Dr Sameer Kaul doesn’t waste time. As a surgical oncologist at Indraprastha Apollo Hospital in New Delhi, he’s seen what can happen when one of his patients spends weeks or months searching for funds so they can pay for drugs to fight their cancer. Some get sicker and harder to cure. Some die.
“Do we really want only people who can afford it to have the best go for treating their cancer?” asks Kaul, who speaks with the clipped efficiency expected of someone whose precision in the operating room means life or death. To increase access to treatment, he founded the Breast Cancer Patients Benefit Foundation two years ago. The group is different from others focused on just raising awareness about cancer and detection because its main focus is to pay for those who need help.
“Raising awareness, education—that’s great. We do some of that too,” says the doctor, who sports an immaculately shaved head. “But the crux of the matter is really getting drugs and surgery for those who can’t afford them.”
In a typical week at the hospital, he sees several dozen patients, most with advanced cases of cancer, and finds himself in surgery up to a dozen times per week. When he’s not with patients, he’s reviewing a large stack of charts in his office, deep in the basement of the hospital talking to patients on a mobile that seems to never stop buzzing.
And as changes in diet and lifestyles in today’s India lead to higher rates of certain cancers and improved detection increases caseload, Kaul’s phone is unlikely to stop ringing so much anytime soon. Asia, which already accounts for about half of cancer-related deaths, is bracing for a surge in cancer rates; one report last week said smoking, drinking and eating unhealthy foods will help drive Asian cancer rates up 60% by 2020.
Cancer specialists such as Kaul are in high demand across India; Hindustan Times reported on Saturday that Kaul was among a group of Apollo doctors being wooed by a cancer speciality centre being started by Fortis Healthcare Ltd.
Kaul confirmed the offer, but said he was undecided.
Fellow doctors and patients alike say Kaul’s concern spreads beyond the clinical. Initially, the foundation focused only on breast cancer because 65% of the patients have the disease. Now it has broadened its focus.
As the latest chemotherapy drugs for breast cancer can cost more than Rs1 lakh per injection, Kaul says many can’t afford to have the “best go” at treatment. Some drugs call for as many as 16 shots spread over several rounds of treatment.
That doesn’t include hospital admission fees, anti-nausea drugs and the latest antibiotics to fight infections that often result from chemotherapy. The total cost for these drugs sends treatment costs soaring, even for middle-class patients.
Anything that helps defray the costs is welcome, says Neelu Khanna, the elder sister of a 44-year-old patient of Kaul’s. And the simpler the programme, the better, she says. “As it is, I run from pillar to post to try and do everything I can think of to raise money and piece together whatever I can for my sister’s treatment,” which costs more than Rs1 lakh a month, says Khanna, who is a political science lecturer at Delhi university.
Khanna’s sister (and her husband) had mortgaged their home to pay for treatment, but those funds ran out long ago in the four-year battle with the disease. “Now I have to struggle to buy even the needles for her,” says Khanna.
Kaul has heard the story countless times—and it fuels his pet project. He wants to start a central repository where any doctor treating a patient who needs a chemotherapy drug, or other medicines needed to fight side effects, can withdraw it from the drug bank. “That way, the doctor, who is in the best position to know what drugs the patient needs and maybe to judge what their resources are, makes the call,” he says.
Some government programmes that offer payment for medical treatment can take months to release funds —months where the patient can progress to an advanced stage of the disease, lessening the chance of survival.
“The idea is to keep red tape and bureaucracy to a minimum because time is what they don’t have,” says Kaul. He noted that government-aid programmes and patient-access programmes provided by individual drug companies are also difficult to navigate, especially for the very sick or poor people that need them the most.
His strategy for getting the drug bank off the ground rests on pharmaceutical companies. Kaul wants to push drug companies to donate as much as they can and offer subsidized drugs for people that can’t afford their treatment.
The problem is that many are hesitant to do that, offering the foundation money instead. Kaul says the companies fear the government will make them drop prices of drugs if they start giving them away.
“Sometimes the drug companies help a little bit, but even if they give us one shot, how do we buy the other?” asks Khanna.
The idea of a drug bank may face some challenges as most pharmaceutical companies’ patient assistance programmes amount to little more than marketing efforts; they give away one shot and expect the patient to buy the others, say doctors.
“I can assure you that pharmaceutical companies are not so open as to give away an endless supply of drugs,” says Dr K.A. Dinshaw, director of Tata Memorial Centre, a leading cancer hospital in Mumbai.
She describes Kaul as a “committed surgeon” and says the foundation’s mission to focus on paying for treatment is novel.
“A lot provide supportive care, find donors or take care of food and travel expenses when people have to travel,” Dinshaw said, “but there is very little for treatment as such.”
Pharmaceutical firms often do donate drugs, said Zarir H. Charna, director of the Organization of Pharmaceutical Producers of India, an industry body, when asked to respond to the characterizations of the sector.
“In times of crisis, our members have made much-needed donations,” he said, citing the aftermath of the 2004 tsunami that devastated parts of India and Southeast Asia, as well as recent floods in Bihar and Mumbai. When it comes to cancer, while many companies do in fact donate cancer drugs, individual policies vary widely, Charna said.
To date, the Breast Cancer Patient Benefit Foundation has raised more than Rs1 crore through gala dinners and events with entertainment or fashion shows, supported by wealthy donors.
The foundation’s staff of seven, which includes other oncologists, a reconstructive surgeon, a psychiatrist, an accountant, entrepreneurs and a fashion executive, all donate their time and skills, according to Kaul.
Effectively operating out of Kaul’s office at the hospital has kept overheads low and allowed 98% of the money raised to go to help more than 20 patients—a “drop in the ocean”, he says.
The foundation hopes to expand its efforts in the near future and is working towards purchasing a special vehicle fitted with a mobile mammography unit, to be able to hold screenings in neighbourhoods or at office buildings. It may also change its name to the Cancer Patients Benefit Foundation to broaden focus to other types of cancers.
If he can grab some time away from the foundation and the hospital, Kaul says he likes to travel, which he gets to do frequently for work, and would play golf if he got the chance. When asked about the last time he played, he pauses.
“I haven’t actually had time to take it up yet. Maybe one day,” he says. He glances down to sign another chart from the pile in his office and hands it to an assistant. He simultaneously launches into suggestions for changes in the presentation he will give a group of East Delhi doctors for an upcoming foundation event.
Sixty in Sixty is a special series that we plan to run through 2007, the 60th anniversary of India’s independence. We will introduce you to sixty Indians—both here and abroad—who are not rich or famous. These are people who are making quiet, but important, contributions without seeking headlines, to help make India and, in some cases, the world a better place. We also welcome your suggestions on people whom you think should be profiled in this series. Please send your suggestions by email to firstname.lastname@example.org