Dr Sameer Kaul, MD

It was a standard curse showered against each other during the legendary fights between boatwomen. But now this curse has come true in Valley

Taking a trip down memory lane leads me to three decades ago, when I was one of a motley group of medical rookies gathered around a hapless patient’s bed in one corner of Ward 16 at Srinagar’s Sri Maharaja Hari Singh Hospital, popularly called ‘Hedwoon’.

 A teaching clinic was in progress. All of us, including our instructor, wore a resigned, sympathetic attitude towards the physically-drained patient, who was suffering from disseminated large gut cancer. Once in a while, we did listen to and watch our adventurous and brave senior faculty operating stomach and colon cancers. But those occasions were few and far between. Most of the old men and women we felt sorry for, ended up going home to die anonymous deaths, quite often without a diagnosis. Those days, there was meager knowledge of early clinical features, diagnostic modalities, treatment options. In the medical and public domain, cancer was an unimportant disease. In our neighborhoods and communities, no one talked about it. The media never wrote about this ‘insignificant malady’ either. Back then, the Government Medical College and associated hospitals were, nevertheless, acknowledged to be at par in academic and clinical standards with the best institutions in the country. While the private medical sector was represented by but a few clinics, it was almost entirely the government infrastructure that delivered healthcare, albeit with a socialistic top-note. Even amidst the educated and higher echelons of society, awareness of healthcare was almost non-existent. Naivety ruled the roost.

In the latter part of the nineties and against everyone’s advice, I began to obsessively reconnect with my roots. By then, the Valley had plunged neck- deep into turmoil, public life was in disarray, skilled manpower – precious to the state – had crumbled and along with it, infrastructure. All institutions were in the throes of developmental arrest.

As my monthly weekend clinics were conducted quite often on a houseboat on the Dal, I gradually woke to the sad reality that cancer had, during my years of absence from the Valley, emerged as the leading killer of my people. It was almost as though the disease was vying with bombs and bullets for that dreadful position.

The Sher-e-Kashmir Institute of Medical Sciences (SKIMS) now had departments for Medical and Radiation Oncology. Doctors there worked tirelessly to cater to the thousands of cancer patients who had begun flocking to their OPDs. Stomach, food-pipe, large intestine, lung, breast and ovarian cancers seemed to have mushroomed over the many years I was away. Children who should have been frolicking with their friends in courtyards and alleys were wasting away from blood cancer. It was heart-wrenching. “Hattay Goye Kansar” (May cancer afflict you), was now a standard curse showered against each other during the legendary fights between boatwomen.

Decidedly, oncology had now emerged as a specialty domain. The sheer onslaught of patients deserved a response from the public and private sector. That response, as you shall conclude, was too unsubstantial and – left too late. 

SMHS hospital, private diagnostic collection centers and laboratories, a couple of small nursing homes/hospitals and – in the interim – the Jawaharlal Nehru Hospital have joined the fight against this deluge. Newly- trained professionals have stepped into haphazardly-run services.

But l hope to God that their enthusiasm to fight cancer does not run out, before we are able to empower them with clear strategies for early diagnosis, the application of technologically-superior Linear Accelerator machines for precision Radiotherapy and PET scans for immaculate staging and quick immuno-histo-chemical and molecular analysis. And last but not least, to make the latest, targeted bio-tech chemotherapy procedures affordable to every last patient.

Consider this. The vital dye 18 FDG Glucose, which is required for PET scans, is produced by a 30-crore rupee mini-nuclear reactor called Cyclotron. But its effectiveness lasts merely 2 hours after production. I fear that the use of this crucial dye will remain a dream, unless and like anywhere else in the country, the Government of J&K invests in Cyclotron to save on those crucial 2 hours of the dye’s efficacy.

Governments always get away with their incompetence, at least in this part of the world. So also in Kashmir. They have failed us in our state. There are no cancer control or screening programs, no genuine records to analyse and formulate strategy, no enhanced access to optimum care. If the government were to really decide to help, its role would lie in enhancing access, monitoring and regulating cancer care. And yet, a specialized cancer hospital continues to be a mirage, while our policy-makers seem far from interested in scrupulously insuring at least Below Poverty Line (BPL) patients. When will we understand that quality cancer care cannot be achieved by cutting corners? Accept that diagnosis and treatment of the killer disease is bound to remain expensive for a long time to come. So, for Allah’s sake, why can’t we insist that it is covered by medical insurance? 

As for now, impoverished cancer patients can at best philosophize that there are no free lunches, and that this is, indeed, the way of the world. But it is up to us, our society, to acknowledge the crucial responsibility we, ourselves bear. There must be more bodies like the Help Poor Voluntary Trust, Cancer Society of Kashmir, and others to help distressed families. There must be ‘end-of-life care’, a concept that remains yet unknown in our country.

Running down slack politicians alone is a national past-time. We seem to forget that we chose them. How long can we, as citizens and the foundation of society, escape blame for our own ineptness? We frantically approach hospitals only after our bodies have begun to show serious signs of malfunction. Unlike in the West where even ambulances are serviced routinely, preventive check-ups still remain an elite phenomenon in our country. We prefer to remain preoccupied with other, more ‘important’ things: like a daughter’s marriage, the construction of a house, a marathon, mutton-eating spree. And when that diagnosis hits us, we expostulate in disbelief and horror. Medical prescriptions and previous treatment records are hastily stuffed into plastic bags and presented at OPD, making it a trying experience for the doctor to construct an accurate history of the disease in the patient. But is it the patients’ fault? No. Because nobody has taken the time to teach them meticulousness in assembling their medical history.

Where’s the media in all this? Why are Engineer Rashid’s antics more newsworthy than stories of hope and desperation of Kashmir’s cancer patients? Do you not think that you are leaving a subject of burning urgency unaddressed? Have you bothered to drill home the message about the devastating effect that our food and lifestyle may be having upon our health, so that readers may correct course before it is too late? Have you repeatedly warned them that cancer kills? That it takes only a few more lives than road accidents but a far greater number than even militancy in the Valley?

“Hum Dekhenge, hum dekhenge, Lazim haiki hum bhidekhenge. Woh din ke jis ka waada tha…” As a cancer specialist myself, I sincerely wanted to help and so joined politics. But the human failures of our leaders can often play spoilt-sport. I quit. But I do believe that my tryst with public life was a means towards all that I desire for my beloved people. And come what may, I shall continue to put in my best efforts to combat and remove death’s shadow from our beloved land so that the sun shines through the bleak windows of the poorest of the poor. 

Courtesy: Kashmir Ink