Incidents of cancer have more than doubled in the last four years, say the medics who are faced with a severe shortage of trained staff and equipment in the southern African country whose health budget is already overstretched.

"We have a cancer crisis in this country caused by HIV which weakens the body's immune system," said Alexander von Paleske, head of oncology at Princess Marina, the largest state-owned hospital.

"The outpatient visits we had in 2002 were 2,050 people but last year we had 5,650 people," von Paleske told AFP.

"As doctors we are seeing about 20 to 30 people a day and we are now working seven days a week, overtimes and still struggling to cope.

"The chance of getting cancer, in this era of HIV/AIDS is now 10,000 times higher than it was before."

Princess Marina's oncology department has 20 beds, three doctors and about 18 nurses who work in four shifts. The department does not have a radiotherapy unit and relies on the nearby Gaborone private hospital.

Von Paleske said a large number of cancer patients admitted were suffering from Kaposi's Sarcoma, a particularly nasty type of skin cancer which starts out as spots before multiplying into ulcerous sores all over the body. It is usually fatal if untreated or diagnosed too late.

He said the cost of treating Kaposi's Sarcoma was an additional burden on the public service health budget.

"The cost per patient is 350 pula (58 US dollars) per course which is repeated four to six times. There is also the cost of radiotherapy which is between 5,000 and 7,000 pula. With other types of cancer, these amounts increase to 2,000 pula per course," he said.

Von Paleske said often patients suffering from the Kaposi's Sarcoma cancer came for treatment too late and this necessitated amputation of the affected limbs. He said the link between HIV and cancer meant that the majority of patients and victims of this cancer were between 20 and 40 years old.

"I have only four patients who have cancer and are HIV negative and hundreds more who are positive. There are cancers that are as a result of HIV and others that become more aggressive because of HIV," he said.

Jeroen Lorist, an official with the Cancer Association of Botswana (CAB), said his organisation was also struggling to cope with the upsurge in patients.

The CAB has a 20-bed interim home where patients can recuperate while receiving treatment from hospital and also provides after-care, support and counselling services.

"We are now seeing that sometimes we do not have enough beds to accommodate people and we have to put mattresses on the floor for them," he told AFP.

"There is access to treatment in this country and we are proud of that, but the challenge may be to increase information on cancer to society.

"A lot of times, people do not come when the disease is in its early stages and this decreases the effectiveness of the treatment."

Last year, the association provided for 90 female and 58 male patients. It also has a psychologist and social worker volunteering their services to the patients. Botswana has one the world's highest rates of HIV, affecting around a quarter of the 1.7 million population, according to the United Nations.

Von Paleske described the situation as a "challenge of unforeseen proportions", saying the department could not demand more funds from government as it was already financing the rollout of Antiretroviral drugs to combat AIDS.

The Botswana government is currently negotiating with the International Atomic Energy Agency to establish a radiology unit at Princess Marina.

However, von Paleske said that the biggest challenge would be to secure experienced staff to run the unit, adding that no one was currently being trained in radiology.

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