When the flood water roared into her home in Assam, Jyoti Bora* saw the morphine pills she takes for head and neck cancer swept away along with all her belongings. At the relief camp she was evacuated to, Bora, who uses a wheelchair, found a boat to take her to the hospital to get more medication.
But when she got to Cacher cancer hospital and research centre she found the entrance flooded – the water was 1.5 metres high. A hospital orderly and a nurse were dispatched in a raft, made from planks of plywood tied to tyre inner tubes, to collect her.
“Initially, she refused to get on. She was very frightened. As it is she is frail. But she knew she could not manage without her morphine injection,” says her doctor, surgical oncologist and deputy director of Cacher, Ritesh Tapkire. “That’s how our outpatients have been coming for radiation, chemotherapy and pain relief for the past week.”
About 5 million people in Assam, in India’s north-east, have been affected by the worst floods in decades, which began in April and show little significant signs of easing. Entire villages have been submerged. More than 114,000 hectares (280,000 acres) of crops have been damaged and 5,000 livestock washed away. The army and relief workers are providing food, medicines and drinking water to 780 camps for those displaced by the flooding.
Cacher hospital, which has 150 beds and treats 20,000 patients a year, got off fairly lightly. One building was flooded at the end of June, along with the nurses’ hostel, but the wards were spared as they are built on higher ground. Radiation and chemotherapy have continued for the 100 patients admitted to the hospital, although a lack of anaesthesia meant only four operations were carried out in a week, instead of the usual 20.
Since the floods, the big issue for staff has been ensuring patients continue receiving treatment. People travel to Cacher hospital from all over the state. It is run by a non-profit and most patients are on low incomes and receive free or subsidised treatment. However, they still have to find money to travel to the centre. In April, prime Minister Narendra Modi laid the foundation for seven new cancer hospitals in Assam. It is hoped they will take some of the pressure off Cachar and the other two other government cancer hospitals that serve the state. The north-east of India is known as the “cancer capital” of the country, and cases are double the national average. Lifestyle is a big factor – high consumption of alcohol, betel nut and tobacco – combined with low awareness of symptoms, late detection and a lack of oncologists and facilities to diagnose and treat cases.
Cacher staff have been calling patients who have not kept appointments to check they have enough medication. They have also got into boats to collect people from their homes and bring them to the hospital, and made rafts to take them inside. They have also set up a makeshift outpatient department (OPD) on a patch of dry land outside the hospital to give out basic medicines and pain killers. Morphine injections given here too, in the middle of swirling flood waters, for patients too scared of the raft ride into the hospital.
“A patient with multiple myeloma came for her chemotherapy session and she refused to get on to the raft. She was petrified. Fortunately, her chemotherapy was only one hour long, did not need close monitoring or have side-effects, so after checking her vitals, we administered it on the dry patch,” says Tapkire.
Last Monday, the niece of an elderly woman with metastatic breast cancer called the hospital in tears, asking for help. The hospital director, Dr Ravi Kannan, dispatched a team from the hospital to collect her. The woman had to be lowered from the second floor of her home, where she and her family had sought safety, into a boat and taken to the hospital.
The State Disaster Response Force has now given the hospital inflatable boats and rafts to make ferrying patients to and from the hospital a little easier.
Kannan is worried people are missing out on treatment. On a normal day, the OPD has between 150 and 200 patients. In the past week, it has seen only 40 people. “We need to reach out to every patient who has not been able to come. Cancer care cannot be interrupted. It bothers us no end,” he says.
Ranjita Singha, 60, who has cervical cancer, ran out of morphine and was unable to reach the hospital. Her daughter, Babita Singha, is her main carer.
“When the doctor called, I told them that my mother had only one pill left. They arrived here by boat to give me more pills and also gave her a morphine injection for immediate relief,” says Babita.
The woman with metastatic breast cancer who was rescued from the second floor of her home died the next day. Kannan says he wondered if bringing her to the hospital was the wrong decision. Until he received a note from her niece.
“For days they had sat by her, dreading her dying, surrounded by water, in the dark in the middle of the night. By bringing her to hospital, where she had light and medical care; the niece said we had spared the family the agony of living with such a painful memory,” says Kannan.
* Name changed
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