Why I almost pulled the plug on my cancer treatment

When I was diagnosed with breast cancer in July 2019, I had no idea what the financial implications would be. Although I have an entry-level hospital plan, I have no life insurance or dread disease cover.

Both my husband and I are freelancers which means that our income fluctuates. We aim to have as few as possible fixed financial commitments which means we have a hospital plan, short-term insurance, and a data service provider. It would be irresponsible of us to commit to any other fixed expenses knowing that our income varies month-on-month. We further have no credit cards, or loans, or clothing accounts. No cash, no purchase.

We also have to take into account our travel and maintenance costs. A trip from Parys to Johannesburg to meet with a client costs R2,300 if one uses the Automobile Associations (AA) calculator. Actual fuel cost is around R500 per return trip, and I travel at least three times a week. And according to the Southern African Freelancers' Association (SAFREA), the average freelancer earns less than R10,000 per month.

But I regress. Although I had to set the stage for the story that I am about to tell.

I remember that day I sat across my doctor when he gave me the bad news. The first question I asked was: "How much is this all going to cost?" He reassured me that I should not worry about money because my hospital plan will pay for everything under something called the oncology prescribed minimum benefits (PMB).

The first specialist I consulted was the surgeon who would perform the lumpectomy, a procedure that removes the entire tumour. Traditionally, breast cancer treatment starts with a biopsy. Still, because my hospital plan did not cover the cost for a biopsy, I opted to be hospitalised for a lumpectomy instead.

When the histology (the study of the microanatomy of cells) results were released, the surgeon referred me to an oncologist. And I asked again: "What does cancer treatment cost?" The answer remains unchanged: "Don't worry about the cost. Your medical aid will pay for everything."

The oncologist registered me for the oncology PMB with my medical aid, and I learned that I have a R200,000 limit to oncology-related treatment for one year. Each year, at the anniversary of my diagnoses, these benefits reset. Should my treatment cost be more than the benefit, my medical aid will continue paying 80 per cent of my treatment cost, and I will be liable for a 20 per cent co-payment.

But, because my husband and I are freelancers, we have come into the habit of making sure we have enough work to cover our costs each month. We plan for our expenses in advance. Freelancers, like the average citizen, usually don't have savings they can tap into for emergencies. If I needed new shoes, we saved until we had the cash to buy new shoes.  And that is why I needed to know what the cost of my cancer treatment would be.

Eventually, I received a cost estimate from the oncologist — about R100,000 for chemotherapy. But before I can start chemo, I needed more surgery. The oncologist referred me to a surgeon for my mastectomy. I was surprised to learn that the hospital plan will pay for breast reconstruction with implants.

Fast forward a few weeks, and I'm sitting across a different oncologist for a second opinion, post-mastectomy. She suggests a slightly different treatment plan than the first oncologist. She once again reassured me that I should not worry about the cost of my treatment.

Seven months later, I reached the limit of my oncology PMB with my medical aid, and I seriously considered pulling the plug on my treatment. We have already sold my husband’s vehicle to help us financially, and we have nothing else of decent value to get rid of. 

A rough calculation shows my treatment cost an average of R7,200 per week. This average excludes the cost of the Herceptin injection, which is R9,800 every three weeks, the Tamoxifen tablets at R260 per month, and the Zoladex injection that costs R6,700 per month. I have to get 24 Herceptin injections over 18 months, Tamoxifen tablets daily for the next 5-10 years, and an estimate of six Zoladex injections between now and the end of 2020.

Thankfully the medical aid still pays 80 per cent of my treatment costs. Still, as a freelancer, it is not easy to obtain that extra R4,200 per month that I have to pay for my cancer treatment. At the end of last year, I spent many hours weighing up the different options I have. Upgrading my medical aid to a better plan would not have been a solution. Even if I had a medical savings account (MSA), my 20 per cent co-payment would use up an entire year's MSA in just two months. Then I am back at making co-payments over and above the increased medical aid instalment. In effect, if I upgraded my medical aid, I would be paying double what I am paying now for the same benefits. Not worth it.

The alternative was to get more work. Because I was weak from the treatment, I struggled to get back into my regular working routine at the start of 2020. On average, it takes me anything between three and six months to sign up a new client for marketing consulting. Last month I signed up my first new client for 2020 - I first met with the client in July 2019. Yes, that is how long it takes from the first contact to a signed contract for marketing-related services. I have since signed up two more new clients and am looking forward to getting back into my usual working routine. Ad-hoc projects are available, but these are far and few between.

Many people I engage with say that they wish they could help me. And you can. You can help me by telling everyone you know about what I do and how I can help their businesses. If I can get one new client per month for the rest of the year, I can safely say that I am confident that I'll see the light at the end of the tunnel come December 2020. Then I can look forward to focussing on my health and getting better in 2021 because I'll be able to afford my treatment and related tests.

So, what is it I do? I do anything marketing-related. What are some of the typical problems I can help you solve?

• My personal or business brand does not have a proper marketing strategy.
• My brand is not as visible as I'd like it to be.
• Social media does not work for my brand.
• Our agency's client service team is short on resources for a project.
• My start-up business cannot afford a full-time marketing manager.
• I need to write a speech or article and don't have the time.
• A member of our marketing or client service team is going on extended leave, and we need someone to help with the workload for a few weeks.

And although I have 24 years' marketing experience, my services are not as expensive as you may think it is. You can work it out for yourself. Typically, a new business should spend roughly 12 to 20 per cent of its projected revenue on marketing. Established companies should allocate about 6 to 12 per cent of its gross income toward marketing activities. Of course, I don't take the full marketing budget as a fee. In most cases, my price is only a small percentage of your total marketing budget.

You can find my professional profile here: www.linkedin.com/in/marisalouw

If you cannot spread the word about my services, and you still wish to help, you can make a donation into the crowdfunding campaign that my husband initiated. You can find it here: https://www.backabuddy.co.za/marisa-louw