It is ironic. A smoke-belching Vikram tempo takes you to the BP Koirala Memorial Cancer Hospital (BPKMCH) in Bharatpur. Ironic, because it's common knowledge that toxic exhaust fumes can trigger fatal lung cancer that the hospital identifies as one of the top three killers among cancers prevalent in Nepal. The irony is compounded when one also discovers that most deaths due to cancer are due to lack of awareness-even among medical professionals.
Medical research indicates that 90 percent of cancers are caused by environmental factors, the rest are attributed to genetic factors. Nepal lacks a comprehensive study on cancer prevalence, but it is emerging as one of the leading non-communicable diseases in Nepal-there are an estimated 35-40,000 cancer patients in the country. Deaths are approximated at 120 per 100,000, with cancers of the cervix, breast and lungs as top killer cancers in Nepal.
Doctors believe that most of these deaths are preventable. Studies show that a third of cancers are preventable and another third are curable if detected early. Giving up smoking can prevent about 30 percent of cases triggered by environmental factors, while another 35 percent require minimal changes in food habits, like avoiding fats and smoked food. Other environmental factors need changes at the policy level like limiting pesticide and chemical fertiliser use in farming and curbing air pollution.
"Most preventable cancers are caused by changes in lifestyle brought about so called modern living," said BPKMCH Public Health Officer Bhola Chalise. A random survey conducted before the establishment of the hospital showed cancer prevalence in urban areas of Nepal at nearly five times that of rural areas.
Approximately 25,000 new cases are detected annually, but oncologists suspect an equal number of patients die without diagnosis and treatment. Their concern needs to be taken seriously, since only about 20 percent of Nepalis have access to more specialised levels of medical help. Until about a decade ago health policies totally neglected cancer as a public heath threat and the development of specialised health care was slow. It was only in 1992 that the BPKMCH was established in the central tarai city of Bharatpur in Chitwan with assistance from China. Four years later, it was declared autonomous under the BP Koirala Cancer Hospital Act of 1996.
The hospital conducts activities to raise awareness among communities at risk, and provides service for diagnosis and treatment. Out-patient services (OPD) began in June 1999 and in-patient services with 25 beds from July that year. The medical team comprises Nepali, Chinese and Indian specialists. There are 30 doctors, 10 graduate nurses, 42 registered nurses and 12 chemotherapy-trained nurses. On average it provides OPD services to about 130 patients a day and undertakes 15 major and 10 minor operations per week. Chemotherapy, radiotherapy and simulation services are provided to 50 patients each day.
In recent months the hospital has seen an increasing number of Indian patients from the states bordering Nepal. Cheaper services, subsidised medicines and a lower patient burden in the hospital draw them here. "Treatment is almost 50 percent cheaper than in India, and one does not have to wait," said Gauri Shankar Ghusala, an oesophagus cancer patient from Sarlahi who was being treated at a Patna hospital before the BP Koirala hospital was set up. The hospital provides a whole range of radio-diagnosis services, pathology and radiation oncology services, including CT scanning, mammography, general and special X-ray, tumour markers, histopathology tests and a range of endoscopy procedures. In addition, a total of 124 beds at the hospital are available for patients requiring short and long term hospitalisation for multi-modality therapy including radiation, chemotherapy or surgery. A hospice situated within the hospital premises provides domiciliary care to 36 terminally ill patients.
"The government concentrated only on communicable diseases all these years. As a result public awareness regarding cancer is low. Even medical professionals hardly consider the possibility of cancer in their patients. When they get here, in many cases it is already too late," said Public Health Officer Kishor Pradhanang who conducts an awareness programme for people visiting BPKMCH and awareness workshops for medical professionals at sub-health posts, health posts and district health care units. The outcome of a 1995 random survey conducted at six major hospitals in Kathmandu revealed that of 172,000 patients discharged, 5100 displayed symptoms of various cancers but had not been referred to an oncologist by their doctors.
The Hospital Based Cancer Registry started in 1995 reveals that a similar percentage of men and women are affected by cancer in Nepal. The highest percentage fall within the 50-69 age bracket followed by people from the 30-49 age bracket. The Registry also revealed another curious fact-most cases are reported from the Chhetri, Newar and Bahun communities. "These are preliminary findings, we need further investigation and data to establish the facts behind why these three communities have higher cancer prevalence," says Dr Murari Man Shrestha, head of Department of Cancer Prevention, Control and Research at BPKMCH. He says that lack of awareness among medical professionals and patients and the consequent delay in availing treatment is causing high cancer deaths in Nepal. "If the government had intensified cancer awareness programmes 20 years ago, we could have prevented almost half of the cancer related deaths at present."