RX: Go to Delhi, elsewhere
Falling Cancer CARE: Lack of diagnostic, treatment facilities forces ‘migration’ of patients to other states; No PET-CT scan facility in Valley hospitals; Surgeries take more than 3 months
The growing cancer incidence in Kashmir has failed to move the successive governments in Jammu and Kashmir as infrastructure for cancer diagnosis and treatment has remained abysmally poor over the past one decade, according to medicos and patients.
The Regional Cancer Center at SK Institute of Medical Sciences (SKIMS) at Soura here happens to be the only dedicated cancer-treatment facility in the Valley. While 4438 new cancer cases have been registered at the RCC in 2015, the number of such patients continues to swell every year, a doctor at SKIMS told.
He said the “rising cancer incidence” in the Valley is “stretching the RCC facility for diagnosis, management and treatment beyond limits”, forcing many patients to seek treatment in the private sector or go outside the state, to New Delhi, Mumbai, Chandigarh or elsewhere—sometimes after selling all the land and property they have.
‘Cancer Surgery? Wait For 3 Months’
According to sources, while surgery is required in most cancer cases, the Surgical Oncology department of the RCC at SKIMS is “unable to meet the requirements.” There is no dedicated ward for Surgical Oncology at the RCC; the Ward-07 at SKIMS is shared by two departments—the Pediatric Surgery and Surgical Oncology. It has only 12 beds and medicos at the department of Surgical Oncology get to operate only twice a week, apart from once a week at Trust Hospital (gynae-onco cases).
According to sources, the cancer patients have to wait in queue for more than three months for surgeries.
“This is unethical and worsens the patient-outcome,” a senior specialist at SKIMS said, referring to the inordinate delay in surgeries of cancer patients with what he called the “shrunk OT days’. “In cancer, every day counts. And we ask the patients to go home and return three months later for surgeries. You won’t see this pathetic scenario anywhere in the world,” he said, insisting not to be identified. Many doctors at SKIMS said sometimes “we have to send patients ‘here and there’, in bid to save their lives.”
An employee at the Surgical Oncology department said the authorities had promised a new OT block where Surgical Oncology will have many OT tables. “The talk of a new OT block has been going on for years, but nothing has moved since,” he said.
A number of patients at Day-Care Ward (1-P) of the RCC are subjected to agony and distress as the “capacity-constrained ward has to house patients for radiotherapy, hematology and chemotherapy doses.” “This Ward is unable to cater to the needs of these three separate specialties,” a doctor said. “Can you believe we have to date patients for Ward 1-P also?”
Situation Grim At SMHS
At the SMHS Hospital here, the situation is grim. There is no separate Surgical or Medical Oncology department. The only Oncosurgeon at the hospital is able to operate five cases a week. There is no separate Oncology OPD at any of hospitals associated with GMC Srinagar—except the flood-devastated Radiation Oncology department at the SMHS Hospital.
In 2014, just before floods devastated the SMHS Hospital, 997 new cases were registered at its Radiation Oncology department.
In October last year, then Chief Minister (late) Mufti Muhammad Sayeed had announced that Kashmir Nursing Home at Gukpar Road here would be developed as a Cancer Institute. However, after the announcement, no ground work was carried out.
“Considering the number of cancer cases, we need a Cancer Hospital in the state, not just a department here and there,” said an oncologist at SKIMS.
Overburdened Facilities, Delayed Diagnosis
Although policy makers have over the years attempted augmenting the facilities for cancer diagnosis in Kashmir, experts believe the steps are “too little.”
For getting a PET-CT scan, a cardinal equipment for diagnosis of many cancers, patients have to travel outside the state. Although, PET-CT itself is a costly scan, the expenses are multiplied with the cost of travel, boarding and lodging that patients have to go through in the neighboring states,” a doctor said.
An oncologist at SKIMS said: “For oesophageal cancer and lung cancer—two very common cancers in Kashmir—the PET-CT can be extremely helpful in management of the disease. It is also important in recurrent cancer management. But since we do not have the facility, we somehow ‘make-do’.”
The SKIMS had announced in 2011 that it will procure a PET Scan for its Regional Cancer Center on a public-private partnership model. In 2012, a tender was issued (NIT 02 for Installation, Operation and Maintenance of PET-CT (Phase-I) & Cyclotron (Phase-II) dated April 14, 2012). A corrigendum followed and nothing moved for a year and in 2013, the then Chief Minister was again told that PET Scan equipment was on its way to the institute.
The commitment was reiterated in SKIMS Governing Body meet of 2014. And two years later, there is no sign of this equipment.
For getting an MRI at SKIMS, a cancer patient is made to wait for “at least three months.”
“There is only one MRI equipment at the Institute, forcing patients suspected of having a malignancy queue up with the general patients for the imaging scan,” a doctor said.
He said the Pathology department of SKIMS has not been upgraded for years. “We are only able to get the basic pathologies here. Over 50 percent of the blocks (biopsy samples) are being sent to the Tata Institute Mumbai or some private hospital for getting Immunohistochemistry (IHC) test done,” the doctor said. “The IHC gives us an insight into the tissue being examined and offers doctors a more holistic picture of the tumor,” he added.
‘De-Centralized Cancer Detection’
Many doctors at SKIMS believe that patients are “mismanaged at other places.” “Oncology has not been a part of policy makers, neither the focus of medical school curriculum planners,” Dr Sheikh Aijaz, HoD Medical Oncology at SKIMS said. “It is quite a norm that many doctors miss out on signs that should have rung alarm bells for cancer.”
He said there needs to better training of doctors vis-a-vis cancers and more cancer diagnostic facilities ‘elsewhere also’.
During Ghulam Nabi Azad’s tenure as Union Health Minister, Cancer Centers were proposed to be set up at Udhampur, Kishtwar and Kupwara each at the cost of Rs. 45 crore. The projects have not even started yet.
