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Dr. Sebathu Chiyapo; The first Motswana Clinical Oncologist



Clinical Oncologist Consultant at Gaborone Private Hospital (GPH), Dr Sebathu Chiyapo, is the first Motswana clinical oncologist. He talks to RACHEL RADITSEBE about one of the most dreaded diagnoses – cancer!


Let’s get to know you a little bit better. What brought you to Oncology? When did you realise that you wanted to help in this fight against cancer?

Chiyapo. I was born in Francistown many years ago. I am a Clinical Oncologist by training specialising in treatment of cancers using all available modalities. I did my undergraduate training in Trinidad and Tobago. 

I had always wanted to be a surgeon. I was very good with my hands so I thought surgery was my calling. But when I was doing my internship at Nyangabgwe Hospital in Francistown I realised there was a gap in Oncology in Botswana and it was one of those specialties which was unknown in Botswana so I took the challenge. I decided to be an oncologist instead. 

Describe the cancer landscape in Botswana?

I would say the landscape of cancer in Botswana is still at grassroots level. There is still a lot to be done. Currently for screening protocols the only programme in place is for cancer of the cervix. We still don’t have proper and adequate screening processes in place. Most of our patients – at least 65 percent or so – present to our services with stage 3 or 4 cancer. With these advanced cancer stages on presentation, the treatment outcomes will also be terrible. So there is a lot of work that needs to be done to our primary health care and public health care systems. There is need for proper consultation and involvement of all stakeholders.

What measures would you suggest to bring down the cancer ratio?

Globally the cancer incidence is increasing and the increase is more in developing countries. Most cancers and cancer related deaths are due to lifestyle and modifiable factors. These factors include things like excessive alcohol intake, smoking, dietary factors, sedentary lifestyles among others. These factors can be modified and that can help to reduce the incidence of cancer. The country also needs to establish some early detection and screening policies. These policies and guidelines may help health care workers and the public to work together in the fight against cancer. There needs to be some awareness campaigns and the parastatals organisations and the community needs to work hand in hand with the government in the fight against cancer.

Tell us something about your achievements. A case you are most proud of maybe?

It’s difficult to look back and point out to one single case and say wow! But generally, some of the things at which I will look back and be happy about will be the legacy I left at Princess Marina Hospital or some of the contributions I made; notably the establishment of the Multidisciplinary Clinics in Princess Marina Hospital which are still functional and improving the landscape of cancer clinics in Botswana. These are specialised clinics where all concerned specialists are in the same room and all seeing patients together and making treatment plans together. They include the Gynecology-Oncology clinic which focuses on female cancers; Breast Multidisciplinary Clinic which focuses on breast cancers; Head and Neck Cancers which focuses on all head and neck cancers.

In seeking the professional advice of a physician, patients typically experience certain levels of anxiety and emotional distress. And although any diagnosis can be a cause for worry, none is more feared than a cancer prognosis. Can you share your experiences/observations when dealing with cancer patients especially where the cancer is deemed terminal?

Rightfully said; after diagnosis of cancer, patients undergo variable anxiety, emotional distress, depression, emptiness and feelings of hopelessness among others. During consultations we do observe a lot of reactions to the diagnosis. Most patients start crying inconsolably during the consultation. We try to give them time and it’s usually easier when they come with a relative or caregiver for support. Some patients just stare and say nothing for a while and we have to give them that space to digest and accept the news. In its own right, cancer is a dreaded disease but it’s not always terminal. Depending on the type of cancer, the stage of cancer and other patient factors, most patients can actually go on to lead a normal life that is cancer-free. We do actually have patients who have been treated for cancer over 20 years ago and they are still alive and living their lives to the fullest.


Many people still see cancer as incurable or terminal; kindly share and elaborate on the advancements that have been made in the field of cancer prevention, screening and therapy over the years?

Cancer is still one of the leading causes of death globally, including in Botswana. With all the advances that have been made over the years, cancer mortality is sill very high. In developing countries the mortality is higher than in developed countries. There have been a lot of new developments in the newer treatments including chemotherapy, radiotherapy, surgical techniques and targeted agents. Nowadays we are trying to avoid the one-glove-fits-all type of approach in cancer management. We try to personalise the treatment to an individual based on their personal needs and disease characteristics. This has helped to improve the treatment outcomes. Technology has also improved quite a lot, which has also revolutionised our treatment approach and treatment plans.

What kind of therapy do you administer during pregnancy?

Cancer treatments usually have a lot of side effects. In pregnant women in particular, we face a unique challenge of having to try to minimise the potential harm to the unborn child from either chemotherapy or radiotherapy. In cases of pregnancy, radiotherapy or chemotherapy can be given with special considerations. The gestation period is very important in deciding to give chemotherapy or not. Chemotherapy is usually discouraged during the first trimester of pregnancy but can be given from the second trimester onwards. Radiotherapy to the upper abdomen and upper body can be given with special shielding to the pelvic area. We usually assess the type of cancer, the aggression of the cancer, the gestation period and assess if there’s any need for termination or if we can proceed with treatment.

Do you give recommendations on treatment options available to your patients? What are your thoughts on Naturopathy for example?

Yes we always do. We discuss all the available options with patients and with relatives or caregivers. All available options are discussed as well as their pros and cons. But unfortunately not all recommended treatment options are always readily available. So sometimes we have to work best with what we have and what is also recommended but ensuring patient care is not compromised. When it comes to Naturopathy, I have no formal training in that regard so it’s difficult to comment but usually if patients want to use some herbal products, I have no problem – as long as they don’t stop their prescribed cancer treatment. You have to look at the patient holistically and allow them also to practice their beliefs and religion but without compromising patient care.

What do you do when a patient does not want the conventional treatment? Chemotherapy for example, has a bad rap and some people even fear going through it.

Unfortunately we never force a treatment down any patient’s throat. It’s a dialogue that we involve the patient, caregivers or any other concerned people. We want the patient to feel they made the decision about their treatment at the end of the day, the patient must be part of that decision making process. There are many instances where patients refuse to do the treatment or part of the treatment either being chemotherapy, radiotherapy or surgery, especially if the surgery involves removal of very intimate parts of the body. We always make an effort to involve social workers, psychologists, psychiatrists if patients can’t make decisions. Sometimes we even recommend that they see another doctor for second opinion. But at the end of the day we respect what the patient wants even if it’s not a wise decision. If at the end of the day they come back, we receive them with open arms and proceed if they have changed their minds and want to start treatment.

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‘It breaks my heart to see my child sick’

Keletso Thobega



A CRY FOR HELP: Young mother Lesedi Pilane is appealing for help as she seeks to get her child healed. The liver transplant will cost P400 000

A Mochudi mother of a baby with liver disease is praying day and night for her child to get a liver transplant. A sick child is every mother’s nightmare. All one can do is hope for the best. This is the situation that 23-year old Lesedi Pilane finds herself in. Pretty with beady bright eyes and soft features, the soft-spoken mother is heartbroken by the pain and anguish that her child Rorisang Nathan Pilane endures.

Rorisang is in the progressive stage of liver disease and needs an urgent liver transplant. When Pilane spoke to The Midweek Sun yesterday, she had just returned from a check-up at Princess Marina hospital. Mother and child are currently at Deborah Retief Memorial hospital in Mochudi where baby Rorisang has been admitted since 1 January 2019. Pilane and baby have been in and out of hospital for the past few months since Rorisang was diagnosed with biliary artesia (liver disease) at three months old.

Biliary artesia is defined as a rare disease of the liver and bile ducts that occurs in infants and is characterised by obliteration or discontinuity of the extrahepatic biliary system, resulting in obstruction to bile flow. This progressive liver problem is a chronic disease that often becomes evident shortly after birth with signs of yellowing of the skin and whites of the eyes (jaundice). Bile eventually builds up in the liver and damages it, leading to scarring as well as loss of liver function and tissue.

The unemployed Pilane seems overwhelmed by the situation and admits that it has been a tall order to come to terms with living with and taking care of an ill child. Pilane is however taking it all in her stride. After her child was born, she did not suspect that anything was wrong. They went for the usual six weeks check-up after birth and the nurses also gave them a clean bill of health.
“I only realised that something was wrong when the baby’s eyes started turning yellow and his urine was also dark yellow. His tummy was also stiff and slightly swollen. I found this strange and that is when I went back to the clinic.”

That is when Pilane was given a referral to Princess Marina Hospital where they confirmed that Rorisang has biliary artestia. Pilane went to register Rorisang at the transplant unit.
At four months old a Kasai operation (surgical treatments performed on children with biliary artesia) was done on Rorisang but it was not successful. They told her that operations of this nature are often done when a child is two months and below. “At Princess Marina hospital, I was told that his liver was already damaged so he needs a liver transplant. I was even told that the situation was so dire that he would live up to a year and a half.”

She did not receive any assistance. She was informed that the doctors were attending a workshop in India. After some time she was contacted and told that she could be his living donor if a donor is not found. “We did tests and everything seemed to be going well. They told me that they had taken the blood samples to a lab in South Africa but never heard from them again.” Pilane says that they were admitted at Princess Marina hospital in March last year.

In April an operation was done on Rorisang to drain bile from the liver. Rorisang was given medication to support his liver but she says it is not working as his situation is still deteriorating.
Pilane was informed that a liver transplant in India costs P400, 000 and P1.3 million in South Africa. Pilane, who is unemployed, survives off the generosity of family members, who she says have been supportive.

She says it is difficult to leave him with anyone else. “He does not cry or complain when he is sick so it is difficult for those who do not know to take care of him. I know that once he sleeps often or looks drawn then it means that he is not feeling well.” Of late, baby Rorisang has not been eating well. “He only drinks milk. He has now lost a lot of weight. Dieticians have recommended him diets and ordered him some foods but he refuses to eat and if you force him to, he actually vomits,” his mother says.

Oddly, a few months ago, baby Rorisang could gain a kilogramme per day. The doctors told his mother that this was because of water accumulation and explained that it was not good as it would compress the organs such as the lungs and make him struggle to breathe. “They said we could lose him before the operation so they suggested that he be medically tapped in order to reduce the water.” Baby Rorisang still faces medical challenges right now.

His eyes, private parts and legs are swollen but his size has reduced since the tapping. Pilane says that she is unsure what the current state is with the liver transplant. “I was told that government only funds one liver transplant patient per year. My particulars are with them so I do not know whether they will assist me.”

On Monday, Pilane was contacted and asked to come to Princess Marina Hospital for a blood test and cross match. She is praying for a breakthrough for her child and in the meantime she takes each day as it comes. “I can’t eat, I can’t sleep. I am stressed. I have put all my faith in God.” At the time of going to print, Pilane was still waiting for a response regarding the possibility of a liver transplant.  She has also received request to assist from a few people and has already sought assistance to get a trust fund account opened for Rorisang.

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UNLIKELY SIGHT: Former DIS Director Isaac Kgosi was arrested on Tuesday night by DIS agents led by his successor Peter Magosi

The arrest of founding Head of Directorate of Intelligence and Securty Services (DISS), Isaac Kgosi at Sir Seretse Khama International Airport (SSKA) Tuesday night adds a new twist in the ominously dangerous local political climate.

Kgosi was arrested in the airport lobby as he pushed his luggage trolley immediately on arrival from South Africa yesterday night by DISS agents led by the new spy boss, Peter Magosi.
He was then handed what appeared to be an arrest warrant, which he read before being handcuffed amidst protestations that the DISS had invited the Press to embarrass him in a public spectacle.
After a brief spell Kgosi succumbed and was whisked away to Mogositshane Police Station where he would be read his charges. He was overheard telling Magosi he was going to “topple this government, I promise you,” a threat which in law constitutes treason.

At the time of writing, Kgosi’s lawyer Unoda Mack and one of Kgosi’s close relatives were said to be at the airport. The arrest happened on the fifth day of President Dr. Mokgweetsi Masisi’s private visit to his Mozambican colleague, Filipe Jacinto Nyusi. Masisi is due to arrive home today Wednesday January 16th.

Kgosi’s arrest is bound to exacerbate the rift between President Dr. Masisi and his predecessor, Dr. Ian Khama. Their feud – initially over a perceived refusal of the state to avail Khama air travel for his personal and official chores – broke irretrievably when Masisi fired Isaac Kgosi from the public service.To make matters worse, Masisi also declined Khama’s overtures to hire Kgosi as his Private Secretary. Parallel to this feuding, the state was busy investigating corruption and money laundering charges against Kgosi and his alleged involvement in the National Petroleum Fund (NPF) scandal.

Kgosi was appointed by Khama during the latter’s presidency. He is not only a close personal friend of Khama but also worked with him at the Botswana Defence Force (BDF). A renowned sniper (marksman), Kgosi’s DISS was the embodiment of fear.

The spy agency was described as a law unto itself and despised for eavesdropping on people’s conversations and alleged acts of terror including extra-judicial killings. His arrest and possible prosecution during an election year signals the state’s unflinching commitment to instil the rule of law and restore public confidence in oversight institutions.However, this could provoke a long drawn-out battle between the antagonistic factionsof the ruling Botswana Democratic Party – the pro-Khama New Jerusalem and pro-Masisi Cava – with the sum effect of compromising public service delivery. It is no secret Kgosi is on the side of Khama, and that Khama depends on Kgosi for his exploits.

Yet again, the arrest is the administrtaion’s unambigous message that it has thrown down the gauntlet for the perceived purveyors of corruption to take up. It remains to be seen how Kgosi will react. He allegedly told Magosi Tuesday night, “You are forcing me to do things I never intended to do,” what these things are, is known only to him. However, on the political front there is general foreboding that feeds the lust of doomsday prophets.

The country’s eminent citizens among them the thrid president, Festus Mogae as well as former Vice Presiddent Ponatshego Kedikilwe and property magnate, David Magang have joined the fray on the side of President Masisi in the protracted Khama/Masisi impasse. And just like at the height of the legal brawl between the State and former Debswana boss, Louis Nchindo – Mogae will not harbour any secrets – not least concerning Khama’s ill-fated succession plan and Masisi’s role in it.

Suddenly, the internal power struggle in the BDP has become a national security threat and a cancer that threatens to eat away the gains made in the country’s 53 year history as a democracy.
Conversely, it has emboldened others and awakened the allure of contestation in former minister Pelonomi Venson-Moitoi to challenge Masisi for the party’s presidency at this year’s July national congress, which thing, some watchers dismiss as “absurd” while other pundits, such as foreign minister Unity Dow, see Mma Venson as a decoy or proxy for Khama’s grand comeback to the presidency.

Khama has however denied attempts at pulling a ‘Putin”- that is, returning to the presidency after his constitutional term has expired.
Just as the Sybilline Oracle warned the Roman Emperor Julius Caesar about the Ides of March, the BDP was forewarned by a Zambian ‘seer’or prophet; long ago about its eventual collapse, which is eerily becoming imminent with the passage of time.

Some may say, the Botswana Democratic Party made its bed when it recruited Khama into politics from the military and must now lie on it. But the reality is that the Khama/Masisi feud risks tearing the county asunder. A Tswana dictum counsels that there can be no two bulls in a kraal at the same time, and in like manner, there can be no two presidents in a republic or two centres of power. This is the warning that all the eminent BDP leaders have sounded to the nation and the party.

President Dr. Masisi stirred the hornet’s nest and rattled the interest of white monopoly capital last year when at the height of the elephant poaching scandal, that made international headlines, he disamrmed the Wildlife Protection Unit.

He also had the audacity to set up a plebiscite to gauge the people’s views regarding the ban on wildlife hunting, which had been a permanent feature of the past adminstration. The disarming of the Unit particularly carried a sting with Khama, himself an avowed conservationist and distinguished fellow of Conservation International. And all these actions that seem to go against the wishes of Khama and his loyalists, threaten to plunge the country into a state of disrepair, for they will not take the latest arrest lying down. Khama will surely react, and the nation should be on the alert.

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