Fill the care gap

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Fill the care gap

Saturday, 31 October 2020 | Sachin Chopda

Fill the care gap

Though healthcare infrastructure has considerably improved over the last two decades, rural areas are still grappling with the lack of necessary facilities for diseases such as cancer

When 53-year-old Preeti (name changed), based in a small village on the outskirts of Pune, felt a lump in her breast, little did she know about the symptoms associated with breast cancer and the treatment for it. Like Preeti, most women in rural India are not aware of the symptoms of cancer, the importance of screening and the treatment options available to them.

This is despite the fact that non-communicable diseases account for 63 per cent of all deaths in India, and at nine per cent, cancer is one of the leading causes of mortality. Out of this, breast cancer forms a major part of the disease burden in the country, having overtaken cervical cancer. While in cities like Delhi, Mumbai, Bengaluru, Bhopal, Kolkata, Chennai and Ahmedabad, breast cancer accounts for 25-32 per cent of the disease burden in women, in rural areas the incidence of breast cancer is one in every 60 women.

A 2018 study by a doctoral student  on 1,000  women in rural Maharashtra indicated that 90 per cent of them are unaware about breast self-examination and almost 50 per cent of women delay seeking treatment by three months as access and awareness about cancer care is very minimal. In India, it’s also more common in the younger age group as almost 50 per cent of all cases are in the age group of 25-50. Sadly, more than 70 per cent of the cases present in the advanced stage had a high mortality rate. The numbers are staggering and constantly rising. As per the National Cancer Registry Programme Report, released by the Indian Council of Medical Research recently, the country will have 13.9 lakh cases of cancer this year and this number is likely to increase to 15.7 lakh by 2025.

Sadly, India is lacking in overall healthcare facilities, including cancer care, even after years of efforts and push by philanthropists, healthcare professionals and the Government. Though cancer facilities have greatly improved in urban areas, the same is not the case with rural India. Our villages are perpetually short of basic healthcare facilities. Hence, advanced treatment procedures for diseases like cancer are still a distant dream for the rural population.

There are a number of issues that rural areas face when it comes to cancer care. Right from lack of adequate screening to minimal awareness and stigma about the disease, there are a few fundamental issues that need attention.

Stigma and lack of awareness: Late detection of cancer is one of the key reasons behind the high fatality rate in the segment. Early detection of the disease is highly correlated with the level of awareness in the locality. Earlier detection results in effective treatment. The word “cancer” has negative connotations in society. This is true not just in rural areas but even in cities. It’s important that we change the way we talk about cancer and opt for a constructive approach towards its treatment and care.

What can be done to bring more awareness and change the conversation? Creating awareness about the disease and its implications is no easy feat. It requires grassroot level planning and execution at a mass level. A number of start-ups and NGOs are working towards building more awareness by holding screenings and through regular interactions with people. Hosting awareness workshops on a regular basis can  help educate people about the importance of early detection and its implication on the outcomes.

Lack of access to doctors, medicines and other required facilities: Official data indicate that in India the ratio of oncologists to patients is 1:2,000. Hence, there is an acute shortage of oncologists to treat current and future cases as the numbers are expected to rise each year. Geographically concentrated centres compel patients from small towns to travel long distances for diagnosis, treatment and follow-ups. Only top hospitals are equipped with expensive equipment like Pet-scan, radiotherapy machine and histopathology laboratories which are critical for diagnosis and post-treatment care. Heavy dependence on these centres increases their load and reduces the quality of treatment.

On the other hand, there are many not-so-famous hospitals with good doctors and equipment that are operating below capacity. Inadequate Government-run healthcare infrastructure for cancer treatment compels patients to depend on private hospitals where the overall treatment cost burden is very high, resulting in extra hardship to patients and their family members. Rural and urban tie-ups can ensure better availability of doctors and create the required infrastructure such as doorstep medicine delivery and post-treatment services to patients. In addition to this, setting up teleconsultation facilities in smaller private clinics  in association with hospitals in urban areas can provide on-time second opinions and consultation for patients. A new-age, tech-enabled hub and spoke expansion across geographies, equipped with live video-conferencing facility for online consultation with oncologists, diagnosis, treatment guidance and pharma delivery support to patients, is needed. Oncology experts from the hub can serve a large number of cases with live monitoring and reporting of instances to the Government authority for better regulation.

Financial burden: Financing is another problem in the treatment of  cancer patients from lower and mid- income groups.  Due to lack of health insurance coverage, treatment becomes a financial burden for the patients and their families. In a number of cases, when the patient has to undergo chemotherapy, man-days are lost which results in loss of income. The feeling of having financial support can ease the burden of the patients to a great extent and it can go a long way in quicker and better treatment in the lower and mid- income patient segment. Though the Government has included cancer in the Ayushman Bharat healthcare scheme, there is not enough awareness of the same.

Emotional and physical drain: Currently, due to the lack of available facilities, rural patients end up travelling to cities to access treatment. In cases that require intensive chemotherapy sessions, most rural patients end up spending considerable money on finding a place to stay and on transportation within the city. In some cases, when there’s a gap between treatment schedules, they have to travel back and forth a number of times. This not only causes a financial burden but also results in emotional drain for the patients as well as their families. Factors such as staying away from their hometown and loved ones, unfamiliar surroundings, rigorousness of the treatment can cause emotional and physical upheaval for the patient and their families.

By establishing cancer care centres in rural areas, patients can focus entirely on the treatment without having to worry about transportation or accommodation during treatment. A number of start-ups are also working towards providing mental health counselling to patients and are offering an integrated approach towards healing the disease. Though healthcare infrastructure has considerably improved over the last two decades, rural areas are still grappling with the lack of necessary facilities for diseases such as cancer.

There is a growing need for better medical facilities in villages and smaller towns. In order to address this humongous problem, a number of public and private players have to come together to create solutions that are in line with the requirements of rural patients. The focus has to be on expanding the covered geographies under affordable rural cancer healthcare facilities in order to make treatments available at an affordable price. The real challenge, however, lies in creating a hassle-free network to support this kind of lower fixed investment model for cancer care and creating mass awareness about the disease so as to avoid delay in detection and healing.

(The writer is Director, Universal Cancer Conquest)

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