OPINION: Stark realities facing cancer patients at Charlotte Maxeke Hospital

The World Health Organization in February this year said that an estimated 1.1 million new cancer cases are being reported in Africa each year with around 700 000 deaths from cancer. PHOTO: DialysisTechnicianSalary

The reopening of the oncology section of Charlotte Maxeke Johannesburg Academic Hospital on Monday 28 June 2021 offers a glimmer of hope for cancer patients in South Gauteng but the stark reality is that many will still not be able to access lifesaving treatment immediately.

To have been diagnosed with cancer is devastating. You face mortality whether or not you are ready for it. It does not have to be this way. Most cancers, that are at stage I or stage II, are treatable and curable if diagnosed early. Cancer is not one disease. In fact, there are over 300 different cancers with each cancer having its own treatment regimen. There is no one size that fits all.

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Cancer can be treated with surgery, systemic or chemotherapy, hormonal therapy and radiation therapy, or a combination of one or more of the modalities. It requires specialised, highly trained health care professionals, medicines, and equipment and is also one of the most expensive non-communicable diseases to treat.

Cancer care against all odds

Most patients diagnosed in the public healthcare system in South Africa are unfortunately diagnosed with Stage III and Stage IV disease, which is far more challenging to treat, and most often treatment is not curative but intended to be palliative. The ten public sector radiation oncology units and three medical oncology units scattered across the country provide excellent treatment to cancer patients.

Only 20% of cancer specialists in the country service 85% of uninsured patients seen in the public sector – an inequity that has been highlighted for many years.

Cancer specialists work tirelessly and against all odds to provide the best service available, as well as serving as training facilities for the next generation of medical and radiation oncologists.

Cancer patients seeking care at Charlotte Maxeke Johannesburg Academic Hospital face similar challenges. By the time they have been referred for treatment, their cancer is often already at an advanced stage. For some prostate cancer patients, the radiation oncology waiting list is longer than three years. Since before the fire and COVID-19, this unit not only had outdated equipment but lacked qualified radiation oncologists to provide treatment.

Radiation oncology is probably one of the most specialised treatments for any cancer patient. A fully functional radiation unit such as the one at Charlotte Maxeke with the number of patients it treats per year, requires at least seven LINAC machines (linear accelerator), two brachytherapy machines used mainly for cervical and endometrial cancer, and a high-end MRI LINAC that can manage more complicated cancers such as head and neck cancers. They require at least eight radiation oncologists, more medical physicists, radiation treatment planning staff, and radiotherapists.

This unit, however, has only four LINACs, no brachytherapy machines, and four radiation oncologists. It is understaffed and under-equipped to deal with the annual patient load, resulting in a backlog of over 1 000 patients even before COVID and before the fire on 16 April 2021. Plans for a new radiation oncology facility to add to the newly opened medical oncology facility at Chris Hani Baragwanath will hopefully improve things going forward.

Patients already on radiation therapy at the time of the fire were “transferred” to Steve Biko and so were some of the staff to assist with the Charlotte Maxeke patient loads that had to be accommodated there.

Although at least four private sector radiation oncology facilities in Gauteng offered their assistance in Public-Private Partnerships, not all of these are feasible and will only assist as a short-term solution. This is because patients sometimes require more than just their radiation treatment which will lead to other unforeseen expenses such as the cost of hospitalisation.

To add insult to injury, Eskom implemented load shedding in April/May 2021, which exacerbated the situation. Charlotte Maxeke Hospital was without power intermittently for four days. This played havoc with the four existing LINACS. The vacuum tubes were affected and now have to be recalibrated in the hope that the tubes were not damaged permanently.

Less political interference, more pragmatic decisions

As this unit opens today (Monday 28 June) it will only be able to start ten new patients per day for the first week, which will then slowly increase. Only with the required new equipment and associated staff, the unit will be able to treat at least 200 patients per day – which can effectively decrease the backlog much sooner. It will cost approximately R252 million to procure the required equipment with the associated maintenance plans.

Certainly, not a lot of money to save lives against the current corruption figures being bandied about.

Most of the backlog patients will also have to be reassessed and re-staged which may have detrimental consequences for some patients. What is needed now is less political interference and more pragmatic decisions about the optimal functioning of the hospital and the radiation oncology unit to ensure that patients can receive their treatments and have hope again.

For medical oncology, the picture is equally bleak. The section where medical oncology is housed on the 9^th floor will not be ready by today. Their patients have been redirected to Chris Hani Baragwanath Hospital where only 15 chemo chairs are available, instead of the normal 32 chairs at Charlotte Maxeke. This results in patients having to come for their treatments on more than one day, which is again another expense for the patient that is already struggling financially.

Many patients have complained that they do not receive proper communication about their treatments and also have to wait long hours only to be told that their treatment is not possible on that day.

This unit, as the radiation oncology unit, will also have to face the influx of new patients that cannot be referred as a result of the third COVID wave and the inability to schedule oncology surgeries at any of the feeding hospitals once the hospitals are able to do cancer surgeries.

A humanitarian crisis

Staff morale is also low as the dire situation of patients and red tape of bureaucrats that are fighting for turf and territory wars are now starting to show. The inability of the Gauteng government and the management of Charlotte Maxeke Hospital to effectively manage the crisis is a sign of how badly the health system is functioning. The claims that the building plans associated with the previous regime are a reason for delay are just another sign of how no one person is willing to take responsibility for good governance.

Civil society and academia warn that we are facing a humanitarian crisis. In fact, the crisis is already with us. Many cancer patients have been sent home without their rightful treatment because the system has failed them. If they die – we will not know about them and no one person will be held accountable for their deaths. Unlike with Life Esidimeni, where it was possible to count the numbers and identify the accountable persons, we will never know the real impact of this humanitarian crisis.

*Salomé Meyer is an activist and the Cancer Alliance’s Access to Medicine campaign project manager.