Going Dutch.

https://www.australianageingagenda.com.au/2014/07/30/dutch-model-offers-alternative-approach-home-care/

 

 

“It is the fastest growing organisation in the Netherlands and for three years running has been named the country’s top employer. Not-for-profit organisation Buurtzorg Nederland, founded and developed by community nurses, is transforming home care in the Netherlands and is quickly garnering attention worldwide, including in Australia.

Since its development in 2006, the Buurtzorg or “neighbourhood care” model has attracted the interest of more than 25 countries including the National Health Service in England. Sweden, Japan and the US state of Minnesota have already begun introducing Buurtzorg nurse-led teams in their jurisdictions.

Speaking to Australian Ageing Agenda ahead of his keynote address to the Leading Age Services Australia (LASA) National Congress in October, founder and director Jos de Blok said his home care model has been shown to deliver higher quality care at a reduced cost. A 2010 Ernst and Young report said costs per patient were approximately 40 per cent less than comparable home care organisations and surveys have shown that patient satisfaction is the highest in the country.

At the heart of the nurse-led model is client empowerment by making the most of the clients’ existing capabilities, resources and environment and emphasising self management.

“The model is much more focused on self-support and working with high qualified nurses that have skills in coaching and supporting patients to do the things that they are able to do themselves,” Mr de Blok told AAA.

While the costs per hour are higher from employing registered nurses, savings are made through lower overhead costs and a reduction in the overall number of care hours required per client.

Notably, the Dutch approach represents a challenge to the wisdom of low-skill, low cost staffing models which have tended to dominate health and aged care systems in Australia and overseas by demonstrating how a high-skill professional model can deliver greater efficiency.

The model also demonstrates the benefits of handing control over to the nurses that run the service.

Under the model, Buurtzorg nurses form self-organising or autonomous teams that provide a complete range of home care services supported by technology and with minimal administrative oversight. “The nurses organise all the work themselves, so there is no management structure and no hierarchy,” said Mr de Blok. The small teams of up to 12 nurses work in close collaboration with patients, doctors, allied health professionals and informal community networks to support the patient.

The emphasis on continuity of care and patient-centred care strengthens the quality of client-staff relationships and has been shown to improve both patient satisfaction and nursing staff morale.

“We have received a lot of attention from all sides – from politicians, from insurance companies but mostly from nurses themselves. In every region in the country groups of nurses came to ask us if they could start a team themselves in the neighbourhood they worked in, so they resigned at the other organisation and they have come to work for Buurtzorg,” he said.

Since its development Buurtzorg has experienced rapid growth and currently employs more than 8,000 nurses in the Netherlands, working in 700 neighbourhoods caring for palliative care clients, people with dementia and older people with chronic disease.

Mr de Blok said the model is based on World Health Organisation principles on integrated community-based care and is universal in its application. “In the last three to four years we have had interest from people in 25 countries. We have already started an organisation in Asia for Japan, China and Korea and in the US we have a team in Minnesota and a few years ago we started in Sweden.”

Mr de Blok will deliver a keynote address on the Buurtzorg model at the LASA National Congress, which runs 20-22 October at Adelaide Convention Cen”

Only the lonely

 

But where are the people? This was very often a question asked during the time we had foreign students living with us. We lived in Balmain. It is a suburb which many Australians would classify as having medium to high density living. We always look back with fondness of the twenty years we lived there. It is the place where our children grew up. So, how come this question; but where are the people?

The foreign students came from Taiwan, Japan, Korea, Germany with a couple from Holland. The question has to be looked at from the perspective of living in cities. Australia right from the start understood it had space.  Space was lacking in England, especially in the big smoked filled cities. Thus the suburban block here was soon to be seen as desirable for people to be housed on. At the beginning, people lived in terrace houses joined together forming complete streets. Balmain was one of those earlier suburbs of Sydney with streets of terrace houses. Parks were everywhere and it still felt very spacious.

However, the foreign students came from cities that were teeming with people. They would form throngs on the streets. I am sure that those that have been to Asia understand there is a huge difference between density of people there in cities compared to here in Australia. It were those people on the streets that the students were sorely missing, even in inner city Balmain.

My parents soon after arrival in 1956 went to live in western Sydney. Real Estate agents and blocks of land were the main topics of conversation amongst the migrants.  We too were swept up into saving a deposit for our ‘own’ block of land.  There was no real understanding of the social consequences in making a choice of where to live.  To be near a rail-station was desirable but as for other desirable needs, it just wasn’t about or questioned. Migrants had a need to have a roof and security of an income, all else was secondary. It was like a fever. One got caught up in the frenzy of making a new life. It was all a bit puzzling for my dad. He was different.

The street that my parents ended up living in was like millions of suburban streets anywhere in Australia. There were people living in houses but you would rarely see them. It felt achingly lonely. Sometimes a curtain would stir or a car would drive by. For me it was deadly, spiritual dehydration. Sure, the petunias and rockeries were plenty. Rosellas would be screeching and flying about and then there was cracker night. This was a yearly event with bon-fire on the street, somehow mysteriously related to Guy Fawkes or something. It was an occasion for neighbours to meet up. https://en.wikipedia.org/wiki/Guy_Fawkes

All this in response to having read a lecture by Hugh MacKay. He is a well know social commentator. “The State of the Nation starts in your Street.”

http://theconversation.com/hugh-mackay-the-state-of-the-nation-starts-in-your-street-72264

It seems to fit in what is happening with all that card swiping and waving at poles. We are forced to dealing with less and less people. Banking is done silently in front of an ATM. People buy food on-line and sit at home all sated and possibly overweight. The steel posts at rail stations. Most work will finally be done by  steel posts and robots. Soon we might go to bed enjoying the icy embrace of a steel post or with a rotating robot with a waving of cards giving consent to heaven knows what sexual delights

.

I don’t know what can be done to liven up lonely suburban streets. My mum did her best and was fearless in her search for social contact. It was difficult. All those Venetian blinds and that obsession with privacy. A sign of change is that most people now prefer an apartment close to the city. People do seem to want to live close to each other, able to walk to shops and work. People need people.

We shall see!

The artist as teacher. (Auto- biography)

After the adieu to the imitation Dutch Grandfather Clock period with the last box of painted clock dials being dropped off at the imitation clock factory,  I did finally apply for the ‘Dutch Artist’ salary.  I filled in  forms with proof of my birth and educational levels. My quantity surveying qualification could easily throw this whole undertaking askew. I had to tread carefully! It was something to ponder about .

What about if the recommendation came back suggesting I should work in an office working out bills of quantities instead of doing art? I knew the Dutch bureaucracy might like art but they also had a very practical side to their culture. They could easily tell me to get a real job. I had nightmares of having gone and left Gertrude Cottage in Australia, travel to Holland itching to paint full time AND finally have an income, only to end up wearing a suit to an office and sadly having to pore over bills of quantities, working out quantities for cement or sewer pipes for the latest and world’s best re-cycling plant.

On the other hand I did have proof with the success of being ‘hung’ at the NSW State Gallery and a couple of prizes at Australian Municipal competitions. Through a friend I had also managed to show some of my work at a gallery in Japan’s Kyoto. I wasn’t totally unprepared. Even so, I decided sagely to remain mum about my Quantity surveying qualification, my previous bank experiences or my prowess in the decorating business with the buff coloured letterheads and matching envelopes.

Was I dishonest or not somewhat duplicitous? Many artists do other jobs, provide for a family and do their art? Why even worry about that? Wasn’t it always a kind of wild-haired bohemian wearing a beret at a rakish angle that created? If it became too hard he would simply disregard spouses and crying babies. He, and sometime a she, would walk out, satchel, easel and pallet on shoulder, whistling in the wind, going up and beyond hill and gone forever.  New daisies and  fragrant meadows were beckoning and to be explored!  Many ‘real artists’ would leave a trail of relationship disasters with endlessly  and chaotically fathering children of many sexes. Desperate love affairs were obligatory in most that claim to possess creative powers. Leaving spouses was the very essence and proof  of creative forces at work.  History is full of the wrath of partners betrayed.  Daggers were raised and many artists lives ended painfully, their canvasses slashed. Today, the Family Court sorts it all out but it  costs an arm and a leg just the same as before  with the knife. Of course, the ‘real artist’ does not care. He continues on creating,. whistling.

Alas, I loved H and

On the farm in Holland

my family dearly and applied for this salary that would give me freedom to paint my pictures. I filled in the forms, submitted some of my work. I was asked to wait in a hallway with other applicants. Some were a bit nervous. You wondered what discussions were taking place. I just hoped they would not get the paintings mixed up. The man who accepted my paintings did look askance and somewhat bored. I suppose if one did that for a job, it might not be all that different from painting seagulls. Would he go home to his partner and regale about the paintings or sculptures and ceramics he had seen that day. I mean, day in day out?  I did hear some laughter coming out of the room. Were they ridiculing some of the work. I had a peek at one painters paintings and they were all of large oysters. He was obviously taken by the sea and its creative forces. Why not? An oyster is such a magnificent work on its own.

At the end of it all, we were asked to take our work back and we would be told by letter. It would be a nervous few weeks.

The years of ‘Gertrude’s Cottage.’ (Auto-biography)

‘Gertrude Cottage.’ Balmain

 

The meandering through life’s travels and travails will continue for as long the memory will keep on serving the details or at least the general gist of them. After a while dates become irrelevant. It is the memory of events that count. This writer is not going for a PhD nor fame. A couple of ‘likes’ will suffice and makes him smile. I just read that cooking chefs are now more esteemed and held in a higher limelight than writers. And yet, most chefs on TV shows don’t really say much more than ‘mm’ or  ‘nice, really nice’  at the most. Of course they fill the program with beautiful scenery. Why cooking has to be done with the Austrian Dolomites in the background or in the middle of the Mekong river is baffling and seems to make us want to travel rather than grab the mortar and pestle. It is perplexing though  how cooking and watching cooking has now overtaken reading Vladimir Nabokov or Chekov. Perhaps all this is due to an ageing population wearing multifocal glasses! Many people also go to bed with food platters, (including smoked eels) instead of a book.

After our second daughter was born, the apartment became too small.  We happened to look at The Sydney Morning Herald with an advertisement for a cottage for sale, which was called ‘Gertrude’s Cottage. It faced the harbour and had a goat. The advertised price was $12.500.-. We knew this was ours right from the start. I don’t believe in premonition or future or fortune telling devises. I took a drive to the address which was right near the harbour of Sydney in Balmain which was an area that used to be ‘working class and ‘cut-throat’ territory, belonging to thieves, drunkards and Irish Catholics. I say, that ‘used’ to be, because it had become a bit of a low cost housing area for students and artists. It was changing and in an upward transit.

Even so, the rabbito men were still doing the rounds, albeit in its final years and the milkmen and bread delivery were still a daily event.  I am running ahead somewhat now. The Gertrude Cottage was as charming as I had imagined it to be with a large living-dining-kitchen area and with the bath all out in the lounge area. I knew Helvi would love it and she did. Upstairs were 2 small bedrooms. The whole cottage was weatherboard, very old and one corner had sunk on its foundations which made the floor canter to the lower side. It was a private sale and the owner a well known architect with 2 blond little daughters and a vivacious wife. The goat was tethered to a stake and eating the vegetation of derelict land between the house and the harbour. In the middle of the ground floor it had a slow combustion cast iron wood heater with a galvanised chimney going up through the roof. As an extra bonus it could also include a huge boulder that was about ten metres by thirty metres long and could be leased from the local Council. This boulder would extend our property to the next street corner giving us the right for intruders to be excluded.

We immediately went to the bank to try and get a mortgage. The manager promised an inspection and after a week he got back to us. Look, Gerard mate, he said, you are buying a glorified shed. Are you sure you want to go through with it?  Our deposit was sixty percent, so the bank had little option but to approve of the loan. The ‘shed,’ after six weeks or so became ours. It was heaven. The morning sun would come up over the harbour bridge and then reflect on the hardwood timber flooring. Looking against the light, the water was sparkling and shimmering, boats and ferries busying themselves with large merchant ships reversing engines before berthing making the landmass our house shake. Sydney still was an industrial harbour and full of life. The derelict land  adjacent and in front of the cottage facing the harbour was ideal for throwing in a fishing line and many did so, especially during week-ends. Our little family thrived and business thrived as well. In the meantime I kept on with my art and painted many pictures. At one stage we had nude life drawing classes and our friends would sometimes strip off and allow themselves to be charcoal drawn. Many early and adventurous couples decided to also buy those cheap places in Balmain, do them up and restore them to former glory.  Of course, working class cottages that were small and modest could hardly become ‘former glory mansions’ and some of the results were far from modest and ruined many of them. Extensions and extra storeys on top of former two bedroom cottage on small parcels of land ended up ugly and bloated. The flexing of moneyed people did not enhance the area in later years either.

Gertrude Cottage with our first daughter.

The bath in the middle of living area was eventually screened off. Adjacent to the bath we had a second hand washing machine with draining of rinsing water done by lowering the hose to the outside and then sucking on it to encourage the flow. Nowadays it could be seen as a bit primitive, but to have a washing machine that did everything except pumping out the water, was seen as a minor dysfunction. The cottage itself with its open sunny feeling could only be improved upon by bits of furniture that we mainly scrounged around for in second hand shops, St Vinnie’s etc. It was shielded from the street by a very high timber fence that the previous architect owner had put up. It was so high that you could not even jump up to get a hold and climb over it. Some friends that had lived in Indonesia remarked it reminded them of a brothel that the Japanese were running then during the occupation.  No doubt, if it would have been possible to have had a look inside during the nude drawing lessons that the brothel conclusion could have been drawn as well.” (from Frank’s story)

 

The magnificent Raan Curry for Christmas beckons

If the Turkey for Christmas is getting a bit hackneyed and the ham has soured, consider the Raan dish. I won’t bother with giving you the exact details in grams ounces or kilos. Try and create your own Raan by just imagining tasting the combination of the different herbs, spices and ingredients.

You know that if you put in a kilo of salt the dish is likely to be very salty. Cooking is very much anticipating how things will taste by mixing and imagining the taste of the mixed ingredients before cooking. The religious following of recipes with the book propped up against the kitchen whisk is never going to be a surprise. Not as a failed dish nor of a basking in the glory of an unimaginable masterpiece, hailed by Rick Stein, Nigella Lawson, Jamie Oliver and all your guests for years to come. Take the risk!

So, here we go. The bulk of this dish is mutton or at least a large leg of sheep. You need a well aged leg not a lamb leg although that is permissible as well. This dish is Northern India and as you travel up further north, the Indian cuisine starts to be less chilli hot and becomes more infused with the sweetness of yoghurt and dried fruit, raisins, currants etc. of the Northern regions.

The secret of this dish is that the leg of mutton is allowed to cure or ‘cook’ for about three days in the fridge by the acidity of the marinade. The marinade has to be enough to cover the meat. Voila, you need plenty of good quality yoghurt, the juice of about 4 lemons about 200 grams of raisons and currants, a tablespoon of turmeric, a couple of teaspoons of cinnamon, about 4 red-hot chillies, some cloves and about two teaspoons of cardamom, salt and sugar.

Mix the marinade in a mixer and let stand for about one hour, mix again. In the meantime pierce the leg and insert cloves of garlic. Good juicy garlic and not the cheap Chinese tasteless carton stuff. Poor the marinade over the lamb in a dish large enough to hold the leg.

Put in the fridge and leave for about two to three days occasionally turning the meat.
Then… as the excitement mounts…pre-heat oven to 200c and cook the lamb for about 30 minutes. Turn heat to 160c and cook 45 minutes for every kilo of the meat. It is cooked when the meat falls off the bone. When it does. Turn off the oven. Boil basmati rice.

I was amazed some years ago when we had Japanese students living in our house they were using an electric rice cooker. When I told them I thought the Japanese had invented boiling rice, they smiled politely but they never tried my system. She said, oh no… too risky! Can you believe it?
Here is how to boil rice; Just cover the rice with one finger digit of water on top of the rice and bring quickly to boil without the lid on. When water is disappearing and holes appear in the rice, put on the lid and turn the gas off. Wait for about twenty minutes and the rice should be dry crumbly and cooked. Perfect

Now, this is the important bit… Break the lamb into bite size chunks, put on the plate with the rice and pour some of the marinade over the lot. Some chutney or cucumber with yoghurt as a side dish compliments the dinner. Have it with chilled water with lime slices floating on top. Don’t muck around with wine. It spoils it. Have it afterwards.
Enjoy and let me know the results.

Possibilties of Life in a Brothel. (it never stops)

The bath in the middle of living area was eventually screened off. Adjacent to the bath we had a second hand washing machine with draining of rinsing water done by lowering the hose to the outside and then sucking on it to encourage the flow. Nowadays it could be seen as a bit primitive, but to have a washing machine that did everything except pumping out the water, was seen as a minor dysfunction. The cottage itself with its open sunny feeling could only be improved upon by bits of furniture that we mainly scrounged around for in second hand shops, St Vinnie’s etc. It was shielded from the street by a very high timber fence that the previous architect owner had put up. It was so high that you could not even jump up to get a hold and climb over it. Some friends that had lived in Indonesia remarked it reminded them of a brothel that the Japanese were running then during the occupation.  No doubt, if it would have been possible to have had a look inside during the nude drawing lessons that the brothel conclusion could have been drawn as well.

We lived in a very narrow street with the before mentioned leased boulder from Leichhardt Council on one side and a cliff face on the other side, giving the impression that the tail end of the street had been cut through solid rock. During the period when we were still living in Pott’s Point and my brother Frank was working for me, we worked on a block of three story home-units that was on the opposite side of Gertrude’s cottage. When sitting on the very ledge where Frank took a swing at me, I used to admire the cottage. It had three goats then and the two blond girls used to play outside. The admiration for that cosy cottage came to owning that very same place some two years or so later. What a coincidence. When I read the advertisement for ‘Gertrude Cottage’, with a goat, I was fervently hoping it would be the one with the goats that I had seen before.

It was.