Lack of facilities, early detection, treatment cost key issues
The number of cancer patients is on the rise in Bangladesh as the authorities have failed to take pragmatic preventive measures, with early detection remaining elusive for common people and treatment being inadequate and expensive.
Public health experts said that due to food adulteration, unhealthy lifestyles and unabated pollutions, deadly cancer is spreading in the country.
According to the latest Global Cancer Observatory estimates, Bangladesh had 1,56,000 new cancer patients and 1,09,000 died in 2020.
In 2018, the report stated, the number of cancer cases in the country was 1,50,781 and deaths from cancer 1,08,137 while the 2012 figures were 1,22,700 and 91,300 respectively.
Health rights activists said that Bangladesh is yet to have a population-based cancer registry. Disagreeing with the Globocan report, they said that the real numbers of cancer patients and deaths in the country were much higher than those quoted in the report.
They estimate that annually more than 2,00,000 people are diagnosed with cancer and only 50,000 of them get access to treatment facilities due to the lack of facilities and the massive cost of treatment.
According to Bangladesh Cancer Society President Professor Golam Mohiuddin Faruque, there are crisis of equipment as well as of manpower.
As per the WHO standard, he also said, Bangladesh needs 170 radiotherapy machines but has only 40 while 70 per cent of them are out of order.
‘We have inadequate expert-level manpower. While the manpower is insufficient, they, too, are often not posted in places where they are needed. We should appoint them in the right places so that they can serve those who need their service,’ he said.
There are more than 200 radiation-practicing oncologists and 50 medical oncologists in the country, said society leaders.
In the public sector, nine medical college hospitals in the divisional cities, are equipped for cancer treatment, and the specialised National Institute of Cancer Research and Hospital provide cancer treatment.
According to hospital sources, the hospitals have 17 radiation machines to provide radiotherapy but 11 of them are currently not in operation.
As public hospitals have inadequate machines and most of them do not work, many patients are forced to go for treatment at private facilities which are highly expensive, said practitioners.
Amid such a situation Bangladesh observes World Cancer Day 2023 today marking the second year of the three-year-long ‘Close the Care Gap’ campaign addressing the issue of equity.
During a visit to the NICRH in the capital’s Mohakhali, Khurshida Begum, 55, a resident of Keraniganj, was found seating, among scores of others, on a hospital bench with her son.
She said that doctors detected blood cancer in her in December 2022 but her treatment was yet to start.
‘I am not getting a serial number here. I have no money to take treatment at a private hospital,’ she said in tears.
She said that the hospital people now asked her to visit the hospital again two months later.
‘We struggle to ensure services for patients due to manpower shortage while, of the six radiotherapy machines at our hospital, four are out of order, only one is functioning and one will be repaired soon,’ said NICRH director Professor Nizamul Haque.
He said that the 300-bed hospital capacity was extended to 500 beds but the manpower was not increased yet.
In the three years from January 2018 to December 2020, the NICRH provided outpatient services to 83,795 patients and 35,733 of them, or 42.6 per cent, were later diagnosed with cancer.
Nizamul Haque said that the government had taken up a project to set up eight specialised hospitals in divisional cities where cancer, kidney and heart patients would get services.
The project director for the planned hospitals, Khan Mohammad Arif, said that the overall progress in the construction of the 450-bed hospitals was 22 per cent.
Cancer epidemiologist and immediate past NICRH chief Professor Habibullah Talukder Ruskin said that installing treatment facilities alone was not the solution to the cancer problem.
‘Some one-third of cancers can be prevented through awareness, education and early screening, but there is no initiative in these regards,’ he said.
He suggested expanding diagnostic facilities to all the district hospitals, which could be helpful in preventing three types of cancer — breast, cervical and oral cancers.
The government had planned to launch an HPV (human papillomavirus) vaccination campaign in 2023 to prevent cervical cancer but missed the deadline. It has set afresh 2025 for the mass HPV vaccination of teenage girls.
‘We successfully piloted HPV vaccination in 2017 in Gazipur. We are waiting for the vaccine from the vaccine alliance Gavi. As soon as it allocates it, we will start the mass vaccination across the country,’ said Expanded Programme on Immunization deputy programme manager Tanvir Hossen.
Cancer Awareness Foundation Bangladesh general secretary Mohammad Masumul Haque stressed a national population-based cancer registry, as, he mentioned, the actual number of cancer patients is a must to adopt a proper plan of action on prevention and treatment of the illness.
Though the government had drafted a plan of action for 2007–12 to control cancer but the plan was not implemented.
‘A national cancer control policy is a must, on the one hand, while a unified message should be worked out to raise public awareness in this regard, on the other,’ he said.
Cancer physicians emphasised a healthy lifestyle, tobacco control, safe food and weight control to prevent cancers.
In order to rein in the cost of cancer treatment, Masumul Haque advised profit regulation on cancer medicine and treatment costs, in addition to introducing health insurance.
He went on to say that the National Cancer Control Council, headed by the health minister, was formed but was not active.
According to radiation oncologist Professor Syed Md Akram Hussain, cancer treatment is costly across the whole world but it is more expensive in Bangladesh.
The government, he added, might give special subsidies to cancer patients towards costs, including transportation and medicine expenses.
He further said that cancer treatment facilities in Bangladesh were mainly Dhaka-centric, emphasising that there must be such facilities at the district level so that patients can get easy excess to treatment.
He suggested free medicine for poor patients and strict control over the pricing of drugs.
According to doctors, early detection of cancer holds a high likelihood of cure but unfortunately most of the cancer patients in Bangladesh are detected at the third or fourth stage of the disease, resulting in high fatality rates.
In the private sector, 10 hospitals have radiation therapy facilities while some others have some partial diagnostic and treatment facilities and six of them are in the capital.
Dhaka University Institute of Health Economics professor Syed Abdul Hamid said that the treatment of a single cancer patient needed approximately Tk 6,39,000 annually.
He pointed out that the additional costs of cancer care are more than that of the core treatment.
Cancer treatment at a public facility in Bangladesh requires Tk 25,000 for a radiotherapy session, Tk 20,000 for a chemotherapy session and Tk 60,000 for a surgical procedure.
Each of the sessions at private hospitals costs Tk 1,50,000 to Tk 3,00,000.
Physicians further said that establishing a cancer treatment facility was a costly affair in terms of one-time investment as a machine costs Tk 20 to 30 crore.
The cost of treatment includes expenses for consultation, diagnosis, surgical or therapeutic procedures, drugs and injections and transport and accommodation for the patient and attendants.
Health rights activists said that government regulation of price and providing adequate facilities could ensure treatment for more patients. They asked the government to cut the out-of-pocket healthcare expenditure.
The Health Economics Unit of the health ministry reported that the out-of-pocket health expenditure in Bangladesh, one of the highest in the world, was Tk 68.5 in a Tk 100 expenditure.
As treatment costs are high and facilities are inadequate, many people die without proper treatment, said experts.
The health department data show that some 67 per cent of the deaths from illnesses in Bangladesh are caused by non-communicable diseases like cancer, cardiovascular diseases, diabetes, high blood pressure, chronic kidney conditions and breathing problems.
Published on New Age
Rashad Ahamad 