Emeritus Professor Margaret Esiri is Professor of Neuropathology and a member of the Neurodegeneration and Inflammation Research Group. Last year she founded the Frederick Foundation, a charity in honour of her late husband, Dr Frederick Esiri.
The Frederick Foundation is the Clinical Neurosciences Society’s chosen charity to support this year. They are running a raffle to raise funds and tickets will be available for purchase at the End of Year Celebration on 17 December or online via the CNS JustGiving page.
Hi Margaret, can you tell us a bit more about yourself? How did you begin your career?
I’ve been working in Oxford since 1960, when I joined as a medical student. The first thing I’d say about my career is it wasn’t planned, it evolved, which I think is a sensible way for one to think about one’s career.
My career has been very much influenced by the fact that I met a fellow medical student from Nigeria, called Frederick. We were married very early on and I had my family when I was still a clinical medical student. I’m sure lots of people thought this was going to end in disaster but it didn’t. So, I’ve grown my family and my career at the same time.
Can you tell me more about your research?
After I qualified in medicine, I was awarded an MRC studentship for learning new techniques and I did electron microscopy. That was concerned with a project on leprosy in muscle, and the leprosy brought me into the nervous system because it affects peripheral nerves. It also brought me into the immunology sphere because the damage that happens to peripheral nerve is also related to the immune reaction to the bacteria.
While I was doing the electron microscopy in the anatomy department, I was approached by someone from the neuropathology department to work on research looking at using electron microscopy to study muscle biopsies diagnostically.
So how did that lead you into the inflammation research?
While I was working on muscle I got interested in the central nervous system. I had a mentor called David Oppenheimer who was interested in Multiple Sclerosis and I became interested in that. MS is an inflammatory disease and I became interested in other inflammatory diseases like herpes simplex encephalitis, and then as the years went on, HIV infection and how it affects the brain. Inflammatory diseases also impinge on dementia and Alzheimer’s disease. In 1998 I helped to found a long-term study of dementia, with the then Professor of Pharmacology David Smith, called the Oxford Project to Investigate Memory and Ageing (OPTIMA), which ran for nearly 30 years.
I was early into brain banking and recognising the value of not just ‘fixing’ brains, but also taking fresh sample of brains for looking at things like genes and the way they’re expressed in tissue.
Tell me more about OPTIMA.
We’ve got an amazing archive of information and tissue from people who donated their brains at the end of their lives, not only from dementia patients but also from controls. There’s still work going on using these samples at the present time; it’s one of the best collections in the world.
Tell me about your husband, Frederick, and your lives together.
My husband was from Nigeria. When we got married we had expected to go back to Nigeria straight away, but we had a young family and there was a civil war going on there, so we decided to bring up our family here.
Frederick was training to do surgery while he was here. In those days you tended to move around quite a lot in the junior parts of your career. He’d travel around the country, coming back at weekends. I wanted to stay in the same place with my family so they felt rooted. In the 1960s/70s it was quite unusual to have a mixed-race family, but Oxford was a good place to bring up children in those days and they had a very happy upbringing.
When the children were old enough for us to leave them my husband developed a clinic in a very remote part of Nigeria. I arranged to work part time in Oxford in order to be able to spend four months of the year in the clinic helping him. We did that for over 20 years.
What was he like?
He was a polymath, not just a medic. He really needed about three different lifetimes to do all the things he was interested in. He also had a lot of interest in politics and farming. He tried to grow wheat in Nigeria in experimental plots, when everyone told him it couldn’t be done. He developed small businesses in the local area to his clinic in Nigeria to try to enable people to find employment. He took out a welding machine and arranged to package tea from the local tea estate. He was full of ideas. But he only had one life, so he didn’t get it all done.
What’s the story behind the Frederick Foundation?
When my husband died six years ago I thought to myself that, in a way, I’d made it difficult for him to do as much as he might have liked on improving medical care in Nigeria, because he was spending a lot of time here. So I thought I’d try and continue his aims there.
I didn’t want to be telling people in Nigeria what was needed; I wanted to hear from Nigerians what they thought would be useful. So eventually I got in touch with a group in Ibadan University, which is one of the bigger and better-known medical schools in Nigeria, and they said they’d find it helpful if they could have help forming an acute stroke unit. The other aspect of what I wanted to achieve was to establish a link between that medical school in Ibadan and Oxford.
Why is this work important?
Strokes are one of the leading causes of death in adults in Africa and they are increasing in frequency. People who get strokes in Africa are often 10 years younger than those who get strokes here. In the UK, strokes peak in the 70s and 80s age range, but in Africa it’s in the 60s and 70s. That means they are often people who are very important in their family set-up. That’s a disaster for a whole family.
We know from studies that have been done in developed countries that the best way to deal with strokes is to have a unit with a dedicated team of staff that concentrate just on this particular problem. I want to try to enable people in Ibadan to improve the performance of stroke treatment in terms of survival and capacity of patients as a result of us intervening.
What’s the overall aim of the Frederick Foundation?
We want to improve stroke outcomes in Africa. If we show in Ibadan that it’s making a big difference, we hope to share that knowledge with other stroke units in Nigeria and perhaps elsewhere in Africa. We’d also definitely like to keep this academic link building up. I think it’s particularly valuable that my own department is willing to support what we’re doing. I’m hoping it will encourage other sources of income to be provided from outside our department, both from Oxford and also international sources of funding.
In what ways do you believe the Foundation will enhance the quality of life for people in Nigeria?
We hope there will be more people surviving stroke, and surviving stroke with better mobility. If we are successful with what we’re trying to do with the acute stroke unit, we want to extend into developing rehabilitation, which can improve outcomes in people who survive a stroke, and also prevention, which is a potentially very valuable way to reduce strokes in Africa.
What other barriers are there to treating strokes in Africa?
If you get a stroke in the UK, the first thing that happens is you have to get to a stroke unit fast, because there’s more you can do to improve outcomes if people are seen quickly. You need to know whether they’ve got a bleed or an obstruction to blood flow to the brain, because those are two very different conditions that need to be treated in different ways. To know whether it’s one or the other you need imaging. In Africa, there are very few imaging centres, and the imaging costs are high. That means that quite a lot of people will arrive at a stroke centre and can’t actually have the imaging because they can’t afford it.
My husband used to emphasise the need for medical care to be available to people who are not affluent. Those are the people who are being excluded at the moment, so we need to try and think of a way that we can make sure that everybody is able to have imaging when they arrive.
What’s the next step for the Frederick Foundation, and what do you hope to achieve with these fundraising events with the Clinical Neuroscience Society (CNS)?
One of the most important features in dealing with stroke is the quality of nursing care. In May and June 2025 Ibadan will be sending a team of people over here: nurses, physios, and a trainee doctor, to observe how we carry out our management of stroke units. I’m hoping with the money raised from the CNS we’ll be able to pay for their accommodation while they’re here. Then they’ll go back and share the information with their colleagues and we want to collect data, which we’re hoping will show they’ll have better outcomes as a result.
Is this collaboration with CNS committee unique or significant in terms of fundraising efforts?
Yes, this is unique. We haven’t got anything like this going at the moment. We’re a new charity, we’re less than a year old. But we’re really at an early stage and the help we can get from NDCN is going to be very valuable to it.
Looking to the future, what do you hope for?
I would love to see thousands of institutions in the developed world strike up collaborative links with institutions in Africa. They need help, but it needs to be collaborative help, not an imposed series of things which are often wrong. I’d like to be an example of a link that has worked and that might encourage lots of other places to do the same.