Doctor and activist


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Category: Accountability

Hospital Crisis is just part of the story.

6 November 2023


The hospital crisis is partly because General Practice has been so downgraded that more cases go to hospital than need to. The Federal government starving Medicare has a number of consequences:
Many GPs are simply retiring and there are no enough new ones taking their place, so we are getting towards a serious shortage
GPs cannot survive on the Medicare rebate, so now charge a co-payment.
Since Emergency departments are free, people wait until the situation gets worse then go there.
Emergency Depts are about 6 times the cost of GP visits, so the total cost of the Health Care system rises.
The other part of the Federal government starving Medicare is that the State governments pay for the emergency departments, so it is a case of the Federal government saving money by making it a lot more difficult for the States.
But an overriding fact is that Australia has been convinced by the neo-liberals that tax is a bad thing and government spending must be a small percentage of GDP. Currently this is about 38.4% of GDP, slightly less than the USA, which has very poor welfare and health systems. This means that the governments cannot actually afford to do anything, and behave like a corporation, cutting employee wages and making cuts wherever it thinks no one will notice, or it has the power to do so. Now if Labor ever tries to raise taxes, the Liberals, who are great exponents of small government accuse Labor of being ‘tax and spend’, and Labor, rather than have a serious debate merely retreats. The fact that he Scandinavian countries have government as close to half of GDP and have their citizens much better off never gets mentioned. Denmark is at 49.9%, Germany 49%, Finland 54% and France at 54%. The UK is at 45%.
We now have a failing GP sector, a problem in aged care, a shortage of nurses, paramedics on strike, a hollowed out public service that merely awards its former tasks to private sector operators that it cannot even monitor and Australia falling down the World educational standards table is not a coincidence. The governments have a virtual monopoly of these jobs. They have deliberately let wages fall, so that now people simply will not do them.
We need to stop privatising, rebuild that public sector so that it can deliver services that we need. Profit is merely another unnecessary overhead. We need to decide what needs to be done, and raise enough tax to pay the people to stay in their public service jobs. Education, health and aged care do not need a ‘market’ to function/. If one exists for comparison purposes, that is fine, but there is no actual virtue in having most of the services delivered by corporations that have the choice of good service or good profits. It is a con, and it is time we forced the government to give us Medicare and a health system that actually works for all, and education for all.
Here is a letter from my Medical partner in today’s Sydney Morning Herald.

The horror stories now emerging about overloaded public hospitals, ambulances and emergency departments comes as no surprise to anyone following the downgrading of Medicare to a ‘‘mixed billing’’ system. This has made it unaffordable for many people to see a GP. But the real cost of turning Medicare into a two-tier system has been to the public hospital system. The only winners are private corporations, private hospitals, private health insurance funds and their many lobbyists in Canberra. We are going the way of the US, and if people don’t fight for Medicare, we are all doomed.
Con Costa, Hurlstone Park:


Here is today’s Herald Editorial

Health system needs its own emergency care
The state of health of the health system has dominated the lives of Australians for four years, but it has never been in such need of urgent care. Indicative of how working conditions for frontline healthcare workers have deteriorated, people now spend a median of three hours and 36 minutes in NSW hospital emergency departments, the longest wait ever. It’s little wonder that health workers are suffering burnout, stress and bullying and are leaving the industry in record numbers.
The COVID-19 pandemic sharpened awareness of our vulnerabilities and forced extra spending on hospitals, clinical responses, vaccinations and prevention measures.
And when we emerged from the pandemic’s worst days it became evident the health system too was experiencing difficulty recovering from years of stress. It had been deteriorating for a long time already, but post-pandemic we became uncomfortably aware that ambulances were queueing for hours to offload emergency patients and hospitals were under enormous pressure with lengthy wait times in emergency and admission.
GPs bumped up fees, forcing people who could not afford the $11-a-visit hike into hospital emergency departments. The industry is being further destabilised by the exodus of 6500 nurses and midwives a year.
If anything, the situation is worse outside the big cities. Last year, for instance, five deaths in regional hospitals could potentially have been prevented, but not in an overworked hospital system with staff shortages that make mistakes even more likely. The NSW parliament’s health portfolio committee report on rural, regional and remote health 18 months ago found a ‘‘culture of fear’’ which did not encourage or value feedback and complaints. Some workers say they were even punished for making complaints.
Now an investigation by the Herald has revealed a health system sinking further into crisis. Eight nurses and midwives have taken their lives in the past three years, while nearly 2000 NSW Health workers have lodged compensation claims for psychological injuries over the past two years. More than 33,500 NSW Health employees have also claimed they are burnt out, while 21,000 workers say they have witnessed bullying in the workplace. One in 12 ambulance employees hold a compensation claim for a psychological injury.
Experts and unions warn that the data, drawn from documents obtained exclusively under freedom of information laws and the state government’s recently released annual employee survey, People Matter, shows a workplace struggling with staff mental health concerns.
Further illustrating the stress, NSW Ambulance fielded a record 363,251 calls and fired up the lights and sirens for more than 181,000 emergency call-outs between July and September, the most of any three-month period since the Bureau of Health Information began taking records in 2010.
Money seems to be the root cause of health’s problems. Today’s national cabinet meeting will address the rampant cost blowouts in the NDIS and Canberra wants the states to take responsibility for funding treatments. On Friday, Premier Chris Minns and Treasurer Daniel Mookhey meet the Health Services Union over a protracted pay dispute threatening to collapse the NSW triple zero call system on New Year’s Eve. Minns said the money is not available.
The future funding and structure of our health systems concerns us all. It is an area where the federal and state governments share responsibility. The solution to the healthcare crisis is complex and will take time, but it is an area where increased funding must be found.
That clearly calls for a better national approach and the states responding with an end to parochial wheelbarrowpushing and finger-pointing.

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68th Walkley Journalism Awards- 23 November 2023

23 November 2023

The 68th Walkley Awards for Excellence in Journalism were presented in 30 categories, announced in Sydney on 23 November.
For those who like transparency, it does give rise to hope.
Edmund Tadros and Neil Chenoweth have won the Gold Walkley, Australian journalism’s highest honour, for ‘PwC Tax Leaks Scandal’ in The Australian Financial Review.
Antony Loewenstein won the Walkley Book Award for The Palestine Laboratory (Scribe Publications) for his analysis of how the Israeli arms industry tests its weapons and population control technologies on the Palestinian population, then uses this ‘testing’ as a sales advantage.
In addition this year, the Walkley Judging Board unanimously decided to present Chris Masters and Nick McKenzie with a special prize, the Walkley Honour for Media Freedom to recognise their Ben Roberts-Smith stories published in The Age, The Sydney Morning Herald and on Nine/60 Minutes from 2018 to 2023.

www.walkleys.com/68th-walkley-awards-winners-announced/

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What is Israel’s End-Game?

25 November 2023

It is hard to see an end to the Palestinian conflict.

Zionists believe that God gave the Jews the historic land of Palestine, and this idea has been supported by some Christians who took the Old Testament literally.

After WW2, the Zionists did terrorist attacks on the war-weary British who let them return to Palestine. In 1948 they ‘Declared the State of Israel’ when they were about a third of the population, killed a village of Palestinians, which made the others flee. They then said that no land title prior to the State of Israel existed and all land titles had to be re-registered and all unoccupied land belonged to the State.  They have then declined to register Palestinian-owned land, so they can give away farms in the West Bank or even unoccupied houses in Jerusalem. Settlers, especially from Eastern Europe, are willing to fight to retain land that they are given on the West Bank.

In Jerusalem, the Palestinians had the menial jobs, which made it hard to pay the high rents there, and more recently Sri Lankans or others are given the jobs, so the Palestinians have to go to Ramullah to find work, which does not pay as well, so they have trouble paying their Jerusalem rent. If they move out or do not visit much, as checked up on by their electricity, water or phone location records, their houses are ‘unoccupied’ and given away. The bottom line of all this is the Palestinians being gradually squeezed out of the West Bank and Jerusalem. If they ever leave Israel they may not be permitted to return.

The settlements on the West Bank are now in a pattern on the high ground linked by roads so that the Israeli military can support any settlers troubled by the Palestinian farmers, now defined as terrorists, who try to defend their land. In Jerusalem, Jews own the West side and now take houses in Palestinian East Jerusalem, house by house.

As all this has gone on incrementally for years, Israel has pretended that it has a ‘two state’ solution, as it put the 700,000 settlers in the area that could or would have been Palestine. In other words it was happy to pretend that there was a ‘two state solution’ as they systematically made it impossible.

Hamas recognised that this was a nonsense. They won the elections in Gaza because the Palestinian Authority was corrupted by land deals.  Israel bullied Jordan and Egypt into compliance then started making wider friendships with Qatar, Dubai and Saudi Arabia and started to talk about ‘regional solutions’ to the Palestinian problem. It looked like the ‘solution’ for them was to go as refugees to anywhere but Israel.  This is why Hamas struck. Naturally everyone is upset about this, but no one suggests what they might have done as an alternative. Perhaps just attack an Israeli military base?

Now Israel has struck back. It is hard to see that flattening Gaza is a rational response.  Netanyahu, being personally corrupt, has retained power by sharing it with evermore dodgy coalition partners, from the fanatical Zionists to the fanatical Right wing. He has also tried to undermine the judiciary to avoid personal corruption charges. Now the much-vaunted Israeli spy network has been caught off guard, probably because they relied on AI tracking of Palestinian communications networks, which Hamas, sensibly enough, decided not to use.  Netanyahu, who was in trouble already and will now be blamed for the Hamas success has hit back to be the strong man.  But simply flattening a city with all its civilians may be revenge, but it is not a solution. He has flattened the Northern half of Gaza, while telling the citizens to move to the South, but cut off all food, water and medical supplies. Now he is bombing the South as well.

Where to from here? Israel seems more bent on revenge than having any rational policy. The other possibility is that they will make Gaza unlivable, and force the US and UIN to allow the Gazans into Egypt as refugees, which will start as temporary and become permanent as Israel does not rebuild Gaza, or let them return to Israel.  Israel will be pariahs, but they are already, and the refugees will be someone else’s problem. Numerically there are as many Palestinians as Jews and even if the Gaza population were moved, the West Bank Palestinians would remain.

The other alternatives are:

  1. The ‘Two State solution, with Israel either moving its 700,000 settlers from the West Bank, or getting them to live with the Palestinians sharing the land that they once owned or
  2. Israel grants equal rights to Palestinians within Israel, admits it was an apartheid state and has a reconciliation process based on the South African model.

In that the ‘Two State Solution’ and the ‘Apartheid reconciliation’ model both look absolutely impossible with the bloodshed, killing and bitterness that has been rekindled as never before, it is very hard to see a solution.  Yet there are still those who want Israel forced into a ‘Two State solution’ by sanctions, as seen below:

 

Two solutions for the “Question of Palestine”

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Argentinian Populist Wins Election

25 November 2023

I visited Argentina, Uruguay and Chile  for 4 weeks over Christmas 2018-9.

Argentina was a pleasant, orderly, developed country. The people were friendly, and you could sit in cafes in town squares where flamenco dancers performed, supported by tips from the enthusiastic locals and tourists.  The main part of Buenos Aires had been built, modelled on Paris around 1900, when Argentina was relatively rich because of beef prices. As commodities fell in price relative to manufactured goods, their economy has suffered. But the fine buildings in the centre of the city remain.  They have alternated between leftist governments that nationalise and take resources from the foreigners and right wing governments, usually supported by the US, who privatise and encourage foreign investment, then use repression to control the people.

The government, when we were there was middle of the road, but having trouble controlling inflation, which was at around 40%.  From a visitors point of view, things were cheap, a meal for two with wine less than half what it would have been in a Sydney pub. We did not feel unsafe.

Because of the concerns with the inflation problem, there were worries about democracy in the future, given the history of right-wing coups in many South American countries.

There had been a military coup in 1975, which seems to have been US-facilitated and the military junta had been in power from 1976 to 1983. Approximately 30,000 people who had been arrested ‘disappeared’.  They were part of a wider ‘Operation Condor’ to persecute and eliminate political, social, trade-union and student activists from Argentina, Uruguay, Chile, Paraguay, Bolivia and Brazil by the right-wing governments in those countries.  The US CIA provided the database so was well aware of what was happening.

Even now, every Thursday at 1pm the mothers and sisters of ‘The Disappeared’ dress in white and walk in pairs around a statue in Plaza de Mayo outside the Parliament.  The women had started protesting in 1977, but anything more than two people walking together was termed a crowd’ and thus illegal. Of those who perpetrated this atrocity only one soldier actually told the tale of what happened. Some of the disappeared had simply been shot in mass graves, but others went to the Naval training headquarters in Buenos Aires where they were kept in the attic and tortured in the basement. Some  were released, but others were drugged with thiopentone, loaded into trucks, then planes and dumped into the Atlantic Ocean.  Some were made to call their families with a gun at their heads and say that they could not talk, but they were happy  in a new life in Paris or some other unlikely tale.

Survivors described how they had a hood over their head at all times and could only see their feet. They described the steps and the colour of the walls, and where the phone was that they had to speak on and the lift next to the phone.  Later, the government came, took out the lift and the phone and painted the walls of the Naval training centre a different colour, so that the building would not match the descriptions of the inmates. Naturally there were no plans of the building changes available. The area was a museum when we were there and there was a small research area, still trying to identify individuals and what had happened to them. They were worried that the government would defund them and close their museum.

Now a far-Right populist, Javier Milei, has won the election, promising to abolish the Central Bank, change the currency to the US dollar, privatise everything and make guns freely available.  He denies climate change and the crimes of the previous military junta.  He has been congratulated by Donald Trump and Jair Bolsonaro, the recently defeated populist from Brazil. He also wants to re-take the Malvinas aka the Falklands.  There is little hope of this simplistic nonsense improving anything in Argentina.  The worry is not only that the ‘Museum to the Disappeared’ will disappear, but that it will all happen again.

www.theguardian.com/world/2023/nov/20/argentina-presidential-election-far-right-libertarian-javier-milei-wins-after-rival-concedes

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Apartheid Education Buses

23 November 2023

I live near a turning circle in a good area of Sydney.  There is a Bus Stop there and the government bus there has an ad with a picture of a forlorn looking schoolgirl saying that she cannot have a decent education, so would I donate to The Smith Family so she can.

As the ad displays there, 8 shiny new buses take private school children from the turning circle to 8 different private schools.

It seems that our governments are happy to subsidise ‘choice’ so that they do not have to fund a fair go and we are happy to tolerate an apartheid education system.

 

www.theguardian.com/australia-news/2023/nov/23/australia-100-wealthiest-schools-earnings-income-data-education-department?utm_term=655e79e42ab1fedfc11542549409ff2e&utm_campaign=AustralianPolitics&utm_source=esp&utm_medium=Email&CMP=aupolitics_email

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Climate Change- a Depressing Update

23 November 2023

In Australia the Labor government struggles mightily to get legislation through to allow Woodside to pipe carbon dioxide to East Timor’s territorial waters for supposed CCS (Carbon Capture and Storage) to allow them to develop a new gas field. East Timor is not a signatory to the Paris Accord- convenient eh?  Supposedly the carbon dioxide will be pumped into a reservoir that used to have gas, but Woodside has a track record of not meeting its CCS targets; if you think CCS is a real thing and not a cop-out farce.

 

Evidence suggests that the world is on target for a 3 degrees temperature rise, which may make human life unsustainable in its present form.  Petrostates are installing lights at beaches so that people can go for a night swim to cool off because it is too hot in the daytime!

 

The graphs below show world energy consumption tripling since 2000 and continuing that upward trajectory.  If one considers that the production of energy by a human is about a kilowatt a day, one realises that the amount of energy consumed now per person is many times that, and far higher in developed countries, the situation is unsustainable. The invention of the steam engine in 1690 and the internal combustion engine in 1872 and the use of fossil fuels, which has resulted in the energy and carbon dioxide stored as carbon over tens of thousands of years being released in a century.  It is ridiculous to think that reforestation can capture this amount of carbon as the total area of forests in the world is still declining.

 

COP28 (the 28th Conference of the Parties) of the UN Framework Convention on Climate Change (UNFCCC), will start on 30 November in the United Arab Emirates (UAE), chaired by Sultan Al Jaber, the CEO of the UAE state oil company ADNOC. How much good is this likely to do?

 

COP-out: Why the petrostate-hosted climate talkfest will fail

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Myanmar- some hope in Rebel Victories.

23 November 2023

Three groups in northern Myanmar have joined together in Operation 1027,  after the day they launched their offensive (27 October). They have been very successful against the hated military dictatorship.  The question is whether this will be the beginning of the end for the junta, who have been helped a great deal by the Chinese, presumably for economic concessions.  But the Chinese may not be happy with the regime, as it has tolerated a ‘scam industry’ near the Chinese border, and it may also be that the Chinese are not sure that the junta have enough control of the country to allow a rail line to be built to a port on the Myanmar coast, which the Chinese want to use to export via the Bay of Bengal and the Indian Ocean without needing to go around the Malay peninsula.

 

It is speculated that the Chinese have given tacit support to the rebels, and if this is the case the junta will have more trouble.

 

I visited Myanmar in 2017 when Aung San Suu Kyi was theoretically in power, but with the unpopular military junta still really in control. (There are a number of posts on my website, chesterfieldevans.com if you search ‘Myanmar’).

 

There was a coup in 2021 and Aung Sang Su Kyi was forced from her figurehead power and charged with treason because she had a few walkie talkies to talk to her staff, which were made ‘illegal’ because the junta could not eavesdrop on them.  There was some  resistance to the coup and unarmed people were shot, but it has led to more organised resistance.

 

Myanmar is a very divided country so there are different ethnic groups and armies resisting with varying success in different parts of the country. Not much news of this has been  in the mainstream media here, until this rebel success.  The military are universally feared and hated, which was evident even to the most casual tourist. They are not done yet, but if they lose Chinese support and the people believe that they can be overthrown, they will be.

 

https://thediplomat.com/2023/10/operation-1027-a-turning-point-for-myanmars-resistance-struggle/

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Israel is Developing East Mediterranean Gas fields without Palestinian ownership

18 November 2023

One of the interesting stories that has had little attention is that Israel is developing a major new gas field in the Eastern Mediterranean and selling the gas to Egypt.  Naturally, this is off the coast of Gaza, but as Gaza is technically part of Israel and Palestine still does not technically exist as a country, it is not sharing the wealth with the Palestinians.

There have been demonstrations in Jordan, but the Western media has not even mentioned the gas field as far as I have seen.

www.newarab.com/analysis/palestinians-denied-drilling-rights-mediterranean-gas-fields?fbclid=IwAR28q511gNLgvm02ScTZcMRlRNH3eciM2BS7_ProcX8b7sKdUMQ1vm4aGM8

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FB Post to School Students 4 Climate

17 November 2023

School students had a strike today and marched to Tanya Plibersek’s office to demand more action on climate.  I posted this to their Facebook page ‘School Students 4 Climate’

I note your slogan ‘Take back the power’. This is good and very important.. While 2 political parties can both be bought by vested interests we will never have the power. The Swiss constitution has citizens able to get a petition and overturn any government decision at quarterly referenda. They have 3 levels of government like us, but any level can be overturned. Politicians are part-time and limited to 2 terms so they cannot climb at party hierarchy, and they keep their original jobs while they are in Parliament and go back to them when their term expires. They also have a number of political parties so the government never has an absolute majority and has to debate and negotiate over every bill. The Swiss model was suggested in 1898, but Aust. went with the US/UK model. The Swiss model gives power to the people. We should work towards it as a better model. When Winston Churchill wrote the German constitution after WW2 he made certain that no single political party could ever have an absolute majority. Look at how polarised the US and UK are and we are going the same way. We must get power back to the people, not the political parties. To get the power back we need a change to the Australian Constitution. It is a long-term project. Can the schoolkids do it?

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Loneliness is a Major Public Health Issue

17 November 2023

The World Health Organisation (WHO) has declared that loneliness is a major public health issue.  The COVID isolation worsened the situation, but at least drew attention to it.  Declining family size, the stress on the individual, and the ability to live alone have worsened the long-term trend to loneliness.

The Japanese have recognised this for some time, but have not mastered the problem.  In Australia it seems only to get attention when some old person is discovered dead for months when the smell emanates from their flat or their electricity is cut off.  In the younger age groups, suicide may be the first  and last sign.

From a medical point of view, I have quite a lot of patients that have long-term painful problems that cannot be resolved and render  them unable to work.  They are often financially embarrassed also, a fact that they often try to hide.  They are recognised as depressed but people are reluctant to acknowledge that medications do not help much.  This week I had a patient who asked if the insurer would pay for a companion dog, as he could not really afford to feed it.  We discussed dog sources and sizes.  My guess is that workers compensation insurers will be willing to pay for tablets that don’t work as they are a ‘medical expense’, but not a little dog that may be a more practical solution.

An article in the Guardian surprised me that loneliness is a bigger problem in Africa than in Western countries.  I had assumed that the strong family ties and interdependency would make it a worse problem in Western rather than African societies.

What is needed is governments to recognise that there is a value in the relationships between people.  It used to be called ‘social capital’, but the term seems to have fallen out of favour. We could encourage ‘Meet Your  Neighbour Day’, street Christmas parties and other activities that encourage interpersonal contact beyond the social media apps.  Both civic and domestic architecture could give more thought to encouraging human to human contact.

www.theguardian.com/global-development/2023/nov/16/who-declares-loneliness-a-global-public-health-concern

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