EDITORIAL | Misdiagnosis remains a dangerous crack in South Africa’s public health system

For two years, 20-year-old Sinentlahla Shinga from Bizana in the Eastern Cape believed she was being treated for tuberculosis (TB).

But instead of getting better, her condition worsened, her body grew weaker, her skin changed colour, and eventually she became bedridden and unable to use the toilet on her own.

Her family’s worst fears were confirmed when doctors at a hospital in Port Shepstone, KwaZulu-Natal, allegedly told them that Shinga had been misdiagnosed. She didn’t have TB, she had lymphoma, and by then, it had already spread throughout her body.

“She was the shadow of her former self,” said Pinky Qushwana, a relative who took her in before she died.

TB rightly receives major funding, but cancers like lymphoma often go undetected in some communities. Early detection and screening programmes for cancers must reach the same rural clinics that distribute TB medication. The two diseases may share symptoms, but they should never share the same tragic fate of being overlooked.

Qushwana said Shinga first went to St Patrick’s Hospital in Bizana in 2023 after feeling unwell. Doctors diagnosed her with TB and placed her on a six-month treatment course. But when her condition didn’t improve, they prescribed another six-month course.

As her condition worsened, Shinga’s family rushed her to Port Shepstone Hospital. By then, she was unconscious and hallucinating.

Sadly, Shinga passed away two weeks ago, leaving her family devastated.

Misdiagnosis of TB and cancers such as lymphoma remains a significant clinical challenge in rural parts of South Africa and other countries with high TB rates. Both diseases share overlapping symptoms, often leading clinicians to treat for the more common TB first.

Her death, devastating as it is, exposes one of the most dangerous cracks in South Africa’s public health system: the persistent and preventable scourge of misdiagnosis.

In many rural hospitals, TB is often the “default” diagnosis when patients present with fever, night sweats, swollen glands and weight loss. Without proper diagnostic tools or trained specialists, doctors are forced to rely on limited tests and their best judgment. Too often, that judgment proves fatal.

We cannot continue treating rural hospitals as dispensaries where doctors guess what’s wrong.

This tragedy demands more than sympathy; it demands systemic reform. If South Africa is serious about saving lives, we must confront misdiagnosis as a health crisis in its own right.

A public health expert, who spoke to The Sunday Times on condition of anonymity, said TB can usually be confirmed through laboratory testing, making such cases rare but not impossible.

“This is not a very common occurrence,” he said.

“It’s possible for a patient to have both TB and another disease, like cancer. But without access to proper diagnostic tools or a full patient file, it’s hard to say what went wrong in this case,” he said.

However, studies suggest that misdiagnosis and improper treatment remain widespread issues in South Africa’s rural healthcare system. A 2021 study published in The Lancet Global Health found a high burden of undiagnosed and misdiagnosed diseases in rural areas, including cases where lymphoma was mistaken for TB, delaying critical cancer treatment.

For Shinga’s family, those statistics have a face, a young woman whose life was cut short by a preventable error.

Eastern Cape health department spokesperson Siyanda Manana confirmed that the department was aware of the case.

“It was investigated and is considered a closed matter,” he said.

Manana explained that there are processes in place to review cases of misdiagnosis in public healthcare facilities.

“Cases of misdiagnosis are reviewed through the Patient Safety Incident committee as well as the Complaints Management Committee, where a patient or relative can lodge any complaint, including those related to alleged misdiagnosis,” he said.

To address the shortage of diagnostic tools and trained specialists in rural hospitals such as St Patrick’s Hospital, Manana said the department has deployed a district clinical specialist team, which includes an obstetrician-gynaecologist and a specialist paediatrician.

“This is part of our strategy to place specialists in rural hospitals and improve the overall quality of care,” he added.

We cannot continue treating rural hospitals as dispensaries where doctors guess what’s wrong. Modern diagnostic tools, such as biopsy equipment, imaging machines and laboratory testing capacity, must be made available beyond urban centres. A proper diagnosis is the foundation of treatment; without it, even the best doctors are powerless.

Continuous medical education and telemedicine support from regional specialists must be standard, not optional. A doctor in Bizana should be able to consult a specialist in Mthatha or Durban within hours, not weeks.

In Sinentlahla’s case, her condition worsened for months without re-evaluation. A culture of humility, where doctors are encouraged, not punished, for seeking second opinions, can save lives. Hospitals must also implement strict follow-up systems: if a patient shows no improvement after treatment, escalation should be automatic, not dependent on chance.

Manana said there are several initiatives under way to enhance cancer screening and early detection in the province.

We cannot bring Sinentlahla back, but we can refuse to let her death be just another tragedy whispered away in a clinic corridor. Her story must force a reckoning: with a health system that forgets the value of a single life, with a government too comfortable with failure, and with a society that looks away until the next obituary.

If we do nothing, then Sinentlahla will not be the last. And that will be our collective shame. This is one too many unnecessary deaths.