Cancer Services under threat in South Africa.
National Department of Health is silent on the cancer crisis!
Cervical Cancer Patient Story - Ziphora
Ziphora Tau, 56, is a mother of two from the North West who is currently living in Vogelstruisfontein with her daughter and grandchild. In September 2019, she was diagnosed with cervical cancer at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) after a biopsy was done. She came to Johannesburg because she felt that she would get the appropriate care that she may not necessarily get in NW.
However, this has not been the case for Ziphora. Following her diagnosis in September, she was supposed to have her simulation and start radiotherapy on 30 October but was called on the 29th and told that the radiotherapy machines where not working. The simulation process involves using imaging such as Computed Tomography (CT) or Magnetic resonance imaging (MRI) to better visualise the invasion of the cancer in the tissue in order to plan for more accurate, targeted radiotherapy. (https://onlinelibrary.wiley.com/doi/pdf/10.1111/1754-9485.12831). Even the pelvic ultrasound she was supposed to have had has been postponed until February.
She went back to CMJAH in November and was told that the machines were working again but there is a waiting list. As a result of the non-functioning machines, there is a backlog of patients waiting to receive radiation and at the moment, they are only dealing with emergencies. But Ziphora feels that “cancer itself is an emergency”. She has not been told where she is on the list, how it works and how patients are being prioritised.
That is not the only thing she is in the dark about. No-one has discussed her case with her. She has not been told what stage of disease she has or what the future hold. The last time she spoke to a doctor was in the early processes of her diagnosis. Someone who isn’t her primary health care provider told her that she has stage 3B and she doesn’t even know what that means. At this point the only care she is receiving is getting morphine and paracetamol to manage her pain.
Over the last month Ziphora’s pain has gotten worse. She is in so much pain that at times she cannot even sleep or eat. The pain starts in her pelvis and spreads down her legs. By the time leaves hospital after a visit, she needs to use a wheelchair because she can barely walk as a result of the unbearable pain and fatigue. When the pain is at its most severe, she wishes she was “dead than living with a pain like this every day”.
Unfortunately, Ziphora is one of many patients suffering the same kind of treatment (or lack thereof). She says “it’s killing me because I wonder what those people think when they look at us because they know what cancer does to a person’s body.”
When asked about the state of cancer care in the South African public health system, Ziphora’s daughter said: “It does not exist. Soapies on TV now are trying to raise awareness but in reality people aren’t getting the treatment or care they need. You ask yourself “do these people really care?” It’s like they diagnose you and just say “ag, can this one just die and follow on the next”. The ones that care are the ones that don’t have that much power… Can a person really go up and down with unbearable pain just to get pain meds and nothing being explained or done about the situation? Is it not a health care facility where every health care professional has taken an oath to save lives but if they are taking a backseat, what happens? Who holds them accountable?”
They have promised to call people in January to tell them when to come from treatment. Her phone is always at her side, while she awaits the anticipated call.
For more information about cervical cancer: https://www.cansa.org.za/files/2019/04/Fact-Sheet-and-Position-Statement-on-Cervical-Cancer-NCR-2014-web-April-2019.pdf
Breast Cancer Patient Story- Tina
Tina is seated on her couch, propped up by a pillow and being fed her breakfast porridge by a young lady. Another young lady emerges from the other room followed by a toddler. I am welcomed warmly into their home in Soweto. The first young lady, who I later find out is Tina’s carer, gets up to get Tina’s pills from the other room. Tina assures me that we’ll be able to start our conversation soon as she just needs to take her tablets, which is no small feat. Her carer has to help her take her tablets because Tina has lost function in her arms. When she is done taking the small mountain of pills her daughter, the other young lady, helps her put on her metal spine brace. She is also unable to walk.
In June 2018 Tina started feeling a lump in her right breast that grew until it ruptured in August and necessitated her going to Chris Hani Baragwanath Hospital, where she was diagnosed with stage 4 HER2+ breast cancer that has metastasised to the lungs and bone. She was also found to have a cardiac problem, previously undiagnosed, which prevented her from starting chemotherapy. She was immediately started on Zometa and Zoladex. Zometa or Zolcdronic Acid is a bisphosphonate used to treat Paget’s disease, high blood levels of calcium caused by cancer, multiple myeloma or metastatic bone cancer. It is also used to treat or prevent osteoporosis in post-menopausal women and to increase done mass in men with osteoporosis ( https://www.rxlist.com/zometa-side-effects-drug-center.htm).
Zoladex also known as Goserelin is Luiteinizing Hormone-Releasing Hormone (LHRH) agonist which helps the down the ovaries and stop them from producing oestrogen so there is less oestrogen to fuel the growth of hormone-receptor positive breast cancer, which Tina has.
“I am taking tablets for my heart. The drip I’m getting is my only saving grace. I’ve only been receiving Zometa and Zoladex.”
Tina stayed on these two medicines and improved enough that she was discharged and was even able to work selling fruit, sweets and chips on the street to get some income for her family. This continued until June 2019 when she was informed that Bara did not have the Zometa infusion. She was referred to Johannesburg Hospital where she could not be helped. Tina and her family tried different GPs and private hospitals as well, to no avail.
“At Bara all they kept telling us is that they have ordered the medicine but it is not available at the pharmacy because it has not been delivered. The doctors said they were attending meetings, I’m not sure what those meetings were about or what was being said… All they could tell us was that there is no drip. At that time I was very sick and in pain but I also felt very sad. I was always crying at home”
This is when Tina’s health started to deteriorate. She started to experience severe pain all over her body, especially in her back, and her arms and legs became weak. After some tests at Bara it was discovered that the cancer had spread to the spine. Tina was rushed via ambulance to Johannesburg Hospital immediately for emergency radiation of her spine. After two days she was sent back to Bara where she was discharged mid-November.
“For now, I am going to continue taking the treatment until I feel well. I am going back to Breast Clinic in January to continue treatment.”
Tina had the following cry for help, “What I would like to ask government, whoever makes the treatment and wherever it comes from, is to please make the treatment for this disease available. This is a deadly disease. It kills people. People are suffering!”
Sadly Tina’s comment that this disease “kills people” is all too true. She sadly passed away in December 2019.