A bright scientific mind leaves his mark on Indigenous health
Early in the 1980s, a young medical student sat with a crisis. He’d chosen to study medicine after tossing up the options of engineering or law – and he wanted his choice to count.
“I had that classic existential crisis. I realised I am on this planet for three score and ten years, and I asked myself, ‘What can I do to make a difference?’ That dilemma stayed with me, and that’s what lead me eventually to research,” says Jonathan Carapetis, pediatrician and outgoing director of the Menzies School of Health Research in Darwin.
“As a doctor you can make a difference to an individual, and it’s great to see that immediate result. But you can only deal with so many patients in a day; whereas with research you can potentially change a whole system.”
That same ambition led Carapetis to Menzies in the Northern Territory (NT) in 1994, and later to take up its top job in 2006.
Over six years the School’s grown from a staff of 100 to around 400 and the organisation’s turnover has grown by $20 million. It has also expanded its scope in a range of areas, including mental health, child health, education and training.
“When I took on the directorship I saw an opportunity to broaden our view of what health is and what wellbeing is. To continue to focus on what we do well – which is biomedical research around diagnosing, preventing and treating disease – but also to think, ‘What are the true determinants of health that are not within the health sector?’ They’re housing, they’re poverty, they’re education,” he says.
This train of thought set Menzies on a course that was new to Australian health research. Carapetis initiated talks between Menzies and the Department of Education, and he strengthened ties with the Northern Territory’s Charles Darwin University. His end goal was a big one, 20 to 30 years in the making: to set up an institute equivalent to Menzies, but with a focus on education and child development.
“To get started we put education and health researchers together to tackle the important questions around education research. We saw that we as health researchers knew a lot about early childhood. We understand how to do research and evidence-based practice, while the education specialists are well-versed in teaching and learning,” he says. “I was amazed at how there was a hunger for this sort of approach. Everyone just lapped it up.”
From there momentum grew. In 2007, Menzies gained a grant to evaluate a preschool service model; and in 2011 it established its Centre for Education and Child Development, headed by eminent researcher Professor Sven Silburn.
For Carapetis this area of research is a personal, as well as a public, passion. “I am a pediatrician. I want my work to make a difference to the kids, to set things up for future generations. Once they become adults, the die is largely cast. You can make adjustments around the edges – but it’s in childhood that there’s the real chance to have an incredibly positive influence.”
Second on his agenda was mental health. Under the leadership of renowned Indigenous mental health specialist, psychiatrist Tricia Nagel, Menzies founded the Healing and Resilience division. Thus far, the team has developed brief interventions for identifying and treating mental illness in remote communities. More recently, it has begun work on alcohol abuse (with patients admitted to the Royal Darwin Hospital) and has been instrumental in evaluating alcohol management programs around the NT.
Though reticent to paint himself as a ‘white fella’ expert, Carapetis sees the key to improving Aboriginal health as two-fold: it stems from ‘self-determination’ and a focus on kids. Above all, he believes in setting up the means for Aboriginal people to be able to take control over their own lives, “without having policy-driven solutions for how they will take control over their lives.”
“In the end, if the next generation is equipped educationally, is brought up in way that’s nurturing and that values community development, economic development and taking care of themselves, then that’s the future,” he says.
His approach, and the role he sees research playing, is to help develop an evidence base that lets us see what works best and what doesn’t – a solution that might help to take decisions out the political atmosphere and into a more constructive, forward-looking space.
A shining illustration of the School’s commitment to research that delivers practical change is Rheumatic Heart Disease Australia (RHDAustralia). “It’s a great example of research translating into policy and practice,” he says.
Australia has amongst the highest recorded rates of RHD despite the disease being almost eradicated in most developed countries during the second half of the 20th century. To tackle this, Menzies launched a National Coordinating Unit in 2009, funded by the Australian Government and in parternship with two other institutes: Baker IDI and James Cook University.
RHDAustralia coordinates a strategy and support system for RHD control programs across the country to improve diagnosis and treatment as well as prevention. “This system also lets us identify the priority issues for research, and tailor our research accordingly,” he explains.
Looking to his own future, Carapetis will next month move to Western Australia to head up Perth’s Telethon Institute for Child Health Research, taking over the post from public health specialist Professor Fiona Stanley.
When pondering what he’ll leave behind, he speaks with a mix of hope and sadness. The Territory has burrowed its way deep into his heart, and he’s sorry to leave it. But he’s pleased with the shape in which he’s left Menzies.
Its future is bright, he believes, predicting big things for the School’s tropical and global health research, among other things. “Over the past few years we’ve seen this team broadening its scope. It now researches tuberculosis, maternal and child health, nutrition, vaccines, staph and strep infection.”
The group has also stretched its arms geographically – expanding to numerous countries in Asia and partnering with Timor Leste’s national health department. The latter, he says, gives Menzies the opportunity to help one of the world’s newest countries take an evidence-based approach to child mortality, malnutrition, malaria and dengue fever.
His other hope for Menzies: that it continues to build skills in remote communities and among Indigenous staff. “That’s a real growth area for us: being the best at community-based research and supporting the development of Indigenous researchers. We’d like to see research become a career path for people in communities.”
Thirty years after his student existential crisis, his belief in research – and fellow researchers – continues to fuel him. “Wanting to make a difference is still what drives me. I see research as the way to make an even bigger difference.”