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KZN's cancer crisis increases demand for palliative care

As KwaZulu-Natal scrambles to recruit oncology specialists, treatment waiting lists grow and so too does the demand for specialised care for the sick and dying, reports Bhekisisa.

Durban lost its last public oncologist in June. The doctor had been one of just three state oncologists left in the province after a flood of resignations, a damning South African Human Rights Commission report into provincial cancer services shows.

The report says released just days after the Durban doctor’s departure, the document reveals that, on average, the province lost one oncologist each month over a five-month period. The provincial health department has blamed the exodus of specialists on more lucrative offers from the private sector, but health professionals told the commission that mismanagement was driving specialists away. In a May letter to the department, the South African Medical Association listed cancer services as one of nine public health “crises” that it said provincial health MEC Sibongiseni Dhlomo had failed to address.

In the wake of the most recent resignation, the KwaZulu-Natal Health Department has continued to recruit new oncologists and contracted private-sector oncologists and radiotherapists to provide treatment at the Inkosi Albert Luthuli Central Hospital, department spokesperson Sam Mkhwanazi is quoted in the report as saying. The department did not respond to queries.

Health Minister Aaron Motsoaledi has developed a two-week plan to resuscitate cancer services in the province and the department is working with the provincial treasury on issues such as staffing and procurement, says National Health Department spokesperson Joe Maila.

By the time the commission began investigating oncology services in 2016, patients were waiting five months to see an oncologist and eight months or more for radiotherapy, the report shows. Now, health professionals say some patients are being told they will only be seen in 2018.

The report says whether the cancer is curable or not, palliative care can help patients manage pain and assist with the psychological aspects of serious illness or dying. South Africa’s public and private sectors are almost entirely dependent on nonprofit hospices and organisations for palliative care services, says Julia Ambler, director of the nonprofit Palliative Treatment for Children (Patch).

With only 19 hospices in the province, KwaZulu-Natal’s cancer crisis may overwhelm its ability to provide palliative care. “We’re seeing that patients are being discharged without wound dressings or pain medication. Since there are no doctors, there are no follow-up appointments, so hospices will end up providing that service,” says Sarah Fakroodeen, the medical director for the Highway Hospice.

Fakroodeen says she expects walk-ins and referrals to her organisation to increase in the coming months, but warns that many hospices continue to rely on donor funding, a pool of money that is shrinking as people look at cutting costs in hard economic times.
Highway Hospice is one of seven hospices in KwaZulu-Natal that will receive R60,000 each month from the provincial health department, starting in September, as part of a pilot project. A third of the money will go to training public health employees to provide palliative care. The rest will cover only the hospice’s inpatient care and not the home care her staff delivers. She says the department will have to find a way of reaching these patients.

“There needs to be co-ordination between us and the hospitals so that we can do more home visits and see bed-bound patients. The people that are relatively well can go and queue (at hospitals, but) these people are so frail they cannot even get to the hospital.

In their weekly meeting, the report says Highway Hospice nurses take turns updating Fakroodeen on the sickest of their 600 patients. In a meeting that lasts more than an hour, not one of the 30 patient cases presented does not need pain medication.

But 80km away, at the only hospital that still boasts public-sector oncologists, there is no medicine to treat those in excruciating pain. Grey’s Hospital in Pietermaritzburg is grappling with a stockout of morphine. The opioid forms an important part of ongoing pain management for the illest patients.

Although there may be alternative pain medication for some adult patients, many – including children – will be left without respite, says Andy Gray, senior pharmacology lecturer at the University of KwaZulu-Natal. He explains: “Once patients need a strong opiate like morphine, there are very few alternatives.”

And for those for whom help came too late and who cannot be cured, the promise of a pill can at least mean the hope of a good death.

[link url="http://bhekisisa.org/article/2017-08-25-00-kwazulu-natals-cancer-crisis-fuels-increased-demand-for-end-of-life-care"]Bhekisisa report[/link]

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