Waiting and more waiting. That is how Thato Moncho, a breast cancer patient has spent the last four years on the waiting list for radiation therapy at Charlotte Maxeke Johannesburg Academic Hospital. Then came the devastating news: her cancer has spread.
The 40-year-old Moncho who resides in Soweto, Gauteng, was diagnosed with a rare, rapidly developing cancer that makes the breast red, swollen and tender, most known as inflammatory breast cancer.
Soon after her diagnosis on 17 September 2020 at Helen Joseph Breast Clinic (HJBCC), Moncho was immediately put on treatment, which she completed on 9 April 2021. She underwent nine circles of chemotherapy, a cancer treatment administered by an oncologist or haematologist.
On 10 May 2021, Moncho had her first surgery to remove lumps on her right breast and she was supposed to have undergone radiation soon after. However, it never took place.
While still waiting for radiation, Moncho had her first reoccurrence of the cancer on 16 September 2021, and she was put back on chemotherapy treatment.
Little did she know that she was bound to have three more reoccurrences while still waiting for radiation therapy. On the occasions that she experienced reoccurrence, she was put back on chemotherapy treatment again.
A year after her first surgery, on 20 May 2022, Moncho’s right breast was removed.

Six weeks after the mastectomy, she was again supposed to have radiation therapy at Charlotte Maxeke. However, it never took place and she continued to wait for her turn.
At the end of May this year, after years of waiting, Moncho was finally seen by a clinical oncologist who specialises in radiation oncology at Charlotte Maxeke.
The mother of one who works as a gym fitness trainer was left with devastating information.
A little too late
Moncho was told that it was too late for her to undergo radiation therapy as the cancer had already spread to other parts of her body, including her lungs, and radiation was no longer necessary.
Moncho says due to the failure of the state to administer radiation on time, she will have to take chemotherapy tablets for the rest of her life to manage the condition and failure to do so might lead to her dying.
“I am still in shock and still finding it difficult to process all this information. It is difficult for me to understand all this. The health ministry has failed me terribly, my dreams and hopes are shattered now because of them,” says Moncho.
Moncho says during the years she waited for radiation, she used to frequently visit Charlotte Maxeke to enquire on why it was taking too long.
“They used to tell me that my turn will come, but look now, I waited all these years, only to be told that it can no longer be possible for me to have radiation. I suffered severe pains all those years while waiting, something which could have been prevented had they performed radiation on my body,” says Moncho.
“Over the years I have seen cancer warriors lose their lives while waiting for their turn to have radiation and I live with fear as I do not know who is next. Something needs to be done urgently to ensure that we access the timely treatment.”

What is radiation and why the wait?
The Mayo Clinic describes radiation therapy as a type of cancer treatment that uses beams of intense energy to kill cancer cells.
Salome Meyer is the Cancer Alliance project manager of the Access to Medicine campaign. Cancer Alliance is an NGO which advocates for the provision of cancer treatment. She says radiation units within public health facilities are expensive to establish.
“The equipment costs a lot – I do not have the exact costs – but each machine has to be housed in a bunker to make sure that exposure to radioactive material does not happen,” explains Meyer.
Meyer says for patients to be treated with radiation, a team of specialists, consisting of a physicist who manages the machines, radiation oncologists who work out the dosage each patient must receive, and radiotherapists who do the actual treatment, are required.
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“Machines have to be calibrated regularly and also have a maintenance contract in place; it is the same principle that applies to a car,” she says.
According to Meyer, to treat one patient with radiation can cost from R90 000 to R200 000, while to treat a single patient with chemotherapy can cost from R250 000 upwards depending on the type of cancer.
In the public sector, Meyer explains, whether chemotherapy or radiation, patients must be fitted into the available schedules.
She says, “For chemo, it is usually easier to fit new patients in but for radiation, it is all dependent on the available spaces with the number of machines and qualified staff that the specific treatment centre has. Usually, a waiting list can be anything between three to nine weeks and that is also for surgery.”
However, this was not the case for Moncho as she waited four years for radiation which never took place.

Shortage of cancer specialists
Lucy Balona, the head of communications and marketing at the Cancer Association of South Africa (Cansa), says there is little equity of care for cancer patients in South Africa as there is an absence of treatment centres for each of the nine provinces.
According to Balona, well-equipped public health facilities such as Charlotte Maxeke end up having a critical backlog as cancer patients are often transferred from other provinces in search of treatment.
“Inequities are a reality for cancer patients in South Africa and are being driven by a severely embattled public health system, constrained by inadequate funding, along with a shortage of technically skilled oncology staff required to effectively deliver this highly complex treatment,” explains Balona.
Meyer says the backlog of patients waiting for radiation at Charlotte Maxeke happened because of equipment that had to be replaced.
“This resulted in patients on the waiting list being pushed further down to accommodate new patients that require treatment. And they always prioritise patients that require palliative care, radiation is part of pain management,” says Meyer.
According to the National Cancer Registry (NCR), the top five cancers affecting women in South Africa, include breast, cervical, colorectal, uterine, and non-Hodgkin’s lymphoma.
Balona says the lack of affordable, effective, and quality cancer services, which enable early diagnosis, appropriate treatment, and care, often means that patients in lower-resourced areas will suffer and die unnecessarily.
Foster Mohale, the spokesperson for the health ministry, says the country does not have sufficient cancer specialists.
“The fact of the matter is, the country doesn’t have sufficient oncologists in the country, mostly provinces like Mpumalanga, Northern Cape, Limpopo, North-West, KwaZulu-Natal and Eastern Cape,” he says.
“The department continuously engages with the National Treasury on additional funds or budget to achieve this goal,” says Mohale.
Attempts to get comments from both the Gauteng health department and Charlotte Maxeke Hospital on why Moncho had to wait for years for radiation therapy, failed.
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