Fighting for dear life - together

Faisal Khan on how cancer, often considered a 'death sentence', can be beaten back - not by individual patients but by Pakistani society

Fighting for dear life - together
It is known as the number one cause of death in Pakistan. An unacceptably large number of men and women die from cancer each year: especially the deadly varieties of colon, prostate, lung and breast cancer.

When all these various types of cancer are put together, the numbers are indeed unsettling.

But a cancer diagnosis does not have to be an automatic death sentence. Medical professionals can never emphasise enough that cancer is treatable: if on the one hand the illness is caught at an early stage, and on the other, the relatives of the patient – and society at large – behave positively.

I have found that cancer treatment is far from an individual exercise. The community around a patient can fulfill one of the basic psychological needs for survival: a sense of belonging. Feeling needed and wanted by society can motivate cancer patients to persist and to struggle for life. And without a doubt, it affects their mental health very positively during an otherwise intensely difficult time.

Pakistani children are particularly vulerable to the neglect of cancer patients by state and society

My medical practice and visits have taken me to comparatively remote parts of Pakistan. I have seen the struggles of cancer patients up close, especially in Bajaur, Charsadda, Swabi and Mardan. I have noticed that cancer patients are often in a miserable condition just due to a lack of hope. And this comes from the lack of social support from their relatives and the community at large. As a pediatrician I have also seen so many heartbreaking cases of leukemia, brain and renal cancer in infants – where the child’s suffering is compounded by parents struggling without any kind of active and systematic support from society.

So, in my view, it is of the utmost importance to organize social and community groups to support cancer patients and their families.

In my view, these groups should work in the form of teams for the betterment of cancer patients. For a properly organised effort, it would be important to engage doctors, oncologists, psychologists, nutritionists, philanthropists and the local public.

The World Health Organisation (WHO) states that there are four key components to cancer control: prevention, early detection, diagnosis, and treatment or palliation. Developing countries, especially Pakistan, are facing major challenges in each of these four areas. As we know, cancer incidence and mortality varies significantly between developed, developing and under-developed areas within Pakistan.

Public healthcare systems in Pakistan have focused more on controlling the spread of infectious diseases

However, a key challenge when attempting to define the scale of the problem of cancer control in Pakistan is the lack of reliable statistics. In this situation, formation of social support groups will be much more fruitful to collect correct data about cancer patients from all areas of the society.

A complex group of diseases like cancer necessarily has to be tackled on multiple fronts by multiple partners. We need to begin with the realisation that problem of cancer in the developing world is so huge that is difficult to find the right way to even measure it.

From a public health perspective, the complexity of cancer control increased enormously following the shift of the disease burden from wealthy to less affluent countries in the world, and from relatively developed areas of Pakistan to under-developed areas. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70% - that means 5.5 million - are now occurring in the developing world. A disease once associated with affluence now places its heaviest burden on the poor and disadvantaged populations of the world.

The factors that make cancer such a killer in poorer communities can only be addressed more effectively with the help and active participation of social and community support groups.

On average, 70% of cancer patients in the rural areas of Pakistan, especially in Bajaur, North and West Waziristan, rural areas of KP, South Punjab, interior Sindh and Baluchistan are diagnosed at a very late stage of the illness – when treatment is no longer effective. The only possible intervention is palliative care, including pain relief. Even this intervention fails to reach more than 50% of the terminally ill cancer patients every year in Pakistan.

We can also measure the problem in terms of an almost total lack of response capacity in the rural, under-developed and densely populated areas of Pakistan. Here we find a lack of capacity for prevention, public education, screening, early detection, diagnosis and treatment. In fact, treatment is often closed off to the poor, whether involving surgery, radiotherapy or chemotherapy. Generally, in our society, such treatments are usually reserved for those rich enough to seek specialised care abroad. What does this say about fairness in access to essential, life-saving care?

The demands for chronic care when dealing with a disease like cancer are simply crippling. They also contribute to poverty, as most patients pay for care directly out of their pockets.

In Pakistan, for decades all the provincial and federal governments are designing their health systems and policies to cope with episodes of epidemic and infectious diseases like dengue, cholera and hepatitis. So our governments do not have the financial resources, facilities, equipment, technology, infrastructure, staff, or training to cope with chronic care for cancers.

Again, all of this points to a community-led effort to extend solidarity and care to cancer patients. These groups should have assistance and active participation of doctors, oncologists, psychologists, nutritionists, philanthropists, cancer survivors and others from society. Well-organised social support will enhance the quality of life and provides a buffer against adverse life events due to cancer.

These support groups will have to fight against cancer on four fronts at the same time. The first one is emotional assistance, with expressions of empathy, love, trust and care. The second one is instrumental assistance through tangible aid and service. The third one is informational –proper advice, suggestions and knowledge about the disease. And the fourth is appraisal of the cancer patient by providing information that is specifically useful for a particular patient.

If such efforts on the part of communities are not forthcoming, or do not receive the support that they need from the state, Pakistan might end up reneging on its responsibility to its own cancer patients as well as its commitments at international organisations to reduce the pain and loss of life caused by this disease.

Dr. Faisal Khan is an M.B.B.S, MPH, MCPS (Scholar) currently based at the Al Dar Hospital, Madina Al Munawara, Saudi Arabia