Making a global difference

Graham Brown vividly remembers the first conversation he had with the University of Melbourne’s Vice-Chancellor Glyn Davis.

“I said to Glyn, ‘What do you want?’ He said, ‘I want you to make a difference,’” Professor Brown recalls.

“He believes the role of a great university is to serve the community – locally, nationally and internationally.”

Six years after its inauguration, the Nossal Institute of Global Health can proudly claim a legacy. The Institute is a global leader on healthcare research, education and practice in the developing world.

The Nossal Institute engages heavily in research, drawing PhD candidates from a wide range of disciplines. One such candidate, Steph Topp, is a strong example of the Institute’s breadth of people and knowledge.

A Rhodes Scholar, Ms Topp completed a Masters in Public Health at the University of Sydney and a Master of Development Studies at Oxford University. She returned to Australia to work with Noel Pearson at the Cape York Institute in North Queensland.

“I concentrated on social and economic policy reform. This was a critical period for me, as I grappled with the inequity and politics of health in my own country,” Ms Topp says.

“Then in 2007 a friend happened to forward me an email about an internship that was going begging in Zambia with a non-government organisation, which had received US Government funding to scale up HIV treatment.”

HIV/AIDS has decimated sub-Saharan Africa. It is estimated that 15 per cent of Zambia’s population are HIV positive.

HIV-specific funding came to dominate Zambia’s health spending, sometimes at the expense of other issues. When Ms Topp arrived in the capital, Lusaka, per capita spending on healthcare was US$25. Of that, US$21 was spent on HIV treatment – most of which was sourced from donors. 

Such skewed spending is potentially damaging to the health system, as pandemic crisis management results in preventative medicine being neglected. Other organisations – such as the Centre for Infectious Disease Research in Zambia – try to fill the breach.

The emergency, episodic approach to HIV treatment had fundamental flaws. Ms Topp soon found herself leading a program within the Centre, seeking a more integrative approach to the African nation’s HIV care delivery.

“The separation of distinct HIV treatment from other health services didn’t make a whole lot of sense considering Zambia’s high HIV infection rate,” Ms Topp says.

“Although retrospectively, that’s easy to say because at the peak of the HIV emergency, the focus was really just on treating those most in need as quickly as possible.”

Immediacy is a theme Professor Brown is all too familiar with. Preventative medicine is hard to fund, as urgency dictates services. Symptoms replace root causes in the line for healthcare resources.

“It’s a situation that repeats throughout the medical world,” Professor Brown says.

“For example in Melbourne, we need to improve the health of the community by placing money into research and support services for diabetes, high blood pressure and heart disease.”

Preventative medicine funding models are often complicated, however, a consequence of budgeting for necessity and the prevalence of bureaucracy.

“The tragedy is that we often can’t get money for research on chronic diseases, because it’s a different budget from that which deals with urgent matters,” Professor Brown says.

“Middle-level management is hard enough to negotiate in Australia. In developing countries, it takes on even greater complexity.”

Non-government sponsorship and philanthropy are therefore vital for research to flourish. Professor Brown champions Ms Topp, because she integrates action and experience into her research.

Ms Topp returned to Australia in 2010, to begin a PhD into Zambian healthcare funded by an Australian Post Doctoral Award. First-hand experience underpins her research, which Professor Brown believes is a hallmark of the Nossal Institute’s work.

“Improved global health requires education research partnerships and field work,” Professor Brown says.

“We want to get researchers like Steph into clinics and hospitals, so they can return with evidence backed by their actions.”

The commitment to first-hand practice means the Nossal Institute is building a global network of experts in preventative and episodic medicine. The focus is wider than diagnosis and treatment – it is about planning and prevention.

Ms Topp’s work stands as testament to the transformative effects of inter-disciplinary research. The Zambian Government has accepted recommendations for an integrated model of service delivery for HIV care and treatment.

“The Zambian Ministry of Health recently announced they want to use our piloted model nationally,” Ms Topp says.

“The integrated HIV and outpatient service model means resources are used more efficiently in Zambia’s healthcare clinics and HIV care is less stigmatised for those who need it.”

The wisdom gained in the field benefits all, with Melbourne’s impact felt far afield. Professor Brown reels off an impressive list, with former students developing innovative healthcare programs throughout Africa and the Asia Pacific.

“These people are fulfilling my dreams of what the Nossal Institute can achieve,” he says.

www.ni.unimelb.edu.au/