Hundreds of cancer patients have missed out on treatment for at least three weeks after last month’s fire suspended oncology services at the Charlotte Maxeke Johannesburg Academic Hospital.
The Gauteng health department has warned that radiation treatment lists are likely to grow and activists say a backlog in cases may threaten to overload an already stretched system.
It is Friday morning and Jennifer Blowers has just taken another wrong turn.
“I think we go this way,” her partner, Warren Potter, calls from behind her. He points to a silver sign hanging high above a row of socially distanced blue plastic chairs lined against a wall.
Blowers is only half-listening as she scans the walls for directions to the front desk at Chris Hani Baragwanath Academic Hospital. She is distracted – and anxious.
Blowers was diagnosed with aggressive breast cancer in early February and was scheduled to start chemotherapy at Charlotte Maxeke on April 23. But just days before her first appointment, a fire damaged Charlotte Maxeke’s radiation clinic and chemotherapy preparation facilities.
By that time, the lump in her breast had already doubled in size.
Blowers is one of at least 750 former Charlotte Maxeke patients who Breast Health Foundation CEO Louise Turner estimates have gone without cancer treatment for at least three weeks due to the fire. In addition, many newly diagnosed patients have spent weeks without being referred for care.
The Helen Joseph Hospital Breast Clinic, for example, could not refer any newly diagnosed patients for care as of late last week.
“That first chemotherapy session was going to help alleviate my pain and [reduce] the inflammation,” says Blowers. “I was actually looking forward to it.”
Unsure of what the fire initially meant for her chemotherapy, Blowers telephoned the hospital, the health department and a dedicated provincial hotline – to no avail, she says. However, early this month, the Helen Joseph Breast Clinic (where she was first diagnosed) called her to let her know that Chris Hani Baragwanath Hospital would see Charlotte Maxeke chemo patients for treatment on May 7 – three weeks after the fire.
Now, at Chris Hani Baragwanath, Blowers is hoping she can finally start chemotherapy. But so are at least a dozen other former Charlotte Maxeke patients who have missed appointments.
Word that cancer treatments have resumed has spread fast among patients on WhatsApp and Facebook groups.
“I’ve been told I’m in for a rough day,” says Blowers as she spots a sign for the hospital’s administration department and heads off down another hallway.
Waiting lists for radiation set to grow
Public-sector chemotherapy and radiation cancer treatments in Gauteng are limited to three hospitals: Steve Biko Academic in Pretoria, Chris Hani Baragwanath in Soweto and Charlotte Maxeke in Johannesburg.
Prior to the fire, Charlotte Maxeke treated 4 700 regular cancer patients monthly and started another 300 on treatment each month, according to the Gauteng health department.
The department admits that cancer care for Charlotte Maxeke patients was disrupted for two weeks while structural damage to the hospital prevented healthcare workers from accessing patient files. It says that although chemotherapy is now getting back on track via services offered at Chris Hani Baragwanath, radiation waiting lists will grow.
However, head of the Cancer Alliance Salomé Meyer points out that the Soweto hospital does not typically provide the kind of radiation therapy needed to cure cancers. Instead, its treatments are geared towards helping patients manage pain.
Four radiation machines at Charlotte Maxeke remain offline, although the department says no equipment was damaged in the blaze. Long waiting times for radiation have prompted some patients to travel to other provinces for care.
Turner warns that mounting patient backlogs could lead an already overstretched system to “implode”, as treatment delays now could result in relapses for certain patients later, adding to the numbers of people in need of care.
Cancer patients hit the road for help
Breast cancer is the most commonly diagnosed cancer among women in South Africa, according to the country’s cancer registry. With poor access to early screenings, many women are diagnosed late, says head of the Helen Joseph Breast Clinic Dr Carol-Ann Benn. Most of her patients will eventually need radiation. One is Sharlene Hartley-Van Boven (39), who – like Blowers – has an aggressive form of breast cancer. She has already undergone chemotherapy and surgery for her cancer and needed to start radiation at Charlotte Maxeke before the fire.
Since the blaze, however, Hartley-Van Boven’s treatment has been in limbo.
“It’s been a complete mess. You don’t get any calls from the hospital and you don’t know where to go,” she says. “Some of the people we eventually got hold of said: ‘You can expect a three-year delay now, because everybody’s been moved out of there [Charlotte Maxeke].’”
After discussing the situation with her doctor at the Helen Joseph Breast Clinic, Hartley-Van Boven decided to leave her husband in Gauteng and move back home to her family in Cefani Mouth just outside East London, where she could access oncology services at Frere Provincial Hospital.
After arriving there last weekend, says Hartley-Van Boven, she saw an oncologist at the East London hospital within the week.
“The oncologist here was saying I needed the radiation within six weeks of my surgery, but it’s been five months,” she says, struggling not to cry. “He was trying [not to show it], but I could see it on his face: [my prognosis] wasn’t good,” she says, bursting into tears. “At least at Frere, they treat you like a person. It’s made such a difference.”
A new decade, a new crisis
Last month’s fire at Charlotte Maxeke came just three years after its oncology department suffered a series of public setbacks, including frequently broken machines and allegations of staff shortages. The SA Human Rights Commission, which investigated labour disputes at the hospital in 2018, told the media 500 people were awaiting treatment at the time.
Turner says the province has still not recovered from the disruptions. “I can give you [the names of] patients from 2019 who’re still waiting for radiation – and there are enough private radiation facilities in Gauteng to catch up this backlog in a couple of months,” she says.
Earlier this month, the Gauteng health department announced measures to improve cancer treatment waiting times, including contracting a private hospital group to treat public sector patients and establishing a radiation unit at Chris Hani Baragwanath. It will also procure new radiation machines.
Meyer says any partnership between government and a private hospital group should be transparently awarded and priced. Meanwhile, the Cancer Alliance has also suggested creating a specialised breast cancer treatment unit at Helen Joseph Hospital and – in the distant future – renovating the old Hillbrow Hospital to become a stand-alone cancer centre.
Benn says keeping cancer treatment overly centralised to a few hospitals could make care difficult to access for patients and it would be vulnerable to interruptions such as fires and other emergencies.
Meanwhile, back at Chris Hani Baragwanath, it has been nearly three hours since Blowers arrived, hopeful of starting chemotherapy almost four months after she was diagnosed. With a new patient file in hand, she can finally rejoin the queue upstairs to see a doctor.
“Please God, please God,” she says to herself. By 10am, she has had her blood pressure taken and is seated with a row of patients waiting to be seen by a doctor. She is number 42 in the queue. Slowly, everyone seems to be called for treatment.
Blowers texts her partner Potter in the waiting room to tell him she has asked a nurse for information, but has simply been told to wait. At 11.27am, she texts him again, saying that a doctor has walked past and told her she will not receive treatment. “He just said: ‘You’re not getting chemo today. I’ll come back and explain why,’” she writes.
Later, she says that when the doctor returned, he explained that – due to the delay caused by the fire – Blower’s last breast scan is too old to use. No scan, no treatment. She will have to wait another week. She is nearly in tears.
“To me, it’s as if we should have been here yesterday. It shouldn’t have taken days and days,” says Potter, as the two head back downstairs. “The struggle she’s having at home is incredible: nausea, pain like you wouldn’t believe – and she hasn’t even started the chemotherapy yet.”
*This article was produced by Spotlight – health journalism in the public interest