By Dr. Caleb Harris M.Ch.
A prominent citizen of Shillong called me a few months ago, wanting to send one of her employees for cancer treatment. She added that she would send someone with the patient, despite my assurance that the patient would be taken care of-insisting that it would be difficult for them to navigate through the hospital. The patient did not need any assistance and eventually completed treatment. However, this reflects the perception that hospitals are not easy places for people to visit. This is ironic, as hospitals are places visited by people when they are most vulnerable.
Pynshaibha Latam, in ‘Need for help desks and quality health care in hospitals’ , ST dated 27.3.25, listed out the challenges faced by patients at hospitals, but the solution is not very simple. There was a very successful hospital chain in South India, whose USP was easy patient navigation. The moment a patient stepped into the hospital, a staff member would greet and lead to the registration desk and help complete the process, following which the patient would be taken to the consultation room of the doctor. Another staff would accompany the patient for investigations, purchasing medicines, etc. While this system seems efficient, it requires a lot of dedicated manpower. Besides, ensuring a motivated workforce is easier said than done in a government setup. It would be a challenge to equip our public health systems with such ‘navigators’.
Navigating the justice system or any government service is not unlike healthcare. Rural folk and the disadvantaged face the same challenges listed in this article. A society may not expect only one aspect(Healthcare) to be super-efficient without addressing the overall professionalism. Would a government servant or court employee who is not courteous in his work expect kindness during his visit to the hospital?
It is heartening to note that the medical world has recognized that the differences in access to treatment may affect overall treatment outcomes. A patient whose cancer has been operated successfully but is unable to receive chemotherapy due to financial or logistic reasons will have a poorer outcome. If he is provided the necessary assistance and encouragement, he may probably be able to complete the treatment. Implementation Research(IR) deals with understanding and closing the gap between evidence-based treatment and practice. Rather than invest in research projects which focus on discovering new treatment options, IR focuses on ensuring that proven treatment reaches those who would benefit from it most. Apart from treatment for cancer, tuberculosis, etc. , strategies to promote health, such as vaccination, cancer detection and screening, mental wellness and maternal health are being studied. While the initial part of IR involves understanding the problems, there is an ‘implementation package’ which is designed to overcome the challenges and improve the outcomes.
Part of the implementation package would be patient navigation which could range from a simple pamphlet explaining the processes, to a video guide, to a physical navigator who would guide the patient. This, of course, depends on the availability of resources. While such IR projects are helpful, the challenge is in the sustainability of these navigation systems once the project is over and there are no longer any project staff to assist as patient navigators.
Harold Freeman is an American physician who is widely recognized as the Father of Patient Navigation. He recognized the poorer treatment outcomes of cancer patients at Harlem, compared to the rest of USA, thereby pioneering the concept of patient navigation. Individuals were trained to work consistently with patients and their families throughout their journey through the medical system. These navigators were trained to identify and overcome the barriers to appropriate and timely treatment and care.
In India, the Tata Memorial Centre, Mumbai, has started KEVAT- a patient navigation program. This is a one year post graduate diploma program offered in association with Tata Institute of Social Sciences(TISS). Apart from being trained to assist patients through their cancer treatment journey, they can counsel patients and work as a bridge between patients and the healthcare systems.
World cancer day, observed on February 4th annually, is an initiative of the Union for International Cancer Control (UICC). The theme for this year is ‘United by Unique’, which places people at the centre of care and their stories at the heart of conversations. Each and every patient is different. Apart from the varied types and stages of cancers, the responses of each patient to the diagnosis is different.
Recently, I saw a patient who was brought on a wheelchair, hence I was not too sure if she would be willing to undergo a major cancer surgery but she surprised us by showing enthusiasm for the procedure. Whereas there are several patients who, despite extensive counselling, refuse treatment. There could be several reasons for refusal of treatment, some of which can be addressed. Financial problems could be mitigated partly by effective implementation of Publicly Financed Health Insurance Schemes such as Ayushman Bharat. But logistic problems are much more difficult to solve. If a parent is sick and the caregiver is the lone breadwinner for the family, treatment may be deferred. If the community would step in to assist, such a patient may be able to complete treatment.
The poor and the illiterate face more problems in navigating healthcare services and may benefit from suitable assistance. While pursuing a course in patient navigation may help, the immediate solution would be for those who have had the experience of being caregivers to come forward and volunteer to help patients. Even if a few of our educated youth come forward to help disadvantaged patients, it would make a big difference in the treatment outcomes of patients. Navigating murky waters would be a lot less stressful in the presence of someone who has walked the path or understands it better.
(The author is Surgical Oncologist, NEIGRIHMS, Shillong (An Autonomous Institute under Ministry of Health and FW, GOI). Views expressed are personal- Email: [email protected])
