By Lydia Di Stefano, MARCH B Theme student liaison
I called Dr Isabella Danel on her mobile from LSHTM while she was at home in Washington. We had originally planned to Skype, but snow storms in D.C. meant that she was not in her office. I was nervous before making the call — Dr Danel is a big name in public health. Currently Deputy Director to the Pan American Health Organisation (PAHO), she has a long list of achievements behind her. Despite her vast experience, we do have something in common: I am beginning my research career at LSHTM, and likewise in 1990-91, she completed a master’s degree at the School. During that time, she worked closely with the maternal health group. As 2019 marks the 30-year anniversary of the group at LSHTM, Dr Danel kindly agreed to be interviewed as part of the celebrations. We spoke about her time as a student and Clinical Research Fellow at LSHTM, and of the past, present and future of maternal health.
A medical doctor, Dr Danel’s focus on maternal health began when she undertook her residency at a public hospital in Chicago where she completed a fellowship in medical complications during pregnancy. Dr Danel was attracted to public health because she wanted to have “a bigger impact”. So, in 1985, she took a break from her medical training in the States and relocated to Nicaragua, where she worked as a medical consultant and was an advisor on tuberculosis control to the Nicaraguan Ministry of Health. Although she enjoyed this field work, she soon realised that her and her team “hadn’t done the research well”: this experience provided Dr Danel with insight into the challenges of research in the field, including techniques for measurement.
Wanting to learn more about the theory behind public health and conducting good research, Dr Danel attended LSHTM for her Masters. At that time, the maternal health group was newly formed. When Dr Danel told me she had worked closely with Professors Wendy Graham and Oona Campbell, I smiled: I have worked with both researchers during my time at LSHTM, and it is amazing to think of the generations of early career maternal health researchers they must have seen come through the school in the past 30 years. Dr Danel reflected on her time at LSHTM fondly. She particularly emphasised her enjoyment conducting fieldwork, and the many interesting people she encountered whilst at the school: she enthusiastically explained to me how “fantastic” it was meeting Cesar Victora at a party hosted by Oona.
After finishing her masters, Dr Danel joined the LSHTM maternal health team as a research assistant. She worked on several projects including Saving Mothers Giving Life which involved measuring and looking at causes of maternal mortality. Dr Danel emphasised the importance of such studies, as “maternal mortality is probably the best indicator of whether the system is working… it’s not just about, you know, whether you have an obstetrician. You have to have an obstetrician, in a hospital, with anaesthesia, with the nursing, with the transportation that gets women from the community, with the community that understands what a complication is.”
Even though Dr Danel thinks that “maternal mortality has absolutely improved and… will continue to improve”, she says that a lot of the challenges for maternal health researchers 30 years ago were not so different from the challenges faced today. For example, earlier in her career she helped to field test an application of the sisterhood method to measure maternal mortality, which “was hard to do and it still is hard to do”.
When asked about the challenges for the future of maternal health in her WHO region, Dr Danel spoke about the major inequalities both across and within countries in the Americas. Although the averages are “pretty good”, they “don’t tell the story because there are huge differences by age, by ethnicity, by race, by rural-urban”. For example, the disparities in maternal outcomes between white and African Americans. Social factors contribute to these disparities, and they also drive other increasing issues for maternal health which Dr Danel mentioned: advanced maternal age, infertility, IVF and overmedicalisation (for example, the C-section rates in Brazil).
Dr Danel concluded that these issues are “really about women” and that “we need women to be empowered and to protect and to fight for their health and their rights… we need to … insist on political power, social power [and] economic power”. Dr Danel hopes that with social changes, such as the #MeToo movement, and more women in politics, issues such as access to family planning will be a higher priority on national agendas.
For future maternal health researchers, Dr Danel’s advice is to follow your passions and interests. Although she thinks that research is “funny because it depends so much on finding money… and getting grants… which means that you have to address what other people are interested in” she says that this should not stop researchers “from asking the right questions”. Her advice is to “find the people that you enjoy working with and talking to… and not necessarily likeminded, but where you can have a debate or discussion that’s stimulating and thoughtful… and keeps you real”. Her final remark was “I had the most fun in the field… so enjoy yourself would definitely be a message… and save the management part for when you get older cos it’s not too much fun anyway”.