First published in the Daily Maverick 168 weekly newspaper.

There was just one functioning public radiation oncology treatment facility for the whole of the South Gauteng region. Currently there is none.

The radiation oncology unit at Charlotte Maxeke Hospital was one of the worst affected departments when the blaze tore through the Johannesburg hospital on 16 April. Along with the rest of the hospital it’s been closed for the past seven weeks. And while the Gauteng premier’s office gave assurances that oncology services would resume by 4 June, this has not happened.

The fallout of interrupted radiation treatment for patients from the facility amounts to “sending patients home to die”, say cancer patient advocacy groups. Patients who have not been able to make it to the closest public facility, at Steve Biko Academic Hospital in Pretoria about 60km away, have simply had to let their treatment lapse.

Once started, radiation treatment is a daily occurence that lasts between five and six weeks. An oncologist who works in the public sector, who spoke anonymously, says a two- or three-week gap in treatment becomes a game of catch-up. Beyond that, he says, the process of screening restarts as the medical team has to reassess treatment strategy and options.

He says cancer treatment and care needs to be revisited in South Africa to ensure that vacancies are filled, services are decentralised, that patients have access to screening services earlier on, and that the pricing on oncology treatment can be better regulated.

“This is like the early days of fighting to get HIV-positive people access to affordable ARV treatment – that’s what needs to happen with the fight against cancer.

“We should also be able to learn from how funds and resources were freed up to respond to the emergency of Covid-19, it’s what needs to be done to get oncology services to patients,” he says.

The reality for patients who have not been able to complete their radiation treatment at Charlotte Maxeke is that now they may be pushed to the back of the queue. Because the public sector is so direly overloaded, doctors have to make the impossible decision of who gets treatment first – rationalising patient care while weighing up the changing medical merits of each cancer case.

For the doctor who spoke to DM168 it is a harrowing moral injury to be faced with, to want to serve but to be hamstrung by a system that provides scant support for staff.

According to Louise Turner of the Breast Health Foundation, there is a waiting list of up to five years for radiation treatment in the public sector. Annually, South Africa records 80,000 cancer cases of all kinds. It is estimated that many more people simply slip through the cracks and die before they are diagnosed.

“Radiation treatment costs upwards of R150,000 in the private sector for those without medical aid so it’s priced out of reach even for someone who earns about R30,000 a month,” she says.

Turner says the announcement earlier this week from the premier’s office that Charlotte Maxeke’s oncology unit would be ready to receive patients by the end of week is misleading, and insulting too, for those who need clarity and certainty about their treatment.

“The government still doesn’t want to admit the severity of the damage to the hospital and the consequences of the radiation unit not being able to function.

“Even if they open, it would be asking patients to walk through a construction site right now and the backlog they have to catch up on is a nightmare.”

She adds: “We have been able to link some chemotherapy patients to care at facilities like Chris Hani Baragwanath Hospital, but with radiation treatment there is nowhere to send them and the government has not communicated with patients or made plans for things like patient transport to facilities like Steve Biko.”

Turner says she’s hearing of desperate patients who have temporarily relocated, with the hope of receiving radiation treatment in other provinces.

Others are losing hope fast, unable to face up to this additional blow even as they try to wrap their heads around undergoing the often brutal realities of cancer treatment.

The fire at Charlotte Maxeke should be a literal blazing bonfire of reckoning for the government, says cancer survivor and activist Linda Greeff of the longstanding crisis in oncology services that has been underplayed and ignored.

“This is a humanitarian crisis and it is a tragedy waiting to happen – like what happened to the people who died in the Life Esidimeni tragedy,” she says.

Greeff says that activists under the banner of The Cancer Alliance are now considering legal action to force the government to be transparent and to live up to providing people with the basic right to healthcare.

“We want answers on why empty posts have not been filled immediately, how administrators are being allowed to make clinical decisions, why senior doctors who are aware of the situations are threatened with being fired and are therefore silenced, and why offers from the private sector to work to clear the backlog of patients needing radiation treatment were not been acted upon when they were put on the table in the first days after the fire at Charlotte Maxeke,” she says.

Litigation is also a consideration from the South African Human Rights Commission (SAHRC), which conducted an onsite visit of the hospital earlier this week.

The SAHRC has for the past few years homed in on the state of health and oncology services across the country.

But the commission itself has come under fire for not being able to hold the government to account when it has failed in implementing SAHRC recommendations.

Professor Bongani Majola, chairperson of the commission, says he is not confident of comments made on 1 June by Thabo Masebe, Gauteng provincial government’s acting director-general, that the oncology unit would reopen this week to receive patients.

Majola says that they were told the fire services would be conducting another inspection of the site only by 4 June – Masebe’s own deadline for reopening.

“We are pushing the hospital and department. The difficulty is that we know that oncology is part of a bigger problem.

“The government has underfunded things like access to healthcare, and Covid-19 has shown this.”

Majola says that over the years the commission’s inspections and investigations have revealed a host of problems and rot from corruption.

It’s a lack of staff; a lack of resources; infrastructure not being maintained; a lack of equipment or equipment procured that is not fit for use.

“We have also seen corruption that has robbed many provinces of money that should have been spent on healthcare.”

Majola says the SAHRC has become toothless with shrinking funding and he acknowledges the public’s growing frustration and loss of faith in the chapter 9 institution’s ability to hold the government to account in any significant way.

“It is true we have limited teeth and indeed the ligaments to make those teeth bite, including the ability to litigate, which would be an option. Our budgets are small and we rely on pro bono attorneys and we also need specialised research,” he says.

Majola has committed to a follow-up site visit to Charlotte Maxeke to push for the safe and speedy reopening of one of the province’s largest hospitals.

A plea to Charlotte Maxeke

Dear Charlotte,

I am a 68-year-old thyroid patient. I have been a patient since 2016. You and I were born on 7 April. I’m finding it difficult to address you by your first name, as my elder, but please allow me to do so under this sad state of circumstances.

My condition is hypothyroidism. It’s imperative to be on permanent thyroid medication. A day without taking pills can cause me damage I may not live to witness. Once I tried, dear Charlotte, to stay without the medication for a few days, something I regret. I will never ever do it again. At the time I was being treated at Medunsa hospital, a taxing experience that called for being up at 4am to be among the first to be attended by the specialist at 8am. A friend recommended a transfer to Charlotte Maxeke Academic Hospital, obviously named after you. This was a relief, and a convenience in terms of travelling and costs.

Dear Charlotte, I have since attended one check-up. I took my monthly medication until I was due for a second check-up at the end of April. Long story short, as you know, the hospital was gutted by fire two months ago.

I hope and pray every morning the hospital gets back into operation before I run out of medication at the end of this month.

Why does it take so long to repair an important medical institution, the best and biggest academic hospital in the country? Patients are vulnerable; sad to say, some lost their lives in this inexplicable delay.

It is terribly frustrating to try to find answers without success.

I am appealing, with your permission, dear Charlotte, for sympathy to prevail among the heartless, incompetent officials, so that for once they do the right thing and speedily save the situation at Charlotte Maxeke Academic Hospital, out of respect for your name.

Sincerely,

Thyroid patient Stanley Bodibe

DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.