The Cost of Cancer in Nepal-Sushil to Sannani

 World Cancer Day 2016  

 “We can, I can”.

The cost of Cancer in Nepal-Sushil to Sannani

Last year ,  in 2015,as cyclists went around Kathmandu with banners  on February 4, I came out of a hospital with a cancer patient, and I could not help but compare the  absolute disparity between Sannani Thapa, an ordinary Nepali, and  Sushil Koirala ,the  Prime Minister of Nepal, who also  had cancer.

As World Cancer Day approaches yet again, I am thinking once again about the huge disparity in costs and treatment facilities available for ordinary cancer patients in Nepal.

Sannani with a new growth of hair

Sushil Koirala,the former
 Prime Minister of Nepal

Former Prime minister and cancer patient Sushil Koirala recently returned from yet another visit to New York, having resigned and spending most of his time outside the country, ostensibly for a “medical checkup”.  Meanwhile, Nepal went through an Annus Horribilis of earthquakes, political uncertainty and an inhuman “unofficial” blockade of all essential goods by India, virtually destroying the economy. There is still a shortage of essential medicines including morphine for terminally ill cancer patients.

Last year, at about the same time as  Sushil Koirala was being treated for  lung cancer, a woman in a village in Sindhupalchowk decided to journey to Kathmandu for a checkup for a lump in her breast that had been present for a few months. Sannani was also diagnosed with cancer, and the doctors suggested Chemotherapy for the first time , followed by radical mastectomy, a complete removal of her breast.

Sannani’s relatives were suddenly overwhelmed by the bewildering battery of medical tests, the costs and the treatments. Sannani had  to leave an old father-in law, a husband, and two small children at home: it was not an extended family any more. They had to think about the costs of travelling, surgery, medicines and whether to start treatment or to just give up and wait for her to succumb to her illness. There were no doctors available, and no nurses in the nearby health post. A man who ran a small pharmacy(‘medical’ the villagers call it)had convinced her the lump was nothing to be concerned about a few months ago. Sannani would travel from her home, a  2 hour bus journey and an hour’s walk to her home in Bhotechaur Village.

 Because Sannani’s sister lived in a doctor’s house,  they were able to avail of the 100,000 rupees (at that time-1,000 US dollars) the government provides to  the financially weak ,as recommended by the  Village development committee. The doctor helped  arranged a meeting with an oncologist and after numerous delays, Chemotherapy was started from July. All the expensive medicines were unavailable, so the grant from the government was of little use. Poor  Sannani came by bus, suffering from severe motion sickness, went hurrying to the doctors, got the chemotherapy, and  left for home the next day. Her father in law looked after the buffalo, the husband tilled the land, and  the 11 year old daughter cooked the food and tended the 4 goats. There was hardly anything to get off the land except green vegetables, the monkeys got to the rest.

By the time the operation was scheduled  in October,the cost of the chemotherapy had reached 300,000 rupees. The best surgery was done in Bhaktapur cancer hospital,so they transferred the government  papers once again and spent 50 thousand rupees . Sannani's relatives were doubtful that she would live and came to visit her; she recovered quickly and left for home a week later. Her hair had started to fall;she used a woolen cap to cover her head. No one in her village had seen a cancer patient undergoing treatment and wondered whether she would ever be cured.

Meanwhile in Kathmandu, in July 2015,the cabinet released  millions of rupees for the  medical treatment of Sushil Koirala (Rs 14.3 million) Rs 12.8 million  for  present Prime Minister KP Sharma Oli ,500,000 for Nepali Congress leader Siddharaj Ojha  and Rs 500, 000  for disgraced   former minister Govinda Raj Joshi .This was all done at a single meeting. We cannot even calculate the total cost of medical expenditure for ailing politicians. Airlifting to other countries, expenditure for routine tests , costs of contingents of attendants and relatives  accompanying virtually useless political leaders are bleeding our country dry.

Sushil Koirala underwent 5 rounds of radiotherapy in eight days in Memorial Sloan Kettering in New York while Sannani  was once more shifted for  radiotherapy from machines dating back to 1991.Frequent breakdowns meant she took 5 months for the radiotherapy to run the full course. Through it all, she has been stoic and pragmatic, and has had to endure the collapse of her house in the April 25 Earthquake, and the landslides that followed 3 months later. I  gave  her 10,000 rupees, clothes and slippers and a place to stay. She refused  an extra tarpaulin for shelter as she did not even have a house after the quake, saying she had  “enough”.She sold her land to pay her debts recently.

Sannani is finally persuaded to give up the cap!

The only difference in Sushil’s and Sannani’s cases has been that of privilege; how is it that in a “democratic” country, an elderly single man and a young woman with small children get such disparate treatment? Why couldn’t Sushil Koirala be treated by Nepali Oncologists in Nepal? Why couldn’t he have used or even ordered a radiotherapy machine for his treatment in Nepal? It would have cost less than all his treatments in New York-and hundreds (no-thousands) would have availed of the new radiotherapy equipment in Nepal. Why is the Government so appallingly shameless, frittering away the nation’s wealth in such an arbitrary manner? Why are there no basic medical facilities and doctors just 76 kms  away from Kathmandu? It takes Sannani 2 days just to get a blood profile.

According to the American Cancer Society , the cost of lung cancer treatment   in the US amounts to about $3000 (three thousand) a day. Compare this to the entire cost of Sannani’s treatment for this year at $4,000( excluding 1,000$from the government). 

There are a handful of radiotherapy units run by the government for the thousands of cancer sufferers in Nepal.The recent  economic blockade led to shortages of every kind of chemotherapy drug,and  morphine for dying cancer patients.

How could our leaders be so shortsighted and selfish? How could they neglect the cancer patients of the whole country? Cancer patients need a lot of care,time ,money and will power. Sannani has decided she can. She can get through this alive. I have decided I can help in any way I know. We can make her story heard.  Cancer patients can,I can,we can all shame the Government for doing so little, and I can question Sushil Koirala, the privileged cancer survivor.