How cancer, often considered a
‘death sentence’, can be beaten back – not by individual patients but by
Pakistani society 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 emphasize 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 vulnerable 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 organized effort, it would
be important to engage doctors, oncologists, psychologists, nutritionists,
philanthropists and the local public.
The World Health Organization (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 realization 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 ofcapacity 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 specialized 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 organizations to reduce the pain and loss of life caused by this
disease.