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• Will protection reveal hidden secrets?
• Letters to the editor

Cancer is on the rise, but the country's only cancer hospital is ill-equipped to cope with it

On the mat

By Tharuka Dissanaike

• Only seven doctors
• Prevention is better

Safras Mohideen lay on a mat. Though sixteen, he was bawling like a baby, sobbing in pain, while his father, Mohideen Adumel,40, looked on helplessly. We stopped by, hesitant to intrude on their distress.

"They did not even give my son a bed," Adumel moaned, as if unaware that there were dozens of other patients sharing the floor space with them. "It's been a day since we came here but the doctor has not even seen my son."

Safras was brought to the Maharagama Cancer Institute's OPD the morning before, by his parents having developed fainting fits following an operation to remove a brain tumour. The doctor had asked that he be warded.

"He is my eldest son. Can you help me to get a bed here?" Adumel pleaded, encouraged by our interest in his situation.

This is the state of Maharagama- the country's only cancer treatment centre. In a pitiful letter to The Sunday Times, an elderly man once begged us to visit the wards and toilets to observe their dismal condition."The nurses here are so rude. They pretend not to hear when patients are screaming out in pain," he said.

Or is it that the nurses are so used to the agony of cancer and cannot cope with the severe overcrowding of wards at the Institute?

Although the wards are spilling over with patients, the Institute's Director, Dr. Randeniya says that a new OPD is the urgent need. "Just take a look at the OPD today," he said. We did.

It was a corridor, jammed with patients, mostly elderly, many without a seat and all who had travelled to Colombo at the crack of dawn from all parts of the island.

They had been referred to the Cancer hospital by other doctors, both private and government for detection and treatment. Last year there were 8000 new patients who sought treatment at the Institute's OPD. In addition to new patients, many come for post-surgical care and drugs, since cancer drugs are very expensive in the market. Daily, doctors at the OPD see some 400 patients.

"We are hoping to raise funds for a new OPD through various projects and private donations," Dr. Randeniya said.

He said the government had purchased a three and a half-acre plot adjacent to the hospital. But the Institute cannot afford to construct even the OPD estimated to cost Rs. 5-6 million.

To raise initial funding the Institute will hold a musical show on April 23.

Although a centre with very sophisticated treatment and equipment, Maharagama has the look and feel of a forgotten hospital. Its buildings are old, the corridors narrow, public areas crammed and the doctors and consultants do not even have a lounge.

Although through the years ad hoc additions and improvements have been made, an overall facelift is long overdue. The wards, which can only hold 478 patients at a given time, easily exceed this number by 200-300, resulting in patients having to make do on the floor, benches and corridors.

"Cancer is a painful disease. Patients here often need more comfort and care," Dr. Randeniya said. Cancer treatment is also long term. The average hospital stay of a patient is around three weeks to a month. Some even stay six months. Severe overcrowding is an ordinary phenomenon at Maharagama.

There is certainly no effort made to make patients comfortable.

Not only is the hospital ill-equipped to handle the number of patients in its wards and OPD, but problems of personnel and equipment also hamper development.

Nurses and attendants, like in any other government hospital, are in short supply. Those there find it difficult to cope with the numbers. Radiotherapists and Physicists are few. Most of all the number of cancer specialists or oncologists is too few for the sheer volume of patients who come to Maharagama.

"To ease the pressure on Maharagama, we have opened up Cancer clinics in regional hospitals like Kandy, Karapitiya and Anuradhapura.

Soon Badulla too will have a unit," Dr. Randeniya said.

But it is no secret that very few patients actually go to these centres, preferring to come to better equipped Maharagama, even if it means a five-hour bus ride in the wee hours of the morning. In any case advanced treatment is only given at the Institute. The Cobalt machine in Galle has been malfunctioning for some time. Its treatment accuracy is very poor and the machine needs to be replaced.

But there has been no move to purchase a new machine. Patients from Galle, well aware that the machine is malfunctioning, come to Maharagama for treatment.

Cancer treatment equipment is very expensive. Six years ago when the Hospital replaced two Cobalt Machines it cost Rs. 25 million each. Today the same machine, a little modified, comes at Rs. 40 million.

For most part, the equipment was donated by various agencies. But doctors say that the Ministry of Health has not given thought to replacing these with newer machines.

Only seven doctors

The Maharagama Cancer Hospital has only seven oncologists for a huge patient population. In Kandy and Galle there are two specialists each based at the hospital and in Anuradhapura, just one. Over 100,000 patients are looked after by 12 doctors.Senior doctors at Maharagama predict that the country will need at least 35 specialists by year 2005/6. But the actual numbers will fall greatly short of that.

The course, which trains doctors to become oncologists, was not conducted for the last four years, despite the severe need for specialists in the field. The new group of six, now being trained will only pass out in 2004 as the course takes all of five years. Until then cancer patients will have to suffer the shortage of doctors. At times a doctor has to see over 100 patients a day, specialists said. In England, they now feel that an oncologist should not see more than 400 new patients a year. Sri Lanka is very far from achieving that ideal target.

Prevention is better

One third of all cancers are curable, Dr. Randeniya said. The key of course, is early detection.

In Sri Lanka the most common cancers are oral, breast and cervix in women, esophageal, blood and related organs and lung cancers.

According to the WHO (World Health Organisation), the worldwide incidence of cancer is on the rise. In a few years, one in every four over-40 people will have some kind of cancer.

"Several factors are important. One is the population-aging pattern. Another important factor is food. Food we eat contributes greatly to cancer, as more and more additives, preservatives and chemical substances are consumed."

Education is important. The Institute is now conducting clinics for women, for early detection of cervical and breast cancers in their workplaces. Field health workers like PHIs and MOHs are trained in cancer detection.

"For our women's clinics we urgently need an ultra-sound scanner and would welcome any contributions for the machine, priced at Rs. 600,000," Dr. Randeniya said.

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