SEVERAL YEARS ago, when Radha’s teenaged daughter suddenly lost her hearing, she knocked on the doors of all hospitals she had heard of, including AIIMS in Delhi. When no doctor could help, Radha says, she got so frustrated that she burnt all the medical reports.
Last Friday, Radha joined several women from Morna village in Uttar Pradesh at the cancer screening clinic run by an ICMR institute in Noida. She had been told her breasts and “lower parts” will be checked but that’s not really why she agreed. She was hoping to come across a doctor who will get her daughter’s hearing back.
Since 2014, the Health Promotion Clinic (HPC) at the National Institute of Cancer Prevention and Research (NICPR) in Sector 39 has conducted cancer screening for nearly 7,500 people from neighbouring villages (see box, page 2). And this, at a time when the government has been pushing the idea of cancer screening since 2010 without much progress.
The clinic’s name has been kept deliberately ambiguous so as not to scare people away with the dreaded ‘C’ word. The hook in most cases is not cancer, it’s weight or any other health issue of concern. And, the idea is to then gradually counsel them into cancer screening, say doctors at the clinic. The clinic is a part of the government’s universal cancer screening scheme in 100 districts.
The first statistics have now started coming in from NICPR and they are in line with the estimated incidences in India — only these are real data, not estimates. Of the total 7,413 individuals screened till date, 2 per cent were found positive for cervical cancer, 0.05 per cent were found to have mouth lesions, of which 0.03 per cent were malignant. The others could go on to become cancers. Of the total number of 899 breast examinations done 0.06 per cent were found to be malignant.
All of these figures, says NICPR director Dr Ravi Mehrotra, are in line with the estimated national incidences. He says an overwhelming 82 per cent of persons screened are women — a natural fallout of the fact that two of the three cancers for which screening is conducted in India happen almost exclusively in females. “We hope to incorporate the lessons learnt from the HPC in the Non-Communicable Diseases (NCD) screening programme with some modifications. We are also doing similar projects in the tea gardens of Assam and in the bordering areas of Bangladesh in that state. We hope to be able to replicate the diverse strategies adopted in the three centres in the national programme,” says Mehrotra, who is a trained oncologist.
The Noida clinic is a far cry from the usual government health facility. It is neat and clean, and the social worker on duty Lata is an articulate, bilingual person who takes pride in her ability to convince people to go for the tests — especially cervical cancer screening for which an instrument is used that most women who have had babies are familiar with and usually have painful memories of.
The punch line for Lata and the ASHA worker on duty, Hemlata, is: “The woman is the engine of the family, if she is well everybody stays well.” They also try to convince women to send the men in their families, especially to the tobacco clinic run from the premises. Lata uses a paper demonstration aid to explain to the women about cancer. A cut pomegranate is used to explain to women what the cervix is and why it is not immediately visible from the outside.
As a “proof of concept” for the national NCD programme, the clinic has taken improvised routes on several counts.
For one, Hemlata a very articulate Class-XII pass, is paid Rs 20 per patient. ”Last week, I brought 27 patients, today I have got another 30. I explain to them why health is important. Some people back out at the mention of cancer but I convince them and say there are many other tests, even a dental test. That works,” she says.
Other things work, too, like in the case of Radha from Morna.
One of the women, for example, came so that she could show her anaemic daughter, who suffers from very severe menstrual bleeding, to a doctor. The clinic, apart from screening, makes sure they have medications for whatever conditions they come across — if required, patients are referred to AIIMS.
Hemlata goes to the village in an SUV and fills it with patients. Along the way there were many important lessons. One was that patients come only when there is a government vehicle to bring them to the clinic. Between endless blood pressure and haemoglobin readings, Dr Roopa Hariprasad recalls how villagers refused to come when the clinic had decided to book a cab as none of the office vehicles was available. The doctors and staff at the clinic have strict instructions not to raise their voice. With all the counselling and convincing, the time spent on each patient is 20-25 minutes, something the national programme can perhaps never do, says Dr Mehrotra.
”We have a liability to ensure that once a person is detected with cancer or any other disease, she gets the best care. So I talk to my friends in AIIMS and refer them there,” he says.