Documentary: "Fighting for Life" (Learning to care for those in harm's way)

Last Sunday night an extraordinary documentary screened on the ABC, entitled "Fighting for Life". It was promoted as one of the most powerful anti-war documentaries ever made, and it presented the human cost of war in a moving and compassionate way.

Made in 2006, the documentary covers the work of doctors, nurses and medics caring for injured soldiers on the front line in Iraq and the doctors-in-training at the Uniformed Services University, where they learn the specialised skills required for military medicine - "Learning to care for those in harm's way".

I was particularly struck by one line late in the film which stated that "tens of thousands" of service personnel had sustained war-related injuries. When this occurs in the context of a natural disaster, it is an international tragedy, and when we talk about "mass casualty incidents" in a Western country it is usually tens or at most hundreds of people. Here is the hidden cost of war - vast numbers of (often young) individuals who suffer horrible injuries that may affect them for the rest of their lives and face the daunting challenge of rehabilitation and building a new life quite different to what they had originally envisaged for themselves and their families. We see amazing courage, determination and resilience in survivors and the genuinely good people who care for them.

It suddenly dawns on you that the cost of war is not just the cost of the war machine but the ongoing costs that must be borne by individuals and society as a result of "service above self".

Even though as a doctor I have to confess to being somewhat inured to the the sight of blood and traumatic injuries, I did not feel that the documentary was either excessively gory or excessively voyeristic. It sensitively portrayed real life on the battlefield and its aftermath and could not have been made without the consent and support of the injured soldiers and their families.

I remember as a teenager watching a scene from the film "Doctor Zhivago" where two armies are marching to war and the invisible narrator comments that both sides were "praying to the same God for victory". It is poignant that in this film we see casualties from both sides being cared for by US Army medics.

Documentaries such as "Fighting for Life" remind us that there are no winners in war, and if only humankind could find a better way to solve its conflicts than resorting to guns and violence. The health professionals in the film are dedicated to caring for the fallen soldiers and to helping them rebuild their lives, but you can't help thinking that they harbour a wish that the need for military medicine might just become redundant ...

The documentary is highly recommended and is a fascinating insight into the "bigger picture" of the casualties of war.

Dining with Altitude – Sea to Sky Restaurant, Village Central, Mt Baw Baw Alpine Resort

http://www.mountbawbaw.com.au/winter-baw-baw-info/winter-bars-and-restaurants.html
“Village Central’s Sea to Sky Restaurant offers spectacular views, great food and wine and excellent customer service. Spend the afternoon on the deck and enjoy Gippsland’s fine produce and great local wines.” For bookings call: 03 5165 1123

Opening hours during the Green Season
Monday to Friday: 11am - Late
Saturday and Sunday: 10am - Late

Operating Hours for Winter:
Monday to Thursday: 11am - 4pm
Friday and Saturday: 10am - late
Sunday: 10am - 4pm

Visited for dinner, Saturday 19 May 2012

The cuisine is ‘Modern Australian’ and the menu offers a good variety of dishes despite the somewhat remote location. All the serving sizes for main course and dessert were very generous.

Our group of four started with the homemade garlic bread. This was thickly sliced and soft and slightly sweet with a hint of garlic and sprinkled with parsley and was slightly pan fried to a golden brown with butter on the outside.

Two members of the group tried the tiger prawns with a creamy white vodka sauce, wilted baby spinach, a touch of capsicum on a bed of rice - I am told that this was very nice.

The other two sampled the eye fillet served on a bed of mashed potato with wilted baby spinach, sauteed mushrooms and a hint of capsicum on a rich dark reduced red wine jus. This was very flavoursome.

One of my colleagues tried the chocolate mud cake served with whipped cream and a chocolate ganache. This was reportedly very rich.

Two of us tried the berry and white chocolate gateau, which consisted of alternating layers of piquant red berry sponge and white chocolate served with fresh berries (raspberries and strawberries), a drizzle of sweet berry sauce and whipped cream. This was also very rich and flavoursome. The berry layers were perhaps a little dry when eaten alone on the spoon, but this was well compensated for by the accompaniments. An inspired combination!

The small pots of post-prandial peppermint tea were made with real tea leaves.

Hostess Michelle provided outstanding service with a smile.

Nespresso Grand Crus Coffee

(Updated 19 July 2012: 'Espresso Decaffeinato' added.)
(Updated 15 June 2012: 'Ristretto' and a new photo added.)
(Updated 8 February 2013 - brief paragraph at end of posting re the Nescafe Dolce Gusto system.)

These little coffee disks are designed to be used in a Nespresso coffee machine, and are a little like the TARDIS – there is a great deal packed inside. The powder is tightly compressed, and there is a generous serve per cup of ground coffee.

Perhaps the approach was a little unorthodox, as the disks are designed to be used in commercial machine, but as access was not easily available, an old-fashioned technique was used. The aroma of each coffee was sampled on opening the disk and then brewed in a single-serve coffee plunger and tasted first black without any additives.

(To spice up your life a bit, you can also "mix and match" disks and create your own funky coffee blends if using a plunger! This idea proudly brought to you by "The Mad Scientist": http://themadscientistcooks.blogspot.com.au/)

LUNGO
Lungo Leggero (Intensity: 2)
This has a smooth, warm and rich aroma which is immediately comforting. Once brewed the flavour is nutty and soft but full-bodied and develops in the mouth without leaving a strong aftertaste. A pleasant subtle cup of coffee.

Lungo Forte (Intensity: 4)
The aroma is soft and sweet with a slight fruity tang. It takes a moment for the flavour to develop on the palate, but it is rich and dark and a little tangy without being overpowering with a mellow aftertaste which leaves a slight tingle on the tongue. The subtleties of the taste are less obvious when milk is added, but there was still a zingy aftertaste.

ESPRESSO
Espresso Leggero (Intensity: 6)
This has a more forthright roasted aroma that once again has a slight sweetness to it, almost like the tempting smell of roasted vegetables in the oven. It makes me think of roast pumpkin! The liquid form packs a punch – robust, full and flavoursome. The lingering aftertaste is smooth and a little smoky. With milk added it makes a strong but well-rounded cup of coffee.

Espresso Forte (Intensity: 7)
There is a strong and soothing aroma of “just right” roasted beans. It is pungent but darkly inviting. Once brewed the flavour is strong and complex with a hint of bitterness and a slowly subsiding forthright aftertaste which leaves a slight tingle on the tongue. When milk is added, it has a silky strong and somewhat smoky taste. I did enjoy this one (as I like strong coffee) but it this is probably the demarcation point in the Nespresso range between those who like their coffee “black and strong” and those who enjoy a milder brew.

Espresso Decaffeinato (Intensity: 7)
Firstly, I have to say that it has a gorgeous aroma – rich and darkly roasted. This is no wimpy coffee. Drunk black it has a dense and dark slightly bitter flavor worthy of its Espresso nomenclature with a rising aftertaste which hangs around and makes its presence felt, with a bit if a tingle in the tail. With milk added it still ‘packs a punch’ and you truly would not know that you are drinking a decaf. If you want the sensual experience of drinking coffee without the accompanying palpitations and insomnia, then this is a very good choice. Recommended!

RISTRETTO
Ristretto (Intensity: 9)
The initial aroma is fresh and spicy yet dark and complex, making you think of enjoying an exotic beverage seated in a comfy leather chair around an open fire surrounded by a deep old forest. Like its sibling, this coffee is strong and not for the faint-hearted, but has a beautiful smoky and smooth depth of flavour with perhaps an echo of peppermint. It has a lovely cleansing sensation when rolled in the mouth, and a confident aftertaste which seems to intensify slightly over time, leaving a ‘tingle’ on the tongue. It is quite delicious drunk black, but its zesty and smoky nature remains when milk is added. An excellent cup of coffee!

Ristretto Origin India (Intensity: 10)
This coffee has a powerful aroma which is smooth, luscious and rich with a hint of dark chocolate. On drinking it has a ‘WOW’ factor! It is strong and quite smoky with a good depth of flavour, and on savouring the taste in the mouth a bitter underlay emerges. There is a forthright aftertaste with a definite ‘tingle’. It is surprisingly milder with milk added, but the underlying strong bitter character shines through. I enjoyed it, but due to its intensity perhaps one for the aficionados or the caffeine deprived!

These are all good coffees, and a good range of flavours depending on your taste or current need for re-caffeination! I would recommend them all – enjoy!

A couple of months ago I had the opportunity to try a cup of coffee from the Nescafe Dolce Gusto machine and system during an in-store demonstration at Harvey Norman. This system offers 16 different types of hot beverages and also provides the milk in a separate capsule. The cappuccino tasted nice (if a bit bland for my taste) and was served hot. This is probably a reasonable choice if you like to be able to serve a variety of different types of coffee (hot chocolate, teas) and not have to worry about frothing your own milk.

Vocational competencies for ski patrollers

Prior to 2011, the accepted standard of first aid training for ski patrollers in Australia was the Australian Ski Patrol Association's Advanced Emergency Care Course. This is held annually at various locations around Australia (Victoria, NSW, Tasmania) and active ski patrollers must recertify every three years. Passing the course involves successful completion of both written and scenario-based assessments. Most resorts also conduct additional resort-based training on an annual basis, and in some cases successful completion of practical assessments is also necessary in order to continue working as a patroller at that resort. Some competencies must be completed on an annual basis e.g., CPR and defibrillator, Oxygen, Penthrane and Entonox.

Mt Baw Baw (http://www.mountbawbaw.com.au/) is one of the smaller Victorian resorts and does not have onsite medical and ambulance services, so there is normally a lengthy wait for ambulance attendance and ski patrollers must care for casualties for extended periods. During 2011 Mt Baw Baw Alpine Resort took the decision to break new ground and introduce vocational competencies for its ski patrollers as a risk management strategy. This proved to be somewhat controversial and some resignations of patrollers occurred as a result. In essence, the assessments involved a written first aid theory paper, a written paper covering resort-specific operational procedures and two practical scenario-based assessments, one for a conscious casualty and the other for a casualty with an altered conscious state. All the scenarios were based on events which actually occurred at Mt Baw Baw and thus were extremely realistic. Different assessment schema have been trialled over the two seasons: intially "competent/not yet competent" and currently score-based. Candidates will be given a summary scoring sheet, and feedback will be given by a resort representative.

An additional innovation for 2012 was a training day based around small-group work in the areas of Approach to the Casualty: Incident Evaluation, Primary, Vital Signs and Secondary Surveys, History Taking; Glasgow Coma Scale; and Hygiene. This was very successful.

The Mt Baw Baw Medical (First Aid) Centre:

WARNING - Do not buy from DinoDirect!

This is a warning not to buy goods online from DinoDirect (who are based offshore) and also to be very cautious about buying any electronic devices via a deals voucher unless the supplier of the goods is based in your home country.

Late last year I bought a NextBook Premium7 Android tablet via a Spreets voucher for a friend. This is a 7 inch Android tablet, which is supposed to be able to do all the normal things that a tablet can do. However, from the time it was purchased there were problems with it. The battery only retained its charge for a very short time, regardless of whether it was being used or not, and using a finger for screen scrolling only worked erratically and generally not at all if the screen image was enlarged, such as if you were trying to read emails through a browser. However, the most significant problem is that it has never been possible to get the inbuilt email program working. At first I thought that perhaps this was due to an inadequate WiFi connection when I tried it at both the local library and at work. I carefully researched the correct connection parameters from Google for Gmail in case that was the problem. Eventually I was able to try setting it up with a direct ADSL connection, and it still would not work. I then emailed NextBook customer service, and they first suggested resetting the email program (which did not work) and then resetting the tablet to return it to its default settings (which also did not work). NextBook told me that it was covered by a one year manufacturer's warranty, but that if I wanted to return it to them I would have to obtain a US shipping address and return the tablet to them in the US, which would be prohibitively expensive. 

By this stage (early April 2012) I had "had enough" and contacted Spreets to ask for a return and refund in accordance with Australian consumer law (http://www.accc.gov.au/content/index.phtml/itemId/1023610). They cheerily referred me on to DinoDirect. I provided DinoDirect with a copy of the purchase documentation, the full background story, photographs to show that the emails were not loading and that the battery was running out quickly and a statement that the goods were faulty and did not do what they were represented to do and were not fit for purpose and that I was asking for a return (at no cost to me as the tablet was under warranty) and refund as provided for in the consumer law. DinoDirect eventually replied offering me a US$50 credit voucher that I could spend in their online store towards another tablet.

As the tablet is so faulty as to be of no use to me or anyone else, I wrote back restating my rights and their obligations under Australian law, and their reply basically said if you want a refund you will have to send the tablet back to us at your own cost, but since that will be expensive perhaps you just want to take the $50! I then contacted Spreets to say that since they were the Australian-based seller that I initially contracted with, they also had responsibilities to comply with Australian consumer law. They just referred my complaint on to DinoDirect again and said to expect a further reply. I am still waiting nearly two weeks later!

In summary:

• DO NOT buy from DinoDirect as they have just thumbed their noses at Australian consumer law and ignored the warranty attached to the tablet. 
• DO NOT buy any electronic gadgets via a deals voucher unless you can be sure that the supplier of the goods is based in your home country and you will be able to exercise your rights under the warranty and local consumer law.

Update as at 6 July 2012:

After more correspondence with Spreets after not hearing anything back and then being referred to DinoDirect again and not hearing anything back, I decided to write to Spreets one final time saying that I held them responsible for ensuring that a solution was reached and that if this did not happen I would be reporting the matter to Fair Trading Victoria and the Australian Competition and Consumer Commission for breaches of the Australian consumer law. Fortunately Spreets took this seriously and undertook to contact DinoDirect again and then got back to me to say that if I did not hear anything within a few days to contact them again.

Within a few days I received a telephone call from DinoDirect (in China) offering to accept a return of the unit and to pay for the postage. This was followed up by an email confirming the offer and providing instructions for returning the unit. I have packaged it up and posted it today (the cheapest cost including a tracking number was A$31.50) and will hope that they are true to their word and provide a refund of all costs once they receive the package. It will be interesting to see how they arrange this as it was originally paid for by credit card through Spreets. I will post a final update once the outcome is clear, but I think for any consumer of electronic goods the summary advice above still stands - it is just too problematic buying from an overseas supplier without local agents if you run into problems.

Update as at 10 August 2012:
I had to follow up with DinoDirect to see if they had received the package and they are now refusing to provide a refund, just a replacement, citing an expired warranty period (patently incorrect) and the :group purchase arrangements". They have gone back on their previous verbal and written agreement to refund the purchase price plus shipping and seem not to care in the slightest about being in breach of Australian consumer law. So, I have gone back to Spreets again asking them to sort it out and get DinoDirect to pay them money to them so that I can get a refund from Spreets. We will see what happens, but this only reinforces the advice in the summary above - give DinoDirect a wide berth!!

Update as at 30 August 2012:
After further pressure from Spreets and prevarication on the part of DinoDirect (claiming to have been in contact with me, claiming to have paid the money, etc.) a refund payment was finally made yesterday through PayPal. However, I was dismayed to discover that the payment had been made in such a way that I was being treated as if I was a seller and fees had been deducted by PayPal, leaving me around A$7 out-of-pocket! After contacting Spreets again they kindly offered to sort things out by providing me with a Spreets voucher for the $7 which I could use at a future time. Given the long and tortuous nature of this matter, it seemed the best solution rather than trying to chase DinoDirect for the extra money. As a result I cannot say anything good about dealing with DinoDirect and the reservations above remain - caveat emptor! ('buyer beware!') in any dealings with them.

Maria Lovisa Årberg (1801-1881)

As part of my Swedish language studies last year, we were required to give an oral presentation about a famous Swedish woman. After doing a bit of online research, I settled on Maria Lovisa Årberg (1801-1881), thought to be the first woman formally practising medicine (and surgery) in Sweden. Hers is a fascinating story, which can be appreciated in English through this Wikipedia article:
http://en.wikipedia.org/wiki/Lovisa_%C3%85hrberg

However, for those who can read Swedish, here is the link to my Powerpoint presentation about Maria Lovisa Årberg. I must thank some wonderful Swedish friends for proof-reading the presentation and providing valuable feedback which turned the finished product into something which the Swedish teacher said she could not fault grammatically!
http://dl.dropbox.com/u/30234302/Maria%20Lovisa%20%C3%85rberg%20%281801-1881%29.ppt

Scandinavian Crime Fiction Book Review: The Ice Princess by Camilla Läckberg

Several years ago a dear Swedish friend of mine gave me a copy of this book in Swedish when departing home after six months of working in Australia. I never did get around to reading more than just a few pages, but a couple of months ago iTunes offered a special deal on selected Scandinavian crime fiction offerings, and I decided to buy the book in English.

The title refers to Alexandra, a beautiful (and secretly pregnant) woman who is found dead with her wrists slashed in a bathtub in the middle of winter in a Swedish seaside town. The tortured alcoholic artist for whom she was a muse likens her dead body to an “ice princess”. Each chapter of the book starts with an elegiac preface from the perspective of this man who hovers between creation and self-destruction. He is at one stage wrongly accused of the murder and is later found dead himself; it is initially speculated at the hands of the same killer but this turns out to be another twist in the tale.

This book does not have chapters in the traditional sense, as they are small in number and some are frustratingly long, especially when you are thinking “I will just finish this chapter before turning the light out and going to sleep”. The first chapter was long and contains frenetic character and scene changes. There is an introduction to many protagonists, some named, some not, and one has the feeling that all these people will in some way be important to the resolution of the storyline. It appears to be a story about secrets, and piecing together the tale that the dead cannot tell.

The second chapter was not so long but continued ‘setting the scene’ and introduced a couple more less likeable characters and a twenty-five year old mystery disappearance of the scion of a local wealthy industrial family, which somehow seems linked to the murder. In the next three chapters we see a darker side to some of the characters as well as a blossoming romance between the heroine Erica and Patrik, one of the detectives investigating the case. The intensity of grief of the cuckolded husband seems to rule him out and the artist is exonerated, but we begin to wonder about various other males that we have been introduced to, including Erica’s abusive and manipulative brother-in-law, her ex-boyfriend Dan and the adoptive brother of the missing scion. Secrets concerning these three men are gradually revealed. There is a strained relationship between the the widow of the industrialist and mother of the dead artist, the widow’s former maid. A mysterious relationship is also revealed between the widow and Julia, the plain sister of the dead woman. Minor characters come and go, some more beguiling than others, including Patrik’s colleague Annika, and Dan’s wife Pernilla is seen to possess unsettling wrathful qualities.

The author hints that relevant clues are being collected by Erica and Patrik, but ‘the big picture’ is not yet clear. There is concern raised about the possibility of harm to Erica if she keeps digging into the matter, but dig she will as she has been commissioned to write a biography about the deceased woman.

Although it would be unsporting to reveal the denouement of the book, all the loose ends are wrapped up in the final sixty pages or so. Patrik, Erica and her sister Anna and her children all have a shot at future happiness. A deep and dark complicity between five of the main characters is revealed along with the truth about the shadows hanging over Alexandra. Surprising secrets are revealed concerning Julia and the identity and motive of the killer. To my great relief, the heroine was not threatened with any harm and thus there were no implausible escapes (such as in Stieg Larsson’s “The Girl Who Played With Fire”).

Unlike television shows, which typically have an “A” story and a “B’ story in each episode, crime writers seem to delight in packing in as many different convoluted story lines as possible. This book is no exception. It is cleverly done, and enough detail is withheld to keep you guessing until the very end. It would not win a Pulitzer prize for fiction, but is a pleasant enough diversion despite its erratic organisation and perhaps a little too much space devoted to vignettes of peripheral characters.

Verdict: Recommended

On Death and Dying – Healing at the End of Life

Last Saturday I attended an excellent seminar on palliative care conducted by the Cognitive Institute (www.cognitiveinstitute.org) conducted on behalf of MIPS, a medical indemnity organisation which I belong to (www.mips.com.au).

The attendees were a mixture of general practitioners, specialists, hospital medical officers and medical educators, and the very open discussions between participants and the facilitator (who is an experienced GP) were very valuable.

It was very interesting to discuss the impact of culture on the approach to death. The human race has a 100% mortality rate, but we heard about a range of cultural approaches ranging from family shielding the patient from the knowledge of impending death to accepting death as a normal part of life. As in every other important area of life, preparation makes a difference- for the patient, for loved ones and for the health practitioners advising and providing care.

In contrast, just a few days previously, I had cause to reflect on how sudden and unexpected death can be.

On Thursday last week I was sitting at the kitchen table working when I became aware of the sound of a persistent helicopter buzzing overhead. Most commonly this occurs when there is a Police helicopter in the area (as I remember when I was living close to the Hoddle Street shootings many years ago), but when I went outside and looked it was a Channel 7 News helicopter. I therefore surmised that something significant must have happened in the immediate vicinity and started to find out what it might be. I started to search news sites on the Web, turned the TV on for news updates, and then turned on the ABC radio.

Normal radio programming was interrupted to bring the sobering news of a fatal fiery car crash in drizzy overcast conditions just a couple of hundred metres down the road. Three people (and perhaps a fourth) had been instantly incinerated with no hope of escape.

In these situations it is very much a case that, as poet John Donne once famously said, “no man is an island entire of itself”, and when it is something terrible that has happened in your local area, one feels an incredible need to understand what has happened and exactly where it has happened. It is not a form of ghoulish voyeurism, but rather a sense of being part of the local community and sharing in the shock and grief and sorrow for those who lost their lives and their families and friends.

So, I went for a walk in the light drizzle towards where I understood the accident to have happened. The Police had both distant and close roadblocks in place, and it was obvious that a lot of emergency responders were hard at work. I wasn’t interested in getting too close, but just to clarify the location where the accident had happened, and from the corner of a small nearby park could see the burnt out rear end of a car covered by a blue tarpaulin resting against a residential fence, diagonally opposite the suburban railway station. The Police said later that it was just a horrible freak accident where a chain of circumstances had culminated in the tragic outcome. If you have ever heard of the ‘Swiss Cheese Model’ which is used in human factors theory to explain how adverse events happen, then this was a perfect example. Just so profoundly sad!

It did make me slightly anxious about driving that evening in the same drizzly conditions, and the information that has been provided about the crash analysis goes to reinforce the point that in wet overcast conditions all drivers should slow down, drive carefully and not take any risks.

The Age Newspaper, 3 May 2012: http://www.theage.com.au/victoria/police-fear-fourth-body-20120503-1y0zs.html

The Age Newspaper, 4 May 2012: http://www.theage.com.au/victoria/fishtail-link-in-fiery-triplefatal-car-crash-20120504-1y2w7.html

Surprisingly good ice-cream from Coles!

(Updated 15 June 2012: Strawberry White Choc added; 23 June 2012: Photos added. Updated 24 December 2012: Lamington Style added. Updated 28 January 2013: Mango Swirl added Updated 01 November 2014: Coconut Lime and Chocolate Orange added.)

Coles Supermarkets recently introduced a range of premium one litre ice-creams. Now, I'm not a big ice-cream eater, but in the noble tradition of the Scandinavians, who love their ice-cream even in winter, I decided to try out a few flavours despite the somewhat chilly time of year and was pleasantly surprised at just how good they are! All the ice-creams are made with real cream.

Verdict: Recommended

Rum and Raisin
The ice-cream is a light butterscotch colour, and has a smooth creamy taste with a definite sharp flavour of rum. It contains plump and juicy raisins which are similarly rum-soaked in flavour.

Rocky Road
This has a solid chocolately background which is not overly sweet, with crunchy nuts and pieces of soft springy pink and white marshmallow as well as some raspberry swirl.

Chocolate Fudge
This one has a denser dark chocolate base with syrupy swirls of fudge and chewy chocolate pieces.

Strawberry White Choc
This ice-cream has a fresh, smooth, sweet and creamy strawberry flavour that bursts out in your mouth like a sunny spring day. There are delicate slivers of white chocolate which amplify the richness of the tasting experience, chunks of real strawberries and tendrils of raspberry swirl, adding small bombs of zesty tang.

Lamington Style Ice-Cream

Indulgent chocolate ice-cream with rich raspberry, swirled with creamy vanilla ice-cream and dessicated coconut.

Well, this is an interesting take on an Australian classic, and it took me a while to be persuaded to try it (really only until it came down to $5.00 a carton, along with the remaining ice-creams in the Coles range).

It is indeed very chocolately in appearance but mild in flavour, with a variegated appearance; presumably the mix of chocolate and vanilla mentioned above. There are occasional flecks of raspberry flavour and quite chewy pieces of dessicated coconut (in a semi-frozen state).

To my mind it is a brave experiment that doesn't quite work. The chocolate is a bit wimpy, the rapsberry insufficiently prevalent, and the coconut just sits there and doesn't do anything - its normal sweet, succulent, juicy nature is missing, as is the classic offset of the golden sponge base. It is probably inoffensive enough and sweet enough to be wildly popular with children, but I would advise adults to choose one of the more sophisticated flavours previously reviewed.

Mango Swirl
Smooth and creamy vanilla ice-cream accompanied by sassy and tangy mango sorbet swirls with real mango flavour.

Coconut Lime
All those of you who are fans of the individual 'Lime Splice' ice-creams will like this one. It has a base of creamy vanilla ice-cream mixed in with generous strands of shredded coconut and pockets of pale green zesty lime flavour. All these elements combine for a refreshing taste.

Chocolate Orange
All who are fans of the famous 'Terry's Chocolate Orange' will like this ice-cream version. There is a nice creamy chocolatey taste with an overlay of orange essence. It is not too rich and the citrus element is not too overpowering. A nice combination and good as a special treat!

Moreish coffee from Timor-Leste

Coffee Mio Timor-Leste Blend
Verdict: Recommended

The Friends of Baucau, a support group for the Baucau region of Timor-Leste, import a fair trade organic coffee blend as a fundraising measure.

The beans are ground and packaged by Coffee Mio into 250g bags, which are available at selected City of Darebin and City of Yarra customer service centres. For further information refer to the Friends of Baucau website: http://friendsofbaucau.org/get-involved/buy-coffee/

The ground coffee is highly aromatic, with a strong, nutty smell which almost has a hint of the rainforest about it.

Once brewed the flavour is strong, robust and unapologetic. There is a good depth of flavour, with a sustained bitter and nutty underlying character which develops into a lingering aftertaste leaving a tingle on the tongue. This is a coffee which can be savoured rather than sculled.

If I had to think about the mental image that drinking the coffee conjurs up when I close my eyes, it would be the sort of coffee you would brew over an open fire in a rustic log cabin and enjoy drinking with friends.

Apple refuses to bite ...

Late last year I decided to buy an Apple iPad "Smart Cover" as a Christmas gift, and as it was a little difficult to find time to shop in person, I looked online. I found an Australian company specialising in computer cases and accessories which was offering what appeared to be a genuine Smart Cover at a good price, so I ordered one. Once it arrived I became suspicious that it was in fact a counterfeit product, especially when I compared it with a friend's genuine Smart Cover.

Having been a lawyer in a previous life, I did not wish to support products which were an example of "passing off" and exploiting Apple's industrial and intellectual property, and contacted the retailer via email to ask for either an exchange for a genuine cover or a refund. After several emails there was no reply, so I thought that I had given them a fair chance to avoid reporting of the matter and then approached Apple offering to provide it with details of the seller and send them the actual counterfeit product and packaging. I made two different submissions through the Apple website, and after I did not hear anything back I also went to some trouble to get the email contact details of a person within Apple Australia. I wrote to this person twice, also with no response. I was then forced to come to the conclusion that I cared more about protecting Apple's intellectual property than it does and that I was "on my own" in terms of seeking resolution of the matter.

I then renewed my pressure on the retailer, and eventually (after a delay of several months) received a full refund after returning the goods after threatening to report them to the authorities. Since life is too short to follow up every injustice that you come up against, and especially as Apple seemed disinterested in doing anything about the counterfeit accessories, I made a decision not to report the matter to the Australian Competition and Consumer Commission, so in this instance the forgers have "got away with it".

The moral of the story is that if you are concerned about buying a genuine product, be very careful about buying online, and check with the retailer in advance whether the item is in fact genuine or a copy. If you want to be sure, buy from an authorised retailer. Some stores like JB HiFi will offer a small discount on the RRP if you ask for a deal (but Apple does not give them much room to move).

As the old legal saying goes, "caveat emptor" (buyer beware)!

The Cider Stakes

Having bought some Swedish cider from Dan Murphy's last year out of curiosity, a few months later they also had a 'taster' pack of twelve different Australian and international ciders so these have been tried and ranked into (a) worth drinking again and (b) did not impress. 

Five of these are good enough to recommend.
1. Bulmers Original Cider 330mL. 4.7% alcohol. An authentic apple cider. (Australia)
2. Three Oaks Cider Co. - Original Crushed Apple Cider. 330mL. 5.0% alcohol. (Australia)

3. Old Mout Cider. Classic Apple. 330mL. 4.5% alcohol. (New Zealand)
4. Castaway Cider. Apple. 330mL. 5.0% alcohol. (Australia) 

5. Kopparberg Preium Cider with Stawberry and Lime. 330mL. 4.0% alcohol. (Sweden)

The Swedish Kopparberg Lime and Strawberry cider is pinkish in colour and has an interesting taste which is a mixture of tart and sweet, in accordance with its contents. Some may feel it is an alternative version of an 'Alcopop', but it would be a refreshing choice chilled on a hot day. 

Whilst not in the mixed pack, the Swedish Rekorderlig Winter Cider is also pleasant drinking, It can be consumed warm in winter, but is also quite lovely chilled, with a fruity cinnamon-tinged flavour

Fish and Chips - Swimmingly good!

Great Bite
Seafood, Fish & Chips
134A Station Street
Fairfield Vic 3078
Tel: (03) 9481 3790
Visited for dinner, Friday 5 May 2012 and subsequently
Closed on Tuesdays. Open from 11am to 8.30pm other days (9pm Friday).
Verdict: Recommended

This is one of the many fish and chip shops in the local area. Conveniently located in Station Street, Fairfield, it is accessible by car, train (a short walk) and bus (stops right out the front).

They sell fresh seafood as well as the take-away staples of fish and chips, hamburgers, steak sandwiches and souvlaki,

It is a bit of a Friday night treat to have fish and chips (perhaps a hangover from the European or Irish Catholic heritage of many Australians) and Great Bite rarely disappoints.

The Family Pack #2 ($22.00) includes three blue grenadier, three potato cakes, three dim sims and minimum chips. They are willing to substitute three calamari rings for the dim sims if asked (not all fish shops will do this, and have in the past lost my custom as a result).

The serving of chips is a fairly standard size, but the size of the other components is usually generous. The blue grenadier fillets were large, thick and juicy, and like the calamari rings had a wonderful "melt in the mouth" quality with crisp batter on the outside. The potato cakes were also crispy on the outside and soft and melting on the inside. The chips had a similar presentation as well as a light sprinkling of salt, which made them very moreish.

All the pack contents were deep-fried to a dark golden colour, but were definitely not overcooked. All the food disappeared quickly without complaint!

Service is friendly and staff remember 'regulars'. Based on past experience, I would recommend not ordering too close to closing time.

On all visits since the original visit the standard has been consistently good. The fish is always juicy and "melt in the mouth". The recomendation stands!

The River Kwai flows smoothly ...

River Kwai
Thai and Burmese Restaurant
3/1310 Centre Road
Clayton South Vic 3169
Tel: (03) 9545 5688
www.riverkwai.com.au
Open Monday to Sunday, 5.30pm to 10pm all year around.
(Visited for dinner, Tuesday 1 May 2012)
Verdict: Recommended



This is a gem of a restaurant, tucked away in Melbourne's south-eastern suburbs. The interior is tastefully decorated in a red and gold theme, which is echoed in the stylish menu folders and the red tablecloths and brass cutlery. The female wait staff, attractively clad in elegant simple black dresses, were polite and helpful.

As the birthday guest of honour in our group is elderly, we decided to move shortly after arriving due to the noise levels in the front of what is obviously a very popular restaurant, and were thereafter able to enjoy pleasant and audible conversation in the back of the dining room.

Carafes of water were provided, and the meal commenced with a small complimetary serving of roti bread and meat curry on a traditional asian soup spoon.

We selected three curries and some plain rice. Due to a mix-up in the kitchen, a seafood curry was brought to the table rather than the vegetarian curry we had ordered. The waitress offered to replace it, but it looked so attractive that we decided that we would keep it.

Dish 23 - Green curry with chicken
Fragrant green curry with bamboo shoots, Thai eggplant, carrot, red capsicum and sweet basil leaves.

A delightfully creamy and slightly spicy sauce was accompanied by fresh and tasty vegetables and thinly slices of chicken breast. An enjoyable but distinctive variation on the 'Thai green curry' theme.

Dish 27 - Gang Phet Ped Yang
Fresh roasted duck breast in a creamy red curry sauce with whole cherry tomato, bamboo shoots, lychees, snow peas and basil.

This imaginative combination of flavours in a subtle glossy sauce came together well. The duck was thinly sliced and complemented in texture by a mixture of linear and chunky vegetables.

Dish 41 - Seafood curry (Burmese)
Mixed seafood of half a crab, mussels in their shells, fish fillets, scallops, prawns and squid cooked in a tomato-based Burmese sauce.

This was the 'lucky dip' surprise curry. It was visually impressive, arriving on a large triangular platter and was quite different in taste to the two creamy Thai curries, with a more tart almost smoky flavour. The fish had a 'melt in the mouth' quality and the rest of the seafood was generally 'just right' in terms of the amount of cooking, but I did feel that the scallop that I had was a little over-cooked. One of the standout elements was the use of strands of fresh coriander, which had softened with the heat to contribute to the overall mix of flavours.

All three curries were tasty and enjoyable. Perhaps the only somewhat negative comment would be that the ratio of sauce to contents in the curries was weighted more heavily in favour of the sauce, with the result that there was a lot of delicious sauce left over. More rice or roti bread would have been needed to mop this up.

Gluten free dishes are available on request as well as a wide selection of vegetarian treats.

Starting out with Orienteering and Rogaining

(Updated 9 July 2012)

In Victoria the Police are provided with support for bush search and rescue operations by volunteers from the SES, Bush Search and Rescue, Alpine Search and Rescue and (within the ski resports) Ski Patrol. Navigation skills, including map and compass and GPS usage, are important skills in this context.

Where do you go if you want to start developing good old fashioned map and compass skills? Melbourne is fortunate in having Orienteering Victoria and the Victorian Rogaining Association as well as a number of orienteering clubs. These organisations are very welcoming and supportive of beginners and the emphasis is on coming along to an event and "having a go".

The VRA runs events regularly throughout the year and there are also a lot of orienteering events, including the popular park and street orienteering series. Over winter OV runs a series of bush orienteering events called MelBushO.

On Sunday 8 July I attended the BushO event at Plenty Gorge in Melbourne ($10 for adults). The volunteer officials were very friendly and helpful, and there were four different courses ranging from easy to hard to cater for the full range of participants from beginners to experienced orienteers. I completed the easiest course at 2.5km with 9 checkpoints, and this was both fun and good experience. You didn't really have to feel worried about getting lost and as the checkpoints were close to the starting area. It was possible to navigate pretty much just with the map (which is apparently how they like beginners to start out) but compass skills might come in handy for the more difficult courses. I enjoyed it enough to want to do some more in the future!

At the end of April 2012 the VRA ran a very successful (free) training day at Birdsland Reserve (in the outer suburbs of Melbourne), which provided practical experience in navigating to checkpoints as well as tips and advice from a VRA trainer with each small group. The volunteer trainers were generous with their time and advice, and we all enjoyed some welcome refreshments provided by the VRA at the conclusion of the day. It was also good to demystify the whole process and there was certainly a great deal of enthusiasm generated amongst the participants for taking part in forthcoming rogaining events.

The VRA runs a "partner-finding service" for each event so that no-one need be constrained from participating due to lack of a someone else to form a team.

Victorian Rogaining Association:  http://vra.rogaine.asn.au/

Orienteering Victoria:  http://www.vicorienteering.asn.au/ 

Bush Search and Rescue Victoria: www.bsar.org/

Alpine Search and Rescue Victoria: www.alpinesar.org.au/

Emergency medicine at the coalface - experiencing a music festival!

I have earlier mentioned (in connection with the World Track Cycling Championships) the great opportunity I have been given of working with Event Medical Services Australia (http://www.emsa.com.au/emsa/Home.html) as an occasional member of the medical first response team at public events.

Last weekend I was part of a large team of around twenty people which provided first aid services for the Creamfields Music Festival in Melbourne. The team consisted of first responders (Paramedic/Nursing students), a senior paramedic and two doctors. Ambulance Victoria was also in attendance and available to assist with seriously unwell patients and hospital transports. I was given a 'heads up' that there were likely to be drug overdoses involved, so spent a couple of days during the preceding week reading up on illicit drugs and overdoses and also sought the advice of one of my tutoring colleagues who was an emergency physician in a past life and provided me with some excellent articles on GHB. 

It was an interesting experience for me, never having had much practical exposure to the management of anything other than acute intoxication, but my colleagues had seen it all before and were very capable and confident in management, so I learned a lot. Even though I had read about it, it still seemed quite remarkable how quickly GHB users can go from unconscious to recovered. We saw people who had used GHB, LSD, ecstacy and of course lots of alcohol. Due to the rapid recovery rate there was minimal call on Ambulance involvement.

The Police came to advise us that they had increased their presence since last year's Festival, especially at the entrance gate, and had five sniffer dogs and a very large number of personnel. When I went to observe, it seemed as if one person was being pulled aside every few seconds to be taken to the holding area for investigation. The Age newspaper reported that two hundred people had been arrested for drugs infringements. Perhaps GHB is more difficult to detect as it is colourless and odourless, but we probably had the Police to thank that there were not more overdoses. A couple of people swore that they would never use drugs again due to the bad experience. It would be nice to believe them.

For excellent information and fact sheets relating to illicit drugs (and an iPhone app) from the Austrailian Government National Drugs Campaign, see:
http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/home-1

This is an article relating specifically to the Creamfields festivals in Melbourne and Sydney:
The Age Newspaper:  http://www.theage.com.au/victoria/drugs-neardeath-plunge-at-creamfields-concerts-20120430-1xu4x.html

This is a further article in which a senior member of Victoria Police comments on the prevalence of and attitude towards illicit drugs and mentions some of the medical implications:
The Age Newspaper: http://www.theage.com.au/victoria/top-policeman-lashes-out-at-drug-national-disgrace-in-wake-of-rave-arrests-20120506-1y73y.html

A subsequent interesting article about Ambulance Victoria callouts involving both illicit and prescription drugs:
The Age Newspaper: http://www.theage.com.au/victoria/prescription-drugs-alcohol-wreak-havoc-20120507-1y95h.html

The Age Newspaper has recently established a "Wiki" page which lists a number of articles relating to the drugs debate and has a link to the WikiCurve and online comments and debate:
http://www.theage.com.au/national/drug-law

A couple of days of days before Creamfields there was an article in The Age (http://www.theage.com.au/victoria/the-drugs-in-the-mail-20120426-1xnth.html) about anonymous websites such as Silk Road which offer illicit drugs for sale (some of which are even advertised as being lab tested for purity). These drugs are then shipped directly to the purchaser and carried by Australia Post right to the front door. According to the article, Australia Post only has the capacity to screen a small fraction of all parcels arriving into Australia. As has been said in the Press lately, it appears that the war against drugs is a war that cannot be won. However, it is indeed fortunate for drug users that in our affluent Western society they are provided with a safety net against the ultimate form of self-harm in death by overdose. Ambulance services will attend anyone in trouble, and our medical team was on-site to save people from themselves and resuscitate them if they stopped breathing. I wonder if they truly appreciate the risk they are taking and if they would still take it if they knew how easy it is to die or be permanently disabled from a simple lack of oxygen to the brain ...

Paramedics are the unsung heroes of our health system, and after hearing a lot over the past couple of years about what they do on a daily basis, I have nothing but respect and admiration for them and their work.

Critical Care Education Services - a learner becomes a teacher!

Six years ago I attended a Basic Life Support and Advanced Cardiac Life Support Course conducted by Ken Hambrecht of Critical Care Education Services, and over intervening years have attended ECG Interpretation, Acute Life-Threatening Emergencies, Recognition and Treatment (ALERT) and Paediatric Advanced Life Support Courses. Ken always impresses me with his encyclopaedic knowledge of critical care medicine and attention to detail as well as being one of the nicest people that you could ever possibly meet. After the PALS course I was emboldened to approach Ken and ask if he ever heard of any clinical education opportunities and he was kind enough to offer me the possibility of assisting with some of his courses.

As a result I recently spent a most enjoyable Saturday afternoon running a workstation teaching groups of nurses and doctors the basic approach and methodology of intubation. For me it was a lovely opportunity to share the knowledge and skills that I had acquired through my work as an Anaesthetics registrar, and I enjoyed the feeling of having these tools in my hands again. I do miss being involved with full-time clinical medicine and hope that I will be able to further my skills and experience in acute medicine again in the future.

Since then I have also run skills stations in another Basic Life Support and Advanced Cardiac Life Support course on Paediatric BLS and Advanced Airway Management (intubation/laryngeal masks) and also the airway management station at the Paediatric Advanced Life Support course. It always gives me a 'warm inner glow' when the people on the course are enthusiastically grateful for the session!

Critical Care Education Services: www.criticalcare.edu.au/

It is interesting to reflect that I have been fortunate in being able to obtain all my clinical and educational work since early last year through personal contacts and not being afraid to approach people and ask. As the iconic saying goes, "nothing ventured, nothing gained"!

If at first you don't succeed ... Scandinavian Pre-Hospital Research Project Proposal

(Updated 11 February 2013)

Having always been a bit of a "Pollyanna" at heart, in early 2012 I embarked on my fourth Churchill Fellowship application (from the early 1990s to the current day) and received my fourth rejection letter. I was also rung by the Victorian Chairman to stress that there was nothing wrong with my application or excellent qualifications but it was merely that the Panel preferred other topics in the extremely competitive environment. This was very disappointing, not only for the time and effort on my own part and that of the referees, but also for the fact that it is extremely difficult to find funding for 'boutique' projects of this nature, which are cutting-edge in their own way but not part of mainstream health research and funding. I suggested to the Churchill Fellowship that perhaps they could do unsuccessful candidates the kindness of having a web page that directed them to other possible alternative sources of funding.

One other option was to apply for an Emergency Services Foundation Volunteer Scholarship. However, this required the endorsement of the head of your organisation, and it was stated to be a "recognised emergency services organisation", which raised issues of its own, as no volunteer search and rescue group or ski patrol in general is specifically recognised under the Emergency Management Manual Victoria. A volunteer with Alpine Search and Rescue has to go through Bush Search and Rescue and then to Victoria Police (as the recognised agency with responsibility for search and rescue). Bush Search and Rescue declined to endorse the project due to the ski patrol component. Ski patrol endorsement could have been obtained but difficulties were encountered through the scholarship secretariat in appreciating that the role of ski patrol was separate to that of search and rescue and thus obtaining a ruling as to whether ski patrol would be recognised as an emergency services organisation for the purposes of the scholarship application. In the end time ran out and I was told to wait until the next round of applications at the end of 2012 and to try again then. I had supplied two written references from both the search and rescue and ski patrol side, but these were deemed insufficient as according to the letter of the law an endorsement of the head of agency was required.

I was both despondent and disappointed with this outcome, as I had spent about a week putting the application together and been involved in extensive email correspondence and telephone conversations in trying to get the application accepted for consideration and the Foundation had publicly stated that they wanted to encourage more scholarship applications. Whether it was sufficiently meritorious to receive a scholarship is another matter but I would really have appreciated the opportunity to have it considered. It has all been so difficult I don't know if I will in fact try again unless the administrative issues are clearly resolved beforehand.

(Update)
With a change of personnel in the National Ski Patrol body, I was able to arrange endorsement of my (expanded) research project proposal and have submitted it as an application for the 2013 round of volunteer scholarships. This year I decided to go direct to Ski Patrol for endorsement as Ski Patrol has operational independence from Victoria Police.

This is a brief outline of the proposed project (the full proposal is available at: https://dl.dropbox.com/u/30234302/Pre-Hospital_Research_Project_Proposal_2013.pdf):

Scandinavian Pre-Hospital Search and Rescue and Ski Patrol Research Project Proposal
Location: Sweden, Norway and Iceland.
Purpose: Learning from and benchmarking international best practice in order to optimize domestic best practice.
Key topics to be examined:

• Alpine and wilderness models of (and equipment and facilities for) casualty care and interface between ski patrol, search and rescue, ambulance and medical services. 
• Content, layout and standardization between agencies of incident reporting forms for the accidents occurring in alpine and wilderness areas and the underlying ‘data set’ used for encoding and processing of this data. 
• Authorised use of medications by emergency responders in the treatment of casualties. 
• First Aid training for emergency responders – ski patrol and search and rescue. 
• Training in mass casualty triage principles for emergency responders – ski patrol and search and rescue. 
• Establishing the extent to which ski patrol and search and rescue organisations are formally recognised as part of the ‘Emergency Services’ and the extent to which funding of these organizations is provided by government bodies.

These topics would be addressed through interviews with relevant respondents, site visits and a series of ‘answerable questions’, which would be distributed beforehand (together with a short briefing paper) to the proposed host organizations. (Further details appear in the Methodology section.)

The Australian Ski Patrol Association (“ASPA”) is a member of FIPS (Fédération Internationale des Patrouilles de Ski)1, an international association of organisations involved with the multi-disciplinary aspects of ski patrolling and ski safety. Through working together with the ASPA VP International Liaison, a number of useful contacts would be sourced for the project. I am also a member of the International Society for Skiing Safety.