Modest expectations – Three hundred and four thousand four hundred and eighty

COVID-19 comes to all. I thought I had some idea where I picked it up. I have limited contact with people, because my disability makes it difficult moving around, especially when there are steps. Until you are disabled, you do not realise how difficult it is to avoid them; the world is not a level field.

The virus is harassing my upper respiratory system, and it has been a challenge to dislodge the tenacious phlegm. The whole picture is that of congested misery.

On Wednesday last, we drove from Swan Hill to Albury, a distance of about 400 kilometres. Lunch was a Cornish pasty and coffee in the shade of pepper trees in Wycheproof.

By the time we arrived in Albury, I had developed a cough, and initially my RAT was negative; but next day it was positive.  The inevitable march of the Virus through the house had commenced.  By the weekend, we were all RAT positive. For us, it was inconvenient to say the least to be away from home, but at least we were isolating ourselves.

I was prescribed Lagevrio (molnupiravir). Paxlovid (nirmatrelvir/ ritonavir), the other antiviral drug, was contraindicated.

Of course, there are no controls to confirm whether Lagevrio had any effect, but now with the cocktail of vaccines and anti-viral capsules, I seem to be holding my own. I have just taken my last four capsules. The congestion has much improved, but is still lingering.

In Albury there has been a supply shortage of antivirals. For a time early in the week Albury may have been in danger of running out of the antiviral drugs if promised deliveries didn’t eventuate. Familiar? Here we go again. Governments blithely change the conditions for availability without determining whether there is a sufficient supply. It is a nightmare, when we – like so many others – are confined to home and depend on the drugs being delivered.

I remember my last tussle with the flu about five years ago. That lasted six weeks with a residual cough for months afterwards., I could see the long dark corridor where there are no open doors and no light at the end.

The pandemic has persisted. Public health measures are now a matter of choice in regard to responsibility. No longer any of those public measures – such as contact tracing, hand washing, masks, social distancing observed. They work, but just as our forefathers did not throw away their weapons because WW11 persisted for more than two years, there is no reason why we could not have adapted if we had had anywhere decent leadership, beyond shutting borders.

Quarantine facilities have been built at great cost, but it seems nobody has thought how to use them. This is very ironic given the decades long experience of confining boat people. Having experienced a period of being in lockdown without any ability to go out, these facilities present the opportunity to enable that group of people to have a shelter until the infective status changes.

It is amazing to see how technology, through the manufacture of new vaccines, anti-virals and diagnostic tests, even down to improved masks, has occurred.

But such improvement in the efficiencies of social practices has lagged, and we all should share the blame, not just Dr Murphy. Nevertheless, it was a time when, except for brief flashes of government accepting responsibility and not blaming everybody else, our social structures have been found lacking. The pandemic still rages; thank God for the scientists and technologists who have provided some weapons, but the virus is far from unconditional surrender.

By the way, a week after testing positive, I am still positive, albeit weakly.

Can you believe these remnants of the Dark Ages!

When I was a first-year medical graduate working at a suburban hospital, one of my earliest memories was coming out of one of the emergency bays on my way to the next when I looked up. At the end of the corridor of flapping curtains against the emergency department wall was a trolley. On the trolley was a young woman who had apparently just been wheeled in and was waiting for a bay in which she could be seen. She was very pale, very grey; she looked very sick, even from where I was standing.

Immediately, I remembered I had seen her in the emergency department the previous day.  She was complaining of a vague lower abdominal pain.

She said she was not pregnant, but she did have some tenderness in the left fornix. She was unmarried; and it was a time when if you were unmarried and under the age of 21, there was a mixture of denial, stigma in her history, and yesterday she had not looked unwell, certainly not as she was now.

I could suspend belief or rationalise why I had missed the diagnosis, so obvious as I looked at her with that grey pallor of impending disaster.

In those days, when you graduated you were considered fully fledged. That was it. Your training wheels had been removed. You could practice unsupervised after you had been through six years of undergraduate education.  I had stuffed up. Looking at her lying on a trolley I knew that I had missed an ectopic pregnancy. I had stuffed up.

I moved with the speed of a penitent, and I immediately ordered that she be taken to the operating theatre. The senior obstetrics resident was alerted and in turn the general practitioner obstetrician. The operation to remove the ectopic pregnancy was successful. Nobody stood around, arguing her clinical diagnosis. They just saved her life; no problem.

I learnt a lesson that day; and my peers were forgiving. It just confirmed  that if you stuff up, admit it and learn; then recriminations are somewhat superfluous. There was none of the huge panoply of undertaking root cause analysis or any of the fancy names designed by bureaucrats to define the scapegoat , the sacrificial offering to protect the system from the predations of legal jackaldom.

Where am I leading? Ectopic pregnancy requires termination for the health of the mother. The embryo is developing outside the uterus, and undiagnosed or untreated will eventually cause a catastrophic haemorrhage and maternal death.

When I was a young doctor, chemical treatment of ectopic pregnancy did not exist. The drug methotrexate was introduced to destroy the ectopic pregnancy. Methotrexate can kill a wide and diverse number of targets, including the ectopic embryo. Usually given in a single injection, methotrexate has a cytotoxic effect on the trophoblastic tissue – the cells that enable the embryo to stick in normal circumstances to the uterine wall.

Methotrexate treatment of ectopic pregnancies is considered safe, effective and cheap, with no major side effects. Intramuscular methotrexate has the advantage of tubal conservation and saves patients from requiring surgery. It is easier to administer than intraoperative route, which these days is laparoscopic and hence needs expertise.

Now what is happening in the Redneck States of the America?

In addition to surgical abortions, anti-abortion laws in some states such as Texas have also banned several drugs that can be used for inducing abortions. Among the medicines banned under these laws include drugs such as methotrexate, mifespristone, and misoprostol. Besides inducing abortion, these medications are also used for the treatment of other conditions.

Moreover, these laws allow the state to prosecute health care prescribers and pharmacists for dispensing such abortion-inducing medications.

Recent reports suggest that the reversal of abortion rights has also indirectly impacted women who use these medications for conditions other than for a medication abortion.

Although States such as Texas have banned these medications for terminating pregnancies, the laws permit the use of these drugs for miscarriages and ectopic pregnancies.

However, the fear of penalties, including being criminally charged, has resulted in some pharmacists refusing to dispense these drugs for the above.

In addition to ectopic pregnancies, methotrexate can suppress the activity of the immune system and is used in the treatment of autoimmune conditions, including rheumatoid arthritis, scleroderma, and lupus. Methotrexate is also used for the treatment of inflammatory bowel disease and a variety of cancers, including breast cancer, lymphoma, leukemia and lung cancer. Depending on the nature and severity of the disease, the dosage required varies; for a period I was prescribed the drug but in a far lower dose than required for neoplasia – or ectopic pregnancy for that matter.

Nevertheless, in these anti-abortion States , believe it or not, there are reports of disrupted access to methotrexate for patients with autoimmune disorders. Some rheumatologists have stopped renewing prescriptions for methotrexate, and moreover pharmacists are refusing to dispense.

Paradoxically, methotrexate can cause birth defects.

This has had a knock-on effect. The risk of birth defects and the lack of access to abortions have made rheumatologists wary of prescribing methotrexate to women of childbearing age with these concurrent diseases. As one source has said: “Frankly, methotrexate is one of my go-to medications for any number of diseases, including rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, myositis, and systemic sclerosis. I expect that some rheumatologists will understandably worry about prescribing methotrexate to patients because if the patient inadvertently became pregnant, the foetus has now been exposed to this medication. This is really worrisome as methotrexate is a very effective medication that we rely on to treat a number of debilitating and serious autoimmune diseases.

Indeed.

Justice John Roberts

Now America has John Roberts as the de facto Surgeon-General. He presides over a Supreme Court which could be reasonably considered is now the legal equivalent of the untreated ectopic pregnancy – eventually if left alone it will all end up in tears – however you pronounce it.

America remains untreated. We await the death of this motherland in the eventual haemorrhage of a Constitution constructed when the population had a median life expectancy of 35 years.

Eventually, the blood of all is shed. See, your gloves, Chief Justice Roberts, are smothered in the blood of your country, shed for no-one but the hubris of your colleagues.

The Unsinkable Molly White

Anissa Gardizy a 35 year old reporter on the Boston Globe. Her short biography states that Anissa Gardizy is a general assignment business reporter. She graduated from Emerson College with a B.S. in journalism and took economics classes at Framingham State University. Prior to joining the Globe full-time, Anissa was a co-op on the business desk, and she held internships at the Telegram & Gazette in Worcester and The Information in San Francisco. 

Below is her recent profile of Molly White, who had to take time out because of her robust criticism of cryptocurrency. She has been verbally attacked; which probably means she has obviously come too close to the festering centre of cryptocurrency activity.

Ms Gadizy writes:

Depending on whom you ask, cryptocurrency is either digital snake oil or revolutionary technology. Crypto markets have plunged in recent weeks and everyone is looking for answers.

So it makes sense that a website dedicated to documenting mishaps, failures, and scams in the industry is suddenly taking off. And who’s behind it? Molly White, a 29-year-old Wikipedia enthusiast and former HubSpot employee who has emerged as one of the industry’s most pointed critics.

How the 2016 Northeastern University graduate, who lives in the Boston area, came to be one of the most listened-to people on crypto and blockchain tech is complicated. But it started in the past year, when the field became impossible to ignore.

The price of bitcoin surged to an all-time-high of nearly $70,000 in November. Ads for crypto companies were featured during the Super Bowl. Celebrities changed their Twitter profile pictures to non-fungible tokens, or NFTs. Some of White’s friends began quitting their traditional tech jobs to work for crypto firms.

White, a longtime Wikipedia editor on the side, started to research the technology. But the more she learned, the more she realized crypto was being marketed as something everyone should be getting into, despite a history rife with fraud, scams, and predatory marketing.

“[I was] seeing people get screwed over again and again and again,” White said. “There wasn’t a permanent record of what was actually happening and how poorly a lot of these projects were ending.”

Her first instinct was to start writing Wikipedia articles about crypto and the related field of web3.” But she quickly realized Wikipedia wouldn’t be the best place for her work — among other things, it would have required her to take a neutral approach.

“I have a pretty strong opinion,” she said.

Software engineer Molly White at work on her laptop

So late last year, while working full-time at HubSpot, White created a website called “Web3 is Going Just Great”. (The name is as sarcastic as it sounds, with the longer version ending with “…and is definitely not an enormous grift that’s pouring lighter fluid on our already smouldering planet.”) On the site, she chronicles  sometimes several times a day — bad things happening in crypto.

“There’s a narrative that’s become so loud and pervasive, that everyone should be getting involved in this,” she said. “It feels like I have this obligation to speak out about it.”

And others are listening.

She is regularly quoted by national news outlets, was a guest lecturer at Stanford University, and has advised US senators, including Senator Elizabeth Warren, on blockchain and cryptocurrency.

As White has learned over the past year, criticizing crypto isn’t easy. In a space known for unwavering optimism and “bro culture,” she’s the outspoken opponent pointing out its problems.

White has been the victim of online harassment, doxxing (when private information is revealed about someone), and threats of violence. As a result, she doesn’t share much identifying information about her family or where she lives.

White, who grew up in Maine, started editing on Wikipedia around the time she was 13. “My family knew I was doing it, and to some extent my friends knew,” she said. “It was kind of just like, ‘Oh, that’s one of Molly’s weird hobbies.’”

Though she got started writing about her favourite bands, White now focuses on controversial viewpoints and male-dominated spaces, including right-wing extremism and “involuntary celibates,” or incels. She has also served on the site’s arbitration committee, which settles its toughest disputes.

Andrew Lih, a Wikipedia veteran who has known White since she was a teen, said most editors concentrate on topics they take a personal interest in. White, he said, tackles things “she absolutely doesn’t like.”

“She wants to make sure the record has the best information,” he said.

Lih credits White’s rise to her ability to present information in a way that is digestible. On her crypto website, she writes in a terse, matter-of-fact style and uses hashtags such as #yikes, #badidea, and #hmm. She isn’t condescending or alarmist, either.

Unlike some critics, White doesn’t think all crypto is a scam. Rather, she believes there has been an explosion of “really scam-y projects” that downplay the risks. She worries crypto is being cast as a “ticket to financial freedom” to people who don’t have money to lose.

According to data published by the Federal Trade Commission, more than 46,000 people have reported losing over $1 billion in crypto to scams since the start of 2021.

Long term, White believes crypto will likely exist as a niche, speculative vehicle for high-risk takers.

Most people would agree that regulators need to address crypto scams for the industry to be viable. More controversial is White’s sceptical view of blockchain, crypto’s underlying technology, which has been hyped in recent years as a potential cure-all for problems related to Internet security, privacy, and financial systems. Blockchains are public, electronic databases that are distributed across a network of computers. The technology is intended to be immutable (meaning records can’t be modified) and decentralized (meaning data are stored across the network and not held by any central party.)

Proponents believe blockchain tech could eventually transform everything from financial systems to social media, creating a digital world where individuals have increased control over their own data. Many people refer to this blockchain-based vision as “web3.”

There’s been a proliferation of venture capitalists, startups, and politicians touting its potential, including a growing cluster in Boston. Late last month, hundreds of people attended an all-day summit on web3 on the top floor of the MIT Media Lab, put on by venture capitalist John Werner. It drew industry heavyweights, including cryptographer Stuart Haber, who co-invented the blockchain.

But White doesn’t think blockchain is revolutionary technology. Last month, she and a group of about two dozen computer scientists, researchers, and academics, signed a letter to US lawmakers to express their concerns about the field. Signatories included well-known technology figures like Harvard lecturer and cryptographer Bruce Schneier, Boston-based entrepreneur Miguel de Icaza, and software engineer Grady Booch.

“By its very design, blockchain technology is poorly suited for just about every purpose currently touted as a present or potential source of public benefit,” they wrote, calling it a “solution in search of a problem.”

White’s critics say the technology is in its early stages and will improve. But she disagrees, noting that the two most popular cryptocurrencies have been around for more than a decade. She also thinks blockchain, by design, contains inherent flaws — such as the inability to edit or delete data — that will make it difficult to use and potentially even harmful.

Greg Raiz, managing director of Techstars Boston — which just launched a crypto accelerator program with Boston-based blockchain firm Algorand — disagrees with White’s assertion that crypto is past its early days. In fact, he said it feels like “we’re still in the first inning of this game.”

While he doesn’t think blockchain will be the “solution to everything,” he isn’t writing off its potential to address social, monetary, and business problems. He added that criticism of web3 is “super healthy.”

“Any type of unbalanced exuberance toward a technology isn’t great,” Raiz said.

Sounds that he is pronouncing an “Amen” to the unsinkable Molly.

Parliamentary staffing

The first reaction to the protesters of the newly-elected backbenchers – not aligned to any particular party – to a reduction in the four advisers to one  in line with other back benchers, was that of the howls of the deprived. Really, you poor diddums – only one adviser and four electorate officers. When perceived as privileged already, complaining about the level of the porks, is one way to lose the electorate, especially before you have even placed your toe in the political water. I was surprised when Dave Pocock started the Whimper.

In 1973, the Leader of the Opposition had a Press Secretary, a Principal Private Secretary (PPS), a Deputy Private Secretary and an Assistant Private Secretary. There was one other adviser who was from the government and picked up much of those tedious jobs and fashioning questions on notice and an add on to the Parliamentary Library. Needless to say, we were all male, and the secretarial staff who did all the work were women. I was the PPS. However, the Leader of the Opposition was thus limited to four advisers, including the Press Secretary – not one backbencher.

I believe it was more important not to interfere with the electorate staffing. For senior members of any party the electorate secretary is very important to remind even the Prime Minister that he represents an electorate, even if it may be traditionally very safe. Nowadays that cannot be guaranteed. Thus, the electorate office is an important bastion. In the case of the backbencher, especially those who have gained their seat by the adroit use of social media to win the popular vote, their activity will be augmented by an electorate office, government funded. Cathy McGowan in the northern Victorian electorate of Indi is an important bellwether since she developed an electorate office system, which was shown to be transferable to her successor, Helen Haines.

Cathy McGowan

As the sociologist Max Weber observed, charismatic leadership is very dependent on the individual’s appeal, but in her case McGowan (an unlikely charismatic) was able to “bureaucratise” the electorate staff so her successor did not need to change the systemic aspects of the McGowan legacy. In other words, the model was robust enough to survive the transition from one to another strong-willed woman.

McGowan concentrated on her electorate and where she thought relevant generalised the needs to that of Australia. Maybe the fact that she came from a large cohesive family provided her with a model for an electorate office, but whatever it was, her electorate brew worked.

Developing her model from an electorate base provides a challenge for the new raft of independents, whatever their colour. She had a strong personal appeal, which translated into strong personal loyalty by her staff. She did it with a strong electorate profile, which contrasted with the dysfunctional style of her predecessor.

A backbencher needing Canberra advisers is presented with the aspirant jetsam seeking to float as a successful “factional candidate” onto a red or green parliamentary cushioned sinecure. At this pupa stage the adviser may be more akin to N’drangheta Consigliere admixed with a tincture of Undergraduate Puerilism. Policy development is not one of the skills of this Canberra hybrid. More, it is a question of hanging out, gossiping, and covering the underlying boredom of those without any constructive thought coupled with outbursts of anti-social behaviour – sexism,  drunkenness and sexual harassment.

Policy becomes a joke; so-called policy becomes exercises in plagiarism – or just the “smart-arse” taking the role of the cynic – tearing down all constructive thought on the grounds that they are protecting Absolute Truth – otherwise excused as the role of the Devil’s advocate. Undertaking policy development is a skill, imperfect at best. It is a special quality requiring knowledge, so you know that you are not re-inventing policies that have been shown not to work, and enough knowledge to provide objectivity in an ocean of bias coupled with an ability to write clearly and succinctly. These skills lie outside the normal skill set of the normal adviser appointee.

Staffers aplenty

Well, minimising the number of advisers minimises the number of people designed to irritate and thus it seems leaving it at one each for all backbenchers is probably about right. Only need one person to get your dry cleaning, run errands, and ensure that the backbencher has his or her ego combed daily.

Mouse Whisper

Don’t know whence it came. Just a scrap of paper with the title “Death of a Babyweight.”

…needless to say, the comment was met with gales of laughter, but then that was another time when the sun shone and they were feckless and shallow students; and yes, the Associate Professor was as Federico would say a total bunghole who played the World for cheap laughs a person who always knew the mouse to kick – and now lies increasingly forgotten – someone essentially trivial. 

Perhaps you will understand the allusion, illusion and in the end the confusion.

 

Modest Expectations – SXM

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

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

But first, the scene should be set for both.

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

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

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

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

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

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

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

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

On the road to Balranald

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

Why? Mining means improved access.

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

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

The Prequel

David Lyle

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

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

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

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

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

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

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

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

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

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

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

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

The Postscript – What’s in a Name!

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

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

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

Lascelles silo art

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

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

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

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

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

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

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

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

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

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

Sarah Jane Halton and her Stomach Knot

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

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

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

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

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

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

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

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

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

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

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

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

Excuse me for gagging on “independent”.

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

Climate Change

Ravenserodd – site of sunken Medieval town

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

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

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

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

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

Mouse Whisper

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

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

Penarie pub

 

Modest Expectations – Jeffrey O’Brien

We had a bushfire the other day up the road at Tullah. It seems not to have been deliberately started, but a stray cigarette or a spark from an exhaust would suffice as explanation.

Tullah

Next minute, fire crews were working on the outskirt of the Tullah village through the night and had the blaze on the nearby Mackintosh Dam Road contained by Sunday morning. In the meantime it burnt down one vacant property and a number of sheds. It was contained, but the resources that were thrown at the fire early were spectacular, drawn from all over Tasmania. The fear was that it would get in the pine forests and then it would have rivalled the mainland fires of two years ago. The other danger was fire getting into the peat, which lies at the base of the button grass meadows that constitute so much of the West Coast. Then it could burn for a very long time.

Tullah, by way of explanation, describes itself as a village on Lake Rosebery. It was a settlement built by the Hydroelectric Commission when one of their schemes was to dam the Tasmanian West Coast (or was it damn?). It would have culminated in the Franklin River being dammed, which would have had a great impact on the region.

Returning to Tullah, the older part of this township lies directly on the Murchison Highway. An old silver lead mining area, it consists of a pub and a few houses and displays one of those famous locomotives now cast onto an Australian coin – Wee Georgie Wood. It was used to transport the ore before there were any roads and was in that part of the township threatened by the fire.

Having had experience some years ago of a fire initiated as a “burning-off” exercise by the Department of Parks and Wildlife (laughingly referred to then as that of Sparks and Wildfire) on the ridge behind our house in which we lost a shed containing most of our stored linen, it was great to read how much the fire fighting service has picked up its game.

One of the newer residents of Tullah, who runs a microscopically-sized café with excellent coffee (and a resident alpaca), was obviously relieved when the fire was halted on the outskirts.

Tullah is on the edge of the West Coast wilderness area, which has some of the most undefiled temperate rain forest in the world. Because of the high   rainfall, an average of 240cm a year, it has been thought of as somewhat protected from fires.  Ironically the wettest place is actually Tullah, with an average annual rainfall of 280cm. So this recent blaze serves as a warning. Climate change is coming – I’m not clever enough to calculate how quickly and how selective will be the change. Yet the forests of the West Coast and South-west are vulnerable. Whether one believes that the forested wilderness is little changed since the time when the dinosaurs walked the earth, it becomes all so academic if this part of Australia catches alight as has occurred periodically in NSW and Victoria.

Ubertas et Fidelitas

An interesting datum. The state which has the highest identification of its inhabitants as Aboriginal people is Tasmania (close to five per cent). As a person who grew up believing the last Tasmanian was Truganini, as I have grown older, I have been surprised by the number of Tasmanian Aborigines who emerged from “among the Huon pine”.

A Dulcie Greeno maireener shell necklace

We have purchased several traditional Aboriginal Maireener shell necklaces, with their characteristic iridescence. Much of this art form is concentrated on the Flinders Island in Bass Strait. We have other cleverly executed pieces of Aboriginal art with a Tasmanian tag – but seemingly made in the last 20 years. My problem is connecting them to a tradition that shows areas of petroglyphs and middens on the shore which have survived the often violent storms which characterised that part of Tasmania for millennia.

To celebrate Tasmania Day in 1986, a collection of papers from the early days of Tasmania was published, including that of Captain James Kelly’s voyage, which commenced on 27 December 1815.

Then James Kelly sailed out of Hobart in a five-oared whale boat, with four men, John Griffiths and George Briggs, who were described as native to the colony and two others described as “European” William Jones and Thomas Toombs, the last named’s previous occupation being listed as“bushranger”.  King’s aim was to circumnavigate Tasmania and, as part of this voyage, he discovered Macquarie Harbour. This harbour, the third largest in Australia, has a treacherous entrance, which was later christened Hell’s Gate. The weather was very compliant as they came into the Harbour under the smokescreen from the Aboriginal fires at the Heads. They reckoned that enabled them not to be seen initially.  They spent some time and made contact with a number of Aborigines, warriors with whom they developed an uneasy relationship.

However, when leaving the newly discovered Harbour, which Kelly named after the then Governor Lachlan Macquarie, (whose territory then incorporated both NSW and Tasmania), the fury of Hell’s Gate kicked in and they were lucky to survive.

The insights into Aboriginal life and the interaction with the whitefellas is expressly discussed under the heading of “female sealing”. Seeing how they went about harvesting the seals obviously astonished the diarist. The women showed a distinctive methodology, as though they had to commune before killing the seals. It shows how important the description of Aboriginal life, when the only chroniclers of the day-to-day activity came from these early reported interactions, at a time before extermination became government policy with the inevitable destruction of the social fabric.

The recent literature trying to show that the Aboriginal tradition progressed from the hunter-gatherer society to one of adopting the tenets of the agricultural revolution as its origin is promoted by a number of Australians who claim Aboriginal descent and are clustered around the University of Melbourne. From what I have read, I do not believe it to be so. Take this excerpt.

The description of female sealing in the Bass Strait islands is a prime example. No mention of herbs and spices in cooking the young seal. Having personally been one of those who have tasted seal, I would suggest it is not among my top ten gustatory phenomena.

“We gave, says the journal of the exploring party, the women each a club that we had used to kill the seals with. They went to the water’s edge and wet themselves all over their heads and bodies, which operation they said would keep the seals from smelling them as they walked along the rocks. They were very cautious not to go to windward of them, as they said “a seal would sooner believe his nose than his eyes when a man or woman came near him.” The women all were about nine or ten seals upon each rock. Lying apparently asleep. Two women went to each rock with their clubs in hand, crept closely up to a seal each, and lay down with their clubs alongside. Some of the seals lifted their heads up to inspect their new visitors and smell them. The seals scratched themselves and lay down again.

The women went through the same motions as the seal, holding up their left elbow and scratching themselves with their left hand, taking and keeping the club firm in their right ready for the attack. The seals seemed very cautious, now and then lifting up their heads and looking round, scratching themselves as before and lying down again; the women still imitating every movement as nearly as possible. After they had lain upon the rocks for nearly an hour, the sea occasionally washing over them (as they were quite naked, we could not tell the meaning of their remaining so long) all of a sudden the women rose up on their seats, their clubs lifted up at arms length, each struck a seal on the nose and killed him; in an instant they all jumped up as if by magic and killed one more each. After giving the seals several blows on the head, and securing them, they commenced laughing aloud and began dancing. They each dragged a seal into the water and swam with it to the rock upon which we were standing, and then went back and brought another each, making twelve seals, the skins of which were worth one pound each in Hobart Town. This was not a bad beginning for the black lakes (sic), who now ascended to the top of a small hill, and made smokes as signals to the natives on the main that they had taken some seals. The smokes were soon answered by smokes on the beach. We skinned the seals and pegged them out to dry. The women then commenced to cook their supper, each cutting a shoulder off the young seals weighing three or four pounds. They simply threw them on the fire to cook, and when about half done commenced devouring them, and rubbed the oil on their skins, remarking that they had a glorious meal.

As I said above, food for thought! 

Reflection in the Pool of the Land of the Anziani

I suspect that the aged care portfolio has caught up with the politicians because when it is part of the health portfolio, it tends to be cast into “the too hard basket”.  Yet with the increase in longevity and the growth of the private nursing home sector as a lucrative business for the owners, government responsibility should have increased not lessened in maintaining our aged through the time of life when a person becomes increasingly dependent on others. Once into the nursing home it is very much one way, but it should not be a nightmare.

When I had my 70th birthday, I half believed the axiom “that 70 was the new 50”. Three years later and that concept went into the rubbish bin.

For myself, the acute phase of the disease took a long time to settle into a chronic burn, and as the years have passed the co-morbidities have accumulated until now I can no longer live independently. In previous times, there may have been an array or servants, but in the modern world this not feasible without wealth.

I had two aunts who entered nursing homes in their nineties, wealthy women who were able to afford a nursing home where all the “creature comforts” were available and provided. What struck me was the number of Filipino and Nepalese nurses, both male and female, and feeling of optimism in this establishment. But it was at the high end. They were both dead before the Virus struck and surveying the conditions in that nursing home gave no reason for me to worry about their care, even as one increasingly succumbed to fronto-temporal dementia.

The Virus has taken a toll in other ways. I used to go to hydrotherapy twice a week. The hydrotherapy pools where there are supervised programs have vanished, as the pools have closed because of the Virus. This gets no coverage, but when one depends essentially on allied health professional services, the Virus has curtailed them, and with any such program, once they cease so too do the levels of personal fitness and social interaction decline.  Gyms get all the publicity, but circumstances for the aged are probably worse once you lock people in their rooms with staff barely having the requisite nursing skills let alone those of allied health professionals.

Some of the drugs required for my treatment, such as the corticosteroids are essential but impose complications. I had the rapid development of drug induced cataracts, both of which have resulted in new improved lens (no longer any astigmatism). Otherwise I have eschewed operative intervention. Some of the operations had the potential to make life worse, and I value the fact that I can still communicate.  The bottom line is that if I did not have my wife, who is a very caring individual, I would be facing institutionalisation and all the uncertainty that entails.

My sleeping arrangements have been modified, so I am close  to the toilets.  I still have been negotiating stairs.  My fall a few months ago emphasised the line between having my immediate daily care and then having to wait face down for someone to come after nearly two hours. I have learnt to curb my impetuosity, since change is now a one way trek, but the nursing home looms as a prison, with the likelihood of solitary confinement.

And a Minister in charge of this crisis who goes to the cricket for three days! He has either given up, or else needs a cognitive test to assess whether he needs the pity for a person with early dementia. Or is he just callously insensitive? I cannot believe that this man is functioning normally; but then the last people who are considered to have such pathology are those with the public relations machinery of denial. Morrison has demonstrated himself to be a Prime Minister with zero human relations skills but with a formidable expenditure on public relations.

Having experienced Bronwyn Bishop’s hair-raising approach to any portfolio in which she was put, I thought that disclosure of kerosene baths in nursing homes under her watch would have elicited a positive reaction for reform. There was the predictable furore and then nothing. Even Royal Commissions do not move the dial, because the people trapped in nursing homes have virtually no say.

The idea of little children mingling with the elderly as gleaned from the ABC TV program has long since been suspended because of the Virus, but it is ironic to see a photograph of myself at two years of age with the wide gait; and realise that I am not that much different now because of loss of proprioception.

I remember a child staring at me from a stroller; I was in a wheelchair.

“Don’t worry son, you’ll be here soon enough.” He was too young to understand, but it certainly brought home to me the irony of existence. His parents did hear me, and laughed. Vulnerability is the product of the child in the stroller and the guy in the wheelchair.

The role of government intervention in both areas has demonstrated the difficulty, because childcare and care of the aged have both been exploited, and over a long period. The failure of the religious institutions in these areas has been shown, and in many areas, disgraceful exploitation has emerged – yet these institutions keep their charitable status in regard to taxation

The whole failure of government intervention has been compounded by the laissez-faire approach to looking after the elderly – maximising profits by exploiting the elderly is a spreading stain on the Australian community.

I can only watch the stain come closer because I have no confidence in the area being afforded the priority it needs and which one only realises as 80 is the new 80.

Yet during my professional life I have sought solutions, but many of the schemes in which I have invested myself have reverted after I have gone. Some have survived.

Is there a solution?

Over my professional life, one way or another, I have had considerable contact with care for the aged in its various forms. The problem with being old as described above is that nevertheless it is not a homogeneous product. People age with different disabilities and hence needs.

The problem with age is that it comes at a point when nothing more can be done for you, but to ensure you are comfortable, pain free, not isolated, able to use the toilet facilities, and that your medications are regularly reviewed, and you have enough to eat and drink and to operate at the higher end of your residual competency.

To accomplish this properly requires both a high level of management skills and continuity of these skills; thus the competency of a clinical manager of each facility should be recognised and rewarded appropriately and succession planning encouraged.

I am a great believer that credentialing and privileging should be undertaken not only in health services but also in nursing homes. I am a purist as I have retained “credentialing and privileging”, whereas others have replaced “privileging” with “scope of practice”. In fact, the process has four stages –

(a)   Credentialing is self-evident as it is based around the qualification.

(b)   “The scope of practice” is what is requested by the health professional, but

(c)    privileging depends on the capability of the health service and confidence of the director of clinical services (or equivalent) that the requested scope of practice is appropriate and safe given the resources of the health service.

(d)   approval of the board on the recommendation of the credentialing and privileging Committee

All recommendations to the Board must involve the director of clinical services and if the terminology is correct, the nursing home manager who should be a nurse.

To me that is a very simple statement of intent, and I was able to successfully implement such a process among a number of small health services over a decade. To me, it satisfied the requirement of the clinician and the administrator and it made those involved take it seriously. In the private sector, that includes the owner (or representative).  In my health service experience the hospital board was very visible, but in the nursing home sector, who knows in the tangled web of business resulting in the lack of oversight in this sector. And with the obscenity of some of the owners with more concern with having the latest Lamborghini, it is a massive task to permanently change the culture when the government is basically uninterested.

When I suggested that the nursing homes be included in the regional credentialing and privileging scheme, the pushback from the Commonwealth Department of Health was fierce. The nursing home was the person’s home; it was not a quasi-health institution, it was said. The residents could have whomsoever they wanted as carers, without interference from government, and certainly by such a scheme which attempted to codify standards. God, no.

Yet there is an unfortunate strain of authoritarian behaviour which I have seen in the transition stage between hospital and nursing home. In the acute hospital, for some of the staff, an old person admitted is an old person to be get rid of, because of his or her occupancy of an expensive acute bed.

As the hospitals move from metropolitan teaching hospitals, the pressure on the bed is not as great. Nevertheless I once was faced with an officious nurse who was attempting to threaten me because I believed my father-in-law needed more time in the acute bed before being sent to a so-called “sub-acute care” environment. She attempted to stand over me by threatening to have him placed in a nursing home in a far-off town where he would have no-one able to visit him easily. After a strong word, that option was removed and he stayed in the hospital for some further period until he was well enough to be transferred. Nevertheless influence, like information, is asymmetric.

The fiction that a nursing home is a domestic situation is nonsense, because of the nature of the residents, who need personalised care but which is often left wanting because staff levels are squeezed for a number of reasons – profit margins, COVID-19 restrictions, poor pay and conditions.

Some nursing homes are attached to the public hospital. Therefore, I was in a position to influence the rules for visiting doctors. My initial approach was to look at the drug charts of each resident as this gives one an idea of how often the resident is reviewed by a doctor. The need for documentation is as essential as regular visits by the local general practitioner, and each nursing home should have access to a consultant geriatrician or specialist in rehabilitation medicine (and ensure one or the other visits regularly).

The requirement for allied health cascades from this overall need to ensure that in a world of specialisation and constantly improving technology, the aged are not deprived of the benefits of these advances.

In the health area where there is increasing specialisation, the pool of generalists in all fields becomes limited. The concept of nursing staff in rural areas acquiring some of the basic skills of allied health professionals has been regularly canvassed. Whatever the current state of this move to develop generalists should accommodate that some of the generalists will develop special area on interest and hence expertise.

The suggestion of “care finders” adds another layer without any improvement. To establish a new professional group is to establish a new bureaucracy, not necessarily improve care of the aged.

I well remember the country hospital which was converted from a general practice procedural hospital to one concentrating on geriatric treatment. The “driver” was a doctor who persuaded the staff to re-train from the theatre to treating the aged. He was successful and well-liked but did not want any limelight – and presumably this pilot program died with him.

However, successful models abound. The problem is each requires a certain discipline, dedication and time to implement and maintain. To change the culture is not just taking a pill. Governments, when pressed, can be reasonable at getting the input right through the multitude of ways enquiries can be organised.

Government falls down in the implementation. Many of the ministers and the bureaucrats think that fussing over the nature of enquiry is enough, and unfortunately too much of the intellectual capital is invested in the initial enquiry and its report. In fact, the report is only the start; but too often it is the end point, gathering dust with so many others.

In the end it is the clinical management standard that counts.

One question, what is the best private nursing home in Australia; and what is the best public nursing home?

In such a search, the common feature I postulate will be the ongoing standard of the clinical management team. Appropriate credentialling and privileging should be able to validate that approach.

In the end I want to know what works; and what has worked over a generation at least. Imprecise, but once you see success, you know what it is. To achieve this insight, experience helps.

Mouse Whisper

Just two items for Trivial Squeaksuit (obviously in a cat-free environment – pur is a palavra proibida).

  • Who is Dorothy Gale?
  • Who is Barbara Millicent Roberts?

Dorothy, the heroine in the Wizard of Oz.

Barbie doll.

Simple really.

Modest Expectation – Corinth & Carthage

We are introducing a new section of aphorisms called “what would Prince Rupert of the Strine have said?”

“Again, I admire Morrison because he has shown himself to be a man intent on currying flavours from the electorate – even if they seem to be a trifle pelagic judging by his stylish ‘barramundi and I’ tweet.”

Decamping

Well, we are taking our own advice. We are decamping to the West Coast of Tasmania in Mid-January until the end of February. It is time to get out of the Pirouette miasma and head for the temperate rain forest in which the town of Strahan, the largest fishing port on the West Coast, will be our base. We are among the privileged few who can flee the pandemic, and although we must travel by car to Melbourne to catch the ferry, we can do that while being in control of our social environment, at least on the basis we can assure our hygiene and maintain social distancing. I have had the three shots; but my wife must wait until probably February for her booster, but the eligibility times keep bouncing around.

Mask up for all your parties

Not that we live in a suburb where the COVID virus is raging; or being of the age when nightclubbing or pub parties will enhance our recreational COVID embrace.

A few years ago, I had a dose of influenza which nearly killed me, a year when I neglected to have an influenza shot. Remember those days when we were jammed on planes and one could hear the congested coughing in the row in front you. We lampooned the few Asians who wore masks in the street; and hand sanitiser was a hot towel in business class, and a mingy alcohol soaked so-called “towelette” in “cattle class”.

Now, two years on, the politicians have given up, except in Western Australia, although I don’t know whether McGowan has charted a course out of his isolation – but then, he doesn’t have to do so. A change in the Federal Government would give him more say. One obvious way out of this mess is selective segregation – banning crowds from those venues where the virus is most likely to appear; and developing a code of behaviour which acknowledges the sedition provisions of the Crimes Act.

The major reason for maintaining a strong public health response is that Australia has not controlled the virus; and though the new vaccines are adaptable, the current state of play is a booster shot at a time after the initial vaccination. This is currently available after the second inoculation at three or four months. There is evidence from Israel which suggests that the effect of the booster is more short term than expected and a fourth injection is being made available there to a limited cohort.

Having such a situation may be adaptable to the disciplined Israeli society, but not elsewhere where the level of coverage in some countries is still very low through choice, hesitancy or simply lack of vaccines. This situation is one where Australia needs to have a clear-eyed view, and perhaps once we get the Federal election out of the way, then a serious attempt to confront the Virus will occur.

Currently it’s a mess; especially with children’s vaccinations anticipated to have begun this week. I do not buy the Omicron variant being less lethal as an excuse to take our collective foot off the accelerator; there are ominous signs emanating from Brazil, where corona and influenza are conspiring together for a new round of buggery.

First, as I have written before, we need a policy on the unvaccinated; some of the anti-vaccination protests are clearly seditious, and therefore there is a need for a public discussion. Remarkably, after almost two years, a clear and understandable public health response is still not embedded in policy, nor is the action of protestors whose actions threaten the health of the public.  The powers are there in the Crimes Act, but this will be an election with the politicians spooked by this group of insane conspiracy theorists.

At the same time, while the community dislikes government-enforced lockdowns, voluntary quarantining is occurring, as instanced by our desire to escape to Tasmania, having effectively home-quarantined for most of the past five weeks in Sydney. The smaller crowds at the various festivities with which the community is infested at this time of the year also demonstrate that many people are voting with their feet and those feet are staying at home. The problem for this neoliberal collection of politicians where government responsibility is totally abrogated is that there is now total chaos.

Secondly, this Virus mutates and it seems that the Omicron version is less virulent but more transmissible than the Delta. It also seems to have an unacceptably high level of morbidity.  The lesson should still not be to reassure ourselves of the “good aspects”, but rather to develop a policy which accepts that while vaccination is in a state of flux, the Virus is liable to mutate; and who knows whether the next strain will be more deadly and kill all the children or the elderly in a day or so. Therefore, Australia needs an adaptive strategy, where “catch-up” – apparently the Federal Government’s preferred option – is not a viable option.

While we may have to live with the Virus, I prefer not to be enslaved. The problem with the politicians is they have no concept of living with the Virus, apart from getting it off the front page.

Leaving on Jet Airplane

From The Washington Post this week:

The decision by federal health officials to cut in half the number of days for people to quarantine if infected with covid-19 says less about our understanding of how the coronavirus spreads than the influence of airline lobbyists.

Air carriers clamoured for the changes as they cancelled thousands of flights over the holidays amid a staffing shortage caused by crews who needed to self-isolate for 10 days after testing positive. The guidance issued on Monday by the Centers for Disease Control and Prevention — which suggests five days of quarantine instead of 10 — shows a new willingness to avert crippling disruptions across society during the busiest travel period in years.

Delta approaching New York

It’s all the more remarkable because airlines have for months successfully thwarted a push by public health experts to require passengers to show proof of vaccination when they fly. This is maybe the most important lever that President Biden could pull — and has so far refused to pull — that might increase the country’s vaccination rate so that hospitals won’t routinely be overwhelmed with unvaccinated patients.

The same authority that allows Biden to require passengers to wear masks on domestic flights, which he has extended to March 18 2022, also allows him to require vaccinations. He told ABC News last Wednesday that he has considered doing so but has been told by staff that it’s not necessary. “Even with omicron,” Biden said. “That’s the recommendation I got so far from the team.”

This is disingenuous at best, dishonest at worst. Public health experts inside and outside government have favoured requiring vaccinations to fly since the summer. In September, White House Chief of Staff Ron Klain said that a vaccine mandate for flying might be unnecessary because the administration’s mandates for employers to require vaccination would be a more effective way to achieve the same result. But that rule has been put on hold pending Supreme Court review.

Biden should stop pretending his resistance to a vax-to-fly rule is about public health — and not politics. The truth is that requiring vaccines to fly, even with a testing opt-out, would provoke a backlash. Those who are vaccinated would be only minimally inconvenienced, if at all. But there would be horror stories about sympathetic-seeming holdouts who couldn’t, for example, fly across the country to see their dying parent because they won’t get the jab. Fox News would have a field day.

And that is true even though only about 62 percent of Americans are fully vaccinated. It’s understandable that airlines don’t want to get squeezed into the middle seat between the feds and unvaccinated customers, but the stakes are too high for the president to capitulate to CEOs.

Lest we forget: The 10 major passenger airlines have received $50 billion from federal government bailouts during the pandemic, including $13 billion in the stimulus package Biden himself signed in March.

The companies and their trade associations say checking vaccine cards would be onerous and logistically difficult and cause delays. But if small restaurants have figured out how to do it, big airlines — which already do so for international travellers — certainly can as well. TSA agents could glance at vaccine cards as they check IDs and boarding passes. Airports can set up stations right by security for unvaccinated passengers to get inoculated.

So much of life in Covid America turns on facts people don’t want to talk about. To wit: What the CDC’s new guidance doesn’t tell people who get infected is that they should take another coronavirus test after five days of isolation before returning to social settings. The unfortunate reason this wasn’t included is because there are not enough tests available. That is another consequence of the Biden administration’s tendency to hope for the best and plan for the best — rather than preparing for the foreseeable contingencies caused by the delta and omicron variants.

Biden sounded determined in his address to the nation last week to avoid using the word “mandate” as he discussed his efforts to increase vaccination. He prefers gentler words that have softer connotations, such as “requirements.” The other term Biden has stopped regularly using is “wartime footing,” which was a staple of his speeches early in the year.

It’s an unfortunate reflection of his desire to move on and not have his tenure defined by the pandemic. But the virus isn’t done with us.

An average of more than 1,400  Americans continue to die every day from Covid. Preventable as most of these deaths would have been with vaccines, as many Americans have died from covid during Biden’s presidency as Donald Trump’s.

That’s why we still need a wartime footing. And more vaccinations. And more tests. World War II took four years and required a draft to conscript enough troops to win. We’re two years into another global war. To prevail, we need to compel all Americans to join the war effort.

I have reproduced this article from The Washington Post which attests to the gutlessness that Biden showed three decades ago when he assisted the confirmation of the unspeakable Clarence Thomas, in the face of Anita Hall’s accusations of sexual predation. I had hoped that he would do better after a promising start, but he has unfortunately retreated to his default position.

It also suggests that it is not only the Republicans that bow to big business, and that is the concern I have with Anthony Albanese. Has he any anti-pandemic strategy where the options are laid out in order to to cover all contingencies, their likelihood and the resources needed to effect each option? Who is your Essington Lewis, Mr Albanese?

By the way, what a pathetic spectacle he cast in promoting a fast train from Sydney to Newcastle so as not to miss the night NRL game. Mate, we have a War on at present, and we ain’t winning – and you want a high speed night train for the football? Did you actually say: “You’ll be able to jump on the train at 6.30pm and be at Sydney Olympic Park for the start of the Knights game”?

Thus, if the Prime Minister is a Sharkie; does this proposal of yours make you a kNightie?

Brain Drain

Back in the mists of June 1998, Peter Doherty bemoaned the brain drain from Australia of “our best and brightest” researchers overseas. He instanced one Vladimir Brusic, who at the time was moving from Melbourne to Singapore. For almost a decade he had been senior programmer at WEHI. Brusic, a Serbian by birth, had been involved in the application of computer power to complex medical problems, the field of bioinformatics. His alleged genius was being able to distil huge amounts of data into a usable amount for laboratories, thus saving hours and hours of “tedious experiments”. Maybe. Anyway, that was the theory.

So, what did happen to Dr Brusic? Has he been lost to Australia?  In fact he has caromed around in the past 20 plus years and is currently the Li Dak Sum Chair Professor in Computer Science at the Ningbo campus of the University of Nottingham. The Ningbo campus is near Shanghai.

Dr Vladimir Brusic

After his stint in Singapore, which lasted seven years, he moved back to be Professor of Bioinformatics and Data Management at the University of Queensland. Then he was off again to the Dana-Farber Institute in Boston where he stayed for eight years as the Director of Informatics (concurrently also having a professorial post at Boston University) and then back to the Gold Coast Campus of Griffith University for three years, before taking up his Chinese appointment.

I am not sure what he has achieved by the peripatetic existence. It is one of the paradoxes of these gurus in information that when they communicate it is so arcane that only their own coterie know what they are really saying to one another.

I noted a paper he co-authored on vaccines, where he seemed to be concentrating on informing the world about the intricacies of the old vaccine technology. Only he can tell us in simple terms whether his work is adaptable to the new vaccines, or whether anybody is interested.

However, the point should be made, but not over generalised that 20 plus years ago, Doherty was regretful of his loss to Australia. Well, he did come back to Australia twice, confounding the Doherty forecast. And perhaps, it would be instructive to see his rating by students at Boston University, when you review this lamentation in 1998 and Australia’s deprivation with Dr Brusic being in Shanghai at an English University, which incidentally seems not to rank very highly, even in the Chinese rankings.

Liz, don’t worry, Nick Coatsworth, the Seer from Garran, says it will be all over this year

A year ago around Christmas, Liz Mover began to feel some hope. The ICU nurse at Massachusetts General Hospital had received her first dose of COVID vaccine. Soon, she thought, everyone will be vaccinated and this terrible pandemic will end.

Liz Mover, ICU nurse, Massachusetts General Hospital

But in the medical intensive care unit where Mover works treating the hospital’s sickest patients, 15 of the 18 beds were occupied last week by people critically ill with COVID. Almost all of them were unvaccinated.

As the pandemic stretches on and cases climb again, a depleted battalion of health care workers is battling yet another big surge of COVID. Despite the widespread availability of vaccines, hospitalisations have approached last winter’s levels. And for many health care workers on the front lines still fighting COVID, hope has evaporated.

The problem with people like Nick Coatsworth, even if you strip them from their political aspirations and, for me personally in relation to Coatsworth a sense of disappointment in his emergent arrogance, is that once you embark on an ideological pathway, there is no turning. Evidence is an inconvenience.

The experience of Ms Mover, the attending nurse in the Blake 7 Medical Intensive Care Unit (MICU), can be found in the midst of the tasks she has become accustomed to in her 15 years at Massachusetts General Hospital.

She highlights a problem that the Virus is presenting. It has not gone away, and while people like Coatsworth and the media editorialists cling to the notion that it will go away and anyway this Omicron variant is not that serious, the problem is that it is neither – it is not going away and for those who contract the disease it can be very serious.

The problem is that it is indeed serious since its very insidious nature is compromising the whole health system.

An airliner crashes and all are killed. A terrible tragedy, but not an ongoing health care problem as is a pandemic which kills everyone in short order.

But that does not often happen; even the Hiroshima and Nagasaki bombing had a horrible aftermath for those who survived.

Then I well remember the AIDS epidemic, but the annual numbers never exceeded 2,500 and hospitalisation generally came in the form of end-of-life hospice care.

AIDS infection was described as a pandemic when it appeared in the 1980s (and curiously, again in the media at the end of 2020 when talking about its 40th anniversary). However, despite all the horrendous warnings as epitomised by the “Grim Reaper” advertisement, it has been very selective.

Influenza has been the disease where the parallels between the current pandemic and that the post-war WWI so-called Spanish flu are mostly made. The difference is that now the health system has developed technology in the health care system where there are high expectations, and where the politicians take for granted the high level of skill and care – but the coping is not endless and it has its limits. Irrespective of who you are, you must have a break – the cute use of “furlough” has become the signature.

In conventional war, if you were in the front line, the expectation of the politicians was that a large number would be permanently furloughed – that is, killed. Nevertheless, there was recognition that survivors needed to be given a break from the frontline, especially if you were inconveniently wounded. Even so, there were inevitable long term mental health problems among these survivors.

Thus, Liz Mover’s experience should merit a response because this pandemic, like those of influenza, will have a long tail. After all, while the pandemic of 1918 has been well aired, there were three influenza pandemics in the twentieth century – adding 1957 and 1968. I spent time in the infectious diseases hospital with the 1957 variant in my last year at school. Not pleasant.

At the very least, government should continue to stress improved hygiene both in relation to: (a) the personal – hand washing and mask wearing; and (b) the social – maintaining appropriate distance and, if the Government does not ban them, avoiding locations where the Virus is liable to lurk in numbers. We all have personal space which should be respected – I hate mine being invaded at the best of times. The community should respect this – even when traditions require one to slobber over one another whether male or female; or embrace one another just because our cave dweller ancestors did so.

Come to think of it. Have you seen the Prime Minister or the Pirouette visit a hospital recently? The problem is that to enhance the photo-opportunity of showing Morrison on the front line (with Pirouette a fuzzy background image), the security detail must make way for him, as occurred at the scene of the Devonport tragedy. The security detail may have to clear the staff away as he searches for a patient’s hand to clasp. Prime Minister, it may be a photo-opportunity of your love and compassion, but you need not bring your wife and leave a bunch of flowers at the entrance of the hospital ICU unit.

Backroads

I went to Boulia a number of times 20 years ago when I was spending a considerable amount of time working at Mount Isa. Putting Boulia into context, it is about three hundred kilometres south of Mount Isa. This is virtually the same distance as Mildura to Broken Hill. There is one intermediate settlement at Dajarra where there is also a hospital. Today, I understand the road has been paved between Mount Isa and Birdsville, but in my days in this Channel country it was not.

My memory of this time was jogged by the Boulia Shire sign, which appears in the opening credits of the ABC’s Backroads program. Not that I watch this very popular program much. I, like the ABC presenters, have visited many of the places they have gone to see, and they have their own perspective.

Bit too much giggling for me. I also grew up with the radio serial “Blue Hills”, the unending bush saga which sustained a huge audience among country people when it ran for nearly 6,000 episodes.

The formula of an unpretentious conservative country serial that both mirrored and confirmed people’s prejudices and, with a dollop of smugness, lasted not unsurprisingly for a long time.

As a microcosm of this smugness on a local level, Backroads goes a long way as the child of “Blue Hills”, never challenging, but in general reinforcing the stereotypes. The only difference in Backroads is there is mostly an Aboriginal segment, a situation very much downplayed in the long running serial.  I remember when miscegenation was dealt with in a number of “Blue Hills” episodes, and everybody in the serial was relieved to know that there would be no “throwback” in the child to be born.

But setting my basic distaste for Backroads aside (although there are a few good episodes since I have started watching it to see how it corresponds with my own bush experience of the place) this is my memory of Boulia.

This is a tribute to the late Jude Sticher.

When we met her, she was in charge of the health services in this tiny settlement on the Diamantina Developmental Road.  Because here we were in the Channel Country. She and her husband, Peter, came to Boulia on the last day of October 1995.

Boulia has a mixed Aboriginal and whitefella population.  Staying at the pub and mixing with the locals, we were confronted with one of the biggest steaks you can ever eat,

But then Boulia had space.  The streets were wide enough to turn a camel train around, and one of Boulia’s main attractions is the camel races in July.

Then there are Min Min lights, which allegedly appear as oval lights in the bush. Driving along the roads, they apparently dance along the horizon. Nothing like unexplained lights in the sky to bring out the juices.

Jude Sticher was a very matter of fact real person. She was a light in that community. She had trained at St Vincent’s Hospital Lismore, in northern NSW and did the triple certificate – general, midwifery, child health. Then she undertook some nursing, married Peter, had a daughter and bought a caravan park in Sarina, south of Mackay. They still had property at Sarina, and so they continued to connect with the sea, but they did not feel displaced; at least, not when I met them.

Reflecting on her being in Boulia, Jude said she nearly tossed it in during the first three months. The cultural and professional isolation had to be overcome. She persisted. There is a term “Boulia blow-throughs”. In three years, she ticked off two police officers, three school principals – and, as an afterthought, four electricians.

Her husband Peter had been a police officer in the police rescue and a Senior Constable for 15 years. In Boulia he was the ambulance driver and the “security detail” when Jude had to go on a night call. There had been a plane in the backyard, for when they went south. In the garage had been the fire engine, the motorbike (recently sold) and the four-wheel drive ambulance. The outback toy shop!

The hospital was very basic, but it served as both hospital and a clinic. One of the reasons that Jude stayed was because the community had learnt not to give her “a hard time”. This community came to know her tolerance levels.

Out of hours demands from those who had simply drunk too much were discouraged, and her “security detail” could be of assistance in reinforcing any definition of unacceptable behaviour from potential patients.

There was good cooperation with Jude’s counterparts at Dajarra, enabling people to have time off; this link was essential for stopping burn-out. There was less contact with the nurse down the road at Bedourie, as there were different employers and there appeared to be less stability in the staff. Bedourie was part of the Frontier Services, John Flynn’s original outfit, but still then with centres inter alia at Bedourie and Birdsville.

Jude was able to deal with emergencies and had the skills to stabilise patients; no different from those of any primary care practitioner working in a town. The RFDS service was there for advice and for evacuating those that needed it. It had worked over a period. Jude was the nurse practitioner with a spouse who has adapted.

Donohue’s Emporium 1920

That time has passed; if the Backroads visited Boulia, would Jude Sticher receive a mention? Or the Donohue’s emporium, which had opened in Boulia in 1920, but shut down there some years later.  I had bought a checked purple shirt there. That shirt lasted longer than the Boulia store.

One of my fondest memories was some years after I first went to Boulia, when one of my closest friends and his wife “rocked up” to the clinic. Jude Sticher answered their knock in the door, looking quizzical and asked what they wanted. My friends then mentioned my name, and Jude’s attitude relaxed. “Come on in. Any friend of Jack Best is a friend of ours”, she said.

I have not been back to Boulia for years, but now that the road is paved the whole way to Birdsville I may well do so. One of the positives about the Queensland Government is that they maintain their developmental roads in Western Queensland.  From Birdsville the road veers east to Beetoota and Windorah.  If you want to venture over the border into South Australia, their desert tracks are a bit of challenge.

Corroboree tree

I hope that the corroboree tree, the last known of the Pitta Pitta people, still exists behind the health centre. As for lasting memorabilia, I do have one of their conical head dresses of woven grass around which are wrapped coils of human hair and topped with emu feathers; the men used to wear them in their ceremonies. Boulia was an important place for such gatherings; for me it still remains an important nidus along the travelled bush roads of my Country.

And I hope they still remember Jude Sticher in Boulia.

Mouse Whisper

Sometime a twitter is so opaque for a simple mouse. Who, for Heaven’s sake, was this twitterata talking about? It led to an exchange.

Very happy our current POTUS didn’t party with Epstein and Maxwell, didn’t fly in Epstein’s plane, didn’t go to Epstein’s Island, didn’t have Maxwell at his daughter’s wedding, and didn’t appoint scumbag US attorney, who gave Epstein a sweetheart deal, to his damn Cabinet.

Hey, who was the Cabinet Member?

Name of Rene Acosta, Secretary of Labour

Who was this POTUS? I’ll give you a clue. In 2002 in the New York magazine article this future POTUS was quoted as saying that Epstein “was a ‘terrific guy’ who enjoyed women ‘on the younger side’.”

Rene Acosta, Secretary of Labour

 

Modest Expectations – At Last Michael Bowlby

Kizzmeika Corbett

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Such a little disease…

Rubella

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

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

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

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

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

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

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

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

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

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

Snottites

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

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

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

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

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

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

Lechuguila Cave

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

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

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

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

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

Personal Irresponsibility

Janine Sargeant MPH

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

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

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

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

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

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

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

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

Endless testing queues

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

Happy Christmas NSW from Uncle Dominic

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

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

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

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

Hazzard with two “Z” – The Alchemist from Wakehurst

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

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

What do you think vaccination is for, you chump?

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

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

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

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

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

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

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

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

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

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

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

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

On the other hand, this seems sensible…

Reprinted from the Boston Globe with thanks.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mouse Whisper

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

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

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

Joan Didion

 

Modest Expectations – Gay Crusader

I have always given an association with the number of the blog, which this week is the 137th in a row. Apart from my first one, each blog has a label associated. The words “Gay Crusader” would evoke a great number of associations in the modern day.

Gay Crusader

I thought I was being suitably obscure. Not true, if you Google “Gay Crusader”, there is the answer at the top of the pile. Gay Crusader was a horse, and a very good one at galloping one mile, four furlongs and six yards. Unfortunately, there are no rods, no poles nor perches; no links nor chains, not to mention the lack of leagues and fathoms – nor, for that matter, inches in this meticulous description of aristocratic length.

O Hail Caesar

I have been accused of being too easy on the Premier of Victoria, but this latest manoeuvre to usurp the power of the Chief Health Officer is fraught with all the dangers of a politician assuming control over an area in which he does not have the expertise.

The Australian public, particularly in Victoria, has become sick of lockdown. It is difficult when one cannot see the enemy. Just as Victoria thought it was free of COVID-19 it was imported from NSW, due to the attitude of the then Premier, disregarding her Chief Medical Officer’s advice.

The Chief Health Officer is appointed for his skill in providing the Government of the day with public health advice. Up to the time of COVID it has been a very dozy job in Victoria – a recent Chief Health Officer was virtually invisible during his tenure. However, the Chief Health Officer has delegated powers for a reason, and in the event of a serious public health matter such as a pandemic, it is important to designate single point responsibility for the execution of legislative orders, but with a clear outcome for such execution.

A place for the Oracles

Clearly Chief Health Officers are no Delphic oracles, but they portray their expertise in both their attitude and behaviour – running the gamut between the laissez-faire and the interventionist.  Some are more risk averse than others. Yet their powers are circumscribed and, unlike the Premier, they don’t have powers outside health to proscribe under the guise of a health emergency.

Premier Andrews’ current intention to usurp these Chief Health Officer powers is a vast overreach, and in this instance was prompted by his disagreement with the Chief Health Officer’s eliminationist strategy, or should I say demand for an unconditional surrender by the Virus, rather than an uneasy armistice.

The past two years have catapulted previously obscure Chief Health Officers into media stardom, with the unfortunate consequence of having to compete with the associated epi-babble. Yet if last year there had not been Chief Health Officers with that power, would it have taken the politicians a longer time to declare an emergency?

Memories are short. Remember, Premier Andrews at the start of the pandemic without experience or indeed knowledge  was very hesitant in cancelling the Grand Prix in 2020 – and also the Prime Minister was inclined to go to the football rather than take the incipient crisis seriously.

Politicians hesitate. This legislation in Victoria throws the normal sop of having an advisory committee. In most of my experience these committees attract people with the gift of the gab – and the ability to obfuscate and confuse the politician who has, prima facie, not that much knowledge, apart from knowing their constituency and not liking unpopularity.

There is a flagrant example in NSW of this political interference, brushing aside public health guidelines designed to protect the community because they interfere with those popular pirouette steps – harks back to March 2020. The impulsive decision to retain popularity – forget about the Government’s public health rule. You know the one which reads:

Until you receive a negative result from your day 7 test you must not go to any:

  • high-risk settings, such as childcare, aged care, disability care, healthcare, schools, education and correctional facilities
  • large gatherings (e.g. concerts, football matches)
  • hospitality venues, except to pick up take-away food or beverages.

This does not include accessing medical care, or aged or disability care services.

How inconvenient for the impatient unthinking incoming Australian. You drop your guard, how inconvenient that the West Hoxton, sorry West Epping party, just can’t be missed.

Premier Andrews, as an example for your Brother Premier, I implore you to leave well alone – but you won’t because although you generally have reasonable judgement, you have been a control freak, with the thinness of your dermis still being a matter of conjecture. The solution is definitely not to set up a tangle of bureaucracy as proposed because that will just introduce more uncertainty, especially when there are other variants in the offing.

Maine Stream

The Supreme Court has rejected an emergency appeal from health care workers in Maine to block a vaccine mandate that went into effect Friday.

Three conservative justices noted their dissents. The state is not offering a religious exemption to hospital and nursing home workers who risk losing their jobs if they are not vaccinated.

Only New York and Rhode Island also have vaccine mandates for health care workers that lack religious exemptions. Both are the subject of court fights. On Friday, a federal appeals court panel upheld New York state’s vaccine mandate for health care workers, rejecting arguments by lawyers for doctors, nurses and other professionals that it did not adequately protect those with religious objections.

As is typical in emergency appeals, the Supreme Court did not explain its action. But Justice Neil Gorsuch joined by Justices Clarence Thomas and Samuel Alito said in a dissent for himself and two fellow conservatives, that he would have agreed to the health care workers’ request.

Justice Amy Coney Barrett noted in a short statement agreeing with the court’s decision not to intervene that the justices were being asked to “grant extraordinary relief” in a case that is the first of its kind. She was joined by a fellow conservative, Justice Brett Kavanaugh.

Democratic Gov. Janet Mills said she was gratified that the mandate was upheld, saying it’s imperative for hospitals to “take every precaution to protect their workers and patients against this deadly virus.”

“This rule protects health care workers, their patients, and the stability of our health care system in the face of this dangerous virus,” she said in a statement. “Just as vaccination defeated smallpox and vaccination defeated polio, vaccination is the way to defeat COVID-19.”

Maine’s requirement was put in place by the governor. A federal judge in Maine declined to stop the mandate, concluding that the lawsuit was unlikely to succeed. The Oct. 13 decision prompted a flurry of appeals that landed, for a second time, in the Supreme Court.

Dozens of health care workers have opted to quit, and a hospital in Maine’s second-largest city already curtailed some admissions because of an “acute shortage” of nurses.

But most health workers have complied, and Maine residents in general have been supportive of the vaccine. The Maine Hospital Association and other health care groups support the requirement.

We have holidayed in Maine, the Pine Tree State, on more than one occasion. We nearly bought a house in Maine in that brief window when the Australian dollar approximated the US dollar in value.

Bordering Canada, it’s only US State border is with Massachusetts, of which it was once part. It has been a traditionally conservative Yankee State, where slavery was outlawed in 1783. Yet this State has a serious ambivalence.

In 1820, the year Maine became a State of the Union on the anti-slavery slate, the U.S. passed an act that made participation in the slave trade an act of piracy. Yet, dozens of Maine vessels engaged in the slave trade illegally during this period. Thousands of enslaved people were transported and traded, leading to huge profits for slave traders – some of whom were Maine sea captains who are remembered as leading citizens of the day. Much of the millions of dollars from the slave trade funded the growth of New England’s economy.

Amistad, slave ship

Thus, Maine has tucked away this heritage; and now in the forefront of COVID-19 vaccination campaigns, it is increasingly leaning towards becoming a permanent “blue” State.  Yet it still has a very prominent Republican Senator, Susan Collins, who has been one of the incumbents since 1996. The other Senator is a Democratic-leaning Independent. In line with the population, the State is only entitled to two representatives in the US Congress – both Democratic.

For a population of just over one million people the Capital, Augusta, is home to 154 members of its house of representatives and 31 state senators, both houses dominated by the Democrats and with a Democratic Governor. That is the profile of a State that has mandated all health workers, without exception, be vaccinated against COVID-19 – and the Supreme Court of the USA, not known for its liberalism, has upheld the decision.

So, what are you waiting for Australia?  Mandate!

By the way the Maine politicians get bugger all remuneration, probably all up less annually than a Darryl Maguire consultancy demand.

Be quiet. Eyjafjallajökull is capturing carbon.

I was browsing through an old New Scientist and I came upon a mention of the Eyjafjallajökull volcano, which erupted in 2010 in Iceland. It is a forgotten fact that the emission then from the volcano of between 150,000 and 300,000 tonnes a day was less than the grounded airlines would have emitted if they had been able to fly. That was 2010.

I went to Iceland three years later. Driving around this volcano, it was very quiet and the sky was cloudless and very blue. The planes were back flying.

Iceland is a geothermal hotspot, with many volcanoes. A boundary between two tectonic plate runs through the country, and it is strange knowing that the shifting of the plates beneath your feet is the fault line ready to quake.

The gap between Iceland’s tectonic plates …

Iceland is thus unusual. It belies its name. None of the country is within the Arctic Circle. From the airport to Reykjavik, there is a plain of basalt – it is a bare landscape. Yet in this plain is the famous tourist attraction, the geothermal pool known as the Blue Lagoon, a heated oasis full of tourists. I stand on a bare spot on the South Coast and look out to the North Sea; I had been told there was not a skerrick of land between where I was standing and the Antarctic Continent. There are many of these instances – “nowhere else”…

The Hotel Ranga is about an hour’s drive from Reykjavik and, as proved, it was an ideal place to see the Aurora Borealis, although it would have been preferable to have a room on the north side of the hotel to view the phenomenon, as I found out.  In many ways, Iceland is very important as viewing the Aurora here is very convenient. One does not have to struggle through the snow to see it. Here at this isolated Hotel, it is just a matter of stepping outside.

Then one afternoon going down the road to the nearby village of Hella, drifting on whim around 2.00 pm into an empty café about to close, the owner hospitably cooked me a magnificent cod pie while I waited. That seemed to be the Icelander way. The land was full of more friendly surprises.

What has happened in relation to climate change in Iceland has been reflected by the unique geology of this country where the uptake of carbon capture and storage has been adapted to its predominant basalt rock structure.

As a result, Iceland has several high-temperature geologic zones, where the underground temperature reaches 250c within 1km depth, and in its so-called “low-temperature” zones, the temperature reaches up to 150c at the same depth. Permeability, the porous nature of such rock, also plays a role in how fast mineralisation of CO2 can happen here. Basalt is such porous rock and assists this faster reaction; elsewhere in this favourable rock formation the mineralisation of CO2 may take thousands of years.

In Iceland, the dissolved gas is injected into the rock formations at a depth of about 500m, where the CO2 can rapidly turn into minerals.  In Iceland it takes about two years for 95% of the CO2 to be mineralised. The process can take more or less time at other sites, depending on a few factors. One is the depth at which the carbon is injected, and another is the temperature of the rock formation – the rate of the mineralisation process is generally faster at higher temperatures. Bedrock still must contain sufficient amounts of calcium, magnesium and iron. These metals are necessary because they react with  CO2 to form carbonate minerals needed to permanently store the CO2.

This year, the Orca plant, 40 kilometres south-east of Rejkavik, designed to capture carbon capture, is now online and is said to extract annually 4,000 tonnes of carbon dioxide from the atmosphere, equal to the emissions of 790 cars. Not much. Thus, it is still essentially an experimental facility.

Despite all the potential advantages of Iceland, this is a salutary piece of advice as our Australian government still waves this technology around as a solution to climate change.

As I have pointed out previously, carbon capture overall is a dud. The extent of its usage in Iceland only says that it has the geology can make minor difference, which may at most offset the carbon dioxide emitted by Iceland’s heavy industry, in particular its aluminium smelting.

Just a few of the 85 …

The lesson here is very clear. When the annual amount of carbon dioxide to be removed needs to be 33 billion tonnes for an effective technology, this facility in one of the most advantageous positions on the planet removes in a year about 3,600 metric tonnes, probably the same amount of carbon dioxide from the atmosphere as emitted by all the limousines of those attending the Glasgow conference. After all, the US President is reported to have had a cavalcade of 85 cars because of COVID-19 restrictions. It seems a matter of what you lose on the…oh, I forget the rest of that aphorism. It must be the nitrous oxide fumes affecting me.

You want a Sharkies jumper, Manny?

Australia has a major embarrassment. You let a dolt in a baseball cap run the country, and then watch aghast at what happens next.

In Rome, the Prime Minister, with his private photographer in tow, interrupts a private discussion President Macron is having with someone else. Macron is civil; he does not take off his mask, but his eyes say it all. An uncivil person appealing to a redneck constituency – unapologetically. Boy, were we impressed?

Then there was Morrison’s speech – the normal meaningless aggressive diatribe in an empty auditorium.  Donald Trump would have applauded. Nobody in Glasgow was listening.

The image of him sitting at the G20 table in Rome, sniggering with the Brazilian President Bolsonaro, has not yet made it to our local media. Macron is in the distance. Trying to muscle in on the photo-opportunity next to Boris Johnson, Morrison actually ends up next to Angela Merkel, who turns away from him as soon as the photoshoot is over. On this occasion, he did not move forward as Macron walked past, neither acknowledging one another. So much for meeting and greeting each other.

Macron has then made the last devastating remark, namely that Morrison lied. If he lied to the French President, who else?

She’ll be right mate!

In any event, the stoush continued along the kerbsides of the Gorbals, with the Baseball Cap saying he would not have his country sledged. I was bewildered, as President Macron had very carefully separated the country from The Baseball Cap – very pointed in his accusation. No sledging of Australia by Mannie, only a pointed reference to you, mate. Julie Bishop, on your selective leak of private government correspondence, has commented: “I’m concerned that the rest of the world will look at Australia and say: Nah. Can Australia be trusted on contracts not to leak private messages?”

What can we expect next? I think he is coming home, concentrating on his political loom trying to spin a jacket of credibility to replace the shreds and tatters of his current international reputation. Meanwhile Glasgow proceeds. Photo-opportunities with the remnant military force still overseas.

Meanwhile, Biden and Macron are getting together, Biden incidentally throwing Morrison under the 2CV while promising Macron that Kamala Harris will visit Paris soon. Back here in Oz, it is increasingly apparent that the nuclear submarine program is just the heading of a media release and will it ever happen?

Advances in technology, as you still glibly spout, Prime Minister, will ensure that it will never happen. Any US body of significance visiting Australia in the wake of this dustup?  I’d doubt it; maybe the odd silver-haired chap in braid sent to keep Dutton and Abetz and the other sabre-rattlers happy.

But back to the Road to Glasgow; Macron seems more interested in Africa where its Francophone countries are increasingly under threat from al-Quaeda type insurgencies – the fundamentalist Islamist force. Biden wants to assist. This seems to be the immediate battleground, not the South Pacific as we were led to believe when AUKUS was at its most raucous. The French will bide their time until after the Australian election.

China and America are now in conversation, and the likelihood of an imminent invasion of Taiwan is increasingly unlikely. The Chinese have done their sums on the cost of invading Taiwan. Nevertheless, keep the cauldron boiling, it keeps the normal suspects here in Australia suitably frothing.

The Taiwanese are adept in providing all expenses paid trips to foreigners who they think may be able to push the Taiwanese barrow at the least cost, and who can still rattle a cage in Australia. I have experienced such extravagant hospitality when the Taiwanese mistakenly thought me able to rattle a cage or two – in my case a birdcage.

As for Biden discussing anything substantial with Morrison, fat chance. Biden seems more concerned with Recep Erdogan and him threatening to buy Russian, rather than  American fighters for Turkey.

Mentioning Turkey reminds one of the Boris, the one of Turkish heritage. He still seems willing to talk to Morrison, but if Morrison clumsily helps wreck the Glasgow meeting, another “dear friend” bites the dust. Did you see the Prince of Wales turn to glass as Morrison talked.

So, there we are with Morrison in Glasgow, the pipe band leader for India, Saudi Arabia, Russia and our old ally China – all coal fellows well met.

The problem is that inevitably, at some stage, the gaseous products of coal will overwhelm the planet, using the Morrison approach. What does it matter if we return to an age where the world was indeed warmer than it has ever been?

Maybe in 2022, it may change … but unfortunately Albanese is such a weak reed – the stuff of Arthur Calwell Revisited. His vision is that of a student politician; it’s all about factional deals. No, it is not, Mr Albanese, given the perilous position of this planet, a factional deal is a puff of dust.

But by 2025, the election after this when I have well gone, let us have a leader by then to navigate Australia out of this climate mess.

Perhaps an insight provided by Rebecca Sykes in her recent book Kindred -Neanderthal – Life, Love and Death will increase the sense of urgency:

What’s happening is unprecedented. Over the next millennium – roughly 30 generations – we are heading into a world hotter and more dangerous than any previous hominin survived. The Eemian 120,000 years ago was on average just a degree or two warmer than today, yet along with hippos in the Thames, sea levels were 5 to 7m (15 to 22ft) higher. Coasts where picturesque cottages and teeming cities now stand were swamped. And that’s with far lower CO2 levels than we’ve already reached.

In the absence of immediate, drastic action, the most up-to-date climate models put us on track for a terrifying future. Polar ice caps are at genuine risk of disappearing, and if so, oceans would rise by 20m (65ft) or more. In the past year the Great Barrier Reef has withered, the Arctic, Amazon and Australia have all been ablaze, and heat records have been breaking like waves, one after the other.

I could not have said it better.

Roaming in the Romantics

I enjoyed Latin at school and obtained second class honours in my Matriculation year. For a few years I attended the University of Sydney’s Latin Summer School, and one year my eldest granddaughter joined me for this one week of concentrated experience.

It kindled my interest in the living languages which owed their syntax to Latin. I learnt French at school, at the time when foreign languages were either French or German. Then I went to France in 1980, travelling around and realising how little French was left in my cranial library.  So, on my return I started French at the Alliance Française. The facilities were superb but undertaking learning French at the end of a working day was too much for me to persist beyond a couple of years. The one word which sticks in my memory driving through the South of France was “vignoble”. It had such an obvious meaning, but I did not immediately get it and was teased unmercifully.

In the past decade we discovered Ravenna and thought how it would be a good idea to learn some Italian.  We embarked on learning Italian, and gradually moved through the grades. I’m glad there are no examinations; and in addition, my accent is foul. Nevertheless, the comprehension has improved and with learning languages on a long-term basis, then you can absorb some of the culture. Funnily, I once lived for many years in Italian cultural Melbourne, but it didn’t encourage me to learn Italian.

However, before going to Romania a few years ago, I tried to acquaint myself with Romanian and while I did acquire a smattering of the language, it vanished very quickly after I returned to Australia. It is reputed to have much in common with Italian. You mean “grazie mille” and “mulțumesc foarte mult”. Thank you very much! Such a similar language!

Mulțumesc mult pentru amintiri

Then we determined, or rather she wanted to go up the Amazon, and so we joined a class of Portuguese for the Traveller which, like so many of those crammed courses, is totally useless, especially if you don’t have an ear for languages. Yet I have persisted through a Portuguese teacher and now a Brazilian, and my love of the language and the diverse culture not only between the two countries, but within, has soared.

In many ways, Portuguese resembles French more than Spanish; but that is a contentious proposition. French monks were indeed the first people to write down the Portuguese language and linguists argue that the common tortuous grammar, especially the irregular verbs, have French “tendencies”. Secondly, extensive French immigration during the first decades of XII century most of the western coastal region around nowadays Torres Vedras, Caldas da Rainha and Alcobaça were colonised by French from Burgundy. And as an afterthought, the two languages share the cedilla (ç).

Needless to say, Brazilian Portuguese is different.

May I say, even though I have driven through the Swiss canton of Grisons on the way to Liechtenstein, I never heard the least known member of the Romantic language, Romansch, spoken. Although it is one of the national languages of Switzerland (which is a story in itself) and a remnant of the time the Romans occupied the territory, I suspect it has survived due to the isolation of the community in the Alps.  For someone who lives in Sydney, the repeated references to Engadine in the Romansch exchanges was disconcerting. Engadine is a suburb of Sydney, but also Engadine is a long high Alpine valley region in the eastern Swiss Alps.  Romansh is vaguely akin to Italian and French but its speakers sound German. Guttural and Romantic are strange bedfellows. As one said, it sounds like Italian with a German accent.

There you are – rambling through a field of mild obsession which unfortunately my Topo has picked up in his whispering below.

Laura

Sometimes you read something trivial; prosaic, but it strikes a chord.

However, let’s begin by writing that some years ago, I bought a book second-hand. It had come from the collection of David Raksin. It was a name I was not familiar with, but anybody who shared my taste in books at least was worth investigating.

He wrote the tune “Laura”, his most memorable work, which was the theme woven into the film of the same name, a film noir in the traditions then of Hollywood. It starred Gene Tierney as Laura. She was an extraordinarily beautiful woman at least on the celluloid. The film still is worth watching, and the theme has endured, recorded by a large number of artists. It always reminds me of waiting for someone to come – but who never did. Some might characterise it as “haunting”. During his life, it was the second most recorded work after “Stardust”.

Charlie “Bird” Parker, one of the great saxophonists, recorded “Laura” and this comment below was attached to his “Bird” version of the tune. As they say in the cliches of our time, the comment has resonated with me.

I met a Laura once, way back in 1964. I met her at a party, we were teenagers but grown up in the way kids were back in Philly of the 1960’s. She was so perfect. Beautiful, smart, engaging, and she liked me. I fell madly in love with her, right there and then. We danced and she fit into my entire spirit. And then the party was over and we all had to connect with our various rides. She chose to ride with me and my friends and we drove her home. She sat next to me, both of us breathless. And standing on the porch was her father, who looked like he would kill me – or any other boy!!! I wasn’t able to get her telephone number and I never saw her again. All these years later, I can still feel her… 

I know how he felt. Our universe then was full of fumbling uncertainty. In my case, her father was a civil educated man. Her name was not Laura, but I persisted.

Mouse Whisper

It’s pretty much clearly Romantic – here it’s in black and white

NIGER

Noir               nero              negro           preto            negru           nair  

ALBUS

Blanc             bianco           blanco           branco          alb                  alv

Modest Expectations – Calling the Cayman Islands

There are certain misuses of words, some of which make me shudder. I once wrote an essay abut the misuse of “disinterest”, frequently used wrongly to express “uninterest”, rather than used in its true meaning of being unbiassed. “Uninterest” admittedly is an ugly word.  “Disinterest” has bounced around in the English lexicon, at various stages indeed meaning lack of interest and, given the way the word is now being used, we are destined for another period of change in the meaning of disinterest back to a lack of interest. The transition of such a change in meaning may only generate uninterest if any disinterested observer can be bothered.

My word of the moment is “visitation”. I was reminded of the dubious use of the word by Dom, the new NSW Premier. From behind his glittering glasses, he announced that he would be making visitations. Now you and I are mere mortals and thus make visits. “Visitations” are somewhat different. I have never made a visitation. Why?

A visitation: The Embrace of Elizabeth and the Virgin Mary

“Visitation” was first defined in about 1300 (sic), “a visit by an ecclesiastical representative to examine the condition of a parish or abbey” It was derived from Anglo-French visitacioun, based on the Latin visitatio. The supernatural sense of “a sight, apparition, a coming of God to a mortal” arises the middle of the 14th century.

On second thoughts, given his proclivities, maybe it did mean “visitation”. The ghosts (or spirits) must conform to social distancing even though they’ve all been wearing masks for years.

Avoca Hotel

Now who would have thought it?

Avoca Hotel has been included in a pilot scheme on “opening up” Victoria for the fully vaccinated in the wake of the COVID-19 virus pandemic.

My association with the pub started when I was rung up by my cousin and informed that Uncle Frank had died. It was the summer of ‘72. Frank, one of my mother’s seven brothers, had died and the funeral service would be at Redbank in Central Victoria. Would I like to join him and go to the funeral?

Redbank Cemetery

The service and burial would be at Redbank, near Avoca near the graveyard. Avoca was the main township in the then Pyrenees Shire, which was the only local government area in Victoria to have a mountain range to itself. That was not quite true because this line of hills was only a spur of the Great Dividing Range.

Frank lived in Avoca and on his small property in the township he kept a flock of sheep.  Since he needed to feed them, he used the Long Paddock which, in this context, was all the roadside vegetation across the Shire and beyond. As a consequence it was affectionately known – through gritted teeth – as Egan’s Paddock. So, we went first to Avoca to pay our respects to his widow, who was too frail to attend the service.

After his funeral, everybody stood around, every now and again peering into the grave, as if they wanted to make sure there was nobody knocking to get out. My cousin’s black humour; not mine. Someone said that it was good to see how many people had turned up for Frank’s funeral, because there wouldn’t be a funeral for 60 miles around that Frank would not have attended.

I remember his youngest brother, Charlie, turned up, with braces over his collarless shirt, looking as if he had just come from shearing sheep on the family property. Charlie said he had problems with his eyes. I did not connect that with why he hadn’t donned normal funeral clobber.

The yarning would have gone on endlessly if the fire bell hadn’t sounded. There was smoke over the hill, and anyway we close relatives wanted to get down to the Avoca pub for a drink. I had never met Uncle Frank, but his son-in-law, known as “Webbie” still touched me for a tenner so he could buy a slab of beer.

When I reflect on that, we were drinking at the pub, so why the extra booze?

There was a great deal of merriment remembering the Frankish eccentricities. Uncle Gordon, who was the eldest brother, a great bloke and a WW1 digger, distinguished himself by drinking one too many and slipping off the bar stool. Fortunately he was caught by us before he hit the floor.

That was my memory of the Avoca pub – the wake for Frank; and of course I never saw my tenner again.

Since that time the area has become well-known for its wines. I remember the first vintages including the brilliant Warrenmang red, with the peppermint taste.

As for the Avoca pub, it has gone a bit upmarket since that summer day so long ago when we buried Frank Egan and drank to his memory.

The Two-Edged Chief Health Officer Role

Continuing on a theme that I have maintained, but undoubtedly one that is difficult to put in place now that two States have been exhausted by the lockdowns – namely selected segregation … quarantine is another word for segregation; imprisonment is another.

It is noteworthy that of all the States, Queensland is building a custom-made quarantine facility at Toowoomba. Queensland has survived by imposing a series of mini-lockdowns, yet neither NSW nor Victoria has dedicated quarantine facilities. Victoria is ostensibly building one, but it has not got much media attention. Of course, NSW has done nothing.

The problem is that politicians are consumed by the short term, and their advisers only reinforce the views of their political masters. Increasingly health policy should be concerned with the preventative aspects of the burden of disease but as I have mentioned many times before, health language is a barrier for most, as is fluency in any language the older one gets. This virus pandemic is not the only public health problem – if not pandemic – that the community will be confronted with in the future.

One of the keystones of inhibiting the spread of disease is to enhance social distancing, and somebody ought to tell the world if there is a better way than segregation. Segregation demands disciplined structuring; hence adequate funding and staffing.

Like many services, where prevention is geared to an anticipated emergency such as police, ambulance and fire brigade, there is potentially substantial downtime. When I reviewed ambulance services some years ago, there was substantial (and, at that time, unproductive) downtime.  As a side but important issue, it is the duty of those responsible for downtime from attending emergencies to assure useful engagement of staff.

However, when downtime is translated as being in an hour long queue to discharge a patient for admission to hospital, that is only as profitable as the use of ambulance officers working as supernumerary carers can be construed. Deficiencies in the hospital admission process being covered up by using the ambulance as a ward on wheels is not the most profitable use of the ambulance service.

Staff in new dedicated quarantine facilities will face the same problem of integration into a wider public health service. Once there were infectious diseases hospitals, but with the rise of economic rationalist vandalism in the eighties and nineties, infectious disease hospitals were one casualty, even despite there being a concurrent AIDS pandemic.   Now the need for dedicated facilities indicates the rebirth of a public health service where care becomes an integral part of the health care system, rather than being reflected as a Greek chorus of epidemiologists where the patient is a scrap of data.

Unfortunately in Australia, for everybody with the merest public health experience and even – or especially – those without any formal training, commentary has become a free-for-all. It is just another of the consequences of the news cycle. People have shifted their position, and as the public health bureaucracy has been sucked into advocacy and prophecy, then it is not surprising that politicians have become irritated.

There is resentment in political circles towards the power accorded to chief health officers – not all, but where the chief health officers have garnered too much attention, albeit becoming cult figures. Generally, they have stuck around for too long – in the spotlight. As a model for balancing the science and the spotlight, Dr Paul Kelly appears to have demonstrated an appropriate mixture, where he chooses his appearance adroitly and leaves the less important public utterances to others. He makes sure that he is conservative in the true sense – of having to be convinced that the course advocated is well-founded to make the change. He stays away from daily pontification.

The Americans consider public health to be a uniformed service; and it is not uncommon to see the US Surgeon-General kitted out thus.

If I were Premier, having made a statement interpreting health policy and the opening up of the State, and a journalist then asked me, as occurred the other day: “What does Dr Chant think…”, I know what I would do. Not immediately, but don’t look now Dr Chant.

Queensland has sent its Chief Health Officer to be Governor, where she can be important without being important. It should be recognised inter alia that a whole Queensland strawberry crop was trashed in 2018 at the cost of $160m, where Dr Young’s advice played a prominent role. As one commentator noted recently on this situation, where needles were found in in strawberries at three sites: “However, in a way, it’s actually kind of quaint to be reminded that a public health scare with three reported instances led to a major national response while the largest COVID outbreak and death toll in the country is followed with talk of how soon we can get the pubs back open.”

There is talk of the Chief Health Officer’s power being curtailed in Victoria, being downgraded; and as for Dr Chant, I would be sure that a promotion awaits her – or her being absorbed as a consultant somewhere.

If the senior positions are downgraded the problem I see is that public health may suffer. Politicians very quickly forget the lessons of the past because in this world the uncertainty of the word “pandemic” has yet to be incorporated into personal ambition and the uncontrollable search for post-political recognition. Another dangerous pandemic.

Nevertheless, whether the power of the senior health officials is downgraded or not, the need for dedicated quarantine facilities or some other effective means of segregating the ill or potentially ill should not be allowed to slip off the policy agenda into a limbo of uninterest.

A Randomised Controlled Trial of One

Voltaran Osteo-Gel is the alias for diclofenac diethylamine – to be rubbed on affected joints 12 hourly. It is one of those potions that bobs up on the television screen where there she is, one moment limping in pain, then next soothingly rubbing the gel on her knee and then nossa running the City to Surf or part thereof. No longer the grimace, now wreathed in smiles with the obligatory male handbag running alongside her, a trail of blue and saffron gossamer dust in her wake.

I have osteoarthritis badly, and also polymyalgia rheumatica – and as such I am a randomised controlled trial of one – it doesn’t work for me this way. For years I have been in pain, sometimes agonising, and I assure the punters topical gels don’t work for my big joints.

However, small joints, particularly finger joints are a different matter. I have found when I get arthritic pain in these small joints, application of Voltaran works. The reason I have written this piece now is that I developed acute pain in my right little finger the other day, the hand with which I use the mouse.  So, I started to apply the Voltaran and the finger has improved, at least the pain has lessened and the functionality has improved.

I found a review of the efficacy of these gels in the BMJ which in part concluded:

… after excluding industry-funded/sponsored trials, only diclofenac patch was statistically superior to placebo for pain relief and none of the topical NSAIDs was better than placebo for functional improvement. This suggests that the efficacy of topical NSAIDs may be inflated by industry involvement. However, the limited number of remaining non-industry-funded/sponsored trials (only 12 trials for pain relief and 11 trials for functional improvement) may be too small to detect the difference, as these trials were small (ranging from 31 to 179 participants, median size 100). Further non-industry-funded/sponsored trials for topical NSAIDs are still needed, as this is a group of drugs with greater contextual effect than their oral counterparts and it is more difficult to blind participants in trials and hence very easy to inflate their treatment benefits over placebo.

Concentrating on my little finger, what objective evidence have I got for this gel helping. It may be just a self-limiting acute arthritis, part of the joys of having a chronic autoimmune disease. I have not had any trauma, because although I struck my hand on the balustrade which caused an ugly bruise on the back of my hand, my adjacent finger is not bruised.

My other fingers are fine, although at the outset of my encounter with PMR, I did develop a swollen middle finger on the same hand, which improved with application of the gel.

I suppose it could be gout, but no family history, and none of the drugs that I am taking predisposes to gout – well, not in the fine print paper that comes in the drug package.

This conceals a far bigger problem –

Namely the privileged place pharmacists have in our society. Having been for a time closely associated with the pharmacists for part of my professional life, I consider they are a very much the curate’s egg.

Pharmacists are, in the main, shopkeepers. Yet as result of a concerted effort to strengthen an academic basis for pharmacy from just a cohort of those working in hospitals and who believed that pharmacy had moved from apothecary status, learning in a university environment replaced the apprentice structure of the profession.

My year of medicine was the last year where we were taught materia medica – the fancy name for compounding pills, potions, unguenta and tonics. I always remember “extract of male fern” as the quaint talisman for this ancient art of sorcery. The next year, materia medica was replaced by “pharmacology”. This change encapsulated the change in the teaching of pharmacy students towards a firm evidential basis.

Yet while this expanded the academic profile of pharmacy, the cornerstone of pharmacy remained the shopfront. Pharmacists have been a protected species; I remember when Ipana toothpaste was only sold by pharmacists. Yet in those days pharmacies still sold cigarettes.

The advent of modern pharmacology, heralded by the development of antibiotics – a major influence – changed the whole face of therapy. Not that certain plant-derived substances, like digitalis, did not work; many of the other medicaments in the pharmacy operated on their placebo effect. This still holds true in so much of the goods being peddled these days, often with outrageous and erroneous claims. The vitamin industry is one such area where the legitimate role of these substances has been subverted into some magical beneficence, to say nothing of serious profits. What I find particularly objectionable is the advertisements depicting whole families, their shopping carts laden with an array of placebo, gaily trotting off to a world of drug habituation and advertisements promoting “chewy vitamins” for children, as if pill popping – or gummy chewing – should be a normal part of growing up.

The pernicious influence extends to the growth of addictive drugs, as witness the use of OxyContin and other similar drugs, another disgrace shared across the whole of the health professions. I believe the excesses of some of the community pharmacies should be trimmed, especially among the warehouse chains where professional ethics can seem very threadbare. Any claims about these arrays of so-called natural remedies should be evidence-based and not some exercise of necromancy, dressed up as beautiful young women.

The Pharmacy Guild has lobbied hard and successfully for the maintenance of their position in the community. The periodic Pharmacy Agreements between the Federal Government and the Guild in relation to reimbursement under the Pharmaceutical Benefits Scheme (PBS) have always been generous.

At the same time, community pharmacies have continued to sell all these peripheral placebos, as well as cosmetics, toys, sweets – in fact almost anything that can vaguely be associated with perceived wellbeing. Inevitably this has led to the growth of the pharmacy warehouse; and I wonder why the advertisements peddled by some of these outlets have not been curtailed by the Therapeutic Goods Administration (TGA). But then organised pharmacy has strong buying power – particularly of political parties where the industry has been and remains a significant donor.

The community pharmacy, despite its lobbying power and probably over-privileged and over-subsidised place in the community, should not be underestimated as being perceived as the true community health centre for much of the community. The fact that there have been those in the Liberal Party who see them as outpost of the Party because of the innate business conservatism of many of the pharmacists should not be used to deny its important role in community health.

Another conservative force, the medical profession, is always paranoid when they perceive pharmacists creeping onto what the profession considers its territory. I always took a lead from my father who, even more than 60 years ago, had the pharmacy next door where he could pop in and get advice, where “out the back” he could discuss the appropriate course of action for patients with complex or difficult conditions. As my father and the pharmacist, Jim Beovich, demonstrated over many years, it was such a rich symbiotic relationship.

The community pharmacy’s involvement with the national vaccination program has been a success. Hence the apparent success of this public health intervention should be written up as evidence of what succeeds and what does not, so it can be incorporated into a policy framework which is not lost. So much corporate memory has been lost, as I can well attest, with the unnecessary need to re-invent the process because of the lack of corporate memory, a common and disastrous fault of modern bureaucracy.

Individual pharmacists are influential in their community. The community pays a price for the Pharmacy Guild’s easy access to that. What is important is to ensure that the methodology for setting prices being paid for prescription pharmaceuticals is transparent and not obfuscated so the community pays more than is reasonable.  Influence through lobbying for political gain is always an essential part of the curate’s egg’s yolk, no matter the standing of the profession, even at a time of beatification of the profession, which inevitably will occur with the success of the vaccination program. Just because the Gorgon, Big Pharma is standing behind you with an outrageous price schedule is no excuse for just passing it in without protest to us punters.

The musical instrument called “hydrodaktulopsychicharmonica”

I could not resist heading a piece with the longest name for any musical instrument currently being played somewhere in the world.

Playing the Hydrodaktulopsychicharmonica

I am no muso. I remember someone mentioned that I could have made a bass if I had not been totally tone deaf. I tried playing the recorder as we all did; and even moved to the clarinet. Mercifully, this was a very small affliction on Australian ears.

Knowledge of this headline word had come from my being apprised of the town of Castelfidardo in Le Marche, one of the lesser known regions of Italy south of Emilio-Romagna on the Adriatic Coast.  Castelfildardo is a town where piano accordions are made and have been made since the beginning of the 19th century, whether in mahogany or maple. They also have dabbled in the manufacture of “armonice” of which the above longest word for a musical instrument – the glass harmonica – is a subset.

Now this is apparently the only reliable place in the world to get this instrument repaired, and it takes three months. Added to this the creatori di fisarmoniche are a dying breed because it is an Italian trait to take your skill to your grave without telling anybody. It does have an effect!

Years ago, I can remember the accordion was a common instrument and, in my youth, Lou Toppano was both its virtuoso and its public face within Australia with his TV appearances. Piano accordions were associated with various ethnic groups. Toppano tried to project the sophisticated sleekness of the Latin amante.  But the invariable characteristic was the smile, the smile when you had this lump of wood and metal weighing between 5 and 14 kilograms on your chest – and you were expected to play it! The accordion fell out of favour with rock n roll; it is said that the bass electric guitar was the instrument that often replaced the accordion in the band.

Somebody who I hold dear admitted she played it when she was young but said that if I wanted to shame her, I would not further identify her. Such a reaction shows how the accordion player has become somewhat of a caricature.

Thus, I was intrigued by an article in the Boston Globe by a young professional accordionist. By and large optimistic in tone, she nevertheless commented on how difficult it was to maintain the accordion in working condition, but she had been lucky to find a repairer in New Jersey.

She indicated in her article how specialised was repair of accordions, which would probably be a disincentive for those who found their grandparents’ accordion as a dusty relic. It is one of the most difficult instruments to play.

But if you think that playing the instrument is difficult, don’t step on it or throw it against the wall or fall over and be pinned by it. Here is an annotated repair requirement, according to the author of the article, with that unsurprising name of Madonna.

A job for Castelfidardo …

First is the know-how; second is spare parts such as keys, reed valves (usually leather strips), and metal rods; and third is tools, though most of these can’t be found at your average hardware store. Tools like a set of bellows to test reeds without having to put the whole instrument back together again; a setup to melt wax at a low enough temperature to set reeds without burning them; maintenance and tuning tools that look like what a dentist might use to scrape plaque off someone’s teeth; even a tray that indexes bass buttons (so there is no confusion of removal order). 

So, there you are – a trip through the Accordion Keys; intriguing when you realise that there had been the demise of an instrument that you never really missed – except that when the strolling accordion player, with the risus sardonicus, is headed for your restaurant table, you knew it was time for a toilet break.

Blue on Blue

Giuliano Cecchinelli is busy these days, as is everyone at Buttura & Gherardi Granite Artisans in Barre, Vt., one of about 20 manufacturers of headstones and other memorials in and near this city of 9,000, which styles itself the “granite center of the world.” 

The pandemic’s staggering death toll, now approaching 700,000 nationwide, is only part of the reason for the rising demand. It’s also driven by baby boomers who are looking ahead, ordering monuments, and deciding how they and their families will be commemorated after death, Gherardi said

The Boston Globe often has these little vignettes. What is it with the Italians and cemeteries? When I read this, I remember the bluestone quarry which, like all bluestone quarries, is memorable for just that – the blueness, especially when the first of these quarries that I ever saw was in Vermont, a closed quarry, the stone left there in all its sombre yet striking solitude, water slowly filling it up.

When I decided that my late parents should have some recognition and a High Celtic Cross was beyond my means and a tad over-the-top anyway – apart from which, I found those traditional grey monumental slabs so cold and depressing – I decided that I would place a bluestone rock as the headstone.

After all, if Victoria ever decided to have a State rock, it would surely be bluestone. My school was a bluestone pile, but it was only one of many buildings built in the latter part of the 19th century.  Other buildings used it for the foundations and for the many cobbled streets, lanes and alleyways were laid out in bluestone. This rock allows for water drainage and prevents the growth of weeds.

So, we went out to one of Italian stone masons whose sites dot the outer northern suburbs of Melbourne. The headstone we chose was a lump of bluestone rock, neither sculpted nor moulded in any way. Just a simple recognition of this stone which forms much of olivine basalt rock which covers the ancient volcanic Victorian plains, one of the biggest in the World. The prevalence of bluestone gives Victoria that image of a conservative sobriety with architecture distinguished by its blue-black stone buildings.

From the beginning of Melbourne, bluestone quarries were opened throughout what is now Melbourne suburbia. Most of these had closed well before I was born. Out of curiosity I eventually went to see one remaining bluestone quarry near Tylden in Central Victoria, I was impressed by the majestic slabs of blue rock, I suppose because it was so much a part of my life for 12 years from first grade.  Recent pictures are disappointing because the quarry no longer has that air of a familiar majesty, but now resembles just any open cut mine.

Nevertheless, what’s in a name? Victorian bluestone is completely different geologically from that of Vermont or indeed that of Eastern USA, which is basically a residue of glaciers namely schist, but not the basalt from an ancient volcanic origin. My eye being attracted to the article of Giuliano Cecchinelli only goes to show what a little vignette can do.

I’m still learning; and that is the real vignette.

Mouse Whisper

O trava-linguas

Eu

Não Quero

O Queijo

No meu Queixo                  … Que, zero?

 

Modest Expectation – An Item for Long Review

Ideas for a scrapbook?

When this blog was commenced 133 weeks ago, it was a different world. I didn’t expect that I would create a rod for my back by labelling each blog with a numerical connection to the name of the blog without being repetitive. When I started the blog, it was just by way of a scrapbook of ideas, and I was lucky to have a number of guest writers. They provided some leavening given that writing on a weekly basis is a serious business. One person caught in the middle of a pandemic with an irregular shuttered existence has a challenge to report usefully when the country’s leadership has been so uneven and where the principle of uncertainty has played into disturbance of the collective mind where the enemy is never “a tangible there” but “an intangible everywhere”.

I remember reading Erving Goffman on “Asylum” and “Stigma” when I was a young man. These books elaborated the concept of total institutions and the relationship between the inmates and those in supervisory positions of the inmates.

Goffman’s “total institutions” concept can be traced back to the establishment of the Hôpital Général in Paris in 1656 by Louis XIV. Once an arsenal, a rest home for war veterans, and several hospitals, the Hôpital Général served as a house of confinement for the poor, the homeless, the unemployed, prisoners and the insane – those who sought assistance and those who were sent there by royal or judicial decree. In the space of several months, one out of every hundred inhabitants of Paris would find themselves confined in these institutions indiscriminately.

Australia is in various stages of lockdown; a euphemistic way of describing imprisonment–lite.

Goffman set out his rules for the game. How relevant are they to our current society after such a period of intermittent lockdowns?

Goffman’s inmate is subject to three rule sets. The first are “house rules”, which should be “relatively” explicit both prescriptively and proscriptively.

In exchange, secondly there are clearly defined rewards and privileges for obedience. Bound up with this system is the nature of release. The third element is the nature of punishment, when the rules are broken.

Does Goffman give any clue as to how the inmate should respond? No, he does not. His analysis of various responses to lockdown is well catalogued whether monastery or mental hospital. The concept of a prolonged imprisonment was not seen as the consequence when the Virus first appeared early last year. Then a selection of politicians from both sides of politics participated in light-hearted advertisements to encourage hand washing. It was as though it was similar to the mood at the outbreak of WW1 when the early prediction was of the conflict being over by Christmas 1914.

With imprisonment, the length of sentence is known; in the asylum, this is less certain, when translated to a whole community locked down.

In the early phase of the pandemic, the conspiracy theorists and the anarchists, the libertarian-authoritarians and anti-vaxxers were yet to form their confederacy.  Rather it was the doomsayers. After initial hesitation, a strong advocacy time for improved hygiene, social distancing leading on to community isolation and, belatedly, masks  and hope improved the compliance of the community.

Unfortunately, Trump and the mad assortment of the above consolidated the COVID nonsense. It should not be forgotten that this activity was unconsciously aided and abetted by elements of the research community scrabbling for funding and prepared to participate in studies, on, for instance, hydroxychloroquine and ivermectin.

The race for a useful vaccine commenced. Over the previous 20 years, there had been much preliminary research on vaccines into these viruses, which was translated into an accelerated pathway for developing an effective vaccine. The nature of the coronavirus, with its chameleon quality, presented a problem, but the value of the previous work became clear with the mRNA vaccines demonstrating efficacy and able to have an accelerated introduction this year.

Last year showed the impressive use of the lockdown – but turning much of Australia into a prison until the Virus was apparently conquered. Unfortunately, the Virus changed into a more virulent form.

The Federal Government refused to develop dedicated quarantine facilities and if it were not from some robust medical advice, a nascent mixture of the above toxic creatures some of which already existed within the Parliament  exhibited the same Trumpian irresponsibility which plunged the World into the pandemic crisis.

The successful suppression of the Virus lulled Australia into a period of self-satisfaction, not recognising that armistice is necessarily unconditional surrender.

The problem has been that, despite enhanced vaccination, the second wave lockdown in NSW has not been as effective once the Delta variant got into the community. The delay in Berejiklian’s response let the Virus loose. It reached Victoria before any lockdown measures were in place. Even the swift lockdown there was insufficient, and the lack of compliance in Victoria has been poor in traditional working class areas, when the Federal government failed to restore sufficient income support to offset not being able to go to work.

“House rules” had not been explicitly stated to the effect that, if the virus appeared again, you, the community would be imprisoned again even when you had been granted both the privileges of vaccination and some income support. The first round had generated sufficient anger, assuaged by Job Keeper and Job Seeker; a second lockdown term in both NSW and Victoria (and the ACT) was not brief, there was little income support and the severity of the lockdown varied according to the particular whim of the government.

However, this lockdown has been resisted by a group of “ex-prisoners” who have set up an urban guerrilla operation designed not only to burn down “the prison” but also to institute a Trotskyist state of permanent revolution. The State has no way of collecting these guerrillas who have become carriers of the virus, the frontline shock troops for the Virus, except by reacting to the rioters. The more strident they become the more the resentment builds up in the rest of the community, made worse because of no improvement. At the same time, the Murdoch media has inflamed the situation by encouraging this resentment without advocating a solution.

Is there one?

In the post WWII community, democracies have paradoxically increased the number incarcerated. Now, what about the vaccine refuseniks and those infected. Prisons are acceptable for the first, but what of the second? Bespoke quarantine arrangements – infectious diseases sanitoria – all linked to a healthy outcome, may be acceptable. But for God’s sake, do not use the words “lock hospitals” or “concentration camps”.

However, all such facilities must have a degree of humanity; but all imply selective isolation.  Our society will have to develop a system of temporary standardised isolation facilities, where those infected are well treated but there is suitable surveillance. Otherwise, as has been shown, this, and future viruses, will spread like wildfire, vaccination or not such facilities need to be integrated into the health system.

Opening up the community becomes a meaningless term while a significant group in the community remains defiant, refusing vaccination, and in fact enhancing the pandemic, replete with the images once invoked by Erving Goffman.  

A small endeavour 

This is the story about how the pandemic has disrupted a small program in Malawi – but first, the background.

Mustapha drove us in the Toyota Land Cruiser from Majete, in the south of Malawi, to Pumulani on Lake Malawi.  It took seven hours, during which time we left the wildlife reserve for a front row seat of rural Malawi and then, contrasting that view, with that of the commercial hub of Blantyre with its profusion of modern buildings, cars and men in suits and ties. Blantyre is the toilet break stopover. Even the posh hotel does not have sufficient toilet paper and the spare toilet paper had been left in the truck. To paraphrase the saying about chooks: “don’t count your rolls until they are attached”.

Mustapha is a Sunni Moslem. He prays five times a day, observes Ramadan and his food is halal. He is a ranger at the wildlife reserve and lives three hours away in a village where he goes home for four days a month. Home is a two-room brick house with separate cooking and washing facilities. In the language of the Chichewa people, he is bambo; his wife mai and they have two ana – one is four years; the other, a ten month old baby. Both are boys.

Most of the rangers are Christian; his village is mixed, like his workplace.  This is reflected in the countryside through which we pass, where church and mosque co-exist in the one village. The Muslim influence spread from the north under Arab influence and there are concentrations of Muslims along the Lake. However, Malawians are predominantly Christian.

The camp we have left lies on the Shire River, which we cross twice more on our trip across Malawi. The riverbank is lined by elephant grass but behind this natural stockade are cultivated rows of corn and squares of green vegetable garden – maize, beans, tomato plants, sweet potatoes and onions are common crops – the abundance of these vegetables is evident in the markets of the various townships we pass through.

Outside Blantyre, rural Malawi is people walking – women and children, water containers or packages on their heads; children in brightly coloured uniforms straggling home from school.  Rural Malawi is also oxcarts being driven and bicycles, mostly ridden by men. Bicycles are loaded down with charcoal or straw-coloured thatching grass or wooden staves. Bags of charcoals standing like sentinels abut the road, ready for sale. Stooks of thatching grass also line the roadside for sale.

Police roadblocks are everywhere, but only once are we asked where we are going.

As we go further north and towards the central Malawi plain the country becomes drier. Baobab trees appear in profusion. Flashes of yellow, red and pink signify the profusion of bougainvillea. It vaguely resembles the Australian Kimberley with the rocky outcrops, the red earth and vegetation dominated by acacia interspersed by villages with signature mango trees. Here lies the difference between this part of Malawi and the Kimberley.

The Kimberley is sparsely populated, unlike Malawi where the villages tumble against one another so that walking between villages is feasible. So much of the traffic is pedestrian, despite two large buses destined for Lilongwe passing us at a breakneck speed. There are minibuses and mitolos clustered in the larger townships overloading themselves with people and goods. We pass a bicycle, one of many, a youth hunched over the handlebars. The message on his violet T-shirt is memorable: “Jesus is my hero.”

Surprisingly at no stage have we seen evidence of the major cash crop of Malawi, tobacco. Hereby hangs another dilemma that Malawi faces. Malawi is recognised as the source of superior tobacco. Yet increasingly in the Western world tobacco is a pariah crop. World opinion is closing in on tobacco usage because of its undeniable link with cancer and a host of other diseases.  It is a matter which cannot be swept as cigarette ash under the carpet of government inertia worldwide.

We reach our destination after seven hours. Lake Malawi extends for 500 kilometres and we’re at the southern end. It looks like a giant sea and it is little wonder that the early Australian explorers, aware of what was happening in Africa, searched for an inland sea. In parts the Lake is 400 m deep and 52 km wide. The Shire River is the only river that flows out of Lake Malawi, joining the Zambezi River in Mozambique. The Lake extends north to the Tanzanian border; and a small part lies within the Mozambican border. This is the Southern end of the Great Rift Valley, where the tectonic plates are inching apart. The Great Rift Valley runs from Mozambique, through the Lake, to Tanzania, where it splits into two.

The Eastern flank runs through Kenya and the West through Burundi, Rwanda and Uganda, before joining again in Ethiopia, running into and along the Red Sea, turning northward to end in the far reaches of Syria. I cannot help thinking that the Great Rift Valley is a metaphor for Africa – a tectonic plate moving its 48 component countries apart. Perhaps the metaphor is too cute and exaggerated, but it is surprising nobody seems to have traversed these jagged faults to find, in documentary terms, the “Real Africa” to see how long the rift really is. Michael Palin has crisscrossed the world; Stephen Fry has landed glancing blows in encompassing the 50 states of America; and David Attenborough has “terrorised” the fauna in his “pan-world”exploration of why and who and what we are.

Life is tranquil – so different from the above intrepid world travellers. The only excitement is the female baboon bounding towards me across the patio and seizing my morning tea biscuits. One into the mouth; and knowing that she has the advantage of surprise, seizing a second. The plate clatters onto the tiles and breaks into pieces. She has gone, chased by the staff.

I sit as a speck on the edge of this enormous freshwater pond. We are eating fish – the chambo – a white-fleshed, elegant tasting fish – drawn from the lake. We sailed around in a dhow and watched the fish eagles circling and the silent men in their canoes, each searching for fish. We sailed past a pod of hippopotami lounging just off the shoreline. A ribbon of villages lines the beach. They could be on a desert island. Except that when the dhow heads back to shore there is this rocky escarpment so reminiscent of north-west Australia.

But there is another facet of the camp where we are staying. They are acting as protection for a dozen albino children living in the nearby villages – the eldest being 18. Albinos are constantly at risk of being kidnapped, slaughtered, and dismembered for their body parts. The superstition in several East African countries that possession of albino remains will provide luck is a grotesque reflection on our human condition; and in the last two years before we went 18 children had been reported killed in Malawi. The real number? Who knows! Family members have been known to be complicit in such barbarity.

We rightly worry about rhinoceros being killed for a lump of inert keratin; we should also express our abhorrence of this human trade for what – a person with a congenital lack of melanin pigment.

There are practical requirements for albinos living in this part of Africa, beside expressing outrage – sunscreen, UV protective clothing, sun hats, sunglasses – and there is a need for eye testing facilities.

The camp where we stayed had set up a project to support albino children in three local villages; this involved their staff and also donations from guests from time to time.  Easy to just hand over some notes and move on, however we decided to become involved in the longer term by providing bulk supplies of sunscreen and sun protective gear that was not easy to obtain in Malawi and other East African countries. However, that plan struck a snag early on – the cost of getting a large amount of sunscreen from Australia to Malawi was prohibitive – $40 to post just one litre and more than three months on the road! A different solution was needed and no assistance was forthcoming from courier companies.

For a number of years one of us had been going to Africa each year so instead of sending supplies, I took packages with me – with more than 50 kgs of sunscreen and 50 pairs of sunglasses.  This was still cheaper for me to take it and pay for a return flight from Johannesburg to Malawi (including a night in Lilongwe) than to freight the stuff from Australia! I would give it to a contact in Malawi who delivered it to the camp from where it was then distributed. Customs in Malawi were bemused by the exercise, seemingly concerned I was planning to set up shop there and long discussions were usually involved with the customs officers about the exercise.

However, COVID put paid to those plans. By the time I can get another large supply to Malawi it will likely be three to four years since the last delivery without outside assistance, just one of the many impacts of COVID on African people. The health devastation wrought by COVID upon African countries and the lack of vaccines for all but a small percentage of the population makes me so sad, given for someone like myself who loves southern Africa and its people.  For the many local people who have relied on tourism for their livelihoods, the sudden and extended cessation of travel to African countries has left many struggling to survive.

Affluent western countries may now be opening up for travel but the acute shortage of COVID vaccines across Africa means day to day living as well as tourism will not return to anything like normal for years.

Armenians in Ireland

I was intrigued when seeing the Armenian Cross, the so-call khachkar, which are still being constructed in that country. I thought how much these khachkars resembled the Celtic cross, particularly the high crosses. Apparently there were Armenian monks in Ireland in around the 8th century, refugees from Islam. The two High Crosses, one at Durrow in Co Offaly and the other at Muiredach in Co Lough are suggestive of the traditional Armenian khachkars.

Ruins of Rahan Church

The one at Durrow is close to the village of Rahan, where there was a monastery dating from the 5th century. The first monastery was established in the 5th century BCE and then extended 100 years later by St Carthage. The site consists of two churches and the ruin of a mediaeval tower house, and therefore existed four centuries before the Armenians are said to have come.

The Armenians may have been housed in the monastery. The Armenian churches have pointed domes to mimic the cone of Mt Ararat, and high vaulting with the height of the church matching the length of the church. There is enough remaining of the Rahan church to strongly hint at the association. The stonework and pitched roof line resemble that of contemporary 9th century surviving Armenian architecture. The other association which may have relevance is that it is known Charlemagne used Armenians as his architects.

However, so much is lost in speculation as the dots joining them have been pulverised in the passage of unrecorded time.

Gտեսություն, ցտեսություն, Գլեդիս

What is going on in Australian politics in terms of corruption is as old as the First Fleet. Gary Sturgess, while Director-General of the Premier’s Office, was once the genius behind Nick Greiner who, as Premier, introduced the Bill creating the Independent Commission against Corruption (ICAC) when Premier in 1988 (sic):

In recent years, in New South Wales we have seen: a Minister of the Crown gaoled for bribery; an inquiry into a second, and indeed a third, former Minister for alleged corruption; the former Chief Stipendiary Magistrate gaoled for perverting the course of justice; a former Commissioner of Police in the courts on a criminal charge; the former Deputy Commissioner of Police charged with bribery; a series of investigations and court cases involving judicial figures including a High Court Judge; and a disturbing number of dismissals, retirements and convictions of senior police officers for offences involving corrupt conduct… No government can maintain its claim to legitimacy while there remains the cloud of suspicion and doubt that has hung over government in New South Wales.

The charge sheet Greiner listed was long.  Later, Greiner was himself a casualty, when supporting one of his Ministers. These actions were referred to the newly-formed ICAC and he resigned when the four independent parliamentarians would not support him.  He was replaced by John Fahey.

What sticks in the craw is the outrage that this Government body, which has done its homework obviously painstakingly and interviewed the former Premier, should be pilloried. The former Premier knows that the game is up, because if ICAC had got it wrong, well somebody as well-versed as her would have invoked the “force field” with anecdotes of the poor little migrant, who has triumphed against the odds.

The concealment of the Deal, which the politicians want to shovel under the carpet, using privacy as the cleaning agent, was not helped by the ambivalent response from Mark Dreyfus. He, the Shadow Federal Attorney-General on one hand indicated that an incoming Labor government would introduce a meaningful ICAC. Yet on the other hand he had the qualification suggesting that there should be more secrecy to enshroud the preliminary investigation, aka “wriggle room”, which suggests that there are a number of sidelong glances towards certain colleagues, given the Labor Party itself is not “squeaky clean”.

Yet recently I received in the mail one of those unsolicited letters sent to his “million closest friends” from Albanese. The letter announced in bold that “An Albanese Labor Government will establish a powerful transparent and independent National Anti-Corruption Commission.” There was no detail, but it seemed more robust than the utterance of Dreyfus. One favourable Dreyfus action was that unlike some of his other Labor colleagues, he did not fall for the trap of effusively praising a disgraced departing Premier.

I suspect Berejiklian has no other life apart from politics; she was coddled by the media, unlike Julia Gillard. It should be remembered that Niki Savva conducted a relentless war against Gillard in the media, with that deadly efficiency women have when they want to bring down another woman. Berejiklian had none of that criticism; she “ascended” to the top unlike the messy way Gillard did.

The requirement for a National ICAC will be advanced if the next election produces a raft of intelligent independents not bound to the mindless obedience that the factional system of both parties imposes. The need for robust debate should be freed from those politicians, often influential, who have been compromised, as has been clearly shown by this Federal Government’s record of thinly-veiled corruption.

Has somebody lost the lock on the Pandora’s Box?

Pandora with her box

It seems that there is a virus of resignation sweeping the NSW Parliament. The one thing I admired in John Barilaro’s resignation was his refusal to criticise ICAC, because the reasons for his resignation are still unclear.

His comment was most unlike that of his Federal National leader, Barnaby Joyce who has likened ICAC to the Spanish Inquisition. I am surprised that Barnaby believes ICAC is thus run by Dominicans obsessed with Jewish and Muslim apostasy.  The Spanish connection on the other hand seems to have formed an important part of Mr Perrottet’s life through his membership of Opus Dei, which was the brainchild of Josemaria Escrivá, a Spanish priest with close links to Franco’s rule. Therefore, if one believes Joyce, Dominic Perrottet with his Spanish connection should be a strong supporter of ICAC.

And you think I’m being ironic!

As well, for those interested in what happens to seats vacated by NSW Premiers requiring a by-election, the Liberals should remember when they picked up Premier Wran’s seat of Bass Hill in 1986. Narrow victory it may have been, but there was a 22 per cent swing. Yet the Labor Party does not seem to have the appetite for such a course in relation to Gladys’ seat; but nevertheless the Liberal Party should call a by-election as soon as possible to stymie any independent candidature.

Now NSW is faced with a trifecta of by-elections, and the more politicians protest about an organisation dedicated to rooting out corruption, the more they lose whatever shred of trust remains within the community,

Yet Jesuit-trained Barnaby can’t shut up. His antics remind me of that old joke (and here I am indebted to The Guardian) about a Franciscan, a Dominican and a Jesuit who are arrested during the Russian revolution for spreading the Christian gospel and thrown into a dark prison cell. In a bid to restore the light, each man reflects on the traditions of his own order.

The Franciscan decides to wear sackcloth and ashes and pray for light. Nothing happens. The Dominican prepares and delivers an hour-long lecture on the virtue of light. Nothing happens. Then the Jesuit gets up and mends the fuse. The light comes on.

Really, you don’t say, Barnaby was taught by the Jesuits. Perhaps he only heard the words, “light” and “fuse” – and made the wrong connection.

“Volere Volare o Vogare Qualsiasi”

Letter from New York City

October 2021

Dear Readers,

It’s the most wonderful time of the year—that is, if you enjoy the spookier things in life. There are more than a few scary tales on our October roster, including Edith Wharton’s own selection of her best ghost stories, a new paperback of the Edward Gorey-illustrated edition of the H.G. Wells classic The War of the Worlds, and another selection of supernatural stories from our friends at Notting Hill Editions. Below you’ll find some fun, spine-tingling readings, as well as a peek inside the latest title in the New York Review Comics series and a little bit of the story behind the cover of Mr. Beethoven, Paul Griffiths’s inventive novel about the eponymous composer.

If you are a local or visiting New York City this weekend, consider coming by the NYRB booths at the Brooklyn Book Festival. We will be at booth 12 for Children’s Day on Saturday, October 2, and at booth 405 and 406 for the Main Day on Sunday, October 3. We will be selling books and, on the Main Day, giving copies of The New York Review of Books away. We would love to see you there. 

— An email received from the New York Review of Books.

Sorry.  Hope to see you next year; but thanks for the invitation. Saturday and Sunday were a bit cloudy, otherwise the weather in this past week has been a bit variable – rain and all, but New York is New York, Virus or Not!

The question I bet nobody will ask Dom Perrottet

Do you wear or have ever worn a cilice?

Do you know of anybody who wears a cilice?

If the reply is no, you, the investigative journalist should then approach his brother who is Dean of Warrane College and ask what is its policy in relation to the wearing of the cilice.

I would be mortified if any of you, the fourth estate, dared to ask, but may do so; but Morrison is not a valid reply.

Mouse Whisper

It is acceptable for the political leader to stand before his or her constituency to make a sweeping gesture and say “I have a vision for the country…”

Often it would be more truthful if the same political leader would rather have said, “I have a hallucination for the country…”

But how acceptable would that be?

I have a hallucination for the country…

Modest Expectations – Dominican Republic

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

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

The great AUK – now extinct

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But then, will this whole extravaganza ever occur?

To boost or not to boost 

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

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

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

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

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

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

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

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

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

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

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

Sweden Calling

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

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

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

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

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

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

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

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

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

To me it seems that Australia 

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

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

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

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

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

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

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

Demonstrators on the steps of the Shrine, Melbourne

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

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

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

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

John Shelby Spong

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

Bishop John Spong

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He did not say Amen. Others may.

There’s a Tree in the House

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

Trees, in the house …

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

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

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

Mouse Whisper

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

Modest Expectations – Renunciation of Citizenship

The Potala

If Australia is the hermit kingdom, what does that make the Lodge in Canberra?  The Potala?  It is not particularly helpful for two of the most powerful politicians to lock themselves away. Perhaps if they were creative geniuses such a juxtaposition may provide positive outcomes; but in the end, with men without such a spark, Australia ends up with a scene of reinforcement of similar attitudes and behaviour – an integral loop brewed around eggs and bacon and lox and cream cheese. A daily diet of fuelled fossils and property developers complete a depressing taste sensation of these eremites.

It is an ironic tableau given the Prime Ministerial shift in stance on the national lockdown.

Cameron Stewart made a shrewd observation on the Insiders program on 20 August to the effect that much would be revealed with Victoria’s ability to get the number of COVID-19 cases under control. The outbreak in the Albanian community in the Shepparton area, which is linked to the Caroline Springs cases, reflects the infectivity of the Delta Variant and the ease with which the virus spreads through families and the various workplaces. Unlike NSW the numbers were “grumbling along” in Victoria – until recently. There is doubt that the Victorian government wants the number lower. Nevertheless, with a lockdown, the numbers were initially contained – with the fear that with any loosening of restrictions the situation would mimic that of Sydney.

If Victoria had forced the daily case numbers down, even if not to zero, then Australia – except for NSW – would have the prospect of emerging from lockdown. NSW is still left with its population in some Berejiklian limbo, supported by an isolated NSW Prime Minister and a Victorian-based Treasurer, being slowly braised on the tip of Morton’s Fork.

The dilemma is that Australia can then be unlocked, except for NSW – the pariah State surrounding the equivalent of wartime Switzerland, called the Australian Capital Territory, providing succour to the war-fatigued refugees from the NSW War Zone, now garrisoned by the Delta Variant.

NSW inhabitants will be seeking refugee status, waving vaccination papers at the border seeking access to a COVID-19 free State. Its health system has collapsed under the load of COVID cases, with everybody wanting their elective procedures to be undertaken interstate because of the compromised status of each of the major NSW hospitals and their depletion of staff.

When anybody is used to being able to more or less control their activities, mostly by using devious tactics laced with lies, the Virus does not buy any of that. This is being shown by politicians hiding away, emerging only for controlled appearances with the media, at best having fragmentary knowledge of health to spread political half-truths. Underneath, the only Federal government strategy is wishing that the Virus would go away – and given his Pentecostal beliefs, the Prime Minister no doubt prays that “Jesus will directly intervene.”

If you want to stop the spread, you have to stop the vectors – people moving around in a disordered fashion (Brownian movement) – for at least two weeks. That is not going to happen in NSW – and, as has been proved elsewhere, vaccination helps, but achieving even 75 per cent is a challenge, not only because of the anti-vaxxers, but also  the unvaccinated  young who are spreaders.

A few weeks ago I set out a plan and inter alia suggested that as school was one place where you can capture the cohort, vaccination be provided at age 12. Vaccination may have to occur at an even younger age. However, that debate has yet to be had, as this Prime Minister’s mental energy is consumed in wedging poor hapless Albo.  Really, is that what governing Australia has been reduced to?

The point is, will Australia open up with NSW locked out? I am sure the other States are sick of Berejiklian and that NSW cabal called the Prime Minister’s office. A Treasurer held hostage because, in the end, plaintively he cries from the overgrown Lodge tennis court, a metaphor for Australia:

I coulda’ been a contender …

You don’t understand! I coulda’ had class. I coulda’ been a contender. I could’ve been somebody. Instead of a bum, which is what I am – let’s face it.”

Maybe he will, because Cameron Stewart has proved prescient. Andrews has not got the Victorian State’s daily average down to 10 cases a day. As the week has progressed the attainment of Andrews’ goal seems unlikely to occur. Andrews is now not a counterpoint for NSW’s abject failure. Andrews now needs to recalibrate without seeming to become another Berekjiklian – the quintessential flailing, failed Premier, being pursued by the hounds of  Queensland and Western Australia. Basking to Baskerville?

Morton’s Fork

To-day everyone has to pay the heaviest taxes in our history, but whereas in former times nobody liked paying taxes, now (let us I hope) we willingly do so, for we know that our money is helping: the fight for freedom. But this willing spirit was not shown in the reign of Henry VII, whose method of taxation produced a dilemma known as “Morton’s Fork.”

His officers of taxation did not hesitate to exact forced loans from people of property. They acted in accordance with the theory that if a man lived economically he could not have failed to have saved money, and was, therefore, in a position to make his Sovereign a handsome contribution.  

Likewise, if he lived extravagantly he evidently possessed means, and was also in a position to assist his King. No wonder we inherited a dislike for taxation!

Most revolutions have originated from the excessive taxation of the common people, such as the American Revolution, which was fought to escape English taxes, and the French Revolution to end the crushing impositions of the ruling classes.

This rather quaint letter the Sydney Morning Herald published in wartime 1940 almost irrelevantly invoked the concept of Morton’s Fork. Here then there was no hint of the dilemma which Morton wilfully created when hunting for extra revenue for Henry VII, after he had come to the throne following the energy sapping War of the Roses where Morton had played an important role.

Cardinal John Morton

Although he was a Dorset man by birth, Morton had hitched himself to the Lancastrian cause, and survived during Yorkist imprisonment with his head still intact on his torso. Between being Bishop of Ely and Cardinal Morton, Archbishop of Canterbury, he did have a stint in Tower of London – more a Morton roller-coaster than a fork. Moreover, Morton was always close to the Church, even though he first appears as the principal of Peckwater Inn, which had been given to an Augustine Priory several centuries before. It later became the site of Christ Church Oxford, but publican to priest gives Morton a special cachet.

Berejiklian is facing her own version of Morton’s Fork if she “lets it rip” and dismantles the lockdown; in all probability the State will collapse, as already clearly exemplified by a health system under extreme stress and NSW would attain complete pariah status within the Federation. If she intensifies the lockdown, then she is a form of Armenian toast with her Liberal Party backers, in a way never seen before by those unaffected in her Statewide constituency.  If they cannot protest in the streets, NSW voters have that alternative in 2023, unless there is revolt and cries for secession from the unaffected parts of the State well before that time.

There has already been the Tweed Heads Secessionist Movement, and what should have occurred at Federation, with all NSW south of the Murrumbidgee River being ceded to Victoria, may emerge as a local sentiment.

Then she would have to put a complete lockdown on the affected areas, allowing for no movement out for at least four weeks. Vaccination – who knows – may be her “opium of the people”. Let us face it, already we have evidence from elsewhere of the short-term effectiveness of the vaccines; but we have no plan to bolster up the very satisfactory take up to date, to include boosters even though Australia is still a long way from Shangri-La.

The World is based on getting your assumptions right

Covid-19 has exposed Australia’s economy for what it is.

We have a large, clean land and good weather. We dig dirt out of the ground which we sell as iron ore to China, which turns it into steel to build often vacant apartment blocks to pump GDP growth. We dig fossilised trees out of the ground which we also sell to China as coal to make that steel, and to burn in Japan for electricity while their nuclear reactors slowly get back online after Fukushima.

We sell immigration dressed up as education, mainly to China, which is now Australia’s third largest “export” market at $32 billion per annum – which is now halted. We are completely dependent on China which is now in a cold war with the US, possibly turning hot – where over one third of all merchandise exports go.”

So where to from here?

Technology and the elaborate transformation of our raw materials into sophisticated products with higher margins and a greater global market is the answer.

The fastest way to get there is to do everything we can to educate the nation with higher skills.

I would be paying people to go to university or TAFE in the right areas instead of sitting around in zombie companies on Job Keeper, use the spare capacity from the drop in international students to educate our own citizens and dramatically ramp up the sophistication and skills base taught at TAFE to make it a world class trade school.

My first assumption is this writer is not particularly friendly to the Morrison Government. However, like all assumptions, I could be wrong.

He is a prolific Twitter user, often commenting on subjects outside his areas of expertise, including the Sydney lockout laws, COVID-19, Politics of the United States, Donald Trump, Economic policy and many others. This has resulted in criticism from various circles including investors, who strongly suggest he should spend more energy growing a profitable company instead of constantly posting on social media.

This comment is inserted at the base of his Wikipedia biography, and my assumption is that the subject of the criticism did not insert that excerpt.

Again, I may be wrong.

Matt Barrie

The subject is Matt Barrie, self-described entrepreneur and IT expert. He has inserted himself into the “Doherty Model” debate with a very long criticism of the Doherty Institute’s modelling. He challenges the underlying assumptions of the model, and his criticism is peppered with annotations such as “garbage”.  I assume that he is calling into question the veracity of the Doherty model.

Parenthetically, when such a report as the Doherty one is commissioned and one can assume when the Government has predetermined the outcome, it politicises the findings and hence any recommendations in the Report. Here is the further parenthetic assumption that the Morrison government is following its normal pathway of creating a scapegoat, in this case in the form of Professor Lewin, if the whole Report goes “pear-shaped”, is discredited joining the $8m COVID-19 app which detected as it did only 17 cases – on the policy scrap heap..

It is part of my assumptions that the Government, which has made a number of appalling decisions, including prematurely congratulating the NSW government on successfully “quashing” the viral spread, has yet to learn.

The concern I have is how any of the models of the outcome of this Virus have factored in its transmissibility by those vaccinated, and the effect of the virus becoming endemic in children. The community has tolerated children as spreaders of that other coronavirus – the common cold – with its seasonal fluctuation. There is no vaccine, but we live with it because it is so mild in comparison with other infections and people are not hospitalised.

I am making the assumption that the AZ vaccine will be phased out as the mRNA vaccines, with their improved methods of production including the ability to be modified,  become the vaccines of choice. In itself this will present the Australian government with a number of problems in setting the policy agenda, including the substitution process, having invested so heavily in the AZ vaccine.

However, the assumption can be made that the shortages of vaccines will pass, and therefore the debate about whether Australia has booster doses or whether we help the disadvantaged countries achieve optimal vaccination also will fade as an issue.

Nevertheless, there remains the unanswered question of if, and when, boosters are required, and how young one needs to be to receive the first vaccine injection. Still questions that need to be answered, I assume.

Needless to say, it is poor form when asked to reveal the change in the modelling, Professor Lewin says she cannot. The assumption may be made that she has something to hide. The Doherty modellers should be asked to explain their model in front of their peers – publicly.

Whether he is right or wrong, Matt Barrie shows how debatable some of the assumptions underlying the report are, and therefore we do have a number of existing media forums where this can be debated, providing that the Chair of any such debate is knowledgeable and talented enough to lead the debate into objective territory. But that again is an assumption in many respects.

Hey Gladys. Where’re You Going This Weekend?

This is a story for you, Gladys.

There is a family we know in Tasmania.

They wanted to go on a holiday to Kakadu, but first they needed to visit relatives in Adelaide.

They boarded the Spirit of Tasmania with their car and were able to drive across Victoria and then stay in Adelaide with their relatives before flying to Darwin, where they rented a camper van and went to Kakadu, whence we received a text to say they were enjoying themselves. Very good people, and really good for them, not only to see their relatives in Adelaide but also to have a holiday in the Tropics during Tasmania’s chilly winter.

Then they drove their rented camper van from Darwin to Adelaide and then went home the way they had gone, in their own car.

What is that about lockdowns here? None.

The point is that the rest of Australia, especially if the smouldering Victorian outbreak is controlled, is leading a normal life, albeit a bit more hygienically than before.

A long time ago we booked a flight to Broome, having already booked on a cruise along the Kimberley coast, which would have also enabled us to go to Tiwi country, ending in Darwin. We anticipated the cancellation (which ultimately occurred) by flying to Broome early so that we could change to an alternative plan of driving to Darwin.  Having been to the Kimberley and the Northern Territory multiple times over the years we  knew what remained on our tourist agenda. However, along came the limo driver and the Berejiklian response, which has left the State locked down, with no demonstrable way of anything changing before the end of the year – if then.

Of course, none of the above  was possible for us, because of the Berejiklian stuff up. Nor any ability to go to Tasmania, nor to see our family in Melbourne.

I fail to see this adulation for the NSW Premier opening us all up for a picnic in the park or Dr Chant teaching us baby steps. Unfortunately, NSW has Berejiklian, who would be seen as an aberration in any other State. She has no strategy except vaccination in the face of the escalation of cases and a stressed health system.

Can I remind her of one thing? During the War, outside Tocumwal, they constructed an airstrip and nearby a 1,000 bed facility for war casualties, effectively taking them out of the firing line. The only way to deal with this crisis is to separate the infected, the virus vectors, until they are no longer vectors. A tent hospital would do it, because although the airstrip at Tocumwal still exists, the tent hospital has long gone and the land restored. The point is that rapidly setting up a fully functioning facility has been shown to be feasible and implementable. And a long way away without being a long way away. The wartime planners understood the apparent paradox and dealt with it accordingly.

Similar sites are available to NSW. What about some of those coastal golf courses in Sydney? Requisition these. Show some guts.

A suitable place for a quarantine village…

Watch what happens at Wellcamp when you have people with a real record of creating an airport and industrial park, as the Wagner brothers have shown; now given the task of creating a bespoke quarantine facility. In three months that will be operating.

However, you need courage to build such a facility in the face of Morrison the underminer. NSW needs a blueprint; the other States have provided various and the only unfortunate shred Berejiklian has in her policy patchwork is if Victoria has failed to reduce the number of cases. How threadbare can you become!

A Distant Mirror

I remember back in 1978, when I was reconstructing my library, I read a review about this new book titled A Distant Mirror by Barbara Tuchman. I remember sending a note to my friend in America asking her to buy me a copy, such were the times then in getting new American books. She bought a handcut first edition, which beautifully encased the views of one of the most influential historian of the 20th century, Barbara Tuchman.

The Distant Mirror metaphor drew attention to the parallels in the phenomena extant in both the 14th and 20th centuries.  On the surface there is Voltaire’s interjection of “history never repeating itself, man does” which may seem relevant, but where does it take one?

Back to this very extensive narrative of the 14th century.

Tuchman noted that there was a tendency of historians to skirt the 14th century, perhaps because of the disastrous consequences of the Black Death plague 1348-1350 “which killed an estimated one-third of the population living between India and Iceland.” She felt this a difficult age for historians as it was an interruption in the story of human progress.

Even now, over 30 years since her death, her thoughtful analysis is worth reading.

How delightful, southern France in summer …

In contrast, read the airy twitter post from the anachronistic Alexander Downer, having got an exemption to travel to France no less. Downer is chortling on about how lovely France is at this time of the year in summer – away from the Australian Oubliette – no lockdowns; just a France with 17,590 cases recorded yesterday and a “trivial” 74 deaths.

Reminiscent of Pope Clement VI during the stint in France away from that infested place called Rome, the papacy lodged in the south of France at Avignon at the height of the Black Death.  He was ordered by his doctor to sit between two fires in the papal apartments – during the summer. Rather than avoiding the miasma, the fire discouraged the fleas, the vectors of the Yersinia pestis bacillus. Also, the Pope had the added benefit of his doctor insisting on him being socially isolated, despite the Pope losing a third of his cardinals, most of whom were some relation in some shape or form to him anyway.

Better than lockdown, milord! Especially when you have no cardinals to worry about.

Now this is Freedom (Thanks to The Boston Globe)

What we are missing by having the lockdown.

For legions of island residents and visitors, traveling to and from Martha’s Vineyard and Nantucket has always been a bit of a headache.”

But this summer, the ordeal of snatching a coveted reservation on heavy travel days, and navigating the maze of buses, cars, and general commotion at the terminals has gone to migraine level, fuelling a season of discontent on the islands and mainland alike.”

Summer crowds at Martha’s Vineyard

“A fresh wave of tourists, along with an influx of new full-time island residents fleeing COVID, have packed ferries with thousands more cars, requiring travellers to book reservations weeks in advance for peak times.”

Mouse Whisper

The reward for reaching a record number of COVID cases in a single day – we can have a picnic outside – le déjeuner sur l’herbe or,

emulating Tom Lehrer’s picnic in the park:

All the world seems in tune
On a spring afternoon
When we’re poisoning pigeons in the park

…or a squirrel or two…”

Lots of ideas. Time for me to get some fresh air.

By the way, Is Tom Lehrer still alive?

Le déjeuner sur l’herbe