Stark realities face cancer patients at Charlotte Maxeke Hospital despite glimmer of hope reopening brings

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. (Photo: Shiraaz Mohamed)

By Salomé Meyer

28 Jun 2021

The reopening of the oncology section of Charlotte Maxeke Johannesburg Academic Hospital on Monday offers a glimmer of hope for cancer patients in South Gauteng, but the stark reality is that many will not be able to access lifesaving treatment immediately.

Salomé Meyer is an activist and the Cancer Alliance’s Access to Medicine campaign project manager.

To have been diagnosed with cancer is devastating, but most cancers at Stage I or Stage II are treatable and curable if diagnosed early. Cancer is not one disease — there are more than 300 cancers, with each having its own treatment regimen. There is no one size that fits all.

Cancer can be treated with surgery, systemic therapy or chemotherapy, hormonal therapy and radiation therapy, or a combination of one or more of the modalities. It requires specialised, highly trained healthcare professionals, medicines and equipment, and is one of the most expensive non-communicable diseases to treat.

Cancer care against all odds

Unfortunately, most patients diagnosed in the public healthcare system in South Africa have Stage III and Stage IV cancer, which is far more challenging to treat, and most often treatment is not curative but palliative. The 10 public sector radiation oncology units and three medical oncology units scattered across the country provide cancer patients with excellent treatment.

Only 20% of cancer specialists in South Africa service 85% of uninsured patients treated in the public sector — an inequity that has been highlighted for many years. Cancer specialists work tirelessly and against all odds to provide the best service available, as well as serving as training facilities for the next generation of medical and radiation oncologists.

Cancer patients seeking care at Charlotte Maxeke Johannesburg Academic Hospital face many challenges. By the time they have been referred for treatment their cancer is often at an advanced stage. For some prostate cancer patients, the radiation oncology waiting list is longer than three years. Before the fire at the hospital and Covid-19, this unit had outdated equipment and lacked qualified radiation oncologists to provide treatment.

Radiation oncology is probably one of the most specialised treatments for any cancer patient. A fully functional radiation unit, such as the one at Charlotte Maxeke with the number of patients it treats per year, requires at least seven Linac (linear accelerator) machines, two brachytherapy machines, used mainly for cervical and endometrial cancer, and a high-end MRI Linac that can manage more complicated cancers such as head and neck cancers. This requires at least eight radiation oncologists, medical physicists, radiation treatment planning staff and radiotherapists.

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. (Photo: Shiraaz Mohamed)

This unit, however, has only four Linacs, no brachytherapy machines, and only four radiation oncologists. It is understaffed and under-equipped to deal with the patient load, resulting in a backlog of more than 1,000 patients even before Covid and the fire of 16 April. Plans for a new radiation oncology facility to add to the newly opened medical oncology facility at Chris Hani Baragwanath will hopefully improve matters.

Patients already on radiation therapy at the time of the fire were “transferred” to the Steve Biko Academic Hospital and so were some of the staff.

Although at least four private sector radiation oncology facilities in Gauteng offered their assistance in public-private partnerships, not all of these are feasible and will only assist as a short-term solution. This is because patients sometimes require more than just their radiation treatment, which leads to other unforeseen expenses such as the cost of hospitalisation.

Eskom implemented load shedding in April/May, which exacerbated the situation. Charlotte Maxeke Hospital was without power intermittently for four days. This played havoc with the four existing Linacs. The vacuum tubes were affected and now have to be recalibrated in the hope that they were not damaged permanently.

Less political interference, more pragmatic decisions

The unit, which reopened on Monday, 28 June, will be able to treat only 10 new patients per day for the first week, which will then slowly increase. Only with the required new equipment and associated staff will the unit be able to treat at least 200 patients per day — which can decrease the backlog. It will cost about R252-million to procure the required equipment with the associated maintenance plans.

Certainly, it’s not a lot of money to save lives when measured against the corruption figures being bandied about. Most of the backlog patients will have to be reassessed and restaged, which may have detrimental consequences for some. What is needed now is less political interference and more pragmatic decisions about the optimal functioning of the hospital and the radiation oncology unit to ensure that patients can receive their treatments and have hope again.

For medical oncology, the picture is equally bleak. The section where medical oncology is housed on the 9th floor was not ready by Monday. The patients have been redirected to Chris Hani Baragwanath Hospital, where only 15 chemo chairs are available, instead of the 32 at Charlotte Maxeke. This results in patients having to come for their treatments on more than one day, which is another expense for patients who are already struggling financially.

Many patients have complained that they do not receive proper communication about their treatments and have to wait for many hours only to be told that their treatment is not possible on that day. This unit, as the radiation oncology unit, will also have to face the influx of new patients that cannot be referred as a result of the third Covid wave and the inability to schedule oncology surgeries at any of the feeding hospitals once the hospitals are able to carry out cancer surgeries.

A humanitarian crisis

Staff morale is low amid the dire situation of patients and the red tape of bureaucrats who are fighting for turf and territory. The inability of the Gauteng government and the management of Charlotte Maxeke Hospital to effectively manage the crisis is a sign of how badly the health system is functioning. The claims that the building plans associated with the previous regime are a reason for delay are just another sign of how no one person is willing to take responsibility for good governance.

Civil society and academia warn that we are facing a humanitarian crisis. In fact, the crisis is already upon us. Many cancer patients have been sent home without their rightful treatment because the system has failed them. If they die we will not know about them and no one person will be held accountable for their deaths. Unlike with Life Esidimeni, where it was possible to count the numbers and identify the accountable persons, we will never know the real impact of this humanitarian crisis.

This article was first published in Spotlight.

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