Cancer kills fast if not confronted

Almost two weeks have passed by after Mohammad Shafi Pandit’s sudden passing away due to cancer. Cancer, that ‘Emperor of all Maladies’ ( Siddhartha Mukherjee’s book ) was so quickly fatal with Shafi Saheb. I asked Dr U. Kaul why was this cancer so quickly fatal with Shafi Saheb, to which he said , ‘Shafi Saheb developed an adenocarcinoma of stomach which spread rapidly to pancreas and surrounding structures. Was in intense pain for a few weeks before the final journey. We list him to a very virulent malignancy.’

To the same question, Dr Samiya Rashid, former Principal, Government Medical College Srinagar, observed as under:

‘Metastatic adenocarcinoma of the stomach depends at what stage it is detected. Adenocarcinoma is carcinoma of anywhere in the GI tract and its very common to have. In countries that are more advanced in health care, they go for mass screening-routine endoscopy to pick it up early. We don’t go for mass screening here. It is only when patient develops symptoms that here we go for screening. That is why it was not picked up early.

There are a lot of factors that affect why a patient is diagnosed with the disease. Environmental, ionising radiation, over consumption of meat, salt, smoked food, pesticides. What truly happens one does not know. In this case it is very likely that it was a genetic tendency. He had a strong history of cancer within the family.’

Even in his death, and true to his reputation of being a crusader for public issues, Shafi Saheb has brought into focus the menace of cancer. Let us then look at its prevalence, diagnosis and treatment in Kashmir.

Although I don’t have the relevant statistics about prevalence of cancer in Kashmir but that its incidence is high is undisputed. The main causes are believed to be the salt tea, spicy foods and possibly adulterated spices and foods, some inappropriately dried vegetables, pickled food, excessive mutton eating, smoking etc. There would be genetic factors also among sections of population which predisposes them to cancer.

Cancer has been quite unsparing as a cause of numberless deaths in Kashmir for decades now, ever since it began to be diagnosed and recognised here. That the cancer treatment facilities were nearly non- existent in Kashmir for many years till about a couple of decades or more back resulted in most patients going without treatment. Although, the treatment facilities have now come a long way, these are still inadequate in comparison to the demand and requirement and that forces patients to seek treatment outside Kashmir.

But only those who can afford are able to go out and out of them only a fraction is able to sustain and bear the continued expenses. We are grateful to the doctors and hospitals outside Jammu and Kashmir for trying their best for the patients from J&K, be it the Tata Memorial Hospital at Mumbai, PGI Chandigarh, Medanta at Gurgaon or AIIMS, Appollo, Max, Rajiv Gandhi Cancer Hospital etc at Delhi and hospitals elsewhere in the country. The cancer specialists in these hospital have been trying valiantly to save our patients and in many cases they have  succeeded.  Our own top hospitals, SKIMS at Srinagar and the two Government Medical College (GMC) hospitals at Srinagar and Jammu have also been trying their best to provide treatment to cancer patients.

The cancer treatment facilities include two State Cancer Institutes, one at SKIMS, Srinagar and another at GMC, Jammu and the Department of Oncology at GMC, Srinagar. The cancer treatment facilities in outlying GMCs are at the very basic level. It is hoped that the new AIIMS hospitals coming up at Srinagar and Jammu will have well equipped and fully functional oncology departments after these are  commissioned.

But the larger question of affordable and quality cancer treatment within Jammu and Kashmir remains. We still don't have an independent cancer hospital anywhere in the UT nor do we have adequately and sufficiently equipped cancer cure centres within our premium hospitals to undertake the load of patients and provide quality treatment for all types of cancers. The existing Cancer Institutes in SKIMS and GMC Jammu and the Department at GMC, Srinagar may neither have enough specialists nor all the facilities to handle the load of cancer patients.

Then there is the question of affordability of treatment. Although, the treatment in government hospitals is partly free, the treatment in private hospitals outside J&K is prohibitively expensive. Even in SKIMS and the GMC hospitals at Srinagar and Jammu, the patients have to pay for the therapies not covered under Ayushman package. These therapies are costly and mostly unaffordable for the average family and majority of the patients are uninsured.

Two previous initiatives for cancer treatment deserve to be mentioned. One is the Cancer Society of Kashmir (CSK), the other is the Cancer Treatment Fund for the whole state which the government had set up sometime in 2009 and was included in the budget for 2009-10. CSK has been struggling for funds as the donations didn’t mature on the expected scale. The CSK  cancer hospital is functional on a modest scale in a private building as its own building is still under construction on bypass road near Nowgam. It is, however, doing good work in providing diagnostic and treatment facilities to poor patients.

The cancer treatment fund of the government could not come up sufficiently during the initial years to be in the forefront of cancer treatment, possibly due to official apathy. The CM’s medical aid fund did better in providing financial assistance to the needy who approached the CM office but was never sufficient to meet all the demands. Ghulam Nabi Azad  as CM did better for some time as he was able to persuade employees to allow minor deduction in salary at source for the CM’s medical aid fund. One is not sure about the current situation of the cancer treatment fund and how it is being operated to help the patients who apply for assistance but reportedly the eligibility conditions and formalities are rather exacting and the maximum permissible financial assistance is only Rs 50000.

Government’s lack of attention in setting up two full fledged cancer hospitals at Jammu and Srinagar has been directly responsible for the suffering of patients who have to go out of the UT for life saving cancer treatment. Nor has the government been able to attract any of the big private hospital chains from outside J&K to come here and set up hospitals with facilities for cancer treatment. Tatas could have been approached to set up a branch of Tata Memorial Hospital (TMH) here in Srinagar or Jammu but that also didn’t happen due to lack of foresight on the part of successive state governments.

It is now for the incoming elected government to think through the whole issue of cancer treatment within the UT of J&K and decide what needs to be done. Advice from the experts is necessary to decide whether to convert the two State Cancer Institutes at Srinagar and Jammu into independent cancer hospitals or strengthen the two within the existing administrative structure. Keeping in view rapid rise in the incidence of cancer and future needs, it may be advisable to convert the two institutes into full fledged cancer hospitals with sufficient manpower, equipment and number of beds. Then insurance against cancer must be partly supported by the government in respect of economically weaker sections of society (EWS). The UT government could work out a scheme for providing affordable insurance cover against cancer with contribution from the insured and the government.

That screening, diagnostic and treatment facilities for cancer within the UT of Jammu and Kashmir need to be revisited and strengthened is unexceptionable. The new government that will assume office after the current elections must attach highest priority to  this. Sooner the better.

(Khurshid Ahmed Ganai is a retired IAS officer of the erstwhile J&K cadre and former Advisor to the Governor, J&K)