In Assam’s Silchar, A Hospital Models Accessible Cancer Care For The Vulnerable
Oncologist Ravi Kannan, one of the winners of the Ramon Magsaysay award in 2023, spearheads efforts at the Cachar Cancer Hospital and Research Centre to provide treatment for patients who cannot afford to journey to big-city hospitals
Guwahati: Three years ago, 40-year-old Baby Begum Lashkar noticed a lump in her right breast. She lived with her husband and three daughters a couple of kilometres away from Silchar town, in the northeast Indian state of Assam.
Lashkar’s husband took her to the Cachar Cancer Hospital and Research Centre (CCHRC) in Silchar town, where she was tested and diagnosed with breast cancer. She went through multiple sessions of chemotherapy, and a surgery, and even now has to visit the hospital regularly for check-ups.
In India, the national average of cancer cases for 2022 is 100.4 per 100,000 population. The northeastern states of India--Assam, Meghalaya, Tripura, Arunachal Pradesh, Mizoram, Manipur, Sikkim and Nagaland--report a higher cancer burden than the Indian average.
Overall, India recorded 80-110 cancer cases per 100,000 people, but in its northeastern states, this number varied between 150 and 200 cases per 100,000, according to the Indian Council of Medical Research (ICMR). The region has 59% of deaths from non-communicable diseases, with cancer the cause of 9.5% of those, the highest in India.
When adjusted for age, the top four districts with the highest incidence of cancer are in northeast India. Among men, Mizoram's capital Aizawl reports the highest age-adjusted cancer incidence rates, while among women, Papumpare in Arunachal Pradesh does.
The health infrastructure in most of these states is not sufficiently equipped to deal with such heavy caseloads, which forces economically weaker patients to travel long distances for treatment. Lashkar says that if CCHRC did not exist, she would have had to travel either to Guwahati or Kolkata for treatment. “Travelling to Guwahati would have been almost impossible for us,” Lashkar told IndiaSpend.
Cancer-care facilities are limited to a handful of major cities, and the poorest patients have to make long, arduous journeys to tertiary care facilities for proper diagnosis or medical care, we reported in our award-winning series on cancer in 2017.
Creating cancer-care infrastructure
Siddharth Singh, Commissioner Secretary to the Government of Assam’s medical education and research department, says an initiative called the Assam Cancer Care Foundation--a not-for-profit company with the Tata Trusts--has been dealing with cancer care in Assam and all of northeast India.
“Most of our patients were going to the southern states and Mumbai which essentially means a lot of money is spent on travel; detection will be at a later stage and for the treatment therapies also multiple trips would have to be made,” Singh pointed out. “Even for people with financial stability, it is difficult.”
Assam Cancer Care Foundation, which was started in 2018, has made considerable progress in providing a viable alternative, Singh said. “They have started seven hospitals across Assam, including the State Cancer Institute, and this has been one of the biggest initiatives in the country,” he told IndiaSpend. “Since last year, we have done more than 100,000 outpatient department consultations, thousands of radiation therapies, chemo sessions and several diagnoses.
“In the next six months we will start three more, and we have another seven coming up--a grid of 17 hospitals. Basically, it’s a paramedical structure where we have a distributed cancer care model. Our aim is to be a major hub for treatment in the entire northeast, east India and parts of south Asia.”
Until a few years ago, however, the State Cancer Institute attached to the Gauhati Medical College Hospital, and the Dr Bhubaneswar Borooah Cancer Institute, a grants-in-aid institute of the Department of Atomic Energy (a unit of Tata Memorial Centre, Mumbai) were the only dedicated cancer hospitals in Assam, treating patients from across the state as well as from the neighbouring northeastern states.
In such a scenario, for patients like Lashkar who live far away (Silchar is 10 hours by road from Guwahati), the CCHRC has been a blessing. Situated on the outskirts of Silchar town in Assam’s Barak valley, CCHRC is a not-for-profit hospital established in 1996 and administered by a charitable society known as the Cachar Cancer Hospital Society which was formed in 1992.
Right man for the job
According to CCHRC, nearly 80% of their patients are daily wage workers, agricultural and tea garden labourers, and nearly 75% are treated for free or at subsidised charges. CCHRC also treats patients from the neighbouring northeastern states of Mizoram, Manipur, Tripura and even the neighbouring countries of Bangladesh and Myanmar.
The hospital was formed because there were barely any cancer hospitals in the region. “The local citizens came together and formed the society and found support from different sections of the community, that’s how they put up the hospital,” said oncologist Ravi Kannan, who came to Assam from Chennai about 16 years ago on the request of members of the Cachar Cancer Hospital Society.
Until 2006, Kannan had worked as a surgical oncologist at the Adyar Cancer Institute in Chennai. The then director of the society in Silchar, Chinmoy Choudhury, frequently visited to learn the latest developments in cancer care. Choudhury also sent patients from northeast India to Chennai. “In the institute (in Chennai) we had a policy that we would treat everybody irrespective of their paying capacity,” Kannan said.
Initially, when they requested Kannan to move to Silchar, his wife, Seeta, refused because “back then we associated the northeast with bomb blasts and floods, so, I told the society that I will not be able to come”, Kannan said. “But they were persistent, so we decided to visit the place.”
When they first visited Silchar, Kannan and his wife realised the enormity of the problem and the urgent need for oncologists in the region, and they decided to stay back. He did not realise, then, that his efforts would earn global recognition--on August 31 this year, Kannan was named one of the four winners of the Ramon Magsaysay Award.
Oncologist Ravi Kannan with a patient at the Cachar Cancer Hospital and Research Centre. Kannan moved to Assam’s Silchar 16 years ago looking at the dire need for cancer care, and says, over the years, there has been a small but definite change in care-seeking behaviour for cancer.
In northeast India, cancer is essentially a lifestyle disease. “Consumption of chewing tobacco, smoking tobacco and raw betel nut tops the list here,” Kannan said, while discussing why cancer is inordinately prevalent in the region. “Apart from that, the dietary practices--a lot of red and smoked meat--and alcohol consumption is very high in the region.”
Almost 90% of the patients are supported through some system or the other, including government schemes such as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Atal Amrit Abhiyan, as also by other funding sources such as Indian Cancer Society, Mahesh Memorial Trust, etc. Lashkar’s treatment, for instance, was facilitated through PM-JAY.
“We also give a lot of discounts from the hospital itself,” Kannan explained. “When we buy drugs legally, the system allows us to sell the drug at a fixed price, the MRP, but we buy a drug for say Rs 3,000 and the MRP is maybe Rs 14,000--that’s how much the margin is.
“So what we do is, we don’t sell drugs at MRP. If we are to buy a drug for Rs 3,000, then we will put a 20% charge for paying pharmacy salaries and we will sell the drug at Rs 3,600.”
Apart from the discounts, Kannan said, they also seek financial help from those who can support them. “If we don’t do that, then we will not be able to ensure that everybody completes treatment. If the patient doesn’t have the resources for their treatment, it is the job of those treating them to find those resources, and that’s what we try to do.”
The hospital has received funding and support from various international bodies, said Kalyan Chakraborty, the former administrative officer of the hospital and one of the founding members of the Cachar Cancer Hospital Society. “This has helped us sustain ourselves,” he said, adding that many patients have a tendency to leave treatment midway because they cannot afford it. “CCHRC also has free meals for patients and for their attendants.”
Chakraborty added that they also make sure that their blood bank always has blood for its patients. “We organise a lot of blood donation and cancer awareness camps across the region.”
Turning things around
For Lashkar, not having to travel a long distance, and finding a support system within the hospital, has been life-saving. “Cancer treatment is a regular treatment and goes on for a while. I have made acquaintances and friends in the hospital, and they in turn have helped me in many ways,” she said.
Over the years, CCHRC has seen the number of patients grow. The annual number of new patients now is more than 5,000, and that number increases every year. The number of people who come for follow-ups after treatment is completed is also on the rise, and the number of people who complete treatment is also improving. “In 2022, follow-up patients were about 30,000 and new patients were 5,062,” Chakraborty told IndiaSpend.
Most patients, Kannan noted, are afraid that if cancer is diagnosed, they will have to go through expensive treatments that will impoverish them, so they avoid check-ups. “They are afraid,” he says “But now there are a lot of resources available in the community, both government and other non-government sources, but there is still a belief that they will go through a lot of suffering because of chemo and radiation.”
The hospital is working to educate people about the need for early diagnosis. “Earlier, people used to come at a very advanced stage of the disease,” Kannan notes. “Now, there is a slight change--they come at a slightly earlier stage. It has been a long process, and it has taken us 10 to 15 years to bring about this change. But it is a gradual, definite change.”
As a team, he said, to witness the transformation that they bring to the community keeps them motivated. “People come back again even when their relatives or loved ones die,” he says. “They come back with more relatives because they say that they were treated well.”Kannan, who is also a recipient of Padma Shri, India's fourth highest civilian award, added that some of his colleagues who joined as youngsters have all grown in the organisation, have learnt skills, and gotten better at their job. “These things are very satisfying, and I wouldn’t trade my position for anything in this world.”
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