Pages

Total Pageviews

Thursday, June 14, 2012

Visits to China 1981 and 1982

Several years ago I retrieved the notebooks in which I had recorded a few details about my visits to China in 1981 and 1982 and wrote a coherent account of the two visits.  This is too long and too detailed for a post on this blog, but here are some excerpts, and a couple of photos.  I'll probably add more photos later, from the large collection in one of our family albums.

In 1980 when I made up my mind to visit China, it was terra incognito  in the West, a mysterious, vaguely threatening nation of close to a billion people, cut off from us by a nearly impenetrable wall of official mutual suspicion and in some respects, overt hostility. Memories of the Communist takeover, Chinese complicity in the Korean War and in Vietnam, and more recently the excesses and atrocities of the cultural revolution were still vivid. But the barriers had begun to break down. Ping-pong diplomacy and tentative cultural and academic exchanges had begun.  In 1980, Carl Amberg, an internationally renowned scholar at Carleton University in Ottawa, husband of my colleague Anne Amberg, came back armed with names of a few possible contacts in my field. In the spirit of casting my bread upon the waters, I wrote to one of these possible contacts, the professor of public health at Shanghai First Medical University sending with my letter a copy of the big textbook of public health and preventive medicine that I had edited, which had come out to considerable acclaim a few months earlier. Armed with his friendly reply which had an open-ended invitation to visit his medical college if I came to China, I called at the Chinese Embassy.  I had several meetings and conversations with the cultural attache, who, to my surprise, was sympathetic and understanding as I explained that despite a total lack of spoken and written Chinese, I wanted to go to China  alone and unescorted.  I wanted to repeat in reverse, so to say, the experience of Chiang Yee, the “Silent Traveler” who explored and wrote about London, New York, and Paris in the 1950s, apparently without being able to speak or read the languages. In the early 1980s, soon after the “bamboo curtain” had been lifted, I was one of the first people from the West to do this. Even now three decades later, it is rather unusual for solo travelers to visit China. By the time of my second visit to China in 1982 accompanied by Wendy I had met the Chinese epidemiologist Su De-long, and my path had been smoothed considerably, bureaucratic roadblocks greatly reduced.

The adventure began with a flight on China Airlines from Hong Kong to Guangzhou (Canton), a very short hop of not more than half an hour in a small, crowded airplane resembling a DC-3 but of Russian origin.  It was not reassuring to see my fellow-passengers boarding the flight with huge, heavy carry-on duty-free goods. Television sets and stereo ghetto-blasters were popular items that would not fit on the overhead rack, and cluttered the aisles and the spaces between the seats. Somehow we managed to take off and land without mishap. At Guangzhou airport, an escort, a businesslike young woman  from the People’s Republic equivalent of the USSR’s Intourist met my flight, took me by car direct to the railway station and gave me detailed instructions about when and where to proceed to a platform to get my train several hours later. She deposited me in the “soft class” waiting room, but it was boring all by myself so I moved out after a while into the bustle and hustle of the large, main station concourse. This was like large railway stations everywhere, crowded with a mixture of bewildered or weary travelers, parties in groups with leaders who addressed them through a microphone with a portable speaker on the platform, skylarking school children, soldiers in crumpled shabby-looking army uniforms. Almost all the men and many of the women wore navy-blue Mao jackets, and only a few women, mostly young, wore brightly colored dresses.  The hubbub and constant movement were fascinating but I had to watch the time carefully, so I could move back to the “soft class” waiting room, where the tourist guide had told me a railway official would meet me half an hour before departure, to escort me to the right platform. 

I had arranged to travel alone on the train from Guangzhou to Shanghai with an intermediate stop, urged on me by the cultural attache in Ottawa, at Hangzhou, a city of about a million at that time, located in the picturesque setting of West Lake. This was a journey of about 36 hours, from mid afternoon until early the following evening.

After a two or three hour wait, one of the station attendants escorted me from the soft class waiting room to the platform where my train was getting ready.  It was a long train, perhaps 20 carriages but only one ‘soft class’ carriage with comfortable padded seats, and next to it, a dining car, which I was pleased to see because I was getting very hungry, and noticed that every one of my less fortunate fellow passengers in the hard class carriages held a large basket or package of provisions for the journey.  For a while I thought I would be the only European on the train. My fellow passengers in the soft class carriage were all Chinese, presumably government officials and some uniformed military officers. Then a few minutes before we were due to leave, I heard someone speaking German, and saw a tall, middle-aged bearded man being escorted aboard and into the next compartment to me. He spoke only a few words of English so we conversed in a weird mixture of his poor English and my equally poor German.  He was the son of former Lutheran missionaries, born in China but left when he was a child after the Communists took control. He was returning on a visit to the town where he had been born.  Soon after dawn next morning at one of our many station stops, I saw him get off the train to be met by a small group carrying a large banner in German and Chinese characters. I could read one word, “Willkommen” and wondered if there would be one like it when we reached my first destination, Hangzhou.  On that first day it got dark soon after the train entered what looked from the little I saw of if to be spectacular mountain pass up which the train labored slowly for many hours. I ate my dinner in a spotlessly clean dining saloon, a tasty meal of noodles and rice with chunks of spicy chicken which I managed to eat with chopsticks dextrously enough to satisfy pride and the attentive table waiter, followed by tinned fruit and a large pot of tea.  I was offered a bottle of beer but declined because I was very tired and feared it would be enough to knock me out. After dinner, one of my fellow passengers managed to communicate to me the fact that he was from Hong Kong, not China, and that he was an opera singer, apparently a well known, even perhaps eminent performer of classical Chinese opera. He did this using a few words of Italian, French and German that he said he had picked up performing European opera. There are too few operas in English for him ever to have had any contact with English, of which he spoke not a single word, apparently. Next day he entertained me and several other passengers with a little impromptu concert of songs from Chinese opera. That wasn’t the only musical treat on the train. Several times, beginning late on the first afternoon, hauntingly beautiful Chinese music played on stringed instruments was piped over the excellent public address system in the carriage. That was the beginning of my affection for Chinese music. 

The next day I had one of the most fascinating journeys of my life, all day long on the train as it made its way slowly across the lush paddy fields and agriculturally bountiful and beautiful countryside of south China, passing through many villages and large towns and cities. The country was very beautiful. Obviously it had been lovingly cared for during many past centuries, and virtually every square inch of it everywhere was productive. There were fat cattle and water buffaloes, goats, pigs and poultry. I saw sights that could have come straight out of mediaeval China, such as a lad herding a large flock of geese, steering them skillfully and nudging them back into line if they strayed, using a long bamboo pole to do so. It was a fine sunny day, quite warm by noon, and once I got accustomed to the routine, I joined other passengers who got off to stretch their legs on the platform when the train stopped for lengthy periods from time to time to allow another train going the other way to pass us (mostly it was a single track railroad). On several memorable occasions, our passing place was not at a station but somewhere in the heart of the country in cultivated fields or pasture on which cattle grazed. Whenever I alighted with everybody else I was immediately surrounded by a large crowd of curious locals, peasant farmers who had obviously never before seen a “round-eye” (European); and so I was able to practice my body language of smiles and gestures that had to substitute for spoken words as a way to communicate in a setting where no words existed in common between me and these obviously friendly and welcoming people. It was the same later in the cities. Whenever I walked about alone, I was approached, not accosted but addressed in a friendly manner and sometimes in what the speaker thought or hoped was English, and sometimes engaged in animated dialogues in a mixture of words and body language. It would have been impossible not to be moved by these displays of friendly curiosity.

Late in the afternoon we passed through several large cities, then soon after dark we arrived at Hangzhou, where sure enough a welcoming party equipped with a large banner was waiting to greet me. Among them was a very impressive authority on agricultural toxicology, Professor Huang Xi-men who would be my principal host and guide in the coming days. Others on the railway station platform were the dean of the medical school and two or three other dignitaries and a young woman interpreter.  For a few hours before we arrived I had been increasingly aware of the onset of an acute upper respiratory infection – hot eyes, runny nose,  rasping throat, dry cough, perhaps a fever – so I confided my concerns about this to the interpreter. She spoke for a few minutes to one of the dignitaries then left the room (by then we had reached the hotel where I was to stay) and returned a few minutes later with a cup containing a steaming infusion of tangy-tasting herbs that I was encouraged to drink, then go early to bed.  I did so, and next morning, after a good night’s sleep I awoke with all traces of the respiratory infection completely, miraculously gone. I would like to import a supply of those herbs into Canada and go into business, marketing them as a new and effective cure for the common cold!  

Next morning I began to get my first good look at a bustling Chinese city in an early phase of its transition to modernity. I was collected from my comfortable western-style hotel where I had eaten an excellent, appetizing western-style breakfast – the hotel was obviously set up to receive European tourists, although there were none to be seen during my visit. I soon saw, however, why Hangzhou was a desirable tourist stop. The car that collected me was an elderly Russian limousine with plush seats and curtained windows. I would have enjoyed sitting in the front seat with an unimpeded view but even from the rear seat all I saw fascinated me. The streets were thronged with thousands of men and women on bicycles on their way to work I suppose, as well as delivery vans, handcarts, occasional animals, but very few if any recognizably private cars.  We drove across the city without passing through an identifiable city centre ( I saw that next day) and at one stage the road skirted West Lake, a prominent scenic attraction that I saw at leisure later.  I had been invited to speak at the medical school, and soon after I was greeted at the steps of the faculty I was led into a rather spartan large lecture hall, crowded with a hundred or more young men and women and a few elderly people who were their teachers. I spoke on very basic epidemiological principles and methods, illustrating my remarks with overhead transparencies, speaking very slowly with frequent pauses so the translator could repeat what I said in Chinese.  It was surprisingly easy and rather relaxing to speak in this style, and I found it enjoyable enough so I had no hesitation about repeating the experience (though not the same talk!) at every medical school I visited on this and the next visit to China the following year.   

After my lecture and a ceremonial tea-drinking break with the medical school dean and other top people whose names and positions I have forgotten, Professor Huang became my companion and escort for the remainder of my stay in Hangzhou.  He was an impressive man, about my own age, who spoke good English (as well as Russian, the language of his graduate experience in USSR in pharmacology and agricultural toxicology). He had very good comprehension of environmental epidemiology and the principles of public health.  He and I soon established excellent rapport. He was a cultured man who read widely both in his scientific specialty and in English literature and good quality modern fiction, probably the most interesting man I ever met in China. He was investigating several of the chemicals then being used as fertilizers and as agricultural pesticides, had published papers in English as well as Chinese on the toxic effects of broad-leaf herbicides, insecticides and soil fumigating agents, and on the ecological effects on West Lake, a national beauty spot, of storm water runoff laced with pesticides and fertilizers. He eagerly read the chapters on these topics in the copy of my big public health textbook that I had brought with me to leave behind, and I hope he was able to keep that book in his departmental library after I left. Our conversations continued over the next two days and ranged widely over many aspects of environmental and public health as well as books we both had read and enjoyed. He was fond of the works of Charles Dickens and Ernest Hemingway. He and I corresponded for several years after my visit. Then he had a year as a visiting scholar in the USA and after his return to China he rose in the hierarchy, moved to Beijing, and I lost touch with him. He made sure that I had time for a good look at the beautiful West Lake, its picturesque islands decorated with some carefully tended ancient monuments; took me to a venerable Buddhist temple where I was interested to see many people praying and worshiping at the shrines in front of a huge statue of the Buddha; and also took me to his modest home so I could see how he and his wife and two teen-age children lived. I have a good photographic record of my visit to Hangzhou.  Some time during my second day he took me shopping.  I had mentioned my wish to get a few little things to take back to Canada so his driver took us into the business and commercial centre of the city, to a large department store. Immediately we entered, we were almost mobbed by a large crowd of curious shoppers, eager to get closer to us for their first sight of a European. I got some silk for Wendy to make a dress and a few trinkets. I vividly remember being surrounded by a large friendly crowd through which I had to make my way to the counter to pay for my modest purchases.  There was nothing in the least intimidating about this, all were friendly and anxious to help me, for instance by offering other items they thought might appeal to me for me to select and add to my shopping list.

Professor Huang was as reluctant to part from me as I was to leave him. It was only about a two-hour train ride to Shanghai so we agreed to postpone my departure until dusk, and therefore I saw none of the country between Hangzhou and Shanghai.  This was a local rather than a long-distance train, with a long, open carriage rather than compartments, and I was probably the only one who was not chain-smoking foul-smelling cigarettes, so I arrived in Shanghai reeking of tobacco smoke,  with red and stinging eyes irritated by the formaldehyde in the smoke. Here too a welcoming party was waiting for me on the platform, complete with a large banner carrying my name. Next day I took a photograph of the same group of senior staff in front of a blackboard emblazoned with the same or a similar message.  
My notes contain the names of the people I met in Shanghai during that visit in 1981 and in 1982 when I met many of the same people and a few others, notably Professor Su De-Long who was away when I was there in 1981.  I gave my hosts in Shanghai a copy of the written text of one of my talks, “The nature and quality of epidemiological evidence” and to my surprise they published this in the Chinese Medical Journal!  Ken Warren, president of the Rockefeller Foundation and one of his colleagues were also visiting Shanghai First Medical College during my visit, and as they were staying at the same hotel, we were able to compare notes.  We wondered how on earth the staff stayed warm in the bone-chilling cold that week. There was no heating in the medical college. It was spring time but unusually cold weather, looked as if it might even snow, with a piercing north wind that went through our clothes. Like I, Ken and his colleague only had summer weight suits and pullovers to wear under their jackets, although unlike I they at least had winter storm linings in their raincoats. Our hotel was a little better, but not much. No escorted sightseeing in Shanghai – not that there were many spectacular sights to see – but I had some free time and wandered about by myself.  I made my way from my hotel to the Bund, the old waterfront commercial district on the busy Wangpu River, and for a time got completely lost in a maze of streets on the way back to my hotel. It was there that I saw two kinds of people I had not expected to see, several beggars with bowls at their feet into which they clearly hoped and expected passers-by to drop small coins (as indeed some had); and on one street near the Bund, several heavily made up young women whose short skirts and behaviour strongly suggested that they were prostitutes. I had been told on more than one occasion that there were no beggars and no prostitutes in the People’s Republic. This was manifestly not so.  Friendly locals with a smattering of English set me on the right road back to the hotel soon after that. What I saw of this huge city was attractive, a blend of quite handsome European “Victorian colonial” architecture of buildings that had been the Chinese headquarters of European banks and other financial and trading companies before the wars of the 1930s and 1940s, with older Chinese mansions and even palaces. Looking at TV images of modern Shanghai, the commercial capital of China, I wonder how much, if any of those graceful old buildings survives. The city obviously has been completely transformed.  However, most of it, especially the central commercial and trading heart of the city, is at or near sea level, so even the half meter sea level rise of the most optimistic global warming scenario would submerge it, so the future of Shanghai could be equivocal.
In 1981 I flew home from Shanghai via Tokyo and Los Angeles. When I returned in 1982, it was towards the end of a round-the-world odyssey, that began with a flight from Mirabel Airport near Montreal, all the way to Calcutta.  From Calcutta I had gone on to Singapore via an overnight station stop in Bangkok; I was external examiner for the qualifying examinations in epidemiology and preventive medicine at the National University of Singapore and spent a couple of weeks there before going on to Hong Kong, where Wendy joined me.  We lived it up in Hong Kong, stayed at the posh Regent Hotel in a waterfront room with a superb view of Hong Kong harbour, and did much the same tourist trips that I had done on my own the previous year. We had several wonderful days there, then flew direct to Shanghai. That was the flight on which the door to the cockpit got stuck, and the cabin crew used an axe to break it open so they could get to the flight deck.  Wendy found this more alarming than I did, having had some prior experiences of Chinese improvisations to cope with unexpected mechanical breakdowns. 

This second visit to Shanghai was far better than the first for several reasons. To begin with, Wendy was with me, then as well as a slight familiarity with the country and its people there was an eminent host, Professor Su De-long to escort me in Shanghai. He was a distinguished and very gracious man, who took me into the field to see the results of the successful campaign to eliminate schistosomiasis which for centuries had killed and crippled countless thousands of children and young adults who worked in the paddy fields. The key to success was thorough understanding of the complex life cycle of the parasite and the ecosystems with which it interacted. The critical step was a concerted attack on the fresh-water snails that were the intermediate hosts, but in addition there were educational campaigns to eliminate defecating in the paddy fields, an anti-cercarial ointment to reduce the parasites’ chances of penetrating the skin, and effective medication for infected people.  The fact that domestic animals, notably water buffaloes, and water rats and feral dogs were also infected made impossible any efforts to eradicate the disease completely, but it had been virtually eliminated from humans, especially children who were the most vulnerable. I saw and photographed children who were clearly in abounding good health, a living tribute to the dedicated work of Professor Su De-long and his teams of field workers. 

Su De-long took Wendy and me to dinner, where a small crowd of nearby diners gathered around us to watch with great amusement the way she handled her chopsticks; and to a theatre, for a spectacular performance of acrobats and dancers. Even an occasional misstep did not detract from a most memorable performance, according to my notes at the time.

From Shanghai we went by train to Suzhou, reputedly the culinary capital of China in the same way as Lyon is the culinary capital of France. Our host was Dr Lee, director of Industrial Hygiene and Toxicology. The medical school is a collection of picturesque old buildings and I delivered my talk in an ancient pavilion, not a lecture hall, but the acoustics were excellent. I spoke here (by request) on the desirability of diversity rather than uniformity in educational methods. There was some local resentment among both staff and students about the centrally imposed curriculum and teaching methods, dictated by authorities in Beijing, and my talk provoked animated discussion. The  impressive fourteen-course banquet to which we were treated confirmed the city’s  reputation for gastronomic excellence. It included several fish courses, shrimps,  a local delicacy, 100-year old eggs (preserved underground for many years anyway) and the most challenging article I’ve ever had to pick up with chopsticks, slippery round translucent eggs about 1 cm in diameter, each containing an embryonic bird nearly ready to hatch. They tasted delicious, with a unique nutty flavor, but getting them to the mouth was difficult for me, impossible with chopsticks for Wendy, who had to use a spoon. There were many toasts with the local fire-water, fortified rice wine like neat vodka which we drank in tiny glasses, saying ‘Gambay’ (Mandarin for ‘Cheers’) and voicing sentiments like ‘Long live friendship between Canadian and Chinese people.’  Suzhow is famous also for canals connecting it to Shanghai and Hangzhou, for the beautiful arched bridges over the canals, and for enclosed decorative gardens. All these appear on willow pattern crockery. On our last afternoon in Suzhou we were taken to one such garden where our guide (one of the professors from the medical college) got us all lost, so we almost missed the train to our next destination, Nanjing. 


With our hosts in Nanjing




At Nanjing railway station we were met by Dr Lee from the health department and Professor Ye, an environmental health scientist from the School of Public Health at Nanjing Medical College, who was my host and later our guide when we visited the tomb of Sun Yat-sen. When we reached the School of Public Health I met about a dozen of the academic and research staff and dutifully wrote their names in the stenographer’s pad that is the basis for these recollections. After more than a quarter of a century I could not put faces to any of the names but I do remember that I was very favorably impressed by their obvious competence, enthusiasm and dedication. This is a large and flourishing medical college and school of public health, set up by Dr Sun Yat-sen on a well laid-out campus with an impressive range and depth of research in progress, but like all the medical colleges I visited it was sparsely equipped with a good but limited library. After we returned to Canada I arranged for the Chinese Embassy to send them a copy of the big public health textbook, for which in due course I received an effusive letter of thanks.  In 1998 I was visited in Ottawa by the current dean and one of his colleagues who remembered me as their first Canadian visitor since before the cultural revolution. They said they had happy memories of my visit in 1982, as did I.  I gave them copies of the latest editions of the Dictionary of Epidemiology and the big public health textbook, now only 1400 pages instead of the 2000 in the earlier edition that had been the first one I edited, and pointed out that it was printed in much smaller fonts so now it had about 1500 words to the page instead of 900 as in the earlier edition. Nanjing Medical College and its School of Public Health were impressive enough for my copious notes to consume eight pages but there’s no need to repeat all that outdated technical information here. It was in the professional reports that I wrote. We were dined and wined like visiting royalty, and treated to a fairly comprehensive tour of this handsome city on the banks of the Yangzte River (although I don’t recall seeing the massive city walls that date from around 800-1000 of our era). The city was badly damaged during the Japanese invasion and had been the scene of horrific massacres and mass rapes, so much of it is modern postwar architecture, but happily it was spared too many of the soulless concrete blocks and towers that some Chinese cities were erecting in imitation of similar buildings in USSR. We visited the tomb of Sun Yat-sen (1866-1925) the physician-statesman founder in 1912-13 of modern China, now rightly revered  only slightly less than Mao Tze-tung, especially in Nanjing where he established the modern medical college. We saw an adjoining beautiful pagoda, a Ming emperor’s tomb dating from the 14th century, and the Divine Way, an avenue of beautifully carved stone animals (elephants, camels, lions, and mythical beasts) that dates from the Ming dynasty and was created in 1350-1400. It would have been good to spend longer in Nanjing, explore it more thoroughly, but our tight timetable did not permit this. Photos and video clips of the city in 2006-7 show many spectacular changes with exciting modern architecturally and aesthetically pleasing public and commercial buildings along and just behind the waterfront on the Yangzte River. It would be good to see it again now.



Stone animal (camel?)  on the Divine Way, Nanjing, 1982














From Nanjing we went by overnight train to Beijing, sharing a four-berth sleeping compartment with two senior military officers, both of whom smoked heavily. Wendy made it emphatically clear with gestures and mime that she would be displeased if they smoked in the compartment, so they retreated to the corridor at frequent intervals. We were impressed by their politeness and their cheerfully willing compliance, and I wondered if anyone had ever stood up to them as she did. 

In Beijing we were met at the railway station by Professor He, a distinguished elderly man who had been educated at Harvard and the London School of Hygiene and Tropical Medicine in the 1930s, and by several others including Mr Wang from the Ministry of Foreign Affairs and the Chinese Academy of Medical Sciences (obviously a Communist cadre man there to watch out for any subversive hanky-panky!) Ostensibly he was our translator, but he was unnecessary for much of the time because many staff members at the medical college spoke good English.  This medical college had gone through several transitions. It had been set up with lavish financial support from the Rockefeller Foundation in 1921 and was named Peking Union Medical College.  After the Communist revolution it had become Capital Medical College. In 1967 it was closed by the cultural revolution, Mao’s most calamitous failure, then it reopened in 1979 as the Beijing First Medical College.  It has now reverted to its original name. In Beijing, the authorities had laid on a full program for me at the medical college with visits also to the  Chinese Academy of Medical Sciences, and several research institutes including the Cancer Research Institute, the group responsible for the Atlas of Cancer Mortality and a team of neurophysiologists who were studying acupuncture, seeking to discover how and why this ancient therapeutic method worked. There had recently been widely publicized demonstrations of acupuncture anesthesia, showing empirically that it was effective for major thoracic and cranial surgery as well as for treatment of arthritis and various other chronic diseases. It did not work for upper abdominal surgery but could be used for appendectomy and repair of inguinal hernia. The prevailing view was that its efficacy was due to overload of pain receptors and release of massive amounts of endorphins under the stimulus of subcutaneous acupuncture needles. I made copious notes during a pressure-packed few days in Beijing and wrote several reports and short articles for medical readers that have been published or circulated elsewhere, so in this account I will focus on the non-professional aspects of the trip.

On our first afternoon in Beijing we were both a bit fragile after a near-sleepless night in an over heated, claustrophobic sleeping car compartment. Perhaps that’s why we did some sightseeing on our first afternoon. Professor Ho’s wife, almost as old as he, but very fit, took us to the Forbidden City, which far exceeded our expectations with its displays of priceless jade, gold and jewelry.  We saw the emperor’s palace and walked on the squeaking floor – designed to squeak loudly at the lightest footfall, to warn those within that someone was approaching, perhaps with sinister intent. We walked into Tiananmen Square, bustling with people as it usually is, and also with traffic, mostly people on bicycles.  We were astonished to see the enormous loads some people were carrying on their bicycles – large pieces of furniture such as chests of drawers, for instance. Beijing was afflicted at that season (spring time) with fine dust that blows with the prevailing wind from the Gobi Desert, so people who wanted to avoid inhaling this dust covered their nose and mouth, sometimes their whole face, with a fine diaphanous silk veil. Many children had been  equipped with these by their caring mothers, and some young women, we suspected, were wearing these dust-resistant veils to make themselves look more alluring. 

Everywhere we went in China we saw groups of beautifully dressed, attractive and very healthy-looking children, ranging from pre-school toddlers to 8 to 10 year old children in the care of (we presumed) school teachers. Less often a solitary child was in the company of parents.  All these children were the products of the one-child policy, a necessary but emotionally demanding action forced on the People’s Republic of China by the relentless increase in numbers, then fast approaching a billion (about 1.2 billion by 2008, because of the demographic momentum of the younger generations that continue to enter the reproductive age groups of the population).  Wendy had several sightseeing expeditions with Professor Ho’s wife Mrs (actually Dr) Ho. At one stage Mrs Ho took her into the new underground railway where she succeeded in getting them both briefly lost.

Professor Ho took Wendy and me to a Beijing restaurant famous for Peking duck, which we duly ate, but without much enthusiasm – like all duck, it was too greasy to please our palates.  What did impress us about this place however was the astonishing variety of faces we saw there. This restaurant is very popular with visitors to Beijing from all over China. I don’t recall ever before seeing in the same room at the same time so many variations of facial bone structure, hair texture, skin color, body build, added to which were styles of clothing from the tropical south to the far north, to the outer reaches of Mongolia.  The variation in that one room full of people was greater by far than on the New York subways I had seen and written about a few years earlier. 



Wendy and John at the Great Wall








Wendy at the Great Wall of China, 1982





On a fine and sunny but cold spring day we went to the Great Wall, a couple hours’ drive away.  It was well worth it of course, justifying its reputation as one of the greatest manmade wonders of the world. We had a very good look at it, climbed up and walked along it, took many photographs, and had lunch there.  Wendy had to use a very public female toilet, where the other women were intensely curious to see if she was constructed as they were.  I wasn’t able to be with her to offer my moral support but she did quite well without me. 

We had the usual banquets in Beijing, and on our last night there I felt the need to repay the generous hospitality we had received everywhere, so rather unnecessarily and quixotically I took our hosts and their spouses to dinner. These were all late middle age or elderly people and most of them were  distinguished leaders of the profession and of academia.  All had horrific stories of their experiences during the cultural revolution when they had been uprooted from their academic roles, humiliated and abused in public, then put to hard manual labor in mines, paddy fields or, in one case, cleaning public toilets. That disastrous public policy which virtually shut down universities for over a decade accounts for the age distribution of university teachers, with large numbers of elderly and old men and women, a young generation just out of graduate training, and very few, in some fields virtually no one in middle years between these two groups. There was an urgent need to rebuild, and in Beijing we met Michelle Higginbothom, wife of the first secretary at the Canadian Embassy, who joined forces with me in Ottawa a few months later in one of several programs aimed at replenishing qualified staff in university departments as rapidly as possible.  Wendy and I were both coopted to take part in this by hosting Chinese epidemiologists during their orientation, helping them to learn English as well as epidemiology. That’s a whole other story.   
Housing: When we were in Beijing in the early 1980s there were a few high-rise apartment towers on the horizon. Now, more than 25 years later, Beijing looks as Hong Kong did then, according to pictures on TV screens. There are forests of high-rise apartment buildings everywhere one looks. In 1982, we looked down from our hotel room to a more traditional kind of dwelling. On most of the streets we could see there were quite large compounds with central courtyards, three or four stories tall, each containing multiple flats that in many cases seemed to be teeming with people. In Hanzhou in 1981, I had been in one such flat, the home of Professor Huang Xi-men. It was small but comfortable, two small bedrooms, a kitchen-dining-living room, a bathroom with a ‘squat’ toilet with a shower over it, similar to those I had seen and used in Greece and Italy in the early 1950s, and a small entrance hall with hooks to hang coats and a rack to place outdoor shoes. Access is along a balcony rather than through an indoor enclosed corridor. This multiple-unit style encourages interaction among neighbours and a communal way of life that fosters congeniality, friendships and mutual support, although of course it can lead to unpleasantness if people living at such close quarters don’t get along.  Professor Huang lived in such a flat in a compound that probably comprised 16-20 similar flats, and the compounds we could see from our Beijing hotel room looked about the same size or perhaps a little larger.
Religions: The People’s Republic of China is a secular state and we have an image of a state that is hostile to religions. The teachings of Confucius may be more like a philosophy than a religion, but I had seen obviously devout Buddhists worshiping at a well-cared-for shrine in Hanzhou, and in Beijing, Professor Ho and his wife walked us past the Protestant church that they attended. They said there had been times in earlier years of the PRC when religious faiths had been driven underground but there had never been serious attempts to eliminate them altogether and at that time the authorities seemed to be turning a blind eye to the practices of most religious believers.  

Postscript: For three years after our visit to China in 1982, about 12-15 Chinese epidemiologists in training came to Canada annually to get advanced postgraduate training. They came to Ottawa for about two months orientation and conversational English classes before scattering to centres across Canada for formal graduate studies leading to an MSc or for a few a PhD in epidemiology. 
Michelle Higginbotham coopted Wendy and me to take part in these classes.  We worked out a happy symbiotic arrangement for meals. We supplied the equipment, they went to the market to buy some of the raw materials (fish, salad, spices, etc), together we all prepared and cooked the meals, then we ate, washing the food down with liquid refreshments that I supplied. We had many happy gatherings, suitably recorded in our family photo albums.  All these men and women were very good company, and all but one of them did well in their graduate studies (the exception was a plant, we think, a communist cadre man sent to keep an eye on the others). They went back to China, but several later returned to Canada and settled here. One very bright man, Gao Ru-nie, who got a PhD, moved out of epidemiology altogether soon after returning to Calgary to open and run a successful Chinese restaurant, but so far as I know all the others stayed in the profession. We are still in touch with several, including some in China and two who returned to Canada. One of them worked for over ten years on epidemiological research in cancer in Ottawa. Besides Yue Chen in our department in Ottawa, I know or know of about half a dozen Chinese physicians who specialize in public health sciences who have settled permanently Canada, and several others who have settled in the USA and the UK. I have an impression that the brain drain from China may be considerable, but the Chinese authorities appear to be relaxed about it. They warmly welcomed Yue Chen when he returned to Shanghai for a sabbatical year recently, and Yue says that he was encouraged to move to Canada, to help establish intellectual links between China and Canada. 

The above is condensed from a longer account of my travels that is part of my memoirs. Among other deleted paragraphs is one with my impressions of the collective national mood, as observed from the facial expressions and body language of the people I saw on the streets, in shops, sight-seeing on the Great Wall, audiences at theatres.  I was struck everywhere by the cheerfulness and sense of purpose that seemed to be the prevailing mood. There seemed to be a sense of optimism, that things on all sides were rapidly improving, life was manifestly getting better all the time. People on bikes in Tienanmen Square were whistling, laughing, greeting each other happily as they wheeled their incredibly heavy loads. I suppose propaganda spread the message that sacrifice and hard work now would pay off, and it's self-evident that it has. Life is getting better for most if not all people as modern China presses ahead with its combination of unbridled capitalism and totalitarian (but not Marxist communist) governance.

Sunday, June 10, 2012

The 1980s

When Wendy and I returned from New York to Ottawa just before Labor Day 1979, we settled into a comfortable town house looking out on Hampton Park less than a Km from where we had lived for 8 years on Island Park Drive. Wendy picked up her volunteer activities where she'd left off, sharpening her skills as a docent at the Museum of Nature. Rebecca was living in Montreal, a part-time student at Concordia University; David was an officer cadet at the Royal Military College in Kingston, and Jonathan was a student at Broadview High School. I soon acquired interesting new duties. I had left the chairman's office of the department of epidemiology and community medicine when I started my sabbatical leave. Gilles Hurteau, dean of the faculty, appointed me secretary of the medical school, a role comparable to that of registrar, so I continued to serve on the faculty advisory board. Liberated from departmental administrative chores, I was free to devote more time to my first love, corrupting the innocent young minds of medical students with my subversive ideas about the importance of preserving and promoting good health.  I became active in the Student Advisory Group, a useful social bridge between faculty and students that led to development of an official mentor program, among other things. With a lot of help from Janet Christie-Seely, Paula Stewart and several others, I reshaped a previously unpopular first year course on 'Human Growth and Development' into a new multidisciplinary course that we called 'Human Dimensions of Health and Illness' with emphasis on social and emotional determinants of health and disease, small group learning activities and getting out of classrooms into clinical settings and patients' own homes. It was a pilot study for problem-based learning that was introduced the year after I officially retired from my active teaching role, in 1992. Soon this course became the most popular unit in the first year and even attracted students from other years and from the school of nursing (where I taught a course on social medicine). I chaired the curriculum committee - an important position because we were initiating major curriculum reforms.

My role as editor in chief of the massive Maxcy-Rosenau textbook of Public Health and Preventive Medicine made me a sort of walking, talking encyclopedia of all things to do with public health. This opened several doors.  I was appointed scientific editor of the Canadian Journal of Public Health and began to transform it into a better quality peer-reviewed journal than it had ever been before. The Law Reform Commission of Canada recruited me as a consultant for several ongoing projects, notably the regulation of urea formaldehyde foam insulation (UFFI) which was a suspected carcinogen. My interests in environmental epidemiology and in ethics coalesced in interesting ways in the European Region of the World Health Organization and in the affairs of the Council of Biology Editors. Most important of my new roles was an invitation from two former mentors, Kerr White and John Brotherston, president and secretary of the International Epidemiological Association, to compile and edit a glossary or dictionary of epidemiological terms, a topic that had interested me since 1964 when I observed frequent inconsistency and uncertainty in the terms epidemiologists were using to describe their concepts, methods and procedures. This was the genesis of the Dictionary of Epidemiology, which may be my most important scholarly contribution.

34 Waverley Street, Ottawa is the end unit nearest the camera in the row of town houses near the Rideau Canal at this end of Waverley Street









Our town house was comfortable and splendidly located, backing on to Hampton Park where bird and native animal life flourished; but it was a long way from the university and the medical school. Wendy spent much energy and time hunting for a more strategically located home. We decided on a row house at 34 Waverley Street in the 'Golden Triangle', at the corner where the Rideau Canal turns 90 degrees before heading to the locks between Parliament Hill and the Chateau Laurier. We could walk easily to the great pulsating heart of downtown Ottawa. We lived there for the next 11 years. We made good friends among our neighbours, entertained a good deal, and covered the walls of our home with book shelves and Wendy's paintings.


David, Jonathan and Rebecca on the rear deck,
34 Waverley Street, Ottawa, c. 1982
















Three generations of Last men: Ray, David and John Last in the Hunterian Anatomy Museum, Royal College of Surgeons, London, 1984







We traveled extensively in the 1980s, to Europe almost every year, combining work for me and rail pass holidays with Wendy when the work was done. We visited Paris several times, Prague, Budapest, Vienna, Berlin, Rome, Pompeii, Florence, Venice, and Switzerland and Sweden several times; in 1982 we went to Hong Kong and China, and in 1985, at the time of the centenary of the University of Adelaide medical school, we had the first of what became annual visits to Australia and New Zealand. At the Centenary celebrations in Adelaide in 1985, we had a rare reunion with my father, my brother and me - only the second time in Peter's and my adult life when we were all three together in the same city at the same time.

John, Ray and Peter Last at Peter's home in Adelaide, August 1985











Some time in the spring of 1987, I was visited by a senior official in the Australian Medical Association. He came with an invitation to me to return to Sydney to become editor of the Medical Journal of Australia and a professor of public health at the University of Sydney.  It was a dream job, tailor made for me. Alas, although very tempting, it came too late. All of us in the family except perhaps Jonathan were too heavily involved in our professional, social, and emotional lives to face such a major disruption and the social and cultural problems of re-entry to Australian life and society. We had been back often enough to recognize some unfortunate similarities in values and behaviours between Australia and Texas. It would have been yet another international migration with all the cultural adjustments to face yet again. We realized that all of us had become too Canadian to reintegrate again as Australians.  We were in Canada for life.

My reputation grew, my professional life blossomed in the 1980s. My first round as editor in chief of the huge reference textbook, Maxcy-Rosenau Public Health and Preventive Medicine 11th edition, was published to considerable acclaim in 1980; the first edition of the Dictionary of Epidemiology followed in 1983, my second round of Public Health and Preventive Medicine - running to 2000 pages - and the first edition of my solo book, Public Health and Human Ecology, came out in 1985-1986, followed by the second edition of the Dictionary of Epidemiology in 1988; several other reference books, encyclopedia entries, book chapters, original articles, and special  reports for WHO and other agencies and the government of Canada also came out in that productive decade.  In 1987-89 I was President of the American College of Preventive Medicine, the only non-American ever to hold this position; and during this period I served on high-level committees and advisory groups, including one that reported to the US Senate, as well as corresponding groups in Canada.  The most important of these was a panel I chaired for the Royal Society of Canada, which examined the health implications of global climate change. There were several other fascinating assignments in that productive decade, and enough of them flowed on into the 1990s and beyond, to fill another post like this one.  It had been the right decision to stay in Canada, not return to Australia.

Sunday, June 3, 2012

Sixty Years Ago...

Today's BBC News has been replete with pictures of the festivities celebrating 60 years since the coronation of Queen Elizabeth II, interspersed with news shots from coronation day.  I just saw a picture of the packed stand where I sat with my mother, watching the great parade go past.  If that picture had stayed on the screen a few moments longer I might have been able to identify us.  I remember the day very clearly. Fearing a possible traffic snarl-up on the day, I had slept in a sleeping bag underneath the stand on the previous night. "Slept" is a figure of speech.  It was a record-breaking cold night, down to 2 C in central London, and I did more shivering that sleeping in my rather poorly insulated army surplus sleeping bag, envying the couple near me who snuggled together - more in amorous union than to keep warm but no doubt their active show of mutual affection generated heat too. About 9 am on coronation day, loud speakers piped the BBC Radio News to all of us waiting in the Australian stand. A cheer rang out when it was announced that Edmund Hillary and Tenzing Norkay had reached the summit of Mount Everest, a cheer drowned by the much louder cheer from the adjacent New Zealand stand Where Wendy - whom I hadn't yet met of course - was watching.  I don't suppose many of us stopped to think about how long the new queen would reign over us. She has presided over a disintegrating empire and a dysfunctional family and can be relied upon to utter comforting words appropriate for all occasions. She deserves at least one of the long service medals she hands out to others in her official capacity.

Thursday, May 31, 2012

Mr g

Whether the gifts of intellectual, artistic and athletic excellence are apportioned by deities, genetic endowment, or blind chance, nobody denies the fact that they are apportioned unevenly. Consider Alan Lightman. He is a professor of theoretical physics and the humanities at MIT with cross-appointments at Harvard in both - theoretical physics and the humanities, specifically the art of writing. Clearly he was dealt a really good hand in life's lottery of gifts and burdens. Some years ago he wrote a best-selling novel, or novella, Einstein's Dreams, a beautifully, lyrically written story about time. Einstein, the Albert Einstein who conceived the theory of relativity, appears as a character in this novel, which could be loosely described as a metaphysical novel about Time as one of the fundamental constants of physics. Except that Time isn't a physical constant in this novel. As we all know from personal experience, time can move rapidly or slowly, can even stop altogether, can move in a circle. Indeed, it's a profound, light-hearted, challenging, thought-provoking, provocative work. Knowledge and understanding of theoretical physics aren't essential prerequisites but helped me to appreciate the book. If you haven't read it, do so.  Now Alan Lightman has done it again with another beautifully written little masterpiece, Mr g,  about how (and why?) god created the universe, or universes, and everything in it, or in them, starting with Time, then Space, then everything else. It's a lovely little book, modest, unassuming, great fun. Lightman has obviously thought very deeply about every detail, starting with lower-case 'g' for god, a modest creature whose Aunt Penelope and Uncle Deva respectively disapprove and are bewildered by Mr g's decision to create the universe and everything in it. Like Einstein's Dreams, Mr g is profound, light-hearted, serious, thought provoking, provocative, beautifully written. Read it!

Thursday, May 24, 2012

Books and what is in them

These days I have enough spare time to respond to on-line questionnaires if I think the questions are worth while; a few weeks ago I responded to 2-3 rounds of questions on the editorial and features content carried by the Globe and Mail, the nearest we have to a national newspaper in Canada. The 'incentive' to complete the questionnaire didn't matter - it was the interesting questions that attracted me. But there was an incentive, a $200 book gift card.  Amazingly, my name was drawn and I won the $200 gift card! It's the first time ever in my life that I've won anything in a 'lottery' like this. I have about $200 worth of books on my "Wish List" with the online book shop Chapters-Indigo, so I'll cash in the gift card and get them all I think. Next time you are invited to respond to an online questionnaire that offers a chance to win an award like this, you might want to spare a few minutes to answer the questions, instead of just deleting it as I've usually done in the past. You never know: maybe you will win too. 

The past week has been a book bonanza -- and I still have over $100 credit to cash in. Two of the books I now own are fictional biographies if such a term exists, fiction based on the lives and careers of famous people. One is the second volume of Hilary Mantel's superb trilogy based on the life, times, actions and interactions with others, of Thomas Cromwell.  The first volume, Wolf Hall, was the first book on which I wrote comments in a post on this blog, in March 2010. At the time I thought it was the best historical novel I had ever read. The second volume, Bring up the bodies, is about Thomas Cromwell's role in the destruction of Anne Bolyn, and the shifting political alliances in and around the court of Henry VIII in those years. It is as historically accurate as Hilary Mantel can make it, it vividly describes the intrigues and violent actions we know about from the historical record, and just as important, it maintains the high literary standard of Wolf Hall - and as I remarked after reading that first volume, I hope I live long enough and remain sentient so I will be able to read the third and final volume too when it is published. My other newly acquired historical fiction is David Lodge's version of the womanizing ways of H G Wells, the prolific and prodigiously polymath public intellectual and writer who bestrode the early decades of the 20th century like a colossus. I first encountered him in my adolescence when I read his Science of Life and Outline of History. I think this was the first work on history that I read for pleasure and enlightenment and it led me directly to the library of historical monographs that I read to preserve my sanity while I was a medical student, trying to learn the bewildering new languages of anatomical and physiological terminology. I moved on to Wells's social novels, Kipps, Anne Veronica and a few others, all of which I enjoyed, and which opened my mind to important social issues, and his science fiction novels, War of the Worlds, Invisible Man, and Things to Come (which I found rather dull and implausible). I didn't know until years later that Wells was a notorious philanderer.  There is nobody better qualified to write about H G Wells than David Lodge - professor of English at the University of Birmingham and author of a hilarious and perceptive series of novels about contemporary academia. The book bonanza didn't end there.  I also got The social conquest of earth, E O Wilson's latest lament about the ways in which modern humans are destroying life-supporting ecosystems on this earth, the only home we humans have; and A universe from nothing, a philosophical work about the universe (Which addresses the tantalizing question, Why is there something rather than nothing?). So far I've had time only to glance at these last two books, but I can see I'm in for a major bout of my habit of reading several books all at the same time. Somehow my brain seems able to discriminate among them, and I am comforted to discover that I seem to be as able as ever I was to pick up the several separate threads as I move from one to another, moved by whim and my mood at the time. Wendy thought it was a bad habit because it meant sometimes that books she wanted to read too got stalled on my bedside table when she wanted to shift them to her bedside table. She never read more than one book at a time despite my frequent encouragement to her to adopt my sinful ways. I revel in these ways, though sometimes so many books pile up on the bedside table that they overbalance and fall to the carpet below. When that happens nowadays, I move them out if I haven't advanced through them in the past few months, out to a book shelf elsewhere in my apartment, or out of my life altogether if I think I will never come back to read the rest of a book, to find out how it ends.  

Sunday, May 20, 2012

As Time Goes By

My daughter-in-law Dorothyanne, mother of my grandchildren, has posted comments on As Time Goes By on her blog. I can't resist adding my thoughts. This is the immensely popular BBC domestic comedy about Lionel Hardcastle and Jean Pargiter, two 20-ish lovers who met at the time of the Korean War, in 1950, were parted for 38 years when a letter went astray, met again by chance when Lionel, now late middle aged, took Jean's daughter to dinner. It ran for 8 years on the BBC, perhaps because Jean's part is played by the great actor Judi Dench, but I think more because of the appeal of the gentle, benign interaction of the principal characters and the excellent supporting cast.  Wendy and I loved it, own the DVDs of the entire series, and watched it repeatedly. Less than a week before she died, Wendy managed to laugh (and cry a little) at the episode in which Lionel and Jean finally marry. Some of the appeal of this domestic comedy of modern manners to Wendy and me is probably because Lionel and Jean were our age, in their early 20s at the time of the Korean War. We could identify with them very easily; Wendy thought she had some of Jean's values and mannerisms, and Lionel's curmudgeonly conduct closely resembles the way I think and behave. The Korean War is an almost forgotten conflict now, but it loomed very large in 1950-53. At one stage the North Koreans pushed the South Koreans and their UN allies into a tiny pocket of land on the south coast of the Korean peninsula. Then American, British, Australian and Indian reinforcements arrived, pushed the North Koreans back to the 38th Parallel, and after a period of stalemate, a truce was arranged. But no peace treaty was ever negotiated and a heavily armed standoff persists even now, 60 years later. For a while in the early 1950s, I seriously considered enlisting in the Australian forces and serving in Korea. If I had remained in Australia in 1951 instead of going to Britain, I would likely have been drafted when conscription was briefly reintroduced in Australia. It's another example of "What might have been" if my life had unfolded in a different way.

Perhaps I should add a chapter to my memoirs on "alternative history"and speculate on how some of those other ways my life evolved might have turned out.

This is my 300th post. I know or can guess the identity of about half of the people who read this blog (up to 40/day now) but as the number of readers rises and the range of the audience widens, more seem to be based in countries where, so far as I know, I have neither friends nor professional colleagues. Who are the Slovenian readers, for instance? I get some feedback from friends and colleagues in personal emails, and - rarely - comments from strangers. I'm intrigued: I wonder who all the other strangers are, and why they read my blog.

Monday, May 14, 2012

Indonesia, 1972


Here is an abridged account of my short-term consultant appointment for the World Health Organization in Indonesia in 1972; when I get my scanner repaired, I will add a few photos to illustrate this.

In January 1972 my first glimpse of Indonesia was from 10,000 meters above. Through breaks in the monsoon clouds I saw a conical volcano with fumes and steam billowing from the summit. It may have been the 3,000 meter volcano on the island of Bali, which I saw later from sea level but it could as easily have been one of  many volcanoes on Java. 

The heat and humidity hit me like a body blow when I stepped off the plane to the tarmac in Jakarta (no air- conditioned arrival hall in those days).  Dr. Iwan Soutjaja was there to meet me, a short, stocky Chinese Christian Indonesian festooned with gold necklaces, bracelets and rings, who had evaded a recent genocidal assault on the 1000-year old Chinese communities in Jakarta and Surabaya in which over 300,000 died in a little-known and bloody episode of the Cold War (the CIA had started a paranoid rumour that ‘Red China’ was planning to take over Indonesia and install the entirely non-political Chinese merchants and traders as surrogate rulers).  Soutjaja was based in the Ministry of Health. He was the liaison man between the University of Indonesia and the local office of WHO, where my fellow consultant and I went next morning to meet the WHO country representative, a pleasant Dutchman, Dr. Kejir who grew up in what was called Batavia when he was a boy, now Jakarta. My fellow consultant was John Pemberton, professor of social medicine at Queen's University in Belfast. I first met him in 1961 at the home of Will Pickles of Wensleydale, a famous British general practitioner, author of Epidemiology in Country Practice.  At that time, John Pemberton was spending his summer holiday doing a locum for Will Pickles, whose biography he later wrote. John Pemberton and I had been asked to assess the status of teaching and research in public health at medical schools then serving the Indonesian archipelago and its 110 million people. There were plans to establish a school of public health in Jakarta, and our principal task was to advise the Regional Office of WHO whether adequate human and material resources were available. 

I found everything about Indonesia fascinating:.the scenery, the energetic and mainly bright people with whom we were working, the delicious exotic food, the contrasts between luxury hotels for rich tourists and corporate executives of multinational corporations, and the simple, sometimes squalid conditions of the Javanese. John Pemberton was not so happy.  He was often unwell and plagued with increasing deafness. A new hearing aid wasn't helping much because he had recurrent fungus infections of his ears. He was irritable and would ask our hosts to repeat things they had already said, because he hadn't heard clearly the first time, and perhaps also because he was more insistent than I on getting the facts absolutely right. I learnt a lot from him about the need for meticulous attention to detail. Since 1972 I have had feedback from some of those we met then, and from others, about benefits derived from our report and recommendations.    

My first day in Jakarta was a Sunday. I spent it by the swimming pool of the Hotel Indonesia.  I was struck by the number of young and beautiful local women who accompanied the middle-aged corporate executives relaxing around the swimming pool. That sight, and variations on it, recurred at other luxury hotels in Jogjakarta, and in Bali (where there were also, of course, many tourists). Bandung, where my room looked out at a smouldering volcano, was less full of overseas corporate executives, but a bevy of beautiful Javanese girls were waiting in the hotel lobby, in case any came along. We were not distracted from our work by these good-looking girls but business seemed brisk with business men from Europe, USA, Australia and Japan.

After a few days in Jakarta, we grew tired of the expensive and rather boring meals at the Hotel Indonesia, and went exploring. Not far along the road were some interesting Chinese, Indian and Thai restaurants. We tried these and liked them. I mastered the use of chopsticks, and consolidated my affinity for Chinese and Thai food. It was an interesting walk to these restaurants. Our route took us about 500 meters along a sidewalk of concrete blocks, some of which had had the ground underneath scoured out by monsoon rains, so they were tipped and tilted every which way; one or two had subsided a half meter or so below the rest, and in the dim street lighting, we had to watch our steps carefully. This was also the beat for some local ladies of the evening, who did their best, although unsuccessfully, to persuade us to dally on the way to and from our evening meal. The best of these restaurants, to which we returned several times, was called the Sky Room; I have a pair of fake ivory plastic chopsticks from there as a souvenir. 

Altogether we had about three weeks in Jakarta, in several instalments. We met the important dignitaries, officials of the Ministry of Health, staff in the University of Indonesia, local representatives of UN and NGO agencies. Also we used Jakarta as a base to visit interesting nearby experimental health centres. I was very impressed by the competence and dedication of the public health nurses who were educating traditional village midwives in elementary hygiene - teaching them to flame the scissors they used to cut the umbilical cord, to ‘drive out evil spirits’ (pathogens) instead of sprinkling ash from the cooking fire on the crushed end of the umbilical cord. They showed us figures to demonstrate the effect of this simple measure alone in reducing the neonatal death rate due to tetanus from almost 10 percent to near zero in a period of three years. Everywhere we went I was captivated by the beauty of the countryside, the lush green trees and neat paddy fields, the placid water buffalo, tidy villages teeming with cheerful, attractive people. I was struck by their youth - we rarely saw old people. The average age of the population, we discovered when we met the demographers at the University, was just over 20, less than half what it was in Canada. Almost half the population was under the age of 15 - their population bomb had not yet gone off. A very high priority was the national family planning program, which in retrospect can be seen to have been successful.   Later, in central Java and in Surabaya, we had our fill of seeing sick people: there was a gastro-enteritis, perhaps even a cholera epidemic, many kids with severe life-threatening measles, and a few with diphtheria, which I had never before seen.  There were cases too of Japanese B encephalitis and hemorrhagic dengue (almost indistinguishable from yellow fever). These are mosquito-borne diseases, with ubiquitous culex mosquitoes as the principal vectors.  But in the region close to Jakarta, although health problems abounded, we didn't see much that was dramatic, except a man who had been cut to pieces by a train (a common injury, because people cling all over every carriage) and several others who would obviously die from the injuries they had received in severe traffic crashes. One of the weaknesses of Indonesian medicine was revealed by these experiences: the nursing service inherited from the Dutch was very highly specialized. They had tuberculosis nurses, leprosy nurses, yaws nurses, and each could deal with no other condition than the one they had been trained to treat. Hence, a mortally injured man, a victim of a severe traffic crash, whom we saw in a small hospital for tuberculosis patients, got no care at all, because he didn't have TB.  The nurses there were very good at treating patients with tuberculosis but had no idea how to care for a critically injured patient – and no appropriate equipment, not even I-V sets.  In 1972 the Ministry of Health was wondering what to do with the large cadre of smallpox nurses who no longer had jobs because smallpox had been eradicated from the region.  In 1997, I met several senior staff of the Ministry of Health of Indonesia at a WHO conference in Bangkok, and heard that they had eventually managed successfully to redeploy most of these disease-specific nurses into more relevant roles.   

I asked Julie Sulianti, the Minister of Health, about this when John Pemberton and I paid her an official visit.   I had met her some years before when she was a political exile (Sukarno, the previous military dictator, had not been a friend of her family; his successor Suharto was, so she came home). In 1964 while I was at the University of Vermont, she was working with Ken Newell at Tulane University in New Orleans; we had other mutual friends as well, and so got along considerably better than lowly WHO short-term consultants usually would. Having had that previous personal contact was most useful; she smoothed the way in encounters with officials of the government, and arranged at my request for us to visit community development projects in and near Jakarta. 

We travelled around Java by road and air. Our first air trip was memorable. We flew from Jakarta to Semarang, a city on the north coast about half way between Jakarta at the west and Surabaya at the east end of Java. We flew, as on all of our internal flights, in a Fokker Friendship, a sturdy little plane with its wings above the wide windows out of which we could see the ground below on clear days. Often we saw little because this was the monsoon season, so heavy overcast and torrential rains were the norm and as often as not we flew bumpily through heavy cloud. We left Jakarta just before a heavy rain squall hit the airport, and flew through this squall all the way to Semarang, where we circled in the bumpy air for about an hour, looking down at the airport which seemed to be almost entirely under water. We could see the rows of landing lights at both ends of the runway, but the runway itself wasn't visible. Eventually the rain eased up and the pilot came in to land. We hit the water that covered the runway to a depth of a few millimeters. Spray flew high in the air all around us; we skated and slid from side to side, but remained upright and eventually came to a stop at the shed which served as the terminal building. Nobody was there to meet us, but we knew that we were expected at the local government guest house and found a taxi driver who spoke some English, to take us there (we had the address on a typed itinerary that we showed him). It was not a very auspicious beginning. The guest house was a mouldy, dilapidated ruin, a relic of Dutch colonial days, vastly inferior to former British Colonial Office guest houses in which I later stayed on several occasions in India. It was mildewed wood with a corrugated iron roof, and several rooms screened against mosquitoes - but the screens were torn and full of holes. Fortunately our beds had reasonably new and clean mosquito netting. Here, in the tropical steamy heat with incessant rain, mosquitoes were teeming throngs, roosting everywhere. Most were culecine, but we also saw anophelenes, the species that can transmit malaria. At that time, the local malaria parasites were said to respond to chloroquin, and neither of us got malaria, so I suppose this was true.

Dr. Amijojo, our host in Semarang, showed up, full of profuse apologies and explanations an hour or so after we arrived at the guest house. He was perhaps the most interesting and impressive man we met in our travels in Indonesia. He was then quite young, a senior lecturer not a full professor. He had some innovative and workable ideas. His work has been written up since then in Health by the People, a book edited by Ken Newell for WHO, although he was not credited - one of his seniors put his name on the paper. What our young host was doing was at that time, as far as I know, unique. He was deploying teams of students from Semarang University in community development projects in the villages in his district. The teams were made up of medical, engineering, agricultural science, economics and other students, each team about 8 to 10 strong. They would go to a village and assess its needs. The medical students did a health survey, the engineering students assessed the roads, dykes, dams and canals for irrigating rice paddies or sugar cane fields, the bridges, etc; the agricultural science students examined the condition of the rice paddies, the productivity of the chickens, and the economics students examined how the local and regional markets worked. The surveys were just the first step. Next the students dealt with the problems they had identified, first discussing at an open meeting with villagers what they had discovered and their plans to improve matters. Not only was this excellent experience for the students, it greatly benefited the villages. 

We spent four days in Semarang, during which the rain hardly ever stopped. At night it drummed on the iron roof in a steady roar that made conversation almost impossible. One night I awoke in the small hours. Everything was absolutely silent, the rain had stopped, the silence had woken me. Then within a few moments, a new sound arose, the cries and love calls of millions of frogs, including many in my bedroom. I put on the lamp by my bed; it was about 2 am. By the dim light of the lamp I could see hundreds of little green frogs within the small radius that was illuminated. They were puffing their necks in and out, out so far as to be almost translucent. They clung to the walls and hopped across the floor, many of them stopping for a few moments to mate, the male hopping briefly on top of a little female, in an orgiastic frenzy of unrestrained reproduction. When I got out of bed I had to tread carefully to avoid squashing them, and congratulated myself when I got back into bed again without any sticky or slimy remnants on the soles of my feet.

There was no shower at the guest house. Instead, in a curtained corner of my room, was a cubical concrete cistern about a meter and a half long, wide and deep. The house-boy explained that this was for ablutions, not drinking. I could dip a large pail in it and pour the water over myself, or I could immerse myself - get right into it and soap myself. I tried both. Immersion was more pleasant, because there was nowhere convenient for the water to drain if I poured it over myself, whereas when I got into the cistern, the overflow (Archimedes' principle dictated that there had to be an overflow) ran down the far side into a drain. The water was room temperature, that is, comfortably warm all the time. My system was to wash first my shirt, socks and underpants, hang these on a string across the other corner of the room, then lower myself gently into the cistern where I floated and washed for as long as I liked. It was comfortable and relaxing. The sides of the cistern were covered with water weed, and the water contained many mosquito larvae, but no frogs as far as I could see - it would not have been a good place for them, because if they got in, they would have no way to get out again. I quite enjoyed this unusual method of keeping myself clean. 

Our next stop was Surabaya, a steamy seaport which maintained some rivalry with Jakarta. The national tropical disease reference laboratory was in Surabaya, and the staff there and at the medical school were determined that if a school of public health was to be developed, Surabaya was the place for it. This and the rivalry were explained to us by Zbigniew Brzeziński, a Polish epidemiologist whom I had first met at an IEA meeting in Princeton New Jersey in 1964, and would meet again several times over the next few years. He had worked on the WHO smallpox and malaria eradication campaigns, and has a habit of escaping from Warsaw winters to warm, sunny tropical parts of the world. We had a rest day in Surabaya, and he, his wife and small daughter took us for a pleasant excursion to the hills above the city, where at an elevation of 1000 meters or so, the temperature and humidity were more tolerable than the steam-bath atmosphere at sea level. On the way to the resort in the hills, we drove past the bits and pieces of a young man who had been engaging in the local sport of hopping from the roof of one railway carriage to the next, had missed his footing, and had been cut into several recognizably human pieces by the wheels of the train as it passed over him. We first saw a leg, then another leg, and finally his head and part of his badly mangled trunk. Not a pretty sight, but an unforgettable one. It's one of my few clear recollections of the time we spent in Surabaya.  I remember nothing about where we stayed or the meals we had. I described and discussed the hospital conditions in my official report to WHO.  There were several epidemics at the time – severe gastroenteritis that probably included cases of cholera, measles which was killing many infants and children, and mixed with these a few patients with diphtheria and some who may have had mild smallpox, variola minor, although smallpox had supposedly been eradicated from Indonesia some years earlier. It was a splendid place for anyone interested in infectious diseases such as I was and am, or an infectious disease epidemiologist, but in other ways frustrating because of the inadequate surveillance system. Infection control, especially of childhood exanthemata, was a whole other matter! In almost all the hospital wards the occupancy rate was greater than 100%, in other words, several patients shared the same bed.  Pediatric beds often held three children at once and as far as we could tell, no distinction was made on the basis of diagnostic groups.

From Surabaya we were driven by car to Jogjakarta on the southern side of the mountains that form the spine of Java. This was a fascinating trip, through some of the most beautiful country I have ever seen anywhere in the world. There were lush paddy fields, some under water, some green, some with the rice ripened into rich golden colours and waving gently in the breeze under a benign sun. They get four crops of rice a year in that part of Java. There were banana plantations, pineapples, groves of rubber trees, then a picturesque winding road through a pass that crossed the ridge of volcanic mountains running the whole length of Java. At higher altitudes we saw tea and coffee growing. We glimpsed several of the volcanic peaks, but clouds concealed most of the highest mountains. 

Somewhere along that journey we stopped to see the ancient Buddhist temple at Borubador, which is on the summit of a low round hill, perhaps 300 meters above the level of the road and the rest house at which we had had lunch. John Pemberton was unwell and stayed there while I set off alone to climb to the top to see the stupas, the ancient bell-shaped shrines with which the hilltop is covered. These are the only Buddhist remnants in Java, which was conquered and converted to Islam during the great Islamic expansion in about the 12th century. A most surprising thing happened. I climbed up one side of the hill at exactly the same time as another man climbed from the other side. We reached the top simultaneously, and recognized each other at once: the other man was Frank Bell, who had been a classmate of mine at the medical school in Adelaide. We had met once since then, in London when he was doing his FRCS in the early 1950s. He was an orthopedic surgeon in Perth, and had been coming to Java every year for some time, spending a few weeks, teaching -- and learning about some simple and cheap prosthetic devices that could be easily manufactured from bamboo. We had a brief reunion there on the hilltop among the shrines, and then each went on our way, he towards, I away from Surabaya. We agreed to meet for a meal and a longer conversation when we both returned to Jakarta later in our travels, and duly did so.

Jogja, as it is usually known, is the ancient capital of Java, and another fascinating place. This is the home of the shadow puppets for which Indonesia, Java in particular, is famous. We stayed several days in a comfortable hotel with a swimming pool, which we had been advised to avoid because it was inadequately chlorinated  (we saw several hotel guests with itchy skin rashes and very red eyes, which presumably were due to infections acquired in that pool). The medical school there was the modern incarnation of a very ancient college of traditional herbal medicine, and our host, the professor and head of the department of public health, was proud of the connection, also proud of his western training in London. We thought his department had the best program of the six medical schools we visited. The hotel put on nightly displays of shadow puppets, as well as having, like all the other high quality places we stayed in, a troop of gamelin players. Gamelins are brass bells of many sizes that are gently percussed with soft-tipped drumsticks to produce most delightful music. I became and still am very fond of the almost liquid sound of gamelin music. One evening I went to a real shadow puppet play, rather than the ersatz variety at the hotel. I went with one of the junior staff members in the Jogja University department, who explained the plot to me. The characters are of course stylized heroes and villains; there is seemingly only one story, repeated over and over in endless variations, with the shadows of the characters moving on a sheet, lit from behind by lanterns and the voices of the puppeteers intoning the parts as they move. I have never seen an audience more totally absorbed in a performance than that one was. The other notable product of Jogja is the best batiks in Indonesia, that is to say, the best in the world. I bought several lengths of batik there for Wendy, and from these she made some fine evening dresses. I also got for myself an elegant summer shirt decorated with the pictures of shadow puppets. Jogja  is, or was then, a delightful civilized small city, where I would have been happy to stay a lot longer.  My friend David Waltner-Toews, a veterinary epidemiologist at the Ontario Veterinary College in Guelph, spent a year there with his wife and family, and says that it was for all of them a most interesting time, but after a few months they had had enough. By the time he was there, 15 years or so after I was, it had grown in size, had a crime problem and wasn't a safe place after dark. Neither there nor anywhere else in Indonesia did John Pemberton and I ever feel the least bit insecure.

We flew back to Jakarta from Jogjakarta, debriefed, then drove across more lovely country to the corner of Java that has the most volcanic activity, and is the setting for another picturesque city, Bandung.  As was the case in the other cities we visited, Bandung was an interesting mixture of ancient Javanese, Dutch colonial, and modern post-colonial architecture.  It is a thriving centre of commerce and trade, though how this began and evolved seems a bit of a mystery in view of its location and precarious position in the midst of so many active volcanoes – I could see three from my hotel bedroom window, a spectacular but rather unnerving sight. The nearest one could not have been much more than 2-3 kilometers away, and never stopped puffing out sulphur-laden steam the whole time we were there. The ground seemed to be in constant motion, shuddering with little tremors and occasionally more perceptible jolts. 

Then came Bali. I have been very fortunate in so many ways in my life and one is to have seen Bali before it was corrupted by tourism as it now is. In 1972, Denpasar was a sleepy backwater, hardly a city; the tourist invasion had barely begun. There was one hotel of acceptable standard, the Bali Beach Hotel where we stayed, and several cockroach-infested old hotels dating from Dutch colonial days along the main street of Denpasar. Bali was famous for its beautiful women, and for the fact that they wore their sarongs wrapped around their waists with their breasts bare. 
We saw some extraordinarily beautiful girls and young women clad like this, and were among the last to do so, because the regime in Indonesia, while not strictly Islamic, decided the following year that it was unseemly for women to walk the streets and go to the market so ‘improperly’ clad. Like the Christian missionaries who made the Polynesians wear clothes, they enacted a law that obliged the easy-going Balinese to conform to the dress code of women elsewhere in Indonesia. Pity. 

Bali is not only a most beautiful little island, with its tall conical volcano at one end, its palm trees, its paddy fields, streams and water falls; it is also culturally unique. First, the tide of Islam swept past it - in the 12th century when the rest of the Indonesian archipelago was conquered by the expanding frontiers of Islam, Bali somehow was overlooked. The sea between Java and Bali is narrow but can be stormy, and perhaps in those times the rulers of Bali were more warlike than they became later. For whatever reason, Bali was spared, and a unique blend of Hindu and Buddhist cultures evolved there, mixed with more primitive animist beliefs. Monkeys are sacred, and allowed to roam wherever they choose to go, as cows are in India. Every household has a multiplicity of gods, and observes many festivals in honour of each of these gods. One festival we saw celebrated several times was the cheerful rite of passage into adult life of girls who have just had their first menstrual period. This is a fertility rite: the little girl is dressed in ornate clothing festooned with trinkets and garlands of flowers, and is paraded through the village on a throne carried shoulder-high, while drums beat and trumpets sound. Another unique Balinese custom is to have male midwives, called dukuns. Balinese carving is justly famous, the only export trade when I was there. I bought two lovely Balinese wood carvings, carried one home by hand, a little woodland sprite playing a flute; and shipped the other, a dukun delivering a baby. I had long given up hope of ever seeing this again when it finally arrived, six months or so after I had seen it being packed and labelled at the Bali Beach Hotel. Those two wooden carvings are my most precious souvenirs of a brief but unforgettable stay in one of the loveliest places I have ever been. I have always wanted to go back there, although I know that by now the whole place has been so corrupted by mass tourism that it would be sad and even unpleasant to behold.  I was able to learn a lot about Bali in a few days because I met Manny Voulgaropoulos and his wife. They are Americans, he a public health specialist who was working for a small NGO, that had sent him to the medical school then being developed in Denpasar. His wife Joan is a social anthropologist, and it was she who told John Pemberton and me all that I know about Balinese culture and customs. I met them both again several times on future visits across the Pacific, after they moved back to Hawaii, where they were both on the staff of the School of Public Health. Occasionally since then I’ve bumped into Manny at annual meetings of the American Public Health Association.

During one of the interludes in Jakarta between the trips around Java and our final fling in Bali, I met and had a meal and a chat with Frank Bell, catching up on arrears of news.    Our dialogue was aided, like many conversations in Indonesia, by glasses of ice-cold Bintang, the excellent local beer, perhaps the only thing the Dutch colonists left behind that the Indonesians truly appreciated. Frank told me about his work as an orthopedic surgeon in Fremantle and his annual visits to Java to engage in an endless round of elective orthopedic surgery, interspersed with occasional emergencies. One recent experience had made a big impression on him. At the end of a day of elective operations, he was doing a final evening round of the patients he had operated on, and saw, at the far end of the ward, a bed that was carefully screened from all the others. He asked about the patient in this bed, and was told she was a young woman dying of gas gangrene, a complication of a compound fracture of her tibia. Frank was appalled, and asked to see her. The gangrene had extended to midway up her thigh, so if her life was to be saved, she would need a hind-quarter amputation - disarticulation of her hip joint and amputation of her entire leg. Gas gangrene is due to a highly infectious organism, Clostridium welchii, and if that gets loose in an operating theatre, disinfection is time-consuming and costly. He made a quick decision: he called for the necessary instruments and anesthesia, and there and then, over the protests of the staff, he did the life-saving operation with the patient in the bed behind the curtains at the end of the ward. He was pleased to observe over the next week or so that she made a smooth and uneventful recovery. But then, after a week or so, he began to ask about her, who she was, where she came from, who would care for her when she left hospital. That was when the staff told him her story. She was a ‘betja girl’ a rather upper-class whore who plied her trade from a betja, or rickshaw. Her leg had been broken when her betja was hit by a car. She had no family - that was why she was a prostitute. What was to become of her now? She needed months of rehabilitation, a very awkward and expensive kind of prosthesis, a tilting-table walking frame to balance on what remained of her pelvis. How was she, a one-legged prostitute to survive? Frank asked me, a specialist in community medicine, to advise him and his friends who would have to care for her after he went back to Australia, what could be done for her. The problem was not much like anything I had never encountered.  Her only possible future seemed to be in some sort of clerical work, perhaps in a community resource centre dealing with the problems of street people. Was she able to read and write?  Were there any suitable places for her to work? Frank didn’t know, he said he would ask.   It had been an enlightening experience for him: he told me that until the day he saw this girl a week after he had performed his heroic surgery, he had never before thought much about the social context of his patients. Now, never again would he fail to consider this aspect of their care, and in his teaching of the medical students in Perth, it would from now on become an integral part of their medical education. So he left Indonesia at the end of that tour a sadder and wiser man, and probably a better orthopedic surgeon and teacher.

Soon after that, John Pemberton and I left Java too. WHO was more relaxed about travel in those days than it later became. And John Pemberton surprised me: he was determined that we would not only return to the Regional Office in Delhi via Bangkok, we would so arrange our flight schedule that it would be necessary for us to stop overnight in Bangkok. The plan was advanced by strained political relations between Indonesia and Singapore, so the obvious route, Jakarta to Singapore then non-stop to Delhi, was not straightforward. Bangkok was the obvious connection, but flights that required an overnight stop called for creative planning. John Pemberton, aided and abetted by somebody in the British Embassy, managed to work out the only itinerary that would allow this. I am grateful to him for this, because although I was interested in seeing Bangkok, I wouldn't have bothered to go to so much trouble to make it happen; I felt fairly confident that some day I would get there anyway (as indeed I have, half a dozen times). On this occasion, we got there in the middle of the day and did not have an onward connection to Delhi until late on the following afternoon. That gave us time to see many famous Buddhist temples and shrines. They are unique, sometimes breath-takingly beautiful, especially the many spires and the Golden Buddha that had been successfully concealed from the Japanese during the war by painting it all over with thick black paint. Some of this still lingered in crevices, cracks and crannies. After our evening meal, John Pemberton surprised me even more - startled me - by suggesting that we should go to see the notorious red light district of Patpong Road. We chaperoned each other, so to say, to ensure that neither of us misbehaved. It was quite a spectacle. We stopped first at a dance hall where very scantily clad and sometimes stark naked young women squirmed and gyrated all over the floor, being ogled by large numbers of American servicemen on leave from Vietnam -- Bangkok was their principal R&R centre. This place was unfit for human occupation. It assaulted our ears with disco so loud it was physically painful and left us deaf for some time after we beat a hasty retreat; its flickering strobe lights made us feel dizzy; and the smell of sweat and cheap scent from a hundred or more naked female bodies was overpowering. We went next door, to a quiet, dimly lit bar, and came in as a young woman lying along the bar was inserting the end of a beer bottle into her vagina.   We sat for a while drinking a glass of the local beer, but we were tired and when it became clear to the management that we were there only to look at the goods and not to purchase any, we were firmly and not very gently encouraged to leave. By then it was quite late, so we went back to our hotel and to our beds and a peaceful, solitary, night's sleep.  On several later visits to Bangkok, I didn't revisit Patpong Road, but I did go to the Thai equivalent of Disneyland, a theme park with sham temples and canals resembling the real ones in Bangkok, without, however, the teeming throngs of people and constantly hooting car horns, noise, dust and turmoil that can make the real Bangkok an unpleasant city at times, despite its many attractions. Of the many cities I have visited around the world, Bangkok merits a place on the list of those I would recommend with cautionary notes, despite the beauty of its genuine temples. I think we were both glad to leave and get on our way to Delhi for our debriefing at the Regional Office of WHO.       

Debriefing in the World Health Organization South East Asian Regional Office, WHO/SEARO, was done by my former Edinburgh colleague Ray Mills, and was a leisurely process that left abundant time for me to explore some of the fascinating city of Delhi, especially Old Delhi.  I even had time on a convenient weekend break, to visit Agra and see the Taj Mahal for the first time.  But all that is another story I will tell in a future post on this blog. 

Friday, May 11, 2012

The end of civilization as we know it?

The financial section of yesterday's Globe and Mail, Canada's national newspaper, a.k.a.  the Moan and Wail has a news item about slumping sales of Vegemite in Australia.  Apparently it's not grabbing the taste buds of the current generation of kids, as it did earlier ones.  The Seventh Day Adventists who originally made it in my childhood sold out to Kraft Foods long ago, and Kraft tried unsuccessfully to go global with it. Basically it's consumed (inhaled? absorbed percutaneously?) only by Aussies and Kiwis and those closely connected thereto.  

It's even possible if current trends continue, that Kraft might some day stop making Vegemite.  If they ever do, I hope by then I'll be long dead. I've lived outside Australia more than half my life, close to 50 years I suppose. But I have eaten Vegemite almost every day of my life, certainly every day when I'm home. I hope to keep doing so until I die.  To be on the safe side, I will add a note to my Advance Directive, the instructions about terminal care.  If I require intravenous fluids to keep me comfortable as I slide towards Valhalla, I want those caring for me to ensure that I get intravenous Vegemite. 

Barack Obama evidently doesn't like Vegemite; when he visited Australia one of his entourage suggested it would be improved if flavoured with chocolate, strawberry or vanilla. What a calumny!

Wednesday, May 9, 2012

Ottawa 1970-1978


What, if anything, would I do differently if I could relive the years from 1970 to 1978? So much happened to me professionally that at times I know I neglected the family when they needed me, although when I ask Rebecca, David and Jonathan about this, their answers reassure me that in reality I wasn’t as totally devoted to my work as I felt at the time, when family matters seemed often to be no more than background noise in my life, and the children’s passage through adolescence was entirely in Wendy’s hands. Professionally these were the most frenetically busy years of my life. One thing I would do differently if I had my life to live over again, would be to ease up, not take on so many things, not spread myself so thin. That was my worst mistake. I suffered because of this, and so did some others. But on balance, almost everything worked out well.


Our family in living room, 495 Island Park Drive,
November 1971






Among my first acts as department chairman was to establish formal weekly meetings to discuss in depth a relevant topic in public health science.  I set an example by taking the floor myself to discuss the policy implications of my research for the Royal Commission on Medical Education, considering the question how transplantable to Canada the conclusions might be. I invited scientists from other university departments and from Carleton University across town to talk to my group, and  government scientists from Health and Welfare Canada, Environment Canada, Statistics Canada, etc, and before long a weekly series of rigorous seminar discussions was firmly established. It became a tradition that is still going strong more than 40 years later.


I began recruiting staff, and soon had an impressive team of dedicated research workers, several of whom also played prominent roles in the teaching program. Together we established research in aspects of psychiatry (suicide and its prevention, depression, early child development); and a series of community health surveys; and under the direction of Lu Neri, studies of coronary heart disease. We also provided statistical and epidemiological expertise for clinical research workers throughout the medical school. For my first 4-5 years in Ottawa, I was also nominally head of family medicine. Indeed, I had been recruited partly because of my track record as an experienced and successful GP. I wanted to maintain the intellectual connection by way of epidemiological studies of family medical care; but the family physicians found my ideas rather threatening. Family medicine was evolving into an academic discipline in the early 1970s, and as a condition of full accreditation, the College of Family Physicians of Canada insisted that the University of Ottawa establish a free standing autonomous department of family practice. So in 1974-75 my department of epidemiology and community medicine went through a no-fault divorce from the department of family medicine, and lived happily ever after side by side with considerable cross-fertilization and mutual benefit   and never again any acrimonious territorial disputes. I kept my hand in, so to speak, and my clinical skills reasonably sharp and well honed, by seeing patients and supervising students at a street clinic, until one evening in the spring of 1975 when a student asked me what was the right dose for a drug he wanted to prescribe for a condition he'd diagnosed. I'd never heard of either the drug or the diagnosis, so I thought it was time for me to quit while I was ahead. After that, I honed my clinical skills mainly at grand rounds and by watching medical dramas on TV. 

I don’t think the weekly seminars were responsible though they may have helped, but soon I was invited to serve on several influential research grant review committees, notably the federal National Health Grant Committee, its provincial counterpart, and the Ontario Mental Health Research Grant committee.  Then came a phone call from Glenn Lamson, executive secretary of the NIH Epidemiology and Disease Control Study section, the influential review committee that set policy and reviewed applications for research programs, projects and personnel training and support in the USA.  This group met three times annually, usually in Bethesda, NW of Washington, but occasionally elsewhere, Los Angeles, Chicago, New York, Boston during my five-year term; additionally there were site visits to assess the quality of the facilities and professional team if the application was sufficiently interesting and/or costly. I was a member of site visit teams to many interesting places all over the USA and continued to serve in an ad hoc capacity as a member of site visit teams for some years after concluding my formal 5-year term.  The consequences of all these activities included several benefits. I visited and got to know the inside workings of prominent research groups all over the USA; I visited cities and towns and – because Glenn Lamson was a gourmet – excellent restaurants, all over the USA.I developed friendship networks with epidemiologists and other public health scientists all over the USA and beyond. Service on all these research grant review committees gave me a magnificent opportunity to get a broad perspective of research in all aspects of public health sciences in Canada and the USA, to meet all the leading research workers in both nations, and to gain insights into research policies and priorities.


In 1971-72 I was elected president of the Canadian Association of Teachers of Preventive and Social Medicine (CATSPM), and became the link to the (US) Association of Teachers of Preventive Medicine (ATPM) which I had joined when we lived in Vermont in 1964-65.  Over the following years I became more active in ATPM, serving on several committees and was elected to the board of directors where I acquitted myself to everybody's satisfaction.


In 1972, and again in 1974 and 1976, I had brief, two-month furloughs from Ottawa, working as a short-term adviser or consultant to the World Health Organization South-East Asian Region (WHO/SEARO) in Indonesia, India, and Sri Lanka. These were each fascinating and mind expanding experiences. I described each of these experiences in chapters of my memoirs, and will post edited versions of each of them in future episodes of this blog. 


One thing I would not do differently would be our home at 495 Island Park Drive.






Wendy and Jonathan in the front garden at our home, 495 Island Park Drive, 1970. The top of the Colorado blue spruce is just visible behind the low hedge. This tree is now more than 20 meters tall.






There is much more I could say about those pressure-packed years of chairing the academic department but this post is already long enough, so I will save further thoughts for another time.

Monday, May 7, 2012

1969-1970: Our first year in Ottawa


As the days drew in and cold weather descended on Edinburgh in late autumn of 1969, I flew to Canada ahead of the rest of the family. My passport and landed immigrant card give the date, November 9, 1969. That was late enough in the year to miss all the fall colours in Ottawa, and for the first hard frost, the first dusting of snow. I observed my first wind-chill factor watching faces pinched against the bitter cold as people bent into the wind walking down O’Connor Street outside the windows of the Bytown Inn, while I sat warm inside eating my breakfast. The sight was daunting enough to reinforce my misgivings about our decision to leave Edinburgh where we were so happy, and start all over again in this bitter cold foreign land.  I went back to Edinburgh to collect the family, and all of us came over together a week before Christmas, incubating the season’s epidemic influenza. We all got it just in time for Christmas, which we spent cheerlessly in our pleasant rented house at 331 Island Park Drive, pleasant but lacking furniture, which hadn’t arrived because of labour disputes on the docks in Britain. So our arrival and early days were inauspicious and unhappy.  The move bewildered our children, shattered their happy friendship networks, obliterated all familiar landmarks in their lives. Perhaps worst of all, Rebecca had somehow become separated from her teddy bear between Montreal and Ottawa. We never did recover her teddy bear, and it took a long time for Rebecca to get over the loss. That loss was unhappier for all of us than the acute influenza we’d all been incubating as our plane left Heathrow, and which struck us down on our second day in Ottawa.  It was a miserable start to our new lives. Wendy and I boosted our morale by looking upon this beginning as the next episode in our journey home to New Zealand or Australia where there were no academic openings on the horizon, but, we felt convinced, there soon would be. We regarded our stay in Ottawa as an interlude, Canada as a stepping-stone in the oceans separating Scotland from our Antipodean homelands. It took many years for that subconscious feeling to dissipate.

The winter of 1969-70 lasted a long time, and we were without beds and other comforts for what felt like months. Friends of my father, David and Margaret McNicholl, the Australian high commissioner and his wife, lent us mattresses so we would not have to sleep on the floor. When our furniture finally arrived we began to feel a little more a sense of belonging, more quickly than we had in Vermont or in Edinburgh. One of the good things about Canada was the way we so soon felt at home. Canada is a nation of immigrants, and its social, cultural and demographic philosophy of the “mosaic” helps to give all who come here a sense of belonging right from the outset. The children settled rapidly into schools, made friends at once, and soon got over their homesickness for Edinburgh and the friends they had left behind. Rebecca, a good mimic, acquired the local accent almost at once. David, who had won a prize for reciting a Robbie Burns poem with the best Scottish accent in the class, clung tenaciously to his Edinburgh accent for years, maybe still has a trace of it. Wendy was soon absorbed into the neighbourhood, making good friends, some of whom she continued to see more than 40 years later. David also remains in touch with classmates from his first year in Ottawa, as well as with his Edinburgh friend John McTernan (who was one of Tony Blair’s staff in the 10 Downing Street years).

The spring brought good cheer. We saw our first display of the tulips which transform Ottawa every May. In those days a lovely avenue of elms lined both sides of Island Park Drive, and our garden was blessed with several more of these stately tall trees. Alas, all died a few years later of the Dutch elm disease. But in that first year they shaded us in the summer and their branches were the setting for high-altitude acrobatics by hordes of black squirrels. Wendy and I watched these acrobatics with fascinated interest, and briefly adopted a juvenile squirrel that was abandoned by its parents after it fell from a high branch.

My first few months were unsettling. I had been recruited by an old man about to retire, with the understanding that I would succeed him as department chairman. He acted strangely (soon after he retired, he became demented, ending his life sadly in a nursing-home for demented elderly people). His behaviour was reminiscent of the man for whom I had worked in Angaston in 1951: suspicious, secretive and very unfriendly; he gave me no help, indeed actively hindered me in getting acquainted with the way to run his little department, and in establishing networks with colleagues throughout the medical school and elsewhere across Canada. He managed to create such an uneasy situation by the time he retired, that the succession of the chairmanship to me was far from automatic. For several months it wasn’t clear whether I would become the chairman at all. Perhaps I might even be out of a job, a harsh and frightening possibility that I managed to keep from Wendy until the situation had been happily and successfully resolved.

Another disconcerting truth that he hadn’t bothered to mention was that the little house on the main campus that had been the department’s offices, was condemned, soon to be demolished to make way for new university buildings. My first quite urgent task was to find somewhere else for us. To a newcomer in town this was daunting. Fortunately I had some allies, and rather quickly I was able to secure splendid accommodation in the Lady Grey Building at the old Royal Ottawa Hospital, with abundant space for expansion as I built up the department. My speed and efficiency in completing the negotiations for this space impressed the dean, Jean-Jacques Lussier, and, I discovered years later, disconcerted another department chairman who was furious that I had been able to move in and secure this space before he even knew it was available.  About six years later I learnt that I had been used in the power struggle between two department heads, one of whom had made sure I would get this prime space before his personal enemy, head of another department, knew it existed. This later had unfortunate consequences; the loser viewed me as an enemy too, and not only never gave me any help but went out of his way to frustrate my plans, blocking or trying to block my attempts to recruit highly qualified staff. I was blissfully ignorant of these machinations in 1970, and set about moving the department into the Lady Grey Building with a song in my heart and ambitious plans to build a team in Ottawa that would be the equal of any in other parts of Canada.




Department of Epidemiology & Community Medicine
staff on veranda of cottage on the downtown campus of University of Ottawa, summer 1970, about the time we got our eviction notice. The splendid Unicentre now occupies the site where this cottage formerly stood.  

Wednesday, May 2, 2012

Making the magic last

My young friend Raman Kumar has posted on his blog a brief account of his parents' meeting, courtship and marriage, which like Wendy's and mine, is somewhat unusual, outside the main stream. You can read this at http://ramanreflections.blogspot.com, where there are many thought-provoking ideas and very well marshalled arguments on issues that matter in our world. Raman is a medical student at McMaster University Medical School, so you might say he's working at the coal face, in an excellent position to observe the human condition. His latest post is about the meeting and courtship of his parents, and I resonate to it because Karen and Pradeep Kumar's story is a little bit like Wendy's and mine. We kept rather quiet about the way Wendy and I met for many years but early in 1997 as our 40th wedding anniversary drew near, we both felt that it was time to come out and share with the wider world the story of our meeting.  The opportunity came when Shelagh Rogers, host of a CBC classical music request program, asked her listeners who had married on St Valentine's Day for stories about how they had first met. This was irresistible. I dashed off a brief account of how we met and what happened after that, sent it off to Shelagh Rogers at the CBC. She phoned me to check a few details, read the story exactly as I'd written it - and awarded me the prize for the best story in the large number she had received. So here is our story.


Winters in Southern Australia are cold, wet and rather gloomy but mercifully short.  By the middle of August, spring is in the air, days are sunny and warm, flowers and trees burst into blossom, song birds are nesting.

On the first fine Sunday morning in the spring of 1955, I was off duty in the group medical practice where I worked, and running late for a golf game with three friends at a modest little golf course on the southern outskirts of Adelaide.  I had delivered a baby in the wee small hours, and called at the hospital on my way to play golf to make sure mother and baby were OK. They were, so to catch up time I took a road I didn't normally use to get to the golf club. 

Some way along it, I saw two young women hitch-hikers by the side of the road. In those days not long after the end of the war and of petrol rationing, we picked up hitch-hikers. I had done a bit of hitch-hiking myself in England not long before then, so I had a soft spot for the custom.  The two I picked up were heading for the South-East, and could not possibly get there on that road.  I said I'd take them to a junction a few miles further on, where they could cut across to the road they needed. 

The young women introduced themselves, Louise and Jan (short for Janet). They were nurses, Louise from Zürich in Switzerland, Jan from Christchurch in New Zealand. They had been nursing in Perth for a year, had just come across from the west on the train – hitch-hiking would not have been feasible in that deserted part of Australia. They intended to see as much as they could in a month or so, were making ultimately for Sydney, where they would part and each would go home.

All this emerged in a conversation lasting perhaps ten minutes, until we reached the corner where I should have dropped them.  But by then I had decided I wanted to see more of the one called Jan, and I made a snap decision that changed both our lives. I was so late for my golf game my partners would have started without me anyway, I'd have had to find someone else, a stranger probably, to partner.  It was a lovely spring day.  I said I would drive them to the south coast, show them some of the sights along the way, then bring them back to Adelaide and they could set off on the right road to the south-east next day. 

Thus began the most magical day of my life. The spring sunshine was perfect, everything sparkled in the sunshine, and so did our conversation as we told each other who we were, what we had done with our lives to that point, what we hoped for in the future. It had got quite hot by mid-day, so I shed my heavy winter pullover and rolled up my sleeves when we stopped at the little town of Yankalilla to buy pasties and lemonade for our lunch.  Louise took a photo of Jan and me as we sat, earnestly talking, on the side of a hill above the beach.

We drove eventually to Victor Harbour, where there is a little island connected to the mainland by a causeway along which an ancient horse-drawn tram plods patiently back and forth during the tourist season. Not that day though, it was too early for the tourist season. So we walked across the causeway and around the island, gazing at huge ocean breakers all the way from Antarctica and dodging the spray as they beat against the rocks on the exposed southern side of the island.  

On the way back to Adelaide the two girls were singing as we drove along, and I did something I'd never done in my life before, I joined in with my hopelessly out of tune voice. By then I knew I definitely wanted to see much more of Jan.  

When we parted at the end of the day, we exchanged addresses, and not long after Jan returned home to New Zealand, I had my first letter from her. Soon there was a drawer full of letters, and another drawer full at her end. Jan's family name was Wendelken, and like all her family, she was nicknamed Wendy. During our intense exchange of letters, which was really an old-fashioned 19th century kind of courtship by correspondence, Jan became Wendy, and she's been Wendy ever since. 

Wendy came back to Australia in July (the winter) of 1956, and I drove through sleety rain in the Adelaide Hills, across to Melbourne to collect her from the airport and bring her back to Adelaide where she nursed at the Adelaide Children's Hospital for the next six months, while we conducted a more conventional 20th century courtship. We were married on February 14th – Saint  Valentine's Day –  of 1957. That photo Louise took as we sat talking on the hillside on the coast near Yankalilla has hung above our marriage bed ever since, coming with us to each of the homes in which we have lived. It is among our most precious family possessions. 

We've had a wonderful, rewarding, and richly interesting life together.  I think it's safe to say that we've made the magic last.