Poor medical assistance, misdiagnoses and delays in the treatment of women with cancer, at the oncology service of Maputo Central Hospital (HCM, abbreviation in Portuguese), the largest hospital in the country, have been putting the health of hundreds of women at risk. By the way, it seems to be the best hospital with conditions for diagnosis.

A lot of women, in conversation with the Citizen’s Observatory for Health (OCS, abbreviation in Portuguese), manifested their concern about these cases.

A few months ago, OCS received complaints from patients of that hospital. Among the alarming cases were misdiagnoses and long waiting queues for screening. According to the patients, the first case is linked to medical error and the second has to do with the slowness in performing the diagnosis because of the restrictions imposed by Covid-19.

The misdiagnoses culminated with unnecessary breast removal and lump reduction.

Below, we tell stories of several patients suffering from cancer. The same patients report mistakes committed, at various levels, by doctors in HCM’s Oncology Department. As a measure to protect sources, the names will remain hypothetic.

Case I

Carla (fictitious name) says that, five years ago, she felt a lump in her left breast and palpated it. After months, she realized that the size was modifying, “I went to a health unit next to my home. After the medical exams, they found out that I, in fact, have a lump in my breast. From there, I was sent to the Oncology Department at Central Hospital of Maputo. Being at the hospital, I received the diagnosis that I had cancer and that I should only remove the lump through surgery.”

Unhappy with the result, and after much reading on the internet, Carla decided to take the samples. Through a private hospital, she decided to examine again in neighboring South Africa. There the test results indicated that she had breast cancer.

“I took the exams to HCM and confronted the doctors with the different results. In South Africa they told me that I have cancer. This situation embarrassed the doctor who assisted me and blamed the medical laboratory, by the way the best in the country. I was then assisted by another doctor. He told me that I should remove the lump quickly and that I should also undergo chemotherapy”, the patient said.

However, the patient asked the doctor how long this process should take and the doctor replied that it should be done immediately, and the patient should go into the operating room for the treatment start.

“After the mistake in the tests, I questioned the quality of treatment and information provided by doctors. The doctors didn’t even tell me what type of breast cancer I have. This type of information is fundamental. So, I explained to my family what was happening”, Carla recalls.

At home, Carla and her family tried to save money, quickly, to get more information about the disease in South Africa. There, after further examinations, the patient was told that she had to cut her breast, remove the lump, and take specific pills for 10 years. Therefore, she did not need to undergo chemotherapy, as it was suggested in Mozambique.

“I was lucky because I was able to save money to get more medical information about my condition and the treatment I needed. My question is: how are thousands of Mozambicans without money (the majority) left in these mistakes committed by our doctors?”, questions the patient.

Case II

Monica felt the lump in her right breast and went to HCM. There, after medical exams, which were negative for cancer, she was told to remove the lump and take medication to cure herself.

“I stayed at home for a week on medication after the surgery, meanwhile my breast was starting to grow and I went back to HCM to figure out what was happening. I was sent home, as they said the swelling would go away. I stayed in this trouble until my breast grew and gain the size of a head. I went back to the hospital, they told me I had cancer and should go to chemotherapy. But what kind of a joke was that for six months? I was outraged”, the patient remembered.

The patient’s luck is that she was also able to be evacuated to South Africa, where she had her breast removed, in a context where it would not have been removed if she had good treatment in Mozambique.

“I was told that the removal of the lump was done badly and that my breast should have been cut a bit more and I should medicate for 10 years. Well, just like me, there are many Mozambicans who even lose their lives”, the patient said.      

Case III

In the Pediatrics service of the largest hospital in the country, heading to the second floor, where the Hemato-Oncology Service is located, we find a mother and daughter in a continuous routine.

“My daughter has lymphoma, a malignant cancer”, says Eurósia, adding that the cancer began to torment her daughter in 2017, in the City of Chimoio, Manica Province. The child did not feel any pain, but something was worrying: a swelling in her neck.

“We have been in this hospital continuously for almost four years”, narrates the woman, adding that the doctors, in Chimoio, had diagnosed tuberculosis in their daughter. She was treated, but it wasn’t tuberculosis and the swelling didn’t go away.

According to the girl’s mother, only in 2019, after exams and the biopsy, it was discovered that it was cancer. Eurasia regrets that lymphoma was tested too late in her daughter, although she arrived at HCM in 2018.

“The doctor said that the cancer had already spread from her neck to her belly and to her liver. It was heavy to receive this information”, said the public user, who, through chemotherapy, is fighting with her daughter to beat cancer.

Case IV

Marcos, 37, was diagnosed with skin cancer, Merkel’s Carcinoma. “Because it is a rare type of cancer, the Mozambican health authorities were unable to contain the disease after administering various types of treatment for years. Finally, they recommended me to seek treatment in neighboring South Africa.

“I think that in Mozambique, as well as in the African continent in general, we have to improve a lot our capacity to diagnose. Even in South Africa, I was getting the wrong treatment for the type of cancer I have. I arrived in Germany and in just 30 minutes the diagnosis was made and I went immediately to the operating room. What I can say is that we can’t treat cancer without equipment and qualified staff to diagnose a disease of such complexity”, said the patient.

Cancer Situation In Mozambique 

Data from the World Health Organization (WHO) indicates that eight million people die annually in the world from various types of cancer, and Mozambique is responsible for 25 thousand deaths.

Cancer treatment, in Mozambique, has evolved significantly over the years, with the introduction of new technologies, as well as more effective forms of treatment and better quality for patients. The health authorities assure that breast and cervical cancers are the most frequent among women.

The installation of the Radiotherapy Service in the HCM is a huge step forward, so that patients will no longer have to travel outside the country in search of treatment. In South Africa, for example, they used to spend between 600 and 800 thousand meticais.

In the country, it is estimated that at least 25,500 people suffer from different types of cancer. It means 5.3% have breast cancer and 17% have cervical cancer.

Cervical cancer is a type of malignant tumor that occurs in the lower part of the uterus, caused by an infection of the Human Papilloma Virus (HPV), which is linked to unprotected sexual intercourse. In 2020, approximately 4,900 new cases were diagnosed, causing 3,000 deaths.

Another cancer that worries health entities is breast cancer, the second most frequent. On average, more than 1,000 cases are registered every year. Breast cancer is a malignant tumor that develops in the breast as a result of genetic changes in a group of breast cells, which start to divide in an uncontrolled manner.

Cancer cases is the HCM Oncology Service, where – before Covid-19 – more than 50 per day. On average, 30 admissions occur, of which 25 are women with cervical and breast cancer.

Every month, before Covi-19, eight to ten women, with breast cancer, were submitted to operation in the largest hospital in the country, coming from all over the provinces. Most of the patients arrive with the tumor at an advanced stage and the affected breast is removed.

Until now, prevention has been the best weapon in the fight against this disease, which, according to data from the World Health Organization, 80 percent of cases that are diagnosed early can be cured. For now, it is recommended that starting at the age of 40, the screening tests must be executed, and a change in lifestyle, such as careful eating, as well as regular physical exercise.

Covid-19 VS Cancer

In the current context of the Covid-19 pandemic, the medical assistance in HCM does not function normally, impacting cancer screening, diagnosis and care services. The OCS has found out that there are many patients on the waiting list to be diagnosed, especially women who have noticed that they have a lump or nodule in their breast.

The OCS finds the reduction in cancer diagnostic worrying, whereas when this disease is later discovered, the less chance of saving one’s life.

However, our attempt to contact the HCM Oncology services failed. In fact, the current administration has been closing doors as a way of refusing to make statements about the problems that affect the users of the largest hospital in the country.

In the current context of the Covid-19 pandemic, the medical assistance in HCM does not function normally, impacting cancer screening, diagnosis and care services. The OCS has found out that there are many patients on the waiting list to be diagnosed, especially women who have noticed that they have a lump or nodule in their breast.

The OCS finds the reduction in cancer diagnostic worrying, whereas when this disease is later discovered, the less chance of saving one’s life.

However, our attempt to contact the HCM Oncology services failed. In fact, the current administration has been closing doors as a way of refusing to make statements about the problems that affect the users of the largest hospital in the country.

CONCLUSIONS

The Citizen’s Observatory for Health (OCS) expresses its deep concern on the denunciations made by patients who use the oncology services of HCM.

It is urgent to have qualified doctors to examine cancer in Mozambique. The Inspection of the Ministry of Health (MISAU, abbreviation in Portuguese) is called to do its work with independence and professional deontology, in order to identify the flaws and induce changes, without entering into the protectionism of the (medical) class. 

It constitutes an attack on human rights and a serious violation of the Patient’s Charter of Rights and Duties (CDDD, abbreviation in Portuguese). The treatment delay, which can last for months, while patients with cancer symptoms wait tirelessly, is serious attack on Mozambican lives. Cancer cannot continue to mean a death sentence to Mozambican people.

As a way to treat cancer patients, whose capacity Mozambique still doesn’t have, the Government must adopt a policy of support for disadvantaged families, so that their members also enjoy the right to life. The State cannot let its citizens die from a disease that, in very well identified places, can be successfully treated.

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