In this edition, Anna Schuh, MD, PhD, speaks about her idyllic childhood in the vineyards of Germany's Moselle Valley and being chased by wildebeest in Africa.
Tell us about your childhood.
Until I was about 10 years old, my childhood felt very free. I grew up in a small village in the Moselle Valley in southwest Germany. Everyone knew everyone else in the village, so I felt protected by all the people around me and I never felt alone when I needed help. I remember feeling very independent.
My great-grandfather owned some vineyards in the valley, and my family were winemakers for three generations. It was a profitable business because predominantly domestic wine was sold in Germany. However, when the European Union and the common market came along in the 1970s, the German wine industry was pressured by cheaper imports from southern Europe. So, sadly, in the third generation, my father had to give up the business.
Then, unfortunately, my parents divorced, and I spent my teenage years living with my mom in Cologne. My siblings were much older than me, so by that time, it was just my mom and me. Until then, I had a sheltered childhood, but I grew up fast when we moved.
Did you always know you wanted to go into medicine?
No, my dream was to count the wildebeest in Africa and study gorilla behavior in the rainforest. I grew up watching the films made by Bernhard Grzimek, a German zoologist, animal conservationist, and longtime director of the Frankfurt Zoo. In the 1960s, he and his son flew to Tanzania to study wildlife and film documentaries, including "Serengeti Shall Not Die," which was the first German film to win an Academy Award. He was a good friend of Julius Nyerere, the first president of independent Tanzania, and together they defined the boundaries of the Serengeti National Park. The park became, and still is, the major national park attraction in East Africa, and his conservation work essentially saved the wildebeest migration, which is essential to the ecosystem in Kenya and Tanzania. He is not mentioned much in the English-speaking press, but he was a hero in Germany.
Why did you decide to pursue medicine and become a hematologist?
It was a combination of things. First, during my last couple of years of high school, I worked at the local hospital as a nurse assistant and found that helping others was incredibly rewarding. I also really liked anything to do with biology, chemistry, and philosophy, which were my major subjects at school.
The other, more mundane reason was a result of what had happened to my family's winemaking business. I needed to be able to support myself and be independent, so pursuing an education that didn't lead to a well-defined profession would have been difficult for me. I wanted job security.
So, right after I finished high school, I started medical school at Cologne University. To earn money for my studies, I continued to work as a nurse assistant, primarily in intensive care, on nights or weekends. The hospital where I worked was run by Catholic nuns; they were intimidating, but they were excellent at what they did and taught me the trade.
On top of everything, I also worked in a hematology laboratory in Cologne. My supervisors were Volker Diehl, MD, a well-known professor in Hodgkin lymphoma, and Michael Pfreundschuh, MD.
For me, being a doctor was always about both making a laboratory diagnosis and then treating the patient. Often, in modern medicine, patients are sent elsewhere for tests, their results come back telling the provider the diagnosis, and then the doctor treats. However, in hematology, I thought it was still possible to do both – focusing on both the laboratory and clinical aspects of hematology. I also trained in France, where I met my husband, and we settled in the U.K. in Oxford. This is where I pursued my postgraduate medical education, both clinically and academically.
I spent five years doing laboratory work, primarily on the transcription factor SCL/TAL1 and its role in early hematopoiesis. After that, the plan was to aim for a research career as an independent investigator doing full-time lab research studying the crystal structure of SCL/TAL1 in a multimeric protein complex. However, in the end, I decided to pursue research that was more patient-centered. People have always said that I'm not really focused because I try to do too many things. However, I think that this is also my strength!
What career accomplishments are you most proud of?
In 2005, I took the knowledge I'd acquired from my time in basic research to set up the Oxford Molecular Diagnostics Centre. It wasn't that long ago, but we already had to do a lot of catching up. Now, this lab has become one of the National Institutes for Health Research in the U.K., with a reputation in diagnostics for hematologic diseases. We have a patent in noninvasive diagnostics of sickle cell disease. We've done pioneering work for the pilots that led to the creation of Genomics England and performed sequencing for their 100,000 Genomes Project, and we've delivered evidence to the National Health Service (NHS) commissioners to help bring whole-genome sequencing and advanced genomic testing to the NHS.
In parallel, I've kept up with my interest in chronic lymphocytic leukemia, so I have led, run, and contributed to many clinical trials that have resulted in changes to how we treat this disease. Although the original ideas are not necessarily coming from me, I was a lead recruiter on many of those studies, and I feel quite proud of that, because the amount of work associated with bringing patients into a study is significant.
Although there still is plenty of work to do, molecular diagnostics is now an established part of our treatment paradigms. That has been accompanied by an explosion in treatment options, including a battery of chemoimmunotherapy, antibodies, and other targeted agents. I'm very grateful to have been a part of this fascinating time.
Now, I'm also volunteering in Tanzania as a hematologist, so I've come back to my childhood dream later in my career.
When did you start volunteering there, and what kind of projects are you involved with?
I first visited Africa a couple of years ago because I wanted to fulfill my dream of counting the wildebeest. I chose Tanzania, and applied to be a volunteer through the American Society of Hematology's partnership with Health Volunteers Overseas.
Because of the tremendous progress that we've made in the Northern Hemisphere, there should be greater access to quality care in other parts of the world. Ten to 15 years ago, that wasn't an area where I thought I could make a difference. It seemed like, because there was so much political and economic instability in these countries, they had bigger problems to deal with than treating leukemia. To some extent, that is still the case, but the internet and other technology coming to Africa has revolutionized the area.
During that first visit, I spent a couple of weeks working with Julie Makani, MD, PhD, a Tanzanian medical researcher from the Muhimbili University of Health and Allied Sciences in Dar es Salaam, and Lucio Luzzatto, MD, a famous hematologist who lives there permanently and founded the Nigerian Society of Hematology 25 years ago. We performed the first-ever manual-exchange transfusion in a patient with sickle cell disease in Tanzania, which was a big achievement for the team. I also helped to get diagnostics and therapeutic monitoring for BCR-ABL up and running for patients with chronic myeloid leukemia, which means that the clinic will have access to free imatinib through the Max Foundation. Now, we have more than 150 patients in Tanzania receiving imatinib for free.
I realized that, with very little expense, you can make a huge impact in sub-Saharan countries. We are working on many other efforts like this – such as leapfrogging chemotherapy to administer targeted agents of limited duration, or possibly going straight to genetic testing for making treatment decisions. If these options were affordable, it would mean a huge difference in the lives of these patients.
What is the best piece of career advice have you received, and what advice would you share with hematologists and oncologists at the start of their careers?
I have had many mentors in my career, and I still do, but I don't necessarily believe in choosing a mentor and just having formal conversations with him or her. I think you can learn from people by watching them and you get bits from each person: You might learn bedside manner from one person, scientific focus and rigor from someone else, and how to be successful with a funding application from another person. I've admired how my mentors have been able to switch from scientific thinking to compassionate care within a second; this is a rare skill, but I have had the privilege to see it in people like Prof. Diehl, Prof. Luzzatto, and Sir David Weatherall, GBE, FRS. I also learned a lot from inspiring academic leaders like Sir John Bell, FRS, HonFREng PMedSci.
The only real advice I ever received was that I should focus more. If you are a focused person by nature, you'll probably have a much easier life. But, I also think that medicine needs people like me who are good at everything but maybe not excellent at anything, who have a broader perspective, and who manage to take a step back and think more strategically about an issue.
I mentioned my career achievements earlier, but in my personal life, my greatest accomplishment is raising four children who were born within four years of each other, with a husband who was often away. Having been through that experience, the best advice that I can give early-career hematologists is, "If you want to have it all – children, a spouse, and a career – live close to the hospital so you don't waste any time commuting. You won't have a social life, so you need to select an extremely understanding spouse." I did, and I'm quite proud that it worked out for 20 years.
"Having it all" is very difficult, but I would strongly encourage people to have children if they want. My kids are all teenagers now – my daughter is 19, my twin boys are 17, and my youngest son is 15 – and they are extremely supportive. I wouldn't have been able to do anything I did without them.
What does a typical day look like for you? What is the best part of your day?
I like being with patients – whether it's an 85-year-old in Oxford or a 25-year-old in Tanzania – so that's where I get my joy and energy. I also like looking at and interpreting data with my colleagues and talking with the young investigators and the postdocs about their career aims.
Are there any parts of your day that you wish you could skip?
Yes – any interaction with a clinical research organization. They generate a lot of paperwork for no good reason.
What do you enjoy doing outside of work?
My husband and I separated, and I decided I needed to find a hobby to stay occupied while the kids are in France with him during the holidays, so I picked up horse riding again. I used to ride when I was younger, then stopped when my children were growing up. Now, when I'm in Africa and not volunteering, I take a long weekend and go on horse-riding safaris. I've been chased by elephants, wildebeest, and even leopards while I'm on horseback. It's great!
When I'm in the U.K., I try to treat the weekends as family time, although I have to admit I still spend some time behind the computer. During the week, the kids are usually tired and cranky in the evening after they come home from school, but on the weekends we always try to have a nice family meal where we all sit at one table and talk. My kids are into music: My daughter sings, and my sons play saxophone, piano, and guitar. I like listening to them rehearsing, and sometimes they do little jazz concerts. To me, that's the perfect day.
I've also started studying Swahili, which would be the fourth language spoken in our household. My husband was French, I am German, we lived in the U.K., and my children went to the European School, so we are a very multilingual family. Learning a new language at age 51 is a challenge, but I'm trying.
Have any of your children expressed an interest in going into medicine?
No, they think medicine is disgusting! They are interested in music and art and writing and literature and history – none of them are interested in the sciences.
I recently took them with me to Tanzania in the summer. They spent a couple of weeks in the pediatric oncology unit, where there is a small school and a palliative care center for children who have to travel long distances to get their leukemia treatment. My children spent their time playing with the patients, helping with math and English lessons, drawing and painting with them, and it was a huge eye-opener for them.