There are no more public health radiation oncologists left in the entire city of Durban in South Africa.
That’s according to Dr. Melissa Wallace, head of research for the Cancer Association of South Africa [CANSA], which holds mobile and screening clinics across the country and often refers patients in need to doctors in the public health sector.
Now, with the number of public health doctors dwindling in Durban and other South African cities, some patients without the means to visit a private doctor may suffer.
“There is a real crisis, because the public health sector is not able to cope with these referrals. Even before the last few doctors left the public sector, patients were waiting up to eight months for treatment. The situation now is going to be even worse,” Wallace said.
“This leaves us with a dilemma — do we as CANSA continue to screen people if we know they are not going to get the required treatment?” she said, adding that “the unavailability of radiation oncologists means that our existing patients are at risk of having their treatment disrupted.”
Durban houses the second busiest harbor on the African continent after Egypt’s Port Said. The city sits in the coastal province KwaZulu-Natal, the South African province with the second-largest population, about 11 million people.
The last radiation oncologist employed in Durban’s public healthcare sector quit on Friday, the news channel eNCA reported.
Samuel Mkhwanazi, a spokesperson for the KwaZulu-Natal Department of Health, said in a written statement on Tuesday that for now, some private doctors are assisting patients until vacancies are filled.
“The department is implementing an interim plan to provide treatment to cancer patients at its facilities. This is while it is recruiting for replacements. Oncologists and radiotherapists from the private sector will provide oncology services at the public health facilities,” he said. “The department has already advertised posts to fill vacancies.”
Cancer is one of the leading causes of morbidity and mortality worldwide. Nearly one in six deaths globally is due to cancer, according to the World Health Organization.
“There are indications that South Africa will see a 78% increase in cancer incidence by 2030,” Wallace said.
‘They could not fold hands and do nothing’
In the last few years, the number of public health radiation oncologists in Durban ranged between five and 10, said Dr. Mzukisi Grootboom, a chairperson for the South African Medical Association.
“Two of them resigned earlier this year, and then two more,” he said. “The last one left last week. That’s just in the city of Durban, which services the whole province.”
Many doctors shifted from the public to private sector — even if they never had a desire to work in private — because the working conditions in public health care made effectively treating patients nearly impossible, Grootboom said.
Many of the machines used to diagnose and treat cancer patients were malfunctioning, and left in disrepair despite multiple appeals, he said.
Radiotherapy machines have not been repaired in three years and, and during that time, patients were dying but public health doctors did not have the machinery to help them, said Dr. Mvuyisi Mzukwa, a chairperson for the KwaZulu-Natal coastal branch of the South African Medical Association.
“They could not fold hands and do nothing,” he said.
Additionally, “doctors have left the provincial hospitals because there’s persistent prolonged shortages of staff caused by austerity measures put in place by the provincial government,” Mzukwa said.
“This has led to freezing, abolishing, unfunding of posts, which led to a dire shortage of doctors from 2014,” he said. “These austerity measures by the provincial government have pushed doctors away to the private sector leaving poor patients alone.”
By the time public health officials acknowledged that there was a problem, it was too late and many doctors had quit their jobs, Grootboom said.
“If this situation continues my appeal will then go to the rest of the population and say, ‘We can not allow the politicians to run our services to the ground, like we have seen,'” Grootboom said. “Not only in this province, but in several others.”
Meanwhile, a dismal divide between the public and private healthcare sectors trickles down to patients, where the quality of care received depends on whether you are rich or poor.
Shortages across South Africa
Across South Africa, “the national public health sector, staffed by some 30% of the doctors in the country, remains the sole provider of health care for more than 40 million people who are uninsured and who constitute approximately 84% of the national population,” according to a paper that published in the New England Journal of Medicine in 2014.
The remaining 16% of South Africans have mostly private health insurance coverage, and this group largely includes higher income levels, according to a 2013 report from the WHO.
“Health spending per capita for the insured group is about five times greater than for the poorest 40% of the population, and the poorer population groups are excluded from health services,” the report said. “In this context, even with high levels of total health expenditure, inequity in its distribution is a contributing factor to poor health outcomes, particularly for the low income groups and those without private health insurance.”
This means that challenges and problems with the delivery of cancer care are not limited to the KwaZulu-Natal province, said the Cancer Association of South Africa’s Wallace.
“Across the country, there are shortages of healthcare providers and specialists required to meet the need for adequate cancer control,” she said. “In addition, the health system and infrastructure requires re-engineering to ensure integrated cancer care through screening, detection, treatment, rehabilitation and palliation.”