Saturday, September 10, 2011

Cancers in rural India

Over the last week we’ve had an epidemic of cancer patients visiting the hospital. When I joined work here, I would not have thought that I could end up dealing with cancer patients in a remote place like this. But the truth is that things are changing.

It all started with RD, a 56 year old Post Office employee from the nearby village of Polpol who had been suffering from invasive cancer of the mouth which extended to his cheek and the jaw. It was quite a pathetic sight to see. It was quite a long time since I had seen such a bad malignancy. Having studied in Medical College, Trivandrum where the Regional Cancer Centre is in the same campus, it was not a new thing for me.

RD had been taking treatment for a quite a long time for his cancer from Mumbai. However, over the last month, the family ultimately realized that there is nothing more which can be done. But, living in a village with such sort of a condition was very difficult. They were very happy to know that we could help them. Over the last 3 months, RD would come on and off. It would be to either adjust his nasogastric tube, or do a bit of extra cleaning of his wounds or just like that. The last time he came over, we had to admit him.
It may sound a bit bizarre. Few maggots had come up in the wound and his family had tried to clean it up. Suddenly, RD became breathless and he was rushed here. Nandamani found out that one of the maggots had slipped into RD’s trachea which was exposed by the malignancy. We thought that this was going to be curtains for RD. The family requested that he dies peacefully in one of our private rooms. We were not very keen – but the family was quite adamant with the request.

RD hung on. He was sick for the first couple of days but made a remarkable recovery and was ultimately discharged after about a week. RD did not wait to say bye to us before he left. Maybe he knows that he will be back soon.

Of course, disease profiles are changing in the rural areas too. The other cancer patients whom we had over the last week – the first one, SSD, about 35 year old male had carcinoma head of pancreas and the second one, KGD, a 40 year old mother of 3 boys had cancer of the bladder. Both the stories are quite pathetic – stories on how the health care profession almost looks like vultures waiting to pounce on the sick and bleed them of their possessions and dignity. But that would be later.

There is a glaring need for palliative care as well as early cancer detection programmes in our area. Considering that tobacco is being abused in all sorts of forms in almost all age-groups, much needs to be done regarding educating communities on cancer prevention as well as early detection of the disease. Ultimately, the truth is that while we still struggle with the good old malaria, tuberculosis, typhoid etc. the newer non-communicable diseases including malignancies makes life quite burdensome to the poor in the rural hinterlands of the Indian subcontinent.

PS: EHA has already started a Palliative Care unit at Harriet Benson Memorial Hospital, Lalitpur, Uttar Pradesh.

1 comment:

  1. Dear Dr Kuruvilla
    Thanks for your regular mails from the field. Reminds me of my work in Gudalur, Nilgiris. Nothing seemed to have changed in the 25 years :-(

    While cancer may be more difficult to prevent, it may be easier to detect HT and DM and prevent complications before they appear. So a simple blood test for DM or a BP for all patients more than 30 years will uncover a lot of latent NCDs. If you are able to put them on an affordable and effective regime with adequate counselling on lifestyle changes and need for regulat treatment, you will have prevented many renal failures and strokes.

    All the best and keep up the great work