Author: Michaela Dunckova, Journal Specialist

Prof. Jo Wilmshurst is the Head of Pediatric Neurology at the Red Cross War Memorial Children’s Hospital in Cape Town, the largest pediatric hospital in sub-Saharan Africa. I took some time to chat with her about her exciting career, spanning three continents, the African Pediatric Fellowship program she runs, and her thoughts on publishing from her role as a Specialty Chief Editor of Frontiers in Neurology - Pediatric Neurology. 

We began by discussing what led her to pediatric neurology and whether this had always been her plan. Although she now lives in South Africa, she was born and raised in a small village in England, and her dream job growing up was to run a pub. “They’re family institutions here in the UK, I actually spent my adolescent years working in one and learning interpersonal skills and how to relate to people,” she admitted “my first references were written by the owners of the pub I had worked at.”

Her parents, however, encouraged her to pursue medicine. They hoped she would follow the career path of their local doctor. “It’s almost by mistake that I ended up in medicine, but I’ve got no regrets about it” she laughed. Following a medical degree at Guy’s Hospital in London, Prof. Wilmshurst completed rotations in different areas of medicine, and eventually settled on pediatric neurology. During her final few months of training she moved to Australia with her husband, who had been offered a fellowship there. Although the first reaction from her forward-thinking mentors at Guy’s Hospital was horror, they soon warmed to the international collaboration that Prof. Wilmshurst established between them and The Children's Hospital at Westmead, Sydney, where she had started a self-funded fellowship. “They thought I was a bit odd there, some strange English woman that was volunteering to come work for them for free!”

The next move to South Africa was the final one, as Prof. Wilmshurst swore to never move continents again. There she took on another voluntary role as the position for a pediatric neurologist had been frozen when the previous post-holder had retired. This was where she encountered some of the biggest challenges of her career. “Child neurology is quite specialized, so you can do it anywhere once you’re fully trained. But it is a very humbling experience transitioning to a new environment. I realized the cases we were seeing were exactly what I was used to managing, they just came with a lot more baggage. For example, a child that came in with seizures might also have had TB, the mother died of HIV, they were from a very poor area, and the drugs I wanted to prescribe were unavailable. So it was that stepping back and thinking: how can I actually use the skills I’ve got and adapt?”

Prof. Wilmshurst on a teaching and APFP visit to Zambia.

Whilst The College of Medicine of South Africa recognized her pediatric neurology qualifications, her general pediatric accreditation was based on a different system. Prof. Wilmshurst had to complete the South African general pediatric exams, which was a challenge having not worked in the country or setting before. She remembers asking her more junior colleagues to quiz her, but still failed the exam on her first try. However, as she so bluntly puts it - “failure is always good for the soul.”

The final levelling experience she discussed was the language barrier in the Red Cross Hospital. The hospital employs two translators, who are often called on as there are nine languages spoken in the country, and clinicians always strive to get a full picture in the patient’s native language – although not without minor misunderstandings. One case in particular that Prof. Wilmshurst recalled was a child presenting with excessive sleepiness, a common symptom of acute illness. It took two questions from the translator to identify the root of the problem -  the child had been staying up too late.

Other than her impressive clinical work, Prof. Wilmshurst now runs the African Paediatric Fellowship Program at the hospital. This is a formal training program where local graduates join as trainees to pick up clinical and research skills. “It covers all areas of pediatrics and has created a network of pediatric healthcare practitioners across Africa who are supported with mentors here, and then go on to share their skills in their home hospitals. There’s a phrase we use from some of our heroes here – lift as you rise. As your career pathway goes up, you better make sure that you pull others up with you."

Pictures shot by APFP Pediatric Neurology Alumnus Dr. Charles Hammond, who is now back at work in Kumasi, Ghana.

When asked what advice she would give her trainees, and other young women starting out on similar career paths, Prof. Wilmshurst mentions that the key is to be consistent, but also remain open to taking opportunities that come up unexpectedly. She describes being a child neurologist as the ultimate detective work; it’s interesting and you have to be open to constantly challenging yourself and your colleagues because this results in much better care for the patients. Some of the best advice she has received has been to keep a good work-life balance – something she is now an expert at with her husband, two daughters and two hyperactive dogs. At home they have a strict rule that when you’re off work – you’re off work, and they try to always take advantage of quality family time.

Finally, we touched on the importance of open access publishing – especially in regions where the resources are limited but the need for support is great. The one piece of advice she would give to junior researchers wanting to publish their work would be to encourage them to first use resources available to learn about methodology (such as those developed by International Child Neurology Association) before starting their research, to avoid the disappointment from a rejection due to a missing crucial point. Through her role as the Specialty Chief Editor for the Pediatric Neurology section of Frontiers in Neurology, she has strengthened her appreciation of the peer review process at Frontiers. “I like to think that through Frontiers, they have a system with real-time reviewer feedback, which gives the opportunity to strengthen the paper, but also the scientist.”