Regina Masetla first noticed a lump in her left breast in 2015. Speaking to Health-e News from their home just outside Tzaneen in Limpopo, her daughter Maria said that the two were told by a doctor at the Dr CN Phatudi Hospital that Regina was healthy. But her breast got worse and the two returned to the hospital where a doctor sent her for an x-ray instead of a mammogram. Many return trips and three biopsies later, the results of which were never given to Regina because of administration mix-ups, and Regina gave up and went home.

“This year we went back again and she was admitted because the pain was so bad and she couldn’t sleep at night,” Maria said. “It was too late. She couldn’t eat, she couldn’t speak. She couldn’t do anything. She was just lying there and her breast was bleeding. It was terrible. It was terribly unfair.”

Desperate, Maria emailed advocacy organisation Project Flamingo on January 24 with a message pleading for help.

Two days later an astonishing response by advocacy organisations and the private Netcare group; ambulance transport, specialist consultations and accommodation were arranged for Regina to come to Johannesburg – where she could finally access treatment or at the very least a breast cancer diagnosis and prognosis.

That very evening, January 26, she died.

“That week, she lost hope. After they couldn’t give us the results of the third biopsy she said ‘I am going to die’. She died,” said Maria. “I’m bitter and angry. I don’t want what happened to my mom to happen to another woman. I want them to get help. I want them to get treatment.”

Cancer services are highly specialised, expensive and are largely only available at academic hospitals: tertiary facilities attached to medical schools. This is why the recent South African Human Rights Council (SAHRC) report on the break-down of oncology services in KwaZulu-Natal (KZN) created such a stir in the media.

The SAHRC found that the rights of cancer patients to access treatment were violated as cancer equipment was found to be not working and there were not enough specialists to meet the demand. Durban’s last public sector oncologist resigned just weeks before the report was published.

Already patients from Northern Cape, Mpumalanga, North West and Limpopo had to be accommodated at the tertiary hospitals in the Western Cape, Gauteng, KZN – and to a lesser extent the hospitals in the Eastern Cape and the Free State.

With KZN oncology in crisis, Eastern Cape patients in need of specialist treatment who would usually be sent to KZN are now being sent to the Western Cape, according to the Cancer Alliance’s, Salomé Meyer.

“I would say cancer treatment in the public sector is in crisis. More and more patients need to be treated. Health care workers and equipment are over-worked and the waiting times have increased, in some cases, to 18 months – while ideally no patient should wait longer than three weeks from diagnosis to treatment,” she said.

She said the private sector accounts for over 80 percent of the cancer specialists in the country and that government should look to partner with private businesses to expand access to cancer treatment. The Cancer Alliance also advocates for the design and implementation of a comprehensive National Cancer Control Plan, the last of which was developed in 1998 and does not represent the current cancer burden or treatment options.

Meyer said she believes that cancer should be elevated to a national priority level and be allocated services from a national budget, as is done with HIV, so that individual provinces don’t have that much influence over provision of services.

“Cancer falls under non-communicable diseases [NCDs], like diabetes and heart disease, and it’s easy to see how it falls off the table. Some of these are preventable but with cancer that does not apply.  Cancer can only by identified at a primary health level; you can’t give a cancer patient a box of pills and say come back next month,” she explained.

But Motsoaledi told Health-e News that he does not believe there is a national crisis.

“The burden, globally, of cancer is exploding. I have been in medicine for 34 years and I’ve never seen so many people with cancer, even at the younger ages,” he said. “It’s true there is an explosion like we’ve never seen before. It’s true cancer is expensive to treat.”

While breast cancer treatment is often cited, he said it costs almost R 1 million to treat one patient for colorectal cancer.

He said that the crisis in KZN is not indicative of a broader systemic crisis. He said the equipment in question: the “linear accelerator” machine, is the backbone of cancer radiation therapy. Two linear accelerators are out of commission at Addington Hospital in Durban as they were not maintained by the original manufacturer. The tender was instead given to a small company but Motsoaledi has intervened to bring the original manufacturer back on board.

“KZN doesn’t differ greatly from the leading provinces, they still have four functioning linear accelerators, Gauteng and the Western Cape have seven each, Free State has one and the North West has one,” he explained. “The biggest difference is the lack of oncologists but the linear accelerators should be back to six very soon.”

He instead blames the lack of procurement capabilities given to KZN health institutions.

“The biggest problem was procurement. They could not even procure to maintain the machines. This combined with a lack of response from management lead to a crisis of carelessness,” said Motsoaledi.

He said academic hospitals in other provinces were given the power to spend up to half a million rand to buy what they need without asking anybody. This is not the case in KZN where costly items had to be approved by the Head of Department’s office which caused delays.

“Teaching hospitals are huge. Their budgets are often bigger than some small countries. Last week I sent the deputy director general for corporate services to go to KZN to force them to give adequate delegation budgets to their academic hospitals to avoid these problems in future,” he said.

He said KZN was the only province which managed academic hospital budgets so stringently.

There is also a plan to expand the number of linear accelerators in the public sector especially in provinces which have none. Motsoaledi said specialist teams could be flown to the equipment instead of making patients travel for treatment.

Finally, his department has been working to develop a National Cancer Control Plan which is almost finished. He said the plan could be revealed at the next sitting of the National Health Council in September or he would call a special meeting of the Council if the plan is ready before that time.

In the meantime, Maria said she is telling her mother’s story so that women, especially, can get the treatment they need from the health system: “There is a big hole in my heart when I think about the way she was treated. She died in my hands. She died while I watched her in my hands. This has to stop. What if this happens to me or my little sister? Will we get help?” DM

Photo: Health Minister Dr Aaron Motsoaledi at the media briefing on the employment status of doctors and newly qualified pharmacists in South Africa, 19 Jan 2017. (Photo: GCIS)