Four months ago the South African Human Rights Commission (SAHRC) released a scathing report detailing the collapse of cancer services in the province. The document accused the KwaZulu-Natal health department and its MEC, Sibongiseni Dhlomo, of failing patients.
Waiting times for life-saving cancer treatment has grown by almost 30% as KwaZulu-Natal’s cancer services crumble and stall.
According to information revealed by SAHRC chairperson Bongani Majola during a recent provincial health portfolio committee meeting, patients are now waiting up to nine months for treatment.
The average waiting time for treatment was previously seven months.
Democratic Alliance spokesperson for health in KwaZulu-Natal Imran Keeka says he doubts the veracity of the information and alleges the data does not reflect patient backlogs at Inkosi Albert Luthuli Central Hospital fuelled by a breakdown of treatment machines at Addington Hospital.
After more than a year of investigation, SAHRC revealed that the province lost one oncologist each month over a five-month period. From October to December 2016, a breakdown in cancer treatment machines forced Durban’s Addington Hospital to refer its patients to the nearby Inkosi Albert Luthuli Central Hospital for treatment.
Durban lost its last public sector specialist in June, leaving only two such professionals in the province at Grey’s Hospital in Pietermaritzburg.
As of August, health minister Aaron Motsoaledi had launched a two-week plan to resuscitate cancer services, taking over some of the province’s procurement and human resources functions, but it does not seem to be working.
Cancer Crisis Fuels Demand for End-Of-Life Care
With only two public-sector oncologists left in the province, KwaZulu-Natal is scrambling to recruit new specialists, and waiting lists for treatment as well as the demand for specialised care for the sick and dying, are growing.
The provincial health department has blamed the exodus of specialists on more lucrative offers from the private sector, but health professionals told the commission that mismanagement was driving specialists away.
In a May letter to the department, the South African Medical Association listed cancer services as one of nine public health “crises” that it said provincial health MEC Sibongiseni Dhlomo had failed to address.
By the time the commission began investigating oncology services in 2016, patients were waiting five months to see an oncologist and eight months or more for radiotherapy, the report shows. Now, health professionals say some patients are being told they will only be seen mid to late 2018.
Beauty Zulu (46) was diagnosed with stage- three cervical cancer at the King Edward Hospital in May, two months after she went to her local clinic complaining of pain in her legs.
The clinic referred her to the Inkosi Albert Luthuli Central Hospital for treatment but, owing to backlogs and a lack of doctors, she’ll only start treatment in November.
“By that time, it’s likely that Zulu’s cancer will have progressed to stage four,” Nurse Angie Makhanya who works with the Highway Hospice in Durban says.
Makhanya was so shocked by the state’s failures that she says she began writing a letter to Health Minister Aaron Motsoaledi herself.
Cancer can be extremely painful: as malignant tumours grow, they can tear through nerves, organs and even bone and about one in two cancer patients will experience some form of pain, according to a 2007 research review published in the Annals of Oncology journal.
Whether the cancer is curable or not, palliative care can help patients manage pain and assist with the psychological aspects of serious illness or dying.
South Africa’s public and private sectors are almost entirely dependent on nonprofit hospices and organisations for palliative care services, says Julia Ambler, director of the nonprofit Palliative Treatment for Children (Patch).
With only 19 hospices in the province, KwaZulu-Natal’s cancer crisis may overwhelm its ability to provide palliative care.
“We’re seeing that patients are being discharged without wound dressings or pain medication. Since there are no doctors, there are no follow-up appointments, so hospices will end up providing that service,” says Sarah Fakroodeen, the medical director for the Highway Hospice.
Fakroodeen says she expects walk-ins and referrals to her organisation to increase in the coming months, but warns that many hospices continue to rely on donor funding, a pool of money that is shrinking as people look at cutting costs in hard economic times.
Highway Hospice is one of seven hospices in KwaZulu-Natal that will receive R60 000 each month from the provincial health department, starting in September, as part of a pilot project. A third of the money will go to training public health employees to provide palliative care. The rest will cover only the hospice’s inpatient care and not the home care her staff delivers. She says the department will have to find a way of reaching these patients.
“There needs to be co-ordination between us and the hospitals so that we can do more home visits and see bed-bound patients. The people that are relatively well can go and queue [at hospitals, but] these people are so frail they cannot even get to the hospital.”
Just 80km away, at the only hospital that still boasts public-sector oncologists, there is often NO medicine to treat those in excruciating pain. Grey’s Hospital in Pietermaritzburg is constantly grappling with a stockout of morphine. Although a delivery of the drug does occurs now and again, the opioid forms an important part of ongoing pain management for the most critically ill patients, and being out of stick is just not acceptable!
“The thought of all of those patients at home tonight with nothing to help with their pain — it’s unbearable,” says Ambler.
Although there may be alternative pain medication for some adult patients, many — including children — are often left without respite, says Andy Gray, senior pharmacology lecturer at the University of KwaZulu-Natal.
He explains: “Once patients need a strong opiate like morphine, there are very few alternatives.”
And for those for whom help came too late and who cannot be cured, the promise of a pill can at least mean the hope of a good death.
Watching a family lose a child is never easy, Ambler says, but it’s not the death that’s the hardest part — it’s the dying.
“If there is no hope and the child is going to die, it’s better you give them hope for a pain-free death, a good end of life, a good last few days or months. You can’t change what’s going to happen, but you can change how it happens.”