourne. I ventured a question to the Conference Israeli organiser, who was a veteran of the Six Day War. He smiled, patted my arm and changed the subject.

Life with Brian 

When I left the Australian Medical Association one of the presents that I was given was a small olive tree in a pot. In honour of a surgeon with a strong link as I had with the Quality Assurance “industry”, I named the tree “Brian”.

The tree was potted and languished outside our office for a number of years making very slow progress.

Then when we moved into a new house, the olive tree followed in its wooden stave barrel. However, it still was stunted and had never produced an olive in five years.

Then one day, a delivery van took out the crepe myrtle tree in front of the house. Crepe myrtles are a favoured street tree in inner Sydney. The colour of their flowers are bright and various.

This incident left a hole in the footpath, the house brick wall exposed, and as the house is located on a poorly cambered corner of inner city asphalt which purports to be a road, the wall was vulnerable to a car running into it. At least the trees provided a barrier for the house.

Early one morning, a car ploughed into the wall, and left a Volkswagen car badge as a calling card. The car had reversed from the rubble and was disappearing around the corner by the time we had come down the stairs. Later “mummy” brought her son around to apologise and to offer to pay for the repair of the wall. We accepted the offer, and the wall was duly rebuilt.

Perhaps we reasoned if we planted the olive tree in the street it would provide some protection. It was a sturdy young tree. We planted the tree in the verge outside the front gate with no real expectations. However, released from the confines of the pot, it started to grow – and did it grow.

Over the next few years, it grew until one spring, there appeared the tiny yellow blossom foreshadowing an autumn olive harvest. The amount of olives varied but in a good years there were seven to ten kilograms. The first time we seriously picked olives, the recipe was just too tedious with the frequent changes in water and brine, and complicated by our being at home irregularly as we travelled around Australia and overseas.

So mostly we left others to come and pick them. Being away for considerable times even if we had intended to harvest them often we would come home and find the tree stripped bare. One year our regular taxi driver, John asked if he could harvest them. In return he presented us with a large bottle of olives, which tasted good and made us think again about our direct involvement.

Then there were a couple of lean years but during that time I had been to Cyprus and watched an aged nun in the courtyard of her retreat, splitting the olives and then placing them in brine. It seemed that with the additions of few sprigs of this and that and chunks of lemon that was it – so fiddling around changing the water was unnecessary.

Now in this year of the Virus, the harvest was bountiful. Locked down, she ventured out and returned with pails of green olives. Only the top most branches escaped because (a) she did not want to climb that high up a ladder and (b) for some reason the rake had gone missing.

However, there were more than enough and for those that are interested, the olive were split, stone retained and than placed in clean jars containing a ten per cent brine solution with white vinegar in a ratio of four to one. A couple of lemons were squeezed into each jar.

It is wise to use non-iodised salt, as olives are bitter enough without that bitterness being augmented by iodine. Put a slice of lemon on the top to keep the olives submerged and then a layer olive oil over the top to keep air out. Seal the bottle and wait. Six weeks later we opened the jar – and bingo. They were good, surprisingly – chewy but full of taste going well with the martini, described in an earlier blog.

Now, that we have entered the olive curing industry, and our olive tree is strong and healthy, as Brian too will be remembered, why not put a grove of olive trees down our street? Our local Council is supposed to be Green, and olive is only a shade of green. The local member of Parliament should be enthusiastic. Jamie Parker is a Green; he once was a purveyor of herbal remedies, one with the interesting title of horny goat weed.

Here is a chance to build on a life with Brian – he could initiate a Grove of Brians with our enthusiastic local member transformed into a Master Olivatore rather than just being remembered as a Faunus vendor, who accidently strayed into Macquarie street.

Mea Culpa

Let me admit to fallibility. Last week I was severely critical of the trial being proposed by the Walter & Eliza Hall Institute for Medical Research (WEHI) to give hydroxychloroquine to frontline health workers, I headed the piece with a quote from a recent Lancet article. It was purported to be an observational trial and its results fitted into my thesis – that the proposed WEHI COVID-19 trial would be ineffective, irrelevant and potentially dangerous.

I was influenced by one particular report of people in Manaus being treated for COVID-19 were given the drug and who died. Manaus had 2000 deaths in April from the virus and the numbers over all of Brazil have topped 30,000 despite their President advocating the use of hydroxychloroquine.

Yes – the Lancet article was neat; it played to my bias; I was blind; the Lancet! How could it be wrong? Surely the journal could not repeat the Wakefield fiasco of 1998, which launched this dangerous Wakefield on his anti-vaxing worldwide rampage.

Therefore, I am very sorry that I used the quote, but in apologizing for its use, I still believe in what I have written, rather than what I quoted. I hope the WEHI trial never takes place, and for all of my above reasons. However, I would still be curious to see the protocol and the ethics committee report of this study.

Mouse Whisper

I have always abhorred this tendency when people are are unsure of the colour to say “bluish” or “yellowish” or size “shortish”.

Therefore I applaud my relative Bmac in refusing to use the word “hamish”.

Now as BMac would know, hame is a two curved wooden padded harness, that forms a collar around the neck of a draft animal. In fact, hame is a yoke – a big yoke. This has to be taken seriously and not referred to as “hamish’’ – a bit of a yoke.

Therefore I applaud you again, BMac, for your deletion of “ish” in all your conversation; as long as you don’t advocate “f with chips” followed a “d of banana fritters.”

A hame in good use

Modest Expectations – Barry Marshall & Obey

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

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

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

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

The one hand clap, Pauline.

But back to reality.

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

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

Telehealth – Look Mother! No hands

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hey, Pellegrini, whatcha doing with that test tube?

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

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

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

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

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

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

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

I wondered how this experiment has come about.

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

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

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

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

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

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

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

The time I under-dosed with Chloroquine (Plaquenil)

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

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

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

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

Le Piton de la Fournaise, Reunion Island

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

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

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

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

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

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

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

Just a lurk

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

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

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

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

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

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

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

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

The Hungerford Games

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

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

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

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

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

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

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

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

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

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

Muri Succursus

Mus Virgilis “destillat ab inguine virus”

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

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

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

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

Modest Expectations – Kennedy

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

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

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

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

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

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

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

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

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

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

Lutheran church, Öland

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

My friend continued:

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

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

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

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

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

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

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

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

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

Non dimentica

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

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

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

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

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

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

Abiden with me, fast falls the eventide …

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

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

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

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

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

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

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

Wilmington Railway Station

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

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

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

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

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

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

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

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

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

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

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

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

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

Just a Footnote – talking of Presidents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Quite a day.

Can I call you Belford?

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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

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

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

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

Benedictine monastery, Tuscany

Modest Expectations – Melbourne

There is no doubt about NSW; by far and away, the most cases of coronavirus in Australia are there. Granted that it is the biggest state, but the cavalier way that public servants and at least one of the politicians have behaved has exacerbated the problem.

Gladys Berejiklian has one very great ability and that is to talk without saying “um” or “ah” without taking a breath.

It makes it is very difficult to interrupt her, and when anybody succeeds in breaking into the flow, her mouth becomes a tiny moue and her dark eyes those of the avenging disapproval. Such a countenance belies the actual situation that she is a weak leader. And now six months to sort out the Ruby Princess fiasco. Really?

Wait a minute, the Premier has adopted the Chant approach of “zig-zag”. She has asked Brett Walker SC to have a look at it as well – a “special commission of inquiry” in the same litany as “loved ones”.

What next – The Premier’s astrologer?

One despairs of any justice in NSW. This confusion gives a number of people time to muddy the waters, and already Ms Sherry seems to have slid away. Predictable! And the same cruise ships with different titles with all their verminous cabins will be back next year scratching the same political backs and contributing nothing to our economy except grief.

Premier, you are always using the words “Loved Ones”. Tell me how many of those with the sobriquet of your favourite words have died because of the Ruby Princess fiasco. No urgency to know, Premier, no need to know. Six months will do. Hiding behind a special commission? No, I am sure you are not, as you already have a good idea of what has flowed between Carnival representatives in Sydney and your Government.

Can somebody get Ms Sherry to front an interview with her sommelier boss? After all, she has a wonderful residence in Annandale as a backdrop.

The Ruby Princess fiasco testifies to a Premier who not only tried to deflect the behaviour of her Health Department but also failed to sack those responsible for its behaviour. After all, the fiasco has led to how many deaths? Instead the Premier has filibustered. Asked specifically whether she would apologise to those whose COVID-19 is due to the Ruby Princess, or to the families of those who have died, the Premier – in time-honoured fashion – just answered a different question. However, at least the media are finally onto it – they took their time.

Now the barbarians are at it again. They are those whose natural constituency is in the dystopian world of Trump. The irrepressible Chant is at it again inadvertently aiding the dystopians, as she advocates a “zig-zag” approach. Are you seriously advocating going off on a tangent and then backtracking, and then going off on another tangent and the backtracking to a different position? Zig-zagging, as I interpret it, is all about confusing everybody. Really, Dr Chant, do you really mean that?

However, the person to watch now is Mr Barilaro – you know, the man who wanted to close the ABC, the bushfire station so important for distributing information in his electorate – and then was overseas initially when the bushfires were ravaging his electorate. You remember the man?

In the background he is a cheerleader for re-opening the Rugby League, presumably because of its precarious financial position which, like the berthing of the Ruby Princess, the financial situation of a badly run organisation being more important than the health of the Australian population.

Perhaps it is a prelude to Barilaro bobbing up on another front. As he said in his maiden speech to the NSW Parliament:

The New South Wales ski fields have been forced by successive governments to compete with one hand tied behind their back. My vision is to make the New South Wales ski fields number one again, by removing barriers, aligning government policy and industry opportunity, creating a level playing field and engaging all stakeholders to develop a strategic plan to deliver a world-class alpine experience to rival the best ski resorts in the world. 

In our last blog but one it was pointed out that ski fields are a potent source of community spread of the virus.

As Mr Barilaro said in this same maiden speech, quoting Jack Lang:

Always back the horse called self-interest, it is the one that is trying.

You highlighted this quote, Mr Barilaro. It must have made an impression. 

Primrose Pell

From the 13th century onward, it’s easy to see how secretly gay men found in the church, and the church alone, a source of status and power. Marginalised outside, within they could become advisers to monarchs, forgive others’ sins, earn a stable living, enjoy huge privileges, and be treated instantly with respect. Everything was suppressed, no questions were asked in seminaries, and psychological counseling was absent (and even now is rare). Scarred, scared men became priests, and certain distinct patterns emerged.

This quote was written by Andrew Sullivan, an openly gay commentator a Roman Catholic and a follower of the great English conservative philosopher, Michael Oakeshott. The full article appeared on 21 January 2019 under the title of the Gay Church in the New York magazine.

Is Cardinal Pell gay? What does it matter if he is? I have no problem with homosexuality that is not predatory. I had a fellow medical student, a good friend, who dropped out of medicine and was subsumed into anglo-catholicism, became an Anglican monk, and I heard that he died of AIDS some time ago.

I have written extensively about Alister Brass, who was an inspiration for me, and whom I miss greatly, even though he has been dead for 34 years. As a teenager I read Peter Wildeblood’s account of being criminally charged with homosexuality and then spending time in prison for what was ultimately bad law. I was appalled on reading his book Against the Law.

As a boy, I grew up when the “confirmed bachelor” culture was transitioning into open avowal of one’s sexual preference. To me it seemed an innocent pastime for blokes who preferred other blokes, whatever the euphemism.

I have always hated the word “closet”; it may just as well be applying to a confessional box or any dark and secretive environment where homosexual activity is possible. However, homosexuality should not be stigmatised. After all, Tasmania, the last state to do so, expunged it from the criminal code 20 years ago.

Celibacy once may have been a means of survival of the intellectual tradition, but now seems to be a honeypot for communal homosexuality. What is distressing is the level of denial and hypocrisy with which the Roman Catholic hierarchy surrounds this association.

Thus celibacy and homosexuality are uneasy companions, although at one end there is Saint Augustine who was openly gay, and at the other end St Thomas Aquinas to whom homosexuality was an abomination.

Now Australia has seen George Pell acquitted by the High Court for historic sexual offences. In the background, there is a heavily scrubbed report of the Commission into Institutional Responses to Child Sexual Abuse.

So as not to misstep in the quagmire of the High Court, below is essentially a compilation of quotes, including from those advocating Pell be freed.

Now the High Court judges say that is not enough. Other witnesses who gave evidence that they thought the Cardinal would not have had the opportunity to commit the lewd acts ought to have been taken into account, even though they could not give a first hand or personal evidence of what happened to those boys on that day.

Bizarre. One witness swears on oath: this is what happened to me at this place on this day. Other witnesses say: I do not know what happened on that day but that is not what usually happens – and that creates a doubt and voids the conviction. Compounding improbabilities become “reasonable doubt”.

It was argued that because Pell’s assistant, Portelli, didn’t have a specific memory of standing on the stairs on the chosen dates of December 15th or 22nd, 1996, that his testimony about Pell’s practice of being out front could not be relied upon.

 Justice Patrick Keane replied: “I can say I shaved last Friday and I don’t have a recollection of it, not because it didn’t happen but because I shave on work days”.

His point? Do you have specific memories of things done out of routine?

No, we remember things out of the ordinary. Therefore it is unreasonable for Portelli to have a specific memory about two dates in 1996.

The judges also made the point that the accuser’s recollection of the sacristy wasn’t actually proof of the abuse, only proof that he had been there.

Let me tell a story – perhaps a parable. Let us say it was the early years of the last century. Let us say it was Lonsdale Street in Melbourne. In this parable, there was once a junior barrister who used to be shaved by a barber, as was the custom of the day prior to going work.

At the same time of the day early in the morning there was a judge, a man of distinction, who would come in to the same barber shop and be shaved also. The younger and older men would exchange pleasantries and talk about legal cases while they were shaved and perfumed. Most days, they would leave together and walk to Chambers. However, there were some days the judge would leave before the young barrister. One day, the young barrister, the judge having left earlier, decided to take a short cut up a quiet lane, and turning the corner, he perceived a familiar person – it was the judge, who seemed to be adjusting his trousers. In front of him against the wall was a young boy not more than 13 or 14 clutching a newly-minted shilling.

The young barrister uttered a cry, the man who was the judge turned, his expression one of power. What was the young barrister to do? After all, he and the judge regularly shaved together; how could he in retrospect possibly ever remember the day years on what had happened on that particular day – unless he had openly accused such a respected member of the community then; a man of power, a man who wore a wig, a man who could pronounce life or death on a personal career?

Perhaps, just like all your hypothetical speculation, Mr Justice Keane, there is always a confounding storyline – fable or parable – however you define it.

Especially in a real life situation getting away from our exchanges of parables, if it emerges that there was a history in a person’s background of systemic cover ups, the law is presented with a dilemma. Men of distinction do not lie under oath. Axiomatic?

Of course, that is only non-admissible speculation to the collective mind of the High Court, but still enough for a jury to convict in a Victorian court. However in the Court of Courts, there is this reasonable doubt, because no other has come forward to dispute the man of power’s testimony. The child is in essence disbelieved.

It will be interesting if Pell, despite all the travel restrictions, suddenly turns up in Rome on his way to a new closeted life in the denizens of the Vatican, away from a succession of the civil cases, which threaten to follow.

However, there was one touch I loved about wee Georgie Pell, the prisoners cheered in Barwon prison when they heard of his release. I remember that the prisoners cheered when Johnny Cash played for them in Folsom prison – but then Johnny Cash had a guitar.

I have one last quote from the porter in Macbeth as he opened the gates – this for the departing Pell, who has had a life of power so eloquently portrayed in the initial quote from Andrew Sullivan.

I had thought to have let in some of all professions that go the primrose way to the everlasting bonfire. 

Boris

He is the type of Pom who reminds me that England is a nice place to visit but not be infected by the culture – by a product of the Eton boot camp – that nurtures the professional buffoon with the razor sharp mind.

Maybe he has now learnt a lesson that will resonate in his future actions. The buffoon, who boasted he was shaking hands with all and sundry in a hospital, while COVID-19 lurked. Hopefully that buffoon will be replaced by a less arrogant and more compassionate person who does not run the country in the same slapdash manner as we have seen him washing his hands – otherwise, God help the United Kingdom.

There is nothing more humbling than looking into the eyes of the person who has saved you. I know from personal experience.

However, the community is sick of spin doctors who aid and abet the culture of lying; Johnson revealed how really sick he thought he was. It was far sicker than the public was led to believe. Those in charge determined that Boris should not die. The fact that he had two staff constantly caring for him showed how intensive his care was. Otherwise he would not have survived. There must have been fear that a secondary cytokine storm may have intervened and finished him off. It must have been close.

Therefore, can we but cast this spinning vermin out from the Temple No 10? Almost Johnsonian?

And for God’s sake Johnson, grow up. There are many unseeing eyes watching you. 

The World that Boris Missed

A lot of radio stations in Europe will collaborate this Friday (March 20th 2020) at GMT 07:45 to sound the track of Gerry & The Pacemakers – You’ll never walk alone. Please join this collaboration to show gratitude to the people that are doing their best to help us survive this pandemic. And to have our thoughts by the people who lost their loved one.

When I first saw this announcement, it triggered a number of conflicting memories. The song originally came from the Rogers and Hammerstein musical “Carousal”, which in turn had been adapted from a French story about a fairground rouseabout who had difficulty declaring his love for his girlfriend; nevertheless she gets pregnant; he is killed in an accident before his child is born; but is permitted to return to earth for a day to see the child.

“You’ll never walk alone” is a highly sentimental song, which nevertheless moves me. It is just one of a number of good songs in this musical. However, the musical’s recognition was dwarfed at its release by some of Roger and Hammerstein’s other musicals: “Oklahoma”, “South Pacific”, the “King and I”. I saw the film as a teenager.

Some years on I was persuaded to go to hear a group of Liverpudlian bands that were touring Australia in the 60s in the wake of the Beatles phenomenon. One was Gerry and the Pacemakers. Gerry Marsden, the lead singer, was one of those Tommy Steele lookalikes – all teeth and quiff.

I went because a friend had free tickets and while I remembered “Ferry cross the Mersey”, the West Melbourne Stadium was not the best place for romantic ballads. My memory of it faded from view, until the late Paul Lyneham, the ABC personality with that somewhat crooked personality, revived memories with a band he called sardonically “Pacemaker and the Gerries”, which as it turned out in a macabre way foreshadowed his death.

Another fragment many years on – I was in the Melbourne Cricket Ground, the night Liverpool played there in 2013. It was one of the last nights, before I was stricken with my illness – a night I remember clearly walking to the ground and then dodging the traffic to catch a tram back to the apartment – almost my last night of freedom.

In any event, the fans as one had erupted into their Liverpool Football club anthem “I’ll never walk alone.” In the bellowing it loses the romantic lilt of Hammerstein’s words and the melody itself is drowned. However, the intensity remains.

All the pieces have come together with that simple announcement above and the accompanying video of ordinary people singing or miming or whatever – there is something about British working class optimism that makes up for all the Boris buffoonery. 

Opening Australia Too Soon

We now appreciate the Tasmanian Premier closing his borders so none of his Tasmanians can cross to the mainland. However, his action in quarantining the Mainland from the outbreak in Tasmania shows great foresight. We always thought it was the reverse. What cunning!

The “Burnie Incident” is unsurprising, given the demonstrated level of incompetence in the health service, proof of what happens when all the rules that the Commonwealth government put in place are ignored or flouted. Strange things happen when discipline is lax – generally such laxity teams up with incompetence.

One of the problems with many, but by no means all, small hospitals is that administrative capacity of the hospitals is deficient. In particular medical administration is often problematical as incompetents are shuffled between these health services, often with glowing references. This a general comment and not one specifically assigned to either the Burnie or Mersey hospitals, which have a conjoint administration.

Tasmania is lucky it has so many hospital beds. Some years ago, the question was always raised as to why the Mersey Hospital needed to be built, but then there must have been a seer in their midst who saw virus in the mist.

In Burnie, the virus has been let out of the bottle – infection control has been such that COVID-19 has been let loose in the community. One of the Ruby Princess passengers has been blamed for being the first case in the North-West. However ascribing actual blame is for others.

What is important now is that there is a real life situation to follow the out-of-control virus, not some abstract model. Australia can now witness from its falling rate overall what happens in a region where it is easily out of control and to see if the Australian remedy can be reinstated and indeed works.

Burnie in its population makeup is not unlike a western Sydney suburb. There are a string of small towns along the coast from Wynyard, abutting Burnie to Devonport like an attentuated suburban Melbourne and Sydney. I mention Wynyard and Devonport specifically because they are the two travel hubs for north-western Tasmania. Rex flies to Wynyard and Qantas though Qantaslink to Devonport. Devonport is where the Spirit of Tasmania berths, and given the current history of boats and the virus, there is a certain vulnerability I would have thought.

With such restrictions the north-west provides an opportunity to see how quickly the virus can spread and how quickly this underprepared community reacts. If the virus escapes the enforced isolation of the 5,000, then every community in this part of Tasmania is at risk. Possibly viral spread could engulf Tasmania.

Wynyard

The next two weeks will tell all, but it is to be hoped that the introduction of the Army, AusMat, and emergency supplies of equipment and trained staff will halt the spread. There is the complication of the FIFO miners, who are flying in through Devonport but are moved immediately to the mines down the West Coast and thus avoid Burnie. Further, there is always the follow up question of how many miners come from Burnie or other north-west coastal towns?

Hopefully, the police will continue to conduct comprehensive surveillance not only along the coast but also the three main ways south. The first is across Cradle Mountain (from the guys who went from the topiary town of Railton to Strahan – they must have got a shock to be apprehended). The second is the main route down the Murchison Highway, although there is a possible diversion through Hellyer Gorge. Finally, for those who really want to take the COVID-19 virus on a scenic trip South, there is a third route along the Road to Nowhere down through the Tarkine and across the Pieman River at Corinna; hopefully the ferry is still running.

I only mention these routes as apparently there has been an allegation of a COVID-19 carrier, known to have infected a number of health workers, who has vanished from the north-west. Cannot be found. But then there a myriad of unmade roads and forest tracks impossible to police.

It is the problem of Tasmania. One of the most beautiful places on the planet, yet its inhabitants demand much while disregarding their responsibility to conserve and preserve; they could give back more. In this case together with the rest of Australia they may watch how this snafu is corrected.

Mouse Whisper

Hairdressers and barbers take a bow. Excoriated because you were allowed to remain open while others were not, you have plied your trade without being a school for scandalous conduct.

But like all mice I fear a Trim.

Trim

Modest expectations – Tom Waits

From the Carnival playbook as reported by The Washington Post:

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

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

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

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

The Carnival is over?

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

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

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

Which reminds me.

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

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

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

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

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

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

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

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

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

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

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

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

Hibernation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Long White Shroud

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper 

From a riverine relative, I am indebted for the following

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

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

Make America Rich Again!!!

Modest Expectations – Year

What a time to reach the anniversary! 

Given there are so many competing voices, one has no expectation that there is any audience but it provides the discipline of writing a diary. As instanced two weeks ago, I addressed the problem then presenting to a potential overseas traveller. The horizon was cloudy, but in two weeks, the world has battened down to ride out the coronavirus torment. The mixed messaged irrationality of the initial responses, plonked on a world inured to a social media prepared to publish blatant lies and worse the next level – “Trump lies” without intervening to insert evidence based comment.

Remember, it was not so long ago that according to Trump, this viral pandemic was a “hoax” and he blamed it on everyone except himself.

In my first blog, my first piece was about Prime Minister Ardern. I wrote:

“Now I am an old man, and seeing this woman, the Prime Minister of New Zealand, she is the first politician since Kennedy to cause me to believe, perhaps that to me she an exemplar against the fear and loathing that has characterised so much of what passes for political debate. I, like many, am just frustrated by the low level of debate. There is no longer any consideration in this Me All The Time rent-seeking political crop for policy discussion.

Yet Jacinda Ardern gives me hope. Her words – her demeanour of grace, compassion, resolve, her ability to call out the bully – the courage of making herself a target for all the “unspeakables”. She is indeed a paragon.

Just as I learnt from Alister, watching him succumbing to AIDS; now at a distance and not knowing the woman I think I have now adapted. Taken a long time, I must say. However, Prime Minister if I have the privilege of ever meeting you, please do not hug me. I am not a hugger.”

I see no reason to change my view a year later; especially in these viral times.

Her action in relation to this virus pandemic was decisive. It provided certainty for her people.

The headlined comment in Time this week said it all to its readership. In large letters, they reprinted Jacinda Ardern’s admonishment of Scott Morrison: “Do not deport your people and your problems.” This was a blunt response at a press conference in regard to this country’s “smart-ass” insistence on deporting foreign-born offenders, who have grown up in this country and have no relationship to New Zealand even though they may have be born there. They did not print the Morrison reply.

However, if this country wanted to deport a New Zealander of no particular merit to this country, why not add Brian Houston to the list? However, that probably would be the last straw for Prime Minister Ardern.

The Meaning of the Blog

So what is the point of the blog? It is more than just vanity press; it is the discipline of committing oneself to a particular position, or in the case of the overseas trip soliloquy two blogs ago, a testimony to how quickly the world changes. We didn’t have to make the decision about our trip. It was made for us, and the one thing to be learnt is not to attempt to “jawbone” the problem and immediately panic and cancel, with all the attendant costs; these don’t occur if the transport company does it for you.

The problem is that Australia is experiencing a community panic attack which, until this week, was fuelled by the uncertainty of the messaging, and therefore it also provides a chance to see if one’s opinion of a few weeks ago was right – and if not, it is in stark relief which no amount of bluster can expunge.

Looking back at my blog with its very select audience, it is a diary through my eyes enabling me to reflect in a contemporary setting on my life for what it is worth.

Babbler or Bubbler

Tower of Babel

The tower of Babel has been alive and well. Everywhere the publicity-shy “experts” on coronavirus have been pontificating, many of the vacuous statements suspended in the ether. Many messages are heavy on gravitas but confusing in fact.

I have suggested that in terms of the media, we should take a lesson from how we handled the bushfires by having single information source, as the ABC provided during the bushfires. It showed very clearly how many magnificent communicators the ABC has and who reported without any hysterical overlay.

The problem in this community is the lack in trust in whatever comes out of a politician’s mouth. So when the Prime Minister delivers a reasonable speech on Wednesday, it was at the end of a very confusing trail of information in relation to the epidemic. Whatever has happened to the “pop-up” clinics, a thought bubble from the week before?

Dr Brendan Murphy in this midweek media conference with the Prime Minister was far better after his disastrous appearance on the ABC program “Insiders” last Sunday where he looked uncertain, rumpled and his muttered response of “the situation is evolving” was a classic statement of uncertainty.

He has had a haircut and been generally tidied up, but even though his comments were far better, he is not an intuitively good communicator. There are all the unseen media coaches which can paper over the cracks but if you are a poor communicator having spent your life as an eminent nephrologist and esteemed medical manager, where bothering to learn the trade of communication has been seemingly irrelevant, then what should we expect. He comes from a world where patients and staff are told. It is not a criticism of Brendan Murphy himself; it’s a fact of being a doctor and a product of the systemic arrogance of the profession. In these stressful times you may need a good doctor for your patient, but if it is the community you need to be a good communicator.

The Prime Minister, during that same media conference, dropped his guard when reporter suggested the government website was not very good, to which the response was “that’s your opinion” rather than seeking constructive advice – and for an instant he was back into the “gossip, bubble,” defensive palaver, which has characterised his stewardship.

Ita Buttrose has been so right in criticising the response and comparing the current mess with the ordered response that occurred with the AIDS/HIV outbreak in the 1980s, with which she was involved. The way that infectious disease was handled, given how much underlying prejudice and stigma was rife in the community, was a model. At that time it was successful in getting the message across to the vulnerable and yet reassuring those who were not vulnerable. There were flaws but the messaging from the Committee chaired by Ita Buttrose and David Pennington provided a strong veneer of certainty.

The ABC has many excellent communicators and this was highlighted by some of performances in the bushfire. Norman Swan has an incomparable knowledge of health, which he communicates well. However, constant exposure to him without a counterpoint is liable to make one want to go to bed and, if there was such a drug, take enough to wake up in 12 months, such is the underlying pessimism of his message.

One doctor, in a letter signed by a couple of thousand of his medical mates suggests that by 4 April 2020 there will be 10,000 cases in Australia. However, are they 10,000 cases still in care? The acquaintance, whom I mentioned in my last blog, has now tested negative after 18-20 days. Freed from quarantine, and a journalist who kept a diary his writings may provide some reassurance. Because at this stage how many in the community know a person who has been infected and has become well again.

I think we should emphasise those who have tested positive and now are negative and publish that data, instead of the headline of how many deaths there have been worldwide. Knowing the number of cases is useful data, but just as there are more being tested positive, how about those like my acquaintance who now are negative – in other words do not have an active infection.

The big unknown is how long the immunity lasts. Having a cold, a suite of other coronaviruses, does not confer immunity for life. However, what this pandemic may do is to improve the overall hygiene in the community. It was thus excellent to hear both the Prime Minister and the Chief Health Officer reinforcing that message.

There is now a need to monitor the school closure situation – a fluid situation and one where false information will just compound the community uncertainty.

Also the community is now being inflicted by the term “modelling of the disease by experts”. As one knows from experience, such modelling is only as good as the assumptions, and I for one would like to see the assumptions.

The Premier of Victoria, among his comments on Thursday on opening up emergency beds and stocking the hospitals with the requisite equipment, stated there were only six people in hospitals in Victoria despite the increased number of cases overall. Six? What is going on? I would like to see the curve in relation to the number of hospitalised patients against time; the curve of those who have recovered.

Nevertheless from the sidelines, the ABC is without a national debate providing up-to-the-minute information; and Norman Swan being a regular feature provides the community with reliable lucid consistent information, irrespective of whether one totally agrees with him or not.

May I insert one small suggestion? Norman Swan is not going to be around forever; he is 67 years of age, already in what the Italians call “vecchio”; I would hope the ABC has a succession plan for Norman given how valuable a resource he has been before it reaches the next level of Italian old age delightfully termed “anziano”.

Already TV ratings are supporting the view of the ABC having that designated role.

However think about it, the ABC as the coronavirus station – it may cost more money but then it would well worth it. After all, the ABC is a public service.

Time to call Time

A pack of well-heeled Australian doctors and dentists on the 500 person M.S. Roald Amundsen off the coast of Chile is marooned in the ice floes of coronavirus. They cannot land in any Chilean port, and while one should not indulge in a dose of schadenfreude, it highlights one of the tax rorts, which should addressed by government.

I have no worry about these prosperous people taking holidays, and if they want some lecturers along the way to stop them from having the first whisky before noon, well and good. However, this is primarily a holiday. The taxpayers should not be asked to subsidise wealthy people’s holiday, even though confinement on ship has provided them now with learning about the physical and psychiatric consequences of being stuck in Paradise. They must be getting loads of Continuing Professional Development (CPD) points.

However, I hear one solution proposed is to dock in the Falkland Islands and be flown home. This may be a helpful quote: “For most commercial flights, passengers are directed to the British Air Force base RAF Mount Pleasant. While the Air Force base is home to a small squadron of Boeing Chinooks, Eurofighter Typhoons and a single Airbus Voyager KC2, commercial operations are also welcome at the airport. Utilizing the airfield’s 8,497-foot runway, British-based AirTanker provides nonstop service to the United Kingdom for military members utilizing 300-seat Airbus A330-200s from the RAF.”

The only commercial flights to South America from the Falkland Islands have been provided by LATAM, the Chilean based airline, which does have a non-stop flight to Australia in normal times, but conceivably if a plane of sufficient size could be chartered and could stop in Easter Island if there was a fuel problem in flying non-stop.

We shall see – but we, the taxpayers should not be footing the bill to get them back in Australia with the enforced quarantine period. The tax break for their conference should be more than enough if coupled with insurance taken out for such a contingency.

As they say, a meat worker in Wuhan was scaling a pangolin in China which results in 500 people of different nationalities being quarantined off the Coast of Chile – catastrophe theory at work.

I would hate to be in this predicament, but it would have been unlikely as (a) I believe these so-called education programs should not be tax deductible, and (b) I am opposed to Antarctic tourism anyway – it should not be an ecological plaything for the affluent.

Thus, when we Australians are faced with hardship, it is bordering on the obscene for the government to allow this tax rort to continue. Full stop! End of story. 

St Patrick’s Day

 Lá fhéile Pádraig sona dhaoibh!

I always enjoy celebrating St Patrick’s Day even though I am not a tyke, as my great uncle Frank used to describe a Roman Catholic. As a Christian, I do not subscribe to the Irish version of Roman Catholicism nor for the Church of Ireland, which is so well represented within the Sydney diocese of the Anglican church. As I have reported earlier, on my mother’s side I come from a line of Co. Clare Egans and McNamaras. The family was all Roman Catholic until, as has been told to me, the priest was so drunk he did not come and give the final rites to a dying Egan child. This was in the first decade of the 19th century, and the whole family changed to the Church of Ireland overnight. The Egans have been known for their unswerving determination, whether logical or not.

However that is what I love about Ireland, it is the predictable unpredictability, and ultimately their successful struggle for independence. I’m sorry dear Uncle Frank, or Ponky as he was known, I don’t subscribe to your solution to the local Irish question – whenever the Roman Catholic Church and in particular Dan Mannix, the Archbishop of Melbourne, was mentioned you would growl: “they should all be boiled in oil.”

So this week I did not miss the Day despite the Virus. To support local industry, we went to lunch at the local pub with sanitised hands and social distancing. May I say my meal of a dozen rock oysters with Irish soda bread on the side was a brilliant start. They were an excellent substitute for Dublin Bay oysters; much better even though they were cloaked in that Kilpatrick concoction.

Why “Kilpatrick”? I love the apocryphal story rather than the actual one. The story goes like this. A fisherman called Patrick went out to sea and his haul of oysters was so large that in trying to bring them on board, he fell into the water and was drowned. The headline in the local paper next day said “Oysters Kill Patrick”. Silly!

However the main course was a generous beef and Guinness pie with a splurge of colcannon – mash of potato, kale and spring onion – on the side. Needless to say the meal was washed down by Guinness, which I realised is the right accompaniment on days like this when you have to sit apart and wait to hear the sound of the hoofs of the black steeds coming to get us.

St Patrick

If St Patrick was able to rid Ireland of snakes, what about asking him to do a job on the virus?

However, we eventually made our way back home, there – horror of horrors – no Irish whiskey. So, being an Egan, from the traditional brehon clan we issued the decree that our household – to wit the dining room – be designated an area where St Patrick’s Day was formally extended to midnight March 18. This enabled the bottle of Black Bush, as it is affectionately known, to be ushered in the next day and drunk with a Munster relish.

Mouse whisper

Even Topellino in his nest washes his hand with mouse sanitiser –three parts absinthe to one part pure alcohol – before he sits down for a meal of gourmet scraps and “micewine”.

Two reliable studies from mousenet:

A Chinese woman arrives late in the evening in the Tasmanian west coast town asking for a bed because the pharmacy was closed. What was she was doing in this remote location and yes, of course the pharmacy was closed, it was the weekend. She replied she was scouring Tasmania looking for clinical face masks to be sent back to China.

The second involved a lakeside town near Melbourne where a couple of blokes in a van drove up to the local grocery outlet and started emptying the store of toilet paper. This was a bit much for the locals, who surrounded the van, retrieved all the toilet paper except for a reasonable amount for the blokes’ personal use. The toilet roll raiders were then told to be on their way and they promptly did so. I am not sure whether they paid or received any monetary recompense for their exercise in black-marketeering.

Modest expectations – J.J. Lyons

The problem is that, over the years, the community has become inured to the laughing mother in the advertisement with a gaggle of inanely smiling children showing how some disinfectant or other has rid the kitchen countertop of 99 per cent of germs.

If we lived in a sterile world devoid of all viruses and bacteria then like them we would all be dead.

Therefore we have to be reasonable, but when we have a media fuelling the hysteria that is not easy. There is a talk about the “surge” in infection and highlighting the number of deaths from the “killer virus”, rather than highlighting those who have recovered. The basic fact is that in a population of 25 million there have been less than 200 reported cases – i.e. as of today, an infinitesimal percentage of the population. The number is small, and it is important to maintain perspective. This is a prime function of government in the face of the irrational community response. Such a reaction dwarfs the other responsible response, which is building an evidence base as to what this coronavirus actually does.

Thus currently the rate of increase has hardly been a “surge” despite its attraction as a media headline – or even the milder use of “tide”. And if you use “surge” as a faux-dramatic metaphor then eventually the metaphor will “abate” as a tide will ebb.

Take Dr Higgins: how is the contact tracing going? It would useful if we were told how many of the people, including patients, with whom he came in contact have returned a positive test. However what we have is some State Health Minister attacking him and the AMA responding, rather than getting together and using this case to obtain useful information about the spread or otherwise of COVID-19.

Dr Higgins was on a United Airlines flight from San Francisco. I know somebody who was on the same flight who has the “sniffles”, all very mild. However, when my acquaintance’s partner became ill with a fever, an attempt to see the local general practitioner, resulted in an immediately referral to the relevant Hot Line which, having established my acquaintance as a resident of that State, then referred my acquaintance back to the general practitioner.

So much for consulting your local general practitioner as the front line defence, as the AMA have been telling the community. My acquaintance went off to a newly-designated centre for coronavirus testing. It was so new that the staff provided a good imitation of not knowing what to do. Waiting, my acquaintance and partner were alone, but it took an hour and a half for my acquaintance to be seen.

Despite my acquaintance’s history, the hospital-based centre was reluctant to undertake a test. Initially, the triage nurse wanted to send them away. Eventually my acquaintance was tested, but not the partner because at that time there was no proven contact with a confirmed virus carrier.

Ultimately they both tested positive and my acquaintance’s partner’s substantial workplace has been locked down for a week. They have children at school and university. The children tested negative.

It should be appreciated that the coronavirus tests for virus RNA being excreted at the time of the tests. There is no serology test to tell whether the person has had the coronavirus. Young people clear their system very quickly because in the main their immune response is very strong, a fact having being confirmed elsewhere. So it is quite possible that the children had been infected but have been asymptomatic and were no longer excreting the virus.

My acquaintance and partner no longer have to fight for attention. They have their own personal doctor contact available and visiting nurses. That is fine when there are so few cases, but this is a government that tends towards engendering fear rather than soothing concerns, when the number of cases are primed to increase.

Already the reluctant-to-test-centre of a week or so ago has a queue of the mostly worried well.

When winter comes is everybody going to receive such personal service? The answer is in the ability of general practice to develop a more hygienic environment this winter – not having waiting rooms filled with coughing adults and children would be a good start.

And what about the United Airlines flight? My acquaintance wasn’t sitting anywhere near Dr Higgins. So what is the evidence basis for the “same row plus two rows in front and two rows behind” exclusion zone? Almost everybody goes into the bathroom on a long flight, and from observation the level of hygiene in the bathroom is generally appalling. Tissues everywhere, an unclean basin and taps, water left in the bowl, used hand towels poking out of the waste bin, handrail and door locks not cleaned between usage.

In the meantime the United Airlines flight had been merrily going everywhere presumably continuing on with the scant hygiene measures which have been characteristic of  airlines.

It may well be that America may prove to be the biggest problem and the irrational behaviour of the President, most recently in a blanket ban on flights coming from “Europe” (senza the UK) and at the same time a reluctance to be tested himself, does not help.  Will America be added to the Australian exclusion list? After all, viruses do not respond to ideology.

I suspect that this scenario which is going on all over America with an unprepared and totally under-resourced public health system. As I’ve just said, Trump’s measures are irrational, and hard to follow, but that is nothing new.

Yet here, summer has been and gone; summer is not conducive for coronavirus spread and a containment strategy based on excluding nationals from an ever expanding list of other countries is in place. So currently it is a good time to be in Australia, and if the medium term strategy is based on a belief that with summer in the Northern Hemisphere the coronavirus epidemic will abate, then the current strategy has a modicum of sense.

The underlying problem is whether the political declamations are actually being carried out. Some of the state governments websites giving advice are very good, but why not consolidate this information into one web site – this is where the federal Government should be the single voice.

One of the problems highlighted by the 1918-1920 influenza pandemic was the destructive effect of the lack of public health co-ordination between States. Ostensibly, the Commonwealth is in control, but with each State seemingly disseminating its own information, it calls into question what is the actual level of coordination.

However, the tipping point is to know how far the government’s policies can go to effectively close the country down before wrecking the whole societal fabric and not just the economy. Having everyone in two-week isolation is ultimately unsustainable.

So a greater number of people who have to work will ignore the ban or not be tested; or the government will relax the ban. The evidence is that the older population are disproportionately affected, not school children or young adults. So why close the schools? We don’t do that if children catch the common cold, a coronavirus relative.

Look at the mixed messages. No wonder the community is perplexed.

Mixed message one: There are the media appearances of politicians elbow bumping and contorting themselves. However, what does the Prime Minister do in a forum where the spread of coronavirus is being discussed? He shakes hands with the guy who introduced him, does not use any hand sanitiser and goes to a lectern where there is no indication that it is to be cleaned between speakers. As far as we could see it certainly was not cleaned in this case.

Mixed Message two: There is a full house at the women’s cricket final – so much for the empty stadium scare that some of the muppets in the football codes seem to be mouthing.

Mixed Message three: There is the spectacle of the women cricketers jumping all other one another, high-fiving, potentially contaminating one another.

Mixed Message four: The Victorian Premier is threatening to close down the education system while at the same time giving an exemption to Ferrari for the Formula One exercise in air and noise pollution. No crowds, Mr Premier, after all it is school but of a different sort.

It was wonderful to see the publicity-shy Dr Mukesh Haikerwal in his medical practice car park collecting specimens for testing in a strapped pathology system. Presumably he continued to do this once the cameras stopped and continued to flood the local pathology laboratories with specimens. But what was his protocol for offering testing? Close contact with a person with who was confirmed positive? Or the worried well? Not clear. But the next day, having put on the show for the TV, his clinic was overwhelmed.

Now pop-up clinics; I suggest the government consider using the expertise of Dr Haikerwal with his car park technique to ensure that the Health Minister’s promise of the having all these clinics popped up by the end of May can be met. After all, he looks good in a suit.

Then as Australia enters the winter unless there is reliable health surveillance, it may be expected the pop up clinics are going to be inundated by people with that other coronavirus, the common cold, or those who are suffering influenza.

It is always disappointing that the first thought of governments is the authoritarian solution. Australia has always been quick to press that button. Such a solution resulted in the misguided lock hospitals of the past on Dorre and Bernier Islands in Sharkes Bay. Aboriginal men and women suffering from venereal disease were sent there. Australia has a dark history of isolation of people with disease and community panic attacks.

It seems at this time the greatest risk group is the elderly. However, they are not all congregated in nursing homes. On the other hand, they are not, by and large, in the workforce. Many roam in the freedom of being child-free and comparatively well off. One has to know where the mobile “grey nomads” will congregate in the coming months, and where they will roam in remote Australia. Perhaps that is why there is a run on toilet paper and disinfectant.

For the sedentary aged care population and their housing, just assure hygiene and that someone is checking on them to ensure they have supplies. Places for the aged should conform to the level of hospital hygiene. After all, we are the vulnerable group, and let me say that this raises very strong questions about the workforce’s ability to communicate with an increasingly deaf population and with its significant demented cohort.

In the end, China may be able to impose Draconian provisions in the short term but will it effect the cultural changes vital to prevent this sort of disease outbreak happening again? And the experts still don’t know whether this infection confers life long immunity. The common cold recurs and it is contained in a set of coronaviruses.

As somebody very wise said to me, the aim of all the actions taken in the public and private sector should be directed to creating a new appreciation and behaviour in relationship to personal and community hygiene. Conceivably then we may be able to blunt the inevitable winter season coming up where we are beset with the common cold and influenza, as well as this COVID-19.

We are already seeing this with the proliferation of hand sanitiser stations in public places, offices, banks and shops. I hope it continues to grow so, for instance, washing your hands before eating which I was taught to do as a child, becomes the accepted norm again.

Rollin’, rollin’ rollin’ – Raw Hide

The problem with toilet paper is that, while it is considered an essential, it is a topic we normally do not discuss.

The picture of three ladies wrestling over toilet paper in the Chullora Woolworths may be appalling for the pious commentators, but there would be a sizeable populace who found the spectacle as mildly diverting as watching mud wrestling.

This toilet paper imbroglio reminded me that a number of celebrities including Magda Szubanski, Merv Hughes and Ita Buttrose, all making fun of themselves, have appeared in toilet paper commercials. However, the prize paper seller was Lleyton Hewitt in his memorable commercials.

Perhaps Government could use these toilet paper spruikers to use their talents in calming the hysteria induced by a country afraid of being quarantined with dirty bottoms.

By the way, when we were young, there were always squares of newspaper hanging on the hook beside the dunny door. Even then we favoured the Daily Telegraph as the paper most worthy of use because we knew that it had been pre-tested.

Nevertheless, we did a trial this week – 15 minutes in tap water at ambient temperature (a) toilet paper, (b) ordinary tissue, (c) paper towel and (d) newspaper of same size – at this time that water agitated to simulate flush. The result, toilet paper and tissue disintegrated, the paper towel dehisced and the newspaper was unchanged and still readable; so much for newspaper and paper towels.

Mount Quilton, a new Tasmanian landmark

Leprosy

Leprosy is endemic in the Kimberley. When I first went to the Kimberley in the 1970s there were obvious signs of past leprosy in elderly aboriginal people, particularly men. This was characterised by loss and deformity of both fingers and toes, and the leprous discolouration of the skin.

Randy Spargo, whom I have mentioned in a previous blog, has also commented on the destruction of cheek bones and the nasal septum as a characteristic Randy remembered – the so-called “lion face”.

The Aboriginals in the early days of the 20th century who were found to have leprosy were rounded up in an appalling manner, put in chains, taken away and confined. Originally there was a leprosarium at Cossack, now a ghost town near Roebourne which, when the patients were moved to the new Derby facility in 1935, was burnt to the ground as a public health measure – such was the fear of the disease.

Bungurun

The was managed by an Irish order, St John of God nuns from the mid 1930s, and the conditions improved so much so that the leprosarium had outlived its usefulness by the time I visited Derby. In the 1940s a treatment had been found, and the public health measures of contact tracing for those with the disease was well in place. I remember one of the nurses saying that they had only one whitefella on their list; all the others were Aboriginals allowed to move around – but their movements were traceable, which was no mean feat.

I met some of the last nuns. They were caring, admirable women who had worked much of their life bringing a more humane way of caring for lepers. Soon the leprosarium would be closed. Contact tracing was maintaining oversight and facilitating care for a diminishing population of lepers.

The Kimberley is strongly Roman Catholic and there were tales of the then Bishop of Broome, John Jobst, who was reputed to have been a panzer commander in World War 2, terrifying everybody with his fierce approach to flying – tales of Aboriginals scattering as he unexpectedly would come into land.

However, the 1970s in the Kimberley was a time of great change there. Its Wild West characteristics as described above began to fade.

For those suffering from leprosy thankfully change had started earlier.

However, there are lessons to be learned. The mere mention of the word “leprosy” incites fear in the average person. Leprosy is a mycobacteria like tuberculosis. Both are contagious diseases.

Tuberculosis was particularly common before antibiotics became available, but in the Western world it was realised that there was a “herd immunity” – in other words we, as a white race, had a better immune response than other people, such as Aboriginals.

The first response of the community is to isolate the infectious ones, these days in more humane ways than in the past. However, a person is isolated, how long is the sentence – and when these poor people try to break out from their isolation our first reaction is to punish them.

Punitive powers exist under current State legislation, but true to form when you have a government such as ours that tends to prey on community fear it’s not unexpected to turn public health into incarceration. After all, the other name for this is “border control”.

We don’t want to end up with armed police patrolling the street to stop people coming out of their houses – and why not a curfew for good measure?

Before the Attorney General, who seems to be a reasonable character, goes further into this murky Duttonian world, he should see what his West Australian forbears did to the Aboriginal population in the name of public health.

After all, recommending 14 days in isolation from an indeterminate starting point when the coronavirus infection possibly occurred is just an informed guess. Why not 40 days as the Bible exhorts, Mr Morrison.

And why this stupid term “self-isolate”? In those days before the Age of Fear” I just stayed away from work when I had the flu and thought it inconsiderate to go out while coughing and presumably infective. Why not retitle the play “Self-isolating for Godot”?

Mouse Whisper

When Marie Curie visited the United States in 1921, interest in radium surged as reported some years ago in one of those journals hoarded by mausmeister. “Americans were flocking in their thousands to buy bottles of radioactive water, believing it would cure their aches and pains.”

Never fear, there is a spa in an old uranium mining area on the border of Germany and the Czech Republic, which advertises the anti-inflammatory effects of radon-infused water. How many, Topollino wonders, are fruitlessly flocking to this spa to escape the virus?

Radium Palace