The Eastern Cape's first foetal medicine candidate hopes to save lives

The oldest of three children, Dr Gubu-Ntaba matriculated in 2000 before going on to study medicine. The daughter of a teacher mom and an agricultural inspector dad, her mother’s love of education motivated her to enter academia. Seeing a close relative succumb to AIDS in 1996 had a major impact on her career choice.

“I know it seems like every doctor says they wanted to help people but that truly is the case with me,” she says. “I find witnessing the joy of people interacting with healthcare professionals who have a positive impact on their lives and restoring hope quite amazing. I remember being asked to write an essay at school on what we wanted to do with our lives. I’d already acquired a basic understanding of HIV and initially thought I’d like to work in that.”

Training to save mothers’ and babies’ lives

Today, Dr Gubu-Ntaba is a Mthatha-based obstetrician and gynaecologist who has invested 14 years of her career at the Nelson Mandela Academic Hospital. With her Discovery Foundation Award, she is undergoing foetal medicine sub-specialty training at Inkosi Albert Luthuli Central Hospital in Durban.

When she returns from Durban in 2021 to the Nelson Mandela Academic Hospital and heads up the Obstetrics and Gynaecology Department, Dr Gubu-Ntaba will be the only public-sector foetal medicine consultant in the Eastern Cape. She has ambitious plans to boost maternal care in the OR Tambo region, having already conducted multiple training sessions in essential steps in managing obstetric emergencies. This has significantly reduced emergency cases in her unit.

“This means that more mothers or infants arriving at the hospital are resuscitated and stabilised, which frees up much-needed space in the ICU. After resuscitation and stabilisation, they only need admission to the high-care ward. We can then treat the really urgent cases instead of being overwhelmed,” she says. By teaching interns, medical officers and advanced midwives how to deal with obstetric emergencies and identify high-risk patients early in real-life situations, she and her 10 obstetric gynaecologists at the Nelson Mandela Academic Hospital have created more tertiary capacity.

They do weekly training sessions on how to handle the most serious presenting cases at the three lesser-staffed district hospitals in their region and conduct intensive workshops twice a year.

“What this also means is that we get to know the people and improve the quality of their resuscitation,” she adds. Because of the frequent interactions they have with each other, they would also use the same terminology in referral forms, making it that much easier to get the full picture. “They also feel more comfortable to call us for advice because we’ve developed relationships,” she adds.

She wants to extend the training to paramedics who accompany women with birth complications in ambulances for journeys of up to five hours from outlying rural districts hospitals and clinics.

Skills training outreach

Her research for her foetal medicine sub-specialty at the Albert Luthuli Hospital is on high-risk pregnancies involving identical twins. The Albert Luthuli Hospital Foetal Medicine Unit typically sees at least two such cases daily, reviewing them fortnightly for complications. The greatest risk period is between 14 and 26 weeks of pregnancy.

“We see far fewer of these pregnancies at Nelson Mandela Academic Hospital where pre-eclampsia complications are the main challenge. I want to establish which gestational age is safer for us to allow such twins to be cared for by an obstetrician or gynaecologist,” she explains.

She says things have improved at Nelson Mandela Academic Hospital over the past two years. “We still need more equipment and a dedicated obstetrics and gynaecology theatre. At present, we tend to share instruments and machines with other surgical disciplines and there’s often a tussle over using the theatre. A hysteroscope and laparoscopic machine would also make a big difference. This all impacts our ability to attract young specialists,” she says.

However, her qualification in foetal medicine will boost training at the Nelson Mandela Academic Hospital and Walter Sisulu University medical campus and save significant cost on travel and accommodation for future generations, not to mention save more lives and avoid complications for her patients.

“We’re getting much closer to a multi-disciplinary approach because we now have a paediatric cardiologist and an adult cardiologist, an intensivist, a gynaecological oncologist, and a general oncologist. I’ll also use the neonatal ICU team. This team means, for example, that mothers and babies with cardiac conditions can be managed mostly on site without being referred out of the province.”

Managing life outside of work

Dr Gubu-Ntaba has a 10-year-old girl, a six-year-old boy, and a self-employed husband who is also studying. Her children and nanny of six years are staying with her in a rented house in Musgrave, Durban. After her studies, she will rejoin her husband in their Mthatha home.

A marathon runner, she does 8 km to 10 km runs three to four times a week and up to 18 km on a weekend if she is training for a full marathon. “I also do ‘weight training’ by playing and picking up the kids,” she says.

Considerable impact on care

The impact she expects to make at Nelson Mandela Academic Hospital when she returns is substantial. “I think I’ll be able to improve both pre- and post-delivery care. I’ll help my staff prepare for high-risk births, take care of the high-risk mothers better and enhance follow-ups, and knowing the needs and the complications to look for. We can also train on-site instead of sending registrars away to other tertiary hospitals. That’s a lot of financial relief and improved quality of care for our patients.”

Following her first love

Dr Gubu-Ntaba says obstetrics has always been her primary interest. “When I got into obstetrics and gynaecology, I initially thought great, take care of the pregnant woman and send home a happy mom and baby. I think gynaecology caught me along the way, but doing foetal medicine is following my first love.”