More of the sea and sea voyages

There's been a lot of notice taken lately of what is happening in the seas that cover about four fifths of the world's surface. The huge oil spill in the Gulf of Mexico off the mouth of the Mississippi has hardly been out of the headlines since April when it happened. Today there is worrying news about the work of another oil company, Chevron, in very deep water in the stormy North Atlantic, where the deepest oil well ever, more than 2 Km below the sea's surface, is being drilled. Years ago when I was writing my memoirs I wrote several pieces that eventually ended on the cutting-room floor. One of these was about the sea and my travels on and over it.


Sea Voyages


In the early 1950s, the word ‘overseas’ had real meaning. It was the only way to get into or out of Australia – intercontinental air travel was little used and very expensive. I am happy that I was able to go overseas as a young man. In those days it was literally that. I sailed over the seas that separated my birthplace from British and European culture.

MV Adelaide Star


In 1951, the ship that took me from my home in Adelaide steamed across the Great Australian Bight into the Indian Ocean, the Red Sea, through the Suez Canal into the Mediterranean, past the Straits of Gibraltar, across the Bay of Biscay, to the English Channel and the Thames Estuary, to Tilbury Docks. Our ports of call were Fremantle, Columbo, Aden, Port Said, and Algiers, a glamorous, exotic city of excitement and mystery. Three years later I left again from Tilbury Docks to go back to Australia, hitching a ride as ship's doctor on the Adelaide Star, a freighter that carried twelve passengers. We refuelled at Tenerife in the Canary Islands, then cruised nonstop around the bulge of West Africa, across the tropical doldrums, the oily calm steel-blue surface broken only by schools of flying-fish on the day I had no shadow at noon; on south around the Cape of Good Hope for the long haul with following seas and winds, across the southern fringes of the Indian Ocean all the way to Adelaide.

That voyage from Tenerife to Adelaide, one of the highlights of my life, took four weeks without a stop at any port, although we sailed across the mouth of Table Bay on a sunny August afternoon, close enough to see the cables of the funicular that went to the top of Table Mountain, the colours of the dresses the girls ashore were wearing. I was with a little band of professional sailors and a few passengers all sharing the same wanderlust and love of the sea. A long sea voyage in company like that is a splendid way to study human nature, and to get to know and understand the sea in all of its moods.

On voyages later with my wife and children, I went back and forth on passenger-carrying freighters between Australia and England. On the way to England in 1961 we stopped in Fremantle, Aden, Port Said, and disembarked in Liverpool. Going back to Australia in 1962, we joined our ship in Rotterdam, sailed to Antwerp, then Marseilles, Genoa, Livorno (with time to visit Pisa and Florence), through the narrow seas between Sicily and the toe of Italy, with spectacular views of the island volcano of Stromboli spewing red-hot molten lava, and then Iskanderun in the angle at the North-Eastern corner of the Mediterranean between Turkey and Lebanon, through the Suez Canal, down the Red Sea, and across the Indian Ocean to Fremantle and Adelaide. In early 1964, all the family had a 7-week voyage across the Pacific Ocean from Australia through the Panama Canal into the Caribbean and the Atlantic Ocean. We travelled on a refrigerator ship carrying about 20,000 tons of frozen meat. We unloaded several thousand tons each in Kingston, Jamaica; Vera Cruz, Mexico; Charleston, South Carolina; Norfolk, Virginia; Philadelphia, Pennsylvania, where I disembarked to fly to Burlington, Vermont; and Boston, Massachusetts where the rest of the family left the ship. We were moving from Australia to the USA where I had a new academic position at the University of Vermont, and that voyage early in 1964 was our last. After that, air travel replaced ships on all my own and the family's journeys across the world. Our only sea voyages since have been on ferries that took us and our car across the North Sea or the English Channel on European holidays when we lived in Edinburgh, Scotland in the 1960s, and a couple of brief cruises in the Mediterranean. I look back fondly on those vanished days of sea travel. Comely freighters have been replaced by ungainly container ships that don't have wide decks for adults to walk and children to play, and from what I’ve seen of them at sea, they appear to pitch and roll much more than the old style freighters, so they’d be uncomfortable for many seafarers.

A great oak tree's branches must bend before the wind, or they would break. So too, a ship's timbers or steel frame must yield before the force of the sea, or the ship would break up and sink. Every vessel I was ever on: yachts, a Greek caique, an Arab dhow, fake Chinese junks in Hong Kong Harbour, large ocean liners, little coastal steamers around South Australia in my childhood, and all those wonderful passenger-carrying freighters, all moved in the water like living creatures. You can hear, sometimes feel, them seemingly breathing as they move with the sea. They are living, they are breathing. Is that why we call a ship ‘she?’

On all these ships I've been most aware of the movements of the ship's protective skin in my bunk before drifting off to sleep. Behind the never-ending heartbeats of the engines that drive the ship forward through the sea are other sounds, comforting sounds of the ship bending and stretching as she moves with the interplaying forces of the sea. Perhaps the sea is getting heavier, the gently swelling rhythm of the waves is evolving into a storm, the pitch and roll are increasing. With every wave the steel spine and ribs and the steel skin of the ship are moving, quietly at first then more, as the waves gather force. The creaking of the shifting plates and rivets gets louder until it becomes a complaining sound closer to a shriek than a creak, too loud to be pleasurable. There are other noises then, the crash of the waves against the deck that make the whole ship shiver - the old sailor's oath, ‘shiver my timbers’ means what it says. There is a rushing sound of water along the hull, the shuddering roar of the propellers biting at the air instead of the sea as the stern lifts momentarily while the bows dig deeply into the next wave. There is a bang from time to time as a hatch not properly fastened slams shut, or the sound of a glass breaking as it falls from where it had been carelessly stowed to shatter on the deck. At times like that I enjoy more the sight of the ship battling against the sea than the sounds I hear in my bunk.

From the safety of the shore, a storm at sea is a grand spectacle. It looks as if the waves are mounting a charge. The breaking waves are aptly named white horses with their foaming manes. Each is a warrior that will attack and destroy a little piece of the shoreline. Turner's seascapes capture the flavour. In the early 1940s when I was a schoolboy one such storm was so violent that even in the sheltered waters of the gulf where the city of Adelaide nestles, the jetties along the foreshore were destroyed, and a warship on patrol was driven ashore. Seaside homes and hotels were badly damaged, the wide sandy beach scoured away, leaving a rubble of rocks. Shorelines were not recognized for what they are - dynamic, negotiable territory that changes hands between land and sea. In their pride and boundless faith in their infallibility the elders of my childhood had built great sea walls to mark the boundary between land and sea. But the boundary moved. The sea proved to be stronger than they believed. Everybody who knows Cape Cod knows this. In 1973 I saw a reinforced concrete house tipped on its end near Provincetown because somebody had not learnt the lesson about building on shifting sands. By now, I dare say, what was once somebody's comfortable home has disappeared beneath the sea, not like Port Royal in Jamaica because of a violent earthquake, but because the sea and the sandy shore are forever moving about, and in the end the sea almost always wins.

Like the worthy captain of the Pinafore, I'm hardly ever sick at sea. Two or three times is all, and never in a really severe storm. The first time was in the Mediterranean out of Port Said. A hot dry wind off the Sahara, laden with dust and grit, whipped the waves into choppy breakers that hit us beam on so we rolled, a shorter sharper roll than we had become accustomed to in the Indian Ocean. All my shipmates looked as I felt, white-faced, sweating, nauseated. Too much beer the previous night into a youthful stomach might have had something to do with it. A couple of other times on other ships it was the same, an unfamiliar motion that the organs of balance weren't expecting and couldn't handle, combined with eating or drinking not wisely but too well.

A storm at sea is an exhilarating experience as observed from a sturdy freighter with a well balanced and securely stowed cargo. Crossing the southern fringes of the Indian Ocean in the Roaring Forties (forty degrees south latitude) we ran for days before gale force winds, and for two or three days, the wind strengthened to Force 10, a full gale (over 62 mph). The dining saloon on that ship was below the bridge, facing forward. It had sturdy armoured glass windows, not portholes. I shared a table with the first officer. We had the fiddles up, movable slats at the edge of the dining table to stop our plates sliding off as the ship pitched and rolled. We had to sit spreadeagled, legs braced wide to keep from sliding with our heavy, splay-legged chairs to the far side of the saloon, and the steward had to place our food carefully in front of us a little at a time. Soup was off the menu. I loved those mealtimes. I had a perfect view of the ship burying her bows in deep green seas, shaking herself free of each wave as it broke over the forepeak, surged back across the hatch covers and ventilators to slam into the superstructure of the bridge, sometimes high enough to cover our windows momentarily. One moment we are in a deep valley of the ocean, the approaching wave is a mountain higher than the cross-trees of the foremast, closing in to port and starboard; the next moment we struggle to the summit of the mountain, and for a few seconds we see beyond the next great wave to a whole mountain range of waves. All have white caps like snow. The spray is flying away from us - we have a following sea in the Roaring Forties, a gale blowing us towards Australia. Those waves really looked like snow-capped mountains. Many times since I have flown high over the Swiss Alps, the Rockies, other snow-clad mountains. They are mundane and boring compared to the close-up view of the mountains and valleys of a storm at sea. On one of those days in that gale in 1954, the ship's log recorded the greatest distance she had ever travelled in a single 24-hour period, thanks to that powerful following wind and sea.

Even in the strongest winds and wildest seas of that storm the albatross never left us. Two or three of them picked us up after we rounded the Cape of Good Hope and came with us all the way to Investigator Strait, the narrow sea between Kangaroo Island and the South Australian mainland, before deserting us to follow another ship. They could hover for hours at a time, hardly moving a muscle or a feather, poised in the slipstream above the stern, their beady eyes darting everywhere, alert for any titbit. When the slops from the galley were tossed overboard, they would bank steeply, glide down and snap a mouthful from the bubbling, boiling wake, then soar up again to resume their place as sentinels over the stern. They must be able to stay aloft for weeks at a time without sleep, because far from land and in stormy seas there is nowhere for them to rest. When I looked out over the stern late at night, they were still there, on guard, alert and wide awake.

Fifty years ago in the 1950s those southern seas were rich with life of all kinds. We saw huge jellyfish, great translucent brownish or green creatures up to two meters across, shaped like the smaller Portuguese man-of-war, the poisonous stinging jellyfish of tropical waters. We saw killer whales, sharks, hammerhead sharks, huge schools of tuna chasing smaller fish that leapt in panic and in vain above the waves trying to escape their fate but were gobbled up anyway. We saw not only the albatross who followed us all the way, but gannets, terns, mutton birds, sheerwaters, far from land – though we knew there were islands, and one day we saw land, shadows rising from the mist to what looked like a high volcanic peak in the distance. This was St Paul Island, confirming if we needed confirmation, that we were deep in the Roaring Forties about halfway across on the great circle route from the Cape of Good Hope towards landfall off Kangaroo Island, South Australia.

In 1964 crossing the Pacific from Brisbane to the Panama Canal we ran head-on into a powerful storm, almost a hurricane, and for three days battered our way into the teeth of fierce winds and huge seas. This was a much stronger storm than the one I had experienced in the Southern Ocean, enough to clear the dining saloon of all but three or four of us when it was at its height. The dining saloon faced aft on that ship; the best vantage point was the bridge, to which I had access as a member of the crew, the ship's doctor. I spent many hours on the bridge discretely out of the way aft of the wheel and the instruments that told us how this storm was slowing our way through the ocean, at times almost bringing us to a stop. It was fascinating to see huge waves breaking over the bows and surging back, with the wind helping them gather force before they crashed into the superstructure, making the ship, sometimes those watching too, tremble. The open decks were dangerous, and if I ventured out the spray hit my face with the force of shots from a gun. I felt then the full power of the sea when it is angry. The dining saloon for officers and passengers thinned out during those days, the table cloths were dampened to stop plates sliding about, the fiddles were raised and our heavy chairs firmly fixed to the deck.

When the storm passed and the sea was calm again, we could see the ocean all around us ablaze with ghostly light on moonless nights from myriads of tiny phosphorescent plants and animals. If you flush a ship's toilet in the dark at such a time, it’s a dramatic sight - ship's toilets use sea water so the luminescent little creatures can be seen there too as well as in the wake and all around the ship.

On that Pacific crossing, thousands of miles out from Panama, we also saw long rows of brightly coloured buoys stretching into the distance, sometimes over the horizon. They marked drift nets, and twice we saw the trawlers that had set these terrible traps for the indiscriminate capture of fish, dolphins and seabirds. Those trawlers flew no flag identifying their nation. One we saw close enough to focus on with binoculars had oriental letters on her stern – a port in Taiwan, perhaps, or Japan or Korea. The rape of the ocean was well under way in 1964.

Once in the late 1990s flying at night back to North America from Tokyo, far out over the Pacific I looked down through the blackest night to what looked like a large scattered settlement – it was the lights of a huge fleet of fishing trawlers, using lights to attract their prey. The pillage continued at night as well as by day. Soon there will be nothing left alive in the sea. Since 1965 my views of the seas and oceans of the world have mostly been from high above, from airplanes. I’ve seen calving icebergs breaking off the Greenland glaciers and scattering in what looked from 10,000 meters above to be calm blue sunny seas; I’ve seen breakers and spray on the rocky cliffs of the Western Isles of Scotland. I’ve seen the brilliant green of coral atolls and volcanic islands in the Pacific. I’ve seen the scattered remnants of rocks and islands which are all that remains of what was once a large island in the Eastern Mediterranean until a massive volcanic explosion blew it to pieces about 3500 years ago, destroying the Minoan civilization of Crete in the process. I’ve flown high above the Bosphorus (and seen it from sea level). On a bright sunny day the blue seas of the Black Sea and the Sea of Marmora are dark brown around the Bosphorus, as they are near outflows of all the rivers that empty into the Mediterranean. As well as being pillaged, the sea is being poisoned by raw sewage and industrial effluents. Where great rivers drain into the sea the runoff contains not only industrial toxics and raw sewage but large quantities of fertilizer that collectively disrupt marine ecosystems and ultimately create huge ‘dead zones’ devoid of all life except pallid jellyfish. I am glad to have seen so much of the seas of our blue planet before they had been so damaged by stupid humans that there is a real risk of irreparable harm.

Memories of a seafaring man

My adventures as a ship's surgeon on passenger-carrying freighters plying the seas between Australia and Europe and later across the Pacific and through the Panama Canal into the Caribbean and on to the USA, have come up in recent conversations. At the risk of boring family members who've heard these before, I'll paste two stories here. These happened on a wonderful voyage in 1954, on the Adelaide Star, a Blue Star line freighter that carried 12 passengers and a crew made up mainly of junior ship's officers about my own age with whom I bonded better than I did with any of the passengers; after all, as the ship's surgeon, I was a member of the crew too.

This anecdote was published as a column-filler in British Medical Journal in 1993

Pushing teeth

In the 1940s when I was a medical student, I had a card with a long list of procedures to perform under supervision and get signed up by clinical tutors: reducing and plastering a Colles' fracture, performing a lumbar puncture, passing a catheter, and so on. At the end of the list was "extract two teeth." Why two? I never discovered the answer. But like some of my classmates, I extracted a great many more. The dentist who supervised us had a sensationally beautiful chairside assistant, and we went back again and again to gaze at her longingly and attempt to invite her to our parties (to no avail; she disdained sex-starved medical students suffering from arrested adolescence). But thanks to her, I soon excelled at extracting teeth. The dentist knew well why I was there, and ensured that my time wasn't entirely wasted.

The secret of dental extractions is not to pull the tooth, but to push it out: push the wedge shaped points of the dental forceps well down alongside the roots of the tooth so the wedge loosens the roots; extraction then is usually easy.

This skill came in handy a few years later. I was hitching a ride across the world as ship's doctor on a Blue Star freighter. Shortly after we had rounded the Cape of Good Hope en route from London to Adelaide, the chief engineer, a curmudgeonly tyrant, bit savagely into a bread roll and broke the cusp off a bicuspid. He was in agony. I had to deal expeditiously and well with this acute dental emergency or my life in this small, closed and highly critical community wouldn't have been worth living. The surgery on this ship was very well equipped; I could have done a craniotomy or a destructive operation on a foetus. And of course there was a full set of dental forceps.

First I premedicated the Chief with a tumbler of brandy. The hard part was injecting local anaesthetic; even semi-stupefied, the Chief didn't like this part at all. The heavy seas of the Roaring Forties were no help, nor was my choice of a dental chair without adequate support for his head and neck (I hadn't planned this part as thoughtfully as I ought to have done).

The rest was easy. I carefully positioned the dental forceps blades beside the broken tooth, and pushed down as hard as I could. The tooth popped up and out like a pea out of a pod. It was so simple I felt like clearing the rest of that side of his mouth while it was numb, but self-restraint prevailed. For the rest of the voyage across the Southern Ocean perhaps it's as well that my reputation for competence wasn't tested further. I've never again been called upon to extract teeth. Pity, really. I think I could have become a master of the art, thanks to those hours of unrequited lust and useful experience in the dental clinic behind our teaching hospital.



Fortunately the other memorable episode happened a few days after I took out the chief engineer’s tooth. I submitted this to Richardson’s Roundup on CBC Radio but if Bill Richardson ever played it, I didn’t hear it.

Catching an albatross

Few of life’s pleasures can beat a long ocean voyage. In 1954 I hitched a ride as ship’s surgeon on a freighter, a cheap way for young doctors to travel between England and Australia in those days. The voyage lasted nearly two months, including four weeks without a port – from a refuelling stop at Tenerife in the Canary Islands to Adelaide. We sailed past Cape Town without stopping, on a sparkling sunny day, so close we could see the colours of the dresses the girls ashore were wearing. It was nearing dusk as we rounded the Cape of Good Hope, and several albatross took station as escorts above our stern. For two weeks, until landfall off Kangaroo Island in South Australia, these great, graceful creatures glided effortlessly in our slipstream. It was the best journey in the world. It was a good time to read Apsley Cherry-Garrard's classic, The Worst Journey in the World.

Cherry-Garrard described how, before reaching Antarctica, he caught sea-birds, including an albatross, by trailing a weighted line in the wake of the ship (this was for scientific observations he was making). The weight bobs up and down on the surface, sustained there by the momentum of the fast-moving ship. To an albatross, it looks like a fish, a tasty morsel worth swooping to swallow; but because the albatross comes in from ahead and to one side, the weight causes the line to tangle about the bird's wings or feet, so it can be hauled aboard. Apsley Cherry-Garrard didn't say what happened after that.

It works. At the first cast, the largest of our escorts swooped down, and just as Cherry-Garrard described, the weighted line wrapped itself around the bird's legs, and we hauled it aboard, its wings flapping ineffectually.

An airborne albatross is one of the noblest sights one could ever wish to see. On the pitching and rolling deck of our ship on a blustery sea in the Roaring Forties, it was disconsolate, deeply embarrassed, very frightened, very angry – and very incontinent. At both ends. I can't recall all these years later which came first, the vomited-up half-digested fish, or the voided bowels; or whether both happened together. It covered most of the well-scrubbed deck with a stinking mess that had the consistency of fish glue and smelled unimaginably abominable.

There was another problem. Mindful of the Ancient Mariner's fate, we wanted to release our albatross, but it couldn't or wouldn't take off from the deck. It was unfortunate that the ship's captain, a descendent of Bligh of the Bounty I shouldn’t wonder, chose to make his daily inspection of the decks while we were wondering what to do. Observing him, I tried to be a detached clinician: Was I about to see a man actually having an apoplectic stroke? Gritting his teeth, he ordered us to get rid of the bird and clean up the mess. His demeanour made it clear that failure to comply, and quickly, would have dire consequences.

In the end one of the other officers launched the bird by running along the deck with it, like getting a kite aloft. Not before he'd slipped and slid on his bottom in the guano, however. We three miscreants who had started all this didn't escape so easily. We were on our hands and knees until after dusk, cleaning and scrubbing the deck to restore it to its pristine pre-albatross condition. Next day the pants I'd been wearing went over the side, stinking past all hope of ever being cleansed of the mess that covered them. Good pants too, my second-best pair.

In those days, the standard British Board of Trade rate of pay for ship’s surgeons who got a free passage across the world in this way was a shilling a month, plus keep. I should have received two shillings. When I collected my discharge certificate in Sydney at the end of what was, all things considered, a voyage that I still regard as one of the highlights of my life, I got only one shilling. I didn’t dare ask why.

Independence and self-sufficiency

Last weekend was very pleasant. David and Desre came up from Kingston, bringing John along with them; Rebecca and Richard, and Jonathan also came over, and Dorothyanne dropped in briefly on her way to the 60th wedding anniversary of her aunt and uncle. So all but our other two grandchildren, Christina and Peter, were gathered here at our apartment for a family party (Christina was working in Peterborough and Peter was in South-east Asia, in Vietnam we think). Jonathan took some photos but we haven't seen these yet. When we do I may add one or two to this post. The original plan had been for all of us to gather in Rebecca's garden beside her pond, but it was a steamy-hot and very windy day, would have been unpleasant there whereas here we sat in air conditioned comfort; an afternoon thunderstorm confirmed that we had made a wise choice. Since then, Janet Wendy has become more breathless, even a little distressed at times, and very willing to use the ventilator to assist her respiratory muscles. She's just skin and bone now, not much muscle left on her neck, back, and arms, but still does her best to be independent. As her legs remain quite strong, she uses the walker to get about and despite our pleas to let us do things for her that she doesn't need to do, she continues on her independent way. For example at meal times she gets up from the table, gets behind her walker, and goes to the kitchen to change the volume on the radio, instead of asking me, or Sharon, to do this simple little thing. She likes to be independent and self sufficient, but it bothers us who try to help her that she wastes her limited energy in this way, with the result that she doesn't have enough left over to breathe comfortably. No amount of gentle persuasion, nagging or -- her word -- bullying, seems capable of changing her lifetime habit of independence and self-sufficiency. It's inevitable I suppose that she should be like this, and we just have to accept it.

Illusion

This story won a prize in the City of Ottawa annual competition in 2007 for ‘novice writers’ (i.e. previously unpublished) aged 55 and over. She qualified with a quarter century to spare.

ILLUSION

Janet Wendy Last

Betty blinked in the glare at the threshold of her pension. It was already scorching hot with the light rippling on the Mediterranean below, and although she should have started earlier she did enjoy the leisurely breakfast. This was her first holiday in years, and after a week on the island she was beginning to relax and enjoy the slower pace. She wandered off along the cobbled street between whitewashed stone houses with bright window boxes. No wonder the people here seemed open and friendly with so much colour in their lives. Strangely though, the population seemed to consist mostly of old women dressed uniformly in black, with very few young people. Of course the children would all be up the hill in school at this time of day.

As she explored, she tried to keep on a horizontal tack, because she had no climbing muscles in her legs. After being flat on her back for so long what muscles she had were pretty flabby. The absence of cars, calmed her: since her traffic crash even the sound of wheels on pavement unnerved her.

Between the two-storied houses the path was shaded, making the air pleasantly cool, but the sun on the higher walls caused sunbeams to dance off the mullioned window panes opposite. Cats were on every window sill, doorstep or on walls by the houses. Several times one jumped up and run in front of her. Was it good or bad luck for a black cat to cross one's path? She wasn't sure but it didn't matter.

At intervals when paths crossed her way the sun flooded through and she got a glimpse of the bay below where the golden sand contrasted with the turquoise water which lazily rolled up the beach.

When one of the bigger roads up the hill intersected she had a view towards a cathedral on a large square and the corner nearest to her had an inviting striped awning and cafe tables where old men sat with their coffee playing dominoes. She decided to rest there.

The road down was steep and by the time she sank into a chair in the shade her knees were wobbly. She really had a long way to go to get back into shape. Who would have thought that these same legs could downhill ski for hours just a few months ago.

From her table she had a different view from the one at her pension which gave onto the east end of the bay where small fishing boats were moored behind the breakwater. She hadn’t seen the west end before and studied it as the sun lit up cliffs and fissures in the rock wall, enormous boulders cascading down as if some giant had thrown them.

She ordered a coffee and baklava and decided to stay under the shade for a while. Just then the cathedral doors opened and some women came down the steps into the square to linger by the fountain while three small children splashed each other with the water spewing from the cherubs' mouths. She felt a deep calm as she gazed at this peaceful scene.

When she could no longer prolong her coffee and the proprietor was bustling about polishing the tables and looking at his watch, she paid him, left a generous tip and wandered off on a side path. The fierce heat had gone out of the sun, and a breeze was whispering off the sea. She wanted to see what was on top of and beyond the cliff.

After about fifteen minutes the character of the streets changed. There were wooden barriers lying about haphazardly, sand was drifting against the walls, litter was blowing around and there were no colourful window boxes. The houses looked empty, shutters nailed up, weeds growing through cracks in the walls. She turned up the inclined path determined to see what was at the top and explore the ruins she had seen from the cathedral square. The ruins came into view as she climbed higher.

It was then that she heard a piano, children’s voices and laughter, so odd in this desolate place. She turned the corner to find a big door propped open, so she paused to look inside. The slanting sun was highlighting the dust motes through which she could dimly see a woman playing a piano. A game of musical chairs was nearly finished as only four chairs remained in the centre of the hall, where five children were racing and pushing to get a seat. About fifty others were grouped around the walls of the room, cheering on their favourite to win.

Betty moved closer to get a better look when a nun dressed in a grey habit came up to her, carrying a large tray covered with a heavy towel. “There you are,” she said in an unmistakable Irish accent, “I’m Sister Brigid. We've been waiting for you. Please take this to Kristos.. You'll need some one to show you the way. Nikos. Come here please!” A small black haired, barefoot kid, with a merry face and a broad grin ran up to the nun. She gave instructions to Nikos who beckoned to Betty and turned to go through the door and along the path to the top of the hill. The going was difficult because she couldn't see her feet below the tray and there were drifts of sand and lumps of rock strewn along the path. It didn't help that Nikos hopped about like a puppy, sometimes hiding and then jumping out at her. The first time that happened she nearly dropped the tray, while he whooped with laughter.

They climbed over a low stone wall into what had been a wonderful formal garden, but now overgrown with oleander and aloe cactus. The central path led to the house door, massive carved wood with a knocker beyond the reach of her small guide. He picked up a rock to hit the door several times, but there was no response. Nikos led the way around the house to the other side where a smaller door opened half way as they approached it. A little boy with a puppy stood there, and after an exchange of words, Nikos indicated that she should put the tray on a wobbly urn standing by the door. Carefully she balanced it, happy to be rid of the weight on her arms. Once more Nikos beckoned her around the house to the wall on the edge of the cliff. He disappeared, and in a panic, feeling responsible for him, she looked over the wall to a sheer drop to the rocks below, now covered by surf blown by the much stronger wind.

“Nikos” she called, and was answered by a shrill whistle carried on the wind. Looking over the wall again she saw a tousled dark head and a wide smile emerge from a small cave about two meters down the cliff. Using hand gestures she called out “Come up please,” but the head vanished again into the cave. Feeling tired, worried and impotent she stepped back from the wall to look around the garden. Her rational mind argued that there must be some secret passage to the cave, maybe a well, or a hole, but she could seen nothing nearby and because Nikos was as agile as a cat she figured he would be alright.

The afternoon shadows were lengthening, and having come this far she felt impelled to see over the crest of the hill to the country beyond. She followed the wall away from the cliff, and came to a steep set of stone steps leading to the top of a sand bank. With difficulty she climbed the narrow steps and started to walk on the sand which oozed away from under her feet and glissaded down the slope to the deep valley below. Caught by surprise she had the luck to fall on her hands and knees and hook her foot over the top of the stone step, thankful to be on solid ground.

She looked down on a large sandy basin, high walled on four sides, the country beyond not visible except on the south slope where the almost vertical sand wall finished at the coast. A hissing noise startled her, making her look landward. On the horizon of the far sand dune, a row of goats was silhouetted against the sky, and the sand they dislodged was cascading down to the floor of the valley, starting like a small waterfall and building to an avalanche. The goats disappeared over the other side. She shivered as the wind picked up, and she hastily climbed sailor wise, backwards down the steps.

The afternoon was nearly over and with no twilight and a strict dinner hour where she was staying she lost no time in retracing her steps to regain the town. At the end of Kristos’s garden she looked over the cliff and called ”Nikos” as loud as she could but there was silence, and no tousled head showed at the cave entrance. The wind on the water blew salt onto her face as she bent over the wall. She paused at the church hall which was empty, the piano and chairs tidied away and the door swinging to and fro on its one hinge.

Taking a lower route than before, she stumbled along the uneven path and was surprised to see the cathedral square open in front of her much sooner than she had expected. The cafe, now full of families having dinner was on her left, so she crossed in front of it and glad of the hand rail on the wall, climbed the steep hill to her main path leading to her pension.

As she entered she saw that the other guests were already being served, but she felt so dirty she had to wash and change before eating. By the time she sat at the table the others were finishing and her hostess seemed put out.

“You will have to hurry if you are going to see the start of St.Anthony's parade,” she said, “This year is the fiftieth anniversary of the great earthquake and they are dedicating a statue in the Square.”

“Who is the statue of?” asked Betty.

“The victims of the big earthquake on this afternoon fifty years ago. A huge wave washed over the cliff as it fell into the sea. The church at the top and many houses just dropped into oblivion. All the school children, their mothers and Sister Brigid were in the church hall celebrating St Anthony and nearly all perished. Only two children survived. Kristos, who had run home to see to his new puppy and Nikos who was found two days later wedged in a cleft of the crumbling cliff. Poor lad had been severely injured, was flown to the mainland for treatment and came back months later in a wheel chair, but he didn't thrive and died soon after. Many of the fathers who were fishermen also perished. A few bodies were washed up along the coast weeks later. The tsunami caused a huge build up of sand on the north shore of the island and that is where the dunes are. Very dangerous, with whispering, unstable sand which has engulfed many an animal and person who has ventured out on them. It is forbidden to go up there.”

“What happened to Kristos?” asked Betty.

“He was taken to Canada by his uncle, and this year he has sent money for a statue of Sister Brigid and the others. Tonight it will be unveiled. ”

Betty arrived late at the square after most of the villagers had left for home, so she could see Nikos clearly with his merry face and broad grin standing next to the nun she had seen earlier, but now they were part of a marble statue.

That oil spill in the Gulf of Mexico

On April 20, soon after it first began, I made a few remarks in this blog about the oil spill off the coast of Louisiana near the Mississippi delta. Today for the first time it seems possible that the unending flow into the formerly rich seas of the Gulf of Mexico has been stopped. It has done horrendous damage, from which the local and regional ecosystems will take decades, perhaps centuries, to recover. The blow-out occurred at a depth of about 1.5 Km below the sea surface, so deep that only robot miniature submarines can operate and the water temperature is zero C or even below zero. The sea remains liquid only because of the immense pressure. But human stupidity and greed are even deeper, indeed bottomless: this ecological catastrophe has not daunted the oil companies that intend to go ahead with undersea oil drilling at even greater depths in the far stormier north Atlantic ocean on the edge of the continental shelf off the coast of Newfoundland; and plans are well advanced to drill in the Beaufort sea off the north coast of Alaska and the frozen tundra of far northern Canada. Will this insanity never end?

Next steps

Yesterday we saw the gastroenterologist, Dr Sylvie Gregoire. She agreed that Janet Wendy is fit enough to undergo the minor surgical procedure of inserting a PEG tube. Because it is summer holiday season the earliest date that this can be done as an elective procedure is August 3; the consensus is that she will be OK until then without this intervention, but if her difficulty with swallowing gets any worse we can always reconsider and do it as an emergency procedure, or pass a conventional stomach tube to provide enough nourishment to keep her going. She is certainly getting painfully thin, so a few days ago I got a case of high-energy liquid compound to give her to try to build her up a bit, or at any rate to ensure that she doesn't lose any more weight. It's also getting harder to understand her speech. Sometimes, especially when we have visitors, she seems to make an extra effort, but when she and I are alone she may get more relaxed, less 'on her best behaviour' and sometimes she becomes unintelligible, has to rely on sign language and gestures. There are many ways we can deal with this problem and we are already using a few low-tech methods. Maybe we will augment these with some high-tech devices like a very fancy electronic touch-screen device that Margot Butler, the speech language pathologist at the ALS Clinic, demonstrated to us last week. But despite all, we can still find things to laugh and joke about, so our remaining time together is mainly fun, not at all a doom laden gloomy period of our lives.

Janet Wendy's status and what's being done about it

Last week we had two sessions at the ALS Clinic, where we saw the neurologist, the respiratory team, the speech language pathologist and the nutritionist. Wendy and I are well aware that she is weaker now than she was last month; she is more breathless and her speech is sometimes hard to understand, and she is having more difficulty swallowing. The challenge of swallowing worries her most and has led her to reconsider her earlier decision not to have a peg tube (stoma or stomach tube) to bypass her throat, so the main agenda item last week was to assess her fitness for the relatively minor surgical procedure involved in providing an artificial opening into her stomach. The consensus of the experts about her fitness is that she qualifies for the surgical procedure -- just. As our palliative care specialist said, they don't like it when patients die on the operating table, or when they have to go to the intensive care unit instead of home after the minor operation to bypass her throat. The gastro-enterologist who does this procedure has just returned from holiday and Wendy will see her tomorrow. Meantime, a community based specialist in ways to deal with difficulty swallowing came to see her today, reiterating the advice and suggestions we've already had from the staff at the ALS Clinic. At the drug store I picked up a whole case of high-protein, high-energy drink that she can swallow very easily. She has lost a lot of weight, is beginning to look quite frail, but she remains in good spirits, and we can still find things to laugh about. So stay tuned for another bulletin after she sees the G-E surgeon.

The Wedding of Desre Kramer and David Last

July 11 has taken on a special new significance. It is the date of David's wedding to Desre. All went smoothly, none of our anxieties about missed flights or other mishaps proved justifiable. Desre and David flew to Los Angeles on July 8, and the two of David's kids who are in North America at present, Christina and John, flew to L.A. on Friday, July 9; we had worried about them arriving too late at Toronto's Pearson airport to catch the early morning flight, but our worries were misplaced: everything went smoothly and according to plan. David phoned to confirm their safe arrival, and phoned again today to report that the wedding ceremony went off without any glitches. There were many photos, and David told us on the phone just now that two laptops were aimed at the celebrants to beam the entire event direct to Desre's family members in South Africa and Seattle by Skype phone. David sounded rather regretful that he hadn't taken his laptop to California too, but said that had he done so there would have been too many people aiming laptops in the right direction and not enough to take part in the service, which was conducted mainly in Hebrew; David had to learn a few words to make appropriate responses but he's a very good linguist so picking up a few words and phrases of Hebrew would not have been a challenge. Christina and John are flying back to Toronto today, and Desre and David will follow tomorrow. They will have a honeymoon in Paris and a walking tour in Brittany and Normandy in August. I'll attach a picture or two to this post:

The lower picture is a scene during the ceremony, showing the bride and groom exchanging vows; Christina and John are standing beside David. The upper picture shows the bride and groom in all their glory.

Green going

Years ago I was among those who lamented the medical school's move from the main downtown campus of the University of Ottawa to the suburban setting of the developing health sciences campus about 6 Km from the city centre. One of the factors I weighed when considering whether to accept the invitation to leave Edinburgh and come to Ottawa was the location of the university in the heart of downtown Ottawa, just a few hundred meters from Parliament hill. Like the ancient University of Edinburgh, and like my own university in Adelaide, South Australia, Ottawa University is intimately entangled with the city, town and gown are entwined. The sylvan setting, the vista of green lawns and trees visible from the picture windows of the staff lounge helped me to get over the pangs of separation. But over the years since then, as the health science centre expanded and budded off satellite buildings, those lawns and trees have disappeared. There was a pleasant little view of trees through the windows of the walkways linking the health science centre to the Ottawa General Hospital on one side, and the Children's Hospital of Eastern Ontario on the other side, at any rate for a while. The trees and lawns on the CHEO side went years ago, but those on the OGH side survived at least in part despite the orgy of building and the new paved parking lots for the cars of those who work in these new buildings ... until this summer. Lately as I've strolled along the walkway to the OGH, the floor has shuddered to the rhythm of heavy earth moving equipment, some of the glass is covered over with opaque plastic and where a window remains translucent the view is dismal: the green has gone, the ground is scarred by a deepening hole, the future basement of yet another new building. I suppose eventually all that will survive of the green spaces will be a few shrubs in tubs. We must adjust and adapt to new realities. Ottawa is a big city these days, the health science centre, the hospitals, the other buildings for research centres and so forth, must expand to keep pace. But I'll miss all that greenery.

We're having a heat wave

It's sometimes called an ear-worm, that irritating problem of a jingle or a tune that keeps on returning again and again no matter how hard you try to think of something else. Today I've been afflicted with a tune from the musical Kiss me Kate, that I've put above as the title of this post. It really is a tropical heat wave, with temperatures in the mid-30s and very high humidity that makes it feel like the mid-40s or high 40s, like Delhi or Bangkok just before the monsoon. If it were not for air conditioning, our apartment with its huge west and north facing picture windows that get the full force of the sun from noon until sunset, would be uninhabitable. Our well being hangs by a delicate thread. There was a power failure in Toronto yesterday; another like it here in Ottawa would be a real challenge to our stamina; and we will be very fortunate if we escape even just one power failure during this heat wave, which is forecast to continue all week and into the weekend. I've considered what we could do if we are hit by a power failure. Retreat to the basement, to the swimming pool, would be one option I suppose. Outside all day and greatly accentuated this afternoon, the air was thick and smog-laden too, as well as heavily humid, the combination of environmental conditions that are quite dangerous for the very young, the very old, and all whose health is precarious because of breathing problems. It's the combination we both have, each in our different ways. All we can do is hope our electric grid holds together...

Altruism

In the book our kids and I compiled of Selected Works of Janet Wendy Last, I stole a few pages to say something about her selfless altruism and other lovely qualities that make her such a unique and wonderful person. As the saying puts it, What Goes Around Comes Around. Our little family, our friends, and our neighbours in the condominium apartment building who have become our friends too, have been demonstrating in innumerable selfless acts of kindness that they too can come to the aid of others in need, bestowing on Wendy the same devoted concern and care for her that she has demonstrated for others throughout her lifetime. We have been provided with splendid, tasty and abundant meals, our apartment is always full of flowers, and almost every day since she fell ill there have been cards, phone calls, emails from near and far, and of course a constant stream of visitors - family, friends, acquaintances - all of whom are sensitive to her need to conserve her energy and don't outstay their welcome. It sustains me and comforts her to know that there are so many good people in the world.

Canada Day

My birthplace homeland and my adopted homeland both have national days that carry the nation's name. I've lived about half my life in each and therefore claim both as my homeland. Australia Day, January 26, commemorates the day in 1788 on which the 'First Fleet,' a small flotilla of sailing ships, arrived to establish a permanent British colony. Canada Day, July 1, commemorates the day in 1867 on which all the territories, colonies and dominions comprising Canada as it then was met in Charlottetown, Prince Edward Island, and agreed to form a confederation. It was an untidy affair because Newfoundland, technically the oldest (albeit non-permanent) European settlement, established in the late 15th century, remained a separate British dominion until 1949. There had been a few non-permanent European settlements, mainly whaling seafarers, in Australia too, before 1788. The European colonists in both Canada and Australia did not acknowledge that the lands they were colonizing had been inhabited for many thousands of years by indigenous people who had their own traditions, cultures and languages. The indigenous peoples were decimated by imported diseases, their traditions were scorned, their cultures largely destroyed. Genocidal actions included fabricated wars, deliberate infection of family groups with smallpox, and segregation of survivors on reservations, usually in remote places with harsh environments. We who are descended from European colonists look back now, apologize for what our ancestors did to their ancestors, grudgingly admit that the indigenous peoples deserve reparation, are our equals, not our inferiors. Not much if any of these aspects of history get mentioned on Canada Day (or Australia Day). It is a national holiday for celebration, festivities, fireworks after sunset, speech-making by leaders and heads of state, performances by popular entertainers. This year the queen is here and our own head of state, the Haitian-born vivacious governor general Michaelle Jean, is away on an official visit to China. Over a million Canadians in the total of 35 million, are ethnic Chinese; about another million have roots in the Indian Subcontinent and close to another million can trace their ancestry to Africa. Increasing numbers have been coming also from Middle-Eastern nations. Canada is truly a rainbow nation. One of the things I like best about Canada is that it is in large part 'colour-blind.' School children, university students, shop and office workers, sports teams and their supporters and spectators, are a multi-coloured free and easy mixture. The 'assortative mating' that I used to observe among medical student classes quite often takes little or no account of ethnic differences. There are rare isolated outbreaks of the kind of mindless and vicious hatred that once led white mobs to lynch black youths in the southern states of the USA, but such outbreaks are extremely rare in Canada, even more rarely violent and lethal. There are also some ethnic gangs, mainly in Vancouver, engaged in gang warfare to gain control of the illegal drug trade, prostitution, protection rackets etc, but these don't seem to threaten the national or even local body politic. At the other end of the spectrum, on Canada Day especially, are displays and celebrations of ethnicity, traditional Ukrainian, Portuguese, Hindu dance and dress, delicious meals of traditional ethnic dishes, recognition that Canada truly is a multicultural nation in which we all get along pretty well together. I hope it will always remain so!

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.