When Nusrat Zerin Zenia, a former master’s student of Jahangirnagar University’s Institute of Information Technology (IIT), was diagnosed with blood cancer in February last year, she knew that many difficult choices would have to be made swiftly to save her life.
Like many families with a cancer patient in Bangladesh, Zenia’s parents were left with two choices: either to treat her in the local hospitals or to take her abroad for a better treatment.
“My family did not feel confident enough about the cancer treatment here. They found that the treatment was not advanced and they were facing severe hassles. It took hospitals an entire day to deliver a simple test report, which actually could have been done in an hour. Furthermore, hospital authorities even lost my blood report,” Zenia told the Dhaka Tribune about her experience at Bangabandhu Sheikh Mujib Medical University (BSMMU).
Doctors themselves admit that the country’s cancer treatment infrastructure is frustratingly inadequate.
The country currently has only nine government and six private centres offering specialised cancer treatment, when the country should actually have at least 160 cancer treatment centres in compliance with World Health Organisation’s guideline of one radiotherapy centre for every million people.
Dr Md Moarraf Hossen, director at the National Institute of Cancer Research and Hospital (NICRH), said: “Every day around 500 people are getting radiation treatment here, while hundreds more have to wait. We see around 1,000-1,200 patients arriving at the outdoor section every day. A new patient has no other option but to wait a couple of months.”
As a result, people are more desperate to get admission to the hospital rather than receiving the right treatment, the NICRH chief said.
“Despite the development in our cancer treatment system, we still cannot control the pressure of incoming patients. We would be satisfied when we are able to start a cancer patient’s treatment within a week,” he added.
Sufia Begum, a Sirajganj resident whose 38-year-old husband is suffering from lung cancer, said she came to the NICRH with hopes of treatment; but even after three months of trying, they have yet to secure admission at the institute.
The financial burden of cancer
Often the biggest challenge facing a patient and their family is the high expenses of cancer treatment. After IT student Zenia was diagnosed with blood cancer, her family also had to weigh all the options.
Zenia said her family consulted with doctors about whether they should take her to India for better care. But doctors said the improved treatment would come with a price tag of around Tk72 lakh.
Despite such large expenses, the families that can afford it, more than often choose to take their patients abroad.
But local doctors say a similar standard of treatment, at a way more affordable cost, can be acquired in Bangladesh.
“People should know that cancer treatment is a formula treatment all around the world. The treatment you will get here, you will find the same in India, USA, Singapore and other countries,” said Dr Moarraf.
“However, the cost is very much lower in our country compared to others. The government provides free treatment to the poor cancer patients, while also giving 50%-60% free medicine with free bed facilities,” he added.
“But it is true that the cost increases twenty times or higher in private hospitals than the government ones. A 3D treatment will cost around Tk14,000 at the NICRH, but it will take more than Tk2 lakh in private hospitals, and the cost will become Tk7-8 lakh in Singapore.”
Another positive sign for Bangladeshi patients is that locally made cancer drugs have made treatment even cheaper here, the NICRH director said.
Meanwhile, Health Minister Mohammed Nasim told the Dhaka Tribune: “The government is continuing its support in cancer treatment services. Since this is an expensive treatment, the equipment and machineries are also very costly. Within our small health budget, we will try to establish new equipment soon and gradually increase the number in different centres.”
The minister further urged the private sector to keep the cost of cancer treatment at a reasonable level for the masses.
The heavy toll of cancer
After much deliberation, Zenia’s family and her doctors decided that the best course of action would be to take her to India.
The treatment eventually cost around Tk62 lakh - less than the doctors initially estimated. The funds came from the family’s savings and from donations.
Luckily for Zenia, after months of treatment, her cancer went into remission in November last year.
Zenia, currently working as a teacher in a private university, now has a better understanding of the country’s cancer treatment scenario.
“The reaction and response of blood cancer patients differ from each other. So the patients require intensive care, which we found absent in our country. Nurses also were not properly trained and lacked in service and care.
“A cancer patient needs counselling and mental support that is absent in our country, even though we pay a good amount of money. The unhygienic hospitals here also pose infection risk for cancer patients,” Zenia pointed out her observations.
According to NICRH sources, around 150,000 cancer patients die each year while a further 250,000 people are diagnosed annually; of them, only 50,000 receive treatment.
The mortality rate from cancer in Bangladesh was 7.5% in 2005, but it might grow to become 13% in 2030, warns the International Agency for Research on Cancer (IARC).
According to the WHO, cancer is one of leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths in 2012.
The WHO also warns that the number of new cases is expected to rise by about 70% over the next two decades, with developing countries facing the biggest share of risk.
However, Bangladesh still surprisingly lacks a population-based cancer registry. Doctors estimate that there are around 1.5 million reported cancer patients in the country at the moment.
“Since we do not have the population-based cancer registry, we cannot see the nationwide cancer scenario. Again, we do not have any idea about how many people are going abroad for treatment and how many are not being treated only because of the high costs,” Dr Moarraf told the Dhaka Tribune.
The absence of a national cancer registry also means that the necessity of required resources, financial support, logistics and human resources cannot be realised, he added.
Small steps to save more lives
Despite all the shortcomings, patients might still have a better chance of cure and survival only if they looked for treatment during the early stages of cancer.
According to the NICRH, 90% patients who come to hospitals and are diagnosed with cancer had already reached the advanced stage of the disease.
Not only in Bangladesh, but saving such patients would be difficult in any other country, Dr Moarraf said.
Cancer specialists say many cancers are preventable through awareness about food behaviour and lifestyle.
Only by consuming healthy and nutritious food and by regularly engaging in physical activities, the chances of cancer can decrease significantly.
According to the WHO, around one-third of cancer deaths are due to five leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use. Tobacco use is the most important risk factor for cancer.
Asked about what steps could save more lives, NICRH Director Dr Moarraf said: “At present we have 300 beds; however, even if you increase the number to 5,000, I can assure you that the problem will still remain unsolved.
“To provide better treatment, first of all we need to decentralise our cancer treatment centres. Cancer centres should be reachable at district-level, and not only in the big cities. It will bring direct treatment to the patients and also decrease a good number of treatment cost,” the cancer specialist added.
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