CANCER: Death sentence for the poor in Nagaland

Cancer patients run from one hospital corridor to other seeking medical attention, and are often fatally misdiagnosed

Imti Longchar
Dimapur | April 29  

Nikki, a 26 year old woman who has been receiving chemotherapy at the Naga Hospital Authority, Kohima (NHAK) is the abject embodiment of cancer patients in Nagaland and the pain and suffering they have to endure.  

Hailing from Tobu subdivision, a neglected town under Mon district, Nikki along with her husband recently travelled to Tuensang district hospital with complains of severe pain in her abdomen. The doctor there misdiagnosed her complaints as kidney failure and prescribed her medicine for its treatment.  

With no improvement even after one month on the medicine, the couple in desperation visited a primary health centre in Tuensang where they were informed that she could not be treated at the centre due to lack of proper infrastructure and was referred to a hospital in Dimapur.  

After one month of undergoing all kind of tests like CT Scan etc, the doctors at the hospital in Dimapur told them that they would not be able to treat her. Nikki was then refereed to a private nursing home in Kohima where an oncologist broke the news that she had cervical cancer.  

Nikki was also recommended that she take chemotherapy for which the cost was Rs 24,000 per batch. The expenditure from the constant travel from one health care service provider to another had taken a toll on the little resources they had saved- after all Nikki’s husband was a farmer and how much could they possibly have? It was then they approached NHAK as a last resort where the cost for surgery and the chemotherapy treatment was subsidized.  

“Whatever little savings we had is already gone. We are surviving on borrowed money,” Khole, her husband told The Morung Express as he tried to comfort his worn out wife reeling from the painful side effects of chemotherapy. “We don’t have anyone to ask for money anymore, I don’t know what we will to do next,” Khole said with the unmistakable tone of anxiety in his voice.  

The four walls of the cancer treatment facility at NHAK is a regular witness to such incidences of helplessness and desperation.  

“Only recently, another patient, a 58 year old woman (name withheld) who was diagnosed with blood cancer got herself discharged from the hospital to resign to her fate after the doctor referred her to Delhi for bone marrow transplant,” a nurse attending to the patients at NHAK revealed.  

The lack of cancer treatment facility and oncologist doctors in most of the district hospitals in Nagaland is taking a toll on the mortality rates of cancer patients particularly those who come from far flung areas.  

There are countless people like Nikki who find no option but to run from one hospital corridor to another seeking medical attention. They are often misdiagnosed, which proves to be fatal.  

“The fact that Nagaland has one of the highest prevalence rate of cancer incidences in India, with at least 600 new cases of cancer detected every year ought to snap the Nagaland State Government as well as the NGOs out of slumber and call for urgent action,” an official from the Nagaland State’s Department of Health and Family Welfare, who wished to remain anonymous, said.  

It is another stark reality that many cancer patients hailing from lower socioeconomic sections of the society cannot afford to pay for diagnosis or chemotherapy treatment; they cannot even afford their fares to avail treatment out of their village.  

According to a revealing 2013-2014 study on cancer prevalence in Nagaland, more than 50% of cancer patients are getting either chemotherapy or no treatment at all which means that socioeconomic inequalities such as poverty, inadequate education, and lack of health insurance plays a crucial role in the mortality of the cancer patients.  

“At least for those cancer patients who are employed in the government departments, they get reimbursement from the government, but what of the poor and the needy; they have no one to turn to,” a doctor from Dimapur questioned.  

Nagaland government still to set up health schemes to assist poor patients

Although there are a number of schemes under the Ministry of Health and Family Welfare, Government of India, to help the poor and the impoverished like Nikki by availing assistance for treatment of major threatening diseases like cancer, Nagaland State is yet to set up such schemes despite repeated directives from the centre.  

For one, Nagaland has not set up the State Illness Assistance Fund to provide financial assistance to the needy individuals through grant-in-aid from the centre for treatment of cancer, cardiac surgery, kidney transplant, liver and multi-organ failure etc.  

Nagaland also does not figure in the list of states availing the Health Minister’s Discretionary Grant (HMDG), Rashtriya Arogya Nidhi (RAN) and Health Minister’s Cancer Patient Fund (HMCPF) grand-in-aid schemes under the Ministry of Health and Family Welfare, GoI. Almost all the states and union territories under India have set up the scheme for its citizens.  

Such financial assistance is provided to the poor patients with family income less than Rs.1,00,000/- annually and suffering from major illness and undergoing treatment in Government Hospitals/Institutions, to defray a part of the expenditure on hospitalization/treatment, in cases where free medical facilities are not available.  

Realizing the cancer toll on its citizens, the neighboring Assam government had announced in 2016 that it would provide free medical treatment to all cancer patients and treatment would be made available in all the civil hospitals from January 2017 onwards. What of Nagaland? Another official of the Department of Health and Family Welfare while admitting that Nagaland was yet to set up these schemes informed that the department was waiting for “approval” from the government.  

Schemes like the RAN and HMCPF required equal matching share from the respective State Government on the grand-in-aid provided by the Centre, and therefore the approval in anticipation from the Nagaland Government, he informed.  

The official also pointed out that HMCPF can be availed by any BPL patients in India wherein 27 erstwhile Regional Cancer Centres (RCCs) are provided with revolving funds to provide immediate financial assistance up to Rs.2 lakh to BPL cancer patients.  

The identified hospitals also include Dr. B. B. Cancer Institute, Guwahati, Assam and the Regional Institute of Medical Sciences, Manipur both in the North East.  

Dr Ambedkar Medical Aid Scheme

The same official also informed that the Nagaland Department of Health and Family Welfare has only recently rolled out the Dr. Ambedkar Medical Aid Scheme under which medical treatment facility will be provided to the patients who are suffering from very serious illnesses involving of kidney, heart, liver, cancer and brain or any other life menacing diseases including organ transplant and spinal surgery.  

Applicable persons for this scheme fall under Scheduled Caste (SC) and Scheduled Tribe (ST). The applicant’s family income should not be more than Rs. One Lakh (1, 00,000) per annum to avail the benefits of the said scheme.  

The forms for the Dr Ambedkar Medical Aid Scheme can be availed from the respective District Health Authority.  

It is without doubt that individuals of lower socio economic status face higher mortality rates than individual of higher status which the state government needs to look into.