Memories of Health
From a farewell speech, 4 Feb 2011
The NSW Dept of Health and I had an “on again off again” relationship over several decades which ended in divorce this week after a trial separation last year.
A few stories, starting with the Drug Research Unit in 1974.
The Drug Research Unit was located in Anchor House, on the corner of Bridge and George Streets near the Quay. Dr David Bell set up the unit to run annual surveys on drug use among several populations, defined as “risk groups” (prisoners, probationers and children in child welfare homes) and “sensitive groups” (school students, tech students, and trainee nurses).
He ran the surveys with NHMRC funding, plus a car and research assistant provided by the Health Commission.
After the surveys in 1971, 1972 and 1973 the data had to be processed and I was employed as a research assistant for that task. The Unit had a phone number which was listed in the phone book and there was a rich variety of incoming calls.
A few examples from October and November 1974
An anonymous woman who wanted to know about mandrax.
A lady wanted to know if tomato plants have red stalks. This related to some plants her son was cultivating at the bottom of the garden.
Someone called at the door looking for drug education pamphlets.
Someone wanted to contact a doctor who “used to work in poisons.”
A doctor phoned looking for a methadone maintenance program for a young addict.
An education officer from Cessnock.
A lady called Anne looking for a man selling an orange Cortina who gave this number.
A lady from St Marys who said that youths were using drugs near the pool room and St Vincents De Paul on Friday and Saturday nights.
A request for pamphlets for a first form student.
A friend of a pregnant drug addict, looking for a termination service.
Someone wanting to contact the Australian Drug Evaluation Committee which passes on information about adverse drug reactions to the WHO.
A request for the phone number of the new drug referral centre at Parramatta.
A lady looking for advice on handling the side-effects of anti-histamines.
An advertising agency wants to know the number of deaths from overdoses of barbiturates in the last five years.
Free publicity from the Sydney Morning Herald.
Tony Vinson in the Bureau of Crime Statistics was preparing a report on convictions related to various categories of drugs and David Bell decided it was ok to pass on some of our figures from the early stage of data processing.
It took over a year to process and write up the whole lot. The Unit was disbanded and I moved into the Health Services Research and Planning unit in the Health Commission. A few months down the track there was a surprise one morning when the Sydney Morning Herald had a banner headline:
“20,000 HEROIN USERS IN SCHOOL” according to “Health Commission research”.
Tony Vinson’s report appeared with some statistics on drug use and the Herald used the highest figure they could find for “ever used heroin”, probably in the fourth or the sixth form, and applied that to the whole school-age population of the state.
This was a complete surprise for the Health Commission and the Minister for Health who at that stage knew nothing about the details of the surveys.
Someone wrote a note for the Minister and I had to run from the Quay to Parliament House to deliver it.
Fortunately Alan Jones was not on the air in those days and the issue died in a couple of days.
The Supply and Use of Hospital Beds
Working with an epidemiologist, we became the gurus of supply and use of hospital beds in NSW, documenting the uneven distribution of beds across the state.
This report had a lot of rather boring numbers in it so we compiled a supplementary reading list. Before the report was cleared for publication I left the Health Commission to work on “Discrimination and Intellectual Handicap” in the Anti Discrimination Board, so a colleague inserted the list in the report before it went to the printer.
The first two items on the list were genuine, one was “Cancer Ward” by Solzhenitzen, The others were less genuine, and a note was appended to the list, stating that not all these resources would be readily available from the library in the Health Commission.
“Utilization of Field Hospitals in the Trojan Wars” by Homer.
“War, Peace and Hospital Morbidity Statistics” by Tolstoy
“Impact of the Wars of the Roses on A&E Waiting Times” by Shakespeare
“The Symbolic Depiction of the Hospital Bed in the Lesser Known Poems of the Lesser Known Female Poets of the Seventeenth Century” by Germaine Greer
Not everyone was equally amused when the report was distributed. The Librarian insisted that a note should go out to tell people not to ask for any of the items.
The Division of Health Services Research and Planning
This was set up under the direction of Dr Rod “Rocky” McEwin. He was the Chairman of the Health Commission of NSW from 1973 (when the Dept of Public Health merged with the Hospitals Commission to form the Health Commission) to round about 1982 when the Department was re-constituted to give the Minister direct control.
The Division recruited a lot of young graduates in the social sciences. There were about 30 people and a lot of good work could have been done with stronger direction and more contact with the front-line services.
The staff aroused great suspicion among the old-style Departmental employees who typically started work at age 18 and stayed in the system until 65. We did not wear suits or ties, beards and long hair were common, and the Transport Officer had to tell the Director that he would be pleased if the cars did not come back from our staff with strange-smelling butts in the ash trays.
We fielded a touch football in the Departmental competition, played on the lawn near the Boy Charlton Swimming Pool near Wooloomooloo. Among the other players who I can recall were Mick Reid (a senior research officer at the time), Nick Shiraev and Garry Egger (fitness consultant and publicist). Bruce Flaherty would have played but he did not come to the Division until after the move to Rawson Place when there was no touch football.
The Road to Bathurst
One of my tasks in the Division was to liaise with the Central Western Region. In 1977 they wanted to do some research on the prevalence of chronic illness and disability in a rural shire. We had a Canadian medical anthropologist, Dr RL doing a short-term project, so we thought she could maybe move on and do the job at Bathurst. The people at Bathurst said to bring her up for an interview when it was convenient.
The date was set immediately after RL returned from three weeks of leave.
The day before the trip the Deputy Director of the division told me, “by the way Dr RL has had a sex change”. I went back to my desk and was just about to pass on this piece of news, when I decided to go back and check before spreading the story any further. The Deputy placed his hand on his heart and promised that it was true so I went down to level 6 to tell my friends there. Di Horvath was working as a Principal Advisor on level 6 at the time, she was just back from a placement at the Johns Hopkins Medical Institute, she overheard the conversation and said “they are doing that all the time over there”. So I suppose that made it ok.
All the way through the Blue Mountains RL told me about his or her amazing three brothers, each with some remarkable talent in different fields. The main thought on my mind was the reaction at Bathurst when Mr RL turned up in place of Ms RL. During the day about six people approached on different occasions, with puzzled expressions, asking what happened to the lady who I was supposed to bring up.
They took on RL to do the research and that was completed, though not without some drama involving RL and his friend and a midnight visit to the Regional Director, a pattern that was repeated with the Deputy Director of Research back in Sydney. RL’s friend was a rather intimidating lady who did counseling on trans-gender issues and she expressed irritation that I had said that a lady was coming to Bathurst, I should have just said that Dr L was coming up.
The King Taskforce
Round about 1978 Dr Trevor King was appointed to head up a taskforce to rationalise the supply of hospital beds across the state. He had been something like the Chief Health Officer and he moved on to be Medical Superintendent of the Rachel Foster Hospital in Pitt Street Redfern. This was established in 1925, named after the wife of the Governor General of the time who was active in charitable and community work. It was run by women. In more recent times it was downgraded to a medical centre and in 2007 the site was sold for residential development.
The task force consisted of five or six heavy medical/admin types supported by two officers from Research and Planning. We crunched millions of numbers to feed into the formula for allocating beds. We convened in the Board Room for some weeks and the hospital had a big car park so I drove to work.
Morning and afternoon tea was served in the Board Room off a very ornate trolley with very classy plates, cutlery and starched napkins, presumably used for the all female Board meetings when the ladies from Point Piper turned up.
We took lunch in the spacious suite of the Medical Superintendent, with special dishes prepared by the chef and served with a selection of wines from the Medical Superintendent’s fridge.
Fortified by this excellent catering, we identified the catchment population of every public hospital in the state and applied age and sex-specific utilization rates from the biblical report on that topic which we prepared previously.
With judicious modifications for special factors like isolation, need for long stay (nursing home) beds in rural areas and the like, we produced a report with the recommended numbers of beds (short and long stay) for the 286 public hospitals.
The plan was to print a large number of copies of the report so it could be widely discussed, being of a controversial nature, given the “sacred cow” aspect of hospitals and the over-supply in most places apart from the rapidly growing western suburbs.
The reports were printed and then locked up in a secret location. About ten copies circulated in very limited circles, with numbers stamped on each page to identify the source of leaked photocopies. Not a word about the recommendations ever escaped for internal discussion (forget about public discussion).
Still, the taskforce was fun while it lasted.
The soles of my shoes.
Interviews for the research officer position in the Anti-Discrimination Board were conducted in the office of the President, Paul Stein, with the other two Board members.
After the introductions I sat down and the chair collapsed backwards underneath me, so the Board members were contemplating the soles of my shoes.
Paul Stein broke the record for the five metre dash around the end of a desk to help me up, followed by great consternation and fussing about getting a safer chair.
I ended up in the job. I thought I did a good interview, but maybe they just thought they owed me one!
After that, I always sat down heavily and leaned back in the chair at the start of job interviews but the chair never collapsed again.
A good turn for the Minister
This is a more recent story about the methadone program when Dr Refshauge was the Minister for Health.
A methadone patient living in Sydney wanted to return to Armidale because his mother was terminally ill. No prescriber was available in Armidale. The patient threatened to set himself on fire outside the Minister’s electoral office.
Feeling sorry for the Minister, and also acting on the precept of being “here to help” we asked whether the Sydney prescriber was prepared to undertake the rather unusual role of “distance prescribing”. I am sure nothing like this has happened since Anne Lawrance came into the building.
He was prepared to do the job, but I had to prepare a legalistic contract for the doctor and patient to sign, promising to keep in touch and have regular face to face appointments in Sydney. My familiarity with the Byzantine complexity of the Strata Titles Act probably helped (see The Australian Home Unit Handbook, Horwitz, 1982).
The contract was duly signed by both parties and we all went home at the end of the day, tired but happy. Like good public servants the world over!