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STATE LIBRARY OF SOUTH AUSTRALIA
J. D. SOMERVILLE ORAL HISTORY COLLECTION
OH 755/14
Full transcript of an interview with
ANTHONY RADFORD
on 6 May 2005
By Karen George
Recording available on CD
Access for research: Unrestricted
Right to photocopy: Copies may be made for research and study
Right to quote or publish: Publication only with written permission from the State Library
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OH 755/14 ANTHONY RADFORD
NOTES TO THE TRANSCRIPT
This transcript was created by the J. D. Somerville Oral History Collection of the State Library. It conforms to the Somerville Collection's policies for transcription which are explained below.
Readers of this oral history transcript should bear in mind that it is a record of the spoken word and reflects the informal, conversational style that is inherent in such historical sources. The State Library is not responsible for the factual accuracy of the interview, nor for the views expressed therein. As with any historical source, these are for the reader to judge.
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Discrepancies between transcript and tape: This proofread transcript represents the authoritative version of this oral history interview. Researchers using the original tape recording of this interview are cautioned to check this transcript for corrections, additions or deletions which have been made by the interviewer or the interviewee but which will not occur on the tape. See the Punctuation section above.) Minor discrepancies of grammar and sentence structure made in the interest of readability can be ignored but significant changes such as deletion of information or correction of fact should be, respectively, duplicated or acknowledged when the tape recorded version of this interview is used for broadcast or any other form of audio publication.
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OH 755/14 TAPE 1 SIDE A
This is an interview with Anthony Radford being recorded by Karen George for
the 30th
anniversary of the Inner Southern Community Health Service. The
interview is taking place on the 6th
May 2005 at Kingswood in South Australia.
First of all I’d like to thank you very much for agreeing to be interviewed for the
project.
Can we start by you just giving me your full name and date of birth?
Anthony James Radford, born sixty-eight years ago tomorrow.
Oh, congratulations! Which is 7th
May.
Seventh of May, 1937.
Okay. Whereabouts were you born?
I was born in Kew in Melbourne, Victoria.
Can you perhaps give me a little bit of background about your training and your
movement into Medicine, so that we can see where you’re coming from when
we’re talking about – – –?
Well, I guess I wanted to be a doctor from about the age of fifteen, and I was going
to do Medicine in Melbourne but my parents – where I was boarding; my parents
were in Hobart, and my last year of school they moved to Adelaide and so I went
into the Medical School here in Adelaide at The University of Adelaide, and
finished my course there in 1960. I then did a year’s internship, as they now call it,
at the Queen Elizabeth Hospital at Woodville, and then I did six months at the
Queen Victoria Maternity Hospital, as it then was, opposite the Victoria Park
Racecourse, and then six months at the Children’s Hospital in North Adelaide. And
I choose those two areas of training because I had a cadetship to go out to Papua
New Guinea, where I worked for most of the next ten years. And in those ten years
I had one year’s training in Public Health in America, and six months’ training in
England in the areas of Tropical Medicine and Public Health.
Where did your interest in public health and primary health care come from?
Well, I guess that I always wanted to practise where there was a greater need than
there was in Adelaide, and in Papua New Guinea you were everything: you were
the doctor, paediatrician, general practitioner, administrator, public health officer.
In one area I was the only doctor for fifty thousand people, so there are two things
4
there: anything you can get anybody else to do competently meant that you didn’t
have to do it; and one also realised that a large amount of the burden of illness and
premature death was from conditions that could be prevented, like immunisation
preventing whooping cough and reducing TB1, and simple nutritional values and
diets would stop the large amount of malnutrition, I was saying, which interacts with
infection – if you’re malnourished you’re more likely to get infected and more likely
to die. And so they were sort of principles that I transferred into the medical course
at Flinders when I came there.
I left New Guinea and went to – actually, for two and half or three years – to the
Liverpool School of Tropical Medicine, where I set up a master’s degree, I think the
first multidisciplinary master’s degree, in Public Health in Britain, if not in Europe,
in 1972, and then came back to accept the Foundation Chair in what was then called
Primary Care and Community Medicine. And I think Deane Southgate had a real
role in choosing that name. He was on the planning team for the new medical
school at Flinders, and also he was involved in establishing, as you know, probably
the first – if not the first, second – community health centre. And this was right
along the lines of my own thinking, that a medical school department should involve
not only the primary care of general practice situations but the primary care of
places of first contact: occupational health nurse, school health nurse, women and
children’s work.
And one of the problems, of course, was that medical students got very little
training in that area. The community medicine in those days, public health, was sort
of a verba non gratia, and so –
Why was that?
– people didn’t talk about public health very much. Community medicine became
the thing. I think one of the real problems – and this was about the time of the
change – is that the only doctors who went into public health were in fact ones who
found it difficult getting a job in other areas in medicine. It was looked down and
degraded – in fact, general practice was degraded by much of the hospital-based
medicine, and yet of course that’s where nine out of ten medical encounters took
1 TB – tuberculosis.
5
place – and so I was determined to establish an undergraduate medical course
stream which raised the status of general practice and students’ exposure to it, and
also of public health. When Whitlam came to power, his government was very keen
on this concept of community health and community medicine, and he in fact did
what I think only two other medical schools in Australia at that time had done: he
actually gave money to every medical school to establish a unit of Community
Medicine and General Practice. In fact, Flinders, in its dream, in its planning, had in
fact already set aside that there would be a department in Primary Care and
Community Medicine, and that was the reason even before I went to Britain that I
was interested in Flinders, in a new medical school –
Where did that idea come from at Flinders?
– with a new ethos.
Do you know?
I don’t know where it came from. I know that the dean of the medical school there,
Frankel, was particularly keen that students should have early contact outside of the
medical school, and (sound of mobile telephone interference) Deane I think
influenced them, because he had an interest which was really far wider than the
average general practitioner.
Tell me a little bit about him, I guess, and his interests.
Okay. Well, he was a graduate of also The University of Adelaide a few years
ahead of me – he was a senior medical student, I think, when I was a junior one –
and he realised that there were many aspects of general practice-type medicine that
in fact other health care professionals could do equally well or better than general
practitioners. And a lot of those aspects in fact some doctors were really not
particularly interested, and they certainly were not trained. A classical one would be
counselling, the use of community health nurses and clinical psychologists.
One of the real problems with medical education at that time was that students
didn’t know what a physiotherapist did, or an occupational health nurse, or even
what a psychologist did except talk to people. And Deane Southgate in Southern
Adelaide, what’s his name, Bonnin – no, who was it? – Richard Laycock down at
Christies Beach, Michael Bonnin out at St Agnes and Tim Murrell, who was the
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counterpart of my department at The University of Adelaide, together with a chap
who was with Tim Murrell – might come to me in a moment: they were all leaders
in establishing the first five community health centres in South Australia. Part of
the Whitlam bag of money for community health was to get community-based
health services available. And I still believe that they’re best attached to a general
practice – whether it’s intimately attached, as they all were to start with, or
adjacently attached, for example as the Clovelly one is, where it’s in the same
building complex at Christies Beach. It was intimately attached, even more so in the
complex, and the general practice moved away from the community health services
and now two kilometres separate, away from them.
There was quite a lot of, even at Clovelly Park, an antagonism from other general
practitioners when the community health centres were set up.
Tell me about that.
Well, they were concerned that they would bleed their patients from their practice to
the adjacent practices. Absolutely no justification for this, but that was their feeling
and we had to go along with it and wear it, and wear it down and out.
How did you go about that, do you recollect?
Well, the thing is that first of all no patients that I know of – and there may have
been one or two – were ever, you know, what the pastoralists call it: ‘sheep
stealing’. They felt that if they sent their patient down to see the community health
nurse at Clovelly Park, for example, that would be the last they saw of them, they
would lose them as a patient. They didn’t appreciate either the value or roles and
responsibilities of the various components of a community health centre, and that
was one of the community health centres’ first tasks. And in this sense Deane was
an excellent person to establish this.
He had a marvellous relationship with the College of General Practitioners, he
was such an outgoing sort of guy that people related very well to him, and of course
he had this particular interest in occupational health because, being in the ribbon
development area of South Road, his practice – and I think there were about five,
from memory, in the practice at the time, and I used to do part-time work there
because Deane had a half-time appointment at Clovelly Park – it was full-time, but
he became half-time at Flinders in the School of Medicine in the Department of
7
Primary Care and Community Medicine – and so one of the areas that he
established, and this is true of most of the community health centres, they
established units in relation to the need. So in this particular area Elva Abrahams, I
think, was the first sister appointed as an occupational health nurse. And
particularly as a resource for the smaller businesses, because there are so many little
businesses along there, people who were electro-platers or something of that nature,
maybe employing two, five, ten people, that certainly couldn’t afford an
occupational health nurse. So there was this resource was available for them.
The other things, for example, in this particular area, evolved quite a concern
over the domestic violence. And I think it was one of the first, if not the first, to set
up – this was some years after they actually got under way – a program for
counselling men in group therapy who were violent towards their wives. There
were psychological services, there were school health services, there were broadly-
based community health nursing activities which were part counselling, part
parenting and so on.
Taking you back just a little bit to the beginning of the Centre, I just want to
establish the date that it’s occurring, so it’s about – you came back to Australia in
19 – – –?
July 1975, and I think the Health Centre really only got going a few months before
that, in early ’75.
And you were invited to come onto that committee.
Yes. Originally Gus Frankel, the Dean of Medicine, I think was the representative.
I don’t know whether he ever attended or very often, because he was so busy. But
right from the very beginning, Flinders had a very, very close relationship with the
Clovelly Park Community Health Centre, and Deane of course had an appointment
– well, he was of course the first director of Clovelly Park, he was one of the senior
general practitioner partners, and he was a senior lecturer and later associate
professor at the School of Medicine at Flinders. And so I took over from Gus
Frankel as the Faculty of Medicine representative on that Community Health Centre
board, as I did with the other one in our then area, the Christies Beach Community
Health Centre.
What sort of role were you to play, being brought onto that committee?
8
Well, I guess one of the briefs of the Health Centre was that they would take
students of varying professions to have attachments to the Community Health
Centre, and of course this was a particular interest, from what I’ve said, of mine:
that students were significantly involved in understanding the roles and
responsibilities of community-based health workers, other than general practitioners
– as well as. And at that particular practice where they got attachments, of course,
they often saw the interaction, because I can remember you’d take down a girl in
tears who’d come in perhaps who was pregnant and you could introduce her straight
away to the Community Health Nurse. Because many of these kinds of things, if
you say, ‘Well, ring up and make an appointment,’ of course a number of them
don’t ever catch up and you don’t know whether they’ve survived or sunk. So I was
particularly interested – I was particularly interested in the development of
community health care anyway, and so this was an opportunity to look at it.
One of my dreams was, in fact, to establish a community health nurse training
program and to try and combine the school health nurses, the community health
nurses, the mothers’ and babies’ health nurses, all in a generic training; and in fact
that they worked from community health centres all over Adelaide in those specific
roles. But of course the ‘territorial imperative’ of Robert Ardrey – I don’t know if
you’ve read any of his books – is that everybody wants their own kingdom,
irrespective of whether it’s better management or better care; it didn’t ever eventuate
as such, although some of them did combine. We had community health mental
nurse from the psychiatric services was also there – ‘mental health nurse’, I suppose
we ought to say, rather than a ‘mental nurse’.
So coming into that –
And then – sorry –
– I’m sorry; you continue, please.
– these groups, they had community groups for children, for women, as I mentioned
also for the violent men, and the psychologist, for example, had a particular role. In
fact, there was a – I think there were two counsellors there: Reg Brand, who had a
very long and extensive experience; Ross Harris was a psychologist there for a
[while] and he also was part-time on the staff at Flinders.
9
Okay. I wanted to talk a little bit about how you set up what the Centre was going
to have, because when you started there really you had the one community health
nurse, I think.
That’s right.
Kate Brown, do you recollect her?
I can remember Kate. She was an excellent nurse, I mean she was just perfect for
that kind of job. She had the right disposition.
What kind of disposition do you think someone needed to have in that role?
Well, I think (a) above all, you’ve got to be able to communicate with people; and
secondly – I think there’s a difference – you’ve got to be able to get alongside them;
thirdly, you’ve got to be able to identify needs; fourthly, you’ve got to know what
the resources are, you’ve got to be able to know what the community resources are;
then you’ve got to be able to connect those people, network those people, with those
people, into the resources they need; and then provide a follow-up that in fact their
needs are being met. And I think – I’m a great believer in middle-aged women in
these roles, particularly if they’re mothers and have successfully brought up a
family. I’m a great believer in experience in the real world in these kinds of places.
Whether they’re social workers or nurses.
So let’s talk about some of the people that were – I can just throw out some names
that were on that committee with you, and whether you can I guess give me an
insight into who they were and what they may have contributed. There was Dr
Denton, who was also at the Southern Clinic with Dr Southgate.
That’s right, Noel Denton. He was a tall, really a fairly quiet, solid individual, I
guess, is the way – – –. I don’t remember him coming forward with a whole lot of
ideas, but he was a solid person who backed the system and was able to put a sort of
mature perspective into the system.
And there was a Mr Payne from the Hospitals Department.
Oh, yes. What was his Christian name?
‘L’ – I don’t have a name.
Len, Len Payne. Len Payne was a much younger man and he was in the
bureaucratic health service mould, but he really had a very strong empathy for what
10
we were doing, as did Peter Pickering I think, who might have been before Len –
even more so, if anything. So in that sense we got great support from these people,
who also helped us tread our way through the health bureaucracy when it was
needed.
So that would have been the reason that they were part of the committee, in a
way?
Well, no; the reason of course is that they – from memory we had both
Commonwealth Health and State Health representatives, because the
Commonwealth, through the Whitlam bag, were providing the cash, but a lot of the
staff – almost all the staff – were employed by the state health system. So as I
remember it – and, gosh, it’s going back (laughs) thirty years – – –.
Well, I have a Mr Dubelly, C Dubelly, who was [from] the Australian Department
of Health, so he perhaps – – –?
Cliff Dubelly, he was a doctor and he was the husband of Marjorie Dubelly, who
was a general practitioner also working in the area and also a member of my staff at
the Department of Primary Care and Community Medicine. Cliff was, in fact, the
Commonwealth representative on that. He was a medical officer in the
Commonwealth Department of Health in Currie Street.
Dr Wadsworth, Dr R Wadsworth, from the Southern Clinic.
Bob Wadsworth. I think that – I don’t know whether Noel Denton and Bob were
there. Bob had a particular interest in hypnotherapy: in fact, he’s now exclusively a
hypnotherapist doctor. I think that the doctors who were on those committees, I
think probably it was a mistake that they were all from the same clinic.
Why is that?
I don’t know – convenience, you know. If you’re going to have a meeting – – –.
Why do you think it was a mistake?
Well, I remember saying before that to start with many of the people of the area,
many of the doctors in the area, were very suspicious of community health centres.
And we didn’t have the divisions of general practice, for example, that we now
have; and if we had had I’m sure there would have been a member of the division
would have been on the committee. And I can’t really understand why we didn’t
11
have any representative from other – it’s even possible they refused to serve
(laughs) on it, but – – –!
Well, I’ll raise one thing I found from minute books – I don’t know whether you
remember anything about it – apparently there was an evening called, inviting
something like eighty GPs2 from the general area to come and nobody came!
Well, this gives you an indication. And, you know, if Deane couldn’t do it – – –.
Deane, as I said, had this very, I think, an excellent gift of communicating with
people. He had an extraordinary sense of humour, he was always cracking jokes
and every time you met him, like three times a week, he’d tell you a new joke! And
his pipe was also a feature. But I think it just indicated the depth of suspicion, and it
seemed to us it didn’t matter what we did we had difficulty in overcoming this fear
that the general practitioners had. We had the same thing twenty years – oh, maybe
not twenty years later; fifteen years – later, when we really felt that we should try
and establish a general practice for the university. To start with, we just had Deane
and I and some of the others, and each worked in their own practices. We had six
part-time general practitioners. But we didn’t have control of the way records were
kept or the research that was done and so on that you want to do from the sort of
academic point of view, and we always had trouble getting the right number of
practices to place the students, particularly at short term if someone had to fall out.
So when we tried to establish a general practice where there wasn’t any general
practice – it was down in the Woodcroft area, and it was all fields before they – it
was just on the planning stage; and we said, ‘Okay, we’d like to establish a general
practice there,’ and spoke to – there was then a general practitioners’ group for each
area; and they were furious and adamant. One, an old classmate of mine I
remember, refused to take any more students, just because we’d set up ..... ..... We
weren’t taking away anyone’s patients, we were trying to set up in an area where
there was not yet a practice. In other words, we weren’t competing with anybody.
And it was a great pity, I think.
What about on the other side, the community around that health centre? What
sort of reaction did you have from the community?
2 GP – general practitioner, doctor.
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Well, the Community Health Centre became very popular. In fact, its staff
increased quite markedly. Right from the beginning we had two, I think,
community representatives.
I’ll give you one name: Mr Williams, Mr D Williams.
Yes, Don Williamson, he was a businessman. Very efficient, in-out, good use of
time, all that kind of thing. And another one was Mrs Parker – what was her
Christian name?
Joy.
Joy. And they represented two quite different people. I think they were both friends
of Deane, we found it (laughs) very difficult to work out how – and I’ve been in this
situation in many places – how do you get someone who is representative of the
community? And of course my attitude is you can’t. But you can find people who
are good, solid citizens who have particular interests within the community and are
good spokespeople for community thought. So here was one businessman,
representing that side, and one person who didn’t have any particular angle to take.
Joy particularly I remember her contributions repeatedly as being sane and sensible
and relevant to people’s needs. And Don also was very good, but Joy I thought was
outstanding in that kind of representative role.
Let’s talk a little bit about that staffing, you said the staff rose from when you
started quite rapidly: how did you – I mean, that seemed to be, from the minutes,
one of the roles of the committee to talk about what kind of staff and who we
should have.
Well, first of all it was what did we see was important? And there were women –
there was a nutrition – I don’t think I mentioned the nutritionist: they had a kind of
weight-watchers’ group, as I recall – it wasn’t Weight Watchers, but it was
equivalent. One of the things – and it’s a bit hazy now – was really, I think Kate
Brown started it, it was a group for women, particularly single mothers, who were
having difficulty coping, and trying to get a life structure for them. So these were –
the kind of groups that were established and the staff were virtually absolutely
respondent to felt needs or demonstrable needs. We didn’t always have the hard
data, but it wasn’t hard to decide that an occupational health nurse should be early
on the thing, because lots of the patients in the practice were from occupational
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health problems, and most – many, many of those problems were easily preventable.
So there was clearly a need for that kind of thing.
We mentioned the domestic violence which, in the late ’70s and early ’80s was
becoming more and more prominent, but I think it was into the late ’80s, I think, or
mid-’80s before we actually established that program.
What about the school health nurses? Tell me a little bit about that.
Well, the school health nurse – and that’s where I think Chris Birkin was involved –
I didn’t actually have a great deal to do with them, because there was, I think that
she was originally with the School Health Program, based outside within the
community exclusively, but now she was doing the same – she still belonged to the
School Health group, as I recall, but she was based in the Community Health
Centre, which meant of course that she had immediate access to other forms of
community-based health care that were thought to be required.
I’ll just stop you there, we’re going to run out of tape.
END OF TAPE 1 SIDE A: TAPE 1 SIDE B
Okay.
Yes, we were talking about school health nursing and Chris Birkin. Yes, her
husband worked at the Medical Centre, I remember, as an orderly in the hospital
there. And so she had these contacts that (a) were not there before, and (b) she was
part of, and could use them much more quickly. But I don’t remember a great deal
about her particular – – –.
One of the things – I don’t know whether it rings any bells – but talking to her,
one of the things she set up initially was a bed-wetting, or anuresis, program. Do
you recollect anything about that?
Yes, I think it might have been Ross ....., one of the psychologists took a particular
interest in that. But again, there was this concentration of resources in one place,
and not so many that it became unmanageable. They had a very good ..... too,
actually, where there were the sort of administrative assistants sort of marshalled the
people well and I thought ran it quite effectively when we had to expand. It was –
the Health Centre still is – had part of some shopfronts adjacent to the medical
practice, and then from memory they actually extended, they need to buy or lease or
14
whatever it was the next two shops adjacent because of its size. But in terms of
things, it was a very low-cost health centre compared to some of the others. The one
at St Agnes, which was purpose-built – and I used to call it the ‘Taj Mahal’ – very,
very expensive by comparison.
Was there any disadvantage to having sort of less space in those days?
Oh, no. I think the – well, there probably was never enough space. It’s difficult to
find space for groups of any size. I think its value was its accessibility: you didn’t
have to have a car to get to it, the bus stopped outside the door and it was
immediately in the centre of the shopping centre, which was really ideally placed.
And anyone going in, you wouldn’t know whether you were going in to see the
general practice or in to see the Community Health Centre, because we had a
common doorway. So that had a lot going for it, I think.
I guess primary health care and community health being a fairly new thing at that
stage, this multidisciplinary working together: was that something – – –?
It certainly was new, and I think we’re doing it much better than we used to. And of
course some general practitioners – we did a study on this, I think, I can’t remember
– never ever used it, that we knew, directly; whereas the people of course in the
adjacent general practice, the Clovelly Park Medical Centre, used it the whole time.
But gradually more and more people in the community began to realise (a) – the
doctors, I’m saying – that it wasn’t a threat and the advertising and word of mouth,
like most services, got around and people patronised it.
Through the minutes – I mean, you’re not likely to remember doing this, but it
may be just worth commenting on what you think you might have talked about –
you agreed to talk to all the staff members about their role within the Centre –
Was that me or (laughs) someone – – –?
– yes, it was you, you agreed to do it. Whether you did, I don’t know, (laughter)
the minutes don’t say, actually.
Well, to start with, we had to work out some ground rules, and I guess because of
my experience broadly in community health issues I might have been asked to do
that. But the point was we were trying to see (a) what would be your individual
roles, what aspects did you take up? And of course that partly matched with the
skills of the person, that if you came out of school health or community health
15
nursing you’d have a set of skills. Most of them because that’s the sort of person
you were, rather than definitive training. And then of course (a) trying to get a sense
of team where there wasn’t a team before – most of them had worked as individuals
– and to get a corporateness and a sense of identity for the Health Centre itself.
How did you go about that, getting a sense of identity?
Well, I don’t really remember. I probably spoke to each of them individually and
asked them what they thought their skills were and what they thought the job might
entail. If I’d been doing it now I would have said – I might have then – ‘What skills
do you think you would like to acquire that you don’t have that will be relevant for
the job?’ and make sure that the health centre system training – because we had an
ongoing training program – could provide that for them. And then I would normally
have said, ‘Well, how do you see this interacting?’ – like school health with the
community health nurse, or the community health nurse with the occupational health
nurse, or the counsellor with the psychologist, and these kinds of things. And some
of them, of course, their different programs we’d probably run corporately, maybe
two or three of them, and, as St Paul says, ‘As much as lieth in you live peaceably
with everybody.’ But, you know, it’s not the way we’re built, so the idea of
working together is not always as easy as it sounds.
One of the people that came in early there was Dr Rosemary Crowley and seemed
to be involved with parenting and various other – playgroups and – – –.
Ah yes, Rose. Well, she – very effusive, direct, get on with it, common sense. Of
course she later went on, for many years, into parliament as a senator. And
particularly, she was obviously particularly interested in women’s issues in the
community. And I can’t remember, I think she was part of that practice, was she?
Or whether she came in as a doctor from the community eventually, I just don’t
remember.
That can be found out.
Yes. I think maybe she came from outside and she wasn’t a member of that
particular practice.
I don’t think she was a member of the practice, no.
16
No, no. So I can’t see in my mind’s eye from which angle she came into it, but she
was a very active person. And she, of course, had a lateral – most doctors, in fact,
are fairly vertically-focused in their approaches, but she and Deane are much more
lateral thinking, otherwise you wouldn’t be in that kind of work. I mean, Deane was
the first chairman of the Service to Youth Council, which was trying to address
some of the youth issues, and he was Chairman, I think, for ten years. He was
Chairman – he was very, very active in Rotary; he was chairman of a housing
complex for old people. Needless to say, he was always late for his appointments,
late for his lectures, late as Chairman of the Community Health Centre. He was a
very, very busy man. But, as I said, (laughs) this marvellous sense of humour. I can
remember once when he came to work and suddenly complained of very severe
abdominal pain, and I said, ‘Well, let’s go round to the Accident and Emergency
Unit,’ which was adjacent to our department, and examining him and listening to his
chest. And I thought, ‘Goodness gracious!’ There was this huge heart murmur that
he had. And I then looked at him, he had his eyes shut, opened one of them – he
knew he had it, you see, but he (laughs) wasn’t going to tell me, he was just seeing
(laughs louder) if I picked it up! And he had quite a severe heart valve problem,
which may well have been one of the main reasons he died at the age of sixty while
playing tennis. I think the word was, ‘Here’s a serve you’ll never forget!’ And he
just dropped down. I’m sure someone else (laughs) will have given you more
information, but that’s my understanding of what happened. And I think that his
heart condition – it was just his way of just checking on whether I picked it up or
not, not saying anything and then smiling broadly. He was a wonderful colleague,
really.
You were talking about trying to find out the needs of the community in order to
establish programs, et cetera, that would fit in well there: how did you go about
just finding out the needs of – what the community was made up of?
Well, I guess some of them were really obvious, like the occupational health one.
Some of the other ones came in from people like Don and Joy and their community
base. I don’t remember us, but we might have done some little community survey,
there’s just a vague bell ringing in the back of my head that we did do a survey of
part of the community – I think we put it out in the shopping complexes around us –
to see what people wanted. Mostly it was because these were the kind of problems
17
that we were dealing with in our individual professions, and saying – and this is the
reason Deane and Michael Bollan and Richard Laycock and co, Tim Murrell, took it
up originally – is that they saw that a number of things – and it’s still true today –
coming to the doctor are better handled by other health professionals, (a) because
they’re very time-consuming and GPs don’t have the time, or (b) the GPs didn’t
have the skills or the interest – you can’t be interested in everything – to deal with
those issues. And I think particularly they were in those days lifestyle issues, which
doctors are dealing with much better these days and are trained to do so, but they
were particularly in the psychological, mental, interpersonal relationship area, and
so the programs gradually evolved around those.
You talked about Reg Brand running some of those early courses. One that the
lady that I talked to today mentioned was in effect a ‘helping the helpers’ course,
or something like that.
That’s right.
Tell me a little bit about him.
Well, we had a lot of volunteers – can’t remember how many volunteers we had in
various activities, but we established a toy library, I remember, and a number of
different groups like that in which volunteers were involved. And Reg, being a
counsellor, was very good at motivating people and getting at where they were at.
And I think he might have come from the school – Education Department, I think; I
can’t remember. But they really had an excellent team there.
One of the things that I noticed was started up was a playgroup, I think it was
Rosemary Crowley that began that, and I wondered whether that was potentially
the beginning of playgroups, which are now very common.
Well, the answer is I don’t know, but that was sort of one of these things that grew
out of need. Rosemary, as I remember, had a particular interest in women and
children’s health. You know, the idea of a toy library – there were a lot of poor
people or lower socio-economic people in that area who didn’t have access to, or
didn’t know how to access, resources that would be available for others. I’m just
trying to think: then that evolved things like speech pathology or ‘speech therapy’,
it was called, a number of these children were disadvantaged at school and they
didn’t have the capacity to access them, or couldn’t afford to, because most of them
18
were in private use, but there was a government-funded speech pathologist, or
‘speech therapist’, as they used to be called. Can’t remember whether we had
podiatry or chiropody there, it might, I don’t think so. You know, like the school
health placed their person there, the CAFHS3 group placed their staff there, and so
there was this corporateness. There was family planning, there was drug and
alcohol, and most of the things started [because] there was an obvious need.
Some of the less obvious ones might have been like the domestic violence one,
because to start with it was all fairly silent before it came out into the open. And
then later I was involved with a thing called the Southern Regional Geriatric and
Rehabilitation Advisory Committee, of which the first chairman was Michael
Gribble, the pathologist, and I was the vice-chairman – again, being another aspect.
And there was the Southern Domiciliary Care group. And most of these had
representatives, so they were interrelated. I can’t remember what Southern Dom
Care had: they were based at Repat4 at the time, and I don’t remember whether they
were represented in the area. But mental health was, women and children’s health,
alcohol. So you had some that were established by the system, in other words they
came out of Mental Health Services, they came out of CAFHS; and others were, if
you like, core staff, although, by and large, they worked very well together as a
team.
So if you like there were two teams – I don’t like to sort of say there was a core
team and an outer team, like you have in some group therapy sessions, but in fact
they were. Some of them were appointed by the Community Health Service, and
others were appointed from their parent organisation, like the community
psychiatrist who came just for – – –. A lot of the other people, like the psychiatrist,
came for a session or two or three sessions a week, whereas people like Kate Brown
you mentioned, Elva Abraham and so on, were full-time.
One of the things that later became part of the involvement of the committee was
getting the constitution going, and I just noted on that pamphlet that I handed
you, from the early days, there is a list of the objectives and the aims of the
Centre. I wondered how important it was to get those things in writing?
3 CAFHS – Child, Adolescent, Family Health Service.
4 Repat – Repatriation General Hospital, catering originally for defence service veterans and their
dependants.
19
Well, I thought it was important at the time because I’m very much an objective
person, in the sense that I like – people need to know the structure of the
organisation that they’re in. But my experience is it doesn’t matter how good the
objectives are, they’re often set aside and nobody knows what they are two or three
years down the track. But, you know, as the top line says: ‘to promote health and
wellbeing of members of the community’. So we were trying to take it out of the
sort of medical model concept: ‘You’ve got acute sore throat, let’s deal with that.’
We were looking at things like trying to raise the percentage of people who were
immunised; decrease the stress levels through these various things of parenting
groups, alcohol groups, violent groups; having counsellors there that you could just
come and chat to if things were getting a bit rough; so this concentration on health
and wellbeing, and ways in which we could do that. And we did that by, as it says,
promoting health education, promoting preventive medical care, and a very good
example of that would have been the small businesses where the – there were two,
may have been three at one stage, occupational health nurses and they’d go into
these businesses, with the support of the people there, to see what could be done to
prevent that happening again. And some of these – I can remember doing it –
someone would come in with some medical problem, whether it was a laceration or
facial injury or whatever it was, and then we’d get the community health people to
go back to the business that it came from to see if something could be put in place –
it wasn’t a sort of punitive thing – to prevent that. So the whole emphasis was on
promoting occupational health, promoting school health, promoting preventive
measures and so on.
And of course, as we were saying, talking to people. One of the things was to
promote and develop a teamwork approach to delivering health care, which of
course prior to 1975 was fairly uncommon. We wanted to base it, as the objectives
said, on the needs of the community. Now, there’s a difference between wants and
needs, and of course you can bring the two together if people are presented with
information that can become a want. A need here is something that’s identified, I
suppose by definition, by some sort of study that showed that only eight out of ten
children were immunised, or only two out of every ten women who were suffering
domestic violence received any help, or whatever. So it was trying to make wants
and needs. And the whole business of having wants and needs was one of the
20
reasons we had two or three community people on that committee that was running
the Health Centre.
Yes, the pamphlet is undated, so it can’t actually be – – –.
I remember the pamphlet well. (laughs)
Yes, we’re looking at a, I guess it would be a sort of late ’70s, early ’80s pamphlet
of the Centre.
Mm, I think it was late ’70s, yes.
Tell me about that area where the Centre is in Clovelly Park: what sort of area
was Clovelly Park in the 1970s, late ’70s?
Late ’70s? Well, it has been, I think, for certainly the – even then, in ’75, there were
very few open blocks of land left, there were just a few. Of course it had been sort
of almond areas in years gone by. But the whole of that South Road area, which
was the focus for it, developed as ribbon development. You had both small and big
businesses, you had what was Chrysler – now Mitsubishi – down one end and you
had some of these engineering firms which came up. But a lot of them were quite
small business, but often related to the automotive industry – welding, electroplating
and that kind of task. But it was very busy. Most of the people, as far as I can
recall, lived away from the area, but a number of them lived in and behind the
businesses there. And of course there were the schools, Marion High School is
nearby, and I forget how many primary schools there were.
But one of the things we did at the university in I think it was late ’75 or ’76 or
somewhere about then, ’77, we in fact established, to find out what was available in
terms of health, we made a directory of all the health services. A medical student
called Glastonbury, now an eye surgeon, and I put together a whole thing of all the
different sorts of practices, health centres, community health nurses, CAFHS, for the
area. But I guess most people seemed to operate fairly independently, I don’t know
whether that’s true or not or whether it’s just my memory, and there wasn’t so much
a sense of community like you’ve got in many other areas, and I think that’s
probably true of many industrial areas.
You talk quite a lot about Flinders and the Centre and the links between them:
how closely were they linked in – – –?
21
Oh, virtually only because of Deane and I, I think. It was more a conceptual linking.
Flinders was aiming to produce community-based doctors and people who would go
into general practice – it was one of the things that they said when they set it up –
but that never actually happened. The people who were appointed, even though
they might have had that idea, we were all products of a different system. In fact, I
had a ridiculously small department of two and a half people to cover General
Practice, Public Health, Behavioural Science, Nutrition and Occupational Health,
whereas the more traditional things like Pharamacology might have had five
government appointees or university appointees or four; smaller departments like
Anaesthetics had the same. So the relationship was – and there were always
pressures to reduce the content of students within the community. So it was never
negative, and it was certainly much more positive to begin with, and it was always
there. But apart from my own department, which had people who worked both in
the Health Centre and in the general practice there, and in the university department,
Faculty of Medicine, there was relatively little contact. I think from memory, for
example, sometimes there was an issue on children’s health, for example: the
paediatricians would be quite happy to come and talk about it, that wasn’t a
problem. And of course we also had Ross Harris, who was there for a while, who is
related to both the Medical Centre and the Community Health Centre.
What can you tell me about him?
He was originally a Methodist minister who worked out in the northern suburbs,
Salisbury area. He was a contemporary of mine at university, and then he became a
full-time clinical psychologist. In the early ’70s he had a lot to do with the
Aboriginal community and the Aboriginal Task Force – I think they were based on
North Terrace. He had a wonderful reputation as a clinical psychologist and as a
teacher, which is one of the reasons I quickly appointed him when I got to Flinders,
originally part-time and eventually full-time, as the lecturer in Behavioural Science,
and he set up one of the very first, I think, hospital counselling services. We had a
primary care clinic which was basically for people who were severely grieved or
traumatised or weren’t coping, from a psychological as distinct from a psychiatric –
they may have been partly neurotic, but they weren’t psychotic. And so his wife
was also a nursing sister, community-based, public health-oriented person.
22
I guess I was asking about that because it seems that Flinders had that – I guess
being that Deane was there and that sort of spark and connection, that it’s
interesting in the long run that the Centre has amalgamated with Flinders. The
Clovelly Park Centre, in the ’90s, amalgamated with – – –.
That must have been – I left in 1994, I don’t know what amalgamation – – –.
That happened afterwards, yes, after you left.
What amalgamation?
They’re now part of the Flinders –
They’re part of the Southern Health Services –
– yes.
– but that’s not part of Flinders as such. Flinders and Noarlunga and the health
centres are all part of the Southern Regional Metropolitan whatever it calls itself, but
I don’t know of the Health Centre being under Flinders’ responsibility. Is
that – – –?
Yes, that has occurred, in 1996 it did that.
Is it?
Yes.
Oh, right.
It doesn’t matter; that’s beyond the –
That’s beyond me, that’s after my time.
– yes, your period. I found the period that you resigned from the committee was
in 1981, in the middle of 1981.
That’s right, I’d been there for six years and someone else took on the role, I can’t
remember who.
They were revamping the committee at that stage I think, too.
That’s right.
And it said the reason you did was because you were heavily involved with the
Christies Beach and Morphett Vale Community Health Centres, which obviously
were coming – – –.
23
Well, I was on all three committees. (laughs) The Christies Beach one came on
pretty much after the Clovelly, and then the Morphett Vale one started later. And I
think that everyone at Clovelly Park knew the way I thought and what I (laughs) felt
about the way in which I could contribute.
Which was what do you think you contributed, I guess?
Well, I think I contributed (a) a wider concept of community health, because that’s
what I’d been doing for so much longer in various areas, not just in the medical area.
I don’t know that there’s anything specific that – you’d better ask the other people
what I contributed: ‘I don’t know’ is the answer to that! (laughs)
I guess it’s about your feeling, I mean you put those six years in and then you left
it behind: do you feel that you contributed to it getting going, I guess?
Well, one of the troubles is that my department was so small, I was involved in so
many activities and I had a teaching role – I think probably I spent more than twice
as much as any other professor actually teaching, face-to-face teaching; wanted to
do some research; I was involved in international health work as well, which was
perhaps my major, or one of my major things; I was involved with the – – –. At one
stage I was on thirty-two committees and sub-committees, and in one particularly
bad meeting I sat down and wrote seven resignations, which occupied me for the
rest of that – – –. In other words, a lot of them I was there just because I was the
Professor of Primary Care and Community Medicine – that wasn’t true of this one,
but many of these committees – and so I thought, ‘I’m not putting anything in, I’m
certainly not getting anything out, I’ve got other things to do.’ And one of the
greatest difficulties I found in my job was in fact deciding what were my priorities,
where should I be putting my energies. I mean, I had a wife and three children, and
often we had many more than three children in the house – five for three years – and
there were other things I wanted to do.
I’ll just stop you there and put on another tape.
END OF TAPE 1 SIDE B: TAPE 2 SIDE A
This is the second tape of an interview with Anthony Radford being recorded by
Karen George for the Inner Southern Community Health Service 30th
Anniversary Project. The interview is taking place on 6th
May 2005 at Kingswood
in South Australia.
24
So perhaps just summing up a little bit: have you kept your eye, or any sort of
involvement, with the Centre since you left in 1981, have you been aware of what’s
happened?
Oh, well, I had a much lighter interest there until the end of the ’80s and kept a very
– I was interested in what they were doing and what other programs were being
developed and so on. But I left Flinders in mid-’94 and I’ve had no contact at all in
the last ten, fifteen years.
So, talking about them being thirty years old, how do you feel about the fact that
they’ve made it – – –?
Well, I’m sure they’d make it, because the need was overwhelming when it was
established. And I think that this kind of community-based centre is usually more
accessible, is usually cheaper. As long as it concentrates on – like any government-
funded, you’ve got to work where there can be a reasonable return for the money.
You can never put enough money into child health or child development. I don’t
know what they’ve got, but if I were in charge of government spending I would be
putting far, much more money into family preparation, family formation, family
development and family joy and stability, because, even if forty per cent end in
divorce, it’s the way homo sapiens has best brought up its children is in a family
context, and I think a lot of our problems would be much less and fewer of them if –
and I’m talking about millions of dollars here – Australia would be very much better
off putting the billions of dollars into this than it is in, say, Iraq. And so I’ve
maintained an interest in things, community health; but since I retired I work now
mainly as an emergency physician twice a week, and once every two months I go
off to do a rural GP locum, and I guess three months a year I’m in international
health work, so either training or looking at programs overseas. Because I had ten
years in Papua New Guinea, which was where I developed this particular interest,
and then the training programs at the Liverpool School of Tropical Medicine.
So in that thirty years that the Centre has operated, how do you feel that field of
primary health care has changed from when it began to now?
Oh, I think the whole profile has risen. Our department in fact changed its name
from Primary Care and Community Medicine, for some time, to Primary Health
Care, because that was the ‘in’ phrase, ‘Community Medicine’, and then ‘Primary
Health Care’ – primary health care meaning the – well, people define it differently,
25
but to me you’ve got primary medical care, like a general practitioner’s situation,
and primary health care, like mothers and babies. And occupational health is
usually a bit of both.
And I think – well, rightly so – it’s become much higher-focused because the
emphasis on primary health care is on prevention and health maintenance. So on
one hand we need government policies which facilitate that, on another hand we
need education programs, I’d say from primary school level; and the community-
based programs, like domestic violence, like child development programs, that are
accessible and affordable, and this is the difficulty is to make them both (a)
accessible and (b) affordable.
Something you were talking about, the name of the Flinders department, you said
that Deane Southgate had been involved in that name, and I didn’t pick up on it.
In fact, Deane was an applicant for the job as Professor of Primary Health Care.
Deane was, right at the very beginning, chosen – I’m not quite sure how: maybe if
it was dean, I don’t know what his relationship with Gus Frankel was. Gus came
from being a professor of surgery in New Zealand to be the first dean. But very
early on, Deane was on the board – and this again shows you his lateral thinking –
of the Sturt College, which was then a separate, independent college of advanced
education and involved in some way with nurse training, I think; but he was on that
board. And then from that he got involved in the initial committee structure that
was looking at establishing a new medical school, and then the Department of – a
department which was going to concentrate on general practice and community-
based care and community things, and Deane was in those up to his neck. And I
don’t know whether he was responsible, but he may well have been, for deciding on
those names, because I can’t imagine who else would have come up with them. Gus
Frankel may have had some say in that; I think he probably just went along with it.
And Josie, his wife, might well be able to tell you whether he was responsible, but I
think it highly likely that he was.
Just to sum up about him, how integral do you think his role in the Centre was?
Oh, it was cardinal, in its establishment. But now you can see it’s roaring along
without him, like many of these things. His initial role, his initial energy, his vision
– in fact, many of the committee people just took that role or that vision, and they
26
are the ones who expanded it and added to it and got growth and development out of
it. But fundamental. He just had so much energy, it was quite incredible. (laughs)
Okay. Well, that’s the end of the questions that I have for you, unless there’s
anything else you want to add to that.
No, I don’t know anything else. I hope it’s helpful.
Good, I’m sure it is. Thank you very much.
END OF INTERVIEW.
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