Modest expectations – Mali

In my heyday

Young men wrote to me

Everybody seemed to have time to devote to me

Everyone I saw all swore they knew me

Once upon a song

Main attraction, couldn’t buy a seat

The celebrity, celebrities were dying to meet

I’ve had every accolade bestowed on me

And so you see

If I never sing another song

It wouldn’t bother me

I had my share of fame

You know my name

This was the last recorded song of Matt Monro when he was dying of cancer. Matt who? Frank Sinatra recognised him as his equal in voice and ability to connect with his audience. However, there is a plaintive quality – you know my name. Really, you, Mr Monro have been a long time dead – and there is limited space in a nation’s collective memory for anyone, even if a superb crooner such as yourself.

The problem is that you may know my name but the passage of time will dull and obliterate it.

That is unless you make sure that there is a memorial, where its message is relevant to an ongoing generation, and not just to remember “my name”.

For me, the muffled sound and grainy sight of Salvatore Allende crying out “Larga vida a Chile”, and the fact that his cousin, Isabel has been such a prominent author, has meant the name has stuck around, as a romantic standard bearer for the oppressed – something South America has in droves.

Museum of Memories and Human Rights, Chile

I have recently returned from Santiago where I made a point of visiting the Museum of Memories and Human Rights. This was the brainchild of President Michelle Bachelet, to ensure that one memory sticks in the mind of the Chilean people. On a wall on the first floor are myriad photographs of Chileans murdered by the Pinochet regime – 130,000, probably more.

People who are just an anonymous as Mr Monro may be now, but they exist, not by names but as a powerful dark photographic reminder of the cruelty of Chilean to Chilean; in other words, you may be nameless, but collectively you are not forgotten and that is due to the overarching forgiveness led by this remarkable woman. After all, her father was killed by Pinochet’s thugs and she and her mother tortured.

Perhaps this memorial will serve the people of Chile and remind them to never abandon democracy again. Never, never. Ask Chileans of the age what they were doing on the 11 September 1973, when the military forces were unleashed on the democratic institution and they know, as well as those of my age know what they were doing when we heard John Kennedy was assassinated.

On the surface, Chile is now a stable country with a reasonable economy, the most robust in South America. Some may say its economy is built on copper, but Chile is increasingly diversified. Santiago could even be a Spanish speaking Australia city if it was not for the appalling slums that litter its outskirts.

But what of the forces behind the public face of the Chilean coup and the lugubrious Augusto Pinochet on 11 September 1973, during which the legitimate President, Salvatore Allende, was probably assassinated? That ghastly horn-rimmed Kissinger and his President Nixon, who also gave us the Killing Fields of Cambodia; only worth remembering for the cold-blooded approach to their fellow humans.

Unlike Michelle Bachelet who has gone some way towards rectifying one of the injustices they perpetrated.

Pain 

Opium poppies, northern Tasmania

One of the most unexpected sights is driving around northern Tasmania in early summer is seeing field after field of opium poppies with their delicate pale mauve flowers giving such an innocent touch to the sinister drug industry which is dependent on its supply from this one of few legal areas for opium cultivation.

I am not one to unnecessarily applaud anyone, but I do applaud the Chief Medical Officer, Brendan Murphy, for sending out 5,000 letters to doctors who have a profile of high prescription of opioids. That letter elicited the usual aggrieved response, particularly as it was sent to so many doctors. The problem with many doctors, even in a climate of increasing peer review, is this natural reaction to being questioned on “infallibility”.

Even if the letters implicate those who have a legitimate excuse, it should flush out those who are just drug dealers with a medical degree. Let us get one matter straight, this letter relates to chronic usage – not acute usage. There are times when complaints have been made of the under usage of such drugs where the need is acute.

I well remember the country doctor who was well known to government for over-servicing which, among other misdemeanours, involved handing out opioid prescriptions. When this particular doctor died, his funeral procession through the town streets was lined by grateful dependent patients. It was an ironic way to end one’s days, with a town, which had become addicted to this one doctor.

I hope that the Murphy initiative ends with a marked decline in the chronic prescription of opioids – it is a strange state of affairs that doctors are reportedly suddenly afraid to prescribe opioids because of the letter rather than fearlessly continue to exert their clinical judgement as to whether opioid use in a patient are justified.

For my part I have an auto-immune disease in which pain has figured so prominently that I was taking the maximum dose of paracetamol each day and counting the hours until my next dose. However, I eschewed opioids because of the fact that I feared addiction, given how long I would gave to take them. Just hankering for my next paracetamol tablets was warning enough. I survived the time without resorting to opioid, and fortunately my need for analgesia has abated.

It was interesting to note that the recommended maximum dose of paracetamol in the USA is lower than in Australia. I wonder whether this had any effect on its use and the substitution to opioids.

The other problem is exemplified by the woman who claims to have been prescribed opioids for 25 years for pain and now her prescription base has dried up. I make no judgement on any individual case but it is not difficult to hypothesise that there is a cohort of people who have become addicted because of doctors, who act as drug dealers rather than as medical practitioners.

I do hope that Dr Murphy’s action will lead to this cohort of medical practitioners being exposed and appropriate action taken. The medical profession will be well rid of them.

In the USA, as usual with the vigilante approach long after the wrong has happened, they are lynching the drug companies without solving the problem. The drug addicts are there; the overdoses are there. Making the drug companies pay does not solve the problem. However, when combined with an initiative such as being prosecuted by Murphy, it just may work. Keep it up, Doctor so that its success will be celebrated as part of Murphy’s lore.

Where do we go from here?

The ABC has produced a four part series Old People’s Home for 4 Year Olds; it is modeled in some degree on a BBC series of the same name.

Lucy Mangan wrote in the Guardian about the BBC version (sic):  The show continues to tread the fine line between heart and sentimentality, between reporting on measures involving vulnerable groups without patronising them … and that at the very least the sociological gubbins should be let fade into the background instead of the makers trying to paint a scientific gloss on the commonsense appreciation that anyone’s mood, mobility and memory will improve if you throw activities, new experiences, a few highly supervised hours with some charming infants and the money to pay for it all at them.

I am somewhat uneasy at the sight of four year olds being led into an old people’s home to play with the residents. To me, the children could just as well be going to the zoo. These are strange creatures to the very young; and the carefully depicted interaction predictably elicited parental clucks by the commentariat at the wonder of it all. Annabel Crabbe is the ideal presenter.

However, where is it all leading after the cameras are turned off and the academics drift away to write their papers? The numbers participating are few and given that the camera cannot be a continuous record but one determined by the selectivity of the director, then the temptation is to have the cutest cuts and leave out the scenes that do not correspond to the producer’s definition of bliss.

There have been other experiments, such as the Seattle one where a preschool was placed in an old people’s home. It has been locally successful if one can believe the reports. However, it is just one example; but what does a policy maker do with such a project to make it generalisable? The other factor is the enthusiasm of those who initiated the transfer of concept to action. They have a vested interest in making it work, but times change, enthusiasm wanes. These sort of projects need a wider support base not only to be sustainable but more importantly generalisable.

The actual conduct of the operation probably requires a high level of supervision, because one is dealing with the interaction of two groups where there is both dependence and yet a high level of unpredictability. One group will soon move to another age group and perhaps will be left with a positive view, while the other group are about to die and leave their trace on a filmed archive only.

I remember when I was a small boy and following my father as he went around a ward full of war veterans. At one bed while my father saw other patients I got talking to a patient – a soldier. He was friendly and he talked so that I understood what his life had been, without any sense of self-pity. I remember saying I would see him next week. He smiled, called me “Blue” and patted my arm.

Later, (I cannot remember the time gap) I came back with my father and went straight to his bed. I don’t remember whether it was empty or if there was another person in the bed. However when I asked about “my friend”, the reply came back that he had died. I could not believe it. I think it was my first experience of loss. Whether this was experienced by any of the children in this “experiment”, coming back to see one of the old people only to find they have died. For me the memory has stayed tucked away for years.

Why do you tell stories as you get older? Nostalgia is the province of the elderly and the benefit of this type of interaction is that the elderly have an audience – admittedly a very fleeting, easily distracted audience to which to tell your tale. Perhaps in the end the ability of old people to tell a tale where the audience still has the flush of wonderment is a good thing. But loneliness is a 24-hour experience.

However, if the attempt of mixing the groups is just voyeuristic – “been there; done that”; then I believe the makers of this series have probably done a disservice to all involved if nothing further eventuates.

Old age is an increasing societal challenge. It should not be just a case of waste management. Yet I fear that is happening – and David Attenborough-like explorations of human foibles and cuteness should not replace serious consideration of what can be done.

The clue is in the series – get the elderly to tell their stories, whether they have a four year old audience or not. After all, it gives you a sense of relevance, even when you may be the only one listening. However even one child listening and responding with questions is a bonus. After all, I believe we are all storytellers.

Mouse whisper

I don’t know what I will be able to squeal and the Press to write once they silence Trump, but this quote from the New York Times has a degree of murine richness. And I thus thank Mr Krugman for the quote.

At that point you might expect an intervention from the grown ups in the room – but there aren’t any. In any other administration the Treasury Secretary Steven Mnuchin, a.k.a. the Lego Batman guy, would be considered a ridiculous figure; these days, however, he’s as close as we get to a voice of economic rationality. But whenever he tries to talk sense, as he apparently did over the issue of currency manipulation by the Chinese, he gets overruled.

Protectionism is bad; erratic protectionism, imposed by an unstable leader with an insecure ego, is worse. But that’s what we’ll have as long as Trump remains in office.

Modest Expectations – Majority

When I was writing a book funded by the Commonwealth Department of Health to celebrate the bicentenary of Australia in 1988, the idea behind the book would be to take a number of people of various backgrounds in the health field and ask them why they were there at that particular time – 1988.

I had very few refusals. One I would have liked to include had terminal cancer, as I learnt later. Most of them I knew to some degree personally, but for some, like Vivian Statham nee Bullwinkel, it was a matter of cold calling. She must have liked what I wrote because she sent me a nice note. Others, like Professor “Pansy Wright”, sent back his annotated chapter with typical pithy oblique yet amusing marginalia. He never said anything was wrong, mind you.

In 2004, Who do you think you are“ appeared on BBC television. Bill Oddie was the first, but most of the subjects have been entertainers or sportspeople because they trained professionally to run the gamut of faux-emotion when the insights are “magically” opened up for them. Judging by the longevity in the series, it is great theatre and being copied in other countries, such as our own.

Business is booming in the whole ancestry business. The growth of analysing the individual DNA for racial heritage is alive – wonderful to know that one has a smudge of Lithuanian with a nuance of Savoyard barbecued on the heritage grill with a smidgen of Genghis Khan.

I do not know why we do it, apart from the fact that we live in a world of self-absorption where “I” overwhelms anything else in the alphabet.

However, who am I to talk? I have always been fascinated by my mother’s Irish heritage.

Crossard is on a hill about three kilometres north of Corofin and one km from Kilnaboy (the Catholic parish). Corofin in turn is about 16 kilometres north of Ennis in County Clare.

I have visited Crossard where John Egan, my great-great grandfather was born about 1770. All that remains of the 18th century Crossard is one stone wall of the Moravian Church, where one of the local families, the Burtons, helped 100 Moravian refugees from Central Europe establish a community at Crossard.

After the Moravians left, the building survived for a number of years, becoming a Catholic Church in the 1830s before falling into disuse. In addition to the remains of the Moravian Church and one stone ruin there are four modern stucco-rendered houses, one unfinished plus a farm called “Crossard Cottage”.

The Moravian Church at Crossard

Crossard is near the river Fergus, and here John Egan was a flour miller, and the flourmill building still exists at Clifden about two kilometres from Crossard on Lough Inchiquin. The Burton family had a large house on the Lough in the 18th and 19th centuries.

I had driven the narrow raised track towards Clifden knowing that would have been the route along which John Egan probably went to work. I have been on better roads, especially when confronted by a large piece of farm machinery travelling in the opposite direction. The road was on the edge of a substantial drop to the river plain. Having to reverse back down the muddy track was a deterrent to plunging back down that road – or off the road.

John Egan married Margaret McNamara and there are still both Egans and McNamaras in Corofin. In fact the McNamaras have a 200 year tradition of being the doctors in Corofin. And as for the Egans, there is a saying “if there are fish in Lough Inchiquin, there will be Egans in Corofin”. Lough Inchiquin is the local lake which lies below Crossard.

His son, my great-grand father Michael Egan migrated to Australia in 1848, and first went to Kapunda in South Australia, as did a number of the Blood family. That settlement was where the first commercial copper mine had been opened, antedating the gold rush. The Bloods, Burtons and Bindons were prominent Protestant landowners around Corofin and I had an idea that Michael Egan was employed by the Blood family as a young man in Ireland. Even to this day there is a Clare castle pub in the main street of Kapunda.

Eventually, Michael Egan was to become a very wealthy man in early Melbourne, benefiting from the gold rush as a wood merchant.

The Corofin Genealogy Centre was very helpful, but records in the National Library only go back as far as 1819. Searches could be undertaken in parish records to try and trace our lineage back further, as John Egan would have been born a Catholic in 1770. It could cost up to 500 euro for an extensive search of remaining baptismal and land records to find out more. These are matters that you intend to do, but I am closer to being a heritage listing and further puddling in baptismal records. My descendants may wish to do so.

I really just wanted to see what type of countryside our ancestors left to assure our existence. Although close to the Burren, it was very arable, but was particularly badly hit by the potato famine. This eventually was the reason the Egans came to Australia, but that is another story.

The Roo Revenge

Charlie McMahon concludes his time in the Western Desert 

Nicholas who had been in much strife at Kintore, was no trouble and was keen to use tools, particularly the screw drills. Charlie Tjakamarra who always wore a men’s red headband was staunch, cheerful and worked with me, always offering to lighten my load. Henry reckoned Charlie stayed close to me because he thought me to be in too much of a hurry (which was probably true), and worried I was likely to harm myself. There was no racial divide, none of the troubles of drink when you are two days drive out from the nearest boozer.  

In my four and a half years in the Western Desert there was not a drop drunk. I did keep an emergency flask of Chateau Tanunda brandy behind the passenger seat but never had to call on it. In the evenings Venus flickered between red and blue on the Western horizon and if I woke at night, the stars of the Southern sky told the time in the cloudless winter dry season, skies so clear that they looked not so much black as a faint blue. Frequent meteor streaks evoked trepidation among the fellas as they were thought to be the spirit of someone who had died far from their home.  

Everyone was pleased to see Minyina aka Anatari Number 3 and his wife, whose name I cannot recall, turn up one day with young Andrew Tjakamarra who was about 16 and the driver, a cheerful lad who immediately moved to camp with us while Minyina set up the first humpy at Kiwirrkurra about 100 meters to the north of us, an indication they must have lived out to the north BTT (before trouser time) because desert people always choose to camp in a spot adjacent to their country.  

They relished hunting fresh terrain, bringing a cooked cat (the one that I described earlier) to our campfire. Three weeks into the job the bush food was well received. With more hands than planned for, the town supplies were running low. We were down to flour, a few cans of bean and we had run out out of tea and sugar.  

The crew saved the day one afternoon returning with a fair sized roo and smaller one that were cooked immediately the Pintubi way. One had a poor little joey in pouch that the crew had some fun with, watching Danger nudge it to try to make it run, but I couldn’t stand to see it suffer and knocked it on the head. With a lot of care and special milk joeys can be nurtured but this was a work camp.  

I was tempted to do a dash to Kintore store for food but it was a day’s drive there and back and with only three days to finish the job I didn’t really want to. Henry dared me to make it through eating roo. The meat didn’t go off in the dry air stashed in a tree. We ate smoked and dried roo for the duration. I imagined how good a counter lunch at the Stuart Arms was going to taste in a few days. I got the runs, which no one else had. So I put it down to me being unaccustomed to roo meat. Still it was a good feeling to have finished the preparatory work so that the next month the windmill and tank could be erected. Henry drove and with no load it was a relatively quick trip but I was a mess when we pulled into Kintore at sunset and came across Jim Dooley at Steve and Kerry’s camp. Dooley had just dropped off freight there. Dooley was a funny bugger always joking, and my predicament was ammunition – I became the butt.’

“Welly welly Charlie Hook has gotten a crook belly playing at being a Pintubi”, he proclaimed.

“Henry, you trying to make a black fella out of Charlie?”  

“Shit you stink, Charlie and you will reek of roo for days.”

“Easy on mate, I’m rat shit!” I said.

Dooley’s kindness was my lucky break. Henry drove my vehicle to the loading ramp, onto the deck of Jim’s truck. Danger and I rode into town through the night in the sleeping bay with a few “crap stops”. Occasional farts erupted and smelt so bad that Dooley’s Jack Russell on the front seat would whimper, looking at me with ears down with forlorn, yet not reproachful face that dogs do so well. My odour did not worry Henry and Dooley. They just yarned all the way to town.

After a few days I recovered though Dooley was correct, the smell stayed with me. I could tell by reactions of the dogs. A yard guard dog had a go at me but turned tail when Danger responded in defending me. Since then I invariably get a vomit reflex when I smell wild roo meat. I am OK with the premium young doe roo meat that supermarkets sell as it has hardly any stench and in a spicy stew with onions I have no worries.

A brief note on Prohibition

Some years I was invited to a social function on a U.S naval vessel. It was a beautiful Sydney night. I had forgotten that there was no alcohol on US naval ships, with few exceptions. For instance, if a vessel has been at sea for 45 consecutive days or more, sailors are allowed to have two beers, on a one-time basis. However, it was salutary to attend an evening function without alcohol and only Kool Aid on offer. The function was pleasant and it was good to wake up the next morning and not regret the previous evening.

I was put in mind of the recent medical shock and horror at the alcohol industry’s response to the recent furore about alcohol and the recognition that alcohol is a part of our daily life.

Everybody knows that alcohol in excess is a poison, but whether lecturing the community is the best way to get the message through is probably problematical.

However, what the medical and other health professions could do is to emulate the US navy and ban alcohol at all official functions – all dinners. There would be mocktail receptions for distinguished guests. No more wine and food society functions under the auspices of medical groups – more than two glasses of booze a day contravenes the NH&MRC warning.

It is after all somewhat hypocritical to have happy snaps of health professionals at dinner with glass of wine in hand, if one is excoriating the alcohol industry at the same time for its collective irresponsibility.

Therefore, if the medical profession were really serious it would implement a total ban on alcohol being served at any sponsored dinner, and check the guests for hip flasks as they arrived.

It would also test whether anybody really wants to go to these functions, where self-aggrandisement is no longer an essential ingredient nor alcohol the essential lubricant. 

Mouse Whisper

Overheard in the Classics department of the University of Chipping Tarcoola.

“You know Scott Morrison has a Shakespearean connection. His name is Scottish-Irish, a derivation from the Latin word “Mauritius” – meaning a bloke from Mauretania – that is, a Moor. Not sure he would have liked to be known as Othello Morrison. Hate to know who he would pick to be Desdemona though.”

Modest Expectations – The Dark Blue

When you read this I shall be far away, floating down the Amazon where the piranhas are actually fish. One of the diseases of the Americas that gets very little airplay is Chagas disease, named for the Brazilian doctor, Carlos Justiniano Ribeiro Chagas. With the globalisation of disease, which is impervious to political shenanigans, cases are turning up in Australia. However, while it has the acute manifestation of any infectious diseases, it is the long-term insidious effects on the cardiovascular system.

Trypanosoma cruzi

It is said that Charles Darwin picked up Chagas disease as a young man when he was “Beagling” his way around South America. It would explain why an outgoing young adventurer increasingly became a reclusive invalid as he grew older, never again venturing from Great Britain.

Chagas disease is caused by Trypanosoma cruzi, a protozoa which is carried by a particular bug, commonly called the ‘kissing bug’, so called because of how it cuddles up to you, sucking your blood and letting the protozoa bug into the blood stream. There are drugs to treat the trypanosoma but the course is long and hazardous as one may be strewn with complications.

However, given its insidious nature and that the fact that when backpacking it is romantic to sleep under thatch or in adobe, remember to have that mosquito net, however inconvenient it may be, and a good amount of insect repellent.

The Lancet has said in a sobering statement: “Chagas disease has been considered a neglected disease, without fully effective drug treatment to avoid the chronic stage.

Australian figures on its prevalence are scanty, but undoubtedly it is there as I noted above. After all, disease is a free market.

I shall keep reminding myself of that as the Amazon drifts by. 

Setting down Bores

Charlie McMahon continues his reminisces …

We took the smoothest route via Papunya but that was still a rough corrugated dirt road for 600 of the 750 km drive. There was one lane of good tarred bitumen up the middle of the road so that you drove half on the dirt shoulder when either overtaking or accommodating oncoming traffic.

Near the Mount Zeil plain we came up to overtake a fully loaded “3 dog” road train doing about 90 kmph to our 100. I reckoned it looked safe enough to overtake with the road ahead dead straight. The truckie was not likely to go half on the shoulder to ease our passage and I indicated my intention to pass with high beam flashes and came up beside the road train driving entirely on the shoulder, which slowed us a bit. I was going OK till about a quarter away from passing the road train, a huge hump appeared on the edge of the shoulder, a blasted drainage gully that the dust swirled up by the road train had obscured. I slowed but still hit it at speed. Up and over we went with the load and fellas on the back bounced around. Danger barked, shouts of dismay and Henry with me in the front woke from his snooze looked back and “oh-ho jingiles, lucky one, Murra Hook. They all there still” was all he said. We barrelled on and made to pass the road train again. The truckie congratulated us with the road train horn blaring. “More better I drive ilta” (true questioningly) Henry said. So he took over at the Papunya turn off. Had Henry been driving he would have seen the bump long before I did and we drove on into the night without incident to camp at the halfway point west of Mt Liebig.

On the way the next day we found Freddy West and his family of six camped 100 km before Kiwirrkurra at the Moying Bore near Tjiterong. They were there as an expression of his eagerness to move to Kiwirrkurra, his traditional land. He waved us over, offering a billy of warm sweet tea and put his son Nicholas on board telling him ‘work karriantjku’ (go work with them). Nicholas had been in a lot of trouble sniffing petrol, breaking into places at Kintore – his ability with locks astonished everyone for a child with zero formal education.

On arrival our Kiwirrkurra camp appeared pretty much as we had left it, though the Vinnie’s bag of clothes had been dragged about. “Lotta myall dog been here”, Charlie reckoned and there was much discussion about tracks the crew saw as they gave the place the once over and the first timers showed elation at being on ancestral ground, old hands pointing to and naming places near and distant.

Danger, the dog, got a good sniff of some scent and bolted off not to be seen again till dark. I took a quick shower and said to Henry “you’re next” as well as suggesting to Charlie that since he had been sitting next to Henry for two days he would do well to have one too. I dried off beside the fire as the crew had started. I got out the scabies oil for Henry. As Aboriginals do, he showers with his clothes on. Whether he was shy or just efficient I didn’t bother to ask but handed him fresh clothes from the Vinnie’s bag.

August was perfect work weather. After about two weeks we were well into the job with the four 1x2sq metre-footing holes for the windmill tower legs dug with crowbar and shovel. The John Deer tractor had a bucket and ripper, good for pipeline trenching, and a trailer for carting water and aggregate but without a backhoe for deep holes. The fairly soft soil of Kiwirrkurra made digging easier, which was one of the reasons for choosing the place, so the proper job pit dunny was finished in three days. It was a design called the Blair Ventilated Pit Toilet, shown to me by Steve Pattman at the Centre for Appropriate Technology.

To briefly describe it, a 2 x 2 meter mesh reinforced concrete slab is poured with an off centre “crap hole”, another near the edge for a vent pipe and left to set while the hole is dug 1.8 metres or more deep. The slab is dragged over the hole and the shelter fastened to it with the vent pipe painted dark running up the exterior of the sunny sidewall. An insect mesh cap goes on top of the vent pipe. The dunny building has a hall type entrance to darken the inside so that when you look down into the “crap hole” there’s a circle of light on the bottom of the pit from the vent pipe. Any flies that enter invariably seek the light to leave and drawn by the draft up the sun warmed vent pipe, get stopped at the mesh. Walla! An odourless fly trap and having a proper dunny was a treat for in two years work at Kintore I had to do with a shallow trench – there was always too much to do and the quartz rock subsoil would have been a very hard dunny pit to dig.

We did not listen to the radio so the outside world mattered little. We worked every day and no one bothered with the time or names of days. Sometimes in the evening we turned on the Codan SSB radio tuned into a frequency used by locals, so that the crew would have great fun telling other clans away of the new place they were building. I heard amazing tales of doings in life out there in the days they laughingly called ‘before trouser time’. They would mix up dreaming stories with actual ones and I gave up asking ‘ilta’ (true) ‘did it really happen’ after realising they were often unsure themselves of what was myth and what wasn’t. The young fellas liked to hear Henry’s take on things and looking at the moon one night he asked me to confirm the moon trips “Tjpangarti (my skin name) true int it, some white fella been longa moon, been leave house and car there too”. We cooked and ate together. A coil of black one-inch pipe on the roof of the half walled shed we had built gave us the luxury of warm showers. It pleased me to see the crew (except for Charlie) use them fully dressed so body and clothes got washed in one go. Bathing was not an option for desert people and living around a fire tends to cure or cover their bodies with smoke.

The missing Horse

One reads brochures about Slovenia and they all say you can get horse and foal meat in some of the restaurants. Intriguing, I thought.

Slovenia is a tiny country nestling between Croatia, Italy and Austria, with the Alps forming a crescentic barrier in the north. In the south, Slovenia has a narrow coastline on the Adriatic Sea, with Trieste nearby.

We travelled to Slovenia by car from Venice headed for Ljubljana, the capital of Slovenia. We were told to get a vinjete before the border. This is the only way to pay the road toll in Slovenia (15 euros for a week). We were warned that the Slovenian police wait just across the border, and the fine for not having the vinjete is substantial, 300 euros.

Otherwise the passage across the border is seamless. One moment the signs are in Italian, the next in Slovene – transition from the Romantic to the Slavic.

However we are travelling in a more north-easterly direction towards the capital of Slovenia. Ljubljana is a trap for the new arrival because of its central hill; the tunnel through it, the shortcut to the north but not to the city centre, can fool even the GPS. Ljubljana is one tricky place to navigate, to coin a phrase.

The Antiq Palace Hotel turns out to be a rambling allegedly 16th century building. We are piloted to the room up stairs, via a lift, along a series of corridors bending and twisting until we are on a landing overlooking an internal courtyard. Here we are greeted with music, its source unseen. There is singing, then a horn; a violin struggling to escape; a cacophony of variable quality. Apparently there is a music school in the building on the other side of the courtyard.

The room turns out to be a suite. There is a huge dining room, a lounge area, a bedroom and a bathroom dominated by a huge spa bath. Over the bed in this white painted room was a painting which seemed to indicate that if you had difficulty with nightmares this would ensure you would get one – a weird sylvan scene.

The centre of Ljubljana has been preserved in its pre-World War One architectural attire. Its Austro-Hungarian past is evident in the two-storey houses with gabled roofs, stuccoed walls and large windows lining Ljubljanica River. One early evening when the sky was still blue and the streetlights were lit, you could be forgiven for thinking that this city was the inspiration for Magritte’s series of Dominion of Light paintings.

The problem with the food started on the first night after a meal of kranski and sauerkraut. Whether it was that or a roll I had earlier bought from a motorway food barn, I had a generous bout of food poisoning. I could not blame the horse. My first day in Slovenia thus was spent recovering, but she roamed the streets far and wide, photographing the Triple bridge and beyond.

The narrow Ključavničarska (The Locksmith) Street in the medieval part of the town, connecting Cankarjevo nabrežje (Cankar Quay) with the Mestni Trg (Town Square), contained a surprise. The central gutter was full of bronze heads about the size of billiard balls, most looking at you, as the water trickles over them. Oddball does not do them justice. These are the work of Jacov Brdar, whose work is scattered around the city. It has a Tolkien feel – with the heads looking like members of the Gollum family. They are featured above in the heading of this Blog.

In many ways, walking from bridge to bridge is a reminder of walking along the Seine in Paris, but without the cars streaking alongside.

Ljubljana and the Ljubljanica River

The river lies just down the hill from the Antiq Hotel and acts as a magnet – so much so that until the last day we did not use the green coloured electric cars, which circle the inner city and are reserved for the disabled and the elderly and their carers. They are called “cavalier”, the name being adapted from the Slovenian for “gentleman”.

On our last night in Ljubljana we used the transport to a traditional restaurant on the outskirts of the old city – the Taverna Tatyana. It was away from the tourists and the bar was full of locals quaffing their beer. It was all brown beams and low ceilings and homely hosts, who spoke passable English. It allegedly had horse and foal on the menu. Not so. Instead they provided a Dalmatian stew and grilled pork with wild mushrooms and after the main course, the magnificent strudel. Slovenian wine is a cheap and good accompaniment as is the complimentary glass of the local honey brandy called medica.

The electric car was there promptly to take us back to the hotel – I wished I had used it more given that my ability to walk was limited –no longer able to roam far and wide. However, the bridge near the hotel was always a site of “a happening” – tonight there was a pumpkin-shaped carriage, which fitted in well with this fairy tale backdrop.

On another night the bridge provided the dance floor for a group of young people elegantly executing the tango. We watched the precisely executed movements while sitting on a granite bench, consuming a cornet of freshly roasted chestnuts.

Yet for all these fairy tale qualities, Ljubljana is a university city. Those walking past are predominantly young and fashionable. The restaurant in the riverfront, overflowing with young people, labelled itself Mexican but the food was “pancake parlour” and the service was poor; yet nobody seemed to care as they oscillated between conversation and iPhone – or just sat, concentrating on their screens, tapping away ensuring future thumb disorders as they decoded life.

The lack of transport and reliance on foot and bicycles accentuates that this is a place for youth. The elderly lady dressed all in white struggling with her bicycle was an exception. She stood out in this world where it was the young who cycled.

We did travel elsewhere – but a full description of our “Cook’s Tour” could well become a Clog. But not a sign of horse on the menu.

When I asked my adviser on Slovenian food about the “missing horse”, he looked at me and asked me whether we had gone to the Tivoli Gardens as he had suggested. Apparently horse burgers are available in the Tivoli Gardens – at least I can confront my vegetarian friends with somewhat of a clear conscience.

But as for the survival of Slovenia, a tiny remnant of the Austro-Hungarian Empire which survived Tito and the break up of Yugoslavia with which it, I am reminded of what that wise observer of human nature, whose writing appears above, Charlie McMahon has said about small countries and survival of language: “Learning a language from a culture where the core practices are gone is really only good for that.” The Slovenes have never let their culture be destroyed, and hence they have a vibrant language with all the blossoms that that will bring.

Still, there is this matter of konjsko meso. 

Mouse Whisper

To further annoy the occasional reader of a vegan persuasion, overheard in a restaurant in Swakopmund in Namibia, after perusing the menu she was heard to say, “I think I’ll try the zebra.”

Not a laughing matter …

To which the waiter impeccably replied ‘Black or white stripes, madam?”

No, it was not an exchange of hoarse whispers, but in fact it was true, (with apologies to Mr Brydon).

Modest Expectations – Hole

In the blog two weeks ago, Neil Baird, and in this week’s Chris Brook have indirectly or directly alluded to self-sufficiency. With the advance of globalisation the need for self-sufficiency seemed not to be so important. The supply chains were efficient, and it may be argued that they remain so. However, the rise of nationalism and the belligerent rhetoric accompanying this surge have made a number of those multi-national corporations worried if you believe The Economist. Apparently, so it goes, most multi-national corporations found that they did not know who supplies the supplier to their supplier; and so it is conceivable that on distant shores there is a vendor who cannot or will not fulfill its obligations. When the supply chain works, as Brook as shown with blood, the tendency is to take it for granted – nothing will change – let’s move on.

However, this quote from The Economist is salutary: “In the wake of the Japanese tsunami in 2011 a global semiconductor giant tried to map its vulnerabilities to third and fourth tier vendors; it took a team of 100 executives more than a year to work out which firms were in its extended supplier networks.” Presumably this would not happen now if Silicon Valley were hit with a massive earthquake – or Seattle for that matter.

Apart from natural disaster, borders are going up everywhere yet we still depend on the integrity of the supply chains.

Meanwhile back at Parliamentary St Andrews, they chortle over their wonderful use of the wedge, the bluntness of the mashie and the judicious use of the constitutional niblick, while along the course the clouds are gathering. 

Blood

 Brook recounts his Success Story

I first got involved in the organisation and management of blood (and then blood products) in 1988 when I was appointed as Victoria’s youngest Chief Medical Officer.

Then every State has its own separate blood service which, although under the umbrella of the Red Cross, could and did have differences in approach, even donor deferral. This could create problems and these were not resolved until the early 2000s. 

Most of the big concerns at that time were about fresh cellular products, including adequacy of supply, in a system where only a tiny minority of the population are donors, predominantly white and “Anglo”. This has not changed. There are many cultural and even religious reasons for this, but it remains a big problem.

In my early stewardship, I was confronted by the HIV scourge and subsequently the rise of Hepatitis C infection in the blood supply.

Preventing their transmission through transfusion was urgently needed and for people with haemophilia the risks were multiplied due to pooling of plasma used to fractionate into products like haemostatic factors and fractionated plasma products like Immunoglobulin. The number of deaths of those with haemophilia due to contaminated products resulted in a drive to eliminate this spectre. 

It is difficult for people who were not there to understand the horrors of the HIV / AIDS era in the 1980s, before adequate testing and treatment. Australia’s response is regarded as a world leader, thanks to Neal Blewett, then Commonwealth Health Minister, whose government funding provided a systemic health response, community programs and research.

The Hepatitis C virus was not even identified at the time – it was suspected to be a new virus, but was known only as “Non A – Non B” hepatitis. Its subsequent devastating long-term effects were then unknown.

Universal testing for HIV was introduced and Hepatitis C antibody testing came later. There were also stringent rules for a person to be accepted as a blood donor thus assuring safety of the supply.

Problems in product supply and clinical usage became evident in the early 1990s. Australia’s blood and plasma product supply was considered to be largely self sufficient, in reality markedly sub-optimal plasma product use was masked, and overuse and wastage of red cells needed to be addressed.

The States and the Commonwealth jointly funded state-based Blood Transfusion Services on a 60:40 basis and the Commonwealth government at that time funded the Commonwealth Serum Laboratories (CSL). CSL did not fractionate some products from Australian plasma due to low volumes and large cost; and while there was funding for some imported products, like purified Factor VIII, the arrangements are best described as chaotic which led to perverse outcomes.

For example, haemophilia was treated only “on demand”, only at the time of a bleeding (often into a joint); and even then the treatment might comprise cryoprecipitate (a form of clotting factor soup)  or even fresh frozen plasma , as these products were “free” being available from CSL, whereas purified  Factor VIII was not and was thus a significant cost to the hospital.

So not only did a generation of young people with haemophilia suffer HIV and Hepatitis C, those who survived grew into adulthood with not only often severely damaged joints but also with repeated painful hospitalisations.

In 1994 CSL was privatised and as a successful case study in the benefits of privatisation when properly enacted CSL Pty Ltd has gone on to become the largest plasma fractionator in the world – a stunning achievement.

In the same year, with support of the then Victorian Premier, Jeff Kennett, I chaired a Working Party to look at Factor VIII in young people with haemophilia. Best practice meant prophylactic daily treatment with purified Factor VIII to prevent bleeding. 

This prophylactic treatment actually reduced hospitalisations, far better adult functional outcomes were achieved, and lives transformed from one of disability to one of approaching normality.

Then imported recombinant Factor VIII became widely available for the treatment for Haemophilia A and other bleeding disorders.

In 1996, I participated in the Red Cross amalgamation of all of the State blood transfusion services into a single national Australian Red Cross Blood Service (ARCBS).

In 1999, the then Commonwealth Minister for Health, Dr Michael Wooldridge, commissioned an enquiry into blood and blood product arrangements in Australia, chaired by Sir Ninian Stephen. Its 2001 report still reads well.

The most important recommendation was to create a National Blood Authority (NBA) to assume all supply planning and purchasing on behalf of all Jurisdictions (including the Commonwealth), using common pricing, and clear jurisdictional agreements.

The design of the NBA included the influential Jurisdictional Blood Committee (JBC), which reflected my belief that overcoming some of the problems of Federation can only be achieved by well functioning cross jurisdictional bodies, a lesson I learned as Chair of the Intergovernmental Committee on AIDS when the initial HIV / AIDS Strategy was devised and which incidentally informed the structure of the Australian Commission on Safety and Quality Health Care. 

During this time I was also the Chair of the AHMAC Blood and Blood Products Committee and remained so until the National Blood Authority creation in 2003.

In 2004 all recombinant clotting factors were funded by the Commonwealth government.

The NBA has performed to above expectations. It is a small agency with around 50 staff and I remain on its Advisory Board.

The NBA has contracts with CSL and with suppliers of imported haemostatic factors. ARCBS is funded by NBA on a product pricing basis for each State and reconciled annually. All products are funded jointly by the Commonwealth and States on an agreed 63:37 split with annual supply plan for each jurisdiction agreed by COAG Health Council.

There are excellent information systems allowing NBA to track fresh product issues and usage, plasma products, and haemostatic factors.

There are guidelines for usage of Immunoglobulin (Ig) and haemostatic factors, and a major blood usage (Blood Matters) program with all jurisdictions having vigilance programs to identify appropriate use and risk. 

In conclusion, Australia is well organised and managed in relation to the availability and supply of blood products.

Red cells are no longer the demand driver. Red cell use is declining as better education and usage monitoring occurs , along with reduction in waste.

Haemostatic products are now predominantly synthetic recombinants. This a great advance, given the tragedies with plasma-derived products in the past as occurred with both boys and men with haemophilia. 

Having said this, demand is now driven by the Ig requirement, which has ever-wider uses but is currently unable to be synthesised. This is not a insurmountable problem, but I also believe some of its uses will be replaced by specific antibody drugs in the future.  

Australia is one of the highest users of Ig, along with the US and Canada, but have long since needed to import Ig. Now imported, Ig is the majority source and costing much less than domestic supply.

Ig usage in Australia, whilst high, is not inappropriate and countries currently with lower usage rates will rapidly catch up – with all kinds of global consequences for its supply. 

Australia can boost domestic supply, but currently at relatively high cost, yet a cost-effective local supply should be pursued given the uncertainty of the global supply.

However, there are three matters that should form the basis of any ongoing review – just because, “it ain’t broke”, does not mean that it could still be improved. 

First, Australia is committed to at least try to achieve self-sufficiency, with minimal waste. We are self sufficient in cellular products, but arguably this should apply also to plasma products, which should this country aim to be?

Second, blood and domestic plasma collection is a totally conducted by ARCBS. The Blood Service is not a charity funded by the Red Cross, but a multi hundred million dollar government funded business, as it should be to assure the community of its efficacy. Should the community know this? 

Third, the ARCBS is trying to increase plasma-only donations but even so, our model has a higher cost structure. As a result Australia uses products from the USA and Germany, which generate the majority of global plasma products. These countries remunerate the donors. Australia is legally committed to a voluntary donation model, and the government would be loath to change. But should it at least be looked at?

Blood is too important a part of the health system not to always be in the forefront of policy considerations, especially when biosecurity and self-sufficiency are on the agenda.

Beware the unintended consequences, my friend

We returned to Australia through Darwin and as always, it is difficult to resist the two-bottle duty free concession. However bottles become heavier as we, not the bottles, age – or else seem to! I am disabled because of an intercurrent autoimmune disease, requiring a wheelchair at the airport. We had to board a flight to Sydney. My companion had recently had a heart attack, and though well enough to travel needs some assistance with luggage.

Thus we have the curious experience of the commissionaire, the name for the wheelchair pusher, being able to place my small bag and two of the four bottles in the overhead luggage compartment.

My companion had gone on ahead, and I was presented with the unedifying spectacle of a young female flight attendant standing by while my elderly companion, who had a recent heart attack, struggled to place her items in the overhead locker.

This spectacle was further compounded by the fact that we had been allocated business seats in row one. In the front row, all bags –including handbags and toiletry bags with necessary medication –must be off the floor. In other words at some time in the flight, bags must be taken down and in a full flight this means moving bags around in the overhead locker often, a strenuous manoeuvre if the passenger is disabled.

Apparently there is some recent ruling that prevents the flight attendant helping with placing luggage in a overhead container. We had not brought on portmanteaux, which for some reason the airline allows people to do. Rather the airline insists that the flight attendants stand back and not help. When I protested, I was put firmly back in my box, old man … them’s the rules.

The problem with rules is that there are those flight attendants with common sense and those without. A rule does not have a brain to distinguish one from another. I would suggest to the airline to stop people bringing on huge cases, and that when people are placed in bulkhead or exit rows, which require all baggage to be off the floor, to exert a bit of common sense. And if they cannot, defer to somebody who can.

Finally, I would say I have been disabled for six years and the problem with airport terminals is they are getting larger, and the demands on disabled services is not getting any less. I have been able to observe many cases where there has been no obvious reason for a wheelchair except it seems culturally important to have your mother when she gets to late middle-aged to be wheeled around the airport. So the task is not getting any easier when you also have to deal with a sense of entitlement as well as disability.

Mouse Whisper

What did you mean by “He met her in abasement” or should it have read “He met her in a basement”? Might be the same. Nevertheless, it put me in mind of the time when I was the MP (mouse parliamentarian) for Mousehole. I sent a stern letter to a PS (parliamentary skunk) where I meant to write that his action was “imprudent” but somewhere along the way, the “r” was dropped. Created quite a stink!

Mousehole