Seema Malik had a heart attack in 2014. The busy, healthy mother of three grownup daughters had taken her two-year-old grandson downstairs to play. After climbing three flights of stairs back up to her flat, she felt uneasy.
Her daughters rushed her to the hospital where she was told two of her arteries were 90% blocked, and two stents were inserted in an emergency operation. (“I was in the hospital just two nights, and the bill came up to Rs 6 lakhs,” rues the 68-year-old retired matron.)
Though the surgery was pronounced successful, Seema developed a severe pain in her right shoulder. Her doctor suggested physiotherapy. Despite several months of therapy from all kinds of clinics – from an ashram to a celebrity sports physiotherapist – Seema’s pain was unrelieved and she was miserable, even wailing in agony at times. Then, in 2016, one doctor conducted an MRI scan and indicated she may need an oncologist.
The subsequent lung biopsy was the “most horrid, confusing and worst thing” in Seema’s life. “I could not take the tube down my throat and my doctor kept blaming me for not doing it right,” she gesticulates hotly in recall. She isn’t even sure if the doctor got any tissue sample from her lungs at all. Even so, the report came back depressing: she had advanced-stage lung cancer.
“I don’t understand. How come no one noticed it during my heart surgery two years earlier?” says a bewildered Seema, who insists no one in her family has ever had cancer. “How can cancer reach the third or fourth stage in less than two years?”
Ten days of radiation relieved Seema’s pain, and she was then put on a long-term anti-cancer treatment with an imported medication that costs her close to Rs 50,000 per month.
But what upsets her the most is her doctor’s indifference and refusal to be honest with her: “Will I die if I stop this medication? He evades my questions. Instead he speaks to my husband over my head, and points at the other five patients seated in his room, telling us my time is up.”
Seema is one among more than 1.5 million new cases of cancer that are reported in India every year. Of the reported cases, only about 30% survive the next five years. According to a new survey published in The Lancet Oncology, more women in India are diagnosed with cancer than men, even though men report a 25% higher incidence of cancer than women all over the world. The report has suggested that more research needs to be done to figure out why.
Doctors have a few theories. One of them is late diagnosis of disease. Dr Punita Bhardwaj, senior consultant (unit incharge) of gynaecology endoscopy and robotic surgery at Sir Ganga Ram Hospital, Delhi, believes women only come forward to get themselves checked or screened when their day-to-day functioning is affected.
“Marriage is a big hindrance to women’s health,” she opines, only half-joking. “Single women are afraid a negative diagnosis may affect their chances of marriage. And married women are afraid of disturbing the family’s home machinery. So they hesitate even to get themselves screened.” No wonder that the Lancet study also found that breast cancer is most often diagnosed in the third or fourth stage in Indian women, versus first or second stage in the US.
The other hindrance is fear of surgical procedures. With only 1.2% of GDP being invested in healthcare; several media reports related to hospital deaths such as the newborns in Gorakhpur; doctors being beaten up by patients in Delhi and Mumbai; and cases of overcharging – such as Medanta Hospital charging Rs 16 lakhs from the family of seven-year-old Shaurya Singh who died of dengue after three weeks in the hospital – there is a massive trust deficit between doctors and patients. Cases such as Seema’s are also typical – when doctors are overworked, and lose the personal touch with individual patients.
The high cost of cancer treatment is also a deterrent for many women, who don’t want to be a burden on their families. According to one report, the cost of a single hospitalisation exceeds the average annual per capita expenditure of more than 60% of the population.
But one of the greatest problems is lack of awareness, especially when it comes to cervical cancer, says a study in the Indian Journal of Cancer. About 1.3 lakh women are diagnosed with this form of cancer every year, and half of them don’t survive more than five years – even though cervical and breast cancer can be cured if detected early and given proper treatment. Shyness and lack of hygiene education prohibit women from bringing up symptoms with their family or doctors.
“This negative attitude towards medical intervention is taking a toll,” rues Dr Bhardwaj, adding that those who come in mentally prepared and are optimistic about treatment benefit the most from it, no matter what their education level.
“Do not ignore your body’s signs,” she warns. “It’s not worth your life.”