Peripatetic pathway to public health

Cate Swannell
Med J Aust
Published online: 27 August 2019

AS career shifts go, Dr Fiona Charlson’s is one of the more intriguing.

Her parents were a teacher and a plumber, and apart from one uncle who was pharmacist there was little in her family history to suggest a future in science, research or medicine.

“Maybe [my uncle] was the inspiration, but to be honest, I didn't have any massive driving direction,” Dr Charlson tells the MJA. “I excelled in math and sciences through school and knew I always wanted to do something in health.” A Bachelor of Pharmacy followed but something else was nagging away in the back of her brain.

“I wanted to do public health before I even knew public health was a thing,” she says.

“This was early 2000, when I started thinking more broadly, but it was the fairly early days of public health. It was a bit invisible.

“I was living in Hong Kong at the time. Talking to a pharmacist colleague of mine, I described what I wanted to do. He said, ‘It sounds like you need to do a Master of Public Health’.

“I looked it up and thought, ‘oh my God, that's exactly what I need to do’.”

Now a Conjoint NHMRC Early Career Fellow in the School of Public Health in the University of Queensland’s Faculty of Medicine, Dr Charlson’s career path has been peripatetic, taking her from pharmacy to global mental health, via New Zealand, Hong Kong, Geneva, Africa, South East Asia and various South Pacific islands.

Halfway through her Masters program at Hong Kong University, Dr Charlson was offered a field placement in Liberia through Medicins Sans Frontieres, as a pharmacist.

“That just cemented with me that I needed a major career change,” she says.

“Liberia was 3 years post-war. The infrastructure was decimated. I was working in the MSF paediatric hospital, and we had three primary healthcare clinics.”

Dr Charlson came back to Australia and finished her MPH in Sydney while working with Scientia Professor Louisa Degenhardt at the National Drug and Alcohol Research Centre at the University of NSW. Then MSF came back to her with the offer of work in their Geneva head office with their Campaign for Access to Essential Medicines.

“It's an advocacy campaign, but also I was in the pharmacist team and we were working with drug developers and generic manufacturers, lobbying for price reduction,” Dr Charlson explains.

After a year in Geneva it was back to Brisbane, with her French husband and a baby on the way. Professor Harvey Whiteford, professor of Global Mental Health at the University of Queensland offered her work, 1 or 2 days a week.

“Ten years later, I’m still there, and I still love it,” she says.

“I always imagined that I'd be in maternal child health or HIV – one of the big-ticket items at the time. When I started working in mental health, learning about it and becoming so much more aware, I just thought, no, this is where I need to stay.”

These days Dr Charlson collaborates with the World Health Organization, in Geneva, and Fiji. She also works on the Global Burden of Disease Study, where she is responsible for the mental disorders components.

“I do quite a lot of global work, and I'm drawn to working with disadvantaged populations. Of course, there's a lot in Australia as well, and I do work in Australia’s Indigenous population,” Dr Charlson says.

At the moment she is scoping research needs for climate change-impacted populations in Australia, including regional and rural drought-affected areas.

In the immediate future Dr Charlson is working with the WHO to get a mental health indicator included in the Sustainable Development Goals.

“The indicator would be looking at service coverage, which has been really challenging for us to reliably measure across countries,” she says.

That's been a big focus -- to get a mental health indicator in, but before we can do that, we need to be able to measure what we want our indicators to be, which I know has not just been a challenge for mental disorders. It's been a challenge for everyone. How do you get a standardised indicator which is reliably captured across every country?

“Suicide rate is an indicator. It's been adopted and that is noted, but that's relatively easy because it's death. It's generally recorded quite well. What we're looking at is how many people are receiving treatment that need it. That's a whole other layer of complexity, relying on health information systems to capture patient data ethically in a consistent reliable way.

“We are making progress. We've designed a tool, which we're field testing at the moment in some countries.”

Dr Charlson’s other passion is mentoring and nurturing young women in research.

“A lot of people [in research] are employed on soft funding. It's contract to contract, and it's not always particularly nurturing to people who want to have children or take time off or have that flexible arrangement. It's quite cut-throat. If you're not pumping out research, then it’s so competitive to get a fellowship, for example.

“I landed in a really lucky place, with a seriously amazing boss, but I know that it is tough for everyone. There's a lot of pressure, and you have to be quite independent. If you're a person who maybe needs a bit more support and guidance -- that's why I want to nurture young women because it's not easy to find a mentor, someone to guide you through.”

How does Dr Charlson sell public health to a roomful of medical students eyeing off the more prestigious specialties?

“I think some maybe don't realise what public health is, and when you start talking about what it is, they're a bit like I was 15 years ago. At symposium days we've had here at UQ for medical students, I've had them come up to me and say, ‘Oh my God. That's exactly what I want to do’.

“They'll go on and finish their medicine degree, but with the awareness of what public health is, and how that impacts their clinical role and how their day-to-day practice is intimately tied to public health.”

Dr Charlson’s message to medical students is to take a few risks along the way.

“I think if you allow yourself to veer off the road sometimes and take a few risks and not be locked down in a career path, then lots of great things can come about that are really rewarding,” she says.

“Whatever you're drawn to, allow yourself to be drawn to that. Don't be locked into ‘this is what I did at uni and this is where I'm supposed to be going because Mum and Dad and my lecturers told me’. If something sounds interesting to you, just go off and try it for a year and come back.”

  • Cate Swannell



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