Punjab has been in the grip of cancer for over a decade but the government has ignored the threat. Sonal Matharu reports with photographer Sayantoni Palchoudhuri from the state
Keeping cancer alive
It all started with a knot in her left breast. Within no time it grew to the size of a tennis ball. In pain, 40-year-old Raj Rani went to the doctor in her village in Punjab’s Ferozepur district. Finding no relief, she started doing the rounds of government hospitals in Ludhiana and Faridkot and then a private hospital in Bathinda. Shelling out money at hospitals was not easy with a non-earning husband and sons bringing home little as small-time mechanics. By this time, a year had lapsed and Raj Rani’s health started deteriorating; she had stopped eating and had no hope of surviving.
“If you want to live, go to the hospital in Bikaner,” told her neighbours. With no option, she undertook a 10-hour road journey to Bathinda to board the train to Bikaner in Rajasthan, another nine-hour journey.
Doctors at Acharya Tulsi Regional Cancer Treatment and Research Center (RCC) removed her left breast and gave her chemotherapy. Three years later, Raj Rani sits patiently at the door of the hospital’s cancer out patient department for further check-ups.
“Correct treatment has kept me alive,” she says. Every district in Punjab is brimming with cancer cases. The Malwa region of Punjab, a cotton-growing belt, has the highest incidence of cancer in India, admitted Montek Singh Ahluwalia, deputy chairperson of the Planning Commission while releasing the plan for states for 2012-13.
Malwa region comprises the southern districts of Bathinda, Faridkot, Moga, Mukhtasar, Ferozepur, Sangrur and Mansa.
Absence of reasonable and quality treatment in Punjab forces hundreds of cancer patients to travel from faraway places to make a beeline for RCC, one of the 18 regional cancer research centres in the country.
In 2005, Down To Earth had reported the inadequate and expensive treatment for cancer in Punjab (‘Cancer train’, June 1-15) when Delhi non-profit Centre for Science and Environment (CSE) tested the blood samples of people living in Bathinda and found unacceptable levels of pesticides in them (‘Residue of a revolution’, Down To Earth, June 1-15, 2005).
Seven years later, government has done little to make treatment for cancer available in the state. Patients like Raj Rani still rely on the distant Bikaner hospital.
Options too few
Bathinda, the hub of cancer in Punjab, has no facility to treat the disease in its civil hospital.
Patients have to choose between small private hospitals and the super-specialty Max Hospital. The hospital was built in November 2011 on government land through public-private partnership after government understood the cancer threat in the state.
But the hospital is run privately. It has the latest technology and equipment and the treatment bill can shoot up to lakhs of rupees.
“One chemotherapy session costs Rs 1.25 lakh. Treatment for pancreatic cancer can cost Rs 3.5 lakh,” says Manjinder Sidhu, oncologist at the hospital.
Patients in the state decide against the Centrally-run Postgraduate Institute of Medical Education and Research in Chandigarh because it takes months to get admission there.
Eighty-year-old Karnail Singh and his wife Balbir Kaur, both cancer patients from Jhajjar village in Bathinda, opted for RCC. “Doctors in Bathinda robbed me,” says Singh. They kept getting the same tests done.
Each time it cost Rs 1,400. A farmer, he took loans for the initial treatment of his wife’s uterus cancer and his stomach cancer. Treatment at RCC added extra years to their lives. Balbir’s surgery and Karnail’s radiotherapy were done for free.
Medicines were also free. Investigations are cheap—Rs 50 each for biopsy and x-ray and CT scan. MRI costs about Rs 1,200.
The state government counters people’s allegations of poor facilities with a list—a brachytherapy machine at Government Medical College and Hospital in Patiala, a radiotherapy machine at Sri Guru Gobind Singh Medical College in Faridkot and a cobalt source machine at Sri Guru Ram Das Institute of Medical Sciences and Research Centre in Amritsar. But these are not enough.
The number of new cases from Punjab remains high, says Ajay Sharma, director, RCC. There has been no decline in the number of follow-up cases either.
In 2009, the hospital received 6,138 new cases and 45,357 follow-ups. In 2010, there were 6,295 new cases and 45,189 follow-ups. In 2011, new cases reduced to 5,787 and follow-up cases to 43,189.
However, the percentage of new cases that come from Punjab remains the same—60 to 70 per cent, says Sharma.
Government’s baby steps
To generate data on the magnitude and pattern of the disease, the Indian Council of Medical Research (ICMR) set up the national cancer registry programme in 1981 with centres at Mumbai, Bengaluru and Chennai.
But the programme failed to yield results. After high incidence of cancer cases were reported in Punjab, in 2010 the Centre asked the state to maintain a separate registry.
It was only in November 2011 that Punjab started maintaining such data. The drawback in the programme was that cancer cases that came only in government hospitals were to be reported.
On October 18, 2011, the state government made it mandatory for all public and private hospitals, pathological, clinical and radiological labs and medical institutions imparting medical education and providing diagnostic or treatment facility for cancer, to report all cancer cases to the pathology department of Government Medical College in Patiala. The college sends the data to ICMR for compilation.
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