Transplant surgeon steers FMHS
In 2022, surgical pioneer Prof Elmi Muller took over the reins from Prof Jimmy Volmink as dean of Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS). This appointment is yet another milestone in a career that is already marked by many formidable achievements.
Interestingly, though, 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.
“When I started studying medicine at the University of Pretoria, I initially felt the course allowed 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 she persevered: “What attracted me to the course was my love for people and desire 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.”
The road to transplant surgery
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 between 1998 and 2000, and then trained further as a general surgeon at the University of Cape Town after returning 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 that requires a lot of teamwork,” she explains.
“Transplantation has multiple sides: there is the surgery, which is clean and detailed and fun to do, but there are also 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 transplantation 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, not everyone agreed, and it was difficult for me to navigate this as a fairly young surgeon.”
Today, Muller serves on various international bodies in recognition of this pioneering work of hers. She is an honorary member of the European Surgical Association and a member of the World Health Organization (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.
Moreover, she has a leading role in the Declaration of Istanbul Group, which calls on the medical community, especially transplant surgeons and nephrologists, to join the WHO in lobbying health ministries to help eliminate organ trafficking and ‘transplant tourism’.
“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 sustained 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 sustained success for the FMHS.
“A sustained-success model does require change but it is sometimes less obvious to observe. So, part of the challenge of this new job is 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 and getting involved with new projects. I will enjoy the wide variety of problems that are 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.”
“Opportunities excite me. New ideas excite me,” she adds.
Short-term goals
Muller has set herself various objectives for the short term. “I would like to look at some of the ongoing projects to help women in the workplace, such as the option of a childcare centre at Tygerberg Hospital that has been planned 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 around postgraduate training in South Africa, I want to explore ways in which to help registrars complete their master’s 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.
“Also, technology and artificial intelligence are at the forefront 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
Although these challenges will take up most of her time, Muller will, hopefully, still be able to occasionally indulge her passion for music and the arts. While at school, she played the piano and the church organ, and was involved in the school’s choir and concerts.
As a university student, she was also a full-time organist at the Kloofsig NG Kerk to supplement her income. She met her husband, a music student at the time, while studying in Pretoria: “Through his interests, I have been exposed to art, literature and music throughout my adult life.”
But today she has no regrets about her choice of career. “People think surgery is a very difficult career for women,” she says. “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.”
