Latest / EHA Unplugged / EHA2025 Diversity, Equity, and Inclusion Award: Prof Anna Schuh

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EHA2025 Diversity, Equity, and Inclusion Award: Prof Anna Schuh · EHA Unplugged

• 0:00
  However, over the past seven or eight years, I also started to
• 0:05
  work in East Africa and that was triggered by a summer stay, two
• 0:13
  weeks of work volunteering with HBO, the ASH Associated Health
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  Volunteering Overseas organization.
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  So you when you practice hematology in those settings,
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  and it's not just about lack of money or lack of funding or
• 0:29
  politics or economics, it's actually cultural differences as
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  well. The, the infection environment,
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  the hygiene environment. It teaches you to practice a
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  completely different, a new type of hematology where the, the
• 0:46
  knowledge that or the, the practical experience and the
• 0:50
  exposure that I've had over the last 30 years in my career in
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  the UK. They helped me to identify what
• 0:57
  would be the right management. But at the same time, you have
• 1:01
  to come up with very new approaches.
• 1:05
  And I find that very interesting because it's a bilateral
• 1:09
  collaboration. It's not something where you
• 1:12
  come, you know, from the global North and you tell people what
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  to do. It's actually something that is
• 1:18
  very interactive and where many times over I realise my
• 1:23
  colleagues right and I'm wrong in in the approach to patient
• 1:29
  management. Of course there's lots of things
• 1:32
  that in theory could be done, but most of them are political
• 1:36
  decisions. And as you've probably seen, the
• 1:39
  political decisions at the moment are going in the opposite
• 1:42
  direction. So this is a much more
• 1:45
  complicated problem than just saying, oh, the North needs to
• 1:50
  give more money. I think what we will see over
• 1:52
  the next 50 years slowing down of what happens in the global
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  North and in the global S, things will grow in the chaotic
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  way and in the end in 100 years from now, but, but we will
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  equalise ourselves out. That would be a very positive
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  outcome. It's like a complex web of knots
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  to be untangled. But if we untangle it 1 by 1
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  then. Unfortunately, it's coming down
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  to those, to those conclusions that it's 1 by 1.
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  You know step by step things will change.
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  Welcome to Asia and Plot, the official podcast channel of the
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  European Hematology Association. I'm your host, Wilson Lim, and
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  today's guest is Professor Anna Shuk.
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  Professor Anna Shuk has won the EHADEI Diversity, Equality, and
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  Inclusion Award for the EHA 2025 Congress session, and today
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  we'll be talking about Professor Anashuk and her work she did
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  behind the award. Good morning, Professor Anashuk,
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  and welcome to the podcast. Could you tell us a bit more
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  about yourself? Yeah, thank you for having me
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  today on this podcast. I'm a professor of molecular
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  diagnostics at the University of Oxford, and I'm also visiting
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  professor at MOHAS, the Mumbili University of Health and Allied
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  Health Sciences. And I've been spending a lot of
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  my career looking and investigating and researching
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  and looking after patients with chronic lymphocytic leukemia.
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  They are mainly older men. And obviously it's the most
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  common leukemia in the Western world.
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  And I've been very privileged to, you know, be part of the
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  journey of the development of new therapies for those patients
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  and looking also at genomics and including whole genome
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  sequencing, trying to identify predictive factors in CLL.
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  However, over the past seven or eight years, I also started to
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  work in East Africa and that was triggered by a summer stay, two
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  weeks of volunteering with HBO, the ASH Associated Health
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  Volunteering Overseas organization.
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  And they basically asked me to go to Tanzania because there is
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  a hematology specialisation program, an Med program at
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  Moorhouse and they are always looking for teachers.
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  So I went there for a couple of weeks and I taught the students.
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  These are fully qualified doctors and they're going to
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  speciality training for hematology.
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  I taught primarily hematology, morphology and bedside teaching.
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  And then, you know, when I got back to Oxford, I, I started to
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  look for small, small funds to help establish some of the
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  diagnostics that weren't available in the university
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  there and at the hospital. And then going forward also to
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  start building capacity and allow students to register for
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  master program, masters dissertations that were maybe a
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  little bit more interesting than just doing retrospective case
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  reviews. So that's how it started.
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  I then increasingly felt that there is a huge gap between my
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  practice in the United Kingdom and they practice in East
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  Africa. And I wanted to address this
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  further and started to apply for programmatic funding in the UK
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  including global health funding. And I was very fortunate after
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  some unsuccessful attempts looking for funding to improve
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  diagnostics of adult leukemias, I was advised to target
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  childhood disease and so I end infection related cancers.
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  So I got my group got significant funding from the
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  NIHR, which is the UK equivalent of the NIH and we developed a
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  program called AI Real, which is stands for aggressive infection
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  related East African lymphoma. And we managed to recruit almost
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  400 children with suspected lymphoma into a sample
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  collection, data collection study in Uganda, in La Chore
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  and, and in in Tanzania in two different sites.
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  And that helped a lot with capacity building because we
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  then had some funding for PhD students.
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  We had funding for nurses, for pathology, for even for health
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  economics. So we were were able to
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  establish a whole programme of work to introduce take transfer
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  of liquid biopsies to improve the diagnosis of Birkett's
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  lymphoma in in children around the the Great Lakes of of Africa
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  where this disease is, they're very common.
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  That's a very interesting background and journey that
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  you've been through. I've realized that I haven't
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  Congratulation, congratulate you on your award for
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  congratulations and. Thank you.
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  How do you feel about receiving this award?
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  So what I said yesterday in the award session is basically that
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  I don't really see that this award is for me myself.
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  It's, it's, it's kind of for my colleagues in East Africa, but I
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  think predominantly it's actually for the patients.
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  And on my journey, although the program was is on the children
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  with Birkett's lymphoma, it goes much beyond that.
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  So we, we, when I do my ward rounds with students or I
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  discuss patients in the grand round or in the
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  multidisciplinary team meetings, most of them are adults, of
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  course. And contrary to what people
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  might think, actually our ward is not full of patients with
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  sickle cell disease. Our ward is full of patients
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  with malignancies and it's basically raising awareness for
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  the the complications, the specific complications of trying
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  of trying to help those patients in resource restricted
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  environment be that because of lack of diagnostics, there's
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  very few serum electrophoresis machines in East Africa.
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  The the, the full blood count machines are often not available
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  in primary care. So patients people don't know in
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  the healthcare how to interpret a full blood count, which means
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  that diseases like chronic myelodic, the leukemia, CLL are
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  not diagnosed, are diagnosed very late.
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  AML is a huge challenge because the intense, the those
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  intensification in sub-Saharan Africa is very difficult because
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  of lack of supportive care, lack of blood transfusions, platelet
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  transfusions, underlying infections like tuberculosis,
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  malaria, and the, the mortality rate in induction in AML is, is
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  very, very high. So you when you practice
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  hematology in those settings, and it's not just about lack of
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  money or lack of funding or politics or economics, it's
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  actually cultural differences as well.
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  The, the infection environment, the hygiene environment.
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  It teaches you to practice a completely different, a new type
• 9:47
  of hematology where the, the knowledge that or the, the
• 9:51
  practical experience and the exposure that I've had over the
• 9:55
  last 30 years in my career in the UK, they helped me to
• 9:59
  identify what would be the right management.
• 10:02
  But at the same time you have to come up with very new approaches
• 10:08
  and I find that very interesting because it's a bilateral
• 10:12
  collaboration. It's not something where you
• 10:15
  come, you know, from the global North and you tell people what
• 10:18
  to do. It's actually something that is
• 10:21
  very interactive and where many times over I realise my
• 10:26
  colleagues right and I'm wrong in, in the approach to patient
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  management. So, so, yeah.
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  So the, the award is dedicated to raise awareness of those
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  patients and that, you know, across the world they, they,
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  they still are the majority of patients.
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  I'm not just talking about Africa, because increasingly, of
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  course, we see poverty and and also cultural clashes within our
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  communities in the global N. So we can learn from that as
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  well. And we can we can try and find,
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  you know, the right type of treatment that is right for that
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  particular patient by listening to the patient and by listening
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  to the environment of that patient and their, their, you
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  know, values, etcetera. You know, it's, it's, it's a
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  very interesting tension that I'm living in because I spend
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  half of my time in United Kingdom and half of my time in
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  East Africa. It's quite difficult sometimes
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  because of the this cultural tension.
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  Talking about sort of mutual collaboration and sort of
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  cultural differences, was there anything that you've learnt in
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  your experience in Tanzania you could help be implemented in the
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  Global North? There are so many things, so
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  many things. I mean, I had it's part of the
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  tech transfer. It's just a very practical
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  example we had. I had my colleagues obviously
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  from United Kingdom, from my lab.
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  They came and they did a lot of teaching in the lab.
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  And what they realized on day one was how mindful people were
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  on resource use, on how you recycle rubbish plastics, how
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  you can reuse sometimes, how you can think very carefully about
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  when to not reuse it and when to reuse it.
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  In Uganda, in Lachaw, which is far in the north of Uganda.
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  It's a, it's a, it's a very, it's an old hospital by that was
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  originally funded by the, by the Catholic Church, but they, they
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  managed to get solar panels installed.
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  So the, the, the whole hospital, including operating theatres
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  functions on, on solar. They, they don't have throw away
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  plastics. They're still using linen in
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  operating theatres and they're ironing it really, you know,
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  it's very hot. So that this infects even
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  further. There's so many things that I'm
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  not saying, you know, we should completely adopt all these
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  things, but you know, being mindful of resource is something
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  that we should really, really, you know, embrace.
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  And that's, that's one of the things.
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  I think another aspect, especially in, in Tanzania,
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  people are very, are very polite and they respect older people a
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  lot. So when you come like myself,
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  you know, as a kind of older person, you, you feel, you feel
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  very welcome. And it's not something that is
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  the case, you know, in in our setting anymore that older
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  people are always being very welcome.
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  So, you know, when, when an older person go goes to a
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  hospital, you can be sure in, in terms and you can be sure that,
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  you know, like the whole family turns up right.
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  And they look after each other in a, in a way that maybe we
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  used to do like 50 years ago, 60 years ago.
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  But there is a very different perception to respecting older
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  people and to embracing death. I find this sometimes very
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  astonishing. But how quickly you know, people
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  embrace and accept that life is over and.
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  Different sort of empathetic practice, you know.
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  Very different and, and to practice in that environment, I
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  think also requires me to be guided by my colleagues.
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  Like in our setting, you know, 75 year old.
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  Yeah, we, we, when they're going through 5 rounds of treatment
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  after that, we offer them CAR T cells, right.
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  And I'm not being ages, but we have to be mindful of, of this.
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  And, and so coming back to when I got my funding for the
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  children, this was in the UK in, in, in an interview room, there
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  were 20 people. There were public health people.
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  And you walk in there as a hematologist practicing really
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  high tech medicine, they do not understand why you even apply
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  for global health funding because for them, there's no
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  role of hematology in global health because global health is
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  all about public health measures, preventative.
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  It's in stuff that is really cheap and has a huge impact.
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  So the, you know, the way to kind of demonstrate that
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  hematology and bring hematology on the table is, is, is by
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  working with children. If you save the child, the, the
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  life of one child, that's always cost effective in the public
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  health view of the world. So, yeah, this grant is now
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  finished. We are still publishing.
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  We've had already, I think 8 publications.
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  Some of them are quite high impact journal papers, which I
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  think is I, I'm very proud for my, for my students in, in
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  Uganda, Tanzania, because it doesn't happen that they are on
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  papers. Usually what happens is that
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  when when these, you know, helicopter research comes in,
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  people collect samples and they ask really clever questions.
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  They do all the analysis in somewhere in Europe or in the US
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  And then, you know, if you're lucky as a African, you're being
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  acknowledged, you know, somewhere in the
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  acknowledgement, but or you, you you'll be somewhere in the
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  middle, you know, drowned in in paper, in the papers authorship.
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  So we wanted to make really clear that this was African LED.
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  So all the first author, the the first authors are Africans.
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  I did actually resist a lot to be a last author, but that
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  didn't quite work out in the end.
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  So I do find myself as a last author, Co Co last author.
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  So it's important that people take ownership and that they
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  feel, you know, what the research they're doing, the
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  questions they're asking are relevant to them and to their
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  context. But I primarily supervise
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  students who are on site and I, I find that more meaningful and
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  I think they do as well. Yeah.
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  So, so the next idea now is that we like finish the publications
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  and then we would like to run a phase one, phase two study where
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  we vaccinate children with Berket's lymphoma.
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  So we have done a lot of sequencing of the BV strains and
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  we've developed a vaccine that we think is rather tailored
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  towards Berket's lymphoma together with the Oxford vaccine
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  group who have obviously had a lot of experience during the
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  COVID pandemic and in developing vaccines that are stable at room
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  temperature and that can be used in sub-Saharan Africa.
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  Agent Hill is very much behind many of the the vaccine
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  developments, malaria vaccine, etcetera.
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  So we're piggybacking on on the Oxford vaccine program to bring
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  this this vaccine to those children after they achieve A
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  remission after chemotherapy. So it's a therapeutic vaccine
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  that we try to to evaluate which which will be another five years
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  of work and again which will bring you know funding for for
• 18:41
  capacity building. You've talked about the people
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  that you've worked with in in your journey in in several
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  places in Africa. Are there any notable mentions
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  that you would like to talk? People that you'd like to talk
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  about? Yeah, I I don't want to start
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  mentioning any specific names because there's so many.
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  I'm sure I would forget some. I think I had definitely had
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  important mentors in my life and they basically taught me various
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  different things. And I think one of them is to
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  critically think and to be able to interrogate whether that's
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  science or whether it's what people say, perceptions.
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  I think being pragmatic and opportunistic and jumping on
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  opportunities, I think is really important, especially when
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  you're doing translational work like this and, and you're
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  navigating different cultures. You, you have to be very
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  understanding and, you know, empathetic.
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  And I've had mentors over the years who helped me establish
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  that, including also bedside manners and how to be
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  compassionate. It's important that you see it.
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  And I think that's also where I see.
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  My role as a, as a mentor now in, in East Africa, it's to, to
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  basically lead by example and to give some form of exposure to,
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  to, to other people so that they see, you know, how you approach
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  a patient, how you approach data, you know, how you try to
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  get funding, how you try to establish a laboratory or, or
• 20:34
  clinic. So, yeah, I, I think what I
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  would like to add is, is that as part of this journey from
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  research from take transfer to, you know, publishing papers to
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  then going, really trying to make a sustainable impact, we
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  created a, a social enterprise that is incorporated in
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  Tanzania. It's called Serenox Africa from
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  Serengeti and Oxford and then Africa.
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  So Serenox is a, is a clinic and laboratory and it's a, it's,
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  it's a private entity that is completely independent from any
• 21:18
  public services. But we're working as a public
• 21:21
  private partnership with the university and with a National
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  Hospital. And it's a, it's a is registered
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  as a mono specialization clinic so and lab and it's the the to
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  our knowledge the only one in East Africa for patients with
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  blood diseases. So we are very proud and by we I
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  mean the eight shareholders who are involved who are all
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  Tanzanians. We are very proud that that we
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  have got this entity now because we can actually apply and
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  practice all the, the, the teachings that the students have
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  are learning and the new hematologists are learning.
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  There's, there's 46 hematologists now and quite a
• 22:05
  few of them want to continue working as hematologists.
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  Obviously, you know, when they're finished their training.
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  So, so the social enterprise is, is one of the ways how you can
• 22:17
  make this impact sustainable in, in Uganda, we're working with
• 22:22
  the, with the Ugandan government and they have allowed us to, to
• 22:27
  run a pilot with the help of the Central public health laboratory
• 22:32
  in Kampala. They're doing liquid biopsy,
• 22:35
  liquid biopsy testing for Burkett lymphoma.
• 22:39
  And I'm hoping that over time we will be able to integrate the
• 22:45
  liquid biopsy testing into the existing network of sample
• 22:52
  referrals that this lab gets because it's the national lab
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  for, for Kampala for HIV testing, for HPV testing and
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  hepatitis B testing. So we we're trying to piggyback
• 23:06
  onto this this network. So yeah.
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  So that process of making the impact sustainable, it's still
• 23:15
  ongoing even beyond the end of the program.
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  And I'm hoping, like the the vaccine study will boost the
• 23:22
  initiative further. Is there anything that the
• 23:25
  global N can help in this journey for a sustainable
• 23:30
  impact? Of course there's lots of things
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  that in theory could be done, but most of them are political
• 23:38
  decisions. And as you've probably seen, the
• 23:41
  political decisions at the moment are going in the opposite
• 23:44
  direction. So in the OK, for example,
• 23:49
  global health funding by the NIHR that funded all of this is
• 23:53
  now being put on hold and funding has been allocated into
• 24:00
  the defence budget instead. So it's, it's a very tricky
• 24:07
  environment. We, we operate in.
• 24:10
  There's lots of, there are lots of rich people in Africa and
• 24:15
  philanthropy is not on their agenda.
• 24:18
  And that is also an issue. And it's the same in India, it's
• 24:21
  the same in many other, you know, in South America.
• 24:24
  So this is a much more complicated problem than just
• 24:28
  saying, oh, the North needs to give more money.
• 24:32
  I think what we will see over the next 50 years slowing down
• 24:36
  of what happens in the global North and in the global S,
• 24:40
  things will grow in the chaotic way and in the end in 100 years
• 24:44
  from now, but but we will equalize ourselves out.
• 24:48
  That would be a very positive outcome there.
• 24:50
  There's lots of catastrophic outcomes that we can imagine as
• 24:55
  well. But we are in this transition
• 24:59
  phase and it's very unpredictable.
• 25:03
  So my conclusion of all of this has been that, yes, I'm raising
• 25:07
  awareness and I'm trying to do what I can do in my little
• 25:13
  world. And then over time, maybe
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  there's, you know, others would think, yeah, actually, she's not
• 25:21
  completely wrong. Maybe we should do the same.
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  Yeah, it's like a complex web of knots to be untangled.
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  But if we untangle it 1 by 1 exactly.
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  Unfortunately, it's coming down to those to to those conclusions
• 25:35
  that it's 1 by 1, You know, step by step things will change.
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  Last question would, do you have any advice for people that would
• 25:50
  like to do the same as you what you did?
• 25:53
  Yeah, so I'm very, very privileged because I had a
• 25:57
  career and I still have a career in Oxford and I'm eternally
• 26:00
  grateful for the University of Oxford and my head of department
• 26:04
  that they're allowing me to do the work I'm doing.
• 26:08
  If you are starting off as a, you know, junior hematologist
• 26:13
  and you want to work in global health, it's very, very
• 26:16
  interesting. But it's very, very tough
• 26:18
  because also you you're kind of in that phase where you would be
• 26:23
  possibly competing with people in the country.
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  And so that's can't be right because, you know, you
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  ultimately the goal has to be that you promote them rather
• 26:32
  than yourself. So it's very difficult.
• 26:36
  I think obviously, you know, the traditional public health type,
• 26:39
  infectious disease type, global health type work.
• 26:43
  There were careers in that. You know, I don't want to be
• 26:46
  negative, but I it, it's, it's a little bit exploitative, you
• 26:51
  know, coming back to the helicopter research.
• 26:54
  So even although the individuals might be very well meaning,
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  ultimately the the system encourages that type of research
• 27:02
  where you just take the samples and you do your stuff, right.
• 27:05
  So you then have the other extreme where you have people
• 27:10
  after they retired, they go and they help and they do some
• 27:14
  global health work. And I think that's really good
• 27:16
  as well. They obviously have a lot of
• 27:18
  experience. I think the problem with that is
• 27:21
  is that sometimes people then try and implement something that
• 27:25
  was the the trend 20 years in our setting, whereas what Africa
• 27:29
  needs is leapfrogging. Africa needs.
• 27:33
  Africa is like the mobile phone. Everybody quotes that as the
• 27:35
  example. So you know, the landline never
• 27:38
  worked in Africa, but the mobile phone is much more advanced in
• 27:42
  Africa than it is in our setting.
• 27:45
  So I do all my banking, pay electric bills, whatever.
• 27:48
  Everything can be done by the mobile phone, via mobile phone.
• 27:52
  You know out of the 66 million Tanzanians, 45,000,000 have
• 27:55
  access to a smartphone. This is very important.
• 27:59
  That's leapfrogging is 1. So rather than saying, oh, we're
• 28:01
  now doing mylaproxidase to look for AML, No, actually you have
• 28:06
  to say we do next generation sequencing to do genomic
• 28:11
  subclassification because you have to leapfrog from where we
• 28:14
  were 20 years ago to where we will be, where Europe or what
• 28:18
  science will be in 10 years from now that would make Africa
• 28:22
  internationally competitive, right?
• 28:25
  And it's, and that's just in our little world of hematology.
• 28:29
  And, and I think when you're like, you know, 70 plus retired,
• 28:34
  it's more difficult because you can't get grants.
• 28:38
  You will have that reflex of getting back to what you what
• 28:42
  was fashionable, you know, when you were a youngster.
• 28:45
  So, so that's why I'm saying I'm very privileged because I was
• 28:48
  allowed to do this at sort of through my 80% through my
• 28:52
  career. But I'm still, I'm still full
• 28:54
  time employed by University of Oxford.
• 28:56
  So I, I can, I can tap into the money that and the grants and
• 29:00
  everything that are, you know, available.
• 29:03
  And I've got a little bit of cloud so that, you know, people
• 29:06
  when I'm saying I want to do something that they think, yeah,
• 29:09
  OK, she can probably do it. It's so, but it's also the time,
• 29:13
  of course, when nobody wants to do this because you know, it's a
• 29:16
  time where most people my age, they say, oh, actually, you
• 29:20
  know, much rather retire and I've got kids at university.
• 29:22
  I've got so much money I spend on other things.
• 29:24
  You know, I'm, it's not for me, You know, at this point in my,
• 29:28
  if there's something like that could be done is get people who
• 29:33
  are senior consultants in hematology, get them to spend 6
• 29:37
  months to a year somewhere else. That's a very good.
• 29:40
  And if they come back, things will change.
• 29:46
  Well, I'm glad that we've heard that you've give us such a good
• 29:49
  story about your experience and your, and your thought about
• 29:55
  situations and global situations and, and, and things that's
• 29:59
  going on at the moment. We'd like to thank you for your
• 30:02
  time. Thank you again.
• 30:05
  And we also like to thank the audience for listening.
• 30:09
  Again, congratulations on your award.
• 30:12
  Thank you. Thank you for your time.
• 30:15
  For all our listeners out there. Please stay tuned for more
• 30:17
  episodes from EHA Unplugged, the official podcast channel of the
• 30:22
  European Hematology Association. Thank you.