The Chris Hani Batho Pele Breast Unit

We learn about the first dedicated government breast unit that was established in Johannesburg.

---

About the clinic

The Chris Hani Baragwanath Academic Hospital, located in Soweto, is the largest tertiary hospital in the Southern Hemisphere, with a catchment population of three to four million people.

The hospital’s Batho Pele Breast Unit (BPBU) was the first dedicated breast unit to be established in JHB; it’s been steadily growing in strength since its inception in 2000.

Batho Pele Breast Clinic is an open access walk-in clinic on the second floor of the Baragwanath Outpatient building. It runs every Wednesday from 07H30 till 16H00.

Referrals to the clinic come from a dense network of peripheral primary healthcare clinics and secondary level hospitals within the drainage area.

However, true to the proud Bara tradition and in keeping with the principles of Batho Pele, no patient is turned away, irrespective of where they come from. The clinic only ends when every patient has been attended to.

In 2017, approximately 1100 patients per month attended the clinic, with about 350 new cancer cases diagnosed throughout the year.

Vision

The journey of a woman with breast cancer in SA varies from patient to patient. Those that seek help in the public sector often must navigate past multiple barriers within the healthcare system before reaching a diagnosis and receiving definitive care.

The unit therefore remains committed to providing the best possible care to every patient for both cancer and benign breast conditions. The unit was the first on the continent to become a member of the International Breast Centres Network in 2009.

Multi-disciplinary team

The unit, headed by Dr Cubasch, offers a specialist consultant driven service that integrates the expertise of a multi-disciplinary team.

The multi-disciplinary team includes breast surgeons, radiologists, pathologists, medical and radiation oncologists, plastic surgeons and  nuclear medicine physicians.

In addition, there is a comprehensive support network of palliative care professionals, social workers, breast cancer survivors, genetic counsellors and patient navigators.

Each week, two separate, combined MDT meetings are held, ensuring treatment plans are not only individualised for patients but that all patients receive world-class care on par with international standards.

The clinic staff

The breast clinic is staffed by three consultant breast surgeons, three surgical registrars and between four to six junior doctors.

The weekly clinic is co-ordinated by Sr Tsotetsi, an oncology trained nurse with years of invaluable experience. The post-operative patients and wound dressings in the clinic are expertly taken care of by Sr Khathi and Sr Bekwa.

Quite an essential component of the unit is patient navigators, Nontlantla Mkwanazi and Raynolda Makhutle. They are pivotal in counselling patients once diagnosed, arranging treatment dates and providing a personalised follow-up for each patient.

Prompt diagnosis and treatment

The BPBU prides itself in offering all patients a swift and efficient service. Dr Kuehnast, the head of breast imaging and MRI, ensures that all urgent mammography, sonar assessments and image-guided biopsies are performed within one week of the patients presenting to the clinic.

Other radiological interventions include stereotactic biopsies and hook-wire insertions. Our experienced sonographer, Florence Mahlobo, is based in the clinic to offer a  real-time ultrasound service.

The histopathology department, led by Dr Van Den Burg, provides patients with a reliable histology diagnosis within two weeks.

Patients requiring surgery have no waiting list and are booked on the next operating list for the following week.

Research endeavours

In 2006, an electronic clinical database was established to facilitate oncological decision making and record keeping for newly diagnosed patients, and to keep track of often complex issues that both patients and clinicians have to deal with. This database has enabled the unit to produce first-rate research papers, with both independent NGOs and international academic partners, to further our collective knowledge and understanding of breast cancer and the many factors that influence patient outcomes. The unit has initiated a National Insitute of Health (NIH) funded grant in collaboration with breast centres in Gauteng and KZN.

Outreach

The unit has a robust outreach programme to both the peripheral referral hospitals as well as to the feeding primary healthcare clinics. As such, the unit has observed that the average stage of presentation of patients with newly diagnosed breast cancer has decreased considerably over the last few years.

Pink Drive provides highly valued support to the unit in delivering both mammographic services in far outlying areas as well as increasing awareness.