NRF Women's Month 2022: Dr Nkateko Mabila

Women’s Month 2022 is celebrated under the theme of “Generation Equality: Realizing women’s rights for an equal future” and links to the achievement of the United Nation’s Sustainable Development Goal (SDG 5) of Gender Equality by 2030. The NRF is committed to supporting women to advance their careers and establish themselves as researchers and, to this end, has developed a range of funding instruments aimed at supporting emerging female researchers.

Dr Nkateko Mabila is a Junior Lecturer in Clinical Pharmacology at the University of Limpopo (UL). She received funding from the NRF’s Black Academics Advancement Programme (BAAP)* from 2019 to 2021.

What impact that NRF funding have on your career?

My relationship with the NRF began in 2018 when I applied for an NRF-FRF Sabbatical Grant to assist me in obtaining my Doctoral degree. And honestly speaking, I was trying my luck; hence I consider myself fortunate to have received the Black Academics Advancement Programme (BAAP) Grant for my Doctor of Pharmacy Degree for 2019/21. This came at an opportune time when I was still trying to get used to the fact that I had just left the job I loved in a non-governmental organisation (ANOVA Health Institute), where I played a significant role as a Pharmacy Technical Advisor for the Department of Health in the Mopani District Municipality.

The decision to leave such an exciting job and take up a lower position in academia was motivated by my dream to pursue a Doctoral degree. For me, the announcement of the awarding of the grant by the NRF came as a confirmation that I had made the right decision. It also sparked my interest in seeing my project progress because the NRF grant had validated it. BAAP came as a welcome injection to my motivation to study and afforded me time to concentrate on my studies.

From 2019 through 2021, I used the grant to find and pay a replacement lecturer who took over the primary responsibility of my teaching load. This gave me sufficient time to conduct my research and produce a quality thesis within the stipulated study time. I was able to submit it at the end of 2021 and graduated during the Autumn Graduations on the 7^th of May 2022.

What has been your study/career journey: how did you end up where you are today?

After completing my Pharmacology degree, I did my internship at Pietersburg Provincial Hospital in 2007 and was allocated an excellent tutor. I got exposed to an array of knowledge and learning opportunities. Then, for my community service, I was assigned to Van Velden Memorial Hospital in Tzaneen. This was a district-level hospital environment, very different from the internship environment I was coming from.

I have always questioned the lack of implementation of policies and the ways of doing certain things in the pharmacy, which were different from the environment I was used to at a provincial level. So, when I completed my community service year in 2008, I knew that I needed to further my studies because I got curious about several issues in patient care and medicine use (prescribing patterns).

Finding the balance between being a new full-time working mother, a wife and uMakoti (daughter-in-law) is never easy. This led to me enrolling for a Master’s degree in Clinical Pharmacology at the then University of Limpopo (MEDUNSA Campus, now Sefako Makgatho Health Sciences University) in 2010. Instead of gaining satisfaction in my qualification, my Master’s spurred my interest in pursuing a PhD. Consequently, my zeal for career development landed me the position of Pharmacy Technical Advisor in the private sector where I worked for the USAID/PEPFAR-funded NGO, ANOVA Health Institute. I loved this position because it gave me more insight into the public healthcare sector’s needs and the health challenges and needs of people in remote rural communities.

After four years of my tenure at ANOVA Health (even though I loved what I was doing), I found myself having to choose between my position and pursuing my dream of obtaining a Doctoral degree. Thus, when an opportunity to take up the position of Lecturer presented itself, I immediately took it, knowing that it would also bring the fertile ground to further my studies. I resigned, even though it didn’t make sense to leave a comfortable managerial position 2.2 km from home for a junior position 42km away.

What is your research focus on/what is your area of expertise?

The title of my thesis was “Evaluation of Antiretroviral Use in Children Managed in Public Clinics of Mopani District, Limpopo Province: Towards a Dosing and Dispensing Training Programme for Nurses”. Professor Patrick Hulisani Demana, currently the Head of the School of Pharmacology and Acting DVC at Sefako Makgatho Health Sciences University, supervised the study. The co-supervisor was Professor Tebogo Maria Mothiba, a Professor of Nursing Science and the current Executive Dean of the Faculty of Health Sciences at the UL.

Antiretroviral (ARV) management in children poses a challenge to health professionals, and patients receiving ARVs remain at risk of medication errors. There has also been an observed increase in treatment failure and drug resistance amongst children on antiretroviral therapy (ART). Yet, this problem is under-recognised for children under the age of 15 years. Adherence to treatment guidelines is challenging among nurses caring for people living with the Human Immunodeficiency Virus (HIV). I conducted a medicine utilisation review (MUR) study to explore the prescribing practices of nurses trained in Nurse Initiated Management of Anti-Retroviral Therapy (NIMART). My study aimed to determine the knowledge, understanding, and competence of NIMART-trained nurses in managing virally unsuppressed children in clinics located in the Mopani district of Limpopo. My study adopted a mixed methods approach within an explanatory sequential design.

The quantitative phase employed a retrospective cross-sectional census of medical records to determine whether or not the children on ART were prescribed the correct ARV regimen, dose, strength, dosing frequency and if they received the right quantities to last until the next appointment date. The qualitative phase embraced a total purposive sampling technique. Even though the nurses’ self-reported competence was highly positive, the study highlighted contradictory observations. Although in most cases the nurses prescribed the correct regimens, I witnessed in my research a prevalence of drug omissions on specific regimens; incorrect dosing and dosing frequencies; and insufficient supplies of ARV quantities for treatment to last until patients’ next appointment.

The study concluded that the nurses’ prescribing practices were irrational since most prescriptions did not entirely comply with established HIV/AIDs treatment guidelines. Drawing from the findings, I developed and implemented a paediatric dosing and dispensing training programme for NIMART-trained nurses. The programme is the first of its kind. One of the significant recommendations of my study is that, similar to the practice adopted for the management of antimicrobials, the Department of Health should adopt a programme for ARV stewardship. I believe ARV stewardship shall contribute to achieving the ambitious 95-95-95 viral suppression target set by the United Nations Programme on HIV/AIDS in children under 15 years.

The study’s novelty is threefold: methodologically, I designed an approach for clinical pharmacologists to explore prescribing practices; in child health, it contributes to the unravelling of intricacies of ARV care; in the field of Pharmacology, valuable literature and training material for health workers involved in supporting nurses’ practising in remote arrears.

Why is your research important?

This project is essential to me because it highlights real-life issues in managing children on antiretroviral therapy in resource-limited settings of the Mopani District, and it sheds light and direction on the effective management of children infected with HIV.

I am hoping that the developed paediatric dosing and dispensing training programme can be adopted and implemented on a larger scale because I believe it will assist in the realisation of the 2030 Sustainable Development Goal (SDG) 3, which should aim at improving the lives of children infected with HIV and ensuring good treatment outcomes. This will help towards the realisation of the target to end the AIDS epidemic by 2030.

What advice do you have for girls who are interested in STEM-related careers?

For girls interested in STEM subjects, it is my wish that they can be exposed to the many role models that have become available in the education, industry and business sector. In my view, Science is real life. Hence, girls and females, in general, should be empowered to look beyond the gender stereotypes in education and those that dominate society. 

What I wish I had known before embarking on my career journey is the fact that studying as a full-time working woman, a mother, and a wife is a very tough journey that very few people understand. Our African culture does not support the needs of full-time working women, mothers or boMakoti (daughters-in-law and wives) in that a woman is a woman no matter what her job demands or what her dreams or ambitions are. Furthermore, in academia, those you expect to understand and support the journey because they have experienced it often become the people who end up frustrating you. Our country and institutions have beautiful policies on paper to support women’s needs to promote equality, but these are often on paper and never implemented. We are marginalised as women in the workplace for better working conditions. However, my Doctoral journey has unravelled that we don’t support each other as women. We often rejoice in frustrating one of our own. I believe that if this practice can change and we form a united front in our quest to fight male dominance in the academic world and working space in general, we can succeed and achieve more as women.

To the girl child: where possible, study as much as you want before you make serious commitments; before you have children. This will help you to avoid situations where you must choose between responsibilities and pursuing your dream(s) or missing out on your children’s progress at school, their special moments/milestones and reading them a bedtime story. My late mother used to say to me back in the days when things were not going well, “Never allow your background to describe you nor to determine your future. Fuel and believe in the beauty of your dreams. Because you are not a product of your circumstances, but a product of your decisions”.

*The NRF’s Black Academics Advancement Programme (BAAP), established in partnership with the FirstRand Foundation, aims to promote the development of Black academics specifically, Black South African citizens and academic staff with disabilities, by accelerating the training of PhD and Post-PhD candidates to enhance their research training and accelerate their progression to become established researchers.

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