The dreaded C, and how the marginalised cope
Pushpa Achanta, Hyderabad
March 3, 2017

In a few years from now, cancer could well overtake cardiac diseases as the most widespread ailment and killer disease in India. However, treatment of the dreaded C, as it is often called, is expensive, long-drawn and available primarily only in health-care facilities run by private agencies or in large government hospitals in metropolitan cities or capitals of states. The other point is, chemotherapy is likely to have harmful side effects and cannot really ensure that the disease will not recur

Dr Ramesh Maturi, asso-ciate professor in the department of Surgical Oncology at Mehdi Nawaj Jung Institute of Oncology (MNJIO) and Regional Cancer Centre, Hyderabad, says, “The governments of Telangana and Andhra Pradesh are planning to ramp up the cancer care services in those states. Medical professionals like me are recommending to the government that cancer diagnosis and treatment facilities must be expanded to the districts to minimise travel costs and income loss for daily wagers.” Pertinent points indeed, as the 61-year old MNJIO is the only cancer-care facility run by the government in Telangana and Andhra Pradesh.

It is not surprising that the persons who seek diagnosis and treatment at MNJIO largely belong to financially disadvantaged families from various parts of the two states. Among them, are the frail looking and barely literate Ramamma, a former agricultural labourer who is around 45 years of age. She lives with her daughter, husband and older son in Tandur District in Telangana, which is situated about a couple of hours from Hyderabad. Accompanied by her sprightly 18-year old daughter, Swathi, she has been visiting MNJIO for investigation and treatment for more than two months after she began vomiting blood six months ago.

Dr Sowmya briefs Arundhati Nagar women residents about breast cancer self-examination.

A doctor in a private clinic in their home town who examined Ramamma, suspected she had a malignancy in her breast and suggested she visit MNJIO. “Diagnosis and treatment for my mother is satisfactory here. We could not have afforded the cost of care in a private hospital. Further, demonetisation made our life tougher as it was difficult to access even the small amount of money that my family has,” Swathi says. She adds that the economic situation of their household has been affected adversely because Ramamma is unable to earn and that they are incurring extra expenses on food when she is in hospital. This is likely to be the situation till Ramamma’s treatment is over.

When her mother is admitted at MNJIO for treatment, Swathi, who has studied up to Class X, sleeps on the floor near the bed and eats at the hospital canteen or eateries nearby. Now, this costs about 100 rupees a day for three meals. Her mother availed benefits under the Aarogyasri, a community health insurance scheme provided by the Governments of Andhra Pradesh and Telangana. The policy covers diagnosis, surgery, therapy and other expenditure up to two lakh rupees a year for serious illnesses for people below the poverty line.

Ramamma could also travel free of charge by train while Swathi got a concession on her ticket, as attendant. Thanks to Swathi and her self-employed second brother who lives with his family in Hyderabad, this was possible.

Patients and their caregivers in the waiting area of MNJIO, Hyderabad.

Let’s meet Khirad and her husband, Zaheer (name changed), age 28 and 30. The come from a village in Nizamabad District where they live in a small house on rent. Says Khirad, “Ever since Zaheer, who earned a living by driving an autorickshaw, was diagnosed with cancer three months back, we began to live at the house of my mother in Hyderabad. As we have no source of income, I earn around 2000 rupees per month as a domestic worker. That is hardly sufficient to meet our needs but Zaheer is unable to do any job at present and I lack academic or other qualifications to get better employment. At least, we do not have children or other people who depend on us financially.”

Khirad was not aware of the rail travel discount available to Zaheer and herself for the nearly 150-km-long trip that they make to their home town, sometimes.

Khirad, Zaheer, Swathi, Ramamma, their respective families and some of the patients and their family members, who go to MNJIO, were aware about the gravity of cancer as a disease before they went there. However, they and many others do not know what causes cancer and how its impact can be minimised, especially by early detection.

“As we have observed these realities, we decided to organise a camp for half a day to create awareness on breast cancer, one of the most common types of cancer. We did this on a Sunday morning in collaboration with the Greater Hyderabad Municipal Corporation at Arundhati Nagar, a low-income neighbourhood of Gandhi Nagar Ward in the city.

Around 75 women largely in the age range of 35-55 years turned up as they came to know of the camp through prior announcements and noticing their friends and neighbours. We plan to repeat this in other wards at least once in a month,” explains Dr Sowmya Korukonda, a surgical oncologist at MNJIO, who was among the seven surgical oncologists who conducted the educational sessions.

It was not surprising to note that the affected arrived at the camp expecting to get medicines free of cost and that their ailments would be addressed. However, when they learnt that the camp was about cancer awareness, a few of them were initially worried. They were informed that cancer was not a communicable disease and the reasons for its occurrence included but were not limited to tobacco consumption, family history, carcinogens in the atmosphere, and ingestion of contaminated food and water.

In a series of short and separate sessions, groups of 5-10 women belonging to Arundhati Nagar were briefed about the nature of breast cancer, when it was likely to manifest, how they could examine themselves and where they could seek clinical investigation and treatment, if necessary. While some of the women could not participate in the camp as they had to go for work, others had domestic chores. Most of those who par-ticipated assured the organisers that they would spread the word among their family members, friends, neighbours and peers.

“My knees and backache are due to 25 years of being a domestic worker and performing household chores. I went to the health camp expecting to receive medicines, prescription or at least guidance on how to address my aches. But I gained crucial information regarding breast cancer and was also advised where I could obtain treatment for my body pains. I will surely disseminate my learning among others,” says 46-year old Anita, a resident of Arundhati Nagar. Barely literate, she lives with her daughters who have studied up to Class X and work in the unorganised sector.

January 2017