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23 October 2020 | Story Nombulelo Shange and Lesego Bertha Kgatitswe | Photo Pixabay
It is #BreastCancerAwarenessMonth, and women in rural areas struggle to receive and understand the life-saving messages, as much of the awareness is predominately in English, while cancer centres and health facilitates are mostly located in urban areas.

It is Breast Cancer Awareness Month, and questions around the reach of awareness are important to ponder. Who is the awareness really for? Much of the awareness is predominately in English, while cancer centres and health facilities are mostly located in urban areas. The result – women in rural areas struggle to receive and understand the life-saving messages. Accessibility remains a huge challenge when it comes to both diagnosis and treatment. Once diagnosed, black women must contend with many other socio-economic challenges that limit them from receiving treatment, even if it is free and provided by public healthcare institutions.

Overwhelming number of black women is poor and marginalised in SA

Women in the Northern Cape and parts of North West, for example, have to travel to Kimberley to access breast cancer treatment facilities. Kuruman has a satellite facility, but with limited resources and staff. Northern Cape is the largest province in South Africa when it comes to land mass, and most poor rural black women cannot afford the cost of travelling to Kimberley because of extreme poverty. A 2019 study conducted by the Pietermaritzburg Economic Justice and Dignity Group shows that 55,5% of the South African population survives on R40,90 per person per day. South Africa is also the most unequal society in the world, with those historically marginalised by colonisation and apartheid still being the most oppressed even today. Black women make up an overwhelming number of the poor and marginalised in SA. When black women are diagnosed with breast cancer, they have the burden of having to pit their bread and butter issues against their health concerns. Transport, food, and other travel costs have the ability to push these women and their families deeper into poverty when important healthcare institutions are far and inaccessible. 

Breast cancer awareness and education needs to be scaled up in the black communities to also consider these socio-economic limitations. Greater focus on primary healthcare is also needed with regard to speedy referral for screening and diagnostic tests. These interventions are still largely lacking in black communities, partly because of the myths around who is affected by cancer. The misconception is often that cancer is a disease that only affects white people, and it still persists despite the growing incidences of cancer among black women. One of the reasons influencing this racialised idea of the illness might be the fact that there are seemingly higher incidences of breast cancer among white women than among black women.

In 2011, the National Cancer Registry reported that the overall risk for breast cancer in South Africa is 1 in 29 women, and further estimated that the lifetime risk is 1 in 12 among white women and 1 in 50 among black women. These figures, however, do not account for the black women who might never receive a proper diagnosis. Current and accurate research is not available on how these figures might have changed over the past 10 years. The 2017 Breast Cancer Prevention and Control Policy, however, attributes lower incidence of breast cancer among black women to multiple socio-cultural factors, such as universal and prolonged lactation, low use of hormone replacement therapy, late menarche, early age of first birth, and a diet low in fat and high in fibre. However, due to rapid urbanisation and lifestyle changes, there has been a significant decrease in these protective factors, making black women vulnerable to increased incidences of breast cancer and mortality.

Public healthcare system had to prioritise simultaneously 

Historically, cancer, along with other non-communicable diseases, have been understood as diseases of affluence, as they are related to economic development, consumption, and lifestyle. In contrast, infectious or communicable diseases were understood as diseases of poverty and impoverishment. These crude categorisations were central in explaining global health inequalities, but the epidemiological transitions of the past few decades have forced us to think more critically about these issues. South Africa as a middle-income country is a case in point, with a disease burden of both communicable and non-communicable diseases, which the public healthcare system had to prioritise simultaneously. Breast cancer has thus been declared a national priority, as highlighted by the Breast Cancer Prevention and Control Policy of 2017.

The policy notes that women who live in rural areas are at a disadvantage regarding access to information and services; however, little is said about the intersections of race, class, and gender in understanding the structural barriers to breast cancer awareness and knowledge. The poor or inadequate breast cancer awareness and knowledge among black women should be a call for concern.

Poor knowledge and awareness of breast cancer leads to delayed detection, presentation, diagnosis, and treatment. This results in a late stage of cancer upon diagnosis, aggressive cancer treatment, severe side effects, poor quality of life, or worse – mortality. As public health specialists often say, ‘equity in healthcare begins with equity in health education’. Sociological analysis and theorising are thus important for us to understand these structural barriers, starting with how black women’s bodies are seen and treated. Researchers around the world have highlighted how the healthcare system treats black women differently as a result of implicit racial bias, discrimination, and racism.

American critical race theorist and feminist scholar, Patricia Hill Collins, attributes the discrimination experienced by black women to vectors of oppression that intersect in black women’s lives. Poverty, lack of representation in healthcare systems/leadership, discrimination along racial and gender lines – all these vectors come together and make access to healthcare a huge challenge for black women. Systems marginalise black women for economic gain or to maintain patriarchal dominance, making even the most basic rights and institutions inaccessible to black women.

The exclusion of black women

Beyond awareness, these challenges also speak to the exclusion of black women in public spaces, in senior positions within healthcare, in leadership, and in important decision-making that can impact how they navigate the world. The lack of representation affects even the personal aspects of black women’s lives, such as how they experience illness.

Feminists tackle this challenge by turning the personal into the political. Politicising the personal is forcing the challenges that women are faced with into the public space, compelling institutions and leaders to address these challenges. Breast cancer awareness does this in part, which is one of the things that makes the movement so important. But is it leaving black women behind?  

While awareness might be lacking for black women with breast cancer, it is important to note that some women have exercised their agency to advance breast cancer awareness. Mama Lillian Dube, for example, used her public platform to talk about her experiences of breast cancer, demystifying the illness, and advocating for quality healthcare services for women. We also need to tap into existing structures and initiatives; community healthcare workers have done great work in the past to create awareness around HIV/AIDS. Similar strategies should be considered for breast cancer awareness to ensure that no woman is left behind.  

Opinion article by Nombulelo Shange, Lecturer in the Department of Sociology, University of the Free State, and Lesego Bertha Kgatitswe (Lecturer in the Department of Sociology at Sol Plaatje University)  

 


News Archive

Centenary medals awarded
2004-10-15

Speech, Rector and Vice-Chancellor: Prof. Frederick Fourie

Op 28 Januarie 2004 het ons die honderdste herdenking van die geboorte van hier­die hoër onderwys instelling gevier met ‘n groot partytjie voor die Hoofgebou. Dit was ‘n wonderlike en vreugdevolle aand.

Die historiese prosessie tydens die amptelike opening van 6 Februarie 2004, in kleurvolle akademiese togas, vanaf ons wortels in Grey-Kollege tot by die Hoof­gebou, het die reistog vanaf die verlede na die hede treffend ge­simbo­liseer.

Talle ander eeufeesgeleenthede het gedurende hierdie jaar plaasgevind. Woensdagaand het ons die premiêre van ‘n dokumentêre film oor koning Moshoeshoe beleef – ‘n belangrike eeufeesprojek van die UV wat onder meer gemik is op die ontwikkeling van ‘ n gedeede geskiedenisbesef – a shared sense of history – and the celebration of a very special leadership, of a spirit of nation-building and reconciliation, in somebody like king Moshoeshoe (also MT Steyn and others…)

Last night we experienced a wonderful and moving honorary doctorary ceremony, with a wonderful group of South Africans like Khotso Mokhele, Antjie Krog, Jakes Gerwel, Van Zyl Slabbert, Jaap Steyn, Saleem Badat, and others - giving so much food for thought.

This evening, where we honour outstanding contributors to the development of this University, is a suitable moment to reflect on the course of the first 100 years of the University of the Free State.

1. ‘n Voëlvlug oor die geskiedenis: die vyf fases

1.1 Eerste fase: 1904 – 1927 (Eerste kwarteeu)

Eerste wankelende treë in die totstandkoming van die
Grey Universiteitskollege

Gedurende 1904 – 1920 word die eerste en mees basiese vakke in geestes- en natuurweten­skappe ingestel, eerste Senaat en eerste Raad saamgestel, en eerste geboue opgerig (hoofgebou en manskoshuis). Teen 1920 was daar egter slegs ongeveer 100 studente, die instelling was finansieel in die knyp, met geen vooruitgang en groei, en ook nie ‘n vaste rektor nie – klaar­blyk­lik was die GUK nog geen lewensvatbare instelling nie. Vrystaatse kinders word steeds eerder na ander universiteite gestuur.

Hierna maak ds JD Kestell, rektor 1920 – 1927, ‘n reuse bydrae om ‘n versukkelde, arm, klein universiteitskollege lewensvatbaat te kry. Hy slaag met fonds­insameling en oortuig Afrikaanse én Engelse ouers om hulle kinders na die GUK te stuur. Teen 1927, met 420 studente, word die eerste nederige mylpale van kritiese massa bereik te midde van ‘n steeds armoedige Vrystaat­se gemeenskap en ‘n studentekorps met gelapte klere. [Maar ook die tyd waarin die Reitz-saal, waarin hierdie plegtigheid plaasvind, gebou is.]

1.2 Second phase: 1927 – 1950 (Tweede kwarteeu)

The Grey University College becomes a fully fledged university

By 1950 the establishment of main basic and career-oriented faculties were completed – Faculty of Commerce in 1937; Faculty of Law as wel as the Faculty of Education in 1945. Student numbers reached 1000 in 1950.

Die UKOVS beleef en oorleef die Groot Depressie, die armblankevraagstuk, die Tweede Wêreldoorlog, taal- en politieke stryd onder Afrikaners, en die stryd van Nat vs Sap, ook op die kampus. Die tydperk word veral gestempel deur die taalstryd met DF Malherbe (rektor 1929 – 1934) as sterk kampvegter vir Afrikaans. Veral na 1948 volg rektor Van der Merwe Scholtz ‘n doelbewuste enkel­talige Afrikaanse rigting (Christelik-nasionaal).

1.3 Derde fase: 1950 – 1976 (Derde kwarteeu)

Ongekompliseerde groei ná onafhanklikheid

Hierdie periode word gestempel deur verkryging van onafhanklikheid as universiteit op 18 Maart 1950. Daarna beleef die UOVS onder rektore Scholtz, Flippie Groene­woud en Benedictus Kok stelselmatige groei sonder beduidende finansiële kommer. Die UV is duidelik ‘n Afrikaanse ‘volksuniversiteit’ op Christelik-nasionale grondslag, onlosmaaklik in­gebed in die dominante politieke bedeling van apartheid en afsonder­like ontwikke­ling. Dit is die hooggety van Afrikaner (en blanke) self­vertroue en heerskappy. Vir personeel sowel as studente is dit ‘n relatief onge­kom­­pliseerde tyd getipeer deur groeiende voor­spoed in die blanke en Afrikaanse gemeenskap, goeie werksvooruitsigte vir studente, kommer­lose studentepret, en min spanning op die kampus.

The academic focus is on teaching, especially to provide staff for the growing public service and education sectors. Research has a low profile. More career-oriented or professional faculties are established: agriculture in 1958 and the medical faculty in 1970. Student numbers reach 2000 in 1960, 4000 in 1970 en 7000 in 1975. Many new residences and academic buildings are erected, especially in the Kok-era.

Teen 1976 was die vernaamste boustene van ‘n medium-grootte universiteit in posisie: onafhanklikheid, genoeg fakulteite, genoeg koshuise en akademiese geboue, goeie sport en kultuur. Op die oog af is die ideaal van volwaardige, onaf­hanklike universiteit verwesenlik.

1.4 Vierde fase: 1976 – 1989

Op koers na die jaar 2000: van die statiese na vernuwing

Politieke onstabiliteit en oorgang in die land begin met die Soweto-onluste, die drie-kamer parlement, PW Botha se Rubicon-toespraak, noodtoestande, die ‘struggle’ en opkoms van UDF, en so meer. Die UOVS is swaar onder die indruk van die ‘totale aanslag’ en die regering se totale teen-strategie. Die Universiteit word polities en akade­mies geïsoleer en intellektueel gemarginaliseer. Ekonomies is dit moeiliker tye na die oliekrisis en die begin van hoë inflasie, en die Staat se finansies wat begin knyp.

Academically this period is distinguished by the strong stimulation and support of the research capacity and orientation by rector Wynand Mouton, which leads to a significant growth in research, especially in the natural sciences. The faculty of Theology is establishyed, the Sasol-UFS library erected. Student numbers continue to grow, but at a much slower rate then before.

Twee ander fasette kenmerk hierdie tydperk: eerstens die toelating van die eerste swart studente (nagraadse 1978, voorgraads 1988) en die begin van die era van multikulturaliteit; tweedens, die begin van subsidie- en finansiële probleme en die eerste rasionalisasie van personeel. Albei hierdie is voortekens van ingewikkelde jare wat sou volg vanaf 1990.

1.5 Fifth phase: 1990 – 2004: The turn of the century brings winds of change

(a) 1990 – 1996:

Die Francois Retief era word gedomineer deur die gevolge van die politieke verande­ringe deur president FW de Klerk en die vrylating van Nelson Mandela. Die UV ontwaak tot die realiteit van die oorgang na ‘n post-apartheid samelewing en komende ANC regering. Die eerste versigtige trans­for­ma­sie­stappe word ingestel, multikulturaliteit word die groot uitdaging, en die eerste fasiliterende strukture (bv. die Multikulturele Komitee) word gevestig. Die eerste senior swart personeel word aangestel.

The dramatic decision about the introduction of parallel-medium teaching in 1993 signals the start of multilingualism as well as a significant growth in the admission of black students. Total student numbers are stable at approximately 9000, but black student numbers grow to 36% in 1995. Initially the change to parallel-medium impact negatively on staff teaching load and hence onresearch outputs.

Die inkrimping in staatsubsidie lei tot ernstige finansiële probleme, besparings­pogings, grootskaalse rasionalisasie van personeel in veral die fakulteit Lettere en Wysbegeerte, spanning tussen Senaat en rektoraat oor finansies – en mismoedig­heid onder personeel.

(b) 1997 – 2004:

The time of rector Stef Coetzee and his successor is the era of the new democracy and transformation. At the beginning of this phase Afrikaans parents start sending their children to other Afrikaans universities; residence become half full. Tensions arise between student groups. This is followed by the large breakthroughs in student transformation in 1997, which normalises the situation. The University becomes a leader in transformation. This leads to the acceptance of the multicultural and multilingual character, on a Christian foundation, of the University. The name changes to the University of the Free State (UFS).

Met ‘n finansiële krisis en verdere rasionalisasie van personeel op hande word die akade­miese en finansiële ‘draaistrategie’ in Januarie 2000 geloods. ‘n Drama­tiese finansiële ommekeer lei tot herinvestering in kampus­fasiliteite en toerusting, ‘n toename in personeel en beduidende verhoging in vergoeding bokant inflasie. Terselfdertyd is daar ‘n opbloei in die akademie: innoverende onderrig­programme, e-leer, ‘n fokus op programgehalte. Konsolidering van fakulteite vind plaas, die Bestuurskool word gestig, daar is sterk internasio­na­lisering en groei in navorsing. Profes­sionele bemarking en strategiese kommunikasie verander die beeld van die UV.

Studentegetalle groei dramaties van 10 000 in 2000 na meer as
23 000 in 2003/4; groei moet nou beperk word. Afrikaanse studente keer terug; koshuise kry lang waglyste. Die verhou­ding tussen wit en swart studente op die hoofkampus is rondom 50:50.

The period ends with the incorporation of the Qwaqwa en Vista Bloemfontein campuses, the approval of a new language policy which also established multilingualism in management and administration, and purposeful efforts to consolidate the foundations of an institutional culture of multiculturalism, multilingualism, non-racialism and non-sexism – a culture of tolerance, embracement and justice in diversity. The Centenary is celebrated with harmony and prosperity on the campus in 2004 (although always with a good sprinkling of unexpected challenges and problems).

2. Vanaand bring ons hulde, en sê ons dankie aan, die bouers van die UV

Oor ‘n honderd jaar het honderde, duisende mense ‘n bydrae gelewer tot die UV se ontwikkeling.

Kom ons eer en dank diegene wat, 100 jaar gelede in a baie arm gemeen­skap wat bykans verwoes is deur die Anglo-Boere oorlog, nooit opgehou droom het oor ‘n eie universiteit om die jongmense te dien, om die mense te dien – die arm Vrystaatse mense van daardie tyd.

Let us honour and thank all those who painstaking built this university from very humble beginnings, from the first fragments and embrio of a university – through a hundred years of various wars, of the struggle, of poverty, of bad times but also good times.

In elke dekade, in elke een van die honderd jaar, is hierdie instelling gebou deur die harde werk, idealisme en verbintenis (“commitment”) van leiers, akademiese personeel, steundiens­personeel, dienswerkers. Laat ons hulle eer en dank.

Let us honour the spirit of commitment and ‘vasbyt’, of ‘never let go’, the determination to overcome obstacles, of timely and pre-emptive adjustment to new challenges and new needs, which made that possible.

Kom ons vier en eer die duisende studente wat in die 100 jaar hier was, wat die spesiale tradisies en spesiale gees geskep het van Kovsiekampus, van Kovsie studentelewe – en wat gedurig nuwe tradisies en gebruike geskep (en gepleeg) het, soos net studente dit kan doen.

Let us celebrate the way this University has, in the last 20 years, once again taken up the challenge of transformation and adjusting to new needs, serving all the people, especially those most in need at this time of our history – thereby closing the circle, going fully “from post Anglo-Boer War to Post-Apartheid”.

Kom ons vier, en wees innig dankbaar vir, die wyse waarop hierdie Universiteit in die laaste 5 jaar gedraai het, finansieel sowel as akademies, en die wonderlike periode van akademiese groei en ontwikkeling en verdieping waarin ons nou staan – tesame met die geleenthede wat QwaQwa en Vista Bfn vir ons bied. Hierdie voorspoed sien ons in die nuwe fisiese aangesig van die kampus, insluitend hierdie wonderlike Eeufeeskompleks.

Let us thank God, the Almighty, who has guided this university through a tumultuous century, for always being there for us, for blessing us in so many ways. In Deo Sapientiae Lux

* * *

So: vanaand is ons hier om erkenning te gee en dankie te sê…

Soveel mense het veel vroeër hul fondament-leggende bydraes gelewer, en alles wat ons vandag hier sien, moontlik gemaak. Selfs mense uit meer onlangse jare is reeds oorlede – enkeles terwyl hulle nog in diens van die UV was, ander na hul aftrede.

‘n Bepaalde groep was bevoorreg en geseend om in die laaste ongeveer 30 jaar by die UV betrokke te kon wees, én om vandag nog in die lewe te wees. Dit is van hulle wat vanaand hier is, en wat vanaand Eeufeesmedaljes ontvang.

Geweldige moeite is gedoen om hierdie proses van seleksie en keuring so billik en deeglik as moontlik te doen. Uiteraard is so ‘n proses nie volmaak nie en sal almal nie saamstem met die uitkomste van die proses nie. Groot moeite is egter gedoen in hierdie fase om mense nie verkeerdelik uit te laat uit of in te sluit in die toekenningslys nie, in volle bewustheid dat daar waarskynlik steeds foute gemaak sal word. Onvermydelik sal daar foute wees, of mense wat uitgelaat is. Ons vra daarvoor nederig om verskoning en begrip.

Billikheid, so ‘n belangrike rigsnoer vir hierdie Universiteit, veral in hierdie tye, lei ons ook dat ons oë oop is vir die bydraes vir mense uit alle afdelings van die Universiteit, wat lei tot ‘n bepaalde balans tussen fakulteite, tussen fakulteite en steundienste, tussen poskategorieë, tussen geslag en ras, en individue soveel as mense in spanverband.

In Deo Sapientiae Lux

God bless this university / Modimo o thlonolofatse yunivesithi ena

Khotso Pula Nala

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