An Old man went to the doctor complaining of a terrible pain in his leg. “I am afraid it’s just old age”, replied the doctor, “there is nothing we can do about it.” “That can’t be” fumed the old man, “you don’t know what you are doing.” “How can you possibly know I am wrong?” countered the doctor. “Well it’s quite obvious,” the old man replied, “my other leg is fine, and it’s the exact same age!”

Up The Creek With A Paddle

Henry Miller once described table tennis as a game of endless fascination. The American novelist, who wrote such masterpieces as Tropic of Cancer and Black Spring, used to play at his home in California.

Howard Jacobson, too, is an aficionado of the little game. The Booker Prize-winner, who wrote The Mighty Walzer about his ping-pong obsession, started playing as a teenager in Manchester in the Fifties and never really stopped. For him, the game is synonymous with a certain type of ironic introspection, a method of engaging with and retreating from the world at the same time.

“Table tennis players,” he wrote, “are so lost in musings of a literary and erotic sort, and such spiders of indoor dedication to the airless game, that it is not so much surprising they are seldom seen, but a miracle they are even seen at all.”

But ping-pong, for so long a fringe activity, is undergoing a renaissance. At the elite end the sport is dominated by China, as it always has been, but elsewhere it has moved into some surprising cultural niches. In many British cities, such as Manchester and London, outdoor tables are positioned in garden squares and railway stations for passersby to use.

There is also a craze for the game among the fashionistas. At the Spin club in Manhattan, leggy blonds and advertising executives mingle around designer tables in a basement venue on the corner of Park Avenue and East 23rd Street. The last time I went down I played doubles with Susan Sarandon and a catwalk model called Jessica. I am not quite sure what Jacobson would have made of it, but Miller would certainly have approved.

Much of the latent charm of table tennis is captured in Ping Pong, a documentary directed by Hugh Hartford. The democracy of table tennis is that anyone can play, regardless of age, and Ping Pong introduces us to eight players as they prepare for the 2010 World Veteran Championships in China. They hail from diverse parts of the world and have very different training regimes, but they have one thing in common: they are all aged over 80.

Much of the film’s power derives from its moral seriousness. Over the course of 75 compelling minutes, table tennis becomes a metaphor for life. We meet Lisa Modlich, an 86-year-old Austrian now living in Houston, Texas, who won the Croix de Guerre after joining the French Resistance during the Second World War. Sassy and sexy, she is brutally honest about her longing for victory. “I should beat that old girl,” she says of a rival. “She can’t even move.”

We also meet Les D’Arcy, an 90-year-old Yorkshireman whose competitive instinct is rather more poetical, but no less implacable. “You have to dream of winning if you are going to have a chance,” he says. “If you don’t dream you can’t win.” Much of his preparation involves lifting weights in a large sports hall. “He is a living legend,” a fellow weightlifter says.

Although each player wants to win, they have also found a particular kind of salvation through table tennis. Inge Hermann, an 90-year-old German, discovered the sport after her husband passed away. “He died of cancer and suddenly my food didn’t taste so good. So I stopped eating,” she says. “I got an illness in my brain and couldn’t think clearly any more. Table tennis saved me. It helped me to regain the broken parts of my brain.”

Sport is invariably viewed through the prism of professionalism. We are preoccupied with full-time athletes and their frenzied pursuit of marginal gains. Ping Pong offers an important corrective. It shows that sport can be competitive, but also redemptive. Playing for love rather than money changes the moral basis of sport. When D’Arcy defeats Rune Forsberg, an 86-year-old Swede, the two men hug. “Table tennis has taught me how to win, “Forsberg says. “But it has also taught me how to lose.”

Certainly, watching Ping Pong reconnected me with something I had almost forgotten. There was a time, before rankings and pay cheques, when table tennis was important for its own sake. I would play in the garage with my older brother and lose myself in its rhythms and acoustics. We would play for hours, exploring the weaknesses and strengths of each other, but also something within ourselves. It felt almost like a kind of awakening.

Local leagues cater to this aspect of amateur sport. In the early 1980s we would play at venues that were often shacks in the middle of nowhere, with icy paths and dodgy electric heaters. The ball was forever getting lost behind the curtains. Tea and digestive biscuits would be offered at half time and tasted like heaven. We would play our matches, fighting like tigers, and then go back to our cars and return to obscurity.

It was — and is — marvellous. We were brought together, like nomads, by a shared passion. The only evidence that we had actually played against each other was not medals or fame, but the scorecards that were collected at the end of the season. We each, in our own way, embraced the paradox of sport as a vehicle to nowhere in particular except personal satisfaction and camaraderie. And, back then, in what seemed like a gentler sporting epoch, that was more than enough.

Ping Pong is a rather wonderful film, but it is much more than that. It is about aging, mortality, friendship, ambition and love. The stories stay with you for hours, weeks, after the credits have rolled. But perhaps its most powerful achievement is to leave us with a more humane conception of sport, and of life itself.

© Copyright (c) The Ottawa Citizen

Ontario's Health Quality Monitor

Ontario’s publicly funded healthcare system is under intense pressure from a combination of spiralling costs, an aging population and government budgetary austerity. The challenge of delivering high-quality care to all Ontarians remains, however, critically important. In order to meet the needs of the population, Ontario’s healthcare system must consistently adopt evidence-based practices that can improve outcomes, eliminate waste in the system and organize the delivery of healthcare around the patient to create a smooth journey for the individual. This is essential to ensuring that our health system is sustainable for future generations.

One of the roles of Health Quality Ontario (HQO) is to monitor and report to Ontarians on how well our healthcare system is performing.

This Quality Monitor is HQO’s seventh annual report. It describes how the different parts of the system – primary care, home care, long-term care and hospitals – perform across nine dimensions of quality: accessible, effective, safe, patient-centred, equitable, efficient, appropriately resourced, integrated and focused on population health. It analyzes whether quality has improved or worsened and, where possible, how Ontario compares to best-performing jurisdictions in Canada and internationally. HQO also has a role in driving change throughout the system. It identifies the evidence-based practices that healthcare providers should implement, and recommends practice standards, also based on evidence, that  organizations need to follow. It makes recommendations on how health services should be funded in order to encourage

the highest quality. It amasses knowledge about the different tools or approaches that are useful in implementing best practices and spreads this knowledge to healthcare providers.

To that end, this year’s Quality Monitor is divided into a series of two-page themes. The first page describes key findings and presents data on how we compare to others and whether or not we have improved. The second page describes improvement strategies.

It highlights the evidence-based practices that should be implemented, including those recommended by the Ontario Health Technology Assessment Committee (OHTAC), now part of HQO. It also lists practical ideas on how to implement best practices, and references ‘change packages’ developed by HQO that describe these implementation tips in greater detail. Ideas for implementation include specific improvements to processes of care, tips on how to measure quality and feed-back results to providers, clinical decision supports to remind providers to carry out important tasks, staff skills that need to be developed, resources that need to be acquired or reconfigured, opportunities for patient engagement to enhance implementation, and accountability mechanisms or incentives that need to be designed. These strategies for improvement are also classified according to the different audiences that have to implement them – providers, patients and policy-makers.

This year’s printed version of Quality Monitor features a more compact design to enhance readability. Additional content, including full graphs for all indicators, will be made available online in stages after the print report is released. There are two-page summaries of key findings for hospitals, long-term care, homecare and primary care, with questions intended to stimulate self-reflection in leaders and caregivers. This year’s report continues to highlight local success stories closely linked to its key findings that demonstrate improvement is possible. Additional stories will also be made available online.

How we compiled this report

HQO examined data from sources that include Ministry of Health and Long-Term Care (MOHLTC) databases, Statistics Canada census data and international surveys from the Commonwealth Fund and others. The Institute for Clinical Evaluative Sciences (ICES) helped us conduct many of the data analyses. Researchers, clinical experts and healthcare executives reviewed our findings for accuracy and validity.

Key findings

All sections of this year’s report point to one overall theme: progress is being made in many areas, but it has been slow. In order for Ontario’s healthcare system to achieve true excellence, the rate of progress needs to be accelerated. Three areas in particular demonstrate the extent to which this is the case:

• chronic disease management and avoidable hospitalizations

• wait times

• hospital safety

Chronic disease management and avoidable hospitalizations

Chronic diseases are common within the Ontario population. Although there are some positive signs of improvement in the management of chronic diseases, there is still huge room for improvement. People are not routinely receiving all of the  evidence based best practices in chronic disease management that could maintain their health. Care is fragmented, especially when people are discharged from hospital or move from one provider to another or have multiple providers. This creates excessive burden on individuals and their families, and leads to hospitalizations and readmissions that likely could be avoided.

For more information, read the full report.

When I Was Your Age

A young man who was also an avid golfer found himself with a few hours to spare one afternoon. He figured if he hurried and played very fast, he could get in nine holes before he had to head home. Just as he was about to tee off an older lady shuffled onto the tee and asked if she could accompany the young man as he was golfing alone. Not being able to say no, he allowed the her to join him.

To his surprise the lady played fairly quickly. She didn't hit the ball far, but plodded along consistently and didn't waste much time. Finally, they reached the 9th fairway and the young man found himself with a tough shot. There was a large pine tree right in front of his ball - and directly between his ball and the green.

After several minutes of debating how to hit the shot the lady finally said, "You know, when I was your age I'd hit the ball right over that tree."

With that challenge placed before him, the youngster swung hard, hit the ball up, right smack into the top of the tree trunk and it thudded back on the ground not a foot from where it had originally lay.

The lady offered one more comment, "Of course, when I was your age that pine tree was only three feet tall."