In January this year, the surgical pioneer, Prof Elmi Muller, took over the reins from Prof Jimmy Volmink as Dean of the Faculty of Medicine and Health Sciences (FMHS). The appointment as the new Dean is yet another milestone in a career that is already marked by many formidable achievements.
And yet medicine was not a natural career choice for Muller, an A1-rated researcher who used to be the Head of both the Division of General Surgery and the Transplant Unit in Groote Schuur Hospital at the University of Cape Town (UCT).
“When I started studying medicine (at the University of Pretoria), I initially felt the course had little room for reasoning and thinking, and I missed maths and science, my favourite subjects at school," says Muller, who matriculated in Vereeniging. “I enjoyed languages and was quite creative. I felt medicine was forcing me into a box, and I also did not enjoy learning all those facts."
But, of course, she persevered: “What attracted me to the course was that I had a love for people and wanted to work with people. Today I think this was a good choice, although there were times when I struggled. Medicine has lots of possibilities. When you finish the course, a world of options opens up."
Muller has certainly made the most of those options. After completing her MBChB in 1995, she worked at various hospitals in England while her husband, Prof Stephanus Muller, was doing his doctorate in musicology at Oxford University: “It was at this time that I started to realise that a surgical speciality might be the best option for me."
She did basic surgical training in the United Kingdom (UK) between 1998 and 2000, and then trained further as a general surgeon at UCT after she returned to South Africa. “I enjoyed the short-term positive feedback of surgery and working with my hands," says Muller. “I quickly found I wasn't ideally suited to be a GP. I am a very impatient person; I hate waiting for results. I also wanted to do something more creative and found surgery attractive from that point of view."
Muller turned to transplant surgery after completing her surgical exams in 2004. “I enjoyed it because it is an interesting field which requires a lot of team work," she explains.
“Transplantation has multiple sides: there is the surgery, which is clean and detailed and fun to do; there are also multiple political issues. And I've worked on several of these, like creating public awareness, building ethical organ allocation policies and preventing organ trafficking.
“These were all issues that I enjoyed getting involved in. Furthermore, the overlap with transplantation immunology, internal medicine and infectious diseases makes this a very interesting field."
A difficult time
Muller went on to perform the first HIV-positive-to-positive kidney transplants in the world. “When I started my career as a transplant surgeon, HIV-positive patients were not deemed suitable for dialysis or transplantation," she recounts. “Between 2005 and 2007, I declined many potential donors who were HIV positive.
“Coming face to face with several HIV-positive patients in 2008, I made a decision to respond to the individual needs of these patients instead of the more global exigencies of the healthcare institution. I decided to use HIV-positive deceased donor kidneys to transplant HIV-positive recipients who were turned down for dialysis."
Initially she faced resistance from several quarters. “One of the most difficult times for me as a transplant surgeon was just after I did the first HIV transplants," she recalls. “At Groote Schuur, there were people who felt this was not a sound clinical solution for HIV-positive patients, which put me in an extremely difficult position.
“Although some nephrologists were very keen to pursue these transplants, everyone didn't agree, and it was difficult for me to navigate this as a fairly young surgeon."
Today Muller serves on various international bodies in recognition of her pioneering work. She is an honorary member of the European Surgical Association and a member of the World Health Organisation (WHO) Transplantation Task Force. In addition, she is the President-elect of The Transplantation Society, a global NGO, and often speaks internationally about Africa's challenges in organ regulation and transplantation.
She has a leading role in the Declaration of Istanbul Group as well: “I was the only clinician-researcher on the African continent to have worked at an institutional level on issues of organ trafficking, regulation, ethics and training. My position as an African-based clinician-scholar catapulted me into the midst of international efforts to deal with issues relating to international organ regulation."
Creating sustaining success
Muller is looking forward to her new role: “The challenge is not to start something new or make a huge turnaround, but rather to think about ways to create sustaining success for the FMHS.
“A sustaining success model also requires change, but is sometimes less obvious to observe. So part of the challenge of this new job is about creating opportunities for change and growth. Naturally, I also need to get buy-in from my colleagues."
But Muller faces this challenge with confidence: “I look forward to building relationships with new people, making new friends, getting involved with new projects. I will enjoy the wide variety of problems that is now going to be part of my daily life. There are so many aspects to the job, so many different sides to the cube that the FMHS represents."
She adds: “Opportunities excite me. New ideas excite me."
Short-term goals
In the short term, Muller has set herself various objectives: “I would like to look at some of the ongoing projects to help women in the workplace, for instance the option of a childcare centre that has been planned at Tygerberg Hospital for many years now.
“I would also like to organise a leadership forum for women leaders in scientific fields. This is such an important issue: I followed the University of Pretoria's Women in Science symposium, and we need to think about expanding this type of work.
“Furthermore, as a clinician who understands the difficulties in postgraduate training in South Africa, I want to explore ways in which to help registrars complete their masters in medicine (MMed) more effectively.
“There is a lot of work to be done in terms of the balance between service delivery and academic work for specialists. I would love to think more about this and how we can streamline some of these processes better.
“Technology and artificial intelligence is at the front of so many fields in the world. We need to consider how we can incorporate this new reality into our undergraduate training.
“Lastly, I know that multidisciplinary and multicentric research can have an important impact on patients. I want to encourage clinicians to tackle fascinating, interesting and potentially multicentric projects."
No regrets
These challenges will take up most of her time, but hopefully Muller will still be able to indulge her passion for music and the arts now and then. While at school, she played piano and the church organ, and was involved in the school's choir and concerts.
While at university, she was a full-time organist at the Kloofsig NG Kerk to supplement her income. She met her husband, then a music student, while studying in Pretoria: “Through his interests, I was exposed to art and literature and music all through my life."
But today she has no regrets about her choice of career. “People think surgery is a very difficult career for women," she adds. “But the truth is that women excel in all areas of life if given a fair chance.
“Gender is not the only thing that contributes to how we do what we do; individuals are talented, curious and endowed with all sorts of character traits and diverse personalities that contribute to how they work and live. What makes the difference is who we are, and how we approach people and problems."
CAREER HIGHLIGHTS
1995: MBChB, University of Pretoria
2001: Member, Royal College of Surgeons, Edinburgh, UK
2004: Fellow, College of Surgeons, SA
2007: MMed (surgery), UCT
2007-2012: Specialist, transplantation and general surgery, Groote Schuur Hospital, UCT
2012-present: Head: Transplant Unit, Groote Schuur Hospital, UCT
2013: Fellow, American College of Surgeons
2016: Women in Transplantation Hero Award, The Transplantation Society (TTS)
2016-2018: Co-Chair: Declaration of Istanbul Custodian Group
2017-present: Head: Division of General Surgery, Groote Schuur Hospital, UCT
2018: PhD (surgery), UCT
2018-2020: Vice-President: TTS
2018-present: WHO Transplantation Task Force member
2018-present: Visiting professor, University of Alabama, US
2019: UCT Alan Pifer Research Award
2019: Chair: Transplant Focus Group, International Society for Nephrology
2019-present: President-elect, African Society of Organ Transplantation
2019-present: Visiting professor, University of Arizona, US
2020-2022: President-elect, TTS (2022–2024 term)
2021: MBA, SU
2021-present: Expert Group on Investigation and Prosecution of Trafficking In Persons for Organ Removal, United Nations Office on Drugs and Crime
Photo credit: Damien Schumann
