Oasis of care

Two new cancer centres in Varanasi are providing patients with high-quality and affordable care and treatment in a region crying out for both

Stuck in a limbo between hope and helplessness, Pradeep Gupta was close to giving up when he came to the Homi Bhabha Cancer Hospital (HBCH) in Varanasi to find care and a cure for his disease-stricken aunt. “We have got a lot of support from the doctors and the staff here, but the future fills me with dread,” says Mr Gupta, a Varanasi native who appears resigned to whatever that future may bring.

The positives are scarce for Mr Gupta and less so for 45-year-old Leelavati Devi, diagnosed with advanced breast cancer and currently undergoing a chemotherapy course that costs 25,000 for every cycle. The treatment charges have driven Mr Gupta, who draws a meagre salary from his job at a local electronics shop, and his joint family to the brink. The silver lining for them is the quality of care Ms Leelavati receives and the money raised by HBCH to meet her expenses.

One new, one rebuilt

That’s par for the cancer care course HBCH has set for itself since opening its doors in May 2018. Located in Varanasi’s Lahartara area, the hospital is a refurbished and reinvented avatar of what once was the Indian Railways Cancer Institute and Research Centre. And the 180-bed HBCH now has a sibling, the Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MMMCC), a sparkling new hospital that has come up in the campus of Banaras Hindu University (BHU).

They may be separated by 7km but MMMCC and HBCH function as a single entity, operating under the wings of, and to standards set by, the renowned Tata Memorial Hospital (TMH) in Mumbai. MMMCC, with 350 beds and space for services to be added on, is the bigger of the two. It started functioning in July 2019 and is nearly fully operational. Together, the combine will go a long way in bringing top-notch and affordable cancer care to a region crying out for it.

What’s remarkable about MMMCC-HBCH is the attempt to replicate the exceptional TMH template of cancer care and treatment, where no patient, no matter his or her paying capacity, is turned away. This is no easy task in a geography that carries a heavy poverty load, where the inability to bear medical costs often condemns patients to life-and-death choices. Just as remarkable is the pace at which facilities for the two hospitals were completed. The HBCH project took six months to finish and MMMCC came up in 10 months flat.

Indian Prime Minister Narendra Modi speaks to Tata Trusts Chairman Ratan Tata at the inauguration of MMMCC

Forward as one

None of this would have been possible without the power of collaboration. MMMCC-HBCH has been created thanks to a partnership involving the Atomic Energy Commission — TMH’s parent institution — and the Tata Trusts, which funded and undertook the construction work. Also in the mix was the Prime Minister’s Office, ensuring timely clearances and speed of execution in a land not known for either. Indian Railways and BHU pitched in with the required land parcels and more.

The two-hospital initiative has had to cope with a cat’s cradle of complexities to become reality. Going by how the people at the centre of it all have benefitted — patients trying to beat back cancer — the effort and the hard work have been worth it.

“We have treated more than 15,000 patients since we opened,” says Satyajit Pradhan, the director of MMMCC-HBCH. “We have dispensed medicines costing in excess of 190 million during this period and they have been made available at 62% less than the printed price. We have a patient welfare fund that has disbursed 50 million to 1,500 patients. And these people have received world-class treatment.”

Nursing staff at the Homi Bhabha Cancer Hospital

Help of this kind is a lifesaver for patients without the means to access cancer treatment, an expensive proposition more often than not. “Many of our patients come from some of the poorest regions in India, from Uttar Pradesh, of course, but also from Bihar, Jharkhand, Madhya Pradesh and Chhattisgarh,” adds Dr Pradhan. “As somebody once said, they have money for food or for medicine, not both.”

The good doctor’s words reflect the TMH culture of cancer care. It’s a way of thinking that the 700-plus staffers at MMMCC-HBCH — more than 50 of them doctors — have imbibed from the mother organisation. A fair number of them have experience of working at the TMH centres in Parel in Mumbai and in Kharghar in Navi Mumbai, and their commitment to the cancer care cause runs deep.

Care comes first

“Improving the quality of care provided to patients is our main objective,” says Priyathama Yadav, a nurse with HBCH for two years. “It makes me happy and proud to care for our patients. It’s great to see a smile on their faces. I struggle sometimes, though, especially when explaining things to people with end-stage cancer.”

Ms Yadav calls the hospital her second home — “In fact, I spend more time here than at my own house,” she says — and that’s the spirit inculcated by the TMH connection. Her colleague Rajni Baghel, who worked with TMH in Mumbai for 15 years before moving to Varanasi, talks up the teamwork factor. “In the TMH culture, no one person is responsible for patient care; the full team is necessary,” she explains. “We truly are like a family.”

Having all hands on deck and labouring in unison is crucial for MMMCC-HBCH, which kicked off slowly and without fanfare but is now busting at its seams with patients. More than 1,000 cancer cases are registered every month at the two hospitals and the number will rise when MMMCC gets to all systems go.

The challenges posed by the patient rush are steep. “The toughest problem is finding the right personnel,” says Rakesh Mittal, the deputy director of MMMCC-HBCH. “India lacks skilled professionals; our education system seems able to produce only clerks. Doctors, nurses, technicians — they are all in short supply. Then there’s the issue of arranging financial support for poor patients. Our social workers are forever trying to bring local philanthropists and charities on board, but it’s very difficult. Varanasi is not like Mumbai in that regard.”

Dr Mittal remains optimistic, however, that tomorrow will dawn brighter. “The backing of the Trusts and TMH’s hand-holding have made everything possible here,” he adds. “The advantage we have is that the TMH system we are following is very easy to implement. It is clean and transparent.”

There are two categories of patients, general and private, in the TMH scheme of treatment and the charges they pay vary: 30% of patients pay nothing; 30% pay 5% of what is spent on them; 20% pay 20% over the cost of treatment, and 20% pay 60-70% over cost. That makes for, as TMH director Rajendra Badwe puts it, a socialistic model in cancer care and its costing.

In comparison with TMH, its inspiration and guiding light, MMMCC-HBCH has plenty of distance to cover. But it has got off on the right track and is taking strides to match its amenities to the acute cancer care need of a huge ‘catchment area’. The equipment and the people are in place, teething troubles have been overcome and a system for efficient and cost-effective treatment is firmly in the slot.

Division of services

Down the line, a division of services between MMMCC and HBCH is being planned. When that happens, HBCH will concentrate on three specific forms of cancer — paediatric, blood, and bone and soft tissue — while MMMCC will handle solid tumours. Meanwhile, a facility for bone marrow transplants is being readied and work is underway on a cancer registry for Varanasi district to better understand the threat of the disease in the immediate surroundings of the two hospitals.

The expectation is that MMMCC-HBCH will, in time, offer all that TMH does at its centre in Mumbai, but this could do with some tempering. “TMH-Mumbai is a 78-year-old institution; we are less than two years old,” says Swagnik Chakrabarty, a doctor who has served at both places. “Even so, in patient care, services and equipment, we deliver almost everything that TMH does. What we really need are good and dedicated people to come and work here.”

Dr Pradhan considers MMMCC-HBCH to be a blessing for the people of Uttar Pradesh and beyond. “This looks like a corporate hospital but our charges are like that of a government hospital, or even less,” he says. “Cancer patients from here don’t have to run anymore to Delhi, Kolkata or TMH in Mumbai for treatment — because TMH has moved to Varanasi.”

A caregiver (whose aunt is being treated for cancer) with Neelima Dalvi and her colleague at the medical social work office

Where the need is never-ending

Neelima Dalvi has no qualms about stretching her arms every which way in search of support, resources, alms, call it what you will. The cause — securing financial assistance for the care and treatment of poor cancer patients — makes the effort worth it, and Ms Dalvi, a medical social worker, understands the difference this can make.

“We try to ensure that no patient goes untreated due to lack of money,” says Ms Dalvi, who moved to the Homi Bhabha Cancer Hospital in Varanasi 10 months back after a 30-year career with the Tata Memorial Hospital (TMH) in Mumbai. There’s more to it than monetary matters, though.

“Medical social work is a science,” explains Ms Dalvi. “We set definite parameters and processes so that the emotions of patients and their caregivers can be harnessed in a way that allows us to step in with help. This help has to be structured and transparent, and it has to follow certain standard operating procedures.”

Counselling and mediation between patients and doctors are components of what Ms Dalvi and her colleagues offer. But finances are the most compelling need in a region where poverty is endemic. “We have to strive very hard to get funds and accommodation for our patients and their caregivers,” adds Ms Dalvi.

Ms Dalvi’s job is made tougher still by the social stigma, fuelled by illiteracy and prejudice, that cancer patients have to live with in this part of the country. “Finding accommodation for patients and families who come from faraway places is a big challenge,” says Nizamuddin Khan, an assistant medical social worker with the Varanasi initiative. “Many lodging places refuse to accept them. They think cancer is contagious.”

The need to raise resources is never-ending and that is what Ms Dalvi and her team have focused attention on. “We have started going to the people of Varanasi, tapping philanthropists and charities,” she says. “We are making headway.”

Counselling of patients and their caregivers is almost as critical as getting finances in place. “We find parents and other caregivers who want to abandon treatment,” says Ms Dalvi. “We try everything under the sun to convince them to continue with the medicines, to not give up.”

Vikas Nishad, a fisherman from Nakhas Sadar in Uttar Pradesh’s Jaunpur district, is certainly not giving up. He’s looking after his 16-year old niece, Saumya, who is suffering from acute leukaemia, and there’s no end to the gratitude he feels for the help he has received.

“I have found hope here,” says Mr Nishad. “Our doctor says Saumya has a 50% chance of getting well. I’m praying she pulls through.”