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The Langford Oration – a brief reflection on its history, purpose and namesake Print E-mail
The Quarterly 2012

Dr Robert Grogan The Langford Oration forms an integral part of the College calendar, and is presented at the Annual Conference. An Annual Oration had been presented since the first Annual Meeting in May, 1968, but the title 'Langford Oration' was adopted by Council in March 1972. The Oration, named in honour of the College's Foundation President, Dr Sam Langford, is delivered by a distinguished person on a topic of his or her choosing.

This paper provides a biography of Dr Langford, lists the Langford Orators and their topics, and provides some analysis of the Orations.

Dr William Ernest 'Sam' Langford

Dr. William Ernest 'Sam' Langford (1905-1992) was born and educated in Brisbane. As there was no medical school in Brisbane at that time he undertook his medical studies at the University of Sydney, graduating in 1928. He joined the Repatriation Department (now the Department of Veteran Affairs) in 1930.

During the Second World War Sam served for five and a half years in Palestine, Greece, Crete, Syria, New Guinea and Malaya, commanding in succession a Motor Ambulance Convoy Unit, a Casualty Clearing Station, and a General Hospital, ending the war with the rank of Colonel. During this period he was Mentioned in Dispatches (MID) on three occasions for meritorious service.

In 1946 Sam was appointed Senior Medical Officer of the Queensland Office of the Repatriation Department, and in 1950 he moved to the Central Office in Melbourne to become the Deputy Principal Medical Officer, becoming the Principal Medical Officer from 1954 until his retirement in 1970. In this role, he manifested the best-practice qualities of a sentinel within the emergent specialty discipline of medical administration, which he helped establish by much advocacy from 1964. He was elected as the foundation President of the (then) Australian College of Medical Administrators in May 1968.

Dr Langford was given the nickname, 'Sam', because of Sam Langford, a well known boxer in the early part of the 20th century. Sam Langford (1883-1956) was called the ‘Greatest Fighter Nobody Knows’, and the 'Boston Tar Baby'. There is a suggestion that William Ernest may have met Sam, and may even have been taught to box by him.


The Langford Orations

The Langford Orators are selected by the State Committee responsible for managing the Annual Meeting in any year, and the proceedings of the Oration have been published in The College Newsletter (later The Quarterly) since 1989.

Selected recent Orations

It had been hoped to provide an outline of all Orations, but given that the texts of so few orations are available, this section only contains a summary of a few selected Orations.

In Canberra in 1989 Professor Peter Karmel spoke about health policy in both a social, and an economic, context. He began by defining ‘health’ and formulating indicators by which a country’s state of health could be measured. With regard to health policy, Professor Karmel differentiated between reactive policies (the treating of sickness) and proactive policies, those that attempt to change the circumstances in which people find themselves, or their behaviour. Further, he stated that health policies needed to be seen within the broader context of general social policies, whilst at the same time operating within the context of resource constraints, and being concerned with both efficiency and effectiveness. He commented on a number of matters that included competition for resources, the issue of resource intensive treatments, ethical issues, the possible divergence of individual and social interests, and the relationship between inputs and outputs. In conclusion he emphasised that policies for health required a great deal of information and a capacity to evaluate a range of health options, and in that regard the Australian Institute of Health has an important role to play.

His Excellency Dr Davis McCaughey took the title of his 1990 Oration from a book by Richard Titmuss. That book compared blood donorship in a number of countries, and Titmuss concluded that Britain's voluntary system was a great expression of 'creative altruism', and he considered that the 'right to give' was one of the basic human rights. Dr McCaughey spoke of a distinction between social policy and economic policy. There are a series of activities such as health and education, the value of which cannot be measured solely in economic terms. These may need to be paid for, but their monetary value is not related to their real value. As recipients we owe no debt except the debt of gratitude. These 'merchandise' are not saleable goods but a gift, an offer of a richer, healthier, more dignified life for others. The survival of our society depends upon the existence of a body of people who see their jobs in that way. Society must say how much it is prepared to pay, although that cannot be left to market forces alone, as in a modern social democracy the taxpayer is invited to enter into a gift relationship.

There are many people who are in a gift relationship with those whom they serve, their clients or patients. If society is to be not only the arena for economic exchange and bargaining but also an organised altruism, this army of .. doctors and administrators … are its agents. The gift relationship, the implementation of social policy which cannot be left to market forces, or thought only in economic terms, in some way touches us all - 'Who is my Stranger?'.

In Darwin in 1996 Mr Gatjil Djerrkura spoke of the need for business partnerships to evolve through mutual trust and a consistent and professional approach to business dealings. He illustrated this by the relationship between his enterprise, Yirrkala Business Enterprises (YBE), and the bauxite and alumina producer, Nabalco, on the Gove peninsula.

The agreement allowed YBE to train many aboriginal people in skills such as driving various vehicles, the repairing and maintenance of equipment, and fencing, concreting landscaping and horticulture. This training has enabled YBE to act as the contract company for Nabalco in areas such as road maintenance, management of garbage services, construction of retention ponds, and the management of a plant nursery.

Mr Djerrkura then spoke of the work of the Miwatj Health Aboriginal Corporation, an independent corporation that promotes health and related services for the Aboriginal people of the Miwatj region of East Arnhem Land. Its functions are as a ‘top end’ primary health care network, implementation of a rural incentives program, a health improvement program, supporting a computerised data network, and providing medical and support services. It is hoped that the work of this corporation will lead to a much improved healthier and stronger future for that community.

Dr Miles Lewis delivered the Oration in Melbourne in 1997 on the topic, Health and the City. He said that in the nineteenth century health considerations were the main factor in the discretionary aspects of city planning. These aspects included consideration of the miasma theory, the problem of water supply, sanitation and drainage, night carts, and the earth closet, and these resulted in the sewerage system, improved ventilation, and slum clearance He considered it ironic that advances in medical and sanitary science eliminated disempowered health professionals from their role in planning.

In the 1999 Oration Dr John Yu began by outlining how, over time, the change in treatment intent had moved from the mere palliation of symptoms and the attempt to make patients feel better, to the making of a precise diagnosis and the correcting of the pathology, to now, healing. This new philosophy was central to the planning for the New Children's Hospital at Westmead. Consequently the hospital was to be about children and be child friendly.

Hence there is only one entrance into a front hall that resembles a hotel foyer and is controlled by a helpful front door porter. Art is widely used throughout the hospital, with the sculptures designed to be touched. The intent of the art is to humanise the institution, particularly the Emergency Department. Other aspects of the arts program include an artist in residence, a musical therapist, and a drama therapist. The Outpatient Department is constructed in a hallway with allusions to a rain forest, as it consists of pipes painted black and angled to the ceiling, the light wells enlarged to enable light and air to penetrate and allow plants to grow. None of the wards are more than two levels above the ground, and the windows are low enough to allow children to see trees growing. Every room in which a child is accommodated opens on to a balcony, court yard or a garden. Behind the art gallery façade, however, the hospital is very modern and very 'high tech'.

Professor John Funder (2001) began by discussing the human genome project as an example of how Australia stood in terms of biotechnology. He stated that this project would help in the understanding of the origin of single gene diseases, with the likelihood that in coming decades the risk factors for common polygenic diseases such as cardiac disease will be known, so turning health promotion from a statement about population health into a personal statement.

Australia contributes about 2.5% of the world's research effort, but as biotechnology is likely to be an important economic generator it is important to ascertain how Australia could participate in the biotechnology revolution as a producer. A SWOT analysis would suggest that Australia’s advantages are that it is an English speaking country, is multicultural, and has a high level of civility, and the weaknesses include time unconsciousness, risk averseness and scientific illiteracy amongst politicians. Its opportunities are geographical, being in the Asian time zone and close to California, and threats include the city country divide, and the Sydney/ Melbourne other capital cities divide. Professor Funder concluded by stating that biotechnology could revolutionise health care in Australia, and be an economic generator for the country.

In 2003 Her Excellency Marie Bashir began by outlining the career of Sir Robert Garran, acknowledged as the architect of the Commonwealth Public Service, and the gradual development of the Commonwealth role of in health care. She then discussed what she considered to be the outstanding health challenges facing Australia – those of indigenous health, mental health, child development, and health and international relations and collaborations.

Professor John Pearn, in 2007, began by stating that medical administrators were both leaders and servants. He then discussed the skills of administration that include 'keeping watch, and watching over those whom we protect', both of which are germane to best-practice medical administration. Professor Pearn raised the concept of a 'sentinel', and indicated that a sentinel’s role in health administration included the monitoring signal-to-noise ratios, and the development of skills of detecting 'signals in the system' when background noise abounded. Whistleblowers have become surrogate sentinels, and their protection, remains one of the most challenging of all managerial skills.

In 2008 Professor Chris Baggoley spoke about the work of the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the need for it to work closely with RACMA.

Both organisations have a role in translation, as well as innovation, communication and implementation. Both need to describe the clinical world to the world of management and health policy and vice versa. He spent the bulk of the Oration reflecting on working relationships with the medical profession and the importance of getting that right so as to ensure that patients do receive the right care.

More than ever, as doctors feel more alienated in the complex health care organisations, there is a need to communicate, to understand and to translate for them.

Professor Fred Hilmer (2009) began by outlining a trifecta of negative situations that were then challenging almost every society worldwide - the Global Financial Crisis, the Global Environmental Crisis, and a serious breakdowns in ethical standards in politics, public administration (health, police forces), community organisations (including the church) and business.

He proposed that the trifecta of failures was due to time frame compression – a shortening of the time frames in which leaders in many fields, including the medical field, are now operating. There were four parts to his argument: - long time frames are essential for ethical, constructive leadership; time frames are being shortened by a number of forces; shortened time frames lead to dysfunctional and unethical leadership behaviour; and, therefore ways to lengthen the time frames within which leaders operate should be pursued.

In 2010 in Hong Kong Professor Judith Mackay spoke about global public health issues, using tobacco as an example of lessons that have been learned over the decades. Those lessons learned are that we need a new paradigm for the 21st century 'health epidemics' of non-communicable diseases such as heart disease and stroke, diabetes, cancer and chronic lung disease. That paradigm should include the utilisation of international laws and treaties for public health, government, because only governments can implement tax policies, can legislate, and can give the core funding needed within a country, the use of political mapping of the obstacles, particularly the misperceived economic concerns and the tactics of the vested industries, and the support of the health profession, academia and civil society.

Last year (2011) Professor John Catford commenced by asking why it was so difficult to achieve change in health care policy. He argued that one of the reasons why progress has been less effective in the political arena of health care reform is that medical practitioners have not placed as much attention to the process or method of policy making as they have on the content or shape of that policy. He stated that health leadership requires a diverse set of skills and insights. Political analysis and strategy have not been at the fore front of those necessary skills, but need to be mastered in order to become more effective at managing the decision making processes.

Conclusions

The word 'oration' is from the Latin, meaning 'speech, harangue, or to plead or pray', and is defined in the Oxford Dictionary as (i) a formal public declaration or speech, (ii) any rhetorical, lengthy, or pompous speech, or (iii) an academic exercise or contest in public speaking.

There may have been occasions when attendees at the Oration thought that definition (ii) or definition (iii) applied, although the orators have spoken with definition (i), a formal public speech, as their aim.

It could not be said of our Orators what Winston Churchill once said of Charles Beresford:

He is one of those orators of whom it was well said: 'Before they get up, they do not know what they are going to say; when they are speaking, they do not know what they are saying; and when they sit down, they do not know what they have said'.

The Orators have included the Governor General, State Governors, Deans of medical faculties, medical researchers, lawyers and jurists, architects, business leaders, as well as those known for their ability to entertain and amuse as well as educate. Surprisingly, only one President of the College has presented the Oration. The choice of topic has varied from the basic elements of administration, issues of change, the latest information on a variety of relevant topics, particularly medico-legal issues, the responsibilities of administrators within a broader societal role, and reflections on changes in society and medical practice.

The Langford Oration has been a great initiative of this College. It would prove to be a valuable exercise to attempt to gather as many of the 'missing' Orations as possible, with the intent that they be published on the fiftieth anniversary of the first Oration.

References

Maurice Cleary; The First Thirty Years 1967-1997, A Chronicle: RACMA, 1998;
Oxford Dictionary of Modern Quotations: OUP, 1991;
RACMA Newsletters: 1990 – 1994;
RACMA Quarterly: 1995 – 2012;



Dr Robert Grogan
FRACMA, Victoria