After 25 years away, Samantha Holdsworth, has returned to the land of her childhood to establish a world-leading medical imaging research centre called Mātai, writes the centre's Jeanette Lepper.
Dr Samantha Holdsworth grew up in the small town of Te Karaka, near Gisborne, where the population has never ventured much past 500.
As a student in the 1980s at Te Karaka Primary school, about half of her classroom was Māori, and te reo Māori was an instinctive part of the school environment.
She noticed many inequalities with her classmates - the unchecked health issues, the lack of school lunchboxes - and says she was acutely aware of her own fortunate circumstances.
"Comparatively, we lived in a comfortable environment. I always thought, 'we can't let people think that we're lazy', so we always went above and beyond to make sure that we weren't seen as 'privileged' kids. Working hard has always been one of our family's values, as has being engaged with the community. It developed in me a keenness to make a difference as well."
Holdsworth and her siblings spent hot summers and cold winters working on the family farm during holidays, riding horses and motorbikes and rousing in the woolshed with the local shearing gang. When her parents started an industrial technology business, dibs were put on the children's weekends too.
"I was always interested in cosmology, understanding the universe, where we came from and how we began. Dad, an entrepreneurial engineer, has always been fascinated by the sciences and astronomy, and we often talked about that when I was growing up. Mum's always been interested in philosophy, the arts and education, and my grandfather on Dad's side, who was a farmer, always had a copy of the Journal of American Medical Association handy, as well as astrophysics journals."
Holdsworth always had a special interest in the human brain too. She was keen on medicine as a profession, driven by a desire to help others, but caught the engineering bug in her teenage years and chose this as her undergraduate degree at the University of Canterbury. It soon became apparent that engineering was not the right fit, so she crossed over into physics, staying on at Canterbury.
After achieving a first-class honours bachelor of science degree in physics, Holdsworth still felt the calling of medicine, so googled the words "medicine" and "physics" and her future vocation appeared: medical physicist.
Medical physicists, Holdsworth discovered, marry the concepts and methods of physics with the diagnosis and therapy of disease and health conditions. Their optimal tool, MRI, or medical resonance imaging, is a state-of-the-art scanning technology operated by highly-skilled medical imaging technologists and physicists to produce detailed images of the body, from the brain to blood vessels and bones. This enables the opportunity to intervene to manage disease or prevent further injury.
Holdsworth crossed the Tasman for her masters of medical physics at the Queensland University of Technology, as the qualification did not exist in New Zealand at the time.
She then crossed the Brisbane River to the University of Queensland to complete her PhD, focused on MRI. It was fast becoming a translational scanning tool, bridging the fields of medicine and science across all parts of the body and in all areas of health.
A chance encounter while visiting her sister in the United States then led Holdsworth to an 11-year post as a postdoctoral fellow and then senior scientist in the Radiological Sciences Laboratory at Stanford University's Lucas Centre. Surrounded by "some of the smartest people in the world", Stanford launched her to new heights of achievement, both as an accomplished and well-published medical physicist, and a pioneer of super-fast, high-resolution scanning methods.
"Stanford for me was an absolutely huge privilege. Our research centre was right next door to Stanford Hospital, and serendipity paved a path from our basement lab to the neurosurgeons and neuroradiologists, our clinical counterparts. These connections gave me access to diversity of opinion and open-minded engagement."
Holdsworth met her husband-to-be Chris Tilghman at a Stanford football game a week after arriving in the US and they had three boys, all born in the Stanford Hospital in Palo Alto.
In 2009, Holdsworth and her colleagues achieved the highest-ever resolution image of the living human brain. This resolution record was only recently overtaken by a group from Harvard.
Advancing scan clarity, as well as shortening time needed for patients in the scanner, is transforming clinical research and diagnostic capability. The shortened time also means that in the future, babies and children are less likely to need general anaesthesia to keep them still long enough to have a scan.
Holdsworth's work also included the development of new methodologies using MRI to help diagnose disease earlier. She has successfully put them into clinical practice, leading to better detection of brain disorders and disease and is now hailed as a global leader in her field.
Holdsworth came home in 2018 with the vision of setting up a medical research institute to better the health and wellbeing of New Zealanders.
"While I was overseas, I realised I had a strong sense of social fairness. My mother always instilled in us the importance of supporting our community."
Settling in Gisborne with her husband and three sons Oliver, now 10, Arthur, 9 and Leo, 4, she began to cement the concept of Mātai, which means to investigate or examine.
Acute and chronic health conditions, including traumatic brain injury, stroke, heart disease, diabetes and renal failure, disproportionately affect Māori. Working closely with the hospital and iwi, Mātai was to engage with patients and undertake research across each of the areas, ultimately resulting in faster diagnoses and earlier treatment interventions.
On her return, Holdsworth, now 42, started teaching at the Department of Anatomy and Medical Imaging at the University of Auckland, and was also appointed a principal investigator at the Centre for Brain Research, to help establish the centre's Traumatic Brain Injury research platform, where she has a strong focus on concussion.
She met two of the country's greatest health research minds - who would be instrumental in helping her get Mātai off the ground – the founder and director of the Centre for Brain Research, Distinguished Professor Sir Richard Faull, and Associate Professor Brett Cowan, chief scientist at the ESR and the founder and former director of the Centre for Advanced MRI (CAMRI). Both sit on the board of Mātai.
Her plan was to plant the centre in the middle of Hauora Tairāwhiti (Gisborne Hospital) which treats patients from the district with the highest level of deprivation in New Zealand. It was a hard-fought battle to have the concept accepted, being based in a small town and with a lingering question around recruiting expertise.
But with a convincing application, Holdsworth managed to secure funding from the Government's Provincial Growth Fund. The decision-makers saw that Mātai would provide immense health and social benefits to the local community and New Zealanders and provided $6 million.
In addition, the University of Auckland contributed $1.25M in-kind to the set-up of Mātai in the form of grants and salary costs of staff involved in research. This funding, along with $1 million from Trust Tairāwhiti, the region's wellbeing trust, meant Holdsworth could purchase a world-class, cutting-edge MRI scanner.
It showcases an intricate view of the organs, blood vessels, fluid, and tissue of patients. The amplified MRI (aMRI) technology - co-developed by Holdsworth and colleague Mahdi Salmani Rahimi and now being advanced by her team - amplifies the chosen area to provide exquisite detail of tissue motion. The scanner can pick up subtle tissue damage such as trauma, injury, cancerous tumours and stroke. The university has also contributed significant in-kind support via a large team of collaborators.
Holdsworth has a number of major research projects at the ready. For concussion – an underestimated and under-reported national health problem - Mātai will collaborate with specialist groups at the university, the Centre for Brain Research, the Auckland Bioengineering Institute, ESR, and CAMRI to work towards identifying a biomarker, or indicator that confirms concussive status.
Holdsworth and Mātai's clinical lead and University of Auckland honorary senior lecturer Dr Daniel Cornfeld, in collaboration with GE Healthcare, are also working on a 10-minute prostate cancer scan. A standard scan can take up to 40 minutes, and visiting urologists are locums who are time-poor.
If successful, this research would contribute to improved and accessible health delivery for Māori and other under-served populations in Tairāwhiti, and would be transferable to other smaller DHBs throughout New Zealand.
Holdsworth is also holding her breath to get a wellbeing study off the ground. Funding-pending, the goal is to scan at least 750 7-year old Tairāwhiti children from the head to the pelvis.
"This study will likely be the world's first of its kind. Acquiring such comprehensive head-to-pelvis MRI scans over a long-term period will enable us to understand developmental changes, and how the health of organs relate to each other.
"Images of the brain, heart, liver, kidney, and the body's vessels will be collected, and we believe that this data will help us to predict disease and disease outcomes, and may change the way we manage or treat disease or disorders along the way. We hope this approach may also help us to understand the impact of childhood socio-economic status on brain, heart and vascular health."
GE Healthcare, which manufactured and installed the MRI machine, is providing pro bono scientific, research and engineering support, as well as hardware and software features. Holdsworth continues to seek funding and is happy to provide a naming opportunity for the machine to any philanthropic takers.
She knows the scanner model inside-out, literally - she's been strapped into MRI scanners for the sake of research on more occasions than she can remember.
She has engaged staff who are leaders in their respective fields and many are local. Most have seen frontline inequity in healthcare and are keen to make translational research accessible to isolated communities.
Holdsworth will work closely with Mātai chief operating officer Leigh Potter (Ngāti Porou, Ngāti Kahungungu and Rongomaiwahine), who has spent the past 15 years building up and supporting the radiology clinical practice at Hauora Tairāwhiti. Potter has also worked as a medical imaging technologist at Middlemore Hospital in South Auckland.
She is overseeing the installation of the MRI scanner – she proudly refers to the MRI as the "Lamborghini of MRI machines" - and is preparing to push the go button on October 12.
Holdsworth says Matai's Māori Advisory Board importantly provides an "on-the-ground" understanding of Tairāwhiti's health and workforce issues. Her longer game includes providing future generations of tamariki with medical and scientific career opportunities. The first scholarship opportunity for a Tairāwhiti student will be announced shortly.
She says the model on which Faull has built the Centre for Brain Research holds the secret formula for bench-to-bedside research to thrive. A linkage of researchers and clinicians with outreach to and input from the community and whānau is the strategy.
"Samantha is extraordinarily driven to make Mātai a success," Faull says.
"One of her many superb attributes is that she is not only a passionate and enthusiastic expert imaging scientist but is also humble. That's what you need to keep your feet on the ground when you're serving your community."