Ntuthu: fighting the good fight

Her birthday is celebrated on the same day that nurses across the globe commemorate World Nurses' Day, the day Florence Nightingale was born. Although no longer a nurse, this MRC cancer researcher is a pioneer in her own right, reports LORENZO RAYNARD.

In October 1997, the MRC's PROMEC Unit invited applications for a position that required them to be familiar with the Transkei area, to have ten years of nursing experience in either nursing education or oncology nursing, and to be in possession of a valid driver's licence. The position also offered the opportunity to study further.

When Nontuthuzelo Somdyala, or better known to her family, friends and colleagues as Ntuthu, saw the advert in Nursing News, she was overwhelmed with excitement because here was an opportunity to learn something new and further her career.

Always wanting to learn something new and expand her view of the world is what continuously motivated Ntuthu throughout her life. Her father, who was a migrant worker for the municipality in Benoni, and who only visited his family once a year, encouraged her by saying that, with enough work and dedication, she could achieve everything she set her mind to.

Young women in the small town of Bizana, Transkei, where Ntuthu was born and raised, had to choose between nursing and teaching if they wanted to educate themselves.

When her father died, Nthuthu was forced to take up nursing, since this enabled her to study while earning a living. It was then that Ntuthu started her nursing career and moved to Butterworth where she worked as a professional nurse, clinical instructor and nurse educator.

In August 1985, her sister sadly died. And only nine months later, her husband also passed away. 'I really do not know how I survived. But I must highlight that the Butterworth community was very supportive. I had emotional support from friends and colleagues who made an invaluable contribution to my recovery from the two sudden deaths. My family, especially my mother, was my strength,' says Ntuthu.

But Ntuthu's constant thirst for knowledge was not destroyed. Left to care for five children: her four sons and her late sister's daughter, whom she has now adopted, Ntuthu decided to complete a Bachelors' Degree in Nursing Science as a part-time student.

It was just three years after completing the degree that Ntuthu saw the MRC PROMEC Unit post being advertised. At this point in her career, as staff development officer at St Patrick's Training Hospital in Bizana, she had reached a ceiling. Her daily activities, while benefiting the nursing fraternity, had become uninspiringly monotonous, without much of a challenge.

To accept the job at the MRC would require, however, for her and her family to relocate to Cape Town.

'It required a huge amount of adjustment. I came from an environment where I worked as part of a team; surrounded by fellow nurses, women and other people of my culture, who spoke my mother tongue ( isiXhosa). Now I was entering a male-dominated environment with a totally different culture, in a strange city where I was left on my own.

'It was stressful, but nursing taught me how to cope with stress and to work with people,' she says.

Once again, the obstacles in her path weren't enough to prevent this driven woman from reaching even greater heights. Seven years later, Ntuthu is in charge of the population-based rural cancer registry in the former Transkei region of the Eastern Cape and boasts a Masters' Degree in Development Studies, acquired in 2002 from the University of the Free State.

Ntuthu at work

Head of the PROMEC Unit, professor Wally Marasas, says of Ntuthu: 'She is very well qualified for the position because of her qualifications in nursing science and her practical experience in the field.

'In addition, she underwent specialised training courses at the International Agency for Research on Cancer ( IARC) in Lyon, France, followed by hands-on training at the Trent Cancer Registry in Sheffield, England, and the Preventive Oncology Department of the Tata Memorial Hospital in Mumbai, India.'

Nthuthu has travelled quite a bit as part of her job. She was part of a South African delegation that visited the high incidence areas of oesophageal cancer in the People's Republic of China. She also attended international conferences on cancer in Thailand and Ghana. She was able to make contact and exchange ideas with specialists in the fields of cancer registration, epidemiology and cancer prevention across the globe. What's more, she did all this travelling while completing her Masters' degree.

Prof Marasas goes on to say: 'Ntuthu Somdyala is undoubtedly one of the best trained cancer registrars with the most experience in population-based cancer registry in South Africa.

'Over and above her cancer registry duties, Ntuthu also improves the working environment in PROMEC in several ways. She is a pivotal person in all the field work done in the former Transkei by PROMEC researchers.

'On these field trips she is the professional nurse, guide, interpreter and person trusted by the local community. She also does all the translations into isiXhosa required by the PROMEC Unit for questionnaires, informed consent forms and brochures.

'Ntuthu is a role model for women in science. She is a widow with four sons and one adopted daughter and has successfully combined her obligations as a parent with those of a professional career.'

It is not only her colleagues that hold this woman in such high esteem. Ntuthu's daughter, Siphokazi, who is modelling her own career on that of her mother, sees her mother as her role-model. She is now completing an internship in the Gender and Research Health Group at the MRC.
Ntuthu with four of her five children

My mother has always encouraged me to work hard and never give up. She is a constant source of motivation and although she travels often, she is a good mother. She is a researcher who takes the information back to the community - we believe that what she does is important,' says Siphokazi.

The two older sons are completing their studies in electrical and civil engineering at Cape Peninsula University of Technology, while the youngest son is in Grade 8 and has received a scholarship in St Joseph Marist College, Rondebosch.

Still driven by the desire to satisfy her curiosity about how things work, and how she can better benefit her community, Ntuthu's goal is to have the cancer registry meet international standards. This will involve expanding the registry area ( which she has already started doing by including six more districts), having the research benefit the people by effectively implementing methods of intervention, and informing the people of their risk for cancer.

As she puts it: 'The biggest risk to the people is ignorance.'

Keeping track of cancer in the Eastern Cape
Cancer registration was started in Transkei as the Bantu Cancer Registry in 1955. The aim of this cancer registry was to provide basic data on variations in cancer patterns, particularly oesophageal cancer, among black people in the region.

After a study revealed an unusually high incidence of oesophageal cancer in this region, the MRC made the continuation of cancer registration possible by providing financial support.

The PROMEC Cancer Registry is a population-based cancer registry because it systematically and continuously registers all cancer cases identified within a defined geographical area. The only other reliable source of cancer incidence estimates is the National Cancer Registry ( NCR); however, NCR is a pathology-based registry, which means that NCR holds information of the cancer incidence ( the number of reported cases) and the type of cancers that has been diagnosed by pathologists on a national basis, without a reference to the geographical area.

Population-based cancer registries are expensive to maintain and are often established when high incidences of cancer are reported in a specific area, and research needs to be done to access cause and possible methods of intervention.

When Ntuthu started working at the PROMEC Unit, cancer registration was conducted in only four magisterial areas of the Transkei region: Butterworth, Centane, Bizana and Lusikisiki. At that stage the research did not include doing a follow up on the patient, but only monitored cases.

Since 2003, the registry has expanded to include ten magisterial areas. These include Ngamakwe, Idutywa and Willowvale in the south, and Flagstaff, Port St Johns, and Umzimkulu in the north. The area has a population of 1,2 million according to the 2001 Census. The registry collaborates with 19 hospitals including the regional Pathology Laboratory. Ntuthu visits the regions frequently to collect and update cancer data.

Ntuthu explains: 'The expansion of the registry will give us unbiased estimates of cancer incidence and survival in this region, and hence a better understanding of the problem.'

Her research has found that the most common cancers in the Transkei region are oesophageal, cervical, breast, lung, prostate and liver. Oesophageal cancer ranked the highest in both males and females.

Not only is cancer a health problem, but it has a social and economic impact as well. Although cancer affects an individual, its effects extend into the family of the patient and into the community. Job loss, economic dependence, social isolation and family tensions may follow on the occurrence of cancer.

While Government deals with cancer as a public health problem, researchers such as Ntuthu are continue to investigate the causes and advice policy makers on the best steps to take.

The PROMEC Cancer Registry is a population-based cancer registry comprising ten magisterial districts in Transkei.