By Neena Bhandari

Growing up in suburban south Sydney, Rebecca Ivers and her siblings were always encouraged to strive for academic excellence and work towards making a positive difference in people’s lives. She got involved with a group called Student Initiatives in Community Health while doing her undergraduate degree in optometry at the University of New South Wales [UNSW]. It triggered her interest in population and public health and gave her an understanding and interest in inequality.

It was while practising as an optometrist in the Northern Territory that she discovered that few Aboriginal people would come to their clinics. She became keenly interested in the health of Australia’s first people and began working for the Northern Territory Aboriginal Eye Health Committee.

“I began hitchhiking on the AirMed Medevac flights to service remote rural Aboriginal communities, but soon realised that one needed to do more than just treat one patient at a time. There was a need for systemic change in the health system”, says Professor Ivers, who retrained in public health and epidemiology and did her doctorate on the relationship between poor vision, falls and hip fractures in older people, which kickstarted her career in injury.

She was amongst the Institute’s initial team of researchers. “It was a perfect opportunity to pursue both my interests – global health and inequality”, says Professor Ivers, who is currently the Director of the Injury Division and Professor of Public Health at the University of New South Wales, Sydney.

She has been involved with the Institute’s work in India since its inception. The main focus of her work has been around health systems, management of injuries, treatment of fractures and traumatic injuries, and falls prevention. “We are working on understanding best models of care to treat serious burns and care of people following road traffic injuries. A study we conducted in Chandigarh with the Postgraduate Institute of Medical Education and Research followed nearly 3000 people after injury to establish out of pocket costs, and impoverishment due to healthcare costs”, says Professor Ivers, who is also associated with a big trauma collaboration, the Australia-India trauma Systems Collaboration, which works with AIIMS and other groups in India to advance trauma science in both India and Australia.

She is also working on International Orthopaedic Multicentre Study in Fracture Care (INORMUS), an observational study across three continents, 18 countries with over 40,000 participants to determine incidence of major complications (mortality, re-operation and infection) amongst adult individuals admitted to hospital with musculoskeletal trauma (e.g. fractures or dislocations).

INJURY AS A PUBLIC HEALTH PROBLEM: While it has been a challenge to prioritise injury as a public health problem and get funding for researchers, she says, “The Institute has become a significant player in India because our work on injury surveillance and road traffic injuries, which we have been doing for the past decade, is high impact and people can see that it does lead to change. My main focus has been to help grow a team in India that’s leading injury work, given that it is the leading cause of death and disability amongst young people. We really need to see much greater investment and time in building capability in the Indian researchers focusing on injury”.

“We still have a long way to go to actually help people understand that these injuries [road accidents, falls, burns] are not “an act of God” or something that just happens, but they are preventable, that they’re predictable, and that we can actually do something to make sure that they don’t happen. When we have talked to older people in slums around fall prevention, they say, “We’ve been knocked down in the street all of our lives. Falls are things that happen to us as poor people”. Comments like that really help us to understand the context in which people are falling and the context in which they live their lives. We know that people who are poor and marginalised are going to be at higher risk. So, it really is telling us about where we should be investing our time and energy”, she adds.

FUTURE GOALS: Professor Ivers, who would like to see much bigger impact studies on injury in India says, “I think there’s a real need to do work on prevention of road traffic and major preventable injuries. Falls and ageing will pose a huge problem in the next 20 or so years as the population ages. There isn’t sufficient infrastructure or healthcare for older people. More work is needed on management, both prevention and cure, of chronic diseases and injuries in older people and the Institute is in a good position to do that; working with the government and international research collaborations”.

Note: This interview is part of the 10th anniversary of The George Institute for Global Health in India booklet.

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