Sunshine in Canada (A VERY POLITICAL POST)

WARNING: A VERY "POLITICAL" POST!

It's too soon to rejoice, and the Liberal Party has a history of failure to fulfill election promises. Nonetheless I feel cautiously optimistic. The Harper government's objective was never clearly defined but seems to have been to cut costs by reducing taxes and the size and influence of the national government. The Treasury Board tightly controlled the flow of money so funds allocated remained unspent. Military Service pensions and benefits were not delivered, nor were allocations to First Nations, enabling the government to boast that they had balanced the budget. If funds voted by their own government had been disbursed they would have had a deficit of several billion dollars. They governed with a unique combination of paranoid fear, austerity, and deceit.  They did terrible damage to Canada's international reputation and standing among the enlightened nations. For these reasons and others set out below I believe the Harper government was the worst for 100 years. It's good to be finished with them. 

In February of 2015 I compiled a list of reasons why I would never support the Harper government, and strongly believed that no enlightened intelligent person would. Here are my reasons:

Why I don't support the Harper conservatives (Compiled February 2015)

1. Ideology, not evidence, determines political decisions; strong anti-science bias

The Conservative Party of Canada is one of the most scientifically ignorant, politically inept sets of political leaders on earth. They are worse than ignorant. They are willfully obscurantist, hostile to science, blindly blundering about, rejecting evidence in favour of their narrow ideology. They have abdicated from international discussions of the most urgent policy issue confronting humanity, the critically urgent problem of climate change and what to do about it. 

2. Lack of vision

The Harper Conservatives have an extraordinarily narrow vision of Canada. Indeed they are without vision. Stephen Harper sees Canada as an ‘energy superpower’ but only considers petroleum fuel as the source of this energy. Moreover, the fuel is very ‘dirty’- bitumen or tar that requires costly, energy-intensive refining. Further, while he seeks to maximize consumption and combustion of oil, Harper has no time or patience with conservation of energy. He has even less time for sustainable energy, for solar, tidal and wind power. This directly contradicts traditional conservative philosophy.

3. Profligacy

Among the gifts left to Harper by the previous Liberal government, along with a large fiscal surplus, was a program of subsidies for enhancing energy efficiency by improved home insulation. Among the first act of the Harper Conservatives was to cancel this program.

4. Fiscal irresponsibility

Another immediate act was irresponsible tax cuts that eliminated the healthy surplus inherited from the previous government. These tax cuts were, of course, very popular with the most short-sighted portion of the electorate. These were truly acts of a visionless government, that called to my mind the biblical saying, “Where there is no vision, the people perish.”  

5. Governs on ‘divide and rule’ principle

Nations run best on collaborative teamwork. The concept of collaboration is alien to the Harper government which functions on a ‘divide and rule’ principle, setting one ethnic or interest group against another. There are many examples of this obtuse behavior. One that is more harmful than most is Harper’s refusal to attend meetings of first ministers of the provinces and territories.

6. Partisan policy in Israel-Palestine dispute

For many years before the Harper government came into office, Canada had a high international reputation based on its record of impartiality and altruism, particularly in the Israel-Palestine dispute. The Harper government has destroyed this reputation. It has sided unequivocally with Israel, boasting that it is Israel’s best friend, needlessly making an enemy of Islam.

7. View populace solely as taxpayers

The Harper government sees the people of Canada first and foremost as taxpayers. Newborn babies, indigent single mothers, old people dying of cancer or dementia are not primarily taxpayers, although they have well defined needs for health and social care. Every Harper government action boasts of an accompanying reduced tax burden. You get what you pay for. I don’t mind paying more for better quality, for example of CBC radio and high quality postal services.

8. Hostile to women’s reproductive rights

The Harper government is unfriendly, to say the least, towards women’s reproductive rights. Some years ago they denied charitable status to the International Planned Parenthood Federation, Family Planning Canada, and several similar NGOs. They withheld approval for the so-called ‘abortion pill’ for over 2 years, longer than any other drug ever submitted for approval in Canada, longer than any other nation. 

9. Mean-spirited and vindictive

The Harper government is mean-spirited and vindictive, for instance targeting altruistic non-governmental organizations that promote concern for the environment. These are seen as enemies, presumably because they disapprove of government policies that are very destructive of environments. These have been subjected to costly and needless audits by Canada Revenue Agency.

10. Attacks on Parliamentary Budget Office and Elections Canada

The Harper government’s way of doing politics relies on hatred and contempt for political adversaries. These adversaries include the permanent civil service. Civil servants are regarded and portrayed not merely as enemies of the CPC, but enemies of Canada – a complete distortion of reality. They have adopted the same attitude to impartial agencies such as the Parliamentary Budget Office and Elections Canada.  The aim seems to be to emasculate or neutralize democratic infrastructure that threatens them by telling the unvarnished truth.

11. Hypocrisy and empty gestures

Examples of this include Harper’s very public ‘apology’ for the atrocities committed during the residential schools fiasco. It was an empty gesture because nothing whatever was done to follow up and make amends for the parlous plight of First Nations people: no move to ameliorate the plight of people on reservations where living conditions are deplorable, outright refusal to establish an inquiry into the root causes of conditions that have led to over 1200 missing and murdered women and girls. 

   

12. Use of omnibus bills rather than parliamentary debate

The Harper government repeatedly bypasses democratic debate by using ‘omnibus budget bills’ as a way to change laws without submitting these laws to formal parliamentary debate.

13. Lemming-like rush towards extinction (opposite of sustainability)

The actions of the Harper government take all life in Canada towards extinction. I wouldn't mind in the least if the Harper government became extinct. But it makes me angry to think of them carrying bright children with them to extinction, children who manifestly could run Canada and the world a great deal better than they have.  In the interests of life in Canada and life on earth, we must get rid of this bunch of scientific ignoramuses who have been mismanaging our lovely part of the habitable world for far too long. 

14. Narrow, ideologically based economic policy

Economic policies are very narrow, based on resource extraction rather than sustainable diversification. In early 2015 we see the adverse consequences as oil prices collapse.

Economic policies are ideologically based, as in dismantling of National Wheat Board, which ensured stability of income for farmers. Taxation relies on 'boutique' tax cuts for targeted segments of the population.

15. Mediaeval approach to crime and punishment

Crime must be punished. That's far more important than preventing crime. More and bigger prisons, harsh sentences, are the solution. If they could get away with it, they would restore the death penalty.

16. Miserable mean-spirited management of refugee resettlement (because they are Muslim?)

 Refugees are viewed as potential or even actual terrorists. If possible, keep them all out "None is too many" which was the prewar government policy towards Jews fleeing the Nazi regime in Germany, is the covert policy of the Harper conservatives. 

A few additional reasons to reject Harper and all he stands for: 

Our flag: Not even $50K for 50^th anniversary paid for from Museums’ budget, versus $400K for War of 1812 when Canada didn’t even exist                                                                                              

False and misleading erection of phantom ‘terrorist’ enemies – stoking fires of ‘national paranoia’

Delay, delay, delay help for distressed Muslims (e.g. Syrian refugees, Al Jazeera journalist)

During the election campaign, Harper and his crony Jason Kenney added a further reason. A woman, just one of two women in the past decade, wanted to wear her niqab (face veil) during her citizenship ceremony.  Harper declared that he would prevent this, if necessary by special legislation. If an ordinary Canadian had made such a statement, couched in language that was an implicit incitement to violence, there would be a strong case for prosecution under legislation against racist hate speech. That the prime minister of Canada should say such a thing, not once as a slip of the tongue but repeatedly, in my view disqualifies him from holding any public office.  

Why and what we write

We write because we have something to say, something to sing, a poem, a story, an item of news, a mathematical formula with predictive power, a theory of how the universe works, that we want to share with others. We feel an irresistible compulsion to share our thoughts, our ideas, with other people. 

By 'we' I mean all humans, everyone, but especially those of us who believe we have something worthwhile, important, beautiful, aesthetically pleasing, that we are impelled to share with others. 'Others' vary in number from our nearest and dearest to all of humankind. 

We began doing this before writing was invented. Balladeers, story-tellers, wandering minstrels, tribal elders and sooth-sayers were talking to the rest of their tribe or clan millennia ago, singing songs, telling stories, relaying the history of their people. Homer, the blind poet, sang the story of the siege of Troy which probably mixed a historical record of real events that happened to real people with the magic and myths of interventions by the gods.  The Iliad, Homer's tale of the siege of Troy, of Achilles, Agamemnon, Helen and Paris, Priam, Hector, Odysseus, the rest of the heroic band of Greeks and Trojans and the Olympian gods and goddesses, dates back, we believe, to long before those who told the tale had written records. It was passed on orally, perhaps for centuries before it was written down, and preserved in perpetuity as one of the greatest of all timeless classics. 

I discovered that I had worthwhile things to say to my professional peers and students aspiring to join our ranks, possessed the ability to express these in language others enjoyed reading as much as I enjoyed writing them down. I could summarize and condense complex concepts into simple generalizable principles. In 1977 I started work as editor in chief of a massive comprehensive reference textbook of public health and preventive medicine. When it was published in 1980, that book had 1926 pages, plus 25 pages of 'front matter' - title page, table of contents, preface, list of contributors and their affiliations. The book attracted praise from many quarters. The praise I appreciated most was for the introductory chapter in which I pulled it all together, summarized the complex and occasionally confusing 'big picture' in an overview devoid of technical jargon, 6 pages a grade school child could understand, about the scope, aims, methods and scientific basis of public health. Here is a sample:


"The ways to preserve and improve health are discussed at length in later chapters. In summary, the methods are to keep the environment safe, to enhance immunity to infections, to behave healthfully, to eat wisely and well, to have well-born children, and to care prudently for the sick." 

Whether I'm writing about tangible things or abstract concepts it's important that I, the writer, and all my readers, give the same meaning to every word in the text. There is no place for Humpty-Dumpty in my kind of writing. Remember what Humpty-Dumpty said to Alice: "When I use a word it means just what I choose it to mean - neither more nor less." That's not to say I reject ambiguity always and forever. Even in the Dictionary of Epidemiology - a dictionary, forsooth - my editorial team and I felt obliged to leave a little wiggle room, a little uncertainty, or two alternative meanings, for an occasional technical term. We also had to recognize that the same technical word or phrase could occasionally mean something entirely different in two (or more) unrelated scientific domains in which its use had evolved independently. But that's a rather arcane discussion for another time and place, not for this post on this blog.   

In this post I'm discussing my own writing, and it would be easy to get carried away, to run on for far longer than the most patient reader would wish. Time to quit while I'm ahead.

Why I write

George Orwell's essay Why I Write was published in an obscure, short-lived English literary magazine in 1947. It was reprinted in (I think) an Australian literary magazine a year or so later, and that's where I must have read it. It made me think for the first time about why I had this odd compulsion to arrange my thoughts in what seemed to be an orderly manner, and set them down on paper.  I remember trying to set down my reasons why I wrote. I wish I still had the two or three badly typed pages I managed to produce as my answer when I was in my early 20s, but like nearly everything I wrote in those days, it hasn't survived. 

Orwell spent a few pages describing how he wrote, and on what topics - fact, political polemics, infrequently fiction, though later works, his two most famous, most timeless books, Animal Farm and 1984, are classified as fiction. He seems to have found it difficult to address the question in the title of his essay, because he flits around it like a bee buzzing from flower to flower and his reasons are sometimes buried almost shamefacedly in paragraphs about something else. At one point in the essay he tries to compile a list of reasons: egoism; aesthetic enthusiasm; to store facts for posterity; political purpose. But he gets distracted, and this essay, which could have been a valuable contribution to literary scholarship, is in the end a rather frustrating, rather inchoate, rather annoying and disappointing mess. I suppose that's one reason I tried to write my own essay on the matter in 1948 or thereabouts. Other collections of essays that I formerly possessed, by E M Forster, Aldous Huxley, Arthur Koestler, half a dozen other 'public intellectuals' of the 1930s, 1940s, 1950s, are long gone, not part of my shrunken downsized library, so I can't check; but I don't recall any other writers or thinkers who addressed the question, and stated their reasons for writing.

My reasons then included desire to clarify complex concepts and ideas, to explain, perhaps to simplify these concepts and ideas by expressing them in my own words, and not insignificantly, the pleasure I got from writing. These reasons are implicit, sometimes explicit, in much of my professional writing. Among my books, I've edited a massive reference textbook of public health and preventive medicine, compiled and edited technical dictionaries of epidemiology and of public health, and co-edited an encyclopedia of public health and a 'Companion' to Medicine in the 'Companion' series published by Oxford University Press. I wrote large parts of all these books, even the encyclopedia, to which I contributed more than my fair share. Working on all of these and other books and articles, and writing editorials for journals I edited, gave me immense pleasure, partly because of collegial relationships with other editors and authors, but mainly because it was such a pleasure to do all that writing. I've always been chuffed to get feedback from readers who say it's a pleasure to read what I've written, more enjoyable than many other textbooks and works of reference because I wrote with a lively style that kept readers awake.

Until recently I've always been able to find exactly the right word, the appropriate phrase, the rounding off paragraph to sum it all up. Alas, as I enter my 90th year I find all this no longer falls trippingly off my tongue, it's no longer there at the surface of my mind, waiting to be plucked and used to the best purpose. Now I must often search, sometimes in vain, for the needed words and phrases. These, no doubt, are signs of declining intellectual vitality that I must accept and make the best of, smiling bravely through unshed tears as I lament the ravages of time.  No, correction: I don't lament them at all, I acknowledge and accept them, thankful to be here still after all these years and insightful enough to recognize my limitations.

And I can add another reason to my list of reasons Why I write: It's the perfect therapy.

What would you do?

A devoted couple in their early to middle 80s confronted a crisis of accumulating health problems.  I'd known that elderly couple almost all my life. He was my favourite cousin, about 5 years younger than I; and I'd known her for more than 70 years. They'd had a marvellous life. Thanks to lucky real estate deals and other sensible investments they were very wealthy. They could afford to pay for all the domestic help and personal nursing care they needed. In their early to middle 80s, they were as in love as they had been when they married more than 60 years ago. They looked back on full lives that had been enormously pleasurable. One of the highlights of their lives had been a three-year yachting cruise around the world, during which their daughter had paired off with a man from Chile, a nephew of the dictator Augusto Pinochet. One of their sons had fallen for a French girl, married her, and settled in France. Their other son wasn't quite so fortunate: he'd been caught with marijuana in Greece, and despite high-priced legal counsel with good arguments, he'd spent several months in the slammer in Corfu. That was one of the few clouds on their horizon,apart from the fact that two of their three children settled far away on other sides of the world after they married.

Now things were going wrong.  He had become forgetful and unable to care for himself as dementia held him in its increasingly relentless and clammy grip. She'd fallen victim to mesothelioma, an intractable malignancy caused by exposure many years earlier to trace amounts of asbestos, the amount that might be shed by a fraying insulated oven mitt or a barbecue apron. Mesothelioma can't be treated. The malignancy hits the lining of the lungs, sometimes the lining of the gut; but it can't be cut out, can't be treated with radiation or chemotherapy.  Their daughter's marriage had broken down so she had come home from Chile to live near her parents in Queensland in a prosperous suburb of Brisbane. As the mesothelioma advanced and her vitality wilted away, and her husband became increasingly dependent, forgetful and childlike, she and I exchanged several emails. She didn't confide her intentions to me, but I can vividly imagine the thoughts she must have had as she considered their options. I was saddened but not surprised when my brother phoned me with the news that they had taken their lives. They used exhaust fumes from their car engine, so the cause of death was carbon monoxide poisoning. My brother, a devout Christian and a retired physician, expressed disapproval of their decision - her decision I suppose - to end their lives together in this way. He'd have preferred the option of palliative care for her, and longterm care for him - care in uncomprehending solitude without his loving wife beside him, because her prognosis was for a rather brief and painful terminal illness, whereas he might have lived for 10 more years. Years ago Wendy and I talked about several scenarios for the end of our lives. One scenario resembled the reality of the fate that befell my cousin and his wife, and they took - or she took - the same decision we'd have opted for in those circumstances. I wholeheartedly support their decision to die together. I picture them in their car, locked together in a final loving embrace: they were an amorous couple who had no inhibitions about expressing their love for each other when in the company of another loving couple like Wendy and me.

They had enough free will and autonomy to decide their own fate, just as Wendy and I would have when we were still together side by side, and I retain, should circumstances arise to justify it. They and I would strongly support physician assisted suicide. Our Supreme Court has decreed that this ought to be the law of the land. It will be, if the next government of Canada is sensibly chosen in the imminent elections. If circumstances arise in my life to make continuing existence unbearable, it would be comforting to know that this option would be available. I wonder how readers of this blog would decide should they face a situation like that of my cousin David and his wife Judy.  Would they opt for Judy's action? Or would they be in favour of my brother Peter's solution? It's an important question that merits debate by all thoughtful people in a society where the fate that overtook my cousin David and his wife Judy occurs increasingly often. In any event, David and Judy live on with a fondly affectionate place in my memories. (The photo shows Judy, Wendy and David at Gordonbrook sheep and cattle station in northern New South Wales, near Grafton, in 1987).

Judy, Wendy and David,
Gordonbrook, near Grafton, NSW, 1987

Values

For many years I discussed values with groups of medical students, occasionally with others such as nursing students, two or three mind-blowing times with combined groups of medical and nursing students. Naturally those discussions focused on health-related values - cleanliness, personal hygiene, fastidious food-handling, consideration of the needs of others where tobacco smoking, noisy behaviour, socially disruptive conduct were concerned. We also talked about fundamental values associated with family formation, cohesiveness and dissolution, which have obvious implications for health. I reported to students my own experience of growing up in a broken home, reared by a divorced mother in an era when divorce was rare and stigmatizing, in contrast to the present time in which separation and divorce are commonplace and socially acceptable. We talked too about Canadian values, respect for human rights and dignity, tolerance, acceptance of social and cultural diversity.  I passionately believe in all the rights embodied in the Universal Declaration of Human Rights (the UN Charter) and the Canadian Charter of Rights and Freedoms.  When I was younger and stronger I would have been prepared to fight to defend these rights. I've supported Amnesty International financially for more than 40 years and rely on this organization and others like it to fight for me now.

I was appalled and disgusted with the blatantly cynical conduct of prime minister Harper, whose fondness for divisive political tactics has reached a new low in exploiting the worst of xenophobic - Islamophobic - impulses with regard to wearing the niqab. A woman - just one woman - wants to wear a niqab when she takes the oath of Canadian citizenship. She will, of course, have removed the niqab and duly identified herself to requisite officials before the citizenship ceremony. I believe she has the same rights as all other Canadians to dress in a manner she finds culturally comfortable during this rite of passage. To deny her this right is to deny everything Canada stands for. It would be the ultimate denial of Canadian values.  It is typical of Stephen Harper - a divide and rule leader - that he would inflame this and make this one woman's wish into an election issue that over-rides all other issues in importance. It speaks volumes about the emotion-driven thought processes of many people than opinion polls reveal the influence this otherwise irrelevant episode seems to be having on voting intentions. I weep for Canada if this becomes the deciding issue in the election.

What it feels like to be a migrant

I've never been a refugee but I've met many. Charles 'Newman' (a self-conferred surname) crept out the back door of his Budapest apartment in 1956 as the secret police were breaking in the front door, with barely enough time to grab his wallet and passport. He'd been in Australia about 4 years when I met him, was still traumatized by the collapse of his comfortable world when the Soviet army moved into Hungary to 'save' it (it was never clear from what). A Vietnamese couple who looked so fragile a puff of wind would blow them away were tougher than the steel cables supporting the Lion's Gate bridge, below which I met them and heard their harrowing story of piracy, rape, being stripped of all they possessed, and worst of all, the pettifoggery of bureaucracy that impeded their resettlement and led them onward from Los Angeles to Vancouver. I empathize strongly with them and many others I've been privileged and honoured to know, but I can't share their experiences.

But I know what it feels like to be a migrant. I've migrated intercontinentally, from one culture to another, three times, uprooting from a neighbourhood friendship network and culture to begin life anew in a strange new world with unfamiliar culture and customs, bringing my willing supportive Wendy and three rather unwilling little children with me. 

Our first migration in January-February 1964, from Sydney, Australia to Burlington, Vermont, USA was a comfortable 7-week affair, a luxurious sea voyage across the Pacific, through the Panama Canal to Kingston, Jamaica, then up the Eastern seaboard of USA. Our first impression of the USA was a vista of miles of squalid shanty-town slums where underclass blacks lived, as our ship crept up river to a berth within walking range of gracious antebellum homes and lovely downtown Charleston, South Carolina. It was a different planet from our first sight of those miles of shantytown slums.  Another first impression was gunshops with displays of ugly automatic pistols and rifles with magazines holding enough bullets to shred the first unlucky deer, wild pig, or newspaper delivery boy to cross the path of a proud owner of such lethal weapons. A newspaper delivery boy was slaughtered by mistake in exactly this way soon after our landfall in the USA. An Op-Ed comment in the Burlington Free Press after that commonplace tragedy twisted facts and distorted logic to imply that getting shot and killed was the boy's own fault. 

Before we left Sydney on that migration from Australia to the USA, I had begun to study socio-demographic and psychological factors associated with migration, so I had some insight into what was happening to me and my family.  I knew an essential determinant of successful migration is a slowly acquired sense of belonging to the migrant's host country. On our very first day in the USA impressions began to accumulate, a little more on the negative than the positive side of the ledger. Reasons not to identify with, not to seek a sense of belonging to American culture, grew more numerous in the months that followed.  

Throughout our 14 months in Burlington, Vermont in 1964-65, Wendy and I tried hard to acquire the sense of belonging that we knew was an essential prerequisite to successful assimilation. I was very fortunate: Kerr White, my host, mentor, guide on the path to assimilation, gave me many opportunities to travel. I went to New York, Washington, Boston, Pittsburgh, Philadelphia, Baltimore, New Orleans, Chapel Hill, Ann Arbor, Chicago and sundry other centres of scholarly life. At weekends and on a short late summer holiday we explored Vermont and the neighbouring states. Wendy and I found much to admire and like about life in the lovely little university city of Burlington, Vermont. But we also found aspects of the American way of life that felt alien - that inhibited us from acquiring a sense of belonging. 

We were disgusted by the profligacy and waste, appalled by casual acceptance of corruption as an integral component of politics, horrified and alarmed by the gun culture, apprehensive about the rising tide of strident militarism all around us. The war was heating up in Vietnam in 1964, and universally there was total misunderstanding of what that war was really about: Americans saw it not as the struggle for national liberation from colonial rule that it really was, but as a conflict between good capitalism and evil communism. 

I'd been reading the New Yorker avidly for about 15 years, but apart from that we searched in vain for local, regional and national evidence of the sort of cultural richness and historical traditions that permeate the lives of people in Britain or France or Italy. It was difficult to detect evidence that the values of Mark Twain, Louisa May Allcott, Henry David Thoreau, Herman Melville, William Faulkner, John Steinbeck, Ernest Hemingway, or a dozen other American writers I admired and loved, had penetrated the souls of any of the Americans we met, nice though they all were. The overriding impression was of a shallow, superficial culture hardly deserving to be called a culture - certainly not a culture to which we wanted to belong. 

Wendy and I felt that we were saved from a fate worse than death when Stuart Morrison invited me to join his team at the Usher Institute of Public Health in the University of Edinburgh. The salary was 40% below what I'd been offered to accompany Kerr White to the Johns Hopkins School of Hygiene in Baltimore; even so it took no more than a nanosecond to decide between the two invitations. I achieved brief fame as an example of 'reverse brain drain' - even a short paragraph in the Lancet.

The process of migrating from New England to Scotland lasted overnight, a red-eye flight from Montreal to Prestwick, and an hour on the train to Waverley Station in Edinburgh. Wendy and I thought our adjustment to life in Scotland would be equally brief. She'd lived in Edinburgh before, for 2-3 years; I'd lived there for about 5 months. I was disconcerted to find that it took 2 years or more to acquire a sense of belonging. Probably this was because I'd lived in London for 4-5 years and had acquired aspects of Englishness that were subtly different from Scottishness.  It was easier and faster for Wendy, perhaps partly because of a little Scots blood in her veins. But it happened: our whole family acquired not so much a veneer as a sturdy sub-surface layer of Scottishness, strongly reinforced in our children by lovely lilting Edinburgh accents. (To my sorrow they lost these accents within weeks of settling in Ottawa, but Rebecca assures me she can retrieve hers if the need arises).  

After 5 years we all felt Scottish and would happily have spent the rest of our lives there. Several factors impelled us to move again. After 5 years I'd become professionally well known.  I began to get invitations to attractive professorial positions elsewhere in the UK, in Canada, USA. None from Australia, alas, and I was turned down for two positions I applied for in my homeland: both went to men who were well-connected rather than well qualified. I couldn't refuse an invitation from Harvard, however, despite misgivings about the politics of a cross appointment between the medical school and the school of public health, doubts about returning to a country and culture we'd found flawed, and painfully long commutes I'd be forced to make. After provisionally accepting the position at Harvard, I flew to Ottawa, arriving late on a balmy summer afternoon. I walked up to Parliament Hill, then around the Canal to somewhere in the Glebe where as dusk gathered, Mums and Dads sat on their front steps sipping wine while their kids played street hockey. I had an epiphany: this was the place to raise our kids, not some distant outer suburb of greater Boston with all the turbulence and racial tensions that afflicted the USA in the late 1960s!

The decision to leave Edinburgh, which we had come to love, and where we felt that we truly belonged, and move to yet another new country and culture was agonizing and drawn out over as many weeks as we could delay saying yea or nay. When we finally made up our minds it was after prolonged consideration of many pros and cons. Better chances for our children to get a good start in life was of over-riding importance.

We found to our surprise and delight that adjustment to Canadian life and culture was easy, fast and painless (but not to the climate! That's a whole other story). The policy and reality of multiculturalism smoothed the way: newcomers to Canada are accepted for who they are. Nobody tried to change us, to force us into a mould that would have us conform,  become like everyone else.  Canada's not like that! It draws its greatest strength from its pervasive diversity. Now after 46 years here I feel deep-rooted; and if my ancestors are all in another country, that just makes me more Canadian, not less, like close to a third of all of us who live in Canada.  The sense of belonging took hold soon after we arrived in Ottawa, and has grown stronger, richer, deeper with each passing year. 

Entering my 90th year

Any honest old wrinkly will admit that despite the sense of accomplishment in surviving this long, its annoying limitations, disabilities, aches and pains, et cetera, make old age a mixed blessing. As I've said before and will doubtless say again - old people being by nature repetitious - being alive at 89 is infinitely preferable to being dead, no matter how tiresome the accompanying ailments of old age may be. I continue to get great pleasure from just being alive.  This year I've had an unusually large number of greetings and good wishes on this, my 89th birthday. I treasure them all. I was especially chuffed to receive greetings from my very good friend and colleague for 40 years, Rama Nair. As I said to him in a Facebook message,  I feel a sense of pride and accomplishment in having brought him to Ottawa, recruited him to our medical school, and watched with approval as he and his lovely wife Sarala put down roots and established a dynasty here. They are a vibrant local symbol of the success of Canada's policy of multiculturalism, the mosaic of cultures that have joined forces here to form a beautiful pattern. There's a good deal of merging and mingling at the margins, but the mosaic is still a mosaic, a model to the rest of the world in how cultures can live together side by side in friendship and harmony. It's a better model and more durable too, than the American (and Australian) policy of assimilation - the melting pot, in which every immigrant becomes an American (or an Australian). When Wendy and I were weighing the pros and cons of staying in the USA or moving on to Scotland, the melting-pot metaphor was firmly in the 'con' column. Later, when we left Scotland and came to Canada, the metaphor of the mosaic was a powerful encouragement  to stay here and become part of the mosaic.  

Migrations - Some official statistics

The Harper government is so secretive with facts that might prove politically awkward or embarrassing if disclosed, that we must turn to official UN agencies to find the truth. 

The International Organization for Migration (IOM) is a useful source. I learnt from IOM that I am one of 21 thousand Australians who has migrated to Canada. Almost 11 thousand have migrated to Canada from New Zealand, Wendy's homeland. According to IOM, as of 30 June 2015, i.e. in the first six months of 2015, Italy, including Sicily and the tiny island of Lampadusa, had received 114 thousand migrants who have arrived by sea across the Mediterranean; several thousand died trying, mostly by drowning, some asphyxiated after being locked in confined spaces, e.g. refrigerated trucks, sealed ships' holds. The land route into western Europe runs through Greece and the Balkans. More than 235 thousand migrants used the land route through Greece in the first six months of 2015. Greece's task has not been made easier by the German bankers who demand repayment in full of loans to Greece.

The United Nations High Commission for Refugees (UNHCR) is another useful resource. I've been observing UNHCR's work and using their statistics for many years (I've contributed to UNHCR as a charitable cause for more than 30 years). One UNHCR statistic I've often quoted is the rapidly rising number of environmental refugees. The number rose from 5 million to 47 million between 2005 and 2010; it has risen more sharply since 2010. Late in 2015 there are more than 60 million refugees but I can't find a table that dissects them into refugees from conflict, habitat loss, etc. The appalling carnage of the Syrian civil war was sparked initially by habitat loss after an unprecedented prolonged drought attributable to climate change. This led directly to a rural-to-urban migration of about 1.5 million Syrian farm families whose formerly fertile land had turned to desert.

The present Canadian government has been obstructive and secretive, delaying action on specific requests from families and church-based groups, refusing to disclose the actual numbers, releasing figures that are misleading, inconsistent or both. Harper boasts that no country is doing as much as Canada, a blatant falsehood. A spokesman for one of the charitable organizations said that as far as he could determine, fewer than 500 claims for refugee status are being processed (painfully slowly) and the number actually brought to Canada under direct government sponsorship or in process of being brought here, is 59. Germany has received over 100,000 refugees from Iraq and Syria, and Sweden, with a population of less than a quarter of Canada's, has taken in 60,000. When our present political leaders lie to us so shamefully I wonder why they expect us to vote them back into office. The Harper government's contribution to the Middle East crisis is 6 fighter-bombers and a campaign of obstruction and lies. Recent news also included information that a Canadian air strike earlier this year led to a record number of civilian deaths. The actions of the Harper government contrast very sharply with the response of Joe Clark's PC Government to the refugee crisis of the 'Boat People' after the fall (or liberation) of Vietnam. Some 60,000 or more were brought to Canada in the space of a few weeks.

Why do people migrate? Stated at the most simplistic, they are either pulled or pushed.  The incentive to leave a familiar homeland, to uproot, is absence of opportunities for advancement, promotion, or even survival in the homeland.  Habitat loss is becoming a 'push' factor in a world of rising sea levels, desertification, shrinking resources. This set of problems often leads to social unrest, political instability, persecution of minorities. The dustbowl years of the 1930s caused habitat loss in some marginal  agricultural regions of USA, leading to some population redistribution. I think we are beginning to see evidence of another trend, a larger region of habitat loss, drought in California which shows signs of a longterm or permanent climatic shift. By the middle decades of the 21st century the south-west corner of USA will probably be unable to sustain even half its current population. California is richer in all resources needed for prosperity except the one essential ingredient, fresh water for drinking and irrigation. Perhaps desalination technology will develop in time to replace depleted freshwater. If it doesn't, millions will be forced to emigrate from California as it transforms into a waterless desert.

Viewed as a biological phenomenon, the turbulent movement of people around the world, often accompanied by violence and armed conflict, is a collective response to the need for resources essential for survival. Currently humanity is living in ecological deficit. Every year the deficit between numbers of people and available resources of drinking water and food grows larger. Many of the world's most intractable conflicts are ultimately attributable to this deficit. The relentlessly increasing size of this deficit is a reliable predictor of future unrest and conflict. 

A sociobiological perspective on migrations

The terms used to describe migrants can reveal much about those who use the terms. In the early 1930s, the period of my earliest conscious memories, cartoons in the gutter press in Australia conveyed frightening images of sinister slant-eyed men, the mythical 'Yellow Peril' who threatened to overwhelm the sturdy but sparsely distributed blue-eyed, fair-complexioned Australians of British stock who were sprinkled across the south-east corner of the desert continent with denser clusters in Sydney, Melbourne, Brisbane and other cities on that long coast facing the South-West Pacific Ocean. The journalists and the owners of the gutter press were deliberately vague about the nationality of those they described as the yellow peril. Were they Chinese? Japanese? Burmese? Indonesian? (Not this: In the 1930s Indonesia didn't exist: it emerged in 1947, the outcome of a colonial war of liberation of the Dutch East Indies that was watched nervously by press, politicians and the public in Australia). 

There were massive and often bloodstained regional population realignments in and after  wars of liberation from colonial status, for instance after the partition of British colonial India into India and Pakistan.  A consequence of the liberation wars in south and south-east Asia were large migrations into Western Europe: Dutch-speaking Indonesians into Holland, French-speaking Vietnamese into France, English-speaking Indians and Pakistanis into Britain.  In 1961-62 I walked every day across the north-east corner of what had previously been Cockney east end City of London with a long history of receiving migrants -- Huguenots, Jewish refugees from Russia and the Baltic States, more Jews escaping from Hitler, then the influx I observed from East Pakistan, which 10 years later became Bangladesh. I suggested to Jerry Morris that the Social Medicine Research Unit should keep an eye on the population redistribution going on around Brick Lane which was becoming a little enclave of East Pakistan.  But I couldn't articulate a relevant research question clearly enough, though doubtless there were some well within the scope of one of the MRC Research Units. Walking past Brick Lane one day in the winter of 1961-62 I first heard the pejorative term 'Paki' applied venomously to these slender and beautiful sari-clad young women from the deltas of the Ganges and the Bramaputra Rivers.   Not long after then there were race riots in Bradford and other cities in the north of England, sparked partly by insulting language used to describe immigrants from South Asia.    

In Australia in the 1950s,the acronym DP (displaced persons) was applied blanket fashion to all immigrants, even those like our friends Dodie and Harald Ziemer who paid their own way to Australia. Sometimes it stigmatized, like the current Oz term 'asylum seekers' - implying that they are somehow inferior, but really just the 21st century way to express xenophobia I don't think we are as bigoted in Canada but I haven't seen an opinion survey and it's hard to read the tea leaves.

The Canadian policy and practice of multiculturalism were powerful attractions to Wendy and me, and we saw many examples of the successful application of multiculturalism. I saw it close-up in the successive 'families' of 84 medical students who passed through my first-year class every year. They were truly rainbow classes in which all variations of skin pigmentation, hair texture, and on special occasions, ethnic costumes, were displayed. I was privileged to have many contact hours exposure to those first year students, watched as they bonded into a single large 'family' and observed assortative mating occurring, often across ethnic and cultural 'boundaries' that these nubile youngsters ignored. I've stayed in contact with enough of these ethnically diverse couples to observe some flourish and others fail for reasons tht had nothing to do with their diversity. At longer range I've observed Canadian multiculturalism being nurtured at grade school level, at the French Immersion First Avenue School at the other end of the block I live on. In the playground the little children play and lark about - in English, spoken with widely diverse accents - with complete disregard for irrelevancies like skin pigmentation and hair texture. 

Canada, this easy-going tolerant multicultural nation could very easily absorb tens of thousands of Syrian refugees. All that stands in the way is the bigotry and intolerance of our current  government. I hope they are resoundingly swept from office next month!       

Migrations, 2: Syria: Dissolution and Diaspora

The nearest I got to Syria was in 1998, a car trip from Beirut almost to the Beckaar Valley in Eastern Lebanon near the border with Syria, haven of Hezbollah and a target for random aerial attacks by the Israeli air force. We wanted to see the ancient ruins, the remains of temples dating back 3 thousand years or more.We had a vaguely defined plan to continue across the border to Damascus, where I had a friend, Ibrahim Abdelnour, one of my correspondents who helped to compile the Dictionary of Epidemiology, an authority on the epidemiology of malaria. Everything seemed aligned in our favour as we left Beirut on a heavily overcast morning but halfway to the Beckaar Valley the clouds blew away, leaving all on the ground in sparkling sunshine, perfect targets for the Israeli air force. We had a phone call from our minders in Beirut: Do not proceed; turn back. Two years later I met my Syrian friend at the IEA Congress in Los Angeles, but it wasn't the same as a meeting in Damascus would have been. He was an urbane scholar who loved his ancient city and had been eagerly looking forward to showing it to me. I've flown over Damascus a few times, en route to or from Kuwait. From the air it looks a fascinating city. I wish I'd been able to stroll its twisting lanes, browse its souk, see its mosques, meet more of its scholars than that witty old man, Ibrahim Abdelnour and one of his bright young proteges. 

After almost 5 years of vicious warfare among a confusing array of adversaries, Syria has disintegrated. Late in 2015 this once cohesive nation, a regional power that the IDF took very seriously, is in an advanced stage of dissolution. More than 11 million Syrians are homeless refugees. Until very recently they were prosperous, well educated, secure in homes where the same families had lived for generations. That drowned toddler whose body at the edge of the sea on a Turkish beach appeared in newspaper photos all over the world, was from such a family. The fanatics of the Islamic State have moved in, taken over large swaths of the country, diligently obliterating ancient artifacts to conform with the perverse brand of Islam propagated by their mentors in Saudi Arabia. 

Germany, to its credit, has welcomed the mass of refugees who have escaped, has promised homes for 800,000. Typically, Harper's government has been evasive, misleading and inconsistent. If they have their druthers, they'll adopt the same policy as the xenophobic Canadian government of the 1930s, for whom "None is too many" was the watchword. I think Germany is getting an excellent bargain by opening its doors and its homes to 800,000 or more Syrian refugees. Would that Canada was led by a similar wise and farsighted statesman! Instead we have a rigid, narrow-minded rightwing Islamophobe ideologue who lacks vision and imagination, can't visualize how immensely such an influx of well educated, highly motivated young people would benefit Canada. Either the NDP, or even the Liberal Party if it could be trusted to honour its promises, would be a paradigm shift and a vast improvement over this visionless conservative government.

Migrations

In 1954-59 I had a front-line perspective of migrants entering and settling in Adelaide. Some assimilated and others became hyphenated Australians,  adjusting while preserving their original ethnic and cultural identity. I saw the impact of migration on the health of migrants and occasionally, subtle effects of migrants on the health of those who were already there. My first 'scientific' article in the Medical Journal of Australia (1960) was an anecdotal description of a few health problems associated with migration. It was neither epidemiology nor social demography but since 1960, my interest in the application of social demography and epidemiology to studies of migration and my grasp of the issues, have grown considerably. Several of my published papers focus on social demography, e.g. on the migrations out of the UK of British-trained medical doctors in and before the late 1960s, and into the UK after 1945 of doctors and nurses trained in South Asia, Africa and the West Indies. 

In the second half of the 1950s my family doctor role meant close contact with individuals and families.  I brushed up the German I'd learnt at school, and took Italian lessons for a couple of years - a delightful experience - so I could speak in their own language with immigrants in these large linguistic groups.  I never really mastered either language but the fact that I tried, that I reached out a helping hand in this way, made me warmly welcome in immigrants' homes, more so than any of my colleagues, none of whom made comparable efforts. Two of my colleagues were covertly xenophobic. I began as a salaried assistant in that 10-doctor group practice, the lowest man on the totem pole, doing all the scut work nobody else wanted, including all the out of hours calls to see sick immigrants in the hostel where thousands stayed when they first arrived. In that way I met several families who not only became my loyal patients, but in a few instances, notably Dodie and Harald Ziemer, became personal friends. Dodie and Harald became among our closest friends in Australia: we stayed with them when we returned on several visits after we left Australia, and they stayed with us when they made a world tour after Harald retired from his post as registrar of the Lutheran boys' college in Melbourne.  

I've long been interested in the social demography of the great migrations of recorded history, especially those of the past few hundred years: the European migrations into the Americas and Australasia, the transportation of some 20-30 million black African slaves into South, Central and North America, and the rearrangement of populations according to ethnic and cultural characteristics as colonialism ended, and rearrangement of borders and populations in Europe after the 1939-45 World War. Some mass migrations have been peaceful and orderly; others have not.

The great migration of 2015 is chaotic and bloody. For 5 years Syria has been engulfed in a catastrophic war in which at least 3 major factions and several lesser groups have been slaughtering each other with unprecedented ferocity. At least 11 million Syrians have been displaced and the entire nation has been laid waste. Syria is at the epicentre of a massive migration of Syrians into Turkey, Lebanon and further afield, across the Mediterranean by sea mainly via Libya, and by land via Turkey, Greece and Serbia, entering the European Union in Hungary, whence the preferred destinations are Germany and Scandinavia. Today Hungarian security staff blocked the tsunami of refugees that previously had flowed unobstructed beyond Hungary into western Europe.  Germany has taken tens of thousands of refugees. Britain has taken a few hundred. Canada undertook to accept 10,000, but the Harper government has done its utmost to obstruct the flow.  It's very difficult to get facts from the Harper government. Harper says Canada has accepted 11,000 Syrian refugees. The xenophobic minister in charge of the file says 1100. A United Church spokesman responsible for placing Syrian refugees who manage to get to Canada knows of 29 families, just over 100 people. That's better than Australia  which intercepts 'asylum seekers' and incarcerates them in off-shore concentration camps. Among the reasons I hope to see Harper consigned to the dustbin of history after the next election is that whoever follows him will assuredly adopt a more humane and compassionate refugee policy.  

One Syrian who didn't make it: drowned child on a Mediterranean beach

Syria's descent into the barbarism of its civil war was precipitated by unrest that followed several years of failed harvests: climate change was at the root of it. It's a chilling thought that climate related collapse of social order and the flight of multitudes of refugees is certain to become quite commonplace in the near future. What will be the next hot spot? North China? The American Midwest? Southern California? Eastern Europe and Ukraine?  We live in interesting times...                                   

Sorrows and pleasures of old age

In Love in the time of cholera, Gabriel Garcia Marquez wrote with perception, empathy and wit about the sorrows of growing old. I know whereof he spoke. As news filters through to me of deaths in the 'family' of my medical class, the 49ers from the University of Adelaide, it's a reason for quiet satisfaction to find myself among the handful still living. The original 60 of us were reduced at last count to fewer than 10. To be living, however uncomfortably, with however many disabilities and incurable afflictions, is decidedly preferable to the oblivion, the nothingness, of being dead. I am sure there is no afterlife.  When we die, we end. We cease to be. There is no paradise, no valhalla, no doe-eyed houris to provide endless sexual gratification, no heaven, no hell. This one life each of us has is all we will have, all we will ever get. 

Maybe I haven't made the best possible use of my life, but I haven't wasted it.  I can look back with satisfaction and pride, on what I've accomplished. That's one pleasure of my old age. I do my best to shrug off the sorrows. It's gratifying   to have had recognition, honorary degrees conferred by two great universities, Uppsala and Edinburgh, the gold medal, the highest honour, of both the Canadian and American Public Health Associations (I'm 1 of only 2 or 3 people ever to have received this honour from both Canada and USA); I've been given about a dozen other awards and distinctions; and then the ultimate mark of recognition, in 2012 I was admitted to the Order of Canada as an Officer of the Order. At the banquet after the investiture, the Governor General gave me the Queen's Jubilee Medal as well. One of my sorrows is that Wendy wasn't here to share the pleasure of those two decorations in 2012.  

My greatest sorrow is that Wendy isn't beside me, holding hands as we often did when walking, or watching a DVD collection of our favourite BBC miniseries, or engaging in one of our other shared pleasures. Our supreme shared pleasure was what she sometimes called wee romps, more often earthier terms. I get vicarious pleasure from memories of those times but it isn't the same. For 55 years she was beside me, sustaining me, my reason to strive always for the best outcome of whatever challenge confronted us, or her, or me, at the time. Losing her was the most devastating sorrow I ever faced, prolonged over the 14 months of her terminal illness. She died of motor neurone disease, known here as ALS, in the  USA as Lou Gehrig's disease. It's regarded as a horrible way to die, and it is for young adults and for people in the prime of life, at the height of their vitality and productivity. In old age it lacks the dismal features that make it so dreaded. We were reassured by the neurologist who made the diagnosis and the superb palliative care physician who looked after Wendy, that almost its only impact on her would be progressively longer periods of sleep until one day she would go to sleep and not awaken. That's what happened. The most distressing aspect was that she lost her voice a few weeks before she died when the muscles she used to speak stopped working. She had no pain, no loss of intellect. Our anguish was softened by superb support services, many provided here in our apartment: personal care worker, visiting nurse, physio, appliances etc, from the ALS Society, others coordinated by the ALS Clinic or the Community Care Access Centre.

I console myself with the thought that I behaved as a gentleman should, letting her go first. 

All my other sorrows are trivial by comparison with the anguish of Wendy's final illness and death. These are almost entirely due to one or more of the incurable disorders that afflict me. I take pills to arrest or retard the progress or soften the impact of some, and rely on mindfulness meditation to help me adjust to their cumulative impact. I take fewer pills than most people in my age group, 2 in the morning, 2 in the evening, plus vitamin supplements. A cane or a walker give me confidence to walk with a sense of balance that's less reliable than it used to be. A footstool makes it easier to reach my feet to put on my socks. My vision is very good, thanks to successful cataract surgery in 2008. This enables me to keep driving my car despite slow reaction time, and this freedom of movement is a pleasure I shall miss when inevitably I have to give up driving some time soon. Nothing is as boring as a recital of someone else's ills so I'll say no more, and change the subject. 

Some collegial relationships have been better than others. Looking back over a working lifetime of well over 70 years if I include university and mature school years, I can't recall any that were detestable. Collectively and individually these relationships have generated far more pleasure than sorrow. Most pleasurable are teacher-learner relationships that became long-lasting friendships. I can't recall any of these ever going sour. Much pleasure there, and very little sorrow. I've always been a loner and since Wendy died I've lived alone in my apartment. When I need help with activities of daily living, I hope to stay here, with a personal care worker to help me, just as I now have a cleaning lady and another lady who comes in to cook for me once a week. Rebecca and Richard feed me once a week too, so between these I rarely have to cook - which is just as well because I'm a terrible cook.

A small pleasure is boasting about my age. Next month I'll be 89, and unless things change I'll mix and mingle as I do now. I proudly announce my age when I'm asked, and in some circumstances, I state it unprovoked. 

Reading is my greatest pleasure. Buying books - to support struggling authors and small independent book shops - is my one remaining incurable vice.

There's much more, and pleasures far outweigh sorrows. I am very fortunate.  

Making the world a better place

In a recent post I mentioned a bold aspiration, to make the world a better place. This is an implicit aim that many of us share as we contemplate our life's work from our different professional and occupational vantage points.  Even when we consciously aspire to make the world a better place and proclaim this out loud, which we seldom do because it seems grandiloquent, we even more rarely pause to reflect on what we mean by 'better.'

I tried to do it on September 22, 1997 in Boston, when the American College of Epidemiology gave me the Lilienfeld Award, which is the ACE's mark of distinction for lifetime achievement in epidemiology. As quid pro quo when the ACE gave me the Lilienfeld Award, I was required to give a little talk. I skimmed over the achievements of epidemiology. We all knew these achievements. Many of us recite them with pride in our introductory lecture to incoming students at the beginning of each new academic year. Instead, while all of us were digesting an unusually good meal at the annual ACE banquet, I asked - but didn't try to answer - an unsettling philosophical question.  My question can be summarized: will our descendants 100 years, or 500 years, or 1000 years, from now still regard what we did to improve the human condition, as the best, or the right thing to do? Will what we have done to clarify causes and achieve control of diseases, injuries and premature death still be considered improvements? I confessed to some scepticism and even cynicism during the discussion after my talk. It was a unique pleasure to harangue a large cluster of epidemiologists with such profound but unanswerable questions on my 71st birthday! (I'm told that my 1997 Lilienfeld Award address is posted on the ACE website, so readers of this blog can dig it up from the ACE archives if they wish).

We believe the greatest contributions of epidemiology to improving the human condition include control, sometimes elimination, of dangerous communicable diseases, clarifying the causes and initiating and maintaining surveillance systems to delineate the burden of diseases like cancer, heart disease, stroke, diabetes, industrial and traffic-related injury and death, mortality and disability of mothers and infants associated with childbirth, and evaluation of health care systems and services. All these are desirable uses of epidemiology. Governments seek our help to address questions that concern them: which health services, for instance, provide best value for professional expertise and money invested in them?  

My personal contributions have been development and application of a useful epidemiological model of many diseases; standardizing epidemiological terminology (compiling and editing the Dictionary of Epidemiology); editing a comprehensive reference textbook of public health, and helping to develop  guidelines for ethical conduct of epidemiological practice and research. I've done or taken part in a few other things too, but those four distinctly different achievements are enough to make me feel that my professional life hasn't been entirely wasted.   

There are other challenges to which epidemiologists, along with the rest of the world's intelligentsia, have had little or no worthwhile response. We've done almost nothing to relieve the burden of one of the most accursed afflictions of humankind, the scourge of depressive illness, as well as other mental and emotional disorders. We've done very little to alleviate the distress of dysfunctional families, who are often afflicted with domestic violence, substance abuse, etc. On an international scale we've done nothing to identify the causes and discover ways to prevent violent armed conflicts. The latest outbreak, the gratuitous violence and destruction of ancient historic sites, the obscene public executions, mass rapes and enslavement of girls and women by the Islamic State, has been unimpeded despite our efforts - which are demonstrably ineffectual. Public health sciences must get engaged with these problems! There have been almost no epidemiological studies of war, especially of the modern kind of unconventional war that has smouldered in the Middle East for several decades. 

As for the greatest danger to all living things on earth, global climate change, almost all epidemiologists, like the rest of humankind, continue to behave as if this isn't happening. 
I've fulminated on this often. I've included this as the key message in almost everything I've written and spoken in professional circles for more than a quarter of a century, so much that I've become like a broken gramophone record.  I feel more and more like Cassandra or Diogenes. 

Is it any wonder that I've turned my back on public health sciences, and taken to writing a story for children?  

More on journeys

Reflecting on Guy Thatcher's journeys got me thinking again about my journeys. I've talked about these journeys in previous posts, probably too much, surely enough to be boring. Collectively they are to some extent the story of my life. My life has been a journey which has included several actual life-altering journeys, migrations from one country and culture to another. Those journeys were educationally and culturally enriching, sometimes almost as enriching as immersion in a new and different milieu, which happened before or after a journey that was a self-contained chapter in the story of my life. Several journeys have been unforgettable in and of themselves - long ocean voyages, long train journeys, long car trips, that I've described in previous posts and illustrated with photos I took at the time. (I've woven memories from several long car journeys in Australia into the fabric of Gloriana, my story for children).  Several journeys were enriching on a scale that exceeds all other experiences in my life by some orders of magnitude. My only regret is that I didn't keep a journal of those journeys, in which I could have set down my sensory impressions and emotions at the time, rather than recollecting them later, sometimes years or decades later.

In the 1960s when I carried out several research projects for the UK Royal Commission on Medical Education from my base in the Usher Institute at the University of Edinburgh, I worked with a  distinguished sociologist, Fred Martin. Fred identified two diametrically opposite kinds of medical students and young doctors. Of course there were several intermediate varieties. The two extremes are the one with unbreakable ties to a family and a community, who will stay in that community and adhere to family there no matter what; and the opposite extreme, one to whom 'profession' or career is paramount, 'profession' meaning specialty, opportunity and facilities to do research, potential for career advancement, promotion etc. Fred Martin coined the term 'spiralist' to describe this type - someone who is willing to go around and around in order to go up, to advance his career (it is his career: we didn't have large enough numbers for reliable or valid generalizations; but we were both quite sure spiralists were much more often male than female, at any rate in the medical profession at that time). 

Fred Martin has been dead for many years, but I know he would agree with me that I am the ultimate spiralist. I've moved around and around to the extent of migrating between continents 5 or 6 times - more than any of my academic peers - as well as making so many journeys  across and between continents and countries and cultures that I lost count long ago. This has given me a rather unique perspective, another of the collateral benefits of my peripatetic professional life. It's also carried a few costs. Apart from books, without which I could no more live than I could without oxygen, I haven't accumulated much in the way of possessions. And a reason for sadness: I haven't had a dog in my life since we left Edinburgh 46 years ago. To a dog-lover like me, that's a serious deprivation. Fortunately this is a dog-friendly condo, so I have doggy friends in several apartments, but it's not the same as having a canine partner of my own. After all these years, I still miss my faithful dachshund bitch Helen who looked after me, then Wendy and me, then Wendy and me and our kids, and who had several lucrative litters that paid for our first fridge and washing machine; and Boomer, our gallumptuous perpetually adolescent Labrador, who matured into a placid adult only after we gave him away and left Edinburgh.  

"What is the meaning of life?"

“What is the meaning of life?” I haven’t thought much, or thought very often, about this question. Douglas Adams answered it as well as anyone when he had a super-computer in Hitchhikers Guide to the Galaxy answer “42” – an answer that is as meaningful as that of many philosophers who have filled fat volumes with words that usually evade a simple answer. I don’t think there is a simple answer even to a more specific question, “What is the meaning of my life?”  I’ve tried to answer this question in my memoirs and I’ve provided hints about my answer in a few of the posts on this blog. Here are some pertinent thoughts.

Chance plays an important part in everyone's life, most certainly in mine. At about 9 am on Sunday September 25, 1955 as I was heading for my golf club I saw two young women hitch hikers ahead of me. In those days I picked up hitch hikers, applying a ‘what goes around comes around’ approach: I’d hitch hiked in Britain and Europe and owed it to other hitch hikers to offer them lifts. Within minutes of picking up these two I knew I wanted to see more of one of them than was possible in the 10 minutes before I’d be dropping them (they were on the wrong road for their intended destination).  That’s when I made the life-changing decision to scrap my golf that day and to spend the day showing them some of the lovely country in my favourite corner of South Australia. Our meeting was as random as any event in life can be. The two girls were on the wrong road, and running an hour later than they'd intended. I'd never used that road before to get to my golf club. I was on it only because I'd delivered a baby the night before in a cottage hospital on the far periphery of our practice catchment area, went back first thing in the morning to make sure mother and baby were OK. What happened afterwards wasn’t random: I made, we both made, things happen the way we wanted them to happen. Our one-day meeting led to a prolific, increasingly affectionate correspondence. Before long I was confident that our letters would bring us back together and soon after that we would be marrying. 

Chance again: In December 1955, early in a long, hot summer, I was senior registrar (= chief resident) in the infectious diseases hospital in Adelaide during the last-ever epidemic of paralytic polio. It was a particularly nasty epidemic. The polio virus was knocking out the nerve-muscle junctions for breathing and swallowing, a strategic viral assault that often had a fatal outcome.  Record numbers of young adults in my age group were in ‘iron lungs’ – artificial respirators – and more than half of them were dying. I did what I had to do, while applying with super diligence all the procedures of universal precautions to protect myself against polio. I didn’t get polio, but it was not because of those universal precautions, which we now know do not protect against infection with the polio virus, but by chance alone.  Chance, not 'universal precautions,' spared me from paralytic poliomyelitis, and perhaps premature death. 

I know more now than I did in 1955 about the mathematics of epidemics, as well as about the modes of transmission of infectious organisms. We know now, but didn't know in 1955, that the polio virus is transmitted mainly, perhaps exclusively, by the fecal-oral route. The same laws of chance govern all biological events and processes, including the chance events of evolutionary biology, which led to the evolution of humans. With variations set by quantum theory the laws of chance apply to the stars and planets of the universe, and what happens inside atoms. The laws of chance placed our earth in an orbit that allows H2O to exist in liquid form, an essential prerequisite for life as we know it. The laws of chance apply also to evolutionary biology, enabling humans to evolve to the status and condition we see all around us, with all the joys and sorrows attendant on this status and condition. (As of the latter half of 2015, I think the status of Homo sapiens is equivocal, and the condition is precarious. There is a finite albeit small probability that Homo sapiens will soon join the vast majority of other species that have existed since life as we know it became possible, and will become extinct. That too will be determined at least partly by chance.) But in this post I’ll stay away from speculating about that possible outcome.

My life acquired meaning and purpose after I met and fell in love with Janet Wendelken, a.k.a. Wendy. Until then, I’d existed and enjoyed most of my experiences but my life was aimless. I mostly just let things happen. After September 25, 1955 I knew, if in a rather inchoate way, what I wanted to do with my life. I wanted to fulfill the potential of my medical education. I wanted to help make the world a better place. These aspirations merged and mingled when I gave up treating sick people one at a time and started my training in public health sciences. I aimed to do my best to elevate the health of the whole population by applying the full spectrum of my knowledge and skills to this end.  Wendy’s moral compass, and her conspicuous altruism, became part of my persona too.

 In the winter of 1958 when we'd been married less than two years I worked on the front line of the Asian Influenza pandemic which killed 2-3 million people worldwide, and several in my practice, including a young ambulance driver with whom I sometimes played golf, a nurse in the hospital where I did most of my obstetrics, and several other young people I knew who were about my age and Wendy’s. Soon after the pandemic subsided I fell dangerously ill with virus pneumonia. Both I and the young specialist physician treating me thought I was going to die. During my rather long convalescence I had time to think about the future I almost didn’t have. I talked it over with Wendy, and decided to leave the group practice where I was very happy and by all accounts, was doing a competent job. For a year we lived on my savings while I retrained in public health sciences.  I got a traveling fellowship with a stipend intended for a single man without dependents, and spent a year in the Medical Research Council Social Medicine Research Unit in London. By the end of that year I was a well-trained epidemiologist. The combination of rich clinical experience in general practice and very good training in epidemiology gave me a profile much in demand – though ironically, not in Australia where there was still massive indifference to anyone with this skill set. That's how we ended up in Canada, but that's another story for another time.

What I understand of evolutionary biology, mathematics, statistics, quantum physics, astronomy, philosophy, and history, among other aspects of knowledge, leads me to conclude that chance has had an important role in the human condition, as well as in my own life. Chance determined the position of planet earth in the solar system, the origin and evolution of life and of humans, and to a large extent, the course of human history.  If Gavril Princip’s pistol had misfired, or if he had arrived 10 minutes later at his chosen position to assassinate Archduke Ferdinand, the Great War of 1914-1918 probably would not have happened.  On a larger, cosmic scale, I am sure there is ‘life’ elsewhere in the cosmos, although whether it is life as we understand it or something beyond our comprehension, is unknowable. There may be ‘living’ crystalline species, or ‘living’ forms of gases or vapors. By ‘life’ and ‘living’ I mean something that has the ability to grow, to reproduce, to be born and to die. Crystals have these qualities and so do free-flowing gases and vapors.  So do colonies of ants, termites and bees.  I embrace James Lovelock’s concept of Gaia as a living entity. If I have faith and belief, it is belief that Gaia is a living entity and faith in Gaia’s capacity to withstand the appalling harms inflicted by predatory and aggressive humans over the course of history. Our current concept of the early history of planet earth is that cyanobacteria proliferated in an atmosphere of hydrogen cyanide and methane, transformed the atmosphere by producing oxygen as a metabolic product, and although the oxygen was lethal to cyanobacteria, oxygen enabled life as we know it to come into existence. Humans and machines powered by carbon-based fuels are transforming the global environment again, rather rapidly rendering this environment hostile to many living creatures – plants, animals, and ourselves – so that a very real possibility exists that we too might soon become extinct. If so, we will be as much responsible for our own extinction as cyanobacteria were for theirs.

All this, all the evidence, leads me to conclude that there's not much more, if anything, I can do to shape my own destiny, let alone anyone else's. However, along the way towards shaping my destiny and my family's, I've had a wonderful, exciting, eventful life. Fun-filled too. Nobody could ask for more, or better.