Modest Expectations – Nadia von Leiningen

I have learnt a great deal over the past fortnight about this infernal virus.

This whole incident started after we had driven from Sydney for a dinner in Broken Hill. On our way home we intended to stay with my wife’s mother, who at 96 still lives at home in Albury. As I reported in my blog two weeks ago, we all contracted COVID and we all took anti-viral drugs, despite some difficulty in accessing them. In all cases, the disease was mild, although mine has lingered with a post-viral cough.

On reflection, given how successful the antiviral treatment seemed to be especially with my 96 year old mother-in-law, I wonder why there appear to be limitations on access to these drugs.

For instance, President Biden, who is 79, received the antiviral drug, Paxlovid. In clinical trials, Paxlovid is said to reduce the risk of severe illness by 90 per cent. He has experienced a mild infection that he attributes to vaccination.

By contrast, when Trump contracted COVID in 202I, eight drugs, from aspirin to the antiviral Remdesivir, were given to Trump in what observers at the time called a “kitchen-sink” approach. Most of those drugs were probably ineffective. Trump’s infection was certainly not mild. He was lucky. Biden’s outcome is predictable, uneventful recovery. One problem is that Biden seems to have undervalued the effect of the antivirals.

When the two cases are compared there is no comment about whether there should be any restrictions on access.

Thus, why can’t the whole Australian community have access? Or is it the same case as it was with the vaccine availability, incompetent supply chain decisions covered up by a military uniform?  Not enough being ordered by government is a familiar refrain. Is it another Department of Health stuff-up? Open government, Minister Butler.

We certainly had difficulty in obtaining the drug in Albury, where there were limited supplies. But this appears to be a common problem, even in capital cities. In the discussions, there seems to be a surprising degree of passivity in the community about the restriction in access without any objective clinical explanation, although that may reflect actual knowledge in the community of the existence of antiviral drugs.

Now, seeing both how our whole family benefited and how his doctors did not muck about with President Biden, who was immediately prescribed anti-viral drugs, why the restrictions on usage? On form, incompetence by the bureaucracy would appear to be the number one reason.  But maybe I am too bleak. So please, what the hell is going on?

The second comment was that when the whole family has the virus, and you are away from home, how do you actually get the anti-viral drugs. You need a doctor’s prescription, and because of the current conditions for that prescription, you need to get your own doctor to prescribe. In both our cases, the practice was contacted, the doctor was busy but rang back and sent the prescription immediately by email or text. The difficulty then is getting the prescription not only filled but in our case, to also locate a pharmacy that had the drugs.

Nevertheless, the key response was that of our doctors – suburban Sydney and Albury. They promptly rang back. I have heard of the contrary situation occurring.  In this case, the general practitioner did not return the call, not that day, not the next, when the prescription of an antiviral drug was essential. How often does that occur – a general practitioner forgetting the Hippocratic Oath? And nothing is done about it.  How many people have died because the doctor did not ring back? One is enough!

On the Cheapside

It was a slow Saturday afternoon, and my wife was looking over a series of ship manifests seeking information about some of her relatives’ arrival in South Australia. She came across a series of ship manifests including one from the 621 ton barque Cheapside which left Plymouth Hoe on sixth July 1849 and berthed at Port Adelaide three months later on the tenth October 1849. The Cheapside was the nineteenth emigrant ship from England to arrive in the South Australian colony in 1849; it was reported in the three months voyage six babies were born and ten persons died.

On board was my grandfather John Egan, then aged five years, together with his younger brother Michael, then three and sister Mary aged one.  My great grandparents were Michael and Bridget, specified as such on the manifest.  Michael is described as a labourer originally from Co Clare. Bridget – nothing added – just the spouse of Michael. I knew she had been born Bridget Corcoran in Cappoquin in Co Waterford.

Strangely, I remember once standing on Plymouth Hoe and looking out to sea and trying to feel what it must have been like sailing from these shores, knowing that you would never to see them again. But then again, they had already trekked across Ireland to Plymouth. Their embarkation had been from Plymouth not from Ireland, where Queenstown (now Cobh) in Cork was the common embarkation point for emigrants.  But to America not Australia!

The Egan family was numbered among the 242 emigrants in steerage. To give a flavour to the “passengers” on the other hand there were a Mr. Clisby and his daughter, Mr. Farmer, Mr, Hodgkin, Revd. Mr. Wood, his wife and five children and Mr. J. Ayre, late surgeon-superintendent of the Tasman are described as being “in the cabin”, 12 in all.

As has been described, for the “emigrants”, they were lodged below the main deck in steerage quarters converted from cargo spaces. This area would have been dark, crowded and close to the water line – when seas were rough passengers were often shut in with poor ventilation.

Added to this were probably the captain and 20 crew; so life was crowded.

On disembarkation, the Egans made their way to Kapunda, where the first commercial mine had been opened in 1842. It’s copper ore was some of the highest quality.

The township of Kapunda lies 80 kilometres north-east of Adelaide, just beyond the furthest reaches of the Barossa Valley, where a landscape of grassland and peppermint scrub here is gently undulating. That was the scene that confronted Michael Egan and his family – wife and two children – when they alighted from the bullock dray. It was early summer.

Michael had been attracted to Kapunda because he knew there were Claremen working in this newly-opened open cut mine.

Michael had always been restless. He had worked as a steward on an estate in Clare owned by the Blood family. He was still in his twenties when he left Clare and obtained work near Ross in Co Wexford, but 20 miles from Co Waterford. Here he met Bridget who was the daughter of a local farmer from Cappoquin, who had been forced into service.

They had married in the years before potato blight took hold and devastated the potato harvest across Ireland. Potatoes were an essential nutrient. As a result, the famine devastated Ireland, the first wave commencing in 1845 and by 1849 those who survived were fleeing The Emerald Isle.

And in the South Australian heat, here he was with his wife and children in November 1849.

But this was a mining community, unfamiliar territory where extraction and smelting of the ore was a task Michael had never encountered. He was rubbing shoulders with seasoned Cornish miners.

Kapunda’s copper mine 1850s

Yes, I have been to Kapunda and walked the perimeter of the overgrown mine which has been fenced off. Strewn around the site there remains clear evidence that this was once a copper mine. The tell-tale pale green cupric ore with tawny iron stains abound in the rock fragments. I souvenir a few pieces and turn away and go back to the car. The first chapter of Michael and Bridget Egan’s Adventures had begun.

For Michael was 35 at the time; he was to die 53 years later, a distinguished and wealthy Melburnian. 

Taking a Taxi to Bethlehem

This is a story about my good friend, Chris Brook, who died suddenly in May. Chris was a complex person, where many facets of his personality flashed, often the light from one cancelling the other out. Yet nestling under the carapace of arch comments and disdain was a compassionate person.

He and I had gone to Jerusalem in 1995 to attend a conference where Chris was then the President-elect of the International Society of Quality Assurance (ISQua). The Conference organiser was a courtly Israeli, a long term member of the Society executive going back to when I had been President of the same institution six years before. He said very little, but I found out that he had been a veteran of the 1948 war. The veterans of this War split in two Israeli factions – Likud and Labour.

Yitzhak Rabin had been a brilliant soldier and strategist, and even though he was a hard man, he was a reasonable man. A member of the Labour Party, in 1995 he was in his second term as Prime Minister.  Just over a year before he had negotiated the Oslo accords with Yasser Arafat, which introduced a period of comparative tranquility into the relationship between Israel and Palestine. For this he and Arafat had jointly received the Nobel Peace Prize in 1994.

We were lucky to go to Jerusalem during this period of peace. One morning, Chris and a colleague, Heather Buchan, decided to go with me to Bethlehem. It was a ten minute drive by taxi; negotiating the border was quick, unlike the time it had taken to enter Israel, being quizzed endlessly by unsmiling Junior Mossadista.

Church of the Nativity

Bethlehem by and large is a nondescript town of little shade and rows of ugly yellow stucco buildings. Yet the taxi was weaving its way unerringly to the Church of the Nativity said to have been situated on the site of Christ’s birthplace. There is a photograph of us all in the Manger Square in front of the Church. On the edge of the photograph of us was a smiling lean young Palestinian, a rifle slung over his shoulder.

Like many Palestinians living in Bethlehem he was a Christian, but unbeknown to me at the time Chris struck up a conversation with him. Chris said very little about him, but after we returned home Chris corresponded with him, and whether he sent money or whether he was prepared to help him migrate to Australia I am not sure.  They continued to correspond. Then one day, he mentioned to me he had not heard from this young man. The silence persisted; Chris tried to find out what had happened. As far as he knew the young man had been killed in some street altercation with Israeli troops; but where, when or how, Chris never disclosed that information. Although he must have been affected, Chris never showed grief.

At the Wailing Wall

We had gone to Jerusalem when a calmness prevailed. We were freely able to visit Jewish, Christian and Muslim shrines.  I particularly remember walking along the Wailing Wall amid the black robes and nodding heads. There was a cave at the end of the wall, where many of these Orthodox Jews were clustered. I had entered it, even though I was obviously a tourist. Nobody seemed to mind. One of these Orthodox Jews I clearly remember was one who lifted his beard to reveal a tracheostomy hole. It did not stop him launching into a crazy tirade. I listened to the invective – vicious invective primarily directed at Yitzhak Rabin for what he had done. I excused myself.  When I walked out into the sun I felt I needed a shower.

Four months later, Rabin was assassinated by a right wing extremist, Yigal Amir, on 4 November 1995 in the Kings of Israel Square.

The Accidental Nobel Laureate

Due to their recent discovery and relative inertness, there have not been many clear establishments for the applications of fullerenes. However, there are predicted applications that are presently being tested – May 22, 2022

Dr Robert Curl died last week. Dr Curl shared the 1996 Nobel Prize in Chemistry.

As recalled in his obituary in the NYT, in 1985, Dr Curl, a Texan, along with Richard E. Smalley, a Rice colleague, and Harold W. Kroto, a scientist visiting from the University of Sussex in England, showed a new configuration: 60 carbon atoms bonded into a molecule that resembled a soccer ball. They also found a larger version made of 70 carbons.

A buckyball

The finding was serendipitous because the scientists had been looking for something else. The chemists named the molecules buckminsterfullerenes after the architect Buckminster Fuller and his geodesic domes. The name was later shortened to fullerenes or buckyballs.

What a great name to enliven an esoteric area – the concept of kicking buckyballs around the molecular framework. The problem is that no matter how enticing the name and how cute the carbon atomic configuration; they were unable to find a commercial use.

In his Nobel Prize acceptance speech in Oslo in 1996, Dr Curl said inter alia

At the outset, none of us had ever imagined these carbon cage molecules. When we looked at carbon, the single astounding carbon sixty peak in the mass spectrum and the circumstances under which it came to prominence admitted no other explanation than the totally symmetric spherical structure, and suddenly a door opened into a new world.

The fullerenes have caused chemists to realize the amazing variety of structures elemental carbon can form from the well-known three-dimensional network that is diamond and the equally well-known flat sheets of hexagonal rings that are graphite to the newer discoveries of the three-dimensional cages that are fullerenes. We have learned that the cages can be extended into perfect nanoscale tubules which offer the promise of electrically conducting cables many times stronger than steel. Or the cages can nestle one inside the other like Russian dolls. Now that we have become more aware of the marvellous flexibility of carbon as a building block chemists may ultimately learn how to place five- and seven-membered rings precisely into a network of hexagonal rings so as to create nano structures of ordered three-dimensional complexity like the interconnecting girders in a steel-frame building.

The statement at the head of the blog was published in March this year.

Ergo, a Nobel Prize awarded for a discovery they were not looking for with a cute name but still in search of a function in the nanoworld of the molecules, let alone the ongoing search for their commercial application.

No Place for the Shamus?

I receive a great amount of stuff from the Lincoln Project, an extreme group of former republicans dedicated to destroying Trump and his acolytes. I receive regular communication because I purchased a print from them of a portrait of Abraham Lincoln with a tear in his eye. It is a powerful image. Those behind the Project are no saints; they are men who have been at the heart of the US government, insiders well versed in the “dirty trick campaign” and seemingly unafraid of using the same tactics.

The critical decision for the reader to make is to whether, if you read on, are you reading fact or “alternative facts”. It is important to factor in your own bias, if you have no idea of what is actually occurring. Yet the last sentence limply reinforces a paean which unexpectedly appears four paragraphs before about the Secret service being essential and valiant; a tincture of an apologia methinks! Rick Wilson the author of this below is what, in the terms of Cain and Chandler, may have been described as “hard bitten and cynical”. But then that is my bias!

Here’s why it matters that tens of thousands of you raised your hands and demanded answers about those deleted January 6th Secret Service texts:

If reports are to be believed, the Secret Service handed over exactly one – ONE! – message. That’s like writing “FU” on a blank cover sheet, crumpling it up, and throwing it in the general direction of Capitol Hill.

To get this straight: the Secret Service let the dog eat all their text messages during, wait for it, and this coincidence will SHOCK you, the two days surrounding the most calamitous threat to our democracy. Literally every possible agency with investigatory power has a duty to figure out just what the hell happened.

It matters that a Federal agency given sweeping powers of action and discretion has quite clearly engaged in a coverup to protect Trump and his coup plot. Stay with me here, because my mind is wandering…

1) The long-rumoured and discussed cadre of Trump Praetorians in the USSS needs to get aired the hell out. This just reeks.

2) The leadership and every single person on the detail and Uniformed Division that day needs to have their personal and work devices of every kind subpoenaed and examined. They must also be deposed.

3) I hope you’ll let the 1/6 Committee know you’ll tune in for “The Long Hot Summer” series. They absolutely should add this to the docket and make it so hot even the DOJ can’t ignore it. They can skip vacation “juuust” this once and crack some skulls. 

4) I’ve noticed many Republicans get very livid lately when this whole scandal gumbo is compared to Watergate.

The Secret Service is a vital agency. Their unchallenged bravery at being the last line of defense between violence and assassination of U.S. Presidents and protectees is storied and written at times in blood. It is a brave and honorable duty. The core of their reputation wasn’t just a fearsome readiness to defend the President. It was also a cool, detached professionalism that served the office, not simply the political whims of the man who held it. 

For months, Mike Pence’s refusal to enter the VP limo has pinged the edges of my radar. I couldn’t quite sort out his reluctance. He’s not a physically brave man, to my knowledge, so what was it? What else did he know or sense? If you ask me, I think Pence knew parts of the Service were compromised and put Trump’s politics over duty.

To go deeper down the rabbit hole: I’m no Presidential staff historian, but Trump’s elevation of hyper-loyalist Tony Ornato from the Secret Service into a political role at the White House (who later planned the photo op with the Bible, and the tear gas attack on peaceful protestors in Lafayette Square…) might have been a tell. I suspect he’s rather a key element here. We also know that when President Biden took office, he felt compelled to change out pro-Trump detail members. Putting all that together leads us to some unpleasant potential conclusions, to say the least.

This is not a matter where all of us – not the Committee, not the DOJ, not every American who cares about the rule of law and the vital role of the Secret Service – can sit back and be satisfied with one lousy text message. We have to pull at these threads and connect these dots.

The danger the Secret Service faces every day in the line of duty is real. Their sworn duty is an honourable one. But it’s starting to look like the MAGA rot runs deep here. Who knows how big of a role all of this played in the January 6th insurrection?

Yes, who knows. Jason Bourne is across it, and he was supposed to be flight from reality.

Mouse Whisper

If that human crowd have not had enough pandemic, Splendour in the Mud in Byron Bay may just be a catalyst for another, especially as it is not an uncommon event as exemplified in this British report:

Unusual transmissions of gastrointestinal diseases have also occurred during large scale open air festivals. An outbreak of Escherichia coli was reported during the Glastonbury music festival in England and was linked to mud contaminated by infected cattle. Heavy rain had turned the site into a quagmire, and attendees had high levels of contaminated mud on their hands and faces.

Leptospira

Also, those coming back from Splendour in the Mud last weekend should become acquainted with the one word “leptospira”. These nasty bacteria, the bane of sewage workers, are associated with my dirty cousin rats – in their urine which they sprinkle over sugar cane and banana plantations and which is washed away when the rains come and into the mud that forms around these bacteria.

Welcome to the disease world of the unprotected youth, acquiring a disease to remember where splendour is in the eye of the beholder as they cavort to the sounds of those masters of the music world. So, as you raise your glass with the muddy hand, do I hear you cry “Here’s Mud in Your Eye”?

No, that is a toast from another era well before Woodstock, in fact it’s biblical.

Hosting a leptospirosis party?

 

Modest Expectations – Fence to Fence

“Of Australian politicians, Penny Wong is wonderfully deft in a way that is not Ardern, yet from the same school; those who can stand outside themselves and see their image as others do. Her minimalist approach to herself is extremely effective.”  Modest Expectations 11 May 2019

                                                **

“I was worried by the absence of Penny Wong and the short statement that she has been ill has been left at that after she turned up on the Insiders program.  The problem with presenting the Albanese foreign affairs approach is to work out what it is. Wong’s comment on Insiders:

Working with partners in the region to build our collective security, to diversify our export markets, secure supply chains, provide renewable energy and climate solutions, avert coercion, and respond to natural disasters. By investing financially and intellectually in the security and stability of our region – because defence capability on its own won’t achieve this. We share with ASEAN states an abiding interest in averting hegemony by any single power – so this is where our energy must be applied.”  Modest Expectations 11 March 2022

Just my idle squiggles. Seems as if Albanese maybe came to the same conclusion.

Personal Responsibility – The Big Cop Out

More useful on the face

Jennifer Hewett: “The idea of sitting in an office and wearing a mask, that is not going to work.” How ridiculous it is that we are not being led by important health advice and going instead with what journalists believe will or will not work.

Jennifer Hewett is one of those irritating know-it-alls, who patrols the border between “opinion” and “opinionated”. Watching this confetti of journalists last Sunday on Insiders pontificating on public health matters suggested to me that having this panel was as logical as after the next Federal Budget is released, Insiders having public health physicians as their expert panel. At least this latter group have been trained in scientific method.

That other pillar of self-opinionation, Peter Van Onselen, was free with his logic-free view, that “We don’t wear helmets in cars.” Yes, you do in racing cars… and when riding motorcycles and bicycles, because it is a matter of risk. Nor, do we wear body armour when we go for a drive. When I was young, I heard the same argument about so-called “personal responsibility” in relation to the introduction of seat belts. Now seat belts are accepted as a normal safety procedure. I ought to know – a seatbelt saved my life.

As with the seatbelt that broke my rib in the accident (so severe the impact), I have got the above off my chest. My outburst nevertheless expresses the frustration of a public health physician in relation to the state of commentary at present on the pandemic.

In a way, having a blog weekly during the whole pandemic  attempts to emulate others who have done so during such trying times, such as Samuel Pepys.

The Prime Minister has said no more lockdowns, no more border closures. I wonder whether he really has understood the significance of that statement.

These were two factors which, from early 2020, guided public policy. This was a time when there was no national leadership, despite the incontrovertible fact that this was a pandemic, probably initiated in China.

The politicians were blindsided by the very word “pandemic”,  confronted as they were by tales of the Spanish flu pandemic, which resulted in the deaths of millions of people worldwide in the early part of the last century.

Quarantine under the Australian Constitution is unambiguously a Commonwealth power. The then Prime Minister Morrison shifted, as he often did, responsibility rather than showing leadership by taking responsibility for a national plan. This inaction gave inordinate authority to a number of State chief health officers, rather than giving single point responsibility to Dr Paul Kelly as the Commonwealth Chief Medical Officer after Brendan Murphy was promoted to head the Commonwealth Department of Health.

One example of an out of control State Chief Health Officer was the bizarre behaviour including her litany of comments of Jeanette Young, the Queensland long term occupant of the post. She was just an extreme example as this fragmentation of authority resulted in contradictory babble. Confusion and anxiety were heightened across the community, and quackery substituted science as exemplified by the proposal of hydroxychloroquine and ivermectin as cures.

In this situation, the easiest response of politicians to show they are doing something is to close borders and within borders to impose restrictions on movement – the lockdown.

Lockdowns work, as testimony of the near elimination of influenza during 2020 and 2021; with the removal of restrictions, flu emerged ferociously this year.

Lockdowns are now considered political poison, but in 2020 it should be remembered that there were no vaccines, no antiviral drugs and even the most basic protective equipment was at a premium. Moreover, people were dying, mostly the elderly in nursing homes but not exclusively.

Nevertheless, there has been one constant with a plus in front of his name – Dr Paul Kelly, the Commonwealth Chief Medical officer.

This is as far I shall write this week. My diaries have a great deal more to say. The COVID Virus still hangs over me, but next week … and I just need more time to arrange the tale. So sorry, to dog it this week!

Nuts to you all!

Balranald on the Murrumbidgee

We stopped in Balranald – always the one place I missed driving around and through the Far West of NSW. It seems Balranald was just not one of my backroads. People are used to talk about the Outback as being “Back of Bourke”, which probably relied on the bush balladeers travelling the country north-west of Bourke, an almost fabled shorthand for the Outback.  Two hundred and twenty kilometres beyond Bourke, straddling the NSW-Queensland border is the tiny settlement of Hungerford. Hungerford has the romantic association of the Outback that Balranald lacks.

Henry Lawson, when he was employed as a journalist for The Bulletin, went to Hungerford. J. E. Archibald, then the Editor of The Bulletin, gave Lawson five pounds and a return train ticket to Bourke to go and write about this adventure. Lawson wrote a short story about Hungerford, to where he walked from Bourke – 220 kms in 1893.

No such legacy for Balranald.

In Balranald we stopped to seek directions. It was a Saturday afternoon, when people are scarce on a country town street. This guy was removing bins from the footpath. The casual “Hey mate” became a conversation, yarning about the town, where he had lived all his life. His forbears, the brothers Giansiracusas, left Sicily in 1932 and settled in Balranald, barely out of their teens. They became market gardeners, and he had grown up in the family business.

As he said, he had lived there all his life, and had watched the town slowly shrivel as a district centre – that is until recently. There were now mineral sand mines opening up, the source of titanium and zirconium, important in steel alloys. Mining of mineral sands had become a conservation problem in the more convenient coastal and riverine areas where they occurred in the past. In some of these areas sand mining was banned. However, being here on the Riverina plain in sparsely populated country, sand mining did not have the same conservation pressures.

When I was a boy, the area on the Murray around the Victorian border town of Robinvale was the centre of the dried fruit industry – the table grapes: muscatels, sultanas, red globes among them which, for a time, were a strong export item, particularly to the United Kingdom. What would Christmas be without table grapes!

Robinvale on the Murray River is about one hour’s drive from Balranald, which lies on one of the major tributaries of the Murray River, the Murrumbidgee. Table grape production as such has declined relatively in the area. Overseas competition and changing food habits have led to the decline in the value of the production.

Almond trees

The “Saviour” has come here in the form of the almond tree. There are hectares and hectares of these trees (over 10 million of them) being grown along the Murray River from the South Australia Riverland to the Sunraysia and then up the Murrumbidgee River, where Balranald has become a district centre for almond growing. Although sealers brought the almond tree to Kangaroo Island as far back as 1836, until the last 30 years growing almonds was a cottage industry in Australia. No more, as the Australian production approaches a billion dollar industry annually. Balranald has become a beneficiary of this planting.

Pistachios

There is also a substantial area close to Balranald being opened up to grow pistachios, a nut which has only recently emerged in the Australian lexicon. A hugely valuable crop to Iran and Turkey, its cultivation is also in America, which is a major producer. By comparison, Australian annual production is currently minuscule.

Walnuts

Around Leeton further up the Murrumbidgee, where once rice was the prime commodity, large broad acres are filled with walnut trees.  The climate is perfect for growing these nuts. Recently, a furore has broken out with the fear that bees essential for pollination of almond blossoms will precipitously decline because of varroa mite infestation in NSW.

More threatening, given Australia is the “dry continent”, these nuts are voracious for water. As one source says “To grow one almond requires four litres of water. The crazy thing about that is that walnuts, hazelnuts, pistachios, and cashews all use roughly the same amount of water to grow as well, but it is the almond which is in such high demand at this time.”

Mr Giansirscusa needed to finish his tasks, yet seemed reluctant to stop talking. To me, it is encounters like this which are the stuff of travelling in rural Australia; the exhilaration of just travelling out of major conurbations which I started to do many decades ago, and I have been glad to have done that.

A Hamlet called Hebel

Mention of Hungerford reminds me of another time when I visited a Queensland settlement just over the NSW Border. It was the time I was travelling with Nick Mersiades, as part of the Rural Stocktake I undertook in 1999; we had stayed the night on the NSW side at Goodooga, an Aboriginal township, which had at that time a long-serving Indian-born doctor whom we wanted to meet.

The township is Hebel. It had been a Cobb & Co stopover point, established in 1889 with the name Kelly’s Point. It achieved notoriety then as Dan Kelly and Steve Hart, members of the Kelly gang, lived in the Hebel area under assumed names. The name was changed to Hebel in the early 1890’s, the name of a local German family that settled there.

In this area of NSW, these are black soil plains. There had been a great amount of rain.  When it rains on black soil, the previously near perfect surface upon which to drive, becomes muddy glue. Thus, vehicle travel is banned as the danger of being bogged or carving out deep ruts in the surface of the road is just plainly too great. Anyway we were free to go this morning, and the road to Hebel showed that it was not a well-travelled highway and there was clay in the road surface. Normally, one does not have grass growing in the middle of the road, I observed. Nick turned and said wryly I had not done enough driving on these backroads.

Along the road were dams, huge shallow stretches of water for use by the cotton farmers taken from Culgoa River Flood plain. Nick and I were kitted out in checked Viyella shirts, woollen ties and moleskins, the very fashion plate of government rural bureaucrats as we strode around the edges of some of these dams.

Eventually we reached Hebel. The settlement had achieved some degree of notoriety because a “willie-willie” had destroyed what I thought was the local post office. As we got out of the car, a large guy with a pot belly encased in a torn navy t-shirt, shorts and thongs emerged from the hotel. To complete the picture was a single front tooth. The complete epitome of Saltbush Bill.

He advanced on us, and looking straight at Nick, said: “Hey, mate have you got any of those gay body-building magazines?”   Unexpected, but memorable.

No, Nick did not trump that question by going back to the car and producing a suitable anthology, if that is the suitable collective noun.

Hebel Hotel

Anyway, we went into the pub, but obviously looked too much like “we’re from the government”. Everybody sitting around in the pub shut up; we each ordered a beer, breaking the silence, drank it as casually as we could interspersed with suitable small talk and then high-tailed it off to Dirranbandi.

We did not talk about gay body builders. Not the type of request one would expect in the Outback.

Yet, I have not been to Hebel for years and as I found out in Balranald, regional settlements do change, especially if their community leadership is re-invigorated. After all, the community centre in these tiny hamlets is mostly the pub; and therefore the community activity often rests on the personality of the publican and his or her family.

Monkeypox – “I don’t think we’re prepared for another pandemic of something that’s actually serious.”

Monkeypox has crept into the infectious disease lexicon. Cases have been reported in Australia, and as reported below it is a disease contracted by close personal contact, but as this report says there is no systematic contact tracing.

As Johns Hopkins School of Public Health has succinctly reported, monkeypox is caused by a virus related to smallpox, but monkeypox disease is usually milder than smallpox. It is called monkeypox because it was first isolated in monkeys. The name “monkeypox” is misleading as rodents, not monkeys, are the primary carriers of the virus.

The disease may be more likely to affect people who have never been vaccinated against smallpox. The smallpox vaccination program ended around 1972 (the last documented case of smallpox in Australia was 1938). I well remember as a medical student that you needed to demonstrate proficiency in vaccination; you proved that by vaccinating a fellow student under supervision. Another lost art?

There seem to be two variants of the virus endemic in West Africa and the Congo Basin respectively. This strain is similar to the West African strain.

In people, monkeypox is spread through contact with an infected person’s rash or bodily fluids, including respiratory droplets. Close personal contact, sexual or not, can cause a person to become infected.

As this case report below indicates, the disease is mild in most people, but there are the usual vulnerable groups common with all viral infections.  Other reports describe more debilitating encounters with the virus.

This abridged report comes from the NYT:

In San Francisco, B, a 43-year-old medical writer who asked that his name be withheld for privacy reasons, found himself shivering uncontrollably with a high fever on June 14, eight days after he had multiple sexual encounters at a bathhouse in Chicago. 

When a blister appeared on B’s wrist on Friday afternoon, he suspected monkeypox. But his health care provider said the city’s health department would not be able to pick up his sample till Tuesday, June 21, after the Juneteenth holiday.

No one reached out to him to ask about his contacts, or to offer vaccines to his roommate or partner. It was Friday, a week later, before the sample was picked up, and the following Wednesday — nearly two weeks after he had contacted his health care provider — before he was told he had tested positive for an orthopoxvirus.

By then, his lesions had healed, and he no longer needed to isolate. “The irony of this happening on the same day as receiving the first test result is not lost on me,” he said.

Even then, the health department told him it would likely be another week before the C.D.C. could confirm that he had monkeypox.

“Two blisters and a rash on my butt is not the worst I’ve had in my life,” B said. But given his experience, “I don’t think we’re prepared for another pandemic of something that’s actually serious.”

A senior Biden administration official, who spoke on condition of anonymity to discuss internal matters, acknowledged that implementation of monkeypox testing had not been as convenient nor fast as it needed to be.

Negotiations between government officials and commercial labs began in the third week of May, soon after the first cases were identified, he said. But it took time to settle contracts, scale up test supplies and train personnel to handle the virus.

Still, the official noted, the C.D.C. published test procedures in early June, and the F.D.A. authorized additional test supplies to allow any interested lab to participate. The wait time for test results has dropped from 15 days to nine days from the start of symptoms, and is expected to drop further as lab capacity expands in July.

Another barrier to containing a disease like monkeypox is a dearth of sexual health clinics. 

Monkeypox was thought to present as a body-wide rash, but in the current outbreak, most patients have developed only a few pox, primarily in the genital area. Patients with genital symptoms are much more likely to seek care at sexual health clinics, because they tend to offer confidentiality, convenience and free or low-cost care.

But funding for these clinics has dropped by about 40 percent since 2003, after accounting for inflation. Partly as a result of the decline, about one in five Americans had a sexually transmitted infection in 2018, according to a C.D.C. report, and those numbers have surged during the pandemic.

If monkeypox can’t be contained, it may become a permanent threat, especially among men who have sex with men. “The fear is that this will become entrenched as an S.T.I., you know, just like, say, syphilis is, or H.I.V. for that matter,”  commented Dr. Varma, Professor of Population Health Science, Weill Cornell Medical College. 

“Without high quality sexual health services, you’re never going to be able to control it, because you won’t identify people fast enough,” he added.

The experts did offer praise for one aspect of the administration’s response: the messaging to men who have sex with men, which hews to the “harm-reduction” approach, urging caution while recognizing people’s needs.

Rather than “stigmatizing them for wanting to have sex and enjoy themselves, you meet them where they are,” Dr. Varma has said of the C.D.C.’s monkeypox messaging. “In terms of things that have gone well, that is among the best sort of harm reduction advice I’ve seen.”

A case too horrible to be true — except that it was

This report below written by Sahar Fatima first appeared in The Boston Globe, and it has been referred to on several twitter entries. If it wasn’t Mid- America, who would believe it? I remember that in one issue, Ripley Believe It or Not reported that a pregnancy had occurred in a Peruvian five and half year old in 1939. 

Ripley Believe It or Not was a syndicated compendium of bizarre facts authored by one Robert Ripley, publication of which he started in 1918. He worked on the basis, for as he said “Facts, to be interesting, must be very close or very far away”. The pregnancy was even more shocking in that the child Peruvian suffered from Albright’s Syndrome, one of the components of which is precocious puberty. It was a “gee whiz” moment – you know Peru is far away, and it’s 1939, many other things were going on. Just a bizarre happening to report in a cartoon without any social context.

However, some of the reactions to this pregnancy are equally shocking if different. Note the intervention of Murdoch and his minions setting a bar below ground. Ripley would have been in his element illustrating this freak of nature – Rupert being able to set a bar below ground. But on reflections it has not been a first.

A 10-year-old Ohio girl who was forced to travel to Indiana for an abortion after being raped, since her home state no longer allows abortion exceptions for rape and incest. The disturbing example of fallout from the Supreme Court’s decision to overrule Roe v. Wade was first brought to light by Indianapolis physician Dr. Caitlin Bernard in an interview with the Indianapolis Star.

The case quickly prompted a backlash from conservatives who claimed there was no record of such a victim and that the details had not been verified. On Tuesday, the Wall Street Journal’s editorial board published a withering takedown of President Biden for repeating the story when he signed an executive order on abortion, referring to it as a “fanciful tale.”

Turns out, the story was all too real.

A day later on Wednesday, the Columbus Dispatch reported that 27-year-old Gerson Fuentes was arrested and confessed to raping the girl. The story said police learned about the pregnancy from Franklin County Children Services, to whom the child’s mother had reported the abuse on June 22.

Confirmation that the story was true made for an awkward situation for those who had publicly raised doubts about it, notably Ohio Attorney General Dave Yost.

Yost said Monday on Fox News that he had heard “not a whisper” of evidence that such a case existed and said it was likely a “fabrication.” After Fuentes was arrested, Yost said he was grateful police got “a rapist off the street”.

Meanwhile, Ohio Congressman Jim Jordan quietly deleted a tweet in which he referred to the 10-year-old story as “another lie.” Jordan is infamously accused of ignoring allegations that wrestlers were sexually abused by Richard Strauss, a former doctor in Ohio State University’s athletics department, when Jordan was assistant coach there, which Jordan denies.

The Wall Street Journal added a note to its original editorial and published another one “correcting the record” while defending the editorial board’s initial misgivings.

The Washington Post’s Glenn Kessler, who had published a fact-check column raising questions about the story’s veracity since he had been unable to confirm details, updated the column after the arrest.

“While reporting this story, the Fact Checker had contacted the Franklin County agency to ask if such a referral had been made. Unlike similar Ohio county agencies we contacted, Franklin County officials did not offer a response,” Kessler wrote.

The episode frustrated abortion rights supporters, who argued that the story was subject to a level of doubt and skepticism that is rarely applied to other single-source stories, such as news reports that take police at their word or stories with anecdotes from doctors about transgender teens being rushed into taking hormones. Publishing details about the case is also complicated by the fact that it concerns the sexual assault of a child, whose identity is protected by law.

These types of stories are bound to become more common, reports my colleague Deanna Pan, underscoring the outsized impact of abortion bans on adolescents, who already face complex legal, social, and logistical hurdles to accessing reproductive health services. Experts told Pan the Supreme Court decision is also likely to reverse the decades-long decline in teen birth rates, and increase stigma and shame around youth pregnancy.

Instead of expressing contrition for scoffing at a story about a child nearly forced to give birth to her rapist’s baby, the Right is getting angry at the doctor who performed the abortion. Vice News reported that Indiana’s Republican attorney general is looking to investigate Bernard for not reporting the sexual assault to Indiana authorities, even though the crime took place in Ohio where police were already aware. In fact, Bernard had actually reported the abortion to Indiana authorities too, according to the New York Times.

A billboard read ‘Welcome to California where abortion is safe and still legal’ on July 12, 2022, in Rancho Mirage, Calif. The billboard was paid for by Planned Parenthood of the Pacific Southwest. The number of patients from outside states increased 900 per cent at Planned Parenthood clinics in San Bernardino and Orange counties the week following the Supreme Court’s decision in the Dobbs v. Jackson Women’s Health case, which overturned Roe v. Wade.

Ruminations on British Breakfast

A small indulgence in a World where the pillars of civilisation are crumbling in the wake of climate change and populist barbarism. There are two personal culinary delights, as British as John Bull, but extremely difficult to find in Australia. The first is kippers, which remind me of a leisurely breakfast at the Randolph Hotel in Oxford gazing out on the hustle and bustle of people hurrying to work in the greyness of an English morning. Some people cannot stand the smell of kippers, and my wife is one of them, leaving me to my indulgence alone.

Kippers, Atlantic herring, halved, salted and smoked, are high in the “good” fatty acids and protein but low in calories, in butter and oil is so simple – and it seems that although it fell out of favour for a time even among the Poms in the face of Kellogg “cereal serial invasions”, it is making a comeback.

The other experience occurred on the Channel Island of Guernsey. Soft boiled eggs and “soldiers” on the breakfast menu. On the surface they are very simple to prepare, you say. Yes, I remember once having them for breakfast in a hotel in St Peter Port of all places, and in the world of Goldilocks, the breakfast was just right.

The soldiers were coated in Marmite and were cut so that they fitted perfectly into the “runny” centre, which was evenly “runny” so that the soldiers could complete their dipping task. Something so simple; but until last Sunday morning not replicated (with substitution of Vegemite) with the same purity as that memorable day in the world where once The Guernsey Literary and Potato Peel Pie Society flourished.

Strange, what little things stick in one’s memory, and how much one values such a memory.

Mouse Whisper

As my son, MouseWit said to me. No wonder he calls himself Antony. As MW said – just imagine if he were introduced in the USA as Tony Albanese – especially in Chicago.  Sounds like the padrone rather than the padre del paese – scusi, Prime Minister.

But Albo? Well, Robert Gordon Menzies was either “Ming” or “Pig Iron Bob”.

But mostly for our leaders it has been “that Bastard” or worse…

Signor Tony

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can you believe these remnants of the Dark Ages!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Paradoxically, methotrexate can cause birth defects.

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

Indeed.

Justice John Roberts

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

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

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

The Unsinkable Molly White

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

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

Ms Gadizy writes:

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

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

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

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

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

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

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

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

Software engineer Molly White at work on her laptop

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

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

And others are listening.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Parliamentary staffing

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

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

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

Cathy McGowan

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

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

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

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

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

Staffers aplenty

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

Mouse Whisper

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

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

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

 

Modest Expectations – SXM

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

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

But first, the scene should be set for both.

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

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

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

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

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

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

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

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

On the road to Balranald

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

Why? Mining means improved access.

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

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

The Prequel

David Lyle

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

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

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

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

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

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

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

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

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

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

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

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

The Postscript – What’s in a Name!

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

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

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

Lascelles silo art

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

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

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

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

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

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

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

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

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

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

Sarah Jane Halton and her Stomach Knot

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

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

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

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

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

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

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

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

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

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

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

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

Excuse me for gagging on “independent”.

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

Climate Change

Ravenserodd – site of sunken Medieval town

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

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

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

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

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

Mouse Whisper

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

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

Penarie pub

 

Modest Expectations – To the Last I will Grapple with Thee

I was walking across a bridge one day,

and I saw a man standing on the edge,

about to jump. I ran over and said:

“Stop. Don’t do it.”

“Why shouldn’t I? he asked.

“Well, there’s so much to live for!”

“Like what?”

“Are you religious?”

He said: “Yes.”

I said: “Me too. Are you Christian or Buddhist?”

“Christian.”

“Me too. Are you Catholic or Protestant?”

“Protestant.”

“Me too. Are you Episcopalian or Baptist?”

“Baptist.”

“Wow. Me too. Are you Baptist Church of

God or Baptist Church of the Lord?”

“Baptist Church of God.”

“Me too. Are you original Baptist Church of God,

or are you Reformed Baptist Church of God?”

“Reformed Baptist church of God.”

“Me too. Are you Reformed Baptist Church of

God, Reformation of 1879, or Reformed Baptist

Church of God, Reformation of 1915?”

He said: “Reformed Baptist Church of God,

Reformation of 1915.”

I said: “Die, heretic scum,” and pushed him off.

  • First appeared in the Guardian 2006 CE – Blueprint for the previous Government’s Religious Discrimination Bill?

We knew this was going to happen

It will be seen if the fury being generated, as exemplified by the following article, will further divide America. This decision is terrible but unsurprising given the underlying pathology of judges prepared to remove a constitutional right and some of the incumbents in effect lying during their questioning by the legislators prior to appointment. This is a Court without shame – a mingle of sociopaths in the majority at the pinnacle of the American judicial system.

The root cause has been Donald Trump and his henchpersons, although Biden bears responsibility for the original appointment of Clarence Thomas.

The following article appeared in the Boston Globe in a State which sends no Republicans to Washington. The author of the article, Yvonne Abraham, grew up in Sydney, Australia, and has been working at the Globe since 1999. She has covered a wide range of national and local politics, immigration, and just about everything else over those years, as stated in her bio.

Since the Supreme Court ruling Governor Charlie Baker, a rare Republican elected official in Massachusetts, who supports the right to abortion, signed an executive order on Friday that he says will “protect reproductive health care providers who serve out-of-state residents.”

Governor Baker’s order bans executive state agencies from assisting another state’s investigation into a person or group receiving or performing abortions that are legal in Massachusetts or extraditing those patients or providers. The order addresses laws imposed in states that criminalise abortions and other services.

His order also protects Massachusetts abortion providers from losing their professional licenses or receiving other professional discipline based on potential out-of-state charges.

Meanwhile, Yvonne Abraham has written this fiery contribution to the debate.

Of course, that doesn’t make it any less enraging or terrifying. If anything, it makes it more so.

Many of us were certain this day would come, long before the leak last month of Justice Samuel Alito’s chilling draft decision overturning Roe. We’ve been watching it all unfold for years, exactly according to the plan anti-choicers have been trumpeting, loudly and entirely in the open, for decades.

We knew it in 2016, knew that if Hillary Clinton lost to Donald Trump, the right’s years-long plan to take over the Supreme Court, led by the utter, shameless partisanship of Senate Republican leader Mitch McConnell, would come to fruition, and we’d be exactly where we are today: Women will no longer have control over their own bodies in half of this benighted country. For millions of pregnant people, including victims of rape and incest, safe and legal abortion will now be an option only for those with the means to travel to a state that still — for now — provides that option. And now that Roe has fallen, decisions on other constitutional rights — including some big ones taken for granted by people who thought abortion was not their problem — will likely follow.

In a single week, this Supreme Court majority — this retrograde, opportunistic, political majority — has kicked over so many of this country’s moorings it’s hard to see how we keep standing: They blew through the separation of church and state, invalidated life-saving state gun safety laws, and now have overturned the constitutional right to an abortion with such force and argumentative sweep that contraception and same-sex marriage are now imperilled, too.

Again, it’s shocking, but it’s not surprising.

We. Knew. This. Was. Going. To. Happen.

What were all of those pro-choice voters thinking — especially the women — casting ballots for the orange menace who, with plenty of help from this court, tanked our democracy? Who couldn’t bring themselves to vote for a woman, or that woman, because she was insufficiently progressive, or because of her e-mails, or her laugh, or whatever other deal breakers they conjured to make their betrayal seem less shameful? Who chose nativism, hatred, and white supremacy over their own interests? Who embraced his world-view because it felt simple, comforting, even entertaining?

You can all sit down today. As can the rest of you who thought Roe didn’t have anything to do with you.

And just in case you still think that, Justice Clarence Thomas would like nothing better than to disabuse you of that notion, ASAP.

Thomas, married to an actual insurrectionist but still somehow on the nation’s highest, and apparently untouchable, court, spelled it all out in his concurrence: Since Roe has been overturned, the court “should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell,” he wrote.

Those cases allowed married couples to use contraceptives, held that states could not outlaw gay sex, and established a constitutional right to same-sex marriage. The whole plan is right there, out in the open, like it always has been.

No pro-choice senator had any business confirming these judges, whose entire careers and public statements gave the lie to their testimony on Capitol Hill.

The name of Maine Senator Susan Collins — the Republican who built a career in part on her support for abortion rights — should forever live in infamy. She went to the mat for nominee Brett Kavanaugh, giving a fiery speech in which she professed her absolute certainty that he would not vote to overturn Roe. That speech, disingenuous then, or hopelessly gullible, is utterly disqualifying now. The West Virginia Democrat and filibuster fetishiser Joe Manchin can spare us his “alarm” over the fact that Kavanaugh and Neil Gorsuch broke his trust here. Ditto Lisa Murkowski, the pro-choice Alaska Republican who voted to confirm Amy Coney Barrett, whose record opposing abortion was the most blindingly obvious.

Not one more word on abortion, from any of them, ever. Unless that word is a “Yea” to abolish the filibuster and fix this.

We knew this was going to happen.

“We have been called chicken little for a long time,” said Rebecca Hart Holder, head of Reproductive Equity Now. “The sky really is falling. We weren’t making it up.”

As always, it is falling more heavily on some than on others: those who are poor, who have jobs and other obligations that make it impossible to travel, who don’t have access to information or services that could help them find care in a nearby state. Some of those women will face insupportable life options and some will die because of Friday’s decision.

And it is falling unevenly, in bits and pieces: Abortion will become illegal in 13 states now that the decision has come down. Thirteen more will follow in coming months. In some states, that means laws empowering any random citizen to take legal action against anyone who helps someone get an abortion.

If the zealots in the GOP have their way, the rest of the states will follow those. House minority leader Kevin McCarthy made that clear on Friday when he said “our work is far from done” when it comes to abortion. Former vice president Mike Pence celebrated the fact that Roe had been “consigned to the ash heap of history” and heralded the emergence of “a new arena in the cause of life:”

He went on: “We must not rest and must not relent until the sanctity of life is restored to the centre of American law in every state in the land.”

You get that? They’re coming after abortion in blue states like ours, too. Bless the Massachusetts Legislature for enacting the ROE act strengthening protections in this state, and the governor for Friday’s executive order protecting Massachusetts providers who help out-of-state residents with abortions from being targeted by authorities in states that make such help illegal.

But in this America, no right that riles the right wing is truly safe any more. This is as much a cynical political strategy as a heartfelt position: For decades, the GOP used abortion to whip up support from voters who would otherwise have little reason to back them. Now that the dog has caught the car, they need to continue the fight or risk diminishing that fervor. That means pushing for federal legislation extending the reach of today’s ruling to the entire country, including Massachusetts.

How do we respond to this?

We do all the things we need to do today: Take to the streets to make our voices heard, donate to funds that help those who would not otherwise have access to abortion services, talk to those who still don’t quite get what is happening here and why it matters.

But none of that is going to solve the main problem here — and it’s the problem at the heart of almost all that ails this country right now.

Clearly, it doesn’t matter to the GOP that large majorities of Americans believe in a legal right to abortion. What we’re seeing here is the triumph of a small-minded minority. And they’re succeeding because they’ve broken our democracy — have been breaking it, for decades. They stacked courts not only with judges who oppose abortion, but who are also willing to take an ax to voting rights. They filled state legislatures with people more than happy to keep themselves in power by making it harder for likely Democratic voters to cast ballots. They sent leaders in Washington who — as the hearings of the Jan. 6 committee have made tragically, abundantly, clear — are willing to gut what remains of our electoral system. Which is to say these are leaders who don’t actually believe in this country.

The only way to fix this is to vote against them, in November and beyond, and in numbers massive enough to overcome their attacks on our democracy.

Friday’s decision is but the latest chapter in this country’s most serious existential crisis since the Civil War era. When it comes to fixing it, it’s now or never.

We knew this was going to happen. And it’s going to keep happening.

The Monroe Doctrine

In the wars of the European powers in matters relating to themselves we have never taken any part, nor does it comport with our policy so to do. It is only when our rights are invaded or seriously menaced that we resent injuries or make preparation for our defence.

With the existing colonies or dependencies of any European power we have not interfered and shall not interfere. But with the governments who have declared their independence and maintained it, and whose independence we have, on great consideration and on just principles, acknowledged, we could not view any interposition for the purpose of oppressing them, or controlling in any other manner their destiny, by any European power in any other light than as the manifestation of an unfriendly disposition toward the United States – President  Monroe December 1823.

James Monroe

James Monroe was a Virginian, the fifth President of the United States between 1817 and 1825. He held numerous positions in government, and during his long life he crossed the Delaware River with Washington on Christmas Day 1776 and was Secretary of State during the 1812 War. He had been involved in the Louisiana Purchase in 1803, and the purchase of Florida from Spain occurred during his Presidency. His Presidency coincided with the independence of South American countries from Spain and Brazil from Portugal.

The Monroe Doctrine in essence was a warning for European powers to stay away from the Western Hemisphere. This Doctrine did not stop the imperial USA from rampaging across the Hemisphere. Between 1908 and 2009, there were 56 incursions of American military and naval forces into the Caribbean and South and Central America including nineteen years occupation of Haiti (1914- 1934) and the Dominican Republic (1916-1924).

One of the spoils of the Spanish American war was the island of Puerto Rico. It was absorbed as a Territory. The Monroe Doctrine did not protect the independence of these countries. Only Cuba has been able to throw off the colonial yoke of its Northern neighbour.

The final nail into the Monroe Doctrine catafalque was the Falkland Islands war, where Reagan sided with his mate Margaret Thatcher against Argentina. At that time Argentina was governed by an unpleasant set of chaps, but a doctrine is a doctrine.

The Monroe Doctrine enabled American monopolistic practices. The notorious activity of the United Fruit Company coupled with the CIA inspired coup ended a decade of democratic rule in Guatemala in 1954, and probably had an accelerant effect on the Cuban revolution.

The problem with the Monroe Doctrine is that just mouthing the words “Monroe Doctrine” provides an apparently easy valid solution for Australia’s relationship with the nations of the South Pacific.

The suggestion recently that Australia participate in a more collaborative version of the Doctrine is confusing. If the suggestion is to develop better communication, more aid in the form of expanded health care and education, access to the Australia labour market to the countries of the South Pacific, I could not agree more.

But a Monroe Doctrine! No.  Let us get this out of our vocabulary.

John Gilbert. Who?

Recently Garbo was published. Robert Gottlieb has written about the life of the Swedish born actress, Greta Garbo, concentrating particularly on the period between 1925 and 1941.  

Greta Garbo

When I was young, and because she was still alive, Greta Garbo to me was a somewhat mysterious Swedish sea nymph; a beautifully coloured outline of what was once a wraith of some substance. She had become a recluse, and I wondered whether she would ever emerge. She was known for her tragedienne roles in a number of films, in both the silent and “talkies” eras. Yet why are people still interested in her? After all, she made her last film in 1941 and died almost 50 years later in 1990. Yet the books and articles keep being written.

I remembered her portrayal of Ninotchka, in a film of the same name. It was an American film released in 1939, just after the beginning of WW11. The film lampooned Stalin’s Russia. Even when I first saw it in my late teens, I had not realised her talents as a comedienne in her role as a Soviet apparatchik. The film has remained as one of the most memorable films of all time.

There are various reasons stated for why she keeps being remembered, as has been Marlene Dietrich. It is a strange situation, where most of the movie stars of the thirties are barely recalled, that memories of these two women remain. It seems that if you were still a “star” after the War, you are more likely to be remembered, especially if you have some unique characteristic – Garbo being a hermit and Marlene Dietrich with her vocal and visual magnetism.  Both maintained their beauty well before plastic surgery had created a line of elderly kabuki dolls among their contemporaries.

Both Garbo and Dietrich were beautiful in their finely contoured features, their dark beautiful eyes and their exquisite silhouettes. The thin pencilled eyebrows, the unremarkable yet perfect noses but encased in cosmetic paint and powder verging on excess. These women were of another age, where they could not be airbrushed. You can see pictures of these women and may wonder how they looked in the morning. Neither would disappoint.

Garbo is thought to have had only one genuine love. It was difficult to substantiate anything as crass as reality in the world where relationships were the stuff of Hollywood gossip columnists.

John Gilbert

The object of Garbo’s affection was an actor called John Gilbert. The only reason that name resonated with me was I remember my mother (who was hardly a film fan) would mention that she really liked John Gilbert. I never heard her say that about any other male actor. He was generally mentioned when my father would have a film night with his 8mm projector, which could only screen silent films, with much unintentional hilarity directed at the overacting melodramatics. It was quite a social occasion, as the film came in reels and therefore there were frequent intermissions while the reels were changed.

Gilbert to me, from his photos, was one of the vaguely repellent males, but popular in the Hollywood of the silent era, with slicked back hair, a pencil thin moustache and a dark, somewhat lascivious look – an exercise in black and white; whose looks today are fashionable among “lounge lizards”.

When Garbo and Gilbert fell for one another passionately on the set of Flesh and the Devil (filmed in 1926), the film director is quoted as saying: It seemed an intrusion to yell ‘cut!’ I used to motion the crew over to another part of the set and let them finish what they were doing. It was embarrassing.”

Garbo and Gilbert never married; there is a rumour that she fell pregnant to him. In any event, Gilbert’s career tumbled with the advent of sound. His voice was said not to be suitable, and with the steepness of his fall from matinee idol, he died in 1936 having drunk himself to death. Films in which he appeared are non-existent today; only the association with my mother made me stop and read about him.

Marlene Dietrich

The actress that my mother would read about was Marlene Dietrich, whose film “Blue Angel” is the classic melodrama of the manipulative woman leading the vulnerable man to ruin. Irresistible, Dietrich was quintessentially the uncensored Germany before the rise of Hitler, for whom she had a deep-seated loathing. Her renunciation of Nazi Germany and as distinct from Garbo her public profile developed after her shift to the USA and her work on its behalf during WW11 created an aura around her, a form of beatitude which followed her, while she lived life to the hilt.

Marlene Dietrich has always fascinated me. I always associated her with Berlin, the Berlin of the Weimar Republic. When I eventually went to Berlin, I found that city exciting. I thought of Dietrich, in that classic photograph, with top hat and lingerie. We don’t use the word “vamp” any longer.

Berlin did not disappoint. It is an entrancing place and sometimes I wished that I had been part of that “Cabaret” scene, a kind of straight Christopher Isherwood. Rather like Garbo. An oxymoron.

Signor Scarafaggio

Mentioning the Blue Angel reminded me of a time long ago when a group of us descended on this seafood restaurant of the same name in the inner Sydney suburb of Darlinghurst. The group had had a few sherbets, but the food at the restaurant at the time was very good, and the signature dish was lobster.

We were shunted into a backroom, presumably because we needed that space for our raucous members. Conversation flowed; wine flowed but there was some considerable delay in the menu. We sent emissaries out to see whether an avalanche had blocked the road to the kitchen

Then there was a lull. Suddenly people were pointing at the ceiling. “It’s not a plane; it’s not a bird; no, it was signor scarafaggio – a decent sized cockroach strolling along the plaster. Now cockroaches can be Australian, American or German squadrons.  However, the Italian name is the most evocative. Hence my use of the name, which I say with that mixture of malice and relish. There are a number of us who suffer from katsaridaphobia, Scarafaggio said with a curl of the lip that sends shudders down the spine of such phobic sufferers.

I have been a student of cockroach movements. They would take up residence or fly in through the open windows. To me the only good cockroach is a dead cockroach, and they do provide a certain contest as they accelerate from a standing start unpredictably and reach a competitive speed, although mostly if they are scurrying across the floor, the contest is unequal and they get squashed with a sense of triumph on my behalf.

Now on this occasion, this cockroach on the ceiling was issuing a challenge. I immediately clambered onto the table, and pivoting, one slip-on shoe in hand, I killed it – with only two substantial clouts required.

The smacking noise on the ceiling was sufficient to alert the staff to this killing.

We were served very quickly after that. The lobster was delicious.

Fortunately, as a footnote, Signor Scarafaggio fell on the floor clear of any of our group.

Mouse Whisper

The family had an extravagant meal on Friday night. No, it was not caviar; no, it was not truffles. It was a classic Caesar salad as devised originally in Tijuana.

The ingredient with its value in gold was lettuce – fresh, crisp cos lettuce. There was nothing left after this epicure meal.

Modest Expectations – Stereo on the Mountain

I have written this story before, but the proposal to increase the travel allowances of patients living in country areas of NSW reminds me of a story which appeared in my 1988 book “Portraits in Australian Health” released in the Bicentenary year, to my knowledge the only book which the Federal Department of Community Services and Health sponsored to honour this occasion.

It related to a long time general practitioner in a northern country town in NSW who, among his diverse interests and skills, was an expert in diseases of the eyes. On one occasion, one of his patients came to see him for advice. Apparently, the advice did not suit this person, and so he sought a second opinion. This meant travelling to Sydney by train, which took about eight hours, in order to consult the eye specialist.  This meant no mean effort.

Days later, he arrives at the specialist’s rooms in Macquarie Street only to find, as he entered the consulting room, there was his own country doctor who, at the time, was undertaking a locum for the specialist.

This is highly unlikely to happen today, but emphasised that just because one may prefer to practise medicine in a rural setting it is in any way different from practising in the city, apart from the technology. It just means getting the skill sets and the incentives right. But I admit that technology has in some areas supplanted a need for the same level of clinical skills, but that generality hides a much deeper discussion on its truth.

The doctor in the anecdote never lost his links with the city. When a doctor practises in a country town, he or she does so as an everyday member of the community and as the repository of the knowledge of the community’s health status, each person by person.  In attracting a doctor to country practice, the community must realise that the doctor must have his or her own space, his or her own privacy – the interaction between the doctor and community, which I once termed “tolerance” – a recognition of the importance of both sides of this interaction played out beyond the doctor’s rooms.

In so doing, another element of potential dysfunction is broached – that of professional isolation. Post graduate education is offered but availability is not the same as uptake. What worried me when I served as Director of Clinical Training was to get the professionals to interact with one another, even within the one practice. I have found collegiality helps in diminishing isolation, because sometimes I think many of my colleagues would prefer a sub-specialty of one.

Over years working in rural areas, it is tragic that I have seen the same mistakes being repeated over and over again. The classic conundrum is that of the doctor who complains about his workload, but when offered another doctor, recoils because of an unsubstantiated threat to income and as a threat to the power structure these long term doctors have created in their town. As a result there is a dearth of succession planning.

The other cultural problem, for which doctors are not to blame, is that the closer one town is to another the greater the rivalry and animosity, often demonstrated in the regional sporting rivalries

Awareness of the dysfunctions of rural life is papered over by the vision of an Acadian life, but despite the attempts at regionalisation, it is always the major regional city which collects the spoils and the rest of the region is left to its own devices. There are success stories; but always it seems there is a time when former patterns of dysfunctional behaviour re-emerge.

Having the will of successive generations of administration to maintain an open co-operative system requires the steely resolve of people like the Mayo Brothers, and how they achieved their success should be studied in every institution where health administration is taught.

“Tasting the winds, that are footless,
Waist-deep in history.” 

I love trees as obviously does Sylvia Plath from this above quote.

One of my most enjoyable times was driving between Bourke and Goodooga in Northern NSW with Stuart Gordon and Nick Mersiades. Stuart Gordon then was moving from growing cotton into the community services sector. He asked whether he could cadge a lift to Brewarrina, as Nick and I were going onto Goodooga to stay the night before proceeding to Hebel just over the NSW border in Queensland the next day.

Brigalow trees

What was unforgettable about this drive was the level of knowledge of the countryside those two blokes had. The bush was varied. At one point we would be driving through predominantly brigalow scrub but at other times gidgee scrub.

Gidgee trees are stockier than brigalow and have dark trunks, which, when they are cut, yield a yellow sapwood corona surrounding an umber core. Brigalow trees are taller. In the dry area, the green brigalow foliage becomes increasingly silvery, and in a breeze I thought it to be almost feathery like giant dowager boas.

Gidgee trees
Leopard gum

Interspersed among these stands of acacia were mallee eucalypts, and the incredibly beautiful leopard and salmon gum trees. The trunks of the latter were smooth salmon in colour and the leopard gum mimicked the spotted hide of the eponymous carnivore.

To me, crushing a gum leaf and smelling the eucalyptus oil is the most tangible reminder of who I am. Although I have been eligible for both British and Irish citizenship, however tempted, I can only be loyal to one country – Australia. Sometimes over the past decade it has been very difficult to assert such loyalty, but the sun always rises.

Some years ago, Thomas Pakenham, who is incidentally the 8th Earl of Longford, a disestablished Irish peerage, authored a number of books, among them extravagant pictorials highlighting the trees of greatest significance to the author. In the first of these, “Remarkable Trees” was an impressive arboreal array, including the oldest tree in the world, a bristlecone pine about 4,600 years old growing at an altitude of 3,000 metres in the White Mountains in California among other aged trunks in the aptly named Methuselah Grove.

Apparently there was an even older tree in which an enthusiastic geography student inserted and then broke a tree corer in trying to ascertain the age of a similar tree. The corer was valuable enough for the tree to be cut down to rescue the corer. The tree turned out to be 4,900 years old at the time of its axing.  It could be said that these trees have been dying for two thousand years, but none had been beheaded in search of an instrument. Two thousand dollars for the oldest tree – a question of priorities.

Yet there were Australian trees among his remarkable trees. One was the famous prison baobab near Derby in the Kimberley.  Another was the bunya pine next to a grand castle in Northern Portugal.  The height of this pine is comparable to the castle’s campanile tower. In our garden here in Sydney we have had a number of bunya pines which we once bought in the Bunya Mountains south-west of the Queensland town of Kingaroy.

Fortunately the remaining one still grows in a pot, saving us from worrying about a putative 45 metre tree overshadowing the whole of our front garden. Australia is thought of as being gum and wattle trees, but Australia is also home to many of the Araucaria relatives of the bunya pine, the most recent member of this genus being the Wollemi pine, named for the wilderness area in the Blue Mountains where it was first discovered.

This book was followed by “Australia’s Remarkable Trees” – another impressive pictorial. I once wrote to its authors Richard Allen and Kimbal Baker, pointing out that there was this remarkable tree at the corner of Punt Road and Alexandra Avenue in Melbourne. It is a huge golden elm at the intersection of these two very busy roads on the banks of the Yarra River.

The amazing element which I found as I entered the dense canopy, seeking an unmarked specimen of leaf, at a time when I was collecting the various glabrous leaves of these trees, was that when you were under the canopy your vision was only of the foliage. The outside world was blotted out. Branches nearly touch the ground, and others are propped up. Here, there was a tranquillity, and even though close by, the traffic noise was muted, although the smell of the dusty, dirty city does penetrate through the foliage.

Most of the foliage bore the scars of insects – it was mid-summer and cool under the foliage. Close up the imperfections in the leaves were very evident. But that is life. The tree appears in the book, and the authors suggest the best time to view the tree is in spring when the foliage is unmarked, a lighter shade of green than its companion elms. Given in Europe that the English elm has been almost wiped out by Dutch elm disease, Melbourne and also other places like Ballarat are major remaining strongholds on Earth of this remarkable tree.

All such books as I describe are based on informed subjectivity. However there is one thing binding all these trees and that is of a deep appreciation, if not awe, of the permanent diverse planet upon which we move about. Thus, when one hears of destruction, it is often a time when I mourn for this lost heritage, as if one has lost a member of the family.

Fire is an ever-present risk to our forests. For some slow growing trees like snow gums it is a ghastly fate, but for others such as banksia it is important for the generation of new stock. The greater danger is overlogging, which has dogged Australia throughout our history. It seems that if you are born Tasmanian, you are born an instinctive forester. A forester is OK; but an indiscriminate logger is a vandal. The stories abound of such destruction in Tasmania, which continually change the undoubted resilience of trees such as the trio of its indigenous pines – the Huon, king billy and celery.

Trees deserve our attention. They are part of us. The introduction of the deciduous exotica, which provide Australia with all the autumnal colour, is probably one of the positive contributions from the colonial Heritage.

Thus, many of us take trees for granted, and when we talk about trees, the appreciation of diversity is unfortunately limited to whether the tree is obstructing my view or not.

 A Virus in the Sand

At a time when the rise in the number of cases of Covid in Australia has been dramatic, the following article from the NYR shows a thoughtful perspective as it describes what the new medical graduate must expect. Much of the clinical experience of all these young health professional graduates would have been in a period when the COVID-19 pandemic dominated health care and the resultant priorities arising. I have read these thoughts, and the stark manner in which ICU practice has been affected in modern medical practice with the advent of a contagious disease dominating the acute patient load.

At the same time, there are the challenges presented by its persistence as the chronic disease in all its manifestations; such as the phenomena of active long COVID or dormant COVID reappearing decades later.

This is a virus which is both deadly and seemingly innocuous, depending on the particular individual response. Whether it creates a deep ravine in medical practice, between infectious and non-infectious disease will ultimately depend on how the organisation of the health care system changes both now and after the pandemic has waned– the resurrection of infectious disease hospitals for instance.

An illustration of the growth in COVID cases

Paradoxically, Australia has spent a considerable amount of money on health institutions, often driven by clever marketing of sub-specialities, with an advocacy group of those affected by the particular condition and their relatives, especially if the affected person has a strong public profile.

The level of sub-specialisation and the disproportionate incentives for this to occur only serves to magnify the cost of health care. Children are an irresistible magnet for funding; and beware any attempt to interfere. Try a review of funding for childhood cancer – impossible to review objectively as to cost effectiveness because of the emotional halo.

A subspecialty exists because, through skill or advocacy, it has carved itself away from a perceived drudgery of general practice. This view has been increasingly encouraged by the various deans of health sciences in universities, where excellence is determined by the amount of research funding and by the number of citations, notoriously subject to gaming.

This obsession with rankings based on the alleged quality of research has been increasingly dissociated from the prime reason for universities to exist – and that is to teach each generation of students in the best available environment. Plus, may I add, not to have half the Faculty away on overseas conferences, on sabbaticals and/or time spent in private practice and outside consultancy work. This state of affairs is hardly conducive to healthy pedagogy.

The doctors who are finishing residency now have completed most of their training in a world without robust family presence. They learned to become doctors to patients who are intubated and under deep sedation, behind closed doors, in a world of masks and alongside the fear that if they are not careful, their patients could make them sick.

Back in my own training, we used deep sedation and paralysing medications infrequently, as we knew that these decisions came with a cost: delirium, long-term brain dysfunction, profound weakness. But today’s doctors in training have learned on Covid patients. When we were uncertain what to do, particularly early on, we reflexively jumped to deep sedation as the answer for them. These are patterns that are hard to unlearn.

And beneath it all is the continued spectre of the virus. Though I did not have a single patient with Covid-19 during my recent weeks in the unit, from time to time, we would receive a message alerting us that one of our patients had a Covid exposure from a staff member who had tested positive and would have to be on precautions as a result. Patients and families were once terrified by this news, but now they are largely used to it and seem reassured that the staff are masked and so any meaningful exposure is unlikely. This is another aspect of our new reality.

To think that a possible Covid exposure would not cause panic is itself a sign of great progress. But at the same time, we are so far from where we thought we might be by now. When I walked through the halls of the Covid intensive care unit back in the spring of 2020, I told myself, as did so many of us in health care, that we would improve care for those who were disproportionately impacted by this virus. The systems to which we had become accustomed would be dismantled, and we would find ourselves somewhere better.

But those sorts of promises are naïve and empty without a plan for how to make and sustain real change to protect the vulnerable among us. So here I am, back in the unit, caring for a patient with severe cerebral palsy, who had aspirated his own secretions and developed a life-threatening pneumonia. His aging parents had done the best they could despite limited resources, making sure to turn their adult son on his side multiple times a day to help him cough, but his muscles were too weak. And now he would require a tracheotomy tube for the rest of his life. I know, talking to his parents, that it is possible that their adult son will not go home, that they will not be able to afford the kinds of services he needs. When and if another virus comes, the son they cared for at home for three decades might be living in precisely the kind of nursing facility that will be decimated by it. It’s easy to feel that the tragedy only repeats.

But then again, in just a few weeks, a group of newly minted doctors begin their internships. Medicine is strange like that, a new generation every three years, and with it a chance for reinvention. They will find themselves in a hospital in transition, in a country that has suffered more than a million deaths. We will teach them about all of it, about how to manage sepsis and heart failure and trauma, about the pandemic and how it was before. And for a moment, maybe, we can step back and see it all through their eyes — the nervousness and the excitement and, more than anything, the hope for what is to come.

Oolong or Earl Grey?

In a previous blog, I worried about the many deficiencies in our approach to the other nations of the South Pacific.

The Chinese might have the money, but Australia has the advantage of Foreign Minister, Senator Penny Wong, who has turned disdain to genuine respect for our South Pacific community. This has been coupled with a change in the Government’s attitude to climate change, to make it easier for the Australian government to adopt a primus inter pares role in the South Pacific area.

Every nation in the South Pacific has been victim of colonisation. China in its entry into the South Pacific is just another coloniser, although the gunboat may be muted, the offered funding comes clutched in a mailed fist.

Therefore, the European countries have been a major factor in the sometimes idiotic distribution of their colonies. Does it make sense that the Western part of New Guinea has been hived off into Indonesia just because it was once the furthest outpost of Dutch colonisation.

One remnant of Portugal’s worldwide speckled colonisation is the Republic of Timor-Leste, whose isolation in a region of muted hostility makes it not unexpectedly seek a powerful ally, such as China. Previously East Timor, as it was before Independence, has always presented an anomaly. Whitlam was worried that East Timor, if it received such independence, would present a risk of an Arafura Cuba.

However any hidden intervention then has been well and truly trumped by the disgraceful behaviour of the Australian Government, as described in the Crikey newsletter namely the bugging of the Timor-Leste cabinet, the motives of the Howard government in its tactics towards the fledgling state, the subsequent decisions of the then foreign minister and then DFAT secretary to take jobs with the biggest beneficiary, the abuse of intelligence agencies for corporate espionage, the attempts to cover up the truth of the bugging and the vexatious attempts to punish those who exposed that truth, amount to the greatest scandal of recent decades.

Cristo Rei, Dili, Timor-Leste

Successive Australian governments have concealed such chicanery that will make any long term relationship between the Republic and ourselves very shaky. Australia has a substantial Timorese population in Darwin, and having been there just before the pandemic, it was to me clear how much the Chinese were investing in the Timor-Leste infrastructure. While the Republic shares the island with Indonesia, it is also a short boat ride from Dili across to the Indonesian island of Alor, part of the extended archipelago of the Southern Sunda islands, one of which Bali is 1,600 kilometres to the west of Alor.

Setting Timor-Leste aside for a moment is not to ignore its importance in a cohesive Australian South Pacific strategy lacking up to now.

Apart from a perception of the Chinese being a new colonial power, one of the points of differentiation is for Australian government ministers to cease to act as colonial masters. The Chinese have difficulty in hiding their sense of superiority, which grates, and in the end makes their presence in the South Pacific unpalatable. Nevertheless, mate, money takes away any distaste.

As I wrote about Andrew Peacock’s actions when he inherited the Ministry of External Territories, he immediately treated the New Guineans as equals, so evident in his relationship with Michael Somare. His predecessor was an old school Country Party politician, who viewed coloured people as inferior. After all, we’ve lived through a long term White Australia policy, and it is testimony to countervailing factors which have assured our role among out neighbours – not the least of which was our generation in speaking out against such a policy.

One of these factors binding us together undoubtedly is rugby; and with that New Zealand and its indigenous Maori population provide a vital bridge to Polynesia. This the Chinese do not have,

Our mutual Anglo-Celtic background provides a deceptive similarity of Australia with New Zealand. Yet it is in part mirage. As one who has headed a hybrid Australian and New Zealand organisation, I found the countries to be very different; the two nations respond differently to external stimuli. As with all neighbours, there is an accumulation of negative factors, which will intrude into all the positive aspects, unless we both recognise and deal with the differences immediately. Recently in her new role, Penny Wong has ably demonstrated with her embrace of the NZ Foreign Minister, Nanaia Mahuta, with her facial moko, her ability to confront the cultural differences. Whatever may be unstated, facial tattoos are confrontational for a country not steeped in Polynesian culture as New Zealand is.

Melanesia, as shown by the Solomon Islands treaty with China, exhibits our vulnerability; this is intertwined in our relationship with Papua New Guinea. Papua New Guinea is a nation borne out of strong colonial links with Australia, both direct with Papua and by the acquisition of a mandate of the German colony of New Guinea after WW1.

Our indigenous Aboriginal people are represented in some of the Southern Sunda islands but more as an anthropological curiosity than as any cohesive force.

There are the Torres Strait People and here the Australian border with PNG provides a problematic divide. Then there is the collection of South Seas islanders – the descendants from the nineteenth century kanaka trade. Predominantly men from Vanuatu, they were press-ganged to work the cane fields of Northern Queensland, and Mackay is where many of the descendants remain. They have their identity, their flag but are not recognised in the same way Torres Strait Islanders are recognised. Only a small fraction of white Australia has ever met a Torres Strait islander. Yet some of the greatest rugby league players have come from both Torres Strait and South Seas Islanders.

On the other hand, the Solomon Islands were always a British colony before independence in 1978; and the Republic of Vanuatu was born from the New Hebrides condominium arrangement between Britain and France in 1980.

France remains the only European power left in the South Pacific and there is no indication that it will leave soon. One of the lessons was our ability to mobilise against the common enemy – this was the French when they were conducting nuclear testing in the South Pacific. We ran a meticulous campaign against the French and, given its modest funding, was very successful if judged by its impact among some of the South Pacific nations, remembering I was fronting an Australian and New Zealand organisation.

One area of which both our nations are guilty is still the magnetism  of Great Britain, even though despite some Whitehall protestations, Britain has long since vacated the South Pacific. The AUKUS arrangement  is redolent of a backward looking, nostalgic stream of thought.

Hopefully  as an early priority Wong will not rush over to the “old Country” to tug the forelock or have tea at Windsor. Fortunately, she seems to have left that to the emissary of the old huntin’ and shootin’ brigade, garbed as an Edwardian remnant of Albion humankind, a man whose name conveniently rhymes with dandy. Leave the UK to these people and let’s get on with dealing with the actual challenges of our region.

We marshalled the forces against one form of climate change 25 years ago. The challenge presented by climate change is far more serious and instead of AUKUS, how about a South Pacific alliance against the great polluter, China. Unfair characterisation? Fairness is not a major constituent in Chinese foreign policy. I am sure that matter is foremost in the Penny Wong mind.

Some are advocating Australia enact a form of the Monroe Doctrine. Next blog I shall discuss this proposal, given it seems to have some currency.

Mouse Whisper

Have you noted those advertisements, where the dentist has his back to the viewer, brandishing what is ostensibly a tooth brush. If you look in the mirror, there is no reflection of the dentist.

Now what a subtle advertisement. Toothbrushes and garlic toothpaste?

As some other rodent has said: “Real vampires do exist – they are life sucking people that are narcissistic, greedy, selfish and vain. They take from you as much as they can. They “seem” to be friends and offer you pleasure and beauty but they take your life. They cannot see their reflections because they portray someone other than their true self.”

In the end, as they say, this is no reflection on anybody.

Modest Expectations – Lionel Messi

The recent visit of the Prime Minister to Makassar in the Sulawesi, reminded us of the links of the Makassan traders with the northern Aboriginal people well before European discovery. It is a neglected area in the study of the cultural influence of these people.  Thus, I thought it interesting to reproduce below a bark painting which I bought some years ago on Mornington Island in the Gulf of Carpentaria. You be the judge of the cultural influences at play in this painting. 

In a tortuous vein

I had a pleasant surprise the other day. This is a lesson in clinging onto a view of what you think you know, and what is in fact reality. You may be dying, but you think tomorrow you will be better. I was reminded of the time leading up to the diagnosis of my underlying disease nine years ago. There was a delay in instituting therapy, and I was largely to blame – but not totally.

This time, my legs have been beset by increasing peripheral oedema, two swollen angry red calves and feet, compounded by the sub-fascial swelling on the soles of my feet.

Overnight, the swelling has always decreased, but the level of that reduction in oedema has slowed since the start of the pandemic because of weight increase and closure of hydrotherapy facilities. I dislike exercise especially if it is painful. Hydrotherapy provided a relief from the pain. My legs began to become more and more oedematous. Nobody offered the panacea I was looking for.

Over this period, there had been mention of vascular specialists and compression stockings but, as I now realise, I need for those who advise me to be assertive and not be ambivalent. The latter gives me an excuse for inaction.

I visit a plastic surgeon, who regularly checks me for skin lesions. I mentioned my legs; and once he saw how bad my legs apparently were, he said he had a vascular surgeon colleague whom I should see urgently.

Nearly ten years ago, it was an orthopaedic surgeon who looked at me, ordered tests, and by the next Monday, due to a fortuitous cancellation, I was able to see a consultant rheumatologist, who immediately confirmed the diagnosis the orthopaedic surgeon had considered, but which had been missed by a variety of other doctors. I might add I had seen another orthopaedic surgeon a week or so before and he offered to replace my knee joint almost immediately without any tests. That is the danger of being referred to a specialist, who may be technically brilliant but would have most certainly have ensured a very stormy post-operative passage for myself.

On this second occasion, it was a Thursday afternoon, and by Monday morning first thing, I had an appointment to see the vascular surgeon.

Now this vascular surgeon is young. He shares a clinic with three others. To the best of my knowledge he is not owned by an American hedge fund. He is actually into the business of helping people, not trading a commodity for financial gain.

Vascular ultrasound image

Under one roof, I had an ultrasound of my lower limbs’ vascular system, a consultation where the specialist did not expect to sit across a desk in a consulting room – inspected, interacted with the allied health professionals, recommended compression stockings. These and the applicator were on hand and my wife was taught the optimal way the stockings should be applied. As she said, looking at me meaningfully, she did read the instructions and watched the video in addition to the initial demonstration.

All in less than two hours – a one-stop shop. We had the compression stockings and the applicator.

Here was a local product where any Medicare benefits paid remained onshore, able to be reinvested. How different to those diagnostic imaging and pathology companies allegedly repatriating Medicare payments overseas.

Over 20 years ago, the Australia Institute in a discussion paper analysed the growth of corporate medicine foreshadowing the decline in standards as the profit motive became the prime driver in health care.

As the growth of corporate medicine grew so did Medicare become the ATM, not only for private entrepreneurs but also for the States, which were up to their filing cabinets in cost-shifting. As many of the purchasers were underwritten by overseas investors, the consequence increasingly will be that Medicare funding, which should remain in Australia, ends up in overseas tax havens.

The problem is that the medical profession has ceded control and hence independence to its corporate masters. As somebody who was involved in the various Inquiries in the regulation of the Medicare Benefits Schedule, I have always regretted that the AMA gave up this privilege, which meant that there was not any regular mechanism to alter the Medicare benefit, which was constantly misrepresented as a fee rather than a financial patient benefit the government provided for payment to the doctor.

During my time at the AMA, the discrepancy between the Medibank (then Medicare) benefit and the fee charged was symbolised by the AMA annual recommended list of medical fees. This was a guide, not an instruction by the AMA. Nevertheless, it maintained a relevance, which has only persisted after the introduction of gap insurance when the private health funds, initially prohibited, were able to re-enter the medical insurance market.

John Deeble, Medicare pioneer

After 1984, when the AMA abandoned the regular fee for Medicare benefit Inquiries, it became a matter for every medical specialty to negotiate for themselves. The problem for some of the medical specialties was a function of what happened following the Nimmo Inquiry in 1969 into health insurance which was that benefit relativities were based on what were the fees charged by each specialty; and these relativities naturally created distortions in the market as technology made a number of items of service much cheaper to perform. In 1977 it was clear that technology advances with automaton replacing manual testing was enabling pathologists to make a bonanza from Medicare payments. This Inquiry into the Pathology Medibank Benefits was the first instance of government intervention into these relativities.

The AMA, through the Inquiries, had effectively maintained control over relativities. It provided a form of “flawed order” even though some of the Medicare benefits were well in excess of the underlying cost of the service while some other areas of the profession had done badly.

Thus, from an exercise where the AMA and the Government were in an edgy if not directly confrontational relationship, then there was none.

As I found out henceforth from the AMA relinquishing its position, it became a matter of having a good cost accountant to negotiate with government. With the growth of technology, while the value of the professional component of the medical service remained important, in some areas of the service there were both a substantial technical and a capital component. The “technical” component includes the cost of the scientists, the technicians, the allied health professionals including nurses required to provide services which were not medical, and “capital”, such as the cost of linear accelerators, MRI facilities and so forth.

Not all capital costs are covered. For instance, disposables were inherent in the delivery of the professional component, and not differentiated into any of the other Medicare benefit components. In fact, most of the cost of these has been borne by the hospital. Even now re-usable devices and prostheses lie outside the cost of the service.

Enter the world of the entrepreneurs, more interested in cash flows and profit rather than patient care. Some of the first were medical graduates, like the criminal, the late Geoffrey Edelsten, who gave the whole area a bad name; but it is the multinational companies that have moved behind a wall of cost accounting to dissect the Medicare schedule to exact the greatest profits, and in so doing, to enable Medicare funding to be sent to tax havens overseas.

Some may say how outrageous such a comment is; but the easiest way to deal with Medicare funding is to prohibit any profits that those companies who benefit in any way from exporting those profits.

This vascular surgeon, whose expertise spreads far wider that just advising on varicosities, demonstrated the one-stop shop advantages, which I frankly did not expect, and another fact – you don’t need to run late if you are a doctor.  And you do not need to be a multinational corporation; his rooms were modern and located within a religious hospital.  Good God, on second thoughts, located in a multinational corporation!

Such a thought in no way diminished my satisfaction with the service.

I, the Cryptosexton

I read about this complicated thing called Cryptocurrency. After riding the Algorithm Hobbyhorse around in my Virtual Nursery, I realised that cryptocurrency must be like a bit of barter behind the tog room at school. Hidden from the authority, a packet of Senior Service for two packets of brown Capstan; but not requiring the electrical power requirements of a small city to accompany the transaction.

But this cryptocurrency surely must be more complicated than that, and thus have more benefits.

Apart from plugging cryptocurrency into the cyptocharger, I decided to call it Tulipcoin. I was tempted to use “Lillionarcissus-coin”, which was the name for “tulip” before this Turkish corruption of a Persian word for “turban” was adopted. But that name was too long, would use too much power.

I thought by calling my cryptocurrency after such a famous flower, irrespective of the corruption implicit in the name, I would honour a previous occasion which may have arisen in a crypt.

Jan Breughel the Younger’s view of tulipomania

The whole saga of the tulip bubble was well expressed years ago in the 1999 book “Tulipomania”. The basic cause of the exorbitant prices which the tulip bulb reached in sixteenth century Netherlands was somewhat eccentric. A Flemish merchant found tulip bulbs in a cargo of cloth from Istanbul, thought they were onions, ate most of them and planted the rest.

The resultant blooms were overwhelmingly beautiful and attracted the eye of wealthy Dutch burghers.

The tulip is thus the most captivating of flowers, and like so many products of the Levant, this was the favourite flower of Süleyman the Great, who not only cultivated the wild variety but also initiated the science of breeding hybrids.

Thus when the tulips bloomed, the Dutch, who had the time and were a very wealthy nation due to their trade in the East (the Dutch had a monopoly on nutmeg for instance), were intoxicated by the flower; and the tulip became the signature of these prosperous people.

As was written in Tulipomania: “In 1633, the flowers served no economic purpose other than relieve the cold wet spring with petals that promised a change from the grey mist”.

Initially they were not only desirable but scarce. They attracted gardeners and the few connoisseurs, where scarcity was compounded by the search for perfection. At one stage when a skilled worker could expect 250 guilders in a year, a single tulip bulb was traded for over 5,000 guilders. A small basket was worth more than an Amsterdam mansion. It took three years for the bubble to burst, which it did in a spectacular fashion in 1637.

One of the reasons for this was that many of the tulips had been infected with a virus, which did not necessarily diminish the spectacular colours but certainly lessened the life of each infected bulb. What’s more by that time trading in bulbs had spread throughout the community into every tavern across the country. One of the supposed benefits of cryptocurrency is to be able to bypass “stodgy banks”. Just like being able to buy a cheap TV at the local pub.  But here it was the tulip bulb.

The value of the bulb during this hectic three period provided a way to extricate oneself from, if not poverty, at least to being able to afford a decent house -only if you sold early.  However, given where many of the transactions took place as the author of Tulipomania wrote: “The trade was conducted for the most part in a haze of inebriation.”

How appropriate! My Tulipcoin placed into such a market – drunk with power but where the mist has yet to lift?

Reprise

I wrote the following italicised in my blog on 15 January 2021 in a vain attempt to promote Craig Reucassel to stand against Falinski. My sentiments yet have been reflected in the deserved dumping of this Morrison sycophant, despite all the protestations.  Subtly, my choice reveals my deep-seated prejudice, born of over 80 years in a male-dominant world. I suggested that a high-profile male with a formidable record in climate change and waste management should mount the challenge. I discounted the fact that he lived far away in the Sydney inner west.

Dr Sophie Scamps MP

I congratulate Dr Scamps (pronounced Scomps), who has been a high-achieving, very well qualified general practitioner who both lived and practised in the electorate, before successfully challenging Mr Falinski in the recent Federal election. My sense of his vulnerability was correct, but I got the gender of the new Member for MacKellar wrong.

I would suggest one of the New South Wales’ seats held by one of the Trump neophytes would be perfect for him, given that upending Abbott showed the way to do it. Maybe Falinski, whose seat is MacKellar, would be the way to go. Falinski is the typical Liberal Party hack toeing the party line.

As Falinski said in his maiden speech full of the pieties expected:

And so a politician is accountable to their community – I am accountable to you.

Mr Jason Falinski

Wrong, he is beholden to his masters, never voted against any government.  He has a voting record which would please Donald Trump – he should be vulnerable to somebody with the Reucassel values. I would love to see them debate why, for instance, Falinski has inter alia disagreed recently with the proposition:

“The Prime Minister to attend the House by 2 pm Tuesday 8 December to make a statement to advise the House whether Australia is speaking at the Climate Ambition Summit and table any correspondence with the summit organisers relating to whether Australia is speaking at the summit.”

This is but one example, but Falinski’s voting record is reprehensible to any person who is genuinely Liberal.

Reucassel is genuinely concerned with climate change and the world becoming a rubbish dump. He should be elected to Parliament to pursue this goal and hold the government to account.  Falinski seems unwilling to do so. Is it Mitch* Falinski, or is that your second name?

*Mitch stands for that annoying Kentucky Senator, who pleads propriety but unquestionably has supported Trump. Dr Scamps reminded the electorate of the false nature of the so-called moderate Falinski’s voting record.

Janus was an EU Politician with the head of Boris Johnson

As an impotent observer of world affairs, I fret over the ambivalent attitudes of politicians over the fate of Ukraine. Angela Merkel defends her legacy in stalling the entry of Ukraine into NATO by saying that, at the time in 2008, the Ukraine was controlled by a pro-Soviet Government.

The root problem was that most governments wanted Zelensky to disappear into some hedonist exile, and he has proved to be very inconvenient.  He wanted to defend the sovereignty of his nation. Suddenly, the Ukrainians had a leader, an uncompromising charismatic leader who, in a matter of 100 days, has differentiated a country from the neighbouring Russians. The ferocity with which the Ukrainians have responded to the Russian invasion contrasts with the bloodless coup where Russia took Crimea back from the Ukraine eight years ago, and have defined a country, which no matter the outcome will never again be just a “Little Russia”.

Zelensky has thus created that which most Ukrainians have always believed; and that is Ukraine as an independent nation. He has ensured this affirmation occurred in the full glare of the World spotlight.

Putin has been revealed as a primitive hominid intent on destroying the world’s energy and food supply as he dresses up as Peter the Great, an absurd travesty of the human condition.

The New York Review of Books provide a comparison of sorts in critiquing yet another book about Anne Frank. The contention is that if only the same courage epitomised by Zelensky had been on display during the time leading up to Anne Frank’s death in a Nazi concentration camp, she may have survived. As has been pointed out, because of the lack of any ongoing focus on Dutch Jews in particular, she was always in peril.

Anne and her Diary

As part of the analysis, a harsh judgement was made about Queen Wilhelmina in that she failed to stand up to the Nazis and fled to Great Britain. She had maintained Dutch neutrality during WW1; but the only indication of her attitude to the plight of Jews was she insisted a Jewish refugee camp prior to WWII be moved further away from her summer palace than it was originally planned.

The American Government declined to give the Frank family a visa to travel to New York via Cuba in 1941. It provides an unsettling view of a country, with a quick trigger for invading non-European countries, and yet basically ambivalent against European aggressors. President Biden’s halting support of Ukraine could be the USA in early 1941. The Allies did not bomb the railway lines to Auschwitz. A matter of unimportance in the scheme of things!

Russia seemed to have infiltrated the top levels of government, politically, socially, financially, corruptly – a passage facilitated by Trump and scattered within the Conservative Party, those that worship the Infantis Johnson. However, there would not be a country in Europe where the malign Putin influence has not infiltrated.

As a result, maybe NATO could imprint the head of Janus as an emblem in acknowledgement of this influence given the way they have responded to the Russo-Ukrainian War.

Mouse Whisper

I was on a field visit when I heard a regional ABC reporter talking to a local farmer about the cost of a box of cauliflowers. He was selling them for $80 a box.

“What was the usual cost?” she asked.

“About $20 a box.”

“Oh, they’re double the cost then.”

Good to see the ABC is maintaining its standards.

Great value at twice the price, or is that four times?

Modest Expectations – Doug Taught Hereabouts

I don’t often start my blog with a straight lift from another paper – this by the distinguished journalist and author, Joan Wickersham.

This is a story about a library in Vyborg.

Given the status of Vyborg, essentially a Finnish city absorbed by a gluttonous Soviet Union at the end of WWII, it provides an insight into how the Russians with Putinic tendencies conceive their view of the world – in this case neglect. However, underlying this neglect was its fortuitous survival of the scorched earth way in which Russia wages war. This normally results in a wrecked landscape which the Russians have neither the intent nor the money to rebuild. This will be the result of his current intent to ensure that the western littoral rim of the Black Sea is in Russian hands, despite the destruction meted out to the Eastern Ukrainian cities.

In the story below it was, until the fall of the Soviet Union and its release from the sullen adversarial conformity in which Russia had been plunged by Stalin that  co-operative work to restore the Aalto masterpiece occurred. It was a time when the deep xenophobia that characterises the mindset of Russians was temporarily dormant.

The Amber Room in the Summer Palace, two hours’ drive South of Vyborg in St Petersburg, is testimony to Russian skills when they want to use them. After all, the Germans dismantled the Amber Room, and it was not until 1979, that the reconstruction of the room commenced, guided by two remaining original items: a single box of relics from the room and 86 black-and-white photos of the space, taken just before World War Two. It took 23 years, but it showed a determined creativity to restore, when Hitler had decided to destroy the best of Russian heritage.

In the article below, the co-operative effort between the Russians and the Finns led to the restoration of the building depicted. After all, for many years if you looked at any hospital built in the interwar period, they had the stamp of Aalto; worldwide he changed the design of hospitals from gloomy buildings where the Florence Nightingale wards were Queen in hospitals where the light could only shine fitfully. Aalto’s creations were far more appealing and, moreover, airy and far more hygienic than their predecessors.

I disagree with Ms Wickersham’s passive neglect ending to her article. Humans create and humans destroy. There is an equilibrium, which provides the opportunity for the world to recognise the need to preserve it for the next generations – knowing in the distant future the Sun will burn itself out and with it, this dependent planet.

However as for Putin, like all megalomaniacs, it is not in his or our remit to deliberately hasten the process.

Viipuri Library

The Viipuri Library, one of the great early masterpieces by architect Alvar Aalto, used to be in Finland. Since 1940, it has been in Russia. The library didn’t move; the border did.

The library was a fluid creature almost from its inception. Aalto’s initial scheme for the building won a design competition in 1927. At the time, he was a promising 29-year-old architect who entered a lot of competitions and rarely won. Finland was a young country, having declared its independence from Russia only 10 years earlier.

After Aalto won the competition, the construction of the library was postponed when the great worldwide economic depression halted new projects. By the time the library client came back to him several years later, the site of the prospective building had been changed. Aalto had also matured and changed as an architect, rejecting the classicism of his earlier design in favour of a more modern Functionalist style, which displayed an airy lightness and asymmetry.

Working together with Aino Aalto, his wife and design partner, Alvar Aalto came up with a new design introducing elements that would become characteristic of his work: a grid of round skylights that let natural light pour into the building; and, in the lecture hall, an undulating natural-wood ceiling. The library was finally built and opened in 1935.

Then, in the winter of 1939, Russia invaded Finland. The Finnish army fought them to a standstill but, as a condition of the peace treaty, Finland had to cede to the USSR the eastern territory, which included the town of Viipuri, now renamed Vyborg. Seventy thousand Finnish citizens were permanently displaced from this border region and moved westward across the new border into Finland.

In 1941, war broke out again between Finland and Russia. Control of Viipuri/Vyborg went back and forth between the two armies; in the fighting, most of the town’s buildings were destroyed. After the war, Finland was forced to accept the 1940 boundary that made Vyborg part of the Soviet Union.

For many years, with communication and travel all but impossible, people in the West knew nothing about the fate of Aalto’s library. After the fall of the Soviet Union, Finnish architects were able to learn that the building had survived. It had been abandoned for 10 years after the war, an empty shell stripped of its contents and left to deteriorate. In the late 1950s, a limited renovation had allowed it to reopen as a municipal library, but it was only a shadow of what it had been.

Starting in 1991, Finnish and Russian architects got together to advocate for the restoration of the library. Drawing heavily on the expertise of Aalto’s widow and design partner — his second wife, Elissa — they gathered the resources to painstakingly restore every detail of the original design, down to the furniture and door handles. It took them 20 years. After the restoration project’s completion, in 2013, the library was hailed by the World Monuments Fund as “a stellar example of international cooperation.”

I learned about the Viipuri Library in 2019, when I visited Aalto’s studio in Helsinki. There was a small exhibit of photographs and drawings that included a timeline of the library’s history. How amazing, I thought, that this building could be lost and then found again, could be built and then neglected and then restored.

Now the library near the border seems like a testament to both durability and fragility. It doesn’t move, but the world keeps shifting around it. Things fall apart and get rebuilt. Things get built and fall apart.

Ron Castan

But while I wish I could say I knew Ron Castan, I don’t think that would be entirely honest. I feel deeply connected to the idea of him, as much as to the man himself. It seems that the true memories I retain of him are like a single grain of sand, sitting in the centre of an oyster. Alone, they are almost invisible – tribute from grandson Samuel Blashki

I was discussing my youngest grandchild’s future with him. He is a very bright youth in his penultimate year of school. Life is, I said to him, a mixture of experience and tribal links, coupled with intellectual, rather than just academic, achievement plus the accumulation of social capital as well as wealth or not. All form the basis of networks, which grow and then peter out as inevitably people move away or die.  Some of these links are more resilient than others.

There is a need to actively cultivate these networks even if, in the course of existence, you rarely see some of those in the network, but when you do, the link is restored as if only a day has passed since you last had contact.

Ron Castan

One such person was Ron Castan, and how relevant it is to remember him on the day when Australia celebrated the contribution of Eddie Mabo and the challenge to the concept of terra nullius. One of the major people behind Mabo was Ron Castan, and when the Aboriginal people are discussing land rights, I hope they will remember Ron Castan. There are a number of memorials to this remarkable man, who tragically died when still having so much to give. In particular it was a travesty that Ron was never made a High Court judge, but it was at a time that the Meanness virus was beginning to infect a Coalition which then bought to the nation one Dyson Heydon, hardly the cynosure of legal practice.

Ron Castan was a member of the University of Melbourne Students Representative Council, he a representative of the law students and myself one of the medical student representatives in 1959/60. A year was enough for Ron, but one distinguishing feature of Ron then was that he drove an American “tank”; it may have been a Cadillac, it was one of those cars that you would expect had the backseat crammed with Hollywood starlets.

Otherwise, there was nothing startling about our relationship, but some of my friends, erstwhile or not, thought I was red but turned out working for the blue – there was a tendency to look askance.  Whitlam was leading an intellectual powerhouse to government. Unfortunately, that was a myth, but for a time a well-concealed myth.

I assumed Ron was a Labor supporter, but never asked. It was not important.

Ron agreed to propose my own son’s admittance to the Victorian Bar. I had not realised what a privilege it was to be proposed by a Queen’s Counsel no less. Ron was very matter-of-fact when I asked him that, yet as I ever delved into questions of legal importance, he became very much a stickler for actual meaning.

Even though I saw him rarely, it was my initial impression which stayed – that of the thoughtful man with the dry sense of humour – and the deep set eyes, which gave him the expression of a raccoon.  But the eyes laughed even when I had made such an outlandish statement.

I remember him inviting my wife and my son and his then girlfriend for a family Friday night Shabbat meal. Ron wanted to pick my brains on the medical course, which apparently his son-in-law was contemplating at the time.  Not that I have been invited to many Shabbat, but I have found such meals, so quintessentially family oriented, always a privilege.

There are two portraits of Ron Castan among the National Portraits collection. One was of him relaxing apparently reading a brief; the ability to exude a sense of physical rest while in a brown study of mental studiousness. That is the Ron I remember.

The other portrait depicts him as if he were in a French film noir, complete with trench coat, beret and dark glasses. Totally convincing, if you did not know the man.

Having reflected on the future with my youngest grandchild, I read the paean of Ron written by this grandson, who hardly knew him, but exudes a sense of admiration as the amanuensis for his long list of achievement.

He certainly merited a black heart, the highest award a whitefella can achieve in the eyes of the Aboriginal people, and if a bar is given for such an award, Ron would have merited it also.

And his grandson certainly thought so; if only my grandchildren would remember me so eloquently.

Benvenuto nel mio incubo

I was going to ignore Dutton this week, given how irrelevant he is to the Normal Australian. However, his comments about the electorate of Hume I could not let pass. This electorate was retained by that other “pin-up boy”, Angus Taylor, in an electorate which is mostly rural but centres on Goulburn, which to me is at the pinnacle of Irish-Roman Catholicism of conservative persuasion.

The city is located in a very wealthy area, grown that way on the back of sheep. I remember one afternoon flying into one of the landed gentry homes near Crookwell, which is in the Hume electorate. I doubt even among the vassals and serfs on the estate, there would have been a Labor vote in the grand house where we were literally served tea and cucumber sandwiches. Yes, here was the country seat for New South Wales Pioneers and members of the Australian Club.

Hence, I was not sure what point Dutton was making when he said that Hansen’s One Nation Party had obtained seven per cent of the vote in Hume, which was much the same as the Informal Party; and the $100 million man Clyde Palmer, whose projected Prime Minister held the adjoining seat of Hughes until election day, received about half that number. Dutton should take one lesson to heart – if you are poison, stay away from the electorate. It obviously served Hansen well.

Now let us have a look at the figures, since Dutton has used the example to justify, as reported, an electoral “pissed off factor” in an election which he so vividly concluded as “a pox on both your houses election”.

The Greens did not do well in this electorate but there was an independent, Penny Ackery, who received 15.5 per cent of the vote. She showed herself as a bit of a petrolhead, but was retired teacher, in the age range of the successful “teals”, had lived in her community for 30 years, personable well-dressed reflecting muted affluence. In her manifesto she rejected all outside funding, stressing she was the “community candidate”. One wonders that if she had been Teal, would she have shaken the Taylor complacency by finishing ahead of the Labor Party.

After all, in the allocation of first preferences, the Labor Party received just less than 20 per cent of first preferences which represented a fall of six per cent. Taylor experienced a drop of ten per cent; and after distribution of preferences Taylor moved to 57 per cent of the vote while the Labor Party candidate moved to 43 per cent. Taylor picked up about 15,000 of the preferences and his Labor Party opponent picked up 23,000; overall a swing to the Labor Party of 5.4 per cent.

Therefore, Dutton should not be too chuffed – whether it be “Hume-bris” or not.

Blowing in the Wind

Storm approaching Melbourne

In the last week, a huge burst of pollen swept across Massachusetts as reported in the Boston Globe. The photographs are graphic, outlining a yellow pollen fog discolouring the landscape.  It reminded me of a similar phenomenon which occurred in Victoria in November 2016. Commencing in the Mallee and spreading quickly across Victoria the strong wind gusts reached Geelong and moved quickly over Melbourne’s metropolitan area, as many commuters were travelling home. The pollen count was high due to the combination of hot, dry northerly winds and rye grass to Melbourne’s north and west. The moisture from the storm is thought to have caused the pollen to break into smaller particles, more able to penetrate a person’s lower airways and cause an asthmatic reaction. 

This incident in which nine people died from respiratory failure augured a future which, because of these extremes in weather consequential on climate change, are liable to become more common in Spring.

The advice to combat the sudden alteration in climate is simple. You know, stay up to date with pollen counts and weather forecasts during Spring and early Summer so you know if a storm is coming. Then just before and during storms with wind gusts, get inside a building or car with the windows shut and the air conditioner switched on to recirculate/recycled.

In 2016, in addition to the nine deaths, there was a serious level of morbidity which kept the ambulance service busy (and that was before the Virus!) Respiratory arrest in the victims had occurred as soon as 15 minutes after the first signs of asthma or wheezing.

“The average time from complaint to respiratory arrest was very short,” she told the court.

“Fifteen minutes does not really leave anyone time to do much, ” one respiratory physician commented at the time.

She added “All the victims suffered asthma and nearly all got hay fever, but only three had official asthma “action plans.”  And to have a reliever puffer, such as Ventolin, on hand and use it generously. Sixteen puffs in four minutes is appropriate.  There is no health danger to using a high dose in emergencies.” In fact, 4,000 people were treated and 30 were admitted to ICU.

In the following article, there is no comment made of the mortality and morbidity of the Massachusetts cloudburst, but highlighting this report should awaken our Health system, already overburdened, to another potentially deadly public threat awaiting at the end of the year – in fact every year.

For allergy sufferers this time of year is always a bit of a headache (mixed with lots of sneezing and coughing).

The yellow cloud in Massachusetts

But a quick-moving cold front that kicked up winds and pushed pollen off trees in great bursts on Tuesday, turning the skyline a strange yellowish-green, was like nothing he had ever seen.

“There was this yellow glow off in the horizon,” said a Marlborough resident. “It looked like a cloud of dust, and it was just yellow. I knew exactly what it was because I’m always worried about the pollen, but I’ve never seen anything like that in my life.” Residents were left covering their faces Tuesday morning after the sudden weather shift created a pollen-heavy scene that resembled smog or “wildfire smoke” or in the air. Parts of the region became so hazy that people described it as a “wall of pollen” that descended on neighbourhoods.

For a Hingham resident, it was like winter with a strange twist. “It literally looked like snow flurries were coming down,” he said of the thick globs of pollen swirling around in his backyard. “It was hazy everywhere. It made everything look kind of golden — it was wild.”

Dave Epstein, a long time Boston meteorologist and horticulturist who writes a weather column for the Globe, said the haze happened after a backdoor cold front with a dramatic change in air mass moved through the region, shaking pollen from the trees.

“As warm tropical air was replaced by cool ocean air, the gusty winds helped release billions of pine pollen grains which were mature and ready for dispersal,” he emailed. “It was just pure coincidence we had a horticultural and meteorological intersection, resulting in a dramatic pollen front.”

“Just a tremendous amount of pollen as the back door cold front is pushing through. I don’t recall ever seeing it so dramatic,” he said.

Others agreed that it seemed unusual.

“Was outside and saw/felt it a few minutes ago too,” one person replied to Epstein’s tweet. “Have never seen anything like it.”

One other meteorologist said the cold front was “so powerful” that it showed up on weather radars and picked up “bugs and pollen and dust in the air” as it moved inland.

The chief meteorologist for WHDH-TV, posted two images of a parking lot surrounded by trees, pictures he said were sent to him from a friend in Concord. Hanging in the air was a thick cloud of yellow dust that looked more like a sepia-toned fog.

“Got pollen?!” he wrote.

The region certainly did.

Mouse Whisper

The story of two Vice-Presidents – two Hoosiers in fact. There was that story of Mike Pence begging Dan Quayle to come up with a way to not certify the votes. Pence sounded scared, as if was he was going to be killed. He is reported to have said to Quayle: “You don’t know the position I’m in”. A quail to a Quayle.

Thanks be, I live in a mouse house, which is not located at No 1 Observatory Circle.

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

Modest Expectations – Grand Final Action

What do you do the day after an election when there has been a realignment of the Australian electorate? Suddenly a majority of Australians are voting to address climate change, for integrity and for now, time is being called on the Paul Hogan vision of the normal Australian – the end of The Australian Sheila – a dutiful object of the male frustration, where sexual violence masquerades as consensual behaviour.

Dargo

We went to Dargo. Dargo is a bush town, where the legend of the mountain is evident. As with so much of settlement in Victoria, it was the pursuit of gold which drove settlement at the foot of the Great Dividing Range where the Dargo River and Crooked Creek flow into the Mitchell River. Here there was alluvial gold and also deeper lead (lode) mining, which is so much the history of Victoria. However the gold did not last long around Dargo; it petered out to the extent that at one point Dargo verged on being a ghost town.

After you leave Dargo, you wind your way into the forested Great Dividing Range and the road eventually ends near the ski resort of Mount Hotham. It is a tortuous trip, a challenge to those prone to car sickness, through that other great resource of Eastern Victoria – timber. Cutting down old forest, which covers much of the land, has become as unfashionable as would tipping all the tailings from mineral mining down the Dargo River, and yet we are told that VicForests continues to actively log right through this area.

Dargo therefore embodies the myth of the rugged hard-riding horsemen of the bush ballad, but in reality these are the stuff of pub myths. The general laidback attitudes of the people belie the scrabble existence.

The day is beautiful; the air is clear. There is neither wind nor cloud. The deciduous trees are all vivid in a mixture of crimson, scarlet, bronze and yellow along the roads and in the Dargo township as it is basking in the late autumn sunshine. Yet much of the background for the mountain man myths are the hills covered in eucalypts. There are none of the variegated colours of the deciduous exotics on the mountainsides. There are these forests of messmate, with its stringy bark, the lofty mountain and alpine ash with their paler trunks. In the end, what is a deep green mountainside as it drifts away through the gorges and takes on the steely blue-green appearance so characteristic of the eucalypt forests. We wonder how much of these mountains has been traversed by white man; and then one of the group pointed out the electric power lines. The area is riddled with deer, which attracts the hunter.  The rivers attract the angler in search of wild trout.

This area has not been burnt for a long time, although to the east there have been devastating bush fires, which razed the settlements of Genoa and Mallacoota two years ago. Today, bush fire season is so far away – and yet Dargo has been threatened and will be again. As we drive through it, the endless expanse of blackened trunks is wreathed with new growth and mingle with white forest skeletons that will never to regenerate.

But today with a bottle of beer I am contemplating a beautiful landscape, where the fire did not come; where there is not a ballot box nor hoarding spruiking some far-off candidate who may never have stepped in the town. This is bliss. We do not see the tears of the vanquished nor the victory speeches nauseating in the myriad of fleeting acknowledgements – only Australian beauty, where only recently in a major coup, back down the valley towards Bairnsdale, a sand mining proposal on the Mitchell River, which would have ripped the guts out of this area has been refused by the local people.

The silt jetties

When we come down from Dargo to the Coast, before we return to where we are staying, we are driven down this long spit of land – the Mitchell River Silt Jetties, which divide the Mitchell River from Lake King.  This narrow tongue of land, which has been built up over thousands of years, is the longest of its type in the world. The river flows into Lake King at the end of this long tongue of silt and sand.

The river shimmers in the twilight, protected from the lake where its waters are now ruffled by the wind coming in from the south-west. Yet despite the buffeting, black swans glide past. What a day to spend; what sights to be seen – and yet another place on the bucket list to be crossed off – or more properly committed to my bank of memories – of places seen, places experienced; a pity I can no longer tramp around as I used to do.

But a memorable election day. Australia has been voted in.

What can I say about the Member for Longman!

They say bad generals always fight the last war, and the Liberal campaign fell into the same trap. Morrison won a surprise victory in 2019 through a negative campaign in which he depicted then-Labor leader Bill Shorten as a dangerous radical. Labor, wary of giving Morrison a second victory, changed its strategy. It matched many of Morrison’s policies and was cautious in its own offerings. Labor was like an echidna, the spiky Australian animal that rolls into a ball when attacked. Morrison kept attacking, as if he knew no other mode, even though Labor’s small-target strategy gave him so few opportunities.

Our own Richard Glover in The Washington Post ascribed ten reasons why Morrison lost government. You cannot disagree with his list, but the reason printed above is the one which went to the heart of Morrison’s failure.

Morrison was the classic flim-flam man who perfected his techniques through his association with Pentecostalism. It enabled him to surf his waves of personal impotence right to the end. His problem was that the spotlight became so intense that the greasepaint melted and he was exposed as an aggressive peddler of untruths. Morrison’s entrails will be barbecued on the fires of Hybris ignited by the fire-starter of “hubris”.

When Whitlam ended 23 years of Coalition rule, the Liberal Party voted for a new leader on the resignation of McMahon, himself a very divisive unpleasant character. The choice made was for Bill Snedden, who had been McMahon’s Treasurer; considered to be a nice guy, but lightweight. He beat Nigel Bowen on the fifth ballot by one vote.

Bowen, who was a distinguished jurist, had replaced Garfield Barwick as the member for Parramatta in 1964, (which indicates that the seat does not have to be held by a local). The current high-flying wealthy young banker, Andrew Charlton, lived in Bellevue Hill at the time of his parachute pre-selection; he not only won, but achieved a one per cent swing towards him. This is by way of a parenthetic comment about what has been occurring for some time, namely that any electorate increasingly cannot be taken for granted – a theme in Australian politics which will cause traditional shifts in alignments. Now back to the main narrative.

Billy Snedden

Malcolm Fraser did badly in this ballot, because he was seen as disruptive and had at that stage an enemy/friend ratio well in the positive. So Snedden, who had grown up in Perth but represented the outer Melbourne suburban seat of Bruce, became Opposition leader and Philip Lynch, the member for Flinders, his deputy. He inherited a divided party and over the course of his two-year stewardship, he was able to reconcile the differences to such an extent that Fraser, pictured as the tough guy, became viable. Nevertheless, bringing the Opposition together as Snedden had done, paradoxically projected him as not being tough enough, namely, in the long term, unfit – and of course the lightweight tag became featherweight if not flyweight among the Fraser acolytes. A member of these acolytes was the newly-minted John Howard.

Thus, the tough guy persona, despite the rants from the “Murdochrinaires”, is not the way to heal a party divided. These people are screaming for the anointment of Peter Dutton. Dutton is an ex-Queensland copper made good. The Queensland police force has been shown on many occasions to be wanting, and to stigmatise Peter Dutton is as much to stigmatise me for being a product of a school that had produced its fair share of “shonks”.

The second reservation is that Queensland has never produced a Liberal Party Prime Minister. Arthur Fadden was the nearest, a Country party stalwart, who was Prime Minister in his own right for 40 days in 1941. However ne’er a Liberal; only fleetingly the Country Party member for Darling Downs, who later was to be Menzies’ Deputy Prime Minister.

One of the results of a major loss is that the Senate representation remains and contains many of the most dysfunctional members of the Party. They remind one of the Calwell stewardship of the Labor Party – as totally unelectable on the left as these jokers are on the right. If one is familiar with the writings of Georges Sorel, one can recognise the similarity in the authoritarian attitudes and behaviour of these people, who live on the extremes. If you viewed the post-election rant of Rowan Dean, it gives a terrifying view of the world of the extreme authoritarian hatred. These people are backing Dutton.

The West Australian Premier dismisses Dutton as a dullard, and his form of strident form of dogmatism and fear mongering will not run well in the southern states, if reliance can be placed on the current voting patterns

Morrison, Abbott, Dutton – mocking climate change

Anybody who said, as he did in 2015: (sic) Noting that today’s meeting on Syrian refugees was running a bit late, Mr Dutton remarked that it was running to “Cape York time”, to which Mr Abbott replied, “we had a bit of that up in Port Moresby”.

Mr Dutton then added, “time doesn’t mean anything when you’re about to have water lapping at your door”.

That exchange alone should disqualify him from the leadership at this time; it was outrageous then, but now, has he demonstrated any change for the better?

The Liberal Party needs to purge itself, not play to a diminishing gallery of misfits. I well remember one of my contemporaries describing the Young Liberals as “five per cent of lawyers leading ninety-five per cent misfits.” This assessment may remain partially true now. These days the misfits are just absorbed in a politician’s office to develop their consigliere profiles. Thankfully, at last the true results of such a generation of these types are being brutally exposed.

The Liberal party needs a healer and one who can reach across Australia, including regional Australia – and that includes humouring the Queenslanders. Snedden had the guts to do so almost 50 years ago. I severely doubt that Dutton has that ability to do that – reach across Australia.

Tell me what is a pharmacist?

From the days of gentlemanly pharmacy

In 1961 I sat down to undertake the last Materia Medica examination for medical students. It was then part of the medical course that we learnt to make pills, lotions and ointment – and the last memory of this immersion in the world of the apothecary was a brush with male extract of fern. That herbalism epitomises “the alchemist” struggling to be accepted. It exemplified the quaintness of the village chemist, with carboys in the windows and the apprenticeship system of pestle and mortar. Our teacher, an old gentleman with a medical degree and a nineteenth century demeanour, passed into folklore that year with the change of the medical course to substitute pharmacology, and the advance of science into the education of the apothecary.

I remember The University of Melbourne rejecting the idea of having a faculty of pharmacy, even though the Pharmacy College was just up the road. Instead, Monash University took on the education of pharmacists. I think The University of Melbourne hierarchy at the time thought that Pharmacy should use the tradesman’s entrance. In fact, the Monash Faculty of Pharmacy and Pharmaceutical Sciences is now labelled number one in world

In a recent statement, the Dean, Professor Arthur Christopoulos, said: “The pandemic has certainly reinforced the crucial and frontline role that pharmacists and pharmaceutical scientists play in society. Over and above their normal services, we’ve seen the whole sector step up and play a huge role in vaccine rollout.”

The Faculty, known for its high profile research through Monash Institute of Pharmaceutical Sciences (MIPS), is responsible for the development of Australia’s first mRNA vaccine candidate for COVID-19 and in 2021 launched the Neuromedicines Discovery Centre. The NDC is an end-to-end academic enterprise for the discovery, development, evaluation, manufacture, and clinical rollout of 21st-century medicines to treat mental health disorders, as well as the Medicines Manufacturing Innovation Centre, which supports Victorian biotech and pharma companies to develop a competitive edge and retain jobs within the state.

The Australian Pharmacy Research Centre was one of the first steps in trying to develop a research program in community pharmacy, and illustrated the dichotomy of the academic pursuit between laboratory and community pharmacy, of which the hospital pharmacist is a subset of the latter.

The problem with community pharmacy, because it is dependent on reimbursement of drugs under the Pharmaceutical Benefits Scheme, has meant the merchant pharmacist, through the Pharmacy Guild, has become a powerful lobby, with the merchant aspect well to the front. Pharmacists have been very strong on restrictive trade practices, and because they have been seen by a succession of Coalition governments as political “blue” outposts, they have done very well out of government largesse. Even the big retailers have been unable to establish pharmacies within their walls, despite having a prominent Liberal Party politician to lobby for them.

The residual problem is that these large chain pharmacies have arisen presumably through a loophole of benefit to the entrepreneurial pharmacist. This is a licence to promote quackery, and not unsurprisingly the Government has done nothing despite having the regulatory power. But then the Pharmacy Guild has been a major donor.

… everything you could want, and then some

Personally, I have a very good local pharmacist, and her pharmacy is not a sterile dispensary but a place where the pharmacist is a source of good advice. Nevertheless, it sticks in the craw to be confronted by television images, usually of young healthy people with children, with shopping baskets overflowing with bottles of vitamins and potions; the implicit message is that it is good, even compulsory, to take all this crap in order “to keep well”.

Further, when these co-called pharmacies move into the cosmetic industry it challenges the definition of what is a pharmacy? What are the professional priorities?

It is one area which must be a priority in any review – whether a health review or as a matter for an Integrity Commission – and I have yet to address the role of the pharmaceutical industry in listing drugs for government subsidy without the need to say “bingo”.

COVID Bare Foot

Guest sufferer: Janine Sargeant

COVID has been blamed for many things, including COVID toe, but COVID ankle? While the “dress shirt above the waist Zoom dressing” and styling your Zoom background may have been entertaining for a while, the accompanying tracksuit pants and bare feet or slippers have resulted in a raft of unexpected injuries. As many of us have spent time working from home in lockdown or avoiding the busy office environment, it has also meant not wearing supportive footwear. For the barefooted and be-slippered, this has delivered up a nasty surprise (particularly for those who normally do wear orthotics).

Nice to wear … just not for too long

Essentially, extended periods in bare feet or slippers plus a lack of regular “normal” exercise have left many with posterior tibial tendonitis (inflamed or stretched tendon that supports the arch of the foot) which can lead to arch collapse and permanent foot problems.

Similarly, the Achilles tendons of the working-from-home brigade have also taken a beating, again with what one expert described as “neglectful footwear”, a few extra COVID kilos, a lack of exercise, the change to treadmill running, prolonged closure of gyms and loss of exercise programs – in other words, the complete change in physical routine brought about by COVID lockdowns.

As one podiatrist commented: he couldn’t believe the number of people who have come to see him with Achilles problems or posterior tibial tendonitis. Such people now need orthotics to help them restore function to their feet; no doubt the physios are seeing the same unintended consequence of working at home. For this author’s painful ankle, the road to resolution is paved with new orthotics and months of exercises designed to strengthen the offending tendon – and a long break from “neglectful footwear”.

Requiem for a Light Welterweight

Really Schadenfreude is not a nice word. I am sure that one Andrew Peacock (or perhaps the ghost of the colt galloping the streets of Hawthorn) would have appreciated finally the final exit of John Howard, a person who started the fashion of a Liberal Prime Minister losing or abruptly vacating their seat.

From the time Howard entered politics in 1974, behind that mild-mannered courteous exterior has dwelt a wellspring of relentless hatred. Do not get me wrong; in his early years as Prime Minister, he made a reasonable fist of it, and he had members of his staff who provided a counterbalance to his instincts which helped preserve his public persona – no more so than Arthur Sinodinos, the long-term moderate who ran his office. For a short period in the early noughties, I was privy to the workings of him as the Prime Minister.

He achieved the shift of the Liberal Party power base to New South Wales, and left the Hamer Liberals in his wake, while detesting Kennett in this latter’s brief flame of power. I remember being at the Adelaide Airport on one occasion when Howard and I were retrieving our luggage. It was the time that Howard was out in the long grass in the early 90s. The initial exchange was inconsequential, when something I said triggered a vituperative response that he would get “them”. Apart from not being one of “them”, before I could ask him who the “them” was, he had rushed off. He disliked Costello, and there was something visceral about his approach to Victoria. I have always wondered whether the “them” were the Victorian Liberals. Paul Keating also was surely one of “them”; Howard was always expansive in his hatreds.  Whether or not it can be attributed to him, Victoria had become more and more toxic for the Liberal Party.

John Howard

But all this is a long time ago, and rather than just advise from the background, Howard still allowed himself to be pushed around in this election campaign. Why? It seems that even 15 years later he still cannot perceive the tsunami coming.

In a way, as a contemporary old buffer, I feel sorry for him. However, the imagery of an old age person with antiquated views campaigning provided a view of the Liberal Party where men wore morning suits and badges, and women made pumpkin scones. The image was painful and did not win any votes.

Bit of gratuitous advice John, write a blog about improving the treatment of the aged and then imagine anybody is reading it. It helps endure life in the gloaming – it is certainly better than just being plonked in front of TV set or wheeled around in a metaphorical Zimmer frame watching your legacy trampled.

Mouse Whisper

If I hear the new Prime Minister mention his rags to riches commentary once again, I doubt if I will be able to hold down my Emmenthaler.

However, I loved the comment which said that the Prime Minister must be happy to be back in public housing again after so many years. Maybe though he could flog off Kirribilli and take over Admiralty House.  Then build public housing on site, except even a mouse could imagine the potential homo sapiens rorts with such a project.

In any event, Governors-General don’t need summer palaces at the cost to the taxpayer. The hunting lodge at Yarralumla should more than do.

The Yarralumla Hunting Lodge – rabbit stew anyone?