SRINAGAR, INDIAN-ADMINISTERED KASHMIR – Two cancer patients share a bed at Sher-i-Kashmir Institute of Medical Sciences-Kashmir, SKIMS, the premier hospital in Srinagar, Kashmir’s summer capital.
One patient, Aquib Ahmad, 13, shrieks and cries as the senior staff nurse in the medical oncology ward, Haji Mohammad Ayoub Khan, prepares his chemotherapy dose. His father stands next to him and consoles him.
Next, Khan gives the other patient in the bed, Shazia Bano, who is in her 30s and asked that her name be changed for privacy reasons, her dose of chemo. Weak and feeble, Bano says she wants to take a nap but she can’t sleep properly while sharing a bed with Aquib.
“We are criminals and sinners,” Khan says. “How can she sleep? Hardly, we’ve 10 beds in this ward, and patients are more than double. Sometimes a bed is shared by three to four people.”
Khan says that drugs and supplies are also limited at the hospital, meaning that patients must purchase medicine and syringes from the market themselves.
“Economically weak patients drop out as they can’t afford treatment,” Khan says. “Medical Mission of India ought to keep these drugs free for poor patients. Cancer is a widespread disease in the state of Jammu and Kashmir.”
Bano’s brother, Showkat Ahmad, has been watching after his sister in the hospital as her attendant since she was diagnosed with cancer in 2005. He says hospital conditions are poor.
“No international norms are followed here while offering treatment to the patients,” Ahmad says.
Ahmad says that international norms dictate that hospital staff be protected while administering chemotherapy and that patients be treated in a sanitary environment.
“Besides, there has to be separate ventilation norms and separate toilets for patients,” Ahmad says. “Hygienic environment has to be a priority. The ward has to be spacious, and movement of attendants has to be restrained.”
Ahmad says that the administration has remained silent on the issue.
“They are just appeasing politicians,” he says. “It is shocking. Our entire family gets disturbed.”
Hospital administrators acknowledge that resources are lacking and say they are doing the best they can to improve care.
But lack of resources for cancer patients is not just a problem at SKIMS. It is a regional problem. Shri Maharaja Hari Singh Hospital, the other local hospital, suffers from resource and space shortages as well.
Health experts in Kashmir attribute rising cancer rates in the valley to frequent tobacco use and poor diet and exercise habits. Hospital staff members say they lack space, supplies and staff to treat the increasing number of cancer patients. Acknowledging the poor situation, hospital administrators say improvements are planned, while the government recently doubled the tax on tobacco products, aiming to reduce their prevalence and raise money to treat low-income patients.
Oncologists in the Kashmir Valley say that cancer is increasing here. Last year, about 5,800 patients with cancer registered with the SKIMS – 2,623 were previous patients and more than 3,000 were new patients – at its Regional Cancer Center, RCC. About 40,832 patients were treated on follow-up.
More than 70 percent of cancer deaths occur in low- and middle-income countries, according to the World Health Organization, WHO, which predicts a rise in cancer deaths to more than 11 million worldwide by 2030. There are an estimated 2 million to 2.5 million cases of cancer in India at any given time and 700,000 new cancer cases diagnosed every year, according to the National Cancer Control Program under the Ministry of Health.
Dr. Sheikh Aijaz Aziz, head of the oncology department at SKIMS, says that esophagus, stomach, lung and breast cancers are the most common kinds of cancer here.
The major risk factors for cancer are tobacco use, harmful alcohol use, poor diet and physical inactivity, according to WHO.
“Every cancer in [the] body is related to smoking,” Aziz says. “[Un]til the year 2000, cardiovascular disease was stated to be [the] No. 1 killer disease followed by lung cancer. Now, lung cancer has shot up.”
Dr. Abdul Hameed Zargar, director of SKIMS, agrees.
“Increase in cigarette smoking leads to increase in lung cancer,” Zargar says. “Mouth cancer is quite common in India, and the same will get increased here as well.”
Aziz says that adverse conditions prevailing here, like stress, curfews and crackdowns during the conflicts of the past 20 years, have increased smoking. He says that Kashmiris spend 10 crore rupees, $2.25 million USD, on cigarettes monthly.
“Smoking-related diseases are increasing in Kashmir,” Aziz says. “Every day, 10 to 15 patients visit me on an average, and 10 out of 15 have health issues related to smoking, especially men.”
More men than women have consistently registered as cancer patients, according to RCC statistics. This may be because more men than women tend to smoke here, Aziz says. But he says that smoking is prevalent among elderly women and gaining popularity among young elite women.
Dr. Hilal Malla, who also works at the RCC, says that smokers don’t usually seek help at the hospital until they are 50 or 60.
“By that time, it is an irreversible disease,” he says. “We can’t do early screening of smokers to diagnose the disease, as acceptance is not there. Primary prevention is important.”
Ghulam Rasool Bhat, another patient at SKIMS, was diagnosed with lung cancer a few months ago. Bhat, 50, worked in the Public Health Engineering Department for 24 years, but is now bedridden.
“I feel general weakness particularly in my limbs,” he says. “A couple of days back, my condition was worse. Today, I am feeling [a] bit better.”
His son says Bhat will receive therapy next month.
“By that time hopefully, he will gather some strength and withstand the therapy,” his son says. “Right now he is too weak.”
Local experts also attribute increasing cancer cases here to poor dietary habits. Dry vegetables, dry fish, red chiles and wur – a Kashmiri spice – contain N-Nitroso compounds and salt tea contains N-Nitroso Pipecolic Acid, which can lead to cancer, according to Cancer Society of Kashmir, a local nongovernmental organization.
Aziz says that there is also a regional trend between smoking and dietary habits and cancer.
“There is a belief, though no scientific data, that frequency of cancers decreases as we move from south to north Kashmir,” Aziz says. “Perhaps, less consumption of alcohol, less smoking and more consumption of fruits – fruits act as antioxidants – in north Kashmir are the reasons responsible.”
Experts here say there are a number of problems that obstruct their treatment of cancer patients.
Aziz says one problem is a lack of general population statistics, which make it hard to assess the scope of the issue.
“For [the] last four years, we’ve registered cancers that have been diagnosed in the hospital, but we lack population-based statistics,” he says.
Zargar says that the number of oncologists also needs to increase to attend to the increasing number of cancer patients.
“For treating this huge pool, we need more oncologists.”
Aziz says another problem is space and equipment.
“We aren’t optimally equipped,” he says. “We don’t have space. We’ve put patients on the wait list, and bed strength is low. We are risking their lives, and people do turn hostile to us at times.”
Zargar says that bed strength, meaning the number of beds they can provide, is the main problem. He says he hopes the RCC will be upgraded soon. He says that awareness is also an issue, but that there have been more conferences on cancer every year.
“People need to have reasonable and respectable information on health,” Zargar says.
Health experts say the real solution is reducing tobacco use and improving diet and exercise to prevent cancer in the first place.
The government here has a new initiative that aims to combine both approaches by preventing new cases and improving the treatment of current ones.
Finance Minister Abdul Rahim Rather announced last month the state government’s plan to double the value-added tax on tobacco products for the 2011-2012 budget year in an attempt to dissuade citizens from buying them. The government will channel the money generated by the tax to the Cancer and Treatment Management Fund, which the government set up last year to help make care accessible to low-income patients.
Still, many say more needs to be done to reduce cancer cases and improve care.
