Cum Laude Medical Student Celebrates Her Success

<em>Cum Laude</em> Medical Student Celebrates Her Success
Dr Jerusha Premraj.

Bachelor of Medicine and Bachelor of Surgery (MBChB) graduate, Dr Jerusha Premraj, who graduated cum laude, said she was very pleased with herself and her efforts because now she knew that all those sleepless nights and long hours spent in the library were not in vain.

‘I expected to pass comfortably but not as one of the top students in the discipline.’

She said her degree meant she could now practise as a competent clinician and contribute to the health care system in the country and hopefully make a difference.

‘It also means that I will now have to take up the role of becoming a lifelong learner as this is only the beginning. Medicine is vast and changes are occurring daily. A good doctor needs to have updated knowledge,’ she said.

Premraj completed her matric at New West Secondary school and matriculated as one of the top three students in 2008.  She then studied Biomedical Science for a year on UKZN’s Westville campus before being accepted to study Medicine.

‘There are no doctors or medical professionals in my family so I am proud to be the medical pioneer in my family,’ she said.

Premraj’s highlights as a student at UKZN were being a part of a friendly student community and gaining lifelong friends along the way. ‘Being taught by seniors who are down to earth and genuinely concerned about their students, made me realise how much I enjoy doing what I do.’

She received numerous merit certificates throughout her seven years at UKZN.

She loves spending time with her family and her pets. ‘I love the field that I’m in but if I didn’t get into Medicine then I would have probably done Engineering.’

 Nombuso Dlamini

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Pneumonia Accounts for Millions of Deaths in Children Under Five, PhD Study Reveals

Pneumonia Accounts for Millions of Deaths in Children Under Five, PhD Study Reveals
Professor Prakash Jeena.

Despite the availability of a wide range of potent antibiotics, pneumonia accounts for 6.6 million deaths in children under five years old, a study conducted by UKZN’s Department of Paediatrics and Child Health’s Professor Prakash Jeena has found.

Jeena was awarded his PhD for the study titled: “The Impact and Management of Viral Infections in HIV-Infected and Uninfected Children with Severe and Very Severe Pneumonia”.

Jeena said many of these deaths occurred in developing countries like South Africa and especially among HIV-infected children. The role of viruses in these deaths has not been fully evaluated.

Supervised by Professor Miriam Adhikari, Jeena’s study described the burden of respiratory viruses among children with pneumonia. 

‘After having identified cytomegalovirus  to be the most common virus implicated in these deaths, we introduced an intervention, ganciclovi, and assessed the benefit of this intervention on outcome,’ said Jeena.

He said the research showed significant improvement in a cohort of mechanically ventilated HIV-infected children with CMV associated pneumonitis treated with ganciclovir.

‘Together with the use of combined antiretroviral therapy we were able to show favourable outcomes of children who required intensive care,’ added Jeena.

According to Jeena, based on these findings they are able to justify the admission of HIV-infected children with pneumonia to scarce ICU resources.

Jeena thanked his supervisor, Professor Adhikari, ‘She is an exceptional human being who assisted me throughout this process. Her intellectual and emotional guidance during my journey were immense.’

Besides caring for children in a busy PICU Pulmonology ward and in an allergy clinic, Jeena is involved in writing up his PhD student’s thesis. In addition, he is involved in the supervision of six other postgraduate students.

He is a content expert for the World Health Organization and the International Union against Tuberculosis and Lung disease. He was also appointed by the Minister of Health to serve on many national advisory committees, including the Essential Drugs Programme, the Advisory Group on Immunisation, the Antimicrobial Resistance Committee and the National AIDS Committee.

He described himself as simple human being who loves normal things men like such as sport, especially football, music, entertainment and great food.

‘I am a devout Hindu and have a wonderful wife, Yaksha, who has a Master’s degree in Education, I also have two daughters, Lisha and Cheshni, both of whom are studying at the Nelson R Mandela School of Medicine.

Born and bred in Durban, Jeena spent his childhood in rural areas of KwaZulu-Natal helping his late dad deliver groceries in the region.

 Nombuso Dlamini

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A Study of Breast Milk Intake by Infants Forms Basis of Doctoral Study

A Study of Breast Milk Intake by Infants Forms Basis of Doctoral Study
Dr Helen Mulol.

“A Longitudinal Study of Breast Milk Intake Volumes in African Infants in a Typical Urban Disadvantaged South African Community” was the title of a study which resulted in Dr Helen Mulol graduating with a PhD through UKZN’s Department of Paediatrics and Child Health.

Mulol followed 100 mother-infant pairs for a year following birth during which five study ages were used – six weeks, three months, six months, nine months and one year.

She used a stable isotope method which measures how much breast milk an infant receives and also measures water intake from sources other than breast milk.

‘This makes it possible to determine if an infant was exclusively breastfeeding. The volume of breast milk and the exclusivity of breastfeeding is then correlated with maternal and infant factors such as maternal HIV status, infant gender and nutritional status.’

Mulol said the stable isotope method could also be used to determine infant and maternal body composition in terms of whole body fat mass and fat-free mass.

‘It is the first time this method has been used in South Africa and the first study worldwide with a large amount of HIV positive mothers,’ said Mulol.

The study showed that breast milk output was not significantly different according to the maternal HIV status and that maternal body composition was not compromised during lactation.

‘The method also showed that infants who were exclusively breastfed for six months had significantly less fat mass at 12 months of age, compared to infants who were not exclusively breastfed for  six months,’ said Mulol.

Study Supervisor, Professor Anna Coutsoudis, described Mulol as a dedicated student. ‘She entered the field of medical science as a Chemistry graduate and set about immersing herself in important primary health care issues which were outside her original skill set,’ Coutsoudis said.

As part of her PhD, Mulol set up for the first time in South Africa the deuterium dilution technique to be able to accurately determine the breast milk intake of infants.

‘Helen successfully undertook valuable explorations in a cohort of 100 mother-infant pairs in a disadvantaged community in Durban,’ said Coutsoudis. ‘Her study revealed that HIV-infected mothers can exclusively breastfeed their infants for six months without compromising their own health and the breast milk output of these mothers was comparable to that of HIV uninfected mothers.’

Mulol, who is currently writing journal articles from her PhD work, is also involved in a follow-on research project from her PhD, is assisting in data management for another research project, and is doing contract lecturing at DUT.

‘My husband encouraged me to start my PhD at the age of 47 and he has been a great support,’ she said.

 Nombuso Dlamini

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Integrated Chronic Disease Management Model Improves Quality of Patient Care

Integrated Chronic Disease Management Model Improves Quality of Patient Care
Dr Ozayr Mahomed graduates with his PhD.

Dr Ozayr Mahomed, UKZN’s Academic Coordinator-Graduate Programme in Public Health, received a PhD in Public Health Medicine for his thesis titled: “The Implementation and Sustainability of an Integrated Chronic Disease Management Model (ICDM) at Primary Healthcare Level in South Africa”.

The study aimed to develop an active implementation model and assess its sustainability at primary care level and also to simultaneously assess the effect of the ICDM model on operational efficiency and quality of clinical care to determine the sustainability of the ICDM model from an implementation perspective.

The study was initiated across 42 PHC clinics in three districts: Bushbuckridge sub-district (Ehlanzeni District) in Mpumalanga; Dr Kenneth Kaunda District in the North West, and the West Rand Health District in Gauteng.

The result showed 93%, 81% and 75% of the ICDM-initiating facilities in the West Rand Health District in Bushbuckridge and the Dr Kenneth Kaunda district were fully engaged with the implementation of the model.

Research results have the potential to improve the operational efficiencies and quality of clinical records for patients with chronic diseases at primary healthcare (PHC) clinics in South Africa.

‘Median waiting times for all patients irrespective of diagnosis declined significantly at 38% (14) of the facilities at 12-month and 24-month post intervention, whilst the median waiting times for patients with chronic conditions declined at  26% of the facilities at 12-month and 24-month post intervention,’ said Mahomed.

He said there was a significant increase in the percentage of clinical records for HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes) between the baseline and six-month post intervention that achieved compliance with the minimum criteria for a record of acceptable standard.

The findings of the study indicated that the model was sustainable with Bushbuckridge having the highest mean sustainability score followed by the West Rand Health District and the Dr Kenneth Kaunda district.

‘The results and lessons from the initial implementation emanating from this study have been beneficial to patients and healthcare providers resulting in the National Department of Health escalating the model across all 52 districts in South Africa,’ he said.

Mahomed said this would be expanded to the Integrated Clinical Services Model and form the backbone of health service delivery at primary care level for the Ideal Clinic initiative of the National Department of Health. 

 Nombuso Dlamini

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HIV Risk Attached to Using Injectable Contraceptives Studied for PhD Degree

HIV Risk Attached to Using Injectable Contraceptives Studied for PhD Degree
Dr Sinaye Ngcapu graduates with his PhD.

Centre for the AIDS Programme of Research in South Africa (CAPRISA) research associate and basic scientist, Dr Sinaye Ngcapu, received a PhD for his research on the HIV infection risk associated with the use of injectable hormonal contraceptives.

Ngcapu’s thesis was titled: “Impact of Injectable Hormonal Contraceptives on Innate Immune Environment in the Genital Tract in Women at High Risk of HIV-1 Infection”.

His studies focused on the HIV infection risk associated with using injectable hormone contraceptives (HC) in the context of a heterosexual epidemic in South Africa; and the potentially confounding effect of DMPA (also known as Depo-Provera) use in prevention research.

DMPA continues to be one of the popular hormonal contraceptive methods used by South African women aged between 15 and 49, Ngcapu said. Although access to effective methods of HC have substantially reduced maternal and infant mortality rates through giving women more control over when to have children, long acting high-dose progestin formulations (such as DMPA) have also been associated with an increased risk for HIV-1 infection.

‘The mechanisms by which DMPA might increase susceptibility to HIV-1 acquisition are important to investigate, especially in a country like South Africa where DMPA is commonly used and HIV-1 prevalence rates are high,’ said Ngcapu.

His study thus investigated the biological effect of injectable HCs on the innate environment in the genital tract of HIV-1 negative women at high risk of HIV-1 infection and the impact of injectable HC use on the genital immune environment and epithelial barrier function of HIV-1 infected women.

‘We demonstrated that injectable HC use down-modulates expression of specific chemokines, adaptive cytokines and growth factors. During acute and early HIV-1 infection, using vaginal biopsies, vaginal epithelial thickness was found to be similar in women using injectable HC compared to non-injectable HC users. Our findings suggest that modulation of cytokine and epithelial barrier factors in the genital tract rather than epithelial thinning might underlie altered HIV-1 acquisition risk in DMPA users,’ he explained.

During his student days, Ngcapu twice scooped best poster awards at the College of Health Sciences’ Annual Research Symposium.

In 2014, he was awarded the prestigious Columbia University-Southern African Fogarty AIDS Training Programme international traineeship that enabled him to spend a three-month internship at Northwestern University in Chicago, which he described as ‘an awesome opportunity to both conduct research with leading scientists in the field and immerse myself in an entirely different scientific world’.

Born in the rural village of Mdolomba near King Williams Town in the Eastern Cape, Ngcapu attributes his success to personal sacrifice. ‘I have never had the luxury of being a full-time student, having to work to support myself through my studies and, despite this, I have consistently aimed for excellence under difficult conditions,’ he said.

The ecstatic Ngcapu thanked his supervisors, Professor Quarraisha Abdool Karim and Dr JoAnn Passmore, and paid tribute to the mentoring environment at CAPRISA as well as the support of CAPRISA and UKZN colleagues in his development. He dedicates his PhD degree to his family, especially his mother for her sacrifices, faith and unconditional loving support.

CAPRISA’s Professor Quarraisha Abdool Karim said: ‘Sinaye defied many odds in obtaining his PhD and is an inspiring role model for other young people particularly from historically disadvantaged communities for what can be accomplished with hard work, discipline, dedication, commitment,  persistence and perseverance.’ 

Lunga Memela

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Cum Laude MBChB Degree for Talented Student

<em>Cum Laude</em> MBChB Degree for Talented Student
Dr Kamal Govind.

‘It is an honour to have graduated among the top students in Medicine at UKZN,’ said Dr Kamal Govind after receiving his Bachelor of Medicine and Bachelor of Surgery (MBChB) degree cum laude.

‘All the years of hard work have paid off. It is satisfying to have reached that goal.’

The Govind family is extremely proud of what he has achieved, ‘In fact, they are more excited about my graduation than I am! For me, achieving my medical degree is just the beginning of a lifelong process of learning. I believe that one only truly starts to learn medicine the day one finishes medical school,’ said Govind.

Govind thanked God for all that he has managed to achieve so far.  He also thanked all his teachers from pre-school to matric as well as all lecturers and doctors who taught him at Medical School.

‘I feel the high standard of training at UKZN has helped to prepare me for life in internship and community service.’

He plans to specialise in Internal Medicine, in the sub-speciality of Cardiology.

‘I thank all my friends and colleagues in the class of 2015 for making my Medical School experience a memorable one and I wish them all the best in their future endeavours,’ said Govind, whose father is an Anaesthetist, his mother a Pharmacist while  his sister is currently in third year at UKZN’s Medical School.

Govind is a sports fanatic and enjoys playing squash and golf.

While studying at UKZN, he received three Dean’s Commendations, a Certificate of Merit in Trauma and Critical Care and obtained a distinction for Internal Medicine in his final year.

He also completed the Toastmasters Leadership programme in 2008 and was named as Toastmaster of the Year.

Nombuso Dlamini

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TB Researchers Obtain PhDs

TB Researchers Obtain PhDs
Dr Navisha Dookie and Dr Parveen Sobia.

Dr Navisha Dookie, Dr Santosh Kumar and Dr Parveen Sobia all graduated with PhDs in Medical Microbiology following studies aimed at advancing global TB research.

The three were supervised by UKZN Infection Control Chief Specialist, Professor Prashini Moodley.

Dookie’s study contributed to understanding the dynamics of antimicrobial resistance and the complexity of the mechanisms mediating resistance in M.tuberculosis (M.tb) strains circulating in our setting.

The Centre for the AIDS Programme of Research in South Africa post-doctoral Research Fellow said understanding the underlying resistance mechanisms driving drug resistance in M.tuberculosis was pivotal in the design of rapid molecular based assays and had the potential to impact on the development of novel drugs and regimens for the disease. ‘My current research aims to identify innate immune correlates of the human host that are protective against recurrent tuberculosis infection. The identification of such biomarkers was crucial for the development of innovative strategies for tuberculosis management and vaccine design.

‘Mycobacterium tuberculosis infects 9 million individuals and kills almost 2 million people every year. The only vaccine available, Bacillus Calmette-Guerin (BCG), has been used since its development in 1921,’ said Kumar. His study was titled: “Improving the Efficacy of BCG Vaccine by Concomitant Inhibition of T Regulatory and T Helper 2 cells”.

Kumar said although BCG induced host protective T helper 1 (Thl) cell immune responses which play a central role in host protection, it also induced Th2 and Treg responses - subsets that facilitate pathogenesis during M.tb infection. ‘The resultant protective immunity is therefore neutralised. Additional methods to enhance protective immune responses are needed,’ he said.

Researchers are a step closer to designing new TB drugs and vaccines thanks to a study by Sobia which exposed the essential virulence role of TlyA in the pathogenesis of M.tb which may be a major advancement in providing a better understanding of host pathogen interaction and designing new therapeutics and vaccines.

Sobia said M.tb was a causative agent of the TB disease – ‘a major cause of death worldwide’. He said although various virulence factors of M.tb had been identified, its pathogenesis remained incompletely understood. Mice infected with TlyA deficient mutant M.tb organisms in the study exhibited increased host protective immune responses, reduced bacillary load, and increased survival compared with animals infected with wild type M.tb. Therefore it was likely that M.tb employs TlyA as a host evasion factor, thereby contributing to its virulence, said Sobia.

Sobia arrived at UKZN in 2014 as an international PhD student. ‘Before coming here I was working as Senior Research Fellow in New Delhi.’

She plans to join the UKZN post-doctoral fellowship programme under the mentorship of Professor AW Sturm in a project looking at the development and optimisation of a rapid diagnostic methodology for detection of M.tb.

Moodley congratulated all three candidates for producing outstanding work that contributed to the further understanding of the pathogenesis of M.Tb.

Lunga Memela

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The Apple Doesn’t Fall Far from the Tree!

The Apple Doesn’t Fall Far from the Tree!
The Zondos and Bothas.

The daughters of two colleagues in the College of Health Sciences (CHS) have graduated as medical doctors.

They are Dr Esté Botha and Dr Amanda Zondo, daughters of the Director of College Professional Services, Professor Fanie Botha, and the School of Nursing and Public Health Operations Manager, Mr Bheki Zondo.

‘It is a dream come true; surreal! Like I need someone to pinch me,’ said Este who overcame being hospitalised with pneumonia in the fifth year of her MBChB degree and persevered because of her passion for people.

‘Despite all their faults and flaws, people fascinate me - their anatomy and physiology, what makes them cry and what makes them smile,’ she said.

Este completed a year of BSc in Biological Science at the University of Pretoria in 2009, receiving membership of the Golden Key International Honours Society. She is no stranger to Dean’s Commendations at UKZN and received a Certificate of Merit for the Trauma module in fourth-year.

Este, who is keen to eventually specialise in paediatrics, said her friends and family were really proud of her. ‘Right now I am just enjoying internship. I honestly love my job!’

Amanda said: ‘I feel humbled and extremely grateful that God’s grace has carried me this far. I’m happy to finally be able to serve the community in my full capacity as a doctor and it feels great to know that people can benefit from my six years of hard work.’

Medicine was her choice because helping people is her calling. ‘Public health is my first love. The idea of mass intervention and strategies excites me because problem solving is my forte. I want to be a decision maker and have a noticeable impact on the health system.’

Amanda, who got the Good Fellowship award during her first year at UKZN, served as a first-year class representative in the Medical Student Representative Council Finance and Projects portfolios as well as secretary and later chairperson of the Rural Development Committee.

She intends to complete her internship and community service in Gauteng before participating in the local Department of Health project centred on medical students. She is also a budding musician and is working on a few songs which she hopes will pave the way for her in the industry.

‘My advice to medical students is to keep up the good fight! Give it your all so that you can rest knowing that you made the most of your learning opportunity.’

Lunga Memela

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Three Zimbabwean Researchers Awarded PhDs in Public Health

Three Zimbabwean Researchers Awarded PhDs in Public Health
Professor Moses Chimbari (centre) with his graduates.

Three Zimbabwean students supervised by the Dean of Research at UKZN’s College of Health Sciences, Professor Moses Chimbari, graduated with PhDs in Public Health.

They are Dr Margaret Macherera, Dr Tawanda Manyangadze and Dr Resign Gunda, who are part of Chimbari’s project, Malaria and Bilharzia in Southern Africa (MABISA), which involves different communities and other stakeholders.

MABISA is an interdisciplinary project examining the impact of climate change on bilharzia and malaria and is being carried out in Zimbabwe, Botswana and South Africa.

Macherera’s thesis was titled:  “Indigenous Knowledge Systems on Malaria in the Gwanda district in Zimbabwe”.

Manyangadze’s thesis was titled: “Spatial and Temporal Modelling of Schistosomiasis Transmission at Micro-Scale in Southern Africa: A Case of the Ndumo area in uMkhanyakude health district in KwaZulu-Natal, South Africa”.

Gunda’s dissertation was: The Burden of Malaria and related household economic costs in the Gwanda District in Zimbabwe.

All three studies are part of the MABISA project.

Macherera’s study involved the determination of the existing Indigenous Knowledge Systems (IKS) pertaining to malaria in Zimbabwe’s Gwanda district.  It  aimed to determine the prospects  and  challenges  of  using  IKS  for malaria in the  health and medical  health  care  system in the district with the view to developing a community-centered malaria early warning system based on IKS.

Manyangadze’s study showed how GIS and Earth Observation tools can be used in modelling the spatial and temporal distribution of schistosomiasis at micro-geographical scale in southern Africa based on data from Ndumo area in the uMkhanyakude District in KwaZulu-Natal.

‘It shows the schistosomiasis infections hotspots across the landscape. This pattern was determined using socio-economic, environmental and climatic factors which expose the population to risk of schistosomiasis infection,’ said Manyangaze.

He said this knowledge could be used in schistosomiasis control and management programmes at community level as it enhanced understanding of the spatial and temporal dynamics of schistosomiasis transmission at a local scale.

Gunda’s thesis reports on studies conducted in Gwanda in Zimbabwe that were aimed firstly at determining the incidence, morbidity and mortality due to malaria in the district.  The studies were also aimed at determining the disability-adjusted life years (DALYs) lost due to malaria, the distribution of malaria by age, sex and household economic status, the individual household economic costs due to malaria and at retrospectively determining the trends of the burden of malaria.

‘The study showed that the economic burden of malaria resulted in some households making catastrophic health expenditures, with some getting impoverished,’ said Gunda.

He said that was very important information for policy makers and other stakeholders in health to come up with interventions that would address the effects of the malaria burden.

‘As part of the MABISA study, there was extensive community engagement including training of community advisory boards (CABS) and community research assistants (CRAs),’ said Gunda.

He said this ensured that key community members were trained to be able to deal with the malaria problem in the future and to also pass on information to the rest of the community.’

‘This was the first study to use DALYs to determine the burden on malaria at ward and district levels in Zimbabwe.  It is also the first study in Zimbabwe to determine the household economic costs due to malaria using health facility data,’ said Gunda.

Nombuso Dlamini

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PhD for HIV-Associated Hypertension Researcher

PhD for HIV-Associated Hypertension Researcher
Dr Anushka Ajith receives UKZN doctorate.

HIV positive pre-eclamptic women have higher levels of peripheral natural killer (NK) cells compared to their HIV negative counterparts, a doctoral study by UKZN Human Physiology Lecturer, Dr Anushka Ajith, has found.

The Reproductive Immunologist investigated the deadly duo of HIV and pre-eclampsia, presented the award-winning study at the 2015 Malaysian Society of Hypertension’s Annual Scientific Meeting and graduated with her PhD.

HIV and pre-eclampsia are the leading causes of maternal morbidity and mortality in South Africa but despite active research, the pathophysiology of pre-eclampsia was not fully understood, Ajith said. This is what led to conducting the novel study which elucidated the role of peripheral NK cells and the Th1 and Th2 maternal immune response in HIV associated pre-eclampsia, also determining the correlation of NK cells and their receptors with a panel of Th1 and Th2 cytokines. 

‘The study found that peripheral CD69 NK cells were higher in pre-eclamptic compared to the normotensive group and GM-CSF was significantly different across each of the six study groups.’

‘Our study supports the hypothesis that the levels of peripheral NK cells are higher in the HIV positive pre-eclamptic group compared to the HIV positive normotensive group. It also suggests a neutralisation effect of Th1 and Th2 cytokines in HIV associated pre-eclampsia,’ Ajith said.

‘Further studies may implicate CD69 and GM-CSF as possible biomarkers for early diagnosis of pre-eclampsia development with the ultimate goal of decreasing maternal and foetal morbidity and mortality rates globally,’ she elaborated.

Ajith received a UKZN College of Health Sciences PhD Scholarship for the study in 2013. She was also funded by CAPRISA’s Columbia University-South African AIDS and TB Training Research Programme Scholarship; research funds from CHS Placental Research Groups Professor Anita Naicker and Professor Jack Moodley; UKZN’s Leverage Fund, as well as the institution’s Medical Education Partnership Initiative Research Ethics Fellowship.

‘I would like to obtain funding in order to continue with my research interest in the field of Reproductive Immunology,’ said Ajith.

Ajith said she loved spending time with her husband and three-year-old daughter. ‘My family members are very proud of my achievements especially my mum.’

Lunga Memela

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Professor Salim Abdool Karim Receives UKZN Fellowship Award

Professor Salim Abdool Karim Receives UKZN Fellowship Award
Professor Salim Abdool Karim with Dr Robert Gallo and Vice-Chancellor Professor Albert van Jaarsveld.

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) Director and University of KwaZulu-Natal’s (UKZN) Pro Vice-Chancellor for Research, Professor Salim Abdool Karim was one of four prominent academics in the April 2016 graduations to receive the UKZN Fellowship Award for research excellence and distinguished academic achievement.

Professor Abdool Karim’s research contributions have been recognised nationally and internationally through several awards including the Drug Information Association’s “President's Award for Outstanding Achievement in World Health”, and the “Science for Society Gold Medal Award” from the Academy of Science in South Africa.

In June 2014, he was conferred an Honorary Doctorate (DSc.) in Medicine by the University of Cape Town. More recently, he was awarded the Platinum Medal for Lifetime Achievement by the South African Medical Research Council, John F. W. Herschel Medal from the Royal Society of South Africa, the Distinguished Scholar Award from the Biomedical HIV Prevention Forum of Nigeria, the US Science and Technology Pioneers Prize (awarded to the CAPRISA 004 team) from US Agency for International Development and the African Union Kwame Nkrumah Continental Scientific Award.

Professor Abdool Karim’s global leadership in HIV-TB treatment and prevention is illustrated by his roles in several national and international committees and advisory groups. He has advised several governments and the world’s leading agencies in AIDS and global health such as the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Global Fund to fight AIDS, TB and Malaria.

He has undertaken numerous reviews of research organisations, including the review of the US Centers for Disease Control and Prevention (CDC’s) intramural AIDS Research Program and the Human Sciences Research Council (HSRC’s) Social Aspects of HIV/AIDS research programme. He is a member of the Academy of Science of South Africa, Royal Society for Science in South Africa, African Academy of Sciences and the World Academy of Sciences (TWAS). He is a Foreign Associate of the US National Academy of Science (previously the Institute of Medicine) and a member of the American Academy of Microbiology.

Few researchers in Africa, or globally, have been as influential and have had impact of such major consequence on both HIV treatment and prevention. He also has a proven track record in establishing and leading research organisations. For his marked global impact on the fight against AIDS and TB, the University honoured Professor Abdool Karim with the award of Fellow of the University of KwaZulu-Natal.


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Young Women Scientists Graduate with PhDs

Young Women Scientists Graduate with PhDs
Dr Lihle Qulu, Dr Musa Mabandla and Dr Thabsile Mpofana.

The School of Laboratory Medicine and Medical Sciences’ Acting Dean, Dr Musa Mabandla, supervised published young scientists, Dr Thabsile Mpofana and Dr Lihle Qulu, who both graduated with PhDs.

Mpofana, a Human Physiology Developmental Lecturer, said her study investigated the effects of post-natal stress on the adult brain.

Published in two international journals, the study confirmed that stress is detrimental to the brain during the early development period of an infant and may promote the development of neurodegenerative disorders later in life. It also found that caffeine has beneficial effects in the treatment of neurodegenerative disorders.

‘I am the first person to go on to Higher Education in my family so they are particularly happy that I have made it to my PhD,’ said Mpofana. ‘My younger siblings who are still in school look up to me as they see a possibility of becoming whatever they want to be.’

From a family of eight and raised by a single parent, Mpofana thanked God for her success. Inspired by Mabandla’s work ethic, Mpofana said she believed in hard work and remained results driven throughout her career. She intends to pursue post-doctoral studies and become a Senior Lecturer in the Discipline.

Qulu, a Human Physiology Lecturer, had three papers published from her studies in three top international journals. Her study, titled: “Exposure to Prenatal Stress Enhances the Development of Seizures in Young Rats”, was conducted under the auspices of UKZN’s Neuroscience Research Group – established in 2008 by former Dean, Professor William Daniels and Mabandla.

Qulu will attend the Federation of European Neuroscience Societies Biennial Meeting 2016 in Denmark, after winning first-prize for her PhD research in the Credentialing Staff category at the 2015 College of Health Sciences Annual Research Symposium.

‘It’s a “pinch myself feeling” yet at the same time it makes one feel proud, humbled and excited that all the hard work paid off,’ said Qulu.

During her studies, she went on a four-month visit to a laboratory in the Hotchkiss Brain Institute at the University of Calgary in Canada where she received special training related to seizures and neuroimmune function under the auspices of Professor Quentin Pittman.

Qulu, who said her family was very proud of her achievements, intends to foster further international collaboration and grow in academia.

Mabandla said: ‘I am proud of Thabisile’s and Lihle’s work ethic and drive towards a doctoral degree in a scarce skills area. You can literally count the number of African female PhD graduates in neuroscience in South Africa on one hand. It is truly an achievement.’

Mabandla said he still remembered the day they came in as honours students trying to understand their research topics. ‘I would find Thabisile eagerly waiting outside my office for corrections to her proposal so that she could get on with her work, while Lihle had to quit her full-time position as a teacher to focus on achieving her dreams. That is true dedication.’

Lunga Memela

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Six Friends Graduate Together at UKZN

Six Friends Graduate Together at UKZN
Professor Anil Chuturgoon with his students.

The dream of six friends came true when they graduated together with PhDs in Medical Biochemistry.

‘It was a pleasure and privilege to work with such a talented group of individuals,’ said Professor Anil Chuturgoon, who supervised the group comprising Dr Shivona Gounden, Dr Vanessa Korb, Dr Niren Maharaj, Dr Savania Nagiah, Dr Charlette Tiloke and Dr Prithiksha Ramkaran. 

Chuturgoon said his students ‘richly deserve’ their reward for the hard work and dedication they put in.  ‘I am very grateful, especially to Savania, Prithiksha, and Charlette for going the extra mile and assisting Medical Biochemistry with teaching and postgraduate co-supervision.’

Chuturgoon thanked two of his previous PhD graduates, Dr D Moodley of the Harvard Medical School in the United States and Dr A Phulukdaree of the University of Pretoria’s Medical School for their active involvement and participation in co-supervision.  ‘I wish these young and new graduates great success in their future,’ he reiterated.

Gounden’s study was titled: “Hyperglycaemic-Induced Regulation of SIRT3 and Downstream Antioxidant Profile”, published as three articles in ISI journals. The PhD will serve as a preliminary study for more epigenetic work, she explained, as regulating SIRT3 activity through chemical or natural therapeutics may be beneficial in improving several mitochondrial-associated diseases such as Type 2 diabetes. She said she also plans to get into clinical research in the biopharmaceutical industry.

Korb investigated the T-cell immune response to TB and HIV in her study published in three high impact factor journals. She said South Africa has the highest TB/HIV co-infection rates in the world, and both mono-infections are driven by pathogenic dysregulation of CD4 T-cells, uncharacterised in co-infection. Her study investigated the pro-inflammatory Th17 and anti-inflammatory T-regulatory lymphocyte response in TB/HIV pleural fluids and found that co-infection reduced T-regulatory stability, Th17 proportion and monocyte mediated skewing towards Th17 polarisation, despite suppressed localised immunity.

Maharaj investigated the clinical, biochemical, immunological and epigenetic factors in Black South African women with preeclampsia (PE) and HIV. The study found no adverse association of HIV/HAART on the clinical and biochemical features of PE.  HAART modulated the proinflammatory cytokines and selected epigenetic factors – microRNA-27a and microRNA 146a in obesity and severe PE. Two manuscripts were published.

Nagiah conducted a biochemical assessment of stress response following acute and prolonged exposure to antiretroviral drugs (nucleoside reverse transcriptase inhibitors) in vitro. Now a UKZN Postdoctoral Fellow, she said novel mechanisms of drug toxicity often pave the way for targeted therapeutic intervention. ‘Although it takes years before findings at the lab can be implemented at a clinical level it is a starting point.’ She published three high impact articles.

The antiproliferative and apoptosis inducing effects of Moringa oleifera aqueous leaf extract and its synthesised gold nanoparticles were investigated by Tiloke through modulation of oncogenes and tumour suppressor genes in human cancer cell lines.

Tiloke said: ‘The study established the use of Moringa as a complementary and alternate medicine in the treatment of both lung and oesophageal cancers. In addition, Moringa gold nanoparticles also showed potential in the treatment of lung cancer. Their mode of action was to induce cancer cell apoptosis with minimal effect on normal healthy cells. It can be concluded that South Afrca’s traditional tree can be used as an antiproliferative agent against cancer.’  She published three high impact articles.

Ramkaran examined genetic and microRNA polymorphisms in young South African Indians with coronary artery disease (CAD) following preceding research which confirmed that Indian populations worldwide have the highest prevalence of early-onset CAD compared to other ethnic groups. The study found that the Black South African population has a low prevalence of CAD and was used as a comparison study group.

Ramkaran said these genetic studies may contribute to a greater understanding of the genomic and epigenetic drivers of heterogeneity in individual responses to CAD, paving the way for personalised medical treatment. ‘Discovery of genetic susceptibility loci may provide a clinically useful genetic risk-prediction tool that will potentially allow identification of those at higher risk for CAD and early administration of therapeutics.’ She published four high impact articles.

Lunga Memela

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PhD Study Provides Evidence for Clinical Management of TB/HIV Co-Infection

PhD Study Provides Evidence for Clinical Management of TB/HIV Co-Infection
Dr Kogie Naidoo.

A UKZN PhD study in Public Health Medicine has generated evidence for policy and clinical management of patients with HIV and TB co-infection.

Conducted by the Head of the Treatment Research Programme at the Centre of the AIDS Programme of Research in South Africa (CAPRISA), Dr Kogie Naidoo, the research assessed and identified strategies to overcome clinical and programmatic challenges when integrating HIV and TB care to reduce co-infection mortality.

‘Integration of HIV and TB treatment is key to reducing mortality in co-infected patients; especially in sub-Saharan Africa where TB-HIV co-infection rates reach 80%,’ Naidoo said.

She said many obstacles impeded the effective scale-up of HIV-TB integration, extending from the clinical complexities in individual patient management, to impediments in health service organisation and prioritisation.

‘The new information generated by this study provides important evidence for policy and clinical management of patients with HIV and TB co-infection,’ she said

The study found that careful clinical vigilance for ‘unmasked’ TB was required in patients initiating ART (antiretrovirals).

It also found that the survival benefit of AIDS therapy in TB patients could be maximised by initiating ART as soon as possible after TB therapy start especially in patients with advanced immunosuppression, i.e., those with CD4+ counts <50 cells/mm3.

‘However, patients with higher CD4+ cell counts should delay ART initiation to at least eight weeks after the start of TB therapy to minimise the incidence and duration of immune reconstitution disease and consequent hospitalisation.

Naidoo said: ‘This approach, which is at variance with current World Health Organization policy and guidelines, is cost-effective and readily implementable within the clinical setting.’

According to Naidoo, addressing the operational challenges to HIV-TB treatment integration could improve patient outcomes with substantial public health impact by reducing mortality by the most important causes of death in South Africa.

‘My research on immune reconstitution inflammatory syndrome, IRIS and rifampicin-efavirenz drug interactions has been influential in defining treatment strategies for these common complications of integrating TB-HIV treatment,’ declared Naidoo.

Naidoo’s work has led to changes in multiple local and international guidelines including the WHO, the US government DHHS, the British HIV Association and the South African national treatment guidelines in the management of TB HIV co-infected patients.

She was awarded the 2013 Union Scientific Prize by the International Union Against Tuberculosis and Lung Disease in recognition for the work emanating from her PhD thesis.

‘We have been awarded R10 million from the SA MRC Newton Fund to conduct this study, which is currently underway in rural public health clinics in KwaZulu-Natal,’ she said.

She is the  Principal Investigator (PI) in a study evaluating TB recurrence in TB-HIV co-infected patients, previously successfully treated for TB, with the aim of better understanding whether exogenous re-infection or relapse of previous TB infection is responsible for recurrent TB in stable HIV infected patients on ART.  

She is also a PI of the CAPRISA Advanced Clinical Care Award which aims to establish regional capability for advanced clinical management of patients with HIV/AIDS, TB and drug resistant TB in all districts within KwaZulu-Natal. ‘This project is being undertaken with technical input from several leading academics from the Health Sciences,’ said Naidoo.

 Nombuso Dlamini

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Exciting Results from HIV/TB Study

Exciting Results from HIV/TB Study
Dr Nesri Padayatchi.

Integrated multi - and extensively drug resistant tuberculosis (M(X)DR-TB) and HIV treatment have the potential to improve treatment outcomes, according to a UKZN PhD study conducted by the Deputy Director for the Centre for the AIDS Programme of Research in South Africa (CAPRISA), Dr Nesri Padayatchi.

The study earned Padayatchi a PhD in Public Health Medicine.

The study titled: “Factors Influencing Treatment Outcomes in Multi - and Extensively Drug Resistant Tuberculosis [M(X)DR-TB] patients Co-Infected with HIV in KwaZulu-Natal,  investigated factors which impact on treatment outcomes in M(X)DR-TB patients with HIV co-infection. 

‘I found that early initiation of antiretroviral therapy (ART) in such patients significantly reduced mortality. Xpert MTB/RIF, a new TB diagnostic tool, reduced the duration of  MDR-TB treatment from three months to three weeks and Clofaziminec (a leprosy drug used to treat drug resistant TB)  improved culture conversion even in patients who are HIV infected,’ said Padayatchi.

‘In South Africa control of TB has been hampered by the HIV epidemic and the increased incidence rates of multi-drug resistant tuberculosis (MDR-TB), and extensively drug resistant tuberculosis (XDR-TB),’ she said. 

According to Padayatchi, between 2008 and 2011, South Africa reported the fourth highest number of MDR–TB cases in the world, with  KwaZulu-Natal being the epicentre of both the HIV and M(X)DR- TB epidemics.

‘A subgroup analysis of the SAPiT trial, a randomised controlled trial (RCT) of TB/HIV treatment integration, showed that early initiation of ART in MDR-TB patients reduced mortality by 86% independent of the late initiation of MDR-TB treatment due to delays in laboratory diagnosis of MDR-TB,’ said Padayatchi.  

She said this was the first randomised controlled trial to show that anti-retroviral treatment would improve survival in patients with drug resistant TB sufficiently long enough for them to obtain a diagnosis and treatment.

‘This is the first study to show that Clofazminine can be safely used in patients with HIV.’

This was also a the first study to show that a point of care diagnostic for drug resistant TB whilst shortening the time to diagnosis, has little impact on outcome; ‘Hence we need to change health seeking behaviour and strengthen the health system for new technology to have an impact.

‘It also highlights the plight of infants and children, that without appropriate preventative treatment for them, they will bear the brunt of the dreaded disease of drug resistant TB,’ she said.

Padayatchi plans to dedicate more time to the issue of multi and extremely drug resistant TB, and mobilise and motivate the same passion in others.

‘My motto in life is “when life hands you lemons, make lemonade” and “Depression is a luxury I can’t afford”,’ said Padayatchi.

Padayatchi said her family was very proud of her achievement, ‘They feel inspired - they have always encouraged me through all my pursuits. Together with my spirituality, this is what sustains me.’

 Nombuso Dlamini

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Honorary Doctorate for Scientist who Discovered that HIV causes AIDS

Honorary Doctorate for Scientist who Discovered that HIV causes AIDS
Dr Robert Gallo receives a UKZN Honorary Doctorate.

UKZN has awarded an Honorary Doctorate of Sciences to the internationally renowned scientist, Dr Robert Gallo, who in 1984 proved that HIV causes AIDS and has since spent much of his career trying to find cures for HIV and other viral, chronic illnesses.

Gallo, who is Director of the Institute of Human Virology at the University of Maryland School of Medicine in the United States; was inspired to pursue a career as a research physician after the death from leukaemia of his six-year-old sister.

‘I was 13 and saw her in her final days when she was at a medical school’s Children’s Hospital which is where I caught my first glimpse of doctors seeking to do better, not satisfied with the present.’

Early on in his career in 1976, his lab discovered a way to grow human T cells for the first time due to a finding of a growth factor, a protein called the T cell growth factor, eventually becoming known as Interleukin-2, or IL-2, among the first cytokines.

They also discovered the first and the second known human retroviruses HTLV 1 & 2 which target CD4 T cells and are transmitted by blood, sex and mother’s milk. This was the start of his journey into the discovery that HIV leads to AIDS. Human trials of more than 100 different AIDS vaccines have taken place since Gallo proved in 1984 that HIV caused the disease.

Gallo and his team also pioneered the HIV blood test which verified the linkage of HIV to AIDS. ‘This was a necessity for scientific progress because whereas virus isolation was then quite difficult and few wished to try it, antibody testing was safe, simple and accurate.’ This breakthrough led to a more rapid diagnosis whilst simultaneously, protecting patients receiving blood transfusions.

In 1996, Gallo discovered that a natural compound known as chemokines could block HIV and halt the progression of AIDS. The discovery of the involvement of chemokine receptors in HIV-1 binding and entry opened the door for new approaches to controlling HIV-1 infection. Gallo’s study was hailed by the Science journal as one of that year’s most important scientific breakthroughs and eventually led to the development of Anti-Retroviral Therapy. Since then, new HIV infections have fallen by 35% and AIDS-related deaths have fallen by 42% since the peak in 2004.

Gallo’s research has brought him international recognition as well as election into the National Academy of Sciences and the Institute of Medicine. He has been awarded honours for his contribution to science from countries around the world and holds 34 honorary doctorates. He was the most referenced scientist in the world in the 1980s and 1990s, during which time he had the unique distinction of twice winning America’s most prestigious scientific award, the Albert Lasker Award in Medicine.

He is the author of more than 1 300 scientific publications.

 MaryAnn Francis

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PhD Study Sheds New Light on Immune Responses that Control HIV Infection

PhD Study Sheds New Light on Immune Responses that Control HIV Infection
Dr Catherine Koofhethile celebrates with her family from Botswana.

UKZN’s HIV Pathogenesis Programme (HPP) celebrated Dr Catherine Kegakilwe Koofhethile of Botswana obtaining a PhD in Immunology with research which has brought scientists a step closer to understanding the phenomenon whereby a rare group of individuals control HIV-1 infection without antiretroviral therapy.

Her novel study, titled: “Protective HLA Class I Alleles: Investigation of Viral Control and Lack of Control in Chronic HIV-1 Subtype C infection”, used specimens of chronically HIV-1 infected individuals in Durban. 

Koofhethile identified a subset of individuals with a genetic make-up associated with highly functional cytotoxic T cells against the HIV Gag protein. In these individuals the loss of these immune responses eventually led to high viral load and she could show that the ability of these isolated immune cells to stop virus growth in the laboratory declined as the patients’ viral load rose.

Interestingly, Koofhethile also identified a subset of individuals who appear to have alternative non-cytotoxic T cell mechanisms of viral control.  These individuals, who were also controlling HIV-1 infection without antiretroviral therapy did not have the genetic make-up associated with highly effective cytotoxic T cells and when their T cells were isolated in the laboratory, they did not stop virus growth. 

Koofhethile therefore concluded that these individuals have alternative mechanisms of achieving virus control.  She believes that these unique controllers may hold the key to an effective HIV vaccine and wants to focus her future research on understanding the novel mechanisms of HIV-1 control in these persons. 

‘During my PhD studies, I got to learn, practice and experience patience, perseverance, respect for other scientists, public speaking, dealing with constructive criticisms, sharing ideas and knowledge with others,’ said the humble graduate.

‘My research contributed to a better understanding of the mechanisms of HIV control during the chronic stage of infection and has also opened up new research questions, which are of great interest for the future vaccine design studies. We appreciate the people who are kind enough to donate their blood to us to conduct research, without whom this work would not have been possible.’

Koofhethile is now a post-doctoral Fellow at HPP under the supervision of Professor Thumbi Ndung’u and the mentorship of Dr Christina Thobakgale. ‘I am still very interested in HIV natural controllers and I hope I can unravel the puzzle and produce information that can be useful for the development of better HIV vaccines and treatment strategies,’ she said. 

Koofhethile will visit the laboratories of international collaborators, for some training to learn and equip herself with new techniques to help her develop into an independent scientist.

Koofhethile had a ‘chance of a lifetime’ opportunity to mingle with Nobel laureates recently at the 64th Lindau Nobel Laureate (Medicine and Physiology) meeting in Germany. She met the esteemed Professor Barré-Sinoussi who received a Nobel prize for her discovery of HIV.

Koofhethile said she was ecstatic to have her entire family present at her graduation – a missed opportunity when she received her BSc and master’s degrees from universities in England.

Lunga Memela

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Medical Science Boffins Graduate Cum Laude

Medical Science Boffins Graduate <em>Cum Laude</em>
Mr Zola Mpofana and Miss Keira Tucker.

UKZN’s Medical Science class of 2015 was topped by cum laude graduates Ms Keira Tucker and Mr Zola Mpofana.

A talented surfer, guitar and piano player, Tucker (21) received six Certificates of Merit and six Deans Commendations, the National Research Foundation Innovation Honours Scholarship for her current degree in Medical Microbiology, was a Peer Wellness Mentor, shortlisted for the Mandela Rhodes Scholarship in 2015 and completed the K-RITH Mycobacterial Genetics Course – all recognising her academic excellence at UKZN.

Two-thirds of Tucker’s fees at St Mary’s Diocesan School for Girls in Kloof were scholarship funded. She matriculated with Academic Colours, Music Full Colours, Leadership Service Awards, and took 1st place in a surfing competition and 2nd place in Inter-House Music.

‘I feel really proud and grateful that my hard work and dedication to studying over the years has paid off,’ said Tucker. ‘My parents are ecstatic and feel so blessed and grateful to have a child who works really hard and deserves the recognition.

‘Never take the fact that you are at university for granted. You are very lucky to have the opportunity to study,’ she advised.

Mpofana (22) was a Newcastle High School’s 1st team rugby, chess and basketball player before enrolling at UKZN where he scooped five Merit Certificates, two Deans Commendations, played for the basketball team and received a certificate for tutoring Anatomy students.

‘I’m very happy and proud of myself for making it this far. My family has always supported me throughout my journey so when they heard I was graduating cum laude they were very excited and happy for me’. 

Mpofana sensed many more doors would open for him. He is now a third-year Medical student at Wits University. ‘If you want something badly enough then go out and fight for it! I may not be the smartest or the most gifted but I have a strong work ethic and I believe that hard work beats talent any day,’ he said.

Lunga Memela

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Cum Laude Degree for Medical Student

<em>Cum Laude</em> Degree for Medical Student
Dr Zubair Haffajee.

Bachelor of Medicine and Bachelor of Surgery student (MBChB), Dr Zubair Haffajee, graduated cum laude at UKZN’s College of Health Sciences Graduation ceremony.   

‘It’s quite surprising but a real honour to be one of the top students in my class,’ said Haffajee. ‘It feels like all my hard work over the past six years has paid off. You always try your best but in the end you never really expect something like this happen.’

He said his achievement had made his family very proud. ‘At least now they know that I wasn't fooling around too often at campus.’

Achieving his degree was a culmination of hard work that began in high school and it gave him a real sense of accomplishment to now be able to practice in the field of medicine.

He is currently looking forward to completing his two years of internship and thereafter his year of community service. ‘I have not yet decided but I plan to hopefully specialise at a later stage,’ he said.

‘Knowing that I can actually make a difference when I go to work is what really keeps me going every day.’

His advice to students is to work smart not hard and enjoy varsity life as much as possible. ‘They probably hear that from everyone but often you never really appreciate the advice until it’s too late.’

Initially medicine was not his first choice, but after getting accepted to UKZN he hasn’t looked back.

One of three children in the family, his elder brother is a Dentist in Cape Town and his younger sister is currently studying for a BCom at UKZN. His parents work in the clothing industry.

He said the highlight during his degree was the new friends he made along the way as well as the fact that as a class they always seemed to help each other and were never hesitant to share notes and give advice.

Haffajee thanked all his classmates and his family. ‘This achievement would not have been possible without your continuous help and support.’

Nombuso Dlamini

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Study Investigates Impact of Hypertension on Peri-Operative Health Outcomes

Study Investigates Impact of Hypertension on Peri-Operative Health Outcomes
Dr Yoshan Moodley.

A study investigating the impact of hypertension, or high blood pressure, on the peri-operative (around the time of the operation) health outcomes of patients undergoing non-cardiac surgery, secured Dr Yoshan Moodley a PhD in Anaesthestics

‘Globally there is still some uncertainty as to whether hypertension is associated with a higher risk of heart attacks, strokes, and kidney failure shortly after surgery,’ said Moodley.

Titled: “Peri-Operative Studies of Hypertension”, the research investigated whether South African non-cardiac surgical patients with hypertension were at higher risk of heart attacks, strokes and kidney failure following their procedures compared to patients who did not have hypertension.  

According to Moodley, the research has important implications with regard to how surgical patients with hypertension are clinically managed prior to their surgery. 

‘This research provided new scientific findings describing the potentially harmful effects of commencing beta-blockers (a medication used to treat hypertension) shortly before surgery. Furthermore, this research also resulted in the development of the South African Vascular Surgical-Cardiac Risk Index (SAVS-CRI), which can be used to identify vascular surgery patients who are most at risk of developing a heart attack around the time of their surgery,’ he explained.

Moodley completed his PhD thesis by publication. In total, his thesis consisted of five research manuscripts published in local and international medical journals.  ‘Completing a PhD by publications can be challenging, but careful planning and determination can make it a rewarding experience, especially when you see your research indexed in international medical databases such as PubMed.’

He is a recipient of an NRF Innovation Postdoctoral Fellowship and is currently involved in post-doctoral research at the Department of Anaesthesiology and Critical Care Medicine at the Nelson R. Mandela School of Medicine where he is investigating the impact of HIV infection on peri-operative health outcomes in patients undergoing non-cardiac surgery. 

He is also currently supervising a master’s student who is conducting a study on hospitalised older adults with HIV infection.

‘I would like to become an academic at a South African university, which will enable me to continue my research,’ he added.

Nombuso Dlamini

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Urgent Need for Intervention Services for Psychotic Youth, PhD Study Finds

Urgent Need for Intervention Services for Psychotic Youth, PhD Study Finds
Dr Saeeda Paruk.

A UKZN study suggests there is a need for urgent dual intervention services for psychotic youth.

Conducted by Dr Saeeda Paruk, as part of her PhD, the study aimed to investigate associations between patterns of cannabis use and family history of psychosis or mental illness, and socio-demographic and clinical features of first-episode early onset psychosis (EOP) in adolescents.

Titled: “Risk Factors Associated with Adolescent Onset First Episode Psychosis in KwaZulu-Natal, South Africa”, it also aimed to compare family history of mental illness or psychosis as well as cannabis use patterns, between adolescents with psychotic and other first-episode non-psychotic mental illness.

‘The equally high prevalence of cannabis use in non-psychotic youth, which is often secondary to their mood symptoms, also reflects the need for improved screening and treatment for psychiatric disorders in adolescents with primary substance use,’ said Paruk.

She said this was the first prospective study of first episode psychosis in an exclusive adolescent sample in Africa that systematically analysed the impact of cannabis use on clinical presentation.

Said Paruk: ‘EOP (psychosis onset by age 18) often marks the beginning of a chronic severe mental disorder with a significant psychosocial and economic burden to the individual, family and community. Identifying the impact of risk factors for EOP may aid in delaying onset and/or modifying outcome.’

She said in contrast to research on adult psychosis, research on EOP was very limited internationally and there were no prospective studies from Africa.

‘Genetic vulnerability, often suggested by a family history of mental illness, as well as early cannabis exposure, has been associated with increased vulnerability to psychosis and earlier onset of disease,’ said Paruk.

‘There is thus a need to better understand the impact of these two established risk factors for psychosis (cannabis use and family history of mental illness) on the socio-demographic and clinical features (age of onset, age of presentation, duration of untreated psychosis and symptom profile) of first-episode EOP, to improve awareness, screening and early intervention programmes.’

The research results were reported in four papers.

The first paper revealed that adolescents with EOP had several negative outcome indicators such as poor recognition of the prodrome period, longer duration of untreated psychosis (DUP) in younger children, high symptom severity, high prevalence of cannabis use and a relatively young mean age of symptom onset.

The second manuscript revealed that the DUP may be influenced by other socio-cultural factors in the African setting.

The third paper reported that the family history of psychosis (FHP) was more specific among EOP adolescents than non-psychotic controls. FHP was also associated with a younger age of presentation for males only and with lower mean PANSS positive and total scores. ‘This suggests that FHP may be of diagnostic and clinical utility. However the findings are limited by the small sample size,’ said Paruk.

The final manuscript suggested that psychotic adolescents were more vulnerable to cannabis related problems than other mentally ill adolescents. It also revealed that psychotic and non-psychotic adolescents also differed in their reasons for cannabis use and in their socio-demographic profiles. 

 Nombuso Dlamini

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Outstanding Medical Student Graduates Summa Cum Laude

Outstanding Medical Student Graduates <em>Summa Cum Laude</em>
Dr Faizal Thayab.

The recipient of several prestigious academic awards, Dr Faizal Thayab, graduated summa cum laude for his Bachelor of Medicine and Bachelor of Surgery (MBChB) degree.

Thayab who previously graduated cum laude for Bachelor of Optometry said; ‘I have worked consistently throughout Medical School aiming for good results.’

Thayab received the Top student Award in the MBChB programme and the YK Seedat Prize for obtaining his degree summa cum laude.

He also received awards from the Academy of Family Practice Prize for top student in Family Medicine, the Servier Prize in Family Medicine for the second highest marks, the Sammy Sacks Prize in Obstetrics & Gynaecology for the second highest marks, and the RWS Cheetham Senior Memorial Prize in Psychiatry for Meritorius Achievement from 4th to 6th year.

Thayab, whose wife is also a medical doctor, said his family was happy he had realised his dream and performed with such merit. ‘I have always wanted to be a medical doctor and I am proud, not only of myself, but of the entire class of 2015 for all our accomplishments,’ he said.

Thayab plans to specialise in Ophthalmology once he has completed both his internship and community service.

He advised those still studying medicine to make the most of their time at the University and treasure their friendships: ‘It is a privilege that you are among the chosen few to pursue a career in medicine.’ 

He had a number of highlights while studying: ‘Making awesome friendships, and of course the “Quiet room”. The time I spent in PMB and at Tugela Ferry was also memorable. And of course this last achievement, obtaining my MBChB!’

Thayab received numerous merit awards and Dean’s commendations during his studies.

 Nombuso Dlamini

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Third Generation “Dr Moosa” Graduates

Third Generation “Dr Moosa” Graduates
Dr Khalid Moosa.

‘I’m honored and pleasantly surprised to be a top student and a third generation Dr Moosa,’ said Medical student Dr Khalid Moosa (24) who graduated cum laude.

‘I aimed to do well but didn't expect to finish as one of the best. It is an honour to graduate from the same Medical School that my grandfather did in 1964 and my father in 1988.’

He said he didn’t quite match his sister, Iman, who qualified summa cum laude, however, his family was ecstatic and extremely proud.

Moosa is currently doing his internship at Prince Mshiyeni Hospital in Durban: ‘I plan to enjoy my internship and bask in the knowledge that there are no formal exams for the foreseeable future. I don’t have any specific plans though I do see myself continuing to work in the public sector.’

The company of his family and friends, the lighter moments in life and good food keep Moosa going.

He advised those who were still studying to make sure they took time to relax and enjoy university life: ‘It is one of the most exciting times in your life. Make sure you cultivate your interpersonal relationships as they are vital to your sanity and success during varsity and when working.’

Moosa’s father is a Radiologist, his mother is an Occupational Therapist while his sister, Iman, is doing honours at UKZN. His younger sister, Jahaan, is still in high school.

‘The camaraderie that the class of 2015 shared and the great friendships I have made form part of my highlights as a student at UKZN,’ said Moosa.

He obtained a Dean’s Commendation in his fifth and sixth years.

‘As a young child my intention was to either become a game ranger or chef. Even though I chose medicine, I still continue to be fascinated by those fields,’ he said.

 Nombuso Dlamini

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UKZN Orthopaedic Surgeon’s PhD Study Develops New Approach to Treatment of Chronic Osteomyelitis

UKZN Orthopaedic Surgeon’s PhD Study Develops New Approach to Treatment of Chronic Osteomyelitis
Dr Leonard Charles Marais.

UKZN’s Department of Orthopaedic Surgery’s Dr Leonard Charles Marais has developed a novel stratification system and treatment strategy selection algorithm for the treatment of chronic osteomyelitis.

Studies emanating from his proposals following research for his PhD degree show favourable outcomes in both low and high risk cases of chronic bone infections with a concurrent reduction in the need for amputation.

His study titled:  “An Integrated Approach to Adult Chronic Osteomyelitis” investigated the short-term outcome of treatment of chronic osteomyelitis where management was based on a refined host stratification system.

‘Chronic bone infections are extremely difficult to treat, not only because of the unique characteristics of the causative organisms, but also due to the complexity of the surgery involved,’ Marais said.

He explained that the surgeon needs to consider the patient’s local and systemic capacity to eradicate infection when selecting a treatment plan, ‘In essence, there are two options: Curative treatment, which involves either complex (and risky) surgical debridement and reconstructive techniques, or palliative treatment, which is less risky and involves chronic antibiotic therapy.’

He explained further that the stakes were high and instituting curative treatment involving distraction osteogenesis, for example, in patients who are not able to meet the metabolic demand of the procedure, could result in amputation of the limb.

He said prior to his research, there was no evidence-based approach to selecting the appropriate treatment strategy. ‘By integrating a modified host stratification system with treatment strategy selection, in an algorithmic approach, favourable outcomes were achieved in both high and low risk patients,’ said Marais.

‘In addition this approach maintained a low amputation rate, which is particularly relevant in a resource-poor clinical environment. We also reported novel data on the outcome of palliative treatment and the outcome of treatment in patients living with HIV,’ he added.

Marais is currently involved in various fields of research, including international multi-centre collaborations. He is continuing his research in the field of bone infections and will be concentrating on post-operative infections in HIV patients in the immediate future.

‘We have also been working on clinical markers predicting the presence of metastases at time of presentation in extremity osteosarcoma. The prognosis of children and adolescents who develop osteosarcoma remains poor.

‘In KwaZulu-Natal we seem to be dealing with a particularly aggressive osteosarcoma phenotype that has a high propensity to metastasise early and respond poorly to chemotherapy. I hope to secure funding to commence genetic characterisation of the osteosarcomas we see in children and adolescents. By identifying the genetic alterations associated I hope to identify novel targets for therapy in osteosarcoma,’ said Marais.

 Nombuso Dlamini

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Cum Laude Medical Graduate Looks Forward to Community Service

<em>Cum Laude</em> Medical Graduate Looks Forward to Community Service
Dr Mumta Hargovan.

Graduating cum laude for her MBChB degree marks the start of a new chapter in her life, says Dr Mumta Hargovan.

‘I am excited and honoured to have graduated as one of the top achievers at UKZN. I have always worked hard with the aim of becoming a knowledgeable and skilled doctor, rather than to achieve high marks or awards. However, I am pleased that my efforts have been acknowledged and rewarded,’ said Hargovan.

For Hargovan graduation represents the culmination of her years of undergraduate study and signifies the start of a new chapter for her.

She is looking forward to gaining practical experience and exposure in various medical fields during her internship and community service years. She believes that would allow her to explore her interests before choosing a field for postgraduate studies.

She said her family is proud to share in her achievements ‘I am strongly motivated by the support and encouragement of my family. I owe my success to my parents who were there for me every step of the way and constantly inspire me. My sisters are strong and hardworking individuals, and are role models for me.’  

‘My advice to Medical students is to look after yourself and be kind to your colleagues.’

Hargovan, who is currently a medical intern at Victoria Hospital in the Western Cape, loves music, travel and running.

Her mother, Dr Hema Hargovan, is a Lecturer in the School of Built Environment and Development Studies at UKZN. She has a Doctorate in Criminology and is a member of the National Council of Correctional Services.

‘My mother’s academic achievements and passion for restorative justice and social development are an inspiration to me.’

Her father, Dr Natvarlal Hargovan is a Specialist Urologist. ‘I learned through his example how to treat patients with care and compassion.’

She is the youngest of three children. Her sister, Dr Seetal Hargovan, graduated from UKZN Medical School in 2010 with an award for Anaesthetics. She has a postgraduate diploma in anaesthetics and is currently working as an Anaesthetics Medical Officer.

Her other sister, Dr Karisha Hargovan, graduated cum laude from UKZN’s Medical School  in 2012, with awards for internal medicine and psychiatry. She also has a postgraduate diploma in anaesthetics and works as Anaesthetics Medical Officer.

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Poole Graduates Summa Cum Laude

Poole Graduates Summa Cum Laude
Dr Alicia Pauline Poole.

Medical student, Dr Alicia Pauline Poole, who graduated summa cum laude plans to specialise in Obstetrics and Gynaecology once she completes her internship and community service.

‘I am extremely happy to be graduating as one of the top students in my Discipline. I feel that I have made my family proud, and made the six years of stress I put them through worth it in the end,’ said Poole.

Poole said she knew she was doing well in her studies ‘but I did not realise I was one of the top achievers’.

Both her grandmothers died during her last two exam weeks. ‘Their passing was unexpected and a shock, so I did not think that I would perform very well in the exams. However, with the support from close family and friends, I was able to make it through and I am very pleased with the results.’

She said her family was overjoyed and very proud of her achievement.  ‘This degree means a lot to me. Being a medical doctor is something I have always wanted to do. I was told in school that I was not tough enough to make it through medical school, so I made it my mission to prove them wrong,’ said Poole.

Poole plans to specialise in Obstetrics and Gynaecology once she completes her internship and community service.

She is the first doctor in her family. ‘My mother is a retired teacher, my sister is a teacher, both my grandmothers were teachers,’ said Poole.

However, her father is a Pharmacist. ‘He would have loved to be a doctor but his financial circumstances did not allow for it. I am incredibly grateful to my family for the sacrifices they made to get me through Medical School.’

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Cum Laude Graduate ‘Done with Studying’

<em>Cum Laude</em> Graduate ‘Done with Studying’
Dr Minette McCabe.

‘I am done with studying now. This is my third qualification,’ said Bachelor of Medicine and Bachelor of Surgery (MBChB) student Dr Minette McCabe, who graduated cum laude.

McCabe said she tried to get into medicine since the day she left school. ‘I did not succeed at first and decided to study BSc: Human Genetics.’

She applied twice again unsuccessfully and then did a BSc Honours in Aquaculture, giving up on medicine and started work as a fish farmer.

McCabe then moved to the United Kingdom where she worked at Heathrow as a livestock import supervisor, importing animals ranging from gorillas and tigers to snow leopards and hippos!

‘But I still wanted to be a doctor and I decided to apply at all the South African universities and also some foreign ones. I managed to get in at UKZN at the age of 31 and the rest is history as they say.’

She plans to be the best doctor she can be, in the smallest of towns in the bushveld.  She also plans to start farming on the side and teach people sustainable farming.

She said the love of life and her family kept her going. ’My family is extremely happy and proud of me. It is the best family under the sun.’

She said among her highlights as a student at UKZN were the friends she made and the amazing teachers she met.

McCabe received the UKZN Academic Scholarship for distinction average in 2011, and a Surgery: Certificate of Merit in 2014.

Her sporting achievements include playing chess in the Far Northern Transvaal championships, and representing the then Northern Transvaal and the University of Pretoria in judo.

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UKZN Study Produces Novel Treatment for Tibial Non-Unions

UKZN Study Produces Novel Treatment for Tibial Non-Unions
Dr Nando Ferreira.

UKZN Orthopaedic specialist, Dr Nando Ferreira, graduated with a PhD in Medicine for his study which developed a novel treatment algorithm incorporating new treatment strategies with the use of circular external fixators for the management of tibial non-unions.

Ferreira’s thesis was titled:  “The Outcome of Tibial Non-Union Treatment Using a Revised Definition, Classification System and Management Strategy”.

According to Ferreira, with the overwhelming incidence of trauma in South Africa, complications such as fracture non-union are frequently experienced.

‘Tibial fractures and subsequent non-unions are particularly prevalent and their optimal management is controversial. My research included novel treatment strategies and incorporated the concept of mechano-biology to non-union management.’

He is currently involved in research in the field of orthopaedic limb reconstruction and also supervises degree research of students.

‘I am contemplating further studies in research methodology and biostatistics,’ said Ferreira.

He enjoys supervising master’s research and aims to start supervising PhD studies.

‘My family supported me throughout my time as a Registrar and all subsequent research activities. When I struggled to stay motivated they were a great source of support and encouragement,’ he said.

Feirreira’s wife, Yvette, is a Radiographer at Greys Hospital in Pietermaritzburg and they have two children.

In his free time he enjoys mountain biking and motorcycle riding. ‘I am currently in the process of restoring a 1942 Harley Davidson!”

Born in KwaZulu-Natal, Ferreira completed his MBChB at the University of Stellenbosch after which he completed specialising in orthopaedics, his Masters of Medicine degree and his PhD at UKZN.

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Study Reveals How Tissue-Dwelling Worm Evades Host Immunity

Study Reveals How Tissue-Dwelling Worm Evades Host Immunity
Dr Nyamongo W Onkoba.

PhD graduate in Public Health, Dr Nyamongo W Onkoba, completed a study which shows how a tissue-dwelling worm which causes Trichinellosis can evade host immunity and establish its parasitism.

The study was titled: “Host Immune Responses to Plasmodium Berghei ANKA and Trichinella Zimbabwensis Infection in BALB/c Mice”.

‘My thesis determines the effect of a worm that dwells in animal and human tissues using host metabolism and immunity,’ said Onkoba.

The study further explored the effect of worm infection before co-infection with malaria in the same host.  ‘It also looks at the effect of deworming on host immunity and the severity of malaria.’

He said the study results were exciting, ‘In the initial stages of infection, I established that the worm is able to influence host food and water intake and glucose metabolism resulting in weight loss. These changes are later compensated by the host through increased feeding as the worm migrates to settle in the skeletal muscles. During co-infection with malaria, the worm was able to ameliorate malaria immunity, improve disease outcomes and enhance survivorship by at least 45% compared to single malaria infection.’

The study also showed that deworming prior to malaria infection improved host immunity against malaria disease outcomes.

Onkoba said the results were of public health interest since they were relevant in the development of policy and guidelines for integrated management and control of worm infections in malaria endemic areas of sub-Saharan Africa.

He said he enjoyed his research and advised prospective students that a PhD study was like a roller-coaster ride. ‘Stop procrastinating, write every day and involve your supervisors in all that you are undertaking in regards to the study.’

He was supervised by Professor Moses Chimbari.

Onkoba is currently involved in mentoring students in the area of biomedical research while lecturing and offering consultancy services at the Institute of Primate Research in Kenya.

His future plans include enrolling for an MBA in strategic management.

A patriotic Kenyan, he is married to Zubeda, and they have a five-year old daughter, Zendai.

‘I am fascinated by classic cars and antique items because they communicate a story to me,’ he said. 

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PhD Explores Voluntary Medical Male Circumcision

PhD Explores Voluntary Medical Male Circumcision
Dr Roger Phili.

The feasibility of integrating Voluntary Medical Male Circumcision (VMMC) with other HIV and sexual reproductive health programmes was evaluated in the thesis of PhD graduate, Dr Roger Phili.

The study titled: “Feasibility of Implementation of Medical Male Circumcision (MMC) in Public Sector Health Facilities Users in KwaZulu-Natal as Part of a Comprehensive HIV Risk Reduction Package”, examined the implementation of VMMC both as an entry and exit strategy for men who use health services for other reasons and were offered VMMC during their visit.

‘This was a field-based operational research study to establish and evaluate the real-world implementation constraints of an integrated HIV prevention strategy following the introduction of VMMC in KwaZulu-Natal,’ said Phili.

The study used three levels of public health care in KwaZulu-Natal to establish the feasibility of implementation and scale-up of MMC - Public Health Care (PHC) level, district level and private health level.  ‘The research included comparisons of the operational efficiencies of different patient entry points within health institutions in order to determine the optimal levels of access to and service delivery at public health institutions.’

The research revealed some limitations and opportunities for service improvements particularly regarding effective expansion of VMMC services and highlighted the implementation challenges and lessons for operationalising new research findings into routine health services.

Amongst the major findings of the study was that the integration of VMMC with existing HIV services as an ‘add-on’ strategy to an existing package of prevention services may not be feasible at the health care facilities currently and that a vertical approach through the male-only facilities may be a more feasible strategy to introduce VMMC services in public sector health facilities in KwaZulu-Natal.

Phili said offering of MMC as an exit strategy for men who present for other services may be more feasible as a medium to long term strategy as the operational barriers are resolved over time.

‘It may be argued that the vertical implementation of VMMC at standalone male-only facilities would invariably attract more clients for VMMC as such clients are already motivated to present for VMMC. However, the study showed that client motivation alone may not necessarily result in the higher uptake of services as several other barriers may restrict access to services.

‘It is further observed that despite higher uptake of HCT and VMMC using the vertical approach, the offering and integration of VMMC with other prevention programmes tends to be compromised. There may be a need to strengthen the offering and/or referral of other prevention programmes through multi-skilling of health providers when using this approach,’ said Phili.

He said his findings were important to inform planning of new prevention services and highlight several areas that pose barriers to effective integration of prevention programmes.

According to Phili, his research was largely based on the rapidly evolving implementation science field. ‘The support and guidance from my supervisor, Professor Quarraisha Abdool Karim, proved invaluable,’ he said.

He said MMC was amongst the most effective HIV prevention interventions recently recommended by the World Health Organization (WHO) and Joint United Nations Programme on AIDS following the three randomised controlled trials conducted in Africa that showed its effectiveness in preventing female-to-male HIV transmission by up to 60%.

He said it also found no significant change in the uptake of HIV counselling and testing amongst patients presenting at health facilities after the introduction of routine offering of counselling and testing to all patients (PICT) vs when the old VCT strategy was being used.

‘Most men preferred to be circumcised at public sector facilities rather than at private practitioners,’ he added.  

The study also found that there were low rates adverse events related to MMC that were comparable to those observed in the RCTs despite VMMC implementation on a large scale. ‘Younger men (<24 years old) were most likely to return for follow-up visits compared to the older men,’ he added.

The HIV incidence and prevalence of sexually transmitted diseases amongst males post-circumcision were found to be low over a one year period. There was also an increase in sexual activity but accompanied by a significant decline in multiple partners after circumcision, and increasing age group and condom use were significantly associated with a higher number of sexual partners. However, condom use was significantly reduced by 48% at 12 months compared to baseline, and most men observed the six-week sexual abstinence post-circumcision.

Overall the study highlighted the fact that a highly effective intervention in a research setting may require the realignment of systems and resources in order to realise the same effectiveness in real-life settings.

The study used a combination of quantitative and qualitative methods to assess key outcomes depicting the operational realities of MMC implementation, scale-up and integration with other HIV prevention, sexual and reproductive health programmes.

‘Despite competing priorities of a demanding full-time job and family responsibilities, Dr Phili impressively and with tenacity and passion stayed the course to complete his PhD that makes important contributions to HIV prevention, strengthening health care delivery systems and introducing new technologies in the public sector that has immediate local and pan-African relevance,’ said Professor Abdool Karim.

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Dream Ending for Zimbabwe-Born Medical Student

Dream Ending for Zimbabwe-Born Medical Student
Dr Naseera Joossab.

Dr Naseera Joossab of Zimbabwe realised a long-held dream when she graduated cum laude with an MBChB degree.

‘Medicine has been a life-long dream career of mine. However, as a foreign student, it has been more challenging for me to reach my goal - my MBChB degree with distinction! The MBChB class of 2015 was no less than extra-ordinary. In the face of such a strong class and demanding degree, at times I felt like it was an impossible goal to reach.’

According to Joossab, she has unlocked and realised her true potential over the years. ‘To graduate as one of the top students in my Discipline was unexpected and I feel truly privileged and honoured.  It has been a great moment for my family as well as I am the only doctor of my generation.’

Joossab’s journey at UKZN began in 2006 and the MBChB is her third degree. She also has a Bachelor of Medical Science (Anatomy) degree, and Honours in Medical Science (Physiology).

‘This honour is not mine alone, I wouldn’t have reached this point without my family.  My parents, husband and sister have made many sacrifices so profound that I feel unworthy of such dedication.

‘My family’s unwavering support and encouragement are what has kept me going over the past 10 years. My husband, who I met in October 2006, has been my pillar of strength and a shoulder to cry on.

‘The professional relationships I have developed with staff members have carried me through the years and I am honoured to have lifelong relationships with many of them, especially now as I join them as a colleague,’ she said.

During her second year of studies she was invited to join the Golden Key International Honour Society. She served as Vice-President of the Society between 2007 and 2008.

In 2009 she presented her research at the Pfizer College of Health Sciences Young Scientists Research Symposium as the only representative from the Department of Physiology.

Other achievements over the last 10 years include presenting The Selectives Experience as a representative of the University of KwaZulu-Natal; and attending the 2013 South African Association of Health Educationalists Conference.

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