Modest expectations – Montana

This is a story about the unexpected – an unremarkable story on the face of it, but like many stories of its ilk, instructive.

In August, as I have recounted several times in my blog, I was in Chile and in particular Valparaiso. As I was hobbling down a flight of stairs and across a doorway in the restaurant, my hand caught on something sharp. Whether metal or wood, it created a spectacular gash over my fifth metatarsal right hand. It as not particularly long, but it bled. My canes clattered to the floor. As I had nothing immediately at hand except paper serviettes to staunch the bleeding, and rudimentary Spanish to say “Ayuda”, it continued to bleed profusely. It took some time for my companion, who was sitting by the window in this upstairs-downstairs configuration, to come and put order into stopping the bleeding, by pressure.

Eventually Chilean band-aids were produced and these reduced the bleeding to an ooze. The wound was not stitched, but there was a bit of debridement and the edges of the wound were roughly opposed – without seeking outside medical help. I thought that was one reason it took a long time to apparently heal, but the skin remained pink as the scar tissue started to form.

One day about a month after I had returned home a lump appeared at the site of the scar. It grew relatively quickly, but the skin did not ulcerate. I went to my long time plastic surgeon in Melbourne. I thought there must have been some retained fragment – a foreign body that had been missed. The surgeon who has operated on me on a number of occasions said nothing except after a little hesitation, that he would take it off immediately.

Jean-Nicolas Marjolin

I was surprised by the length of the incision and its depth; I should not have been so surprised when the pathology came back – squamous cell carcinoma. Sometimes in wound tissue an aggressive skin cancer can erupt. That had occurred in my case – Marjolin’s is the eponymous name for it – normally these cancers appear as an ulcer, and this would probably have occurred in a few days if it had not been removed.

That was a month or so ago, but now the area has healed and the scar from the incision is barely visible.

A very good astute surgeon, now onto my next experience…

The Surgeon Never Replied

Below is a letter I wrote to a surgeon just prior to a proposed operation three years ago. I have still not had the operations, and although I have a few mild symptoms I have not had to endure the morbidity or my family the funeral costs which could easily have resulted from operative intervention. I am writing this blog to provide an informed consumer perspective on my doubts about spinal surgery.

The other problem with surgery, especially with severe osteoarthritis in the shoulder joints, is that when you are being moved about during cervical surgery the anaesthesia will mask any incidental damage being done in the shoulder. One does not feel the pain of tearing a ligament or muscles or the rotator cuff of the shoulder joint until one comes out of the anaesthesia, and suddenly there is another centre of pain. In the aftermath of proposed surgery, pain relief for me is always going to be tricky because of my sensitivity to opioids. That does not matter to the orthopaedic surgeon – the surgery itself is the centrepiece, not the subsequent morbidity nor the rehabilitation. After all, I was facing three major orthopaedic operations in short order – nearing the end of my eighth decade.

The following is my letter to the surgeon appropriately de-identified sent in the days before the operation.

I thought I would explain the reasons for deferring my operation. I am sure you respect that the choice I have made has not been undertaken without much deep consideration of balancing the risks and benefits. My response was largely generated from our last consultation and your subsequent letter to Dr A. 

I note you made a comment that if I stressed my spine that there was a possibility of worsening the condition but I recently spent nine days in Malawi on a number of extremely rough terrains in a four-wheel drive without any apparent change.

Currently I have very mild numbness in my little and ring fingers intermittently in the morning on waking – not every day!

If one reads my latest MRI report it demonstrates that I have significant pathology in my cervical spine, yet I am virtually symptom free. You list the risks associated with the procedure without setting out the probability of any them occurring. Hence I take the paragraph in your letter to Dr A to mean that they are considerable risks. I thought it preferable to have the MRI at JHospital well before the operation rather than the day before – and there is no doubt that JHospital runs a very professional operation. However, so does the Diagnostic Imaging Department at IH, with which there appears to have been an unfortunate failure in communication (with yourself. I am sure you did not meant to criticise the IH nor the fact that at that time it was more convenient for me to have my imaging undertaken there.  

In addition you intend to take iliac crest bone which, as you rightly point out, is better than cadaveric bone for the putative operation on my cervical spine

However I have chronic polymyalgia rheumatica, the aetiology of which condition remains obscure, but there is one observation I would make which is that any shift in the dose of cortisone (currently 4 mgs a day) has a far more marked clinical effect than would be expected – manifested as stiffness and muscle weakness. There is no mention of the possible impact of operative trauma on such a condition, but you would have more information than I do. Therefore, that is one matter that needs to be resolved. The other of course is the effect that the cortisone has had on my bone given that I have been on the drug for three years, despite taking Vitamin D regularly.

I am nearly 77 years old, which is a factor, and the fact is that my cervical spine has significant pathology. The question that is raised is whether there is any guarantee that intervention would not have a cascading effect requiring more operative intervention for diminishing returns.

In relation to my lumbar spine, I do have symptomatology of mild spinal claudication as you have noted as 5/10, but as one senior physician said to me the other day, the major problem is my right knee – and knowing the success of such an operation would it not be preferable to do any operative intervention starting with the knee?

The question then arises of whether the operative schedule should be in reverse, and would a laminectomy guarantee relief of my symptomatology – particularly my ataxia and loss of proprioception? Your letter would seem to suggest otherwise. Is the fact that even if I had a lumbar spine operation I would not be helped? What are the odds of improvement given my age and lumbar pathology. 

I walk with two sticks for social reasons not because I need them invariably. For instance, I challenged myself the other day to walk without sticks but accompanied for three blocks to the coffee shop. There was some pain in my knee, minimal pain in my back and no symptomatology referable to my neck. The pain did not stop me at any stage, there and back.

I continue to do hydrotherapy twice a week and find it very helpful and, so as to clarify your comments in the letter concerning “Panadol Osteo” dosage, I am taking 4 tablets of Panadol (625mg) a day in divided doses and not six as previously. Do you think that a significant observation?

There are a number of other matters in your letter to Dr A, which could be better put. The comment concerning my heavy smoking history is totally ambiguous given that I have not smoked for 36 years, and it was taken not from any direct interrogation but lifted from my “confidential note”. The fact that I produced those notes to inform you so that it saved time and helped you to take a comprehensive history. I am sorry to have to make that point, but in providing such information it should be attributed and not just “noted”.

A copy of the letter was sent to Dr P who retired at the end of June and my doctor is now Dr Q locally. Given that the letter was sent to Dr A, who made the initial referral I am at a loss to understand how that occurred. The copy to Dr P has been archived at NHospital with certain agreed caveats. I believe that any copies of correspondence should not only be sent to Dr Q but also to Dr R, who has been the rheumatologist responsible for my treatment for PMR since 2013, when Dr A referred me to him, Dr A having made the initial diagnosis.

You have not referenced my severe shoulder osteoarthritis, which would be a consideration in any cervical spine surgery? (Here a confidential matter relating to another person has been excised from my letter.)

There are there other matters that puzzle me and that, given all the potential complications set out, I understand you will be away the week after the proposed date of surgery – and if that is true who would undertake my post-operative care, should any of the dire consequences set out in your letter occur. 

The second source of my puzzlement is an initial comment you made that you would be prepared to operate on my back four days after my cervical spine operation. Does that still hold true? 

The third matter is your comment that “ agreed with your need to alter the plan on the day before”. I must have misheard but I do not remember agreeing to a change in plan –especially as it would appear that a substantial part of my cervical spine is affected and yet I am virtually asymptomatic. My cervical symptomatology is better than it has ever been given the problems I had with it 20 years ago, and which were relieved by some excellent physiotherapy.  

Those cervical symptoms were resolved a long time before I first presented to Dr A. It is certainly not a decision I would take the day before the operation, given the seriousness of the complications you have listed. Hence this was my reason for undertaking the imaging a substantial time before the proposed operation.  

The underlying question is would it not be better to reverse the operative schedule on the basis of relief of symptomatology and enabling me to walk pain free, with a reasonable gait and with an improved ability to negotiate stairs, reverting to what I could do in early 2013 before the onset of the PMR, which seems to have acted as the tipping point for all this? 

As you foreshadowed in your letter you have awaited my further advice –and my basic response is the question above couched against the previous consultation, but not with the benefit of you reviewing the MRI and spinal X-rays

I asked for a number of second opinions. The average elderly person who is suffering from degenerative disease does not have that option because information in the health sector is so asymmetric.

To me the non-response to the letter reflects on the person. Here there is an arrogance characteristic of some of the medical profession. They do not see it, especially when they have only patient contact and are acting like a high paid tradesman, who comes in does his job, gets paid and moves on. From my experience very few tradesmen ever come back to view their work. Unfortunately, I was brought up to be a doctor and now as a consumer my perspective has only shifted to the other side of the desk. There should be debate, including this doctor who has remained silent for over three years. 

Boeing Sub-Max

In a investigative piece on Boeing at the time that it was amalgamating with McDonnell Douglas to monopolise the American plane construction in 1997, Boeing’s warts were well and truly revealed. McDonnell Douglas had some very good planes, but inter alia fell over because of its failure to build economic wide-bodied airliners, despite in 1995 receiving US$334m in rebates from kindly Uncle Sam.

Meanwhile the Pentagon was awarding Boeing US$1bn for “restructuring costs” and so eager was Export-Import Bank to ease any problems that Boeing might have, was renamed by some in Congress as the “Bank of Boeing”.

If you want to blame the Republicans for allowing this monopoly to occur, well that’s just not true. Increasingly when the truth of this has emerged, since there in the centre of these appalling decision, smoking a cigar in his Oval office was Mr Teflon – Bill Clinton.

He agreed with the advice that the Boeing position was legal because of the pressure it faced from Airbus. As the1997 correspondent said: “Using this logic all the US automakers could merge because the ‘Big One’ would still face foreign competition. Too bad the Detroit lobbyists can’t figure out a way to hide price hikes in the airline tickets and Pentagon procurements.”

Now Boeing is being confronted with a major problem – its latest airliners appear to be duds – and dangerous duds at that.

I have flown on most types of Boeing: 707 through to 747 internationally, 727 and 767 domestically, and even the 717 and 757 although not as commonly as the workhorse, the 737. They have all been good aircraft, although the Qantas 747s are becoming creaky and by preference I try to avoid them.

A former retired Boeing engineer and policy analyst has been reported recently as saying: “(There has been) a shift in the culture at Boeing from one which strove for engineering excellence to one focused on cost cutting. This deliberate strategy from the very top of the company led to massive, ill-thought-out outsourcing and the discarding of engineering talent as work was moved out of the Puget Sound region…(and in turn) has led to major failures on Boeing’s latest two major airplane development programs — first the heavily outsourced 787 Dreamliner and then the minimally upgraded 737 MAX. Both planes had to be grounded over safety issues.”

This failure has left companies in the supply chain in tatters. Fiddling and tweaking has not worked. Other airlines are running out of patience and are ordering planes from Airbus. As the airline fleets age then attention turns to maintenance; and if cost cutting takes over there as at Boeing, then air travel becomes not just an atmospheric pollutant but also a health hazard.

As has also been reported locally in the Seattle media “Boeing hopes for its first good-news event: the long-delayed first flight of the new 777X, with its massive composite wings. In late January, Boeing’s new leadership will reveal the latest tally of the cost of the MAX grounding, updating the $9.2 billion estimate through October. The rest of the year is likely to be a long slog, getting the MAX program restarted and slowly ramping back up again. No one can yet foresee the long-term impact.”

Boeing 737 Max engine

It sounds forlorn, since many of the mistakes Boeing has made in the 20 years interval have been glossed over by Government not holding them to account and the accompanying high profitability of the 737 until the MAX version came on line.

There have been failures such as not exploiting the 717, which, as one our own Alan’s choices, was particularly shrewd. There is now an increasing requirement for jet airliners with 100-150 seat capacity to run on regional services. The 717 fulfilled that need, but it was given the cold shoulder at Boeing because it was essentially a McDonnell Douglas enterprise and Boeing stopped making them. Only Delta, Hawaiian and Qantas have the plane in any numbers, and they are not selling them. Now through its Bombadier subsidiary, Airbus is filling the need. In the end the 717 will suffer as we all do – it will need spare parts that are no longer there.

However, all is not lost on the bottom line. There are the cost-plus projects where the Defence force chiefs inflate their budgets with expensive projects. Because they are seen as symbols of military might, it is interesting to reflect on the giant transport plane, built by Boeing, the C-17. With a budget of between USD200-300m a year for each one, one official labeled it the Golden Turkey because of its cost and its vulnerability to being blown apart by $22 mortar shell. Perhaps it has been made less vulnerable, especially after one crashed into an Alaskan forest in 2010.

Nevertheless more recently than that, someone who had experienced the joys of travelling in a C-17 said despite all the hype of being long range and being able to be refuelled in midair, it was more like a “stopping all stations conveyance” between the United States and Afghanistan, even including a stop for repairs.

Despite all the rending of garments, the Defence establishment continues to pour money into Boeing. In 2018, Boeing won contracts to build a new pilot training jet for the Air Force, an in-flight refueling drone for the Navy, and a fleet of the Airforce security helicopters.

As reported, Boeing’s “Defence revenues” had fallen by more than one-third over the timeline of a decade: from USD32.1 billion in 2007 to USD21.1 billion in 2017. But, President Donald Trump’s higher defence spending and three new military contracts put Boeing back in the game in 2018.

Still, to put all of the boondoggle in perspective, the Boeing commercial division in 2018 before the Supermax crisis billed USD60bn by airlines around the World.

Cap in hand to the Government you would think can go only so far, but Boeing has shown it has a capacious chapeau.

Mouse whisper

Just a message for the Nimbin anti-vaxxers …

Your child about two years old gets chicken pox; has a high fever – starts fitting – you prescribe one of those herbal remedies that incidentally has aspirin hidden away in it. Child severely incapacitated mentally – or dies.

Remember the name Reye, who first described the mixed brain and liver symptoms and signs as a syndrome in small kids.

Chicken pox plus aspirin; vaccinate against chicken pox. Reyes Syndrome no longer. QED.

Ralph Reye incidentally was an Australian pathologist – normally they are the doctors who deal with the dead.

Like polio, Reye’s syndrome was nearly eliminated until your mob came along.

Reye’s Syndrome

Modest Expectations – The Two Noble Kinsmen

Leigh Sales, what planet are you on? Take your statement last week about those poor tradies who need to drive Uber at the weekend for extra cash. It was put into perspective a few nights later when – that “uber tradesman” Scott Cam was revealing as “chiselling” the Government out of a six-figure sum for his part time services. For his part-time activity he was not behind a steering wheel. He is the Wheel!

Ms Sales, “tradies” as you call them are doing very well, by and large. Probably given you are upwardly mobile, it is just conceivable that you employ a “tradie” or two. I like the word “tradie”; it fits into all forms of the alphabet a-gender

From personal experience, one of my “tradies” owns a hotel and the other has so much work, the last thing he requires is the wheel of car in the evening other than to go home. I suggest that Ms Sales profiles the Uber driver. I know anecdotally my Turkish-born taxi driver who has been driving me for years and who has had a network of drivers from the pre-Uber days, now drives for Uber in addition to his own clientele. However, I suspect that you will find a great many Uber drivers, who are first generation arrivals in this country.

One of the interesting aspects of taxi travel, of which I once did a great deal, always riding in the front seat, I learnt a lot about the outside world; it was the front seat to an ethnic collation.

However, the racial profile of taxi drivers has changed. I always remember a young Greek doctor who, when he first arrived in Melbourne in the mid 90s, could not believe the number of Greek taxi drivers here. Now there are less Greeks. Taxi driving is an indicator of a less established community. For instance, you may find that an increasing number of Sikhs, newly displaced from the Punjab, are a major taxi or Uber population. But freed from the bureaucratic entanglement of the old taxi cartel, Uber driving attracts the retrenched older person and the student out to make a quid – particularly overseas students. I do not deny that there is a poor postilion under-class, but it ain’t “tradies”.

Nevertheless, it made me think about the proposition of the under-utilised “tradie” workforce, if indeed there is such a thing.

Given that it is a local council responsibility to provide a home maintenance and modification service in addition to hospital adjustment to daily living (ADL) for patients returning home, I would have thought that if there were these Sales’ “tradies” out there looking for twilight cash, then they should be easily absorbed more usefully into an Australia-wide home maintenance and modification service co-ordinated as it is locally. It is difficult to gauge how prevalent these schemes are; I remember when I was running a community health program nearly 40 years ago, some of the more progressive local governments had begun to set them up, but in those days there was a bureaucratic separation between health and housing.

Michael Portillo has recently fronted a documentary on the UK public housing situation acting unfortunately as an apologist for (rather than he once was an acolyte of) Margaret Thatcher. She was guilty of poor decision making when she sold off the social housing stock for a pittance without any strategy for its replacement. Portillo himself tried to absolve her of the social vandalism.

The whole question remains of who pays for social housing but more importantly prevents the purchase for its speculative purchase to drive up prices and hence to conceal the underlying inflation in the economy. At the same time the tacit pact between big business and government suppresses the earning power of those who should be able to afford such housing, either by renting or purchase.

In any event, it is just another area for you to explore, Ms Sales, especially with all this talkfest going about us aged across Australia, rather than indulge in the mythology of the “poor tradie”.

Albanese and the Coal Scuttle

The Adani Coal Mine is a private mine. It’s been approved. It is going ahead. It’s not a Government mine… Finance has been the issue with the Adani mine, but it’s had its environmental approvals. I support the jobs that will be created by any project, any project in Queensland or anywhere else for that matter. What Government needs to do is to set in place strict environmental guidelines. When those guidelines are approved, then you have projects which go ahead if they receive private sector support. 

The first reaction to this Albanese mouthing is that the weasel should be removed as a protected species irrespective of the Albanese predilection to cuddle the animal.

Let us make an early prediction. Albo will have difficulty retaining his seat if he does not do a better job of explaining whether he will be emulating the Prime Minister and going into the House brandishing a lump of coal – Balmain coal – or not. After all, his electorate boasted a coalmine, and my late neighbour remembered as a boy running around the corner to pick up some lumps of coal for the family stove. The air was full of coal dust, pit ponies were still being lowered every day into the mine and there were several major accidents when men were killed. However, the coal was convenient to keep the stove going and the fire alight; ensuring the skies were grey.

It is written in the wind as far as you are concerned Mr Albanese. Go on a trip to Queensland, hug a replica of the Balcaldine tree, and desert a Sydney where the pall of brown smoke foreshadows summers of the future, where blue skies are an increasingly distant memory, as they were when coal was mined.

I have lived in the electorate long enough (although we were only recently redistributed to Albo) – long enough to have seen it desert its working class legacy to that of wall to wall cafés. I can remember the whistle signalling that work had commenced on Cockatoo Island across the Parramatta River. I can remember the odours from the soap factories, which had saponified the river for years. I had walked up the hill and been shown the entry to the Birthday and Jubilee mine shafts that had been sunk when Queen Victoria was in her venerable years. The area was a wasteland of weeds, but you could still see the access points to the mineshafts. The soil is thin and poor in Balmain and as you stir it you wonder how much of the contamination of the past is floating into the atmosphere. And the working class had to endure it, while the tycoons flourished.

Balmain coal mine

In Balmain, one of Paul Keating’s achievements in decontamination was the development of the old Ballast Point Caltex site into a magnificent public park; so much of the harbour waterfront was lined by industrial sites, now gradually renovated, although not necessarily reflected in the growth of liveable space. The working class has become educated, but the same tycoon-types still exist, now complicit with a rising rent seeker class, a.k.a. politicians.

Now, Albanese of Grayndler goes off to circulate in central Queensland, unfamiliar territory for a Sydneysider well versed in the rent seeker class who inhabit Sussex Street but will the Camperdown boy be seen at the end of the street in Moranbah? How much can a fleeting visit do for the Queenslander’s view of you, a Mexican arrayed in RM Williams clobber, your sombrero at a rakish angle to display your winning countenance.

Then that statement you made of: “if we don’t mine it, somebody else will.” A variant of “if we don’t kill our grandchildren than somebody else will”. How well you demonstrate the Hollow Man.

When you come back to your ex- coal mining electorate of Sydney, I’m sure you’ll get a rapturous welcome with us all waving soot laden miner’s lamps to welcome your return.

Oh, by the way, when you are hob-nobbing with the Adanis, tell them we exported coal from Sydney to India in 1799. It will inform how important your electorate has been in defining the genesis of Coal as an invaluable Export -and you as a reaper in the Carbon field, its representative.

Anti-Vaxxer – Prosecute for Genocide Part 2

According to a 2018 report by Complementary Medicines Australia, the country’s complementary medicines industry made $4.9b in revenue last year — including $2.77b in vitamin and dietary supplements — and is expected to grow by another $2b over the next five years.

Just a casual comment to indicate how much porcaria Australians are pouring into their bodies every year. What I find disgusting are the advertisements which show the happy family images loading up their shopping baskets with this stuff – as though a healthy young family needs it – and some of these naturopathic fanatics have the hide to fill their children up with these drugs while at the time perniciously undermining of the community’s health status, trying to claim that vaccination is harmful. Anti-vaxxers have been allowed to roam in this community.

We should take a leaf out of the Samoan legislative book, and prosecute and jail those who would willfully promote ant-vaccination messages and promote rubbish substitutes. To kick this matter along a letter will be sent to each politician in Australia, asking the simple question of whether they support vaccination or not. It will made very clear that a non-response will be taken as a “no”; and the results will then be published, so that at the next elections these enemies of the welfare of our children can be identified and dealt with at the ballot box – at least in the first instance. Legislation will follow.

Telling it how it is

Below is a note received from my private health fund. It is clear and needs to be read against the outpourings of the Grattan Institute.

I read the comment of one journalist the other day, who describes herself as “senior”. She reckons that she does not need all that private health insurance stuff – you know cataract, hip surgery and that unfamiliar set of lesions called “grab bag”. She boasts that she is fit and into marathon running. The association between long-distance running and knee and hip injury is still in dispute.

The problem is that the attitude being promoted by such comments constitutes an attack on community rating. Once community rating is destroyed, then life is a lottery as you enter the realms of catastrophic insurance and you being rated on your individual profile. You are laid bare – no community rating to protect you; warts and all, literally.

The other factor, which has had a disastrous effect on the health system, are all the cost shifting antics of the States, to which the health fund attests below. And even more outrageous, the diversion of money destined under the Commonwealth-State funding agreements being diverted to uses other than the health portfolio.

Anyway, in the meantime, read what is said by a health fund, which is not set up to make obscene profits to be repatriated offshore, but one where the membership is put first. Surprising, you say, but it does occur.

It can be a distressing time when you are admitted to a public hospital emergency department due to an accident or unexpected illness. 

Together with seeking medical care, you will be faced with another decision – do I use my private health insurance policy or Medicare to cover my admission?

What does it mean to be a private patient in a public hospital? 

To be privately covered in a public hospital means your private health insurance policy with us is covering your admission, rather than Medicare.  The admission costs can include your accommodation, theatre and medical fees. 

There are genuine and appropriate reasons to receive treatment as a private patient in a public hospital. However, its increasing prevalence in recent years has raised concern around the reliance of public hospital funding on private health insurance, and the impact this is having on premiums.

You may be approached by administrative hospital staff. Roles have developed within public hospitals and these staff, called patient or client liaisons, are responsible for signing up private patient’s health funds. There has been recent criticism made of the tactics used by these staff, so it is important you have the facts to make your own choice if you are approached: 

There is no obligation to use your private health insurance 

If you are eligible for Medicare benefits, you can choose to be covered as a public patient and all medically necessary inpatient costs will be covered by Medicare. You have a right to be a public patient, even if you have private health insurance, and this should not affect the level of clinical care you receive. 

The hospital may offer additional ‘perks’ if you choose to be a private patient.

Public hospitals are known to offer additional benefits to patients who choose to use their private health insurance, including free Wi-Fi, food vouchers or parking discounts. Information about being a private patient in a public hospital can be hard to find and varies between hospitals; particularly in regards to more important benefits such as guaranteeing choice of doctor, access to single rooms and specialised follow-up care. It is important to ensure you are receiving the right benefits by using your private health insurance. 

You could have out-of-pocket costs if you use your private health insurance. Your policy with us will apply to your admission if you choose to be a private patient in a public hospital. This means, you may be required to pay any excess, and the doctor who treats you may charge a gap for their services, above what Medicare and the health fund will cover. It is important to remember that if you are covered by our basic policy, no matter how it is promoted, any exclusions or restrictions of your policy will apply, so you may not be covered for the services you require.

Using your private health insurance can affect premiums. It has been reported that growth in private patient admissions in public hospitals has contributed to approximately 0.5% per annum increase to premiums over the past five years. This means, private health insurance premiums can be contributing to services that could be receiving public funding paid through taxes.

It is important to remember you have a choice when deciding how you will be covered for services in any private or public hospital.  

Be informed, be equipped with the right questions, and know your rights as a patient.

Amen.

Mouse Whisper

Some years ago, when Aleppo was still a beautiful place, an Australian senator was reported in The Weekend Australian as saying

“Syria is a country that has been a bastard state for nearly forty years.” However it should have read: “Syria has been a Baathist state for nearly forty years. The Australian regrets any embarrassment caused by the error.”

Sadly, no need to correct the statement these days.

Souk of Aleppo

Modest expectations – Temperature

There has been a great amount of strategic mucking around in the Northern Atlantic and the question of whether climate change had made the north-west passage navigable for most of the year has been troubling among others the Canadian security boffins. After all, there are many competing claims for the Arctic.

The Canadians … and the Danes claiming Hans Island

However, one of the most bizarre events was when the Canadians sent a helicopter to a speck called Hans Island, which lies in the stretch of water between Ellesmere Island and Greenland separating the Arctic Ocean from Baffin Bay. Canada disputes ownership of the rock with Denmark and after the Danes had raised their flag on the rock in 2002, the Canadians came back in 2005 and planted a windproof Canadian flag which promptly fell over. However the Danish flag was removed and returned to the Danish ambassador in Ottawa. There was Danish outrage, and immediate consideration was given to the dispatch of a destroyer, complete with not only the Danish flag but also a bottle or two of Danish schnapps.

The dispute is still raging with the Canadians retaliating with Canadian rye whiskey to complement the Canadian flag. The issue of course is definition of fishing and sea floor mining rights.

It is understood that the puffins, being very clever birds, have difficulty leaving the island now that they have learnt to open the bottles.

But as the Chinese have shown, you do not want to leave your rocks unattended and then complain about any unexpected consequence.

Confucius was a very wise man

It is somewhat ironic to see the SMH headlines screaming about Chinese infiltration when snugly lying within the paper was “China Watch”. It is like finding a copy of “Watchtower” in the Book of Common Prayer.

I glanced through the contents, and there was a piece about one of the many minorities. In this case it was about the sea gypsies or Tanka people who were resettled on the Fujian coast in Southern China. I always shudder at the word “resettlement” and who was the architect of the resettlement? It was none other that Xi Jinping, then the deputy secretary of the Communist Party in Fujian where he honed his political skills with minority groups over 17 years, as instanced by moving the Tanka people onshore. Much better for their life style onshore, rather than honour the centuries of tradition living on the sea. Sound familiar?

This was probably done for a strategic reason. Fujian is a sub-tropical province lying opposite Taiwan. Cleanse the water and give a clear line of sight to the rebellious “’province”. Yet Fujian itself is underdeveloped and quaint, the birthplace of oolong tea, soya sauce and a fermented fish sauce called kê-tsiap, which over the centuries with the addition of tomatoes became an Anglo-American national delicacy called ketchup with no residual relationship to its Chinese antecedent.

However, as I flicked through this insert, what attracted me as well was the announcement that the Sea Dragon 2, China’s new ice breaker was making its maiden voyage to the Antarctic base at Zhongsan, which is close to Australia Davis Station on the continental Antarctic mass; and also to Chang-cheng (“Great Wall”) located near the Chilean station on otherwise uninhabited King George Island in the South Shetlands. The crew complement was announced as containing scientists and support staff. Built in Shanghai, the vessel is 122.5 metres long and capable of sailing 37,000 kilometres in a single voyage. Moreover, China is already building a third.

Australia is building its new icebreaker in Romania named “Nyuna” (the Tasmanian aboriginal word for “Southern Lights”) due for delayed delivery next year. This icebreaker is longer, wider, and has twice the displacement of the Chinese vessel. It is supposed to have a life of 30 years. One wonders incidentally what ice sheets will be like in that time.

However, it was clear from incidents in 2013 when both the first generation Chinese and Australian icebreakers had difficulties in accessing a Russian ship stuck in the Antarctic ice that they needed vessels with improved capabilities.

Most of icebreaker activity has been confined to the Arctic region. After years of indecision, the U.S. government has issued a contract for the U.S. Coast Guard’s three new heavy icebreaker in decades, the first be delivered in 2024. As one source commented, “These ships are absolutely critical to the United States’ continued ability to conduct operations in ice-filled waters, especially in the increasingly strategic Arctic region.”

There was no mention of the Antarctic region because in the 60th year of the Antarctic treaty, the sacrosanctity of the Antarctic remains in place where everybody makes no territorial claims while agreeing to work together in spheres of scientific influence. This situation is in place until 2048 – neither mining nor militarization, even if contemplated, being allowed until that year.

However, like Japanese whaling for ostensibly research purposes and the self-regulated tourist pollution, the fact that the Chinese are already planning a third icebreaker, which will give them a distinct tactical advantage in navigating the Antarctic, the word “research” can be used to cover any number of deceptions.

Given the Chinese activities in the South Chinese Sea, there are many uninhabited places in the Southern Ocean, some of which come under the Antarctic treaty and some not. However, it will only take one nation to throw a rock into the Southern Ocean – and whether it will be noticed in the storms that rack that part of the world, who knows.

Not to put too fine a point on it, the Russians have 41 icebreakers and have just launched the first of three combination icebreaker warships complete with cruise missiles and of course a landing area for helicopters. The Arctic has no treaty to protect it and much jostling for sovereignty over the resources, especially now the waterways are more accessible because of climate change.

The Chinese I’m sure will be watching. They are always in for the long haul. The “China Watch” provides a useful insight into the thinking, even if we Australian readers may think it a bit of Sino-“puff”, remember “puff” is followed by the dragon – the magic dragon.

The new plague – the online anti-vax ‘influencer’

Guest blogger: Janine Sargeant#

A new plague is sweeping the world and we seem powerless to stop it. This is the epidemic of online anti-vaxxer ‘influencers’ whose commentary influences people to not protect their children from preventable disease; these ‘influencers’ should hang their heads in shame.

At a time when Samoa is struggling to deal with a shocking measles epidemic, this hasn’t stopped those who peddle nonsensical cures for measles from spruiking their wares. As of today, more than 60 have died, over 50 of these are children aged less than four. There have been more than 4,000 measles cases in Samoa’s population of around 200,000 since the outbreak began about seven weeks ago.

Measles is the most infectious disease and it has spread through much of the developed world this year. In developed countries there has been comparatively little loss of human life; New Zealand recently suffered its worst epidemic of measles in 20 years – 2,000 people were infected, but there were no deaths.

However, Samoa has been another story. Measles travelled from New Zealand to Samoa where the population had very low vaccination rates; WHO estimated Samoa’s total population immunity to be as low as 30-40%. Samoa’s health service was not equipped to deal with an epidemic.

In response to nursing error that resulted in two deaths in 2018, (the guilty nurses now serving five year prison terms) the immunisation program was shut down for months and was slow to recommence, and the anti-vaxxers leveraged off this medical error. Samoa’s vaccination rate plummeted.

A perfect storm – the Samoan population had no chance to resist and those who paid the price were the youngest and most vulnerable of the population who had no say in whether they should be vaccinated or not.

Anti-vaxxer advocates were proposing vitamins and alkaline water cures instead of the vaccine; but the prize goes to Samoan-Australian online influencer, Taylor Winterstein, who is reported as “liken(ing) the new mandatory vaccination regime (in Samoa to combat the outbreak) to Nazi Germany.” There’s been plenty of angry responders in the Australian media to that fatuous comment.

Winterstein’s husband is a Samoan-born rugby league player, who after stints with Manly and Penrith is now in France – not back to his native country to apologise for his wife’s behaviour. 

But back to Mrs Winterstein … let’s look a little further into this person’s medical and public health qualifications: well, she has none. However, as a self-described “Integrative Nutrition Health Coach” she is unqualified but adept in self-promotion and encouraging her “followers” to part with money to hear about the dangers of vaccinating children. 

Mrs Winterstein is quoted as saying: “The amount of NRL players and their partners who consciously choose NOT to vaccinate would seriously surprise you”. Well, she does mention the name of the pregnant wife of a Titans player – nobody else, but perhaps she should name names.

For my part I would strongly encourage all NRL players and their wives to publicly support vaccinating their and our community’s children from an entirely preventable disease that has caused so many deaths and continues to do so.

And let’s not forget those who suffer terrible long-term post-measles conditions such as subacute sclerosing panencephalitis (SSPE) – one for Mrs Winterstein and her ilk to look up. This causes a terrible, lingering death, brain gradually reduced to “porridge”.  

Mrs Winterstein, my anger is palpable. Perhaps if young parents see what happens to their children with this post-measles neurological complication, they may think again and defy your “influence” and head for the clinic. 

What are “influencers” in the online psyche? They are individuals with the power to affect purchase decisions because of their authority, knowledge, position or relationship with their audience. They drive traffic and sales to a product or service based on their recommendations. All very commercial; time to remind these “influencers” that this authority and power comes with very real responsibility and if you stray into public health and medicine, just remember that you should also do no harm. 

What is her solution? Black rice, which can be bought at the supermarket and which she sells at a substantial price premium.

Mrs Winterstein, you intended to go to Samoa with a pocketful of rice to give a workshop when there was one family in Samoa – their three very small children were all taken by this measles outbreak. Did they heed your advice? 

The Samoan Government has now arrested a “traditional healer” who has been telling people to not vaccinate their children.  His “traditional healing” that involved the use of somewhat non-traditional bottled vitamins, was facilitated by Mrs Winterstein’s “influencing”.  A recent post by Mrs Winterstein now says her family is coming under attack from media outlets around the world and she’s the target of a witch hunt – well that might just be the problem of being in the business of promoting eye of newt, toe of frog … and charms of powerful trouble*.

And Shannelle, the wife of the Titans player, you would have given birth by now – get your child vaccinated, please.

*with thanks to Mr Shakespeare from many ages ago.

#Among other things, Janine Sargeant is a Master of Public Health

How much are we paying these jokers?

In such circumstances, monetary policy needs to be accommodative. Low interest rates are acting to support borrowing and spending. While the recent changes to some lending rates for housing will reduce this support slightly, overall conditions are still quite accommodative. Credit growth has increased a little over recent months, with credit provided by intermediaries to businesses picking up. Growth in lending to investors in the housing market has eased. Supervisory measures are helping to contain risks that may arise from the housing market. 

There are further signs of a turnaround in established housing markets. This is especially so in Sydney and Melbourne, but prices in some other markets have also increased recently. In contrast, new dwelling activity is still declining and growth in housing credit remains low. Demand for credit by investors is subdued and credit conditions, especially for small and medium-sized businesses, remain tight. Mortgage rates are at record lows and there is strong competition for borrowers of high credit quality.

The easing of monetary policy this year is supporting employment and income growth in Australia and a return of inflation to the medium-term target range. The lower cash rate has put downward pressure on the exchange rate, which is supporting activity across a range of industries. It has also boosted asset prices, which in time should lead to increased spending, including on residential construction. Lower mortgage rates are also boosting aggregate household disposable income which, in time, will boost household spending.

The pace of growth in dwelling prices has moderated in Melbourne and Sydney over recent months and has remained mostly subdued in other cities. In other asset markets, prices for commercial property have been supported by lower long-term interest rates, while equity prices have moved in parallel with developments in global markets. The Australian dollar is adjusting to the significant declines in key commodity prices. 

Such are the public releases from the Reserve Bank Board. Two of the above paragraphs are from the latest report; and two from a report from 2015 when now Emeritus Sheriff Stevens was in the saddle. Then to give it extra emphasis I have mixed them up so each two-paragraph excerpt has one from Sheriff Lowe and the other the benefit of Emeritus Sheriff Stevens’ wisdom.

I asked someone wise in the world of finance what he thought of the following quote:

The genius of the recent administrations has been to transfer inflation to the stock market – that is to the prices of stocks and bonds instead of to the price of labour and production. Real wages are lower than they were in 1964 (written in 2005). 

He missed the bracketed attribution, and thought the quote referred to the current situation, whereas it was a prescient comment made in 2005 before the GFC. He agreed with the sentiment. Nothing has changed, he admitted.

As the excerpts from the RBA writing show, there is not much new thinking going on there, but what would one expect of a Board, with the Governor, the Deputy Governor, and Secretary of the Treasury being committed public servants that inhabit the Morrison self-described bubble; another who has lived in that curious chimera of public servant and multiple company directorships, three representatives of big business, a highly placed investment banker, and an academic with close links to the Anglican Church, which has been described as big business on its knees.

The problem with this economic and morally stagnant Australia is that the people making decisions enjoy the benefits of that stagnation. Neither political party dares to throw a stone into the fen where the water has stopped flowing and the fragrant algae of our political system, which thrives on stagnation, is hiding the poison that is killing Australia. Soon the beautiful fen with its wondrous fauna and flora will become an irreversible cesspool full of the tailings of illusionary productivity.

Which of the current Board would suggest that a wealth tax, a large increase in funding providing for education and health care systems and climate change proofing action, should get an airing rather than just allow this country to sink into an algae infested sink hole. From the sidelines one could imagine all the myriad rent seekers and mercantilists scrambling to get out of the hole while the ordinary Australian drowns in debt.

What is needed is to build the new political movement, which defines ‘the honest toiler” centre, which looks after the wellbeing of the nation rather just that of self-absorbed politicians. Development of this concept is just the shorthand for a series of future blogs, to assist in stirring the pool, clearing the algae and starting the water flowing.

After all, I do not want my grandchildren growing up in an increasingly uninhabitable planet.

Mouse Whisper

Talking of Danish schnapps or its other Scandinavian name aquavit, Finns are known for their taciturnity. So when a Swede and a Finn sat down to a glass of aquavit, the Swede said “Skol” the Finn said nothing, and they drank the philtre. This ritual was repeated five times the Swede said “Skol” on each occasion and the Finn said nothing. So they drank on, refilling their glasses on the way.

Aquavit for two

However, on the seventh occasion the Swede again said “Skol” and this time the Finn burst out, “The trouble with you Swedes you talk too much,” and drained his glass.

They say alcohol loosens the tongue.

Modest Expectations – Klinefelters

Robert Mugabe, that unpleasant man from Zimbabwe, died recently at 95. I remember one of those Rhodesian types, I could see him elegant in a safari suit sipping a Pimms in a Bulawayo club in the days when Cecil was a remembered name. This guy voiced what I had wondered about for some time. He said that it was an open secret that Mugabe suffered from tertiary syphilis – or in more specific terms that variation known as general paralysis of the insane.

For some years after he assumed power in the new Zimbabwe carved out of the old Southern Rhodesia, Mugabe was viewed as a being a reasonable ruler of an emerging country but slowly over the years he was transformed into a tyrannical paranoid despot prone to grandiose ideas – and it was also noticeable that he was increasingly having difficulty with his balance.

The problem is that dementia has many manifestations, as does syphilis, which in its clinical manifestations is the great chameleon. While primary syphilis is relatively easy to diagnose, as the causative spirochete agent then wanders away from its genital base through the body and across the blood-brain barrier, syphilis can manifest itself clinically in many ways.

In a post-graduate examination may years ago, I was presented with a specimen of a large aortic aneurysm, which fortunately in my discussion I said could be a tertiary manifestation of syphilis – not the paretic but the luetic form. My examiners then launched into a thorough menu to find out how much I knew about syphilis. The specimen was just the amuse-bouche.

Syphilis is very well treated by penicillin if diagnosed, as the spirochaete does not or cannot conjure up any defence against the drug. However, the disease can disguise itself well, once the primary focus is healed. One of my recollections is that of a guy bought into the emergency department comatose and with these strange lumps over his body. One was biopsied and showed masses of plasma cells and then when stained appropriately, there was coil upon coil of spirochete. Syphilis unmasked and I believe once penicillin was administered he lost his lumps and became alert. Syphilis cured. However, it showed how deceptive syphilis can be.

However, penicillin availability has not cured the disease. Syphilis still prowls the community often strand in strand with the HIV virus.

Once upon time in the 1950s and 1960s, if Australians wanted a US visa, they needed to have a Wasserman test to show they were free of the spirochete; and before World War 11 some of states of the US, at the urging of the then Surgeon General, instituted mandatory testing for syphilis before a marriage license could be issued. How that was enforced is an area of speculation, but data did show that those about to marry was not necessarily the area where the Surgeon General should have been looking.

Now the Amazon behemoth is moving into heath care data collection with Alexa chirruping from the Bezos hip pocket. So what happens now if the data find the deceptive spirochete coiled up the policy maker brain? What of this person? Increasingly irrational you say – maybe we should wait till the person in question starts to fall over – literally. Then Mr Bezos may have the answer for us.

Not on my Kisser

I have always preferred shaking hands when greeting anybody, but I was taught as a boy to shake hands with a person of the opposite sex only when she proffered her hand. Relatives were different. As a small boy they would come at one at different angles to kiss me. Apparently, that was an acceptable trespass.

I agree very strongly with Leigh Sales about the unwanted kiss, especially when it lands on the lips whether dry or oozing with saliva. However, it applies for both sexes. As presumably Leigh Sales does, I like to control my personal space – those that come into it are only licensed to do so. Personal space varies; you know roughly how much you have. For me, it varies with the mount of grog I have drunk; and thus when one drinks too much that space is more easily invaded and vice versa.

I not only dislike being kissed by someone where the feeling is not reciprocated, but I also avoid the hug as much as possible. The hug makes me feel very uncomfortable, and here again personal space is violated unless it is consensual. In one TV chat program I watched, someone proudly said she was a hugger as though that gave her a complete license to do so.

Personal space I found out long ago is variable. Having tested it, if someone comes up to me, and wants to shake my hand, I have no problem with distance of the outstretched hand. I have been known to grasp the arm to regulate the greeting distance. If someone comes up to me aggressively, I generally do not back away.

People coming up behind me whether putting their hand on my shoulder or not do not worry me, but this is one area of personal space where many people feel most vulnerable and hate the person coming up behind them and touching them.

And of course it depends on the venue – a back lane at 3.00 am or an office at 10.00 am are somewhat different. Therefore, context is always important.

Being male gives one an advantage in maintaining personal space integrity. You develop strategies, but I would imagine a high profile person as Leigh Sales is, has many, but the ambush is difficult to manage especially if the assailant is someone you believe should have known better.

Eye Gouging

The National Rugby League recently inflicted an eight-week penalty for eye gouging on a Canberra Raider, but the Australian Football League slapped the wrist of a GWS player with a fine. Irrespective of the history of this player on the field, I found the defence by his captain ironic. He is alleged to have said, in reference to his colleague: “sometimes that means people look at stuff that he’s involved in in a light that’s probably not neutral”.

I agree if the eye gouging had resulted in blindness his victim would be in a light that was probably not neutral. He would be blind.

I am not an ophthalmologist but perhaps such a specialist could more eloquently tell the community of eye gouging leading to retinal tears, dislocation of the lens, vitreous haemorrhage, globe rupture, traumatic optic neuropathy or fracture of the orbital floor – and of course blindness is always an option.

I have a simple remedy. Ban eye gougers for life from the sport and call in the police.

After all, look at the penalty meted out for sandpapering a cricket ball. A cricket ball versus an eye!

Caribbean storm

This time it is the Bahamas; last time Puerto Rico. These are high profile remnants of hurricane fury. Battered by hurricanes of increasing intensity, the Caribbean is increasing liable to become a tropical rubbish dump.

The funny thing is that these events seem to be increasing in intensity while the climate changer Canutes are clustered on the shores of their indoor swimming pools sipping their strawberry daiquiris and watching the clouds roll by.

This troubling development is not going away, as these micro-nations, which are exploited either as reservoirs for the black economy whether money laundering or drug trafficking or for the tourist playground. There is a huge discrepancy between the living standards of the tourists and the ordinary citizens with many living as little more than subsistence farmers.

Climate change is real, and in countries which are as vulnerable as most of those in the Caribbean, these events of Nature, whether they be hurricanes or volcanic eruption like the one which destroyed most of Montserrat, have not the financial capacity to do much.

Then Haiti is the classic failed State. Ruthlessly exploited by the Duvalier regime, classically described by Graham Greene in The Comedians, Haiti was subject to a massive earthquake in 2010 which killed 300,000; followed by a cholera epidemic; followed by two hurricanes. What chance has that country got to be anything but a pile of impoverished rubble. In my recent visit to Chile, I noted a number of black people roaming the streets obviously in low paid work. They were Haitian refugees. There are over 150,000 of them in Chile alone, about 10 per cent of the immigrant population.

However, only in one Caribbean country can you detect any systematic response to what will become a regular summer hazard – and unsurprisingly that is Cuba. In an article after hurricane Irma in 2017 devastated a 300 kilometres swathe across the island, affecting 90 per cent of the population, Jon Anderson noted in an article in the NYT:

Taking part in preparations for the defense of the island from the vicissitudes of hurricane season may have a practical imperative, but this, too, is framed as a revolutionary duty. For decades, beginning under Raúl’s late brother Fidel, Cubans have conducted annual drills to prepare for hurricanes, resulting in a national disaster-response system that has saved many lives during past storms. 

As another source noted about Cuba: These attributes are: (1) actively learning and incorporating lessons from past disaster events, (2) integrating healthcare and public health professionals on the frontlines of disaster response, (3) proactively engaging the public in disaster preparedness, (4) incorporating technology into disaster risk reduction, and (5) infusing science into risk planning.

None of the other countries have invested the way Cuba has in guarding against Nature’s invasion. There is no doubt that in disaster planning centralised control has its advantages as long as the people are part of that control. Cuba has had to live within constricted means because of the United States’ embargo. Although, like a growing number of people, I have visited Cuba, but for my part as a “working tourist” on an American delegation flying out of Miami in an unmarked Delta jet. I have sampled Cuban tourism, but it is not the mainstay as it is in the legitimate economy of other Caribbean nations.

Granted that Cuba is the biggest island but only 25 per cent more in land mass than Hispaniola which is shared by Haiti and the Dominican Republic. So size does not necessarily equate to economic stability.

Tourism is a fickle contributor to the economic health of the community. You can see the consequences of damaged resorts left to rot after experiencing a weather catastrophe. Nearer to home, just wander up the Queensland Coast. In the case of the Caribbean countries, which country of the G20, say, is prepared to go guarantor to rebuild after Nature has had her way? Certainly not the United States, the nearest and wealthiest neighbour. One just has to see the continuing plight of Puerto Rico, which has been left as a wreck by Trump – despite the fact that it is part of the United States, with even one non-voting resident commissioner in the US Congress.

In other words, the Caribbean is very much going to be the bellweather of climate as small nation after small nation is knocked over until even those of us reaching for a third daiquiri may be concerned that the increasing pile of rubble is blocking the view – and then there is that stench from a decayed economy!

But then it will be too late to do anything, and we, the generation who have caused it, have gone on our way out of earshot from the curses of the future generations for the legacy that we have left.

Mouse Whisper

The Modest Reflector loves conundra, and the title is Klinefelters – you know, the syndrome where people who can look a bit like women because they have XX sex chromosome, in fact have the attributes of men through their “Y” chromosome. And one Y trumps XX when it comes to sex.

Klinefelter’s syndrome has caused all sorts of problems in working out in which gender a sporting person with the XXY chromosome should compete. There is some suggestion before chromosomal testing was available, that a number may have competed as females in various Olympic Games, despite having the male sex chromosome.

Well, why is modest reflections Klinefelters? 25 is XXV in Roman numerals. Now take the stalk off the Y … not even original and he promises not to do it again.

“Babe” Didrikson Zaharias – “The Texas Tomboy”

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 – Photo: Janine Sargeant

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 …         Photo: Janine Sargeant

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