Cancer patients left on India's streets

As a study highlights the spread of the 'Western' disease, Andrew Buncombe meets the patients forced to live rough

Cancer survivor Rekha Devi has few complaints about the treatment she has received at India’s largest specialist hospital. But she wouldn’t mind somewhere a little more comfortable to sleep at night.

Nine months ago she arrived in Mumbai after a rattling, 36-hour train ride from Bihar, and apart from a few days either side of an operation to remove a breast at the beginning of July, she has spent every night bedding down in a makeshift shack on the pavement outside the hospital’s main entrance. “It’s very tough for us to live. We don’t have money to rent a room or to travel,” she said. “We keep a piece of wood to hand to scare away the rats.”

She is not alone. In the streets surrounding the city’s Tata Memorial Hospital there are scores of people camped out in pavement shacks, either patients themselves or relatives of those undergoing treatment. Most are obliged to wait here for months; some end up staying for years.

The hospital says it tries to provide affordable accommodation for as many as possible, while charities provide dormitory rooms nearby for as little as 50 rupees a night. But for the very poorest the only option is the street.

Ashok Naik has been alone in his shack for 10 months. He is suffering from throat cancer and when he speaks the effort sound painful and squeezed. The skeletal 55-year-old has undergone 35 sessions of radiotherapy and three months ago a tube was inserted to connect his throat to his stomach, into which he can pour warm milk.

He said he had to wait a fortnight before finding out whether there will be more surgery. “I think I will have to stay here for five to six months. The doctors have told me to be available for surgery at any time,” he said.

Those obliged to live on the street do what they can to make the shacks as comfortable as possible. Mr Naik had put up plastic flowers and pictures of religious icons, including the Hindu guru Shri Swami Samarth. Mrs Devi’s shelter was covered with plastic sheets, tied down with rope and weighted with bricks. Everyone appeared to be keeping their precious medicine in polystyrene boxes.

At the end of the street was an unpleasant-smelling toilet block which charged three rupees to use the lavatory and ten rupees for a bucket wash or to charge a cell phone. An attendant said the majority of customers were patients. Those on the roadside said their days revolved around trips to the block, washing their few clothes and hanging them to dry on makeshift lines.

“Even if we got a place to stay it would be far away and then we’d have to spend 500 rupees on a taxi,” explained Usha Kumar, whose husband, Shiv Kumar, was being treated for mouth cancer, caused – she said – by his addiction to chewing tobacco. “It’s very tough. When it rains, the water comes inside the shack.”

The family had come several weeks ago from Jhansi in Uttar Pradesh, where they worked as day labourers. Mr Kumar had his operation three weeks earlier and they were unsure how much longer they would have to stay. His wife estimated there were 200 families in their position, camped out on the pavement. “I pray a lot for my husband – I hope gets better soon and we are able to go,” she added. “Sometimes the guards on the [underground railway] construction site tell us to leave.”

In recent years, doctors in India have expressed concern about the increasing occurrence of various forms of cancer, some suggesting it was the result of changing lifestyles and increasing urbanisation. A three-year study by the INDOX Cancer Research Network - a partnership between the University of Oxford in Britain and 12 Indian cancer centres - was launched last year to investigate the causes behind the apparent rise.

The network’s director, Dr Raghib Ali, said most data on cancer was based on Western studies and that this would allow research into two factors specific to India – the lifelong vegetarianism of 20 per cent of the population and the ubiquitous chewing of tobacco. “Some reasons suggested for the increase of cancer include increased smoking, increased urbanisation and the so-called Westernisation of lifestyles. But these things are hard to measure,” he said.

The Tata hospital was established in 1941 by the industrialist and philanthropic Tata family, founded by Jamsetji Tata. A hospital spokesman, S.H Jafri, said a family member had been sent to Britain for cancer treatment but died. The family had said that if a rich person could lost their life in such circumstances, then a poor person would have no chance and were inspired to fund the clinic.

Mr Jafri said the hospital currently treated around 40,000 patients a year and that more than 60 per cent of them paid a nominal fee. For 14 per cent of patients, there was no charge whatsoever.

On the matter of accommodation and people being forced to sleep on the street, he said space for 150 families was provided in the suburb of Bandra while there were other cheap options locally. “But [because] of our demands, we cannot do everything. People come here because of the treatment,” he said. “They don’t mind where they stay – they just want to be treated.”

The hospital in Mumbai’s Parel neighhourhood has given rise to a rush of thriving businesses, from cheap eateries to photo-copying shops and instant notaries, whose customers are clients.  There are also several charities which help the patients, providing meals and medicine for the poorest.

KH Saula set up his Jeevam Jyoti Trust 27 years ago and now his team feeds 600 people twice a day at three locations. He claims the number of cancer patients, including those forced to sleep on the street, is increasing every year. Most, he said, were obliged to stay between four months and two-and-a-half years for their treatment.

“It’s the spread of the disease,” he said. “It’s not just tobacco. Everything is artificial – vegetables, milk, steroid injections into cattle, artificial grains.”

Among those his organisation helps is Manisha Patel, a 30-year-old woman who has a two-year-old son, Ganesh. She had been brought here two years ago by her husband who abandoned her when it revealed she was infected with HIV. She receives treatment at another nearby hospital and sleeps under a tarpaulin on the pavement outside Tata Memorial. She said she had now idea how she got infected.

As for the future, her ambitions were modest. “The child is too small at the moment,” she said, hugging her little boy. “I am waiting for him to grow up so I can go to work and make some money.”