SA’S CANCER STORY (PART 4): The many long journeys for cancer treatment far from home

In a lush garden in central Bloemfontein, inside the Cansa Olea Katleho Care Home, Ian’sha de Vasch’s eyes brim with tears that streak down her cheeks. The cancer care home’s coordinator for 10 years, De Vasch speaks between sobs, telling us about one of their residents, 16-year-old Blessing Manju, a patient with leukaemia, who appeared “100% fine” before suddenly passing away two days before.

At the home, a special room for teenagers had been readied for Manju, and Prince Molongwane, also 16 and also a patient with leukaemia.

“We painted it over, we installed a new TV, we did new bedding, we did a nice new desk for them if they need to study,” says De Vasch. “Blessing was a blessing. The talkative one, the funny one, the one who takes on challenges. So yes, it’s a shock for all of us. It’s very difficult.”

A home for patients from far away

Free State Department of Health spokesperson Mondli Mvambi explains that Bloemfontein sees a high volume of long-distance oncology patients as it serves as a hub for specialised tertiary healthcare across central South Africa and neighbouring Lesotho. Mvambi says the city’s public oncology facilities treated 1,984 new patient referrals in 2025, with 22,096 follow-up visits for patients receiving chemotherapy or other care. He adds that their most commonly treated cancers are cervical cancer, prostate cancer, breast cancer and then lung cancer.

With 24 beds, the Olea Katleho Care Home accommodates cancer patients from the Free State, the Northern Cape, the Eastern Cape, Lesotho and further afield, providing a homely space while they receive treatment at the public National Hospital or Universitas Academic Hospital, or within the private sector.

This is one of eight Cansa homes in cities around South Africa. “Our care homes primarily accommodate cancer patients who live 50km or more from their treatment facility. Patients must be able to care for themselves independently, including managing their personal hygiene, dressing, eating and mobility, as the care homes are not medical or nursing facilities,” says Cansa spokesperson Lucy Balona.

De Vasch says Manju had stayed at the home for four months while receiving chemotherapy. During a two-week break from treatment, the boy returned home to Bultfontein, about 100km from Bloemfontein, where he suddenly deteriorated and passed away.

Blessing’s sudden passing

At his office at the University of the Free State, Dr Jacques Malherbe, head of the Division of Clinical Haematology, who treated Manju, relays that Manju had T-lymphoblastic lymphoma, an aggressive type of leukaemia, but had responded “incredibly well” to an initial intensive phase of chemotherapy.

“Everything was going very well and he got his last dose of chemo, his blood was looking great and we said okay, you can go home for two weeks and then come back. Then apparently suddenly he became ill at home and was taken to the local hospital where he had a cardiac arrest. It sounds to us like a potential blood clot, which is a risk with some of the medications.”

At Universitas Academic Hospital, next to the university’s medical campus, at the time of our interview Malherbe and fellow clinical haematologist (doctors who specialise in blood disorders, including leukaemia) Dr Caroline Steyn are treating 13 patients, aged 13 and older. Children younger than 13 are treated in a separate paediatric ward.

Shaking his head, Malherbe describes Manju as “quite a character”. What made this case extra tragic is that the team genuinely believed the teenager was over the worst.

Emotional attachment

Malherbe says as clinical staff they become attached to patients, especially children, “because it’s a long road and we often see them from when things are going really badly, and then they get through it and we see them grow up. So that’s very satisfying but it’s also distressing when things do go wrong – and they do.”

On emotional attachment, the doctor adds: “Sometimes you also realise from the beginning that the situation is dire and the chance of success is very limited. So you tend to step back a little bit in terms of emotion... Sometimes when you see a patient and it’s another relapse, it’s like, ‘No, please no’.”

Malherbe attests to patients travelling vast distances to their ward for specialised cancer treatment, noting one patient from Port Nolloth in the Northern Cape, 1,085km away.

Liteboho Sello’s cancer journey

A patient near to Malherbe’s heart is the late Liteboho Sello, from the Leribe district in northern Lesotho. His cancer journey crossed a national border in addition to provincial ones.

Sello travelled from Maseru to Bloemfontein, and Cape Town, overcoming considerable logistical hurdles as Malherbe and other doctors went beyond the call of duty to help him.

At 19 years old, on his first day as a graphic design student at Limkokwing University in Maseru in 2017, Sello was diagnosed with bone cancer. The next year he started chemotherapy with Malherbe in Bloemfontein and had surgery to replace much of the bone in his right leg with metal.

The youngster was in remission for three years, after which he was diagnosed with leukaemia due to a rare complication related to his previous chemotherapy. At the time the only way forward was a stem cell transplant, Malherbe says. They identified Sello’s then 12-year-old sister as a suitable stem cell donor.

But funding was a challenge, since Lesotho’s healthcare system would not fund the stem cell transplant, while South Africa’s healthcare system would not fund a transplant for a citizen from Lesotho, says Malherbe.

On patients referred from Lesotho, Mvambi tells Spotlight and Daily Maverick: “There’s a standing agreement with the government of Lesotho for the Free State health facilities to see them as referral cases. Payment arrangements are in place for such to be proceeded with.” Regarding citizens of other countries apart from Lesotho, he says “there is no discrimination against foreign nationals”.

South Africa and Lesotho’s health authorities signed a memorandum of understanding in 2005, which has come under increasing strain, with Lesotho’s government reportedly owing the Free State Department of Health about R145-million for healthcare services, including cancer treatment. Experts note that the increasing number of foreign nationals seeking healthcare in South Africa fits within a broader trend of global travel for medical treatment.

Undeterred by bureaucracy, Malherbe approached the blood cancer nonprofit DKMS Africa, formerly known as the Sunflower Fund, which agreed to fund Sello’s procedure. However, such stem cell transplant services are not offered in Bloemfontein, and doctors at Groote Schuur Hospital in Cape Town initially turned Sello down, citing his poor prognosis and a lack of bed capacity.

Malherbe recalls phoning his former mentor, Professor Vernon Louw, then head of the Division of Clinical Haematology at Groote Schuur Hospital, affiliated to the University of Cape Town, to plead Sello’s case. “So I phoned my colleague Prof Louw who trained me. I said: ‘I just want to make sure it’s not about the funding, because we’ve got the funding.’ I said to him that we pursued exceptionally intensive chemotherapy on Sello, on the understanding that he would be eligible for a transplant if he achieved remission…”

After Louw then agreed, Malherbe bought Sello an overnight Intercape bus ticket from Bloemfontein to Cape Town, since there were no ambulances available, and Sello was in reasonable health. Malherbe recounts getting the youngster a phone for the journey. “He had lost his phone on the transfer from Lesotho to Bloemfontein, and I just thought, ‘Gosh, I can’t let this boy go down to Cape Town to get a transplant without a phone’. And I actually posted a WhatsApp message on our cycling group: ‘Does anybody have a phone?’ And so we got him an old iPhone from someone’s wife – an iPhone with a pink cover.”

Malherbe says it was his first referral of a patient from Lesotho to receive a stem cell transplant, with plenty of administration, “so it felt like quite a win to get him down to Cape Town”, he says. In Cape Town, Sello stayed at the Eikehof Cansa home in Athlone for several months, before returning home to Lesotho where he was in remission for three to four years.

“Actually, his transplant went extremely well, he was doing really, really well,” says Malherbe. “He eventually relapsed. I don’t know how to describe this; he told me that he was ready to die, that he’s just worried about his sister and his parents who he was leaving behind. A really inspiring young man. All the patients knew him, he had advocated for patients, and so on.”

Referral to urban centres

Since many cancer treatments in South Africa are only available in urban centres, such long journeys are a reality for many, whether they are travelling to Bloemfontein, Cape Town or Johannesburg. One recent study looked at the experiences of people with cancer from rural areas in the Eastern Cape and Mpumalanga. Among the challenges the researchers identified were bad roads, long travel distances, the cost of transport, poor service in hospitals and long waiting times in hospitals.

Given the cost and complexity of some cancer treatments, there are limits to the extent that these services can be decentralised. But if some travel is inevitable for people who are not already living in urban centres, then it is important that that travel happens as early in the course of the cancer as possible. Experts suggest that much emphasis should thus be placed on early detection of cancer and improving referral pathways. There is some evidence suggesting that these systems aren’t working very well – one recent study found that two-thirds of breast cancers were only diagnosed once the cancer was already at an advanced stage.

A homely lounge with open windows that let in birdsong

Back at the Cansa Olea Katleho Care Home, De Vasch takes Spotlight and Daily Maverick on a tour of the house. In the book-lined lounge, residents recline on sofas, chatting, while a lunch of chicken strips and green salad is being prepared in the adjoining kitchen.

In a wingback armchair, Khosi Rani, from Queenstown, says she uses a light dusting of cornstarch to soothe her skin during radiation therapy. “It protects the skin like no one’s business,” she says. Rani, the provincial head of school exams for the Eastern Cape government, is being treated for breast cancer at the private Icon Oncology facility in Bloemfontein.

“This is home from home. Staying here has exposed me to so many different people. They don’t see themselves as sick. I don’t feel like I’m sick, it feels like I’m on holiday,” she says, laughing. “I am putting on weight.”

On a sofa, Jan Mulato, a gardener from Springfontein in the Free State near the Eastern Cape border, says he possibly has cancer of the bladder, but that he is still waiting for test results. “It’s going well here, I feel less stressed. The people here are friendly,” he says shyly.

De Vasch leads us along a corridor to a bedroom to meet secretary Andrieka de Clerk. As we walk into the room, she shrills into her phone: “Liefie, ek bel jou terug hier is mense!” (“Sweetheart, I’ll call you right back, I have company!”)

From Gariep Dam in the Free State, De Clerk says her breast cancer was detected very early. “The test indicated that it is responsive to hormone treatment, so I was two and a half months on that treatment, an estrogen blocker, so the tumour shrank, it was very tiny when they operated. I’m so glad, because I still have my breast, they just removed the lump, it is called a lumpectomy.”

Her voice grows quiet as she clutches her hands: “It was just such a shock. I’m not young anymore, I am 65, but it was such an emotional shock. I said thank you to the Lord that I did not have to lose my breast. I am very glad that there is that option for people.” She had surgery at Universitas Academic Hospital and was set to start radiation at National Hospital the following week. As we part, De Clerk shows us her embroidery project, a floral bouquet. “See, pink embroidery yarn for breast cancer.”

In another room we meet Manyakallo Mokete, a primary school teacher of Sotho and English in Maseru. Relaying that her name means happiness, Mokete is seated by a window in the morning sun, a platter of cake on a table beside her. She had chemo for breast cancer in Maseru, and surgery there in July, after which she was referred to National Hospital in Bloemfontein for radiation. “They told me the surgery went well, that the chemo worked really well. The radiation is just to clear whatever is left here,” Mokete says.

About the side-effects of radiation, she says: “It’s not that bad, but it’s not easy to swallow this week. I take food with hot water so it becomes soft to swallow.”

Mokete explains that an ambulance from Lesotho brought her to Bloemfontein. “And when I am done, it will take me back home,” she says, smiling as she tells of her two adult children, whom she misses dearly.

Wrapping up, De Vasch says she keeps in touch with her residents, that they become friends. “I love what I do,” she says. “It’s all sorts of people from all walks of life, all ages, private and public sector from all over.” She has stopped crying when she says goodbye, leaving us with the knowledge that in the heart of Bloemfontein inside this birdsong-shrouded sanctuary, cancer patients from far-flung corners will continue to find refuge. DM

This is the fourth of six articles in the series. Part 1 told the stories of two women who got breast cancer. Part 2 zoomed in on the numbers, and asked whether cancer cases are really going up in South Africa. Part 3 took stock of the huge progress we are making against some cancers, particularly cervical cancer.