Journal articles on the topic 'Hospitals Complaints against Victoria'

This article presents data from two sources. The first set of data comes from complaints received by the Health Services Commissioner (Health Ombudsman) in Victoria from Consumers of Health Services about health service providers. The second set of data has been provided by 92 public hospitals using the health complaints information program. The Health Complaints Resolution Process is described and the data are presented in the hope that they may assist in formulating policies for women's health.

Background: The current status of medical malpractice in Tehran medical centers is unclear, while understanding the situation may help the authorities carefully plan, continuously monitor and, consequently, be sensitive to eliminate the weaknesses. Hence, the present study aimed at investigating the existing problems. Methods: In the present Descriptive and cross-sectional study, all patients complaining of the medical staff of public hospitals affiliated to three medical sciences universities (i e, Tehran, Iran, Shahid Beheshti, and Baqiyatallah) were evaluated in terms of demographic characteristics, physicians gender, the type of hospital, the type of specialty, the type of staff, and reason for complaint (disability, death) using a data collection form, and the results were analyzed in SPSS version 18 using the Chi-square and Fisher tests. P-value <0.01 was considered the level of significance. Results: Most of the filed complaints were against hospitals affiliated to Tehran and Shahid Beheshti universities of medical sciences, and 66% against private centers. Most cases won in the court were against general practitioners, dentists, general surgeons, and hospital technicians. The number of malpractices proven for teaching hospitals was significantly lower than that of non-teaching ones. Given the prevalence of plastic surgery in Iranian society, the number of complaints filed from female patients was two-thirds of male ones; almost 50% aged 21-40 years. For some reason, more than three-fourths of wrongful death complaints were for female patients. Conclusion: Complaints of medical malpractice in hospitals are an integral part of physicians and nursing staff work, as the saying goes: an unwritten dictation has no errors.

Abstract— Information on public services is an important part of increasing community satisfaction with government policies. Complaints and Complaints of the community become mediators to improve public services according to community needs.Twitter is one of the most widely used social media in the community to post activities, experiences, and complaints about public services through the internet easily and realtime.The amount of information on Twitter is mixed between satisfaction and extensibility of public services, making it difficult for the government to make decisions in public policy. The role of Big Data can be a solution to classifying data to predict satisfaction or extensibility of public services with parameters: markets, transportation and hospitals.Data sources taken from Twitter are 700 data texts. The twitter classification of public service complaints is built using the Naïve Bayes Algorithm Method, because the algorithm can classify based on probability values. Text processing is done by filtering text and selecting text to be ordered.The results of this study indicate that the Naïve Bayes Method is able to properly classify public service complaints based on 3 parameters, transportation, markets and hospitals. System testing using 700 data obtained the best results accuracy value: 86%, and precision: 72%, recall 81% and f-measure: 83%.

Background: Complaints from patients and their carers are important indicators of problems in a healthcare system and provide valuable insights into safety-related problems within healthcare organisations. The objectives of the present study are to identify the frequency distribution of the people complained about, the units complained about and the total number of complaints.Methods: We employed a descriptive, cross-sectional study to conduct this research. The research population included cases registered at the complaints unit of a tertiary care hospitals in selected months of May 2017 to August 2017. The data were collected through observation of available documents. Excel software program was used for data analysis.Results: The administration received 692 complaints between the study period. The highest rate of complaints was filed against admission process (30.06%) and the lowest rate of complaints are filed against staff (2.51%). Our study results showed a significantly less complaints against nursing staff and no complaints against medical staff, indicates that the nursing and medical staff of the hospital might be observing medical ethics and professional commitment to a high standard and communicating well with the patients. High rate of complaints against admission unit, house keeping unit and high billing amount indicates the unrealistic expectations prevailing in the minds of clients from the health care provider.Conclusions: The current study generated the profile of patient’s complaints in a tertiary care hospital running in a charitable model. Such data can be utilised to identify common problems and to plan strategies.

AbstractObjective:To examine the policies and practices in hospitals within the state of Victoria, Australia, with respect to vaccination of staff against hepatitis B infection.Design:A written self-administered questionnaire to be completed by the infection control officer (or designated officer for hepatitis B vaccination) within each hospital.Setting:Public (teaching and nonteaching) and private hospitals, including metropolitan and rural institutions in Victoria.Participants:A random sample of 30% of Victorian hospitals were asked to participate in the survey. Of 78 eligible institutions, 69 (88%) completed and returned questionnaires.Results:There was no consistent hepatitis B prevention policy in place across Victoria. Of the 69 responding hospitals, 63 (91%) offered hepatitis B vaccination to staff, and 58 (84%) of these also paid all costs of vaccination. Of the 63 hospitals offering vaccination to staff, 39 offered vaccination to all staff, 23 offered vaccination based on job title, and one offered vaccination based on anticipated exposure. In many institutions, postexposure protocols were recalled more readily than preexposure vaccination guidelines. Numerous respondents indicated a need for clear guidelines on policy and clarification on practical matters of management, such as acceptable immune levels, management of nonresponders to the primary series, and the need for, and timing of, booster doses of vaccine. Eleven (18%) of the 63 hospitals offering hepatitis B vaccination to staff undertook routine prevaccination screening, a practice not generally regarded as cost-effective in Australia. Fifty-five of these hospitals (91%) also undertook postvaccination screening.Conclusions:It is evident from this study that a considerable number of potentially susceptible healthcare personnel in Victorian hospitals remain unprotected against hepatitis B infection. A more reliable and consistent approach to preexposure hepatitis B vaccination is recommended

Anesthesiologists consider professional insurance and its medico-legal problems as a remarkable aspect of their job. “Associazione Anestesisti Rianimatori Ospedalieri Italiani—Emergenza ed Area Critica” (AAROI-EMAC) is the Italian professional association of anesthesiologists and intensivists that works to train its subscribers on safety measures. This is a retrospective observational study on an insurance complaints database for anesthetic accidents that result in injuries to patients. The analyzed period runs from 1 January 2014 to 31 December 2016. A total of 1309 complaints related to 873 insurance claims were analyzed. Criminal complaints comprised 805 (64.4%) of the total, and civil complaints were 445 (35.6%). The iatrogenic damage claimed included: death (58% of the cases); peripheral nerve damage (8%); spinal cord injuries (5%); unspecified injuries (7%); dental damage (4%); infections (3%); needing second surgical procedure (2%); and other injuries (13%). There is a statistical significance between the size of the hospital and the number of the claims: small hospital complaints comprised 40.1% of the cases, while complaints against medium-sized and large hospitals constituted 20.6% of the cases (χ2GL = 8 = 39.87, p = 0.00). In Italy, anesthesiologists and intensivists are often involved in litigation even when they are not directly responsible for iatrogenic injuries, and the most frequent claims in ICU are related post-operative complications.

Abstract Background The 2019–20 influenza season was predominated by early onset B/Victoria viruses followed by A(H1N1)pdm09 virus circulation. Over 95% of circulating B/Victoria viruses were subclade V1A.3, different from the Northern Hemisphere vaccine strain. Annual estimates of influenza vaccine effectiveness (VE) are important because of frequent changes in circulating and vaccine viruses. Methods We assessed VE among children 6 months–17 years old with acute respiratory illness and &lt;10 days of symptoms enrolled during the 2019–20 influenza season at 7 pediatric hospitals (ED patients &lt; 5 years at 3 sites) in the New Vaccine Surveillance Network. Combined mid-turbinate/throat swabs were tested for influenza virus using molecular assays. We estimated age-stratified VE from a test-negative design using logistic regression to compare odds of vaccination among children testing positive versus negative for influenza, adjusting for age in years, enrollment month, and site. For these preliminary analyses, vaccination status was by parental report. Results Among 2022 inpatients, 324 (16%) were influenza positive: 38% with influenza B/Victoria alone and 44% with influenza A(H1N1)pdm09 alone (Table). Among 2066 ED children, 653 (32%) were influenza positive: 45% with influenza B/Victoria alone and 43% with influenza A(H1N1)pdm09 alone. VE was 62% (95% confidence interval [CI], 51%–70%) against any influenza-related hospitalizations, 68% (95% CI, 55%–78%) for A(H1N1)pdm09 and 55% (95% CI, 35%–69%) for B/Victoria. VE by age group for any influenza-related hospitalizations was 57% (95% CI, 40%–69%) among children 6 months to &lt; 5 years and 66% (95% CI, 49%–77%) among children 5–17 years. VE was 53% (95% CI, 42%–62%) against any influenza-related ED visits, 46% (95% CI, 28%–60%) for A(H1N1)pdm09 and 54% (95% CI, 39%–66%) for B/Victoria. VE by age group was 52% (95% CI, 37%–63%) among children 6 months to &lt; 5 years and 42% (95% CI, 16%–60%) among children 5–17 years. Conclusion Influenza vaccination in the 2019–20 season provided substantial protection against laboratory-confirmed influenza-associated hospitalizations and ED visits associated with the two predominantly circulating influenza viruses among children, including against the emerging B/Victoria virus V1A.3 subclade. Disclosures Janet A. Englund, MD, AstraZeneca (Scientific Research Study Investigator)GSK group of companies (Scientific Research Study Investigator)Meissa vaccines (Consultant)Merck (Scientific Research Study Investigator)Sanofi Pasteur (Consultant) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member)IDConnect (Advisor or Review Panel member)Quidel (Advisor or Review Panel member) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support) Christopher J. Harrison, MD, GSK (Grant/Research Support, Infant menigiciccal B conjugate vaccine trial)Merck (Research Grant or Support, Infant pneumococcal conjugate vaccine trial)

<p><strong>Background:</strong> Health systems, as part of the social system, consider public values. This study was conducted to examine the role of social values in the health priority setting in the Iranian health system.</p><p><strong>Methods:</strong> In this qualitative case study, three main data sources were used: literature, national documents, and key informants who were purposefully selected from health care organizations and other related institutions. Data was analyzed and interpreted using the Clark-Weale Framework.</p><p><strong>Results:</strong> According to our results, the public indirectly participates in decision-making. The public representatives participate in the meetings of the health priority setting as parliament members, representatives of some unions, members of the city council, and donors. The transparency of the decisions and the accountability of the decision makers are low. Decision makers only respond to complaints of the Audit Court and the Inspection Organization. Individual choice, although respected in hospitals and clinics, is limited in health care networks because of the referral system. Clinical effectiveness is considered in insurance companies and some hospitals. There are no technical abilities to determine the cost-effectiveness of health technologies; however, some international experiences are employed. Equity and solidarity are considered in different levels of the health system.</p><p><strong>Conclusion:</strong> Social values are considered in the health priority decisions in limited ways. It seems that the lack of an appropriate value-based framework for priority setting and also the lack of public participation are the major defects of the health system. It is recommended that health policymakers invite different groups of people and stakeholders for active involvement in health priority decisions. </p>

Problem setting. According to the data as of 01.01.2020 in the register of the European Court of Human Rights (ECtHR) are registered 8850 applications filed against Ukraine, which is 14.8% of the total number of applications. And although Ukraine took 3rd place (in 2017 Ukraine ranked first) in the number of complaints against it to the ECtHR, after Russia (15,050 complaints) and Turkey (9,250 complaints), it should be noted that a significant number of complaints, namely 40 complaints are still in breach of Article 3 of the ECHR (prohibition of torture or inhuman or degrading treatment or punishment). Thus, the correct interpretation and understanding of the concepts used in Article 3 of the ECHR is very important for Ukraine, it is related both to the quality of adopted laws and to the practice of the authorities, especially law enforcement and courts. Analysis of recent researches and publications. The research of certain aspects of the interpretation of the concepts of Article 3 of the ECHR was studied by the following Ukrainian legal scholars: Orlova O.O., Trykhlib H., Tsebenko S., Okhota Y., Shishkina E., Rabinovych P. , Pushkar P., Fuley T., Chervyatsova A. Target of research is interpretation of the concepts used in Article 3 of the Convention on the basis of judgments of the European Court of Human Rights, for their proper understanding and application. Conclusions and prospects for the development. Thus, the prohibitions in Article 3 of the ECHR are absolute and unconditional. Prohibition of torture or inhuman or degrading treatment or punishment is one that contains no exceptions, regardless of the situation in which the person is. This norm is an imperative norm and clearly reflects the basic (fundamental) values of a democratic society, and any violation of it by the international community is considered a gross violation of human rights. Everyone has the right to be treated with dignity by others, regardless of individual characteristics, circumstances or place (in hospitals, at large, in places of imprisonment). Everyone should be aware of the inadmissibility of such actions, and these prohibitions should not only be declared, but also implemented. In general, the ECtHR has a positive effect on respect for human rights in Ukraine and is a real mechanism for protecting citizens in many cases.

The article analyzes the incidence of COVID-19 and complications after the disease, especially in terms of the mental health of the world’s population. The purpose of the study was to analyze changes in the mental health of the population of Ukraine after the transfer of COVID-19 and determine the resources of health professionals in the field of health, summarize the most common complaints that arose during the disease, identify compliance with quarantine measures and duration of treatment as in the hospital and at home, in the systematization of complications after the disorder, the duration of antidepressants and the assessment of respondents’ attitudes towards vaccination against COVID-19. A sociological survey has been conducting of 611 respondents mostly students, and teachers of Vinnytsia National University Pirogov. According to the results of the questionnaire, complaints from the nervous system: fatigue – 85.6%, sleep disorders during the disease were noted – 41.4%, irritability – 38.6%, anxiety disorders – 26.0%, memory impairment – 23,2%, depression – 17.9%, fear – 13.3%, confusion – 11.9%, panic attacks – 10.2%, convulsions – 4.9% and suicidal thoughts in 2.1% (66.6% of men) respondents. In Ukraine, it is necessary to create new conditions for alternative treatment of the mentally ill and the population that has negative consequences in mental health after the transfer of COVID-19 based on primary health care, namely: in psychiatric wards of general hospitals, day hospitals, in crisis centers, mental health centers. It is necessary to create a single electronic medical system for recording appeals from the public (personal data) to improve the health care system, as is done in European countries.

AbstractLocating psychiatric wards in general hospitals has long been seen in many countries as a key element in the reform of services to promote community integration of the mentally ill. In the UK, however, this is no longer a policy priority, and the recent trend has been towards small freestanding inpatient units, located either within the communities they serve, or on general hospital sites, but separate from the main building. Whether locating the psychiatric wards in the general hospital is essential to psychiatric reform has been little discussed, and we can find no relevant evidence.Perceived strengths of general hospital psychiatric wards are in normalisation of mental health problems, accessibility to local communities, better availability of physical health care resources, and integration of psychiatry with the rest of the medical profession, which may faclilitate recruitment. However, difficulties seem to have been encountered in establishing well-designed psychiatric wards with access to open space in general hospitals. Also, physical proximity may not be enough to achieve the desired reduction in stigma, and complaints from the general hospital may sometimes result in undue restrictions on psychiatric ward patients. There are strong arguments both for and against locating psychiatric wards in general hospitals: an empirical evidence base would be helpful to inform important decisions about the best setting for wards.Declaration of Interest: None.

Massive splenic infarction (SI) is an extremely rare disease in childhood, the genesis of which is not always clear. Most often in children, SI develops against the background of oncohematological (in particular, myeloid leukemia), hematological (sickle cell anemia) and infectious (malaria, mononucleosis, cytomegalovirus infection) diseases and is small in size. Two own observations are presented, unique in the absence of a clear cause of SI and the massiveness of the lesion. In the first case, a 10­year­old girl was admitted to the hospital on about the 10th day of illness with complaints of undefined abdominal pain, about which she had already twice applied to other hospitals in Moscow. SI was suspected on ultrasound and confirmed on CT, and then the echographic dynamics of SI was followed for more than 2 months. Against the background of anticoagulant, antibacterial and symptomatic therapy, recovery was achieved. In the second case, total SI was observed in a premature infant with severe multiple organ failure. The publication is extensively illustrated and contains a brief review of the literature.

Alkaline batteries have become the second most swallowed foreign bodies following coins. Most cases have an uncomplicated course, but some may lead to serious complications and even death.Here we report a 28 months old boy who had experienced discomfort, eating refusal, vomiting and slightly wheezing after falling from a sofa bed. He has been in three different county hospitals and two private hospitals due to complaints, has been examined by two pediatricians and a cranial surgeon. A cranial CT imaging, a cranial X-ray radiograph and a chest X-ray radiograph was obtained. Firstly, diagnosed as head and neck trauma, then diagnosed as acute bronchiolitis, and finally pneumonia. Hospitalized twice. Finally, a chest radiograph revealed a button battery in the esophagus. The foreign body was endoscopic removed. The child had a quick clinical impairment after removal of the battery.As a result, alkaline batteries with their increasing risk of engulfment poses very serious problems. The parents and physicians should be informed against increasing frequency of ingestion of alkaline batteries by infants and children. Also, clinicians should be careful about the risk of these batteries that they can cause pneumonia and infiltration which may make it difficult to detect the foreign body.

Background. The rarity of the disease and, in this regard, the lack of doctors awareness about the pathology, late diagnosis and severe complications of the musculoskeletal system emphasize the relevance of clinical case demonstrating. The uniqueness of the case lies in the fact that hypophosphatemia, noted 3 years after the disease debut, was not taken into account.Case description. A 45-year-old patient with complaints of muscle weakness, gait disorders, torso deformity and multiple vertebral body fractures that appeared against the background of any somatic diseases absence, a differential diagnosis of metastatic vertebral bodies lesions and secondary osteoporosis complicated by vertebral body fractures was carried out for four years in various hospitals, and was even treated with bisphosphonates. Against this background, the chest deformity increased, kyphosis and remodeling fractures of other bones appeared. The assessment of calcium and phosphorus homeostasis was first performed at the 4th year of the disease, but the detected hypophosphatemia was not regarded as a manifestation of hypophosphatemic osteomalacia.Conclusion. Among adult patients with multiple low-energy fractures, severe muscle weakness and bone pain that appeared against the background of complete health, to exclude hypophosphatemic osteomalacia induced by mesenchymal tumor, it is necessary to include the level of phosphorus in blood and daily urine assessment in the diagnostic algorithm.

<p><strong>Background and Objective:</strong> Coronavirus disease-2019 (COVID-19) pandemic starting from China has been spread internationally. This rapidly spreading and high mortality epidemic of Coronavirus caused significant anxiety and panic globally and affected more than 197 countries. This study aims to assess the anxiety level among health care professionals working on frontline against Coronavirus disease in teaching hospitals of Bahawalpur. <strong>Methods:</strong> A cross sectional analytical study was conducted in Bahawal Victoria Hospital and Civil Hospital Bahawalpur from February to April 2020 after taking ethical approval from institutional ethical review committee. A total of 343 physicians and nurses were surveyed through predesigned, pretested questionnaire after taking written informed consent from each respondent. Anxiety was assessed by using Hamilton Anxiety Rating Scale (HAM-A). The sociodemographic variables of the respondents were cross tabulated with anxiety levels and Chi-square test was applied to assess statistical analysis. P-value less than or equal to 0.05 was taken as significant. <strong>Results: </strong>Mean age of the participants was 37 &plusmn; 10.54 years. Majority of the study participants (39.6%) were in the age range of 31 to 40 years. More than two thirds (69.7%) respondents were working on Contract/Adhoc basis. Job experience of 270 (78.7%) participants was between 1 &ndash; 5 years. Statistically significant association was observed between severity of anxiety and job status (P &lt; 0.001), marital status (P &lt; 0.001) and job experience (P &lt; 0.001). <strong>Conclusion: </strong>Job status, marital status and experience of health care professionals has significant association with severity of anxiety which suggest that hiring of healthcare professionals should be on permanent basis which will ensure their job security that may help to reduce their anxiety level and improvement in performance.</p>

Introduction: The mental health impact of COVID-19 among food handlers working in food establishments/canteens of Dedicated COVID Health Centers and Hospitals are unrecognized. Aim/Objectives: This was an analytical cross-sectional study conducted among all the food handlers working in food establishments/canteens of a tertiary care hospital in central India using a pre-designed, pre-tested proforma that included Depression, Anxiety and Stress Scale 21 (DASS 21). Results: Out of 76 study subjects, 9 (11.8%) had some form of mental illness; 7(9.2%) had depression, 3(3.9%) had anxiety and 1(1.3%) had stress. It was observed that study subjects traveling to the worksite in their own vehicle (OR=5.75, 95% CI=1.29- 25.72), difficulty with transport during lockdown (OR=14.75, 95%CI=3.07-70.92) and those with active complaints (OR=16.25, 95%CI=2.25-117.10) were at increased risk of some form of mental illness in comparison to their counterparts (p<0.005). The study subjects who received training or attended sessions had significantly better knowledge on COVID-19 prevention and control measures than those who didn’t (t=2.448, mean difference= 0.82, 95%CI= 0.13-1.51). Conclusion: It has to be reiterated that effective risk communication and periodic reinforcement of the non-pharmacological measures focusing food handlers to curb the spread of infection has to be continued in the fight against COVID-19.

Social and healthcare workers are at high risk of experiencing sexual harassment in the workplace. Although sexual harassment is detrimental to people’s well-being, only a few studies have systematically investigated social and healthcare workers’ experiences of different forms of sexually harassing behaviors by patients, clients, and residents in Germany. This study aimed to address this gap by determining the prevalence rates and frequency of nonverbal, verbal, and physical sexual harassment by patients, clients, and residents against social and healthcare workers. In addition, we examined the associations of sexual harassment with workers’ well-being and described employees’ awareness of offers of organizational support for sexual harassment prevention and aftercare. Data were collected from n = 901 employees working in a total of 61 facilities, including inpatient and outpatient care, psychiatric facilities, hospitals, and facilities for persons with disabilities. While the prevalence, frequency, and predominant forms of sexual harassment differed across sectors, the results indicated that nonverbal, verbal and physical sexual harassment were highly prevalent in social and healthcare work, with both men and women being affected. Furthermore, we found that sexual harassment was positively related to impaired well-being (e.g., depressiveness and psychosomatic complaints). In terms of support offers for sexual harassment prevention and aftercare, we found that approximately one-third of social and healthcare workers were not aware of any offers at their facilities. In addition to highlighting the problem of sexual harassment by patients, clients, and residents in social and healthcare settings, this study provides recommendations for the development of interventions and suggests several avenues for future research.

Background and context: Reducing the rate of cancer through awareness and prevention programs as well improvements in screening and treatment techniques is paramount. Citizen especially in rural India tend to neglect health due to routine chores of family life. The nonavailability of facilities worsen the issue. Tobacco habits leads to potentially malignant disorders and oral cancers. There is increasing trend of breast cancer, uterine and cervical cancers and also oral cancers. In India oral cancers are main cancers in males. Member of legislative assembly is public representative to represent state of Maharashtra. Cancer Free Constituency Drive was for creating awareness and screening for villagers. Katol is a rural constituency. There are 288 constituencies in Maharashtra state. Aim: 1) To create public awareness of all types of cancers. 2) To provide diagnosis and investigations and treatment to affected population. 3) Capacity building of young medical and dental professionals in cancer diagnosis and paramedical workers in screening all types of cancers. Strategy/Tactics: 72,056 house visits by 220 Asha workers and 129 nursing students and 30 dental interns to sensitize about 3,00,000 people through well designed brochure for all cancers. Self-Mouth mirror examination was designed for oral cancers and awareness against tobacco. The persons with complaints were told to visit camps on scheduled dates at 10 primary health centers. Program/Policy process: The mammography facilities and Papanicolaou test examination, dental examination in mobile vans and self-mouth mirror examination for oral cancers with trained professional carried out diagnosis in 10 primary health centers with the help of experts in medical and dental professionals. Suspeced cases were referred to tertiary referral medical hospitals. Outcomes: 5100 (males 2216 and females 2954) with complaints visited. Total 813 patients suspected to have cancers were examined by specialists from gynecology(84) general surgery (374) otorhinolaryngology (77) pediatrics (37) dermatology (19) and dentistry (131). 38 abnormal on mammography in 132 females, 55 abnormal reports from Pap smears in 472 females were evaluated, however no cancer detected in three months span. Twelve cases of oral cancers were detected and treated. Six breast cancers were detected and treated. Seven other cancers were reported by medicine and pediatric specialists. 150 cases of potentially malignant disorders were also identified. 90 had the oral submucous fibrosis (inability to open the mouth) caused due to areca quid chewing. The self-mouth mirror examination helped to create awareness against tobacco. What was learned: Awareness of cancer leading to early detection and treatment is possible in rural areas through “Cancer-Free Constituency”. The concept will help to pave the way for improved strategies and policies to better control occurrence and treatment of cancer and to address tobacco related health disparities across cancer care continuum.

The extraordinary (unplanned) review of clinical privileges is the means by which an organisation can manage specific complaints about individual practitioners’ clinical competence that require immediate investigation. To date, the extraordinary review of clinical privileges for doctors and dentists has not been the subject of much research and there is a pressing need for the evaluation and review of how different legislated and non-legislated administrative processes work and what they achieve. Although it seems a fair proposition that comprehensive processes for the evaluation of the clinical competence of doctors and dentists may improve the overall delivery of an organisation’s clinical services, in fact, little is known about the relationship between the safety and quality of specific clinical services, procedures and interventions and the efficiency or effectiveness of established methodologies for the routine or the extraordinary review of clinical privileges. The authors present a model of a structured approach to the extraordinary review of clinical privileges within a clinical governance framework in the Australian Capital Territory. The assessment framework uses a primarily qualitative methodology, underpinned by a process of systematic review of clinical competence against the agreed standards of the CanMEDS Physician Competency Framework. The model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction. What is known about the topic?In Australia, there is a national standard for credentialing and defining the scope of clinical practice for doctors working in hospital settings. However, there are no published reports in the national arena on established processes for the extraordinary review of clinical privileges for doctors or dentists and, despite the major inquiries investigating health system failures in Australian hospitals, the effectiveness and adequacy of existing processes for the extraordinary review of clinical privileges has not yet been prioritised nationally as an area for improvement or reform. Internationally, health care organisations have also been slow to establish frameworks for the management of complaints about doctors or dentists. What does this paper add?This paper makes a significant contribution to the national and international safety and quality literature by presenting an exposition of a working model for the extraordinary review of clinical privileges of doctors and dentists. The authors describe a methodology in the public health sector that is territory-wide (not hospital-based), peer-reviewed, objective, fair and responsive. Because the model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction, this paper provides an opportunity for policy makers and legislators to drive innovative change. Although incursions into the provision of care by other health professionals have been avoided, the model could be readily adopted by clinical leaders from the nursing and allied health professions. What are the implications for practitioners?An organisation dedicated to investigating serious complaints with a real sense of urgency, objectivity and transparency is far less likely to fester a climate of disquiet or anger amongst staff, or to trigger concerns of a ‘cover-up’ or disregard for accountability than an organisation not adopting such an approach. Anecdotal experience suggests the model has the potential to minimise, if not prevent, the occurrence of the kinds of complaints that become much-publicised in the media. This is positive because these types of damaging high profile cases often have the effect of diminishing community confidence in the health care system, in particular, confidence in the medical profession’s ability to self-regulate. Often, they also lead to a misrepresentation of the medical profession in the media, which is unfair since the overwhelming majority of doctors do meet the standards of their profession.

Background: The Claim Digital Verification System (VEDIKA) is a system developed by BPJS Healthcare to reduce claim of pending, accelerate the process of verifying claims, and reduce the operational burden of BPJS healthcare. This is as a follow-up to the emergence of hospital complaints regarding the implementation of INA CBG'S claim payment, The complaint has an impact on hospital satisfaction rate against BPJS healthcare decline. Purpose: This study aimed to described the VEDIKA BPJS Healthcare at the Regional Public Hospital of Sidoarjoin 2019. Methods: This descriptive research was condented by researcher at the regional public hospital of Sidoarjo during August – February 2020. The unit analysis in this research is the installation of the regional public hospital of Sidoarjo and the ample are installation head, inpatient Coordinator, outpatient Coordinator, 2 entry V-claim officer, 8 claim file Sender officers, control officers And antifraud officers. All colected data presented in descriptive or narative form. Analytical techniques using univariate analysis. Result: The results showed that the submission of claims at the Regional Public Hospital of Sidoarjowas adjusted to the VEDIKA system, the number of hospital staff supported the implementation of the VEDIKA system so that the implementation of the VEDIKA system at the Regional Public Hospital of Sidoarjo could be carried out properly. Conclusion: submiting claims at the Regional Public Hospital of Sidoarjo has adjusted to the VEDIKA BPJS Healthcare system but in the implementation of the VEDIKA system it is still not optimal in minimizing file returns, the use of the Vclaim application which often experience server downtime and maintenance class rights that do not appear in the system output and often occur differences perceptions between hospitals and BPJS healthcare are due to the regulation of service episodes and the accuracy of claim documents. Suggestion: the need for BPJS Healthcare to develop the Vclaim output, the need for hospitals to conduct coding for the accuracy of claim documents and conduct marking.ABSTRAKLatarbelakang : Sistem Verifikasi Digital Klaim (VEDIKA) merupakan sistem yang dikembangkan oleh BPJS kesehatan untuk mengurangi klaim yang tertunda, mempercepat proses verifikasi klaim, dan mengurangi beban operasional BPJS kesehatan. Adanya sistem VEDIKA berawal dari munculnya keluhan rumah sakit terkait penerapan pembayaran klaim INA CBG’s sehingga menurunkan kepuasan rumah sakit terhadap kinerja BPJS kesehatan. Tujuan : tujuan penelitian adalah menggambarkan sistem VEDIKA BPJS Kesehatan di RSUD Kabupaten Sidoarjo tahun 2019. Metode : Jenis penelitian yang digunakan dalam penelitian ini adalah Deskriptif dilakukan di instalasi Pejaminan RSUD Kabupaten Sidoarjo pada bulan Agustus – February 2020. Penelitian ini menggunakan unit analisis dengan mewawancarai semua petugas di instalasi penjaminan diantaranya kepala Instalasi, koordinator monev rawat inap, koordinator rawat jalan, 2 petugas entry Vclaim, 8 petugas pengirim berkas, tim kendali JKN dan tim antifraud. Teknik penyajian data dalam penelitian ini adalah bentuk uraian narasi. Teknik analisis menggunakan analisis univariat. Hasil: Hasil penelitian menunjukkan bahwa pengajuan klaim di RSUD Kabupaten Sidoarjo sudah menyesuaikan dengan sistem VEDIKA, jumlah petugas rumah sakit menunjang dalam pelaksanaan sistem VEDIKA sehingga implementasi sistem VEDIKA di RSUD kabupaten Sidoarjo dapat dilaksanakan dengan baik. Kesimpulan : Pengajuan klaim di RSUD Kabupaten Sidoarjo sudah menyesuaikan dengan sistem VEDIKA BPJS Kesehatan namun pada pelaksanaan sistem VEDIKA masih belum optimal dalam meminimalisir pengembalian berkas, penggunaan aplikasi Vclaim yang sering mengalami server down dan hak kelas perawatan yang tidak muncul pada output sistem serta sering terjadi perbedaan persepsi antara rumah sakit dan BPJS kesehatan diakibatkan tentang regulasi episode pelayanan dan keakuratan dokumen klaim. Saran : perlunya BPJS kesehatan untuk mengembangkan output Vclaim, perlunya rumah sakit untuk melakukan pelatihan pengkodingan untuk keakuratan dokumen klaim dan mengadakan bencmarking.

In Victoria, complaints against the police made by members of the public are predominantly investigated and determined by serving police officers. Such police-dominated complaints mechanisms are widely considered to be ineffective, and are being increasingly abandoned the world over. With reference to the obligations imposed by the International Covenant on Civil and Political Rights, this article critically examines Victoria’s police-dominated complaints mechanism and argues that it violates the right to an effective remedy contained in article 2 paragraph 3 of the Covenant. As a constituent state of a state party to the Covenant, Victoria is obliged to give effect to the Covenant’s obligations, and so must create an independent police complaints mechanism tasked with investigating complaints made against the police involving allegations of breaches of the Covenant’s protected rights.

Abstract Background Predominance of 2 antigenically drifted influenza viruses during the 2019–2020 season offered an opportunity to assess vaccine effectiveness against life-threatening pediatric influenza disease from vaccine-mismatched viruses in the United States. Methods We enrolled children aged &lt;18 years admitted to the intensive care unit with acute respiratory infection across 17 hospitals. Respiratory specimens were tested using reverse-transcription polymerase chain reaction for influenza viruses and sequenced. Using a test-negative design, we estimated vaccine effectiveness comparing odds of vaccination in test-positive case patients vs test-negative controls, stratifying by age, virus type, and severity. Life-threating influenza included death or invasive mechanical ventilation, vasopressors, cardiopulmonary resuscitation, dialysis, or extracorporeal membrane oxygenation. Results We enrolled 159 critically ill influenza case-patients (70% ≤8 years; 51% A/H1N1pdm09 and 25% B-Victoria viruses) and 132 controls (69% were aged ≤8 years). Among 56 sequenced A/H1N1pdm09 viruses, 29 (52%) were vaccine-mismatched (A/H1N1pdm09/5A+156K) and 23 (41%) were vaccine-matched (A/H1N1pdm09/5A+187A,189E). Among sequenced B-lineage viruses, majority (30 of 31) were vaccine-mismatched. Effectiveness against critical influenza was 63% (95% confidence interval [CI], 38% to 78%) and similar by age. Effectiveness was 75% (95% CI, 49% to 88%) against life-threatening influenza vs 57% (95% CI, 24% to 76%) against non-life-threating influenza. Effectiveness was 78% (95% CI, 41% to 92%) against matched A(H1N1)pdm09 viruses, 47% (95% CI, –21% to 77%) against mismatched A(H1N1)pdm09 viruses, and 75% (95% CI, 37% to 90%) against mismatched B-Victoria viruses. Conclusions During a season when vaccine-mismatched influenza viruses predominated, vaccination was associated with a reduced risk of critical and life-threatening influenza illness in children.

Abstract Aboriginal and Torres Strait Islanders have suffered violence and extreme prejudice in every walk of life as a result of the European colonisation of Australia. We acknowledge the ongoing colonial legacy to this suffering and discuss how cultural safety is a solution to overcoming some elements of the disadvantages that still beset Aboriginal and Torres Strait Islander people in terms of accessing health care. Accessible and culturally safe health services are critical in reducing health inequalities for First Nations’ people because of the burden of ill-health they experience. ‘Cultural safety’ in this context refers to approaches that strengthen and respectfully engage with Aboriginal and Torres Strait Islander cultures in mainstream services. Alongside holistic Indigenous health and primary prevention approaches, a broad range of medical, socio-cultural and allied health support is needed to alleviate these inequalities. In this article, we describe how the working relationship between Aboriginal Hospital Liaison Officers and Social Workers in public hospitals in Victoria, Australia, contributes to cultural safety, and thereby improves the quality of care and a reduction in discharges against medical advice by Aboriginal patients. We conclude that elements of this model may be applicable to improving care for First Nation peoples in other countries.

Emerging voices of patients in the form of opinions and expectations about the quality of care can improve healthcare service quality. A large volume of patients’ opinions as online doctor reviews (ODRs) are available online to access, analyze, and improve patients’ perceptions. This paper aims to explore COVID-19-related conversations, complaints, and sentiments using ODRs posted by users of the physician rating website. We analyzed 96,234 ODRs of 5,621 physicians from a prominent health rating website in the United Kingdom (Iwantgreatcare.org) in threetime slices (i.e., from February 01 to October 31, 2020). We employed machine learning approach, dynamic topic modeling, to identify prominent bigrams, salient topics and labels, sentiments embedded in reviews and topics, and patient-perceived root cause and strengths, weaknesses, opportunities, and threats (SWOT) analyses to examine SWOT for healthcare organizations. This method finds a total of 30 latent topics with 10 topics across each time slice. The current study identified new discussion topics about COVID-19 occurring from time slice 1 to time slice 3, such as news about the COVID-19 pandemic, violence against the lockdown, quarantine process and quarantine centers at different locations, and vaccine development/treatment to stop virus spread. Sentiment analysis reveals that fear for novel pathogen prevails across all topics. Based on the SWOT analysis, our findings provide a clue for doctors, hospitals, and government officials to enhance patients’ satisfaction and minimize dissatisfaction by satisfying their needs and improve the quality of care during the COVID-19 crisis.

Research evidence suggests children experiencing adversity are at risk of language disparities in early childhood. This puts these children at risk of poor language outcomes, perpetuating disadvantage in later development and academic life. This study aimed to investigate associations between Early Childhood Education and Care (ECEC) attendance, hours of attendance and quality in a cohort of 2-year-old children experiencing adversity with their language outcomes at age five. Pregnant women experiencing adversity, based on women meeting two or more of 10 factors on a brief risk factor survey, were recruited from maternity hospitals in Victoria and Tasmania, Australia. At age 2 years, ECEC data was collected via survey, including ECEC attendance, amount of time spent and ECEC quality (using the Australian government’s national measure of quality, the National Quality Standard assessment) ( n = 161). At age 5 years, child language outcomes were measured using a standardised language assessment. This data was analysed using logistic regressions and the non-parametric Kruskal–Wallis test to identify associations. After adjusting for potential confounders, we found language scores at age five were higher, on average, for children who attended ECEC at age two compared to those who did not attend. However, hours of attendance and ECEC quality, was not found to be associated with language outcomes. Findings suggest ECEC attendance in the early developmental years (birth to age 3 years) may be a protective factor against social disadvantage factors and contribute to positive language development for children experiencing adversity. This information is important for the ECEC sector, policymakers and families to advocate, enable and ensure high-quality ECEC is accessible, particularly for children experiencing adversity.

Abstract: In a competitive market, consumers are protected by law to avoid the risks and damages resulting from the asymmetry of position between the seller and the consumer, or the concept of “persons disadvantaged”. Taiwan (China) and Vietnam's consumer protection laws create all the necessary legal foundations that consumers can use during the consumption process and even in the event of damage, risk. The legislative experiences and the results of the implementation of regulations in Taiwan are also important lessons for Vietnam in the development of consumer law. Keywords: Taiwan, consumer law, disadvantaged, consumer protection. References: [1] United Nations (1985), Guidelines for Consumer protection. [2] Quốc hội Việt Nam (2010), Luật Bảo vệ người tiêu dùng. [3] Lập pháp viện Đài Loan (1994), Luật Bảo vệ người tiêu dùng, ban hành ngày 11/1/1994, bổ sung ngày 22/1/2003 và tháng 5 năm 2005. [4] Iain Ramsay (2007), Consumer law and policy: text and materials on regulating consumer markets, Oxford and Portland, Hart Publishing. [5] G.Corones & Philip.H.Clarke (1997), Consumer protection and Product liability law: commentary and materials, LBC Information services. [6] United Nations Educational, Scientific and Cultural Organization (2013), The principle of respect for human vulnerability and personal integrity - report of the International bioethics committee of UNESCO, UNESCO. [7] Eige Experts - Eige Europa (2013), E/2013/27-E/CN.6/2013/11, CSW Agreed conclusions on the elimination and prevention of all forms of violence against women and girls, para. 34. [8] Dennis E. Garrett và Peter G. Toumanoff (2010), Are consumers disadvantaged or vulnerable? An examination of consumer complaints to the better business bureau, The Journal of Consumer Affairs, vol.44, No.1 (Spring 2010), p.3-23. [9] Consumer Affairs Victoria (2004), What do we mean by ‘vulnerable’ and ‘disadvantaged’ consumers, Discussion paper. [10] Bairagya Ramsundar & Sarkar Shubhabrata (2013), Information Asymmetry - Consumer behavior and market equilibrium, Euro-Asian Journal of Economics and Finance, vol.1, Issue 1 (11/2013) p.33-40.

Abstract Background Nurses have limited time outside of work for continuing professional development. Consequently, strategies need to be explored to enable them to better maintain their competence. This article describes recent research investigating if nursing behaviours in the use of mobile technologies could be leveraged to better facilitate mobile learning. It addresses a gap in the existing literature around how nurses resource their own professional development and learning in the absence of appropriate learning resources in the workplace. Methods The research employed a classic grounded theory methodology which was conducted with 27 registered nurses from Public and Private Hospitals in Queensland and external postgraduate nursing students from Victoria, South Australia and the Northern Territory enrolled at the University of Southern Queensland. Results The Theory of Economising Learning describes how nurses maintain competence with limited resources. Unfavourable staffing levels and a fast-paced workplace mean that nurses rarely prioritise their professional learning while at work. Instead, it requires the nurse to contribute personal resources including time and money. Though the research revealed nurses were unconcerned about using mobile technologies, they were concerned about maintaining competence with limited resources. To counter this, nurses economised their learning by balancing personal resources against their motivation to maintain competence. The process of economising learning begins and ends with the development of the nurse’s personal curriculum in response to what they identify as being the most significant knowledge deficits at work that jeopardise their competence. A learning opportunity that addresses the knowledge deficit is sought. Nurses balance the opportunity to address the deficit against the cost of personal resources, to decide if they will engage with the opportunity and update their personal curriculum accordingly. Conclusions It is suggested that workplaces need to create reasonable expectations within nurses to address knowledge deficits and provide the resources, including time, to allow them to do so without personal cost. It is also necessary for workplaces to moderate the flow of learning opportunities so as not to overwhelm and demotivate the nurses. Currently, nurses use several strategies to optimise their learning using mobile technologies which could be leveraged in the workplace.

ObjectiveTo utilize syndromic surveillance data timely detecting herion overdose outbreaks in the community.IntroductionEarly detection of heroin overdose clusters is important in the current battle against the opioid crisis to effectively implement prevention and control measures. The New York State syndromic surveillance system collects hospital emergency department (ED) visit data, including visit time, chief complaint, and patient zip code. This data can be used to timely identify potential heroin overdose outbreaks by detecting spatial-temporal case clusters with scan statistic.MethodsHeroin overdose cases (Heroin_OD) were identified from ED visits by searching Heroin_OD key terms in the chief complaints. Then the space-time permutation model (using the SaTScan package) was applied to detect clusters of Heroin_OD. ED visit date served as the time variable and the case residential zip code was the spatial coordinate variable for the SaTScan analysis. A SAS program was developed to carry out the prospective scan statistics analysis weekly and produces reports of detected clusters in table and map format. Cluster detection parameters were set to detect heroin overdose aggregation in maximum geographic radium of 20 kilometer (km) and maximum time span up of 21 days at the P-value <= 0.05. Chief complaints within the clusters are reviewed to ensure accuracy of detection. Messages have been developed and are shared with community members including law enforcement and public health identifying the cluster and offering suggestions of activities that can occur at the local level to identify and address the cause of the cluster, as well as to reduce potential harm. This includes the 23 syringe exchange programs (SEPs) regulated by the New York State Department of Health.ResultsUsing ED visit data from 138 NY upstate hospitals, a total of 12 Heroin_OD clusters were detected by the SaTScan analysis during the period of 9/1/2016 through 9/17/2017. There were 845 cases identified. The average age was 35 years and ranged from 7 to 95 years. Sixty nine percent (69%) of the cases was in 20 to 39 age group and 66% in males. A cluster was identified earlier 2017 in Suffolk County, and the local SEP was alerted. This encouraged communication between partners within the alerted county which ultimately resulted in identifying the substance endangering people who used drugs in the area. It also helped public health to partner with public safety, ensuring that the availability of the substance was interrupted.ConclusionsAs the space-time permutation scan statistic only requires disease counts, event date and disease location, the method can be easily implemented for detecting disease outbreaks using data routinely collected from disease surveillance systems. The current study showed that scan statistic is a useful tool for identifying clusters of non-fatal overdoses from specific drugs. This method also returns important information to assist outbreak investigations, such as geographic location and time-span of the potential outbreaks.

Purpose Whistleblowing is one of the most imperative instruments to unveil wrongdoing. The purpose of this study is to explore the whys and wherefores of undertaking the act of whistleblowing by Indian nurses. This study also delves into the reasons that would stimulate the nurses' whistleblowing intentions and, on the contrary, the reasons that would keep them silent on encountering any wrongdoing. Design/methodology/approach This study incorporates interpretative phenomenological analysis, a qualitative method aiming to provide a detailed examination of the personal lived experiences of the nurses. This technique helps to understand the individual perspective of nurses. It, thus, allows the researchers to generate common themes from the data giving insightful and in-depth knowledge about the same. Findings The findings of this study suggest that nurses felt a sense of morality and responsibility toward the hospital, which motivated them to raise their voices to the concerned authorities within their organizations before reaching out to external agencies. The other motivators include peer and management support regarding the surety that appropriate action would be taken if reporting is done against the wrongdoer. On the other side, job loss or fear of harassment from peers and supervisors demotivates and discourages them from involving in the act of whistleblowing, especially in cases where they had dependents. Practical implications This study implies that hospitals/health-care units should provide an affirmative organizational culture to the nurses through sensitivity training that spreads awareness and a sense of responsibility. Also, setting favourable examples would help nurses gain motivation from the organization's past experiences. Having independent agencies to investigate whistleblowing complaints can be more encouraging than in-house management. Additionally, assurances by the government to protect the interest of the nurses who blow the whistle through anonymous whistleblowing and stringent rules for the job security of whistleblowers need to be aligned. Originality/value This study highlights the whistleblowing intention of Indian employees of the health-care sector, that is, nurses, which is the pioneer research work in the Indian context. In India, the profession of nurses is subjugated by females; hence, this study would contribute to the literature by looking at whistleblowing through gender predisposition. As the work of nurses is wholly based on patient advocacy, the ethical dilemma of raising their voices or remaining silent is very natural. This study brings about specific concerns related to the whistleblowing of women nurses and talks about the solutions that can be undertaken to encourage them to engage in the act of whistleblowing.

Objective: The objectives of this study are to (1) create a mental health syndrome definition for syndromic surveillance to monitor mental health-related ED visits in near real time; (2) examine whether CC data alone can accurately detect mental health related ED visits; and (3) assess the added value of using Dx data to detect mental health-related ED visits.Introduction: Between 2006 and 2013, the rate of emergency department (ED) visits related to mental and substance use disorders increased substantially. This increase was higher for mental disorders visits (55 percent for depression, anxiety or stress reactions and 52 percent for psychoses or bipolar disorders) than for substance use disorders (37 percent) visits [1]. This increasing number of ED visits by patients with mental disorders indicates a growing burden on the health-care delivery system. New methods of surveillance are needed to identify and understand these changing trends in ED utilization and affected underlying populations.Syndromic surveillance can be leveraged to monitor mental health-related ED visits in near real-time. ED syndromic surveillance systems primarily rely on patient chief complaints (CC) to monitor and detect health events. Some studies suggest that the use of ED discharge diagnoses data (Dx), in addition to or instead of CC, may improve sensitivity and specificity of case identification [2].Methods: We extracted a de-identified random sample of 50,000 ED visits with CC from the National Syndromic Surveillance Program (NSSP) for the period January 1—June 30, 2017. NSSP’s BioSense Platform receives ED data from >4000 hospitals, representing about 55 percent of all ED visits in the country [3]. From this sample we extracted 22868 ED visits that included both CC and Dx data. We then applied our mental health syndrome case definition which comprised mental health-related keywords and ICD-9-CM and ICD-10-CM codes. We queried CC text for the words “stress,” “PTSD,” “anxiety,” “depression,” “clinical depression,” “manic depression,” “unipolar depression,” “agitated,” “nervousness,” “mental health,” “mental disorder,” “affective disorder,” “schizoaffective disorder,” “psycoaffective disorder,” “obsessive-compulsive disorder,” “mood disorder,” “bipolar disorder,” “schizotypal personality disorder,” “panic disorder,” “psychosis,” “paranoia,” “psych,” “manic,” “mania,” “hallucinating,” “hallucination,” “mental episode,” and “mental illness.” We queried Dx fields either for ICD-9- CM codes 295-296; 300, 311 or for ICD-10-CM codes F20-F48. The ICD-9- CM and ICD-10-CM codes used to identify mental health-related ED visits are based on the mental health disorders most frequently seen in EDs. Alcohol and substance use, suicide ideation, and suicide attempt were excluded from this study because they are included in alternate syndromes [2]. We manually reviewed the CC text to validate the search terms. Sensitivity, specificity, and positive predictive value will be calculated based on agreement of coding mental health against the human review of mental health visits.Based on our case definition, the sample of 22868 ED visits with CC and Dx data was further stratified into two groups: (1) mental health identified in either CC or Dx, and (2) no mental health identified in CC and Dx. Group 1 was further stratified into three groups: (a) mental health identified only in CC, (b) mental health identified in both CC and Dx, and (c) mental health identified only in Dx. The sample of 27132 ED visits with CC and no Dx data was further stratified into two groups: (1) mental health identified in CC, and (2) no mental health identified in CC (Figure).Results: Of the 50,000 sample of ED visits with CC data, 22868 visits had both CC and Dx data. Of the 22868 visits, we identified 1560 mental health-related ED visits using the mental health syndrome case definition. Of those visits, 241 were identified by a CC only, 226 were identified by both CC and Dx, and 1093 by a mental health-related Dx. Of the 27132 ED visits without Dx data, 421 had mental health identified in CC.Conclusions: Based on our preliminary analysis these findings suggest potential benefits of including Dx data in syndrome binning for mental health. Mental health terms are more likely to be found in Dx data than in the CC (1093 vs. 662). Using CC alone may underestimate the number of mental health-related ED visits. This study had several limitations. Not all facilities reporting to NSSP provide chief complaint data in the same manner, some provide CC as a drop down menu with predefined terms while others include the full text of CC. Not all records contained a Dx code which limited our ability to examine the added value of Dx code for that subset.

ObjectiveWe present a new approach for pre-syndromic disease surveillance from free-text emergency department (ED) chief complaints, and evaluate the method using historical ED data from New York City’s Department of Health and Mental Hygiene (NYC DOHMH).IntroductionAn interdisciplinary team convened by ISDS to translate public health use-case needs into well-defined technical problems recently identified the need for new “pre-syndromic” surveillance methods that do not rely on existing syndromes or pre-defined illness categories1. Our group has recently developed Multidimensional Semantic Scan (MUSES), a pre-syndromic surveillance approach that (1) uses topic modeling to identify newly emerging syndromes that correspond to rare or novel diseases; and (2) uses multidimensional scan statistics to identify emerging outbreaks that correspond to these syndromes and are localized to a particular geography and/or subpopulation2,3. Through a blinded evaluation on retrospective free-text ED chief complaint data from NYC DOHMH, we demonstrate that MUSES has great potential to serve as a “safety net” for public health surveillance, facilitating a rapid, targeted, and effective response to emerging novel disease outbreaks and other events of relevance to public health that do not fit existing syndromes and might otherwise go undetected.MethodsMultidimensional semantic scan uses topic modeling to learn illness categories directly from the data, eliminating the need for pre-defined syndromes. Topic models are a set of algorithms that automatically summarize the content of large collections of documents by learning the main themes, or topics, contained in the documents4. Our method learns two sets of topics: a set of topics over the historical data designed to capture common illnesses, and a set of emerging topics over only the most recent data that are optimized to capture any new illnesses not captured by the historical topics. We then use multidimensional scan statistics to identify clusters of cases isolated to a certain topic, hospital, and/or demographic group of patients5.To evaluate the ability of MUSES to detect a diverse set of emerging patterns relevant to public health in large and complex data, we apply our algorithm to historical chief complaint data from NYC. This dataset has over 28 million ED cases from 53 NYC hospitals during 2010-2016. For each hospital we have data on the patients' free-text chief complaint, date and time of arrival, age group, gender and discharge ICD-9 diagnosis code. Public health practitioners at NYC DOHMH performed a blinded evaluation of the top 500 highest-scoring clusters detected by our method and by a competing state of the art keyword-based approach6,7,8. For each of these clusters, the evaluators indicated if the cluster (1) represents a meaningful collection of cases and (2) is, in their judgement, of significant interest to public health.ResultsThe blinded evaluation by NYC DOHMH demonstrated that our method correctly identifies a larger number of events of interest to public health than the baseline keyword-based scan method. 320 (64%) of the top 500 results from MUSES corresponded to meaningful health events, while the keyword-based method only detected 246 such events (49.2%). MUSES also identified 6 more highly relevant events and 74 less meaningless clusters than the keyword-based method. Figure 1 shows that for any fixed number of clusters that public health officials choose to examine, MUSES identifies more meaningful events than keyword-based scan. Alternatively, for any desired number of true clusters detected, MUSES exhibits substantially higher precision: for example, in order to identify 100 true clusters, it had to report 159 total clusters (precision = 63%) as compared to 225 total clusters (precision = 44%) for the keyword-based scan. This corresponds to a 53% reduction in the number of false positive clusters.Additionally, to determine how our approach might provide situational awareness of emerging health concerns following a natural disaster, we examined the clusters identified by our approach in the week following October 29, 2012, when Hurricane Sandy struck New York City and caused a historic level of damage. These results show a progression of clusters from acute cases related to falls and shortness of breath, to mental health issues like depression and anxiety, to chronic health issues that require maintenance procedures, like dialysis and methadone distribution. It is of note that public health officials manually inspected emergency room data immediately following Hurricane Sandy and noticed an increase in the words “methadone”, “dialysis” and “oxygen”7. The ability of MUSES to automatically identify similar symptoms as human experts highlights its ability to learn meaningful but novel combinations of symptoms.ConclusionsOur MUSES system offers a novel method for pre-syndromic surveillance that achieves the goals set forth by public health practitioners during the ISDS Consultancy. When evaluated against a state of the art baseline, MUSES identifies a larger number of events of interest, has a lower false positive rate, and produces more coherent results. This ability to report newly emerging case clusters of high relevance to public health, without overwhelming the user with a large number of false positives, suggest high potential utility of the approach for day-to-day operational use as a “safety net” for public health surveillance, complementing existing syndromic surveillance approaches. We are currently building a pre-syndromic surveillance system based on the MUSES approach and plan to make this software widely available to public health partners in the near future.References1. Faigen Z, Deyneka L, Ising A, et al. Cross-disciplinary consultancy to bridge public health technical needs and analytic developers: asyndromic surveillance use case. Online J. Public Health Inform. 2015;7(3).2. Maurya A, Murray K, Liu Y, Dyer C, Cohen WW, Neill DB. Semantic scan: detecting subtle, spatially localized events in text streams. 2016. arXiv preprint arXiv:1602.04393.3. Nobles, M., Deyneka, L., Ising, A., & Neill, D. B. Identifying emerging novel outbreaks in textual emergency department data. Online J. Public Health Inform. 2015;7(1).4. Blei D, Ng A, Jordan M. Latent Dirichlet allocation. J Mach Learn Res. 2003; 3:993-1022.5. Neill DB. Fast subset scan for spatial pattern detection. J. Royal Stat. Soc. B. 2012; 74(2):337-60.6. Burkom H, Elbert Y, Piatko C, Fink C. A term-based approach to asyndromic determination of significant case clusters. Online J. Public Health Inform. 2015;7(1).7. Lall R, Levin-Rector A, Mathes R, Weiss D. Detecting unanticipated increases in emergency department chief complaint keywords. Online J. Public Health Inform. 2014;6(1).8. Walsh A, Hamby T, St John TL. Identifying clusters of rare and novel words in emergency department chief complaints. Online J. Public Health Inform. 2013;6(1).

IntroductionAustralia is at a particular point in its history where there is a noticeable diaspora of artists and creative practitioners away from the major capitals of Sydney and Melbourne (in particular), driven in no small part by ballooning house prices of the last eight years. This has meant big changes for some regional spaces, and in turn, for the face of Australian cultural life. Regional cultural precincts are forming with tourist flows, funding attention and cultural economies. Likewise, there appears to be growing consciousness in the ‘art centres’ of Melbourne and Sydney of interesting and relevant activities outside their limits. This research draws on my experience as an art practitioner, curator and social researcher in one such region (Castlemaine in Central Victoria), and particularly from a recent interview series I have conducted in collaboration with art space in that region, Wide Open Road Art. In this, 23 regional and city-based artists were asked about the social, economic and local conditions that can and have supported their art practices. Drawing from these conversations and Bourdieu’s ideas around cultural production, the article suggests that authentic, diverse, interesting and disruptive creative practices in Australian cultural life involve the increasingly pressing need for security while existing outside the modern imperative of high consumption; of finding alternative ways to live well while entering into the shared space of cultural production. Indeed, it is argued that often it is the capacity to defy key economic paradigms, for example of ‘rational (economic) self-interest’, that allows creative life to flourish (Bourdieu Field; Ley “Artists”). While regional spaces present new opportunities for this, there are pitfalls and nuances worth exploring.Changes in Regional AustraliaAustralia has long been an urbanising nation. Since Federation our cities have increased from a third to now constituting two-thirds of the country’s total population (Gray and Lawrence 6; ABS), making us one of the most urbanised countries in the world. Indeed, as machines replaced manual labour on farms; as Australia’s manufacturing industry began its decline; and as young people in particular left the country for city universities (Gray and Lawrence), the post-war industrial-economic boom drove this widespread demographic and economic shift. In the 1980s closures of regional town facilities like banks, schools and hospitals propelled widespread belief that regional Australia was in crisis and would be increasingly difficult to sustain (Rentschler, Bridson, and Evans; Gray and Lawrence 2; Barr et al.; ABS). However, the late 1990s and early 21st century saw a turnaround that has been referred to by some as the rise of the ‘sea change’. That is, widespread renewed interest and idealisation of not just coastal areas but anywhere outside the city (Murphy). It was a simultaneous pursuit of “a small ‘a’ alternative lifestyle” and escape from rising living costs in urban areas, especially for the unemployed, single parents and those with disabilities (Murphy). This renewed interest has been sustained. The latest wave, or series of waves, have coincided with the post-GFC house price spike, of cheap credit and lenient lending designed to stimulate the economy. This initiative in part led to Sydney and Melbourne median dwelling prices rising by up to 114% in eight years (Scutt 2017), which alone had a huge influence on who was able to afford to live in city areas and who was not. Rapid population increases and diminished social networks and familial support are also considered drivers that sent a wave of people (a million since 2011) towards the outer fringes of the cities and to ‘commuter belt’ country towns (Docherty; Murphy). While the underprivileged are clearly most disadvantaged in what has actually been a global development process (see Jayne on this, and on the city as a consumer itself), artists and creatives are also a unique category who haven’t fared well with hyper-urbanisation (Ley “Artists”). Despite the class privilege that often accompanies such a career choice, the economic disadvantage art professions often involve has seen a diaspora of artists moving to regional areas, particularly those in the hinterlands around and train lines to major centres. We see the recent ‘rise of a regional bohemia’ (Regional Australia Institute): towns like Toowoomba, Byron Bay, Surf Coast, Gold Coast-Tweed, Kangaroo Valley, Wollongong, Warburton, Bendigo, Tooyday, New Norfolk, and countless more being re-identified as arts towns and precincts. In Australia in 2016–17, 1 in 6 professional artists, and 1 in 4 visual artists, were living in a regional town (Throsby and Petetskaya). Creative arts in regional Australia makes up a quarter of the nation’s creative output and is a $2.8 billion industry; and our regions particularly draw in creative practitioners in their prime productive years (aged 24 to 44) (Regional Australia Institute).WORA Conservation SeriesIn 2018 artist and curator Helen Mathwin and myself received a local shire grant to record a conversation series with 23 artists who were based in the Central Goldfields region of Victoria as well as further afield, but who had a connection to the regional arts space we run, WideOpenRoadArt (WORA). In videoed, in-depth, approximately hour-long, semi-structured interviews conducted throughout 2018, we spoke to artists (16 women and 7 men) about the relocation phenomenon we were witnessing in our own growing arts town. Most were interviewed in WORA’s roving art float, but we seized any ad hoc opportunity we had to have genuine discussions with people. Focal points were around sustainability of practice and the social conditions that supported artists’ professional pursuits. This included accessing an arts community, circles of cultural production, and the ‘art centre’; the capacity to exhibit; but also, social factors such as affordable housing and the ability to live on a low-income while having dependants; and so on. The conversations were rich with lived experiences and insights on these issues.Financial ImperativesIn line with the discussion above, the most prominent factor we noticed in the interviews was the inescapable importance of being able to live cheaply. The consistent message that all of the interviewees, both regional- and city-based, conveyed was that a career in art-making required an important independence from the need to earn a substantial income. One interviewee commented: “I do run my art as a business, I have an ABN […] it makes a healthy loss! I don’t think I’ve ever made a profit […].” Another put it: “now that I’m in [this] town and I have a house and stuff I do feel like there is maybe a bit more security around those daily things that will hopefully give me space to [make artworks].”Much has been said on the pervasive inability to monetise art careers, notably Bourdieu’s observations that art exists on an interdependent field of cultural capital, determining for itself an autonomous conception of value separate to economics (Bourdieu, Field 39). This is somewhat similar to the idea of art as a sacred phenomenon irreducible to dollar terms (Abbing 38; see also Benjamin’s “aura”; “The Work of Art”). Art’s difficult relationship with commodification is part of its heroism that Benjamin described (Benjamin Charles Baudelaire 79), its potential to sanctify mainstream society by staying separate to the lowly aspirations of commerce (Ley “Artists” 2529). However, it is understood, artists still need to attain professional education and capacities, yet they remain at the bottom of the income ladder not only professionally, but in the case of visual artists, they remain at the bottom of the creative income hierarchies as well. Further to this, within visual arts, only a tiny proportion achieve financially backed success (Menger 277). “Artistic labour markets are characterised by high risk of failure, excess supply of recruits, low artistic income level, skewed income distribution and multiple jobholding” (Mangset, Torvik Heian, Kleppe, and Løyland; Menger). Mangset et al. point to ideas that have long surrounded the “charismatic artist myth,” of a quasi-metaphysical calling to be an artist that can lead one to overlook the profession’s vast pitfalls in terms of economic sustainability. One interviewee described it as follows: “From a very young age I wanted to be an artist […] so there’s never been a time that I’ve thought that’s not what I’m doing.” A 1% rule seems widely acknowledged in how the profession manages the financial winners against those who miss out; the tiny proportion of megastar artists versus a vast struggling remainder.As even successful artists often dip below the poverty line between paid engagements, housing costs can make the difference between being able to live in an area and not (Turnbull and Whitford). One artist described:[the reason we moved here from Melbourne] was financial, yes definitely. We wouldn’t have been able to purchase a property […] in Melbourne, we would not have been able to live in place that we wanted to live, and to do what we wanted to do […]. It was never an option for us to get a big mortgage.Another said:It partly came about as a financial practicality to move out here. My partner […] wanted to be in the bush, but I was resistant at first, we were in Melbourne but we just couldn’t afford Melbourne in the end, we had an apartment, we had a studio. My partner was a cabinet maker then. You know, just every month all our money went to rent and we just couldn’t manage anymore. So we thought, well maybe if we come out to the bush […] It was just by a happy accident that we found a property […] that we could afford, that was off-grid so it cut the bills down for us [...] that had a little studio and already had a little cottage on there that we could rent that out to get money.For a prominent artist we spoke to this issue was starkly reflected. Despite large exhibitions at some of the highest profile galleries in regional Victoria, the commissions offered for these shows were so insubstantial that the artist and their family had to take on staggering sums of personal debt to execute the ambitious and critically acclaimed shows. Another very successful artist we interviewed who had shown widely at ‘A-list’ international arts institutions and received several substantial grants, spoke of their dismay and pessimism at the idea of financial survival. For all artists we spoke to, pursuing their arts practice was in constant tension with economic imperatives, and their lives had all been shaped by the need to make shrewd decisions to continue practising. There were two artists out of the 23 we interviewed who considered their artwork able to provide full-time income, although this still relied on living costs remaining extremely low. “We are very lucky to have bought a very cheap property [in the country] that I can [also] have my workshop on, so I’m not paying for two properties in Melbourne […] So that certainly takes a fair bit of pressure off financially.” Their co-interviewee described this as “pretty luxurious!” Notably, the two who thought they could live off their art practices were both men, mid-career, whose works were large, spectacular festival items, which alongside the artists’ skill and hard work was also a factor in the type of remuneration received.Decongested LivingBeyond more affordable real estate and rental spaces, life outside our cities offers other benefits that have particular relevance to creative practitioners. Opera and festival director Lindy Hume described her move to the NSW South Coast in terms of space to think and be creative. “The abundance of time, space and silence makes living in places like [Hume’s town] ideal for creating new work” (Brown). And certainly, this was a theme that arose frequently in our interviews. Many of our regionally based artists were in part choosing the de-pressurised space of non-metro areas, and also seeking an embedded, daily connection to nature for themselves, their art-making process and their families. In one interview this was described as “dreamtime”. “Some of my more creative moments are out walking in the forest with the dog, that sort of semi-daydreamy thing where your mind is taken away by the place you’re in.”Creative HubsAll of our regional interviewees mentioned the value of the local community, as a general exchange, social support and like-minded connection, but also specifically of an arts community. Whether a tree change by choice or a more reactive move, the diaspora of artists, among others, has led to a type of rural renaissance in certain popular areas. Creative hubs located around the country, often in close proximity to the urban centres, are creating tremendous opportunities to network with other talented people doing interesting things, living in close proximity and often open to cross-fertilisation. One said: “[Castlemaine] is the best place in Australia, it has this insane cultural richness in a tiny town, you can’t go out and not meet people on the street […] For someone who has not had community in their life that is so gorgeous.” Another said:[Being an artist here] is kind of easy! Lots of people around to connect—with […] other artists but also creatively minded people [...] So it means you can just bump into someone from down the street and have an amazing conversation in five minutes about some amazing thing! […] There’s a concentration here that works.With these hubs, regional spaces are entering into a new relevance in the sphere of cultural production. They are generating unique and interesting local creative scenes for people to live amongst or visit, and generating strong local arts economies, tourist economies, and funding opportunities (Rentschler, Bridson, and Evans). Victoria in particular has burgeoned, with tourist flows to its regions increasing 13 per cent in 5 years and generating tourism worth $10 billion (Tourism Victoria). Victoria’s Greater Bendigo is Australia’s most popularly searched tourist destination on Trip Advisor, with tourism increasing 52% in 10 years (Boland). Simultaneously, funding flows have increased to regional zones, as governments seek to promote development outside Australia’s urban centres and are confident in the arts as a key strategy in boosting health, economies and overall wellbeing (see Rentschler, Bridson, and Evans; see also the 2018 Regional Centre for Culture initiative, Boland). The regions are also an increasingly relevant participant in national cultural life (Turnbull and Whitford; Mitchell; Simpson; Woodhead). Opportunities for an openness to productive exchange between regional and metropolitan sites appear to be growing, with regional festivals and art events gaining importance and unique attributes in the consciousness of the arts ‘centre’ (see for example Fairley; Simpson; Farrelly; Woodhead).Difficulties of Regional LocationDespite this, our interviews still brought to light the difficulties and barriers experienced living as a regional artist. For some, living in regional Victoria was an accepted set-back in their ambitions, something to be concealed and counteracted with education in reputable metropolitan art schools or city-based jobs. For others there was difficulty accessing a sympathetic arts community—although arts towns had vibrant cultures, certain types of creativity were preferred (often craft-based and more community-oriented). Practitioners who were active in maintaining their links to a metropolitan art scene voiced more difficulty in fitting in and successfully exhibiting their (often more conceptual or boundary-pushing) work in regional locations.The Gentrification ProblemThe other increasingly obvious issue in the revivification of some non-metropolitan areas is that they can and are already showing signs of being victims of their own success. That is, some regional arts precincts are attracting so many new residents that they are ceasing to be the low-cost, hospitable environments for artists they once were. Geographer David Ley has given attention to this particular pattern of gentrification that trails behind artists (Ley “Artists”). Ley draws from Florida’s ideas of late capitalism’s ascendency of creativity over the brute utilitarianism of the industrial era. This has got to the point that artists and creative professionals have an increasing capacity to shape and generate value in areas of life that were previous overlooked, especially with built environments (2529). Now more than ever, there is the “urbane middle-class” pursuing ‘the swirling milieu of artists, bohemians and immigrants” (Florida) as they create new, desirable landscapes with the “refuse of society” (Benjamin Charles Baudelaire 79; Ley New Middle Class). With Australia’s historic shifts in affordability in our major cities, this pattern that Ley identified in urban built environments can be seen across our states and regions as well.But with gentrification comes increased costs of living, as housing, shops and infrastructure all alter for an affluent consumer-resident. This diminishes what Bourdieu describes as “the suspension and removal of economic necessity” fundamental to the avant-garde (Bourdieu Distinction 54). That is to say, its relief from heavy pressure to materially survive is arguably critical to the reflexive, imaginative, and truly new offerings that art can provide. And as argued earlier, there seems an inbuilt economic irrationality in artmaking as a vocation—of dedicating one’s energy, time and resources to a pursuit that is notoriously impoverishing. But this irrationality may at the same time be critical to setting forth new ideas, perspectives, reflections and disruptions of taken-for-granted social assumptions, and why art is so indispensable in the first place (Bourdieu Field 39; Ley New Middle Class 2531; Weber on irrationality and the Enlightenment Project; also Adorno’s the ‘primitive’ in art). Australia’s cities, like those of most developed nations, increasingly demand we busy ourselves with the high-consumption of modern life that makes certain activities that sit outside this almost impossible. As gentrification unfolds from the metropolis to the regions, Australia faces a new level of far-reaching social inequality that has real consequences for who is able to participate in art-making, where these people can live, and ultimately what kind of diversity of ideas and voices participate in the generation of our national cultural life. ConclusionThe revival of some of Australia’s more popular regional towns has brought new life to some regional areas, particularly in reshaping their identities as cultural hubs worth experiencing, living amongst or supporting their development. Our interviews brought to life the significant benefits artists have experienced in relocating to country towns, whether by choice or necessity, as well as some setbacks. It was clear that economics played a major role in the demographic shift that took place in the area being examined; more specifically, that the general reorientation of social life towards consumption activities are having dramatic spatial consequences that we are currently seeing transform our major centres. The ability of art and creative practices to breathe new life into forgotten and devalued ideas and spaces is a foundational attribute but one that also creates a gentrification problem. Indeed, this is possibly the key drawback to the revivification of certain regional areas, alongside other prejudices and clashes between metro and regional cultures. It is argued that the transformative and redemptive actions art can perform need to involve the modern irrationality of not being transfixed by matters of economic materialism, so as to sit outside taken-for-granted value structures. This emphasises the importance of equality and open access in our spaces and landscapes if we are to pursue a vibrant, diverse and progressive national cultural sphere.ReferencesAbbing, Hans. Why Artists Are Poor: The Exceptional Economy of the Arts. Amsterdam: Amsterdam UP, 2002.Adorno, Theodor. Aesthetic Theory. London: Routledge, 1983.Australian Bureau of Statistics. “Population Growth: Capital City Growth and Development.” 4102.0—Australian Social Trends. Canberra: Australian Bureau of Sttaistics, 1996. <http://www.abs.gov.au/ausstats/abs@.nsf/2f762f95845417aeca25706c00834efa/924739f180990e34ca2570ec0073cdf7!OpenDocument>.Barr, Neil, Kushan Karunaratne, and Roger Wilkinson. Australia’s Farmers: Past, Present and Future. Land and Water Resources Research and Development Corporation, 2005. 1 Mar. 2019 <http://inform.regionalaustralia.org.au/industry/agriculture-forestry-and-fisheries/item/australia-s-farmers-past-present-and-future>.Benjamin, Walter. Charles Baudelaire: A Lyric Poet in the Era of High Capitalism. London: NLB, 1973.———. “The Work of Art in the Age of Mechanical Reproduction.” Illuminations. Ed. Hannah Arendt. Trans. Harry Zohn. 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New York: Columbia UP, 1993.Brown, Bill. “‘Restless Giant’ Lures Queensland Opera’s Artistic Director Lindy Hume to the Regional Art Movement.” ABC News 13 Sep. 2017. 10 Mar. 2019 <https://www.abc.net.au/news/2017-09-12/regional-creative-industries-on-the-rise/8895842>.Docherty, Glenn. “Why 5 Million Australians Can’t Get to Work, Home or School on Time.” Sydney Morning Herald 17 Feb. 2019. 10 Mar. 2019 <https://www.smh.com.au/national/why-5-million-australians-can-t-get-to-work-home-or-school-on-time-20190215-p50y1x.html>.Fairley, Gina. “Big Hit Exhibitions to See These Summer Holidays.” Arts Hub 14 Dec. 2018. 1 Mar. 2019 <https://visual.artshub.com.au/news-article/news/visual-arts/gina-fairley/big-hit-exhibitions-to-see-these-summer-holidays-257016>.Farrelly, Kate. “Bendigo: The Regional City That’s Transformed into a Foodie and Cultural Hub.” Domain 9 Apr. 2019. 10 Mar. 2019 <https://www.domain.com.au/news/bendigo-the-regional-city-you-didnt-expect-to-become-a-foodie-and-cultural-hub-813317/>.Florida, Richard. “A Creative, Dynamic City Is an Open, Tolerant City.” The Globe and Mail 24 Jun. 2002: T8.Gray, Ian, and Geoffrey Lawrence. A Future For Regional Australia: Escaping Global Misfortune. Cambridge: Cambridge University Press, 2001.Hume, Lindy. Restless Giant: Changing Cultural Values in Regional Australia. Strawberry Hills: Currency House, 2017.Jayne, Mark. Cities and Consumption. London: Routledge, 2005.Ley, David. The New Middle Class and the Remaking of the Central City. Oxford: Oxford University Press, 1996.———. “Artists, Aestheticisation and Gentrification.” Urban Studies 40.12 (2003): 2527–44.Menger, Pierre-Michel. “Artistic Labor Markets: Contingent Works, Excess Supply and Occupational Risk Management.” Handbook of the Economics of Art and Culture. Eds. Victor Ginsburgh and David Throsby. Amsterdam: Elsevier, 2006. 766–811.Mangset, Per, Mari Torvik Heian, Bard Kleppe and Knut Løyland. “Why Are Artists Getting Poorer: About the Reproduction of Low Income among Artists.” International Journal of Cultural Policy 24.4 (2018): 539-58.Mitchell, Scott. “Want to Start Collecting Art But Don’t Know Where to Begin? Trust Your Own Taste, plus More Tips.” ABC Life, 31 Mar. 2019 <https://www.abc.net.au/life/tips-for-buying-art-starting-collection/10084036>.Murphy, Peter. “Sea Change: Re-Inventing Rural and Regional Australia.” Transformations 2 (March 2002).Regional Australia Institute. “The Rise of the Regional Bohemians.” Regional Australia Institute 24 May. 2017. 1 Mar. 2019 <http://www.regionalaustralia.org.au/home/2017/05/rise-regional-bohemians-painting-new-picture-arts-culture-regional-australia/>.Rentschler, Ruth, Kerrie Bridson, and Jody Evans. Regional Arts Australia Stats and Stories: The Impact of the Arts in Regional Australia. Regional Arts Australia [n.d.]. <https://www.cacwa.org.au/documents/item/477>.Simpson, Andrea. “The Regions: Delivering Exceptional Arts Experiences to the Community.” ArtsHub 11 Apr. 2019. <https://visual.artshub.com.au/news-article/sponsored-content/visual-arts/andrea-simpson/the-regions-delivering-exceptional-arts-experiences-to-the-community-257752>.

It seems clear that people who are deaf ... struggle continually against the meanings that others impose on their experience, and the way that this separates them from others. They struggle for acknowledgement of the way they see their lives and wish to live them, and aspire to connection?with other people, to share and belong. (David Moorhead. Knowing Who I Am. 1995. 85.) Nga Tapuwae and Before I am deaf but, before that part of my life started, I was hearing and worked for many years as a librarian in New Zealand. My first job was in a public library located within a secondary school Nga Tapuwae Secondary College in South Auckland. Its placement was a 1970’s social experiment to see if a public library could work within the grounds of a community college (and the answer was no, it could not). The experience was a great introduction for me to the Maori and Polynesian cultures that I had not previously encountered. Until then, I was wary of both groups, and so it was a revelation to realise that although there were many social problems in the area including low literacy, many of the children and teenagers were bright, talented individuals. They simply did not connect to the Anglo-Saxon reading materials we offered. Years later, my interest in the social dynamics of literacy led to my enrolment in a post-graduate literacy degree in Melbourne. This action may have saved my life because at the end of this course, a minor ailment resulted in a visit to the university doctor who diagnosed me with the life-threatening medical condition, Neurofibromatosis Type 2 (NF 2). NF2 is a late onset genetic condition in which one’s body grows tumours, always on both hearing nerves, sometimes elsewhere as well. The tumours usually cause deafness and can cause death. I was told I needed to have my tumours removed and would probably become fully deaf as a result. This is how my life as I knew it changed direction and I started the long journey towards becoming deaf. Diagnosis and Change Predictably, once diagnosed, friends and colleagues rallied to comfort me. I was told things probably weren’t as bad as they sounded. Helen Keller was mentioned several times as an example of someone who had succeeded despite being deaf and blind. ‘Really,’ my friends asked, ‘how bad can it be? ‘Inside myself however, it couldn’t have been worse. A day later the enormity of it all hit me and I became inconsolable. A friend drove me back to the doctor and she did two things that were to change my life. She referred me to the University’s counselling services where, happily, I was counselled by Elizabeth Hastings who later went on to become Australia’s first Disability Services Commissioner. Secondly, the doctor organised for me to visit the HEAR Service at the Victorian Deaf Society (VDS). Again by happy accident, my friend and I stumbled into the ‘wrong building’ where I ended up meeting John Lovett, who was Deaf and the CEO there, via an interpreter. When I met John Lovett I was distraught but, unlike other people, he made no attempt to stop me crying. He simply listened carefully until I realised he understood what I was saying and stopped crying myself. He said my fears that I could end up alone and lonely were valid and he suggested the best thing I could do for myself was to join the ‘Deaf community’; a community. I had never heard of. He explained it was made up of people like him who used Australian sign language (Auslan) to communicate. He was so engaging and supportive that this plan sounded fine to me. By the time we finished talking and he walked me over to the HEAR Service, I was so in his thrall that I had enrolled for a Deaf awareness workshop, an Auslan class, and had plans to join the Deaf community. Had I stayed on and learned Auslan, my life may well have followed a different path, but this was not to be at that time. Becoming Hearing Impaired (HI) Across at the HEAR service, an alternate view of my potential future was put to me. Instead of moving away from everything familiar and joining the Deaf community, I could learn to lip-read and hopefully use it to stay in the workforce and amongst my hearing friends. I had a cousin and aunt who were late deafened; my cousin in particular was doing well communicating with lip-reading. I discussed this with friends and the idea of staying with the people I already knew sounded far less confronting than joining the Deaf community and so I chose this path. My surgeon was also optimistic. He was confident he could save some of my hearing. Suddenly learning Auslan seemed superfluous. I phoned John Lovett to explain, and his response was that I should do what suited me, but he asked me to remember one thing: that it was me who decided to leave the Deaf Community, not that the Deaf community had not wanted me. He told me that, if I changed my mind, I could always go back because the door to the Deaf community would always be open and he would be still be there. It would be a decade before I decided that I wanted to go back through that door, and around that time this great man passed away, but I never forgot my promise to remember our conversation. It, and a few other exchanges I had with him in the following years, stayed at the back of my mind, especially as my residual hearing sank over the years, and the prospect of total deafness hung over me. When I had the surgery, my surgeon’s optimism proved unfounded. He could not save any hearing on my left side and my facial and balance nerves were damaged as well. The hospital then decided not to operate again, and would only attempt to remove the second tumour if it grew and threatened my health again. Consequently, for close to a decade, my life was on hold in many ways. I feared deafness—for me it signalled that my life as I knew it would end and I would be isolated. Every hearing test was a tense time for me as I watched my remaining hearing decline in a slow, relentless downward path on the graph. It was like watching the tide go out knowing it was never going to come in as fully again. My thinking started to change too. Within a week of my diagnosis I experienced discrimination for the first time. A library school that had offered me a place in its post graduate librarianship course the following year made it clear that they no longer wanted me. In the end it did not matter as I was accepted at another institution but it was my first experience of being treated less favourably in the community and it was a shock. After the surgery my life settled down again. I found work in public libraries again, rekindled an old relationship and in 1994 had a baby boy. However, living with a hearing loss is hard work. Everything seemed tiring, especially lip-reading. My ears rejected my hearing aid and became itchy and inflamed. I became aware that my continual hearing problems were sometimes seen as a nuisance in work situations. Socialising lost a lot of its appeal so my social world also contracted. Around this time something else started happening. Outside work, people started expressing admiration for me—words like ‘role model’ and ‘inspiring’ started entering the conversation. Any other time I might have enjoyed it but for me, struggling to adapt to my new situation, it felt odd. The whole thing reminded me of being encouraged to be like Helen Keller; as if there is a right way to behave when one is deaf in which you are an inspiration, and a wrong way in which one is seen as being in need of a role model. I discussed this with Elizabeth Hastings who had helped me prepare mentally for the surgery and afterwards. I explained I felt vulnerable and needy in my new situation and she gave me some useful advice. She thought feeling needy was a good thing as realising one needs people keeps one humble. She observed that, after years of intellectualising, educated people sometimes started believing they could use intellectualisation as a way to avoid painful emotions such as sadness. This behaviour then cut them off from support and from understanding that none of us can do it alone. She believed that, in always having to ask for help, people with disabilities are kept aware of the simple truth that all people depend on others to survive. She said I could regard becoming deaf as a disability, or I could choose to regard it as a privilege. Over the years the truth of her words became increasingly more evident to me as I waded through all the jargon and intellectualisation that surrounds discussion of both deafness and the disability arena, compared to the often raw emotion expressed by those on the receiving end of it. At a personal level I have found that talking about emotions helps especially in the face of the ubiquitous ‘positive thinking’ brigade who would have us all believe that successful people do not feel negative emotions regardless of what is happening. The Lie Elizabeth had initially sympathised with my sadness about my impending deafness. One day however she asked why, having expressed positive sentiments both about deaf people and people with disabilities, I was saying I would probably be better off dead than deaf? Up until that conversation I was unaware of the contradictions between what I felt and what I was saying. I came to realise I was living a lie because I did not believe what I was telling myself; namely, that deaf people and people with disabilities are as good as other people. Far from believing this, what I really thought was that being deaf, or having a disability, did lessen one’s worth. It was an uncomfortable admission, particularly sharing it with someone sitting in a wheelchair, and especially as up until then I had always seen myself as a liberal thinker. Now, faced with the reality of becoming deaf, I had been hoist by my own petard, as I could not come to terms with the idea of myself as a deaf person. The Christian idea of looking after the ‘less fortunate’ was one I had been exposed to, but I had not realised the flip side of it, which is that the ‘less fortunate’ are also perceived as a ‘burden’ for those looking after them. It reminded me of my initial experiences years earlier at Nga Tapuwae when I came face to face with cultures I thought I had understood but did not. In both cases it was only when I got to know people that I began to question my own attitudes and assumptions and broadened my thinking. Unfortunately for deaf people, and people with disabilities, I have not been the only person lying to myself. These days it is not common for people to express their fears about deaf people or people with disabilities. People just press on without fully communicating or understanding the other person’s attitude or perspectives. When things then do not work out, these failures reinforce the misconceptions and these attitudes persist. I believe it is one of the main reasons why true community inclusion for deaf and people with disabilities is moving so slowly. Paying for access is another manifestation of this. Everyone is supportive of access in principle but there is continuous complaint about paying for things such as interpreting. The never-ending discussions between deaf people and the wealthy movie industry about providing more than token access to captioned cinema demonstrate that the inclusion lie is alive and well. Until it can be effectively addressed through genuine dialogue, deaf people, hard of hearing people and people with disabilities will always be largely relegated to life outside the mainstream. Collectively we will also continue to have to endure this double message that we are of equal value to the community while simultaneously being considered a financial burden if we try to access it in ways that are meaningful to us. Becoming Deaf In 2002 however all this thinking still lay ahead of me. I still had some hearing and was back living in New Zealand to be close to my family. My relationship had ended and I was a solo mother. My workplace had approved leave of absence, and so I still had my job to go back to in Melbourne if I wanted it. However, I suspected that I would soon need the second tumour removed because I was getting shooting pains down my face. When my fears were confirmed I could not decide whether to move back to Melbourne or let the job go, and risk having trouble finding one if I went back later. I initially chose to stay longer as my father was sick but eventually I decided Melbourne was where I wanted to be especially if I was deaf. I returned, found temporary employment, and right up to the second surgery I was able to work as I could make good use of the small amount of hearing I still had. I thought that I would still be able to cope when I was made fully deaf as a result of the surgery. It was, after all, only one notch down on the audiogram and I was already ‘profoundly deaf’ and still working. When I woke up after the surgery completely deaf, it felt anti-climactic. The world seemed exactly the same, just silent. At home where I was surrounded by my close family and friends everything initially seemed possible. However, when my family left, it was just my seven-year-old son and myself again, and on venturing back into the community, it quickly became clear to me that at some level my status had changed. Without any cues, I struggled to follow speech and few people wanted to write things down. Although my son was only seven, people communicated with him in preference to me. I felt as if we had changed roles: I was now the child and he was the adult. Worse was soon to follow when I tried to re-enter the workforce. When I had the surgery, the hospital had installed a gadget called an auditory brainstem implant, (ABI) which they said would help me hear. An ABI is similar to a cochlear implant but it is attached to the brainstem instead of the cochlear nerve. My cochlear nerve was removed. I hoped my ABI would enable me to hear enough to find work but, aside from clinical conditions in which there was no background noise and the staff knew how to assist, it did not work. My most humiliating moment with it came when it broke down mid job interview and I spent half the time left trying to get it going again in full view of the embarrassed interview panel, and the other half trying to maintain my composure whilst trying to lip-read the questions. The most crushing blow came from the library where I had happily worked for seven years at middle management level. This library was collaborating with another institution to set up a new library and they needed new staff. I hopefully applied for a job at the same level I had worked at prior to becoming deaf but was unsuccessful. When I asked for feedback, I was told that I was not seen as having the skills to work at that level. My lowest point came when I was refused a job unpacking boxes of books. I was told I did not have experience in this area even though, as any librarian will attest, unpacking boxes is part of any librarian’s work. When I could not find unskilled work, it occurred to me that possibly I would never work again. While this was unfolding, my young son and I went from being comfortable financially to impoverished. My ex-partner also decided he would now make childcare arrangements directly with my son as he was annoyed at being expected to write things down for me. My relationship with him, some family members, and my friends were all under strain at that time. I was lost. It also became clear that my son was not coping. Although he knew the rudiments of Auslan, it was not enough for us to communicate sufficiently. His behaviour at school deteriorated and one night he became so frustrated trying to talk to me that he started to pull out his own hair. I calmed him and asked him to write down for me what he was feeling and he wrote down ‘It is like you died. It is like I don’t have a Mum now’. It was now clear to me that although I still had my friends, nobody including myself knew what to do. I realised I had to find someone who could understand my situation and I knew now it had to be a Deaf person. Fortunately, by this stage I was back learning Auslan again at La Trobe University. The week after the conversation with my son, I told my Auslan teacher what had happened. To my relief she understood my situation immediately. She told me to bring my son to class, at no cost, and she would teach him herself. I did and my life started to turn around. My son took to Auslan with such speed and application that he was able to not only converse with her in one month but immediately started using Auslan with me at home to get the things he wanted. We were able to re-establish the mother/son relationship that we both needed. I was also able to help my son talk through and deal with all the changes that me becoming deaf had foisted upon him. He still uses Auslan to talk to me and supplements it using speech, copious finger spelling, notes and diagrams. More than anything else, this relationship has kept me anchored to my long-term goal of becoming a clear signer. Encouraged by my son’s success, I put all my energy into learning Auslan and enrolled in a full time TAFE Auslan course. I also joined a chat group called ‘Here to Hear’ (H2H). The perspectives in the group ranged from strongly oral to strongly Deaf but for me, trying to find a place to fit in any of it, it was invaluable. Almost daily I chatted with the group, asking questions and invariably someone responded. The group acted as a safety net and sounding board for me as I worked out the practicalities of living life deaf. The day of my fateful interview and the ABI humiliation, I came home so shaken that I used the Irish remedy of a couple of swigs of whisky, and then went online and posted an account of it all. I can still remember the collective indignation of the group and, as I read the responses, beginning to see the funny side of it . . . something I could not have done alone. I also made use of easy access to Deaf teachers at TAFE and used that to listen to them and ask advice on situations. I found out for example, that if I instructed my son to stand behind me when people in shops insisted on addressing him, they had no alternative but to talk to me; it was a good clear message to all concerned that my son was the child in this relationship. About this time, I discovered the Disability Discrimination Act (DDA) that Elizabeth Hastings had worked so hard on, filed my first DDA complaint, and received my first apology at the mediation session that followed. My personal life also improved, relationship by relationship as everyone adjusted. Slowly the ice melted in most of my relationships; some relationships faded and were replaced with new ones with signing people, and eventually hearing people again. My life moved forward. Through a member of ‘Here to Hear’, I was invited to apply for my first post deaf job—covering holiday leave at a Deaf sports organisation. I practically finger-spelt my way through the interview but not only did they offer me the job, they were delighted to have me. I was able to buy a few things with the money I earned, and suddenly it felt as if everything was possible again. This acceptance of me by Deaf people had a profound impact on me. I mixed with people more, and it was not too long before I was able to use my basic signing skills to use Auslan interpreters and re-enter the workplace. I have discovered over time that living in silence also has advantages—no more noisy parties or rubbish trucks clanging at dawn and in its place a vastly heightened visual awareness that I enjoy. Before I was deaf I thought it would be lonely in the silence but in fact many of life’s best moments—watching rain hit and then run down a window, swimming in the sea, cooking and being with good friends—do not rely upon sound at all; they feel the same way they always did. Sometimes I have felt somewhat of an outsider in the Deaf community. I have sometimes been taken aback by people’s abruptness but I have learned over time that being succinct is valued in Auslan, and some people like to come straight to the point. At crisis points, such as when I asked for help at the Victorian Deaf Society and my Auslan class, it has been a huge relief to talk to Deaf people and know immediately that they understand just from reading their eyes. Having access to an additional world of deaf people has made my life more enjoyable. I feel privileged to be associated with the Deaf community. I can recall a couple of Christmases ago making dinner for some signing friends and suddenly realising that, without noticing, everything had become alright in my world again. Everyone was signing really fast – something I still struggle with; but every now and then someone would stop and summarise so I felt included. It was really relaxed and simply felt like old times, just old times without the sound thrown in. Le Page and Tabouret-Keller, two ethnographers, have this to say about why people communicate the ways they do: The individual ... creates for himself the patterns of his linguistic behaviour so as to resemble those of the group or groups with which from time to time he wishes to be identified, or so as to be unlike those from whom he wishes to be distinguished ... . We see speech acts as acts of projection; the speaker is projecting his inner universe, implicitly with the invitation to others to share it ... he is seeking to reinforce his models of the world, and hopes for solidarity from those with whom he wishes to identify. (181) This quote neatly sums up why I choose to communicate the ways I do. I use Auslan and speech in different situations because I am connected to people in both groups and I want them in my life. I do not feel hugely different from anyone these days. If it is accepted that I have as much to contribute to the community as anyone else, becoming deaf has also meant for me that I expect to see other people treated well and accepted. For me that means contributing my time and thoughts, and advocating. It also means expecting a good level of access to interpreters, to some thought provoking captioned movies in English, and affordable assistive technologies so I can participate. I see this right to participate and engage in genuine dialogue with the rest of the community as central to the aspirations and identity of us all, regardless of who we are or where others think we belong. References Le Page, R.B., and Andree Tabouret-Keller. Acts of Identity: Creole-Based Approaches to Language and Ethnicity. London: Cambridge University Press, 1985. Moorhead, D. “Knowing Who I Am.” In S. Gregory, ed., Deaf Futures Revisited. Block 3, Unit 10, D251 Issues in Deafness. Open University, 1995.

Sugar pigs are traditional confections shaped like sugar mice with little legs and no tail. One might, therefore, nibble the trotters of a sugar pig or suck delicately upon the nose of a sugar pig, but one must never eat one’s sugary treats like a pig. As an imagined border between the private world inside the body and the public world outside, the mouth is an unstable limit of selfhood. Food can easily cause disgust as it passes through this hazardous terrain, and this disgust is produced less by the thought of incorporation than by socially constructed boundaries such as the division between human and animal. In order to guard against disgust and the moral judgement it incurs about the eater, the mouth is governed by myriad rules and, in the case of the juvenile mouth, subject to adult surveillance. This paper investigates children’s consumption of confectionery in relation to the mouth as a liminal border space. Children are “sugar pigs” in as much as they disregard the conventions of civilised eating that govern the mouth, preferring instead to slubber, gnaw, lick, and chew like animals, to reveal the contents of their mouths and examine the contents of others, to put lollies in and out of their mouths with dirty hands, and to share single lollies. Children’s lolly rituals resist civilised eating norms, but they hold important cultural meanings that parallel and subvert those of the adult world. Children’s mouths are communal spaces and the rituals that take place in them are acts of friendship, intimacy, and power. Eating norms instituted over thousands of years ensure that people do not eat like animals, and the pig, in particular, stands in opposition to civilised eating. In On Good Manners for Boys (1530), Erasmus of Rotterdam advises that a general guide to eating like a human being is to eat inconspicuously and self-consciously—to “lick a plate or dish to which some sugar or sweet substance has adhered is for cats, not people,” he explains, and to “gnaw bones is for a dog”—and he compares ill-mannered eating with that of pigs, observing how some people “slubber up their meat like swine” (qtd. in Kass 145). Unrefined table manners and uncontrolled appetite continue to elicit such expressions of disgust as “dirty pig” and “greedy pig.” Pigs grunt. Pigs snuffle among refuse. Pigs, as Bob Ashley et al. note, represent all that is uncivilised and exist only as a signifier of appetite (2). The pig and civilisation, however, do not exist simply in opposition. Cookery writer Jane Grigson argues that European civilisation has been founded upon the pig (qtd. in Ashley et al. 2). Also, because the pig’s body is pinkish, soft, and flabby like a human body and because pigs were usually housed near or even inside human dwellings, the pig confounds the human/animal binary: it is “a threshold animal” (Stallybrass and White qtd. in Ashley et al. 7). Furthermore, the steady evolution of eating practices suggests that humans would eat like animals if left in their natural state. Food rules are part of the “attempt to exclude piggishness” from human civilisation, which, according to Ashley et al., demonstrates “precisely the proximity of human and pig” (7). As physician Leon Kass observes, eating conventions “show us both how much we have taken instruction and how much we needed it” (139). Humans aspire to purity and perfection, but William Ian Miller explains that “fuelling no small part of those aspirations is disgust with what we are or with what we are likely to slide back into” (Anatomy xiv). Eating norms, therefore, do not emphasise the difference between human and the pig as much as they express the underlying anxiety that the human mouth and the act of eating are utterly animal. ‘Lollies’ is the Australian term for the confectionery that children mostly buy, and while the child with a lolly pouched in its cheek is such a familiar, even iconic, image that it features on the covers of two recent books about confectionery (Richardson, Whittaker), licking, gnawing, and slubbering—Erasmus’ wonderfully evocative and piggish word—aptly describe the consumption of lollies. Many lollies are large and hard, and eating them requires time, effort, concentration, and conspicuous mouth activity: the cheek bulges and speaking is difficult; a great deal of saliva is produced and the area around the mouth becomes smeared with coloured drool; and there is always the possibility of the lolly falling out. The smaller the child’s mouth, or the larger the lolly, the more impossible it is to eat inconspicuously and self-consciously. Endless chewing is similarly animal-like, and “the bovine look” of teenagers featured in public complaints when chewing gum was mass-produced in the twentieth century (Hendrickson 7). Humans must not eat like animals, but overly-stuffed cheeks, sucking and slubbering mouths, licking tongues, gnawing teeth, and mindlessly ruminating jaws are unashamedly animal-like. Other rules guard against disgust arising from the sight of half-chewed food. When food is in the process of becoming part of the body, it quickly acquires the quality of things with which disgust is more readily associated, things that are, according to Miller, moist rather than dry, viscid rather than free-flowing, pliable rather than hard, things that are “oozy, mucky, gooey, slimy, clammy, sticky, tacky, dank, squishy, or filmy” (“Darwin’s Disgust” 338). Soft lollies with their vividly-coloured and glossy or sugar-encrusted surfaces look magical, but once they go into the mouth are “magically transformed into the disgusting” (Anatomy Miller 96). Food in the process of “becoming” must, therefore, never be seen again. The process of transformation takes place in the private interior of the body, but, if the mouth is open, half-transformed food is visible, and chewed food, according to Miller, “has the capacity to be even more disgusting than feces [sic]” (Anatomy 96). Sometimes, the sight of half-consumed lollies inside children’s mouths is deliberate because children poke out their tongues and look into each other’s mouths to monitor the progress of lollies that change colour as they break down. Miller explains that the rules of disgust are suspended in sexual and non-sexual love: “Disgust marks the boundaries of the self; the relaxing of them marks privilege, intimacy, duty, and caring” (Anatomy xi). This principle applies to children’s lolly rituals. If children forget to note the colour of a Clinker as they bite it, or if they want to note the progress of a Cloud or gobstopper, they open their mouths and even poke out their tongues so a friend can inspect the colour of the lolly, or their tongue. Such acts are marks of friendship. It is not something children do with everyone. The mouth is a threshold of self that children relax as a marker of privilege. The clean/unclean binary exerts a powerful influence on food because, in addition to the way in which food is eaten, it determines the kind of food that is eaten. The mouth is a border between the self (the eater) and the other (the eaten), so what is eaten (the other) eventually becomes the eater (the self). Paradoxically, the reverse is also true; the eater becomes what is eaten—hence, “we are what we eat.” Little wonder then that food is a site of anxiety, surveillance, and control. The pig eats anything, but children’s consumption is strictly monitored. The clean food imperative means that food must be uncontaminated by the world outside the body, and lollies violate the clean food category in this regard. Large, hard lollies can fall out of the mouth, or children may be obliged to violently expel them if they are danger of choking. The young protagonists in Saturdee, Norman Lindsay’s bildungsroman set in country Victoria after WWI, arrange a secret tryst with some girls, and when their plan is discovered a horde of spectators assembles to watch the proceedings: [Snowey Critchet] had provided himself with a bull’s-eye; a comestible about the size of a cricket ball, which he stowed away in one cheek, as a monkey pouches an orange, where it distended his face in a most obnoxious manner. He was prepared, it seemed, to spend the entire afternoon inspecting a scandal, while sucking his bull’s-eye down to edible proportions. (147) Amid a subsequent volley of taunts and cow dung, Snowey lands in the gutter, a reprisal that “was like to be Snowey’s end through causing him to bolt his bull’s-eye whole. It was too large to swallow but large enough to block up his gullet and choke him. Frenziedly he fought his way out of the gutter and ran off black in the face to eject his windpipe obstruction” (147-8). Choking episodes are further aspects of children’s consumption that adults would deem dangerous as well as disgusting. If a child picks up a lolly from the ground, an adult is likely to slap it away and spit out the word “Dirty!” The child’s hands are potentially part of the contaminated outside world, hence, wash your hands before you eat, don’t eat with your fingers, don’t lick your fingers, don’t put your fingers into your mouth, don’t handle food if you aren’t going to eat it, don’t eat food that others have touched. Lolly-consumption breaches the clean/unclean divide when children put fingers into mouths to hook tacky lollies like Minties off the back teeth, remove lollies in order to observe their changing shape or colour, pull chewing gum from the mouth, or push bubble gum back in. The mouth is part of the clean world inside the body; adult disgust stems from concern about contamination through contact with the world outside the body, including the face and hands. The hands are also involved in playground rituals. Children often remove lollies from their mouths, play with them, and put them back in. Such invented rituals include sharpening musk sticks by twisting them in the mouth before jabbing friends with them and returning them to the mouth. Teenagers also bite the heads off jelly babies and rearrange the bodies in multicoloured versions before eating them. These rituals expose half-consumed lollies, and allow lollies to be contaminated by the outside world, but they are markers of friendship and ways of belonging to particular groups as well as sources of entertainment. The ultimate cause for disgust, apart from sharing with a pig perhaps, arises when children violate the boundary between one mouth and another by sharing a single lolly. “Can I have a lick o’ your lollipop?” is an expression that belongs to a time when germs were yet to consume the public imagination, and it demonstrates that children have long been disposed to sharing confectionery in this way. Allowing someone to share an all-day sucker indicates friendship because it involves sacrifice as well as intimacy. How many times the friend licks it indicates how important a friend they are. Chewing gum and hard lollies such as bull’s-eyes and all-day suckers are ideal for sharing because they last a long time. Snowey’s choking episode is punishment both for having such a lolly while others did not, and for not sharing it. When friends share a single lolly in Markus Zusak’s The Book Thief it is a sign of their growing intimacy. Rudy and Liesel had only enough money for one lolly: “they unwrapped it and tried biting it in half, but the sugar was like glass. Far too tough, even for Rudy’s animal-like choppers. Instead, they had to trade sucks on it until it was finished. Ten sucks for Rudy. Ten for Liesel. Back and forth” (168). Rudy asks Liesel to kiss him on many occasions, but she never does. She regrets this after he is killed, so here the shared lolly stands in lieu of intimacy rather than friendship. Lollies are still shared in this way in Australian playgrounds, but often it is only hard lollies, and only with close friends. A hard lolly has a clearly defined boundary that can easily be washed, but even unwashed the only portion that is contaminated, and contaminable, is the visible surface of the lolly. This is not the case with a stick of chewing gum. In response to Tom Sawyer’s enquiry as to whether or not she likes rats, Becky Thatcher replies,“What I like, is chewing gum.” “O, I should say so! I wish I had some now.” “Do you? I’ve got some. I’ll let you chew it a while, but you must give it back to me.” That was agreeable, so they chewed it turn about, and dangled their legs against the bench in excess of contentment.” (58) Unlike the clearly defined boundary of a gobstopper, the boundary of chewing gum continually shifts and folds in on itself. The entire confection is contaminated through contact with the mouth of the other. The definition of clean food also includes that which is deemed appropriate for eating, and part of the appeal of lollies is their junk status. Some lollies are sugar versions of “good” foodstuffs: strawberries and cream, wildberries, milk bottles, pineapples, and bananas. Even more ironic, especially in light of the amount of junk food in many adult diets, others are sugar versions of junk food: fries, coke bottles, Pizzas, Hot Dogs, and Hamburgers, all of which are packaged like miniatures of actual products. Lollies, like their British equivalent, kets (which means rubbish), are absolutely distinct from the confectionery adults eat, and British sociologist Allison James shows that this is because they “stand in contrast to conventional adult sweets and adult eating generally” (298). Children use terms like junk and ket intentionally because there is a “power inherent in the conceptual gulf between the worlds of the adult and the child” (James, “Confections” 297). Parents place limits on children’s consumption because lollies are seen to interfere with the consumption of good food, but, as James explains, for children, “it is meals which disrupt the eating of sweets” (“Confections” 296). Some lollies metaphorically violate a different kind of food taboo by taking the form of “unclean” animals like rats, pythons, worms, cats, dinosaurs, blowflies, cane toads, and geckos. This highlights the arbitrary nature of food categories: snakes, lizards, and witchetty grubs do not feature on European menus, but indigenous Australians eat them. Neither do white Australians eat horses, frogs, cats, dogs, and insects, which are considered delicacies in other cultures, some even in other European cultures. Eating human beings is widely-considered taboo, but children enjoy eating lollies shaped like parts of the human body. A fundraiser at a Queensland school fete in 2009 epitomised the contemporary fascination with consuming body parts. Traditionally, the Guess-The-Number fundraiser involves guessing the number of jelly beans in a glass jar, but in this instance the jar held teeth, lips, noses, eyeballs, ears, hearts, and feet. Similarly, when children eat Tongue Pops—tangy tongue-shaped lollies on a stick—the irony of having two tongues, of licking your own tongue, is not lost on children. Other lollies represent tiny people, and even babies. In the ordinary world, children are small and powerless, but the magic of lollies enables them to be the man-eating giant, while Chicos and jelly babies represent the powerless child. Children welcome the opportunity to “bite someone else’s head off” for a change. These lollies are anonymous people, but Freddo Frog and Caramello Koala have names as well as bodies and facial features, while others, like Cadbury’s seven Magical Elves, even have personalities. One of these, Aquamarine, is depicted as a winking character dressed in blue, and described on the wrapper as “a talented musician who plays music to inspire the Elves to enjoy themselves and work harder, but is a bit of a farty pants.” Advertisements also commonly personify lollies by giving them faces, voices, and limbs, so that even something as un-humanlike as a red ball, in the case of the Jaffa, is represented as a cheeky character in the act of running away. And children happily eat them all. Cannibalism rates highly in the world of children’s confectionery (James 298). If lollies are “metaphoric rubbish,” as James explains, they can also be understood as metaphorically breaking food taboos (299). Not only do children’s rituals create a sense of friendship, belonging, even intimacy, but engaging in them is also an act of power because children know that these practices disgust adults. Lollies give children permission to transgress the rules of civilised eating and this carnivalesque subversion is part of the pleasure of eating lollies. James suggests that confectionery is neither raw nor cooked, but belongs to a third food category that helps to define “the disorderly and inverted world of children” (“Confections” 301). In James’ analysis, children and adults inhabit separate worlds, and she views children’s sweets as part of the “alternative system of meanings through which [children] can establish their own integrity” (“Confections” 301, 305). In the sense that they exist outside of officialdom, children have inherited the carnivalesque tradition of the festive life, which Bakhtin theorises as “a second world” organised on the basis of laughter (6, 8). In this topsy-turvy, carnivalesque realm, with its emphasis on the grotesque body, laughter, fun, exuberance, comic rituals, and other non-official values, children escape adult rule. Lollies may be rubbish in the adult world, but, like the carnival fool, they are “king” in the child’s second and festive life, where bodies bulge, feasting is a public and often grotesque event, and children are masters of their own destiny. Eating lollies, then, represents a “metaphoric chewing up of adult order” and a means of the child assuming control over at least one of its orifices (James 305-6). In this sense, the pig is not a symbol of the uncivilised but the un-adult. Children are pigs with sugar—slubbering around hard lollies, licking other children’s lollies, metaphorically cannibalising jelly babies—and if they disgust adults it is because they challenge the eating norms that guard against the ever-present reminder that eating is an animal act. Eating practices “civilize the human animal” (Kass 131), but eating is inherently an untidy experience, and any semblance of order, as anthropologist Mary Douglas explains, is only created by exaggerating difference (qtd. in Ashley et al. 3). The pig is commonly understood to be the antithesis of civilisation and, therefore, the means by which we understand ourselves as civilised beings. The child with a lolly, however, is evidence that the line between human and animal is a tenuous divide. References Ashley, Bob, Joanne Hollows, Steve Jones and Ben Taylor. Food and Cultural Studies. London: Routledge, 2004. Bakhtin, Mikhail. Rabelais and His World. Trans.Helene Iswolsky. Cambridge: M.I.T. P, Massachusetts Institute of Technology, 1968. Hendrickson, Robertson. The Great American Chewing Gum Book. Radnor, Pennsylvania: Chilton, 1976. James, Allison. “Confections, Concoctions and Conceptions.” Popular Culture: Past and Present. Eds Bernard Waites, Tony Bennett and Graham Martin. London: Routledge, 1986. 294-307. James, Allison. “The Good, the Bad and the Delicious: The Role of Confectionery in British Society.” Sociological Review 38, 1990: 666-88. Kass, Leon R. The Hungry Soul: Eating and the Perfecting of Our Nature. New York: Free Press, 1994. Lindsay, Norman. Saturdee. London: Angus & Robertson, 1981. Miller, William Ian. “Darwin’s Disgust.” Empire of the Senses: The Sensual Culture Reader. Ed. David Howes. Oxford: Berg, 2005. Miller, William Ian. The Anatomy of Disgust. Cambridge: Harvard U P, 1997. Mason, Laura. Sugar Plums and Sherbet: The Pre-history of Sweets. Devon: Prospect, 1998. Richardson, Tim. Sweets: A History of Temptation. London: Bantam Books, 2003. Twain, Mark. The Adventures of Tom Sawyer. New York: Collier, 1962. Whittaker, Nicholas. Sweet Talk: The Secret History of Confectionery. London: Phoenix, 1999. Zusak, Markus. The Book Thief. Sydney: Picador, 2005.

Hundreds of thousands of Australian children were born in the shadow of the Great War, fathered by men who had enlisted between 1914 and 1918. Their lives could be and often were hard and unhappy, as Anzac historian Alistair Thomson observed of his father’s childhood in the 1920s and 1930s. David Thomson was son of a returned serviceman Hector Thomson who spent much of his adult life in and out of repatriation hospitals (257-259) and whose memory was subsequently expunged from Thomson family stories (299-267). These children of trauma fit within a pattern suggested by Marianne Hirsch in her influential essay “The Generation of Postmemory”. According to Hirsch, “postmemory describes the relationship of the second generation to powerful, often traumatic, experiences that preceded their births but that were nevertheless transmitted to them so deeply as to seem to constitute memories in their own right” (n.p.). This article attempts to situate George Johnston’s novel My Brother Jack (1964) within the context of postmemory narratives of violence that were complicated in Australia by the Anzac legend which occluded any too open discussion about the extent of war trauma present within community, including the children of war.“God knows what damage” the war “did to me psychologically” (48), ponders Johnston’s protagonist and alter-ego David Meredith in My Brother Jack. Published to acclaim fifty years after the outbreak of the First World War, My Brother Jack became a widely read text that seemingly spoke to the shared cultural memories of a generation which did not know battlefield violence directly but experienced its effects pervasively and vicariously in the aftermath through family life, storytelling, and the memorabilia of war. For these readers, the novel represented more than a work of fiction; it was a touchstone to and indicative of their own negotiations though often unspoken post-war trauma.Meredith, like his creator, is born in 1912. Strictly speaking, therefore, both are not part of the post-war generation. However, they are representative and therefore indicative of the post-war “hinge generation” which was expected to assume “guardianship” of the Anzac Legend, though often found the narrative logic challenging. They had been “too young for the war to have any direct effect”, and yet “every corner” of their family’s small suburban homes appear to be “impregnated with some gigantic and sombre experience that had taken place thousands of miles away” (17).According to Johnston’s biographer, Garry Kinnane, the “most teasing puzzle” of George Johnston’s “fictional version of his childhood in My Brother Jack is the monstrous impression he creates of his returned serviceman father, John George Johnston, known to everyone as ‘Pop.’ The first sixty pages are dominated by the tyrannical figure of Jack Meredith senior” (1).A large man purported to be six foot three inches (1.9 metres) in height and weighing fifteen stone (95 kilograms), the real-life Pop Johnston reputedly stood head and shoulders above the minimum requirement of five foot and six inches (1.68 metres) at the time of his enlistment for war in 1914 (Kinnane 4). In his fortieth year, Jack Johnston senior was also around twice the age of the average Australian soldier and among one in five who were married.According to Kinnane, Pop Johnston had “survived the ordeal of Gallipoli” in 1915 only to “endure three years of trench warfare in the Somme region”. While the biographer and the Johnston family may well have held this to be true, the claim is a distortion. There are a few intimations throughout My Brother Jack and its sequel Clean Straw for Nothing (1969) to suggest that George Johnston may have suspected that his father’s wartime service stories had been embellished, though the depicted wartime service of Pop Meredith remains firmly within the narrative arc of the Anzac legend. This has the effect of layering the postmemory violence experienced by David Meredith and, by implication, his creator, George Johnston. Both are expected to be keepers of a lie masquerading as inviolable truth which further brutalises them.John George (Pop) Johnston’s First World War military record reveals a different story to the accepted historical account and his fictionalisation in My Brother Jack. He enlisted two and a half months after the landing at Gallipoli on 12 July 1915 and left for overseas service on 23 November. Not quite the imposing six foot three figure of Kinnane’s biography, he was fractionally under five foot eleven (1.8 metres) and weighed thirteen stone (82.5 kilograms). Assigned to the Fifth Field Engineers on account of his experience as an electric tram fitter, he did not see frontline service at Gallipoli (NAA).Rather, according to the Company’s history, the Fifth Engineers were involved in a range of infrastructure and support work on the Western Front, including the digging and maintenance of trenches, laying duckboard, pontoons and tramlines, removing landmines, building huts, showers and latrines, repairing roads, laying drains; they built a cinema at Beaulencourt Piers for “Brigade Swimming Carnival” and baths at Malhove consisting of a large “galvanised iron building” with a “concrete floor” and “setting tanks capable of bathing 2,000 men per day” (AWM). It is likely that members of the company were also involved in burial details.Sapper Johnston was hospitalised twice during his service with influenza and saw out most of his war from October 1917 attached to the Army Cookery School (NAA). He returned to Australia on board the HMAT Kildonian Castle in May 1919 which, according to the Sydney Morning Herald, also carried the official war correspondent and creator of the Anzac legend C.E.W. Bean, national poet Banjo Paterson and “Warrant Officer C G Macartney, the famous Australian cricketer”. The Herald also listed the names of “Returned Officers” and “Decorated Men”, but not Pop Johnston who had occupied the lower decks with other returning men (“Soldiers Return”).Like many of the more than 270,000 returned soldiers, Pop Johnston apparently exhibited observable changes upon his repatriation to Australia: “he was partially deaf” which was attributed to the “constant barrage of explosions”, while “gas” was suspected to have “left him with a legacy of lung disorders”. Yet, if “anyone offered commiserations” on account of this war legacy, he was quick to “dismiss the subject with the comment that ‘there were plenty worse off’” (Kinnane 6). The assumption is that Pop’s silence is stoic; the product of unspeakable horror and perhaps a symptom of survivor guilt.An alternative interpretation, suggested by Alistair Thomson in Anzac Memories, is that the experiences of the vast majority of returned soldiers were expected to fit within the master narrative of the Anzac legend in order to be accepted and believed, and that there was no space available to speak truthfully about alternative war service. Under pressure of Anzac expectations a great many composed stories or remained selectively silent (14).Data gleaned from the official medical history suggest that as many as four out of every five returned servicemen experienced emotional or psychological disturbance related to their war service. However, the two branches of medicine represented by surgeons and physicians in the Repatriation Department—charged with attending to the welfare of returned servicemen—focused on the body rather than the mind and the emotions (Murphy and Nile).The repatriation records of returned Australian soldiers reveal that there were, indeed, plenty physically worse off than Pop Johnston on account of bodily disfigurement or because they had been somatically compromised. An estimated 30,000 returned servicemen died in the decade after the cessation of hostilities to 1928, bringing the actual number of war dead to around 100,000, while a 1927 official report tabled the medical conditions of a further 72,388 veterans: 28,305 were debilitated by gun and shrapnel wounds; 22,261 were rheumatic or had respiratory diseases; 4534 were afflicted with eye, ear, nose, or throat complaints; 9,186 had tuberculosis or heart disease; 3,204 were amputees while only; 2,970 were listed as suffering “war neurosis” (“Enlistment”).Long after the guns had fallen silent and the wounded survivors returned home, the physical effects of war continued to be apparent in homes and hospital wards around the country, while psychological and emotional trauma remained largely undiagnosed and consequently untreated. David Meredith’s attitude towards his able-bodied father is frequently dismissive and openly scathing: “dad, who had been gassed, but not seriously, near Vimy Ridge, went back to his old job at the tramway depot” (9). The narrator-son later considers:what I realise now, although I never did at the time, is that my father, too, was oppressed by intimidating factors of fear and change. By disillusion and ill-health too. As is so often the case with big, strong, athletic men, he was an extreme hypochondriac, and he had convinced himself that the severe bronchitis which plagued him could only be attributed to German gas he had swallowed at Vimy Ridge. He was too afraid to go to a doctor about it, so he lived with a constant fear that his lungs were decaying, and that he might die at any time, without warning. (42-3)During the writing of My Brother Jack, the author-son was in chronically poor health and had been recently diagnosed with the romantic malady and poet’s disease of tuberculosis (Lawler) which plagued him throughout his work on the novel. George Johnston believed (correctly as it turned out) that he was dying on account of the disease, though, he was also an alcoholic and smoker, and had been reluctant to consult a doctor. It is possible and indeed likely that he resentfully viewed his condition as being an extension of his father—vicariously expressed through the depiction of Pop Meredith who exhibits hysterical symptoms which his son finds insufferable. David Meredith remains embittered and unforgiving to the very end. Pop Meredith “lived to seventy-three having died, not of German gas, but of a heart attack” (46).Pop Meredith’s return from the war in 1919 terrifies his seven-year-old son “Davy”, who accompanies the family to the wharf to welcome home a hero. The young boy is unable to recall anything about the father he is about to meet ostensibly for the first time. Davy becomes overwhelmed by the crowds and frightened by the “interminable blaring of horns” of the troopships and the “ceaseless roar of shouting”. Dwarfed by the bodies of much larger men he becomestoo frightened to look up at the hours-long progression of dark, hard faces under wide, turned-up hats seen against bayonets and barrels that are more blue than black ... the really strong image that is preserved now is of the stiff fold and buckle of coarse khaki trousers moving to the rhythm of knees and thighs and the tight spiral curves of puttees and the thick boots hammering, hollowly off the pier planking and thunderous on the asphalt roadway.Depicted as being small for his age, Davy is overwrought “with a huge and numbing terror” (10).In the years that follow, the younger Meredith desires emotional stability but remains denied because of the war’s legacy which manifests in the form of a violent patriarch who is convinced that his son has been rendered effeminate on account of the manly absence during vital stages of development. With the return of the father to the household, Davy grows to fear and ultimately despise a man who remains as alien to him as the formerly absent soldier had been during the war:exactly when, or why, Dad introduced his system of monthly punishments I no longer remember. We always had summary punishment, of course, for offences immediately detected—a cuffing around the ears or a sash with a stick of a strap—but Dad’s new system was to punish for the offences which had escaped his attention. So on the last day of every month Jack and I would be summoned in turn to the bathroom and the door would be locked and each of us would be questioned about the sins which we had committed and which he had not found out about. This interrogation was the merest formality; whether we admitted to crimes or desperately swore our innocence it was just the same; we were punished for the offences which, he said, he knew we must have committed and had to lie about. We then had to take our shirts and singlets off and bend over the enamelled bath-tub while he thrashed us with the razor-strop. In the blind rages of these days he seemed not to care about the strength he possessed nor the injuries he inflicted; more often than not it was the metal end of the strop that was used against our backs. (48)Ironically, the ritualised brutality appears to be a desperate effort by the old man to compensate for his own emasculation in war and unresolved trauma now that the war is ended. This plays out in complicated fashion in the development of David Meredith in Clean Straw for Nothing, Johnston’s sequel to My Brother Jack.The imputation is that Pop Meredith practices violence in an attempt to reassert his failed masculinity and reinstate his status as the head of the household. Older son Jack’s beatings cease when, as a more physically able young man, he is able to threaten the aggressor with violent retaliation. This action does not spare the younger weaker Davy who remains dominated. “My beating continued, more ferociously than ever, … . They ceased only because one day my father went too far; he lambasted me so savagely that I fell unconscious into the bath-tub, and the welts across my back made by the steel end of the razor-strop had to be treated by a doctor” (53).Pop Meredith is persistently reminded that he has no corporeal signifiers of war trauma (only a cough); he is surrounded by physically disabled former soldiers who are presumed to be worse off than he on account of somatic wounding. He becomes “morose, intolerant, bitter and violently bad-tempered”, expressing particular “displeasure and resentment” toward his wife, a trained nurse, who has assumed carer responsibilities for homing the injured men: “he had altogether lost patience with her role of Florence Nightingale to the halt and the lame” (40). Their marriage is loveless: “one can only suppose that he must have been darkly and profoundly disturbed by the years-long procession through our house of Mother’s ‘waifs and strays’—those shattered former comrades-in-arms who would have been a constant and sinister reminder of the price of glory” (43); a price he had failed to adequately pay with his uncompromised body intact.Looking back, a more mature David Meredith attempts to establish order, perspective and understanding to the “mess of memory and impressions” of his war-affected childhood in an effort to wrest control back over his postmemory violation: “Jack and I must have spent a good part of our boyhood in the fixed belief that grown-up men who were complete were pretty rare beings—complete, that is, in that they had their sight or hearing or all of their limbs” (8). While the father is physically complete, his brooding presence sets the tone for the oppressively “dark experience” within the family home where all rooms are “inhabited by the jetsam that the Somme and the Marne and the salient at Ypres and the Gallipoli beaches had thrown up” (18). It is not until Davy explores the contents of the “big deep drawer at the bottom of the cedar wardrobe” in his parents’ bedroom that he begins to “sense a form in the shadow” of the “faraway experience” that had been the war. The drawer contains his father’s service revolver and ammunition, battlefield souvenirs and French postcards but, “most important of all, the full set of the Illustrated War News” (19), with photographs of battlefield carnage. These are the equivalent of Hirsch’s photographs of the Holocaust that establish in Meredith an ontology that links him more realistically to the brutalising past and source of his ongoing traumatistion (Hirsch). From these, Davy begins to discern something of his father’s torment but also good fortune at having survived, and he makes curatorial interventions not by becoming a custodian of abjection like second generation Holocaust survivors but by disposing of the printed material, leaving behind artefacts of heroism: gun, the bullets, the medals and ribbons. The implication is that he has now become complicit in the very narrative that had oppressed him since his father’s return from war.No one apparently notices or at least comments on the removal of the journals, the images of which become linked in the young boys mind to an incident outside a “dilapidated narrow-fronted photographer’s studio which had been deserted and padlocked for as long as I could remember”. A number of sun-damaged photographs are still displayed in the window. Faded to a “ghostly, deathly pallor”, and speckled with fly droppings, years earlier, they had captured young men in uniforms before embarkation for the war. An “agate-eyed” boy from Davy’s school joins in the gazing, saying nothing for a long time until the silence is broken: “all them blokes there is dead, you know” (20).After the unnamed boy departs with a nonchalant “hoo-roo”, young Davy runs “all the way home, trying not to cry”. He cannot adequately explain the reason for his sudden reaction: “I never after that looked in the window of the photographer’s studio or the second hand shop”. From that day on Davy makes a “long detour” to ensure he never passes the shops again (20-1). Having witnessed images of pre-war undamaged young men in the prime of their youth, he has come face-to-face with the consequences of war which he is unable to reconcile in terms of the survival and return of his much older father.The photographs of the young men establishes a causal connection to the physically wrecked remnants that have shaped Davy’s childhood. These are the living remains that might otherwise have been the “corpses sprawled in mud or drowned in flooded shell craters” depicted in the Illustrated News. The photograph of the young men establishes Davy’s connection to the things “propped up our hallway”, of “Bert ‘sobbing’ in the backyard and Gabby Dixon’s face at the dark end of the room”, and only reluctantly the “bronchial cough of my father going off in the dawn light to the tramways depot” (18).That is to say, Davy has begun to piece together sense from senselessness, his father’s complicity and survival—and, by association, his own implicated life and psychological wounding. He has approached the source of his father’s abjection and also his own though he continues to be unable to accept and forgive. Like his father—though at the remove—he has been damaged by the legacies of the war and is also its victim.Ravaged by tuberculosis and alcoholism, George Johnston died in 1970. According to the artist Sidney Nolan he had for years resembled the ghastly photographs of survivors of the Holocaust (Marr 278). George’s forty five year old alcoholic wife Charmian Clift predeceased him by twelve months, having committed suicide in 1969. Four years later, in 1973, George and Charmian’s twenty four year old daughter Shane also took her own life. Their son Martin drank himself to death and died of organ failure at the age of forty three in 1990. They are all “dead, you know”.ReferencesAWM. Fifth Field Company, Australian Engineers. Diaries, AWM4 Sub-class 14/24.“Enlistment Report”. Reveille, 29 Sep. 1928.Hirsch, Marianne. “The Generation of Postmemory.” Poetics Today 29.1 (Spring 2008): 103-128. <https://read.dukeupress.edu/poetics-today/article/29/1/103/20954/The-Generation-of-Postmemory>.Johnston, George. Clean Straw for Nothing. London: Collins, 1969.———. My Brother Jack. London: Collins, 1964.Kinnane, Garry. George Johnston: A Biography. Melbourne: Nelson, 1986.Lawler, Clark. Consumption and Literature: the Making of the Romantic Disease. Basingstoke: Palgrave Macmillan, 2006.Marr, David, ed. Patrick White Letters. Sydney: Random House, 1994.Murphy, Ffion, and Richard Nile. “Gallipoli’s Troubled Hearts: Fear, Nerves and Repatriation.” Studies in Western Australian History 32 (2018): 25-38.NAA. John George Johnston War Service Records. <https://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=1830166>.“Soldiers Return by the Kildonan Castle.” Sydney Morning Herald, 10 May 1919: 18.Thomson, Alistair. Anzac Memories: Living with the Legend. Clayton: Monash UP, 2013.

The American Broadcasting Company (ABC) Family Network show Switched at Birth tells two stories—one which follows the unique plot of the show, and one about the new openness of television executives toward integrating more people with a variety of visible and invisible physical embodiments, such as hearing loss, into television content. It first aired in 2011 and in 2017 aired its fifth and final season.The show focuses on two teen girls in Kansas City who find out they were switched due to a hospital error on the day of their birth and who grew up with parents who were not biologically related to them. One, Bay Kennish (Vanessa Marano), lives with her wealthy parents—a stay-at-home mom Kathryn (Lea Thompson) and a former professional baseball player, now businessman, father John (D.W. Moffett). She has an older brother Toby (Lucas Grabeel) who is into music. In her high school science class, Bay learns about blood types and discovers her parents’ blood types could not have produced her. The family has professional genetic tests done and discovers the switch (ABC Family, “This Is Not a Pipe”).In the pilot episode, Bay’s parents find out that deaf teen, Daphne Vasquez (Katie Leclerc), is actually their daughter. She lives in a working class Hispanic neighbourhood with her hairdresser single mother Regina (Constance Marie) and grandmother Adrianna (Ivonne Coll), both of whom are of Puerto Rican ancestry. Daphne is deaf due to a case of meningitis when she was three, which the rich Kennishes feel happened because of inadequate healthcare provided by working class Regina. Daphne attends an all-deaf school, Carlton.The man who was thought to be her biological father, Angelo Sorrento (Gilles Marini), doesn’t appear in the show until episode 10 but becomes a series regular in season 2. It becomes apparent that Daphne believes her father left because of her deafness; however, as the first season progresses, the real reasons begin to emerge. From the pilot onwards, the show dives into clashes of language, culture, ethnicity, class, and even physical appearance—in one scene in the pilot, the waspy Kennishes ask Regina if she is “Mexican.” As later episodes reveal, many of these physical appearance issues are revealed to have fractured the Vasquez family early on—Daphne is a freckled, strawberry blonde, and her father (who is French and Italian) suspected infidelity.The two families merge when the Kennishes ask Daphne and her mother to move into their guest house in order get to know their daughter better. That forces the Kennishes into the world of deafness, and throughout the show this hearing family therefore becomes a surrogate for a hearing audience’s immersion into Deaf culture.Cultural Inclusivity: The Way ForwardShow creator Lizzy Weiss explained that it was actually the ABC Family network that “suggested making one of the kids disabled” (Academy of Television Arts & Sciences). Weiss was familiar with American Sign Language (ASL) because she had a “classical theatre of the Deaf” course in college. She said, “I had in the back of my head a little bit of background at least about how beautiful the language was. So I said, ‘What if one of the girls is deaf?’” The network thought it was wonderful idea, so she began researching the Deaf community, including spending time at a deaf high school in Los Angeles called Marlton, on which she modelled the Switched at Birth school, Carlton. Weiss (Academy of Television Arts & Sciences) says of the school visit experience:I learned so much that day and spoke to dozens of deaf teenagers about their lives and their experiences. And so, this is, of course, in the middle of writing the pilot, and I said to the network, you know, deaf kids wouldn’t voice orally. We would have to have those scenes only in ASL, and no sound and they said, ‘Great. Let’s do it.’ And frankly, we just kind of grew and grew from there.To accommodate the narrative structure of a television drama, Weiss said it became clear from the beginning that the show would need to use SimCom (simultaneous communication or sign supported speech) for the hearing or deaf characters who were signing so they could speak and sign at the same time. She knew this wasn’t the norm for two actual people communicating in ASL, but the production team worried about having a show that was heavily captioned as this might distance its key—overwhelmingly hearing—teen audience who would have to pay attention to the screen during captioned scenes. However, this did not appear to be the case—instead, viewers were drawn to the show because of its unique sign language-influenced television narrative structure. The show became popular very quickly and, with 3.3 million viewers, became the highest-rated premiere ever on the ABC Family network (Barney).Switched at Birth also received much praise from the media for allowing its deaf actors to communicate using sign language. The Huffington Post television critic Maureen Ryan said, “Allowing deaf characters to talk to each other directly—without a hearing person or a translator present—is a savvy strategy that allows the show to dig deeper into deaf culture and also to treat deaf characters as it would anyone else”. Importantly, it allowed the show to be unique in a way that was found nowhere else on television. “It’s practically avant-garde for television, despite the conventional teen-soap look of the show,” said Ryan.Usually a show’s success is garnered by audience numbers and media critique—by this measure Switched at Birth was a hit. However, programs that portray a disability—in any form—are often the target of criticism, particularly from the communities they attempting to represent. It should be noted that, while actress Katie Leclerc, who plays Daphne, has a condition, Meniere’s disease, which causes hearing loss and vertigo on an intermittent basis, she does not identify as a deaf actress and must use a deaf accent to portray Daphne. However, she is ASL fluent, learning it in high school (Orangejack). This meant her qualifications met the original casting call which said “actress must be deaf or hard of hearing and must speak English well, American Sign Language preferred” (Paz, 2010) Leclerc likens her role to that of any actor to who has to affect body and vocal changes for a role—she gives the example of Hugh Laurie in House, who is British with no limp, but was an American who uses a cane in that show (Bibel).As such, initially, some in the Deaf community complained about her casting though an online petition with 140 signatures (Nielson). Yet many in the Deaf community softened any criticism of the show when they saw the production’s ongoing attention to Deaf cultural details (Grushkin). Finally, any lingering criticisms from the Deaf community were quieted by the many deaf actors hired for the show who perform using ASL. This includes Sean Berdy, who plays Daphne’s best friend Emmett, his onscreen mother, played by actress Marlee Matlin, and Anthony Natale who plays his father; their characters both sign and vocalize in the show. The Emmett character only communicates in ASL and does not vocalise until he falls in love with the hearing character Bay—even then he rarely uses his voice.This seemingly all-round “acceptance” of the show gave the production team more freedom to be innovative—by season 3 the audience was deemed to be so comfortable with captions that the shows began to feature less SimCom and more all-captioned scenes. This lead to the full episode in ASL, a first on American mainstream television.For an Hour, Welcome to Our WorldSwitched at Birth writer Chad Fiveash explained that when the production team came up with the idea for a captioned all-ASL episode, they “didn’t want to do the ASL episode as a gimmick. It needed to be thematically resonant”. As a result, they decided to link the episode to the most significant event in American Deaf history, an event that solidified its status as a cultural community—the 1988 Deaf President Now (DPN) protest at Gallaudet University in Washington. This protest inspired the March 2013 episode for Switched at Birth and aired 25 years to the week that the actual DPN protest happened. This episode makes it clear the show is trying to completely embrace Deaf culture and wants its audience to better understand Deaf identity.DPN was a pivotal moment for Deaf people—it truly solidified members of a global Deaf community who felt more empowered to fight for their rights. Students demanded that Gallaudet—as the premier university for deaf and hard-of-hearing students—no longer have a hearing person as its president. The Gallaudet board of trustees, the majority of whom were hearing, tried to force students and faculty to accept a hearing president; their attitude was that they knew what was best for the deaf persons there. For eight days, deaf people across America and the world rallied around the student protestors, refusing to give in until a deaf president was appointed. Their success came in the form of I. King Jordan, a deaf man who had served as dean of the College of Arts & Sciences at the time of the protest.The event was covered by media around the world, giving the American Deaf community international attention. Indeed, Gallaudet University says the DPN protest symbolized more than just the hiring of a Deaf president; it brought Deaf issues before the public and “raised the nation’s consciousness of the rights and abilities of deaf and hard of hearing people” (Gallaudet University).The activities of the students and their supporters showed dramatically that in the 1980s deaf people could be galvanized to unite around a common issue, particularly one of great symbolic meaning, such as the Gallaudet presidency. Gallaudet University represents the pinnacle of education for deaf people, not only in the United States but throughout the world. The assumption of its presidency by a person himself deaf announced to the world that deaf Americans were now a mature minority (Van Cleve and Crouch, 172).Deaf people were throwing off the oppression of the hearing world by demanding that their university have someone from their community at its helm. Jankowski (Deaf Empowerment; A Metaphorical Analysis of Conflict) studied the Gallaudet protest within the framework of a metaphor. She found a recurring theme during the DPN protest to be Gallaudet as “plantation”—which metaphorically refers to deaf persons as slaves trying to break free from the grip of the dominant mastery of the hearing world—and she parallels the civil rights movement of African Americans in the 1960s. As an example, Gallaudet was referred to as the “Selma of the Deaf” during the protest, and protest signs used the language of Martin Luther King such as “we still have a dream.” For deaf Americans, the presidency of Gallaudet became a symbol of hope for the future. As Jankowski attests:deaf people perceived themselves as possessing the ability to manage their own kind, pointing to black-managed organization, women-managed organizations, etc., struggling for that same right. They argued that it was a fight for their basic human rights, a struggle to free themselves, to release the hold their ‘masters’ held on them. (“A Metaphorical Analysis”)The creators of the Switched at Birth episode wanted to ensure of these emotions, as well as historical and cultural references, were prevalent in the modern-day, all-ASL episode, titled Uprising. That show therefore wanted to represent both the 1988 DPN protest as well as a current issue in the US—the closing of deaf schools (Anderson). The storyline focuses on the deaf students at the fictitious Carlton School for the Deaf seizing one of the school buildings to stage a protest because the school board has decided to shut down the school and mainstream the deaf students into hearing schools. When the deaf students try to come up with a list of demands, conflicts arise about what the demands should be and whether a pilot program—allowing hearing kids who sign to attend the deaf school—should remain.This show accomplished multiple things with its reach into Deaf history and identity, but it also did something technologically unique for the modern world—it made people pay attention. Because captioning translated the sign language for viewers, Lizzy Weiss, the creator of the series, said, “Every single viewer—deaf or hearing—was forced to put away their phones and iPads and anything else distracting … and focus … you had to read … you couldn’t do anything else. And that made you get into it more. It drew you in” (Stelter). The point, Weiss said, “was about revealing something new to the viewer—what does it feel like to be an outsider? What does it feel like to have to read and focus for an entire episode, like deaf viewers do all the time?” (Stelter). As one deaf reviewer of the Uprising episode said, “For an hour, welcome to our world! A world that’s inconvenient, but one most of us wouldn’t leave if offered a magic pill” (DR_Staff).This episode, more than any other, afforded hearing television viewers an experience perhaps similar to deaf viewers. The New York Times reported that “Deaf and hard-of-hearing viewers commented by the thousands after the show, with many saying in effect, “Yes! That’s what it feels like” (Stelter).Continued ResonancesWhat is also unique about the episode is that in teaching the hearing viewers more about the Deaf community, it also reinforced Deaf community pride and even taught young deaf people a bit of their own history. The Deaf community and Gallaudet were very pleased with their history showing up on a television show—the university produced a 30-second commercial which aired within the episode, and held viewing parties. Gallaudet also forwarded the 35 pages of Facebook comments they’d received about the episode to ABC Family and Gallaudet President T. Alan Hurwitz said of the episode (Yahr), “Over the past 25 years, [DPN] has symbolised self-determination and empowerment for deaf and hard of hearing people around the world”. The National Association of the Deaf (NAD) also lauded the episode, describing it as “phenomenal and groundbreaking, saying the situation is very real to us” (Stelter)—NAD had been vocally against budget cuts and closings of US deaf schools.Deaf individuals all over the Internet and social media also spoke out about the episode, with overwhelmingly favourable opinions. Deaf blogger Amy Cohen Efron, who participated in 1988′s DPN movement, said that DPN was “a turning point of my life, forcing me to re-examine my own personal identity, and develop self-determinism as a Deaf person” and led to her becoming an activist.When she watched the Uprising episode, she said the symbolic and historical representations in the show resonated with her. In the episode, a huge sign is unfurled on the side of the Carlton School for the Deaf with a girl with a fist in the air under the slogan “Take Back Carlton.” During the DPN protest, the deaf student protesters unfurled a sign that said “Deaf President Now” with the US Capitol in the background; this image has become an iconic symbol of modern Deaf culture. Efron says the image in the television episode was much more militant than the actual DPN sign. However, it could be argued that society now sees the Deaf community as much more militant because of the DPN protest, and that the imagery in the Uprising episode played into that connection. Efron also acknowledged the episode’s strong nod to the Gallaudet student protestors who defied the hearing community’s expectations by practising civil disobedience. As Efron explained, “Society expected that the Deaf people are submissive and accept to whatever decision done by the majority without any of our input and/or participation in the process.”She also argues that the episode educated more than just the hearing community. In addition to DPN, Uprising was filled with other references to Deaf history. For example a glass door to the room at Carlton was covered with posters about people like Helen Keller and Jean-Ferdinand Berthier, a deaf educator in 19th century France who promoted the concept of deaf identity and culture—Efron says most people in the Deaf community have never heard of him. She also claims that the younger Deaf community may also not be aware of the 1988 DPN protest—“It was not in high school textbooks available for students. Many deaf and hard of hearing students are mainstreamed and they have not the slightest idea about the DPN movement, even about the Deaf Community’s ongoing fight against discrimination, prejudice and oppression, along with our victories”.Long before the Uprising episode aired, the Deaf community had been watching Switched at Birth carefully to make sure Deaf culture was accurately represented. Throughout season 3 David Martin created weekly videos in sign language that were an ASL/Deaf cultural analysis of Switched at Birth. He highlighted content he liked and signs that were incorrect, a kind of a Deaf culture/ASL fact checker. From the Uprising episode, he said he thought this quote from Marlee Matlin’s character said it all, “Until hearing people walk a day in our shoes they will never understand” (Martin). That succinctly states what the all-ASL episode was trying to capture—creating an awareness of Deaf people’s cultural experience and their oppression in hearing society.Even a deaf person who was an early critic of Switched at Birth because of the hiring of Katie Leclerc and the use of SimCom admitted he was impressed with the all-ASL episode (Grushkin):all too often, we see media accounts of Deaf people which play into our society’s perceptions of Deaf people: as helpless, handicapped individuals who are in need of fixes such as cochlear implants in order to “restore” us to society. Almost never do we see accounts of Deaf people as healthy, capable individuals who live ordinary, successful lives without necessarily conforming to the Hearing ‘script’ for how we should be. And important issues such as language rights or school closings are too often virtually ignored by the general media.In addition to the episode being widely discussed within the Deaf community, the mainstream news media also covered Uprising intensely, seeing it as a meaningful cultural moment, not just for the Deaf community but for popular culture in general. Lacob wrote that he realises that hearing viewers probably won’t understand what it means to be a deaf person in modern America, but he believes that the episodeposits that there are moments of understanding, commonalities, and potential bridge-building between these two communities. And the desire for understanding is the first step toward a more inclusive and broad-minded future.He continues:the significance of this moment can’t be undervalued, nor can the show’s rich embrace of deaf history, manifested here in the form of Gallaudet and the historical figures whose photographs and stories are papered on the windows of Carlton during the student protest. What we’re seeing on screen—within the confines of a teen drama, no less—is an engaged exploration of a culture and a civil rights movement brought to life with all of the color and passion it deserves. It may be 25 years since Gallaudet, but the dreams of those protesters haven’t faded. And they—and the ideals of identity and equality that they express—are most definitely being heard.Lacob’s analysis was praised by several Deaf people—by a Deaf graduate student who teaches a Disability in Popular Culture course and by a Gallaudet student who said, “From someone who is deaf, and not ashamed of it either, let me say right here and now: that was the most eloquent piece of writing by someone hearing I have ever seen” (Emma72). The power of the Uprising episode illustrated a political space where “groups actively fuse and blend their culture with the mainstream culture” (Foley 119, as cited in Chang 3). Switched at Birth—specifically the Uprising episode—has indeed fused Deaf culture and ASL into a place in mainstream television culture.ReferencesABC Family. “Switched at Birth Deaf Actor Search.” Facebook (2010). <https://www.facebook.com/SwitchedSearch>.———. “This Is Not a Pipe.” Switched at Birth. Pilot episode. 6 June 2011. <http://freeform.go.com/shows/switched-at-birth>.———. “Not Hearing Loss, Deaf Gain.” Switched at Birth. YouTube video, 11 Feb. 2013. <https://www.youtube.com/watch?v=F5W604uSkrk>.Academy of Television Arts & Sciences. “Talking Diversity: ABC Family’s Switched at Birth.” Emmys.com (Feb. 2012). <http://www.emmys.com/content/webcast-talking-diversity-abc-familys-switched-birth>.Anderson, G. “‘Switched at Birth’ Celebrates 25th Anniversary of ‘Deaf President Now’.” Pop-topia (5 Mar. 2013). <http://www.pop-topia.com/switched-at-birth-celebrates-25th-anniversary-of-deaf-president-now/>.Barney, C. “’Switched at Birth’ Another Winner for ABC Family.” Contra Costa News (29 June 2011). <http://www.mercurynews.com/tv/ci_18369762>.Bibel, S. “‘Switched at Birth’s Katie LeClerc Is Proud to Represent the Deaf Community.” Xfinity TV blog (20 June 2011). <http://xfinity.comcast.net/blogs/tv/2011/06/20/switched-at-births-katie-leclerc-is-proud-to-represent-the-deaf-community/>.Chang, H. “Re-Examining the Rhetoric of the ‘Cultural Border’.” Essay presented at the American Anthropological Association Annual Meeting, Philadelphia, Dec. 1988.DR_Staff. “Switched at Birth: How #TakeBackCarlton Made History.” deafReview (6 Mar. 2013). <http://deafreview.com/deafreview-news/switched-at-birth-how-takebackcarlton-made-history/>.Efron, Amy Cohen. “Switched At Birth: Uprising – Deaf Adult’s Commentary.” Deaf World as I See It (Mar. 2013). <http://www.deafeyeseeit.com/2013/03/05/sabcommentary/>.Emma72. “ABC Family’s ‘Switched at Birth’ ASL Episode Recalls Gallaudet Protest.” Comment. The Daily Beast (28 Feb. 2013). <http://www.thedailybeast.com/articles/2013/02/28/abc-family-s-switched-at-birth-asl-episode-recalls-gallaudet-protest.html>.Fiveash, Chad. Personal interview. 17 Jan. 2014.Gallaudet University. “The Issues.” Deaf President Now (2013). <http://www.gallaudet.edu/dpn_home/issues.html>.Grushkin, D. “A Cultural Review. ASL Challenged.” Switched at Birth Facebook page. Facebook (2013). <https://www.facebook.com/SwitchedatBirth/posts/508748905835658>.Jankowski, K.A. Deaf Empowerment: Emergence, Struggle, and Rhetoric. Washington: Gallaudet UP, 1997.———. “A Metaphorical Analysis of Conflict at the Gallaudet Protest.” Unpublished seminar paper presented at the University of Maryland, 1990.Lacob, J. “ABC Family’s ‘Switched at Birth’ ASL Episode Recalls Gallaudet Protest.” The Daily Beast 28 Feb. 2013. <http://www.thedailybeast.com/articles/2013/02/28/abc-family-s-switched-at-birth-asl-episode-recalls-gallaudet-protest.html>.Martin, D. “Switched at Birth Season 2 Episode 9 ‘Uprising’ ASL/Deaf Cultural Analysis.” David Martin YouTube channel (6 Mar. 2013). <http://www.youtube.com/watch?v=JA0vqCysoVU>.Nielson, R. “Petitioned ABC Family and the ‘Switched at Birth’ Series, Create Responsible, Accurate, and Family-Oriented TV Programming.” Change.org (2011). <http://www.change.org/p/abc-family-and-the-switched-at-birth-series-create-responsible-accurate-and-family-oriented-tv-programming>.Orangejack. “Details about Katie Leclerc’s Hearing Loss.” My ASL Journey Blog (29 June 2011). <http://asl.orangejack.com/details-about-katie-leclercs-hearing-loss>.Paz, G. “Casting Call: Open Auditions for Switched at Birth by ABC Family.” Series & TV (3 Oct. 2010). <http://seriesandtv.com/casting-call-open-auditions-for-switched-at-birth-by-abc-family/4034>.Ryan, Maureen. “‘Switched at Birth’ Season 1.5 Has More Drama and Subversive Soapiness.” The Huffington Post (31 Aug. 2012). <http://www.huffingtonpost.com/maureen-ryan/switched-at-birth-season-1_b_1844957.html>.Stelter, B. “Teaching Viewers to Hear with Their Eyes Only.” The New York Times 8 Mar. 2013. <http://www.nytimes.com/2013/03/09/arts/television/teaching-viewers-to-hear-the-tv-with-eyes-only.html>.Van Cleve, J.V., and B.A. Crouch. A Place of Their Own: Creating the Deaf Community in America. DC: Gallaudet University Press, 1989.Yahr, E. “Gallaudet University Uses All-Sign Language Episode of ‘Switched at Birth’ to Air New Commercial.” The Washington Post 3 Mar. 2013 <http://www.washingtonpost.com/blogs/tv-column/post/gallaudet-university-uses-all-sign-language-episode-of-switched-at-birth-to-air-new-commercial/2013/03/04/0017a45a-8508-11e2-9d71-f0feafdd1394_blog.html>.

Kangatarianism is the rather inelegant word coined in the first decade of the twenty-first century to describe an omnivorous diet in which the only meat consumed is that of the kangaroo. First published in the media in 2010 (Barone; Zukerman), the term circulated in Australian environmental and academic circles including the Global Animal conference at the University of Wollongong in July 2011 where I first heard it from members of the Think Tank for Kangaroos (THINKK) group. By June 2017, it had gained enough attention to be named the Oxford English Dictionary’s Australian word of the month (following on from May’s “smashed avo,” another Australian food innovation), but it took the Nine Network reality television series Love Island Australia to raise kangatarian to trending status on social media (Oxford UP). During the first episode, aired in late May 2018, Justin, a concreter and fashion model from Melbourne, declared himself to have previously been a kangatarian as he chatted with fellow contestant, Millie. Vet nurse and animal lover Millie appeared to be shocked by his revelation but was tentatively accepting when Justin explained what kangatarian meant, and justified his choice on the grounds that kangaroo are not farmed. In the social media response, it was clear that eating only the meat of kangaroos as an ethical choice was an entirely new concept to many viewers, with one tweet stating “Kangatarian isn’t a thing”, while others variously labelled the diet brutal, intriguing, or quintessentially Australian (see #kangatarian on Twitter).There is a well developed literature around the arguments for and against eating kangaroo, and why settler Australians tend to be so reluctant to do so (see for example, Probyn; Cawthorn and Hoffman). Here, I will concentrate on the role that ethics play in this food choice by examining how the adoption of kangatarianism can be understood as a bargain struck to help to manage grief in the Anthropocene, and the limitations of that bargain. As Lesley Head has argued, we are living in a time of loss and of grieving, when much that has been taken for granted is becoming unstable, and “we must imagine that drastic changes to everyday life are in the offing” (313). Applying the classic (and contested) model of five stages of grief, first proposed by Elisabeth Kübler-Ross in her book On Death and Dying in 1969, much of the population of the western world seems to be now experiencing denial, her first stage of loss, while those in the most vulnerable environments have moved on to anger with developed countries for destructive actions in the past and inaction in the present. The next stages (or states) of grieving—bargaining, depression, and acceptance—are likely to be manifested, although not in any predictable sequence, as the grief over current and future losses continues (Haslam).The great expansion of food restrictive diets in the Anthropocene can be interpreted as part of this bargaining state of grieving as individuals attempt to respond to the imperative to reduce their environmental impact but also to limit the degree of change to their own diet required to do so. Meat has long been identified as a key component of an individual’s environmental footprint. From Frances Moore Lappé’s 1971 Diet for a Small Planet through the United Nations’ Food and Agriculture Organisation’s 2006 report Livestock’s Long Shadow to the 2019 report of the EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems, the advice has been consistent: meat consumption should be minimised in, if not eradicated from, the human diet. The EAT–Lancet Commission Report quantified this to less than 28 grams (just under one ounce) of beef, lamb or pork per day (12, 25). For many this would be keenly felt, in terms of how meals are constructed, the sensory experiences associated with eating meat and perceptions of well-being but meat is offered up as a sacrifice to bring about the return of the beloved healthy planet.Rather than accept the advice to cut out meat entirely, those seeking to bargain with the Anthropocene also find other options. This has given rise to a suite of foodways based around restricting meat intake in volume or type. Reducing the amount of commercially produced beef, lamb and pork eaten is one approach, while substituting a meat the production of which has a smaller environmental footprint, most commonly chicken or fish, is another. For those willing to make deeper changes, the meat of free living animals, especially those which are killed accidentally on the roads or for deliberately for environmental management purposes, is another option. Further along this spectrum are the novel protein sources suggested in the Lancet report, including insects, blue-green algae and laboratory-cultured meats.Kangatarianism is another form of this bargain, and is backed by at least half a century of advocacy. The Australian Conservation Foundation made calls to reduce the numbers of other livestock and begin a sustainable harvest of kangaroo for food in 1970 when the sale of kangaroo meat for human consumption was still illegal across the country (Conservation of Kangaroos). The idea was repeated by biologist Gordon Grigg in the late 1980s (Jackson and Vernes 173), and again in the Garnaut Climate Change Review in 2008 (547–48). Kangaroo meat is high in protein and iron, low in fat, and high in healthy polyunsaturated fatty acids and conjugated linoleic acid, and, as these authors showed, has a smaller environmental footprint than beef, lamb, or pork. Kangaroo require less water than cattle, sheep or pigs, and no land is cleared to grow feed for them or give them space to graze. Their paws cause less erosion and compaction of soil than do the hooves of common livestock. They eat less fodder than ruminants and their digestive processes result in lower emissions of the powerful greenhouse gas methane and less solid waste.As Justin of Love Island was aware, kangaroo are not farmed in the sense of being deliberately bred, fed, confined, or treated with hormones, drugs or chemicals, which also adds to their lighter impact on the environment. However, some pastoralists argue that because they cannot prevent kangaroos from accessing the food, water, shelter, and protection from predators they provide for their livestock, they do effectively farm them, although they receive no income from sales of kangaroo meat. This type of light touch farming of kangaroos has a very long history in Australia going back to the continent’s first peopling some 60,000 years ago. Kangaroos were so important to Aboriginal people that a wide range of environments were manipulated to produce their favoured habitats of open grasslands edged by sheltering trees. As Bill Gammage demonstrated, fire was used as a tool to preserve and extend grassy areas, to encourage regrowth which would attract kangaroos and to drive the animals from one patch to another or towards hunters waiting with spears (passim, for example, 58, 72, 76, 93). Gammage and Bruce Pascoe agree that this was a form of animal husbandry in which the kangaroos were drawn to the areas prepared for them for the young grass or, more forcefully, physically directed using nets, brush fences or stone walls. Burnt ground served to contain the animals in place of fencing, and regular harvesting kept numbers from rising to levels which would place pressure on other species (Gammage 79, 281–86; Pascoe 42–43). Contemporary advocates of eating kangaroo have promoted the idea that they should be deliberately co-produced with other livestock instead of being killed to preserve feed and water for sheep and cattle (Ellicott; Wilson 39). Substituting kangaroo for the meat of more environmentally damaging animals would facilitate a reduction in the numbers of cattle and sheep, lessening the harm they do.Most proponents have assumed that their audience is current meat eaters who would substitute kangaroo for the meat of other more environmentally costly animals, but kangatarianism can also emerge from vegetarianism. Wendy Zukerman, who wrote about kangaroo hunting for New Scientist in 2010, was motivated to conduct the research because she was considering becoming an early adopter of kangatarianism as the least environmentally taxing way to counter the longterm anaemia she had developed as a vegetarian. In 2018, George Wilson, honorary professor in the Australian National University’s Fenner School of Environment and Society called for vegetarians to become kangatarians as a means of boosting overall consumption of kangaroo for environmental and economic benefits to rural Australia (39).Given these persuasive environmental arguments, it might be expected that many people would have perceived eating kangaroo instead of other meat as a favourable bargain and taken up the call to become kangatarian. Certainly, there has been widespread interest in trying kangaroo meat. In 1997, only five years after the sale of kangaroo meat for human consumption had been legalised in most states (South Australia did so in 1980), 51% of 500 people surveyed in five capital cities said they had tried kangaroo. However, it had not become a meat of choice with very few found to eat it more than three times a year (Des Purtell and Associates iv). Just over a decade later, a study by Ampt and Owen found an increase to 58% of 1599 Australians surveyed across the country who had tried kangaroo but just 4.7% eating it at least monthly (14). Bryce Appleby, in his study of kangaroo consumption in the home based on interviews with 28 residents of Wollongong in 2010, specifically noted the absence of kangatarians—then a very new concept. A study of 261 Sydney university students in 2014 found that half had tried kangaroo meat and 10% continued to eat it with any regularity. Only two respondents identified themselves as kangatarian (Grant 14–15). Kangaroo meat advocate Michael Archer declared in 2017 that “there’s an awful lot of very, very smart vegetarians [who] have opted for semi vegetarianism and they’re calling themselves ‘kangatarians’, as they’re quite happy to eat kangaroo meat”, but unless there had been a significant change in a few years, the surveys did not bear out his assertion (154).The ethical calculations around eating kangaroo are complicated by factors beyond the strictly environmental. One Tweeter advised Justin: “‘I’m a kangatarian’ isn’t a pickup line, mate”, and certainly the reception of his declaration could have been very cool, especially as it was delivered to a self declared animal warrior (N’Tash Aha). All of the studies of beliefs and practices around the eating of kangaroo have noted a significant minority of Australians who would not consider eating kangaroo based on issues of animal welfare and animal rights. The 1997 study found that 11% were opposed to the idea of eating kangaroo, while in Grant’s 2014 study, 15% were ethically opposed to eating kangaroo meat (Des Purtell and Associates iv; Grant 14–15). Animal ethics complicate the bargains calculated principally on environmental grounds.These ethical concerns work across several registers. One is around the flesh and blood kangaroo as a charismatic native animal unique to Australia and which Australians have an obligation to respect and nurture. Sheep, cattle and pigs have been subject to longterm propaganda campaigns which entrench the idea that they are unattractive and unintelligent, and veil their transition to meat behind euphemistic language and abattoir walls, making it easier to eat them. Kangaroos are still seen as resourceful and graceful animals, and no linguistic tricks shield consumers from the knowledge that it is a roo on their plate. A proposal in 2009 to market a “coat of arms” emu and kangaroo-flavoured potato chip brought complaints to the Advertising Standards Bureau that this was disrespectful to these native animals, although the flavours were to be simulated and the product vegetarian (Black). Coexisting with this high regard to kangaroos is its antithesis. That is, a valuation of them informed by their designation as a pest in the pastoral industry, and the use of the carcasses of those killed to feed dogs and other companion animals. Appleby identified a visceral, disgust response to the idea of eating kangaroo in many of his informants, including both vegetarians who would not consider eating kangaroo because of their commitment to a plant-based diet, and at least one omnivore who would prefer to give up all meat rather than eat kangaroo. While diametrically opposed, the end point of both positions is that kangaroo meat should not be eaten.A second animal ethics stance relates to the imagined kangaroo, a cultural construct which for most urban Australians is much more present in their lives and likely to shape their actions than the living animals. It is behind the rejection of eating an animal which holds such an iconic place in Australian culture: to the dexter on the 1912 national coat of arms; hopping through the Hundred Acre Wood as Kanga and Roo in A.A. Milne’s Winnie-the-Pooh children’s books from the 1920s and the Disney movies later made from them; as a boy’s best friend as Skippy the Bush Kangaroo in a fondly remembered 1970s television series; and high in the sky on QANTAS planes. The anthropomorphising of kangaroos permitted the spectacle of the boxing kangaroo from the late nineteenth century. By framing natural kangaroo behaviours as boxing, these exhibitions encouraged an ambiguous understanding of kangaroos as human-like, moving them further from the category of food (Golder and Kirkby). Australian government bodies used this idea of the kangaroo to support food exports to Britain, with kangaroos as cooks or diners rather than ingredients. The Kangaroo Kookery Book of 1932 (see fig. 1 below) portrayed kangaroos as a nuclear family in a suburban kitchen and another official campaign supporting sales of Australian produce in Britain in the 1950s featured a Disney-inspired kangaroo eating apples and chops washed down with wine (“Kangaroo to Be ‘Food Salesman’”). This imagining of kangaroos as human-like has persisted, leading to the opinion expressed in a 2008 focus group, that consuming kangaroo amounted to “‘eating an icon’ … Although they are pests they are still human nature … these are native animals, people and I believe that is a form of cannibalism!” (Ampt and Owen 26). Figure 1: Rather than promoting the eating of kangaroos, the portrayal of kangaroos as a modern suburban family in the Kangaroo Kookery Book (1932) made it unthinkable. (Source: Kangaroo Kookery Book, Director of Australian Trade Publicity, Australia House, London, 1932.)The third layer of ethical objection on the ground of animal welfare is more specific, being directed to the method of killing the kangaroos which become food. Kangaroos are perhaps the only native animals for which state governments set quotas for commercial harvest, on the grounds that they compete with livestock for pasturage and water. In most jurisdictions, commercially harvested kangaroo carcasses can be processed for human consumption, and they are the ones which ultimately appear in supermarket display cases.Kangaroos are killed by professional shooters at night using swivelling spotlights mounted on their vehicles to locate and daze the animals. While clean head shots are the ideal and regulations state that animals should be killed when at rest and without causing “undue agonal struggle”, this is not always achieved and some animals do suffer prolonged deaths (NSW Code of Practice for Kangaroo Meat for Human Consumption). By regulation, the young of any female kangaroo must be killed along with her. While averting a slow death by neglect, this is considered cruel and wasteful. The hunt has drawn international criticism, including from Greenpeace which organised campaigns against the sale of kangaroo meat in Europe in the 1980s, and Viva! which was successful in securing the withdrawal of kangaroo from sale in British supermarkets (“Kangaroo Meat Sales Criticised”). These arguments circulate and influence opinion within Australia.A final animal ethics issue is that what is actually behind the push for greater use of kangaroo meat is not concern for the environment or animal welfare but the quest to turn a profit from these animals. The Kangaroo Industries Association of Australia, formed in 1970 to represent those who dealt in the marsupials’ meat, fur and skins, has been a vocal advocate of eating kangaroo and a sponsor of market research into how it can be made more appealing to the market. The Association argued in 1971 that commercial harvest was part of the intelligent conservation of the kangaroo. They sought minimum size regulations to prevent overharvesting and protect their livelihoods (“Assn. Backs Kangaroo Conservation”). The Association’s current website makes the claim that wild harvested “Australian kangaroo meat is among the healthiest, tastiest and most sustainable red meats in the world” (Kangaroo Industries Association of Australia). That this is intended to initiate a new and less controlled branch of the meat industry for the benefit of hunters and processors, rather than foster a shift from sheep or cattle to kangaroos which might serve farmers and the environment, is the opinion of Dr. Louise Boronyak, of the Centre for Compassionate Conservation at the University of Technology Sydney (Boyle 19).Concerns such as these have meant that kangaroo is most consumed where it is least familiar, with most of the meat for human consumption recovered from culled animals being exported to Europe and Asia. Russia has been the largest export market. There, kangaroo meat is made less strange by blending it with other meats and traditional spices to make processed meats, avoiding objections to its appearance and uncertainty around preparation. With only a low profile as a novelty animal in Russia, there are fewer sentimental concerns about consuming kangaroo, although the additional food miles undermine its environmental credentials. The variable acceptability of kangaroo in more distant markets speaks to the role of culture in determining how patterns of eating are formed and can be shifted, or, as Elspeth Probyn phrased it “how natural entities are transformed into commodities within a context of globalisation and local communities”, underlining the impossibility of any straightforward ethics of eating kangaroo (33, 35).Kangatarianism is a neologism which makes the eating of kangaroo meat something it has not been in the past, a voluntary restriction based on environmental ethics. These environmental benefits are well founded and eating kangaroo can be understood as an Anthropocenic bargain struck to allow the continuation of the consumption of red meat while reducing one’s environmental footprint. Although superficially attractive, the numbers entering into this bargain remain small because environmental ethics cannot be disentangled from animal ethics. The anthropomorphising of the kangaroo and its use as a national symbol coexist with its categorisation as a pest and use of its meat as food for companion animals. Both understandings of kangaroos made their meat uneatable for many Australians. Paired with concerns over how kangaroos are killed and the commercialisation of a native species, kangaroo meat has a very mixed reception despite decades of advocacy for eating its meat in favour of that of more harmed and more harmful introduced species. Given these constraints, kangatarianism is unlikely to become widespread and indeed it should be viewed as at best a temporary exigency. As the climate warms and rainfall becomes more erratic, even animals which have evolved to suit Australian conditions will come under increasing pressure, and humans will need to reach Kübler-Ross’ final state of grief: acceptance. In this case, this would mean acceptance that our needs cannot be placed ahead of those of other animals.ReferencesAmpt, Peter, and Kate Owen. Consumer Attitudes to Kangaroo Meat Products. Canberra: Rural Industries Research and Development Corporation, 2008.Appleby, Bryce. “Skippy the ‘Green’ Kangaroo: Identifying Resistances to Eating Kangaroo in the Home in a Context of Climate Change.” BSc Hons, U of Wollongong, 2010 <http://ro.uow.edu.au/thsci/103>.Archer, Michael. “Zoology on the Table: Plenary Session 4.” Australian Zoologist 39, 1 (2017): 154–60.“Assn. Backs Kangaroo Conservation.” The Beverley Times 26 Feb. 1971: 3. 22 Feb. 2019 <http://nla.gov.au/nla.news-article202738733>.Barone, Tayissa. “Kangatarians Jump the Divide.” Sydney Morning Herald 9 Feb. 2010. 13 Apr. 2019 <https://www.smh.com.au/lifestyle/kangatarians-jump-the-divide-20100209-gdtvd8.html>.Black, Rosemary. “Some Australians Angry over Idea for Kangaroo and Emu-Flavored Potato Chips.” New York Daily News 4 Dec. 2009. 5 Feb. 2019 <https://www.nydailynews.com/life-style/eats/australians-angry-idea-kangaroo-emu-flavored-potato-chips-article-1.431865>.Boyle, Rhianna. “Eating Skippy.” Big Issue Australia 578 11-24 Jan. 2019: 16–19.Cawthorn, Donna-Mareè, and Louwrens C. Hoffman. “Controversial Cuisine: A Global Account of the Demand, Supply and Acceptance of ‘Unconventional’ and ‘Exotic’ Meats.” Meat Science 120 (2016): 26–7.Conservation of Kangaroos. Melbourne: Australian Conservation Foundation, 1970.Des Purtell and Associates. Improving Consumer Perceptions of Kangaroo Products: A Survey and Report. Canberra: Rural Industries Research and Development Corporation, 1997.Ellicott, John. “Little Pay Incentive for Shooters to Join Kangaroo Meat Industry.” The Land 15 Mar. 2018. 28 Mar. 2019 <https://www.theland.com.au/story/5285265/top-roo-shooter-says-harvesting-is-a-low-paid-job/>.Garnaut, Ross. Garnaut Climate Change Review. 2008. 26 Feb. 2019 <http://www.garnautreview.org.au/index.htm>.Gammage, Bill. The Biggest Estate on Earth: How Aborigines Made Australia. Sydney: Allen and Unwin, 2012.Golder, Hilary, and Diane Kirkby. “Mrs. Mayne and Her Boxing Kangaroo: A Married Woman Tests Her Property Rights in Colonial New South Wales.” Law and History Review 21.3 (2003): 585–605.Grant, Elisabeth. “Sustainable Kangaroo Harvesting: Perceptions and Consumption of Kangaroo Meat among University Students in New South Wales.” Independent Study Project (ISP). 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The Leichhardt Highway is a six hundred-kilometre stretch of sealed inland road that joins the Australian Queensland border town of Goondiwindi with the Capricorn Highway, just south of the Tropic of Capricorn. Named after the young Prussian naturalist Ludwig Leichhardt, part of this roadway follows the route his party took as they crossed northern Australia from Morton Bay (Brisbane) to Port Essington (near Darwin). Ignoring the usual colonial practice of honouring the powerful and aristocratic, Leichhardt named the noteworthy features along this route after his supporters and fellow expeditioners. Many of these names are still in use and a series of public monuments have also been erected in the intervening century and a half to commemorate this journey. Unlike Leichhardt, who survived his epic trip, some contemporary travellers who navigate the remote roadway named in his honour do not arrive at their final destinations. Memorials to these violently interrupted lives line the highway, many enigmatically located in places where there is no obvious explanation for the lethal violence that occurred there. This examination profiles the memorials along Leichhardt’s highway as Gothic practice, in order to illuminate some of the uncanny paradoxes around public memorials, as well as the loaded emotional terrain such commemorative practices may inhabit. All humans know that death awaits them (Morell). Yet, despite this, and the unprecedented torrent of images of death and dying saturating news, television, and social media (Duwe; Sumiala; Bisceglio), Gorer’s mid-century ideas about the denial of death and Becker’s 1973 Pulitzer prize-winning description of the purpose of human civilization as a defence against this knowledge remains current in the contemporary trope that individuals (at least in the West) deny their mortality. Contributing to this enigmatic situation is how many deny the realities of aging and bodily decay—the promise of the “life extension” industries (Hall)—and are shielded from death by hospitals, palliative care providers, and the multimillion dollar funeral industry (Kiernan). Drawing on Piatti-Farnell’s concept of popular culture artefacts as “haunted/haunting” texts, the below describes how memorials to the dead can powerfully reconnect those who experience them with death’s reality, by providing an “encrypted passageway through which the dead re-join the living in a responsive cycle of exchange and experience” (Piatti-Farnell). While certainly very different to the “sublime” iconic Gothic structure, the Gothic ruin that Summers argued could be seen as “a sacred relic, a memorial, a symbol of infinite sadness, of tenderest sensibility and regret” (407), these memorials do function in both this way as melancholy/regret-inducing relics as well as in Piatti-Farnell’s sense of bringing the dead into everyday consciousness. Such memorialising activity also evokes one of Spooner’s features of the Gothic, by acknowledging “the legacies of the past and its burdens on the present” (8).Ludwig Leichhardt and His HighwayWhen Leichhardt returned to Sydney in 1846 from his 18-month journey across northern Australia, he was greeted with surprise and then acclaim. Having mounted his expedition without any backing from influential figures in the colony, his party was presumed lost only weeks after its departure. Yet, once Leichhardt and almost all his expedition returned, he was hailed “Prince of Explorers” (Erdos). When awarding him a significant purse raised by public subscription, then Speaker of the Legislative Council voiced what he believed would be the explorer’s lasting memorial —the public memory of his achievement: “the undying glory of having your name enrolled amongst those of the great men whose genius and enterprise have impelled them to seek for fame in the prosecution of geographical science” (ctd. Leichhardt 539). Despite this acclaim, Leichhardt was a controversial figure in his day; his future prestige not enhanced by his Prussian/Germanic background or his disappearance two years later attempting to cross the continent. What troubled the colonial political class, however, was his transgressive act of naming features along his route after commoners rather than the colony’s aristocrats. Today, the Leichhardt Highway closely follows Leichhardt’s 1844-45 route for some 130 kilometres from Miles, north through Wandoan to Taroom. In the first weeks of his journey, Leichhardt named 16 features in this area: 6 of the more major of these after the men in his party—including the Aboriginal man ‘Charley’ and boy John Murphy—4 more after the tradesmen and other non-aristocratic sponsors of his venture, and the remainder either in memory of the journey’s quotidian events or natural features there found. What we now accept as traditional memorialising practice could in this case be termed as Gothic, in that it upset the rational, normal order of its day, and by honouring humble shopkeepers, blacksmiths and Indigenous individuals, revealed the “disturbance and ambivalence” (Botting 4) that underlay colonial class relations (Macintyre). On 1 December 1844, Leichhardt also memorialised his own past, referencing the Gothic in naming a watercourse The Creek of the Ruined Castles due to the “high sandstone rocks, fissured and broken like pillars and walls and the high gates of the ruined castles of Germany” (57). Leichhardt also disturbed and disfigured the nature he so admired, famously carving his initials deep into trees along his route—a number of which still exist, including the so-called Leichhardt Tree, a large coolibah in Taroom’s main street. Leichhardt also wrote his own memorial, keeping detailed records of his experiences—both good and more regretful—in the form of field books, notebooks and letters, with his major volume about this expedition published in London in 1847. Leichhardt’s journey has since been memorialised in various ways along the route. The Leichhardt Tree has been further defaced with numerous plaques nailed into its ancient bark, and the town’s federal government-funded Bicentennial project raised a formal memorial—a large sandstone slab laid with three bronze plaques—in the newly-named Ludwig Leichhardt Park. Leichhardt’s name also adorns many sites both along, and outside, the routes of his expeditions. While these fittingly include natural features such as the Leichhardt River in north-west Queensland (named in 1856 by Augustus Gregory who crossed it by searching for traces of the explorer’s ill-fated 1848 expedition), there are also many businesses across Queensland and the Northern Territory less appropriately carrying his name. More somber monuments to Leichhardt’s legacy also resulted from this journey. The first of these was the white settlement that followed his declaration that the countryside he moved through was well endowed with fertile soils. With squatters and settlers moving in and land taken up before Leichhardt had even arrived back in Sydney, the local Yeeman people were displaced, mistreated and completely eradicated within a decade (Elder). Mid-twentieth century, Patrick White’s literary reincarnation, Voss of the eponymous novel, and paintings by Sidney Nolan and Albert Tucker have enshrined in popular memory not only the difficult (and often described as Gothic) nature of the landscape through which Leichhardt travelled (Adams; Mollinson, and Bonham), but also the distinctive and contrary blend of intelligence, spiritual mysticism, recklessness, and stoicism Leichhardt brought to his task. Roadside Memorials Today, the Leichhardt Highway is also lined with a series of roadside shrines to those who have died much more recently. While, like centotaphs, tombstones, and cemeteries, these memorialise the dead, they differ in usually marking the exact location that death occurred. In 43 BC, Cicero articulated the idea of the dead living in memory, “The life of the dead consists in the recollection cherished of them by the living” (93), yet Nelson is one of very few contemporary writers to link roadside memorials to elements of Gothic sensibility. Such constructions can, however, be described as Gothic, in that they make the roadway unfamiliar by inscribing onto it the memory of corporeal trauma and, in the process, re-creating their locations as vivid sites of pain and suffering. These are also enigmatic sites. Traffic levels are generally low along the flat or gently undulating terrain and many of these memorials are located in locations where there is no obvious explanation for the violence that occurred there. They are loci of contradictions, in that they are both more private than other memorials, in being designed, and often made and erected, by family and friends of the deceased, and yet more public, visible to all who pass by (Campbell). Cemeteries are set apart from their surroundings; the roadside memorial is, in contrast, usually in open view along a thoroughfare. In further contrast to cemeteries, which contain many relatively standardised gravesites, individual roadside memorials encapsulate and express not only the vivid grief of family and friends but also—when they include vehicle wreckage or personal artefacts from the fatal incident—provide concrete evidence of the trauma that occurred. While the majority of individuals interned in cemeteries are long dead, roadside memorials mark relatively contemporary deaths, some so recent that there may still be tyre marks, debris and bloodstains marking the scene. In 2008, when I was regularly travelling this roadway, I documented, and researched, the six then extant memorial sites that marked the locations of ten fatalities from 1999 to 2006. (These were all still in place in mid-2014.) The fatal incidents are very diverse. While half involved trucks and/or road trains, at least three were single vehicle incidents, and the deceased ranged from 13 to 84 years of age. Excell argues that scholarship on roadside memorials should focus on “addressing the diversity of the material culture” (‘Contemporary Deathscapes’) and, in these terms, the Leichhardt Highway memorials vary from simple crosses to complex installations. All include crosses (mostly, but not exclusively, white), and almost all are inscribed with the name and birth/death dates of the deceased. Most include flowers or other plants (sometimes fresh but more often plastic), but sometimes also a range of relics from the crash and/or personal artefacts. These are, thus, unsettling sights, not least in the striking contrast they provide with the highway and surrounding road reserve. The specific location is a key component of their ability to re-sensitise viewers to the dangers of the route they are travelling. The first memorial travelling northwards, for instance, is situated at the very point at which the highway begins, some 18 kilometres from Goondiwindi. Two small white crosses decorated with plastic flowers are set poignantly close together. The inscriptions can also function as a means of mobilising connection with these dead strangers—a way of building Secomb’s “haunted community”, whereby community in the post-colonial age can only be built once past “murderous death” (131) is acknowledged. This memorial is inscribed with “Cec Hann 06 / A Good Bloke / A Good hoarseman [sic]” and “Pat Hann / A Good Woman” to tragically commemorate the deaths of an 84-year-old man and his 79-year-old wife from South Australia who died in the early afternoon of 5 June 2006 when their Ford Falcon, towing a caravan, pulled onto the highway and was hit by a prime mover pulling two trailers (Queensland Police, ‘Double Fatality’; Jones, and McColl). Further north along the highway are two memorials marking the most inexplicable of road deaths: the single vehicle fatality (Connolly, Cullen, and McTigue). Darren Ammenhauser, aged 29, is remembered with a single white cross with flowers and plaque attached to a post, inscribed hopefully, “Darren Ammenhauser 1971-2000 At Rest.” Further again, at Billa Billa Creek, a beautifully crafted metal cross attached to a fence is inscribed with the text, “Kenneth J. Forrester / RIP Jack / 21.10.25 – 27.4.05” marking the death of the 79-year-old driver whose vehicle veered off the highway to collide with a culvert on the creek. It was reported that the vehicle rolled over several times before coming to rest on its wheels and that Forrester was dead when the police arrived (Queensland Police, ‘Fatal Traffic Incident’). More complex memorials recollect both single and multiple deaths. One, set on both sides of the road, maps the physical trajectory of the fatal smash. This memorial comprises white crosses on both sides of road, attached to a tree on one side, and a number of ancillary sites including damaged tyres with crosses placed inside them on both sides of the road. Simple inscriptions relay the inability of such words to express real grief: “Gary (Gazza) Stevens / Sadly missed” and “Gary (Gazza) Stevens / Sadly missed / Forever in our hearts.” The oldest and most complex memorial on the route, commemorating the death of four individuals on 18 June 1999, is also situated on both sides of the road, marking the collision of two vehicles travelling in opposite directions. One memorial to a 62-year-old man comprises a cross with flowers, personal and automotive relics, and a plaque set inside a wooden fence and simply inscribed “John Henry Keenan / 23-11-1936–18-06-1999”. The second memorial contains three white crosses set side-by-side, together with flowers and relics, and reveals that members of three generations of the same family died at this location: “Raymond Campbell ‘Butch’ / 26-3-67–18-6-99” (32 years of age), “Lorraine Margaret Campbell ‘Lloydie’ / 29-11-46–18-6-99” (53 years), and “Raymond Jon Campbell RJ / 28-1-86–18-6-99” (13 years). The final memorial on this stretch of highway is dedicated to Jason John Zupp of Toowoomba who died two weeks before Christmas 2005. This consists of a white cross, decorated with flowers and inscribed: “Jason John Zupp / Loved & missed by all”—a phrase echoed in his newspaper obituary. The police media statement noted that, “at 11.24pm a prime mover carrying four empty trailers [stacked two high] has rolled on the Leichhardt Highway 17km north of Taroom” (Queensland Police, ‘Fatal Truck Accident’). The roadside memorial was placed alongside a ditch on a straight stretch of road where the body was found. The coroner’s report adds the following chilling information: “Mr Zupp was thrown out of the cabin and his body was found near the cabin. There is no evidence whatsoever that he had applied the brakes or in any way tried to prevent the crash … Jason was not wearing his seatbelt” (Cornack 5, 6). Cornack also remarked the truck was over length, the brakes had not been properly adjusted, and the trip that Zupp had undertaken could not been lawfully completed according to fatigue management regulations then in place (8). Although poignant and highly visible due to these memorials, these deaths form a small part of Australia’s road toll, and underscore our ambivalent relationship with the automobile, where road death is accepted as a necessary side-effect of the freedom of movement the technology offers (Ladd). These memorials thus animate highways as Gothic landscapes due to the “multifaceted” (Haider 56) nature of the fear, terror and horror their acknowledgement can bring. Since 1981, there have been, for instance, between some 1,600 and 3,300 road deaths each year in Australia and, while there is evidence of a long term downward trend, the number of deaths per annum has not changed markedly since 1991 (DITRDLG 1, 2), and has risen in some years since then. The U.S.A. marked its millionth road death in 1951 (Ladd) along the way to over 3,000,000 during the 20th century (Advocates). These deaths are far reaching, with U.K. research suggesting that each death there leaves an average of 6 people significantly affected, and that there are some 10 to 20 per cent of mourners who experience more complicated grief and longer term negative affects during this difficult time (‘Pathways Through Grief’). As the placing of roadside memorials has become a common occurrence the world over (Klaassens, Groote, and Vanclay; Grider; Cohen), these are now considered, in MacConville’s opinion, not only “an appropriate, but also an expected response to tragedy”. Hockey and Draper have explored the therapeutic value of the maintenance of “‘continuing bonds’ between the living and the dead” (3). This is, however, only one explanation for the reasons that individuals erect roadside memorials with research suggesting roadside memorials perform two main purposes in their linking of the past with the present—as not only sites of grieving and remembrance, but also of warning (Hartig, and Dunn; Everett; Excell, Roadside Memorials; MacConville). Clark adds that by “localis[ing] and personalis[ing] the road dead,” roadside memorials raise the profile of road trauma by connecting the emotionless statistics of road death directly to individual tragedy. They, thus, transform the highway into not only into a site of past horror, but one in which pain and terror could still happen, and happen at any moment. Despite their increasing commonality and their recognition as cultural artefacts, these memorials thus occupy “an uncomfortable place” both in terms of public policy and for some individuals (Lowe). While in some states of the U.S.A. and in Ireland the erection of such memorials is facilitated by local authorities as components of road safety campaigns, in the U.K. there appears to be “a growing official opposition to the erection of memorials” (MacConville). Criticism has focused on the dangers (of distraction and obstruction) these structures pose to passing traffic and pedestrians, while others protest their erection on aesthetic grounds and even claim memorials can lower property values (Everett). While many ascertain a sense of hope and purpose in the physical act of creating such shrines (see, for instance, Grider; Davies), they form an uncanny presence along the highway and can provide dangerous psychological territory for the viewer (Brien). Alongside the townships, tourist sites, motels, and petrol stations vying to attract customers, they stain the roadway with the unmistakable sign that a violent death has happened—bringing death, and the dead, to the fore as a component of these journeys, and destabilising prominent cultural narratives of technological progress and safety (Richter, Barach, Ben-Michael, and Berman).Conclusion This investigation has followed Goddu who proposes that a Gothic text “registers its culture’s contradictions” (3) and, in profiling these memorials as “intimately connected to the culture that produces them” (Goddu 3) has proposed memorials as Gothic artefacts that can both disturb and reveal. Roadside memorials are, indeed, so loaded with emotional content that their close contemplation can be traumatising (Brien), yet they are inescapable while navigating the roadway. Part of their power resides in their ability to re-animate those persons killed in these violent in the minds of those viewing these memorials. In this way, these individuals are reincarnated as ghostly presences along the highway, forming channels via which the traveller can not only make human contact with the dead, but also come to recognise and ponder their own sense of mortality. While roadside memorials are thus like civic war memorials in bringing untimely death to the forefront of public view, roadside memorials provide a much more raw expression of the chaotic, anarchic and traumatic moment that separates the world of the living from that of the dead. While traditional memorials—such as those dedicated by, and to, Leichhardt—moreover, pay homage to the vitality of the lives of those they commemorate, roadside memorials not only acknowledge the alarming circumstances of unexpected death but also stand testament to the power of the paradox of the incontrovertibility of sudden death versus our lack of ability to postpone it. In this way, further research into these and other examples of Gothic memorialising practice has much to offer various areas of cultural study in Australia.ReferencesAdams, Brian. Sidney Nolan: Such Is Life. Hawthorn, Vic.: Hutchinson, 1987. Advocates for Highway and Auto Safety. “Motor Vehicle Traffic Fatalities & Fatality Rate: 1899-2003.” 2004. Becker, Ernest. The Denial of Death. New York: Simon & Schuster, 1973. Bisceglio, Paul. “How Social Media Is Changing the Way We Approach Death.” The Atlantic 20 Aug. 2013. Botting, Fred. Gothic: The New Critical Idiom. 2nd edition. Abingdon, UK: Routledge, 2014. 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