For more than 30 years Helen Seale,  APAM, has been at the forefront of advocating for and providing a sustainable model of care for patients diagnosed with heart and lung conditions. This has included helping medical and other allied health professionals to develop a better understanding of the impact exercise can make to a person living with the chronic condition pulmonary hypertension.

Helen is clinical consultant physiotherapist for the Heart Lung Program at The Prince Charles Hospital within Queensland Health. In recognition of her research and clinical work, Helen has been voted to the board of the Pulmonary Hypertension Society of Australia and New Zealand, which has predominantly been composed of doctors.

Helen is the first physiotherapist to take up such as position, and has been working within the clinical and research space for pulmonary hypertension since 2002. She has attended hypertension conferences for many years, often as the only allied health professional within a room of medical specialists.

Impressed with her years of dedication and commitment, a doctor recommended she be appointed to the board. After being voted in last October, Helen’s goal is to improve the knowledge of physiotherapists in the management of pulmonary hypertension. This includes having ‘more physiotherapists and more allied health’ attend the Australian New Zealand conference that is scheduled be held in Sydney later this year.

‘I am delighted,’ she says of the achievement. ‘I’m looking at a two-year appointment and I’m looking forward to the challenge and seeing where that will take me.’

Her board inclusion is significant for the profession as it gives physiotherapists a valuable seat at a table with medical professionals to review the recommendations of new drug therapies. This includes consulting with the pharmaceutical goods administration on bringing new drugs online and setting the guidelines for the management and treatment of pulmonary hypertension.

‘Recommending drug guidelines is certainly not my area of expertise, but it will be interesting to watch that process from the inside at a board level and undertake an advocacy role for the profession and patients.’ The experience, she adds, will offer an interesting perspective on how pharmaceutical goods administration is debated and advocated for, and is ready  to participate in ‘robust discussions’.

‘The discussions are very well rounded, as the board looks at the international guidelines that are established at the world symposium on hypertension that’s held every four years. The symposium brings together experts in different areas from around the world, and the process involves them having reviewed the research from the previous four years to making a recommendation, debating it and having  it voted on.

‘There’s no pharmaceutical or other involvement or any external influences at that meeting; just 1000 people having robust discussion is a fascinating process. I’ve been to the last three symposiums, and to be able to watch the people who have written all of the papers debating the evidence is fascinating. It’s an honour to be able to influence what those recommendations should be. Because I’ve been working in this space for a very long time, I thought it was probably time that I put my hand up and try and move guidelines forward again to another level.’

Helen brings to the board more than 20 years’ experience of ‘hands-on’ management and research into pulmonary hypertension. She was involved in the landmark first pharma trial using the sixminute walk test as a primary outcome that was undertaken in the early 2000s.

More recently, she and a team of specialists and researchers from the hospital and Griffith University have been using stateof-the-art technology to examine the factors which limit exercise in patients with pulmonary hypertension. The research is the first of its type in Australia and aims at assisting early diagnosis and long-term management of the chronic condition. Tour de France winner Cadel Evans tested the technology, which involved exercising on a compatible magnetic resonance imaging cycle ergometer, to review his cardiac performance compared with that of a patient.

‘When I first started in this sphere, the recommendation for a patient that was breathless was to do nothing and sit down; now they have a medical therapy that’s improving their condition. All of the questions patients asked challenged my thought process about what exercise they should do and what advice I give them. This probably started my questioning management and interest in this area,’ she says.

Her initial interest in physiotherapy came when participating in extracurricular activities during years 11 and 12 at secondary school.

‘It was probably to make us a little bit more community minded,’ Helen says, reflecting on the school program that included visits to a cerebral palsy clinic, where students helped physiotherapists and occupational therapists work with children with disabilities. It proved to be a pivotal activity and a foundation for a career in health.

‘I remember thinking that I really enjoyed the visits, and given that I liked the sciences I initially thought medicine would make a great career. But 40 years ago women weren’t really encouraged to go into medicine, so I thought becoming a physiotherapist would be ideal. I went on to really enjoy the course and have been happily working in this field ever since.’

After graduating from University of Queensland (at the time there was only one physiotherapy course in the state), Helen moved to New South Wales to work in a clinic in Byron Bay, focusing on musculoskeletal therapy. Experience was then gained working in a number of private practices before being introduced to ‘the respiratory sphere through private hospital work’.

Helen adds: ‘The physiotherapist who owned the practice was the first person to introduce the Flutter®, which is one of the initial respiratory devices for chronic respiratory disease patients in Australia. That kind of tweaked my interest in looking at these devices and the like.’ Helen then secured a position at The Prince Charles Hospital and has been integral to its heart and lung team ever since. ‘I’ve been here for 28 years, yet it seems to have gone incredibly quickly.’

No doubt driven in part by a desire to improve the care of respiratory patients through the introduction of more dynamic respiratory techniques, Helen’s tenacious attitude and drive has gained respect from multiple sides of the health profession. Her roles at the Queensland hospital have included being clinical lead in charge of the thoracic program, which included lung transplant, and pulmonary hypertension and rehabilitation, to her current position as clinical consultant for the heart–lung program following a ‘job redesign’. The change expanded her responsibilities to include care for patients with congenital heart disease and pulmonary hypertension.

Respectful of a career that is rewarding and fulfilling, she says working within an environment where patients require a high level of care can be confronting, with a ‘lot of self-preservation and a work–life balance’ a professional necessity. Balance for Helen is working part-time in her musculoskeletal private practice, ‘just to completely make my life a little bit more complex,’ she laughs. ‘But it’s like having a balance of heavy and light. The lightness is treating patients with sprained ankles, sore knees and backs and necks, against the heaviness of high-level care. Not all patients get better and leave, so having something else to do helps balance the emotional stresses and the roller coaster you are on with patients—and that can span years.’

With myriad career highlights, a standout is accepting a research trip to Tanzania in 2016 to climb Mount Kilimanjaro. Despite having less than seven weeks to prepare, Helen leapt at the chance to be part of a 10-person team that was tasked to undertake 27 studies. Each researcher was a trial participant to better understand the effects of altitude because it mimics some diseases, such as heart failure.

‘That was a life-changing experience, one of the most awesome experiences of my life doing unbelievable research. If I was told back when [I was] a graduate that I would be involved in research with the Mayo Clinic, climb a mountain in Tanzania all because of my interest in pulmonary hypertension, that that’s where my career would get me, I would have said that was impossible. To me, it shows you need to grab opportunities, and that’s what I would say to young physiotherapists today.’

She would also add empathy as another important perquisite for life in the health profession, recalling working with a specialist 20 years ago who forwent Christmas Day with his own family to spend time with a dying patient.

‘He treated patients with such humanity. He had great observational clinical skill and acumen, and while other staff would look at machines and monitors and everything else, he spent the time looking at the patient. This particular patient had cystic fibrosis—she was very sick—and I vividly remember him sitting beside her on the intensive care bed sketching her picture, which he gave to her family. They couldn’t believe that this doctor gave up his time and did this for them.’

The act of kindness has profoundly influenced Helen’s career and how she sees the patient–physiotherapist relationship. ‘Sometimes we are so busy that we lose sight of the humanity—yes, there are times when we need to be really tough, but I also think there is a time to sit back and go well, you know, where do we go? What’s the best thing for the situation? What is best right now for the patient?’

Leading by example is evidently important to the respected clinician, who is advocating for more recognition of clinical excellence within the profession. Celebrating achievements is an avenue for the profession to retain experienced

physiotherapists, especially those who work in a high-pressured and busy hospital environment. ‘We need these people to mentor and nurture junior staff.’

She is also calling on the APA to benchmark working conditions within hospital settings, and to improve the standard of university graduates to ensure retention within this vital frontline space.

‘These junior physios will be the people that are going to be caring for you when you’re 75 and need assistance, so we need to nurture them and ensure they have the best conditions in which to work. One of the great influences on my life was my dad. He said to me: “Helen you need to be engaged and get involved. You can’t implement change if you sit on the sidelines.” So, I think that’s why I push to innovate and to improve the patient experience. You cannot change everything, but at the end of the day I want to make a difference to my patient’s journey, no matter how it ends.’