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A lifelong quest to reduce infant deaths

For most doctors in training, obstetrics is hectic and too busy, but for Dr Felicia Molokoane it is a calling. Her bold career choice has led to her being part of groundbreaking research on the effects of HIV treatment on the growth of babies.

“When I did my internship, none of the others wanted to do obstetrics,” she says while reminiscing on being given a choice of departments at a busy district hospital early on in her career. “I chose it and I felt welcome - I belonged in the department.”

Molokoane’s journey begins during her early years as an undergraduate at the then University of Natal (now the University of KwaZulu-Natal (UKZN)). There she was inspired to focus on obstetrics and HIV at a time when the disease was still steeped in stigma and denialism in South Africa.

Describing herself as “short and tiny”, Molokoane never imagined herself conducting vaginal examinations and dealing with HIV-positive mothers as an obstetrician. That all changed when a Professor Moodley encouraged her in her third year at the University of Natal.

“The interest started because the professor paid so much attention to teaching me these things,” she says.

As an intern at Jubilee District Hospital, she got hands-on hospital experience - from the use of sonars to dealing with crises such as doctor shortages. She even volunteered occasionally as she came to enjoy obstetrics. She especially loved helping patients - usually in pain and crying, and oblivious to what would happen to themselves or their babies.

“Seeing them feel fulfilled after the delivery really gave me a love for obstetrics,” she explains.

Molokoane came to the University of Pretoria (UP) to specialise in obstetrics at the institution she was advised was the best in the country. She also recalls that as an intern, she was trained in part by a consultant who studied at UP.

“I applied to study as a registrar in 2006,” she says. “Training in obstetrics is hard, but the teaching and support I received from UP was amazing.”

After completing her training, she became a consultant at UP in 2010 and has been part of the Department of Obstetrics and Gynaecology ever since.

She is currently a consultant in charge of the Maternal and Fetal unit at Kalafong Hospital in Gauteng, after qualifying as a subspecialist in Maternal and Fetal Medicine in 2015. Her time is now mostly occupied by her research into fetal growth in HIV-positive mothers, where she is particularly looking at the effects of antiretrovirals (ARVs) on growth and pregnancy outcomes.

Molokoane’s research was inspired by a study done by Professor Ute Feucht from the Department of Paediatrics and Child Health, who found that there was poor growth associated with HIV-exposed children in whom the mothers had been on ARV therapy during the pregnancy.

“South Africa has been hit hard by HIV/AIDS, and ART is a key public health strategy to prevent mother-to-child transmission of HIV.  However, recent evidence of low birth-weight and premature deliveries in mothers on ART has experts concerned,” she says. “In dealing with uninfected, HIV-exposed infants, we are trying to find the exact causes of suboptimal growth throughout the child’s development.”

The study is being undertaken by the South African Medical Research Council's Unit for Maternal and Infant Health Care Strategies at UP, which consists of a multidisciplinary team of researchers. While she is a member of the antenatal part of the team as an obstetrician, other research conducted by the Unit include paediatricians and immunologists, among others.

“We are aiming to start recruiting patients from December, but we are waiting for the Tshwane Ethics District to approve the study,” she says. Building on previous studies, she intends to root out the causes of growth problems associated with the use of ARVs.

“If they are causing harm to fetuses, we would have to talk to the policymakers about it,” she says. “Maybe we need to change the regime that we are using to reduce the impact on fetal growth.”

For Molokoane, the study brings her journey into obstetrics and the impact of HIV in South Africa full circle, and while she may physically still be “short and tiny”, she is quickly growing into a giant of the obstetrics field.

Dr Felicia Molokoane is working with HIV-positive pregnant mothers to understand how antiretrovirals affect pregnancy, birth and childhood development.

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