Dr. Thandeka Mazibuko graced the covers of Get It Magazine in 2012 after winning the KwaZulu Natal Business Women of the year under Social Category in 2012, honored by Business Women Awards

1. 2016
Thandeka Mazibuko
Stu no: 973118487
UNIVERSITY OF KWAZULU NATAL
Nelson Mandela School of
Medicine,
RADIATION ONCOLOGY
Inkosi Albert Luthuli Hospital
3/7/2016
Request for sponsorship for the 1 year research and
training in Radiation Oncology, Haematology and
Medical Oncology Departments in USA

2. TABLE OF CONTENTS
1. Introduction
2. Problem Formulation
3. Research Topic and Research cost in America
4. Problem Statement and Academic challenges in South Africa
5. Aims of the studying and pursuing research in USA
6. Study and USA Training and Research Objectives
7. Background of the study
8. Methodology
9.1- Study design
9.2 – Study Site
9.3 – Study setting
9.4 – Study population
9.5- Sample strategy
9.6 – Sample size
9.7 Inclusion criteria
9.8 Exclusion criteria
9.9 Data collection
9.10 Study Period
9.11 Study Limitation
9.12 Significance of the study
9.13 Legal and Ethical Consideration
References

3. LIST OF ACRONYMS
ACR – American College of Radiology
ABS - American Brachytherapy Society
AIDS - Autoimmune Deficiency Syndrome
ASTRO – American Society of Radiation Oncology
DNA – Deoxyribose Nucleic Acid
HIV - Human Immunodeficiency viruses
HPV - Human Papilloma Virus
NCCN - National Cancer
PAP- Papanicolaou smear
Ca cervix- cancer of the cervix

4. MOTIVATION FOR SPONSORSHIP TO
1. Research: Topic: Exploring the
relationship between cervical cancer with
vaginal snuff usage amongst females of
kwaZulu Natal, South Africa
2. Academic: Skills and Development in
the following departments:
 Radiation Oncology
 Medical Oncology and
 Haematology

5. INTRODUCTION
My name is Dr Thandeka Mazibuko, a female from the village of kwaNyuswa, Durban. I am
born of a single parent mother who is a domestic worker, who solely depends on me for her
survival. In my family no one managed to complete matric, no one has managed to get a
chance to be at the University level. My primary and secondary education is from
kwaNyuswa schools. I then completed my basic education final year called matric at
Chesterville Township, when Siyajabula High school got burnt down during the uprising. I am
the only doctor in the village of kwaNyuswa, I have one sister who has also managed to get
a basic university degree. I also have 1 son to care for who is also at the university level. I
care for my immediate family, my aunts, uncles as well as be the main sponsor for the
charity organisation, we are running at the community level since 2004. I have invested a lot
of my revenue, time, salary and savings in uplifting my family, extended family and
community. As a female this role is very demanding and not easy but when found to be
alone with a challenge one has to do what we can to survive, improve our society and that
for me women empowerment through education and skills development.
I happen to be the first black to enter the department of Radiation Oncology in 2009. This
caused a lot of friction between me and the white old male professor who in his whole life
had never been defeated in refusing black students to enter Radiation Oncology Department
at Inkosi Albert Luthuli Hospital. I was refused an opportunity to train as a Radiation
Oncology specialist at UKZN, Nelson Mandela School of Medicine, and Inkosi Albert Luthuli
Hospital jointly, for a period of 4 years between 2007 and 2011 I was patient and persistent
until the white male Prof contract was not renewed, only then I was able to get an
opportunity to get training. A lot of time has been wasted and I have been very patient with
all the abusive situations that comes with racism, racial segregation, male dominancy and
denial of human rights to access to education.
It is indeed not easy to train to be a specialist in Radiation Oncology not because the subject
is hard but because indigenous blacks are not allowed by the existing system to train to be
Radiation Oncologists. In 60 years only 5 black Radiation Oncologists has been trained in
South Africa. A great embarrassment to our democracy. As we celebrate Human Rights day
in South Africa today, speeches about ending racism are delivered, we the academic
interested citizens of this country still feel that human rights to free and fair education has not

6. been met, proven by the latest spark of the students striking for academic rights, end of
discrimination and racism in South African Institutions of higher learning for a free and
compulsory education.
I founded an organisation called Sinomusanothando
Community Development in 2004, when I was still a
medical student at Nelson Mandela School of Medicine.
The aim of this organisation is to educate, provide mobile
free cancer screening to the previously disadvantages
communities, with major emphasis to the rural community
through this community work done at the community level
winning us many awards.
No other Radiation Oncologist in South Africa has ever
been honoured with so many awards for raising cancer
awareness, educating the community free of charge for a
period of 10 yrs. I am saying this to show the impact and
the community need for doctors to give back to their
community.
.
Radiation Oncology Training and Training Gaps
In 2012 HPCSA , the office of the Premier of kwaZulu Natal , The University Ombudsman
and the office of the Public protector discovered that my training number was fraudulently
and unlawfully taken by the Dean of the University of kwaZulu Natal, the then Acting Head of
the Department Radiation Oncology and of the Department of Health. My identity was then
given to the Indian male doctor. Despite multiple warnings to the above male scholars to
return my identity they continued to sign my identity to the most junior Indian male on 3
different occasions over the period of 3 years. The harassment worsen after these results of
the findings came out, the working environment became too hostile and unbecoming, as the
cabal abused their powers to cover up this fraudulent action of identity theft. I endured such
a bondage until I could not bare the abuse anymore hence looking for a peaceful, supportive
academic environment to prepare for my examinations and PHD scholars to supervise my
research.
Dr Thandeka Mazibuko
Awards
1. Nominee of South African of the
year 2015
2. Women of Influence 2015
3. Finalist -Standard Bank Rising
Star 2014
4. Prominent Women of Africa
2013 honoured by Nigeria
5. KZN Business Women of the
year 2012
6. Oprah Heroine 2010
7. Nominee of Checkers Women of
the year 2009

7. RESEARCH TOPIC
Exploring the relationship between cervical cancers with virginal snuff usage amongst
females of kwaZulu Natal, South Africa is the topic that, I Dr Thandeka Mazibuko will be
researching during my trip to the United States of America
This research and training also entails getting academic support in my final stages of my
training in Radiation Oncology.
Qualifying as a Radiation Oncologists is the main goal.
THE PROBLEM STATEMENT
Cervical cancer burden is increasing at an alarming rate especially amongst the black rural
communities (Pisani et al 1990)
World-wide, cervical cancer continues to be an important cause of morbidity and mortality
(Shingleton, 1995). Cancer of the cervix is the second most common in South Africa.
(Department of Health, Statistical notes, Vol.3 No.5, May 2001)
Pisani et al have projected a 30% increase in the number of cancer deaths in developed
countries, and more than twice this amount (71%), in developing countries, between 1990
and 2010, due to demographic changes alone ( Pisani et al 1990). Rising incidence will only
add to this burden.
Cancer was estimated to account for about 7 million deaths in 2000, 12% of all deaths
worldwide. (Was also estimated to account for almost 6% of the entire global burden of
disease in that same year (World Health Organization, World Health Report 2001. Mental
Health: New Understanding, New Hope).

8. The relationship between cervical cancer and sexual
intercourse has created a stigma amongst South African
women leading to reluctance of screening for cervical
cancer which is an additional major contributory factor to
late stage disease presentation
(www.sasgo.co.za/images/simonds_advanced.ppt)
Skills and Training Development for Black Specialists
in South Africa, KZN, Durban
The above statistics forces us as medical doctors to get
even more advanced training in Radiation Oncology and to
focus even more on research during our training. The above
stats also forces our leaders to increase academic budget
spending money to training medical doctors in South Africa
as Radiation Oncologists, Medical Oncologists,
Haematologists, Physicist, Radiobiologists and
Radiotherapists which are all highly imperative scarce skills
in the treatment of cancer. .
In South Africa we only have 1 black Radiobiologist,
originally from Ghana out of 10 0ther races. He is in his late
50yrs, soon to retire. An embarrassment to our democracy.
Too many people are dying yet too little production of
Oncologists as South African Population is 55 million, these
communities are depending on only 175 Radiation
Oncologists, which only 5 are indigenous black and only 2
are Zulu Speaking. According to HPCSA South Africa has
38 Radiation Oncologist in KZN but only 4 are in the state
hospital, 3 Indian male and 1 black female. Out of all these
Radiation Oncologists that are in the state, I am the only one who visit rural communities and
raise cancer awareness at a larger scale for a period of 10 years. This is the major challenge
Radiation Oncology department is male dominant, white race medical doctors are still the
predominantly trained at Inkosi Albert Luthuli Hospital and Nelson Mandela School of
Medicine followed by Indian males. This lack of Africans training puts the names of these
great Noble Peace Winners into disrepute in the likes of Nelson Mandela and Inkosi Albert
Luthuli. It is still a very racist department and completely overtly, unapologetically,
deliberately and intentionally systematically excluding blacks from training and frustrating
MAJOR
PROBLEM
Approximately 1500 women die
of cervix cancer in South Africa
each year Department of Health,
Statistical notes, Vol.3 No.5,
May 2001). From 1993 to 1995,
averages of 3387 new cases of
cervix cancer were reported. By
contrast, 1,497 deaths from
cervix cancer were reported for
1994 by the Statistics South
Africa.(Department of Health,
Statistical notes, Vol.3 No.5,
May 2001)
CERVICAL CANCER IS
EARLY DETECTABLE
PREVENTABLE
DETECTABLE
CURABLE

9. them to resigning by delayed academic progress, unbearable hostile environment hence the
students are impinged by circumstances to leave the department looking for academic
support in countries like India, Ireland, USA, UK, Turkey and Cuba.
There is no Radiation Oncologists in KZN and UKZN, Nelson Mandela School of Medicine
with a PHD which sets a major challenge for pursuing research of PHD standard. When I
submitted a Masters with a PHD intent I was told I cannot be allowed to be the first one to
submit a PHD paper. The level of mediocracy is too much, setting the academic ceiling to
low for driven researchers to survive. The South African Radiation Oncologists are private
sector oriented, financially driven, having minimal interest in research if at all. Most of them
when they qualify they go to open private practices to care for their families, themselves and
few , if at all cares about the research and making an impact in the community . Hospitals
like Addington Radiation Oncology department, has not been working for years due to non-
functioning Radiotherapy machines which sets a major challenge for training and skills
development for the junior registrars.
Patients with cancer comes to our centres with advanced disease, as the majority are rural
based but the one that hinders good training is the delay in treatment where patients with
cancer are booked for treatment 1 year after diagnosis, this means that doctors are
competent in treating only majority of advanced diseases not early disease.

10. HYPOTHESIS OF THE STUDY AND SKILLS DEVELOPMENT &TRAINING IN USA
1. Insertion of per vaginal snuff increases the risk of cervical cytological abnormalities and
eventually cervical cancer.
2. Training in the United States of America in Radiation Oncology, Medical Oncology and
Haematology will make me a far more advanced Radiation Oncologist in South Africa when I
qualify in 2017
3. I will be prepared to do my examinations which will be done in South Africa
AIM OF STUDY AND SKILLS DEVELOPMENT &TRAINING IN USA
1. To determine the prevalence of vaginal snuff insertions amongst women with
cervical cytological abnormalities presenting in an outpatient colposcopy unit
1. To get training and skills development in Radiation Oncology
2. To get an opportunity of rotation in Medical Oncology
3. To get supervision by the expects in the world in the field of Oncology
4. . To get full academic support which is lacking and association with victimisation by
the head of the department and the current University Dean
5. Increase the number of black females in the province of kwaZulu Natal to be trained
specialist in Radiation Oncology
6. To improve the quality of life of South African community
7. . To bring the world knowledge to South Africa
8. To study in a supportive environment

11. OBJECTIVES
 To determine the prevalence of vaginal snuff insertions amongst women with
cervical cytological abnormalities
 To establish the reason for females to use snuff
 Determine the demographics of women who use snuff as opposed to those who
don’t, in particular, the HIV serostatus, no. of sexual partners etc.
 To qualify as a competent Radiation Oncologist
 To complete the training in Radiation Oncology and come back to work in South
Africa, Durban.
 To study without victimisation, hostility and discouragements

12. BACKGROUND OF THE STUDY
Cancer of the cervix is the most common cancer in women (lifetime risk=1in 41)(
Department of Health, Statistical notes, Vol.3 No.5, May 2001). Approximately one in every
41 women will, within their lifetime, develop this form of cancer (Department of Health,
Statistical notes, Vol.3 No.5, May 2001).
Theories of the possible causes of cervix cancer were also recorded. Many physicians in the
early nineteen century shared the opinion that the disease was stress related, however,
others suggested that injuries, particularly those related to parturition, preceded cancer. In
1861 von Scanzoni was the first to observe that the disease was more frequent in city
dwellers and thus possible related to the manner of living (Ricci, 1945).
Early age at first sexual intercourse, smoking, immunosuppression and number of lifetime
partners are amongst other risk factors for cervical cancer. (CA Cancer J Clin 2005; 55:74–
108), JNCI J Natl Cancer Inst (1995) 87 (11): 796-802), American Cancer Society, Inc.,
2005).
The relationship between cervical cancer and sexual intercourse has created a stigma
amongst South African women leading to reluctance of screening for cervical cancer which
is an additional major contributory factor to late stage disease presentation
(www.sasgo.co.za/images/simonds_advanced.ppt
Early age at first sexual intercourse, smoking, immunosuppression and number of lifetime
partners are amongst other risk factors for cervical cancer. (CA Cancer J Clin 2005; 55:74–
108), JNCI J Natl Cancer Inst (1995) 87 (11): 796-802), American Cancer Society, Inc.,
2005)

13. LITERATURE REVIEW
Tumour arises from an uncontrolled cell division and failure of self-elimination (Eric J.Hall,
2006, page 274 and 371).
More than 90% of pre-invasive and invasive carcinoma is associated with the high risk
Human Papilloma viruses (HPV) 16, 18, 45 and 56, the most common viral infection of the
genital tract. Subtype 16/18 for 70% are responsible for cervical cancer worldwide. The main
cause of invasive cervical cancer is the production of full length E6 and E7 protein following
the production of stabilized E6/E7 full length mRNA from full high risk HPV types. (Joseph
Monsonégo: 98 Emerging issues on HPV infections: from Science to Practice).

14. RESEARCH METHOLOGY
METHODOLOGY
This study will interview of 200 patients seen at colposcopy clinic with some form of cervical
cytological abnormalities
Study Design
It’s a Retrospective, Observational, cross sectional study design looking at the following:
Site of the study
King Edward Hospital, Room 4, colposcopy room, Gynaecology Department
Study setting
King Edward Hospital, Room 4, colposcopy room, Gynaecology Department
Study population
All women with cervical cytological abnormalities
Sample strategy
Non-probability or convenience sampling will be used because questionnaires will be
distributed to 200 patients with premalignant lesion. The interviews following the
questionnaire will be asked in order to gather history of any virginal snuff usage.
Sample size
200 patients will be interviewed
Inclusion criteria
 Pap smear results confirming an abnormal smear
 All ages of patients presenting with abnormal smear or cervical cancer on biopsy

15. Exclusion criteria
 Normal pap smear
Data collection methods and tools
Ethics approval will be sought from UKZN Ethics Committee and the Ethics Committee of
the Department of Health.
Study Location
Inkosi Albert Luthuli Hospital, Radiation Oncology Department and Kind Edward Hospital,
Room 6
Study Period
April 2016 to August 2016
Limitation of the Study
The study does not include the stratification of patients according to their HIV status and
CD4 counts. It also does not look at other causes of cervical cancer. Bearing in mind that
cervical cancer is associated with multiple causes, snuff alone may not be the only cause of
cervical cancer or an abnormal smear.
Significance of the Study
There is a need for a scientific investigation of the snuff usage virginally and to find out how
common its usage is amongst females.

16. Ethical and Legal Considerations
 Patients will be allocated Research codes which state the site of the study as
well as the first 3 letters of their surname and the number which determines
their number according to the interview sequence.
 Only the people involved in the study will have excess to the files
Statistical planning
A statistician will be requested to assist with guidelines of data collection, processing,
interpretation and analysis.
Study and Academic skills development and Training Budget
The study budget covers the expenses already paid for and the expenses needed to be
covered during the one year training in Haematology, Medical Oncology and Radiation
Oncology training while in New York.
The tuition, registration, accommodation and flights tickets to and from America in February
2016 was paid for. The interview was a great success and the 1 year training confirmed to
be commencing 20 April 2016 to May 2017.
The Universities and Cancer centres do not provide accommodation. At multiple request this
was not successful even a university accommodation was not a possibility

17. 13 SKILLS DEVELOPMENT BUDGET
ITEM REASON AMOUNT ACTION
Application process To get academic training and research
support, phone calls to New York and
South Carolina, setting up
appointments for the interviews for 1
year.
R5000-00 Paid
Registration
Fee in New York
Medical Oncology and Haematology R15 000-00 Paid
Tuition fee New York for
1 year
Medical Oncology and Haematology
for 1 month
R23000-00 Paid
Tuition Fee South
Carolina
Radiation Oncology and Research for
1 year
R45000-00 Paid
Return Flight ticket
South Africa to JFK
February interview in New York R26 000-00 Paid
Exam Registration For 2 examinations to be written R10000-00 R10000-00
Return Flight from New
York to Atlanta
For the February interview in South
Carolina.
R6000-000 Paid
Research Flight back to South Africa for Data
collection and 2 examinations.
R48000-00 R48000-00
New York
Accommodation for 1
month
Accommodation during the stay in New
York from 17April 2016 to 20 May
2016
Fully furnished accommodation
R30000-00
weeks
R30000-00
Flight from New York to After 1 month of training in New York, R5000.00 R5000.00

18. South Carolina a flight to South Carolina for 1 year
studies
Accommodation in South
Carolina for 1 year 206
to 2017
$2200 per month as per Cancer
Centre Agency, full furnished flat
R35200-00 x 12
months
R422000- 00
Hotel Accommodation
February 2016
3 days in New York for interview in
Feb, 2016 Columbia University and
Atlanta
R18 000-00 Paid
STYPENT Salary will not be coming through while
studying
R30000-00 x12
months
R300000-00
Books and Stationery Research books, medical oncology
and haematology books, taking notes,
presentations material etc
R20000.00 R20000.00
Return Flight for 17 April,
2016 to returning 17 May
2017
To go do research and training in 3
departments.
R24 000-00 Paid
Transportation
Cabs to and from the
airport, 3 hr drive to the
hospital
The drive from the hotel to the Cancer
centre in South Carolina for the whole
day interview in February. Including
meals
R6200-00 Paid
Food for 1 year R35000.00 R35000.00
Transportation for 1 year A car is required in South Carolina due
to rough weather and distance
R40000.00 R40000.00
Amount Already Paid TOTAL R168000-00
Amount to be paid Total R910000-00

19. REFERENCES
1. Andrej Strojnik, Rad Oncol 2008,42(3): 170-2(marked as 13)
2. ACR-ASTRO Practice Guideline for Performance of High-Dose- Rate Brachytherapy,
Revised2010
www.acr.org/secondarymenucategories/quality_safety/guidelines/ro/high_dose_rad_brac
hytherapy.aspx. Accessed 08.11.2010
3. American Brachytherapy Society , Akila et al
(PMID10924990-http//www.ncbi.nlm.nih.gov/pubmed/10924990?dopt=Abstract)
4. American Cancer Society, Inc., 2005
5. American College of Radiobiology practise guideline on informed consent- radiation
oncology. Practise Guidelines and Technical Standards. Reston, Va: American College
of Radiobiology; 2008: 931-941
6. American College of Radiobiology practise guideline for Radiation Oncology. Practise
Guidelines and Technical Standards. Reston,: American College of Radiobiology;
2008:923-929.
7. CA Cancer J Clin 2005; 55:74–108World Health Organization. World Health Report
2001. Mental Health: New Understanding, New Hope. Geneva: WHO, 2001
8. Dale et al, 1998: 465-483, The British Journal of Radiobiology, The British Institution
9. Devlin P page 1- 19 Brachytherapy Applications and techniques published by Lippincott,
William and Wilkin’s. Accesses 24.12.2010 Hall E.J. Radiobiology by (19Department of
Health, Statistical Notes, Vol. 3 No.5, May 2001.
10. International Journal of Cancer 1999; 83(1):18-29.
11. JNCI J Natl Cancer Inst (1995) 87 (11): 796-802
12. Khan F, The physics of Radiation therapy, 4th
edition.
13. Nag et al, Int. J. Radiation Oncology Biol. Phys., Vol. 48, No.1, pp.201-211, 2000, USA.
The American Bracytherapy Society Recommendations for High-Dose-Rate
Brachytherapy for carcinoma of the cervix
14. Orton et al(50) Otton and Colleague in Seymour H. Levitt (1992)
15. Pearce et al 91(2009) 194-196, Radiotherapy and Oncology , University of Calgary,
Canada) www.thegreenjournal.com

20. 16. Pisani et al, 1990.Worldwide Mortality from 25 Cancers
17. Potter et al, 2000,Definitive radiotherapy based on HDR brachytherapy, Pubmed
,4(2):159-72]
18. SA Fam Pract 2006; 48(2): 17. Accessed 21.12.2010)
19. Simonds H, 2008 “Cervix carcinoma, HIV and Radiotherapy: The Challenges and the
Rewards” (www.sasgo.co.za/images/simonds_advanced.ppt. Accessed 21.12.2010).
20. The ICRU System of Dose and Dose Reporting”(http://www.uthgsbsmedphys.org/GS02-
0154/Brachytherapy/01.03.03-ICRU38.pdf. Accessed 08.10.2010
21. Walter and Miller, 2003: 287-288 Textbook of Radiotherapy, Radiation Physics, Therapy
and Oncology, 6th
Edition.
22. Washington Manual, 2ND edition. JNCI J Natl Cancer Inst (1995) 87 (11): 796-802.