Dr Jin Russell is a community and developmental paediatrician at Starship Children's Health. She is also working towards her PhD in the field of life course epidemiology with the Growing Up In New Zealand study at the University of Auckland. Through her work at Starship, Russell has come to realisethat child poverty is the primary driver for poor health outcomes for our tamariki.
My parents tell me I was a very happy child. They tell a story - I can't believe it now, as it's developmentally impossible – but apparently, the first thing I did when I was born, I looked at Mum and I smiled. I was also a curious child, and very sensitive to the needs of others. When I was little, we would visit family in Malaysia, and I always had this overwhelming sense of gratitude when we returned to New Zealand. In Malaysia, out the windows of trains you'd see shanty towns beside the tracks where families lived in ramshackle houses, or on the street, in extreme poverty. We were in a restaurant once, in my parents' home town of Ipoh, and I saw an old man on the street begging with a cup in his hand, and I used to feel a huge amount of empathy towards those less fortunate, while also feeling very lucky to be growing up in a country with a social welfare system and a sense of neighbourliness.
When I was about 5, an adult asked me what I wanted to be when I grew up and I said, "I want to be a doctor like my mum." It's as if I was binding myself to that outcome by saying it, because that's what happened. Even though I loved writing, thinking and reading, my ambition was always to become a doctor and to help people. On the last day of high school, when I told my English teacher, who'd been so supportive of my creative writing, that I was going to medical school she said, "what a shame".
Medical school was fun but very intense. We had to absorb a huge amount of information but what most took me by surprise was how technical a discipline medicine was. You have to master chemistry, biology, anatomy, pathology. Once you get your head around all that technical information, then you are able to enjoy medicine as a craft. Someone once said "medicine is the junction between the humanities and the sciences" and that really resonated with me. Being a junior doctor was also very tough emotionally.
Dr Jin Russell is working towards her PhD in the field of life course epidemiology with the Growing Up In New Zealand study at the University of Auckland. Photo / Supplied
When I first went through the children's ward, as a house surgeon at Middlemore, I saw kids in wheelchairs sparring with each other and a toddler with an IV line in her arm running away from the medical team and I thought "this is where I want to work". I love this happy chaos. I also enjoyed how, when you work with children, you admit them, treat them, and mostly they bounce back and when they start playing, you can send them home.
I had an epiphany at Middlemore when I was a junior doctor. I was working the night shift when a little girl of about 3 came into ED with wheezing. She was Cambodian, her father spoke little English and they'd brought an uncle as a translator. I asked uncle where the mother was, as mums usually bring kids in in the middle of the night. They told me she was working at a chicken packing factory. As I listened to the girl's chest - I could hear her struggling to breathe - I asked about their social history and was told that their house was damp and mouldy. When I went back to the desk to write up the notes, I sat with that for a moment. This girl had been in a number of times, and she faced numerous disadvantages through poverty, housing, the language barrier and all those things were affecting not just her health, but her long-term development and I started to think about how society might support children in the most positive way.
That epiphany led me to think about social drivers of health and development for the people coming into our hospitals. The economic and cultural factors, and historical influences, over the course of a life. I also read articles, scientific papers and books about poverty's impact on childhood health and development. Eventually, a colleague suggested I do something formal. I spoke to researchers at Auckland University and other paediatricians which led me to do my PhD with Growing Up In New Zealand. Life course epidemiology is a diverse field of study, and as a discipline it gives me a framework for how we can do our best for children.
I enjoy having time during the week to think about the big picture, but when you're doing population-level health work, you don't really know how you are impacting people, which is why I'm also grateful to have two days a week to work with families and children in the clinic, to be able to think deeply about one child and what they need. Then I step back into the academic environment and think about what policies are needed to support families across the board, to help kids reach their full potential. But it comes down to the same factors every time, the circumstances you grow up in have a long-reaching arc of influence over your whole life.
Through her work at Starship, Jin Russell has come to realise that child poverty is the primary driver for poor health outcomes for our tamariki. Photo / Supplied
When health professionals advocate for change, their work is peer-reviewed by highly skilled networks of professionals and that is very powerful. This is why they make excellent advocates for health because we can take what we see on the ground and combine that with up-to-date scientific research and translate it into sensible ideas for policy.
One thing that gives me hope, is how child poverty has made it into public discourse. In just a short few years it has become the number one issue for many New Zealanders. Which is why it's really important that medical professionals share their stories and knowledge. Modern medicine has done such good job of hiding disease. We take children into hospitals, make them better and send them out, but many will come back with the same things because we don't talk about, or treat, the underlying causes of this revolving door of children's illness. In order to do better, we have to bear witness to the invisible drivers behind health inequitable health outcomes.
The pandemic has magnified all sorts of inequities in our health system and how they impact health outcomes, so when I think beyond this pandemic, I don't want us to return to the "normal" ways of doing things that allowed those inequities to exist. I want us to move intentionally towards building a new normal, which means actively dismantling the structures that led to health inequality - like poor housing, exploitative jobs, colonisation, the things that hold people back.
I'm an Anglican and I have a deep Christian faith. I know suffering is part of the human condition, but as human beings we can also help alleviate suffering by caring, being present and living generously. The reason I don't collapse into a heap at the end of every day is because I look for and see instances where the human spirit is working to overcome suffering and I hold on to that.
Epidemiological training has taught me to see things multi-factorially, and I'm working towards a vision of Aotearoa New Zealand as a place where every child flourishes, and where every family is supported. I will keep working towards that goal because that's the kind of society I'd like us to be.
