Our little family

Here are two generations of our small family yesterday morning, as arranged and posed by Jonathan, the unofficial and increasingly competent and confident family photographer. For readers of this blog who don't know the family, those standing are our three kids Jonathan, Rebecca, David, and Rebecca's husband Richard; seated are Wendy, me, and Desre Kramer who will be marrying David in a private ceremony at her sister's home in Irvine, California, in about two weeks. Our three grandchildren were not present. Christina, we hope, was working in Peterborough, not demonstrating and protesting at the G20 meetings in Toronto; Peter was/is in Cambodia, on his way with Sylvie to the ancient shrine and temples at Angkor Wat, and John was in Kingston where he faces a choice about an attractive and stimulating job opportunity that he's been offered; I hope he accepts this! If he does, I'll have more to say about it. Some time soon, I hope, we will be able to assemble all members of all three generations of our family for a group photo of all of us together.

Photo ops and other matters

Here is Wendy last Friday with Sharon Morrison, her 'Personal Care Worker' -- a lovely young lady who really cares for and about her. We are very fortunate to have such a splendid helper to take the load off my shoulders. We also have various other professionally qualified staff, nurse, physiotherapist, occupational therapist, from the Community Care Access Centre who see her here at home, and a large team of dedicated experts at the ALS Clinic. Between all of them and an array of assistive devices, our lives are manageable. It is just as well we have abundant help because Wendy's condition is progressing, slowly but relentlessly.


This weekend has been rather special. David came from Kingston, and he and Desre, who flew over from Toronto, took Wendy and me to the Museum of Nature which recently reopened after extensive (and expensive) renovations. David pushed Wendy around in a wheelchair. We were all tremendously impressed by the sparkling new look of exhibits and dioramas, which I recall were in some instances looking rather moth-eaten before the renovations; some of them dated from the original opening of the museum more than 100 years ago, so they had good reason to look a little the worse for wear. After a two-hour tour of the Dinosaur Hall (very impressive), the Bird Hall (also impressive), and a passing glance at the Minerals, we came home, and David and Desre made an excellent meal for us all. That was our Saturday treat. Our Sunday morning treat was a visit from all three of our kids plus Richard and Desre, the partners respectively of Rebecca and David. David and Desre will be getting married at her sister's home in Irvine, California, on the southern outskirts of Los Angeles, in early July. Today's visit was primarily a photo op, arranged at Jonathan's request, and in my next installment I will post one or two of the photos he took.


We have become so preoccupied with our own affairs recently that we have hardlybeen aware of momentous events like the G8 and G20 meetings that were held near and in Toronto in the past three or four days. There were some clashes between police and demonstrators yesterday and a few more today, and some property damage resulting from the stupid choice of downtown Toronto for the G20. Our fearless leader prime minister Harpo (sorry, Harper) chose the location, presumably knowing there would be damage to property, presumably not caring, because the tolerant, broad-minded folk of Toronto elected none of his mean-spirited far-right team, nor ever will, absent some cataclysmic political upheaval. Further off in the distant background the battle for the World Cup has been going on in South Africa. Under different circumstances I'd have been glued to the TV nonstop to see as much of this as I could, but in the present circumstances I've hardly been aware of it. Both Australia and the USA were eliminated in the opening round, and today Germany convincingly beat England. The quarter finals may be mainly a Latin American affair with a sprinkling of European nations and perhaps the one remaining African nation, Ghana. That has yet to be determined. With a bit of luck and good management I might be able to catch at least a glimpse of a few of the remaining matches and the finals at the end of the coming week.

The earth moved

Today the earth moved. Not in the Hemingway sense, but literally, a small earthquake, 5.5 on the Richter scale, with the epicentre about 50 Km north-east of Ottawa. Our building shook itself and shuddered a little bit, there was a lot of loud noise like heavy earth-moving equipment, my revolving bookshelves revolved a few degrees and most of the pictures on our walls looked more awry than usual when it was all over. It lasted about 35 seconds according to the CBC radio news. At the epicentre, a road was closed because a bridge had collapsed, a church was severely damaged, and doubtless we will hear of other consequences as the news filters in. The president of China arrives in Ottawa today for a 3-day state visit, so the route in from the airport just across the Canal, and other downtown streets are bedecked with the red flag and its yellow stars, but I don't know whether he was here in time to feel the earth shudder and rumble. He's the first of a great procession of world leaders who will be coming to Canada in the next few days. There's a G8 meeting at a resort community north-west of Toronto, followed by a G20 meeting in Toronto. Much though these world leaders think of themselves as movers and shakers I doubt if the earth will move for these meetings but a great deal of movement and fuss and bother has been going on to prepare for them. When I was in Toronto last week, the city was already being carved up by 3-4 meter high chain-link fences to keep the visitors and dissenting agitators apart. By now Toronto is quite severely segmented so it's difficult for people to get around or to go about their daily business. I don't think many national leaders are coming to Ottawa, for which we can be thankful. Many, perhaps most of us are outraged at the cost of all this, about $1.2 billion for "security" and associated frills to impress the leaders and their retinues of acolytes. For instance, an artificial lake has been constructed in the Toronto convention centre to the scorn and derision of just about everybody who knows about it. Its purpose is to simulate the lakes near the resort community where the G8 meetings will be held. All but a handful of carefully selected reporters will transmit their televised reports with this little artificial lake as a backdrop. pretending that they are speaking from the setting of the G8 meeting. Only this handful - the likes of the BBC and CNN top-rank commentators - will be allowed inside the security barriers around the resort where the G8 meeting takes place. I don't know whether similar arrangements will be applied for the G20 meetings in Toronto but as it would be impossible to simulate the megalopolis of Toronto inside the Toronto convention centre these reporters will presumably be able to go anywhere they choose - so long as it is on the outside of the chain-link security fences that have carved Toronto up into segments. It all seems to me as pointless as these gatherings usually are (and much more costly!). Our world would be a much better place if adequate effort and expense were directed at problems obviously needing effort and expense - like providing homes for all the homeless people in the world - rather than at worthless, pointless and futile activities such as superficial beautification and heavy-handed security for these meetings of national leaders. If they were held on military bases, the security needs of timid world leaders could be met without the disruption and enormous costs of turning a bustling large city into a dysfunctional ghost town as Toronto is for the next few days. But we live in a real world, not an ideal world, so such a sensible solution isn't likely any time soon.

Fresh Air

This year we have used our rather spacious balcony more than we have in all previous summers combined. We can thank the kindly weather for this. Spring arrived early and was much warmer and drier than usual, and summer, which began officially today, the longest day of the year but has actually been with us for several weeks, has been tolerable so far. We have had many calm, warm but not hot sunny days, so we have sat out on the balcony day after day, with only the traffic from the cross-town expressway a dull murmur half a kilometer away, as background to our conversation. It has been very pleasant outside in the fresh air. Our balcony faces north so at midsummer with the sun setting almost due north of us well after 9 pm, we have the setting sun in our eyes, but we are indoors by then: Wendy tires quickly after our evening meal and usually wants to go to bed by about 9 pm. Helen Scott, our friend and neighbour several floors below us, skillfully planted our balcony pots with a variety of flowers, including pansies of several unusual colours. Almost every morning when I go out on the balcony to water the plants there is a fresh crop of ripe pansies for me to pick and put in a miniature vase beside Wendy's place at the breakfast table to help cheer up her start for another day. (I don't think "ripe" is quite the right word to describe flowers that are ready to pick, but it will serve).

Fresh Air is the title of a Sunday morning radio program as well as what we've experienced on our balcony lately. This past Sunday the host of the program, a Japanese-Canadian woman called Mary Ito, invited her listeners to send tributes to fathers that she could read on air, to help celebrate the Sunday designated as Father's Day. David sent her a short piece he wrote about my formative influence on him, that she said she would read,but although David and others, including I, listened to as much of her program as we could, none of us heard it. I will copy and paste it into this post:

While I was growing up, my father’s formative influence was through carefully chosen books. The many hours he spent reading Tolkien’s Lord of the Rings to my sister and me left me with a vivid image of small ordinary people saving the world with dogged determination, more important than kings and warriors. Looking back, and ahead, I think his example is more important than the books. He was committed to his work as a public health teacher in a way that has sustained him and served the public good. Last year my mother, fit and hardy into her eighties, was diagnosed with ALS and has declined rapidly. Watching my aging father take care of his lifetime companion is touching and inspiring. For the first time, I can imagine getting old myself, and hope that I can approach it with the same dignity and determination as my parents. That’s the thing about fathers—always there ahead of you, and as important at the end as the beginning.

Core Values of Public Health

The organizers of the centennial conference of the Canadian Public Health Association paid my travel expenses and two nights' accommodation at the convention hotel, but I had to sing for my supper. I was invited to perform in a session entitled "Equitable public health engagement" which is evidently this week's jargon for considering all alike when providing public health services. I puzzled over this a little bit, before deciding that I could most usefully contribute by talking about the core values of public health. Here is what I said:

Core Values of Public Health

My favorite image signifying the meaning of public health is a picture of rescuers at the scene of an earthquake. People, often strangers, do all they can to help other strangers who are in danger. They tear at the rubble with their bare hands on the off-chance that there may be somebody alive buried beneath it. It is a vivid demonstration that we are hard-wired with something akin to an instinct to come to the aid of others who need help.

That’s what public health is about: coming to the aid of people who need help. I spent much time and effort compiling a Dictionary of Public Health, defining the concepts, methods, and procedures that collectively comprise the science, practice and art of public health. The purpose of public health can be summed up in the phrase: coming to the aid of people who need help. That may mean all people everywhere, as with safe drinking water (in Canada, residents on many reservations for aboriginal Canadians do not have this necessity for healthy life). Or it may mean any of a myriad of population subgroups, some easily identified and easily reached, others vaguely delineated and hard to reach, some elusive, and needing urgent help. Today’s session, I think, may be focused mainly on one group, Native People, especially children and youth. Other groups needing help include single-parent mother-led families, particularly their infants and children; isolated elderly people living alone in a former family home; street people with mental disorders; prison inmates. Not all these are adequately represented at strategic planning conferences.

At conferences and planning meetings where environmental problems are being considered, some groups may be over-represented. Industrialists, developers, and their spokesmen, speak loudly, act aggressively, drown out or try to suppress dissent. In some countries they silence dissent or opposition to oil exploration and mining by brutal means, up to and including murder and genocide.

In coming to the aid of people who need help, we don’t distinguish one group or class of people from another. We don’t discriminate on the basis of age, sex, race, income, occupation or any other identifying quality. That’s what ‘equity’ means: all are considered equal. There is no such thing as some being more equal than others, like the pigs in George Orwell’s Animal Farm.

I’ve thought deeply about the philosophical foundations of public health. I have considered its core values, the moral basis of public health. The 1940s UK social administrator Geoffrey Vickers described the historical progress of public health as ‘redefining what is unacceptable.’ This is a core value of public health. The pioneers of the sanitary revolution in the late 19^th and early 20^th century knew enough about the causes of disease to recognize that it was morally unacceptable to cough and spit indiscriminately, to provide polluted municipal water supplies, to allow owners of mines and factories to employ little children. By the 1990s public health workers and many others knew it was morally unacceptable to smoke without permission in somebody else’s home, or on an airplane or in a crowded elevator or bus; to drive a car while impaired by alcohol or drugs, to carry infant and child passengers in a car without correctly fitted seat restraints.  Soon I hope it will be morally unacceptable for any person or corporation to pollute the land, sea, or air, or to emit combusted carbon products into the atmosphere. It is morally unacceptable to ignore distress signals like suicide of young native people, nutritional deficiency diseases among isolated old people, drug and substance abuse by homeless street people, and other less obvious signs of the persisting inequities in modern Canadian society.

In public health practice we are proactive, not reactive, seeking and solving potential problems, not just waiting for problems to happen. That’s why we have immunization programs to prevent outbreaks of polio, measles, diphtheria and the like, why we purify municipal water supplies, why we campaign against tobacco smoking and substance abuse. It is why we have sex education classes in school, and family planning clinics accessible to teen-age girls whether or not their parents know; and why we oppose patriarchal authoritarian attempts to restrict access by school girls to education about sex and sexuality and access to contraception (and if this fails, access to safe, legal abortion).

Sometimes we are not proactive enough. There are subgroups in every population who need our help but do not seek it for one reason or another. Some equate public health services with authority figures that for one reason or another they dislike, are averse to, or distrust. Some marginalized people feel stigmatized for instance by their appearance or their shabby clothing, and avoid waiting rooms in clinics because of shame or reluctance to be seen by and, they fear, overtly or covertly criticized by others they might encounter there. Some have a problem understanding the language used by public health professionals. E is for extra effort as well as for equity, to ensure that these people receive public health services of the best possible quality.

An important consideration in equitable public health engagement is the baggage that the public health worker brings to her or his interaction with individuals and groups that need help. Ideally public health workers should be impartial, objective. They should always be ready to provide the only therapy

administered by ear – words of comfort.

          But they should possess what William Osler described and discussed in Aequanimitas, the capacity to evaluate and resolve complex problems without becoming emotionally involved with the people who are the victims of the problem (or with others who may be causing them). Yet the role and function of the public health professional includes being an advocate for the persons or groups afflicted with the problem. Striking a balance between impartiality and advocacy can be very difficult!

Among Canada’s attractive features is multiculturalism. It has some potentially harmful features; but its strengths and inherent goodness outweigh these. I mention it only to offer a cautionary word. The cultural roots of a public health professional must never influence her or his interaction with clients or population groups who happen to have different cultural backgrounds. First and foremost we are Canadians. We may be hyphenated Canadians, but the qualities embodied in that hyphenated word are irrelevant in our professional interactions. This is a necessary statement, but it is not sufficient. Public health professionals have a responsibility to know and to understand enough about the culture of the population groups with whom they work so that they do no harm by inappropriate kinds of interaction.

Inequitable public health engagement is commonplace, even in nations that pride themselves on their equity, their fairness. In Canada we proclaim our tolerance and the excellence of our democracy but our body politic is so manifestly, so blatantly inequitable, the playing-field so obviously uneven, that it amazes me when our political representatives, our elected “leaders” boast about the excellence of all things Canadian, implying that it’s so perfect it can’t be improved.

In March 2010, disturbing news reports emerged about the shockingly high incidence and prevalence of tuberculosis among First Nations and Inuit Canadians. The flames of infection with tuberculosis are fanned by deplorable living conditions, by poverty, overcrowding, poor nutrition (and by ignorance, alcohol and substance abuse). If we needed any further warning signals of inequitable public health engagement with these underprivileged members of the Canadian population, the latest morbidity and mortality statistics for tuberculosis have provided them! This is more than a public health issue; it is a public policy issue. In 2008, prime minister Stephen Harper issued an apology on behalf of Canada for past injustices perpetrated against the descendents of the original inhabitants of Canada. As Barack Obama said in another context, that apology was “just words.” To have any meaning, the words had to be matched with action, and no action has been forthcoming to remediate the deplorable living conditions of the descendents from the original inhabitants of our country. As the Nobel Peace Laureate Amartya Sen pointed out in The Idea of Justice, social justice is a powerful determinant of health. It follows that victims of social injustice will be unhealthy; the morbidity and mortality statistics of tuberculosis eloquently and accusingly illustrate this harsh reality, as do many other health indicators. Canadian public health has been an abject failure in not advocating effectively to correct this injustice. The next generation of public health leaders must do better than my generation has to correct these inequities.

When I delivered my talk in Toronto a couple of days ago I left out the paragraph about Aequanimitas and the one about cultural baggage; I didn't read this text of course, I spoke it, and as I was speaking I realized that it flowed better without those bits -- and leaving them out left a wee it more time for discussion, which was as well because there was a good deal of discussion, much of it on points for me rather than either of the two other speakers to deal with.

So I'm safely back now from my brief respite in Toronto. David came back with me, we sat together on the five-hour train trip and I don't think we stopped talking for more than a few moments. It was a great bonus to have that much quality time together, something we rarely manage.

CPHA Centennial Conference, Toronto

Troubles began even before I set off on the train for Toronto. Rebecca phoned in great distress to say that one of her cats - her surrogate children - was acutely distressed so she had to take him to the emergency veterinarian clinic. The cat turned out to have widespread abdominal cancer and has now gone to the great catnip patch in the sky. His mortal remains repose beneath a flagstone beside the actual catnip patch in Rebecca's garden. We will have to tread softly as we pass by on the way to the patio table where we eat out so often in clement weather. When troubles come they come not singly but in whole battalions. Richard developed severe chest pain, was taken to the Ottawa Heart Institute where last night he had angioplasty and a stent placed in a coronary artery. I'll get the details when I return home. Meantime Wendy has been ably cared for by Jonathan and by at least one of our friendly and helpful neighbours. She has sounded very frail and old when I speak to her on the phone.

Meantime the meeting is going very well for the large numbers of public health specialists who are gathered in Toronto, ranging from some 250 eager young students to elderly has-beens like me. Many of the youngsters, students and others, seem to know who I am and want to shake my hand, take my picture, have me sign their books or even several of the books I've written or edited. I have so far spent most of my time networking with old friends and new friends, but have attended a couple of the plenary and smaller sessions where the standard of discourse has impressed me, especially when it's been the young comers doing the discoursing. There's hope for the future of public health in Canada with these bright, knowledgeable, altruistic and dedicated youngsters coming up through the ranks. A year or more ago I was one of a number of prominent Canadian public health specialists who submitted to a televised interview, and this is playing on large screens as part of the exhibits in the exhibit hall. As I've gone to and fro I've seen my time-ravaged face and my bright blue Ken Done sweater (from a bargain bin in the departure lounge at Sydney's Kingsford Smith International Airport more than 20 years ago) several times. The interviews have been well edited so our comments on each of the themes we were asked to discuss all appear together. It's not the best interview I've ever given but it's not the worst either. It's available at the CPHA Centennial website and I'll locate and add the URL to this post. Continuing this post the day after I started, I can report now that I performed to my own and as far as I could tell, everybody else's satisfaction on a topic with which I didn't feel at all comfortable. And this evenings Gala Banquet went very well too, with opportunities both to renew old friendships and make at least one new one, with a very impressive young woman who shows every sign of becoming a major figure in our field. What's more, she comes from New Zealand. Admittedly I am biassed in favour of New Zealanders for obvious reasons, and also because there are so many extraordinarily talented Kiwis in every field of human activity with which I'm acquainted, from dictionary-making to nuclear and abstract physics. So it's high time for yet another outstanding Kiwi to make her mark upon the world. Meeting her and seeing in her the next generation of public health leaders rising to prominence made this conference more worth while for me than otherwise it might have been. It's very reassuring to know there are very able newcomers entering our field -- this one is exceptionally well qualified -- who will carry on the good fight to protect, improve and enhance the prospects for all life on earth including the most predatory and destructive of all species, Homo so-called Sapiens. (In passing, let's reflect on how inappropriate that qualifier is, but that will have to be a topic for another post some time).

This is Public Health; A Canadian History, is available at http://www.cpha100.ca and I think the interview I contributed is part of this. I also played a rather prominent role in editing the work and wrote an Epilogue. But the credit for assembling and editing the work as a whole belongs to Sylvia Fanjoy and Sue Sullivan. They have done a magnificent job, and their combined effort is well worth reading in detail.

Back to books: Greek Classics

This has been a high-tech week for devices to deal with the vicissitudes of motor neuron disease, or ALS. We can get medications and devices to deal with many of its manifestations but some of the annoying symptoms, like excessive secretion of mucus, are troublesome and hard to relieve. But enough already! Let's talk and think about something else entirely. Some months ago David asked me to identify 'essential' books and say why they are essential. Many others more knowledgeable and with more relevant expertise than I have made lists of this kind and written learned discourses to justify them. All I can do is offer haphazard selections. Today I'll try to say something about literary works in languages other than English that perforce I must read in translation -- in a few cases with books I've really loved, admired, enjoyed, I've read more than one translation. That has been my way with Homer.In the early 1950s I back-packed around Europe twice, each time with a few Penguin classics that I still have, battered and travel-stained but too full of happy memories ever to let go. I took Homer's Iliad on one journey, the Odyssey on the other. They are both prose translations. Despite John Keats's poetic praise, I never got far with Chapman's translation but I enjoyed Robert Fitzgerald's rolling verses almost as much as those Penguin classics in prose, and it's those I've returned to several times. In the 1950s I also read the great Greek tragedians, Aeschylus, Sophocles and Euripedes in the Penguin classic translations, and these are somewhere on the shelves scattered throughout our apartment. A project I promised myself that I'd do eleven years ago when we moved into this apartment is to arrange my remaining books in some sort of rational order; it remains undone, and now I rationalize that it's fun to go searching as I have in the past few minutes to verify that indeed these precious tattered volumes are still here; searching can disclose other books I'd forgotten that I have, and vow to reread them some time. For whatever reason, I never got as deeply immersed in translations of the great Roman writers as I have always been in the Classical Greeks. Of course I've read bits of Ovid, Apuleus's Golden Ass in the rollicking bawdy translation by Robert Graves (someone purloined my copy years ago and I've never replaced it as I would if any of my precious Greek classics went missing; I suppose that's a measure of my attachment to Roman classics). But I've never attempted most other Roman writers, except Julius Caesar's Conquest of Gaul which is hardly a work of great literature. What does distinguish great literature? The greatest of all tragedies, Sophocles' Oedipus trilogy, especially Oedipus Rex, contains the essential elements. A young man gets into an argument with a stranger, fights and kills him at a place where three roads meet near Thebes. (This place where three roads meet was pointed out to me by Peter Collett at the time student reading Classics at Oriel College Oxford, a life-long friend I met on that back-packing holiday). The young man goes on into Thebes, meets and soon marries the widow of the man he killed, has children with her. Then it is revealed that he is the firstborn son of the woman he has married, sent away into exile when he was born because a sooth-sayer looked at him, at the swollen feet that gave him his name, foretold he would kill his own father and bring disaster upon the family. Oedipus realized that he has killed his own father and married his own mother. Overwhelmed by the horror of what he has done, Oedipus puts out his own eyes. It is an ancient myth perhaps originally founded in fact, there is a sense of relentless inevitability about the way actions lead to reactions and events unfold; and all is told in a drama that, in modern translation anyway, and as seen on stage and even on TV, takes hold of you and never lets go until you reach the end, drained by intense emotion yet fulfilled, satisfied, the better for the experience. Homer's Iliad has similar effects, prolonged though less intense, dealing with the series of tragic events that follow an episode in the ten-year siege of Troy, the wrath of Achilles when his leader Agamemnon deprives him of his favorite slave girl.

I had thought in this post that I could say something useful about the great Russian writers, and even the German, French, and others I've had to read in translation because my language skills are so limited. But limited also is time to escape reality into my blog. Cervantes, Thomas Mann, Dostoevsky, Flaubert, Proust and a dozen or more others will have wait until another time.

Breathing machines

Yesterday at the ALS Clinic, Wendy seemed to adjust easily and quickly to relaxing and allowing a machine to do the breathing for her. The machine has a name and an acronym but it's simplest when talking about it to the uninitiated just to call it "the machine." We brought the machine home with us, and have found that it's not quite as easy to do it on our own as it was in the clinic with the respiratory technician, an excellent teacher and mentor, to guide us through the process. Last night when we ought to have set it up and used it, we were both tired out after a long afternoon learning all the ins and outs of the machine. So we put it off until today. This morning, I set it all up ready and this afternoon she tried it out for the first time. Almost every day she has an afternoon sleep (euphemistically called a 'nap' although it usually lasts up to a couple of hours). She relaxed and used the face mask and breathing machine quite well, but was unable to fall asleep. So this evening she was more than usually tired, too tired to let me fit the face mask in place and entrust her breathing to the machine. So we wimped out, and now, almost an hour before her usual bedtime, she is deeply asleep without it. We will try again tomorrow. It is basically quite a simple device, certainly nothing to deter us from mastering the technique of using it. I'm confident we will have it doing exactly what we want it to do in another day or two.

Janet Wendy's status

Wendy complains that our condo's swimming pool is getting deeper. It isn't of course; what is happening is that her back is becoming more bent, her neck more bowed so her chin almost touches her chest. This is because the muscles that support her head and neck, and her spine, are becoming weaker and weaker. Despite this, she really enjoys her daily dip in the pool; but I notice that she can't do the full range of her exercises, and can't swim more than the width of the pool before she gets breathless, because the muscles she uses to breathe are getting weaker too. As I listen to her breathing when she is asleep I can tell that it is an increasing effort. Tomorrow we have another appointment at the ALS Clinic where she will try out a machine that can take over from her muscles while she is sleeping, and give these muscles a chance to rest, get ready for the next day's breathing while she is awake. Despite all her increasing disability, she remains cheerful and we find things to laugh and joke about. As for me, I'm holding together well too, most of the time. We have an increasing array of assistive devices. The latest of these, called a 'Headmaster' collar, struck us at first as akin to a medieval torture instrument, and is was a real torture for her to wear it longer than a few minutes. After it had been molded and bent to her exact anatomical shape by Susan Geis, the physiotherapist at the ALS Clinic, it's a near perfect fit, it holds her head up high so she can look ahead rather than only down at her feet. She still doesn't like to wear it for longer than about three quarters of an hour at a time but we are imperceptibly increasing the time each day. Soon, I hope, she will be able to tolerate it most of the time except when she is eating or wants to engage in animated conversation -- it holds her head up by supporting her under her chin, so it interferes with both eating and talking. Even without it, talking is something she doesn't do very well any more because those muscles are weakening too, and another problem looming up in her future is how we can communicate if her voice fails altogether. She pins her faith in the laptop MacBook Pro that I got specifically in anticipation of speech difficulty, but when she has tried to use it, she has had trouble getting her fingers to work the keyboard and the track pad, so I am a little bit uncertain whether this will prove to be a satisfactory solution. Time will tell, no doubt.

The writer/editor and some of his books

The final chapter of the CPHA-sponsored history of public health in Canada takes the story up to 1986. I was one of the committee members who argued strongly against attempts to bring it up to date, to 2010 -- we must wait until we have some historical perspective, not try to describe impartially the events in progress now. I edited the Canadian Journal of Public Health from 1981 until 1991, so the chapter dealing with the period from 1970-1986 says a bit about my rabble-rousing years as editor. That was a wonderful time that I enjoyed from start to finish, despite occasional spats with aggrieved authors whose masterpieces I rejected, with the backing of peer reviewers and the editorial board, I hasten to add (I instituted the peer review process and did my best to elevate the scientific quality of the papers we accepted). The piece that some one else (not I) wrote doesn't mention this, which I consider the most important step forward of my time as editor. Sylvia and Sue, whom I wrote about in the previous post, selected a very unflattering photo to accompany the paragraph they composed about my work as editor of CJPH. I asked them to consider some alternatives, so they chose the one above, taken by a reporter for the Ottawa Citizen, to illustrate a story they ran about some of my ideas on the ethical management of life-endangering epidemics. It was the reporter's idea, not mine, to pose me behind a heap of some of the books I've written and edited. My brother says I look like a hobbit peering out of his hole, but since it's about to appear in a book I helped to edit and to which I contributed a few bits and pieces and an Epilogue (with a lot of help from my friends) I suppose it deserves a place in this blog.

Electronic copies of the book on CD-ROM will be available in about 10 days, at the Centennial Conference of the Canadian Public Health Association in Toronto. I'll get a few spare copies to give to family and friends.

This is Public Health: A Canadian History

A year or so ago I got involved (rather unwillingly) in preparations for the centennial celebration of the Canadian Public Health Association. CPHA was founded 100 years ago, in 1910. I've been on a committee concerned with the history of public health in Canada. A prominent part of the "history project" has been a book describing the history and development of pubic health and public health services in Canada. At first this looked like being a disaster. The early drafts of the chapters were atrocious, almost unreadable, very poorly written, too much emphasis on some details and not even a mention of other relevant and important aspects. The organizers of the centennial celebrations have been fortunate: two women, Sylvia Fanjoy and Sue Sullivan, came to the rescue. Between them they completely rewrote the drafts of the chapters in the history book, made them readable, indeed made them a pleasure to read, keyed into the text a large number of very apt illustrations and side-bars about historically interesting and important characters who contributed to the advance of public health in Canada, in short, breathed life into the book. Now it seems to me that instead of an embarrassment to all who have been associated with the project, there is a piece of work that we can all be pleased and proud to be associated with. Sylvia Fanjoy, with some help from others, has also created an exhibit about public health in Canada that will appear at the Centennial conference in Toronto in ten days or so from now. So far I've seen only snippets of this on my computer screen. I'm eagerly looking forward to seeing the real thing when i go to Toronto at the end of the week. If it's as good as I expect it to be, I hope this exhibit will tour across Canada after the conference. Not only is it educationally enlightening, I think it's probably an excellent recruitment vehicle to attract eager young enthusiasts into the public health profession.

Messages received

These days I don't have time to respond to the emails I get from friends and family scattered about the planet, reacting to remarks I've posted on this blog. As you know, I started it as a convenient way to provide updates on Janet Wendy's condition but very quickly realized that such a blog would be as depressing to read as to write; so the blog morphed into a form of occupational or psychotherapy for me. It's easy to find a few minutes from time to time to ramble on about anything and everything. So this is my reply to my surprisingly numerous email correspondents in Australia (Sydney, Melbourne, Adelaide, Perth) and in various parts of UK, USA and Canada: thank you all for your comments and reactions. And thanks also to all who react in phone calls and conversations, although of course I can at least thank you in person when we speak or meet.

Wheelchair access, or Image is everything.

There was an interesting discussion last night at the annual general meeting of owners of our condominium. The matter of wheelchair access was raised, as it has been before, this time by one of the owners who is temporarily disabled by an orthopedic problem for which she is awaiting corrective surgery. The president and treasurer said that it would be very expensive to make the necessary alterations to install a ramp or an elevator to permit wheelchair access through the front entrance where three shallow steps, a level landing then four more shallow steps, present an insuperable obstacle to wheelchairs. The chairman pulled from thin air a grossly exaggerated cost figure and the treasurer said an elevator from the outer to the inner lobby would destroy the 'esthetics' of our lobby. I am not alone in thinking the lobby is quite ugly now, and that either an elevator or a ramp would not make it any uglier. The issue of human rights was raised by one owner, but regrettably was not pursued. Those opposed to any change insisted that access down the ramp to the garage and through the corridor from the garage to the lower ground floor will suffice. I would love to watch one of them do this and see for themselves how difficult it is. It is also demeaning, like separate entrances for blacks and whites in the bad old days. I think the opponents of improved wheelchair access are out of touch with the times: it is universally accepted in all civilized countries now that all public buildings must be wheelchair accessible, and those built before rules were in place must be modified to make them accessible. I believe modifications to accord with 21st century standards would raise, not lower, the value of our investment in this condominium. I hope this will all be discussed again soon, if necessary at a special general meeting.

Deconstructing and reconstructing the universe

Another delightful al fresco meal last evening with food as usual most deliciously prepared by Richard (how lucky we are to have such a talented son-in-law!). The two photos unfortunately come without sound, just pictures alone, so you'll have to imagine the debate that raged among our three grandchildren, Christina in the middle and Peter on the left are both at university now, John is bearded like many university students but isn't quite yet one himself. He's formidable now in debate, and passionate withal, will be invincible after a few years at King's College, Dalhousie University, where he intends to take a combination of religious studies and journalism. Listening to it all last night as they talked about science and religion took me back over 60 years to memories of many similar passionate arguments on the veranda beside our tennis court at 7 Olive Street, Glenelg where several very vocal and argumentative friends of mine deconstructed and reconstructed the universe when we were at the age and stage that these three are now. I envy them starting out with the world at their feet! We had the world at our feet sixty years ago too, and looking back, I can see that with some extraordinarily good luck on our side, we shaped it all pretty much to our specifications. I hope our three grandchildren can do the same.