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South Africa’s battle to resuscitate cancer care
DURBAN, South Africa, June 24, 2018 (BSS/AFP) – South African electrician
Phiwankosi Mkhize was diagnosed with lung cancer in May last year and told by
the hospital to come back for a scan in 15 months.
But after just 12 months he died, before having the chance to receive
treatment.
The 66-year-old’s fate is far from unique in southeastern KwaZulu-Natal
province, the country’s second most populous.
Hundreds of patients have died in the region over the past three years as
cancer services come under acute pressure following a decision by the
provincial government to cut costs and stop recruiting or replacing doctors,
say rights activists and doctors.
“Patients who have cancer survive after going for chemotherapy, but for my
dad it was too late,” Mkhize’s daughter, Londiwe, told AFP, days after his
death on May 7.
South Africa’s human rights commission says patients at publicly-funded
hospitals in KwaZulu-Natal wait between five months and a year to see an
oncologist and another eight months for radiotherapy or chemotherapy.
Mkhize is “a classic case of a patient who was failed by the system,” said
opposition Democratic Alliance provincial lawmaker and doctor Imran Keeka.
Indeed, on social media the plight of cancer sufferers in KwaZulu-Natal is
referred to as #KZNOncologyCrisis, but the problems are not isolated to the
province.
– ‘Very distressed’ system –
South African Health Minister Aaron Motsoaledi acknowledged this month
that the national healthcare system in general was “very distressed”, as it
battles a rise in cancer cases like in other countries, and a shortage of
doctors.
“We are painfully aware of poor, or lack of management skills in most of
our hospitals,” he said.
He announced funding of 100 million rand ($7.6 million, 6.5 million euros)
shared between hospitals in KwaZulu-Natal and Johannesburg to buy and repair
machines and hire staff to help clear a treatment backlog.
“We have helped them to hire private oncologists… and the contract is
for them to see 450 patients per month, and once the two machines start
working, we will contract others to help them,” Motsoaledi told AFP.
– ‘Died waiting’ –
The development came too late for Mkhize, however. In December, he had
gone back to hospital in excruciating pain and been given morphine but told
nothing more could be done and to go home as he only had a few days left to
live, Mkhize told AFP three months later.
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“He was crying like a baby, like anybody would do,” said his daughter
Londiwe, 28, sitting next to him on a visit to the provincial parliament
aimed at exposing his plight.
On that rainy March day, Mkhize, Londiwe, his son and a nephew travelled
to the parliament in Pietermaritzburg, 235 kilometres (150 miles) from their
village, and sat in the public gallery as lawmakers discussed the cancer care
problem.
At least 499 patients in KwaZulu-Natal province “died while waiting for
radiotherapy and curative therapy” over a 12-month period between 2015 and
2016, according to Keeka, citing figures presented to parliament by the
provincial health department.
The number excludes those who died at home or in palliative care
facilities, said the lawmaker.
“The patients we send to hospitals don’t get attended to, the cancer
advances and they die,” said Mvuyisi Mzukwa, who heads the South African
Medical Association (SAMA) in the province.
Contacted by AFP, the provincial government declined to comment.
– Resigning out of frustration –
Keeka estimates that KwaZulu-Natal province should have at least 16
oncologists.
But the doctors’ association and opposition lawmakers say that, by last
year, all but two oncologists in the province had resigned, largely due to
frustration at not being able to save more lives, a lack of equipment and an
overload of patients.
Overall, South Africa has 38 radiation oncologists working in public
hospitals, compared with 147 in the private sector, according to Raymond
Abratt, chairman of the South African Society of Clinical and Radiation
Oncology.
Abratt said there was now no full-time oncologist at any public hospital
in Durban, the provincial capital, and that the crunch in cancer care had
been “a major problem for a couple of years”.
Speaking on condition of anonymity, a senior doctor working at the Inkosi
Albert Luthuli hospital in Durban said government funding had dried up
without warning.
A recruitment freeze was put in place and repairs halted for radiotherapy
and ultrasound scanners, the doctor said.
– ‘Losing people unnecessarily’ –
Doctors “felt useless… oncologists decided to resign because they were
frustrated. The department is in shambles”, said Mzukwa, SAMA’s KwaZulu-Natal
provincial head.
In the economic hub of Johannesburg, cancer care staff numbers are
falling, while the eastern province of Mpumalanga has no oncologist at all,
Abratt said.
At a Durban palliative care centre run by the non-profit Cancer
Association of South Africa (CANSA), father-of-three Hendrik Prinsloo, 64,
from the seaside town of Margate, has cancer of the mouth.
He only began receiving treatment more than a year after his diagnosis, he
said.
“You are sent home and you wait. They say they will call you for radiation
and they never call,” said Prinsloo.
“Unfortunately we lose our patients because of long waiting periods
between the time of diagnosis, to the time when they actually receive
treatment, or if ever (they get treated),” said CANSA nurse Siphelelisiwe
Mabaso.
“It’s heart-wrenching, it’s devastating. We are losing people
unnecessarily.”
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