An Open Letter to Dr. Nolutshungu, New Head of the Gauteng Department of Health, Concerning the Radiation Oncology Crisis

Dear Nomonde,

Congratulations & Enjoy the Challenge

Firstly, congratulations on your recent appointment. I trust that you will be able to make some inroads into the huge challenges that presently face the Gauteng Department of Health.

I am writing this open letter to you in the hope that, under your guidance, the GDoH will begin to address ways to reduce the long waiting lists affecting the timely administration of oncology radiation therapy to patients in the province, specifically at Charlotte Maxeke Johannesburg Academic Hospital.

Radiation Oncology Crisis

We are all aware of the challenges that the hospital has faced due to events like Covid-19 and the 2021 fire. Although these are certainly factors contributing to the waiting lists, the truth remains that the problem already existed much earlier and I’m sure you agree that the time has come to stop using these events as excuses and actually do something to solve the problems.

Unfortunately there is no further time for you to acclimatise. Under your predecessors the radiation oncology crisis has been allowed to worsen and nothing visible has been done to reduce it. Sure, a Cancer Crisis Task Team was recently set up but, according to reports, no actual decisions have been made and no dates have been set to put processes in place to remedy the problems.

We’ve had about four meetings which are every two weeks and we are trying to keep them accountable but I cannot tell you how much red tape, lack of performance (and) lack of accountability we have been experiencing. It’s just like everybody talks; they acknowledge the crisis now at least, but the action required to really address this in a speedy, crisis mode has not been delivering.

Linda Greeff, Chairperson for the Cancer Alliance and Member of the Cancer Crisis Task Team, speaking to eNCA.

Public vs. Private

In the meantime, government doctors are not divulging the truth to certain patients. In an April 2022 meeting with the Head of Radiation Oncology at CMJAH and certain members of his team, a breast cancer patient was told that radiation therapy would remain effective, no matter how long after surgery it was carried out. The department head insisted that breast cancer radiation therapy remains effective after longer waiting periods. He pointed out that if it wasn’t, there wouldn’t be such a long waiting list. Of course, a second reason for the long waiting list could be that doctors are neglecting to tell breast cancer patients that radiation treatment is actually largely ineffective after a postoperative wait of six months or more.

How could we even assume this second reason? Consultations with two separate Radiation Oncologists in the private sector have indicated that radiation therapy for breast cancer loses its effectiveness after a six month waiting period. In fact, one of the doctors actually stated that she would not take the patient’s money if six months had elapsed since breast surgery, as it would be pointless having the radiation therapy. The other told the consulting patient that, five months after surgery, she was on the borderline and needed radiation treatment immediately in order for it to effectively counteract cancer recurrence.

A No-Win Situation for Public Doctors

With regards to the above-mentioned patient, being told the truth from the beginning would have afforded her the opportunity to perhaps secure private treatment five months earlier. Let’s face facts though, a public doctor is in a catch-22 situation. Option one would be to tell the truth to a waiting list patient. This could potentially make the GDoH or the government susceptible to human rights claims or lawsuits, and might also land the doctor in deep water. Option two would be to keep this information from a patient. It’s likely to be the easier option as the majority of patients in the public sector probably don’t even realise the implications. And they trust their doctors.

The problem with the second option, which seems to be the most popular one at CMJAH, is that the majority of patients on the radiation therapy waiting list will remain there, despite treatment not holding any actual effectiveness for them. This, in turn, means that many of those patients who could benefit from radiation therapy are pushed further down the list and, due to this, will potentially only end up getting their treatment when it is actually too late. This could be one reason for the long list of palliative care patients currently also requiring treatment.

The Truthful Solution

So what is the solution? I defer to your greater knowledge and experience here, Dr. Nolutshungu. I certainly hope that you have the solutions. The only one that I can envisage is that doctors actually start telling their patients the truth. This would certainly decrease the length of the waiting list and mean that patients who could still benefit from radiation therapy, would benefit. This, in turn, would mean that fewer patients would need to return to Medical Oncology for further chemotherapy treatment and the waiting list for that department would decrease too. Of course, this is a solution for a perfect world though, isn’t it? There are so many other factors to consider, aren’t there?

Of course, you could always just wait. The Cancer Crisis Task Team might eventually get it right to form a PPP, but what’s it going to look like when private radiation oncologists start turning away public breast cancer patients because radiation therapy won’t benefit them as they’ve been waiting for longer than six months?

Although I have only specified maximum waiting periods for breast cancer radiation therapy in this letter, I’m sure that effective time frames also exist for other types of cancer as well.

Thank You in Anticipation

I would like to take this opportunity to commend you on your bravery for accepting your new role. You have some very tough and urgent calls to make. I’m sure that the over two thousand cancer patients awaiting radiation therapy at Charlotte Maxeke, and millions of public voters, would appreciate you making the correct ones.

Good luck.

In closing, on a personal note, I would encourage you to give Professor Carol Benn and her exceptional group of volunteers at the Helen Joseph Breast Care Clinic as much support as your budget allows. A number of patients on the current radiation therapy waiting list, and many others, would be much worse off without them.

Yours in Proactivity

Warren Potter

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