Cancer train

Cancer train

At 9.20 pm everyday, a passenger train leaves Bhatinda town for Bikaner in Rajasthan. "It's full of cancer patients," says Umendra Dutt of the ngo Kheti Virasat. The patients are bound for the Acharya Tulsi Regional Cancer Treatment and Research Center (rcc) -- one of the 19 regional cancer research centres in the country. A train full of cancer patients? How widespread could this killer disease be in Bhatinda district (it carries the same name as the town)? I head there. The initial foray reveals that the re is very little documentation to to show the disease's prevalence in the district. But that's no hindrance. For, the villagers I meet are full of talk of cancer-caused deaths in recent years, and of numerous co-villagers who suffer the disease.

37-year old Bimla Devi of village Mahi Nangal near Bhatinda town is one of them. She is battling cancer of the ovary. In January 2004, Bimla had jaundice followed by urinary problems. Several rounds made of doctors at Talwandi Sabo block and Bhatinda town were of no avail -- one even suggested that Bimla had contracted aids. Meanwhile, her pain intensified and she bled profusely. So, in June 2004 she did what most people afflicted with an 'unknown' aliment in the region do: head for Bikaner. At rcc, doctors confirmed the worst. She underwent a round of radiation therapy.

"There are about seven cancer patients in the village," says Harbans Singh, a registered medical practitioner who lives near Bimla's home. "I have been practising at Mahi Nangal since the last 10 years, but did not hear people here suffering cancer before the last 4-5 years," he adds. "We have never had any doctors because people did not fall sick, but now everyone seems to have medicines in their pockets," rues Gurcharan Singh, whose wife Mukhtiar Kaur died of cancer last year.

Back at Bimla's, a week later
The family is preparing for another trip to Bikaner. Bimla's second round of radiation therapy is due. The preparations become feverish once Sita Ram, Bimla's husband, returns: he runs a ration shop and had gone to Talwandi Sabo to seek permission to close shop for a few days. Bimla jokes with her children, Modka and Gursharan, while packing her bag: clothes, medical records and the all-important travel concession form; bedding, utensils and a gas stove had been left at Pardayatji Shri Dhuriji Dharamshala, a charitable resthouse near rcc she'd stayed in when she'd gone to Bikaner last. Though rcc runs a subsidised canteen, a meal for just five rupees, Bimla prefers to cook her own food.

Meanwhile Naseeb, her elder son, returns from school. He looks visibly strained. The prospect of looking after the household in his parents' absence seems to weigh heavy on the 15-year old: the next day he has to get labourers to spray the family's cotton fields with pesticide. At 5.30 pm he hefts his mother's bag onto his cycle and moves towards the bus stop. Boisterous Bimla is suddenly sombre; she hugs her children goodbye and with Sita Ram follows Naseeb.

The bus arrives at 5.45 pm. It takes about half-an-hour to Bhatinda, but over bumpy roads that has Bimla grimacing in discomfort. She tells me later of the blisters left behind by the first round of radiation. It's another jerky and uncomfortable ride -- this time on a rickshaw -- to the railway station. The Bhatinda-Bikaner passenger train is already in platform no 1. Though it's a good three hours for departure, Sita Ram scurries for seats. Of course, "Bimla will anyhow get a place to lie down, people on the train are usually helpful to cancer patients," he says.

Cancer patients can travel free throughout the country, but rcc has really made things easier for its wards: there are people in the hospital specifically to sign the travel concession forms. "Lots of cancer patients travel free on this train," says Rajinder Singh, supervisor (booking) at the Bhatinda railway station. He even shows me that week's records: they show that an average of six patients travelled everyday on the Bhatinda-Bikaner passenger mail, that week.

Family problems besides cancer
Getting a seat on the train is easy for Bimla and Sita Ram. The compartment is stuffy. Bimla takes her mind off the discomfort by relating her family's problems: the ration shop does not pay, taking leave requires bribing the inspector and their landholding is too small to be profitable. But she does not list her health -- and mounting expenses on it -- as a problem. However, the day has taken a toll. As the train judders into motion, Bimla falls asleep: next day will be taxing for her.

Meanwhile, Sita Ram tells me that treatment at rcc is cheap: the last time they spent around Rs 8,000. This brings to mind Dalip Kaur (Surjeet Kaur in rcc's records), also of Mahi Nangal: she spent Rs 30,000 in Talwandi Sabo and Bhatinda hospitals for chemotherapy for her breast cancer. Another resident of the village, Satya Devi, spent Rs 1 lakh for therapy on a cancerous growth on her lip. Both had to go to Bikaner anyway. Satya still visits rcc every six months for check ups. Though much better now, she rues not being able to tend the cotton and maize her husband grows on his 2.8-hectare (ha) farm. Dalip's joint family holding is even larger: about 13 ha. "We didn't use much pesticide till five years back. Now we spent Rs 10,000 per ha," she informed.

Indeed, my visit to villages in the area is a spiral of similar stories: there is Bhola Singh, a school teacher from Jajjal who had brain cancer. He is dead. "The entire village had grieved, for Bhola was one of the few educated here," said Gurmeet, Bhola's brother. He, too, has been spraying his 4 ha land with liberal doses of pesticides, since the last two years. Pesticides hold centrestage in another sorry tale: Gurbaksh Singh of Jajjal. He died of throat cancer in 2002. Gurbaksh's brother Sukhdev told me that in 1985 they sprayed a litre of fenvalerate over 8 ha. Now they spray the same dose over 1.2 ha. Gurcharan Singh at Mahi Nangal described the bane aptly, "We inflict poison on our land. We grew pulses earlier but now these don't even flower. This is because the soil is not rested. We suffer diseases for the same reason."

Memories of these conversations, all stories of suffering and separation, constantly come to mind. The train screeches to a halt at Bikaner.

Away from home
The sun beats down as Bimla and Sita Ram head for her doctor's residence, carefully picking their way over railway tracks and through pothole-rutted roads. This, it seems, is the norm: a preliminary check up is done at the doctor's residence and the patient is then directed to the hospital for further tests. The two then walk on towards the dharmashala. The guard here chooses this moment to insinuate that the survival rate of patients of the doctor looking after Bimla is quite low . T he two somehow manage to wriggle away and deposit their baggage with one of the resthouse residents. They would fix up a room only later: the physician's signature is required for this.

Bimla and Sita Ram make towards the nearest dhaba: not a dirty place, but ideally best avoided by those with reduced immunity such as Bimla. But she and Sita Ram have not had a morsel in the last 16 hours. They sip tea and munch matthis with relish.

At the hospital
Inside the hospital, Sita Ram points towards the Life Saving Medical Shop -- the biggest reason treatment is cheap at rcc . The hospital has arranged with pharmaceutical companies to make drugs available at wholesale price to patients. A radiotherapy consisting of 30 'fractions' or sessions costs just Rs 600 -- Rs 20 per cycle compared to Rs 600 per cycle in Punjab.

Bimla's medical records in hand, Sita Ram waits outside the doctor's room. It's still some time for treatment to begin: a few general checkups have to be conducted, it has to be decided if Bimla requires short cycles of radiotherapy, or if a long course would be needed. Bimla's blister might also affect the decision on her treatment. There is confusion because she is late for her second round of radiotherapy; doctors reprimand the couple. After much waiting, and whispered conferences about why the doctors were taking so long, the couple is told that Bimla's treatment would begin the next day. They trudge back to the dharamshala.

The next day, I visit the hospital again to get data on cancer patients visiting rcc ( see box: They do care). There is Bimla on a stretcher on her way to radiation therapy.

The bane
rcc is carrying out a study to find out the reason for increased incidence of cancer. "Pesticides could be a problem but it's too early to link the two conclusively," avers D P Punia, rcc's director. "We do know, however, that pesticides cause mutations. And significantly, lymphoma and leukaemia, which are linked to mutation, are on the rise. But cancer is a group of diseases and cannot have just one reason," he adds.

rcc 's experts will take time to complete their study, and might zero in on the relation of pesticide use -- or tobacco, or diet -- to increased cancer incidence. Villagers are sure of one thing. Pesticide use has zoomed. "20 different types of pesticides are used in our village, every year. They cost us more than Rs two crore," says Kewal Singh, Mahi Nangal panchayat member, evoking memories in me of the overpowering chemical stench invariably hanging around the fields. And cancer? "I cannot directly link cancer to pollution. But pollution has increased and so has the disease," says Harbans Singh. Adds Karnail Singh of village Mahi Nangal, "We read about pesticide use and cancer in local newspapers all the time."

Isn't it time this doubt is resolved?