Africa-Press – South-Africa. The resignation of renowned breast cancer specialist surgeon, Professor Carol-Ann Benn, from Helen Joseph Hospital has fuelled concerns about the loss of expertise in the public health sector amid existing pressures on cancer services in Gauteng. Ufrieda Ho spoke to health authorities, patients, and breast clinic volunteers about the potential impact on cancer care at the hospital.
The resignation of renowned breast cancer specialist surgeon, Professor Carol-Ann Benn, from Helen Joseph Hospital has fuelled concerns about the loss of expertise in the public health sector amid existing pressures on cancer services in Gauteng.
Concerns were also raised about what some labelled an unconducive workplace culture and worsening working conditions at the hospital.
Some hospital insiders called the environment toxic with patriarchy and petty hierarchies. This, compounded by ongoing operational challenges, is having a dire impact on staff retention and the quality of patient care.
Benn’s last day at the clinic at the end of September ended a 17-year relationship with the public health facility. Volunteers from the not-for-profit Breast Health Foundation, which Benn is a founding director of, backed her decision and ended their services at the hospital.
“The Breast Health Foundation’s decision to withdraw services in solidarity with Professor Benn comes after months of trying to address barriers to the provision of quality patient care and a lack of support from senior management,” its statement read.
Louise Turner, chief operations officer at the foundation, said after an initial phone conversation there were no further discussions on a way forward to restart their services. The foundation had five patient navigators and three volunteers based at Helen Joseph Hospital (HJH).
Navigators guide patients through their journey from diagnosis to treatment, help to link them to services, and to advance them along long cancer treatment waiting lists. They also offer psycho-social counselling and become a practical support net. Spotlight previously reported on their work here.
‘It is only one employee who has resigned’
Responding to the concerns raised, the Gauteng Department of Health, however, said no patients would be affected negatively by the exodus of Benn and the foundation and that the clinic remained fully operational.
Department spokesperson Kgomotso Mophulane said: “The Breast Clinic is not closed at Helen Joseph Hospital. It is only one employee who has resigned but the clinic continues to have other specialists who run the clinic.”
Mophulane said that the Breast Health Foundation did not have a formal agreement with the health department, adding that “existing agreements with other facilities such as Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) continue”.
If the shoe doesn’t fit
Benn has straddled public and private healthcare throughout her 30-year career. She remains head of the Netcare Breast Care Centre and continues to lecture at Wits University’s department of surgery.
“My patients have taught me so much over the years,” said Benn. “Leaving Helen Joseph after 17 years has been a struggle. There was harassment and an obstructive workplace culture that made our daily working lives impossible, but I can’t spend my time getting into trouble for trying to find solutions. And if my patients have to face so much to survive, then I can survive this too.”
Benn said she was “stepping outside to find solutions”. She said her next focus would be to find ways to reform access to cancer treatment on lower-level medical aid schemes without massive co-payments. She added that her work in the public sector would continue.
Benn said she was managing her existing Helen Joseph Hospital patients at her practice at Milpark Hospital. She said she already had positive advances to set up a “patient-centred unit for equitable care for public patients within the private sector” that would be ready to launch within the next few weeks.
She said:
According to Helen Joseph Hospital CEO, Dr Relebohile Ncha, Benn has raised issues of “challenges she had with her supervisor, which is one of the clinical managers. Unfortunately, these issues were brought forward at the time of her resignation and therefore there was no time to redress (sic) the issues raised directly with her”.
Ncha added that the labour relations department would have dealt with the “workplace relationship challenges”. She said the psychology department would provide counselling for cancer patients in the absence of the foundation.
According to Ncha, the system in place remains that new patients are seen on a Tuesday for diagnosis and are “booked within a week” for further treatment.
Ncha said that currently there were between 400 and 550 outpatients and between 20 and 30 patients booked for surgery per month. According to her, there are no oncology specialists at Helen Joseph Hospital as this care is referred to Charlotte Maxeke hospital.
A long history
According to Turner, the Breast Health Foundation has helped turn the clinic into a hub of excellence over the years. “So much of what is in the clinic we raised money for – from painting the walls, decor, to the chairs and furniture in the counselling rooms.”
Turner said they helped around 200 000 patients to be “navigated” through the maze of cancer diagnosis and treatment at the facility, and around 10 000 people who were diagnosed with cancer were supported through their journey of ups and downs.
But she said it was clear the workplace environment had become increasingly untenable for Benn and the foundation’s team.
According to Turner, Benn was constantly being summoned from the hospital floor to meetings to answer for her decisions and was criticised and undermined for veering off administrative procedures.
“Professor Benn’s approach has always been about putting the patient first. She has used her own money to buy things like surgical drains or surgical gloves so that she could do her work. She always made a plan, including squeezing in surgeries, and she did accept patients who do not fall into the Helen Joseph catchment area because of their need to access services. But senior management would make her life hell unnecessarily over this,” she said.
‘A family of survivors’
Patient navigator for the Breast Health Foundation Ouma Mamatela was a patient of Benn in 2016 before she joined the foundation. She said patients at Helen Joseph Hospital were paying the price for “egos and mismanagement”.
“It’s going to be very, very hard for patients who expect to find the navigators there to hold their hand through everything. We built up a family of survivors. I am still waking up very early on Tuesdays and Thursdays because those were the days I knew I was getting up to serve our patients at Helen Joseph,” added Mamatela.
She said Benn’s out-of-the-box thinking, accessibility to patients, and transparency in the way she worked irked senior male managers and doctors.
“Professor Benn is one person who speaks to everyone. She doesn’t make herself untouchable. I want to say to those managers that they need to put their egos aside because it is the patients that need quality care the most who are suffering,” she said.
‘You can feel that it’s different now’
Twenty-six-year-old *Thandiwe was one of Benn’s last patients at Helen Joseph Hospital. Her mother *Thawe said she and her daughter experienced kindness and professional care from Benn and the foundation but also bore the brunt of bureaucratic pettiness and outright bullying from senior clinical management at the hospital.
Thawe asked for their identities to be protected, fearful of being victimised at the hospital.
Thawe spoke of how her family’s world came to a crashing halt when Thandiwe found a lump in her breast in July this year. Thandiwe, who lived in North West at the time, had a biopsy done at Moses Kotane District Hospital but said she never received the results.
Being unwell she couldn’t keep her job and eventually went to Johannesburg to be with her mom. Thawe’s employer donated R10 000 towards her daughter’s treatment.
“When I asked in the office and googled about where I could get help, the name that kept coming up was Professor Benn’s, so we decided to use the money to do another biopsy and to see Professor Benn at her private practice in Milpark.
“When we saw the prof, she was so kind and informative. She explained everything and gave us some peace even when she confirmed that Thandiwe was cancer-positive. When it came time to pay, she realised that we didn’t have medical aid, so she told the receptionist not to charge us anything,” said Thawe.
Benn told them to go to her clinic day at Helen Joseph Hospital so that the next steps of surgery could begin. Benn also advised plastic surgery at the same time, as the removal of the cancerous lump would significantly reduce the size of Thandiwe’s left breast.
On the clinic day, Thawe said, they waited for hours but added: “Everyone from the foundation was friendly and explained what was happening. When it’s like that, you accept that you have to wait.”
But then Thawe was told her daughter would not be admitted for surgery and that her case was being referred to Charlotte Maxeke Johannesburg Academic Hospital instead.
“Another doctor took Thandiwe off the surgery list and sent a junior doctor to us with the referral letter without any explanation,” she said.
At Charlotte Maxeke, Thandiwe was sent from department to department and could not get admitted there either, she added. Eventually, a desperate Thawe returned to Helen Joseph Hospital to demand an explanation.
She said:
Thawe and Thandiwe stayed in contact with Benn. Mother and daughter kept fighting and eventually took their complaint to hospital CEO Ncha. Only then was Thandiwe’s surgery approved.
She said Benn kept her promise to operate on Thandiwe and also made arrangements with a plastic surgeon from Charlotte Maxeke hospital to help with the reconstructive surgery.
“I cannot find the words to thank Professor Benn for all she did to save my daughter’s life,” Thawe said.
But she said since Benn and the foundation’s exodus at the end of September, “it’s been a mess at Helen Joseph”.
At the beginning of October, she accompanied Thandiwe to have a drain removed and her bandages and dressings changed.
“All those ladies in pink that used to help us were gone. All the patients were just sitting without knowing what was happening, and no one telling us anything. When we eventually saw a doctor, she said she didn’t know how to remove the drains. She took some photos of Thandiwe and told us to come back the next day.
“I had to change Thandiwe’s bandages myself and tell the nurses how to tape the drain. You can feel that it’s different now without Benn and the navigators,” she said.
Eventually, they were forced to go to Charlotte Maxeke hospital, where the plastic surgeon who operated on Thandiwe helped to remove the drain properly.
“It’s been hell at HJH (Helen Joseph Hospital) – I worry for what will happen to other women who cannot fight like we did,” she said.
Dozens of Helen Joseph Hospital patients have also weighed in on social media in support of Benn and the foundation, sharing their stories and deepening worries about what comes next during their treatment.
**Patients needing to get in touch with the Breast Health Foundation can continue to do so via their support line, 0860 283 343.
*Identities withheld.
*This article was published by Spotlight – health journalism in the public interest.
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