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.
BATTLE FOR MMADIKOLO
University of Botswana students are bracing themselves for the Student Representative Council (SRC) elections. Contenders are fighting tooth and nail to appease the electorate. Three camps are in contention to fill the 13 council positions.
Umbrella for Democratic Change’s (UDC) Moono-wa-Baithuti has the onerous task of defending all the 13 seats which they hauled at the last elections of 2018. “As Moono wa Baithuti, we have lots of achievements. We are on the verge of getting the student bar open, so we need to go back and fix what we started,” said UDC’s Tumelo Legase who is vying for the position of Vice President.
He said they have advocated for student empowerment policies and are also proposing a third arm of student representation. “We have the SRC and the Judiciary, what we need is the student Parliament so that we have a large number of leaders who can independently attend to problems across the university.” The dark horse in this race is the University of Botswana’s Alliance for Progressive (AP) which will take another leap of faith despite their loss in the previous election.
They are rejuvenated and redefined. Candidate for Vice President Karabo Bokwe said central to their mandate is making the welfare of the student community a priority. “We want to help eradicate school policies that border on oppression, and through new polices call for initiatives that come with enterprenuership benefits to students.”
AP candidate for Information and Publicity, a first year Criminal Justice student Gracious Selelo said they are more united than other parties even at national level. “We don’t have internal squabbles within our party, we are more focused and can deliver our mandate easily,” she noted.
However the ruling party’s BDP GS-26 will come with all guns blazing after an embarrassing defeat in the previous elections. Preparations have been made and the GS-26 is looking to take the elections by storm.
According to their Presidential Candidate Boniface Seane, they come with the message of hope that addresses the current status quo at the University.“The university is not functioning so we drew three policies that embrace inclusiveness. We want to lead collectively with the students, through the student body meetings which the previous SRCs have failed to do. “We will consult with the students with no discrimination.”
Healthcare system to improve
The Health ministry has developed a seven-point programme to guide the country in improving the healthcare system, says Minister of Health and Wellness, Dr Alfred Rabashemi Madigele.
“The seven priority areas will serve as a roadmap and a guardian angel towards improving the overall healthcare system and increasing access to health care while fighting the burden of disease that confronts us,” said Madigele at Masa Square Hotel on Tuesday.
The focal areas include decentralisation; Universal Health Coverage, Tertiary Care, Strategic leveraging on the Private sector; Supply Chain; Research as well as Staff welfare and accountability.
Point-one of the seven priority areas according to Dr Madigele is about empowering the District Health Management Teams (DHMTs) and transforming them into fully fledged Regional Health Authorities.
“In this case, they will be rationalised from 27 to 18 and have the authority to hire A and B Scales, promote up to C1 and manage micro procurement,” he said. Point two is about improving the quality of healthcare services. “The main causes of mortality and their risk factors in Botswana are Primary Health Care issues,” Dr Madigele said.
He added that “Our efforts for the attainment of Universal Health Coverage should thus focus on: Prevention; Comprehensive screening; Early treatment; and Surveillance at the community.”
This he said, would require revamped grassroots efforts in which adequate numbers of community health workers through partnerships with the non-governmental sector will be deployed as necessary.
According to Dr Madigele, the top five causes of death in Botswana in 2017 were HIV/AIDS, Ischemic heart disease, stroke, lower respiratory infections and Diabetes. He said compared to 2007, NCDs among these had increased in burden by an average of 34%. The top five risk factors related to these causes of mortality were unsafe sex; poor diet; high blood pressure; alcohol abuse and tobacco use.
Improving the quality of care, Madigele said will also include the safety and security of patients; attitudes of staff as experienced by patients; time taken in queues either before seeing a health worker or receiving medication and the availability of drugs.
Meanwhile, the health minister revealed that the commissioning of Sir Ketumile Masire Teaching Hospital (SKMTH) is ongoing with the facility scheduled for opening on April 24th. “This will be a phased approach commencing with some services including paediatric oncology, internal medicine, rheumatology and endocrinology, diagnostic radiology, laboratory services and pharmacy”.
A phased commissioning of SKMTH will reduce overdependence on South Africa for referrals, reduce costs and also institutionalise provision of super specialist services within Botswana.
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