Putting UCT Global Surgery on the world stage

In June 2019, Professor Salome Maswime took a leap of faith when she and her husband, Gundo Vhusani Maswime, packed their two young sons, Farai and Taurai, into a car and left Johannesburg. Professor Maswime came to the University of Cape Town (UCT) to assume the newly created position of head of Global Surgery. At the time she was a team of one, but her mandate was simple: dream big and fly.

Seven years later, at a farewell lecture event, which filled the auditorium of UCT’s Neuroscience Institute, dignitaries and students paid tribute to Maswime’s extraordinary accomplishments. They described her as a visionary leader who transformed UCT’s fledgling Global Surgery Division into a continental leader, global player, and tireless advocate for accessible and equitable surgical care for those who need it most.

Tribute was also paid to her mentorship, capacity for building communities, connecting with students and bringing out the best in people; her easy laughter and her power of persuasion. As Simon le Roux, the chair for the evening, said: “One minute you could be having coffee with Salome, and the next you find yourself in scrubs in Burundi!”

Maswime said: “If I look back to 2019, I could never have imagined the legacy we see today. I’m humbled.” She was addressing a room that included the chair of the Parliamentary Portfolio Committee on Health, Faith Muthambi; the national Department of Health’s chief director of Hospital and Tertiary Health Services, Dr Relebohile Ncha; the president of the South African Medical Research Council, Professor Ntobeko Ntusi; and the chairman of the Mandela Legacy Foundation; Zondwa Mandela.

“I have faith that global surgery will not end with me.”

Also present was the president of the Medical Association of Tanzania, Dr Mugisha Ntiyonza Nkoronko; the chief of Thongwe Ha-Rammbuda Limpopo, Thovhele Matshidze Ramuvhundu; and the recently appointed chief executive of the Musina Makhado Special Economic Zone in Limpopo, Maswime’s husband, Gundo – a leader in the field of public infrastructure and former lecturer in UCT’s Department of Civil Engineering.

His new position is also the reason behind the latest geographical move by this power couple, and her new role as the head of the School of Clinical Medicine at the University of the Witwatersrand (Wits).

“I have faith that global surgery will not end with me. We’ve ignited something new; something powerful; something big – and global surgery is going to grow into something even more beautiful than it is today.”

Pioneering Global Surgery

In a world in which approximately five billion people lack access to safe, affordable surgical and anaesthesia care, and where only three to six percent of operations are accessed by 30% of those who are poorest, Global Surgery works to strengthen surgical health systems, notably in low- and middle-income countries. This is accomplished through education, research, implementation and advocacy.

As recently as 2015, the concept of global surgery, was yet to exist. In stepping into the arena, UCT aimed to build an internationally recognised, interdisciplinary hub leading a global movement towards high-quality, cost-effective surgical care for the vulnerable and marginalised.

“It wasn’t come in and grow a division. It was come in and start something. There was no curriculum. We were going to create a blueprint for Global Surgery and where it is going,” said Maswime, an obstetrician and gynaecologist who stepped into the role fresh off a postdoctoral fellowship at the Massachusetts General Hospital and Harvard Medical School. Much of her career has been dedicated to maternal health, notably around stillbirth and complications with childbirth.

Tasked with growing UCT’s fledgling MSc in Global Surgery, Maswime was also tasked with establishing the world’s first Master of Public Health (MPH) Global Surgery track and PhD with specialisation in Global Surgery for MPH and MSc students. It is a framework designed to interface between surgical services, health systems and governance, running the gamut from surgeons to policy and decision makers.

“There’s an effervescent energy that Salome has brought to this work, which is hard to describe.”

Since those early days, she and the Global Surgery team have overseen five PhDs and 20 MScs in Global Surgery, and 10 enrolments for an MPH, while her staff has grown from one member to 10. In addition, access to global surgery education across Africa has been significantly improved through short courses in Zimbabwe, Rwanda, Burundi and Malawi. As one of the very few advocates for global surgery in Africa, it fell to Maswime and UCT to lead the continent, and to represent it in in bigger multinational institutions.

In addition to degree programmes, the division has established short courses for policy makers, managers and administrators. To date, 104 surgical leaders from 22 countries have completed a certificate in Executive Leadership in Global Surgery at the UCT Graduate School of Business, and 150 have been through Global Surgery Foundations and Introduction to Global Surgery short courses.

“Global Surgery has been so much more than a division within the Department of Surgery,” said Professor Lydia Cairncross, who heads the Department of Surgery. “It is interconnected with students, the faculty, the university, countries throughout the continent and beyond, and the Department of Health – provincially and nationally.

“There’s an effervescent energy that Salome has brought to this work, which is hard to describe. And I think might be tricky to replicate, but it has been really, truly impressive,” she added.

Thank you for seven good years

“First I want to say thank you for actually getting in your car and driving down here in June 2019 on the promise of a job, without a contract, hoping that it would all work out,” said Professor Graham Fieggen, who was one of a coalition determined to lure Maswime to UCT. Others included former UCT vice-chancellor (VC) Professor Mamokgethi Phakeng; deputy vice-chancellor for People, Culture and Society, Professor Elelwani Ramugondo; and Associate Professor Greg Petro.

Professor Fieggen’s quest began in 2015 with a paper in the Lancet Commission which established Global Surgery but did not include a single South African voice. “A few of us looked at that and thought: this is terrible. I mean, this is what we do every single day as surgeons in South Africa.”

Which brings us to Maswime sitting in an office going through the rest of her key performance areas with the VC and Fieggen, whom she describes as a visionary, saying; “We could fly to the moon together.”

“The rest was a bit fuzzy!” Maswime laughed. “Research? ‘We want you to fly’. Social responsibility? ‘Be the best in the world’.”

Since then, she has transformed Global Surgery at UCT, having developed the world’s first and most comprehensive Global Surgery education track on surgical systems strengthening, connected local and continental partners, raised over R25 million in research grants and established UCT as a World Health Organization (WHO) Collaborating Centre for Integrated Clinical Care with the Emergency Medicine Division.

“What began as a strategic project supported through VC funding evolved into an enduring academic and institutional contribution,” said Professor Ramugondo.

“In many ways, her work in Global Surgery challenged us to rethink whose lives count in global health conversations. She consistently reminded us that maternal mortality, surgical inequity, and healthcare injustice are deeply human realities that demand ethical action and scholarly attention.”

Creating a sense of belonging

Said Kwezi Zwane via video feed: “I’d like to tell you about the first time I met prof.” Zwane is currently a first-year medical intern at Chris Hani Baragwanath Hospital. “I was in second year, very young, very nervous to meet this prof who had many accolades, as well as being a black woman, a specialist and someone whom I looked up to.

“When I met her, I was taken aback by how human, real and warm she was … I speak for many young people when I say she has an ability to see you and fan an ember within you that grows into a flame and fuels your dreams, your leadership.”

Ramugondo said: “Salome’s presence at UCT has inspired young scholars, clinicians, and especially young African women, to see themselves as leaders in medicine, research, and prestigious universities such as UCT.”

“She has an ability to see you and fan an ember within you that grows into a flame and fuels your dreams, your leadership.”

“It’s been an incredible leadership journey,” said Maswime, who came from Wits as a lecturer. “I’ve had amazing opportunities to serve women’s health and global health, notably as former vice-president of South African Women in Global Health, and board member of FALF [Female Academic Leaders Fellowship], an organisation that supports black female academic leaders, ensuring that there is a continuous pipeline.”

She is also the founder and currentpresident of the South African Clinician Scientists Society and the director of the WHO Collaborating Centre for Integrated Clinical Care.

“Looking at this room, and everyone who’s joining us online, there are a lot of us who have been deeply mothered, mentored and shaped by prof. You rarely see so many student representatives at these events,” said Dr Yanelisa Pulani, the founder of the African Research Society.

“But that just speaks to prof. It is a story of dedication to student affairs and commitment to growing leaders who are sensitive to local realities and passionate about changing things.”

Looking to the future

In addition to her role on such institutional bodies as the Faculty Board, Senate, Institutional Forum and University Research Committee, Maswime is noted for her exceptional role in leading the University of the Future initiative. Launched in 2022 and aligned with UCT’s Vision 2030, it aims to create a roadmap for future infrastructure and campus transformation.

“The University of the Future is probably one of the most exciting things that I’ve done at UCT. It’s been a journey,” she said.

Richard Perez, deputy chair, said: “Under Salome’s stewardship, what may initially have begun as a project focused on infrastructure evolved into something far more important. It became a project about people, about community, about belonging and a social fabric of the institution itself.”

He added: “For her, this was never simply an academic exercise or another institutional report to be written. Salome genuinely believes the work needs to have lasting impact, that it should help shape a more meaningful, humane and hopeful future for this great university.”

Maswime concluded: “What have I learned from UCT? I learned about improvement science. I really think the future of healthcare lies in improving health systems.

“I can sum it up in these words: ‘The future depends on what you do today’.”