Millions of childbearing women in SA are HIV-infected, but there is hope. The return of Dr Salome Maswime after a Discovery-funded year in America studying placental pathology with the world’s best clinicians will no doubt save even more lives.
Obstetrician and gynaecologist Dr Salome Maswime is fast becoming one of South Africa’s top experts on the contribution of HIV and triple ARV drug treatment combinations to the alarmingly high incidence of stillbirths.
Says Dr Maswime, a Discovery Fellowship beneficiary who spent a year learning at Massachusetts General Hospital (MGH) in Boston, “It’s quite a controversial field. The real research question for me is to pay more attention to the foetal effects of ART.”
Changing the focus to the foetus
South Africa’s current stillbirth incidence for babies of 500g or more is estimated at 24 per 1 000 births, compared to the US average of 10 per 1 000 births. With 95% of SA’s eligible pregnant women now on triple therapy, knowing just which drug combinations will best ensure the birth of healthy babies is vital.
She stresses that the reduction in PMTCT (Prevention of mother-to-child transmission) in South Africa to around one percent is hugely impressive and important. However, she adds, “It’s been, Let’s prevent Mother-to-Child Transmission, instead of What’s happening to the babies in the meanwhile?”
“This is an important shift, else we’ll just end up with more neonatal deaths, developmental issues, pre-term births, low birth weights and early neonatal deaths.”
Exposure that’s enabled a move to ‘the next level’ as a scientist
Other eye-openers included working in the MGH laboratories with cutting-edge researchers on placental pathology and the causes of stillbirth – and accompanying maternal health teams around the hospital.
“They have a great peri-natal mental health team and I was shadowing the psychiatrist and social worker who support women with complications during and after pregnancy. It all helped me move from where I am to the next level as a scientist. I had an amazing research mentor whom I met with weekly. The real thing though was learning how to think, rather than the actual work,” she enthuses.
Improving health tech and patient care: A call to learn by example
Dr Maswime was also impressed by the levels of technology supporting foetal medicine at MGH. “We’d walk into a labour ward and there’d be foetal monitors everywhere. Sitting at the nurse’s station, you can monitor what’s happening in every cubicle.”
“It’s very different to South Africa where in many hospitals and areas, there’s a dire shortage of monitors. The other thing was the marked differences in the way we interact with our patients,” she said.
She explains that at MGH, the dignity of the patient is paramount, with clinical teams discussing individual cases away from the bedside while limiting patient interactions to physical examinations and psychological care, such as probing for signs of anxiety or depression.
The way forward in maternal and foetal healthcare
Asked what she’d wave a magic wand at in South African healthcare, she replies, “Improving the quality of care.” She feels a pressing need for reducing maternal mortalities locally, noting that this is often caused more by systemic barriers than actual disease.
“While we have some amazing hospitals, multi-disciplinary care is limited to certain spaces that already have a high patient-burden. Patients in rural hospitals often die because there was no anaesthetist or obstetrician or no lights, or a lack of appropriate or sufficient equipment,” she adds.
She also wants more research on stillbirths and to further probe the causes of SA’s high rate of pre-term labour and pre-term deliveries, which too often cripple children’s prospects. In her new role as an Associate Professor at The University of Cape Town, we’re certain she’ll do just that.
We're on your pregnancy journey with you
With Discovery Health Medical Scheme, you have access to comprehensive maternity and post-birth benefits supported by access to 24/7 support, advice and guidance through the My Pregnancy and My Baby programmes on the Discovery app and website.
The healthcare services are covered from the Maternity Benefit at the Discovery Health Rate. This cover does not affect your day-to-day benefits and depends on the plan you choose.
We want to improve primary healthcare in needy communities
The Discovery Fund has an important goal: to improve the quality of life of South Africans by providing primary health services in communities that don’t have access to mainstream healthcare. This aligns with Discovery’s core purpose of making people healthier and enhancing and protecting their lives. Our focus areas include:
- Maternal and child healthcare, to reduce maternal and infant mortality
- Community health interventions that enable access to healthcare services to those in under-resourced and marginalised communities
- Human capital and skills development to enhance the quality of public health services and increase the number of qualified public healthcare workers.
The Fund has an annual spend of around R30 million and currently works with approximately 40 partner organisations. Be inspired and learn more about the Discovery Fund here.
Discovery Foundation recipients, alumni and leaders in clinical medicine and education came together for the annual Discovery Foundation conference and awards. This year, the Discovery Foundation awarded grants to 42 medical specialist and institutions to the value of R27 million.
Back home a year since returning from 12 months of Discovery Fellowship-funded training in America, Dr Allwood is thrilled that his new skills are saving lives. His mission: to raise the bar of medical excellence in SA.
The Discovery Foundation MGH Fellowship Award – valued at R2.1 million – enables a specialist clinician to experience Harvard Medical School’s largest teaching hospital for a year. We caught up with our five Fellows here to learn what impact they’re making.