Transkei's daily bread may be kiss of death

words by David Macgregor

Staple diet of homegrown brew and samp linked to high incidence of gullet cancer

A toxin in homegrown maize - the staple diet of rural black South Africans - could be the reason why Transkei ranks as one of the worst regions in the world for male gullet cancer. Almost 500 000 black men, mostly in the former bantustan, face an agonising death from the "silent killer" - which is normally only detected when it is too advanced to cure. But a cheap capsule used to brush the throat could save thousands of lives.

UMTATA --- Fifty three year-old subsistence farmer Phindile Gidana should be sitting in his Libode kraal enjoying the fruits of his labour and watching village life go by. His cattle are fat, all the mielies have been harvested and the homebrew is almost ready for the festive season.

But, instead of preparing for the Christmas celebrations, his family are already beginning to mourn his looming death and making funeral preparations - even though he is still alive.

Time is rapidly running out for the reed thin farmer and doctors doubt he will even get to celebrate Christmas with his family.

Although 1998 has been a bumper harvest for Gidana, his body has finally reached the end of the road. He will not get to savour his renowned umqombothi (maize beer) and umngqusho (samp and beans) one last time. In fact, years of quaffing litres of homebrew could be the reason for the gullet cancer death warrant.

For the past two months Gidana has not eaten a morsel of food despite the sizable harvest of mielies that lie drying in his rural kraal. Knowing he was desperately ill, but not realising that he had advanced throat cancer and little time to live, Gidana rapidly withered away in front of his family.

By the time a severly malnourished Gidana reached doctors in Umtata, his only sustenance in recent months had been liquid. He could not even swallow soaked bread - which brought on vomitting attacks - and had become so weak his daughter, Nomalady, had to carry his stick frame on her shoulders into the bustling Umtata General Hospital.

Gidana is just one of the more than 430 000 black men in South Africa that are at risk of suffering from gullet cancer. Doctors say his cancer is so advanced that he will only live for another 'month or two' before becoming another victim of the 'silent killer.'

Trying to fathom out why this cancer is more prevalent in black South African men - particularly those in the Transkei - has prompted the recent formation of the national Oesophageal Cancer Research Group and more than R3million in funding over the next three years.

Established and funded by the Medical Research Council and the Cancer Association Association of South Africa the ground breaking project involves the Universities of Transkei (Unitra), Cape Town (UCT), Stellenbosch, Western Cape and Free State.

Ugandan born and Glasgow trained head of Unitra's Department of Cardiothoracic and Vascular Surgery, Professor David Mugwanya, recently said the late detection of gullet cancer was a death sentence.

A co-director of the research group, Prof Mugwanya has spent the past 20 years working in the Transkei and claims the region is well known globally in medical circles for its high incidence of oesophageal cancer.

'Transkei is well known as a cancer region and ranks alongside China and Iran as one of the world's worst hot spots.'

Although cancer was previously thought to be more prevalent in certain areas of the Transkei the whole region has now been classed as a 'hot spot' along with certain areas of southern KwaZulu Natal.

Since 1965, the MRC has been running a limited cancer registry in the former bantustan with Butterworth and Centane districts - over the years - having a markedly higher incidence than Lusikisiki and Bizana.

But, recent data has shown consistently higher rates in Centane, decreased incidents in Butterworth and progressively higher levels in Luikisiki and Bizana.

MRC research has revealed that a toxin-producing fungus in homegrown maize - a staple diet of the region - could be linked to the high incidence of oesophageal cancer.

Weighing up his words cautiously to prevent public panic, Prof Mugwanya said there was a possibility that pesticides were aiding a toxic fungus which made good beer, but had major health implications.

'Everytime people in the region swig homemade beer or eat samp and beans they are taking a cocktail of myco-toxins. Corn is the staple food of the Transkei and it is possible that the people are chronically overdosing on the toxic fungus.'

OCRG director Professor Mohammed Iqbal Parker, of the Department of Medical Biochemistry at the University of Cape Town, said the high incidence in the region was a 'combination of several factors.'

These included dietary habits, selenium deficiencies from the soil, toxin and iron overload from traditional pots and certain vitamin deficiencies.

Selenium compounds have been found to possess certain properties which could prevent the development of cancer and a researcher will investigate whether dietary fatty acids and micro-nutrients such and zinc and selenium can retard the progression of early pre-cancerous lesions.

Prof Parker explained there was also a possible genetic susceptibility in people in the region that once identified could be remedied through nutrients.

'There are no external symptoms for oesophageal cancer and normally by the time it is detected it is far too late. Once a person is showing symptoms of not being able to swallow then they usually have two or three months left.'

But, if detected early, gullet cancer can be easily beaten and a major initiative has been launched in the region to test people for the disease using a cheap, capsule covered sponge, a piece of string and a cup of water.

Developed 20 years ago in Japan, the Nabeya Encapsulated Brush helps detect early lesions in the throat by scraping cells which are then studied under a microscope.

Reporter David Macgregor decided to try the 'painless' brush method and found the tampon sized capsule more than a mouthful to swallow.

The Nabeya Brush consists of a golf ball sized sponge wrapped in a capsule about half the size of a finger and attached to a long string. The capsule is rested on the tonque, with the string attached to your finger, and is swigged down with a glass of water.

But, despite being reassured by doctors and nurses that swallowing the capsule was as easy popping a pill, I made the mistake of trying to swallow the bomb in small sips and almost vomited several times - to the amusement of medical staff and patients.

With tears in my eyes and a pill lodged halfway down my throat I suddenly wondered what possessed me to try the Nabeya Brush. After all, I was white, umqombothi and umngqushu were never my staple diets and I did not spend years living in a hot spot.

But, without trying the brush I would have to rely on the experts - who probably never tried one themselves - saying how painless and simple it was.

They were not far wrong - once the the capsule had been properly swallowed. But, it was no stroll in the park trying to swallow the capsule and then having it slowly pulled back up your throat after seven long minutes of expanding. The size of a golf ball and with a rough spongy surface the brush finally popped out and was then taken for testing.

Thinking I was going soft and left with a sandpapered throat, I managed to rope in 27 year-old Nombitha Rala into trying the Brush - so I could get a second opinion. She started off with a broad smile on her face when she heard I was a newspaper photographer and ended up displaying exactly the same reactions as me - again to the amusement of spectators.

But, looking at Phindile Gidana in the waiting room next door made me realise that the Nabeya Brush was painless alternative to agonising death the old man was now facing.

'The brush is very cost effective and is one of the easiest and best methods for the early detection of throat cancer. It is also non-invasive,' Prof Parker said.

Researchers are also investigating the effects of local tea varieties in possibly preventing the development of throat cancer. Already, research has show that green (Japanese) or Chinese tea drinkers have a reduced chance of developing the silent killer.

According to a recently released Medical Research Council paper 'previous research has shown that extracts of local teas have more potent anti-cell changing activity than either green or black tea.

'Evaluating the cancer-preventing properties of our local tea could have important implications for its possible use as an agent against oesophageal cancer.'

Plans are also being made to investigate why oesophageal cancer is rising among the coloured population of the Western Cape and the research paper plans to check if migratory patterns in Transkei affected the incidence of the disease.

Although the project plans to target certain age groups and help detect and prevent the early onset of the disease it has all come too late for Phindile Gidana and thousands of other South Africans. - @LiveWire

Aaaargh...a cheap test for throat cancer.

The golf ball-sized sponge, ready for lab tests.

pix by David Macgregor