South Africa's battle to resuscitate cancer care
South African electrician Phiwankosi Mkhize was diagnosed with lung cancer in May last year and told by the hospital to come back for a scan in 15 months.
But after just 12 months he died, before having the chance to receive treatment.
The 66-year-old's fate is far from unique in southeastern KwaZulu-Natal province, the country's second most populous.
Hundreds of patients have died in the region over the past three years as cancer services come under acute pressure following a decision by the provincial government to cut costs and stop recruiting or replacing doctors, say rights activists and doctors.
"Patients who have cancer survive after going for chemotherapy, but for my dad it was too late," Mkhize's daughter, Londiwe, told AFP, days after his death on May 7.
South Africa's human rights commission says patients at publicly-funded hospitals in KwaZulu-Natal wait between five months and a year to see an oncologist and another eight months for radiotherapy or chemotherapy.
Mkhize is "a classic case of a patient who was failed by the system," said opposition Democratic Alliance provincial lawmaker and doctor Imran Keeka.
Indeed, on social media the plight of cancer sufferers in KwaZulu-Natal is referred to as #KZNOncologyCrisis, but the problems are not isolated to the province.
- 'Very distressed' system -
South African Health Minister Aaron Motsoaledi acknowledged this month that the national healthcare system in general was "very distressed", as it battles a rise in cancer cases like in other countries, and a shortage of doctors.
"We are painfully aware of poor, or lack of management skills in most of our hospitals," he said.
He announced funding of 100 million rand ($7.6 million, 6.5 million euros) shared between hospitals in KwaZulu-Natal and Johannesburg to buy and repair machines and hire staff to help clear a treatment backlog.
"We have helped them to hire private oncologists... and the contract is for them to see 450 patients per month, and once the two machines start working, we will contract others to help them," Motsoaledi told AFP.
- 'Died waiting' -
The development came too late for Mkhize, however.
In December, he had gone back to hospital in excruciating pain and been given morphine but told nothing more could be done and to go home as he only had a few days left to live, Mkhize told AFP three months later.
"He was crying like a baby, like anybody would do," said his daughter Londiwe, 28, sitting next to him on a visit to the provincial parliament aimed at exposing his plight.
On that rainy March day, Mkhize, Londiwe, his son and a nephew travelled to the parliament in Pietermaritzburg, 235 kilometres (150 miles) from their village, and sat in the public gallery as lawmakers discussed the cancer care problem.
At least 499 patients in KwaZulu-Natal province "died while waiting for radiotherapy and curative therapy" over a 12-month period between 2015 and 2016, according to Keeka, citing figures presented to parliament by the provincial health department.
The number excludes those who died at home or in palliative care facilities, said the lawmaker.
"The patients we send to hospitals don't get attended to, the cancer advances and they die," said Mvuyisi Mzukwa, who heads the South African Medical Association (SAMA) in the province.
Contacted by AFP, the provincial government declined to comment.
- Resigning out of frustration -
Keeka estimates that KwaZulu-Natal province should have at least 16 oncologists.
But the doctors' association and opposition lawmakers say that, by last year, all but two oncologists in the province had resigned, largely due to frustration at not being able to save more lives, a lack of equipment and an overload of patients.
Overall, South Africa has 38 radiation oncologists working in public hospitals, compared with 147 in the private sector, according to Raymond Abratt, chairman of the South African Society of Clinical and Radiation Oncology.
Abratt said there was now no full-time oncologist at any public hospital in Durban, the provincial capital, and that the crunch in cancer care had been "a major problem for a couple of years".
Speaking on condition of anonymity, a senior doctor working at the Inkosi Albert Luthuli hospital in Durban said government funding had dried up without warning.
A recruitment freeze was put in place and repairs halted for radiotherapy and ultrasound scanners, the doctor said.
- 'Losing people unnecessarily' -
Doctors "felt useless... oncologists decided to resign because they were frustrated. The department is in shambles", said Mzukwa, SAMA's KwaZulu-Natal provincial head.
In the economic hub of Johannesburg, cancer care staff numbers are falling, while the eastern province of Mpumalanga has no oncologist at all, Abratt said.
At a Durban palliative care centre run by the non-profit Cancer Association of South Africa (CANSA), father-of-three Hendrik Prinsloo, 64, from the seaside town of Margate, has cancer of the mouth.
He only began receiving treatment more than a year after his diagnosis, he said.
"You are sent home and you wait. They say they will call you for radiation and they never call," said Prinsloo.
"Unfortunately we lose our patients because of long waiting periods between the time of diagnosis, to the time when they actually receive treatment, or if ever (they get treated)," said CANSA nurse Siphelelisiwe Mabaso.
"It's heart-wrenching, it's devastating. We are losing people unnecessarily."
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