The KwaZulu-Natal health department's failure to pay a maintenance contract for two radiotherapy machines has robbed hundreds of cancer patients at a Durban hospital of the critical treatment they need.
The department did not respond to requests for comment on accusations it was not paying because a R120 million tender for the state-of-the-art machines was fraudulently obtained.
The non-payment meant about 100 patients a day who would have received the treatment at Durban's Addington Hospital had been referred to Inkosi Albert Luthuli Hospital over the last four months.
Prof Amo Jordaan, who headed up Addington's oncology department since 1980 and quit last year over the failure to keep the machines operational, said up to 100 patients daily had been receiving radiotheraphy when the machines were up and running.
Also, it had seen Addington Hospital's waiting list for cancer treatment cut from eight months to two weeks.
"I became aware late last year of the fact that the provincial government was not paying the service contract of these very expensive machines, which was part of the tender award."
He said when he queried the non-payment, fearing his patients would be compromised should the company Tecmed stop servicing the machines, he received no response.
He said he found the answer in an interview KwaZulu-Natal health department head Dr Sibongile Zungu had with Durban's afternoon newspaper, the Daily News.
Criminal investigation underway
Zungu told the newspaper in December the department was investigating the R120 million tender and that a criminal investigation was underway. She told the newspaper the tender for the machines was put out in the 2008/2009 financial year and awarded in 2010.
Questions put to the department of health went unanswered. Despite several phone calls and e-mails sent on April 2, 3, 5, 11 and 26, no comment was forthcoming.
National Prosecuting Authority spokeswoman Natasha Ramkisson declined to comment on the tender. Hawks spokesman Paul Ramaloko said he was not aware of any investigation.
Jordaan said: "I am not aware of any accusations made in court or any person or company sentenced in court for corruption in the oncology contract."
Zungu said in the newspaper interview the department was investigating whether the machines had been sabotaged. However staff members, including oncologists and radio therapists, denied this.
Jordaan, as well as several of the staff members, spoke to Sapa on condition of anonymity out of fear they would lose their jobs.
Jordaan said the two machines Varian Rapid Arc Linear Accelerators --did not damage tissue next to a tumour and were much quicker than any other machines the department had.
Jordaan said the KwaZulu-Natal health department only offered radiotherapy at Grey's Hospital in Pietermaritzburg and the province's flagship Inkosi Albert Luthuli Hospital.
Only one other hospital in the country had similar machines.
Jordaan said he did not see any reason for the machines not to be operational while investigations were underway.
An oncologist said: "To be diagnosed with cancer and then told you can't be treated until it's too late... I don't know if we are doing a disservice."
Staff kept in the dark
He said staff had been "completely kept in the dark", but "we are the ones facing the patients. And they all ask what's going to happen to them in that time".
He said one of Albert Luthuli's three machines would be out of service for a month as it underwent maintenance, leaving the provincial health service with only three of its six radiotherapy machines in operation.
One patient kicked up a fuss about not receiving treatment, which prompted a senior official in the KwaZulu-Natal premier's office to intervene.
A copy of the senior official's e-mail sent to Addington Hospital management reads: "The patient is seriously depressed and thinks we as a government don't care, especially looking at when she was diagnosed until now, we keep on moving the date [for radiotherapy] and in a way we are giving her a death sentence."
In its reply, the hospital confirmed she was an oncology patient and had been referred to another hospital. The hospital said "the radiation treatment machines at Addington broke down and these cannot be fixed immediately due to the... (contract) which needs to be finalised between the company and department of health".
That patient, Octavia Zuma, 57, said on Friday morning, before she was due to be taken to Inkosi Albert Luthuli Hospital for treatment, that she had been diagnosed last June with cervical cancer and had begun treatment on March 5.
"I had to wait because I was told that the machines here are not functioning properly and that there is a backlog. So I had to wait a long time before they called me in for treatment." She was concerned she would not be going home to her four children in Hammarsdale.
"I was supposed to only be here for six weeks and this is my fifth week but I don't think I will be going home anytime soon."
From radical treatment to palliative treatment
A senior staff member at the unit, who also spoke on condition of anonymity, said she believed since the machines had stopped working, about "50 to 80 patients have come down from radical treatment to palliative treatment".
Jordaan said with radical treatment the aim was to cure a patient, whereas palliative was meant to address pain and suffering before the patient died.
One radiotherapist believed Addington's waiting list had increased to between four and five months since the machines had stopped operating at the start of the year.
She denied the machines were sabotaged. "It's like having a car which is not maintained. Obviously it's going to give up at some time.
"We are actually going for psychological counselling... I think they [hospital management] noted there's been a change in our characters. There's been one too many outbursts from staff."
She said all the hospital's 15 radiographers, who were commuting daily to Inkosi Albert Luthuli Hospital, were receiving treatment. She said she was witnessing patients arriving in "a more deteriorated state" and patients who arrived in January would only receive radiotherapy in August.
"Somebody who could have been cured in January and February is now coming in August [for treatment] as maybe a palliative [patient]. We are trying to stop your symptoms and that is it."
The staff, including Jordaan, praised Tecmed and the service provided.
One radiotherapist apparently also quit and entered the private sector.
Tecmed Africa denied any impropriety in the tender process. Dave Smit, the Tecmed director involved in the installation of the machines, said three years ago the company had been asked by police and health officials for documentation, which was then provided. He had not heard anything since.
Smit said the company had continued servicing the machines for another 10 months after the department stopped paying the service contract. He said the department had been warned maintenance would be stopped.
The contract was part of the tender and entailed Tecmed servicing the machines for five years, with the company being paid monthly for its work. Smit said it would take two hours to get the machines up and running.
According to the Daily News the department had paid a monthly R400,000 maintenance fee since the machines were installed in 2010, but the department could not find the contract detailing what Tecmed's obligations were.