Dr Jin Russell: Fired up to get things right for our children

You can be forgiven for thinking that voices of reason are in sharp decline in Aotearoa, especially if you’ve been doom scrolling the developments at the protest in Wellington (where tin-foil headgear to repel radiation attacks seems to have become the latest must-have protest accessory).

But among the voices to have emerged during the pandemic, and worth listening to, is Dr Jin Russell, a developmental paediatrician in Auckland.

As well as dispensing sensible advice on keeping children safe during the pandemic, Jin is doing a PhD in paediatric epidemiology. Her research confirms the lasting damage that poverty can lead to. But by no means are the pointers all negative. For instance, there’s an indication that Māori and Pacific households often give their infants an “edge” in their social and emotional development. 

Here she is talking to Dale Husband.

 

Tēnā koe, Jin. You’re not only a doctor but, so I understand, your mum and dad and your brother are doctors as well. That’s impressive from a single whānau.

Yes, all four of us have medical careers. At one point, Dale, I calculated that our family had already contributed 120 years to medicine in New Zealand.

And how did that come about?

Well, first, I’ll explain how my parents got to Aotearoa. My father, Heng Teoh, and my mother, Yeen Chan, were born and grew up in Ipoh, a small tin-mining town in Malaysia. My father’s side of the family is originally from the Fujian province in China and they speak Hokkien.

Where the Hokkien noodles come from?

Yeah! Same Hokkien!

My mother’s side is Cantonese, originally from Guangzhou, a southern province in China. But both Mum and Dad grew up in Ipoh, in the state of Perak. And when they were teenagers, there was a missionary from New Zealand who came to their church — and he used to talk about how beautiful his country was. He said it was heaven on Earth. 

So, when my mum and dad graduated from university as doctors in the 1970s, they came to live here in New Zealand.

And later, there was an unusual link because my brother, Laurence, married a girl from Cambridge, Louise, my sister-in-law, whose family church was the one that had sent that missionary to Ipoh. 

So, it feels to me like New Zealand had called to our family from a long time back. 

Were there any barriers that your parents had to overcome? It’s a big decision to leave your country and your whānau.

Mum and Dad both come from large families. So, moving to Aotearoa was a big decision — and it was something that, only now, as an adult, I can fully appreciate.

When they moved to Christchurch, my father had his medical degree from the University of Singapore, and it was recognised by the New Zealand Medical Council. But my mother graduated from what was then the University of Malaya, now the University of Malaysia, and her medical degree, initially, wasn’t recognised. 

However, the New Zealand Medical Council made an exemption for her, and in the end, my parents were both able to work, and they did their specialist training in New Zealand. My father is a neuropathologist and my mother is a general practitioner.

Laurence, who’s four years older than me, is a rheumatologist. And, at the moment, all of us are still practising medicine. 

In your early days in the 1980s, what contact did you have with Māori and Pasifika?

Laurence was born in Christchurch in 1979, but then my parents moved to Wellington where I was born. I grew up in Maungaraki, in Lower Hutt, and I went to a school where there were hardly any Māori or Pasifika students. 

One of my closest friends at high school was the only Māori student in my year. So, one of my memories growing up in Wellington was that it just seemed a very segregated community.

It was a big cultural awakening for me when I started working as a house surgeon at Middlemore Hospital and encountered a whole other side of Aotearoa. A real eye-opener. 

Much of your work has followed on from your experience there. But why did you go into medicine?

When I was five, my parents had a dinner party, and a grown-up asked me what I wanted to be when I grew up. I said I wanted to be a doctor like my mum. The answer just kind of came out of me. I felt that being a doctor was just the best thing that I could think to be. 

In Wellington, I went to Samuel Marsden Collegiate School. I was there on a scholarship, because Mum and Dad didn’t have a lot of money. They were sending money back home to Malaysia to support their families. 

I was a little bit self-conscious about how we didn’t have as nice a home as, for instance, some of my classmates. And I was already keen to do medicine, but the other thing that took my fancy was writing — and, all the way through high school, I had teachers who coached me in creative writing.

I always wanted to combine medicine and writing, and I feel like it’s only in recent years that I’ve been able to bring those two things together.

But what was it that interested you so much about societal issues and how they can have so much impact on our kids’ health?

What drew me into paediatrics was just the wonder of children’s development. Children develop, for the most part, in an almost magical way. As a parent myself, it’s just such a delight. 

I work now with a lot of children who are disabled. Watching them learn new skills is also a great privilege — and celebrating achievements with their families is a joy.

I’ve always been fascinated by children’s development, so it made sense to go into developmental paediatrics. Then I became interested in community paediatrics, which is a sub-specialty that looks at how children are embedded in their environments and in relationships. It pays attention to the way social systems and relationships influence the development and health of children. 

Medicine itself has become increasingly technical in many aspects. But there are some sub-specialities, where there’s more focus on the child within a social system and within a family unit. 

I’m also working towards a PhD in paediatric epidemiology, where I look at things like where you grew up and what the circumstances were. 

So, the paediatric fields where I’ve ended up all coalesce around this idea that children’s development is shaped by their whānau relationships and by the sort of society they’re in. 

I’m picking that their development is hugely affected as well by economics because it’s that which determines the housing, overcrowding, poverty, skipping school, and not having jobs. And you’d have become familiar with all those factors in your time at Middlemore Hospital? 

My time at Middlemore was a moment of awakening for me in understanding the social drivers of health and development. These things are beyond people’s choices and behaviour.

Often when I was working night shifts, I’d come across families, some of whom were migrants, who were having a very different experience in life than I was. They were having to overcome multiple disadvantages. 

One time, a three-year-old girl was brought in because she was wheezing. She had a virus, and she was wheezing. They were a Cambodian migrant family. The father didn’t speak English and so an uncle was there translating for him.

This little girl had come in many times with a wheeze, and the hospital had treated her and sent her back home. But, when I went into the history, I found that they were living in substandard rental housing. It was mouldy and overcrowded. 

I wanted to know where the mother was. Because, you know, often in the middle of the night, children are brought it with both parents or just by their mother. The uncle said that the mother was working at a factory packing chickens but would be there soon. 

I remember going back to my desk and thinking about the number of disadvantages facing this little girl. 

Firstly, you’ve got the issue of poverty and housing. Then there are the knock-on impacts leading to her needing to be seen in hospital quite frequently. You also have the parents working difficult shifts for low pay. And then there’s the disadvantage of being a migrant family and having English as a second language.

We like to tell and hear stories about how people overcome obstacles — and they absolutely can, because the human spirit is incredible. 

But, in this case, I wanted to understand, through statistics, how badly the odds were stacked against a child like that. And, more importantly, understand what we could do as a society to reduce the social disadvantages that she was facing. It fired me up to want to get things right for young children.

It sounds like you’re tapping into the Growing Up in New Zealand longitudinal study — and getting some valuable data from that research?

Yes. I’m writing up my thesis at the moment. What I’ve found in my research is that these inequities arise in the first thousand days of a child’s life — and they’re measurable by the time children turn two. 

Growing Up in New Zealand is the country’s largest child cohort study — it’s contemporary, it’s diverse, and it’s got incredibly rich data from that first thousand days of children’s lives. 

I’ve used the data to try to map out children’s developmental trajectories and to see what extent disadvantage and advantage affects those trajectories. 

No doubt there are already some positives coming out of your work.

I think it’s important to note how resilient children are. Statistics give you only part of the picture. 

One of the things I’ve learned in clinics and sitting with whānau, is just how determined whānau are to support their children and get a good life for them. And that gives me great hope.  

So, when I’m using data from Growing Up in New Zealand or reading international studies that might show inequities for certain groups, I’m always bearing in mind that there are capacities within our ethnic minority groups and within Indigenous groups, which are difficult to measure, but they are real and important.

There’s your sense of belonging, your sense of who your family are and what your whakapapa is. And there’s your sense of spirituality and where your roots are. 

Having large family groups, and having aunts and uncles and cousins all around and other people involved in your life — all that buffers you. It creates resilience. It’s good for your mental health. It’s good for your social and emotional development. 

In the data that I analysed from the study, I found that Māori and Pacific infants were rated highly by their mothers for their social emotional skills — and they were rated higher than other ethnic groups in their social and emotional skills. 

So, one of the things that I hypothesised was whether there was something about growing up in a Māori or Pacific household that might give you an edge on those skills.

Another thing that I think we’re starting to do as a society is to recognise the skills and aptitude of Māori and Pacific children. In scientific research, the measures and tools we use to measure children’s development have often been developed in western nations. 

And I’ve been interested in whether those tools and measures are actually picking up developmental capabilities that are important for Māori and Pacific people. 

You’ve worked with many Māori families over the years. Do you have any thoughts on how we could use more tikanga or mātauranga to complement western medicine and do a better job of setting up our tamariki for a healthy future?

What I can tell you is that it’s become especially important to me over my career as a paediatrician to learn how to be a good Treaty partner. 

When I was in medical school at the University of Auckland, I went to a lecture by Professor Papaarangi Reid where she put out two chairs facing each other. 

She asked one of my Māori classmates to sit in one chair and asked some of the Māori students to stand next to her.

Then she asked one of the Pākehā students to sit in the other chair, and asked students whose families had migrated to New Zealand to stand next to him. 

Papaarangi explained that the Treaty creates space for everybody in Aotearoa — and that, if you were here because your parents or your family had immigrated, then you were Tangata Tiriti.

That concept of being Tangata Tiriti has become increasingly important to me over the years. I’d say it’s as important to me now as being ethnically Malaysian Chinese is important to me. 

I’m on a journey to work out how I can be the best Treaty partner that I can be in the health system. Lots of clinicians I know and work with are on a similar journey. 

And I think when we put our hearts into this, that’s when we’re going to be able to transform our health system from the inside, to make it a space where Māori and Pacific whānau flourish. 

In some ways, the pandemic is a microcosm of the issues we face. It’s a case study of how inequities in the health system play out. And I really hope that we learn something from this. 

Over the pandemic, I’ve appreciated working closely with my Māori paediatric colleagues, up and down the country. There are actually disproportionately few Māori paediatricians, given the younger age structure of the Māori population. 

One of my colleagues has said that, if the proportion of Māori children were properly represented in the make-up of the New Zealand health system, you’d expect there to be more than 100 Māori paediatricians. Instead, there are seven. I would love to see more Māori paediatricians.

Of course, we have Omicron in our midst now, and a lot of your recent public mahi has been in making sure that parents get good information about how to keep their children safe. What would you say about where we are with our current rates of Covid vaccinations for 5- to 11-year-olds, especially for Māori and Pacific children?

Almost half of the children who are 5 to 11 years old have already had their first dose. That’s fantastic. But there’s signs that Māori and Pacific children are missing out already compared to other children. We need to close those gaps and make sure they’re well protected.

And what would you say to parents who are still unsure about the safety of the vaccine for their children? 

The Pfizer vaccine is an incredibly safe vaccine for children. It’s one third the dose of the adult dose. It’s very protective against serious complications of Covid, like needing to be in hospital or multisystem inflammatory syndrome. 

Covid is less severe for children than for adults — but it can be unpredictable. We don’t want to see children in hospital from Covid if we can protect them with a very safe vaccine.

Now, Jin, let’s turn from medicine to one or two other topics. Like music. Do you play any instruments?

Yeah, I do. Violin and piano. To be honest, though, I don’t consider myself very good, even though I learned from a very early age. I started with the violin when I was three.

Do you pull it out now and again to share it with the kids?

I do, just to try and impress my boys. They don’t know how bad I sound because they’re still young. Chester is seven and Toby is four. 

And who’s your lucky bloke?

That’s Matheson Russell. He’s a good man. He’s a political philosopher at Auckland Uni. He’s originally from Australia, but he now calls Aotearoa home.

Finally, Dr Jin Russell, let’s hear about one aspect of your life that may surprise readers.   

A few years ago, I challenged myself to learn how to swim. Despite growing up in New Zealand, I never became a swimmer. So, I started taking adult swimming classes.

And I tell you, that’s just one of the most humbling experiences. When I started, I couldn’t swim to the end of the pool. I was there with all these other migrants because most New Zealand schoolkids, at some point, get swimming lessons. 

So here we’ve been, coming from all different parts of the world and now living in New Zealand, and we’re all learning how to swim because now we live on islands. 

But I’m a terrible swimmer. Yes. Terrible.

(This interview has been edited for length and clarity.)

© E-Tangata, 2022