Dr Justus Apffelstaedt is a specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology. He practices in both Cape Town and Namibia and has been at the frontline of a recent project to bring Namibian cancer patients to Cape Town for essential breast cancer-related surgery.

Aged between 29 and 64 years of age, the women are all in the midst of breast cancer treatment. Most have had locally advanced breast cancer or particularly aggressive breast cancers that require chemotherapy as initial treatment before surgery. For these tumours, it is very important to do surgery when the tumour burden is as small as possible. Once the chemotherapy regimen has been administered, there is a window of opportunity for the surgery of about one to three months before the tumours start growing again. Timeous surgery is vitally important.

As Dr Apffelstaedt was unable to travel to Windhoek during the lock down restrictions, the women have been working with him in an effort to travel to his Cape Town practice. He employs advanced immediate reconstruction techniques after mastectomy, which are not available in Namibia.

Negotiating the complexities of their travel has resulted in the successful surgeries on three women on Sunday, 31 May and Monday, 1 June.

Says Apffelstaedt: “Cancer does not stop in the face of Covid-19. In our practice, we have seen a massive decline of women coming for screening and a significant number of cancer patients delaying their consultations or treatments. This will in due course translate into more advanced cancers being diagnosed and needing more intensive and expensive treatment. For these women, it has taken weeks to surmount the administrative obstacles to travel to Cape Town. There has been a dearth of clear communication, there did not appear to be any established “mercy pathway” for urgent, but not emergency cases and the regulations were requiring two-week quarantines on either side of the border in spite of potentially chartering flights and arranging for safe transport. It has been very challenging simply to give women the best possible chance in their cancer fight.”

There were originally nine patients attempting to travel to Cape Town. One has forsaken reconstruction and has had a mastectomy locally.  Two are waiting until corona lifts without regard to the cancer situation. Out of six that are trying to travel, one has had no specific therapy for three months (not even induction treatment), the others are at the one to two months’ stage after chemotherapy. There are also other patients who are about to finish chemotherapy.

Says Francina van der Merwe (55), from Windhoek, Namibia, who underwent a reconstruction at Mediclinic Louis Leipoldt on Sunday, 31 May: “My general practitioner in Windhoek discovered the cancer when I was diagnosed in October 2019, and recommended that I make contact with Dr Apffelstaedt for treatment. We were happy with the way he treated us from day one, especially considering the dark thoughts and fear that the word ‘cancer’ can evoke in one’s minds’ eye. There are surgical options available in Windhoek but my doctor recommended we speak to Dr Apffelstaedt as this is a complex reconstruction, which we could thankfully have done at the same time as the tumour removal.

“It really is not an easy process to travel internationally under current lockdown conditions, but Dr Apffelstaedt and his team took care of everything – they arranged all the permits we needed to be able to travel. He really made it much easier.”

Concludes Apffelstaedt: “We owe it to cancer patients to ensure that their lives are not put at risk due to this pandemic.”

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