March 24th, 2017
Located in the southern region of Assam is the resource-rich and lush Barak Valley. The main city of the Valley is Silchar, a city which has come to be hailed as the “Island of Peace” due to its reputation of being politically stable in the otherwise disturbed region.
Whatever the name might indicate, Barak Valley is not named after former US President Barack Obama. The name “Barak” has derived from the Dimasa (a Sino-Tibetan language) words “Bra” & “Kro”. “Bra” means bifurcation and “Kro” means upper portion/stream. The Barak River – after which the Valley is named – is bifurcated into two in the region.
The people of Barak Valley had a history of limited access to healthcare. The nearest cancer hospital was in Guwahati, which was 350 km away and, owing to the harsh terrain, several hours away.
The poor state of healthcare coupled with the high incidence of cancer in the region were causes of great concern to the local population. The citizens of Barak Valley took matters into their own hands and set up a hospital in 1996. This was the foundation of the Cachar Cancer Hospital Society.
The hospital faced multiple challenges from the very beginning. Lack of funds, poor infrastructure, lack of sufficient medical professionals – the hospital toiled against several obstacles for about a decade. Finally, in 2007, Barak Valley and the Cachar Cancer Hospital Society got their saviour – in the form of Dr Ravi Kannan.
It was an unique match, initially. Dr Kannan, a renowned oncologist from the Adyar Cancer Institute in Chennai, shifting with his family to Silchar, Assam. To learn about his journey and his experiences, The Logical Indian interviewed Dr Ravi Kannan.
Dr Kannan used to work for the Cancer Institute (WIA) in Chennai. He said, “I was there for about 15 years and learnt from and worked with some wonderful and humane individuals. My mentor, Dr Krishnamurthi, often used to say that in medical practice the only interest in mind should be the patient’s interest. He would insist that if a patient did not have the resources for his or her treatment, then it is the job of the treating clinician to find the resources.”
When the Cachar Cancer Hospital Society was established in 1992, the then Director of the hospital had visited a number of cancer centres in the country, searching for support. He also spent 3 months with Dr Kannan in Chennai and was in regular touch after that, often referring patients who needed support.
Soon after Dr Kannan left the Cancer Institute, the Director called him regarding some patient. “During the conversation,” Dr Kannan said, “I mentioned that I was no longer working at the Institute. His first reaction was that I should relocate to Assam. All we knew about Assam in those days was the bomb blasts and the floods. My wife’s first response, understandably, was ‘Anywhere but Assam’. But the [Cachar Cancer Hospital] Society persistently wrote letters and called over the phone. So my wife, daughter (who was then in the fourth grade), and I paid a visit to Silchar.”
“I spent time in the hospital and Seetha went around the community. We also visited a number of schools. In many of the schools that we visited, the principals were very supportive: ‘Doctor, we know why you would come’, ‘Your daughter will get admission’ and so on When we visited the local Kendriya Vidyalaya, I realised the principal, Mr Hari Singh, was my batch alumnus. We discovered the link in two minutes and bonded instantly! Before we could go back, my wife told me “Ravi, this is what we should be doing, it makes a lot of meaning. Let’s move here.”
On their return, before Dr Kannan could even initiate discussion with his colleagues, Mrs Kannan resigned from her work. The Doctor’s father supported their decision. They relocated to Barak Valley in June 2007. “In a couple of months, we had have completed 10 years here … time has just flown.”
When he finally arrived in the Valley, Dr Kannan must have assumed that it would be a difficult task to adapt to the new environment, given the cultural and linguistic differences. However, the family actually did not find it difficult at all. “We were fluent with Hindi, and most patients understand Hindi. The local communities are extremely warm and welcoming. They may be poor but will always welcome you with tea. That is the beauty of India: you live for 25 years in the US and yet you will always be a migrant and an Asian. You go to any part of India and you will be assimilated easily.”
In the last few decades, the occurrence of non-communicable diseases (NCDs) such as cancer is on the rise in India. Many global commentators have hinted that the next pandemic could very well be NCDs in developing countries. This is due to the growing burden of NCDs in low- and lower-middle-income countries, the drivers of this change, and failure of healthcare systems in bridging the resource gap to deliver appropriate NCD care for patients.
Dr Kannan told The Logical Indian that the incidence of NCDs like cancer is so high in Barak Valley and the Northeast because of the very high incidence of tobacco use. Cancer harms the body because certain sets of cells divide uncontrollably to form lumps or masses of tissue called tumours. If these tumours grow to a considerable size, they are capable of interfering with body functions and damaging proper functioning of the nervous, circulatory, and digestive systems.
India’s healthcare system is highly disorganised. Our health spending in proportion to annual GDP, the number of hospitals and doctors, and the lack of political will in providing universal healthcare to all Indians are some of the causes of this. We asked Dr Kannan about his opinion on which form of healthcare is better – public or private. He replied, “Health and education, in my opinion, should always be the government’s responsibilities. Unfortunately, successive union and state governments have been abdicating their responsibilities in this by encouraging private players at the expense of the people.”
Dr Kannan argues that quality healthcare should be a right. “The government should spend more on health and education. All medical graduates and post-graduates should spend 2-3 years in underserved communities following which they must appear for a qualifying exit exam. Government-sponsored insurance schemes may be an option. The ratio of private medical colleges and hospitals to public institutions must be skewed in favour of public agencies. All drugs, antibiotics, equipments must be tax-exempted. A ceiling must be placed on costs of medicines and consumables. Government doctors should be forbidden from private practice, but should be adequately compensated.”
The Cachar Cancer Hospital and Research Centre is a famous example of experienced and well-versed medical personnel improving the standards of rural healthcare. But for most of India, the quality of healthcare depends on whether you live in an urban or a rural setting. According to Dr Kannan, the standards of rural healthcare can – and must – be raised. “By improving infrastructure, providing incentives, and ensuring security for doctors to work in rural areas, by similarly encouraging other professionals in IT and engineering etc. to spend time in rural areas. Standards of health care can rise and be maintained there only if standards rise in all spheres of life.”
The Cachar Cancer Hospital Society has come a long way since 1992. What drove Dr Kannan and his team to go forward, despite the odds stacked against them? “Two main things motivate and inspire me,” the Doctor told us. “Firstly, the change that we as a team are able to bring about in the community. Some time ago, one of the local physicians remarked to me, ‘Sir, after your arrival, the standards of healthcare have gone up in Silchar.’ I laughed and replied, ‘No, Sir, patients have started to expect the quality of care that they get at the cancer hospital in all other hospitals too.’ Secondly, my colleagues motivate me. They are a group of young, energetic, and committed individuals who are capable of moving mountains. We started in 2007 as a team of 23 and today we are nearly 300. All of us understand perfectly that we are more than the sum of each one of us.”
The Logical Indian community applauds the dedication and efforts of Dr Kannan and his team at the Cachar Cancer Hospital and Research Centre. A team working hard to reduce the incidence of diseases in rural, remote regions is a team that inspires all of us to work to make our society a better one.
(If readers are interested in learning more about the Cachar Cancer Hospital Society, they can visit them at their official website.)