Voices in Health and Wellness

Why Disaster Planning Belongs In Every Chronic Care Visit with Dr Danielle Esler

• Dr Andrew Greenland • Season 1 • Episode 80

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Power fails, smoke drifts, roads close—and chronic conditions do not pause. We sit down with Dr Danielle Esler, dual-trained in primary care and public health and former Deputy Chief Health Officer in Australia, to map a practical path for making everyday care truly disaster-ready. From evacuating before a category five cyclone with an asthma-prone child to coordinating elements of a globally admired pandemic response, Danielle brings hard-earned insight and calm, actionable guidance.

We start with a clear look at respiratory care that moves with the patient. Danielle explains why noisy, wall-tethered nebulisers fall short during disruption, and how quiet, hands-free, breath-activated delivery can bring hospital-grade therapy anywhere. We dig into connected care, remote monitoring, and the promise of devices that can deliver a range of particle sizes—from standard inhaled meds to emerging biologics—without a power outlet. Alongside the tech, we keep equity front and centre: rural communities, people with disabilities, and children with sensory needs benefit most when care is mobile and calm.

Preparedness belongs in primary care. Danielle outlines a simple, high-yield checklist for routine chronic disease reviews: planning for smoke days, heatwaves, floods, blizzards, power loss, and supply shortages; maintaining flexible medication refills; storing action plans offline; and making smart choices between sheltering in place and evacuating. We compare health records in the UK, Australia, and the US to show how interoperable, patient-held records safeguard continuity and dignity when patients cross systems. We also confront training and policy gaps—why clinicians often avoid these talks, how to teach disruption-ready triage, and why cross-agency alignment matters when schools schedule athletics during heavy smoke.

If you want your care plan to hold when the grid doesn’t, this conversation offers a blueprint: connected records, mobile devices, and brief but decisive preparedness questions woven into every chronic care visit. Subscribe, share with a colleague who manages complex patients, and leave a review with one step you’ll add to your next care plan.

👤 Guest Biography

Dr Danielle Esler is a dual specialist in Primary Care and Public Health and the Chief Medical Officer at Misti, a women-led health innovation company focused on accessible, digitally enabled respiratory care. With more than 20 years of experience across clinical medicine, health policy, education, and AI ethics, she has held leadership roles including Deputy Chief Health Officer of the Northern Territory. Danielle splits her time between Australia and the US, advocating for equity-driven system design and disaster preparedness in healthcare.

🔗 Guest Contact & Socials

About Dr Andrew Greenland

Dr Andrew Greenland is a UK-based medical doctor and founder of Greenland Medical, specialising in Integrative and Functional Medicine. With dual training in conventional and root-cause approaches, he helps individuals optimise health, performance, and longevity — with a focus on cognitive resilience and healthy ageing.

Voices in Health and Wellness features meaningful conversations at the intersection of medicine, lifestyle, and human potential — with clinicians, scientists, and thinkers shaping the future of care.

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Dr Andrew Greenland:

Welcome to Voices in Health and Wellness, where we connect with health leaders, clinicians and changemakers redefining what care looks like in today's complex world. I'm your host, Dr. Andrew Greenland, and today's guest brings a unique lens to that conversation. I'm joined by Dr. Danielle Esler, Chief Medical Officer at Misti, a digitally enabled women-led healthcare platform focused on accessible team-based care. Danielle is a dual specialist in primary care and public health with more than 20 years of experience across clinical medicine, health policy, medical education, digital health and AI. She's held leadership roles at the national level, including as Deputy Chief Health Officer in Australia, and now splits her time between the US and Australia. Danielle, thank you so much for joining me today and welcome to the show.

Dr Danielle Esler:

Thanks so much for having me, Andrew. I value the opportunity to have a chat.

Dr Andrew Greenland:

Lovely. So maybe we could start off just a little bit about your journey. You've had a very interesting career, you've got a very interesting portfolio. How did you end up doing the various things that you do from the clinical work and public health leadership in Australia to your current role as chief medical officer of Misti?

Dr Danielle Esler:

So when I studied medicine at Monash University in Victoria and Australia, it was very much the traditional disease-centric focus and hospital-centric education. And sometimes life just draws you via its own path. As a new doctor, I married another doctor who had a return of service obligation to the Royal Australian Air Force. And he was posted to Darwin in the Northern Territory. I know this is a global audience, so a bit of context about the Northern Territory. It's approximately twice the size of Texas, with a population of only about 200,000 people, and a significant proportion of that population are Australian First Nation Aboriginal people. So Darwin, the capital, is a very remote locality, about a four-hour flight from Sydney or Melbourne. And as an early career physician or doctor, this really informed my perspective on health. So when we first moved there, and this was a long time ago now, I did train in general practice in an Aboriginal community-controlled organization. And so that practice really focused on chronic disease, significant burden of diabetes, for example, in the Aboriginal population, but also with a strong tropical health focus as well. And I really felt that more could be done at the health systems perspective to assist patients. So then I combined my career by bringing in another specialty, which was public health medicine, and I trained for that in the Northern Territory and as we moved around various Australian localities. So we moved back to Melbourne at some stage, and so I ended up working in more traditional urban settings. But back in 2020, right at the beginning of the pandemic, before we knew the pandemic was coming, I went back to the Northern Territory to reconnect with my public health roots. And as you can imagine, that was a unique time to be reconnecting with a public health job that was working for the Northern Territory Department of Health. And so I worked in a leadership role for the pandemic, including as the Deputy Chief Health Officer of the Northern Territory for some of that time, really being involved in what was one of the most successful pandemic responses in the world. And so I'm really proud of that piece of work. Sometimes, again, life has other ideas, and so I'm a mum of three kids. We have uh complex health issues and disability in our household. And so a couple of years ago, we made the decision to move or spread our time between the United States and the Northern Territory of Australia to meet some of those additional needs in our household. So at the moment, I'm spending nine months of the year in uh Tennessee and three months of the year in the Northern Territory, and that was a wonderful opportunity for a career pivot. I've been excited to be involved with a respiratory device startup, Misti, which is a Melbourne-based company, and I'm able to anchor some of the um US focus uh for emerging markets there, uh, as well as support their work from an advisory perspective uh in Australia.

Dr Andrew Greenland:

Amazing, such a portfolio. So we've got much to talk about on this call. Um, let's just quickly start. I know we've got some things that you particularly want to talk about, but um let's start with MISTI, because it has such a clear mission around equity and access, particularly for women in priority populations. What excites you most about the model and its potential impact? And perhaps just a little bit more information about MISTI for those that um don't know about it.

Dr Danielle Esler:

Yeah, so so MISTI, um the mid-MISTI is their their primary device for it, seed sage startup, and uh an exciting uh device that provides hospital-grade respiratory care anywhere, anytime, and and that uses novel uh technology that generates a mist and the potential for a broad range of therapeutics to um be inhaled into specific areas of the lung, it's breath activated, hands-free, um uh not connected to wall-based power. And and so, as someone with a rural and remote focus, um, the potential for in particular hospital grade, respiratory care, anywhere, anytime, and with connected care using smart technology as well, uh I I can just see the vast potential there, and and I'm so excited to see where that company goes.

Dr Andrew Greenland:

And just very briefly, what for people that might have heard of a nebulizer versus the device that you were talking about, what will be the main differences?

Dr Danielle Esler:

So I'm an asthma parent, which is one of one of the other reasons I was drawn to uh to MISTI. And um, if we if we think about asthma, um the standard of care is uh actually a spacer inhaler, you have to hold that on. I'm thinking from a pediatric perspective, hold that on the child's face. Um patients will require a nebulizer, and and when my son was younger, he he just didn't get the response from the spacer, um, and it used a nebulizer, which is loud, sensory um patients are tethered to the wall. Uh so this is hands-free, quiet, um, patients can remain mobile, and for for particularly children or patients with sensory issues, that's particularly uh appealing. Uh, but the uh the technology um related to the mist generation is particularly exciting in that uh there's a range uh for um generating a mist for a very broad range of particle sizes. So for traditional um asthma medications all the way up to biologics or potentially mRNA. So uh that that it's really the sky's the limit in terms of what's possible there.

Dr Andrew Greenland:

And thank you for that for that clarification. Um, you're also involved in medical education and clinical AI consulting. What's the through line for you across these different spaces?

Dr Danielle Esler:

Really, for me, it's about optimizing impact. Uh I've had an extensive career now in a range of settings, and and obviously uh as AI is um coming to the forefront in healthcare, I just I really um value the opportunity to bring my voice uh to that space, particularly from a patient safety perspective. Um I'm I'm concerned about the potential for bias from an equity perspective, and I'm aware uh that my career has brought a particular niche perspective to rural and remote health, um, disaster preparedness, aboriginal health and health systems. And uh I've been fortunate to have the opportunity to consult to a range of companies uh in that capacity.

Dr Andrew Greenland:

Thank you. So let's go on to the meat of the conversation, which is the disaster preparedness. Um, when we spoke earlier, you mentioned you had a deep interest for this, especially from the level of patient clinician interaction. What sparked this focus for you in this area?

Dr Danielle Esler:

So I've already mentioned my asthma kid. And back in 2011, he was requiring uh a nebulizer, so a power-based device, and and frequent, we had frequent hospital visits for him when he was a young kid. Fortunately, he's he's grown out of the worst of the asthma. So um category five cyclone Yasi was headed to where we were living, which was North Queensland at that particular time, or hurricane for um for my US uh friends and colleagues. And uh I knew I woke up really early in the morning, I knew that uh that a category five cyclone was likely to interrupt power and interrupt hospital uh services, and uh I just thought, well, before they called for an evacuation, we need to get out of here. This is not a safe place for us. And so as I was booking airline tickets, just trying to figure out the best route out of town, the price was going up and up and up. So so, in the space of um really 15 minutes, you know, that normal sort of checking to find the best the best airline ticket that you do when you're buying a ticket, usually the price was doubling. So uh that really I I guess was a learned experience. We we did, we we got out, um, of course, while we were in our evacuation point, which was Sydney at that time, my child did have a severe uh asthma exacerbation, and we needed them, uh we needed the nebulizer, um, didn't need a hospital admission that time, and so we made the right call. But I was aware that um that there was no health systems advice from us in the patient space. And so now, as someone that lives across uh two countries, we have uh it does feel like another job for me sometimes, um, my uh health systems caring role uh with my kids with a variety of conditions. Never once have uh any of our clinicians talked to us about what we should be doing in a disaster. It's not factoring in to those clinical consultations at all. I've been involved as a public health physician in disaster response and disaster preparedness. I'm very familiar with the global landscape and and I'll just um mention that the Sendai framework, which is the uh the global agreement related to disaster risk reduction, that that has an understanding or a global understanding that this preparedness will be happening in health systems, uh, and but I think it's just terribly underdone. So I'm I'm a strong advocate for improvements in that at the clinical interface and from a policy perspective for people with particularly chronic disease or disability, but even with emergency presentations, people are discharged often to heat waves, or in our instance, we were discharged uh after a significant emergency presentation, right into a blizzard situation, and and I just love to see these discussions and preparedness brought into the clinical space to support our patients.

Dr Andrew Greenland:

Thank you. So we often hear about disaster response at a government or hospital level, but what does it actually look like in primary care, particularly for people with complex chronic conditions? You've kind of touched on a few areas. I'm just trying to get a sense of what it means. Yeah.

Dr Danielle Esler:

So from my work in general practice, chronic disease um planning is is our bread and butter, and and and that's how how many GPs or primary care physicians spend their time. Uh, I I would love to see a conversation occurring in in that space that's um uh tiered to the needs of the patient, uh, but but also the geography where they live. So, for example, someone having their asthma plan annually, um just having a question of what are we going to do when you uh when it's a bushfire smoke day, um, and and Australia's gearing up for bushfire season at the moment, and there's going to be a lot of bushfire smoke around. Um, what are you going to do if a blizzard happens and you need to stay at home for five days? Uh, how are you going to access your medications? So I think there's not many clinicians that consider this to be part of the chronic disease planning. I personally believe it should be part of uh chronic disease planning for for all patients because disasters are becoming more common. Uh just I've been through tornado warnings, blizzards, floods, cyclones, if if if listeners um reflect on their own experience, it's actually the norm for us to be exposed to to various um uh disasters, the pandemic, we've all had essentially stay-at-home orders under the pandemic, and the assumption that patients know what to do or families know what to do, I think is flawed. Uh, and and and we know that um disasters don't impact equally. People with chronic disease and disabilities have much worse outcomes in disasters, and there are um opportunities for clinicians to improve on that.

Dr Andrew Greenland:

Interesting. I mean, do you have any sense about? I mean, I don't know how much knowledge you have of the UK, and it's a bit of an unfair question, I guess, but do you have any sense of what the kind of things that we should be thinking about in the UK? Obviously, we don't necessarily some of the extreme weather events that you've talked about, but um, what are we missing?

Dr Danielle Esler:

Well, I know you have heat waves. Um, and and and and you have floods. Look, uh, you perhaps um you can answer the question because I'm not sure if the UK has a universal patient-held um electronic medical record, like Australia has the My Health record, which means that patients have access on their device and clinicians have access to histories um wherever they are in the country. Is that something in the UK?

Dr Andrew Greenland:

Yes, and we've actually moved to that within the last couple of years, and it's sort of gradually evolving. But yes, there is a national um health record.

Dr Danielle Esler:

So uh the potential for that record to improve outcomes and not just outcomes, but improve people's dignity and and well-being in disasters is considerable. And so uh ensuring that that's a resource that patients are aware of and using, and clinicians are using and ensuring that the depth of information there is um meaningful and and can assist people, for example, if they need to evacuate and access care elsewhere.

Dr Andrew Greenland:

And is there anything you're working on at the moment, anything you're kind of forecasting or looking into the future and thinking, okay, we don't have a plan for this, or anything that you know you think there's a gap that needs to be addressed where you are?

Dr Danielle Esler:

I think technology technology innovation related to connected care and um clinicians, patients, carers having access to information wherever they are is uh is really important in terms of disaster preparedness. Because whether someone needs to stay at home or show train place or uh evacuate, you can probably hear my dog in the background, sorry about that. Um whether they're evacuating, um they are separate from their usual care teams. And so connected care innovation and and Misti, I mentioned that's one uh part of the story there with that respiratory device. Um just just keen to advocate for that and and be involved uh in um spaces that are looking to do that, and then there's benefits obviously beyond disasters that that translates to everyday um rural and remote care for connected care.

Dr Andrew Greenland:

So you were talking about digital platforms earlier on, and I just wonder what you have locally and where you are in terms of um platforms that support the work that you're doing and how you use the information for your planning because obviously we've just started to have more of a national record. I'm just curious to know how it's being used to the full and the kind of work that you do.

Dr Danielle Esler:

So uh I guess I can speak to the US setting and and again bringing the um the carer perspective in, and and there aren't any universal um held records here, it's a very siloed and fragmented system. Uh, so that for example, if we um uh need medication prescribed, the physician will send a prescription to a very specific pharmacy. And and even on in in everyday life, um if there are uh challenges with supply chains, uh there then becomes this to and fro with the physician and the pharmacy to try and find somewhere to access it. And so if you bring in displacement or or additional challenges or for example worsening supply chain vulnerability, then the ability for uh patients to be able to access the medications in the United States is is fraught and much more difficult to than what I'm used to in the Australian system. So I guess just being part of discussions such as this and around this are helpful. Um I'm fortunate in that Nashville is a hub for uh uh medtech and digital health. And so um really for me uh as I'm splitting my time between two countries, being part of those conversations uh is where I'm putting my energy.

Dr Andrew Greenland:

Thank you. And are you seeing any gaps in how clinicians are trained or supported when it comes to managing care during disruption?

Dr Danielle Esler:

Well, I I I think uh clinicians don't see it as their core business. So there are opportunities from a medical education perspective at uh at all levels from medical school and beyond to um improve capacity uh and um confidence for um for multidisciplinary teams across a full range of specialties to be having these conversations and feel comfortable. to do so and it and it may be just as simple as training uh training our our doctors or our um nurses to say um to assist patients in deciding whether a a shelter in place or an evacuation pathway is is the best option for them with their particular medical problems um and the particular hazards they face with where they reside thank you so in your what's if we take your sort of day to day what does your day to day look like at the moment I know you've got various interest and things that you do what's a typical day or week like for you and I dare say that no day is typical but I'm just want to try and get a sense of where you kind of focus your time so uh because at the moment um my Australian health expertise is very much the anchor in terms of the um the opportunities that that are presented to me um for uh consulting um for example and and and for for ai work um so i i that that does mean that um i'm I'm working to the Australian time which is in the evenings uh frequently unfortunately with flexible um work uh my my evenings tend to be the the busiest in terms of meetings for Misti I'm heading out to the um JP Morgan healthcare event in San Francisco next week so um supporting MISTI um at a variety of um global health events uh and um have had the opportunity to be really an adjunct position a community fellow with the Belmont University's medical school and um their health systems uh department so uh I do have the opportunity for face-to-face teaching with medical school uh medical students here in Nashville. Brilliant and is there a space in the curriculum for getting this important message around disaster preparedness from your experience in teaching uh so so I'm not on staff there but my um my colleague there uh is an expert on disaster preparedness uh which is why he's um uh invited me to become involved with the Department of Health Systems and so I'm sure he is flying the flag um for disaster preparedness. I my next talk is on um health and the built in built environment so um social determinants of health are obviously that the broader umbrella in which this sits and and so um having opportunities to contribute in that space. So what do policymakers misunderstand about um disasters and um chronic illness in from your perspective uh so I think they they underestimate the need for really integrated um disaster preparedness and and the Cinder framework does call for that and if I could just use an example of how um potentially different departments need to be working together from policy so so in the Northern Territory we have um significant season of bushfire smoke where uh the um uh the bushfire fire risk may be remote but but there's heavy smoke and and we know that that's terrible for people with respiratory disease. So my team would be issuing bushfire smoke advisories um that you know there are I I might be asked to um speak to the on the radio about what people should be doing in terms of avoiding the bushfire smoke if they had respiratory disease and yet the I would then find that um the the schools would be still scheduling their athletics carnivals and having all of these children out running their track and field in the bushfire smoke and I'd be left as a parent to make decisions about what I should be doing for my own child which was obviously keep them at home that day. So so the need for integration and use an emergency management framework does um look to to bring the policymakers and the various um departments together but in that preparedness um phase I think that coordination is absolutely key and and also considering disaster preparedness as core business in health um we know that the the drivers often to reduce emergency department visits and investment in doing this will reduce emergency department visits.

Dr Andrew Greenland:

Thank you and you've obviously had experience of the US and Australian systems and how do they differ and what's what can they learn from each other from your perspective?

Dr Danielle Esler:

Well I I've mentioned um that uh that um striving for interoperability and the hand universal handheld um medical records and and I think uh the Australian example is really a a strong positive uh global role model for that. Um integrated uh health systems um are needed at all times and and and I've I've definitely found that that's a a lack here in the United States as as a parent of of a of kids with complex issues. I'm not sure if that answered your question. It does no thank you very much and what are the biggest challenges in the work that you do um I don't know what is there anything in particular you've had to really overcome in this work or is there anything like a big hurdle that you're trying to overcome in this um field uh well I mean this is a personal challenge and uh many um professional women in particular the listening will understand that um women's careers are not linear and and we often have competing demands and so when I was in a a a uh senior leadership role as the deputy chief health officer of one of Australia's jurisdiction uh it it was easier for me to impact as someone that's had to um make some complex changes it's just my my knowledge and my ability to um inform uh decisions and in relation to this is still there and and just seeking uh pathways to to amplify that message um sometimes is is harder outside of the um sort of clear government frameworks that I've worked in for so long. Thank you and looking six 12 months down the line what's kind of top of mind for you what does success look like personally and professionally well uh I'm I'm looking forward to um the spending the Australian winter the the US summer uh back in Australia and and seeking really to um optimise my impact there uh from a um what I would describe as a mainstream um health perspective but but really uh seeking opportunities to amplify my contribution um in this space and in particular the corporate space in the United States um I'd love to have uh pharmaceutical and um device companies really understand that there's there's market value in disaster preparedness and uh that um smart companies will be investing in this um uh as we move forward.

Dr Andrew Greenland:

Thank you. If you had a magic wand and you could change one thing in the way health systems prepare for emergencies, what would that be?

Dr Danielle Esler:

I would just love more conversations happening at the chronic disease care planning space between patients with chronic disease and their primary care providers.

Dr Andrew Greenland:

And if a natural disaster or major system failure hit tomorrow what do you think would break in the average clinical care model?

Dr Danielle Esler:

What would break? Look uh access to medications uh is is a is a particular concern um from supply chain up to individual access um uh that I'm particularly worried about that okay and have you seen any sort of surprising resilient strategies from individual patients that you've worked with or any local care teams that we should all be learning from well um I am I am aware of um work that was being done from the asthma peak body in the in the Northern Territory and um where they had um uh a phone line for asthma education and and those asthma educators very much had um bushfire smoke um as a health risk front of mine in their asthma education discussions and and they were saying that they did have a subset of patients certainly not in them in the majority who had that risk of bushfire smoke front of mine and were being proactive uh so so people that are listening who have their own chronic conditions as I know many many will um would really advocate for um don't expect your clinicians to be bringing disaster preparedness to the conversation but um but I'm sure that they'll be willing if you if you bring it yourselves. And if you were starting again in this field today knowing what you know now what would you approach differently if anything so uh my my career's been really organic and and with competing demands of um as I mentioned earlier at one stage a military husband and and now kids with um health issues and actually the uh the organic nature of my career has led to really many beautiful professional moments and um has uh engendered a a unique and niche career which has turned out to be my strength uh at this stage of my career so I can't really say that I change anything um I I just I I think being willing to embrace the opportunities professionally as they present themselves uh you know I never in my wildest dreams would have expected to be in a leadership role in a pandemic uh and we don't want bad things to happen but um being willing to to step up when they do is important.

Dr Andrew Greenland:

Thank you with that thank you so much for your time on this podcast. I really appreciate the depth and clarity you've brought to this conversation. I think these are topics often get overlooked until it's too late. But I think your work and your conversation shows just how essential it is to build preparedness into the DNA of care at a systems level but also at the patient level. So thank you so much. Really appreciate it.

Dr Danielle Esler:

Thanks so much for the opportunity to um discuss these issues Andrew