More than 3000 cancer patients’ lives are on the line as they wait to receive radiation treatment at Charlotte Maxeke Johannesburg Academic Hospital. According to Cancer Alliance, a collective group of non-profit organisations and cancer advocates some patients have been waiting since 2020. 

All this while the Gauteng health department sits on R784 million that the treasury has allocated for the outsourcing of radiation oncology services. Cancer activists, patients and their families staged a protest in Johannesburg last week, demanding that the department use the allocated funds.  

Among the protestors was 51-year-old Lesego Matolo, whose sister Lesedi recently died of breast cancer. 

“My sister was diagnosed with stage 3 breast cancer in September 2022. She died while waiting for radiation treatment at Charlotte Maxeke. While on the waiting list, she was given painkillers to manage her pain from home,’’ says Matolo.

Cancer is a growing public health concern with more than 85,000 people diagnosed, and nearly 44,000 deaths recorded in South Africa in 2019. While fewer people are dying in the country, deaths due to cancer have increased by 29% between 2008 and 2018. 

Most of these deaths happened in Gauteng, where public health facilities are in crisis. 

Treatment and prevention advocate for Cancer Alliance, Salome Meyer says the department is not being transparent with patients. 

‘’This matter dates as far as 2020, where we had been in communication with the Department of Health about the lack of radiation oncology services which started at  Charlotte Maxeke hospital, then spread to other hospitals such as Steve Biko Academic Hospital,’’ she says. 

Health-e News recently visited the radiation oncology department at Charlotte Maxeke hospital where we spoke with department head Dr Duvern Ramiah. 

Ramiah says there are three main drivers of the treatment backlog: radiation machines that are old and broken; a shortage of staff; and the high number of patients being referred from other facilities in the province. 

Broken and old machines 

The oncology department at Charlotte Maxeke was established in 2005, when the unit – equipment included – was moved from the old Hillbrow hospital.  

“When the unit first opened, the number of patients it used to treat was lower, and there was more treatment available. The unit was better staffed and had better functioning equipment,’’ says Ramiah.

Over the years the equipment at the hospital has become obsolete. Technicians could not get some parts that were needed for repairs. The machines have not been serviced since 2005 and are no longer functional. 

Only two machines are functioning, but even these are not operating at their best. 

Ramiah explains that the hospital will put out the tender for an oncology radiation machine this month. 

‘’If everything goes well, we should have the machines installed and ready to roll by next January.’’

This, he says, will help the department get through the backlog by the end of 2025, and attend to new patients.  

Staff shortage

Like most government hospitals, Charlotte Maxeke is plagued by staff shortages. According to Ramiah, currently there are four radiation oncologists, three to four medical physicists, 24 planning radiation therapists, and 12 oncology nurses. 

‘’Our patient to doctor ratio is quite shocking. Four radiation oncologists serving 4000 patients. That’s a ratio of one doctor to 1000 patients,’’ he says. 

For the department to function effectively it needs at least six radiation oncologists, 15 planning radiation therapists, and nine medical physicists who conduct research and 12 oncology nurses.  

However healthcare workers with these skill sets are pulled into the private sector because of higher salaries.

Because of these problems, Ramiah explains, the radiation oncology department does not have the capacity to accommodate the high volume of patients. The oncology department sees about 4000 to 4500 patients per year.

‘’The waiting list fluctuates and although the hospital doesn’t have the exact numbers, the last time we checked it was under 2000 patients who were waiting for treatment,” he says.   

Families demand answers 

Activists and families say the situation is dire across all levels of care – it’s not just the major hospitals that are failing cancer patients.

Speaking to Health-e News at the protest last week, Matolo says that her sister, Lesedi, was turned away from Unjani clinic in Thokoza in 2019 when she first felt a small lump in her breast. On her second visit in 2020 she was referred to Thelle Mogoerane (Natalspruit) Hospital in Vosloorus. From there, Lesedi was referred to Chris Hani Baragwanath Hospital where she was told there’s no lump in her breast and sent home. 

In 2022 she went back to Baragwanath because she could feel the lump growing. A biopsy was done to test for cancer. About three weeks later test results confirmed that she had stage three breast cancer. 

Breast cancer is the most prevalent cancer in South Africa with 1 in 27 women being at risk of being diagnosed with it in their lifetime. 

‘’The doctor at Bara delayed giving my sister the help she needed because the lump in her left breast was still small when she first felt it. If they had paid attention to my sister when she first went to the hospital she would still be alive,’’ says Matolo. 

After a short course of chemotherapy at Baragwanath hospital in 2023, Lesedi was referred to Charlotte Maxeke. Her cancer was aggressive and not responding to chemotherapy, oncology radiation was the next option to kill the cancer cells in her breast. She was placed on the oncology radiation waiting list. While on the waiting list she was given painkillers to manage her pain from home. 

In January she fell sick and was admitted to Baragwanath hospital.The cancer had developed to stage four and had spread to other vital internal organs in her body. 

‘’The disease had spread to her lungs, kidneys and liver before she could receive her radiation treatment. My sister passed away on the 26 March 2024,” Matolo says.  

The Gauteng health department spokesperson, Motalatalane Modiba, admits the department has not kept its promise of communicating with the Cancer Alliance and Section 27 about the tender procurement process, and when the allocated funds will be released.

Furthermore he acknowledges that patients have been losing their lives while on the radiation waiting list. He says the department will discuss the memorandum handed to them and return with a way forward. 

‘’Loss of life for any patient, not just cancer patients, does not sit well with us as a department because no one should ever have to lose their life in our healthcare facilities,’’ says Modiba. – Health-e News