Dr. Caleb Harris M.Ch.(Surgical Oncology)
In September 2019, we received the shocking news of a doctor being lynched following the death of a tea estate worker. This worker injured himself following a fall in his home, maybe due to a stroke. The doctor was lynched because the angry mob felt that his delay in attending to this patient resulted in his death. While what this mindless mob did makes me angry and sad, I am amazed at the amount of faith they had in the healthcare system-that a 73 year old doctor in a small hospital could single-handedly prevent this patient from dying. Unfortunately, such incidents have not been uncommon in our country, where doctors are made the scapegoats for unsuccessful treatment outcomes.
Several factors may lead to such incidents and while the society is responsible for such deterioration, in a way, I would blame the medical community too for this. We have allowed the glorification of this profession, which is portrayed as having the potential to snatch a person away from the jaws of death. Young doctors who are reared in this milieu are groomed into thinking that working in a setting wherein you are able to save a dying person is to be aspired for, much more than other branches of medicine, thereby glorifying these branches. The demand for a ‘speciality’ is gauged by what is selected by the toppers of the NEET post-graduate and super speciality exams, and a perusal of the selection lists would point to such ‘glamorous’ specialities.
Most of the ‘glamorous’ specialities are the ones which are primarily concerned with ‘curing’ the diseases, leaving behind the branches which deal with preventing disease and promoting health. It is sad that most of us forget that Prevention is better than cure. Very few of the toppers take up branches which deal with public health and community medicine. Dr. Sandra Albert very rightly pointed to the need to train more health workers in public health in ‘Public health and medicine-is there a difference?’(Shillong Times, May 14th, 2020). It would be interesting to note that she has taken up public health after initial training in a ‘curative’ speciality.
Prevention of cancer is an important aspect of Oncology, which is found lacking in our country. While we have Surgical, Radiation and Medical Oncologists, there are very few Preventive Oncologists in Northeast India. In Meghalaya, there are no positions available for a preventive oncologist. This is expected to change once the Regional Cancer Centre in NEIGRIHMS is inaugurated, where a dedicated Preventive Oncology department has been proposed. That leaves this important job to us oncologists, in addition to our responsibilities in offering ‘curative treatment’.
Personally, it is frustrating to see people continuing the use of tobacco, despite knowing the ill-effects and lack of any nutritional benefit. The Global Adult Tobacco Survey(GATS 2016-17) showed that 91% of adults believed smoking causes serious illness and 94.2% believed chewing tobacco causes serious illness, yet people continue to use these products. I am appalled to see even relatives of patients suffering from cancer, continuing to use the same products that are killing their loved ones. It suggests that people feel that even if they develop diseases due to tobacco, there is a treatment for it.
It makes me sad as I wonder if I am the reason for such an attitude.
Covid-19 is a viral illness that results in death of only around 6% of those infected, and yet it has brought the whole world to a halt. Businesses are shut, aeroplanes aren’t flying, trains have been converted to hospitals, children are not going to school and people have stopped gathering together to worship their gods!Even after more than 60 days of lockdown, people are willing to rather die of hunger than come out into the open. Is covid-19 really that dangerous? It is just a bad flu, but it’s the perception that it lacks a cure that has caused the paranoia.
Imagine a world where there was no cure for the diseases caused by tobacco. No cure for cancer, cardiac diseases, lung diseases caused by cancer. A world where I could not operate and ‘cure’ a person of cancer; where there was no treatment for the breathing difficulties brought about by smoking and there was the fear of death due to a heart attack which could not be treated. Would people continue to use tobacco?
Tobacco is responsible for over 50% of cancers in Northeast India. It is sad to note that this is higher than the national average and corelates well with the high prevalence of tobacco use. While an average of 28.4% of individuals use tobacco in India, around 50% use it in the Northeastern states.
World No Tobacco Day is observed on the 31st of May every year,since the year 1987. An initiative of the World Health Organisation(WHO), this year, the focus is on “protecting youth from industry manipulation and preventing them from tobacco and nicotine use.” The tobacco industry targets the youth as tobacco users die early, and hence the need to ‘recruit’ more victims. If the youth of our land realise that there is no real cure to the ill effects of tobacco, they may not take up the habit.
I may operate and remove a tumour, but it leaves behind scars and might result in disability. My colleagues may treat a patient with radiotherapy or chemotherapy, but there are long term side effects to deal with. Besides, there is no guarantee of ‘cure’. If youngsters realise that there is no cure for these scars and side effects, maybe, like they feel that covid-19 can only be prevented, they will not use tobacco.
Let us re-imagine this world: a world where tobacco has no need and has no cure!
(The writer is Associate Professor and Head, Department of Surgical Oncology, NEIGRIHMS, Shillong and can be reached at [email protected]. Views expressed are personal)