Humanitarian Crisis Looms Due to Escalating Gauteng Public Sector Radiation Oncology Waiting Lists

Gauteng is in the midst of a public sector radiation oncology crisis. Thousands of patients are suffering, and this situation has only worsened over the past five years. Too many cancer patients are paying with their lives. Is the current state of the Gauteng Department of Health’s radiation oncology services leading to a humanitarian crisis in the province?

A lack of operational equipment, brought about by years of poor maintenance, and a shortage of qualified staff, are major factors in this escalating crisis. Already long waiting lists grow more each day. The COVID-19 pandemic and a 2021 fire at Charlotte Maxeke Johannesburg Academic Hospital certainly did not help the situation but the reality is that these events didn’t cause the problem either.

Charlotte Maxeke is one of the country’s busiest public healthcare facilities and one of only two hospitals, along with the Steve Biko Academic Hospital in Tshwane, that provides radiation oncology services in Gauteng. As such, the ongoing and growing problems at the institution limit options for multitudes of cancer patients.

New Linear Accelerators

By 2019, the Gauteng Department of Health had invested over R500 million in new Linear Accelerator machines. Some of these were made available to Chris Hani Baragwanath and George Mukhari Academic hospitals in an attempt to alleviate existing backlogs yet any anticipated patient benefits resulting from the outlay of these funds remain to be seen.

Linear Accelerators (Linacs) are radioactive. The new machines require protective bunkers to be in place before use and, at present, there are none available. Existing bunkers at Charlotte Maxeke Hospital are too small to house the new Linacs and new bunkers still have to be built at both Chris Hani and George Mukhari hospitals. As a result, the costly new radiation equipment now sits in storage awaiting bunker construction. This may happen, reportedly, by November 2022 but, until construction is complete and the equipment is commissioned radiation oncology waiting lists look set to continue to grow.

COVID-19 and the Charlotte Maxeke Fire

The COVID-19 pandemic required additional health protocols to be implemented. These stretched the already-limited resources in public hospitals even further. In April 2021, just as hospital management and staff had begun adjusting to these protocols, there was a devastating fire at Charlotte Maxeke Hospital. The fire damaged the hospital’s entire Oncology department, meaning cancer patients’ treatments were further delayed and treatment waiting times increased even more.

What the Charlotte Maxeke fire tells us about health and safety in Gauteng hospitals

Chemotherapy treatments were delayed before some were rerouted to other hospitals. No alternative solutions were available for patients awaiting radiation treatment however. Charlotte Maxeke Hospital’s Oncology department was closed to all cancer patients for over three months and, on re-opening in late June 2021, could only attend to existing outpatients. The fire and resulting repairs placed additional pressure on oncologists and further extended already-overloaded waiting lists.

Human Resources Shortage

Plans are reportedly in place to eliminate the radiation equipment shortage but another problem remains unsolved. The Radiation Oncology Department at Charlotte Maxeke Hospital is severely understaffed due, in part, to a spate of public health sector resignations that have been taking place since mid-2021. Charlotte Maxeke’s Radiation Oncology HOD told Carte Blanche in January that staff shortages form a major part of the hospital’s inability to provide effective services to public cancer patients.

There are just four radiation oncologists in this unit to cope, to manage the treatment of about 4000 radiation patients a year. The doctors here at the moment are pushing patients through onto treatment but they are doing much more and managing far more patients than should actually be safely managed by radiation oncologists annually.

Dr. Davern Ramiah, Head of Radiation Oncology at Charlotte Maxeke Johannesburg Academic Hospital

Dr. Ramiah’s statement explains, to some degree, the delays in cancer treatment in Gauteng’s public sector. It also raises questions about the quality of care being provided. Time constraints placed on overworked medical staff could logically lead to patients not being provided with a level of care that would otherwise be expected.

Cancer Alliance Action Leads to Task Team Formation

In November last year the Cancer Alliance, a collective group of cancer control non-profit organisations and cancer advocates, along with members of the Treatment Action Campaign, marched to the Johannesburg offices of Gauteng Premier, David Makhura. The participants demanded the urgent establishment of a task team to address the province’s cancer crisis. Marchers were dressed in black and carried a mock coffin and several white crosses signifying the growing number of the population affected by and dying from cancer.

‘The government is killing cancer patients by keeping us on waiting lists then sending us home to die’

A Cancer Crisis Task Team was formed by the Gauteng Department of Health as a result of the march. Chaired by the Gauteng Department of Health’s Acting Head of Hospital Services, Dr. Freddy Kgongwana, the task team included other local government members from the Human Resources, Procurement, and Clinical Service sectors. Members of both the Cancer Alliance and the Treatment Action Campaign represented civil society while clinical representatives public Gauteng cancer treatment providers filled the remaining seats.

Cancer Crisis Task Team Delays and Resumption

The Cancer Crisis Task Team commenced bi-weekly meetings in April 2022 on a year-long mandate. The team was to find ways to reduce the radiation oncology waiting lists at Charlotte Maxeke Hospital by investigating treatment options, including potential public-private partnership formation, and also deal with the hospital’s pressing human resources issues. After that it would assess any necessary equipment improvements required at both Charlotte Maxeke and Steve Biko hospitals and look into the future needs of other Gauteng public hospitals.

Little is publicly known about the task team’s progress. By July, Dr. Kgongwana had been removed from his position leaving a void in leadership. On 26 July bi-weekly meetings were postponed after the Gauteng Department of Health sent out a short message to members notifying them of an indefinite adjournment. No reasons were given.

Please note that today’s meeting will not sit until further notice.

Gauteng Department of Health Representative

I submitted numerous enquiries to the office of the Gauteng MEC for Health, Dr. Nomathemba Mokgethi, requesting reasons for the postponements of the Cancer Crisis Task Team meetings, and whether they were scheduled to continue. Feedback was finally received, over three weeks after my initial enquiry. No reasons were supplied for the delays however, nor has Dr. Mokgethi yet answered any of the questions I posed to her in my July open letter.

Please note that the Cancer Alliance Task team meeting met on the 16 August 2022. The subsequent set of meetings will follow. The next scheduled date is the 30 August 2022.

Motalatale Modiba, Chief Director: Communication, Gauteng Department of Health

Dr. Stephen Mankupane, Chief Director of Hospital Services in Gauteng, now chairs the meetings. Although this news has taken time to arrive, it does offer some potential solace to cancer patients regarding the prospect of future solutions being found.

Waiting List Escalation

The Gauteng Department of Health and the NPOs involved in forcing change might appear to be taking some positive action through the Cancer Crisis Task Team, but the radiation oncology crisis shows no sign of abating. A July Cancer Alliance petition update informs readers of still-growing waiting lists at Charlotte Maxeke Hospital.

The reality is that the waiting list for Charlotte Maxeke is growing conservatively with about 40-50 patients per month. These are mainly prostate and breast cancer patients.

Cancer Alliance Petition Update

Waiting periods at the hospital range between six and 18 months for breast cancer patients, depending on individual case urgency, and stand at over five years for prostate cancer patients. The situation’s compounding seriousness is fast becoming, as the Cancer Alliance petition states, “a humanitarian crisis”.

Patient Constitutional Rights

The South African Constitution states in Section 10 that everyone has inherent dignity and the right to have their dignity respected and protected. Section 11 states that everyone has the right to life. Section 27 of the constitution states:-

According to the constitution every South African has constitutional rights to health care services, emergency medical treatment, and dignified life. Right now, are the constitutional rights of public sector cancer patients being adhered to by the South African Government and, more specifically, by the Gauteng Department of Health? Is Gauteng heading for a humanitarian crisis or is it already actually in the midst of one?

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