SINOMUSANOTHANDO COMMUNITY DEVELOPMENT PROPOSAL

INTRODUCTION AND BACKGROUND

Sinomusanothando is a non-profit non-governmental organisation whose vision is to facilitate the realization of the potential of individuals and communities and enhance their ability to improve their health and quality of life in a democratic society., It was founded in 2004 by a medical student from Nelson R Mandela School of Medicine who is the only medical doctor from the village of KwaNyuswa now specialising in Radiation Oncology, managing cancer patients on daily basis. This NGO was formally registered in 2007 with the aim to:

  • Raise cancer awareness in the rural communities.
  • Facilitating cancer resources accessibility and availability for the rural community.
  • Free medical screening including screening all preventable cancers in collaboration with the HIV testing and other medical screening.
  • To prevent the escalating numbers of mortality and morbidity related to cancer and HIV/AIDS in the rural communities by increasing the knowledge of cancer amongst the rural communities of KwaZulu Natal Province.
  • To form support groups for cancer survivors and their families by forming support groups
  • To create discussions and education on challenges facing cancer management in our province

MISSION

  • Cancer of the cervix
  • Cancer of the breast
  • Cancer of the prostate
  • Aids-related malignancies

VISION

  • Provide screening to the rural and township communities Provide screening to the rural and township communities
  • To mobilise the communities for cancer awareness walks as a sign of committing themselves to prevent, screen, adhere to treatment and support the cancer survivors To mobilise the communities for cancer awareness walks as a sign of committing themselves to prevent, screen, adhere to treatment and support the cancer survivors
  • To work with medical students in educating the rural high schools about cancer screening To work with medical students in educating the rural high schools about cancer screening
  • To start support groups in the communities after the cancer screening events To start support groups in the communities after the cancer screening events
  • To start the cancer survivorís community projects To start the cancer survivorís community projects

PROJECT OBJECTIVES

  • Create awareness on cancer by community walks Create awareness on cancer by community walks
  • To educate the community about all types of cancer To educate the community about all types of cancer
  • To provide medical and cancer screening at the community level To provide medical and cancer screening at the community level
  • To collect statistics of the number of cancer patients and families in each area we visit To collect statistics of the number of cancer patients and families in each area we visit
  • To follow up, guide and support those who test positive for malignancy To follow up, guide and support those who test positive for malignancy
  • To work in collaboration with other relevant stakeholders To work in collaboration with other relevant stakeholders
  • To develop the community support structure for the benefit of the cancer survivors To develop the community support structure for the benefit of the cancer survivors

According to the Boyle and Levin estimates by 2020, the number of new cancer cases is expected to rise worldwide to 16.8m and by 2030 is expected to rise to 27m, with 17m cancer deaths. These alarming statistics and such future projections prompted us to contribute not only in the treatment of those living with cancer but to assist in the prevention of the preventable cancers by mobilising the knowledge and screening to the rural communities in Kwa Zulu Natal. An aggressive collaborative effort is mandatory in this fight against cancer.

They also estimated the costs associated with new cancer patients management in 2009 to be at least US$286bn. which make up more than half of that economic burden, while productivity losses account for nearly one-quarter of the total.(Boyle and Levin, 2008). Our state hospitals cannot accommodate any more cancer patients admissions, the admission wards are full to capacity, the hospitals waiting lists for treatments is too long in this province. The treatment facilities are located in towns; there are no cancer facilities in the majority of the KZN rural communities hence this chronic lack of awareness of the disease that is slowly taking their lives. Treatments machines are not coping hence are breaking down often due to the treatment overload. Cancers like cervix and breast are costing the state a fortune to treat and are costing the patients and their families the priceless gift of life.

Sinomusanothando as the rural based community young and unfunded organisation have taken a stand to work together with other relevant stakeholders, government and non-government health and interested business stakeholders to try our best to reverse this current catastrophic situation.

REASON FOR RURAL ORIENTATED SERVICES

In 1844, Samuel Ashwell (Guys Hospital, London) observed that the majority of the patients with cervical cancer were dark complexioned. In 1872, when South Carolina, USA deaths from cervical cancer was reported, it was apparent that the mortality rates were higher in black women (Shingleton, 1983). This historical finding emphasises the importance of these rural based cancer awareness campaigns.

ďTraditionally, black patients seek a cause for illness within the framework of indigenous beliefs; good health is perceived as consisting of a healthy body as well as a healthy social, emotional, and spiritual life. Cancer was interpreted as a reflection of conflicts, particularly in social relationships. Many patients with cancer believed that a special witchcraft caused their cancer, and, therefore, their first priority was to reverse the sorcery before presenting to hospital to be treated by modern medicine methods. The patient sought help first from a traditional healer as a way of dealing with the cause of the disease, and, in their views, this did not imply delaying medical treatment. The concept that a painless breast lump was a cancer and therefore a potentially fatal disease is difficult for many black rural women to accept 80% of black women with breast cancer decide to refrain from modern medical treatments.

Education awareness campaigns, uplifting of socioeconomic conditions, access to diagnostic resources, and availability of higher standards of health care, and sensitivity with regard to some patientsí beliefs are all necessary, should be implemented, and must be considered in an attempt to increase early detection of breast, cervical and prostate cancer cancer and, therefore, improve long-term prognosis and survival. This is a challenge to be fulfilled mainly in the rural and disadvantaged populations, but campaigns should be extended to all women, irrespective of their race, socioeconomic and cultural status, and place of residenceĒ. (Vorbiof et al, 2001)

From the clinical experience perspective, the majority of African patients present with late disease when it is impossible to treat with curative intent. From our experience this is possibly due to lack of education and awareness about cancer, poor screening , centralisation of resources, myths, illiteracy, poverty making it difficult to access the screening resources, lack of aggressive referral and proper management at the primary health facilities.

CURRENT HEALTH CHALLENGE IN CANCER MANAGEMENT

  • High cancer Incidences of preventable cancers like breast, cancer of the cervix, prostate High number of AIDS-associated malignancies
  • High death mortality and morbidity rates from preventable cancers
  • High number of rural black communities presenting with late stages of cancer
  • Younger generations presenting with late stage and cancer complications
  • Limited knowledge about cancer amongst the rural communities
  • Poor and late referral system amongst health institutions
  • Wrong or incomplete diagnosis
  • Scarcity of qualified Oncologists
  • Poor accessibility to health clinics, hospitals or screening sites within the rural communities
  • Limited resources within the public sector to support such screening
  • Cultural beliefs and stigma
  • Low literacy rates and a lack of education; and
  • Myths that cause severe delays in management of those diagnosed with cancer.

PROPOSED SOLUTION

  • Community based cancer and medical screening
  • Collaborated effort between NGOís, public, private, military health services and business sector
  • Awareness Walks that engage the communities in committing to prevention, screening and preventing in the form of songs, walks, health slogans
  • Rural directed health approach
  • Massive health screening of one community in one venue by united stakeholders
  • Intensive Community Follow up involving all the health stakeholders on a team base
  • Community based health to prevent delays in patient management, to address myths, alleviate stigma, preventing loss to follow up and create a good knowledge about disease profile.

DETAILS OF THE EVENT AND CHESTERVILLE

Our 5th cancer Awareness walk and screening will be held at Chestervile Township for the Chestervile, Masxhawulane, Mayville and Ridge-view community. The event will be held o the 08 October 2011. Chestervile is part of the then Durban City Council (DCC) and later the national apartheid governmentís urban racial segregationalist planning of urban spaces. This policy of racial segregation guaranteed the political and economic power of the white minority and increased the poverty of the township residents.

Chestervile was built in 1940. Housing developments were frozen in 1945 and the residents faced the threat of removal for about 40 years. In 1959 part of Chestervile was removed to KwaMashu under the guise of urban relocation. 64% in Chestervile are presently unemployed, 90.2% were previously unemployed, 22% of the respondents live in the main building,  31% occupy outbuildings, 14% flats and 11% garages. 55% had grades 1 to 7, 38.1% grades 8 to 12 and 6.9% had tertiary education, 4% with Bachelorís degrees.

Chestervile is about 10km away from town and 3km from the Pavilion shopping centre yet the above statistics exists. It is the time for the children of such a generation portrait above to bring change to such statistics. It is such arrears that Sinomusanothando wants to make a difference. This cancer awareness and screening is not only relevant but needed for early detection of cancer which in turn will begin a process of demystifying cancer and the cultural beliefs and stigma some cancers hold in this community,"

Sinomusanothando Community Development will be hosting this event in collaboration with EThekwini District Breast Health Foundation, CHOC, Chatsworth Youth Centre and Military Health Services.

In the first world countries breast cancer is no longer considered a "death sentence" by both patients and medical professionals because the majority of their citizens are literate, have a basic education that allows them to conceptualise the dangers involved in cancer diagnosis, they also have easy access to the medical centers which is not the case in arrears like KwaNyuswa, Ingwavuma, Pietermaritzburg, Chestervile, the arrears we have covered, where illiteracy is the main problem for the village women to really understand the real dangers and life implications of being diagnosed with cancer and HIV and Aids to them its either a foreign disease or itís not a disease itís something that only myths, believe structures and other forms of cures can heal.

PROJECT RESULTS AND OUTCOME

At the community level we have experienced the good outcomes of the project of this nature, where communities gather, walk and screen against diseases. These events have created a platform for communities to discuss, voice their concerns, learn, educate and be educated but mostly be treated at their home base that makes them feel cared for and true SA citizens. As a clinician I find that we have reached a point where people do not want to hear about HIV-AIDS, but respond in numbers if the topic is cancer related with HIV/AIDS education incorporated.

We have seen communities uniting after our cancer awareness, changing their attitudes toward KZN health service provision, feeling of relief knowing that their medical concerns are being cared for and there are available avenues to address their medical obstacles.

We have worked with the EThekwini District in booking mammogram with RK Khan Hospital for the women who had suspicious mass during our cancer screening.
We have assisted with speeding up treatment processes for the patient who was discovered to have severe per virginal bleeding who were found to be waiting for a treatment for more than a year at Inkosi Albert Luthuli Hospital. Although we have lost 1 patient while waiting for cervical cancer treatment, that particular lady was referred for admission due to her severe bleeding at our cancer awareness walk in 2009.
We have seen communities starting support groups and projects after our cancer awareness walks. Pink ribbon projects from KwaNyuswa communities are still at its infancy, this are th Sector who work closely with St Johnís who deals with follow up of the communities, home visits etc.
6) Highway hospice: who has a branch in Chestervile arrears providing support that is highly required by this community.

Dr Thandeka Mazibuko decided to adopt this community system because of the demands from her rural community and realized it was impossible to cater for the needs of her whole community on one on one bases and  has been requesting as well as setting a challenge to all health care workers to join ventures in such a wonderful productive community orientated prevention campaign that will later benefit our hospital system with producing knowledgeable patients about their diseases, well screened patients, improve compliance, remove the stigma, reduce the long queues in the hospital, prevent the unnecessary deaths of the patients in their hospital, the frustration of staff shortages may be catered for if all stakeholders unite in treatment management.  
Our rural communities need us out there; they need us as professionals to cater for them. It begins with us and they depend on our collaborated effort.

FOLLOW UP PLAN FOR THIS EVENT

We have started a very healthy relationship with

  1. Breast Health Foundation: is the NGO that cares for breast cancer patients only, it has formally confirmed the continued support for the Chestervile and they have started the work KwaNyuswa.
  2. CHOC: deals with children with disabilities, they are doing a pre- and post-cancer awareness school visits
  3. Chatsworth Community Youth: Have medical stakeholders and bikers which will be helping us in raising awareness and screening for the community
  4. Military Health Sector who works closely with St Johnís who deals with follow up of the communities, home visits etc.
  5. Highway Hospice: who has a branch in Chestervile.
  6. Nelson R Mandela School of Medicine students have been working with this NGO on voluntary bases for 3 years and have done great job in screening and education as well as follow up.

CONCLUSSION

The study done by Free State province Universities Hospital in Bloemfontein, South Africa, these cancer high rates are attributed to a lack of awareness of the rising incidence of breast cancer in the province by the public in general, and probably also by the healthcare professionals. The study would appear to suggest that there is a need for an aggressive education campaign targeting both groups if breast cancer awareness is to be realised in the province. It is worth noting that international trends show that since introducing breast cancer screening programmes, many countries have reported a decline in deaths from breast cancer, hence similar strategies can be done with the preventable cancers. If we can partially win this war against preventable cancers that can then not only save lives but also save massive state funding that is used to treat end stage disease when it is even cheaper to treat early disease.