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The Quarterly

2017 Cilento Oration Print E-mail
Delivered in Brisbane on Thursday 19 July 2017 by Dr Richard Ashby, Chief Executive, eHealth Queensland 

I’d like to respectfully acknowledge the Traditional Owners on whose land we meet today – the Turrbal and Jagera people and their Elders, past, present and emerging.

I acknowledge VIPs, members of the Cilento Family and other College representatives.

May I also thank the QLD Faculty and Executive of RACMA for the honour of their invitation to present the 2017 Sir Raphael Cilento Oration.

An oration presented in the name of a distinguished predecessor, presents an additional challenge over and above that of an elaborate and dignified speech on a selected subject as there is a customary expectation that the subject of the Oration will bear some relationship to the life of the person in whose honour the Oration is commissioned.

As I was reading about Sir Raphael, his family and his achievements I found my mind wondering how serendipitous, contingent or contextual this all was – if this man had been born into another era, what would be the same, what would be different? Was his leadership contingent on the times?

What if Raphael West Cilento had been born 100 years later? Would he now be stereotypical GenY / Millennial supposedly characterised by self-absorption, indulgence and petulance, wearing a black t-shirt and thinking about smashed avo and coffee for lunch? Or would he be hard working and thinking about whether he could lift his GPA by point 02, and so top the graduation year in medicine.

And then what? Would he be different, what would be the same?

Bring forward Cilento’s intellect, ambition and strategic vision to the current era and what might that look like?

So, my hypothesis is that if Raphael West Cilento were born one century later, on the 2nd December 1993, he would have achieved many of the same things as he did because his human skill set is as relevant today as it was in his time.

To the extent that there would be a difference, this would be defined by that which defines Gen Y – technology.

Certainly, Cilento would be fascinated by the change going on in his birthplace – James, 200 kms to the north of Adelaide. Only ten days ago Elon Musk announced TESLA would build the world’s biggest lithium ion battery there, storing 100 megawatts of renewable energy from the Honsdale Wind Farm.

Cilento’s father was the stationmaster in Jamestown, and so the family was not well-to-do.  Cilento always wanted to study medicine but couldn’t afford university so after school became a teacher. However, through hard work and scholarships he would study medicine at the University of Adelaide finishing at the top of the class and largely without personal debt.

Of course, there have been some profound and not-so-profound changes in medical education since 1918, largely based around the technology of delivery rather than the fundamental model – necessary now with medical knowledge doubling every 78 days!

But on reflection, there is nothing in history to suggest that Raphael Cilento would not, or could not, have successfully pursued his dream of being a doctor today as many of todays’ graduates have similar stories.

One thing also likely to be unchanged would be the fact that Cilento married another doctor from his graduating year, Phyllis McGlew.

It remains the case today that the most likely spouse of a young doctor will be another doctor.

The Cilento doctors undertook internship at the Adelaide Hospital and were briefly in a suburban General Practice there.

Phyllis Cilento would continue to work in general practice for the best part of 60 years!

Some of the medical headlines in the journals of the 1920s have changed supplanted by then unimaginable advances in technology- some remain unchanged. Back then, antibiotics were just coming into use – today we ae struggling to curtail their use.

Influenza remains a major existential threat to humanity.

As a young doctor in the 1920s, Cilento was well aware of the Spanish Flu described by some as the greatest medical holocaust in history, killing more people in a year than the Black Death did in a century.

It is not clear whether the great pandemic played any role in Cilento’s specialisation in infectious tropical disease but a contemporary Cilento could well take an interest in viruses that are just 5 mutations and a plane flight away from a repeat.

Of course, also to note, the Spanish Flu did not originate in Spain – Cilento would have had to deal with fake news in either era.

In the 1920s the discovery of vitamins and vaccines was Nobel Prize winning stuff – hard to believe that, 100 years on, vitamins are overused and anti vax campaigns still get airtime.

By far the greatest changes have been in technology.

In the 1920s, the ECG had been invented by Einthoven.  Today Cilento could be working in a hospital where the 100 ECG machines feature computer augmented diagnosis and are interfaced, together with 3000 other medical devices, into an electronic record in a fully Digital Hospital.

And while the discovery of insulin changed the prognosis of Type 1 diabetes from certain death, Banting could never have conceived the advanced in diabetes management coming forward today.

After spending some time in Papua New Guinea, Cilento returned to work at the Australian Institute of Tropical Medicine and was later the head of the Commonwealth Division of Tropical Hygiene from 1928 to 1934.

The original Australian Institute of Tropical Medicine in Townsville had been established in 1913 in the grounds of the second Townsville Hospital and was Australia’s first medical research institute.
Its original mission was to develop an understanding of how Europeans could live and adapt to Tropical Australia.

In relation to infectious tropical disease, the research agendas seem remarkably similar 100 years on. Cilento was described as demonstrating “sound research and policy in the control and eradication of tropical diseases, as well as epidemiological techniques”.

In an early example of citizen science, Cilento, who was leading the politically charged fight against an outbreak of Weils Disease in Ingham, asked the local Catholic priest, who only spoke Italian, to ask the cane cutters to provide stool samples in tin cans provided by Cilento.

Something must have been lost in translation, as the next Sunday, all the cans were found on the steps of the Church, full-of-money.

Coming forward a century, it is not hard to imagine a dynamic Raphael Cilento leading the Anton Breini Centre making best use of new techniques in genomics, molecular biology and health systems research.

Whilst Cilento’s achievements in Tropical Medicine were significant, his abilities were arguably to see their peak expression as the first Director General of the Ministry of Health in Queensland.

The very establishment of the Minister and the Director-General positions had been deftly planned and orchestrated by Cilento himself with key allies in E.S. Meyers and William Forgan-Smith who won the 1932 Queensland election on promises of infrastructure development and health reform.

Cilento was a neighbour of Forgan-Smith at Annerley and it has been said that Cilento selected his Minister, to be Ned Hanlon, while walking with Forgan-Smith alongside the nearby Brisbane river.

At just 41 years of age, Cilento became the first Director-General in 1934, embarking on an unprecedented legislative and service reform agenda.

By way of professional development at this time, he also studied and was admitted as a Barrister–at–law.

His legislation included:
• Hospitals Act 1936 [in which the government took responsibility for funding public hospitals] as well as establishing standards for private hospital for the first time.
• Health Acts 1936 and 1937.
• Medical and Pharmacy Act 1939, years ahead of anything else in Australia.
• Mental Hygiene Act 1938 demonstrating his understanding of the significance of mental health.

Much of this legislation was described at the time as “logical, exemplary documents”.

He was a foundation member of the NHRMC, The Medical Board of Queensland and was instrumental in establishing the Faculty of Medicine at the University of Queensland, and a predecessor research facility of the QIMR Berghoffer.

He recognised the Laboratory of Microbiology and Pathology and tarted research and statistical services, and also a new Radium Institute.

He was first in the world to establish a Chair in medical faculty with the word ‘social’ in the title.

For years, he strove to improve Aboriginal Health and Culture and was an early proponent of the concept that social and housing issues were major determinants of Aboriginal Health.

He played a seminal role at the beginning of the National Medical Insurance debate and essentially invented the concept of salaried medical service in Australia.

Needless-to-say, these latter issues put him seriously at odds with the medical profession just as the Weils Disease outbreak in North Queensland in 1934 has put him in confrontation with the unions but, his political instincts and outstanding negotiating skills saw him survive.

He finished as Director-General in 1945 but not before publishing what was effectively a manifesto; ‘Blueprint for the Health Nation’.

This attracted huge opposition at the time to the extent that a biographer described him as “a prophet without honour in his own land”.

Nevertheless he travelled to Europe and became the first doctor into the Belsen Concertation Camp at the end of the war and subsequently became the U.N. Director for refugees and displaced persons returning to Australia in 1951.

So, moving forward a century, could Raphael Cilento achieve at this level?

Well, he at least wouldn’t get lost! His office would still be on Williams Street. Just a bit higher…

He would still have ample opportunity to innovate and excel in the organisation and delivery of mental health and indigenous health services.

His sound research, policy and epidemiological skills would find full flight in the Big Data and Analytics of Population Health and the concept and execution of 'Intelligent Healthcare Enterprise’ and, he would relish the reality of ‘Evidence into practice in a day not a decade’ enabled by Digital Health.

As a long time challenger of authoritarian professions and narrow thought, he would welcome the democratisation of healthcare through the evolution of massive open online medicine with fully empowered consumers constructing their personal health ecosystem.

And as a staunch supporter of health and medical research, he would be in his element in the academic health science centres and their genomics, microbiomics, synthetic biology, nanotechnology, and machine intelligence.

In 2017, and with the new, 13th time lord, Dr Who being announced 3 days ago as actress - Jodie Whittaker - I think it would be politically incorrect not to speak of Lady Phyllis Cilento, and whether she could also manage the time warp forward 100 years.

Phyllis was also an extraordinary person. She had an affinity with mothers and children dating to her internship at Greater Ormond Street and later as a GP Paediatrician at the Brisbane Childrens Hospital.

She wrote over 24 books and monographs and was the ‘go to’ person in Australia for media in relation to all things ‘mothercraft’.

She promoted natural child birth, family planning, fathers at births, paediatric nutrition and prevention, and in 1974 was the first Queensland Mother of the Year.

Would Phyllis Cilento likely be as successful today? I think, “Without a Doubt”.

Clever, ambitious, articulate, empathetic.

The difference would be technology - apps instead of books.

I could even imagine her inventing MIMO – wearable technology for babies that measure heartrate and temperature, respiration in sleep and body position – with everything going to mums smartphone.

Raphael West Cilento as a GenY.

Yes I’m sure he would enjoy an avo smash and a macchiato, but I’m equally sure his intellect, his exceptional talent as an administrator and negotiator, and his strategic vision are as relevant and indeed, necessary this century as they were last.

The challenge for the GenY Cilento is the same as it was for Sir Raphael - the need to discern what is feasible at a given point in time. What has changed is the complexity of that consideration.
Talent aside, Cilento also had TWO indispensable situational ingredients for success.

Longevity and Political support, synchronously.

Cliento was Director-General for 13 years. Throughout that entire period, he enjoyed the political support and patronage of the Premier, William Forgan Smith.

In the last 20 years in Australia, no Director-General in any jurisdiction has served 13 years, let alone with the same government and Premier. In Queensland, there have been seven Directors-General in the past 20 years, with one serving nearly half that time. The average tenure of the past five DGs has been just a couple of years.

The life cycle for the political leadership is no different with five State Health Ministers in the past eight years, and four Premiers in the past decade.

Today’s world of profoundly partisan Media Gatekeepers, “Shock jocks”, Hype and Media Cycles, paid Bloggers and Twitterers etc, means that the probability of any Director-General having the longevity of tenure to enact significant organisational, policy or legislative reform is remote, irrespective of talent.

And I haven’t even mentioned the ongoing, entrenched power of the major professional organisation and the media amplified influence of thousands of NGO’s and special interest groups and even individuals with a cause.

So, could Gen Y Raphael Cilento have the same legislative and foundational impact today – I don’t think so.

But an astute Cilento would likely settle one layer below the political, and actively and successfully lead and influence development in a wide range of agendas in health services and academia to the extent that, should the immediate part Prime Minister ever regain the Lodge, he would again be Sir Raphael Cilento!

Dr Richard Ashby

Last Updated on Thursday, 28 September 2017 13:46