Only one radiation oncologist is left to treat cancer patients in North West, reports Bhekisisa , meaning the sole specialist is theoretically responsible for the treatment of 660 000 patients.
“With only one oncologist, cancer treatment here is impossible,” says Adele Botha, the North West divisional manager for the Cancer Association of South Africa (Cansa).
South Africans have a 19% chance of developing cancer before they turn 75, according to 2012 data from the World Health Organisation’s International Agency for Research on Cancer. Figures like these mean the sole specialist, who works at the Klerksdorp Tshepong Hospital Complex, could be left to treat more than 660 000 patients.
Cancer patients don’t have time to waste, but Botha says staff shortages and treatment backlogs are forcing people in North West to go without treatment entirely. She explains: “When people get to the oncologist in Klerksdorp, they aren’t seen immediately. After sitting in a queue for two days, they usually go home until they have the energy to queue again.”
The report says one of Botha’s cancer patients has been struggling to get treatment in the public sector since 2013. In April, photos of Ntombizodwa Matthews being transported home from Mafikeng Provincial Hospital went viral. She had been sent home as protests calling for then-premier Supra Mahumapelo’s resignation had encircled the facility, forcing health workers to discharge patients.
Matthews had been diagnosed with breast cancer, but her family says she was never told. She died a month later without ever seeing a specialist or receiving treatment despite the fact she had reported the lump in her breast to health workers almost a year ago.
The report says North West is not the only province struggling to care for cancer patients. Only 38 radiation oncologists are working in public hospitals across the country this year, annual census data from the South African Society of Clinical and Radiation Oncology (Sascro) shows. According to the census, not a single radiation oncologist remains in Limpopo or Mpumalanga.
Meanwhile, experts fear North West’s crisis in oncology care is a symptom of a province’s ailing healthcare services — with no cure in sight. “It’s not only in oncology. There is a total breakdown of health services in the North West,” says oncology social work manager and cancer advocate Linda Greeff.
The first thing that happens when a system collapses is that doctors see fewer new patients, Greeff says in the report. Diagnosing cancers may also become more difficult. As surgery backlogs grow, biopsy procedures to determine whether someone has cancer are also likely to be delayed.
“When cancer treatment relies on only one doctor, the whole system suffers. Not only is it more expensive to treat patients with advanced cancer, but the patient is less likely to survive,” explains Cansa head of health Michael Herbst.
KwaZulu-Natal’s cancer care crisis paints a dark picture of what might already be happening in North West and other underserved provinces, Herbst says. The last public sector oncologist in Durban left in June 2017, leaving just three public sector specialists at Grey’s Hospital in Pietermaritzburg.
The report says the province has since roped in private cancer specialists to treat patients, but people are still forced to wait up to a year for an appointment with an oncologist, data presented at a recent South African Human Rights Commission hearing showed.
And without a radiation oncologist, even existing patients have little hope of getting treatment. Only a radiation oncologist can decide whether a patient needs to have surgery, chemotherapy or radiation treatment and whether the treatment is working, Greeff says. “Without their recommendation, there is no further treatment.”
Greeff argues in the report that bad budgeting could be behind North West’s cancer treatment woes: “Money for cancer treatment should be controlled by the national health department. At the moment, provinces control their (own) budgets, but the money often disappears, and so do the cancer services.” When provinces control the budgets, the national department is completely powerless over what happens to the money, she says.
The non-governmental organisation Rural Health Advocacy Project (RHAP) works to help health districts to analyse budgets. In North West, the advocacy project found that budgets allocated to specific line items, such as human resources, are often underspent and instead reallocated to provincial priorities or goods and services budgets that are used to procure services and buy medicines.
In the goods and services budget, there is greater opportunity for directing the funds to service providers such as the Gupta-linked medical technology company Mediosa, which illegally won an R180m tender for two mobile clinics in the North West, RHAP’s health system and policy programme manager Russell Rensburg was quoted earlier as saying.
Now, even in well-resourced provinces, non-profit organisations are being forced to pick up the government’s slack. The report says Cape Town-based breast cancer treatment programme Project Flamingo performs surgery for breast cancer patients in a bid to slash backlogs. “These doctors are working for free to provide a service that a working health system could easily cover.” The Western Cape is the province with the most cancer specialists. Sascro’s data shows 16 radiation oncologists worked in the province’s public sector this year.
The report says in North West, Burger and her team at Cansa will continue to screen as many North West patients for cancer as they can. But she fears they will get stuck in the province’s under-resourced clinics and hospitals. “We work very hard to get people screened for cancer. We then send them to clinics and hospitals. And they just get stuck there. And they won’t get treated, or even diagnosed in time,” Burger says. “They’ll get stuck there in the queue, and just become a number.”
Parliamentary questions by the Democratic Alliance (DA) have revealed that at least 499 cancer patients died during 2015 and 2016 at two of KZN’s largest hospitals – Inkosi Albert Luthuli Central Hospital (IALCH) and Greys – as a result of the ongoing KwaZulu-Natal oncology crisis. The response also shows that the patients died while waiting for cancer treatment.
Yet, writes Imran Keeka, DA KZN spokesperson on Health in a Politicsweb statement: “the Health MEC, Sibongiseni Dhlomo, told both the provincial and national Health Portfolio Committees that he does not know how many people died. During a subsequent hearing by the South African Human Rights Commission (SAHRC) the MEC was compelled, while under oath, to supply the names of the dead which he has previously refused to.”
Keeka writes: “MEC Dhlomo must admit here and now that all of these people died under his watch. He must admit that they died because he did nothing to help them for years and admit his own culpability.
“The DA remains committed to bringing a charge of culpable homicide, if not murder against MEC Dhlomo. If he is not prepared to admit his culpability, a court of law will do so.
“Had it not been for the DA in this province – and the SAHRC’s findings and coercive means – the MEC would until this day have done nothing. We know this because when he had the opportunity to do something, he did nothing.
“The fact is that this ANC-led government, under this premier does not believe in accountability. If it did, MEC Dhlomo would have been gone a long time ago. The order to stop the cancer machine maintenance payments, which led to them falling apart, was under MEC Dhlomo’s patronage system. It is also what chased oncologists away from this province. The MEC blames a certain supplier but then still settled the amount due to them. Why would he do this if they are indeed the thieves he claims they are? And why does the DoH still do business, in almost all of KZN’s hospitals, with this same company?
“It is also as a result of MEC Dhlomo’s interference in the affairs of the department that that lives have been lost. Any progress announced in terms of the resolution of the oncology crisis, is done so under duress. The MEC and this government are no heroes or saviours.
“During a recent oversight inspection by the DA to Durban’s RK Khan Hospital, we found that it takes three months to get a CT-scan and a further six months to get an appointment at IALCH – let alone the 12-month waiting period to then receive treatment.
“Add to this the fact that not all diagnostic and screening equipment is properly working in KZN. The earliest appointment for a mammogram at RK Khan is in 2019 and at another hospital in 2020 – let alone then having surgery or a referral to oncology. Durban’s Prince Mshiyeni Memorial Hospital – the third largest in the country – still has challenges with simple X-rays.
“Despite being recently advertised as ‘cancer machines’, Large Loop Excision of Transformation Zone (LLET) machines do not detect cancer. If ever there was a cheap publicity stunt by MEC Dhlomo and his department this must be it. At the hospital level where these machines are available, GPs can only do limited scopes of work with them. After that, patients must still be referred to gynaecologists where there are also massive backlogs when it comes to procedures. And when there is established cancer, all the patients fall into that same long waiting queue and become victims of the oncology crisis. That is why so many women die of breast and cervical cancer – cancers that could have been treated and cured.
“During his opening remarks, the SAHRC’s chair confirmed that the reason for the MEC being subpoenaed to appear under oath was because they were not satisfied with the progress in resolving the oncology crisis. The SAHRC resorted to this because this MEC and his department did not adequately respond to them, as they are compelled to.
“Yet the MEC has the gall to stand in this House and tell us that the commission is satisfied.
“The DA has had enough of this lack of accountability. If the premier does not act, he too will be complicit in this crime against society. In the unlikely event that the crisis is resolved, there will never be justice for the any people who have died or for their loved ones.”