Cancer as a disease has not been defeated. Nor is any cure in sight in the near future. The disease continues to consume people of all ages, races and religions. Especially, if the patient has crossed a certain stage and the abnormal cells are spreading fast and eating up the nearby health parts. The disease has found a happy home in tragic Kashmir. It is thriving among the masses of Kashmir. The new figures which have come out recently reveal that 16480 cases of cancer have been reported up to August in this year. The graph is rising. The top victims of cancer are stomach, oesophagus and colon-rectal areas of the body. This "emperor of maladies" as described by Siddhartha Mukherjee in his 2010 Pulitzer Prize winning book by the same name, has been around since the times of the Greek, and the search for treatment continues ever since the earliest reported cases in history. From Kings to beggars no one is secure. From the pious to the wicked the disease has cast its net very wide. The stories around cancer in Kashmir are as varied as they are agonizing. The density of cancer cases is only matched by the meagre facilities to meet the inconceivable challenges that the disease poses. With inadequacies of various kinds hitting the patient and his attendants in the eye, the only solace received is from the whims of destiny.
There is no doubt that something seems to break inside when the doctor announces the stage of cancer and the number of months left with the patient. The internal screams are suppressed by the imposed silence from outside. The need for a fierce determination to quell the pangs from the killer disease is met with the urge to express the sea of feelings. The desire for early death to relieve the pain comes under the shadow of the deep affection with the affected person. We know that there is no treatment for many cases after the announcement is made except chemotherapy and palliative care. Even chemotherapy is ruled out for patients who are weak and cannot endure the disadvantages which the doses can bring about. Therefore what is left for these kinds of patients is palliative care or what is in common language called pain management. It is here where focus should be in Kashmir when it is well known that medicines for treatment are only for temporary support and cannot cure the patient. The point is giving the patient a dignified way out from the severe illness which has caught him. It is true that it is good for a person to pass away into quiet silence when the illness is ruthless and the permanent treatment is not available. However, what should one do from the time when the announcement is made to the point the person leaves the world. We know how many cases are there in Kashmir, we know which areas of body are most affected, we also know which areas of Kashmir are perhaps more prone to this disease, and yes, we also know that in most cases the diagnosis is late but even after knowing all of this it is pointless to repeat the obvious. What is critical is the management post-declaration of the stage of cancer. Now there are many fortunate cases in which pain does not go beyond a tolerable degree but in most of the cases the pain can reach the stage, often referred to as "shooting." Death may be inevitable but is the absence of pain management also inevitable. No it is not.
In the absence of pain management centres at the district and sub-district level the patient is left to the mercy of brutal fate. The National Health Mission had conceived the proposal to start pain management centres at the district level. However, till date there is no visible initiative in this regard, and the little sound-bytes which come are only of perfunctory nature without anything substantive to back them up. A large number of these cancer patients come from far off areas where medical facilities are nominal, and what is witnessed is such cases are horrible cases of pain, and the patients literally writing with helpless attendants watching the immeasurable misery. Generally, the cases of cancer from rural areas arise from lack of early diagnostics because the latter facilities are not easily available at the sub-district level, and when their limited time on earth is declared, they have to again go through the brutal travails because the post-diagnosis required facilities are not available. We often see crowds of people waiting at the SKIMS for dosage. The lack of a good doctor-patient ratio is made worse in the case of cancer patients where such ratio is even pathetic. With the speed with which cancer cases are rising, the apathy of the government to fix the ratio of oncologists and patients is inexcusable. Add to all this the general condition in Kashmir, and you have a heart-breaking picture. We saw last year how patients had to reach SKIMS for dosage, when the valley remained locked down for months. It is here is such climate of general uncertainty, the facility at the local level, at the sub-district and district level, becomes crucial for an honourable exit for the cancer patient.
When JBS Haldane wrote the poem "Cancer is a funny thing" he was poetically making light of the terminal disease only in a context in which early diagnosis is matched by quality care. We cannot here speak of cancer as funny unless we are hopelessly heartless. Because our context is tragic in more senses than one can imagine. We can perhaps make it a little less painful if a "local turn" is given to the temporary treatment, and prevent the patients and their attendants from being dragged to far off places like Bombay, AIIMS and PGI, Chandigarh. The pain management has to be made the focus at the local level until a permanent cure is discovered.