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14 September 2021 | Story Dr Jan du Plessis and Dr Mampoi Jonas

Opinion article by Dr Jan du Plessis, Head of the Paediatric Oncology Unit, and Dr Mampoi Jonas, senior lecturer in the Paediatric Oncology, University of the Free State 


For many years childhood cancer has remained a taboo subject in our communities, mainly because too little was or is known about it. Many have known or come across an adult with cancer but for a child to be diagnosed with cancer is totally unheard of. No parent wants to hear the news that their ‘heartbeat in human form’ has fallen ill. One moment they are OK, the next, waves of emotions flood the parents. Mixed in all this are feelings of guilt, anxiety, uncertainty, constant wondering if they could have done anything differently. Most importantly the question, often unuttered remains “Is my child dying/ how much time do I have”.

Most young cancer patients live in developing countries

Childhood cancer is rare and involves only 1% of all cancers. It is reported that globally approximately 70% of all childhood cancer cases occur in low- and middle-income countries. If diagnosed early, approximately 70-80% of childhood cancers are curable in developed countries. Unfortunately, most children with cancer live in developing countries with limited resources and the cure rate does not reflect the same success. The low survival rates can be attributed to poor diagnosis coupled with too few specially trained doctors and nurses and the misbelief that child cancer is too difficult to cure. However, even in resource-poor environments at least 50% of childhood cancers can be cured.

Numerically, childhood cancer is not a significant cause of death in sub-Saharan African countries, which leaves childhood cancer less of a priority. In Africa, the most common paediatric health problems are malnutrition, infectious diseases such as HIV and tuberculosis. Whereas in Western countries, after accidents, cancer is the second leading cause of death in children and is a burden to the health system.

A study done by Stones et al in 2014 published the survival rates for children with cancer in South Africa at two different Units (Universitas and Tygerberg Hospitals) to be around 52%. The conclusion was that the children present late and with advanced-stage disease, which obviously affects their outcome. They also concluded that strategies to improve awareness of childhood cancer should be improved. Identifying early warning signs of childhood cancer is critical for parents and healthcare workers to ensure early diagnosis and improved cure rates. We often refer to these as red flag signs that should raise suspicion of the possibility of cancer as a diagnosis for the presenting patient.

Almost 85% of childhood cancers will present with the red flag signs, which could suggest the possibility of a childhood cancer, namely:
1. Pallor and purpura (bruising)
2. Bone and joint pain
3. Lymphadenopathy
4. Unexplained masses on any body part
5. Unexplained neurological signs
6. Changes in the orbit or eye
7. Persistent unexplained fever and weight loss

The most common cancer in children is leukaemia (blood cancer). Brain tumours are the most common non-haematological cancers, followed by nephroblastomas (kidney cancers) and neuroblastomas (sympathetic chain cells, the adrenal glands the most common site of origin).

We honour the children currently battling cancer and their families 

Once there is clinical suspicion of cancer, the child should be investigated or referred for the relevant investigations to be conducted to get to the right diagnosis. Treatment for childhood cancer includes chemotherapy, surgery or radiotherapy. These may be given separately or in combination depending on the diagnosis. Many models of care exist, but regardless of the outcome, children and families who receive compassionate, holistic care of symptomatology and address their non-physical needs are able to face their illness with dignity and energy.  

Childhood Cancer should not remain a taboo subject in South Africa and should be a topic of conversation more often so that people can be educated regarding the early warning signs and become more aware of its occurrence amongst children. Get the word out that a cure is possible. This month, which is known as Childhood Cancer Awareness Month, and throughout the year, we honour the children currently battling cancer, the families who love them, the clinicians and other caregivers treating them, the survivors of childhood cancer and the children who lost their lives to childhood cancer. 

Authors

Dr Jan Du Plessis for web 
Dr Jan du Plessis is the Head of the Paediatric  Oncology Unit in the Faculty of Health Sciences at
the University of the Free State (UFS).  


DrJonas for web
Dr Mampoi Jonas is a senior lecturer in the Paediatric Oncology, University of the Free State (UFS).

News Archive

Inaugural speech of the 13th Rector and Vice-Chancellor of the UFS
2009-10-17

Inaugural speech of the 13th Rector and Vice-Chancellor of the University of the Free State (UFS)

For such a time as this


Jonathan D Jansen
In Honour of Adv. Bram Fischer

Preliminaries

Welcome, welcome, welcome. I thought this would never happen. In fact, many of you told me it could never happen because of my refusal to snuggle up to power. Yet here you are, some from foreign lands like Chris and Lynette Abels from the United Kingdom, Joel Samoff from Stanford University (California), Josephine Allen from Cornell University (New York), and half of you from the Western Cape. All foreign protocols observed. To my South African friends of Indian descent, welcome to you too; you may stay overnight.

Thank you so much for honouring the University of the Free State this evening.

I am accompanied tonight by two high school leaders. Foster Lubbe was the first Free Stater to write to me, while I was still working in Durban, to welcome me to the province; he is the next head boy of Sentraal Secondary School in Bloemfontein. Portia Lehasa is the first black head girl in 134 years of the famed Eunice Girls Secondary School also here in Bloemfontein. Foster and Portia represent our future as a country; they remind me of my first love, school teaching. And when I sit down and talk with these two youth leaders, I become profoundly optimistic about the future of our country.

I dedicate this Inaugural Lecture to arguably the greatest son of the University of the Free State (a law student here when it was still called Grey University College), the man who led the defence of Nelson Mandela, the patriot who laid down his life for black and white South Africans, so that we could all be free today. I am so delighted that his daughters Ruth and Ilse could be here this evening.

To the children of Bram Fischer, I now hand over a specially prepared version of the Inaugural Lecture.

A place like this

You are in the centre of South Africa. In a small city with a big heart. In a place that gave rise to the two most important nationalist movements of the past century, and possibly a third (we’re not sure yet). This is a place of contrasts, for the city of roses (Bloemfontein) is also the home of the Cheetahs (Mangaung). It is a place that has given birth to the full spectrum of humanity, from JRR Tolkien the creator of the Hobbit all the way across to Steve Hofmeyr the creator of, well, many things.

Significantly, it is to the city of Bloemfontein that the condemned criminal comes with his last and desperate plea, the Supreme Court of Appeal. And so we also come together this evening with a plea for our university, a plea for our country, a plea for Africa.

A time like this

One hundred and ten years ago a terrible tragedy played out in this city and changed the course of South African history. The President of the Orange Free State, MT Steyn, convened the so-called Bloemfontein Conference to settle differences between the British High Commissioner, Alfred Milner, and the Transvaal President, Paul Kruger, on matters that included voting rights for Uitlanders and the use of English in the Transvaal Volksraad. For President Steyn this was a last-ditch effort at reconciliation between what was called “two races”.

The reconciliation talks failed, and a few months later the Second Boer War broke out leaving more than 26 000 people dead: white and black, adults and children. The failure to reconcile at such a crucial time as that left scars on the South African political psyche to this day. And I have no doubt that the single most important reason for the breakdown in the Bloemfontein Conference was, profoundly, a failure of leadership.

We stand at another crucial time in our history this evening. Who would have thought that barely a decade after the miracle of our transition we would be talking about “minorities” in a democracy founded on the principles of non-racialism? Who could have imagined that in Mandela’s country human appointments to jobs would be instructed by that calculating phrase, “the demographics of the country”? And who could have predicted the bare-knuckled violence that kills white farmers on their lands and foreign nationals on our streets, or that the poorest of black citizens would be felled by the racial anger of an 18-year old white boy barely out of high school?

South Africa faces today what John Samuels calls “our unfinished business.” Our university, too, faces unfinished business, so let me get right to it.

The University of the Free State is 105 years old. In its long and proud history this institution has produced some of the finest jurists (including our Chair of Council, Judge Faan Hancke), teachers, medical scientists, architects, agricultural economists, poets, musicians, authors and nurses. The university has also produced some of our leading sportspersons, including the unbelievably talented Springbok flanker Heinrich Brüssow and  Boy Soke, our athletics sensation with his national colours in track and field, cross country and road running.

Closing the book on Reitz

But this history, as is the case with all South African universities, is not unblemished.

About 100 metres to the left of where I stand, is the famous Abraham Fischer Residence (affectionately called Vishuis), named after the father of the younger Fischer. This century-old student residence is living testimony to a proud history of the University of the Free State.

About 100 metres directly behind me is the Reitz student residence, a place of infamy that brought great shame to our university and unprecedented outrage to our country as the world saw four young white men racially humiliate five black workers.

In the past few months I have visited the grounds of Reitz often in an attempt to understand how such an atrocity could have been committed on the grounds of an institution of higher learning. I believe I now have part of the answer, and that answer has important implications for how we move towards healing, forgiveness and social justice on our campus and in our country.

You see, the biggest mistake made in the analysis of Reitz is to explain the incident in terms of individual pathology. Yet to dismiss the video as a product of four bad apples is too easy an explanation. This video recording was preceded by a long series of racial incidents protesting racial integration especially in the residences of the university. Not all of these racially charged incidents made the press; in fact, had it not been for the public release of the video recording, no-one outside the university would have known about it. And few outside the campus realise that what is now regarded as an offensive video production in fact won an award from the residence for its content.

The question facing us, therefore, is a disturbing one, and it is this: What was it within the institution that made it possible for such an atrocity to be committed in the first place?

And there are other questions. Why is it that one after another parent and colleague have come to tell me that the incident was, and I quote, “blown out of proportion?” Why is it that so many adults came to tell me that it was Oros, and not urine, as if it mattered in the simulated act of boys urinating into food? What must I make of the many representations to my office to inform me that the boys, I quote again, “loved the squeezas and brought them food from their parents’ farms?”

When the focus of analysis shifts from that of individual pathology to one of institutional culture, then it becomes clear that the problem of Reitz is not simply a problem of four racially troubled students. It is, without question, a problem of institutional complicity.

For this reason it is also clear that the deeper issues of racism and bigotry that conflict our university – and many others - will not be resolved in the courts. Whoever wins and loses in the Reitz case, I will still wake up on Monday morning dealing with the same social, cultural and ideological complexities that stand in the way of transformation – unless we do something differently (more about that in a minute).

Acknowledgement

I am inextricably part of the University of the Free State, and tonight I ask your forgiveness for what we have done. I apologize to every black person on this campus and in this province for our long history of exclusion and marginalization of black people within this institution. I have spent many nights in tears regretting what we (yes, we) did to the five black workers of the University of the Free State. This institution begs your forgiveness.

I apologize to every decent white citizen of our university that you were shamed by the Reitz incident. I know too many of you have felt private guilt and racial remorse, as well, that we as an institution failed you. And I know that you took what the four students did, personally, and that the relentless criticism of whites in the wake of Reitz, you absorbed as a commentary on the group.

Tonight, as the head of this institution, I apologise to you.

I apologize to the memory of Bram Fischer, the patriot who warned us that separate living would bring collective trauma. I apologize to Sheila Aronstam and Kalie Strydom, who long before it was fashionable, pushed the Council of the university to transform this treasured institution when it was simply not ready to do so. I apologize to my predecessors, Professors François Retief, Stef Coetzee, and Frederick Fourie – for in your own ways you asked for the transformation of Kovsies sometimes at great personal cost to you, and to your families.

I also feel compelled to say this to you tonight. Those four students who committed that heinous act, are my students. If I may borrow from another leader, I cannot deny them, anymore than I cannot deny my own children. The four Reitz students are children of this country, they are youth of the province, and they are students of our university. They are, I repeat, my students.

And so I have made some decisions.
 

  1. 1. In a gesture of racial reconciliation, and the need for healing, the University of the Free State will withdraw its own charges against the four students. The University will therefore not pursue any further action against the four young men implicated in the Reitz incident. In this spirit of toenadering, the University will go further, and invite those four students to continue their studies here.
  2. In recognition of our institutional complicity in the Reitz saga, and the need for social justice, the University of the Free State will not only pursue forgiveness but will also pay reparations to the workers concerned for damages to their dignity and their self-esteem.
     
  3. And,

    In a determined commitment to the urgent task of reconstruction, the University of the Free State will re-open the Reitz residence and transform it into a model of racial reconciliation and social justice for all students.

Opening the book on the future

As we seek to close the book on Reitz, we are determined to open the book on a new and reconstructed future for the University of the Free State. In this, we will be driven by two goals.

Firstly, the university will become a place that exemplifies the scholarship and the practice of reconciliation, forgiveness and social justice. Scholars and students from around the world will descend on the institution to study and understand the theory and practice of building community across the divides of race but also religion, gender, dis/ability, national origins and, thanks to Athletics South Africa, sexual identity.

In this respect the University will soon launch what we hope to call The Reitz Institute for Studies in Race, Reconciliation and Social Justice.

Secondly, the university will move very quickly to become a national and indeed international centre for academic excellence. While the UFS has great programmes in fields like chemistry, agriculture and medicine, we are acutely aware of the need to dramatically scale-up the academic standards of a promising institution.

In this respect let me be clear that the UFS will be unashamedly elitist in its drive to become an African university instantly recognized for excellence in research, teaching and what my predecessor so beautifully called “engaged scholarship” in relation to the communities around us.

A university is not a welfare organization. It is not a FET College. It is not a giant compensatory programme for students who crawled over the matric finishing line demanding to study for a degree.

A university is an institution of higher learning serving the best available talent in the nation and beyond. With this purpose in mind, we will recruit only the best white and the best black students and academics to the University of the Free State.

Learning to serve

However, no South African university can afford to wait for students to show-up at the end of Grade 12 and then tell them that they’re not good enough; that would be cruel and unjust to children failed by the school system. Because of our history, the university has a responsibility to work with the most disadvantaged schools in our country in the earlier grades to prepare especially first-generation students to be successful in their application to and their passage through university.

In this respect the UFS will be working with disadvantaged high schools starting in rural provinces such as the Free State and the Northern Cape to prepare young people for university through summer and winter schools on our three campuses where they will learn in libraries, laboratories and lecture-rooms about how to prepare for success in university studies. The major thrust of our community engagement as a university will therefore be through a large-scale university-school partnership in poor communities. 

Staff equity

The University remains, however, in its cast of scholars, largely white and male especially in the professoriate. This will change quickly, not only as a matter of equity but also as a matter of excellence. We cannot and will not become a university with academic standing in the world if we draw on such a limited pool of available scholarly talent.

Starting next week, therefore, we will advertise on open billet 25 senior professorial positions that will attract only the smartest and most diverse pool of scholars to this institution. The UFS will transform the face of its academic staff at pace, and we will do this without being forced to make the false choice between excellence and equity.

Troubled knowledge

The real problem for transformation, however, is not simply the number of black faces in the staff and student bodies of a former white university. The most important challenge is the problem of knowledge. The often troubled knowledge the student comes to university with—the knowledge of the past, the knowledge of black and white and, especially, the knowledge of the future. The university curriculum, here and elsewhere, has not yet confronted the crucial question of what a student needs to know in a dangerous and divided world.

And so I will propose to the Senate of the University of the Free State that we do a fundamental curriculum overhaul and that no student graduates from this university without engaging basic human questions such as who we are and where we come from; without learning how to live and learn together in ways that prepare our youth for leadership in the workplace;

Too many of our universities produce young people who specialize too early in their disciplines and do not have that broader base of education that prepares them to be compassionate humans, critical citizens and ethical leaders in their disciplines and professions. A degree is not enough, and the University of the Free State will design an innovative and distinctive undergraduate curriculum that deals with the knowledge problem in South African higher education.

Part of what we will teach our students is not only how to give of their skills, but how to give of themselves in service to communities. I will ask my staff to lead by example, and I am pleased to have taken the first step by returning my salary to the university and asking that they take back a percentage to fund a poor white student and a poor black student; the only thing the two students must have in common is financial need.

Sub-cultures of derision

There are still, however, damaging cultural legacies that lie deep within the institutional fabric of our university, and that I have discovered in the 12 weeks on the job. There is the problem of small-mindedness among undergraduates who see the university as an uninterrupted extension of high school with authoritarian rituals learnt elsewhere. There is the problem of alcohol abuse in especially male residences, a practice that invariably spawns the racism and sexism that afflict fellow students. There is the problem of ontgroening (initiation) in which seniors routinely humiliate first-year students inspired through a militarism that belongs in another time and place.

Together these residence practices constitute a powerful sub-culture in the university that produces the explosive violence that every now and again breaks out into public view.

As a student of institutional cultures, I know that such embedded practices do not change easily. But as a student of educational change, I also know that through decisive action, these negative cultural practices can be steadily eroded. In this respect, the following decisions:
 

  1. The practice of ontgroening is illegal. Any senior student who lays his hand on a first-year student will not only be brought before a disciplinary committee of the university, but will face criminal prosecution in the courts under the charge of aanranding.
  2. The practice of drinking alcohol in the residences comes to an end with the start of the new academic year. The university is not a kroeg; it is a place of higher learning. We are not in the business of producing alcoholics; we are in the business of preparing leaders for the 21st century.
  3. The mindless rituals that treat first-year students as children and seniors as parents will be replaced by gradually building a new institutional and residential culture. We have already started intensive training with the new student leadership of the SRC and of the 23 residences. In 2010 we will take the first group of first-year students into a study-abroad programme. And we will connect all new first-years to electronic networks that deepen and enrich their learning.  

Our students will be prepared to learn and live together. Our residences will therefore be integrated on a 50/50 basis in January 2010, starting with the first-year students and the residence student leadership. Neither black nor white will dominate until such time that social and physical integration happens as naturally as possible. But I am under no illusion that, left to themselves, students will regroup by tribe and that is unacceptable 15 years into our non-racial democracy.

 What do you stand for?

At a university with more than 27 000 students, three campuses and 105 years of history, there is much to do, and so let me simply list five other key commitments.
  1. I am deeply committed to closing the social, intellectual, resource and cultural distance between our Main Campus and the Qwaqwa and South Campuses. The Qwaqwa Campus especially must not become a place marked by constant disgruntlement and ritual complaint, but an academically vibrant university campus that produces well-trained students who can address the poverty of that region of the Free State.
  2. I am deeply committed to the promotion of Afrikaans and Sesotho at the University of the Free State. Many of you have asked me to do away with Afrikaans in the name of pragmatism. Let me be clear: that will not happen on my watch. We will respect the history of this institution and its founding language. Rather than do away with languages, we should embrace more languages. In 2010 I will open discussion on ways in which we can get every white student to learn Sesotho or Setswana and every black student to learn Afrikaans, and all our students to learn to write and speak English competently.
  3. I am deeply committed to staff and students with disabilities, and will do everything possible to advance access to buildings and facilities but also to teaching and learning. The measure of our humanity as a university must be the ways in which we embrace and promote blind, deaf and physically challenged staff and students.
  4. I am deeply committed to the internationalization of our campus, and that we treble the number of visiting staff and students from all continents at UFS. A university worthy of the name thrives on the universality of ideas and people that comes with the cross-currents of international scholars and students on its campuses.
  5. I am deeply committed to leading the fight against HIV and AIDS on our campuses, and offering compassion and care to all staff and students infected and affected by the virus.

Closing

I come before you tonight as leader of this great university as one who is weak, vulnerable and aware of my own brokenness.  I am not unscarred by the long shadow of our divided history. And yet I declare boldly tonight that I am able to lead because I am being led. I can forgive because I have been forgiven.  And I am daily conscious of the fact that whatever I have achieved, or will achieve, is a consequence of grace.

Speaking of Grace, I would not be here tonight if it were not for my wife by that beautiful name. Despite her own professional life in the hospitality industry, she has kept the family together during my long absences as consultant, administrator and now as Vice-Chancellor. She is my best critic and companion, and I thank Grace tonight.

I am inspired by my two wonderful and decent children. My smart son Mikhail doing his postgraduate studies in psychology at the University of Pretoria, and my smart daughter Sara-Jane who will be starting her undergraduate studies in social work here at the University of the Free State. While they were both born in another country, they are deeply committed to South Africa and not to lead selfish lives but to serve those in need. Thank you both for your support.

I know where I come from

I miss my late parents on this grand evening. They would have been proud. My mother would, typically, have said little on such an occasion but her eyes would have welled up with tears of joy. My father would have smiled, too, and then added quickly: “There’s room for improvement.”

To all of you, thank you so very, very much for your support.

Those who supported me financially as an undergraduate student; those who encouraged me not to drop out after I had failed my first year at university; those who took the risk of hiring a Vice-Chancellor with a streak for independent thinking; and those who commissioned me to national service when lesser politicians squirmed at the notion of bringing in a public critic. Thank you.

I know I am not alone

Soon after my appointment, I received an e-mail from my friend Chris Abels. It contained a verse of Christian scripture, from the book of Esther 4:14. I ignored it, at first, but since then those words have become very meaningful to me. “Is it possible that you have come into the kingdom for such a time as this?”

I know I must be here,

for such a critical time in the history of our university, and our country. For if we are able to succeed here, in the heart of the country, then as South Africans we might just be able to finally lay our ghosts to rest (Ramphele).

Finally,

many of you have asked me in recent months why I would come to the Free State, of all places.

Well, one week ago a first-year medical student of ours went to the corner of a Bloemfontein street raising money for charity. With her little tin at the red robots, she stood at a car window with her Rag mates. A drunk driver came rushing over the red lights and took off her leg. I stood at her bedside this week, and her joy, her optimism and her humanity were unbelievable. As I turned to leave, Hanjé Pistorius grabbed my hand and said this, “Professor, I am sorry I cannot stand to greet you.”

That is why I am here.

And so I accept the challenge you offer me with humility and with determination.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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