Feature Researcher: Sarka Lisonkova, MD, PhD

Dr Sarka Lisonkova is an Assistant Professor in the Division of Maternal Fetal Medicine and an Associate Faculty member in the School of Population and Public Health. She obtained her medical degree from Palacky University, Olomouc, Czech Republic before studying epidemiology in the US and Canada. She obtained an MSc in Epidemiology from the State University of New York, and a PhD in Epidemiology from the School of Population and Public Health, UBC. She completed a Michael Smith Foundation-funded Post-doctoral fellowship in our Department before joining the faculty.

In 2016 she received an award for one of the most Highly Cited Research papers from the editors of the American Journal of Obstetrics and Gynecology. She is a Co-Principal Investigator on a $1M CIHR Team Grant ‘Perinatal Healthcare System Improvement’, and a Co-Principal Investigator on a CIHR Operating Grant ‘Application of the fetuses-at-risk paradigm for advancing knowledge and improving obstetric and neonatal care’. She is also a Co-Investigator on several other grants.

What is your day job?
Research – I usually have several projects at different stages of completion. For projects at the initial stage, I am searching the current literature and talking to collaborators to refine relevant questions and ideas and then applying for research ethics approvals.

For projects that are a little further along, I may be communicating with data stewards regarding data requests or refining analytical strategies and performing data analysis. For larger, multi-centre projects, I may be liaising with participating sites or clarifying issues around data collection. Once the analysis is completed, I prepare manuscripts and discuss results with collaborators and clinicians at seminars, conferences, etc.

Like all researchers, I also spend time writing grant applications.
Supervising students – I supervise students, helping them with their projects, encouraging them to think independently and come up with new ideas, find their passion in research and define their own career goals. Occasionally I prepare lectures for classroom teaching.

Communicating – So much of my work depends on communication with others, whether it is collaborators, colleagues, trainees, data stewards or funders, to keep projects moving forward and to share the results of my work.

What is your primary research focus?
Very broadly, I study maternal, fetal and neonatal health. It is a very large area of research, however, all three domains – maternal, fetal and infant health – are interconnected. For example, two of my previous studies highlighted differences between early- and late-onset preeclampsia with respect to risk factors and fetal/infant and maternal adverse outcomes. Recently, I published a paper on differences in severe maternal morbidity and perinatal outcomes among women in rural versus urban areas of British Columbia. The paper generated quite a lot of debate and I am planning a follow-up study to better disentangle the reasons behind the discrepant rates. I have just completed two other studies examining severe maternal morbidities among older women and those with high BMI.

Currently, I am working closely with a group of clinicians and researchers in an initiative led by the Society of Obstetricians and Gynaecologists of Canada and Canadian Perinatal Surveillance System on improving our understanding of maternal mortality and morbidity and preventing adverse health outcomes among pregnant women.

I also collaborate with my departmental colleagues who focus on women’s health more broadly. For example, I work with Drs. Geoff Cundiff, Roxana Geoffrion and May Sanaee on a study of obstetric trauma during delivery and its association with pelvic floor disorders later in life; and with Drs. Paul Yong, Christina Williams and Catherine Allaire on projects studying dyspareunia and endometriosis.

With respect to my neonatal research, I collaborate with members of the Division of Neonatology on a number of studies, for example, a study of antibiotic resistance in the NICU, or a study on temporal trends in neonatal mortality and severe morbidity following preterm delivery.

What drew you to the subject?
As a medical student I was drawn to obstetrics and also neonatology. Perinatal and neonatal health is an important area of research. Pregnancy and childbirth is a very happy event in medicine and in life in general. For new mothers and fathers, everything changes with the arrival of a newborn baby that demands feeding, attention, and care. However, sometimes things don’t go smoothly, and the demands or grief can be onerous. My goal is to better understand determinants of these adverse events and to predict and prevent things from going wrong.

What do you find are the biggest challenges in pursuing research?
Funding – Perseverance is key. You get a lot of rejection. Some areas of research are more “popular” than others, and going against popularity can be difficult. Some women’s health issues can be underfunded because they are taboo or not broadly talked about – for example urinary or fecal incontinence – and it can be difficult to access research dollars that will lead to improved care.
Confidence – Building confidence in your own ability to do good research. The level of excellence in academic settings is very high, and it can be intimidating to compare yourself to all these highly accomplished people. But excellent research can be done at any stage of your career and at different places if you are not afraid to bring new ideas and persevere.

How do you ensure that you do get your own projects done?
Sometimes it is a challenge. There are some projects I haven’t finished … yet.
You have to keep moving all projects forward. If you started something you have to finish – unless there are obstacles that are outside your control.
Other times – and it can be hard – you have to say “no” to new projects or collaboration. If you don’t have time or you are not very enthusiastic about a project, it is better to decline than become overwhelmed later on. It is easier if you have funding and hire an assistant to help.

What are the greatest supports for your research?
My colleagues. In early stages, it is really important to have a good mentor – your enthusiastic peers are not always enough. Ideally there will be two or three people that you aspire to be like. In each field there are some giants that you admire for their new ideas, hard work, or collegial approach to students. Your colleagues and mentors are very important even later in your career, because conducting impactful research does not get necessarily easier as you progress.
It is good to have someone – your family, a colleague, or a friend – who will encourage you through tough times.

What advice would you give to others in regards to funding?
In population health you can still do good research without large grants. Several data sources are free to access or not very expensive. You can also get access to data through your collaborators.
Funding can certainly help you achieve your research goals and be more productive. It enables you to support students or contract research support if needed. However, the amount of funding should not be a measure of your success. Improvement in health outcomes through better health care services or better prevention and understanding of disease etiology is ultimately the most important goal.

What are your future plans and goals? What would you like your research to achieve?
Right now my focus is on maternal mortality and severe morbidity – how to accurately ascertain morbidity and death during pregnancy and postpartum on the population level, how to predict it, and how to prevent it. Maternal morbidity and mortality are intimately tied to fetal and newborn health. You can’t really separate them.
For each parent, arrival of a new baby should be one of the happiest moments in life – my motivation is to safeguard these happy moments.

When you aren’t busy being a researcher – what do you do?
I love music – I like to go to concerts at the Vancouver Symphony Orchestra or choir concerts. I am also an avid chess player and I enjoy swimming and hiking. My new thing at the moment is salsa dance lessons – it is a good workout and a great way to take my mind off problems and deadlines because I have to really concentrate on the steps! I have also started to play poker, bi-weekly with a group of players – just for fun, no money involved! I think balance is really important – if your life is only about your work it is hard to relate to others.

If you weren’t doing the work doing that you’re currently doing, what career would you pick?
I think I would obtain my medical license and work as a clinician locally or go abroad with Doctors Without Borders.