Dr Maswime brings home global learnings in women’s health

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.