Journal articles on the topic 'Woden Valley Hospital'

The Canberra Clinical School is attached to Woden Valley Hospital, the principalhospital in the Australian Capital Territory. The clinical school arose out of amemorandum of understanding signed between the University of Sydney and theACT Department of Health (as it then was) in March 1993. One of theaspirations of those who negotiated the memorandum of understanding was thatthe creation of the clinical school would lead to a cultural shift in attitudes towardschange within the health care system. This paper looks at the management structureof Woden Valley Hospital and at what the development of a clinical school inCanberra can achieve, particularly in relation to hospital and health servicemanagement.

Newborn resuscitation requires a multidisciplinary team effort to deliver safe, effective and efficient care. California Perinatal Quality Care Collaborative’s Simulating Success program was designed to help hospitals implement on-site simulation-based neonatal resuscitation training programs. Partnering with the Center for Advanced Pediatric and Perinatal Education at Stanford, Simulating Success engaged hospitals over a 15 month period, including three months of preparatory training and 12 months of implementation. The experience of the first cohort (Children’s Hospital of Orange County (CHOC), Sharp Mary Birch Hospital for Women and Newborns (SMB) and Valley Children’s Hospital (VCH)), with their site-specific needs and aims, showed that a multidisciplinary approach with a sound understanding of simulation methodology can lead to a dynamic simulation program. All sites increased staff participation. CHOC reduced latent safety threats measured during team exercises from 4.5 to two per simulation while improving debriefing skills. SMB achieved 100% staff participation by identifying unit-specific hurdles within in situ simulation. VCH improved staff confidence level in responding to neonatal codes and proved feasibility of expanding simulation across their hospital system. A multidisciplinary approach to quality improvement in neonatal resuscitation fosters engagement, enables focus on patient safety rather than individual performance, and leads to identification of system issues.

Background: Urinary tract infections “UTIs” are one of the frequently encountered problems during pregnancy. Untreated UTI can be associated with serious obstetric complications. Hence the management and prevention of UTI in pregnancy is the crucial factor for the sustained pregnant period. Hence the present study was designed to identify the pathogenic agents of UTI and its associated risk factors in antenatal mothers in two private hospitals at Kathmandu city. Aim: The main objective of the study was to identify the etiological agent and associated risk factor in Urinary tract infection among pregnant women attending the antenatal care service visit in a selected hospital. Study Design: Cross-sectional descriptive study. Place and Time of Study: The study was carried out under the supervision of University and field study was carried out in Kathmandu, Nepal from March 2019 to October 2019. Methods: The cross-sectional study was performed at the Norvic Hospital and Baidya and Banskota hospital from March 2019 to October 2019. In this cross-sectional study, a total of 510, clean catch midstream urine (MSU) samples were collected aseptically and analyzed using standard microbiology methods. Data for the factors associated with UTI were obtained by use of questionnaires and standard laboratory tests for selected underlying conditions concerning associated risk factors were collected using structured questionnaires and the sample was also processed for antimicrobial drug susceptibility testing. Results: The study revealed 193/510(37.84%) UTI prevalence among patients attending two hospitals in Kathmandu valley. Escherichia coli was the most prevalent bacterial uropathogen with 119/193(61.6%) followed by Klebsiella pneumoniae 35/193(18.13%), Staphylococcus aureus 22/193 (11.39%), Proteus mirabilis 7/193 (3.6%), Enterococcus faecalis 2/193 (1.0%), Enterobacter aerogenes2/193(1.0%) Serratia odorifera 3/193(1.5%), Streptococcus species3/193(1.5%). Conclusions: The high prevalence of urinary tract infection in pregnant women warrant the need to screen all pregnant women and treat those infected with appropriate antimicrobial regimens in order to reduce its complications. Urinary Tract Infection screening is essential in pregnant women.

Background: Motherhood is often a positive and fulfilling experience but for many women it is associated with suffering, ill health, and even death. Improving maternal health is one of the thirteen targets for the sustainable development goal 3 (SDG-3) on health adopted by the international community in 2015. Objective of the study was to find out the attitude of pregnant women towards institutional delivery in Khaag block of district Budgam.Methods: A cross-sectional, community-based study was conducted, in February 2018 to March 2018, to assess attitude of pregnant women towards place of delivery in a tribal area of Khaag area of district Budgam. For this study, 99 pregnant women were approached. Informed consent was obtained from the participants and the registered pregnant women were interviewed by a pre-designed questionnaire. Results: Mean age at the time of contact was 28 years with a standard deviation of 3.87 years. The maximum years of schooling were 10 years. It was found that the last delivery was conducted at hospital for about 76% of women but for the present pregnancy 88% of the women had decided to have it conducted at the hospital. Thus, the attitude of women towards institutional deliveries has changed positively (p=0.001).Conclusions: Percentage of institutional deliveries is still less in rural area of Khaag is Kashmir. For decreasing the maternal and infant mortality rates further, much is still to be done. Awareness needs to be generated among common masses for promoting institutional deliveries. Educating women folk will make them confident in decision making.

Background: One of the positive outcomes of improvements in cancer care is the increasing number of people who survive the disease. Worldwide, the number of cancer survivors will continue to increase, with a threefold increase predicted from 25 million in 2008 to 75 million in 2030. Breast cancer survivors have the highest survival rates compared other types of cancer. Following a diagnosis of breast cancer, issues that women often worry about include the possibility of cancer recurrence, challenges with reacclimatizing to daily life posttreatment completion and numerous other emotional and physical challenges. It is unknown whether over time the coping skills of these survivors enable them to have a similar quality of life (QOL) as other normal women. This study aimed to assess and compare the quality of life (QOL) among breast cancer survivors and nonbreast cancer survivors in the Klang Valley, Malaysia. Methods: This case-control study used the European Organization for Research and Treatment of Cancer - Quality of Life Questionnaire (EORTC-QLQ) to ascertain QOL within breast cancer survivors and nonbreast cancer survivors. Simple random sampling was used to identify i) participants from the case arm -from four cancer-related NGOs in the Klang Valley; and ii) participants from the control arm - from women attending Kuala Lumpur Hospital. 176 number of participants were involved in this study with a 1:1 ratio. Result: There was no significant difference in quality of life (QOL) between breast cancer survivors and nonbreast cancer survivors in the Klang Valley, Malaysia. The longer the period of survival (5 years and above), the higher the QOL levels in breast cancer survivors. Conclusion: In conclusion, women with breast cancer especially those who had survived more than 5 years, had similar quality of life (QOL) levels as women who did not suffer from the disease. Women with breast cancer may have developed additional coping skills which could be taught to other patients living with cancer or even those with other chronic illnesses.

Background: Cardiac disease is an important cause of maternal mortality and morbidity both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is <1%. Objective of present study was to determine maternal outcome in pregnant women with heart diseases in terms of fetal complication, maternal complication and Mode of delivery.Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Government Lalla Ded Hospital, an associated of Government Medical College, Srinagar which is the sole tertiary care referral centre in the valley. 90 women with heart disease which were previously established or diagnosed during pregnancy were enrolled in the study.Results: In 90 women pregnancies was complicated by heart disease in the study. The prevalence of heart disease amongst all pregnancies found in hospital was 4.3%. The principal cause of cardiac lesion was Rheumatic heart disease (RHD) (56.6%) while congenital heart disease was seen in 13.3%. Among the women who had RHD, mitral stenosis seen in 21 (23.3%) was most common lesion and Multiple cardiac lesions 21 (24.4%) women. Among the women with congenital cardiac disease, mitral valve prolapse was most common constituting 5 (5%) cases. Cardiomyopathy was the most common constituting 7 (7.3%). Heart failure developed in 10 (11.1%) whose NYHA class changed from class I/II to class III/IV. Majority of the women delivered by caesarean section 33 (36.7%) while (35.6%) had a normal vaginal delivery with spontaneous onset of labour. 7% had assisted instrumental vaginal delivered. 9% women had first trimester abortion. There were 4 maternal deaths. 85.6% live births were observed in these women. No baby had congenital heart disease. 72.8% babies born weighed more than 2kg.Conclusions: This study concluded that pre- pregnancy diagnosis, counselling, appropriate referral, antenatal supervision and delivery at equipped centre improve the pregnancy with heart disease outcome for both mother and baby.

Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.

Background: Ovary is a complex structure and its neoplasms show a wide spectrum of histological types and clinical behaviour. The present study was done with the aim of studying the histopathological pattern of the ovarian tumours in women of various age groups.Methods: This was prospective study conducted over a period of 2 years from Jan 2015 to Dec 2016 and included 193 cases of ovarian neoplasms.Results: Of 193 cases 155 (80.3%) were benign, 8 (4.1%) were borderline and 30 (15.5%) were malignant tumours. Surface epithelial tumours constituted majority of the tumours (64.7%). Mature cystic teratoma (30.6%%) was the most common benign tumour followed by serous cyst adenoma (26.9%). Serous cyst adenocarcinoma (7.8%) was the most common malignant tumour of the ovary. While tumours were seen over a wide range of 6-75 years, >80% of benign tumours were seen in patients of <40 years and 60% of malignant tumours were seen in patients of >40 years of age.Conclusions: The findings of present study are comparable to the published data from the subcontinent.

Pregnant women with high blood lead posed high risk to their fetus as placental transfer can occurs to the fetus. The objective of this study was to identify the relationship between blood lead and the neuropsychological score of women who were in their 3rd trimester of pregnancy. These respondents were undergoing a routine antenatal checkup at a teaching hospital located in Klang Valley areas. Blood lead concentrations were analyzed using graphite furnace Atomic Absorption Spectrophotometer (AAS). The neuropsychological scores were measured with WHO Neurobehavioral Core Test battery (NCTB). The test consists of 7 items, which made up of the Digit Symbol, Trail Making, Digit Span, Benton Visual Retention Test, Pursuit Aiming, Santa Ana Manual Dexterity, Reaction Time and Movement Time tests. The mean blood lead was 7.78±4.77 µg/dL. The mean score for the total NCTB test was 50.00±5.24. Statistical analysis showed blood lead concentrations were inversely correlated with the total NCTB score (r= –0.462, p≤0.01). The correlation was about 21.3%. The General Linear Model (GLM) showed that age (β= –0.15, p=0.017), weight (β=2.67, p=0.05) and height (β=–1.97, p=0.05) also influence the total neuropsychological scores. In conclusion, blood lead reduces the total neuropsychological scores. The scores for each of the 7 items were inversely and significantly correlated with blood lead concentrations except for the Trail Making and Santa Ana Manual Dexterity tests.

ABSTRACTThe study is done to know the causes for the abnormal uterine bleeding in perimenopausal women atChitwan valley and to compare the histopathological findings between the pre-menopausal andpostmenopausal women. Retrospective analysis of patients who have had abnormal bleeding during a periodof one and a half years' from January 2000 to June 2001 in Department of Gynaecological Oncology of BPKoirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. There were total sixty women (aged 45years and above) having abnormal bleeding managed at BPKMCH. A total of sixty patients were studied.Majority (57%) of them was postmenopausal ladies presented with abnormal vaginal bleeding. The agerange was 45 to 81 years. Only 37% had pathological bleeding including malignancies and only about 17%had malignancies. Malignant diseases were found in 7.7% cases in the pre-menopausal ladies whereas itwas 23.4%, almost three times higher, in the post-menopausal ladies. Carcinoma of the cervix and of theendometrium occurred with increasing frequency with increasing age in this study. So, a thorough work-upis needed for the elderly women presenting with an abnormal vaginal bleeding especially to rule outmalignancies.Key Words: endometrial biopsy, endometrial cancer, postmenopausal bleeding.

e19029 Background: California has the most immigrants of any state in the U.S., with approximately a quarter of the residents being foreign-born. The impact of migration on breast cancer incidences over time has not yet been characterized in the Northern Central Valley. This provides a unique opportunity to study the influence of migration, socioeconomic gradient, and racial identity on the incidence of breast cancer in San Joaquin County. Methods: This study was a retrospective, single-institution study that compared the socio-demographic variables and clinical characteristics of the patients who had a history of breast cancer in a teaching central valley hospital. We reviewed all charts with a breast cancer diagnosis from 2014-2019. We compared age, demographics, socioeconomic status comorbidities, pathology, treatment, and outcomes. Appropriate statistics have been used to analyze the data. Results: A retrospective chart review of all patients with a diagnosis of breast cancer from 2014-2019 at a central valley teaching hospital. 33.5% were white, 17.2% African American, 26.6% Hispanic, and 22.6% were Asian. Migrated Asian women are having three times increased incidence in central California compared to their peers in Asian. Additionally, those of lower socioeconomic status were more often affected (61.9% vs. 30.4% of middle-class status) in our population. Demographics and comorbidities were studied. Smoking was seen in 23.2% of patients, alcohol in 16.3%, hypertension in 43.6%, Diabetes in 18.9%, lung disease in 11.7%, and Kidney disease in 6.9%. 23.8% of the patients had a family history of cancer. Screening was only done in 41% of patients, and the distribution of race was as follows: white 10.6%, African American 7.7%, Hispanic 8.9%, Asian 8.9%. It was found that infiltrating ductal carcinoma was seen in 54.8% of patients, of which 16.1% were white, 10% African American, 15.5% Hispanic, and 13.2% were Asian. Triple-negative breast cancer was seen in 14.9% in our patient population. We further reviewed treatment methods, including chemotherapy, radiation, and surgery, as well as recurrence rates. Conclusions: We suggest that screening has to be more concentrated in all communities. The fact that the Asian population in the Central Valley shows higher rates of breast cancer could be due to epigenetic, western lifestyle, and environmental factors. Higher awareness and willingness as a subgroup may be contributing as well or there may be an actual increase; this requires further investigation, and we will present further subgroup analysis at presentation.

Given the ongoing COVID-19 (C-19) crisis in Nepal, this section includes some vignettes related to combatting the crisis in Nepal, and includes diverse experiences. When the editor-in-chief of this journal invited me to assist, I thought it would be useful to present the experiences of the actual professionals engaged in combating the pandemic in the field. This effort resulted in the collection of brief articles in the form of commentaries in this section. Voices from the Field: Combating COVID-19 Pandemic in Nepal: Section Editor; Shyam Thapa Mobilizing Ambulance Services during the COVID-19 Pandemic in the Kathmandu Valley: Kulesh B. Thapa A Medical Officer Amidst the COVID-19 Pandemic in Far-western Nepal: Robin Jung Bhandari Upon being Discharged from the Hospital, I felt as if I was Released from a Prison: The Experience of a Coronavirus-infected Nurse: Ismita Sharma From the Desk of a Psychiatrist: Emerging Mental Health Issues during COVID-19 Pandemic in the Kathmandu Valley, Nepal: Rishav Koirala Higher Workload Experienced by Women During the COVID-19 Lockdown Period: Shristi Kolakshyapati, Binita Pandey, Bindu Sharma, Elawati KC COVID-19 Kaleidoscope on the FM Radio: Samjhana Paudel Rising Levels of Suicide during the Pandemic: Bidhya Rai

Introduction: Urinary tract infection (UTI) is one of the most frequently encountered problems owing to significant number of patients needing hospitalization during pregnancy. The incidence of UTI in pregnant women is reported to be high up to 7-8%.Methods: This is a prospective study conducted in Valley Maternity Hospital during a period of 6 months (Jan 2011 to June 2011). 520 MSU (Mid stream urine samples) from pregnant women clinically suspected of urine infection were evaluated by urine dipstick analysis, microscopic and culture method. The isolates were identified and antibiotic sensitivity pattern was determined by standard protocol.Results: The majority of the patients were in-between the age group of 20-30years- 338cases (65%) and these patients usually presented in the first trimester of pregnancy- 317cases (60.96%). Out of the 520 clinically suspected UTI cases, 232 (44.61%) was culture positive. Out of the culture positive cases; Escherichia coli (E.coli) was the most common accounting for a total of 144cases (80%). Nitrofurantoin was found to be the most effective drug against the gram negative (Gm-ve) bacteria. Similarly, Ampicillin, Amoxycillin and Cloxacillin were found to be effective agent against gram positive (Gm+ve) bacteria.Conclusions: Screening for bacteriuria is recommended among all pregnant women at the first prenatal visit and in the subsequent trimesters of pregnancy. Prompt treatment of symptomatic UTI and asymptomatic bacteriuria is required in pregnant women to avoid complications like preterm birth, low birth weight and increased perinatal mortality.

Background: Though benign breast diseases are very common, not many studies have focussed on this entity. In Kashmir valley, no major study has been undertaken before, to look into the profile of the benign breast diseases in women.Methods: This prospective study was conducted in the Postgraduate Department of General Surgery of SMHS Hospital from October 2012 to September 2014. The patients with features of benign breast diseases were subjected to detailed history, clinical examination and investigations. Analysis was done using this data.Results: 80% of the benign breast lesions presented in the second and third decades of life. Mean age was 24.46 years. Most common benign breast lesion was fibroadenoma. Lump in the breast was the predominant symptom. Duration of symptoms mostly ranged from 1 to 6 months. There was a slight preponderance of lesions in the right breast. Most of lesions presented in upper outer quadrant. 81.39% of the patients had only a solitary lump.76.74% of lumps had a size of 2 to 5cm. Clinicopathological correlation in case of fibroadenoma, showed 60% sensitivity, 75% specificity, PPV=85.71% and NPV=42.85%. Cytohistological correlation in case of fibroadenoma, showed 85% sensitivity, 87.5% specificity, PPV=94.4% and NPV=70%. 38 cases (38%) were managed conservatively and 62 cases (62%) were managed surgically.Conclusions: Results grossly similar to other parts of the word were obtained. Fibroadenoma was the most common benign lesion encountered followed by fibroadenosis and breast abscess. Majority of breast lumps were painless. Conservative approach for fibroadenoma is acceptable option in the adolescents.

Background: Clinical breast examination (CBE) is one of the most accessible screening methods for breast cancer and widely used in the Malaysian public health system due to the wide availability of trained healthcare personnel and low costs; especially in government hospitals. However, discovery of an abnormal finding from the CBE does not necessarily translate into action for further clinical investigations. An understanding of the patients' motivations in decision making, which causes them to ignore the need for further clinical investigations despite abnormal findings in CBEs may be an important element to improve holistic cancer prevention efforts; of which early detection is a key strategy. Aim: The aim of this study was to investigate the barriers for women to receive follow-up care upon obtaining abnormal results for CBE. Methods: The National Cancer Society of Malaysia has an active ongoing public outreach program in which trained healthcare personnel conduct CBEs at various screening campaigns throughout the Klang Valley with a total of 1017 women screened in 2017. Women who were screened and found to have an abnormal finding from the CBE were referred for further investigations at a center of their choice. Women found to have an abnormal CBE finding were reached via a phone call to determine whether they had proceeded to i) get an appointment for further clinical examination; or ii) had already undergone a further clinical examination. Those who had done neither were interviewed via phone to determine their reasons for not proceeding with further clinical investigations despite an abnormal CBE finding. Results: Out of the 1017 women screened, 38 were found to have an abnormal CBE finding. Of them, 16 women had not sought further investigations. Qualitative interviews revealed that there strong issues that posed barriers to these women pursuing further investigations. These barriers included a lack of knowledge and understanding about breast cancer or rationale of undergoing a CBE; a lack of urgency pertaining to CBE results and feeling of embarrassment engaging with family members on facilitating attendance to the investigation. Conclusion: Significant barriers remain which deter women who have abnormal CBE findings from pursuing further clinical investigations which ultimately reduces the effectiveness of current breast cancer screening strategies. These findings may prove to be important for designing effective methods to encourage confirmatory clinical examination among those already found to have abnormal findings from tests such as the CBE.

Background: Cervical cancer is one of the most prevalent cancers in Honduran women. Lacking national or population-based registries, we rely on hospital registries to establish incidence: San Felipe General Hospital in 2012 diagnosed 38% of 998 women and The League against Cancer Hospital (LCC) in 2016 diagnosed 54.4% of 695 women with cervical cancer CC. According to PAHO's Honduras Profile 2013, screening coverage with Pap was 48.1%. Bruni in 2010 reported a prevalence of high risk HPV (hrHPV) infection for Central America of 13%, identifying genotypes 16, 18, 52, 31 and 58 as most frequent. Information about pathogenesis of hrHPV to induce cervical lesions is based on models of genotypes 16 and 18 only. Aim: Inform evidence of hrHPV genotypes collected in Honduras from an urban and a rural population, generate discussion and subsequent improvement of cervical cancer control strategies in our country. Methods: In 2016, 2 clinical studies funded by Norris Cotton Cancer Center at Dartmouth College and the LCC accrued 913 women: 401 in Locomapa Valley (rural), 111 in La Mosquitia (remote rural), and 401 in a textile factory in San Pedro Sula (urban). Women were consented, to obtain 3 cervical samples, during a cervical cancer screening brigade. One sample for conventional cytology, and 2 for hrHPV by PCR genotyping. One local with our customized PCR device and the second at Dartmouth. An educational component and survey were included. Positive patients identified with hrHPV, pre or invasive cancer were referred to LCC for treatment and follow-up. Results: In Locomapa and the factory (rural and urban sites) 13% of participants were positive for hrHPV. Only 15% had HPV 16. The following common genotypes varied by location: urban factory HPV 59, 12% in rural location HPV 58, 10%; HPV 31, 9%; HPV 39 8%; HPV 35 and 66, 7%; HPV 45 and 51, 6%; HPV 18 and 56, 3%; HPV 33 and 52, 1%. 17% of women had multiple hrHPV coinfection. 7.7% had abnormal Pap tests. In La Mosquitia (remote rural), 24% of women were positive for hrHPV: HPV 52, 29%; HPV 16, 23%; HPV 39, 10%; HPV 68, 6%; HPV 58, 6%; HPV 45, 6%; HPV 51 and HPV 31, 18, 66, 59 and 35, 3% each. 1.8% had abnormal Pap tests; all participants identified with hrHPV were referred for follow-up. The average age was 40.3 years, parity, 3 children, education 6.0 years; and 15% were first-time users of a cervical screening program. Conclusion: Associate the burden of disease, with risk factors, will help us to generate models of prevention and care that are reproducible and effective to reduce morbi-mortality. Brigade-type screening models, with trained providers working at a community location over a single day, can offer improved access for women at risk and facilitate educational activities for health promotion. Introducing tests as hrHPV DNA detection, effectively reduces the volume of women to follow. Strengthening the capacity of primary care with novel screening techniques and ensure diligent follow-up is essential.

Background: Urinary tract infection (UTI) is one of the most frequently encountered problems owing tosigniÞ cant number of patients needing hospitalization during pregnancy. The incidence of UTI in pregnantwomen is reported to be high up to 7-8%.Methods: This is a prospective study conducted in Valley Maternity Hospital during a period of 6 months(Jan 2011 to June 2011). 520 MSU (Mid stream urine samples) from pregnant women clinically suspected ofurine infection were evaluated by urine dipstick analysis, microscopic and culture method. The isolates wereidentiÞ ed and antibiotic sensitivity pattern was determined by standard protocol.Results: The majority of the patients were in-between the age group of 20-30years- 338cases (65%) and thesepatients usually presented in the Þ rst trimester of pregnancy- 317cases (60.96%). Out of the 520 clinicallysuspected UTI cases, 232 (44.61%) was culture positive. Out of the culture positive cases; Escherichia coli(E.coli) was the most common accounting for a total of 144cases (80%). Nitrofurantoin was found to be the mosteffective drug against the gram negative (Gm-ve) bacteria. Similarly, Ampicillin, Amoxycillin and Cloxacillinwere found to be effective agent against gram positive (Gm+ve) bacteria.Conclusion: Screening for bacteriuria is recommended among all pregnant women at the Þ rst prenatal visit andin the subsequent trimesters of pregnancy.Key words: UTI, Pregnant women, Antibiotics, Culture method.Prevalence of Metabolic Syndrome and its Component inPatients with Acute Coronary Syndrome.Conclusions: Metabolic syndrome is most common and important risk factor in patients of coronary arterydisease. Other risk factors like smoking, obesity, dyslipidemia, hypertension and diabetes were also frequentlyfound. Public awareness to control the risk factors can reduce the prevalence of coronary artery disease in ourcountry.doi: http://dx.doi.org/10.3126/mjsbh.v12i2.12928

e19028 Background: California acts as a boiling pot for immigration and the perfect ecosystem to study epigenetic changes from dietary and environmental factors in various ethnicities. It has a significant immigrant population, with approximately a quarter of the 40 million residents being foreign-born. The impact of migration on colon cancer incidences over time has not yet been characterized on a broad-scale level in the Northern Central Valley. This provides a unique opportunity to study the influence of migration, socio-economic gradient, environmental, and racial identity on the incidence of cancer in a subset of California’s San Joaquin County Population. Colon cancer affects around 100,000 annually, with white and African Americans being more often affected than Asians or Hispanics. Methods: This study is a retrospective, single-institution study that compared the socio-demographic variables and clinical characteristics of the patients who had a history of colon cancer in an academic central valley institution. We reviewed all the patient charts with a diagnosis of colon cancer from 2014-2019 and compared the age, demographics, socioeconomic status, comorbidities, pathology, treatment, and outcomes in the population. Appropriate statistics have been used for analyzing the data. Results: A retrospective chart review of all patients diagnosed with colon cancer from our Hospital from 2014-2019 which revealed that 23.9% of patients were younger than 50 years at diagnosis, and mean age of diagnosis is 56.6 years, compared to the national average where younger population constituted at 11% and mean age for men and women are 68 years and 72 years respectively. 36.5% were 50-60 years old, and 39.2% were > 60 years old. Women constituted 31% in our group compared to compared to 35.6% nationally. Asians are 23% of the central California population, but only 11.4% of patients in our group of colon cancer patients were Asian/pacific islanders, with 6.4% being average weight. 36.7% of patients have obesity. 67.4% were > 25 BMI, of which 12.8% were younger Hispanics with BMI 25-30. Adenocarcinoma is seen in 91.4% of patients. Conclusions: The younger population with male predominance is seen. Asians see a surge in colon cancer incidence, but the incidence rate is still lower. Epigenetic, western lifestyle, and environmental are responsible factors. Younger overweight Hispanics are increasing in number as well. We will present further subgroup analysis at presentation.

All 4 dengue viruses (DENV) cause sporadic outbreaks of human disease in the Rio Grande Valley along the US-Mexico border. In addition, West Nile virus (WNV) is enzootic in most border communities, and is the only arbovirus known to cause human disease in the El Paso, Texas community. In an effort to determine if DENV were also endemic in the El Paso community, a serosurvey was conducted among mothers at the time of delivery of their babies in selected hospitals. Cord-blood plasma samples obtained from mothers were tested for DENV antibody by an enzyme-linked immuno-sorbent assay (ELISA), plaque reduction neutralization test (PRNT) and a multiplex microsphere immunoassay. All DENV antibody positive plasma samples were also tested for WNV antibody by the same assays to consider the possibility that DENV antibody positive samples reflected WNV cross reactive antibody. The results indicated that 0.74% (11/1,472) of the mothers had a previous DENV infection and that 3.3% (48/1,472) had a previous WNV infection. Of these mothers, 0.20% (3/1,472) had antibody to both DENV and WNV as evidence of infection by both viruses. The results indicated that 0.2% (3/1472) of the mothers were positive for antibody to only WNV envelope, thus suggesting an undetermined flavivirus infection. Although 6 of the 11 DENV antibody positive mothers did not have a history of travel to a DENV endemic country, the findings of this survey provided further evidence of local transmission of WNV and suggested the possibility of focal autochthonous transmission of DENV in the El Paso community.

e13087 Background: Lung cancer is one of the common cancers worldwide, and is the commonest cancer in Nepal, with an incidence of 16%. There is a high incidence of smoking in Nepal, being highest in the mountain region in the north and lowest in the tarai region in the south. Smoking kills around 15,000 people per year. The prevalence of smoking in the urban population of Kathmandu over the age of 15 has been estimated at 64.6% in men and 14.2% in women. Nepal has diverse population with various ethnicities and different cultures. The aim of this study was to determine the relation of smoking, epidemiology of lung cancer and distribution of lung cancer in various ethnicities of Nepal. Methods: All patients attending National Hospital and Cancer Research Center in Kathmandu who were diagnosed with lung cancer between January 2012 and December 2018 were enrolled in the study. Informed consent was taken before enrollment and data was collected by the nursing staffs prospectively using a preset questionnaire for interviewing patients. Results: Data was collected from 250 patients over the seven years with histologically proven lung cancer. About 85.6 % of patients were male and 80% of them were smokers. 50% of men and 30 % of the women were smokers. Most common age to start smoking was in 11-20 years group (60%). 58% of patients were from Kathmandu valley, and 42% of patients from outside the valley. 38% of male were literate and 16% were illiterate where as 13.6% of female were literate and 32.4% were illiterate. Among the various ethnic groups, 44% were Newars, 20% Mongols, 18% in Chhetris and 18% Brahmins. The incidence of lung cancer was highest (57.6%) in the age 61-80 years age group. 14.4% of the patients had family history of cancer M = 8.6% and F = 6.0%). Squamous cell carcinoma was the highest (51.2%) followed by small cell carcinoma (22%) and adenocarcinoma (26.8%). Carcinoma of right lung was frequent (62%) compared to the left lung (38%). Local cigarette were used by 82.5% of the smokers and 54.5% of them used filtered cigarettes. 40% practiced relighting the butt ends. Conclusions: The study shows that smoking is a single major contributing factor observed in lung cancer in Nepal across various age groups as well as diverse ethnic groups. Given the high incidence of smoking starting before the age of 20, there is an urgent need for organized mass anti-smoking campaigns, especially in schools targeting the younger age group. Need of awareness against the smoking and the cause of lung cancer needs to emphasized to reduce the burden of the lung cancer.

Background: Cancer of breast has recently become the leading cancer among women in Kashmir. Worse prognosis of this disease is with the features of higher grade, positivity for Her-2/neu, negativity for ER, PR, and presence of BRCA gene. Thus the receptor status like are a very useful tool for rapid diagnosis, treatment as well as for prognosis of the disease. The objective of the study was to analyze the pattern of expression of hormone receptors which include ER, PR and Her-2/neu in breast cancer cases among Kashmiri females and to find their association with various clinicopathological parameters.Methods: A cross sectional hospital based study done in a tertiary health care centre of Kashmir valley. We selected 102 consecutive breast cancer cases for the period of one year. Cases were sent for biopsy of the tumour lesion and for receptor status analysis.Results: In about 50.9%of cases tumour had spread to T2 stage. There was a significant difference in the tumor stage and the age groups at presentation. The HER 2 status was positive in 85.5% of cases. About 65% were ER positive and 51.9 were PR positive. Only 8 were triple negative and 42 were triple positive for receptors. We did not found any significant relationship between grade, stage of disease and age when compared for receptor status.Conclusions: We found a high percentage being receptor positive tumours which has been found to be a good prognostic sign.

Abstract The Nunamiut of Anaktuvuk Pass, Alaska have been going to town, one way or another, even before they relinquished their nomadic life in 1949-1950 to become settled in a village 100 miles from the nearest road and 250 miles from Fairbanks. Some years before they ever set foot in town, a few had credit accounts at the city’s Northern Commercial Company. In the mid-1950s a few village men were recruited as human subjects for cold adaptation experiments carried out at Ladd AFB outside of Fairbanks. This was their first plane ride and their first taste of city life. Medical emergencies—a flu epidemic, TB, and other illnesses that demanded medical treatment were the other ticket to Fairbanks in the 1950s, and then one typically had to wait to be flown out until the monthly mail plane came in. But by the 1960s the Native health care system saw to it that Anaktuvuk women came to town to deliver their babies in the hospital. Today Fairbanks is not only the doctor’s office but also the shopping mall and supermarket for outlying villages like Anaktuvuk Pass. It is many other things as well to the Nunamiut—site of the annual World Eskimo-Indian Olympics, the University of Alaska’s annual Festival of Native Arts, and the summer Tanana Valley Fair. It is Second Avenue with its string of dingy bars. This paper looks at more than 50 years of going to town, the significance of “town” in villagers’ lives, and the varied associations Fairbanks holds for the Nunamiut.

5582 Background: Sexually active adolescents have high rates of infection with human papilloma virus (HPV) and abnormal pap smears. They are considered a special population as they are likely to regress to normal cytology. The aim of our study was to identify factors associated with regression of cervical dysplasia in adolescents. Methods: We identified adolescent patients (aged 12–21 years) who had abnormal pap smears at the Center for Women's Medicine at Lehigh Valley Hospital in Allentown, PA, by CPT code from a database between Jan 2004 and Dec 2006. A chart review was performed to capture demographic data, cytology, smoking history, number of sexual partners, parity, race, contraceptive choice, use of barrier contraception. Chi-square analysis with logistic regression and multivariate analysis were used to identify factors associated with regression of cervical dysplasia. Results: Two-hundred two patients were identified. Mean age was 18.84 years (14–22 years). One hundred twenty-two (57.8%) were Hispanic, 71 (33.6%) Caucasian, and 16 (7.6%) Black. Fifty-two (24.6%) were pregnant at the time of diagnosis. Seventy-six (36%) were smokers. There were 125 (61.9%) cases of ASCUS, 33.7% (68 cases) LGSIL and 4.5% (9 cases) HGSIL on initial pap smear. One hundred eighteen (55.9%) patients had colposcopy, and of these, 32 (15.2%) had surgical intervention. Follow-up demonstrated that 72 (57.6%) patients had disease regression, 24 (19.2%) persistence and 29 (23.2%) progression. On multivariate analysis, patients who did not smoke were significantly more likely to show regression of cervical dysplasia on pap smear than women who smoked (OR 2.17, 95% CI 1.03–4.55, p = 0.039). Other factors were not statistically significant in predicting regression of cervical dysplasia. Conclusions: Adolescents who smoke were more likely to have persistent cervical dysplasia than non-smoking adolescents, putting smokers at an increased risk of advanced disease. We suggest that this subset have follow-up at shorter intervals and be enrolled in a smoking cessation program. No significant financial relationships to disclose.

Purpose: We previously demonstrated that including walnuts in the diets of adults at risk for type 2 diabetes mellitus (T2DM) led to improved overall diet quality. This report examines the specific changes in their nutrient intake. Design: This was a randomized, controlled, modified Latin square parallel design trial with 2 treatment arms. Participants were randomized to walnut intake with, or without, dietary advice to regulate caloric intake. Within each treatment arm, they were further randomized to one of 2 sequence permutations (walnut-included/walnut-excluded or walnut-excluded/walnut-included diet), with a 3-month washout between treatment phases. Setting: Community hospital in Lower Naugatuck Valley in Connecticut. Participants: Cohort of 112 participants (31 men and 81 women) at risk for T2DM. Intervention: Participants included 56 g (366 kcal) of walnuts in their daily diets for 6 months. Measures: Nutrient intake was assessed using web-based Automated Self-Administered 24-Hour Dietary Assessment. Analysis: Data were analyzed using generalized linear models. Results: Walnut inclusion led to increased intake of total fat, calcium, magnesium, thiamin, total saturated fatty acids, and monounsaturated and polyunsaturated fatty acids (379.0 ± 90.3 g vs −136.5 ± 92.7 g, P < .01; 230.7 ± 114.2 mg vs −95.2 ± 117.4 mg, P = .05; 111.0 ± 33.9 mg vs −32.3 ± 34.9 mg, P < .01; 0.28 ± 0.2 mg vs −0.47 ± 0.2 mg, P = .02; 8.6 ± 3.4 g vs −1.1 ± 3.5 g, P =.05; 6.3 ± 3.9 g vs −6.3 ± 4.0 g, P = .03; and 25.4 ± 4.0 vs −6.6 ± 4.2 g, P < .01, respectively). Vitamin C intake decreased (−65.3 ± 55.3 mg vs 98.9 ± 56.8 mg, P = .04). Protein intake increased from baseline with the inclusion of walnuts (20.0 ± 8.8 g, P < .05). Walnut inclusion led to an increase in total calories consumed when caloric intake is not regulated. Conclusion: Including walnuts in the diets of these adults led to increased dietary intake of some nutrients associated with lower risk of developing T2DM and other cardiometabolic risk factors.

Stuart Anderson (‘JS’ to most colleagues, and in this memoir) was born on 9 January 1908 at 134 Englefield Road, Islington, London (U. K.) and died on 25 December 1990 at the Woden Valley Hospital, Canberra (Australia). He was the youngest child and only son of John Anderson (1850-1916), a master cabinet maker who was born and brought up in Aberdeen, and Emma Sarah, née Pitt (born Ipswich, died 1937). Knowledge of his ancestry is limited and contains no suggestion of science, his antecedents being in business or teaching or, in the case of his maternal grandfather, a sailor. His parents, both widowed, married about 1901-2. Being of his father’s previous marriage, two step-sisters were much older than he, by about 20 years; his sister Olive was about four years older. His father was a good violinist and also played the cello; he enjoyed musical evenings with his daughters and friends, playing instrumental quartets and sometimes more ambitious efforts such as, on one occasion as JS recalled, ‘Handel’s Toy Symphony’ [ sic .]. The house was well stocked with books, especially the main classics of the Victorian period; but family circumstances, at first ‘modestly prosperous’, declined in the years just before and during World War I, catastrophically so in 1916, when his father died. Just before that, his mother went to work in a munitions factory, his sister left school early and they suffered upwards of ten years of great difficulty and acute poverty. He believed that these years which, due to his mother’s ‘overdone ideals about gentility’, were solitary and self-contained ones, left on him a permanent mark; a lack of self-confidence, mainly manifest as shyness and an inability to get on with people. He was certainly a private man but, at least after he passed the age of 30, his younger colleagues did not detect this supposed lack of self-confidence.

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly.Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed.Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste.Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future._______________________________________________________________________________________Keywords: abortion; pattern; socio-demographic.

Objective: to describe the clinical periodontalstatus and the subgingival microbiotacomposition in a group of 81 women havingpreeclampsia.Methods: clinical, medical and periodontal datawere determined in women with preeclampsiaat the University Hospital of Valle in Cali-Colombia.Periodontal status and diagnosis weredetermined by means of probing depth andclinical attachment level (Diagnosis Consensus AAP-1999). A sample of subgingival plaquewas taken for microbiological analysis.Results: 63% of the cases had mild preeclampsiaand 27.2% had severe preeclampsia. Theperiodontal status was affected in 91.4% of patients(n=64); 59.3% (n=48) of them presentedchronic periodontitis and only 8.6% presentedhealthy periodontium. Periodontopathic bacteriawas found in preeclamptic women, the mostprevalent microorganisms were Fusobacteriumssp 80.2% (n=65), P. gingivalis 59.3% (n=48)and Prevotella intermedia/nigrescens 51.9%(n=42).Conclusion: preeclamptic women showed ahigh percentage of chronic periodontitis andpresented also periodontopathic microbiota. Alow percentage of pregnant women presentedhealthy periodontium.

Anxiety was the barrier mostly chosen by women for not performing mammography examination. Music was perceived as an effective method in reducing these barriers. Thus, this study was done to investigate how music would influence anxiety level among women undergoing mammogram screening. A cross-sectional descriptive study was conducted at randomly selected private hospitals around Klang Valley. The ’State-Trait Anxiety Inventory’ form was used to measure the level of anxiety. Respondents were categorized into two groups, which are control (no music) and experimental (with music) groups. Descriptive analysis was used to determine the anxiety level and T-test analysis were used to compare the anxiety level between both groups. A total of 60 respondents participated in this study in which 30 (50.0%) were in a control group and 30 (50.0%) were in the experimental group. Mean age of respondents were 53.5 (±12.7) years. The anxiety level is high in women who underwent mammography with no music (60.0%) as compared those with music (53.3%), although the difference is not significant (p>0.05). Music intervention has potential in reducing anxiety level during mammography examination.

Introduction: Cervical cancer is the leading gynaecological cancer in Nepal. Most of the time, it is diagnosed in the late stage with its associated morbidity and mortality. This study aimed to find out the prevalence of late-stage presentation of cervical cancer among confirmed cases of cervical cancer in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at a tertiary care centre of Nepal from March 2021 to May 2021 after obtaining ethical clearance from the Institutional Review Board (Reference no.805). A convenient sampling method was used. A descriptive analysis was done of all cases of cervical cancer who were diagnosed within the last 36 months and attended hospital during the study period. The information was collected by interview and hospital record was checked. Analysis was done using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among the 142 confirmed cervical cancer cases, the prevalence of late-stage presentation of cervical cancer was 93 (65.5%) (57.7-73.3 at 95% Confidence Interval). The mean age at diagnosis was 50.6±10.9 years. More than two-thirds of the women were from outside Kathmandu valley 102 (71.8%) and came from >50km distance. The majority of the women 83 (58.5%) were illiterate. Conclusions: The study showed that two-thirds of the women presented in advanced stage and the factors leading to the late stage. This highlights the fact, that the focus should be on the provision of organized screening programs and early diagnosis and treatment of cervical cancer.

Introduction: Necrotizing enterocolitis (NEC) is, over all newborn surgical afflictions, the most deathly, representing the main GI problem in neonatal intensive care units (NICU) and a medical/surgical emergency in which early diagnosis and opportune treatment may diminish surgical needs and mortality. Objective: To describe the features of patients with NEC attended at a third-level hospital NICU in the city of Cali in 2006. Method and materials: We conducted a pilot descriptive retrospective study that included 32 clinical records of newborns in the NICU (named CIRENA) from the Hospital Universitario del Valle (HUV) with NEC diagnosis. Finally, we made a descriptive analysis of the data by using the Epi-Info statistics program. Results: In 2006, 1555 newborns were admitted to HUV-CIRENA and 32 (2%) of them were diagnosed with NEC, a percentage that is similar to that of other countries; half of which weighed less than 1500 grams and only three pregnant women had adequate prenatal care, 17(53.1%) of these newborns were female and 15(46.9%) were male. Conclusions: Although the majority of NEC cases occurs in premature and/or very low weight children, it is outstanding the number of full-term newborns, either on gestational age and weight, that developed early NEC. There is a visible relationship among low birth weight, prematurity, and the development of NEC, especially in the higher degrees of the disease, where the tendency is the presentation of late NEC.

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> <w:UseFELayout /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%; tab-stops: 78.0pt;"><strong style="mso-bidi-font-weight: normal;">Background:</strong> Urinary tract infection (UTI) is one of the most frequently encountered problems owing to significant number of patients needing hospitalization during pregnancy. The incidence of UTI in pregnant women is reported to be high up to 7-8%.</p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%; tab-stops: 78.0pt;"><strong style="mso-bidi-font-weight: normal;">Materials and methods: </strong>This is a prospective study conducted in Valley Maternity Hospital during a period of 6 months (Jan 2011 to June 2011). 520 MSU (Mid stream urine samples) from pregnant women clinically suspected of urine infection were evaluated by urine dipstick analysis, microscopic and culture method. The isolates were identified and antibiotic sensitivity pattern was determined by standard protocol.</p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%; tab-stops: 78.0pt;"><strong style="mso-bidi-font-weight: normal;">Results: </strong>The majority of the patients were in-between the age group of 20-30years- 338cases (65%) and these patients usually presented in the first trimester of pregnancy- 317cases (60.96%). <span style="mso-spacerun: yes;">&nbsp;</span>Out of the 520 clinically suspected UTI cases, 232 (44.61%) was culture positive. Out of the culture positive cases; Escherichia coli (E.coli) was the most common accounting for a total of 144cases (80%). Nitrofurantoin was found to be the most effective drug against the gram negative (Gm-ve) bacteria. Similarly, Ampicillin, Amoxycillin and Cloxacillin were found to be effective agent against gram positive (Gm+ve) bacteria.</p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%; tab-stops: 78.0pt;"><strong style="mso-bidi-font-weight: normal;">Conclusion: </strong>Screening for bacteriuria is recommended among all pregnant women at the first prenatal visit and in the subsequent trimesters of pregnancy. Prompt treatment of symptomatic UTI and asymptomatic bacteriuria is required in pregnant women to avoid complications like preterm birth, low birth weight and increased perinatal mortality.</p> <p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%; tab-stops: 78.0pt;"><span style="text-decoration: underline;">Key words</span>: UTI, Pregnant women, Antibiotics, Culture method.</p> <!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]-->

Coffee changes people. Moreover, it changes the way they interact with their friends, their fellow citizens and their community. (Ellis 24) On my daily walk around the streets of my neighbourhood, I pass the footpath cafés that have become synonymous with the area. On this particular day, I take a less familiar route and notice a new, small café wedged between a candle shop and an industrial building. At one of the two footpath tables sit a couple with their young child, conveniently (for them) asleep in a stroller. One is reading the Saturday paper, and the other has her nose in a book—coffee, muffins, and newspapers are strewn across the table. I am struck by this tableau of domestic ease and comfort, precisely because it is so domestic and yet the couple and child, with all the accoutrements of a relaxed Saturday morning, are situated outside the spaces of the home. It brings to mind an elegant phrase of Robert Hughes’ about the types of spaces that cities need, where “solitudes may lie together” (cited in Miller 79). I could, of course, also have drawn my attention to other vignettes at the café—for example, people involved in animated or easy conversation—and this would support Hughes’ other dictum, that cities need places where “people can gather and engage in energetic discourse” (79), which is of course another way in which people inhabit and utilise the café. The ascendancy of the café is synonymous with the contemporary city and, as semi-public space, it supports either solitude—through anonymity—or sociability. “Having a coffee” is central to the experience of everyday life in cities, yet it is also an expression of intent that suggests more than simply drinking a café latte or a cappuccino at our favourite neighbourhood café. While coffee aficionados will go the extra distance for a good brew, the coffee transaction is typically more to do with meeting friends, colleagues or connecting with people beyond our personal and professional networks. And under the umbrella of these types of encounters sit a variety of affective, social and civil transactions. In cities characterised by increasing density and cultural difference, and as mobile populations move back and forth across the planet, how we forge and maintain relationships with each other is important for the development of cosmopolitan cultures and social cohesion. It is the contemporary café and its coffee culture that provides the space to support sociability and the negotiation of civil encounters. Sociability, Coffee, and the Café Café culture is emblematic of social and urban change, of the rise of food culture and industries, and “aesthetic” cultures. The proliferation of hospitality and entertainment industries in the form of cafés, bars, restaurants, and other semi-public spaces—such as art galleries—are the consumer-based social spaces in which new forms of sociability and attachment are being nurtured and sustained. It is hardly surprising that people seek out places to meet others—given the transformation in social and kinship relations wrought by social change, globalization and mobile populations—to find their genesis in the city. Despite the decline of familial relations, new social formation produced by conditions such as workforce mobility, flexible work arrangements, the rise of the so-called “creative class” and single person households are flourishing. There are now more single person households in Australia than in any other period, with 1.9 million people living alone in 2006. This figure is predicted to increase to 30.36 per cent of the population by 2026 (ABS). The rapid take-up of apartment living in Australian cities suggests both a desire and necessity for urban living along with its associated amenities, and as a result, more people are living out their lives in the public and semi-public spaces of cities. Maffesoli refers to restructured and emerging social relations as “tribes” which are types of “emotional communities” (after Weber) based upon the affective, life-affirming impulse of “being togetherness” rather than an outmoded, rationalised social structure. For Maffesoli, tribes have strong powers of inclusion and integration and people are connected by shared affinities or lifestyles. Their stamping ground is the city where they gather in its public and semi-public spaces, such as the café, where sociability is expressed through “the exchange of feelings, conversation” (13). In this context, the café facilitates a mode of interaction that is both emotional and rational: while there might be a reason for meeting up, it is frequently driven by a desire for communication that is underpinned by the affective dimension. As a common ritualistic behaviour, “meeting for coffee” facilitates encounters not only with those known to us, but also among relationships that are provisional and contingent. It is among those less familiar that the café is useful as a space for engaging and practicing civil discourse (after Habermas) and where encounters with strangers might be comfortably negotiated. The café’s social codes facilitate the negotiation of less familiar relationships, promoting a sociability that is not as easy to navigate in other spaces of the city. The gesture of “having coffee” is hospitable, and the café’s neutrality as a meeting place is predicated on its function as transitional or liminal space; it is neither domestic, work, nor wholly public space. Its liminality removes inhabitants from the potentially anxious intimacy of the home and offers protection from the unknown of public space. Moreover, the café’s “safety” is further reinforced because it is regulated temporally by its central function as a place of food and beverage consumption: it provides a finite certitude to meetings, with the length of encounter largely being determined by the time it takes to consume a coffee or snack. In this way, the possible complexity or ambiguity associated with meetings with strangers in the more intimate spaces of the home is avoided, and meeting in a café may relieve the onus and anxiety that can be associated with entertaining. Café culture is not a new phenomenon, though its current manifestation differs from its antecedent, the sixteenth-century coffee house. Both the modern café and the coffee house are notable as places of intense sociability where people from all walks of life mingle (Ellis 2004). The diverse clientele of the coffee house is recorded extensively in the diaries of Samuel Pepys and unlike other social institutions of the time, was defined by its inclusivity of men from all walks of life (Ellis 59). Similarly, the espresso bars of the 1950s that appeared in Europe, North America and to a lesser extent Australia became known for their mix of customers from a range of classes, races and cultures, and for the inclusion of women as their patrons (Ellis 233). The wide assortment of people who patronised these espresso bars was noted in Architectural Digest magazine which claimed the new coffee bars as “the greatest social revolution since the launderette in 1954” (Ellis 234). Contemporary café culture continues this egalitarian tradition, with the café assuming importance as a place in which reconfigured social relationships are fostered and maintained. In Australia, the café has replaced the institution of the public house or hotel—the “pub” in Australia—as the traditional meeting place of cultural significance. Not everyone felt at home, or indeed was welcomed in the pub, despite its mythology as a place that was emblematic of “the Australian way of life”. Women, children and “others” who may have felt or may have been legally excluded from the pub are the new beneficiaries of the café’s inclusivity. The social organisation of the pub revolved around the interests of masculine relationships and culture (Fiske et al.) and until the late 1970s, women were excluded by legislation from its public bars. There are many other socio-cultural reasons why women were uncomfortable in the pub, even once legislation was removed. By comparison, the café, despite the bourgeois associations in some of its manifestations, is more democratic space than the pub and this rests to some extent on a greater emphasis placed on disciplined conduct of its patrons. The consumption of alcohol in hotels, combined with a cultural tolerance of excess and with alcohol’s effect of loosening inhibitions, also encourages the loosening of socially acceptable forms of conduct. A wider range of behaviour is tolerated and sanctioned which can present problems for women in particular. The negotiation of gendered relationships in the pub is, therefore, typically of more concern to women than men. In spite of its egalitarianism, and the diversity of patrons welcomed, the café, as a social space, is governed by a set of rules that communicate meaning about who belongs, who doesn’t and how people should behave. The social codes inscribed into café culture contribute to the production and reproduction of different social groups (Bourdieu and Lefebvre) and are reinforced by the café’s choice of aesthetics. Bourdieu’s concept of cultural capital accounts for the acquisition of cultural competencies and explains why some people feel comfortable in certain spaces while others feel excluded. Knowledge and skills required in social spaces express both subtle and sometimes not so subtle hierarchies of power and ownership, cutting across gender, ethnic and class divisions. Yet despite this, the relatively low cost of obtaining entry into the café—through the purchase of a drink—gives it greater accessibility than a pub, restaurant, or any other consumer site that is central to sociability and place attachment. In cities characterised by an intensity of change and movement, the café also enables a negotiation of place attachment. A sense of place connectedness, through habitual and regular usage, facilitates social meaning and belonging. People become “regulars” at cafés, patronising one over another, getting to know the staff and perhaps other patrons. The semiotics of the café, its ambience, decor, type of food and drink it sells, all contribute to the kind of fit that helps anchors it in a place. A proliferation of café styles offers scope for individual and collective affinities. While some adopt the latest trends in interior design, others appeal to a differentiated clientele through more varied approaches to design. Critiques of urban café culture, which see it as serving the interests of taste-based bourgeois patterns of consumption, often overlook the diversity of café styles that appeal to, and serve a wide range of, demographic groups. Café styles vary across a design continuum from fashionable minimalist décor, homey, grungy, sophisticated, traditional, corporate (McDonalds and Starbucks) or simply plain with little attention to current décor trends. The growth of café culture is a significant feature of gentrified inner city areas in cities across the world. In Brisbane’s Fortitude Valley in Australia, an inner-city youth entertainment precinct, many cafés have adopted a downmarket or “grunge” aesthetic, appealing to the area’s youth clientele and other marginal groups. Here, décor can suggest a cavalier disregard for bourgeois taste: shabby décor with mismatching tables and chairs and posters and graffiti plastered over windows and walls. Ironically, the community service organisation Mission Australia saw the need to provide for its community in this area; the marginalised, disadvantaged, and disengaged original inhabitants of this gentrified area, and opened a no-frills Café One to cater for them. Civility, Coffee, and the Café One of the distinctive features of cities is that they are places where “we meet with the other” (Barthes 96), and this is in contrast to life in provincial towns and villages where people and families could be known for generations. For the last two decades or so, cities across the world have been undergoing a period of accelerated change, including the rise of Asian mega-cities—and now, for the first time in history, the majority of the world’s population is urban based. Alongside this development is the movement of people across the world, for work, study, travel or fleeing from conflict and persecution. If Barthes’s statement was apt in the 1980s, it is ever more so now, nearly thirty years later. How strangers live together in cities of unprecedented scale and density raises important questions around social cohesion and the civil life of cities. As well as offering spaces that support a growth in urban sociability, the exponential rise of café culture can be seen as an important factor in the production of urban civilities. Reciprocity is central here, and it is the café’s function as a place of hospitality that adds another dimension to its role in the cultivation of civility and sociability. Café culture requires the acquisition of competencies associated with etiquette and manners that are based upon on notions of hospitality. The protocol required for ordering food and drink and for eating and drinking with others encourages certain types of behaviour such as courtesy, patience, restraint, and tolerance by all participants, including the café staff. The serving of food and drink in a semi-public space in exchange for money is more than a commercial transaction, it also demands the language and behaviour of civility. Conduct such as not talking too loudly, not eavesdropping on others’ conversations, knowing where to look and what to hear, are considered necessary competencies when thrust into close proximity with strangers. More intimately, the techniques of conversation—of listening, responding and sharing information—are practised in the café. It can be instructive to reprise Habermas’s concept of the public sphere (1962) in order to consider how semi-public places such as the café contribute to support the civil life of a city. Habermas’s analysis, grounded in the eighteenth-century city, charted how the coffee house or salon was instrumental to the development of a civilised discourse which contributed to the development of the public sphere across Europe. While a set of political and social structures operating at the time paved the way for the advent of democracy, critical discussion and rational argument was also vital. In other words, democratic values underpin civil discourse and the parallel here is that the space the café provides for civil interaction, particularly in cities marked by cultural and other difference, is unique among public amenities on offer in the city. The “bourgeois public sphere” for Habermas is based on the development of a social mode of interaction which became normative through socio-structural transformation during this period, and the coffee house or salon was a place that enabled a particular form of sociability and communication style. For Habermas, meeting places such as the urban-based coffee house were the heart of sociability, where conversational rules based on reasoned exchange were established; the cultivation of conversation was aimed at the dialogical egalitarian. Habermas’s bourgeois public sphere is essentially and potentially a political one, “conceived […] as the sphere of private people come together as a public” (Johnson 27). It refers to a realm of social life in which something approaching public opinion can be found. I am not claiming that the contemporary café might be the site of political dialogue and civic activism of the type that Habermas suggests. Rather, what is useful here is a recognition that the café facilitates a mode of interaction similar to the one proposed by Habermas—a mode of interaction which has the potential to be distinguished by its “open and inclusive character” (Johnson 22). The expectation of a “patient, willing comprehension of sympathetic fellows” (Johnson 23) refers to the cultivation of the art of conversation based on a reciprocity and is one that requires empathetic listening as well as dialogue. Because the café is a venue where people meet with less familiar others, the practice and techniques of conversation assumes particular significance, borne out in Habermas’s and Ellis’s historical research into café culture. Both scholars attribute the establishment of coffee houses in London to the development of social discourse and urban networking which helped set the ground for conversational rules and exchange and worked towards a democratic culture. In this context, values were challenged and differences revealed but the continued practice of conversation enabled the negotiation of such social diversity. Demonstrations of civility and generosity are straightforward in the café because of its established codes of conduct in an environment focussed upon hospitality. Paying for another’s drink, although not a great expense is a simple gesture of hospitality: “meeting for coffee” has become part of the lingua franca of workplace and business culture and relationships and is weighted with meaning. As cities grow in density, complexity and cultural diversity, citizens are adapting with new techniques of urban living. At a broad level, the café can be seen as supporting the growth in networks of sociability and facilitating the negotiation of civil discourse and behaviour. In the café, to act as a competent citizen, one must demonstrate the ability to be polite, restrained, considerate and civil—that is, to act in accordance with the social situation. This involves an element of self-control and discipline and requires social standards and expectations to become self-monitored and controlled. To be perceived as acting in accordance with the needs of certain social situations, participants bend, limit and regulate their behaviour and affects. In sum, the widespread take up of café culture, based on hospitality and reciprocity, encourages a mode of interaction that has implications for the development of a social and civic ethic. References Australian Bureau of Statistics. "1301.0–Year Book Australia." 2009. 31 Jan. 2012 ‹http://abs.gov.au/AUSSTATS/abs@.nsf/0/916F96F929978825CA25773700169C65?opendocument› Barthes, Roland. Empire of Signs. New York: Hill and Wang, 1982. Bourdieu, Pierre. Distinction: A Social Critique of the Judgement of Taste. Trans. Richard Nice. London: Routledge & Kegan Paul, 1984. Ellis, Markum. The Coffee House: A Cultural History. London: Weidenfeld and Nicolson, 2004. Fiske, J., B. Hodge, and G. Turner, eds. Myths of Oz: Reading Australian Popular Culture. Sydney: Allen & Unwin, 1987. Habermas, Jurgen. The Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society. Cambridge: Polity Press, 1962. -----. The Theory of Communicative Action. Trans. T. McCarthy. Boston: Beacon Press, 1984. Johnson, Pauline. Habermas: Rescuing the Public Sphere. London: Routledge, 2006. Lefebvre, Henri. The Production of Space. Oxford: Basil Blackwell, 1991. Maffesoli, Michel. Time of the Tribes: The Decline of Individualism in Mass Society. Trans. D. Smith. London: Sage, 1996. Miller, George. “A City that Works.” Sydney Papers Spring (2001): 77–79.

This essay combines life writing with meditations on the significance of walking as integral to the ritual practice of pilgrimage, where the individual improves her soul or health through the act of walking to a shrine containing healing relics of a saint. Braiding together insights from medieval literature, contemporary ecocriticism, and memory studies, I reflect on my own pilgrimage practice as it impacts the land itself. Canterbury, England serves as the central shrine for four pilgrimages over decades: 1966, 1994, 1997, and 2003.The act of memory was not invented in the Anthropocene. Rather, the nonhuman world has taught humans how to remember. From ice-core samples retaining the history of Europe’s weather to rocks embedded with fossilized extinct species, nonhuman actors literally petrifying or freezing the past—from geologic sites to frozen water—become exposed through the process of anthropocentric discovery and human interference. The very act of human uncovery and analysis threatens to eliminate the nonhuman actor which has hospitably shared its own experience. How can humans script nonhuman memory?As for the history of memory studies itself, a new phase is arguably beginning, shifting from “the transnational, transcultural, or global to the planetary; from recorded to deep history; from the human to the nonhuman” (Craps et al. 3). Memory studies for the Anthropocene can “focus on the terrestrialized significance of (the historicized) forms of remembrance but also on the positioning of who is remembering and, ultimately, which ‘Anthropocene’ is remembered” (Craps et al. 5). In this era of the “self-conscious Anthropocene” (Craps et al. 6), narrative itself can focus on “the place of nonhuman beings in human stories of origins, identity, and futures point to a possible opening for the methods of memory studies” (Craps et al. 8). The nonhuman on the paths of this essay range from the dirt on the path to the rock used to build the sacred shrine, the ultimate goal. How they intersect with human actors reveals how the “human subject is no longer the one forming the world, but does indeed constitute itself through its relation to and dependence on the object world” (Marcussen 14, qtd. in Rodriguez 378). Incorporating “nonhuman species as objects, if not subjects, of memory [...] memory critics could begin by extending their objects to include the memory of nonhuman species,” linking both humans and nonhumans in “an expanded multispecies frame of remembrance” (Craps et al. 9). My narrative—from diaries recording sacred journey to a novel structured by pilgrimage—propels motion, but also secures in memory events from the past, including memories of those nonhuman beings I interact with.Childhood PilgrimageThe little girl with brown curls sat crying softly, whimpering, by the side of the road in lush grass. The mother with her soft brown bangs and an underflip to her hair told the story of a little girl, sitting by the side of the road in lush grass.The story book girl had forgotten her Black Watch plaid raincoat at the picnic spot where she had lunched with her parents and two older brothers. Ponchos spread out, the family had eaten their fresh yeasty rolls, hard cheese, apples, and macaroons. The tin clink of the canteen hit their teeth as they gulped metallic water, still icy cold from the taps of the ancient inn that morning. The father cut slices of Edam with his Swiss army knife, parsing them out to each child to make his or her own little sandwich. The father then lay back for his daily nap, while the boys played chess. The portable wooden chess set had inlaid squares, each piece no taller than a fingernail paring. The girl read a Junior Puffin book, while the mother silently perused Agatha Christie. The boy who lost at chess had to play his younger sister, a fitting punishment for the less able player. She cheerfully played with either brother. Once the father awakened, they packed up their gear into their rucksacks, and continued the pilgrimage to Canterbury.Only the little Black Watch plaid raincoat was left behind.The real mother told the real girl that the story book family continued to walk, forgetting the raincoat until it began to rain. The men pulled on their ponchos and the mother her raincoat, when the little girl discovered her raincoat missing. The story book men walked two miles back while the story book mother and girl sat under the dripping canopy of leaves provided by a welcoming tree.And there, the real mother continued, the storybook girl cried and whimpered, until a magic taxi cab in which the father and boys sat suddenly appeared out of the mist to drive the little girl and her mother to their hotel.The real girl’s eyes shone. “Did that actually happen?” she asked, perking up in expectation.“Oh, yes,” said the real mother, kissing her on the brow. The girl’s tears dried. Only the plops of rain made her face moist. The little girl, now filled with hope, cuddled with her mother as they huddled together.Without warning, out of the mist, drove up a real magic taxi cab in which the real men sat. For magic taxi cabs really exist, even in the tangible world—especially in England. At the very least, in the England of little Susie’s imagination.Narrative and PilgrimageMy mother’s tale suggests how this story echoes in yet another pilgrimage story, maintaining a long tradition of pilgrimage stories embedded within frame tales as far back as the Middle Ages.The Christian pilgrim’s walk parallels Christ’s own pilgrimage to Emmaus. The blisters we suffer echo faintly the lash Christ endured. The social relations of the pilgrim are “diachronic” (Alworth 98), linking figures (Christ) from the past to the now (us, or, during the Middle Ages, William Langland’s Piers Plowman or Chaucer’s band who set out from Southwark). We embody the frame of the vera icon, the true image, thus “conjur[ing] a site of simultaneity or a plane of immanence where the actors of the past [...] meet those of the future” (Alworth 99). Our quotidian walk frames the true essence or meaning of our ambulatory travail.In 1966, my parents took my two older brothers and me on the Pilgrims’ Way—not the route from London to Canterbury that Chaucer’s pilgrims would have taken starting south of London in Southwark, rather the ancient trek from Winchester to Canterbury, famously chronicled in The Old Road by Hilaire Belloc. The route follows along the south side of the Downs, where the muddy path was dried by what sun there was. My parents first undertook the walk in the early 1950s. Slides from that pilgrimage depict my mother, voluptuous in her cashmere twinset and tweed skirt, as my father crosses a stile. My parents, inspired by Chaucer’s Canterbury Tales, decided to walk along the traditional Pilgrims’ Way to Canterbury. Story intersects with material traversal over earth on dirt-laden paths.By the time we children came along, the memories of that earlier pilgrimage resonated with my parents, inspiring them to take us on the same journey. We all carried our own rucksacks and walked five or six miles a day. Concerning our pilgrimage when I was seven, my mother wrote in her diary:As good pilgrims should, we’ve been telling tales along the way. Yesterday Jimmy told the whole (detailed) story of That Darn Cat, a Disney movie. Today I told about Stevenson’s Travels with a Donkey, which first inspired me to think of walking trips and everyone noted the resemblance between Stevenson’s lovable, but balky, donkey and our sweet Sue. (We hadn’t planned to tell tales, but they just happened along the way.)I don’t know how sweet I was; perhaps I was “balky” because the road was so hard. Landscape certainly shaped my experience.As I wrote about the pilgrimage in my diary then, “We went to another Hotel and walked. We went and had lunch at the Boggly [booglie] place. We went to a nother hotel called The Swan with fether Quits [quilts]. We went to the Queens head. We went to the Gest house. We went to aother Hotle called Srping wells and my tooth came out. We saw some taekeys [turkeys].” The repetition suggests how pilgrimage combines various aspects of life, from the emotional to the physical, the quotidian (walking and especially resting—in hotels with quilts) with the extraordinary (newly sprung tooth or the appearance of turkeys). “[W]ayfaring abilities depend on an emotional connection to the environment” (Easterlin 261), whether that environment is modified by humans or even manmade, inhabited by human or nonhuman actors. How can one model an “ecological relationship between humans and nonhumans” in narrative (Rodriguez 368)? Rodriguez proposes a “model of reading as encounter [...] encountering fictional story worlds as potential models” (Rodriguez 368), just as my mother did with the Magic Taxi Cab story.Taxis proliferate in my childhood pilgrimage. My mother writes in 1966 in her diary of journeying along the Pilgrims’ Way to St. Martha’s on the Hill. “Susie was moaning and groaning under her pack and at one desperate uphill moment gasped out, ‘Let’s take a taxi!’ – our highborn lady as we call her. But we finally made it.” “Martha’s”, as I later learned, is a corruption of “Martyrs”, a natural linguistic decay that developed over the medieval period. Just as the vernacular textures pilgrimage poems in the fourteeth century, the common tongue in all its glorious variety seeps into even the quotidian modern pilgrim’s journey.Part of the delight of pilgrimage lies in the characters one meets and the languages they speak. In 1994, the only time my husband and I cheated on a strictly ambulatory sacred journey occurred when we opted to ride a bus for ten miles where walking would have been dangerous. When I ask the bus driver if a stop were ours, he replied, “I'll give you a shout, love.” As though in a P. G. Wodehouse novel, when our stop finally came, he cried out, “Cheerio, love” to me and “Cheerio, mate” to Jim.Language changes. Which is a good thing. If it didn’t, it would be dead, like those martyrs of old. Like Latin itself. Disentangling pilgrimage from language proves impossible. The healthy ecopoetics of languages meshes with the sustainable vibrancy of the land we traverse.“Nettles of remorse…”: Derek Walcott, The Bounty Once my father had to carry me past a particularly tough patch of nettles. As my mother tells it, we “went through orchards and along narrow woodland path with face-high nettles. Susie put a scarf over her face and I wore a poncho though it was sunny and we survived almost unscathed.” Certain moments get preserved by the camera. At age seven in a field outside of Wye, I am captured in my father’s slides surrounded by grain. At age thirty-five, I am captured in film by my husband in the same spot, in the identical pose, though now quite a bit taller than the grain. Three years later, as a mother, I in turn snap him with a backpack containing baby Sarah, grumpily gazing off over the fields.When I was seven, we took off from Detling. My mother writes, “set off along old Pilgrims’ Way. Road is paved now, but much the same as fifteen years ago. Saw sheep, lambs, and enjoyed lovely scenery. Sudden shower sent us all to a lunch spot under trees near Thurnham Court, where we huddled under ponchos and ate happily, watching the weather move across the valley. When the sun came to us, we continued on our way which was lovely, past sheep, etc., but all on hard paved road, alas. Susie was a good little walker, but moaned from time to time.”I seem to whimper and groan a lot on pilgrimage. One thing is clear: the physical aspects of walking for days affected my phenomenological response to our pilgrimage which we’d undertaken both as historical ritual, touristic nature hike, and what Wendell Berry calls a “secular pilgrimage” (402), where the walker seeks “the world of the Creation” (403) in a “return to the wilderness in order to be restored” (416). The materiality of my experience was key to how I perceived this journey as a spiritual, somatic, and emotional event. The link between pilgrimage and memory, between pilgrimage poetics and memorial methods, occupies my thoughts on pilgrimage. As Nancy Easterlin’s work on “cognitive ecocriticism” (“Cognitive” 257) contends, environmental knowledge is intimately tied in with memory (“Cognitive” 260). She writes: “The advantage of extensive environmental knowledge most surely precipitates the evolution of memory, necessary to sustain vast knowledge” (“Cognitive” 260). Even today I can recall snatches of moments from that trip when I was a child, including the telling of tales.Landscape not only changes the writer, but writing transforms the landscape and our interaction with it. As Valerie Allen suggests, “If the subject acts upon the environment, so does the environment upon the subject” (“When Things Break” 82). Indeed, we can understand the “road as a strategic point of interaction between human and environment” (Allen and Evans 26; see also Oram)—even, or especially, when that interaction causes pain and inflames blisters. My relationship with moleskin on my blasted and blistered toes made me intimately conscious of my body with every step taken on the pilgrimage route.As an adult, my boots on the way from Winchester to Canterbury pinched and squeezed, packed dirt acting upon them and, in turn, my feet. After taking the train home and upon arrival in London, we walked through Bloomsbury to our flat on Russell Square, passing by what I saw as a new, less religious, but no less beckoning shrine: The London Foot Hospital at Fitzroy Square.Now, sadly, it is closed. Where do pilgrims go for sole—and soul—care?Slow Walking as WayfindingAll pilgrimages come to an end, just as, in 1966, my mother writes of our our arrival at last in Canterbury:On into Canterbury past nice grassy cricket field, where we sat and ate chocolate bars while we watched white-flannelled cricketers at play. Past town gates to our Queen’s Head Inn, where we have the smallest, slantingest room in the world. Everything is askew and we’re planning to use our extra pillows to brace our feet so we won’t slide out of bed. Children have nice big room with 3 beds and are busy playing store with pounds and shillings [that’s very hard mathematics!]. After dinner, walked over to cathedral, where evensong was just ending. Walked back to hotel and into bed where we are now.Up to early breakfast, dashed to cathedral and looked up, up, up. After our sins were forgiven, we picked up our rucksacks and headed into London by train.This experience in 1966 varies slightly from the one in 1994. Jim and I walk through a long walkway of tall, slim trees arching over us, a green, lush and silent cloister, finally gaining our first view of Canterbury with me in a similar photo to one taken almost thirty years before. We make our way into the city through the West Gate, first passing by St. Dunstan’s Church where Henry II had put on penitential garb and later Sir Thomas More’s head was buried. Canterbury is like Coney Island in the Middle Ages and still is: men with dreadlocks and slinky didjeridoos, fire tossers, mobs of people, tourists. We go to Mercery Lane as all good pilgrims should and under the gate festooned with the green statue of Christ, arriving just in time for evensong.Imagining a medieval woman arriving here and listening to the service, I pray to God my gratefulness for us having arrived safely. I can understand the fifteenth-century pilgrim, Margery Kempe, screaming emotionally—maybe her feet hurt like mine. I’m on the verge of tears during the ceremony: so glad to be here safe, finally got here, my favorite service, my beloved husband. After the service, we pass on through the Quire to the spot where St. Thomas’s relic sanctuary was. People stare at a lit candle commemorating it. Tears well up in my eyes.I suppose some things have changed since the Middle Ages. One Friday in Canterbury with my children in 2003 has some parallels with earlier iterations. Seven-year-old Sarah and I go to evensong at the Cathedral. I tell her she has to be absolutely quiet or the Archbishop will chop off her head.She still has her head.Though the road has been paved, the view has remained virtually unaltered. Some aspects seem eternal—sheep, lambs, and stiles dotting the landscape. The grinding down of the pilgrimage path, reflecting the “slowness of flat ontology” (Yates 207), occurs over vast expanses of time. Similarly, Easterlin reflects on human and more than human vitalism: “Although an understanding of humans as wayfinders suggests a complex and dynamic interest on the part of humans in the environment, the surround itself is complex and dynamic and is frequently in a state of change as the individual or group moves through it” (Easterlin “Cognitive” 261). An image of my mother in the 1970s by a shady tree along the Pilgrims’ Way in England shows that the path is lower by 6 inches than the neighboring verge (Bright 4). We don’t see dirt evolving, because its changes occur so slowly. Only big time allows us to see transformative change.Memorial PilgrimageOddly, the erasure of self through duplication with a precursor occurred for me while reading W.G. Sebald’s pilgrimage novel, The Rings of Saturn. I had experienced my own pilgrimage to many of these same locations he immortalizes. I, too, had gone to Somerleyton Hall with my elderly mother, husband, and two children. My memories, sacred shrines pooling in familial history, are infused with synchronic reflection, medieval to contemporary—my parents’ periodic sojourns in Suffolk for years, leading me to love the very landscape Sebald treks across; sadness at my parents’ decline; hope in my children’s coming to add on to their memory palimpsest a layer devoted to this land, to this history, to this family.Then, the oddest coincidence from my reading pilgrimage. After visiting Dunwich Heath, Sebald comes to his friend, Michael, whose wife Anne relays a story about a local man hired as a pallbearer by the local undertaker in Westleton. This man, whose memory was famously bad, nevertheless reveled in the few lines allotted him in an outdoor performance of King Lear. After her relating this story, Sebald asks for a taxi (Sebald 188-9).This might all seem unremarkable to the average reader. Yet, “human wayfinders are richly aware of and responsive to environment, meaning both physical places and living beings, often at a level below consciousness” (Easterlin “Cognitive” 265). For me, with a connection to this area, I startled with recollection emerging from my subconscience. The pallbearer’s name in Sebald’s story was Mr Squirrel, the very same name of the taxi driver my parents—and we—had driven with many times. The same Mr Squirrel? How many Mr Squirrels can there be in this small part of Suffolk? Surely it must be the same family, related in a genetic encoding of memory. I run to my archives. And there, in my mother’s address book—itself a palimpsest of time with names and addressed scored through; pasted-in cards, names, and numbers; and looseleaf memoranda—there, on the first page under “S”, “Mr. Squirrel” in my mother’s unmistakable scribble. She also had inscribed his phone number and the village Saxmundum, seven miles from Westleton. His name had been crossed out. Had he died? Retired? I don’t know. Yet quick look online tells me Squirrell’s Taxis still exists, as it does in my memory.Making KinAfter accompanying a class on a bucolic section of England’s Pilgrims’ Way, seven miles from Wye to Charing, we ended up at a pub drinking a pint, with which all good pilgrimages should conclude. There, students asked me why I became a medievalist who studies pilgrimage. Only after the publication of my first book on women pilgrims did I realize that the origin of my scholarly, long fascination with pilgrimage, blossoming into my professional career, began when I was seven years old along the way to Canterbury. The seeds of that pilgrimage when I was so young bore fruit and flowers decades later.One story illustrates Michel Serres’s point that we should not aim to appropriate the world, but merely act as temporary tenants (Serres 72-3). On pilgrimage in 1966 as a child, I had a penchant for ant spiders. That was not the only insect who took my heart. My mother shares how “Susie found a beetle up on the hill today and put him in the cheese box. Jimmy put holes in the top for him. She named him Alexander Beetle and really became very fond of him. After supper, we set him free in the garden here, with appropriate ceremony and a few over-dramatic tears of farewell.” He clearly made a great impression on me. I yearn for him today, that beetle in the cheese box. Though I tried to smuggle nature as contraband, I ultimately had to set him free.Passing through cities, landscape, forests, over seas and on roads, wandering by fields and vegetable patches, under a sky lit both by sun and moon, the pilgrim—even when in a group of fellow pilgrims—in her lonesome exercise endeavors to realize Serres’ ideal of the tenant inhabitant of earth. Nevertheless, we, as physical pilgrims, inevitably leave our traces through photos immortalizing the journey, trash left by the wayside, even excretions discretely deposited behind a convenient bush. Or a beetle who can tell the story of his adventure—or terror—at being ensconced for a time in a cheese box.On one notorious day of painful feet, my husband and I arrived in Otford, only to find the pub was still closed. Finally, it became time for dinner. We sat outside, me with feet ensconced in shoes blessedly inert and unmoving, as the server brought out our salads. The salad cream, white and viscous, was presented in an elegantly curved silver dish. Then Jim began to pick at the salad cream with his fork. Patiently, tenderly, he endeavored to assist a little bug who had gotten trapped in the gooey sauce. Every attempt seemed doomed to failure. The tiny creature kept falling back into the gloppy substance. Undaunted, Jim compassionately ministered to our companion. Finally, the little insect flew off, free to continue its own pilgrimage, which had intersected with ours in a tiny moment of affinity. Such moments of “making kin” work, according to Donna Haraway, as “life-saving strateg[ies] for the Anthropocene” (Oppermann 3, qtd. in Haraway 160).How can narrative avoid the anthropocentric centre of writing, which is inevitable given the human generator of such a piece? While words are a human invention, nonhuman entities vitally enact memory. The very Downs we walked along were created in the Cretaceous period at least seventy million years ago. The petrol propelling the magic taxi cab was distilled from organic bodies dating back millions of years. Jurassic limestone from the Bathonian Age almost two hundred million years ago constitutes the Caen stone quarried for building Canterbury Cathedral, while its Purbeck marble from Dorset dates from the Cretaceous period. Walking on pilgrimage propels me through a past millions—billions—of eons into the past, dwarfing my speck of existence. Yet, “if we wish to cross the darkness which separates us from [the past] we must lay down a little plank of words and step delicately over it” (Barfield 23). Elias Amidon asks us to consider how “the ground we dig into and walk upon is sacred. It is sacred because it makes us neighbors to each other, whether we like it or not. Tell this story” (Amidon 42). And, so, I have.We are winding down. Time has passed since that first pilgrimage of mine at seven years old. Yet now, here, I still put on my red plaid wollen jumper and jacket, crisp white button-up shirt, grey knee socks, and stout red walking shoes. Slinging on my rucksack, I take my mother’s hand.I’m ready to take my first step.We continue our pilgrimage, together.ReferencesAllen, Valerie. “When Things Break: Mending Rroads, Being Social.” Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.———, and Ruth Evans. Introduction. Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.Alworth, David J. Site Reading: Fiction, Art, Social Form. Princeton: Princeton UP, 2016.Amidon, Elias. “Digging In.” Dirt: A Love Story. Ed. Barbara Richardson. Lebanon, NH: ForeEdge, 2015.Barfield, Owen. History in English Words. Grand Rapids: William B. 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Baltimore: Johns Hopkins UP, 2010. 257-274.Haraway, Donna. “Anthropocene, Capitalocene, Plantationocene, Chthulucene: Making Kin.” Environmental Humanities 6 (2015): 159-65.James, Erin, and Eric Morel. “Ecocriticism and Narrative Theory: An Introduction.” English Studies 99.4 (2018): 355-365.Marcussen, Marlene. Reading for Space: An Encounter between Narratology and New Materialism in the Works of Virgina Woolf and Georges Perec. PhD diss. University of Southern Denmark, 2016.Oppermann, Serpil. “Introducing Migrant Ecologies in an (Un)Bordered World.” ISLE 24.2 (2017): 243–256.Oram, Richard. “Trackless, Impenetrable, and Underdeveloped? Roads, Colonization and Environmental Transformation in the Anglo-Scottish Border Zone, c. 1100 to c. 1300.” Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. 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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. 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Resilience is an interdisciplinary concept that has been interrogated and investigated in a number of fields of research and practice including psychology, climate change, trauma studies, education and disaster planning. This paper considers its position within critical disability studies, popular understandings of disability and the emergence of a disability culture. Patrick Martin-Breen and J. Marty Anderies offer a colloquial definition of resilience as: Bouncing back after stress, enduring greater stress, and being less disturbed by a given amount of stress. … To be resilient is to withstand a large disturbance without, in the end, changing, disintegrating, or becoming permanently damaged; to return to normal quickly; and to distort less in the face of such stresses. (1182) Conversely, Glenn E. Richardson argues that resiliency is a ‘metatheory’ that can best be described as ‘growth or adaptation through disruption rather than to just recover or bounce back’ (1184). He argues that resiliency theory has progressed through several stages, from the recognition of characteristics of resilient individuals to an appreciation of the support structures required beyond the level of the individual. In her memoir Resilience, Ann Deveson describes resilience as a concept that people think they understand until they are called upon to define it. Deveson offers many definitions and examples of resilience throughout her book, beginning with stories about disability, people with disability and their experiences of changing levels of social inclusion and exclusion (632). She paints an evocative picture of a young mother whose five year old son has cerebral palsy giving evidence before a Royal Commission into Human Relationships during a period of significant social change involving the deinstitutionalisation of people with disabilities: A few years earlier, this child with cerebral palsy would have been placed in an institution. His mother might not even have seen him. Now she had care of her child but the pendulum had swung in the opposite direction. (632) During the 1980s a number of large institutions caring for people with developmental impairments and psychiatric illnesses were closed in favour of community care (Clear 652). Although giving an appearance of endorsing equality of disabled people in the community, the ‘hidden agenda’ of this initiative was to cut public expenditure on social services (Ellis 163). As a result, an undue burden fell to women who became primary carers with little support such as the woman Deveson remembers. She questions where this young mother mustered such ‘magnificent resilience’ when she had such little support: When he was born, she had been discharged from the hospital with her baby, a feeding formula and a tiny pink plate for the child’s cleft palate. The only advice she received was to come back later to have the plate refitted. Her general practitioner prescribed her sedatives for depression, and she and her husband found their own way to the Royal Blind society by asking a blind man they saw outside a supermarket. She had only learned accidentally from one of the nurses that her baby was blind. ‘He’s mentally retarded too,’ the nurse had added, almost as an afterthought. (632) Thus Deveson’s consideration of resilience includes both an individual’s response to what could be described as tragedy and the importance of social support and the drive to demand it. Despite her child’s impairment and the lack of community resources made available to her family to cope, this young woman was leading public discussion about the plight of people with disabilities and their families in the hopes the government would intervene to help improve the situation (Deveson 632). Indeed, when it comes to the experience of disability, resilience is implied and generally understood to mean an attribute of the individual. However, as resilience theory has progressed, resilience can no longer be considered as existing exclusively within the domain of an individual’s personal qualities. Environmental support structures are vital in fostering resilience (Wilkes). Despite resiliency theory moving on from the level of the individual, popular discourses of resiliency as an individual’s attribute continue to dominate disability. As such, some critical disability commentators have redefined resilience as a response to a disabling social world. My aim in this paper is to explore this discourse by engaging with ideas about disability and resilience that emerge in popular culture. Despite the changing social position of people with disabilities in the community, notions of resilience are often invoked to describe the experience of people with disability and attributes of successful (often considered ‘inspiring’) people with disability. I begin by offering a definition of resilience as it is bound up in notions of inspiration and usually applied to people with disabilities. The second part of the paper explores disability as a cultural signifier to comment on the ways in which disability offers cultural meanings that may work to reassure nondisabled people of their privileged position. Finally, the paper considers interpretations of disability as a personal tragedy before exploring the emergence of a disability culture that recognises the social and cultural oppression experienced by people with disabilities and reworks definitions of resilience as a response to that oppression. Defining Resilience: Good Outcomes in Spite of Serious Threats Disability is often invoked in stories about resilience. Gillian King, Elizabeth Brown, and Linda Smith argue that a clear link exists between resilience and feeling that life is meaningful. They argue that the experiences of people with disabilities can offer a template for how to develop resilience and cope with life changes (King, Brown and Smith 633). According to the Oxford English Dictionary Online, resilience is ‘the action or an act of rebounding or springing back’ (653). King et al add that several concepts are associated with resilience such as hardiness, a sense of coherence and learned optimism (633). Deveson, resilience ‘has come to mean an ability to confront adversity and still find hope and meaning in life’. She comments that it conjures up notions of heroism, endurance and determination (632). Each of these characteristics we might describe as inspirational. It is telling that both Deveson and King et al use people with disabilities as signifiers of resilience in practice. However, Katherine Runswick-Cole and Dan Goodley argue that this definition of resilience has not necessarily been useful to people with disabilities and instead recommend a definition of resilience that Deveson only alludes to. For Runswick-Cole and Goodley resilience can be located in social processes. They argue that a thorough investigation of resilience in the lives of people with disabilities considers the broader social and cultural restrictions placed on top of impairments rather than simply individualising resilience as a character trait of people who can ‘overcome the odds’: An exploration of resilience in the lives of disabled people must, then, focus on what resources are available and who is accessing those resources. Crucially, in seeking to build resilience in the lives of disabled people, this can never simply be a matter of building individual capacity or family support, it must also be a case of challenging social, attitudinal and structural barriers which increase adversity in the lives of disabled people. (634) This is an alternative approach to disability that sees ‘the problem’ located in social structures and inaccessible environments. This so-called social model of disability is based on principles of empowerment and argues that able-bodied mainstream society disables people who have impairments through an inaccessible built environment and the perpetuation of stereotypes and prejudicial attitudes. Disability Dustbins and Inspirational Cripples Arthur Frank, sociologist and author of The Wounded Storyteller, explains that ‘the human body, for all its resilience, is fragile; breakdown is built into it. Bodily predictability, if not the exception, should be regarded as exceptional; contingency ought to be accepted as normative’ (634). Frank argues that we do not want to admit that our bodies are unpredictable and could ‘break down’ at any moment. Those bodies that do break down therefore become representatives of many of the things [the able-bodied, normal world] most fear-tragedy, loss, dark and the unknown. Involuntarily we walk- or more often sit- in the valley of the shadow of death. Contact with us throws up in people's faces the fact of sickness and death in the world … A deformed and paralysed body attacks everyone's sense of well-being and invincibility. (Hunt 186) People with disabilities therefore become loaded cultural signifiers, as Tom Shakespeare argues in Cultural Representations of Disabled People: Dustbins for Disavowal: ‘it is non-disabled people’s embodiment which is the issue: disabled people remind non-disabled people of their own vulnerability’ (139). As a result, people with disabilities are culturally othered. Several disability theorists have argued that this makes the non-disabled feel better about themselves and their tenuous privileged position (Barnes; Ellis; Kumari Campbell; Oliver, Goggin and Newell; Shakespeare). Disability, as a concept, is both everywhere and nowhere. Generally considered a medical experience or personal tragedy, the discipline of critical disability studies has emerged to question why disability is considered an inherently negative experience and if there is more to disability than a body that has something wrong with it. Fiona Kumari Campbell suggests ableism – ‘the network of beliefs, processes and practices that produces a particular kind of self and body (the corporeal standard) that is projected as the perfect, species typical and therefore essential and fully human’ – is repeatedly performed in our culture. This cultural project is difficult to sustain because by their very nature all bodies are out of control. People with disability are an acute reminder of the temporariness of an able bodied ontology (650). In order to maintain this division and network of beliefs, the idea that disability is a personal tragedy rather than a set of social relations designed to exclude some bodies but not others is culturally reproduced through stereotypes such as the idea that people with disabilities who achieve both ordinary and extraordinary things are sources of inspiration. Resilience as a personal quality is implicated in this stereotype. In a powerful Ramp Up blog that was republished on the ABC’s Drum and the influential popular culture/mummy blogging site website Mamamia, Stella Young takes issues with the media’s framing of disability as inspirational: We all learn how to use the bodies we're born with, or learn to use them in an adjusted state, whether those bodies are considered disabled or not. So that image of the kid drawing a picture with the pencil held in her mouth instead of her hand? That's just the best way for her, in her body, to do it. For her, it's normal. I can't help but wonder whether the source of this strange assumption that living our lives takes some particular kind of courage is the news media, an incredibly powerful tool in shaping the way we think about disability. Most journalists seem utterly incapable of writing or talking about a person with a disability without using phrases like "overcoming disability", "brave", "suffers from", "defying the odds", "wheelchair bound" or, my personal favourite, "inspirational". If we even begin to question the way we're labelled, we slide immediately to the other end of the scale and become "bitter" and "ungrateful". We fail to be what people expect. (610) These phrases, that Young claims the media rely on to isolate people with disabilities, are synonyms for the qualities Deveson attributes to resilient individuals (632). As Beth Haller notes, although disabled activists and academics attempt to progress important political work, the news media continue to frame people with disability as courageous and inspirational simply for living their lives (216). By comparison, disability theorist Irving Zola describes rejecting his leg braces (symbolic of his professional status) electing instead to use a wheelchair: If we lived in a less healthiest, capitalist, and hierarchal society, which spent less time finding ways to exclude and disenfranchise people and more time finding ways to include and enhance the potentialities of everyone, then there wouldn’t have been so much for me to overcome. (654) Harilyn Russo agrees, and in her memoir Don’t Call Me Inspirational highlights the socially created barriers put in her way and the ways these are ignored in favour of individualising social disablement as something inspirational people ‘overcome’: I’ll tell you why I am inspirational: I put up with the barriers, the barricades, the bullshit you put between us to avoid confronting something—probably yourself—and still pay the rent on time and savor dark chocolate. Now that takes real courage. (651) Throughout her book, Russo seeks to ‘overcome disability prejudice’ rather than ‘overcome disability’. Russo establishes herself and her experiences as normal and every day while articulating the tedium she finds in being pigeon holed as inspirational. These authors are constructing a new way of thinking about disability. Michael Oliver first described this as the ‘social model of disability’ in 1981. He sought to overturn the pathologisation of disability by giving people ‘a way of applying the idea that it was society not people with impairments that should be the target for professional intervention and practice’ (Runswick-Cole and Goodley 634). Resilience: A Key Concept Fiona Kumari Campbell questions whether resilience is a useful concept in the context of disability and reflects on its use to obscure “the ‘real’ problem, namely disability oppression” (649). She interrogates traditional definitions of resilience as they draw on notions of good outcomes in spite of risk factors or experiences of severe trauma and calls for an understanding of the interactive and dynamic features of resilience as opposed to ‘individualised psychological attributes’. Thus, individualised notions of resilience as they are implicated in the cultural stories of inspirational people with disabilities are embedded within the ableist relations that Kumari Campbell seeks to expose. In Empowerment, Self-Advocacy and Resilience, Dan Goodley argues that resilience is a key concept that has repeatedly emerged throughout his research into disability and self-advocacy. He draws on the reflections of people with disabilities to offer a re-definition of resilience as a response to a disabling society that includes five interrelated aspects (648). First is resilience as contextual, which recognises resilience as the result of the contexts in which it emerges, including through relationships with others and the experience of disabling and enabling environments. Secondly, resilience complicates preconceived notions about people with disabilities such as the view that they are passive. Goodley’s third feature of resilience is optimism. He notes resistance toward oppression as a key characteristic of optimistic resilience. Goodley again considers the importance of interpersonal relationships and group identity when he argues that the fourth feature of resilience relies on people with disabilities forming relationships with each other and group identities to question their oppression. Finally, Goodley argues ‘resilience is indicative of disablement’ and suggests that people with disability must be resilient in everyday life because we live in a disabling society. Kumari Campbell posits that individualised notions of resilience are a ‘cop out’ designed to ‘distract and defuse the reality of people labouring under very difficult circumstances of which the solution is better access to quality services’. She is hopeful, like Goodley, that resilience can be redefined as a political project, and encourages people with disabilities to develop a critical consciousness and find a new sense of community through art, humour and peer support. Therefore, according to Kumari Campbell and Goodley, resilience can be redefined as a response to social disablement rather than bodily impairment. Disability Culture: Acts of Resilience in a Disabling Society Russo and Zola’s work is part of a disability culture that has emerged in response to narrow ways of understanding disability. Steven Brown emphasises the importance of experience and personal identity in his definition of disability culture: People with disabilities have forged a group identity. We share a common history of oppression and a common bond of resilience. We generate art, music, literature, and other expressions of our lives and our culture, infused from our experience of disability. Most importantly, we are proud of ourselves as people with disabilities. We claim our disabilities with pride as part of our identity. (520) Brown’s definition of disability culture therefore draws on all five of Goodley’s features of resilience. Disability culture is contextual, complicating, optimistic, interpersonal and indicative of disablement. The forging of a group identity reveals the resilience of disability culture as contextual and interpersonal. The creation of art, music, literature and other cultural artefacts reveals resilience as optimistic. The notion that people with disabilities are proud of their identity complicates traditional understandings of disability as a personal tragedy. Brown’s emphasis on the common history of the oppression of people with disabilities, as it initiated the whole disability culture movement, is ‘indicative of disablement’. The bonds of resilience that create the disability cultural movement are a result of the social oppression of people with disabilities (Gill; Martin; Brown; Goodley). Conclusion Whereas people with disabilities going about their every day lives have often been considered inspirational and as possessing resilient qualities, a new disability culture is emerging that repositions the resilience of people with disabilities as a political response to social oppression. Drawing on Runswick-Cole and Goodley’s argument that individualising qualities of resilience in inspirational people with disabilities has not benefitted people with disabilities, this paper sought to reveal the importance of resilience as a response to social oppression. People with disabilities in their formation of a disability cultural movement are reworking and redefining resilience as a response to oppression. Throughout this paper I have drawn on the reflections of a number of people with disabilities to illustrate the emergence of a disability culture as it has begun the work of redefining resilience as a political project that “‘outs’ the problems that disabled people face and names and prioritises the concerns” (Kumari Campbell 649). As Goodley argues, people with disabilities have developed a politics of resilience ‘in the face of a disabling world’. References Barnes, Colin. “Disabling Imagery and the Media: An Exploration of the Principles for Media Representations of Disabled People.” 1992. Brown, Steven. “What Is Disability Culture?” Disability Studies Quarterly 22.2 (2002). Clear, Mike. Promises, Promises: Disability and Terms of Inclusion. Leichhardt: Federation Press, 2000. Deveson, Ann. Resilience. Crows Nest: Allen & Unwin, 2003. Ellis, Katie. Disabling Diversity: The Social Construction of Disability in 1990s Australian National Cinema. Saarbrücken, Germany: VDM Verlag, 2008. Frank, Arthur. The Wounded Storyteller: Body, Illness and Ethics. Chicago: The University of Chicago Press, 1995. Gill, Carol. “A Psychological View of Disability Culture.” Disability Studies Quarterly (Fall 1995). ———. "Disability in Australia: Exposing a Social Apartheid." Sydney: University of New South Wales, 2005. Goodley, Dan. “Empowerment, Self-Advocacy and Resilience.” Journal of Intellectual Disabilities 9.4 (2005): 333-343. Haller, Beth. Representing Disability in an Ableist World: Essays on Mass Media. Louisville, KY: Avocado Press, 2010. Hunt, Paul. “A Critical Condition.” Stigma: The Experience of Disability. Ed. Paul Hunt. London: Geoffrey Chapman, 1966. King, Gillian, Elizabeth Brown, and Linda Smith. “Resilience: Learning from People with Disabilities and the Turning Points in Their Lives.” Health Psychology. Ed. Barbara, Tinsley. Westport, CT: Praeger, 2003. Kumari Campbell, Fiona. Contours of Ableism: The Production of Disability and Abledness. New York: Palgrave Macmillian, 2009. ———. “Out of the Shadows: Resilience and Living with Ableism Seminar.” The University of Dundee, 13 Sep. 2010. Martin-Breen, Patrick, and J. Marty Anderies. “Resilience: A Literature Review.” The Rockefeller Foundation, 2011. Martin, Douglas. Disability Culture: Eager to Bite the Hands That Would Feed Them. New York Times, 1997. Oliver, Mike. “Understanding Disability: From Theory to Practice.” Houndsmill, Basingstoke: Macmillian, 1996. Oxford English Dictionary. “resilience, n.” Oxford University Press. Richardson, G. E. “The Metatheory of Resilience and Resiliency,” Journal of Clinical Psychology 58.3. (2002): 307-321. Rousso, Harilyn. "Don’t Call Me Inspirational: A Disabled Feminist Talks Back." Philadelphia: Temple University Press. 2013. Runswick-Cole, Katherine, and Dan Goodley. “Resilience: A Disability Studies and Community Psychology Approach.” Social and Personality Psychology Compass 7. 2 (2013): 67-78. Shakespeare, Tom. “Cultural Representation of Disabled People: Dustbins for Disavowal?” Disability & Society 9.3 (1994): 283-299. Wilkes, Glenda. “Introduction – A Second Generation of Resilience Research.” Journal of Clinical Psychology 58.3 (2002): 229-232. Young, Stella. “We’re Not Here for Your Inspiration.” Ramp Up 2012. Zola, Irving. Missing Pieces: A Chronicle of Living with a Disability. Philadelphia: Temple University Press. 1982.

Introduction Utopia has always been countercultural, and ever since technological progress has allowed, utopia has been using alternative media to promote and strengthen its underpinning ideals. In this article, I am seeking to clarify the connections between counterculture and alternative media in utopian contexts to demonstrate their reciprocity, then draw together these threads through reference to a well-known figure of the Rainbow Region–Rusty Miller. His trajectory from iconic surfer and Aquarian reporter to mediator for utopian politics and ideals in the Rainbow Region encompasses in a single identity the three elements underpinning this study. In concluding, I will turn to Rusty’s Byron Guide, questioning its classification as alternative or mainstream media, and whether Byron Bay is represented as countercultural and utopian in this long-running and ongoing publication. Counterculture and Alternative Media in Utopian Contexts Counterculture is an umbrella that enfolds utopia, among many other genres and practices. It has been most often situated in the 1960s and 1970s as a new form of social movement embodying youth resistance to the technocratic mainstream and its norms of gender, sexuality, politics, music, and language (Roszak). Many scholars of counterculture underscore its utopian impulses both in the projection of better societies where the social goals are achieved, and in the withdrawal from mainstream society into intentional communities (Yinger 194-6; McKay 5; Berger). Before exploring further the connections between counterculture and alternative media, I want to define the scope of countercultural utopian contexts in general, and the Rainbow Region in particular. Utopia is a neologism created by Sir Thomas More almost 500 years ago to designate the island community that demonstrates order, harmony, justice, hope and desire in the right balance so that it seems like an ideal land. This imaginary place described in Utopia (1516) as a counterpoint to the social, political and religious shortcomings of contemporary 16th century British society, has attracted accusations of heresy (Molner), and been used as a pejorative term, an insult to denigrate political projects that seem farfetched or subversive, especially during the 19th century. Almost every study of utopian theory, literature and practice points to a dissatisfaction with the status quo, which inspires writers, politicians, architects, artists, individuals and communities to rail against it (see for example Davis, Moylan, Suvin, Levitas, Jameson). Kingsley Widmer’s book Counterings: Utopian Dialectics in Contemporary Contexts reiterates what many scholars have stated when he writes that utopias should be understood in terms of what they are countering. Lyman Tower Sargent defines utopia as “a non-existent society described in considerable detail and normally located in time and space” and utopianism as “social dreaming” (9), to which I would add that both indicate an improvement on the alternatives, and may indeed be striving to represent the best place imaginable. Utopian contexts, by extension, are those situations where the “social dreaming” is enhanced through human agency, good governance, just laws, education, and work, rather than being a divinely ordained state of nature (Schaer et al). In this way, utopian contexts are explicitly countercultural through their very conception, as human agency is required and their emphasis is on social change. These modes of resistance against dominant paradigms are most evident in attempts to realise textual projections of a better society in countercultural communal experiments. Almost immediately after its publication, More’s Utopia became the model for Bishop Vasco de Quiroga’s communitarian hospital-town Santa Fe de la Laguna in Michoacan, Mexico, established in the 1530s as a counterculture to the oppressive enslavement and massacres of the Purhépecha people by Nuno Guzmán (Green). The countercultural thrust of the 1960s and 1970s provided many utopian contexts, perhaps most readily identifiable as the intentional communities that spawned and flourished, especially in the United States, the United Kingdom, Australia, and New Zealand (Metcalf, Shared Lives). They were often inspired by texts such as Charles A. Reich’s The Greening of America (1970) and Ernest Callenbach’s Ecotopia (1975), and this convergence of textual practices and alternative lifestyles can be seen in the development of Australia’s own Rainbow Region. Located in northern New South Wales, the geographical area of the Northern Rivers that has come to be known as the Rainbow Region encompasses Byron Bay, Nimbin, Mullumbimby, Bangalow, Clunes, Dunoon, Federal, with Lismore as the region’s largest town. But more evocative than these place names are the “rivers and creeks, vivid green hills, fruit and nut farms […] bounded by subtropical beaches and rainforest mountains” (Wilson 1). Utopian by nature, and recognised as such by the indigenous Bundjalung people who inhabited it before the white settlers, whalers and dairy farmers moved in, the Rainbow Region became utopian through culture–or indeed counterculture–during the 1973 Aquarius Festival in Nimbin when the hippies of Mullumbimby and the surfers of Byron Bay were joined by up to 10,000 people seeking alternative ways of being in the world. When the party was over, many Aquarians stayed on to form intentional communities in the beautiful region, like Tuntable Falls, Nimbin’s first and largest such cooperative (Metcalf, From Utopian Dreaming to Communal Reality 74-83). In utopian contexts, from the Renaissance to the 1970s and beyond, counterculture has underpinned and alternative media has circulated the aims and ideals of the communities of resistance. The early utopian context of the Anabaptist movement has been dubbed as countercultural by Sigrun Haude: “During the reign of the Münster (1534-5) Anabaptists erected not only a religious but also a social and political counterculture to the existing order” (240). And it was this Protestant Reformation that John Downing calls the first real media war, with conflicting movements using pamphlets produced on the new technology of the Gutenberg press to disseminate their ideas (144). What is striking here is the confluence of ideas and practices at this time–countercultural ideals are articulated, published, and disseminated, printing presses make this possible, and utopian activists realise how mass media can be used and abused, exploited and censored. Twentieth century countercultural movements drew on the lessons learnt from historical uprising and revolutions, understanding the importance of getting the word out through their own forms of media which, given the subversive nature of the messages, were essentially alternative, according to the criteria proposed by Chris Atton: alternative media may be understood as a radical challenge to the professionalized and institutionalized practices of the mainstream media. Alternative media privileges a journalism that is closely wedded to notions of social responsibility, replacing an ideology of “objectivity” with overt advocacy and oppositional practices. Its practices emphasize first person, eyewitness accounts by participants; a reworking of the populist approaches of tabloid newspapers to recover a “radical popular” style of reporting; collective and antihierarchical forms of organization which eschew demarcation and specialization–and which importantly suggest an inclusive, radical form of civic journalism. (267) Nick Couldry goes further to point out the utopian processes required to identify agencies of change, including alternative media, which he defines as “practices of symbolic production which contest (in some way) media power itself–that is, the concentration of symbolic power in media institutions” (25). Alternative media’s orientation towards oppositional and contestatory practices demonstrates clear parallels between its ambitions and those of counterculture in utopian contexts. From the 1960s onwards, the upsurge in alternative newspaper numbers is commensurate with the blossoming of the counterculture and increased utopian contexts; Susan Forde describes it thus: “a huge resurgence in the popularity of publications throughout the ‘counter-culture’ days of the 1960s and 1970s” (“Monitoring the Establishment”, 114). The nexus of counterculture and alternative media in such utopian contexts is documented in texts like Roger Streitmatter’s Voices of Revolution and Bob Osterlag’s People’s Movements, People’s Press. Like the utopian newspapers that came out of 18th and 19th century intentional communities, many of the new alternative press served to educate, socialise, promote and represent the special interests of the founders and followers of the countercultural movements, often focusing on the philosophy and ideals underpinning these communities rather than the everyday events (see also Frobert). The radical press in Australia was also gaining ground, with OZ in Australia from 1963-1969, and then from 1967-1973 in London. Magazines launched by Philip Frazer like The Digger, Go-Set, Revolution and High Times, and university student newspapers were the main avenues for youth and alternative expression on the Vietnam war and conscription, gay and lesbian rights, racism, feminism and ecological activism (Forde, Challenging the News; Cock & Perry). Nimbin 1973: Rusty Miller and The Byron Express The 1973 Aquarius Festival of counterculture in Nimbin (12-23 May) was a utopian context that had an alternative media life of its own before it arrived in the Rainbow Region–in student publications like Tharnuka and newsletters distributed via the Aquarius Foundation. There were other voices that announced the coming of the Aquarius Festival to Nimbin and reported on its impact, like The Digger from Melbourne and the local paper, The Northern Star. During the Festival, the Nimbin Good Times first appeared as the daily bulletin and continues today with the original masthead drawn by the Festival’s co-organiser, Graeme Dunstan. Some interesting work has been done on this area, ranging from general studies of the Rainbow Region (Wilson; Munro-Clark) to articles analysing its alternative press (Ward & van Vuuren; Martin & Ellis), but to date, there has been no focus on the Rainbow Region’s first alternative newspaper, The Byron Express. Co-edited by Rusty Miller and David Guthrie, this paper presented and mediated the aims and desires of the Aquarian movement. Though short-lived, as only 7 issues were published from 15 February 1973 to September 1973, The Byron Express left a permanent printed vestige of the Aquarian counterculture movement’s activism and ideals from an independent regional perspective. Miller’s credentials for starting up the newspaper are clear–he has always been a trailblazer, mixing “smarts” with surfing and environmental politics. After graduating from a Bachelor of Arts in history from San Diego State College, he first set foot in Byron Bay during his two semesters with the inaugural Chapman College affiliated University of the Seven Seas in 1965-6. Returning to his hometown of Encinitas, he co-founded the Surf Research accessory company with legendary Californian surfer Mike Doyle, and launched Waxmate, the first specially formulated surf wax in 1967 (Davis, Witzig & James; Warshaw 217), selling his interest in the business soon after to spend a couple of years “living the counterculture life on the Hawaiian Island of Kauai” (Davis, Witzig & James), before heading back to Byron Bay via Bells Beach in 1970 (Miller & Shantz) and Sydney, where he worked as an advertising salesman and writer with Tracks surfing magazine (Martin & Ellis). In 1971, he was one of the first to ride the now famous waves of Uluwatu in Bali, and is captured with Steven Cooney in the iconic publicity image for Albe Falzon’s 1971 film, Morning Of The Earth. The champion surfer from the US knew a thing or two about counterculture, alternative media, advertising and business when he found his new utopian context in Byron Bay. Miller and Guthrie’s front-page editorial of the inaugural issue of The Byron Express, published on 15 February 1973, with the byline “for a higher shire”, expressed the countercultural (cl)aims of the publication. Land use, property development and the lack of concern that some people in Byron had for their impact on the environment and people of the region were a prime target: With this first issue of the Byron Express, we hope to explain that the area is badly in need of a focal point. The transitions of present are vast and moving fast. The land is being sold and resold. Lots of money is coming into the area in the way of developments […] caravan parts, hotels, businesses and real estate. Many of the trips incoming are not exactly “concerned” as to what long term effect such developments might have on the environment and its people. We hope to serve as a focus of concern and service, a centre for expression and reflection. We would ask your contributions in vocal and written form. We are ready for some sock it to ya criticism… and hope you would grab us upon the street to tell us how you feel…The mission of this alternative newspaper is thereby defined by the need for a “focal point” that inscribes the voices of the community in a freely accessible narrative, recorded in print for posterity. Although this first issue contains no mention of the Aquarius Festival, there were already rumours circulating about it, as organisers Graeme Dunstan and Johnny Allen had been up to Main Arm, Mullumbimby and Nimbin on reconnaissance missions beginning in September 1972. Instead, there was an article on “Mullumbimby Man–Close to the Land” by Nicholas Shand, who would go on to found the community-based weekly newspaper The Echo in 1986, then called The Brunswick Valley Echo and still going strong. Another by Bob McTavish asked whether there could be a better form of government; there was a surf story, and a soul food section with a recipe for honey meade entitled “Do you want to get out of it on 10 cents a bottle?” The second issue continues in much the same vein. It is not until the third issue comes out on 17 March 1973 that the Aquarius Festival is mentioned in a skinny half column on page four. And it’s not particularly promising: Arrived at Nimbin, sleepy hamlet… Office in disused R.S.L. rooms, met a couple of guys recently arrived, said nothing was being done. “Only women here, you know–no drive”. Met Joanne and Vi, both unable to say anything to be reported… Graham Dunstan (codenamed Superfest) and John Allen nowhere in sight. Allen off on trip overseas. Dunstan due back in a couple of weeks. 10 weeks to go till “they” all come… and to what… nobody is quite sure. This progress report provides a fascinating contemporary insight into the tensions–between the local surfies and hippies on one hand, and the incoming students on the other–around the organisation of the Aquarius Festival. There is an unbridled barb at the sexist comments made by the guys, implicit criticism of the absent organisers, obvious skepticism about whether anyone will actually come to the festival, and wonderment at what it will be like. Reading between the lines, we might find a feeling of resentment about not being privy to new developments in their own backyard. The final lines of the article are non-committal “Anyway, let’s see what eventuates when the Chiefs return.” It seems that all has been resolved by the fifth issue of 11 May, which is almost entirely dedicated to the Aquarius Festival with the front page headline “Welcome to the New Age”. But there is still an undertone of slight suspicion at what the newcomers to the area might mean in terms of property development: The goal is improving your fellow man’s mind and nourishment in concert with your own; competition to improve your day and the quality of the day for society. Meanwhile, what is the first thing one thinks about when he enters Byron and the area? The physical environment is so magnificent and all encompassing that it can actually hold a man’s breath back a few seconds. Then a man says, “Wow, this land is so beautiful that one could make a quid here.” And from that moment the natural aura and spells are broken and the mind lapses into speculative equations, sales projections and future interest payments. There is plenty of “love” though, in this article: “The gathering at Nimbin is the most spectacular demonstration of the faith people have in a belief that is possible (and possible just because they want it to be) to live in love, through love together.” The following article signed by Rusty Miller “A Town Together” is equally focused on love: “See what you could offer the spirit at Nimbin. It might introduce you to a style that could lead to LOVE.” The centre spread features photos: the obligatory nudes, tents, and back to nature activities, like planting and woodworking. With a text box of “random comments” including one from a Lismore executive: ‘I took my wife and kids out there last weekend and we had such a good time. Seems pretty organized and the town was loaded with love. Heard there is some hepatitis about and rumours of VD. Everyone happy.” And another from a land speculator (surely the prime target of Miller’s wrath): “Saw guys kissing girls on the street, so sweet, bought 200 acres right outside of town, it’s going to be valuable out there some day.” The interview with Johnny Allen as the centrepiece includes some pertinent commentary on the media and reveals a well-founded suspicion of the mediatisation of the Aquarius Festival: We have tried to avoid the media actually. But we haven’t succeeded in doing so. Part of the basic idea is that we don’t need to be sold. All the down town press can do is try and interpret you. And by doing that it automatically places it in the wrong sort of context. So we’ve tried to keep it to people writing about the festival to people who will be involved in it. It’s an involvement festival. Coopting The Byron Express as an “involved” party effects a fundamental shift from an external reporting newspaper to a kind of proponent or even propaganda for the Aquarius festival and its ideas, like so many utopian newspapers had done before. It is therefore perhaps inevitable that The Byron Express should disappear very soon after the Aquarius festival. Fiona Martin and Rhonda Ellis explain that Rusty Miller stopped producing the paper because he “found the production schedule exhausting and his readership too small to attract consistent advertising” (5). At any rate, there were only two more issues, one in June–with some follow up reporting of the festival–and another in September 1973, which was almost entirely devoted to environmentally focused features, including an interview with Kath Walker (Oodgeroo Noonuccal). Byron Bay 2013: Thirty Years of Rusty’s Byron Guide What Rusty did next is fairly well known locally–surfing and teaching people how to surf and a bit of writing. When major local employer Walkers slaughterhouse closed in 1983, he and his wife, social geographer Tricia Shantz, were asked by the local council to help promote Byron Bay as a tourist destination, writing the first Byron guide in 1983-4. Incorporating essays by local personalities and dedicated visitors, the Byron guide perpetuates the ideal of environmental awareness, spiritual experimentation, and respect for the land and sea. Recent contributors have included philosopher Peter Singer, political journalist Kerry O’Brien, and writer John Ralston Saul, and Miller and Shantz always have an essay in there themselves. “People, Politics and Culture” is the new byline for the 2013 edition. And Miller’s opening essay mediates the same utopian desires and environmental community messages that he espoused from the beginning of The Byron Express: The name Byron Bay represents something that we constantly try to articulate. If one was to dream up a menu of situations and conditions to compose a utopia, Australia would be the model of the nation-state and Byron would have many elements of the actual place one might wish to live for the rest of their lives. But of course there is always the danger of excesses in tropical paradises especially when they become famous destinations. Australia is being held to ransom for the ideology that we should be slaves to money and growth at the cost of a degraded and polluted physical and social environment. Byron at least was/is a refuge against this profusion of the so-called real-world perception that holds profit over environment as the way we must choose for our future. Even when writing for a much more commercial medium, Miller retains the countercultural utopian spirit that was crystallised in the Aquarius festival of 1973, and which remains relevant to many of those living in and visiting the Rainbow Region. Miller’s ethos moves beyond the alternative movements and communities to infiltrate travel writing and tourism initiatives in the area today, as evidenced in the Rusty’s Byron Guide essays. By presenting more radical discourses for a mainstream public, Miller together with Shantz have built on the participatory role that he played in launching the region’s first alternative newspaper in 1973 that became albeit briefly the equivalent of a countercultural utopian gazette. Now, he and Shantz effectively play the same role, producing a kind of countercultural form of utopian media for Byron Bay that corresponds to exactly the same criteria mentioned above. Through their free publication, they aim to educate, socialise, promote and represent the special interests of the founders and followers of the Rainbow Region, focusing on the philosophy and ideals underpinning these communities rather than the everyday events. The Byron Bay that Miller and Shantz promote is resolutely utopian, and certainly countercultural if compared to other free publications like The Book, a new shopping guide, or mainstream media elsewhere. Despite this new competition, they are planning the next edition for 2015 with essays to make people think, talk, and understand the region’s issues, so perhaps the counterculture is still holding its own against the mainstream. References Atton, Chris. “What Is ‘Alternative’ Journalism?” Journalism: Theory, Practice, Criticism 4.3 (2003): 267-72. Berger, Bennett M. The Survival of a Counterculture: Ideological Work and Everyday Life among Rural Communards. New Brunswick: Transaction Publishers, 2004. Cock, Peter H., & Paul F. Perry. “Australia's Alternative Media.” Media Information Australia 6 (1977): 4-13. 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