Professor Ruth Marshall AO

Faced with choosing between her role as medical director of the SA Spinal Injury Service and several other positions, Professor Ruth Marshall decided her existing job would be most interesting.

More than 37 years later she is still enchanted with the role, defying a self-confessed propensity for early onset boredom and despite not really enjoying spinal cord injury rehab as a registrar.

‘When I become bored, I’ll know it’s time to retire,’ Prof Marshall says with a laugh.

‘I fell in love with rehabilitation medicine when I was in my second post-graduate year, having been introduced to it in half a day in fifth-year med.

‘I knew this was the kind of work I wanted to do – helping people take back their lives, engaging them and helping them and working with a team of dedicated health professionals, including nurses and allied health.’

Her passion and dedication have led to her becoming an Officer of the Order of Australia (AO) for services to rehabilitation medicine, and particularly for working with people living with spinal cord injury and disease, teaching, mentoring and research. She became the first female president of the International Spinal Cord Society when elected in 2020 and will complete her term in October this year. Meanwhile, she continues to engage in international research to improve the experience of people living with spinal cord injuries and diseases.

Prof Marshall says the complexities of spinal cord medicine and rehabilitation – from clinical complications, to the psychosocial, to practical aspects of tailoring a wheelchair to a person and their home to the wheelchair – are routinely underestimated. It requires a balance between care and the capacity to foster independence by knowing when not to help.

‘When I got to Hampstead and the Royal Adelaide Hospital, I found there was so much to do,’ she remembers. ‘Then, after a while, I became interested in research because my registrar raised some questions I couldn’t answer.

‘I never came into spinal cord rehab or medicine generally to do research – I came to be a clinician and first and foremost I am a clinician.

‘For me, any research has to be related to what’s really important; that is, the people living with spinal cord injury who I look after. They are really central to what I do.

‘I consider myself incredibly privileged. Getting an AO is not the reason one does work but it is very nice to be recognised in this way.’

As the only person in South Australia in 1986 doing spinal cord medicine, Prof Marshall quickly realised the importance of mentoring and being able to call on people in Sydney and Melbourne for advice. Decades later, mentoring remains a joy.

She also continues to relish opportunities to visit regional and remote areas, particularly in the Northern Territory. ‘I’m very privileged to look after and work with our First Nations people,’ she says.

‘Getting people in wheelchairs out of the communities in small planes is difficult, so since 1994 I’ve been going into communities in East Arnhem region. I fly in with a nurse and often with an allied health person.

‘We have a lot of Indigenous patients – in Alice Springs more than 50% people living with spinal injury are First Nations people. There are a few in Darwin but also all over the ‘Top End’. Seeing them in their own place, on their own country is an enormous privilege and really wonderful.

‘To sit on the ground and talk to a grandmother about a grandson with spinal injury is a very special and not everyone gets to do that,’ says Prof Marshall.

Prof Marshall and her SA Spinal Injury Service team are engaged in a range of research projects, including rare international drug studies for spinal cord patients and a study of the lived experience of people with spinal cord injury and disease.

She notes that life has become significantly less challenging for most people living with spinal cord injuries and disease in Australia with changes in funding (NDIS and no-fault motor accident insurance) and technological advancements such as voice activated devices.

The new rehabilitation facility at Daw Park is a ‘showcase of innovation’, including ceiling tracks that can take slings to assist in moving patients, reducing the risks of manual handling.

‘Things have changed a lot. When I first started in spinal cord injury, young people were in nursing homes because they could not get funded personal care,’ she says.

‘NDIS costs a lot of money but sticking a 25- year-old in a nursing home is very expensive – it is actually cheaper to keep people at home. Technology and its uses for people with disability is exciting.’