/ 4 February 2020

#WorldCancerDay: Getting treatment in Limpopo is like waiting for death

An updated cancer registry could provide direction to health programmes and research
While cancer ravages millions across the world, cervical cancer is even more lethal, particularly in Sub-Saharan Africa.


That is how 30-year-old Nkhanyeleni Vele spent her last few days. 

“It’s so painful losing your loved ones, knowing that there was something that could have been done to prevent their death,” says Patrick Tshoteli, speaking about his sister who lost her battle with cervical cancer.

According to him, his sister’s death could have been avoided — if only her cancer was diagnosed sooner. 

But that was impossible with only one oncologist employed by the provincial health department. This single cancer specialist is tasked with treating and caring for cancer patients in all of Limpopo’s public healthcare facilities — which is about 43 hospitals. The oncologist operates from Polokwane’s Mankweng Hospital, and patients travel long hours and face months of waiting for their turn to be seen by the only oncologist in the province.

Tshoteli, who lives in Nzhelele village, says the public health system has failed him and his family. Vele — his now late sister — was in and out of the Siloam Hospital for most of 2019, but doctors couldn’t figure out the cause of her illness until tests were done late last year. 

“She was diagnosed with cervical cancer in the first week of December. They didn’t admit her until she was very sick and we went back three days before Christmas when she was finally admitted. They told us that she would only be booked to see an oncologist in Mankweng Hospital in February the following year,” he remembers.

Unrelenting health burden 

According to the World Health Organisation (WHO), cancer is the second leading cause of death globally, accounting for an estimated 9.6-million deaths in 2018. As the cancer burden continues to grow globally, it further causes significant physical, emotional, and financial strain on cancer patients, their families and community, and health systems.

While cancer ravages millions across the world, cervical cancer is even more lethal, particularly in Sub-Saharan Africa. 

Sub-Saharan Africa has the highest number of new cervical cancer infections in the world and the disease is the deadliest cancer among women in the region, according to a 2013 study published in the Vaccine journal.

In South Africa, black women bear the brunt of this. 

A 2018 study published in the Cancer Genetics and Epigenetics journal found that black women were almost six times more likely to die of cervical cancer than white women and that the five-year survival rates of Black and Coloured women were significantly worse than those of white and Indian women.

Researchers analysed 1994 to 2009 cervical cancer data from the South African National Cancer Registry and mortality rates from Stats SA. At the time the study began, the data for cancer incidences and mortality were not available later than 2009 and until 2012 respectively.

In 2014, 5 000 black women were diagnosed with cervical cancer in South Africa alone. 

‘They could see she was in pain’

Cancer patients who cannot afford private healthcare depend on public health facilities and are left without many options — except to wait in hope until their appointment. Tshoteli says if they hadn’t pleaded with the provincial health department, and sought assistance from the South African Human Rights Commission (SAHRC) branch in Limpopo to make the appointment a month earlier, his sister could have died without ever seeing an oncologist.

Vele travelled to Mankweng Hospital in mid-January for her appointment but was transferred back to her local hospital to wait for another one. 

She died while waiting. 

“My sister would still be alive if she saw the specialist much sooner. But they don’t care and we’re the ones left suffering,” he says. “We’ve been told the health department is experiencing a shortage of specialists, I believe that my sister’s situation should have been treated as an emergency, as they could see that she was in pain.”

SAHRC’s provincial manager in Limpopo, Victor Mavhidula, says that they are aware of the shortage of specialists doctors in the province, and are working with the department on this urgent issue.

“We have already engaged the department of health on the issue of shortage of specialists doctors in the province. It is something we are all worried and concerned about, and we are now awaiting their feedback on the way forward,” says Mavhidula. 

The Limpopo Department of Health points to the scarcity of oncologists as a national problem and systemic issue, however, they have tried to rectify it in the province. According to spokesperson Neil Shikwambana, the health department has tried to incentivise oncologists to work in the province, without success. 

“We have been trying to source oncologists, but they are scarce. Over the past few years, we have managed to source various specialists, but when it comes to oncology, the field is limited. At the moment we are still trying to attract oncologists to come and work in the province, but there aren’t so many in the country.”

The shortage of oncologists has created a huge backlog of patients waiting to be seen by the specialist and reduces the level of care that cancer patients have access to. Shikwambana says they are aware of the situation and are managing the backlog. 

“Currently we are managing the backlog, but we will gladly send anyone who wants to qualify as an oncologist doctor to medical school,” Shikwambana adds. 

A few years ago the department invested in a medicine student, who specialised in oncology, and Shikwambana says the student is due to return, as he had qualified as an oncologist. 

“We have a doctor whom we sent to school years back — the good news is that he is back as a qualified oncologist and will begin duty very soon,” says Shikwambana. 

Shortage leads to preventable deaths

The difficulties in retaining oncologists in South Africa, especially in the public health system, is something that Cancer Association of South Africa (CANSA) Polokwane, reiterated. CANSA is a non-government organisation that provides temporary care to cancer patients within their communities, and supports cancer patients families. Corne Marais, administrative manager of CANSA Polokwane, says that they are aware of the shortage of oncologists in the province, but points to how these shortages are linked to national deficits.

“We are faced with a shortage of oncologists, not only in the province but I think nationally, as there are not many of them in the country, which is something we have to worry about as a nation,” she says. 

Although the deficit of oncologists is a structural issue within the public health system, the people who bear the burden are ones like Vele, who waited to death to see a cancer specialist.

And while her family prepares to lay her to rest, they’re pleading with the government for shortages to be filled, so that no other family experiences their tragedy. 

Tshotheli says: “Something needs to be done urgently at our public health facilities as we cannot continue to lose people in this manner, knowing that there was something that could have been done to prevent the death. The weeks and months that patients have to wait before they are seen by specialist are torture to both patients and families.” 

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