Cancer is a racist murderer. This fact did not start out life as a story, another local tale about privilege and fear and projection and retribution, it was born an actual fact—with data and graphs and peer-review mechanisms. Aside from existing in a variety of unlikely spaces that define contemporary South African life (the library of the Wits Medical School, for instance), the data in question occupies a corner of the Paediatric Haematology and Oncology Department in the Charlotte Maxeke Johannesburg Academic Hospital, known to most as the children’s cancer ward at the Joburg Gen. The graph headings say things like “Acute lymphoblastic leukemia: survival patterns in Black and White patients 1982 to 1990,” and they all demonstrate the same pattern.

Measured as a cumulative proportion of surviving patients, cancer kills way more black children than white children.

“The short answer?” says Dr Jennifer Geel, one of five paediatric oncologists at the unit. “We don’t know. Take leukemia. Black kids will have a 60 percent survival rate and white kids an 80 percent survival rate in the same city. It’s something we’ve been trying to get to the bottom of for years. Some of it can be explained by genetics and some of it by nutrition, but we haven’t come close to a scientific understanding of the issue.”

What also doesn’t come close to explaining the issue—in fact, what makes the issue an outright anomaly—is that you can’t, in your charming South African way, say to yourself that Charlotte Maxeke is a public hospital, a particularly infernal circle of our national hell, a realm where poor black South Africans go to learn that they are as unequal in death as they have been in life. You can’t say that because, in this particular case, it appears not to be true.

Sure, there was that matter in January 2015, the tragic passing of seven-year-old Annamarie Tewitz, whose parents insisted that hospital negligence had killed their child, and whose funeral became a cause célèbre for the white right. Appearing under the AfriForum banner as “medical neglect of poor whites,” and alongside such love-and-tolerance spreading headlines as “Gat kruiping ANC’s Rubbish Education is training Racist and Sexist BARBARIANS,” the Tewitz case served to pour a little more gasoline on the fire that separates those of us who know everything (white and/or black) from those of us who don’t (ibid).

“We get a lot of brain tumors here,” Dr Geel tells me, by way of response to the members of the Protect-the-Boer community who’d discovered, to their surprise, that they had lying latent within them a thorough clinical grasp of paediatric cancer in all of its forms. “And so the neurosurgeons are always in the firing line. Annamarie had a very bad brain tumor with a very high chance of not surviving. Maybe where we went wrong was that we didn’t make that clear enough to the parents.”

But while the above does shed some light on the racialisation of even our most intimate family crises, and while more light will be shed on the phenomenon in the paragraphs below, we have yet to deal with the question of why the children’s cancer ward at the Charlotte Maxeke Johannesburg Academic Hospital can in all fairness choose not to display—to return to Dante’s Inferno—those immortal lines from Canto III: The Gate of Hell.

Per me si va ne la città dolente,
per me si va ne l’etterno dolore,
per me si va tra la perduta gente…
Lasciate ogne speranza, voi ch’entrate.

Through me the way to the suffering city;
Through me the everlasting pain;
Through me the way that runs among the Lost…
Abandon all hope—Ye Who Enter.”

Nope, instead of those words above the lintel there is a cartoon mural of bright houses and picket fences and blooming flowers and blue skies. There is a Lego table and a toy cupboard full of toys. There is a new coat of paint on the walls, potted plants in the hallways, and private cupboards for the patients and their parents (who have their own beds specially reserved, should they wish to sleep over). Aside from a mother who has her head in her hands and is sobbing by an infant’s cot, the ward today is inhabited by people who are teasing each other, laughing and joking, smiling at Dr Geel and her strange note-taking guest. The only person who gives either of us the stink-eye is a hospital security officer who wants my “papers” or some such. Dr Geel parries with a derisive snort that melts the mulish woman, a la the magical powers of Dante’s Beatrice, into a puddle of insignificance.

“So what,” I ask the doctor, duly overcome by this collective refusal to play victim, “is your overall survival rate here… as in, across the racial divide?”

Dr Geel clears her throat. There is context, of course, and one needs to be careful. The only accepted measure of survival rates, according to paediatric oncologists, are “published” data in peer-reviewed journals such as Pediatric Blood & Cancer, a US-based title that operates under the auspices of the International Paediatric Oncology Society. As per this journal, the survival rates in developed countries are around 80 percent, which seems remarkably high until you learn that children’s cancer is clinically different from its adult counterpart. “It’s more aggressive,” says Dr Geel, “ which paradoxically makes it easier to treat.” In South Africa, a developing country (italics employed to address any lingering doubts), the survival rate is an official 52 percent, as determined by the latest published results taken from two centres, Universitas Hospital in Bloemfontein and the Tygerberg Children’s Hospital in Cape Town. Dr Geel can’t go on the record with the actual number, but the suggestion is that the Charlotte Maxeke Johannesburg Academic Hospital is above that.

Given the already observed and noted anti-victim mentality on the ward, I’m not about to demur. I wonder aloud what the difference is between this ward and, say, the children’s cancer ward at the private Donnie Gordon hospital up the road. “The food is a little better there,” says Dr Geel. “The beds are more comfortable, the coffee is better in the coffee shop.”

She should know—the paediatric oncology unit at the Donnie Gordon is staffed by five oncologists from Baragwanath and the same five oncologists who work at Charlotte Maxeke Johannesburg Academic. It’s part of these doctors’ “RWOPS,” remunerated work outside public service. Which is exactly where the racialisation of our most intimate family crises comes back into play. “Black people definitely have less of an issue being here,” says Dr Geel. “It’s just my impression, but if a black person has a medical aid that won’t get him into the Donald Gordon, he’ll fight it less.”

I’m kind of floored, if not altogether surprised. It’s tough to be reminded that your skin colour and accent lumps you with people who are thought of as congenitally whiney. But hey, we all have our problems. For the oncologists in the paediatric units at South Africa’s public academic hospitals, where the vast majority of our children with cancer are treated, the real problem is this: why, measured as a cumulative proportion of surviving patients, does cancer kill way more black children than white children?

If the experts closest to the disease don’t yet know the answer to this question, it’s not for lack of trying. Unlike the debates that are raging ever more forcefully in our public institutions, this particular racial discrepancy is not going to be settled by rage or reasoned argument or even the verdict of history—it is going to be settled by science. And when that day comes, when the evidence arrives in terms that can’t be disputed, maybe more of us will remember what our country has been trying forever to teach.

Maybe more of us will remember that it’s a different conversation entirely when people get hurt. DM

Photo by Guillermo Viciano.