209. Professor Fiona Wood AO & Assoc Professor Dale Edgar on Innovation and Resilience The Mindset Behind Game-Changing Discoveries

Welcome back to the Ben and Bergs Podcast. Today we're missing Ben, your favorite high school dropout and founder of Collective Shift. And you're with me, Bergs, your favorite MBA and COO of Collective Shift. And today we have something very special for you. This is one you're going to want to strap in for with two of my favorite people. First off, we have a lady who is a plastic surgeon by trade, WA's first female plastic surgeon. Director of the Burn Service of WA since 1991 at RPH, BMH, FSH, and now PCH, the Director, Director of the Fiona Wood foundation, previously the McComb foundation, co creator of Spray on Skin. 2003 and 2004, she won the WA Citizen of the Year award for her contribution to medicine in the field of burns research. Australian of the year 2005, 2024 Science hall of Fame inductee. Oh, there's still more to go. Most trusted Australia for successive years 2005 to 2010. Recognised as an Australian living treasure. Mum of six, grandmother of seven, an absolute lass and one of my most favourite people. Fiona Wood. How are you?

I'm very well, thanks. Exhausted after that, but all good.

You were the most trusted Australian for six successive years, 2005 to 2010. What happened? They just stopped testing.

They stopped testing. It's all over.

And with me as well, we've got a man I've worked with for 16 years, physiotherapist by trade, prolific researcher and publisher, current research fellow at the Institute for Health Research at the University of Notre Dame, Previous director of the Burn Injury Research Node, previous research manager of the Fiona Wood Foundation, Queenslander and absolute lad. Welcome, Dale Edgar.

Thank you so much, Aaron. It's fantastic to be here 16 years. We probably could have both got off on good behavior prior to that, surely.

That's it, mate. Some people get off early for worse charges. Now, a place I would like to start is Dale. How did you and Fiona meet? Because I've not heard this story and I'm dying to hear it.

Yeah, look, we would. I think I've been thinking back, trying to remember when we first clapped eyes on each other. And.

I got Into Burns In 1996, working in Brisbane, and soon after I started, I realised that I was interested in burns research. And so we started presenting some of the work that we were doing in Queensland at the time with a fellow named Professor Stuart Pegg. He was the big boss back then and at the time he was, I think, the oldest burn surgeon in the world. He'd worked already 30 years by the time I started working with him. Anyway, long story short, he had a fund that allowed us to go to conferences. And being a young physio, it was like, wow, what's this? No one usually supports us to go on these conferences way, way, way back then. This is now close to 30 years ago. And so I went to Queenstown to present some work that we were doing there. And I noticed that this mob from Western Australia were getting up and talking about the spray on skin and they're talking about some stuff that they. And it was getting people up early. And I'm like, my ears are pricking up as a physio.

And then I think Fiona and I worked out that she presented some work for the physio from Western Australia at the time. And that obviously really pricked my ears up. And at some point we had a conversation and met each other in 1997 in Queenstown in amongst all of the crazy activities that you can do in Queenstown.

Well, I remember the ice skating and.

The pizza and beer afterwards. And then at the end we all went and jumped off the top of the mountain in parachutes. So that was cemented things.

Yeah, scary stuff. But I think it was really, at the time and still early mobilization, getting people up is like, well, a day or two. Most places around the world. It's six weeks still. And so that's why. Well, I need somebody to actually really get the teeth into this. And Dale was the person that did it. Yeah. So it's great.

I had this memory, and this is when I was at Raw Perth and I was very overweight, eating too many sausage rolls. And I was walking up the stairs and we were like on level 11. So I'm just like fat and sweaty. And I remember you're in the stairwell with this poor lady who would have been like in her 50s, had surgery the day before, and you're making her go up the steps. And I'm thinking, Jesus Christ.

Back then, I guess when I, you know, I haven't been doing much clinical for most recently, but I was certainly hardcore in those.

The person you're talking about actually was almost the same age as my mom. And.

I still think about her today. She's still around, but she always gets me because this is now. Yeah, yeah, yeah, yeah, yeah. And, you know, she. She was someone who could have been my mom. And, you know, I think that was why perhaps I was so hardcore and trying so hard was because, you know, this person. I could see that parallel. And yeah, obviously from the Outside looking in, I probably sounded like a maniac, but. But I remember carrying Val up the stairs. You know, like, literally the first time I had to take her up there, I was literally lifting her. Like, she. She had no power in the legs. She had no ability to walk up the stairs. And for some stupid reason, I thought it was a good idea to go up the stairs. Anyway, I did. And. But, you know, within a couple of days, she was doing it on her own. And, you know, she came along so rapidly. And.

And that's another story where, you know, you have. You can you motivate yourself for future patients because you see someone get out of the hospital, go back to driving, you know, see their kids get married, see their grandkids grow up and be born, you know, and, yeah, that. That is what, you know, burn recovery is about. As a physio, it's actually getting back to that stuff.

But it's interesting, isn't it, because I. I mean, I came from general surgery, plastic surgery, and I die laying in bed.

Yeah.

And like, people leave people. And I was thinking, in the literature, it says that a fit young person like you, Deb.

Maybe like you, Aaron.

24 hours in bed, you will notice. So I'm thinking, why are we doing this? Why are we keeping people in bed? You know, he goes, oh, something wrong with you? Must keep. Ooh, ooh, rest. And I'm going, no, no, no, keep moving, keep moving. And what was that mantra? Use it or lose it. And so we've been considered a bit crazy for a long time, probably with good reason. However, our recovery for our patients is second to none.

And I think that's, you know, we just looked at a little bit of data yesterday, which, you know, is all about the timing of surgery. And the thing that smacked me in the face is that some of our patients are finished their treatment with us in less than two weeks. Right. And these are patients who have had to have surgery for their burn. Right. It's not someone who's just had a little burn. And yeah, okay, they're not huge burns in terms of size, but they're deep enough that they've needed surgery.

And.

And, you know, they're finished with our service other than we check them a little bit down the track within two weeks. And I'm like, that's up to 30% of our patients who need surgery no longer need treatment, like dressings and other treatments within two weeks. I mean, that. That is phenomenal. When I hadn't actually started to compute that until I saw that in Black and white yesterday, phenomenal.

I remember going to conferences with both of you and international people were there and this wasn't that long ago. And just doing that was incredibly foreign. Getting people in with a burn injury for early surgery, early ambulation. A lot of people in the world still don't do that.

Oh, yeah.

I think Fiona's got a story about ISBI this year where she.

Well, it's interesting because, you know, the, the push and they're starting to change. Last year I spent a lot of time in the U.S. speaking about this new technology, the spray on skin cells. And I was like, it's really an exercise in politics and stuff because I first sprayed skin cells on in 1994. Right. And so it's like, okay, we'll take you through this journey. A little bit truncated. And so people are starting to explore it. It's always really interesting because I think, wow, I hadn't thought of that. So there's new things coming through and also. So it's really good. And. And then at the isbi, I wasn't in the room. It was day two. One of the other physios and there was a panel of four international experts. What was the burn, the biggest burn you want to survive? How far should we push? Because of course, when I first started, people with major burns very often didn't make it. And if your age and your body surface area involved in percentage was greater than 100, the chances were very slow, low. And so we've rewritten that and people like we were just talking, talking about 80% body surface area burn. And we're talking 30, nearly 30 years later, she's still, still going. Yeah. And so stood back from that, they were asked, what burn? What's the biggest burn you want to survive as an individual? Having you seen what it's like for all these people who are burned. And then when they decided on a number, the facilitator said, and where in the world, anywhere in the world, would you want that treated, that burn of that level treated? And all of them said, burn. But you've given us such a hard time for so long. But you all want to come here, get sprayed on, get out of bed, on the Fit Ball within 24, 48 hours, in the gym, in front of the mirrors with all the imaging and imagery, I should say, and all of our ideas. Oh, it's all right for you, but what about your patients?

This is amazing. The most isolated capital in the world has the best burn care. And I'm going to call it, come On. Okay. Okay. Top, top few percent of burn care. Can we say that?

Okay.

All right.

Yeah.

You got. At least. It's a small world. That's the problem. Yeah.

And you've been an innovator for a very long time. You always want to change things and improve things. I remember you telling me if you added that the day you stop trying to make things better is a day that you should retire. You should always try and continually improve. And you've done so much just within burns and so many other areas as well. And I want to know sort of where does that drive come from for you? What is it within you that really, you know, applies yourself and tries to make these things better every day?

I think it's a. I mean, it's a question that's impossible to answer, I guess. Things like motivation. I don't. I've said many times, I don't know what motivation is, but I know it's contagious. And I know connecting with people like you guys means like, yeah, we're in this together. We've got this vision. Let's just keep going. And on the tough days, when you've got a team like that around you, it's always. Then the tough days are less tough. Yeah. And so you keep moving forward. But for me, I guess I was brought up with the idea that you could do anything you like. You just work hard enough. And so I bring to the table a capacity to work. And that's right. Okay, then the next question is, what are you going to do with that? And, you know, so many people say so many things.

You kidding me? You know, I don't believe that. And I remember even as a youngster, thinking that doesn't sound right to me. And I go, and I'd find out other ways and I'd. So right from the beginning, I was never a believer, if you like, I was never a follower because just that if that doesn't sit right, that doesn't sit right. End of. I've got to figure it out. And so that figuring it out. And I see. But people with burn injury. And I think we have not got the answer yet. Absolutely, categorically, we have changed the paradigm. We've shifted those. But it's some big changes, some small changes. We're just being relentless and pushing and pushing and pushing. But we've started to see that we connect with people in cardiology, endocrinology, neurology, all these psychology or psychiatry, all these areas around us, because we're starting to see that someone with a Burn injury is, which can be anyone is inflamed in such a way that it has ramifications beyond. And so that's taught me that you cannot, it's important not just to think for yourself and the person in front of you. We have to think on multiple levels. And then we work in a really complex system. Oh my gosh, I'm twitching like cluser. And so then we've got to translate it into a complex system. System that is rigid and that is made rigid by people not thinking.

Yeah.

And so I remember when we came to Fiona Stanley from Royal Perth, I remember having the conversation with you two guys, are we going to thicken? We're in a bubble. The burns bubble is this group of people that are doing things that are just cutting edge. We're always on the out, we're not in the box at all. We're outside the box all the time. Right. And I remember saying to you guys, do we thicken the skin of our bubble or do we offer the hand of friendship and try and help the system and those around us? On one hand I think we made an error in the decision to help others because it distracted us from our core business and what we were really good at. But on the other hand, it was a really good thing to connect with others. But it made us vulnerable to all those different.

Pressures within the system, particularly of those people in positions of power who do not think. And so now I spending time trying to just, I mean, and in that kind of space, people just don't know. You don't say, oh, you're not thinking about that? Okay, then I'll think about it. That does not work. Right. So you've got to work out how to get this stubborn rigidity loosened up and exposed to innovation, exposed to the excitement of maybe doing something different tomorrow. Because let's face it, today, if today's as good as it gets, what are we doing?

Let's all go to the beach. So trying to foster that in those around us in a broader context has been hard. Yeah. And so maybe thickening the skin of the bubble would have been a good idea, but it would have limited us and we were never going to be limited.

It's one of those things where it's, you know, go fast, go alone, go far, go together. And it's always a very difficult choice, especially in a complex system. And when you're dealing with people that are risk averse and also people that expect tomorrow to be like today, which was like yesterday, I remember going through during with the Commissioning team. And, you know, Fiona Stanley's big one and a half billion dollar hospital, or two billion, whatever it was, and it's supposed to be a paperless hospital. All the IT guys knew we're never going to get there anyway. They come in and I was there early, you know, guarding the desks. Our little territory. And they came through with the team. They're like, right, we'll have. In the clinic, we'll have a printer there, there, there, there. And I'm like, no, we're going to delete all of those and have one right at the front. They're like, why? Like, well, people won't print stuff. You're going to go pay for us. You'll force them to do something. They're like, that's the innovative thinking that we need. And I was like, oh, geez, if this is the bar.

It was really, really challenging.

I've just saved you five grand as well. One printer.

Oh, I would like to know, how did Fiona end up snagging you and getting you to come across from Queensland to wa? Because that's a pretty big move.

Yeah, it was funny. I'd done a couple of years work in. In Burns in Brisbane, and I think. I don't know. I don't know, I probably can't pat myself on the back enough to say that I had noticed that, you know, it was a bit stagnant there. Maybe it was just more a feeling that I had that, you know, the, the person that was doing the job was clearly getting towards the end of his career and, you know, the, the people that were banging their heads trying to get up into the position of running the Burns unit, there were just not really getting anywhere. And. And maybe I noticed that, I don't know. But anyway, I got interested in moving out of Brisbane, but I still wanted to stay in Burns, and. And obviously I went to Queenstown and thought, oh, that's a. You know, that's some really interesting stuff going on there. So I went across to. As it turned out, I went across to Western Australia on a conference that was supposed to be in Bali. So there was a Australian physio conference in Bali.

Nice junk.

But the problem was the Australian Physio association couldn't organize a chook raffle. So.

It didn't happen in Bali, it happened in Broome. And so I went.

Well, actually, it didn't happen in Broome, it happened in Perth. But I was able to tag a little bit instead of going to Bali, because we were supposed to fly to Bali. I just said, oh Suze, let's fly to Broome. So we stayed in Broome a couple days and then we went to this conference down in Perth and I presented some respiratory stuff that we were doing and.

And I came in and visited the burns unit and I must have met Fiona at that stage and it was like, yeah, this is where we need to go. So there was jobs in Tasmania and there was jobs in Perth and yeah, at that time, this is about back into 1997, going into 98. Yeah, we just up stumps and came across and said we're working in Perth and I started in plastics, working as a physio in plastic surgery. And that obviously at the time was work. Plastics and burns were together. Yeah and then I guess a few dominoes fell which fell my way and I ended up as a senior in burns basically. So went from working in plastic surgery which had a little bit of burns and then I ended up as a senior in burns and that was about 1998. Back into 1998 or going into 99 I think. And yeah, and then it was throttle, throttle down, throttle down from then on and that's.

Yeah, I ended up working at the Fiona Wood foundation because of you. So you work next to my mum who was in the hospital, she was on the adjacent ward and she heard there was a job. I was like quite happy having like a few month break, you know, after I did one role in health and I kind of had a break, like I didn't really like working where I was working. And she's like nah, you're not going to be at my house and do nothing. If you have to get up and go. Got this data entry job three days a week, great, it's like whatever, go, go to the hospital. Wearing my ill fitting suit as a 22 year old, Debbie was there, she greeted me and said oh, Fiona will be up shortly. I'm like okay, whatever, I'm just doing this for my mum. Sit down. And then like, you know, traditional Fiona style, rolling late but you're wearing scrubs so it's super forgivable. Like these hands save people. When I was in surgery and I remember looking at you going holy shit, that's Fiona Wood. Because I knew because of the Australian of the year. And anyway we ended up having an interview, we nerded out about data and then I was hired after that interview and I wanted to know what did you see back then and even now because you've been an innovator and a forward thinker about what a multidisciplinary team needs to be and having someone like me in your team in a clinical area sit with the clinicians is very weird. It's still weird.

It's way, way, way ahead of the wave.

It's weird but it shouldn't be. And I did it because your mum told.

We got a game from the computer games.

But I absolutely could see and it's breathtaking to me that we're 20 years further on nearly, you know, and every team needs.

Data capture, data management, data analytics, data prediction, machine learning, cognitive offloading with AI. I mean it's so obvious to me and it was obvious back then we've outcomes, we've got to measure these things, we've got to actually have these things in place. And so when we got the funding from Microsoft and you built the Burns information management system with them, we were starting. We have now like the data that Dale was talking about, we're looking at yesterday thousands upon thousands upon thousands of people. We can actually see the impact of what we do and then we've linked it with our biobank and specimens and things and then we can actually see the difference, differences between individuals and their trajectory of healing and what influences that. So we're still pushing right in front of the wave. But I don't know how people can even begin to think about how to have a health system that is data driven, that's evidence based without people like you. So it boggles my mind and it was very obvious that, I mean, and I tell everybody I was the crash dummy because the deal was if I could use this system, anybody could use it because I was my age demographic and I don't like black boxes. I want to know what happens inside. And I had to just let it go because this black box is going to tell me something. And in the the person who knows about what's in that black box is Aaron. My kids used to say I should pay you danger money.

But yeah, but even from a person like that it was obvious to me. And so I'd still, you know, sometimes I look around and I just, I don't get why this is not obvious to others.

I read a paper some years ago, maybe just before COVID that in America they'd increased administration by 300% FTE in a 15 year period. At the same time they'd increased by 3 or 4% clinical FTE crazy. Well why aren't some of that 300% people like you who actually make the people like me and Al actually get put in a position where we can give the right information and treatment tailored to the individual. We talk about tailored medicine. Well, we've got to get there. How do we get there? Data, but not just data on a plate on the middle of the table, actually organized in a way that we can understand it. Yeah.

I remember this because we were. And it was just so crazy to me because I've got information systems degree and I came into the hospital and everything's on paper. And this is kind of like, you know, I understood, I worked in payroll for a few months. I understood that part of it. But I'm like, wait, we don't have. This is not electronic. This is weird. And then you have someone that comes for a fellowship, highly paid person, and they're doing a research project and they're going through files and transcribing things. I'm like, this is just crazy. And it was insane. And just what we did with the burns information management system, being able to automate workflows and capture data and then working heavily with you, Dale, with all of your long term outcomes. So measuring people over time and seeing how they're doing on standardized tests, then putting that in a system, graphing it so a clinician can see it on a traffic light system. So when you treat someone in a clinic, you know which areas to actually ask them and go after. Because you have a very short consult, you can't. You can only cover so much. You ask them what's important to them, but there may be a glaringly obvious thing that they're not saying that'll give you that data and it gives you information. You need to then treat that patient.

Yeah. And you know that that's something that we're still developing even today, you know, is being able to pop that stuff up, make it part of a natural conversation. Because I think the surveys, because we do a lot of surveys, survey items that give us cues for conversations. And I think that we probably.

As.

A team, we don't even, you know, we haven't even leveraged that as well as we could have. It's all there. We. Our next step is that's the next frontier. Because we talk about healing, you know, early healing, you know, rapid healing and healing, the physical aspects of a burn. And I think we're well on the way to doing that, you know, at an excellent level. But I think we've got. Our next frontier is actually being able to unpack the scarring in the mind. And how do we identify people who are going to not do so well early and then put in place, wrap around Them the things that they need to do well, to nudge them off a recovery pattern because we've got enough data now that we can talk about recovery patterns, that's the next piece of work that we're going to do this year is really trying to identify those recovery patterns and profile patients and then start to work backwards and say, okay, when do we identify someone who's not going to stick to our recovery pattern? Which is the best we can get. And so that's what those systems are going to do for us. You know, that's how I want to see them in the next year or so, working.

For our clinicians to support decision making, to support identifying people who aren't doing so well. Because they don't always say that in front of the docs. You know.

They'Ll say a completely different story. But if they're filling out stuff independently, which is what our, our BIMS system, our burns info system does, it allows them to fill out stuff independently. They say quite different things to what they'll say to a human 100.

You know, the classic one bringing up something with sexual function that's very hard to talk about but if it's there, you can broach the subject. You can say, okay, this area of.

Your life seems like you're having trouble.

Yeah.

And it's an important thing, right?

Yeah.

But before we fall off the edge of the planet, we've realized that, that.

We'Re in a unique position. Well, because we've got so much data and we've got all these systems in place. But the other is we've been doing this for a long time and people in WA stay here. And so there's hardly anything in the literature around a knowledge around really long term follow up. So our next goal is to see how people go 20, 30 years and so actually work out how we facilitate those people coming back and giving us that information. Because I think that is going to be the ultra long follow up.

So is this something you did with Janine? Was that a longer term follow up as well?

That was data linkage at the very high level. This will be dropping down and saying how are you each individual all these years later? And link it with the health data, but in much more granular what's your life been like and has it it changed because of the burn? Because we know the physical scar, we know the psychological scar, but we've also discovered the physiological scar scars in your immune system, your biochemistry in your body and that make you some people vulnerable. And so to really, I don't think anywhere in the world can do that.

No, we are unique. So I'm gonna throw it out there. It's the old fab, right? The ultra long follow up after burn. The old fab. That's what I'm throwing it out there. That's what I'm, that's the project I'm setting.

And I think it's very exciting because I think that we've got opportunity to look at.

The biochemistry and the genomic profiles of patients before they have a burn. So there'll be some things that won't have changed and we can potentially identify patients who are going to heal better or worse or, you know, have complications or not. You know, so there's, there's a nice piece that I think we could potentially look at there with our biobanked specimens and then bringing in some other new, a new cohort. And then what I'm interested in is obviously, okay, so where does exercise activity, you know, and function fit into or those outcomes? How do, how do we better predict who's going to have trouble there and you know, or who's going to do well and how do we emulate that in other patients? And then of course we've got all of our, you know, the mind frontier, which is I think still our big area, that we will also start to bring that in, you know, education and learning how to, how perhaps does a burn influence education and learning? We know it influences your neurological system. Does it also influence your learning and your ability to learn? We don't know that, you know, there's, but we have opportunity to start looking at those types of outcomes as well as, you know, our, our actual patient outcomes, our.

You know, the, the measurable outcomes that we look at, the clinical outcomes.

This is really exciting because you're collecting a whole bunch of data, you're collecting biological data as well, biobanking it, doing a lot of research in that area. And then you've also got the crazy science side, you know, out at UWA that I don't understand. Things like scar in a jar. Everything else that you've got, what's going on in that space that kind of connects to this whole journey that you both are on.

I think that's really. Yeah, I've tried very hard to put a research sort of program into some kind of order because we do so much in so many different areas that for very long time people have just been bemused. And look, we appear to be like a pinball machine and a bit random, but it's all the Master plan. Yeah, it is a master plan and.

We'Ve got to get that out before someone else steps away from someone.

Got to get in on that.

I have this with my co founder Ben as well where he's just got this master plan but he can't explain it to me.

I gotta give it a go. Look.

You're good at explaining.

I'm going to give it a go. Because basically our research is into five areas. Our basic science kind of research. One is following up on the spraying skin cells on from you to you. How can we do it better? How can we do it so it regenerates in a more complete way with hair and sweat glands and the full thickness of skin. So we do a lot of experimentation with collaborating very across.

Nationally and internationally. Tristan is, Clemens is one of the guys we as a homegrown West Australian who runs a lab in Mississippi now anyway and he's got for example he's got a molecule that we're spraying on with our cells and it's actually providing the framework, self assembling framework and we're spraying and looking at spraying fat cells as well. So There's a whole 3D printing. Tissue engineering. How do we actually regenerate skin? So that's the one, one sort of section. The next section.

I love that it's just one small section. Let's just regenerate skin. Let's go.

And the next section is looking at skin chemistry and look at that as a window to clinical decision making, to diagnosis. And that's from swabbing the surface of the skin. And we're trying to. We've got data that, that shows that the chemistry from the skin matches the chemistry in the blood. So why do we take blood tests? This gives us. We'll be able to monitor changes in a more exquisite way if you like. And then we've got the eye knife where we're cut with the specimen at the moment. We will take it into theater eventually. So it's augmented decision. We know exactly what we're cutting through. From a chemistry profile I could go bzzz. And with the sort of electronic knife I look up and within seconds I see 3,000 molecules and the quantity. Yeah. So really powerful.

How does it go again?

Just chicken. Just chicken.

Top level science.

Another section and then we've got unscarring the scar and we've worked with people in pharmaxis interstate and taken a molecule. We've done the scar in the jar and all that sort of stuff and a whole raft of experiments and we've taken that first in human and now we're going to more clinical trials unscarring the scar. Cause we know that scars turn over all the time and people think, oh, it's static, but it's not. If you look at a little scar on a baby, it's not a little scar when they're an adult. Yeah. And so how can we influence that as it's turning over? So unscarring the scar that links in with the laser programs and things. And then we've got the systemic impact of injury where all the biological specimens trying to understand and like we already know that the boys and the girls recover differently. We can predict now in some of the adult data, even though we haven't looked prospectively, when we look back, we can see where we could have said we could have told you that that group were going to be a poor trajectory. So working that sort of thing out and how certain people are vulnerable and things like they don't respond to vaccination. If you've had a burn injury, certain people will be vaccinated and they will not respond. That's really important. And that's led to link with all the immunology people. So that's the next, the systemic. And the last one, which is my favorite is the neurological one. The skin is part of the nervous system. Yeah. In my view, because we've got the eye, the nose and all that sort of stuff is very smell and sight people. It's discreet. But the skin is much smarter. It does so many more things and it's out there on the surface. It's underrated, you know. But the intimate attachment with the nervous system integrated is so important. For example, if you're burnt on the back of your right hand, the nerves change. On the back of your left hand, the cell bodies by your spinal cord change. Your brain patterning changes. And this is where can we use that visualization like with various techniques and to drive improved outcome. And we have a trial that's just coming to conclusion. I don't know the result of it yet, where we've used transcranial magnetic stimulation to drive improved outcome in our adult burn patients. And this is a randomized controlled trial with a sham. So stimulating someone's brain will change neuroplasticity and in doing so will they be able to improve their outcome functionally? It is out there. It is a really impressive sort of.

Piece of work that's led us to work with Anne Marie Valance, who's a Murdoch neurophysiologist with a special area interest in tms and to bring everybody together. And then we've got the data and the clinical outcomes and all that, that underpins and all the clinical data and all the biological specimens and all that sort of stuff facilitates all these fire areas. So there it is in a nutshell, really, isn't it?

It's sort of like there's a bunch of horizontal layers and what we now need to do is drive the nails through to join them all up.

Absolutely.

It's a matrix.

And I think that is something that.

I think there is no spoon.

It's definitely. Yeah, that's it.

No, I think that is really what's exciting is I feel like we are in our lifetime, in our work lifetime, going to see these things coalesce. Because I've worked with Fiona for a long time and.

I guess I have always subscribed to the vision because the neurological system, I think, is your interaction with the world. And obviously your primary sensor is your skin. So it makes a lot of sense that we should be thinking a lot more about the neurological system when we're talking about healing and. And recovery from burns. Because by definition, a burn injures your primary sensor to the world. And I think we didn't see any appreciable change in the use of analgesics until probably 15, 10, 15 years ago, where they started to actually think of burns pain in a different way because they thought, oh, it's a neuropathic pain. Well, obviously it's a neuropathic pain because you've got damaged nerve endings. As soon as you have a burn, that's what you have. So there's. I think it gets back to that point about just thinking differently. You know, we have tried to not put the blinkers on and not to be an echo chamber. And I think that, you know, one of the greatest assets that Fiona has is that she's been able to network so broadly. And I think it's your saying that is, you know, or maybe it's your dad saying, except all but blows. You know, something like that. You say it much better.

Hey, don't refuse. Nothing but blow. So that's it. I loved it then.

Yeah. And I think that it's been very exciting for me as a physio coming into that, into the team, but also into the opportunities that. That networking has afforded me. It's why I've got some crazy publications in different areas.

I've been the international awarded medalist physio of the world in burns of the world.

Of the world. Yeah. Oh, my goodness.

Shout that one out.

Yeah, but, but I think that, that that really is. Has been what's exciting for me is that, you know, I never envisaged, you know, that doing really simple things like getting people out of bed would be almost like the flagship of what we're pushing out to the world in, in terms of physio. You know, there's lots of other things that Fiona's team's pushing out, but that's really interest.

So the simplification, it's simple, it's not. But that getting somebody out of bed changes all their proprioception, their capacity to move. No, massive different swelling, whole raft of different things. Yeah. And so people have walked away from it because it's not easy.

It is hard. Yeah, it is hard on a one to one basis.

Yeah. But actually the concept is simple really, how you execute it as its challenges. But then the benefit are just extraordinary. And so it's a really, it's like really pare it right down. It just sounds like, oh, yeah, we get people up, out of bed. But then you go, you see a patient come from intensive care to the ward and the intensive care come, guys come down, they go, they're walking and you say, dale go. Yeah, they're going to the gym. And the intensive care guys go.

You know, it's like, you what, mate?

It does. It freaks them out because. And I think that that comes back to the blinkered thinking, you know, because, oh, in intensive care we don't get these people up. We, you know, or we can't get them walking until, you know, three minutes before they're leaving intensive care. Well, they'll leave intensive care in the morning or, you know, early afternoon and by that late afternoon I'll have them walking up, you know, 30, 40 meters. On a frame. Yes, they're on a frame, but you know, they're out of bed and they're going, you know, within hours. Now you can't tell me that their physiology's changed from 3 hours ago enough that they couldn't walk then, but now they can walk.

But it's interesting, these simple things like the classic. I arrived here in 87 and I was a young doctor and the patient was called in from Kununurra. That took a like, that blew me away because it took so long for the patient to arrive. And I was thinking, wow, you know, because a lot can happen in that time. And so we started that program of sitting up, up, you're sick, you lay down. No, sit up. Because there's no one out in the bush. That can vent, that can ventilate, incubate you, to ventilate you until the rfds get there. So you've got to sit up, otherwise you'll swell up. And that simple thing, I mean, we've done lots of research around it now, and we absolutely know it's real. We ventilate a third of the number of patients here in WA that are ventilated in the eastern states because of that simple strategy that's now embedded in our. We've had it in the teaching, in the burn management program. Teaches since 1994. And so.

If you've got a burn, don't lay down, sit up, elevate. If your legs burn, elevate it. If your legs burnt, elevate arms burnt, elevate it. And so the swelling, I mean, a lot of the work you've done, Dale, around the swelling and the control of swelling actually saves tissue. You save tissue from the collateral damage, then you get better quicker with less scarring. And it sounds simple. Yeah, but executing that whole pathway has taken a lot of energy, hasn't it?

Yeah.

I remember even not long ago. Well, first of all, in WA, like, what is it, 2.6 million square kilometers. 2.6 million people. Huge place. One adult burn unit, one kid's burn unit. It is absolutely crazy the amount people have to travel if they have a burn injury and they need to come and see you guys at the hospital. And I remember you saying, dale, this thing sounds simple, right? Getting people up and moving. Adult burn unit, roughly 10 beds. You spend over 90% of your time in that room, had a major injury, probably lots of trauma. Everything else, explosion, fire. Then they come and see you and you're like, get off your ass. We're going to get you in the gym. They're kicking and screaming, and you're making them move because you know it's going to help them with their range of motion and get them back to doing the things that they need to do. Even now, I remember you telling me this is maybe three years ago when I was still there, that.

It'S such a difficult thing to do. People will give up because they will. Patients will refuse. They won't want to do it. They won't understand. But you are a guy that gets through to them. And whenever I walk past you and I have a quick look like, you're always smiling the most when you're treating a patient. And I want to know, like, what is that for you? How do you. How do you get them to do that? And what makes you Keep doing it. Because that's a very uncomfortable, difficult thing.

Yeah, look, I think it's probably why I've been like, if I, if I think about it from the 30,000 foot view, it's because I had to justify why, you know, like why I was getting people out of bed and causing them pain. Pain. So that was the first reason. That's probably been one of my motivators for trying to understand why we do early ambulation. What are the advantages and the benefits of early ambulation? And so there's that whole sort of part of my research activity that is about justifying why we ask patients to crash through the pain barrier. Because they do. Right. There is zero chance that they will have zero pain. Pain. And the other thing that I guess I've worked a lot on is my script. So my script has changed a lot.

Because the first thing we have to do for patients to allow them to get their head around busting through that pain barrier because they have to get beyond it to get the benefit. Right. So they do have to get through the pain barrier. It's really about de. Threatening pain. Pain. And I defer to, you know, some of the greats in this space in physio, like David, David Butler, who's a crazy.

He's kind of our tribe.

Yeah.

I like this conversation because this is going from, you know, it's a physical kind of response, a mental thing as well. And you're crossing from being a physio into another domain of pain and understanding and utilizing that to help these patients.

Yeah. And. And I think that's probably been my greatest achievement in my own personal professional development. Development is changing my script so that I get people to crash through that barrier and not feel like it's coercion, you know, because, because that is the thing. Initially, I think that's where my, you know, that's where it was. It felt like coercion. It was, you're gonna, you know, we're, we gotta bring you through this. It was, it was almost to the point of bullying. And then you actually start thinking, hang on, there's a consent issue here. That's the first thing. The other thing is it's like, I don't want people to feel like I've had to drag them kicking and screaming to this better place. Right. I have to work out a way to get them through the barrier that they're perceiving. And pain is a very strong barrier. I had to get them. I had to work out a way that I could get them through that without them feeling like it was that physio told me. And that's where my script has changed a lot.

Because my observation and the people you've taught is that the patient comes out. I did that.

Yeah.

There's a pride because. So you've enabled. It's more like a mentoring than that, really, the coach whipping you because they go, oh, I did that. Because we know that the pain at the other side is less. Yeah.

Because we've observed that.

We've shown it, We've observed it, we've measured it, we've published it. And so. But if they're at the other side and they go, go. Cause Dale told me it's very different from, oh, I did that. You know, that straight in the back and like, oh, I'll come back again. And I've seen people come out of the burns unit fitter, more attuned with the whole exercise paradigm than when they came in, not just once or twice. And that's because of that philosophy that you've fostered, that empowering the individual and making it their own. It.

Yeah. And I think, you know, that that really has to be the way we have to go forward with. With patients. Self efficacy is, you know, what I think will contribute to their.

Recovery and the scarring of the mind as well. You know, and we've. We've done, you know, Dr. Lisa Martin has started to go, you know, to explore that area a lot more. She's in. In our group at PCH looking at post traumatic growth. And actually, can you be better after a burn? Because one of the things that I noticed many moons ago is that, okay, we lock them in. Right. Patients are locked in. They're not going anywhere. So we've got an opportunity. And if you're someone who's come in with some poor lifestyle choices or.

Some poor behaviors, or there's some people around you that are encouraging you to do poor behaviors. Well, we've got an opportunity to break that cycle. Cycle. And what's made that harder is the pressure on beds and the speed at which we get people out the door. Yeah. So I don't know how, whether we're quite as effective as perhaps a few years ago when we had 10 or 14 days to actually change people's minds about the holistic things that could make their life much better after they were in the burns unit. You know, it's almost like a reboot of the computer. You push the, you know, did you turn the computer on and off again? Well, yeah, if you have enough time when the patient's not able to get out and smoke, not able to get out and take their drugs and alcohol, you know, not able to be influenced by the people around them that were encouraging them to do those things or whatever else it is, you know, all of a sudden there are, there are a lot of opportunities for people to end up better off for the burn, you know, and we're doing. I think that's almost like the way that we're approaching all of the other things that we've got our fingers into as well. You know, there's, there's. You get a burn. But we're, but we've been able to apply our research and our findings in all sorts of places. And I think that's been exciting for me too, because that's the network that Fiona has built around it. Yeah. And what we've learned in burns, people think, oh, it's just a burn, it's an acute injury. Well, we know it's not. It's a chronic injury for starters. It's a chronic condition. And it has all of these other flow on effects that if we understand the mechanisms of all of those things, then perhaps we can fix a lot of other things or at least make a lot of other disease states better. Better.

What I always liked about working in the burns unit was it was a true multidisciplinary team. And there was so much cross talk. Like you would literally sit with different clinicians, physios, OTs, surgeons, psychologists, social workers, and you would just talk about different things and understand different areas. And it was. It's a place where whatever skill set you have, you can bring to the organization and you can deploy that skill set and it comes back to, and this is just a master stroke, Fiona, about the quality of the scar must be worth the pain of survival. And every intervention from the point of injury affects a scar worn for life. Just in those two statements, people can immediately see, at least I can, how I can fit in and how I can help as well. And I want to ask you about, you know, your leadership, particularly with this, because you are very different from a lot of surgeons that I know. A lot of them are quite command and control. And I remember, remember being in your office in Raw Perth one day, I was looking through your bookshelf. You were doing something on the computer and you had these organizational behavior books and leadership books and a few other things. What kind of made you go down that path and kind of become this transformational leader?

I don't know that I was anything other Than Fiona at any stage, to be perfectly honest. Because in my day, we didn't have formal training in this leadership space that I think is exceptional now. But I think I've always been somebody who's interested in doing things differently and better.

I mean, and it's obvious, you look, as a kid at school, you look at history. Well, we don't behave like that now, surely we learn something so we behave differently. We've got, you know, we don't put leeches on. Well, plastic surgeons do occasionally and that sort of thing, you know, so you can see this progress going on around you and you with the light bulb or whatever it is. Yeah. And so. And I was at a Quaker school where, you know, everybody has a voice. And so it's a very flat pyramid where everybody could contribute. And I came to the table knowing that there's absolutely no point in having a team as not listening, because what's the point?

Hiring experts are not listening to them.

We haven't had that happen before, have we?

And I remember actually Janet Holmes, of course, saying, there's no point. She knew she'd done her job when everybody in the room knew more about this area than she did. Yeah, because that's the point, isn't it? Because everybody, like all the nursing capability, this allied health, which is huge in our space, Physio, ot, psych, social work, dietitian.

There's no point in sitting there and going, oh, yeah, but I'll do this anyway.

But equally, I'm a questioner. And so people who fell away and stayed the course were people who wanted to stick with the yesterday. And so for me, we've got to think about how to do our nutrition better, how to do our exercise programs better, better. Not because today is bad, but because we should be learning all the time. And when I came here and I met Harold McComb, he was a cleft surgeon, plastic surgeon, a really interesting man. And I remember him saying, the one thing you should always remember is to learn something every day. It doesn't have to be big some days it will be, if you're lucky. But learn something every day to make tomorrow better. And that was really stuck. I remember him singing in the operating theater, looking out over the river in Bethesda. It was 1987, and I'd come halfway around the world, basically because I'd married a West Australian sight unseen. I thought, oh, yeah, it can't be bad. So clearly I'm a bit bonkers.

Wait, sight unseen, your husband, or.

I'd.

Known him three weeks A big three weeks.

Yeah. And there when you know, you know.

Yeah. And he's looking over this like, this is the opera in theater. Like, where have I come. You know? And that's. Yeah, that's what I always. My image of Harold Macomb is his exquisite clef work. Absolutely. But him singing, looking out over the river and turning to me and saying, what do you really need to know now? What you need to remember, I should say, is learning something every day.

You're always doing that. You're looking for new things. I remember once you told me you were talking to an Egyptologist. Okay.

Well, there's interesting things. I mean. Yeah. What they did with the brains and stuff and silver, that would have been around silver and honey and antimicrobial stuff, as I recall. Yeah, yeah.

And always talking to whatever the latest thing is, whether it's, you know, AI, data, science, some weird space thing just to get your brain going. How.

Yeah. And I mean, some of the interesting things. Things like I say to the youngsters, file it away. File it away. The first paper I wrote was a model where I did looked at the skin of sensation and demonstrated that with the tissue expansion contrary to what we've been told. Well, everybody who said, oh, you won't feel it as much because the skin's expanded, you won't feel it. I'm like, oh, that makes sense, because my pregnant abdomen, I can feel anyway. And so I did a formal experiment that's in the British Journal of physiology in the 80s, because I measured it and it was untrue. There was plasticity within the nervous system in the skin. Now, that was in the 80s, filled away. Yeah. It took a long time to get back to that because I went through training and children and whatever. But that neurology thing. So filing things away. 2003, I read a paper from Ralph Martins on Alzheimer's. The protein in Alzheimer's is the second most concentrated is in the fibroblast, in the skin. Is that why we scar the fibroblasts in the skin, clearing the protein? That's what we're measuring now with the skin chemistry. File things away. Don't lose them. Yeah. Because you never know when it'll fall out of your head and be useful. Nothing's wasted. Yeah.

And so this is the thing. Like, to be have extraordinary outcomes, you need extraordinary inputs as well. I remember Kobe Bryant, he was looking. I can't remember. He was doing something with basketball. And then he was on the mental side. Eventually led him to how seals and whales interact. This Oddest thing. And then he had this whole kind of thing about how he then interacted with players. And that is just one of the things, like always be curious and look outside your little sphere of influence, your little echo chamber and seek things out.

Curiosity, I think is one of the. Absolutely hit that on the head. That is so important to keep our kids curious. If they're not asking questions, why not?

Yeah, exactly.

Right.

Now, if I would've asked you 30 years ago and I asked you both this question, what would science and medicine be like? You would have said, we'll have a bacta tank in 30 years. If I was to ask you today, 30 years in the future, what do you think that burns wound healing medicine and what do you think that will look like?

Yeah, what'd you rector?

Well, I think physically we'll be almost at the point where you won't be able to see scars. You know, I think that the reconstructive, the reconstruction of the skin is going to move forward such that we will be replacing it, plus or minus regenerating it. You know, we want to see regeneration because we know that that's going to give less scarring. So I think the physical aspects, we'll have a. We'll, you know, they'll be that much better than what we see now. I'm hoping that across the world we see everybody getting up early, you know, that, that those simple things, doing those simple things well will change the outcomes for people. In places where there's a perception because we don't have any money, we're going to have poor outcomes, you know, and that, that's something that, I guess I've been doing some stuff in global outcomes and it just boggles my mind that, oh no, what we need.

In this burns unit in Nepal is a ventilator. I'm like. Except that you clean the floor with the rag that you've wiped the toilet out with and you wouldn't get a patient out of bed for a week. Like there's just, there's things you can do the simple things well. So I think I've got, I've gone a bit off piste here but you know, I would love to see early ambulation across the world. A lot of the physical problems that we see after a burn will be non existent. That's what I think. And then, you know, I think we've got opportunities to.

Actually use.

An incident like a burn because they rarely happen by accident as a general rule. It's usually people's behavior that put them in the risk in the first place. So then every time that burn occurs, there's some advantage that should be delivered to the patient in terms of their lifestyle or the way that they approach life. And so I think we need to not necessarily think post traumatic growth is something that just happens. I think we need post traumatic growth is our opportunity. And that's how we, you know, I think heal the scarring of the mind as well. And so we'll be that much further along in 30 years in that space.

Absolutely.

All right. Oh, well, I was just sitting here thinking, okay, I'm going to go back to go forward, but I'm slightly crazy. When I was a med student, I was picked on a bit on the war drowns because I was. I stood out as being the only girl. And they put an X ray on the. And the X ray, a chest X ray, was full of ping pong balls. Wood. What's that? Says the professor. And I was like, ping pong balls? And I was like, whatever. And so I'd never seen anything like it. Right. And what it was was plummetage where people with TB had had their lungs collapsed. And in order for their chest wall to be maintained, they put these ping pong ball type things inside there. I mean, how would I ever have known that? But my point is, at that time, as a medical student in the 70s, they were treating TB very effectively with antibiotics. And then more recently, as a junior, as a registrar in general surgery, which I did before a plastic surgeon, every night on call, I would sew over a perforated ulcer, stomach ulcer part.

Rigid abdomen, painful. Wash them out, seal them up. Sometimes we cut the vagus nerve, vagal to a pyloroplasty, and away you go. Now, Barry Marshall and Robin Warren have rendered that surgery almost obsolete. Yeah, not totally, but almost. So what I'd like to do is render burn surgery obsolete. Now, I've put those two examples before, because when I've said I'd like to render burn surgery obsolete, people just look at me and glaze over and walk away because I'm bonkers. Yeah. So in my paradigm, given that the bacta tank is probably a bit further away in Star wars, on another planet is when you're burnt, you have a surface, an interactive smart surface that will limit bone wound conversion and that will facilitate electric microelectric currents. And you will take a tablet so that your bone marrow produces stem cells or your fat produces stem cells that will migrate to the said area and populate that area with regenerative cells. Guided by the microcurrents. Amazing that.

And our thoughts.

Yes, you absolutely visualize and send. Because we've started this with the mirror box. You put your hand, the burnt hand in a box with the mirror in the outside. You move the good hand, you trick, you get less swelling and you get better quicker. So that whole visualization autologous cells and retain the framework of the skin and facilitate the cells to come into it to in situ tissue guided regeneration. And then I wake up.

But will we see that in 30 years? No, but we will see it at some point. Categorically. And we will see it at some point because of the work we're doing right now. Because like I say, we've done the mirror, we do this, we do bits and that comes back to chipping away all these little bits and pieces. Because I can see the big jigsaw. Yeah, we can see that jigsaw. Just because you can't see it, Joe blow over there, doesn't mean to say it doesn't exist. And as we get the pieces of the jigsaw built, then they'll be able to see it and then that section will run with it. So that's what I'd like to see. Surgery is crude across the board in health there's a problem, we'll cut it out. Right. And then we cut it out and then we get smart, we go, oh, maybe take tablet for this. And then we get smart and well, maybe we should prevent this in the first place. So that's the natural way of going, isn't it? It, you know, from surgery to the physician and the sort of non interventionists and then to actually be awful lot easier if we didn't have this in the first place and we do some prevention.

Yeah, I remember you always saying that where you're trying to or whole teams, their job is to do themselves out of a job. And you used to say like the surgeons back in the day, they cut him open and let them do it.

That's what they will say. Like they have these, these surgeons, they cut bits off each other. It's like what? Yeah, were they crazy? But right here, right now, that's what we do because that's the best we can do. But that doesn't mean to stay. We stop there. We've gotta think of the tomorrow and like prevention. If we actually got up, got up early. Yeah. From an injury. But what about getting up early anyway?

Yep.

Going for a walk, going for a.

Run or I was just thinking like if you had your way, everyone would get up early and exercise. What would the world look like if everyone was.

It'd be spinning.

Yeah, that's right. We just got to make them all go in the right direction, speed up the day. I think one of the things I like this week, for some reason I was thinking about it, someone asked me about Ozempic, and, you know.

One of the things that I've heard and I keep thinking myself, is that okay, really, to get the benefit of the. Of exercise, you have to do reps, right? Yeah. And if you don't do the reps, you don't get the benefit. Benefit, which is where you're going with, you know, everybody get up early and go and, you know, do stuff. And look, I know I can do better in terms of how much activity and exercise I can do, you know, but we all know what we should be doing now. What does a zempic do to that equation? You know, because we all love a silver bullet. Yeah, we all love a pill. Yeah, that's what we want. We want a pill. But what happens because you can't take a zempic forever, or maybe eventually they'll crack that nut as well, and you might be able to take a zempic forever. But what does it do to the motivation to get people exercising and actually sustain the benefits? Or is it just that we're, as a society, we're going to basically be happy to go on that for three months and lose weight and accept the side effects that come with it, rather than actually. Because now, I think as a general thought, you know, people struggle to do exercise regularly. Yeah, we know the benefit. We all struggle to do the exercise regularly.

Everyone knows they need to do it. Everyone knows roughly what to do.

Correct.

Move a bit more.

Correct.

Right.

But what does azempic doing, you know, and that type of, you know, drug doing to the motivation for. Is that going to remove motivation across the board?

That's an interesting question, because it's not just the motivation to lose weight. It's the motivation to explore, to remain curious. That's an interesting question.

We should actually get someone to do some psych questionnaires on people who've been on these things for a week, a.

Month, a year, and it's just another tool. Right. So doing a regular exercise program might be too hard, like quitting cigarettes or something like that. Going cold turkey is very hard. Behavior modification, building a habit that can be used in conjunction but at the same time might be too reliant on it. It's. Yeah, it's a very challenging thing. It's just another tool that's thrown.

Yeah. And. And unfortunately, we just don't know where. Where it's at at the moment. I was hearing some listening to some podcasts from, you know, from the uk and it's out of the box over there and it's, you know, and. And it's being overused, you know, for. For things that, you know, it probably shouldn't. You know, it's a. It's off label and all that sort of stuff. And, you know, I know that that's where it has to go till people work out how far is too far. But the concern for me is, it's like, well, you know, everyone in the world knows about. Probably everyone in the world knows about this stuff, so what's it going to do to our thoughts and our culture around doing the reps? Yeah, you know, I don't know.

It's very interesting.

I want the answer to that.

Maybe we'll all end up. We won't need anything. We'll all end up with a. As a blob in a jar.

That's it. We'll end up in the matrix.

Absolutely.

Now, before we wrap up, you were talking, talking before the show about Istanbul. And I've been dying to hear this story. Let's go.

Like, this is my favorite time with Fiona, apart from every day, playing in. In the, in our. In our clinical roles. When I turned 40, it was many, many moons ago. Yeah, you can. You can leave now.

He's gonna bash me up.

Yeah, that's right. I'll get you later. No, um, I'll make you walk up the stairs.

I'm out.

Um, no. So anyway, we. It was my 40th, and. And I realized that the International Society of Burn Injury meeting, you know, big conference, the world, World big conference for burns was around about the same time as my birthday. And so Susan, I. My wife and I planned to go to Greece and then link into Istanbul where the conference was. And we're at the conference and this almost organic.

Impromptu 40th birthday party happened in the foyer of one of the. Of the really smart hotel, this very, very smart hotel. Fiona says, right, we're having a drink for your birthday. And Fiona's son Joe was with us, and Sue's my wife. And so we were sitting in the foyer of this thing and she said, said, do you like Mum? As in Mum, the champagne?

Mum. Mum.

Yeah. And I think it cost like $400 a bottle. It was ridiculous price. We said, yeah, we do. And so that's what we Had. We had. We were sitting in the foyer. We'd actually been out on.

We were well down the Bondabel by that stage.

We had a good start. We had a head start.

We had a very head start.

And then at the end of the night, we were drinking Mum for my birthday, my 40th birthday. And it was. Was one of the most enjoyable and funny nights. I remember, I vaguely remember earlier in.

The night we were dancing like nobody was looking. That was a bit more than. And my son Adam did try and.

Had difficulty. We left the next morning and he had difficulty getting out. But the next morning I said, the car's here. And we were going on to Croatia afterwards. But he had a rough day that day.

And I think my name was mud because it was my fault apparently, that he couldn't get up the next day.

Gotta blame someone, mate. You can't blame yourself.

It was one of the. One of the stark memories over the years of. There's been. There's been plenty.

There's been plenty.

There's been plenty. But that was one of my most funny. Funny and enjoyable moments.

Susan came out of the Turkish bath. Oh, we've had his and hers Turkish bath. And it's really amazing. And that was the beginning of the night before we got chased. Oh, let's go, Joe. And because the Joe, like, we were clearly not a couple, so I was taken down one route and then this really big fellow comes and looks. Mom, Mom. And he comes out the other side.

Like a wet rag.

Later, scrub. So bright. Never do that to me again.

I didn't do anything.

One of my mates, Hamo, said that where there was a giant guy and he had this, like, awesome, like, mask and at the end he's massive chop.

Across the back, he's like, why I was enjoying that.

So brutal. Before we wrap up, is there anything either of you would like to cover off? Anything we haven't spoken about, Anything you want to bring awareness to?

Oh, look, I think I need to, you know, shift the focus to you, mate. Because. Because one, thank you very much for. For helping us to have this conversation today because, you know, know, we. Nowadays it's hard for us to sit in the same room and just, you know, shoot the breeze. But so that's. That's been really cathartic for me. But I think the other thing is that I don't think that you recognize. Well, maybe you do. I hope you do. I hope you recognize how much you brought to the Burns team and how much the facilitator, you know, role you played over all of those years has led us to this place where we now have have a unique opportunity in the world because of our data. We've got mature data, we've got a lot of data. So it's long term data and it's also mature data. And that set us up for.

I think, creating the legacy that I would like to create in Burns. And I'm sure that Fiona would be the same. And it comes back to, I guess, Fiona's vision of having you as a person in our team.

And also I'm hoping that you can be proud of the fact that you have played a huge part in us being where we are today as well. So thank you.

Absolutely. I think, yeah. Graham, your apprentice, Obi Wan, he's the.

Temu version of me.

He's fabulous and fantastic.

He's awesome.

Absolutely awesome. But, yeah, you're sorely missed and certainly well respected and like Dale said so, well, we would not be in this situation without your input because that's just the data, it's the systems and everything and it's the belief in it. The rest of the team. Oh, can you just tell me this? How many people have had the left toenail.

Burnt whilst wearing red nail varnish on a Sunday afternoon? Oh, right. Funny she'd ask that. But it's the whole of the team coming together to respect the power of the information and really what that sort of anchors everything that we do.

Thanks so much. And really, I started off with you guys as a 22 year old kid and you were my manager. I learned so much from you.

How?

How, first of all, crazy. You were hard. You worked doing so many things and then modeled that from you. And then.

Fiona, I'm sorry.

Yeah, there's no off button. No one ever tells you that, right?

Yeah, yeah, yeah. This is our tribe.

Fiona, your mentoring and constant motivation, you made us believe we could get to the moon with duct tape and paperclips.

It was so good.

We just absolutely went for it. We absolutely went for it.

Fiona MacGyver.

Because of that, we were able to. Everyone in the team is able to achieve way more than they thought they could. And that is a very inspiring thing. And once you have that, it changes you and it changes your life and it changes you as a person. And that stayed with me ever since I started off with you guys. And it's just been an absolutely amazing experience.

Well, now with us at this stage of the game, we're trying to clear the decks a bit because of all those ideas. Ideas that are in our heads, we've got to cement them. And so that that really drives something that's sustainable into the future for those that come behind us. So you know, okay, we've got to deal with the bits and pieces along roughly the edges and working in such a system but really making people think differently and remain curious, that's what we're setting up now, isn't it? So that they can can. There's no excuse.

Absolutely. And before we close off.

I want to hear from you guys, what is the ask? So you're in the Fiona Wood Foundation. It's a not for profit charity. You're doing a whole bunch of research. Whether you want to say something to any students that may be listening, any institutions or crypto guys that are aped to fat bag and got a burning hole in their pockets and they want to donate. What sort of things are you after and how can people get into in touch with you?

Dream big, say the big thing, go for it.

I think we have been limited by our financial resource across the whole decades. However, having the foundation right from the word go and I put semi intellectual property in there and the books and all that sort of stuff has kept a corpus so that we could keep going between the highs and lows, the highs and lows of competitive granting. But you know, we've been able to absolutely doggedly stay at this table and here right now what we want to do is ask big because what we want for financial support and absolutely students always welcome but there is no off button. But we really need to be able to consolidate the ideas and embed the research in such a way that it can continue to be commercialized, can continue that innovation pathway, feed back into the foundation and be sustainable into the future. So really money matters. There's no two ways about it. The more we have, the more we do.

And I love this quote by Tim Ferriss. Life punishes the vague wish and rewards a specific ask. If you were to put a dollar figure on it, how much are you after?

35 million.

There you go. That's beautiful.

Yep. And for me I think we need data scientists.

Yes, yes.

Because they're always the rate limiting step and I'm not saying the person is, but our ability.

This is a very important thing. Sorry, I'll just interrupt here. Where a lot of research in that research kind of value chain, it's the biostatisticians and data scientists that are the scarce resource. You can come in and volunteer your time to the Fiona Wood foundation and help these guys accelerate their Research.

Research, absolutely. And you know, that is always our rate limiting step in getting the information out there. And you know, we love telling ourselves the, you know, the interpretation of our results and that sort of stuff, but really we can't have the impact that we want to have unless we get it out there. It's got to be published, it's got to be in, it's got to be printed, it's got to be published, it's got to be talked about. And I guess that's what part of today is about, is to try and get some of our information and our, our ideas and some of the things that we've done. We want to try and get that out into a different audience, into the social media audience, which is something that I'm certainly a Luddite Happy hour man.

Yeah.

And so once again, I thank you, Aaron, for helping me out here to get me over the line. You've managed to smash me through that pain barrier.

So you've learned something from me.

Are you proud? Are you?

The Apprentice listened. Yeah, there you go.

Yeah. So look, if I was to say what our ask is, it's data scientists, biostatisticians who would love to put their shoulder to the wheel. We have so many different projects, so much data, so many different projects and research questions that your point of view on those things, you'll find something that will interest you if you were to come and join us. And then in addition to that, we have a fantastic program over the next couple of years that I think we're going to really start to look at the outcomes across a whole bunch of different domains for humans. So we need allied health students, we need medical students and high degree research students who want to come and work with us in our own environment and the money to pay them properly so, so that, you know, so that they don't have to mortgage their house or they don't lose their house when they come and study with us and they can really dedicate their time to sorting out the problems that we're trying to chase.

Absolutely.

And then, you know, our final ask would be collaborators, you know, if you've got a good idea or something that we've talked about today that you think, oh, I've got a perspective on that, come and have a chat to us. You know, we'll, as we've already said, we won't refuse anything but blows. And, and I think that that's something that I've learned very much from. Fiona is one, you know, I've been able to, I guess see the vision and get behind the vision. But it's like, you know, you just never know where the answer to that question and the. And the piece that joins those, you know, the jigsaw puzzle together, there'll be someone's different perspective. Is. Is the link between those two pieces that perhaps is, you know, we haven't spotted dotted, you know, in our experience, but someone else comes and joins with a fresh set of eyes. Then all of a sudden, you bring those things together and we all gain from that. So collaborators, data scientists, HDR students, bring it on.

Absolutely. Fiona. Dale. Oh, and sorry, you can reach them. Dale, you're on LinkedIn. Probably fionawoodfoundation.com would be the best place to reach Fiona. If you've heard something in this episode that you like or you'd like to be a part of it, or you see a gap in that little knowledge, thinking, hey, I can connect the dots with these. People, people, please do get in touch. Fiona. Dale. Thank you so much.

This has been amazing. Awesome, right?

Thank you.

And thank you, listening champions.

Thank you, champions.

All right, that was awesome.

Should we do it again?