Dr Liezl du Plessis was the Northern Cape’s first and only paediatric oncologist. But after eight years of treating children and teenagers at the Robert Mangaliso Sobukwe Hospital in Kimberley, as “things fell apart”, she left, citing exhaustion and accumulated trauma. In February, Du Plessis returned to her hometown of Pretoria where now, for the first time, she practises in the private sector, writes Biénne Huisman for Daily Maverick and Spotlight.
There wasn’t any particular incident that made her give up on her goal of running a paediatric oncology unit in Kimberley, Du Plessis said. “It accumulates over time. I think when you leave the state (sector), you actually have post-traumatic stress disorder or something… you cannot work there day in and day out and not have some form of trauma.”
A broken system
At Robert Mangaliso Sobukwe Hospital, she said: “You’ve got no support. When you’re a doctor and you want to get a patient healthy, you rely on so many services that should function well. Lab services – when I take blood from a child, I need a functional laboratory that can run my sample in a timely manner, that can phone me when the results are abnormal, not lose my sample.”
She recalled having to take her patients’ blood samples to the laboratory herself. “We would take our own samples to the lab. You could not put it in a container and hope for the best… it will never reach the lab. (In a smoothly running hospital, when a doctor or nurse draws blood, the sample vial is put in a collection bin for internal hospital porters to collect.) So the only way to make sure you actually get your results, you take it yourself, and tell them it’s urgent, otherwise it will lie there.”
Maintenance of the hospital also slipped into disrepair. “Back in the day, I think there were 40, 50 people working in the maintenance workshop who had been appointed by the hospital. The workshop that fixes a toilet that’s not working, a pipe that’s leaking, basic maintenance… By the time I left, I think there were two or three people in maintenance. So you work in this environment where everything is broken.”
Du Plessis said many of their patients at the Kimberley hospital were from poor socio-economic backgrounds and did not think to question the facility’s compromised state. “And you know, these are humans, sick humans who actually need to heal. But the problem is they come from such deprived home circumstances. Their expectations are so low, and that’s really sad because they don’t know to ask for better.”
With a population of about 1.38m, the Northern Cape covers an area of 372 889 square kilometres – roughly 20 times the size of Gauteng.
From Canada to Kimberley with big dreams
Du Plessis earned her medical degree in 2003 from the University of Pretoria, completing her master of medicine in paediatrics at the University of the Free State in Bloemfontein in 2012. She specialised further in paediatric haematology, oncology and bone marrow transplantation at the BC Children’s Hospital in Vancouver, Canada.
Returning to South Africa, initially she struggled to find a position, until, she says, the now retired Dr Pieter Jooste, a long-time paediatrician at Kimberley Hospital Complex, recruited her in 2018 to start a paediatric oncology unit. That same year, the facility was renamed Robert Mangaliso Sobukwe Hospital.
“He (Jooste) was always so open for anything new, that’s just his personality. He was always at the forefront of change and wanted to improve things even as they literally started to fall apart. So he facilitated me being appointed in the Northern Cape as a paediatric oncologist.”
A unit specially for children
In rooms formerly used for private patients, Du Plessis set up the paediatric oncology unit with seven beds. In time, the four single rooms, with adjoining bathrooms, and a larger ward with three beds, were beautifully decorated by the NPO Reach for a Dream, which also transformed an adjacent old storeroom into a play area.
Because the Northern Cape is South Africa’s largest province, its geographical size means most patients must travel long distances to Kimberley, with some children needing accommodation between chemotherapy cycles. Du Plessis also tried to accommodate their caregivers in the unit.
Treatment for adolescents and teenagers, she said, is close to her heart, since this is a vulnerable group needing support to adhere to their treatment, both from medical staff and caregivers (hence the importance of creating a space where parents could sleep over at the unit).
Cancer in children and teenagers is often treatable, she adds. “Their diseases are often curable. But you need somebody who supports them through that. They get sick, you often have these periods, these months of intensive therapy, but often they are cured.”
Learning to work IVAC infusion pumps
Du Plessis said that coming from a well-resourced training facility in Vancouver, this had been a steep learning curve. “All of a sudden I had to learn how to work the IVACs (infusion pumps) just to put up the chemotherapy. Administering chemotherapy, that is a nursing job. But nobody could really get the ball rolling on training people. I could never establish a team. In all of eight years, that was impossible.”
While she says the hospital system failed her, she mentions the CHOC Childhood Cancer Foundation of South Africa which appointed a local social worker, “a very dedicated woman who could speak Tswana”, to help her.
Fortunately, the hospital had a chemotherapy pharmacy. “At least I didn’t have to mix the chemotherapy,” she said. "There was a chemotherapy pharmacy that mixed the chemo. The hospital had that because they’d had an adult oncology unit for many years. There’re safety issues around working with chemotherapy and mixing it and how you store it.”
One remaining public oncologist in Northern Cape
Du Plessis said while she was working at Robert Mangaliso Sobukwe Hospital there were three oncologists – two for adults, and herself as the paediatric oncologist. But one of the others also left – to work in Kimberley’s private sector.
“So there was one adult oncologist for the entire province.”
The one remaining public oncologist in the entire Northern Cape is based at Robert Mangaliso Sobukwe Hospital, while also being responsible for the JF ‘Boeboe’van Wyk Oncology Clinic in Springbok (776km away) which, according to an official statement, admitted its first cancer patient in July.
When we called the oncology clinic, a receptionist said the facility was “up and running” and confirmed that the oncologist in charge was from Kimberley (we were given the same name that Du Plessis told us was the only remaining oncologist in the province).
Spotlight and Daily Maverick made several attempts to obtain comment from the Northern Cape Department of Health for this article, but had not received a response by the time of publication.
Research on the disparities in oncology services between provinces have found that Gauteng has the highest number of oncologists, followed by the Western Cape, with the lowest number working in the Northern Cape, Mpumalanga, North West and Limpopo. A recent response to a parliamentary question painted a similar, if incomplete picture. It also showed only one public sector oncologist in the Northern Cape.
Meanwhile, within this broken and under-resourced system, poor and vulnerable people are falling through the cracks. Speaking from Carnarvon, the town famous as the site of the Square Kilometre Array (SKA) telescope, 400km from Kimberley, Donella Harris said her son, Obakeng Maphalatlasa, now 14, was diagnosed with BCOR-sarcoma, a rare type of bone cancer, and treated at the paediatric oncology unit at Robert Mangaliso Sobukwe Hospital, where he had chemotherapy from August last year.
Harris recalled: “Dr Liezl said she would call us about the [cancer test] results, and she did. And she explained to us and told us to come back to Kimberley as soon as possible, which we did.”
Harris said they were transported to Kimberley by ambulance for chemotherapy. “We would start travelling from Carnarvon at 2am and arrive at 7am or 8am. Dr Liezl would always be there. She was always up early. They would draw blood, by 10am or so they would have the results. And if his blood was right, he gets chemo. At the children’s unit, he had a single room there. When he had chemo, I slept on a mattress on the floor of his room.”
Harris said she and Maphalatlasa were at the hospital when Du Plessis left in February, that they had a farewell party for the oncologist. “We were so sad when she left. We were there for chemo at the time.”
Maphalatlasa’s treatment continued after Du Plessis left, but he was transferred to an adult ward. “After Dr Liezl left in February, the children had to get treatment with the adults, in the adult ward,” she said.
“So what happened, there was a time when that ward was out of stock. My child was without (chemotherapy) treatment for a month. Once a week, we travelled up all the way from Carnarvon to Kimberley, but when we arrived, there wasn’t treatment. Nobody called us to say there’s no treatment, so we travelled all that way in the ambulance for nothing. I was so desperate. Eventually they got stock and we stayed for three weeks.”
Sadly, after the stockout and interrupted treatment, Harris said recent tests had revealed new cancer development in her son.
“Now he doesn’t want to go again (to Robert Mangaliso Sobukwe Hospital). He was so traumatised in the adult ward because people were dying there next to him. In the children’s unit these things did not happen.”
Travelling overnight for treatment, to arrive to nothing
The Cancer Association of South Africa’s services co-ordinator based in Springbok, Geraldine Farmer, told Spotlight and Daily Maverick she attended a breast cancer awareness event at the JF ‘Boeboe’ van Wyk Oncology Clinic last month. She described the facility as “beautiful and encouraging”, adding that it had enrolled 200 patients so far. Farmer said she hopes the clinic will ease the load of people in the region having to travel to Kimberley for cancer care.
Farmer corroborates Harris’ story, relaying how some patients travel all the way from Springbok to Robert Mangaliso Sobukwe Hospital for treatment overnight, only to arrive at a dead door. “I think their (the hospital’s) load is a lot. People get transferred there, taken there by ambulance and then there is no one to meet them, no service. They travel all the way from Namaqualand, they drive there overnight. When they arrive there isn’t even a toilet for them. They don’t get service; they don’t get treatment.
“Then they have to drive all the way back to Namaqualand. Three days out of their lives, without having received treatment,” she said.
People can’t get through to the facility on the telephone. “Why doesn’t the hospital staff tell the local clinics that they don’t have treatment available; that machines are broken, or that they don’t have a doctor? So the local clinics can inform patients not to travel?” she said.
Farmer adds that most of the serious cancer cases are ultimately referred to Bloemfontein, where the service is good.
‘I could not foresee things getting better’
Meanwhile, Du Plessis said it was extremely hard to leave the children’s unit at Robert Mangaliso Sobukwe Hospital. “There is a senior doctor… she had learned quite a bit from me and I trained her and she liked oncology and the kids. And she helped to finish up some of the patients, some of whom were in the midst of a treatment plan. Many children now will be referred to Bloemfontein.”
Du Plessis said that ultimately she left because she could not imagine the situation improving. “If I things would be any better in 10 years, I think I might have stayed,” she said. “But I could not.”
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