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Out of the ashes by Dr. Simamkele Hela
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Out of the ashes by Dr. Simamkele Hela
It’s no secret that South Africa is an unequal society, this is of course very evident in the health sector. When covid struck it exposed some of the frailties within our health system. Read Amani's Community Engagement Director, Dr. Simamkele Hela's lessons learnt as a young doctor in South Africa's healthcare system.

It’s no secret that South Africa is an unequal society, this is of course very evident in the health sector. When covid struck it exposed some of the frailties within our health system. At the peak of the pandemic, services in the health sector which were deemed non essential were either stopped or postponed while the world was learning about the virus and how to mitigate its effects. This strategy was employed by almost every country and most probably saved millions of lives in the process; however it has had its own casualties.

In a country with a fragile health care system like ours, it meant patients with chronic conditions had to make way for those patients who were acutely ill, mostly from covid 19. Surgical interventions were postponed, elective procedures held unless they converted into emergencies, outpatient departments closed or had staff diverted and sadly cancer treatments were momentarily stopped.

In South Africa most of our patients with cancer are diagnosed late (stage 3-4), for several reasons ranging from health attitudes or stigmas, a culture of poor health seeking behavior, lack of awareness and education on risk factors and early symptoms, poor or in many cases non-existent screening, delayed diagnosis due to backlogs in imaging, biopsies (procedurally and the actual processing) and referral to oncology centers, the list is endless. The problem is amplified by other concomitant issues like malnutrition, immunosuppression, HIV and other comorbidities.

These patients require specialized treatments in radiation oncology or medical oncology units. While 85% of all oncology cases exist in the public sector, these patients are served tirelessly by a mere 20% of our cancer specialists in SA. The Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) plays a pivotal role in treating cancer patients. CMJAH provides such important cancer care to the lower Gauteng area, some parts of North West, Mpumalanga, Limpopo and Free State that it is arguably one of the most important cogs in our health system.

For many years the hospital has had a huge patient backlog, with patients having to wait three years in some cases to get treatment. This was not due to just the patient load or numbers, other factors like lack of equipment or aging equipment and understaffing were also to blame. Of course a little bit of corruption added to the problem.

On the 16 of April 2021, a fire broke out on the north side of CMJAH affecting every single one of the five major blocks. Staff had to evacuate 800 patients that night, they were distributed to various other health institutions in Gauteng, split across both the public and private sector.

Relationships were forged between these two sectors because it was deemed necessary for the survival of these patients. The hospital was closed for months until staff demanded that it reopen. The national government was involved and a resolution was reached to start services in July 2021. Fast forward to 2022, some good strides have been made, CMJAH has reopened its oncology services fully, there is new equipment even though still not enough, more staff have been employed as well and there has also been fewer corruption allegations against the management and Gauteng Health Department during this process.

Many patients are still at home waiting for that call from CMJAH to tell them to come for treatment. This wait must be very agonizing to our people, knowing that this call could come too late. This situation is tragic but sometimes we do need to stop and celebrate the small wins.

Addressing health inequality in our country is a wicked problem and cannot be fixed overnight but we can take a moment to reflect and learn. At Amani we are constantly looking to learn because we recognize that we are going to need social innovation to create a future in which no South African is left behind. Out of the ashes of CMJAH I realised two important lessons.

Firstly, social movements do not need to be grand campaigns in the media to deliver change. It can be as simple as a few dedicated staff willing to stand up, reclaim their power and not let up until there’s action. The staff at CMJAH have demonstrated what is possible if we come together in our respective communities.

Secondly, we are capable of finding new models and approaches to address health inequality in our country if we strengthen collaboration between public and private healthcare. We shouldn’t be ok with a system that continues to promote inequality of any kind. The idea of NHI might sound like a gross overreach but if we start cultivating and sharing resources, it might make it less alien when, or if, it finally arrives. In fact nothing stops us from reimagining the health system while we wait!

Finally, I’ve been asking myself how I can do more for my country and the feeling of wanting to contribute only grows as the elections close in.

If you are like me and wondering what you could do, perhaps the simplest thing is start talking to the communities that you belong to, find out what’s collectively important to your tribe and then make a plan to fix it. Incremental changes are better than nothing at all. If you are willing to do that then our team at Amani are willing to support where we can.

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