IELTS Academic Reading Practice Test 371

Inland Australia in the early twentieth century was a hard place to fall ill. Distances between settlements were enormous, roads were often little more than tracks, and a station might be hundreds of kilometres from the nearest hospital. A stockman injured by a horse, a mother with a difficult birth or a child with an infected wound could wait days for help, and some died before it arrived. The population of the outback was tiny and scattered, so nobody expected doctors to live among them. The suggestion that medical care might arrive from the sky seemed, to most people, a fantasy.

The person who took the fantasy seriously was John Flynn, a Presbyterian minister who had been sent to the Northern Territory in 1912 to report on the needs of the church's scattered congregations. Flynn saw for himself how far many families lived from any help, and he became convinced that the aeroplane, then in its infancy, offered a practical solution. He spent the following years raising money, writing articles and persuading church committees. Progress was slow, because money was short and few people believed that an aircraft could land safely in country without runways.

A modest but useful intervention came in 1917, when Flynn received a letter from Clifford Peel, a young medical student who had read about his plans. The writer set out, in enthusiastic detail, his idea of an aerial ambulance service staffed by a doctor and a nurse, and asked what was being done to create one. Flynn kept the letter and quoted from it in his fundraising for years. It was not in itself a technical proposal, but it captured an idea that would shape everything that followed.

The first practical step came in 1928, when the Presbyterian Church established the Australian Inland Mission Aerial Medical Service at Cloncurry, in western Queensland. Cloncurry was chosen because it had a hospital, a railway and a reasonably level landing ground. The service leased a single-engined de Havilland biplane, employed a pilot and a doctor, and on 17 May 1928 the aircraft made its first official flight. Its early flights were few, but they proved that a plane could reach an isolated property, land on rough ground and carry a patient back to hospital.

Aviation solved only half of the problem. A flying doctor could not be summoned unless somebody could summon him, and most remote properties had neither a telephone nor electricity. By the late 1920s Flynn had recruited Alfred Traeger, a young engineer, to design a radio that would work without mains power. Traeger's answer was a transceiver driven by pedals like those of a bicycle, which generated enough current to send a signal over long distances. Sets were installed on outback stations, and within a few years the network linked homesteads across the inland to the service's bases.

Flynn had also prepared for the problem of treatment before the doctor arrived. He designed a medicine chest, supplied to isolated households, in which every bottle and package carried a number. A doctor speaking by radio could then tell a caller to give the contents of a particular bottle, without having to describe the medicine in words. The system assumed, correctly, that in an emergency the most valuable thing was often advice rather than evacuation.

The consequences of the radio went well beyond medical emergencies. Isolated families could now speak to one another, and the network carried news, weather reports and, later, school lessons. From 1951, children on remote stations in central Australia began to receive their education by radio; the School of the Air, as the system became known, used the same technology and much the same territory as the flying doctor. For many families the radio was the only link with the outside world.

The service expanded across the continent. After the Second World War it acquired surplus aircraft and trained its own pilots, and its reputation grew. In 1955 the organisation was granted the title Royal. Money came from donations and fundraising and, eventually, from government. Today the service operates from more than twenty bases and provides not only emergency flights and evacuations but also clinics in remote towns, dental care, mental health support and advice by telephone, radio and satellite link.

John Flynn did not live to see the service at its height. He died in 1951, having spent nearly forty years arguing that distance need not mean neglect, and since 1994 his face has appeared on the Australian twenty-dollar note. Services working on similar principles have since been established in other countries with scattered populations, including Kenya, where an air ambulance organisation carries patients from remote districts. The idea that a community might organise itself around an aircraft, which seemed absurd in 1912, is now ordinary.

For more than sixty years, humans have lived and worked in Earth orbit, and doctors have studied what the absence of gravity does to the body. Weightlessness is not a lack of force but a state of continuous free fall: an orbiting spacecraft and everything inside it are falling towards Earth at the same rate, so nothing presses on anything else. The human body, which evolved to stand upright in a gravitational field, responds in ways that are sometimes trivial and sometimes serious. Almost every system is affected, and the longer the mission, the more the changes matter.

One of the first changes is the redistribution of fluid. On Earth, gravity pulls blood and tissue fluid towards the legs; in orbit that pull disappears, and fluid shifts towards the head and chest. Astronauts develop a puffy face and thin legs. The body then responds as though it had too much blood: sensors in the blood vessels of the neck and chest signal an excess of volume, the kidneys excrete more water and salt, and total blood volume falls by as much as a tenth within the first days. Crews must drink and eat against an appetite that the shift itself has dulled.

A second set of problems concerns balance. On the ground, the balance organs of the inner ear detect both rotation and the direction of gravity, using tiny crystals that rest on sensitive hairs. In orbit these organs continue to send signals, but the signals no longer match what the eyes report, because there is no stable up or down. The brain receives conflicting information, and for the first two or three days of a mission many astronauts feel nauseated and develop headaches. Most adapt within a week, but returning to gravity often produces a second period of dizziness.

The most familiar effects are on muscle and bone. Muscles that normally work against gravity — the calves, the muscles of the back and the small muscles that hold the spine upright — are barely used in orbit and waste away. Bone mineral density falls in the hips and spine at roughly one per cent a month, many times faster than in age-related bone loss, and the loss is not fully reversed after return. Crews on the International Space Station therefore spend well over an hour a day exercising, using a treadmill with a harness of elastic straps, a bicycle and a resistance device that can load the skeleton. Exercise slows the loss but does not stop it.

The heart changes too. Because it no longer has to pump blood upwards against gravity, the muscle of the left ventricle may lose a little mass and the heart becomes slightly more spherical. After return to Earth, blood can pool in the legs again and pressure may fall when a person stands, so crews wear compression garments during descent. More puzzling is a condition known as spaceflight-associated neuro-ocular syndrome. Some astronauts develop swelling of the optic nerve, a flattening of the back of the eye and a change of prescription that may persist for months. Vision usually recovers, but in a few cases the changes have lasted long after the mission ended. Raised pressure in the head is one suspect, but no single cause has been confirmed.

Immunity appears to be disturbed as well. Studies of astronauts have found that certain immune cells, particularly T cells, respond less vigorously to challenges in orbit, and that viruses which normally lie dormant in the body, such as those that cause glandular fever and chickenpox, can reactivate and be shed in saliva and urine. Most crew members do not become ill and the reactivated viruses rarely cause symptoms, but the pattern suggests that immune surveillance is altered. Sleeping badly and breathing recycled air may also contribute, and whether these changes would matter during a real mission is unclear.

Much remains uncertain. Estimates of the size of these changes vary widely between individuals, and it is not clear whether the body eventually settles at a new equilibrium or continues to deteriorate over years. Separating the effects of weightlessness from those of radiation, isolation and disrupted sleep is difficult, because astronauts experience all of them at once. Ground-based studies in which volunteers spend months in bed with their heads tilted down by six degrees reproduce some of the fluid shift, but not all of it. The sample is also tiny: only a few hundred people have ever flown in space, and they are unusually fit. Blood and urine samples taken in orbit are therefore hard to interpret.

Research now concentrates on countermeasures. Exercise is the mainstay, and its prescription has been refined: high-intensity interval training and heavy resistance work appear to protect bone and muscle better than long sessions at low intensity. Researchers are also testing whether a short-arm centrifuge, which spins astronauts to recreate the pull of gravity for a few minutes a day, could be a practical supplement. Nutritional supplements and drugs used to treat osteoporosis are being studied as well, and a spacecraft that rotated to provide artificial gravity would solve the problem in principle, at enormous cost. For a journey to Mars, which might last two or three years, the question is not whether the body can survive weightlessness but whether it can return from it.

Every winter, hospitals try to persuade their staff to accept a flu vaccine, and every winter a proportion decline it. The question of whether persuasion should give way to obligation is not new, but the COVID-19 pandemic made it urgent: within months of the first vaccines being approved, governments in several countries announced that staff in hospitals and care homes would have to be vaccinated. Some of those policies were challenged in court, argued over in professional journals and, in a few places, abandoned. Behind the practical arguments lie older questions about what people owe one another when they work where the sick are gathered.

The strongest argument for compulsion begins with the patient. People in hospital are, almost by definition, more vulnerable to infection than the population at large: a patient receiving chemotherapy, a premature baby or an elderly person recovering from surgery may be unable to mount an effective immune response even if vaccinated. Health workers, meanwhile, are exposed to infection at work and may pass it on before they notice symptoms. Studies of influenza vaccination in care homes have reported lower death rates among residents when a higher proportion of staff are vaccinated. The duty to do no harm, it is argued, is not only a matter of individual competence; it is a matter of the conditions a hospital creates.

Compulsion is also less of a departure than it sounds. Hospitals in many countries already require new staff to show evidence of immunity to measles, rubella, chickenpox and hepatitis B, and surgeons are expected to follow infection-control procedures that they did not choose for themselves. Few people regard these requirements as an attack on liberty. On this view, vaccination is one of a set of ordinary conditions attached to a job that carries unusual risks, comparable to the training a pilot must complete before flying, and the only real question is whether a particular vaccine meets the same threshold of necessity.

Against this stands the principle of consent. Medical ethics has long held that a competent adult may refuse any intervention, even one that others believe to be in their interest, and that consent obtained under threat of losing a livelihood is not consent at all. Mandatory schemes can also damage the trust on which public health depends: staff who feel coerced may become less willing to accept other advice, and patients who learn that their nurse was obliged to be vaccinated may wonder why persuasion was thought insufficient. Some professional bodies have argued that the language of obligation is counter-productive.

The evidence itself is less decisive than either side suggests. Influenza vaccines vary in effectiveness from year to year, depending on how well the strains they contain match those in circulation, and they prevent infection imperfectly. The claim that vaccinating staff protects patients therefore rests on indirect evidence: observational studies in which hospitals with high uptake are compared with those with low uptake, and in which other differences, such as staffing levels and hand hygiene, are hard to control. Systematic reviews of this literature have generally concluded that the direction of the effect is promising but that the quality of the studies is weak.

The practical record is mixed. Mandatory influenza vaccination in some American hospital systems has produced very high uptake, and the near-elimination of measles in countries with high childhood coverage owes much to requirements attached to schooling and employment. Yet when England announced in 2021 that front-line health workers would have to be vaccinated against COVID-19, the policy was dropped within a few months, in part because of concern that it would push experienced staff out of an already stretched service. Where a rule is introduced and then withdrawn, the effect on confidence may outlast the rule itself.

Alternatives to compulsion deserve more attention than they receive. Several hospitals that ask staff who decline a vaccine to sign a short declaration recording their reason have reported substantial increases in uptake without any threat of penalty: the requirement to explain a decision to oneself, and to a manager, seems to change behaviour. Making vaccination convenient, by bringing it to the ward at the start of a shift, matters too, as does honesty about what a vaccine can and cannot do. Vaccination is also only one control among many, alongside ventilation, masks, hand hygiene and the separation of infected patients.

My own view is that compulsion can be justified, but only under conditions that are rarely met. The disease must be serious for the patients in question, the vaccine must be safe and reasonably effective at reducing transmission, the risk of spreading infection at work must be real rather than theoretical, and the scheme must provide exemptions on genuine medical grounds, support for those affected and a clear explanation of its purpose. Judged by these tests, routine annual compulsion against influenza looks disproportionate, because the vaccine is imperfect and the evidence for patient benefit is indirect. A requirement to be immune to measles or rubella is a different matter. What I object to most is neither compulsion nor refusal, but the habit of presenting a genuinely difficult trade-off as though it were obvious.