April 2016 | Issue 23
Russell Gruen: a career at the cutting edge of global healthcare

Surgery and public health are unusual bedfellows. Yet, by traversing the boundaries between disciplines and challenging the status quo, Professor Russell Gruen has shaped a career that has been at the cutting edge of some of the biggest issues in modern medicine. And it has brought him to NTU as Director of its Nanyang Institute of Technology in Health and Medicine (NITHM), and to LKCMedicine where he is now Vice-Dean for Research.

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Born into a family of scientists, Prof Gruen wanted to become a medical researcher and studied medicine at the University of Melbourne. However, the science was not the only aspect that interested him. “I really enjoyed getting to know my patients, their families, and the journeys that connected us,” said Prof Gruen. “As a medical student, I learned the importance of science in broader contexts, and of engaging the world with both heart and mind.”

Several events that were pivotal to his career followed. The first was a fifth-year student elective at a leprosy hospital in rural Nepal. Having selected Nepal primarily to climb mountains, he found himself doing emergency and reconstructive surgery with basic equipment in a rudimentary operating theatre, and following up with patients by walking to remote villages for outreach clinics. “The focus and precision of surgery, and the breadth and scope of global health was a compelling combination for me,” said Prof Gruen.

Blazing a new trail

With no ready-made career path, Prof Gruen had to create his own. After medical school, he trained as a
surgeon, and applied, unsuccessfully, to specialise in plastic and reconstructive surgery. Being overlooked was an important learning moment. “Sure the competition was fierce, but I really thought I’d get onto the programme. I’d been captain of my school and president of my university’s medical students’ society, and up to that point I don’t think I’d encountered a door that wasn’t open,” confessed Prof Gruen.

Soon, however, a new path was lit. He met Professor Ian O’Rourke, a respected Sydney-based surgeon who
was so concerned by the poor health of Australian Aborigines that he moved to Darwin, in Australia’s remote north, to focus on providing better healthcare to people in remote communities. Prof Gruen joined him as a PhD student in 1999 and studied specialist outreach models of healthcare delivery. With a surgeon, a health services researcher and a social scientist all acting as supervisors, it was his first real taste of interdisciplinary research.

“I was right at the leading edge of the world’s interest in using public health methods to study surgery, and thinking of accessibility, quality and cost of surgery as public health issues,” said Prof Gruen.

Living out bush

To really understand the healthcare delivery challenges faced by rural people, though, he had to get out of
the city. For more than two years, Prof Gruen and his wife, Dr Theresa Yee, a general practitioner, lived and worked in a small remote Aboriginal community in Arnhem Land, 300km east of Darwin. The area was made inaccessible for four months each year by monsoonal floods. Chronic diseases such as diabetes and rheumatic heart disease were so prevalent that half the population died before their 50th birthday. There were financial, geographic, logistic and communication barriers to healthcare.

“Many Aboriginal people feared that a trip to hospital was a journey from which they would never return, so we worked on how we could transform specialist care delivery through visiting clinics, telemedicine, and better integration of primary care and hospital services,” said Prof Gruen.

From working with a community that had to make the most of the limited resources available, Prof Gruen was about to be catapulted into a very different world when he was nominated for a prestigious Harkness Fellowship in Health Care Policy in the US. The week before the formal interview, he took some Aboriginal children to swim at a waterhole. On the way, they encountered a frill-necked lizard climbing a tree. The children ran out and pelted the lizard with rocks. Instead of hitting the lizard, however, one of the rocks found its target right between Prof Gruen’s eyes. “Clutching my forehead to stem the bleeding, all I could think was – the interview!” said Prof Gruen.

“Theresa sutured my face well, but I was still terribly bruised when I fronted the panel in Sydney one week later. My wound was an elephant in the room. So I said, ‘Before we begin, let me just tell you how I got this bruise.’ I took the rock from my pocket and put it on the big oak table, and I told them the story,” recalled
Prof Gruen. He got the Fellowship.

Going global

He arrived at Harvard School of Public Health in Boston in July 2002 just as the medical community was debating how to teach and assess professionalism, which was going to be a requirement of every medical school in the US from 2003, and which is now taught worldwide.

With his Harvard colleagues, Prof Gruen helped define and test the components that make up medical professionalism. The work he did that year has been incorporated into medical training throughout the world. The President of the American College of Surgeons then invited him to help formulate the College’s first Code of Professional Conduct. “All this happened before I’d even become a surgeon,” said Prof Gruen.

He re-entered surgical practice in 2003, completed his general surgical training in Australia in 2004, and then undertook further training in trauma surgery and critical care in Seattle.

In 2006, Prof Gruen returned to Australia as Associate Professor of Surgery at the University of Melbourne and Royal Melbourne Hospital. In 2009, at the age of 40, he was recruited to The Alfred Hospital, Australia’s busiest trauma centre, and Monash University which created a unique position for him – Professor of  Surgery and Public Health, and Director of the National Trauma Research Institute (NTRI).

This was the next major chapter. The NTRI was a struggling institute with fewer than 10 staff. In his first five years, Prof Gruen transformed the institute into an internationally-recognised centre with more than 40 staff and students and an annual turnover of AUD$4 million. During his tenure, Prof Gruen led multicentre trials and a programme in brain injury research. He established the Australian Trauma Registry and a trauma system development programme in India, and worked with the WHO and The Lancet to influence healthcare systems globally.

Being a trauma surgeon perfectly embodies Prof Gruen’s broad interests. “In many cases, the lives of the severely injured, and their families, are changed in an instant, and they depend on the system that  provides their acute, rehabilitation and long-term care. I have to be precise, action-oriented and make life and death decisions, but I also have to communicate well and manage a team in a high-pressure and high-stakes environment. In caring for patients, and in improving trauma care more broadly, I have to work with different agencies and a wide range of people.”

Taking on new challenges

It is the focus on interdisciplinary research and NTU’s global ambitions that attracted Prof Gruen to Singapore in 2015. “As Director of NITHM, it is my job to determine how we can best support the development of new technologies, particularly at the interface of medicine and engineering. I was also very interested in the new medical school. It was a rare opportunity to be part of something very ambitious and influence its future trajectory,” said Prof Gruen, who joined LKCMedicine last August as the School’s first Professor of Surgery, and Tan Tock Seng Hospital as a consultant surgeon.

As the School’s Vice-Dean for Research, Prof Gruen intends to build on the foundations that were laid by Professor Philip Ingham FRS, the School’s first Vice-Dean for Research. With his clinical and research experience, and qualifications in both medical ethics and business management, Prof Gruen is well positioned to do so.

His vision is of an outstanding research ecosystem that attracts the world’s best, propels the careers of young researchers, and ultimately helps the School to deliver on its ambitious vision of redefining medicine and transforming healthcare. “As we lay its research foundations, we’re making important investments in the School’s future.”

Making use of his clinical connections, Prof Gruen will focus efforts on developing clinician scientists as key
enablers in a vibrant medical research culture. “Clinician scientists ground our work in the needs of patients and health services, they do the clinical studies, and they can access clinically-oriented funding sources. They are also great role models for our students,” said Prof Gruen.

Furthermore, his dual roles as Vice-Dean and NITHM Director create an opportunity to strengthen interdisciplinary research between LKCMedicine and other schools at NTU and Imperial College London. “Not every problem needs a multidisciplinary solution, but the biggest challenges often do. At the end of the day, I want to ensure the capability exists across NTU to find technological solutions to the most important problems, and to ensure LKCMedicine sits proudly with NTU and Imperial on the world stage.”