Modest Expectations – Ernst not Sebastian

But if you want my quick take on it, it’s this: Whether Trump is wolfing down Big Macs on the Mar-a-Lago golf course or bargaining for bootlegged tanning lotion in prison, he will be the GOP nominee. Don’t give into magical thinking and never stop the fight to beat him at the ballot box. First, the trial itself. It’s happening in Miami. A hotbed of Trump voters, MAGA radicals, skells (tramps), boat-paraders, and people terrified of dead communists and imaginary communism. (By the way, I love Miami, I really do. But I’ve got to call this place how I see it.) Rick Wilson June 2023.

Mar-a-Lago – bought by Trump in 1985 at more than 62,000 square feet, with 58 bedrooms, 33 bathrooms, 12 fireplaces, three bomb shelters, and a 29-foot-long marble top dining table, the house is extravagant to say the least. It is the 22nd largest house in the US – the White House comes in 33rd place. – Not Alternative Fact

In response to Rick Wilson’s “By the way”, I thought I would write about my time in Miami at a time when Trump was still a two-bit grifter. Nor when Miami was the warlock’s crucible.

I have passed through Miami more than once – even taken a Concorde flight out of there to New York on my way to London. However, this occasion was the one time we had time to do some sightseeing. We had just come back from Cuba in an unmarked Delta airline plane – nevertheless a commercial fight. As the flight attendant said to us at the time, Delta flew to Havana every day. On arrival in Miami, having been duly warned that if we had any Cuban rum or cigars in our luggage, it would most likely be confiscated, we found that there was no-one from customs on the gate barring our way into Miami. In any event, we don’t smoke, and we had enough mojitos in Cuba to last a lifetime.

17th Street

This time we had decided to go on to New York by train, stopping off in Savannah. In the meantime, we went for a stroll along 17th Street downtown, the weather being perfect, to see some of Miami. We had lunch at one of those places where the food is barbecued rib, the drink is beer or bourbon, and the music is loud and country. More Texas than Miami, but Miami is cosmopolitan, a shelter against the winter for the aged, a playground for the rich and a refuge for the colourful.

As we walked down towards Miami Beach, we stopped by the Cadet Hotel emblazoned with Clark Gable memorabilia, remembering the time he was there as an instructor of the recent inductees in the air force. The year was 1942, and he was still mourning the loss of his wife, Carole Lombard, who had been killed the year before in a plane crash.

Gable and Lombard

Gable went on to serve for most of WWII, seeing action in Europe.  As we looked in on the reception area of the Hotel, there is no doubt that Gable had a charisma, which belied the fact that he had had all his teeth extracted and his leading ladies had to be inoculated against a cloud of halitosis. Still, I remember that film “It Happened One Night” which starred Clark Gable and Claudette Colbert and that it was the first of only three films which have won the five Oscars – best film, best director, best actor, best actress, best screenplay.

Clark Gable has always had a place in the lexicon of my memories because I saw the film “Soldier of Fortune” when I was in Hong Kong in 1956, the film itself being an adventure story of Gable playing the title role opposite Susan Hayward in a story where Gable rescues her screen husband, Gene Barry from the clutches of the Chinese Communists. I most remember the scene at the top of the Peak in Hong Kong where Gable is expressing ruggedly his love for Hayward. Imagine my chagrin to find out that Hayward remained in Hollywood the whole time the picture was filmed, and Gable was romanticising a Hayward double – her screen sosia.

Looking at the photograph of Gable, his distinctive expression walks the line between sagacity and salacity, but I was not the first to gaze. Judy Garland sang to his photograph in Broadway Melody – “You made me Love You”. Well, not that I sang, I might add; and my wife has never liked him. This is a slightly troublesome matter since Judy was only 15 when she recorded the song. But the teenage crush has history, and I would have preferred Grace Kelly, the first choice for the “Soldier of Fortune” heroine, but which she declined. Then I had only just turned 17 and Grace Kelly was 25 years old.

But let’s continue walking.

We stopped off on the lawns outside the Frank Gehry designed New World Centre where we listened to the New World Symphony rehearsing and the music being piped outside to those of us who stopped to listen. We did not expect to be listening to a piece of old world music in a beach resort not famed for its cultural attainment.

Well, back to reality. By that I mean Miami Beach – a wide strip of sand lined by fenced-off villas where the rich, the famous, the colourful and the pyrites reside. There is something foreboding about high walls, with palm trees and the white stuccoed storied homes poking their heads above the parapets. In the distance is the sea, a pale blue ribbon cast against an equally azure sky, with a wisp of cloud interrupting the blue.

Beguiling. Well, yes, but really depends on when one visits.

Here in Miami the 1926 Great Hurricane left its calling card, precipitating the end of the Florida land boom and the start of The Great Depression three years early. Miami was wiped out and it is salutary to think that a comparable hurricane today would leave little change out of US$250 billion. Despite Miami being recognised as one of the most vulnerable cities in the United States to experience hurricanes, the only other one which has been classified as severe and centred on Miami was Cyclone King in October 1950, which caused severe damage but not comparable with that of 1926.

In recognition, the University of Miami has adopted Hurricanes as its nickname for all its sporting teams, but the touch I like the most is that the mascot is an ibis named Sebastian, since the ibis is the first bird to leave when a hurricane is imminent and the first to return after the hurricane has passed.

I wonder what the status of the ibis population is at Mar-a-Lago these days.

The famous Miami ibis


I have been to Antwerp twice, once in the early seventies when we were travelling through Europe and the United States, the first time, my then wife had been back to Europe from which she had come – from a British displaced persons camp in Carinthian Austria. Arriving in Australia she was unable to speak English but, as I found fluent in Slovenian and German with an Austrian accent. A medical graduate and PhD in pharmacology, she had her research papers accepted for several conference presentations, whereas I scored zero. No matter; it just meant I could track along without having to give a paper to a half empty theatre or back room. I remember that we went to Antwerp that trip, and it was somewhat comical walking through the Munich airport, past all the big planes, down the stairs, across the tarmac to the DC-3 – our air chariot dwarfed on all sides by its younger siblings.

My strange memory of that visit was having walked around a sculpture garden with all the shapes and forms representative of the interpretative impenetrability of some of this modern sculpture, I escaped from the park by climbing through a fence onto a major thoroughfare. Having been sensitised to the bizarreness of the display, the utilitarian throughway structures were replaced by my surreal vision of them.  The street with all its tubular forms, interlacing overhead wires, lights changing like giant eyes – all the street architecture which we normally ignore or accept had, to me, become the workshop of the absurd. I hasten to add I don’t do drugs, nor had I been drinking.

I had spent several hours accustoming myself to these sculptural forms, and when I emerged onto the streets, it seemed to me just an extension of what I had been looking at. It was a sensation that I’ve never had since. I do not have the imagination to concoct the vision of the great architects, but I understand the meaning of “surreal”. After all, we may be induced to say something is “surreal” when it is just something that one has never experienced; whereas surreal is a departure in a different sensory experience. I remember looking at the overhead tram wires and the stanchions and thought what if these had been placed in the garden, dimensions changed or left as stark forms amid the wooded lawns where the rail lines would lead nowhere – a phantom silvery transport system hidden under a cascade of blue leaves. Then I shook my head and followed the tram line back to our hotel to find out how my wife had gone with her presentation.

An okapi in Antwerp

The second time, my second wife and I ended up in Antwerp, because we were travelling to Cambridge. Qatar Airways had a “special return flight” from Sydney to Brussels. Having a few days to spare, we went to Antwerp by train. We stayed across the railway square in the Blu Astrid Hotel. What made this foray worthwhile was that the Antwerp Zoo was close to the railway station. The Antwerp Zoo has probably the largest number of okapi in captivity as part of a breeding program. The okapi is the only known relative of the giraffe and its natural habitat is the Congo jungle. Given that the Congo was colonised by the Belgians, it is not surprising that the first okapis were brought to Belgium. There were five or six okapis in what I thought was a generous enclosure. The total area of the Zoo is 10 hectares. However, zoos will always be imperfect, as animals are for all intents incarcerated so that we humans can stare at them.

The okapi, much smaller than its relative giraffe, was first discovered in 1901. It has a striking appearance, being almost burgundy in colour with striped legs. It’s also worthy of study, because its long term future may depend on its ability to breed in captivity. The female okapi is said to be choosey in her choice of mate, and there is not much choice in a zoo.

My wife does not much like zoos and having watched the okapi pacing around in a stressed manner, that was enough for her. She had spent a decade photographing wildlife in Africa, and hardly needed to visit an urban zoo. Okapi were an exception; she was not likely to see one in the wild unless she wandered through the Ituri Rain Forest in the Congo.

However, she does like flamingos, which we had seen in the wild, both in the south of France and in the salt pans of the Atacama Desert in Chile. Caribbean flamingos near the entrance of the zoo, attracted attention because of the noise and their vivid vermillion in colour – they seemed chatty enough.

The printing workshop

Of other places in Antwerp, The Plantin-Moretus is a unique museum that celebrates the history of European printing through the 16th century workshop and home of the city’s most celebrated printer, Christophe Plantin, which he bequeathed to his son-in-law, Jan Moretus. They printed books and maps – the cartography section being very impressive. There is a copy of the Gutenberg Bible lodged here, together with a collection of material tracing the evolution of printing up to the 19th century when innovations were introduced as a by-product of the Industrial Revolution which rendered the printing work obsolete. Looking at ancient printing presses and some of their products is to marvel at how such a collection has survived in area where bombardment, siege, and troop movements would all seem to mitigate against the existence of such an exquisite place.

I suppose we could have sought out the Diamond district where it has been near the main square since the Middle Ages. Antwerp, through its Jewish population, developed some innovative ways in cutting and polishing of all grades of diamonds. It survived two World Wars. In WWI the Germans captured Antwerp early and held the city for the duration. While there was some hesitation in deporting Jews in WWII to preserve the expertise in diamond cutting, eventually a substantial number of the Jewish population were killed in the various concentration camps, and thus compromising Antwerp’s future.

The Sinjoren, as those who live in Antwerp are nicknamed, are certainly resilient.

I found it amazing that Antwerp was able to hold the Olympic Games less than two years after the Armistice, but given the survival instincts of the population, why should anybody be surprised. Australia was represented at the Games. The flagbearer, George Parker, born in Leichhardt, died in Five Dock, seems to have spent his life walking. At the Antwerp games, he finished second in the 3,000 m walk, beaten by an Italian. The only other Australian medals were awarded in swimming – a silver and a bronze.

And my lasting impression? Workers eating this green food with chips and mayonnaise. This is palint ‘n groen – eels served with a green sauce made with fresh river herbs and wild leaf vegetables, chervil, sorrel, spinach, watercress and wild garlic leaves. Tasted it – not too bad.

Pride comes before a Fall saith Solomon

When I was undertaking the National Rural Stocktake in 1999, I found it frustrating to arrive at a desert destination to find no-one there.  I had to accept that the Aboriginal people spend a substantial amount of their time on “Sorry Business”, which took them away and thus they would be unavailable because one of their number had died. Travelling around Aboriginal communities, I often found a great amount of argument, dispute, aggression – and when I was confronted with stories about harassment and violence, I had to make a decision. Namely, I was not there to deal with the problems of the individual Aboriginal person, unfortunate as that may have been. That deserved a review of its own, and although I made incidental comments, my prime aim was to prosecute the case for developing clinical and public health education facilities in the bush, which occurred with funding allocated in the 2000 Federal Budget.

I was brought up in a whitefella world where Aboriginal people were labelled as “stone age” and hence patronised as if they should be kept in an ethnological zoo. It is not surprising therefore that the bulk of whitefellas just did not know how to communicate with Aboriginal people. At the outset I had not appreciated that being taciturn with whitefellas belied a highly complex system of communication, where verbal was only one of the means. Being able to communicate, whitefella to blackfella is a privilege, as I found out.

As background, I had become aware of the level of discrimination from a young age. It had been coated by kind paternalism. For example, when I was a child in the time of the “picaninny”, I received the Church Missionary Society news from the Roper River Mission in then far off Arnhem Land. The growth of missions, both secular and religious only served to emphasise the separation of the Aboriginals from their Land, which did not become recognised until Aboriginal artistic skill with all its complexity became recognised by whitefellas. When I had gone to Alice Springs in 1951, I came back with a large shield, which languished in the storeroom, because every time I picked it up, my hands were covered with red ochre. Over the years as I collected more Aboriginal artifacts, I began to celebrate the diversity, but not without making errors in walking the line of what was taboo and what not.

Martin Luther King

Afro-American emancipation grew out the 1960s’ cry for emancipation led by Martin Luther King and Malcom X and then the black Panthers, injecting an edgy defiance challenging the comfortable world of middle-class America. At the same time, until he was assassinated, King tried to persuade. His was an evolutionary approach, to which he harnessed public opinion for recognition.

Aboriginal advocacy grew alongside. Recognition of Aboriginal identity grew, dispatching the equivalent of “Uncle Tom” as contempt of the so-called the Aboriginal “coconut” – brown on the outside, white on the inside.  Aggression has been the watchword, mixed with a litany of Aboriginal grievances such as the stolen generation and life expectancy being continually drilled into us whitefellas, some of whom have succumbed to guilt, preferring to give in; other whitefellas in power have just employed passive resistance. Rather than mollifying the aggressors, the level of J’accuse by the voluble few has increased with bombastic Noel Pearson as one of the leading Accusers.

From Whitlam onwards, governments sought to increase funding and opportunities for Aboriginal people, despite the opposition of some of the parliamentarians. As I have said, symbolism and metaphor are simple; real action is not. I was around at the time of the first aboriginal medical graduates. I saw many of the Aboriginal medical services (AMS) which arose from the Congress model in Alice Springs, and I looked for change. Many of the AMS were clearly dysfunctional, mainly because there was no continuity in the treatment objectives. Congress has been operating since 1975 and it has had a substantial amount of funding. It has had its vociferous defenders, given it has been the oldest Aboriginal Health Service. However, stripping away the “blah-blah” apologia, what has it actually accomplished?

It is a serious question when there is this push for an ephemeral Voice, as though there is a pot of gold at the end of the Indigenous Larynx. I see the ability of the Aboriginal people to contribute and shape our destiny, but I’m afraid I’ll not accept the pompous sullen uninformed Voice of a few Aboriginal people.  Some people who should know better are attempting to gain cheap political acclaim, without thinking through what outcome is expected and what it means for the many Aboriginal people who won’t be part of the Voice. The Voice does not have a powerful Champion who can coherently unite an increasingly divided nation. Linda Burney is not that champion; unfortunately, she lacks the intellectual firepower, and those who spring to her defence further weaken her, only serving to exaggerate her deficiencies.

Narenda Jacobs

I would prefer Narelda Jacobs and Pat Anderson; but the male Aboriginal able to communicate with those tending to Vote “No” – the critical cohort I believe – should be a Rugby player in Queensland and an Australian Rules player in the West. But perhaps if the women’s football team is triumphant, Sam Kerr will trump every male.

When I undertook the Rural Stocktake, I tried to identify examples of what worked in relation to Aboriginal health, but such success could never be long term because of the harsh reality of the eventual failure to provide a plan for succession. It is not unexpected because so much of Aboriginal success depends on charismatic leadership, which does not necessarily translate to a long term success and is eventually swept under the sands of failure.

I well remember the activities of Geoff Clark and the fate of the Aboriginal and Torres Strait Islander Commission, which he chaired. This fiasco has not come into the conversation about the Voice, even though Geoff Clark was never short of a word. In the end at a time in Australia when funding is short, homelessness is on the rise and where poverty has increased, to see affluent, mostly university-affiliated sections of the Aboriginal community continually meeting in a non-wintry part of the country and complaining about their lot, begins to grate. The Mayor of Broken Hill may not be the most subtle of individuals but in explaining why the Council would not in future pay for “welcome to country” or smoking ceremonies by Aboriginal elders made it clear when questioned responded: “Why should he pay for welcoming people to his Land.”

Grievances are met with counter grievance. As someone said, looking at the Aboriginal flag and the Australian flag flying alongside each other on the Harbour Bridge, why? The same person sees the Aboriginal flag as a sign of division and the Australian flag as an embarrassing relic – both to be replaced by a single flag for everyone in the country.  Personally, I believe the Aboriginal flag should be the Australian flag rather than the colonial relic. But to me whose ancestors have occupied the country as part of the Celtic diaspora, the Eureka flag flown first by the Ballarat miners during their 1854 insurrection also epitomises that Australia is my Land – and let nobody forget that. I too have a Voice. That is precious privilege of Democracy.

Brisbane – The Novel

Having won the Solzhenitsyn Prize, the Big Book prize, and the Yasnaya Polyana Literary Award, as well as having been short-listed for the National Bestseller Prize and the Russian Booker Prize, Eugene Vodolazkin has emerged in the eyes of many as the most important living Russian writer.

I was thumbing through a recent issue of the NYRB and came across a review by the above author. The book was entitled Brisbane. Given that Brisbane and Russian literature are not ready companions, I read the review. On reading this, it seemed to be just an extension of my perspective of Russian literature, telling the Russian story where Death is an ever-present metronome of the various degrees of misery and cruelty which pockmark the whole literary Russian Treasury of the mysteries of life. These mysteries have always been palpable in the Russian Orthodox liturgy, and in its extraordinary church music, where it soars from the depths to the heights. Terra ad caelium.

Why is this novel called Brisbane? It is about Gleb Vanovsky, a celebrated Russian guitarist who, at the age of fifty, is diagnosed with Parkinsonism which not only inhibits his ability to play the guitar but also ultimately will kill him. He has a biographer named Sergei Nesterov who, offering to write his biography, sets about establishing this dual perception of Vanovsky’s early life from each of Vanovsky’s and Nesterov’s perceptions. The second part of the novel details what has happened since his diagnosis. It seems from reading that it is a novel about various interpretations of the meaning of life.

And what of the Brisbane allusion? Apparently Vanoksky’s mother was enamoured by the image of Brisbane as a subtropical Utopia and had an Australian male correspondent, who said she should come. Unfortunately, she was killed on the way to the airport by some thugs. So Russian!

Ah, the Russian tome called Brisbane.  The author was born in Kyiv but has spent most of his life in Russia.

Premier Palaszczuk with her Polish heritage should be indeed interested in such a view of Brisbane as Utopia. But watch out going to a Russian airport.

Mouse Whisper

My mäusemaister has this obsession whence Melania Trump has gone. She seems to have vanished to Europe – no longer the lady hand in hand with the Trump.  The prominent Irish author Fintan O’Toole, in a recent response to criticism of an article of his appearing in NYRB, has suggested that Cohen, the lawyer and once Trump confidant but who has now decamped from his side to be a pigeon with a stool, is one reason for the disappearance. He was told by Trump to pay Stormy Daniels and tell Melania that the payment was made to avert Daniels’ “fake story” about Trump himself.

As Trump was reported to have said, paying Daniels off was far cheaper than a divorce settlement, as Trump wanted his wife to be mollified. O’Toole opens up another front on the besieged Trump – the circus of a potential divorce. He is probably only saved by Melania not wanting her laundry aired, well at least not before it is appropriately washed.

Modest Expectations – Sudan

It was a modest dilemma, but a dilemma nevertheless. We had stopped in Genoa, a small sliver of civilisation which had nearly been razed to the ground two years ago by the 2019-2020 bushfires which had burnt through the far east of Gippsland. It resembled a ghost town. The late autumn day was beautiful, and we noted that there was a new bridge over the river which flowed through the hamlet. So even though there seemed to be no one around, someone had spent money on the bridge.

We stopped in front of a very shabby building. The sign on the front of the building indicated that it was once a hotel/motel. It seemed to me to be disused; my wife disagreed. She thought there were people living there. There was no fence around the front of the motel.

However, in the front of the building was a tree loaded with lemons. There was only one windfall, and that was on the wrong side of ripe.

As we were contemplating a guy riding on a tractor rode up to the north wall of the motel, but did not stop. That was the only person we saw.

I looked at the lemons. They were many beautiful ripe yellow lemons.

I was tempted; my wife said no.

The dilemma:  Would you pick lemons off the tree or not?

We were only 45 minutes by taxi from Eden. Could not see any apple tree though.

Wistful in Werriwa

Werriwa (Lake George)

My eye was caught by a small piece which said that Morrison was contemplating winning Whitlam’s old seat of Werriwa. He had descended on that electorate to start the day with a group of locals, or so it was reported. Now Werriwa is the Aboriginal name for Lake George, which mysteriously periodically fills up with water and then empties, with no river flowing in and out to explain its fluctuation. Werriwa was one of the original electorates at the time of Federation.  As the population has grown, the electorate has moved closer to the southern outer suburbs of Sydney, and thus has been a stronghold of the Labor Party since 1934.

Morrison believed such a seat was winnable, as he cast himself as the Everyman battling the Political Elites. He was encouraged by a media machine that we have endured for a long time, particularly after the accession of Rudd, biased to the Coalition. Morrison was also buoyed by his surprise victory in 2019, with a major swing in Queensland. He made the assumption that he could cast himself as the champion of the working man. “Man” was the operative word. Werriwa has a woman member, and with a very “Anglo” name, Anne Stanley.

Added to that were migrant communities where you could sow the divisive wedge politics, particularly playing upon conservative religious practices. Here, sexuality and general relaxation of patriarchal family relationships, admixed with spurious declamation about religious freedoms, were perceived by Morrison and his advisers to be fertile ground for playing on prejudice to gain votes. The Liberal Party candidate was Sam Kayal, the surname Lebanese; and obviously he seems to be very friendly with the Mayor of Liverpool, who is also of Lebanese heritage, presumably Christian.

When you reviewed the first preferences in the recent Federal election, the Liberal Democrats, the One Nation Party and United Australia Party collected about 23 per cent of these. The Greens received a modest increase of just over one per cent to 6.6 per cent.

Both the major Parties in the allocation of first preferences lost ground – Labor lost eight per cent and the Liberals four per cent. After the allocation of preferences, the swing against the Labor Party had been reduced to 0.3 per cent. If the three right wing splinters had been solid for the Coalition, the seat would probably have fallen to the Liberals.

When I first read the piece about Morrison, I scoffed. Now it is food for thought; maybe it was a lockdown reaction, where each side received electoral contumely. Certainly, how the votes flow in the NSW election next year will be more interesting, because the antipathy to the enforced “lockdowns” should have faded by then.

Enter Dr Ryan

Let me say, as I have said before, that my health care has been very good, considering my co-morbidities. Yet I do not have one health professional who can provide all my ongoing care. Why? Because the world of medicine is so sub-specialised that having all the information in one place is impossible. As I have been a medical practitioner, I have navigated the system with varying degrees of success. This has meant that for probably six months my auto-immune disease was undiagnosed; but I knew when I was fibrillating and not reverting to sinus rhythm.

Take for instance, because of arthritic changes in both my cervical and lumbar spine, coupled with some symptomatology which suggested impairment of neural function, a spinal surgeon that he would operate. I found his clinical approach puzzling and consulted a colleague of mine – a neurologist – who said that, in his opinion, the operations were unnecessary. That was six years ago, and the disability caused by these changes has not progressed.

He retired but referred me to a neurologist in Sydney. The cost for the initial consultation was announced by the practice to be $800, more than three times the appropriate Medicare benefit. I would have thought that outrageous, especially so given that he would have my notes passed on by my previous neurologist who had settled for the Medicare benefit as full payment for a consultation.

Ironically, through the consultant physician professional association of which I was vice-president at the time, I had negotiated with the Commonwealth Health Department in 2006 to create the Medicare item which reflected recognition of significant complexity in consultations.

Let me say that the neurologist whom I consulted was understated, yet had an eye for detail; more importantly, he had wide clinical experience and a great modicum of common sense.

Talking of neurology, Professor Monique Ryan, a prominent paediatric neurologist has been elected to the Federal Parliament. As a member of a small sub-specialty, her natural health constituency is one of the “elitist” areas of the profession – small patient load given there are about 120 paediatric neurologists; yet, irrespective of needs, the sub-specialities keep on expanding. There is also a tendency in these small specialties for the doctors to become researchers or even more sub-specialised. In a review of the field, 250 neurological disorders have been isolated, but most are very rare diseases.

Yet reflexly the tendency continues to also train more and more, despite smaller and smaller patient load per neurologist.

As a result, they tend to “keep” their patients rather than “returning” them back to the referring doctor. The other way to expand the clinical base of the paediatric neurology sub-specialty is by moving into the mental disability field, where rehabilitation is the aim, or areas such as attention deficit disorders and autism, which have become very “popular” diagnoses.

Whenever I watch reports on these spectrum disorders, I am reminded of the successful long distance swimmer, who was concurrently being treated for chronic fatigue syndrome.

While many of my medical colleagues would bristle and dismiss my comments, it’s very difficult to get any medical sub-specialty to objectively review what has been achieved as against that which was promised over a given period – and to agree on when is “enough is enough”.

Monique Ryan may now represent the electorate of Kooyong; she also represents by her professional attainment and experience, a rather narrow tranche of the health system. That is not to decry its importance; it is a matter of the allocation of scarce resources. Now she has Parliamentary standing, her utterances will be interesting; especially as the ego lurks very close to the surface in most maiden speeches to Parliament. I will read hers with very great interest, given my own experience, and see where her priorities lie, once you strip away the comments of the generalities.

The dangers of  rampant sub-specialisation in medicine and elsewhere in the health system is just one potential dysfunction which needs to be rebalanced in the health system after the COVID-19 experience, an indifferent series of Federal Ministers and the unfortunate influence of a number of public servants,  some of whom should be ashamed to take their pensions let alone the consultant work they fouled up – and that is before Australia has a decent Integrity Commission to investigate whether there are shenanigans and rorts to attract any action.

If the aim is to get a more equitable spread of health professionals, then as one whose nationwide Rural Stocktake in 1999 led to the creation of the rural clinical schools and university departments of rural health among other changes and who introduced a successful intern training program and opposed lengthening the post-graduate training in the name of professional “slavery” rather than education, I have been disappointed that its success has been seemingly ignored and structures dismantled. Yet there is a crescendo of complaints about the lack of rural health professionals. I shall define the systemic pathology and suggest what has to be done in a number of my following blogs.

I just hope that the incoming Health Minister can think outside and beyond the normal temptation to just get the matter off his desk and onto the States, with resumption of the “blame game”.

The Fall of Globalisation – How inconvenient.

Danube Delta

In the years just before COVID-19 struck, I travelled widely, and in doing so visited Finland, the Baltic countries, and the countries on the lower Danube (Romania, Bulgaria, Serbia and Hungary), the boat on which I was travelling ending up nosing into the Black Sea before turning around; also Croatia, Bosnia & Herzegovina, Montenegro; Slovenia. I had been to Russia and Poland on earlier trips. Although it did not occur to me at the time, I was able to do this under the mantle of Globalisation; in fact, as long as you flew there you could also then visit Belarus from Lithuania. Belarus, together with Russian exclave of Kaliningrad, were the only two places where entry was not automatic in these European wanderings.

All the time Russians were seething; or rather Putin was seething with his Peter the Great complex. Plotting – planning for his dystopian world is just the end product of the authoritarian narcissist who gazes at their image in the world; the Chaplinesque caricature now widely spread across the world.

In the USA, it is unbelievable that the Republican Party, which ostensibly believes in free enterprise, has been complicit through the Vandal Trump in the Putin destruction of globalisation.

Trump was not the only one. For instance, the narcissist Rumsfeld cajoled a group of politicians into a “coalition of the willing” on the grounds that Iraq would be easy pickings for the American oil industry. Others may nuance it to share the blame around and saying pillorying one person is never the reason. However, George W. Bush’s famous assessment of Putin: “I looked the man in the eye. I found him to be very straightforward and trustworthy. We had a very good dialogue. I was able to get a sense of his soul; a man deeply committed to his country and the best interests of his country.” needs no commentary.

It seems that remains the belief of that great meddler, Henry Kissinger, who was so important in Hanoi winning the Vietnam war. Kissinger turned 99 a week ago; and his wrongheadedness is still being reported.

Nevertheless, the greatest win for Putin was to have his Manchurian candidate, Donald Trump, in the White House. Thus, while America slept or was “tarbabied” in Afghanistan, Putin consolidated his power base. If Hilary Clinton had been voted in as President instead of Trump in 2016, this current situation would not have arisen. She would have kicked the All European cocktail circuit which for years has gone under the name of NATO, in the backside. At the same time, Putin was meddling with a British Isles polity befuddled by one Nigel Farage who may well have been on the Soviet payroll in order to play wazir to the aspirant sultan Boris.

After all, in a prescient speech 12 years ago, Clinton stated inter alia: NATO Headquarters is bulging with over three hundred committees, many with overlapping responsibilities. Too often, our budgets – military and civilian – are divorced from Alliance priorities, and the most important priorities have been under-resourced for years. Our secretary general has not been invested with the power he needs to truly manage the organization. This must change – and we must agree to that change in parallel with the new Strategic Concept. A new Concept with old structures will not be transformational. In fact, it may not change much of anything at all.

But that did not happen. Hilary Clinton was a casualty at a time when the world was reaching a crescendo of dystopian behaviour.

Now, it has taken a young man, unencumbered by the cocktail circuit and with the true insight of the comedian, to stand up and fight. As he said, he does not need martini glasses, he needs the armaments to vaccinate Europe against this particularly virulent Russian variant of Monkey Pox. But old habits die hard; the clinking of glasses still resonate around the palaces of Brussels.

Old Age

“It is a giant labyrinth that you walk into, they lock the door behind you, and there is no exit,” she said. “I can’t keep doing this. I’m falling apart.”

I have been concerned with care of the aged since not long after I graduated in medicine in 1963. It is now 2022. During this time, there has been a huge change in the technology surrounding care of the aged.

Yet is this reflected in the care?

People are living longer, and hence the gap between ceasing employment and death is growing. I have joined the throng.

There is this myth that looking after old people is more about care rather than medicine. When I was in practice, I was less concerned with “fast rehabilitation”, typically treatment of the sporting injury, but more with so-called “slow rehabilitation”, the staff, including the doctors, employed all the expertise available to assures each person attains his or her highest level of capability, and then maintains it. While most are old; that is not necessarily the case.

The projected Labor Party policy is to have a registered nurse on duty 24/7 in every aged care facility, which equates to employing six registered nurses to cover the one position. This is very difficult to achieve given that government has allowed the nursing home to be separated from mainstream health care with different rules – and for aged care to be largely private. The more you diffuse the expertise of a group of professionals, especially with an absentee landlord, the more you undermine the staff morale which, in turn, leads to increased staff turnover.

When almost 20 years ago I started working as Director of Medical Services in a country hospital, to which was attached a nursing home, the first thing I did was a drug audit for each of the residents with the local pharmacist. I then asked each of the general practitioners how often they reviewed each resident’s medication charts, which most did with varying degrees of reluctance.

There was a visiting geriatrician at the time. “Visiting” was a joke. He would not visit the nursing home; insisting each patient be brought to the rooms from which he worked. Incredible. In the end I secured a mate of mine, a city geriatrician to periodically visit to not only see the nursing home residents but to also provide tutorials to the local doctors and other health professionals. The problem with any program which involves visiting staff is its sustainability.

When the policy makers – divorced from reality – say “train more staff”, it is far from a magic solution.

There are basically three ways of training staff

  • In dedicated training institutions,
  • On the job – apprenticeship style,
  • Importing staff trained in other countries,

coupled with:

  • Periodic in-service training programs.

To me, what is important is to reduce the attrition levels and minimise the spread of disease. Simple to say; hard to accomplish.

There has been a shift from people suffering stroke to those suffering dementia. The incidence of stroke has fallen because of improvement in cardiac treatment, in particular in the treatment of high blood pressure. With stroke, the hope is that the patient will improve; once improvement is stabilised, then the level of independent living ability can be assessed. The problem with dementia is to slow the rate of deterioration; but in both cases, redemption is a limited commodity.

Care of the aged as I have found out is care and competence. One of the most frustrating aspects to exercise even the basic function of getting out of a chair, which once was automatic, is having to wait for someone. The horrors of not being able to undertake normal bodily functions without soiling yourself is ever present. If many of the population are like me, impatient, then learning to wait becomes one of the challenges. This is compounded everywhere by the challenge of the furniture: once it was great to be able to sink into an armchair. Now the softness becomes a giant jellyfish from which you alone cannot escape.

The giant jellyfish

When I was involved with a nursing home attached to a country hospital, the key to its success was that the manager was very competent. Competency is being able to utilise the resources allocated to achieve that no patient is neglected – falls, hygiene, bed sores, nutrition, compliance with treatment being uppermost in those items monitored continually. She had an eye on how everyone was performing, which is what is needed in developing a coherent happy team and thus reducing the turnover of staff. This is important if employment is continually being disrupted by the pandemic.

I am one who believes that in community health structures you build from the bottom, not with great fanfare spray funding from the seat of government and the assumption it will work. There are packages of care everywhere, but who is monitoring the implementation rather than just the distribution of these government initiatives, which are often encased in impressive language, but of what meaning?

One may suggest a number of ways to improve the quality of care of the aged. I believe that there are indicators which denote good care. I also believe that there should be a credentialling, definition of practice and privileging system across the whole sector. When I tried to implement this process in aged care, despite it being the norm for hospitals, the Commonwealth Department of Health protested. Gives you an idea of the appalling track record of the Commonwealth Health Department in that sector. after all, has the sector improved since the kerosene bath era when Bronwyn Bishop was the Minister at the turn of the century? I have viewed hapless Federal Ministers, but the antics of Richard Colbeck in this sector shows how little the Coalition continue to view this sector of human existence.

As a result, a bad situation has festered.

Nursing homes should not be an area where the output is conspicuous consumption, as shown in the media by the acquisition of a yellow Lamborghini because of the apparent profitability embedded in the current aged care arrangements. As can be seen in the media, or in expensive church vestments (as we saw during the first year of COVID-19 when deaths in nursing homes were rampant), the residents of these facilities, many without comprehension, are in need of care, compassion and dignity. However, then give some thought to all the marvellous medical technology which has enabled lives to be extended in this way.

I am well aware that any system which seeks to monitor behaviour in all its forms will receive resistance; however, over a long period of time I have found that it works if you have the will to make it so. I am also a believer in hands-on management, not of the individual interaction between patient and health professional, but of the system. This has enabled me to pick up when inevitably, even with the best of intention, events go “pear-shaped”.

Also accept the blame for such situation where you are ultimately responsible. Then review when this happens – and one of the results of credentialing, defining the appropriate clinical practice and then privileging is that the staff members can learn from others – both the right and the wrong – with recriminations as a last resort.

Unfortunately, most systemic failures have an individual implicated; and that is often the hardest part – to get rid of that individual or individuals. A well constituted system under the new government, where all the parties are bought together in perhaps an electorate-based arrangement, so that each elected member can follow the monitoring of aged care in their electorate – and, as I said above, credentialing, definition of clinical practice and privileging would be one way of attracting attention to an area of past government neglect.

Perhaps a Prime Minister faced with the care of the aged will find out sooner than he thinks that he may need to enter its portals. Therefore he may like to receive periodic factual reports of what is currently occurring in his electorate of Grayndler and aim to visit each over the lifetime of the Parliament. After all, across Australia 151 committees should not be too much of a burden to assure better care of the aged, providing  insurance for that time which each of us will eventually reach, if we live long enough. To face being placed in a nursing home, and knowing that I will be cared for in the best way possible; not left to wallow and nobody comes.

After all, as I found out, 70 may be the new 50 years; but I assure you 80 is still 80.

I am not alone. However, even though there has been an extensive review of this area recently, who of us has been consulted? Who among us aged is the protector of that increasing group of people alongside me who are demented? You see in your contemporaries the slow decline in cognitive function, the irrational behaviour, and unless each one of them has a carer who truly cares for them and has the resilience to battle the many hurdles to getting an acceptable aged care situation, they end up on a scrap heap which, for administrative purposes, is called a nursing home.

The nursing home nightmare is when I cry out, but nobody comes.

Mouse Whisper

Serious Mouse! 

Since 1982, 123 mass shootings have been carried out in the USA by male gunmen. In contrast, only three mass shootings (defined by the source as a single attack in a public place in which four or more victims were killed) have been carried out by women.

Mass shooter