It was a sunny Sunday afternoon and Mr Dlomo was sitting in his yard under the tree, drinking his umqomboti (traditional beer) when he felt a lump in his right breast. He recalls not thinking anything of it and did not even see the need to tell his family as he was too busy travelling across the country as a truck driver.
His wife asked him, seven months later, “Baba why is your right side of the chest bigger than the left.” Trying hard not to mention the word breast since in an African culture a man does not have breast (ibele), so she respectfully called it an isibele. She begged him to go see the nurse at the clinic, which was a battle as most nurses in the village were women.
On his first day at the clinic, the line was very long and he didn’t get treatment. A week later they saw a GP who started him on antibiotics to treat his right breast for an abscess. This was a very costly process and his job as a truck driver took him away from home for a month. He assumed he was healed and waited for this mass to reduce in size. Four months later he felt some lumps under his arm and the right side of his neck while taking a shower.
He went back to the clinic where he was given a booking to go see the doctor at a nearby hospital in a month’s time. While he was waiting for his appointment a close friend took him to the nearest traditional healer, within walking distance away from their home, who needed no prior booking. He was diagnosed and treated at the same time.
Back at the hospital, his doctor sent him for scans and then decided to perform a mastectomy. Mr. Dlomo consulted with his family before signing consent and slaughtered a goat for his ancestors to ask for protection while undergoing surgery.
When he came back coughing badly, he could not be offered surgery as the cancer had spread into the lungs. His CT can (that has a one month waiting period) showed that he had pulmonary metastases. He then received three cycles of chemotherapy that were severely interrupted by septic neutropenia. He did not complete chemo and never came back after the third cycle. On calling his number, there was no response. We had lost him as his home had no proper address. He also lost his job as a truck driver.
These are challenges we are faced with when working with rural patients. They are delayed for months at the local hospital after that they are delayed as they wait to see a doctor. In addition, they are delayed for another three months while they wait for their histology reports before they are delayed again before receiving surgery.
To get a booking to see an Oncologist takes another two months, while they wait for another CT scan, and a chemo booking takes another month.
It is a very long process that promotes development of metastasis.We need to stop delaying treatment and losing patients.
Written by Dr Thandeka Mazibuko