Professor Fiona Stanley, epidemiologist

Professor Fiona Stanley. Interview sponsored by the Australian Government as an ongoing project from the 1999 International Year of Older Persons.

Fiona Stanley was born in 1946 in Sydney, New South Wales and moved to Perth, Western Australia in 1956 where she received a Bachelor of Medicine and Surgery from the University of Western Australia (1970).

Stanley received an MSc in Social Medicine (1976) from the University of London and became a member of the Faculty of Public Health Medicine (MFPHM) of the Royal College of Physicians, UK. While studying there she was introduced to epidemiology, biostatistics and public health, the areas that became her life's research focus.

From 1978 through to 1990 Stanley had two significant roles; as senior medical officer (child health) for the Western Australian department of public health and as deputy director and principal research fellow of the National Health and Medical Research Council unit in epidemiology and preventive medicine at UWA. It was during this period she also received an MD from the university (1986).

In 1990 Stanley was appointed to the position of director, TVW Telethon Institute for Child Health Research, and professor, Department of Paediatrics, UWA.

Interviewed by Dr Norman Swan in 2000.


Acquiring an interest in science

What is your first memory of childhood?

One of my first memories is of the huge bush area around our house in Sydney. It was all bush from La Perouse to Long Bay Gaol and Bunnerong Power House, and that was our playground, especially just below Prince Henry's Hospital. With the rubbish dump and gaol it sounds terrible, but for a kid it was a fabulous playground. We had Botany Bay and Kurnell. My father had built a boat, so we had a yacht in which we used to sail at weekends. It was a very exciting, wonderful magic childhood.

What was exciting about it?

I was a pretty excitable little girl and I used to get excited about most things. But all those games we played in our bush cubbies are with me today, the things I used to dream up and do – a lot of it dominated by the elder brother. (My sister is 12 years younger than I, so it was not till we moved to Perth that I actually had a sister.)

How did you become interested in science? Did it just grow on you?

It did grow on me, and as a younger person I used to say, 'Oh no, my family had no influence on me at all.' Yet I had a father who was working on a polio vaccine, in the middle of the polio epidemics of the 1950s, when the Queen came to Australia and people weren't allowed to shake her by the hand. And you couldn't go to the Saturday afternoon pictures, one of our special treats. It was very scary, actually. I remember seeing all those people in the iron lungs up at Prince Henry's Hospital. In fact, among my first memories is watching Neville, my father, blowing a spinal cord out of a mouse and injecting polio virus into the baboons in his primate colony at the hospital.

Wasn't he one of the first virologists in Australia?

Probably Australia's first virologist, and one of the first anywhere. There were only about eight in the world then, and so we met Salk and Sabin and all those people – who I thought at the time were very boring, as one does at the age of six or so. That was a pretty fantastic environment in which to grow up. Neville absolutely loved his science, and for more than just virology. He used to read us fantastic stories by Jean-Henri Fabre about ant and bee colonies and other things which had me enthralled. When you think of it, we may have been a poor family – my father was still studying when I was born – living out near La Perouse in a little fibro house, but we were surrounded by intellectual excitement.

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Science to save the world

Presumably what your father was giving you was curiosity.

Yes, but probably a bit more than that. My brother has ended up in really curiosity-driven science: he is head of a cancer biology unit in New York and is very much a basic scientist. But I have a commitment to making a difference – perhaps because the iron lungs were so powerful and also I saw that science could be used to do good.

So you wanted to save the world?

Oh yes, very much. The dream I had when I was eight was that I would sail out to some islands – we did have a boat, but I don't know quite where these islands were – inoculate the 'natives', leap back on the boat, put the scuba back on board and sail to the next island. It was Marie Curie and Albert Schweitzer all rolled into one.

Reading Marie Curie's biography was an incredibly important influence on me as a person. There was romance, there was the wonderful relationship with Pierre, but most of all there was her intellectual commitment, the fact that she had to fight to get trained during her early life in Poland, when they weren't allowed to do things Polish or to get an education. She had to be educated in people's living rooms to get her degree. And then to get to Paris and the Sorbonne, and take that road struggling against the male domination of science, I thought it quite fantastic – apart from her devotion to finding out about radium and then using it to benefit mankind. I still think it's a fabulous story.

But it is the same as your fantasy about going round the islands. You've been to those islands now, you know what they're like, and you know you can't go back on the boat. Do you wonder about what happened between that fantasy and now?

Not a great deal, because that was something I left behind when the reality took over, the hard grind of getting where I had to get. Looking back, though, there is a sense that at least one's followed that road a bit, tried to bring the science into something that is going to make a difference. So there is still some part of the fantasy, if you like.

Keeping the faith can be hard. If you are a scientist, your PhD and post-doc experiences can undermine the vision. Your father was in a sense fortunate that he didn't go through medicine and have the professionalisation and socialisation of a medical education.

Absolutely. And I had to unlearn a lot of what I had learnt in medicine, even to become a researcher. My research career really started through my being influenced by the situation in Aboriginal health, with a real sense that the need was always there, so would that kind of research – almost social epidemiology – make a difference? The thing which started me properly on the road to epidemiology was trying to find out the cause of disease, rather than becoming a paediatrician to wait until kids got sick and then not being able to make them much better. Clinical medicine has such limitations. I thought that to help the world I needed to find out what causes disease. So for me there was very much an applied end of it, I guess.

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A black sheep at medical school

Were you a rebel at medical school?

Yes. I nearly didn't get through. Going through medical school was a very difficult time for me, actually. For one thing, although I was very keen to do medicine, my parents didn't want me to do it.

By this time you had moved to Perth from Sydney, and your father had got the foundation Chair of Microbiology – a non-doctor in the medical school.

Yes, and not always loved as the 'members of the club' are. Here was a daughter who wanted to do medicine, and neither of my parents were particularly keen on it. It was such a long course, there were very few women doing medicine in those days – only six out of 100 in my course – and in my family doctors weren't beloved. I was the 'black sheep' going into medicine, because to them science was pure science and a PhD was the way to go.

Also, I wasn't a particularly socially well-adjusted teenager. I was a very late developer in being able to cope with how to handle boys, for example. And doing medicine didn't help, because you were seen as a freak. I don't know where that late development came from – perhaps from the way that we were brought up as kids, in a family which did not have a very open relationship about voicing fears or emotions. I wasn't particularly happy with how I related to other people at the age of 23 or 24. I thought I was quite delayed compared with other people, but maybe everyone felt like that and it was just our era. I think my own children now are very much more open and competent socially than I was. So I found medicine difficult from that perspective, and it wasn't really till the end of my course that I suddenly got very switched on because of a couple of people. One was Kevin Cullen.

I know of him as the general practitioner in the Busselton area who set up the Busselton Study – one of the large-scale, population-based studies in Australia – and also one of our better wineries.

Exactly. Kevin was the first MD in Western Australia, and he was a GP. He was a most unusual person: an enthusiastic, hypermanic guy. I opted to do my general practice weeks with him because he was so enthusiastic. I'd been up in Papua New Guinea as a medical student for the three months of the holidays, and had got very unhappy about where I was going in medicine. Kevin actually forgot about general practice and for the three weeks he just said to me, 'Look, you've got a brain, woman. Use it. Get your degree and start making something of your life.' He was the first person to say anything like that to me, and I just worked through that final year of medicine – inspired by Kevin and also by Bill McDonald, our Professor of Paediatrics. His inspiration was different. He kept saying, 'Yes, there is a child. But that child lives in a family, and it lives in a community, and it lives in a political structure.' So I started to get a much better idea of the social causal pathways to disease outcomes, and how profoundly important they could be. That has stood me in good stead throughout all of my epidemiological training.

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A Papua New Guinea pilgrimage and a revelation

Was the elective in Papua New Guinea a revelation, considering that you already had a family connection with that country?

Yes. For me it was both a pilgrimage and a revelation. My grandfather was one of Douglas Mawson's students in geology and got the Tate Medal in Adelaide around 1905. His first posting was to Papua New Guinea, as the first government geologist in the Territory. Imagine: he had to go up there in 1908 and build his own house, his own photographic equipment. Actually, he had first to go and find his boss, who had been lost for three months in the Highlands. They didn't know three million people lived in the Highlands at that time. I never met my grandfather – he died at the age of 36 – but he has been an inspiration to me because he was such an eclectic person. He had to know the languages; he was a geologist, obviously; he was a pioneer. And he was a beautiful-looking man.

Who died of what today would be a curable illness.

Yes. It's just amazing. He came down on 'furlough' – a three-month period every so often when the family would come to Adelaide – and he got an infected boil. Perhaps he was weakened by malaria and all the other things they got up there, but anyway he died within about four days of a septicaemia, which now is entirely preventable. My father was six at that time; his sister was nine. Perhaps that influenced my father in doing his doctorate in streptococcal diseases. You don't quite know how these things happen.

I was keen to go to Papua New Guinea for medical experience but also because I wanted to find some of my grandfather's original movie films from 1912 (they had been lost) and some of his maps. They are now all in the National Archives. It was a sort of a pilgrimage, and I really loved it. It was fantastic.

And the revelation, the conversion?

Well, that was getting back to the dream about the islands and the natives. Those three months of working in the Highlands showed me the hugely different problems that a country like Papua New Guinea faces in terms of diseases and in the disease spectrum, and it reinforced for me how limited medicine is as a means of coping with that. A seed started to grow in my mind: if only you could prevent disease, if only you could find out why it was caused. It seemed obvious, for example, that vaccines to prevent malaria are the way to go, rather than just treating such an expensive disease.

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Aboriginal health: 19th century hygienic poverty

Generations of white Australians have grown up in big cities and on the coastal fringe, vaguely knowing about Aboriginal problems, maybe caring about them, but basically getting on with life. What made the difference for you?

It really started during my first year out as a resident doctor. Our Aboriginal Medical Studies Fellowship formed part of the New Era Aboriginal Fellowship. Also, we had an Aboriginal Advancement Council in East Perth. I was heavily influenced by two trips that we did around the state, not as a proper epidemiological survey but really as a fact-finding expedition. That was my education of social environments and health, in that we were seeing 19th century hygienic poverty.

Those trips were just amazing. We visited every mission, camp, reserve and fringe-dwelling group in Western Australia. We didn't quite do the south-west but we did the Eastern Goldfields and around right out to Warburton Ranges, and then a sweep round Balgo Hills, Halls Creek, Fitzroy Crossing. Talking to the old people, talking about what life had been like, trying to get a handle on the health issues and the environmental issues, I became absolutely involved in what was happening – and I have been from then on.

That was 1971–72, when there was a Black Power movement in Australia. It was very easy for me then: everything black was good, everything white was bad. I was very naive in many ways about the whole thing. But our group put up a lot of fantastic proposals: if Aboriginal people are 3 per cent of the population, there should be 3 per cent teachers, 3 per cent doctors, 3 per cent social workers, 3 per cent of all these people – encouraging that kind of thing. But it was paternalistic. We thought we knew the answers, so we didn't consult very widely with Aboriginal people. We were 'helping' them. We had a 'We're here to help you' kind of approach to things. Although some of my very best friends, such as [Aboriginal leader and writer] Jack Davis, were hugely influential on how I thought, I wasn't really capable of taking a lot of that in until much later on.

When you are young and enthusiastic, you imagine you can achieve things – as in your fantasy dream. But with Indigenous health it takes a long time, because you have to ask and listen to what people themselves want.

Yes. How I perceive that and how we run our Indigenous health research in the Institute has changed totally now.

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Epidemiology and biostatistics: starting the little motor

After your medical studies at the University of Western Australia you went overseas. Why did you leave?

I was specialising in paediatrics, but I didn't finish. I was running the Aboriginal clinic from the children's hospital and we would bring kids into hospital. Working in Aboriginal health can make you very depressed, and I was extremely despondent about the Aboriginal situation. I didn't think it was going to improve. Also – reinforcing that whole bit about trying to make a difference, and doing epidemiology and investigating causal pathways to disease – I realised that trying to deliver health care to these Aboriginal kids was not really going to change the situation. I felt I had to go and do something else, and probably it was wrong that I had done medicine, I wasn't going to be a good doctor. I was going through all of these questions about what my role was going to be in life and I was very unhappy.

You might say that I ran away. I have heard Michael Marmott say that he turned down a registrar position at the top Sydney hospital. I turned down a registrar position at the Royal Melbourne Children's and went off to England to try and find out what I wanted to do with my life. And there I discovered epidemiology and social medicine, biostatistics and public health.

Did you think about leaving Australia for good?

Yes, but a whole lot of things happened which changed my attitude totally. I met Geoff Shellam, who is my husband.

And who now holds the Chair that your father used to have.

Yes, in Western Australia. Geoff became an incredibly important mentor for me. When we got to London he encouraged me, for example, to take up an opportunity to join the social medicine unit at the London School of Hygiene and Tropical Medicine, and to follow the route of becoming a researcher, doing a PhD. And the luck bit was that I walked into the London School of Hygiene when it had all of the top people in England – in epidemiology, biostatistics, social medicine. That's when all the lights turned on, when what Geoff calls my 'little motor' started. Once, when an interviewer asked me how I kept going, I said, 'I just have this little motor inside me,' so Geoff sometimes says to me, when I'm looking absolutely dreadful on Saturday morning, 'How's your little motor this morning, dear?' But it was just as if the little motor switched on. I realised then that epidemiology was extraordinarily powerful.

I was also lucky that in OPCS (the Office of Population Censuses and Surveys) at that time in the UK was another incredibly powerful and wonderful group of people, with databases for the whole of Great Britain, with record linkage, and the Oxford record linkage survey. It was the place: registers of diseases, like birth defects registries being set up and linked into databases. So I learnt the usefulness of not only epidemiology but biostatistics, even though two of the great people with whom I was working – David Clayton, now Professor of Statistics at Cambridge, and Peter Armitage – said to me, 'We tried, Fiona, to teach you statistics!!' I always had to have some very good biostatisticians around me – which is a good message for being a role model. You don't have to do everything really well; you can get those around you to help you.

Luck played a part again when we had a year in the United States at the National Institutes of Health, just after I had finished my thesis in London on low birth weight babies. When I lobbed into the National Institute of Child Health and Human Development they asked what I would like to do, and I said, 'Well, what about running a workshop on the epidemiology of prematurity, preterm birth?' I was extremely interested in the aetiologies of preterm birth and the outcomes of babies who were increasingly being treated in intensive-care units – and the very, very high rate (we didn't know just how high then) of preterm birth in Aboriginal mothers. In those days NIH was very good to its foreign visiting scientists. Although I was very junior, I was told, 'Here's a cheque. You can invite anyone in the world you want to for a three-day symposium and we'll publish the proceedings.' Can you imagine? I invited the world of perinatal epidemiology to this workshop: they all came to NIH.

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Innovative methodology and causal pathways

Since your return to Western Australia, you and people like Michael Hobbs have set up an immense database to link hospital records and keep track of what happens to people. That is unique in Australia and one of the few in the world. In your use of those sorts of disciplines and data, what are you proudest of?

I guess there are two answers to that question. One is actually setting up the innovative methodologies – doing the record linkage and exploiting it, setting up really good cohort studies – and using the methodologies to address really important hypotheses. My approach with my people is still, 'What's the most important research question we can answer now in this area?' – be it neural tube defects, other birth defects, cerebral palsies, brain development, preterm births. I call 'What's the most important research question?' going for the jugular, and it's become a bit of a joke.

But also we went right in there and did it. Our first study for the birth defects registry was the folate hypothesis; our first study for preterm births was looking at whether social support in pregnancy was effective in reducing preterm births – a hugely difficult study to do; we looked at the issues of survival of the very low birth weight preterm neonate and what that has done in terms of cerebral palsy rates; and we looked at the whole area of birth asphyxia and cerebral palsy. Some of what we did in those four areas led straight into and furthered our interest in Aboriginal maternal and child health. The low birth weight, preterm birth story, and how that was important in Aboriginal health, is still a profoundly important aspect of our work.

So there have been two very important things. One was the methodologies and getting all of 'the' expertise, training people up in that area of epidemiology when there were very few epidemiologists in Australia. The other has been the specific areas we have worked in. I guess the two that we are best known for – whether I'm proudest of them I don't know – are the cerebral palsy work and the folate and spina bifida work.

The cerebral palsy work is showing, essentially, that birth asphyxia, certainly at the time of delivery, is not the most important factor. And that there are unknown factors.

Yes. Also, antenatal pathways – things like neuronal migration and placental effects, and infections and inflammation, and early human brain development and how it goes wrong – is probably going to be profoundly important in cerebral palsy. They're going to be more like birth defects than birth asphyxial causes.

But what I hope I'll be remembered for 10 or 20 years down the track is a whole new thinking about causal pathways to brain damage, or brain anomaly. You start with the population, yes, but you don't think of simple, single risk factors. I am excited that you can actually start to get into molecular epidemiology (cerebral palsy is a good example) and to look at the genetic/environmental interactions in terms of the ways brains might develop and develop badly, or go wrong, go off the track, off the program of normal development, and how that might happen – and social epidemiology, and how that all fits together.

We are becoming more rigorous in our epidemiological methodology and thinking, and causal pathways thinking means not just thinking of single risk factors. We are in a single risk factor epidemic: you must eat this or that. Yes, eating soy has been shown to be beneficial in breast cancer, but these are single risk factors. Look at the social, physical and environmental context in which risk factors arise, and then you might get a much better handle on true causal pathways – which are very complex and much more difficult to elucidate. If you analyse the causal pathways properly, not only will you get them right but you'll have better chances of knowing when to intervene, to prevent. These are very exciting new developments (even if I do summarise it all so briefly).

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Promoting evidence-based policies

Having returned and developed powerful data in relation to cerebral palsy, spina bifida and those other major advances that you and your colleagues have made, you have found you need to enter the political arena if epidemiology is to be used for change. Someone you knew who actually manipulated things politically was Dougal Baird. But politics means taking a position, which is not very scientific.

The time away was very important: I came back with both the capacity to do epidemiology and the knowledge of databases and their power, and also it led to my network of international researchers. Some of them were incredibly important for me – Mervyn Susser and Zena Stein from New York, Eva Alberman, who had been my thesis supervisor from London, and Dougal Baird, as you say, from Scotland. He was an outstanding social epidemiologist/obstetrician and even after his death he is still an enormous influence on the social obstetric/epidemiology area. It was fantastic to have this kind of group.

I don't agree, though, that science must be compromised. When we go into that political arena, as you call it, we try and get evidence-based policies. People say I am very successful politically because I have pulled in government money, and money for our research institute building, and I've lobbied the federal government to double the medical research budget and so on. But I am very careful to come from an extremely credible position of data with which to inform and influence. This is again Geoff's mentoring: never step outside that, because you'll lose credibility.

So you don't jump on the ideological bandwagon?

Certainly not. When I retire it will be different: I am going to come out and speak on lots of things. For now, I stick to those issues on which I have some data and I won't go beyond that. I think you can only be a good politician for the kind of research you are doing if you stick to that message. Yes, we have tried to influence lots of things, but with very good data to support it. We might make some mistakes, because sometimes you have to make public health decisions on data which is imperfect. That's an issue, but I think we do the best job we can.

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The long path to career security

You referred earlier to being a role model. A woman planning a career in science might look at your success and say to herself, 'That's all very well, but the world is a lot more insecure now than it was then.' When in your career did you first feel you were in a position where you could feel secure?

Oh, that's been relatively recently, in the last 10 years. When we decided for family reasons to come back in 1977 after our year in the States at NIH, I wrote to the professors of paediatrics and obstetrics in Western Australia and said, in effect, 'Here I am, an epidemiologist.' But there was a resounding silence on that score. 'Very nice to see you again, Fiona,' they'd say – no offer of senior lectureship, research fellowships or anything. I'd been on an NH&MRC training fellowship, yet no-one mentored me about the possibilities of where my career should go.

But I needed to start my research career properly. The process was that I got a job in the Health Department, where I was reasonably well paid as the chief medical officer in child health. It may sound crazy, after this research career, to become a sort of mini-bureaucrat, but it set up my networks and databases all over Western Australia. I was very disappointed that I hadn't got a research job, but in my two years there I met every midwife in Western Australia and I was able to revamp the entire midwives database, I was able to link it with all perinatal and infant deaths, I was able to actually start my research – and research infrastructure, if you like.

So you had a budget and you used the system, essentially?

Absolutely. Every child health nurse still knows and works with us in amassing the fantastic database that we have built in Western Australia. Then I decided to move on. I'll never forget the interview with the chief bureaucrat in the Health Department, who said, 'What? You're going off to be a research officer with NH&MRC? You're going to decant yourself, go down the scale, de-evolve?' And I said, 'Yes, but this is my true love.' We were setting up an NH&MRC unit at that stage in epidemiology, and I went and set up my perinatal research group there.

When I went on enforced maternity leave to have my children, it was not very well paid and I had to take out a loan to continue research work. It was very fragile. Geoff was also only on a research fellowship at that stage. Perhaps people would not do that now – I don't think they should, actually – but we were committed to doing it because there wasn't any alternative. But I had a full-time mothercraft nurse looking after my children and giving quality care, which is very important to me. Paying off the mortgage, doing all these things, you didn't feel very secure at all. I've now paid off the loan, but it wasn't till I had already got into that NH&MRC senior fellowship level that I felt secure enough in my path.

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Passion: necessity or handicap?

I hear in your voice, even without your actually saying it, 'If you don't have that level of commitment, you're not going to be a good scientist.' But that's what really hampers women in getting on in science.

It worries me. I've always prided myself that my getting to where I've got has been good for other women – 'You can do it,' et cetera. But a woman said to me once, 'You're actually not a very good role model, Fiona. I want to do other things in my life as well as have this little motor going all the time.' I was shattered, because I did really want to be a good role model, but I could see what she meant.

You're more like Marie Curie than you like to admit. Perhaps you haven't discovered radium, but you have that utter commitment.

That's true. When I employ people in my Institute, one of the criteria I apply subliminally is whether they are passionate about their science. It is really important that you care very deeply about your science – that you would almost lie down and die for it.

And come in at 4 a.m. to look at the gel, and so on.

Yes, absolutely. If we want to attract the best minds into science, we're going to have to start paying people more and rewarding them more, creating environments in which they can have a family and do other things. I realise it is important. But without that passion for science, you might not pursue it fully. I know that subliminally I do look for that kind of commitment, because it is an important aspect.

In a way, the previous system sorted people out pretty early. You were either into that NH&MRC system or you weren't, and it was very tough. Now I believe it will be easier, there's more opening up for people in science. And if you're not quite there with the commitment, there will be other things you can do. You can go into industry, or into applying research into policy; you can be a good clinician that uses evidence and asks questions about 'Why am I doing this?'

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Privacy issues

The perennial funding problems are always going to be there. What else do you see as the biggest potential barrier to progress in the work you are doing?

I can see a threat when, every now and again, the issue of privacy raises its head because some very vocal minorities in the community don't understand the importance of data and how it is collected in epidemiology. I don't think we have been very good at selling the importance of public health research and its benefits. Most of the database is collected without consent, and if we had to go and get consent it would be scientifically invalid and cost the earth. It is terribly important that we can collect this information, link it and then take away the identifiers – with computing we can actually promise complete confidentiality and privacy now – but people don't seem to realise it is essential. We have not sold that very well. We've tended to keep quiet about it, I guess because we don't want people to criticise us.

The other challenge is getting the bright minds to go into research, particularly in an isolated place. It is hard to pull the people in and keep them. A lot of people are going not into science but into things that will earn them a buck. One of my biggest criticisms of the 'global economy' and economic rationalism is that greed seems to be pulling people into jobs rather than, 'Gee, isn't it going to be great to work for the community.' I am hoping there will be a bouncing-back, because when I talk to groups of people about what we do they find it inspirational, they love it. I know that there is a groundswell out there of people who care deeply about the community. But at the moment a lot of the brightest people are going out of science into medicine, not because they want to go into medical research but to earn a big buck or to be very prestigious.

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The little motor keeps on running

So here you are now, one of the most senior women in Australian science. Whenever somebody wants a woman on a committee they come to Fiona Stanley and you're pulled every which way. Your life is as frenetic as ever. What would your daughters say about their Mum, if I were interviewing them?

Oh, I'd love you to interview them and tell me afterwards! I think they are actually proud of me in a way, although they also get worried about me now – which is very sweet of them. Of course the maternal guilt has been with me, but they're doing well and they're fine. They are wonderful young women.

Did you feel guilty that you were not there when you wanted to be? Did they lay that guilt on you?

Of course they did, and of course I laid it on myself. There I was in maternal and child health. I had my children at the height of the 'earth-mother' phase, you know – breastfeeding for five years and naked skin to skin contact – but there I was leaving them in the care of somebody else and going off to work. And also society laid guilt on us. That was difficult.

Did getting diagnosed with breast cancer slow you down at all, or did the little motor keep on running?

It slowed me down for a little while, but the motor kept on running. I was going to say to everyone that I was going to work less but, you see, I actually love my work. A lot of my self-esteem, my inner feeling of worth about myself, comes from doing things, and doing those sorts of things where I feel as though I am making a difference in doing my work.

Gus Nossal once said to me that one of the most important characteristics of an institute director was generosity. He's absolutely right. I think that one of the things I am good at as an institute director is being generous. And that means being generous with your time. Taking time out to mentor our young Aboriginal researchers is really important, taking time out to find out about what is happening to people in the Institute and where they are going – it takes time to be generous, actually, to do that job properly.

And in 25 years' time what would you like to have achieved? Are you still going to be the Institute director, or do you want to be overseas? 'What do you want to be when you grow up, Fiona?'

Those are interesting questions. If I could leave the Institute in good shape when perhaps I take a slightly early retirement, I'd quite like to do something to apply research at the international or the national level – say, having a greater role in how research is done and managed and being a very good advocate for research, or doing something in an international health arena, encouraging the use of data to improve health services or public health.

So you'll be on your boat, on the island, but with a computer.

That's it.

Fiona Stanley, thank you.

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