Bathinda to Bikaner,aboard ‘cancer train’https://indianexpress.com/article/news-archive/latest-news/bathinda-to-bikaner-aboard-cancer-train/

Bathinda to Bikaner,aboard ‘cancer train’

The embattled Gehlot sees his free medicine scheme as his best weapon in Rajasthan polls.

In the final days of Rajasthan’s heated campaign,both the Congress and BJP focused on the Ashok Gehlot government’s free medicine scheme. The embattled Gehlot sees it as his best weapon,and the upbeat BJP obviously thinks it too. Away from the politics of it,those who welcome it whole-heartedly are people of neighbouring states,who are lining up at Rajasthan’s hospitals. Sweta Dutta reports.

7.30 pm,Bathinda railway station

It is a damp cold evening. Sudden showers have washed the platforms clean while pulling the mercury a few notches lower. Pushpinder Kaur,45,staggers down the narrow metal stairs,her son Pawanjot and sister-in-law Kuldeep Kaur following close behind. They look for a dry spot on the platform,spread out a bedsheet and sit down. The three-hour bus ride from Tarn Taran district always takes a toll on Pushpinder,debilitated from her battle with breast cancer.

A little distance away,Jaspreet Kaur,32,bundled in a blanket,lies against a kiosk while elder brother Gurmail Singh and his wife Manjeet Kaur sip tea.

The last train from Mansa,a neighbouring city,has been bringing an unending stream of passengers to the platform,and it is now bustling. Some share pleasantries,others just a weary smile. They are not friends or family,but they are not strangers either — something more immediate than blood ties joining them together.

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“Cancer. They are waiting for the cancer train,” says Rajendra Singh,who has been running a tea and snack kiosk on the platform for a decade now. “Over the last two years we have been seeing them. I can tell from a single glance. The disease leaves its ghastly mark.”

It is in Punjab’s water,Singh stresses,adding,with a pause,“Hope you haven’t had the unpackaged water here.”

Minutes before the train to Bikaner,350 km away,chugs in,station master Pradeep Kumar Sharma directs a few other passengers to the platform,adding that they must claim their concession offered by the Railways in this division to cancer patients. “Free for the patient and 75 per cent off for the attendant,” Sharma shouts,over the sound of the train’s persistent horn.

9.30 pm,Aboard the Abohar-Jodhpur passenger train

Pushpinder,Jaspreet,their attendants settle down in the only reserved coach of the train,pulling down the window shutters against the night chill. The larger part of the crowd rushes to the general,unreserved coaches. “It will be a long,cold night,” Balwinder Singh sighs,helping a neighbour settle down on the lower berth.

Minutes after the train sets off,tiffin boxes come out,the smell of buttered rotis and sabzi wafting through the compartment. In the circle of shared pain,conversation flows easily,unstilted.

“Exactly a year ago,we first boarded this train to go to Bikaner. When I tested positive for breast cancer,it was like the world had come crashing. My mother had it too,but when it happens to you,you are in denial for days. It is not any other disease,it is cancer,” says Pushpinder,her eyes a weary blank. “We got the tests done in Moga but decided to go to Bikaner for treatment. That was where my mother had gone about two decades back. The cancer facility there is popular and now they even give free medicines. Every penny matters.”

Co-passenger Kulbir Singh,from Gobindgarh village in Punjab,agrees. “My father Sardar Sohan Singh is suffering from Hepatitis C and the medicines are very expensive. So every other month,I travel to Bikaner for free medicines.”

Discovering she had leukaemia barely a few months after she lost her husband to a road accident,Jaspreet says she has to survive this. Her 12-year-old son waits for her at home,while she is on her way to Bikaner for the seventh time. “First we thought it was the bereavement that took away her strength,but when we took her to Ludhiana for tests,it turned out to be cancer,” says brother Gurmail.

The two of them are from Mansa,virtually the capital of Punjab’s cancer belt. And this isn’t Gurmail’s first brush with the disease. “My father,grandfather and aunt all succumbed to cancer. But they were all quite old. She is too young.” 

Gurmail doesn’t know about the ticket concession for cancer patients or their attendants,but he doesn’t mind shelling out

Rs 120 for the sleeper tickets. Once in Bikaner,it will cost him maybe another Rs 2,000 or so for tests and for the medicines the cancer hospital doesn’t have in stock. That’s virtually nothing,Gurmail says. “If we were to go to any of the cancer hospitals in Punjab or Delhi,we would not be able to afford it. In Bikaner,chemotherapy and all other medicines are free. Some of the tests too are free. It saves us lakhs of rupees.”

Detailed profiles of outstation patients to Rajasthan are kept only at the cancer institute in Bikaner. The total number of patients this year to the centre has already touched 60,000. Of this,approximately 18,000 are registered from Punjab and Haryana. That’s a 50 per cent jump in the patients from the two states to this centre from last year.

At least 40 cancer patients from Punjab arrive at Bikaner everyday for treatment.

5.30 am,Bikaner

railway station

Pushpinder,Pawanjot and Kuldeep head for the waiting hall and freshen up. As they leave after a quick cup of tea,they are met at the exit by auto drivers calling out names of doctors. Pushpinder goes with Rinku,who has been plying his auto at the station for four years now,to the house of one of the doctors. Many others from the train,including Jaspreet,are already there.

Their medical cards are kept in a pile outside the doctor’s chamber,which will open at 8 am for just an hour,before he leaves for the cancer hospital. Pushpinder says she could have saved the doctor’s fee of Rs 200 had he seen her directly at the hospital,but then there is a crowd and he insisted she come home. This may technically be wrong,but Gurmail doesn’t complain. “We will have bypassed the long queues. Why take a chance? We also have to take the evening train back home,” he says.

10 am,Acharya Tulsi Regional Cancer Treatment and Research Institute Pushpinder’s son lines up at the drug distribution centre while Jaspreet lies outside the chemotherapy ward awaiting her turn. “We are number 42. It has been over an hour. There have been instances when the ward has closed for the day and we were just two turns away,” despairs Gurmail.

Their next stop on such days are the dharamshalas that have sprung up in the vicinity,sheltering patients and relatives for Rs 150 a night.

“The 250-bed facility draws over 300 patients in the OPD per day. Over 200 undergo radiotherapy and there are just 10 doctors. This cancer facility is considered the best in North India and,with the free medicine scheme,it draws not only an increasing number of patients from within the state but also from neighbouring ones,” says Dr Ajay Sharma,professor and head of the research institute.

He admits that given the high incidence of cancer in Punjab and Haryana,a bulk of their patients are from there but,lately,patients are increasingly coming from Uttar Pradesh and Delhi.

Statistics show that the total number of new patients in 2011 was 5,787 at the centre. This went up to 6,983 in 2012. This year,till September,  5,685 new patients had registered themselves at the facility. Dr Sharma believes the figure will touch 7,500 by the end of the year.

That’s apart from the follow-up cases — the patients who make repeated visits for chemotherapy or for radiation sittings.

Among the facilities available at the centre are Gamma camera,CT scan,sonography,X-ray,MRI,three machines for cobalt therapy,a linear accelerator,brachy therapy. Besides,it provides palliative care,deluxe cottages,free food and milk for admitted patients. A canteen and three dharamshalas are also part of the facilities available while one AC dharamshala is under construction.

However,there are only nine consultants and 12 residents to oversee all this.

Tahira Ansari,who is waiting for brother Mohammad Irshad’s chemo session for food-pipe cancer to get over,has come all the way from Saharanpur in Uttar Pradesh,530 km away. “My brother is a daily wage labourer. Our relatives and friends suggested this hospital. The train fare is all we had to pay,” Tahira says.

In the leukaemia ward,Rahul (9) and Satinder Singh (12) lie on adjacent beds. Rahul’s father is a daily-wage labourer in Suratgarh town in Sri Ganganagar district,Rajasthan,while Satinder’s father is a farmer in Ferozepur district of Punjab. “Had this free medicine scheme not been there,I doubt if I would have been able to get my son such advanced treatment,” says Saarj Singh,Satinder’s father.

Saarj and his wife,like Rahul’s parents,take turns to sit by their son as the other goes out to fetch lunch from a government-aided subsidised meal centre next to the hospital. It costs Rs 5 a person.

Meanwhile,inside the male chemotherapy ward,Darshana Kaur from Akbarpur,Haryana,whose husband Jagbir Singh has been detected with rectal cancer,complains that she has been asked to “buy” a number of medicines,the bill running up to thousands of rupees. Dr Naval Kishore Gupta,Senior Medical Officer (Supply),Rajasthan Medical Services Corporation,gets mobbed by several other attendants with similar complaints. A few phone calls later,Dr Gupta finds out that the facility has run out of some medicines but no new requisition has been sought. He assures this will be rectified soon.

Suddenly Gurmail squeezes his way out of the crowd,beaming. “We are done. We will take the evening train back home,” he says. Looking over his shoulder,he shrugs: “There are problems with most government schemes,but something is better than nothing. Back home we don’t even have this.”

***

The scheme Gurmail is referring to is Rajasthan’s Mukhyamantri Nishulk Dava Yojana (CM’s free medicine scheme),the state Congress government’s trophy project. In the first of its kind scheme in the country,anyone who walks into a government-run health institute in Rajasthan is entitled to free medicines. The beneficiaries do not have to produce any identity proof or BPL card.

The Rajasthan Medical Services Corporation (RMSC),formed to implement the scheme and steer the state towards a Right to Health,cites studies to point out that expenditure on medicines accounts for about 50 to 80 per cent of the total cost of treatment in India.

Dr Samit Sharma,Managing Director,RMSC,notes that as per the WHO,65 per cent of the Indian population lacks regular access to essential medicines. “The expenditure on health is the second most common cause for rural indebtedness and is responsible for the 2 per cent who shift from above poverty level to below poverty level annually. Over 40 per cent of hospitalised patients have to borrow money or sell their assets to sponsor their treatment. A further study by World Bank shows that 24 per cent of people fall below the poverty line because of hospitalisation,” says Dr Sharma.

Deen Dayal Soni,70,a retired central government employee,started visiting the local government hospital regularly only over the past two years. At the new geriatric care centre in Bikaner that he visits,senior citizens can get their vital signs checked for free apart from getting free medicines.

Soni is just one example of the scheme bringing in the old,poor,women and marginalised sections under the umbrella of organised healthcare. Officials say that since the scheme started,there has been a substantial increase in the number of girl children in the state (from 921 in 2001 to 928 in 2011,with the rise in urban areas being 890 to 914). They are even hopeful of the state’s sex ratio improving drastically as a result.

There are those who have their doubts though. Manmal Acharya,85,the president of the Bikaner senior citizens’ committee,says,“Free medicines do not always mean effective medicines. There is always a possibility of side effects and reaction.”

Prem Kumari (68) and Razia Sultana (63),who are at the geriatric centre for a check-up,agree. Kumari complains,“I was taking free blood pressure medicines from the local hospital,but those did not work. As soon as I started taking branded medicines,my condition improved. So while I get my tests done here for free,I take only medicines of a reputed brand name and buy the rest from outside.”

There remain other glaring shortcomings in the implementation of the scheme,including short-staffed hospitals,unavailability of listed medicines and low-level corruption by doctors. However,in fighting severe anti-incumbency,the free medicine scheme is about the only weapon Chief Minister Ashok Gehlot has.

Congress vice-president Rahul Gandhi has said that the scheme will be implemented at the national level if the UPA is voted back to power. At least 17 state governments and several countries including Nepal and Canada have also expressed interest in replicating it.

Gehlot’s arch foe,Vasundhara Raje of the BJP,has often called the free medicines “poison”. However,for now,there are few takers for this. Her remarks only attracted the ire of social activists in the state,who sent out an open letter to her seeking a public apology.

Soni argues though that the scheme won’t be enough to see Gehlot through. “There are so many other issues with the UPA government. We might be saving money on medicines but paying through our nose on fuel to reach the hospital. Fruits,vegetables have become unaffordable.”

Over 12 crore beneficiaries

Rajasthan’s Mukhyamantri Nishulk Dava Yojana aims to provide essential medicines free,and the others practically free,to anyone walking into a government-run health institute. With Rs 681.20 crore spent so far,it is estimated to have benefited over 14 crore people in two years.

The scheme is facilitated through the state healthcare network,covering 17,000 health institutions,including 28 major hospitals,56 district/satellite hospitals,543 community health centres,1,880 primary health centres,232 urban PHCs,and 14,365 sub-centres. Acharya Tulsi Regional Cancer Treatment and Research Institute at Bikaner is one of these institutes.

According to Dr Naval Kishore Gupta,Senior Medical Officer (Supply),Rajasthan Medical Services Corporation (RMSC),“The scheme is grounded in generic medicines,which are therapeutically equivalent but cheaper alternatives of branded medicines.”

So a strip of 10 Diclofenac sodium tablets,a painkiller that is sold by Novartis for

Rs 31.73 in the market,is provided by the RMSC at

Rs 1.24. Similarly,a strip of 14 Clopidogrel tablets (for heart disease) by Sanofi,costing

Rs 1,615.88 in the market,is available for an RMSC tender price of Rs 8.54. A vial of Paclitaxel injection used in breast and lung cancer is priced at Rs 10,850 in the market while the corporation supplies it to government medical institutions for

Rs 533.87.

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In the year of its launch,200 generic medicines,surgical and sutures were available at RMSC drug distribution centres. The list went up to 400 last year and 600 this year. In this year’s budget,the CM announced an allied scheme of free medical tests,leading up to a planned Right to Health Act.

‘Drugs poison,will do review’

In its election manifesto,the BJP has promised to “review the free medicine scheme” and “make qualitative changes for better implementation”. While the popularity of the scheme has never been in doubt,the charge of poor implementation has been hitting home.

The BJP first called the free medicines “poison” at a seminar on October 10. Its CM candidate Vasundhara Raje accused the state of handing out “infected life-saving drugs” and giving medicines “even after their expiry”.

“I have gone across the state and found there are no doctors to prescribe the free medicines. What is the point of having the scheme when it helps no one?” Raje says. “Why haven’t these vacancies been filled up?”

Raje adds that the free medicine scheme will be retained if she comes to power but only after it has been thoroughly reviewed. “We need to do some stock-taking,make qualitative changes.”

Insiders in the former Raje government say she is aware of the benefits of generic medicines and it was under her tenure in 2007 that enterprising district-level officers had first made a presentation at a conference on setting up ‘fair price medicine shops’ as a pilot project. In the absence of a formal plan,the pilot was introduced in Chittorgarh in early 2008,with generic medicines made available at heavily discounted rates.

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It was under Gehlot though that several models from across the globe and a similar project introduced on a much smaller scale in Tamil Nadu in the late 1990s were studied and a blueprint drawn up.