Bringing cancer care to Soweto

The Soweto Comprehensive Cancer Centre of Excellence is the township’s first cancer treatment center

April 26, 2022

Last summer, just three months after finishing her oncology training, Dr. Thina Mathiba was asked by her mentor to take the reins of the brand-new Soweto Comprehensive Cancer Centre of Excellence, which was about to open in the midst of the surging pandemic. “I asked Professor Ruff, why did you pick me?” Dr. Mathiba recalled. “He just said, ‘You will be the right person for this enormous task.’ And now, I have the chance to be part of something new that’s never been offered here before. I was raised in Soweto, I did my early training here, and this was an opportunity for me to come back to serve my community.”

Cancer care

It was a community in desperate need of a cancer treatment center. The new facility — located in a wing of Soweto’s Chris Hani Baragwanath Academic Hospital formerly occupied by a podiatry clinic — quickly became known for the quality of the care and the kindness of the staff. Within a few months of opening, the center had seen 400 patients — which meant Dr. Mathiba herself, as the facility’s sole oncologist, had seen 400 patients. Handling a caseload like that takes energy and compassion — qualities Dr. Mathiba has in abundance.

The doctor’s patients realize how lucky they are. Dorcas S., currently halfway through her chemotherapy treatments for breast cancer, lights up when talking about her. “When I met my beautiful doctor, I was so happy!” she said. “She gave me a shoulder to cry on. I had been told I needed chemo. I didn’t even know what chemo was! Dr. Mathiba explained it. I could ask her anything, and she told me everything. I say thank God I am in the right hands.”

To understand how significant this new treatment center is, context is helpful. Soweto’s population is 99% Black, and the township includes many of the poorest neighborhoods in the province of Gauteng, South Africa’s smallest yet most populated province. Zulu is the township’s dominant language, with only 2% of inhabitants speaking English as their first language.

Before the Soweto Comprehensive Cancer Centre of Excellence opened, there were just two cancer treatment centers in the entire province, with a population of nearly 20 million. Soweto residents who received a cancer diagnosis (and couldn’t afford private medical care), had two options for a treatment facility. They could travel to Johannesburg, or they could make the journey to Pretoria. In neither place would they be likely to find a staff member who spoke their language.

Let’s say an individual’s treatment plan includes eight rounds of chemo, one every three weeks. The trip from Soweto is a long and expensive bus ride away. And when you get there, you don’t see anyone who looks like you, you can’t read the signs, and you have difficulty understanding what you are told. It’s easy to see why many patients don’t follow through on their treatment. As Dr. Mathiba pointed out, the barriers are both logistical and political. “These two facilities were built during apartheid, to serve Caucasian patients. The barriers of apartheid have fallen, yet in a way they still remain. The reality is, before our center opened, cancer patients in Soweto were largely unable to access treatment.”

The diagnosis for AFib isn’t complicated, but how you manage it gets to be extraordinarily complicated.

Dr. Gehi and his team created a new program, launched via Zoom right in the middle of the pandemic, in which two groups of forty physicians, nurse practitioners, and physician assistants spent six months with weekly video conferences, being educated on AFib treatment best practices. The impact has been significant. “If we train 40 providers, that translates to 2,500 patients getting better care,” said Dr. Gehi. “And that means fewer strokes, fewer ER visits, and better quality of life for a lot of people.”

If you traveled due east 150 miles from Chapel Hill to the small town of Lenoir, in the foothills of the Blue Ridge Mountains, you’d find a family doctor who would agree wholeheartedly.

Dr. Robert Reichling has been serving that community for more than twenty years, with a practice that serves mostly elderly patients, who are at increased risk of atrial fibrillation and therefore of the strokes that are the most dangerous consequence of the heart condition. He estimates that he sees three or four AFib patients every day. Dr. Reichling recently completed the UNC training program, officially called the Atrial Fibrillation and EKG Interpretation TeleECHO Clinic.

“The diagnosis for AFib isn’t complicated, but how you manage it gets to be extraordinarily complicated,” Dr. Reichling said. “The range of treatments available has just exploded in the years since I was in medical school. But if you’re not in a university hospital, you don’t necessarily know enough about all the treatments that are available, whether it is left atrial appendage occlusion, or ablation, or even standardized templates for reading EKGs. I’m now much better equipped to manage the care of my AFib patients. And when they do have to see a cardiologist, I’m able to give the specialist a much more in-depth picture of the patient so that they don’t have to start from scratch developing a treatment plan.”

Dr. Gehi’s goal has been to improve the standard of care for atrial fibrillation patients, especially among underserved communities like the one Dr. Reichling serves. It’s clear he’s benefiting not only patients but the healthcare providers as well.

“Sometimes you kind of trudge through your day and don’t think you’re making any impact,” said Dr. Reichling. “But the UNC program really reinforced the importance of the primary care physician and gave me tools to help me provide the level of care my patients deserve.”

The success of the AFib Clinic has Dr. Gehi thinking about what’s next. “What we’d really like to do is expand our outpatient provider training program across a lot more of North Carolina, but focused on underserved communities. We think that’s where we have the most potential impact moving forward.” If what Dr. Gehi and UNC Health Care have accomplished so far is any guide, North Carolinians can expect to see some very positive developments in the understanding and treatment of AFib.