Improving cancer care in rural IndiaBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3826 (Published 14 June 2013) Cite this as: BMJ 2013;346:f3826
- Sanjeet Bagcchi, physician and medical journalist, Kolkata, West Bengal, India
“A doctor in the town hospital said I have oral cancer. I have no idea what to do now,” said the 50 year old farmer to an unqualified rural medical practitioner at a tea stall in an eastern Indian village.
“Cancer in almost 100% of cases leads to death; it will gradually absorb your money, land, assets, and ultimately your life,” said the practitioner, adding, “Come to my room; let me see if I can do anything for you.”
Although this sounds anecdotal, it is typical of cancer care in rural India. Three quarters of the Indian population live in villages, but three quarters of qualified doctors live in cities and towns.1 This huge discrepancy in the doctor-patient ratio makes the lives of rural Indian masses miserable. For cancer care they have to depend mostly on practitioners who don’t even have any medical training.
“Cancer means no answer”
This compels villagers to believe that “cancer means no answer.” They often die miserably, without any treatment, or with the wrong treatment provided by unqualified doctors.
“Poor villagers in most cases spend all their money to pay the unqualified rural doctors who don’t know even the basics of cancer treatment,” Somnath Naskar, a physician attached to the Department of Community Medicine at R G Kar Medical College Hospital in Kolkata, told the BMJ.
Developing a national cancer grid
To tackle this situation, one of the Indian institutes for cancer care and research, the Mumbai based Tata Memorial Hospital has started an initiative to establish a national cancer grid. First proposed by India’s Department of Atomic Energy,2 the grid would provide a uniform standard of cancer care throughout the country. It would link all existing and proposed cancer centres throughout the country, with the aim of providing villagers with proper cancer treatment.3
“This initiative would reduce the patient load of Tata Memorial Hospital, which already has to see around 43 000 new patients a year from India and abroad,” said Naskar, adding, “The rural masses of the country are also expected to receive an optimally standard cancer care, through this grid.”
The grid would mean that rural populations would be able to receive proper treatment for cancer, the same as provided by the Tata Memorial Hospital, but in regional cancer centres situated near their villages.”
“Ghulam Nabi Azad, the Union health minister, said that under the national grid Maharashtra state has proposed financial support of 3784.7 million rupees (£41m; €49m; $64m) to set up a cancer institute at the Nagpur government medical college, but no other states or union territories have made similar pledges.2 4
To set up the national cancer grid, preliminary meetings were held in August 2012 and February 2013, with participation of the major cancer centres.4 To date, 27 cancer centres throughout India have joined the grid.3 Shortcomings related to human resources might take 5-10 years to overcome, according to Tata Memorial Hospital.3
Swapan Jana, secretary of the Society for Social Pharmacology, a non-governmental organisation based in eastern India that works for people with cancer in villages, told the BMJ, “A proper network of various cancer centres across the country needs time and professional skills of the people connected with it. Though there are no specific data, the ratio between Indian oncologists and patients with cancer is a matter of concern, given that there are few oncologists in the country and that more than half a million people in India die from cancer every year.” As well as oncologists, the grid will need health assistants, technicians, and nurses, said Jana.
The Tata Memorial Centre is working with King’s College London to improve workforce planning and to develop systems to provide affordable cancer care.5 The centres in the grid are also working with King’s College to review cancer research in India.5 The Tata Memorial Centre has suggested it would train 30-35 people a year to distribute to other centres in the grid.6
Will the grid be a success?
Integrated cancer care systems have been successful elsewhere—for example, the National Comprehensive Cancer Network (www.nccn.com) in the US and London Cancer (www.londoncancer.org) in the United Kingdom.
“The national cancer grid may change the scenario of cancer care in India,” said Jana. “It has the potential to save lives of poor people who are based in villages and hardly get any treatment when diagnosed with cancer.
“The grid may encourage qualified Indian doctors—such as physicians, general surgeons and gynaecologists—to motivate their rural patients to visit a nearby regional cancer centre under the grid, and thereby getting their cancer treated in a right manner,” Jana added.
“That apart, a proper functioning of the national cancer grid may help stop the unscientific practice of the unqualified rural medical practitioners in villages.”
To motivate rural populations to engage with the network, particularly those living in villages, awareness campaigns will be needed, said experts in community health. “If common people are not properly aware of the functioning of the grid, the whole venture won’t be optimally successful,” said Naskar. “So, awareness campaigns should be done properly in the grass root level,” he added.
Cite this as: BMJ 2013;346:f3826
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.