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COLUMN ONE

In India, poor cancer patients rough it

On streets outside a charitable hospital in Mumbai with state-of-the-art facilities, hundreds of poor and suffering Indians live in makeshift tents, waiting and hoping for a chance to see a doctor.

January 08, 2010|By Mark Magnier
  • Meena Dahale holds her daughter, Deepali, 3, who was born with a blood clot in her eye that turned cancerous and had to be removed, the mother says. Streets near a Mumbai charitable hospital have been their home.
Meena Dahale holds her daughter, Deepali, 3, who was born with a blood clot… (Mark Magnier / Los Angeles…)

Reporting from Mumbai, India — In this makeshift cancer ward, there's little risk of enduring bedsores, fussy nurses or tasteless hospital food.

In fact, on some days, the cancer patients living on the sidewalk in front of Mumbai's Tata Memorial Hospital have no food at all.

At any given time, there's a floating population of several hundred patients awaiting treatment, with barely a rupee to their name. Many have lived for months, even years, in makeshift tents that hug the hospital walls and gates.

They recline, surrounded by their medicine bottles, religious icons and tattered luggage, waiting for a hard-won appointment at this, one of India's few state-of-the-art charitable hospitals. Their bed is a few square feet of hard pavement, their sheets a plastic tarp, their erratic food supply left to the gods and the beneficence of charities in a city that's home to more than half of India's 52 billionaires.

Cancer is only one of numerous serious illnesses the poor grapple with, but it's among the more dramatic. Government-run Tata Memorial, which specializes in the disease, is a magnet for poor people suffering from its ravaging effects.

Jerbai Wadia Road and adjoining streets, a tangle of belching taxis, street vendors and garbage-lined gutters, is the only home Deepali Dahale has known for most of her 3 years.

She was born with a blood clot in her eye, said her mother, Meena Dahale, 25, as the rambunctious toddler grabbed at her mother's bangles and the legs of passing pedestrians.

The clot soon turned cancerous, forcing the family to borrow $500 from relatives when Deepali was 4 months old to pay for an operation to remove her eye at a local clinic near Akola, their village in Maharashtra state.

The procedure was unsuccessful and the cancer spread. Soon Dahale's husband turned on her, she said, blaming the illness on her genes. A little later, he banished her and their daughter, forcing them to find their way, broke and disillusioned, to this street in Mumbai, the state capital. The couple's two older sons, considered little treasures in patriarchal village society, remained with him.

"My husband can't stand having her in his sight," Dahale, who married at 12, said as tears slid down her cheek. "She's his daughter too. Even if he hates me, he should care about her."

The toddler will need a second operation, but doctors haven't yet told Dahale how much it will cost, she said, adding that she'll have to petition local charities for the money. She hasn't seen her two sons in a couple of years, a source of anguish.

Most of her neighbors in the row of crude shelters tell similar stories of crushing debt, superstition and family alienation after their diagnosis.

Anita Kamble, 29, racked by painful stomach cancer, considers her husband a rare exception. Farmer Sudhir Kamble, 38, has stood by her through a major operation in 2007, 11 subsequent rounds of chemotherapy, numerous injections and countless tablets.

Forced to leave their three children with grandparents back in the village after her diagnosis three years ago, the couple have lived here on the street ever since. Most of the husband's days are spent lobbying various charitable trusts to open their checkbooks for her. "I'm extremely lucky," she said.

"He tells me, 'Whatever happens, I'm with you.' I'm terrified what will happen to our children if I die, though."

Rising cancer rates -- India is bracing for 27 million new cases annually by 2030, up from 12 million this year, partly a function of longer life expectancy -- have coincided with growing healthcare privatization. It has become so lucrative to treat rich patients and foreign medical tourists that even tractor and trucking companies have rushed to open specialized hospitals.

"The American system is being copied here, unfortunately," said Dr. V. Shantha, chairwoman of the Cancer Institute in Chennai. "Now it's all about 'how much am I going to make from this patient.' "

That's left the poor scrambling for care at the few remaining public or charitable trust hospitals, including Tata Memorial, which handles 43,000 new cancer patients annually, most for a nominal fee.

Kamlakant Tripathi, 49, sits along Jerbai Wadia Road beside his mother, Lal Devi, 70, who has liver cancer. Her yellow, listless body lies on the pavement, barely able to move. "We have no insurance," he said. "Catastrophic illness is the biggest worry for an Indian family."

Statistics bear that out, with healthcare the second-largest source of debt among India's rural poor after dowry, wedding banquet and related social obligations, activists say.

By the time they arrive at Tata Memorial, most patients have spent everything on a parade of local doctors.

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