A great Jewish Presbyterian Australian

Systematically working through a pile of recommendations for appointment, I found a Professional Organisation I hadn't come across before - The John Loewenthal Club. Being the obsessional - I thought I should check it out. After all it would be embarrassing if the Vice Chancellor asked I didn't know.

What an amazing man John Loewenthal was. A surgeon who headed up key health promotion organisations like the National Heart Foundation. A gardener and a military man. Survivor of some of the most difficult battles in World War 2. Internationally acclaimed and farewelled from Rose Bay.

"In the words of Professor Alexander Boyd, he was 'a really good, safe and dependable clinician; a neat and careful operator who [paid] great attention to technique'." What an amazing person. Who collapsed at an event given in his honour and never recovered. After living a very full life. Someone I would have liked to have known I think.

Neglected tropical diseases

An excellent and relatively brief factsheet from the World Health Organization highlights the reality that one billion people, most poor and marginalised in rural parts of low income countries, are living with and dying too early from diseases such as buruli ulcers, chagas disease (American trypanosomiasis), dengue fever, dracunculiasis (guinea-worm disease), leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis (river blindness), schistosomiasis (bilharzia), trachoma and yaws.

To my shame I have not even heard of many of these diseases, have heard of some but really know nothing much about them, and can comment in a knowledgable way about only two. I guess that underpins how neglected these debilitating conditions are.

WHO notes that key challenges to addressing the incidence and impact of these diseases include:

• Limited visibility since the diseases are tied to specific geographical and environmental conditions and do not spread easily to industrialized countries;
• Not on the radar screen of most decision makers, mainstream research and funding agencies;
  
• Little market incentive to develop medicinesand vaccines as mainly poor people areaffected.
  

The authors note that "children and women are disproportionately affected by some neglected tropical diseases and may face additional barriers to seeking and receiving treatment. Women also tend to suffer more severely from social stigma. Dissemination of information is necessary for awareness-raising, and for impeding stigmatization, which is both a cause and consequence
of neglected tropical diseases."

I thought the 'cause and consequence' phrase was interesting. Stigma is so pervasive.

And as we in the 'West' manage to find billions and billions of dollars to bail out imprudent financiers and to deploy ineffective but highly visible thermal imaging devices in our airports - what proportion diverted to sanitation and safe drinking water, housing and education, information and community development would be needed to eliminate these conditions and to adequately provide for those already affected.

As Pete commented I need to start in my own backyard with this. And to advocate for those whose voices are seldom heard when the money is distributed.

For Fiji, ever Fiji,

Last weekend in Fiji I noted how regularly the national anthem played on television. At dinner last night we were discussing recent events in this beautiful island nation and someone wondered about life expectancy. So I've just looked it up - 68 years in 2007. Well below Australia and New Zealand.

Some of the other indicators are very concerning. While primary school enrollment is at 91 per cent, I learned last week that the growing economic climate has resulted in some children, especially from rural areas, being withdrawn from secondary education because the parent's cash crops were washed away in the January floods. Even in urban areas more than half the population are without improved drinking water facilities (maybe why a fellow traveller had to leave our aircraft on the way home due to apparent gastroenteritis).

In 2007 other indicators like vaccination rates were positive, equalling many developed countries in the Pacific. The challenge will be to maintain these rates in the face of serious cuts in government agency budgets.

From this far away perspective it is hard to know the best response to recent events. For us in the Uniting Church in Australia, we need to look to our partner church the Methodist church in Fiji and to support them in theior important role. And to keep watch with them.

Amen

Advent longings

A wonderfilled seasonal Friday Five from Sally this week:

"Imagine a complex, multi-cultural society that annually holds an elaborate winter festival, one that lasts not simply a few days, but several weeks. This great festival celebrates the birth of the Lord and Saviour of the world, the prince of peace, a man who is divine. People mark the festival with great abundance- feasting, drinking and gift giving....." (Richard Horsley- The Liberation of Christmas)

The passage goes on, recounting the decorations that are hung, and the songs and dances that accompany the festival, how the economy booms and philanthropic acts abound....

But this is not Christmas- this is a Roman festival in celebration of the Emperor....This is the world that Jesus was born into! The world where the early Christians would ask "Who is your Saviour the Emperor or Christ?"

And yet our shops and stores and often our lives are caught up in a world that looks very much like the one of ancient Rome, where we worship at the shrine of consumerism....

Advent on the other hand calls us into the darkness, a time of quiet preparation, a time of waiting, and re-discovering the wonder of the knowledge that God is with us. Advent's call is to simplicity and not abundance, a time when we wait for glorious light of God to come again...

Christ is with us at this time of advent, in the darkness, and Christ is coming with his light- not the light of the shopping centre, but the light of love and truth and beauty.

What do you long for this advent? What are your hopes and dreams for the future? What is your prayer today?

In the vein of simplicity I ask you to list five advent longings....

In this time of waiting
for the coming of the Saviour
For what do I long?

• For a world where justice and peace are rampant
• For every child to be born in a context of love and concern
• For meaningful connections with family and friends across seas and continents
• To be in touch with nature; to feel the sand between my toes and the wind on my face
• To eat well and share abundantly; and know this experience is universal
  

Spread the Word

World Aids Day. A quick post to remind us that menopausal women are one of the groups most at risk of HIV AIDS, especially in developed nations. Especially women of our generation who followed a traditional pattern of marrying first heterosexual partner and remaining monogamous. Until death or divorce leads to singleness, without experience or knowledge to negotiate safe sex in any new relationship. Of course many women equate condoms with pregnancy prevention, which seems irrelevant after 'the change of life' (as my mother used to refer to menopause). And the sort of middle-aged men that middleaged heterosexual women might choose to date are not necessarily ones they would have qualms about unprotected sex with. It's over seven years now since the article about Jane Fowler was written, but it is the most eloquent and relevant piece that I could find. I am surprised at medical students who assume that people aged over 50 years don't engage in risky behaviour. And surprised that Viagra doesn't come with safe sex warnings. As Monica Rodriguez is quoted in the article, "This isn't a population that grew up talking about sex or condoms or HIV/AIDS. But we can't let our discomfort around issues of sexuality get in the way of conversations about safe sex."

11th hour 11th day 11th month

I bought a poppy at the railway station this morning and have been wearing it all day.

When I wrote about my uncle Thomas recently I certainly felt in one of those 'thin places' but I hadn't made the intellectual connection that it was so close to Armistice/Remembrance Day.

This year of course marks 90 years since the end of World War One. Sadly not the war to end all wars. But maybe the first time that armed conflict involved so many nations. And taught such hard lessons especially for the colonial nations. And changed forever the lives of generations.

I was 'on' for reflection at our curriculum meeting this morning. So chose Flanders' Field. With the modifications suggested by the narrative of those who saw the original pencilled by John McCrae.

I hadn't realised that this oft-repeated verse was written by a physician. John McCrae was Professor of Medicine at McGill University. Served in the Boer War as a gunner, and in WWI as a medic. More about him and the writing of the verse here.

In Flanders’ Fields

In Flanders’ Fields the poppies grow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.
We are the dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved, and were loved, and now we lie
In Flanders’ Fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies blow
In Flanders’ Fields.

Tomorrow at the eleventh hour I hope I remember to take time to pause and observe silence. Taking up the torch for me means working for peace and seeking justice. The Ottawa Charter sets out clearly the prerequisites for health - peace is the first fundamental condition.

As I think of our students, whose hands were so recently blessed by the Cardinal, I wonder where their careers will take them. What their eyes will see and their hands write. What healing they may bring. What will move their hearts. What torch they will carry and what faith they will keep.

Zero to two in under three

Talk about amazing. After six months with no paid employment I followed a lead from a friend which led to me accepting a part-time position in Palliative Medicine. The NEXT DAY I had an interesting phone call testing out my interest in a Public Health role in a new medical school. Today I had an interview which led to an offer and I will start that academic position part-time in two weeks. Still to be officially confirmed of course but all is in train to complete the paperwork. So from no job to two jobs in less than three weeks! I am a happy lassie. And even more so when I found the Uni is across the road from an art supplies shop. I love beautiful papers and this shop is full of those. As well as every kind of paint you can imagine. It was a great place to look around after the successful interview.

I'm not sure what to make of all this. Should I just have been more patient and trusted that the right position would eventuate? Was my 'bird in the hand is worth two in the bush' mentality about the first offer an example of that lovers' impetuous nature that leaps at the present and doesn't plan for the future? Was I just giving in to the pressure from within and without to find a job? At some level I know I was wondering what is wrong with me that I was perpetually shortlisted but never appointed. Others around me were asking the same question.

Then again - if there is any branch of clinical medicine that I would consider Pall Med is in there - alongside rehab/ psych/ addiction med/ gerontology. It was not a rash decision but something I had been thinking about for some time. Attending PallMed journal club I find synergies between the issues my new colleagues discuss and my experience in Public Health. Both these positions came as a result of invitation to consider. Both 'seemed right at the time'. One extends me in new directions and the other is a consolidation and affirmation of experience to date. In time I think I will find that the diversion into PallMed will have significant impact on my professional development. The Public Health questions around end of life care need to be addressed. I have a new perspective already.

So I am glad. Not too interpreting. Glad and grateful. For opportunities abounding and knowledge to gain and to share. However I got here.

Principalities and Powers

At the NSW Public Health Association meeting last night I supported a motion calling for a formal complaint to be made to the Australian national airline, QANTAS, regarding the decision to sell cigarettes in-flight and to instruct staff to display them prominently on the trolley. I could have shouted crikey when I found this post saying that the new QANTAS non-executive director recently retired as finance director of British American Tobacco. QUANTAS of course denies any link between these two news items. Yet offers no real explanation for this giant step backwards from a commitment TO public health when they removed cigarettes from in-flight sales in 1999.

Vigilence and tenacity are clearly attributes I must continue to develop as I participate in public health practice in this country, and internationally. I understand that Singapore Airlines, Cathay Pacific, British Airways and Virgin Atlantic all sell duty-free cigarettes in-flight. I am asking airlines to accept a sense of social responsibility over profitability and voluntarily remove such products from sale. For airlines with government funding, such a step would be consistent with national commitments to the World Health Organisation Convention on Tobacco Control.

On a personal level I will be writing to QANTAS myself, and intentionally booking with airlines that take a lead in population health protection. I hope that public service organisations and agencies will follow. And churches????

Be watchful and wary ...

Several people have been blogging about organisational integrity after the issues to do with Dave Walker and a chain of Christian bookstores in the UK. Sam Norton at Elizaphanian has links to the relevant sites and information.

The latest British Medical Journal page includes a video describing very clearly how drug companies recruit doctors to boost market share in pharmaceuticals. It makes me question the independence of recent American Pediatric and Cardiology recommendations that children as young as two should be tested for high cholesterol and treated with statins.

I'm hoping to get some more information and to determine the extent of the evidence base underpinning such recommendations. I take this information as a pointer though, to be ever watchful and discerning about the 'principalities and powers' that influence apparently independent and individual choices.

Beyond nutrients

Population Health Congress was a stimulating event. Wednesday's plenary on advocacy for food security brought to mind my second response to the Poetry Party. Michael Marmot is always so inspiring - and certainly no less on this occasion. I missed the first day plenary but heard good reports of the renewed challenge to environmental sustainability and mitigation of the effects of climate change. The lack of overlap between my public health circle and my faith community struck me during the week. The potential overlap is enormous. I did cite Brian McLaren in the paper I presented. And thought how relevant the Young Ambassadors for Peace programme was when I listened to a paper about the homicide of journalists. Back to the Wednesday plenary. Among many good things I was struck by Jane Dixon and her analysis that over emphasis on nutrient content has robbed food of cultural meaning. And contributed to the obesity crisis in developed nations. To round off a busy week I had a couple of hours to spare on Wednesday afternoon and enjoyed a wander through the impressive Brisbane art gallery. I will enjoy exploring more of this my new country with a trip to Darwin and the Litchfield National Park - starting tomorrow. I will be taking a camera this time!

Taking in the view

Sally offers this week's Friday Five at RevGalBlogPals and says:

This week I took some time out to stop and walk and take in the view; my son Chris is studying in one of the most beautiful parts of the country, too often we simply drive up there, turn around and come home! This time Tim and I took time out to take in the view. It occurs to me that we need to do that more in life....

Here's my play

1. How important is the "big picture" to you, do you need a glimpse of the possibilities or are you a details person?

A crazy mixture really. I do need the big picture and thrive in dreaming and brainstorming and visioning situations. Yet much of my work involves the detail. I can hardly believe that I recently cited matching cryptosporidiosis (a gastro bug) disease notification data with drinking water supply quality data as an example of innovative work I have done. For many years I have been passionate about the needless loss of lives in house fires, where poverty is a key determinant. I have always admired Ian Roberts and his brilliant work in this area. I attended to the detail to statistically demonstrate what was patently obvious - that poor living standards are associated with a six-fold increase in risk of dying in a fire. At last Fire Safety campaigns were empowered to move from an individual responsibility focus only, to a community development approach.

2. If the big picture is important to you how do you hold onto it in the nitty gritty details of life?

Oh yes. This is an important question. With difficulty is the short answer. I am getting better at recognising the signs that I'm not holding on to it and making space. A couple of weeks ago I stayed at home and went for a walk along the river. I'm creating a few cards at the moment. Tonight I attended a meeting of the Tongan Congress within the Uniting Church and was blown away by the amazing LOUD praise of their young people. Solitude, creativity, and collective worship are some of the ways I hold on to the big picture.

3. Name a book, poem, psalm, piece of music that transports to to another dimension ( one....what am I thinking....)

There is a balm in Gilead ... (PCUSA Hymnal)

Psalm 121 - probably a genetic link there as it was a favourite Psalm of my great-grandfather and has been part of most family occasions in the succeeding generations. I like any version but the Scottish Psalter sends special tingles down my spine.

Chris Mason-Battley's Karanga and Karakia

AND I do love old books. From the Family stash I have my Great-Uncle's dictionary, several special Bibles (see previous post) and some devotional books that belonged to my Great-grandfather.

4.Thinking of physical views, is there somewhere that inspires you, somewhere that you breathe more easily?

In this immediate time and place I love coming down Marsden Rd and looking out over the city of Sydney, then taking a back route so that I drive briefly along beside the Parramatta River. I do breathe in deeply and have a sense of being where I'm meant to be when I see that view from the top of the hill, especially at night with lights bright into the distance.

5. A picture opportunity... post one if you can ( or a link to one!)
The hot air balloon ride which began my second half-century ...