Jin Russell: 'Let's have a conversation about child development'
2 August 2021
Dr Jin Russell is working at the coalface of children’s health and says poverty has a major effect on childhood development as well as contributing to illness.
Dr Jin Russell’s lightning-bolt moment came during a night shift as a paediatric registrar in the emergency department (ED) at Middlemore Hospital.
“I was working with a public health physician and she said to me, ‘Come here and look at the whiteboard. This is the list of all the children in the emergency department. For every single one of these children here, the underlying diagnosis is poverty’.
“That really hit me. I read a lot of material that confirmed the international evidence around the impacts of poverty and disadvantage on children’s development. Around the same time, I had heard a seminar by Professor Susan Morton about the longitudinal Growing Up in New Zealand (GUINZ) study, so I latched onto that because children’s development is so important.”
Jin completed her medical degree in 2007 and entered specialty training in paediatrics. She graduated as a developmental paediatrician in May, becoming a Fellow of the Royal Australasian College of Physicians.
“Working at the hospital, I was seeing children coming in and out of ED. I realised that it was like a revolving door. We would fix them up and send them home, and they would come back again with the same illnesses. I thought, what’s happening here?”
Answering that question has now become important to her as a physician, academic and a member of society.
Two days a week she works as a consultant developmental paediatrician at Starship Children’s Health and two days she writes her PhD. In 2020 she was the Starship Foundation Fellow and that research is incorporated into her PhD research with GUINZ. Seven days a week she’s mum to two boys aged four and six, and wife to Dr Matheson Russell (from Philosophy) whom she met at church around 12 years ago.
She also keeps busy on Twitter @drjinrussell where she regularly raises issues of health inequity and Covid-19 misinformation.
“I like communicating, I like writing. When I was a kid, I did more writing than anything else.”
That includes creative writing but she has to make do with Twitter and writing op-ed pieces while she’s this busy with work, study and parenting. She admires Dr Renee Liang who is a poet and playwright as well as a paediatrician.
The mental load of poverty means it’s harder to give children your best attention.
Jin’s thesis looks at health inequities that lead to some children being behind in their development before they head to school. It’s being supervised by Professor Susan Morton along with Professor Cameron Grant who, as well as being part of the Faculty of Medical and Health Sciences, is a general paediatrician at Starship.
“During 2020, my research for the Starship Foundation and clinical work at Starship was a full-time job – there was little time for my PhD. But I’m nearly there, it should all be finished next year.”
Covid-19 was also an interrupting factor.
“I had to pause my PhD work. There were plans for my team to be redeployed to work in acute wards if needed in 2020. I went back and did advanced cardiac life-support training and that sort of thing, just preparing to be of use on any ward. Fortunately, in the end, I wasn’t needed. But Covid was still disruptive for routine hospital care. I spent all of last year trying to just keep up with my hospital work.”
Jin wasn’t too worried about the thought of being on the front line during a pandemic but was concerned for her mother who is a GP in her 70s.
“I asked her to retire but they were really short of doctors at that time so she decided to continue working once there was plenty of PPE.
“Mum speaks three languages, Mandarin is one of them, and just before the government closed its borders to China, she had seen a string of visitors from China, people who’d managed to get out of there, even one from Wuhan so I was really worried for her.”
Both of Jin’s Malaysian Chinese parents have medical degrees.
“Dad graduated from Singapore University. And mum was a graduate of the first medical class of the University of Malaya when only a handful of women were in the class.”
Her parents moved to Christchurch in the 1970s, then to Wellington. Jin won scholarships and did her schooling in Wellington, before moving to Auckland to study medicine.
Although her life is hectic, she loves research and working in a field that’s important to her.
“Society is talking a lot about how poverty affects children’s physical health. Poverty means kids get more skin infections, or are at greater risk of pneumonia or being hospitalised with respiratory infections, which we’ve seen a lot of this winter.
“But we don’t seem to be having a national conversation about how poverty affects children’s development, and this is just as important as their physical health.”
Jin says as much as she enjoys the hospital environment, there is something special about academic life.
“At heart, I’m a learner. I love that you have space to look at the big picture and to set aside time to learn and think about complex questions. I like the way that the academic community grows and learns together.”
I was seeing children coming in and out of ED like a revolving door. We would fix them up and send them home and they would come back with the same illnesses. I thought, what’s happening here?
Although she’s immersing herself in academia, she admits to missing being ‘on call’ a bit.
“One of the things I found really hard back in the university environment was that I’d been working in ED doing shifts in neonatal intensive care and that sort of thing. I was used to being on call constantly, and I found it hard not to be on call.”
But there are certainly advantages – sleep being one of them.
“Doing a PhD has meant I get to think about abstract problems and about the health of the whole population, rather than just the one child in front of me. I’ve found my PhD uses a different part of my brain and I’ve loved that.”
From reading to writing, swimming and baking, Jin is undoubtedly one of those people who uses every part of her brain.
“I enjoy being a part-time academic and don’t think I could give up my clinical work. I just love seeing children in the clinic and the two facets really complement each other. That’s why there are a lot of academic-clinicians because you stay in touch with the real-life issues.
“There’s nothing quite like child epidemiology – you can look at outcomes across a whole population which is so interesting. It also grounds me when I’m doing Starship work.”
Jin had been working at Starship for two and a half years before she began a contract as a permanent consultant in Starship’s developmental paediatric service, working with children with developmental difficulties and disabilities.
There’s a strong sense of social justice and political opinion running through Jin’s veins. But is there any frustration about whether we can enact change to address inequities in health?
“I’m actually really hopeful. I don’t mean about enacting change as a single agent. I mean that I’m working in highly networked areas where child well-being is at the centre of lots of different organisations. There’s a strong child advocacy theme to New Zealand life and how we think of ourselves as a fair society.
“We’ve seen a massive rise in acceptance of talking about child poverty, for a start, and a lot of progress as a result. We now have the measuring and monitoring framework necessary to make more progress. New Zealand is actually a great place to do advocacy and research, because it’s a community in which you make multidisciplinary connections. I think this is why we have a history of being very progressive. Obviously there’s a huge amount of work to be done, but I do feel hopeful.”
She says the biggest change she would make if she were in power – that would directly affect child health and development outcomes – is to introduce a liveable income.
“Poverty is a massive determinant of many outcomes for children. Not being able to afford fresh fruit or vegetables, or trips to see the doctor, poor housing – these factors have such an effect on children’s health and well-being and on their development.
“Parents who are under financial stress can struggle at home, and the mental load of poverty means it’s harder to give children your best attention.
“Fixing poverty is a lever to pull that has multiple positive effects.”
Social disadvantage has multiple facets. There’s not one thing you can do that’s going to fix everything. But if you can decluster disadvantage, people can do a lot better.
She says research coming out of GUINZ shows that children’s development and health outcomes are on a gradient. Incremental gains in children’s health and development help by lifting children from the lowest end of the gradient towards the middle. She says there’s not a dollar figure that solves everything.
“We need to tilt that gradient back so it’s not so steep and so there’s not such a big gap between children who have and the children who don’t. We may not be able to eliminate the gaps completely. But we can definitely reduce them.”
She says trying to reduce inequities in health and development has measurable outcomes.
“It comes down to declustering disadvantage. Social disadvantage has multiple facets. There’s not one thing you can do that’s going to fix everything. But if you can decluster disadvantage, people can do a lot better.
“As an example, maybe a family will have better housing than they did last year. That’s a start.”
Her Christian beliefs drive her determination to help.
“I try to do things that I find really meaningful, and I’m pursuing a career that makes the best use out of my skills and my passions.
“Faith is a major driver behind a lot of the advocacy work I do. The central tenet of the Christian gospel is to love your neighbour as yourself. That’s a pretty tall order but at a population level it’s about what’s fair and what’s not fair. I’ve never shied away from thinking about those things.”
This story first appeared in the August 2021 edition of UniNews magazine.