At age 32, Linda Greeff was a social worker specialising in cancer care. Thirty years later, she remembers how her understanding of treatments counted for nothing when she learned she herself had cancer.
She felt “an overwhelming sense of fear”, largely connected with how her two small children would manage without her if she died.
Linda has since recovered and now devotes her life to helping South Africans receive the cancer care they need. It’s been an almost impossible job, though, given the country’s socio-economic realities.
Still, Linda’s intimate knowledge of cancer drives her daily efforts to help patients. Now the manager of Oncology Social Work Services at GVI Oncology, and co-founder of People Living with Cancer, she talks to Cipla about how South Africa, and South Africans, should fight cancer.
Cipla: How big is the cancer problem in South Africa?
LG: I think it’s reached epidemic proportions. Unfortunately, our country’s reality is that we don’t have a proper cancer registry. This means we have no way of knowing how big the problem really is. Another fact is that, while cancer is a notifiable disease, doctors aren’t adhering to the legislation. Nor is their adherence being enforced. Also, everything is paper-based rather than digital.
Then, there’s the problem of our death certificates not reflecting how many people are actually dying of cancer. Instead, they say someone died from lung failure, heart failure, multi-organ failure or something else. So, while we know cancer kills more people than HIV, malaria and tuberculosis in South Africa, we can only guess the true figures.
Cipla: Many South Africans don’t have medical aid. What sorts of problems prevent them, in particular, from getting proper treatment?
LG: Eight million people have medical aid in South Africa. The other 55 million depend on the government sector.
A friend of mine and I have just completed a qualitative study about the challenges that patients face with regards to cancer. We interviewed 318 people and asked them about their biggest challenges during their cancer journeys.
The biggest challenge was poverty. Others included a lack of transport, the stigma attached to cancer, and poor service delivery (which included waiting lists, broken medical machines and chemotherapy not being available). Then there were staff attitudes and the lack of emotional support at hospitals. In fact, at one big hospital in South Africa, one social worker can be given 2 000 new patients a year! None of these patients will actually see the social worker, though, other than for a grant.
Other problems revolve around the physical challenges of cancer. There are, for example, the side effects like nausea and fatigue. There’s also the loss of a job due to cancer. And for children suffering from cancer, the illness may lead to them being out of school for a year and a half. This could have an impact on their whole lives.
Cipla: What are the problems with primary healthcare clinics in South Africa?
LG: Basically, primary health-care services in South Africa are not cancer-minded. For example, a patient might go in to a clinic with a lump on her breast and be turned away, with the nurse saying, “The lump is too small. Come back later.”
Those nurses and doctors need to be trained to do proper testing. We have to have pathology services. We have to have feedback services. We need a proper medical system.
Also, the referral pathway from a primary clinic to a tertiary hospital can take up to one-and-a-half years. By the time patients get there, they’re terminal. They die. If they had got in earlier, they may have been cured. Early treatment is why I’m here today.
Cipla: What do we need to do to improve cancer treatment in South Africa?
LG: We’re advocating for bigger budgets. We also want the government department to have a national fund for cancer, and not put money into the provinces. That way, cancer care can be equitable across the whole country. We also need to train doctors and nurses to be more cancer-minded.
If we do these things, hopefully service delivery will improve. But we have a big crisis on our hands. Actually, we’ve been fighting cancer without a cancer plan for 15 years already. There’s just a lack of political will to improve things. Consequently, we’ve learned to be more aggressive in our advocacy.
Cipla: You’ve spoken about the stigma attached to cancer. Can you elaborate on that?
LG: It’s a huge problem. If you ask a lot of people about the first thought they had when they learned they had cancer, they answer that they thought it was a death sentence. That’s the belief of the general public. So, it’s very important to showcase survival and to show people that if you get treated early enough, there’s a very strong chance of beating the illness. And that you can live for a very long time afterwards.
Cipla: What does it take to beat cancer?
LG: I think it takes tenacity. You have to make a decision of your will, and you have to become empowered.
Regroup and come up with a plan – a plan that covers all the areas of your life. It has to be a plan for your health, your spirituality and your diet too. It also has to include your close relationships, a way to deal with emotional baggage that you might have, some fun activities, and a plan for your career and goals as well.
Lastly, and without it sabotaging your life, you have to include preparing to depart this world one day. But again, with the right treatment, you can live a long, full life.