2016

Thandeka Mazibuko

Stu no: 973118487

UNIVERSITY OF KWAZULU NATAL

Nelson Mandela School of

Medicine,

RADIATION ONCOLOGY

Inkosi Albert Luthuli Hospital

3/7/2016 Request for sponsorship for the 1 year research and

training in Radiation Oncology, Haematology and

Medical Oncology Departments in USA

TABLE OF CONTENTS

1. Introduction

2. Problem Formulation

3. Research Topic and Research cost in America

4. Problem Statement and Academic challenges in South Africa

5. Aims of the studying and pursuing research in USA

6. Study and USA Training and Research Objectives

7. Background of the study

8. Methodology

9.1- Study design

9.2 – Study Site

9.3 – Study setting

9.4 – Study population

9.5- Sample strategy

9.6 – Sample size

9.7 Inclusion criteria

9.8 Exclusion criteria

9.9 Data collection

9.10 Study Period

9.11 Study Limitation

9.12 Significance of the study

9.13 Legal and Ethical Consideration

References

LIST OF ACRONYMS

ACR – American College of Radiology

ABS - American Brachytherapy Society

AIDS - Autoimmune Deficiency Syndrome

ASTRO – American Society of Radiation Oncology

DNA – Deoxyribose Nucleic Acid

HIV - Human Immunodeficiency viruses

HPV - Human Papilloma Virus

NCCN - National Cancer

PAP- Papanicolaou smear

Ca cervix- cancer of the cervix

MOTIVATION FOR SPONSORSHIP TO

1. Research: Topic: Exploring the

relationship between cervical cancer with

vaginal snuff usage amongst females of

kwaZulu Natal, South Africa

2. Academic: Skills and Development in

the following departments:

Radiation Oncology

Medical Oncology and

Haematology

INTRODUCTION

My name is Dr Thandeka Mazibuko, a female from the village of kwaNyuswa, Durban. I am

born of a single parent mother who is a domestic worker, who solely depends on me for her

survival. In my family no one managed to complete matric, no one has managed to get a

chance to be at the University level. My primary and secondary education is from

kwaNyuswa schools. I then completed my basic education final year called matric at

Chesterville Township, when Siyajabula High school got burnt down during the uprising. I am

the only doctor in the village of kwaNyuswa, I have one sister who has also managed to get

a basic university degree. I also have 1 son to care for who is also at the university level. I

care for my immediate family, my aunts, uncles as well as be the main sponsor for the

charity organisation, we are running at the community level since 2004. I have invested a lot

of my revenue, time, salary and savings in uplifting my family, extended family and

community. As a female this role is very demanding and not easy but when found to be

alone with a challenge one has to do what we can to survive, improve our society and that

for me women empowerment through education and skills development.

I happen to be the first black to enter the department of Radiation Oncology in 2009. This

caused a lot of friction between me and the white old male professor who in his whole life

had never been defeated in refusing black students to enter Radiation Oncology Department

at Inkosi Albert Luthuli Hospital. I was refused an opportunity to train as a Radiation

Oncology specialist at UKZN, Nelson Mandela School of Medicine, and Inkosi Albert Luthuli

Hospital jointly, for a period of 4 years between 2007 and 2011 I was patient and persistent

until the white male Prof contract was not renewed, only then I was able to get an

opportunity to get training. A lot of time has been wasted and I have been very patient with

all the abusive situations that comes with racism, racial segregation, male dominancy and

denial of human rights to access to education.

It is indeed not easy to train to be a specialist in Radiation Oncology not because the subject

is hard but because indigenous blacks are not allowed by the existing system to train to be

Radiation Oncologists. In 60 years only 5 black Radiation Oncologists has been trained in

South Africa. A great embarrassment to our democracy. As we celebrate Human Rights day

in South Africa today, speeches about ending racism are delivered, we the academic

interested citizens of this country still feel that human rights to free and fair education has not

been met, proven by the latest spark of the students striking for academic rights, end of

discrimination and racism in South African Institutions of higher learning for a free and

compulsory education.

I founded an organisation called Sinomusanothando

Community Development in 2004, when I was still a

medical student at Nelson Mandela School of Medicine.

The aim of this organisation is to educate, provide mobile

free cancer screening to the previously disadvantages

communities, with major emphasis to the rural community

through this community work done at the community level

winning us many awards.

No other Radiation Oncologist in South Africa has ever

been honoured with so many awards for raising cancer

awareness, educating the community free of charge for a

period of 10 yrs. I am saying this to show the impact and

the community need for doctors to give back to their

community.

.

Radiation Oncology Training and Training Gaps

In 2012 HPCSA , the office of the Premier of kwaZulu Natal , The University Ombudsman

and the office of the Public protector discovered that my training number was fraudulently

and unlawfully taken by the Dean of the University of kwaZulu Natal, the then Acting Head of

the Department Radiation Oncology and of the Department of Health. My identity was then

given to the Indian male doctor. Despite multiple warnings to the above male scholars to

return my identity they continued to sign my identity to the most junior Indian male on 3

different occasions over the period of 3 years. The harassment worsen after these results of

the findings came out, the working environment became too hostile and unbecoming, as the

cabal abused their powers to cover up this fraudulent action of identity theft. I endured such

a bondage until I could not bare the abuse anymore hence looking for a peaceful, supportive

academic environment to prepare for my examinations and PHD scholars to supervise my

research.

Dr Thandeka Mazibuko Awards

1. Nominee of South African of the

year 2015

2. Women of Influence 2015

3. Finalist -Standard Bank Rising

Star 2014

4. Prominent Women of Africa

2013 honoured by Nigeria

5. KZN Business Women of the

year 2012

6. Oprah Heroine 2010

7. Nominee of Checkers Women of

the year 2009

RESEARCH TOPIC

Exploring the relationship between cervical cancers with virginal snuff usage amongst

females of kwaZulu Natal, South Africa is the topic that, I Dr Thandeka Mazibuko will be

researching during my trip to the United States of America

This research and training also entails getting academic support in my final stages of my

training in Radiation Oncology.

Qualifying as a Radiation Oncologists is the main goal.

THE PROBLEM STATEMENT

Cervical cancer burden is increasing at an alarming rate especially amongst the black rural

communities (Pisani et al 1990)

World-wide, cervical cancer continues to be an important cause of morbidity and mortality

(Shingleton, 1995). Cancer of the cervix is the second most common in South Africa.

(Department of Health, Statistical notes, Vol.3 No.5, May 2001)

Pisani et al have projected a 30% increase in the number of cancer deaths in developed

countries, and more than twice this amount (71%), in developing countries, between 1990

and 2010, due to demographic changes alone ( Pisani et al 1990). Rising incidence will only

add to this burden.

Cancer was estimated to account for about 7 million deaths in 2000, 12% of all deaths

worldwide. (Was also estimated to account for almost 6% of the entire global burden of

disease in that same year (World Health Organization, World Health Report 2001. Mental

Health: New Understanding, New Hope).

The relationship between cervical cancer and sexual

intercourse has created a stigma amongst South African

women leading to reluctance of screening for cervical

cancer which is an additional major contributory factor to

late stage disease presentation

(www.sasgo.co.za/images/simonds_advanced.ppt)

Skills and Training Development for Black Specialists

in South Africa, KZN, Durban

The above statistics forces us as medical doctors to get

even more advanced training in Radiation Oncology and to

focus even more on research during our training. The above

stats also forces our leaders to increase academic budget

spending money to training medical doctors in South Africa

as Radiation Oncologists, Medical Oncologists,

Haematologists, Physicist, Radiobiologists and

Radiotherapists which are all highly imperative scarce skills

in the treatment of cancer. .

In South Africa we only have 1 black Radiobiologist,

originally from Ghana out of 10 0ther races. He is in his late

50yrs, soon to retire. An embarrassment to our democracy.

Too many people are dying yet too little production of

Oncologists as South African Population is 55 million, these

communities are depending on only 175 Radiation

Oncologists, which only 5 are indigenous black and only 2

are Zulu Speaking. According to HPCSA South Africa has

38 Radiation Oncologist in KZN but only 4 are in the state

hospital, 3 Indian male and 1 black female. Out of all these

Radiation Oncologists that are in the state, I am the only one who visit rural communities and

raise cancer awareness at a larger scale for a period of 10 years. This is the major challenge

Radiation Oncology department is male dominant, white race medical doctors are still the

predominantly trained at Inkosi Albert Luthuli Hospital and Nelson Mandela School of

Medicine followed by Indian males. This lack of Africans training puts the names of these

great Noble Peace Winners into disrepute in the likes of Nelson Mandela and Inkosi Albert

Luthuli. It is still a very racist department and completely overtly, unapologetically,

deliberately and intentionally systematically excluding blacks from training and frustrating

MAJOR PROBLEM

Approximately 1500 women die

of cervix cancer in South Africa

each year Department of Health,

Statistical notes, Vol.3 No.5,

May 2001). From 1993 to 1995,

averages of 3387 new cases of

cervix cancer were reported. By

contrast, 1,497 deaths from

cervix cancer were reported for

1994 by the Statistics South

Africa.(Department of Health,

Statistical notes, Vol.3 No.5,

May 2001)

CERVICAL CANCER IS

EARLY DETECTABLE

PREVENTABLE

DETECTABLE

CURABLE

them to resigning by delayed academic progress, unbearable hostile environment hence the

students are impinged by circumstances to leave the department looking for academic

support in countries like India, Ireland, USA, UK, Turkey and Cuba.

There is no Radiation Oncologists in KZN and UKZN, Nelson Mandela School of Medicine

with a PHD which sets a major challenge for pursuing research of PHD standard. When I

submitted a Masters with a PHD intent I was told I cannot be allowed to be the first one to

submit a PHD paper. The level of mediocracy is too much, setting the academic ceiling to

low for driven researchers to survive. The South African Radiation Oncologists are private

sector oriented, financially driven, having minimal interest in research if at all. Most of them

when they qualify they go to open private practices to care for their families, themselves and

few , if at all cares about the research and making an impact in the community . Hospitals

like Addington Radiation Oncology department, has not been working for years due to non-

functioning Radiotherapy machines which sets a major challenge for training and skills

development for the junior registrars.

Patients with cancer comes to our centres with advanced disease, as the majority are rural

based but the one that hinders good training is the delay in treatment where patients with

cancer are booked for treatment 1 year after diagnosis, this means that doctors are

competent in treating only majority of advanced diseases not early disease.

HYPOTHESIS OF THE STUDY AND SKILLS DEVELOPMENT &TRAINING IN USA

1. Insertion of per vaginal snuff increases the risk of cervical cytological abnormalities and

eventually cervical cancer.

2. Training in the United States of America in Radiation Oncology, Medical Oncology and

Haematology will make me a far more advanced Radiation Oncologist in South Africa when I

qualify in 2017

3. I will be prepared to do my examinations which will be done in South Africa

AIM OF STUDY AND SKILLS DEVELOPMENT &TRAINING IN USA

1. To determine the prevalence of vaginal snuff insertions amongst women with

cervical cytological abnormalities presenting in an outpatient colposcopy unit

1. To get training and skills development in Radiation Oncology

2. To get an opportunity of rotation in Medical Oncology

3. To get supervision by the expects in the world in the field of Oncology

4. . To get full academic support which is lacking and association with victimisation by

the head of the department and the current University Dean

5. Increase the number of black females in the province of kwaZulu Natal to be trained

specialist in Radiation Oncology

6. To improve the quality of life of South African community

7. . To bring the world knowledge to South Africa

8. To study in a supportive environment

OBJECTIVES

To determine the prevalence of vaginal snuff insertions amongst women with

cervical cytological abnormalities

To establish the reason for females to use snuff

Determine the demographics of women who use snuff as opposed to those who

don’t, in particular, the HIV serostatus, no. of sexual partners etc.

To qualify as a competent Radiation Oncologist

To complete the training in Radiation Oncology and come back to work in South

Africa, Durban.

To study without victimisation, hostility and discouragements

BACKGROUND OF THE STUDY

Cancer of the cervix is the most common cancer in women (lifetime risk=1in 41)(

Department of Health, Statistical notes, Vol.3 No.5, May 2001). Approximately one in every

41 women will, within their lifetime, develop this form of cancer (Department of Health,

Statistical notes, Vol.3 No.5, May 2001).

Theories of the possible causes of cervix cancer were also recorded. Many physicians in the

early nineteen century shared the opinion that the disease was stress related, however,

others suggested that injuries, particularly those related to parturition, preceded cancer. In

1861 von Scanzoni was the first to observe that the disease was more frequent in city

dwellers and thus possible related to the manner of living (Ricci, 1945).

Early age at first sexual intercourse, smoking, immunosuppression and number of lifetime

partners are amongst other risk factors for cervical cancer. (CA Cancer J Clin 2005; 55:74–

108), JNCI J Natl Cancer Inst (1995) 87 (11): 796-802), American Cancer Society, Inc.,

2005).

The relationship between cervical cancer and sexual intercourse has created a stigma

amongst South African women leading to reluctance of screening for cervical cancer which

is an additional major contributory factor to late stage disease presentation

(www.sasgo.co.za/images/simonds_advanced.ppt

Early age at first sexual intercourse, smoking, immunosuppression and number of lifetime

partners are amongst other risk factors for cervical cancer. (CA Cancer J Clin 2005; 55:74–

108), JNCI J Natl Cancer Inst (1995) 87 (11): 796-802), American Cancer Society, Inc.,

2005)

LITERATURE REVIEW

Tumour arises from an uncontrolled cell division and failure of self-elimination (Eric J.Hall,

2006, page 274 and 371).

More than 90% of pre-invasive and invasive carcinoma is associated with the high risk

Human Papilloma viruses (HPV) 16, 18, 45 and 56, the most common viral infection of the

genital tract. Subtype 16/18 for 70% are responsible for cervical cancer worldwide. The main

cause of invasive cervical cancer is the production of full length E6 and E7 protein following

the production of stabilized E6/E7 full length mRNA from full high risk HPV types. (Joseph

Monsonégo: 98 Emerging issues on HPV infections: from Science to Practice).

RESEARCH METHOLOGY

METHODOLOGY

This study will interview of 200 patients seen at colposcopy clinic with some form of cervical

cytological abnormalities

Study Design

It’s a Retrospective, Observational, cross sectional study design looking at the following:

Site of the study

King Edward Hospital, Room 4, colposcopy room, Gynaecology Department

Study setting

King Edward Hospital, Room 4, colposcopy room, Gynaecology Department

Study population

All women with cervical cytological abnormalities

Sample strategy

Non-probability or convenience sampling will be used because questionnaires will be

distributed to 200 patients with premalignant lesion. The interviews following the

questionnaire will be asked in order to gather history of any virginal snuff usage.

Sample size

200 patients will be interviewed

Inclusion criteria

Pap smear results confirming an abnormal smear

All ages of patients presenting with abnormal smear or cervical cancer on biopsy

Exclusion criteria

Normal pap smear

Data collection methods and tools

Ethics approval will be sought from UKZN Ethics Committee and the Ethics Committee of

the Department of Health.

Study Location

Inkosi Albert Luthuli Hospital, Radiation Oncology Department and Kind Edward Hospital,

Room 6

Study Period

April 2016 to August 2016

Limitation of the Study

The study does not include the stratification of patients according to their HIV status and

CD4 counts. It also does not look at other causes of cervical cancer. Bearing in mind that

cervical cancer is associated with multiple causes, snuff alone may not be the only cause of

cervical cancer or an abnormal smear.

Significance of the Study

There is a need for a scientific investigation of the snuff usage virginally and to find out how

common its usage is amongst females.

Ethical and Legal Considerations

Patients will be allocated Research codes which state the site of the study as

well as the first 3 letters of their surname and the number which determines

their number according to the interview sequence.

Only the people involved in the study will have excess to the files

Statistical planning

A statistician will be requested to assist with guidelines of data collection, processing,

interpretation and analysis.

Study and Academic skills development and Training Budget

The study budget covers the expenses already paid for and the expenses needed to be

covered during the one year training in Haematology, Medical Oncology and Radiation

Oncology training while in New York.

The tuition, registration, accommodation and flights tickets to and from America in February

2016 was paid for. The interview was a great success and the 1 year training confirmed to

be commencing 20 April 2016 to May 2017.

The Universities and Cancer centres do not provide accommodation. At multiple request this

was not successful even a university accommodation was not a possibility

13 SKILLS DEVELOPMENT BUDGET

ITEM REASON AMOUNT ACTION

Application process To get academic training and research

support, phone calls to New York and

South Carolina, setting up

appointments for the interviews for 1

year.

R5000-00

Paid

Registration

Fee in New York

Medical Oncology and Haematology R15 000-00 Paid

Tuition fee New York for

1 year

Medical Oncology and Haematology

for 1 month

R23000-00 Paid

Tuition Fee South

Carolina

Radiation Oncology and Research for

1 year

R45000-00 Paid

Return Flight ticket

South Africa to JFK

February interview in New York R26 000-00 Paid

Exam Registration For 2 examinations to be written R10000-00 R10000-00

Return Flight from New

York to Atlanta

For the February interview in South

Carolina.

R6000-000 Paid

Research Flight back to South Africa for Data

collection and 2 examinations.

R48000-00 R48000-00

New York

Accommodation for 1

month

Accommodation during the stay in New

York from 17April 2016 to 20 May

2016

Fully furnished accommodation

R30000-00

weeks

R30000-00

Flight from New York to After 1 month of training in New York, R5000.00 R5000.00

South Carolina a flight to South Carolina for 1 year

studies

Accommodation in South

Carolina for 1 year 206

to 2017

$2200 per month as per Cancer

Centre Agency, full furnished flat

R35200-00 x 12

months

R422000- 00

Hotel Accommodation

February 2016

3 days in New York for interview in

Feb, 2016 Columbia University and

Atlanta

R18 000-00 Paid

STYPENT Salary will not be coming through while

studying

R30000-00 x12

months

R300000-00

Books and Stationery Research books, medical oncology

and haematology books, taking notes,

presentations material etc

R20000.00 R20000.00

Return Flight for 17 April,

2016 to returning 17 May

2017

To go do research and training in 3

departments.

R24 000-00 Paid

Transportation

Cabs to and from the

airport, 3 hr drive to the

hospital

The drive from the hotel to the Cancer

centre in South Carolina for the whole

day interview in February. Including

meals

R6200-00 Paid

Food for 1 year R35000.00 R35000.00

Transportation for 1 year A car is required in South Carolina due

to rough weather and distance

R40000.00

R40000.00

Amount Already Paid TOTAL R168000-00

Amount to be paid Total R910000-00

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