Back to Braeside …

Braeside Park was a regular haunt when I lived in Melbourne. It’s located in the eastern suburbs not far from the bay. The land has been used for a sewage treatment plant and then for horse agistment and training. There was a beautiful old stable there years ago. Every time I drove past I would say to myself “must take a photo of that”. I never did, can’t now. It burnt down. Let that be a lesson.

These days it’s an oasis of nature sandwiched between residential and commercial development. It preserves some River Red Gum grassland, some heathy woodland on an old sand dune and a wetland rich in swamp paperbark. It’s great place to watch birds. A three hour circuit will generally turn up at least 50 species.

This morning I concentrated on the wetland.

Great Egret
Royal Spoonbill

Darters and Little Pied Cormorants are nesting in the Paperbarks out on an island.

The woodland is home to a number of species. The ubiquitous and aggressive Noisy Miner and a bird that can hold its own against a pack of them were kind enough to pose …

Noisy Miner
Grey Butcherbird

The highlight, however, was a bird that I rarely get to see. It is probably more common than we think but it mainly skulks in the reeds. When it does venture out it is always ready to bolt at the slightest alarm. Photos … forget it , you won’t get close and you won’t get time … unless luck is really on your side.

Baillon’s Crake

Dr Bawa-Garba …

I was fortunate enough to get through my career as an Oral and Maxillofacial Surgeon without ever finding myself in court defending my practice. Not everyone is so fortunate and indeed some deserve to go the distance. The fact is that the majority of medical errors, even serious ones, do not result in litigation and the majority of cases that do are the result of a perceived lack of empathy rather than malpractice on the doctor’s part.

When a case does get to court the evidence is something like this …

On 18th February 2011 Jack Adcock was admitted to Leicester Royal Infirmary with a history of severe gastro enteritis. He had previously had an AVSD repair, doing well, on enalapril. He had a temperature of 37.7 degrees centigrade, dehydration and shock. A Blood gas showed a Ph, 7.0, base deficit, -14, lactate 11 mmols. He was prescribed a fluid bolus and maintenance fluids. Blood tests including CRP were undertaken and a chest x –ray ordered. There was a delay of two and a half hours in review of chest x-ray during which time Jack showed some recovery, playing with the radiographer, drinking juice from his beaker, improvement in blood gas, to ph 7.24. Jack was moved off the Children’s Assessment Unit (CAU) to the wards, where an unprescribed dose of enalapril was administered. Approximately one hour later he suffered a collapse from which he was very sadly unable to be resuscitated.

Which I’ve taken from a description of the case against Dr Hadiza Bawa-Garba. This is translated for the jury but just think how much information is packed in that single paragraph, multiply that by a large number of paragraphs and think about the volume of information that a jury has to process to arrive at its verdict. The medical defence organisations do their best to keep us out of trouble and I was often reminded that should a case go to court a matter that a trained doctor would regard as a lay down misere could very easily go either way.

Dr Bawa-Garba was a junior doctor just back from maternity leave. She had an unblemished record and had done good work for charitable causes. Young Jack was a much-loved six-year-old with a lot of medical problems stemming in the main from Down Syndrome.

On the day that Jack died …

  • The medical team was relatively new due to the February change over
  • Dr Bawa-Garba had not received an induction to the hospital
  • Another registrar did not attend work
  • Her supervising consultant was rostered elsewhere
  • The hospital computer system was down
  • A senior house officer was diverted to chasing test results by phone
  • When the computer did come on-line abnormal results were not flagged

On this day: Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning 4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls.

Quite how long Dr Bawa-Garba was on duty is unclear but it is clear that she was involved in two instances of resuscitation 11 hours apart.

For large numbers of the medical profession who have read this account, the clinical circumstances surrounding Jack’s death sound exceptionally horrific, with Dr Bawa-Garba struggling against all odds to keep her young patients safe and undertaking the roles of 3 or 4 doctors in the absence of her supervising clinical consultant. It seems clear to us that even the most competent junior doctor would struggle to keep children safe under such conditions.

Appropriate tests were performed, results eventually received ,  a proper diagnosis made appropriate treatment was administered.  Jack showed initial improvement but then collapsed. Resuscitation was unsuccessful.

When she eventually discussed the case with her consultant Dr Bawa-Garba was encouraged to write a full and frank account of the events which she did. The logic behind this is obvious – no one learns from mistakes or system failures that are hidden. On the other hand what is good for the community may not be good for the doctor. There were errors in Jack’s management.

The crucial error was the administration of enalapril,  a medication used to treat high blood pressure, diabetic kidney disease, and heart failure. Jack’s blood pressure was in his boots. Dr Bawa-Gaba did not order the enalapril but she failed to make it clear to Jack’s mother that it should be stopped. Mum gave Jack his regular dose by mouth.

Four years after the event Dr Bawa-Garba and two nurses were found guilty of manslaughter. Dr Bawa-Garba was given a two year suspended prison sentence. The independent Medical Practitioners Tribunal Service (MPTS) ruled that she was a competent doctor who made mistakes in the context of serious systemic failures, and recommended that she should be allowed to continue to practise medicine. The General Medical Council (GMC) appealed the MPTS’s decision, and on 25 January 2018 the High Court allowed the GMC to permanently erase Dr Bawa-Garba from the medical register.

This is a dire miscarriage of justice.

You can do something about it and maybe help do some good. Visit this site www.crowdjustice.com.

 

Boort …

About 250km NNW of Melbourne the little town of Boort seems to thrive on tourism and agriculture. Its claim to fame is Little Lake Boort which I have never seen dry and is a popular water skiing destination. Lake Lyndger and (Big) Lake Boort are also adjacent but are often dry.

Major Mitchell and his party passed through the area in 1836 and gave a good report of its agricultural prospects. White settlers followed through the 1840’s. The town was founded in 1871. Prior to that the area had been the home of the Jaara people. There are still scar trees and shell middens around the lakes.

It’s a good spot to go birdwatching, and from where I live it is a pleasant day out. Today Lake Lyndger was dry …

Lake Lyndger

Lake Boort was mainly dry and nowhere near as green …

Lake Boort

but there was some water way out in the middle with some nice birds including Red-necked Avocets and Black-tailed Native Hens, always a pleasure to catch up with but too distant for portrait photos.

The top photo shows Boort looking across Little Lake Boort. Not surprisingly the birds were mainly around the margins of the water.

Great Cormorant
Australian White Ibis
Australasian (Purple) Swamphen

This Great Egret was quite skittish but I did get close enough to show off the breeding colours of its face and bill. When it gets over its reproductive urges the bill and facial skin will become yellow again. It also had a few plumes on its back although these are never as gorgeous as an Intermediate Egret’s finery …

Great Egret
Great Egret – breeding colours

Whistling Kites were well represented. This one has taken a small tortoise …

Whistling Kite

Australasia’s largest bird family is the Meliphagidae – the Honeyeaters. The Noisy Miner is a common member of the family in south-east Australia. It is unpopular because of its aggression to other birds. The Miners hang around in flocks and where they are found other small birds are largely absent. It occurred to me that I had never bothered to work at getting a decent photo of them. Time to put that right …

Noisy Miner

Cheddar Man …

James Ussher (1581 – 1656) was the Archbishop of Armagh and Primate of all Ireland for about 30 years of his life. He is remembered today mainly for his  assertion that the earth was created at about 6pm on the 22nd of October 4004 BC.

I learnt from his Wikipedia entry that he was taught to read by two blind spinster aunts which must have been an interesting exercise.

Dating the creation has been quite a popular exercise among theologians. Ussher’s date falls in the mainstream for his era but more recently an older date has emerged as a contender.

In 1970 Harold Camping, an American radio evangelist, published his calculation moving the creation back to 11,013 BC.

This fits much better with what we know about Cheddar Man. His remains were discovered in 1903 in Gough’s Cave in Somerset, England. Sometime after the beginning of Climate Change he (or his immediate forebears) meandered across Doggerland which connected Britain to Europe before Sea Level Rise severed the connection. He made it to the south-west of England about 10,000 years ago. This was not long after ice sheets up to three miles thick had melted.

Scientists have recently extracted C M’s DNA from a small quantity of bone taken from his skull. The Guardian reports …

The team homed in on genes known to be linked to skin colour, hair colour and texture, and eye colour. For skin tone, there are a handful of genetic variants linked to reduced pigmentation, including some that are very widespread in European populations today. However, Cheddar Man had “ancestral” versions of all these genes, strongly suggesting he would have had “dark to black” skin tone, but combined with blue eyes.

About 10% of modern-day poms are descended from this early population. The sun rarely shines in England and sunlight striking skin creates Vitamin D without which children suffer Rickets. Subsequent generations have become lighter skinned.

A pair of very skilled modern Europeans have produced an extremely accurate model of C M’s head, and as you can see, incontrovertible evidence of the oldest known human head tilt.

Alfons and Adrie Kennis stand with their model on display in a big, dark lit museum hall

Post Script …

Wikipedia tells us that Ussher’s timing of the creation is …

frequently misquoted as being 9 a.m., noon or 9 p.m. on 23 October.

Is that really worth quibbling about when you’re out by more than 4 billion years?

Harold Camping not only dated the creation he was also kind enough to date the end of the universe. This occurred on May 21st, 2011. If you’re reading this he may well have been wrong.

 

Syzygy …

In case you missed last night’s lunar eclipse.

A lunar eclipse can only occur on the night of a full moon. The sun is on the opposite side of the earth. The photo was taken as the moon passed into the earth’s shadow. Light refracted through the earth’s atmosphere illuminates the moon and is reflected back to us. The colour is red for the same reason that a sunset is red – Rayleigh Scattering …

Rayleigh scattering is inversely proportional to the fourth power of wavelength, so that shorter wavelength violet and blue light will scatter more than the longer wavelengths (yellow and especially red light).

You can work it out for yourself from the formula …

Let me know the answer.

Phola …

For a black musician South Africa was a very tough place in 1959. Inspired by Art Blakely’s Jazz Messengers some relatively unknown young musicians formed The Jazz Epistles and recorded this track …

 

It was an even tougher place a year later after the Sharpville Massacre. Most of the band found themselves in exile. Abdullah Ibrahim (piano), Kippie Moeketsi (reeds) and Hugh Masekela (trumpet) went on to become the aristocracy of South African Jazz.

Hugh Masekela died the other day (January 23, 2018) age 78.

Much of his music concerned the struggle against apartheid but let’s hear something gentle on the flugelhorn. Farewell Hugh Masekela …