Nine on­col­o­gists for half of SA?

Lim­popo and Mpumalanga are with­out ra­di­a­tion on­col­o­gists and a lone spe­cial­ist in North West caters for 3.7-mil­lion peo­ple

Mail & Guardian - - Health - Joan van Dyk

There is not a sin­gle ra­di­a­tion on­col­o­gist left in Lim­popo or Mpumalanga, ac­cord­ing to an an­nual sur­vey con­ducted by the South African So­ci­ety of Clin­i­cal and Ra­di­a­tion On­col­ogy (Sascro). Half the coun­try’s prov­inces may be re­ly­ing on just nine ra­di­a­tion on­col­o­gists as can­cer ser­vices in five prov­inces buckle — and Jo­han­nes­burg may no longer be able to pick up the slack.

Only ra­di­a­tion on­col­o­gists are qual­i­fied to pro­vide the treat­ment many can­cer pa­tients re­quire.

This type of treat­ment is needed in about half of can­cer cases, a 2012 study pub­lished in the In­ter­na­tional Jour­nal of Med­i­cal Sci­ences found.

In North West, a lone doc­tor at Klerks­dorp Tshe­p­ong Hos­pi­tal Com­plex re­mains as the last ra­di­a­tion on­col­o­gist in that prov­ince, pro­vin­cial health spokesper­son Tebogo Llekgeth­wane ad­mits.

In the North­ern Cape, the pro­vin­cial health depart­ment says it may have the spe­cial­ists, but it doesn’t have the ma­chines to pro­vide ra­dio­ther­apy, which uses high-en­ergy ra­di­a­tion to kill can­cer cells.

Ra­di­a­tion can mean the difference be­tween life and death for can­cer pa­tients. A study pub­lished in In­ter­na­tional Jour­nal of Med­i­cal Sci­ences in 2007 found breast can­cer pa­tients who re­ceived ra­dio­ther­apy af­ter their mas­tec­tomies had a 10% bet­ter chance of sur­vival over 10 years than those who didn’t.

A typ­i­cal pa­tient in the North­ern Cape will wait four months to be seen in the Free State. Wait­ing times to start treat­ment can be even longer.

Mpumalanga and Lim­popo are now two of four prov­inces, along­side North West and KwaZu­luNatal, which re­fer can­cer pa­tients to Gaut­eng. In most cases these referrals are made through for­mal ar­range­ments be­tween prov­inces, Health Min­is­ter Aaron Mot­soaledi con­firmed in his bud­get speech on Tues­day.

No such ar­range­ment ex­ists be­tween Gaut­eng and KwaZu­luNatal, but at least some pa­tients from the coastal prov­ince are pay­ing their own ex­penses to travel to Gaut­eng to es­cape their prov­ince’s col­lapsed can­cer ser­vices.

“Doc­tors don’t un­der­stand just how lit­tle is avail­able in the ru­ral ar­eas. It’s al­most im­pos­si­ble to get them treat­ment,” says Jayne Bezuiden­hout, the KwaZulu-Natal rep­re­sen­ta­tive for the Ru­ral Doc­tors As­so­ci­a­tion of South Africa.

“You just have to hope your pa­tient doesn’t have can­cer.”

For decades, some ru­ral doc­tors have re­lied on big, ur­ban cen­tres such as Jo­han­nes­burg and Cape Town to care for their pa­tients when they couldn’t. Once a bea­con of hope, Gaut­eng may be buck­ling un­der the weight of the coun­try’s spi­ralling can­cer cri­sis.

Only three on­col­o­gists — all based at Char­lotte Max­eke Aca­demic Hos­pi­tal — are left in Jo­han­nes­burg and five re­main in Pre­to­ria, Sascro says.

There are 500 can­cer pa­tients wait­ing for treat­ment at Char­lotte Max­eke Hos­pi­tal, says chief ex­ec­u­tive of­fi­cer Gla­dys Bo­goshi. The hos­pi­tal is short of three ra­di­a­tion on­col­ogy con­sul­tants and two full-time spe­cial­ists.

Na­tion­ally, South Africa has just 38 ra­di­a­tion on­col­o­gists in the pub­lic sec­tor, April data from the as­so­ci­a­tion shows. Although the na­tional health depart­ment has re­searched how many such spe­cial­ists the coun­try would need, this is not pub­licly avail­able.

At Char­lotte Max­eke Hos­pi­tal, pa­tients re­port be­ing given ap­point­ments into the early evening as the hos­pi­tal’s few spe­cial­ists work into the night to try to de­crease back­logs. Bo­goshi says that two com­plaints about the qual­ity of care at the hos­pi­tal have landed up on her desk. Can­cer ad­vo­cates say con­cerns about the level of care at the hos­pi­tal have prompted a let­ter to the Health Pro­fes­sions Coun­cil of South Africa (HPCSA). The HPCSA was un­able to con­firm this, how­ever.

In con­trast, the Western Cape has 16 can­cer spe­cial­ists, ac­cord­ing to a pro­vin­cial health depart­ment state­ment. Pa­tients wait be­tween two weeks and two months for treat­ment.

The Free State, East­ern Cape and Lim­popo health de­part­ments did not re­spond to Bhekisisa’s re­peated re­quests for com­ment.

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. The coun­try di­ag­noses about 77000 new pa­tients an­nu­ally, the agency found.

At his State of the Na­tion ad­dress in Feb­ru­ary, Pres­i­dent Cyril Ramaphosa an­nounced that a na­tional plan to ad­dress can­cer treat­ment back­logs and short­ages of spe­cial­ists would be rolled out by mid May. The campaign has not been launched and no de­tails about it have been re­leased pub­licly.

How­ever, both Gaut­eng and KwaZulu-Natal will re­ceive R100mil­lion to deal with ra­di­a­tion on­col­ogy back­logs, Mot­soaledi said in his bud­get speech.

Can­cer ser­vices in Dur­ban came to a stand­still in June 2017 when the last pub­lic-sec­tor on­col­o­gist re­signed. Provin­cially, the state now em­ploys only three full-time spe­cial­ists, who work at Grey’s Hos­pi­tal in Pi­eter­mar­itzburg. KwaZulu-Natal pa­tients may now wait as long as a year for their first con­sul­ta­tion with an on­col­o­gist, ac­cord­ing to data pre­sented at a South African Hu­man Rights Com­mis­sion (SAHRC) hear­ing on Mon­day. The hear­ing fol­lows a two-year SAHRC in­ves­ti­ga­tion into KwaZulu-Natal’s can­cer cri­sis.

Demo­cratic Al­liance spokesper­son for health in KwaZulu-Natal Im­ran Keeka says the party has un­suc­cess­fully tried to open a case of cul­pa­ble homi­cide against the prov­ince’s health depart­ment and its em­bat­tled MEC Si­bongiseni Dhlomo. Pub­lic health of­fi­cials can be held per­son­ally li­able if pros­e­cu­tors can prove their neg­li­gence caused pa­tient deaths, an ar­ti­cle pub­lished in the June edi­tion of the South African Med­i­cal Jour­nal ar­gues.

For Bezuiden­hout’s pa­tients, ac­cess to can­cer treat­ment has al­ways been tough.

“This cri­sis in on­col­ogy care is not new; it’s just come to life,” she says.

By July, Dur­ban’s Ad­ding­ton Hos­pi­tal will have two work­ing can­cer treat­ment ma­chines, ac­cord­ing to a pro­vin­cial health depart­ment state­ment.

Until then, pa­tients will be treated at the city’s Inkosi Al­bert Luthuli Cen­tral Hos­pi­tal, where the Wits Health Con­sor­tium, a com­pany owned by the Univer­sity of the Wit­wa­ter­srand, will pro­vide on­col­ogy ser­vices as part of a six-month state con­tract.

Pri­vate health­care com­pany Joint Med­i­cal Hold­ings will also con­tinue to pro­vide can­cer ser­vices at Em­pan­geni’s Ng­welezane Hos­pi­tal until the end of 2019.

But for some, new ma­chines and pub­lic-pri­vate part­ner­ships will come too late.

About 500 can­cer pa­tients have died in KwaZulu-Natal hos­pi­tals while wait­ing for treat­ment, although this fig­ure is likely to be higher, says Keeka, quot­ing an­swers given in the pro­vin­cial leg­is­la­ture. “We’ll prob­a­bly never know how many peo­ple this has af­fected,” he says.

For Bezuiden­hout, she knows that treat­ment may be so un­likely for pa­tients with ex­tremely ad­vanced can­cers that she doesn’t re­fer them to far-off cen­tres for treat­ment but in­stead pro­vides pal­lia­tive care close to home.

She ex­plains: “Pa­tients from ru­ral ar­eas are go­ing to spend a lot of time on a bus to get treat­ment. They may as well spend that time with their fam­ily.”

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