New Delhi: It is bad to have cancer. It is worse to have it if you are poor.

“And it is nothing short of a death sentence if you have cancer and seek care in a government hospital in Delhi," says Dr K.T. Bhowmik, head of the department of radiotherapy at Safdarjung Hospital, run by the Union health ministry.

He is not exaggerating. In Delhi, cancer care is available in 18 private centres and only four government hospitals—Institute Rotary Cancer Hospital (IRCH) at the All India Institute of Medical Sciences, Delhi State Cancer Institute (DSCI), Safdarjung Hospital and Lok Nayak Hospital. It gets worse.

There’s more (and it’s not good).

Among these four hospitals only two, IRCH and DSCI, are currently fully functional. “Delhi’s hospitals, private and public, are overrun by patients from neighbouring states. Having only four government hospitals for cancer is a bad joke. Our cancer burden is grossly underestimated. This disease isn’t like cold or cough that we can have patients on a wait list," said R.K. Grover, director at DSCI.

On 4 February, as the world observes World Cancer Day, experts say equitable, quality and affordable cancer care in the Indian capital remains a dream.

Then, the situation isn’t very different in most northern states. Most patients from Uttar Pradesh, Bihar and Rajasthan end up in Delhi.

The experts add that the southern states are different. Tamil Nadu has government cancer hospitals in Chennai, Kancheepuram and Vellore while Kerala has the Malabar Cancer Institute in Thalassery, Thiruvananthapuram, and reputed cancer departments in medical college hospitals in Alappuzha and Kozhikode.

More importantly, state-level health insurance schemes such as the Yeshasvini scheme in Karnataka, Kudumbashree in Kerala and Rajiv Gandhi Aarogyasri Yojana in Andhra Pradesh open private hospitals to workers in the informal sector.

“Good state-sponsored insurance has made a huge difference in quality of care for critical illnesses. Especially in Andhra Pradesh, the state government’s insurance scheme covers expenses up to 2,00,000 per family unlike Rashtriya Swasthya Bima Yojana, which covers expenses up to 30,000," said Manoj Sharma, professor of Radiation Oncology at Maulana Azad Medical College.

Last week, Safdarjung Hospital’s only functioning cobalt machine, which uses gamma rays from cobalt-60 radioisotopes, stopped working. With the radiotherapy unit shut, cancer care for nearly 100 patients at Safdarjung came to an abrupt halt.

Over the week, patients from Safdarjung tried moving to other hospitals, unsuccessfully.

“I went to IRCH and was told they have a long wait list," said Kishore, who goes by only one name, whose 53-year-old mother Manjula was diagnosed with stage I cervical cancer last year. “Her chances of recovery are good. She has already undergone surgery and is responding well to chemotherapy. It will all go to waste if we can’t get her radiation therapy."

Such life-threatening interruptions in treatment are consistent across government hospitals. As of now, none of the three cobalt machines is functional at Safdarjung Hospital. One cobalt machine is working at the Lok Nayak Hospital, which hasn’t had a key radiation treatment for at least 10 years. Indeed, in 2010, the Medical Council of India discontinued the postgraduate specialization in radiation oncology at the Maulana Azad Medical College (attached to Lok Nayak Hospital) because students signing up for the course were graduating without any experience of actually treating patients.

That leaves All India Institute of Medical Sciences’ IRCH and DSCI, both of which are overwhelmed with patient load. The radiotherapy unit at IRCH and DSCI treat nearly 350 patients a day. “We have around 15,000 patients in outpatient department every day. Cobalt machines can no longer be the main equipment to treat patients. We need linear accelerators to provide state-of-the-art cancer care," added Grover of DSCI.

Globally, over 12.7 million people are detected with cancer and at least 7 million die of the disease every year. By 2030, India will have 1.6 million cancer patients, according to Globocan 2012, the World Health Organization’s cancer database. Experts say the country is ill-prepared to deal with the cancer burden due to the combined effect of rapidly ageing population, increased life expectancy and limited health infrastructure.

According to the State of Oncology 2013 report by European Cancer Congress, the global cancer burden doubled in the last 25 years and is likely to double again by 2030. In 2012, India had over one million cases and 0.6 million deaths due to cancer.

Quantifying the burden of disease is central to planning cancer-control activities. Despite India sitting on the verge of a non-communicable disease epidemic, policy interventions are not evidence-based due to lack of data on cancer mortality at the national and state level.

“From Delhi’s experience, what I know for certain is that Indian government hospitals cannot handle the cancer burden," said Bhowmik. “For cancer, there is an urgent need to enter in public-private partnerships with private centres if we want make any meaningful intervention."

According to the Atomic Energy Regulatory Board regulations, radiation cannot be administered to patients in the absence of a radiation safety officer (RSO) and one medical physicist is required per cobalt machine. “Since private hospitals offer triple the salaries we do, we have not been able to hire physicists. So, two cobalt machines are lying idle while patients get desperate," added Bhowmik.

The same is true for Lok Nayak Hospital, where only one cobalt machine is functional and two are lying idle. The hospital has not had a permanent RSO since 1994.

Meanwhile, at Safdarjung, it has been 13 days since the cobalt machine broke down and patients are getting desperate. “There is nowhere to go. It is as simple as that," said Bhowmik.

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