Tuesday, August 20, 2013

Cancer Institue Adyar- A Centre for excellence

No story about the Cancer Institute, Adyar , located on a sprawling 9 acres campus, next to IIT Madras,  in Chennai, can be complete without a meeting with the living legend of the Institute, the Magsaysay Award winner, Padma Bhushan  Dr. V Shantha. Infact the Institute and Dr Shantha have become synonymous with each other over the years, because of her tremendous contribution to the phenomenal growth of the Institute against several odds.

I met her at her small office in the old campus of the Institute in Gandhi Nagar.  A diminutive lady who looks a little frail at 85, but still displays the same enthusiasm and energy when she talks about her favourite ‘temple’.  During the course of the interview she admits that she does not believe in going to temples as  she considers the Cancer Institute, where she has served for 60 long years, as her temple.  I responded  that for lakhs of cancer patients who come with hopes in their hearts  to the hospital  she and her team of dedicated doctors are like ‘Gods’, for which  she smiled.  She also mentioned that  she is never tired of talking about the institute and its growth story, the trials and tribulations that it has gone through  before  reaching the pre-eminent position it has reached today, in Cancer care.


Cancer Institute (WIA) was founded in 1952 as a voluntary charitable institute by Dr. Muthulakshmi Reddy, first Indian woman to graduate in medicine,  who was also the first woman to become a member and subsequently  the Vice President of Madras Legislative Assembly.  Loss of  her young sister to cancer affected her deeply which propelled her to institute a Cancer Relief Fund in 1949.

 It took her several years  to translate her dream of having a speciality hospital for Cancer to serve the growing number of poor patients. With relentless pursuit she managed to get a narrow strip of two acre land abetting the Buckingham Canal in Gandhi Nagar, Adyar. With the support of the Women’s India Association (WIA) of which she was a President for 30 long years. she started the first  Cancer Hospital in South India at Gandhi Nagar, Adyar. The foundation stone of the hospital was laid by Pandit Jawaharlal in Nehru in 1952 and inaugurated on 18th June,1954 by the then Finance Minster of the Government of India Shri C.D.Deshmukh. The facility with just 12 beds in a small hut was run right from the inception  by  Dr. S Krishnamoorthy(son of Dr.Muthulaxmi who passed away in 2010),  and Dr. V Shantha (both of whom were  earlier working with the Government General Hospital)  doubling themselves as doctors and assistants in the initial years.

Since the death of Dr. Reddy in July 1968  both  fought against all odds to keep the facility going,
According to Dr.Shantha right from the beginning it has been a running battle between  supportive and non supportive governments.  . Since the hospital is totally dependent on donations , in the initial years getting money to run the Institute  was itself a stupendous task. But thanks to the generosity of both  Corporate and individual donors and the dedicated team, the hospital has made tremendous strides and is celebrating its Diamond Jubilee this year, which was  inaugurated by the Chief Minister of Tamilnadu on 12 th June,2013.

The hospital which had a single  building with minimal  diagnostic and therapeutic facilities has now   become the  Comprehensive Care Centre for Cancer, comprising of a 450 bed hospital, a very active Research division, Dr. Muthulakshmi College of Oncologic Sciences and a Division of Preventive Oncology.

The patients,  mostly poor from across the country, come with fear in their minds  but hope in their hearts.  Every day the institute registers over 410 cases out of which  nearly 80% are poor, who are given totally free or highly subsidized treatment by the hospital.

The hospital treated over 1,40,000 patients in 2012, a phenomenal jump of  over 60% from a figure of  85000 patients it treated in 2000,  reflecting the growing incident of the dreaded disease in the country.

Today`s Research, Tomorrow`s Treatment

Dr . Shantha was proud to talk about the Research Centre in the hospital which  is recognized as a Centre of Excellence by the Department of Science and Technology of Government of India  and  comprises  Molecular Oncology, Electron Microscopy, Immuno Hematology and  a Tumor bank including Pathology.    Intense  research is also  going on in the Institue  for finding a vaccine for prevention of cancer. 
Another  area which  the department is researching is the  ‘gene profiling`’ of the disease, literally creating a horoscope of the disease for each patient.

Dispelling the concept of miracles in cancer cure, Dr.Shantha  said that all improvements in this area were a result of modern science, which today can provide ‘targeted treatment` for different types of cancers, resulting in a  much higher success rate.  Today the disease can be diagnosed even at the molecular stage (without any sort of growth / tumor or physical appearance, as such). If diagnosed early 65% of the Cancer cases can be treated and the patients can lead a normal life. It is no more a Killer disease as it was in the early years, because of the tremendous strides made in researching     the area of Oncology.

Education & Training

The institute introduced the concept  of  Oncology as  a Super Speciality as early as  1982  and started the first Super Speciality College in Oncology – Dr. Muthulaxmi College of Oncologic Sciences in 1984.  The Institute affiliated to Dr. MGR Medical University and Madras University offers courses in Surgical Oncology, Medical Oncology and Radiation Oncology.  Every year 18 students covering the three specialized fields pass  out of the college.  The college also offers para professional training covering a wide variety of support services. 

“I am happy to tell you that thanks to the efforts of the Institute in the area of education and professional training in cancer care, today cancer Hospitals across the country have doctors and support staff who have been trained at the Institute and who are all doing well.” Dr.Shantha referred to one Dr. Ravi Kumar, who moved out of the Institute to start a new Cancer Speciality Hospital in Silchar, Assam to provide free or subsidized cancer care  to poorer patients there with support and guidance from Cancer Institute , Adyar.

Pediatric Oncology

A visit to the Pediatric Oncology unit, located in the old hospital premises, will move  anybody.  This is the place where thousands of poor children from the villages of South India come for treatment of cancer – mostly cancer of lymphoblastic  Leukemia.    From a dismal 20% survival rate earlier, today the patients being treated at the State of the Art  Mahesh Memorial Pediatric ward, have a cure rate of 60%.  According to Dr. Shantha this can be increased if patients come in the earlier stages of the disease

The hospital was the first to establish a Pediatric Oncology unit in India as early as 1960.  In 2009 a Comprehensive Pediatric Oncology centre including long term survivor clinic  was established in the premises of Mahesh Memorial Pediatric Ward,  thanks to a generous donation from friends of Mahesh who himself was a patient at the Institute and survived the disease for over 12 years with excellent care from the doctors at the institute.

Prevention is better than Cure

At every forum and at every meeting she addresses  Dr Shantha is never tired of emphasizing the importance of prevention of cancer, through education of the people. According to her, “Lung Cancer  is the top killer among men mainly due to tobacco related habit, whereas among women breast and cervix cancer are most common.  Both these cancers can be detected early through simple check -ups.  Apart from regular mammograms, it will be a good idea for women to physically check up for any lumps in their breasts regularly and also consult gynecologists if they find any unusual discharge between two  periods”.
The department of Preventive Oncology established by the hospital is a mission of service which reaches out to every nook corner of the state through seminars, lectures, screening  camps conducted by specially trained  Village Health Nurses (VHN) and multipurpose workers in the early detection of cancer of the cervix, oral cavity and female breast.
The tobacco cell in the institute is aggressively involved in the anti-tobacco programme with numerous cessation  classes in schools and colleges.

 Demographic Cancer Registries

When I asked Dr.Shantha why patients are asked very detailed questions regarding not only symptoms but also a lot of personal and family details before they are registered as patients at the Cancer institute. she said, “ it is to help compile the Demographic registry of the disease maintained by the Hospital”.

The Madras Metropolitan Town Registry is one of the oldest demographic registry in the country established in 1984 that provides data on cancer incidence, mortality and long term survival on all treated cases.  The institute is the only centre that provides life time  follow up of patients.

In 2012 the Institute  launched a joint effort with the Dept. of Health and Family Welfare, Government of Tamilnadu , to start the largest population based Cancer  Registry in the world covering 72 million people of Tamilnadu. The information collected through such efforts is of immense help for researchers doing research on the subject. This initiative was one of the faciilities inaugurated by the Chief minister at the Diamond Jubilee celebrations

Leader in Diagnostic  & Treatment facilities

According to Dr. Shantha, Cancer Institute  is always the first to buy any latest equipment  related to diagnostic and treatment of Cancer because of its ability to take quick decisions and with help from supportive  Corporate and Individual donors who are willing to help the hospital,   whatever may be the cost. The Institue was the first

a.        to introduce super voltage era  in Asia  with the installation of Cobalt Therapy unit  in 1956.
b.      to install an Indigenously  built  Caesium Tele  Curie  therapy unit  in 1962
c.       have an indigenously  designed Therapy Simulator in 1968
d.      to Introduce the Hyperbaric Oxygen Therapy in 1978 and at present the only place where the facility is available. In the same year it also introduced the first blood compound unit, using the blood cell separator in  the  supportive treatment of high dose chemotherapy and Hyperbaric Oxygen Therapy.
e.      Installed  the first intraoperative Radio therapy (IORT) and Brachy therapy (CITRON) between 1995-98
f.         Acceleraor  Clinac 2300 C (a) the first conformational therapy unit installed in 1999
g.       First Rapid Arc Accelerator installed in 2009

The State of the Art Accelarator for Radio therapy costing Rs. 12 crores, with a grant of Rs 6 crores from  Government  of India was also inaugurated by the Chief Minister as a part of the Diamond Jubilee celebrations.

Transforming quality of Cancer care

The hospital was also very fortunate to have Tata Consultancy Services (TCS) the top  IT company in the country, providing a state of the art Hospital Management System `MED Mantra,` and also maintaining the same totally free. Operational since 2010, Med Mantra has helped the institute automate all administrative, Clinical and Nursing, Patient admission and transfer and all imaging functions.  All the information pertaining to a patient is securely stored and accessible to an authorized  doctor at the  click of a mouse.  This information system, unique to Cancer Institute,  enhances the quality of care for all patients besides providing easy access of data for research.

I had the opportunity to see the system in operation when my wife was admitted for treatment at the Institute. Whether it was the specialist medical oncologist or the duty doctor ,they could get complete details of the diagnosis, and progress of the treatment at the click of a button which ensured that every doctor attending on my wife was fully aware of her case.


 Expounding on the philosophy of the hospital Dr.Shantha said, “the institute believes in offering the same kind of care to both paying and non paying patients.  Patient care is foremost.  Returns are secondary.  If the institute can save a patient with its expertise, it will do so . It will never  turn him back because he cannot afford the treatment.  Affordable and equitable treatment for all is the mantra at the cancer institute”.

At the end of the interview, I posed a question to Dr. Shantha regarding the future of the institute. When I asked her “After Dr. Shantha, who?” she smiled and said, “the current Director of the Institute Dr. T G Sagar, who himself has been with the institute for over 40 years and his team of dedicated doctors and staff , I am sure,  will carry the vision of the founder, in the years to come!”

Having had a first hand experience of dealing with the hospital as an attender of a patient I have no doubt that the Cancer Institute will continue to serve the poor and needy with compassion and commitment in the future with or without Dr.Shantha.

Wednesday, August 14, 2013

Joint & Nuclear families

As a recent `widower` the one question that I face repeatedly from well wishers is “What do you do for your meals?” I tell them that it is the least of my problems because apart from my own ability to cook a decent meal, I  also get to enjoy a variety of dishes cooked by my siblings  and children who live nearby.

We all know how the breaking down of the joint family system and the rise of nuclear families has badly affected the senior citizens and children in the families.  However,  there is an idea which is beginning to provide a solution to this problem.  The concept of joint and several families.

Thanks to my father’s dream, I am a part of one such  J & N family  now.  Let me elaborate.

My sister and I had bought a plot of land in Sastri Nagar, Adyar in South Madras, a few years ago.  Within the 2 ½ ground property, which was shared equally by us, we both built our independent homes, with living accommodation on the ground and first floors.

While my son’s family lives with me now  on the first floor, my younger brother’s family lives above my sister’s home.  Each house with an independent kitchen, separate entrance offers the members of the families, the space that they need for themselves .

There are many other advantages  too. The most obvious is the guaranteed support that each family enjoys from the other families whenever they need any form of help.  Including the guarantee of security of the home when any family decides to go on an outstation trip. While the elders have the advantage of getting the attention from some member of the family, the growing up children do not have the problem of coming back to an empty home when  both parents are working.  There is always somebody or the other in one or more of the houses to take care of them, in case of necessity.  Presence of elders also help the children learn family values.

If any member falls sick, there is someone in the family to offer help. In case of hospitalization of any member for any  reason, the support system ensures that members in the joint families take turns to don the role of attenders at the hospital.

If there is a problem of cooking at anyone’s house for some reason or even if the lady  of a  house is lazy  to cook on a particular day, cooked items  from other homes are sent to tide over the situation.

Similarly, any occasion for celebration in one family is celebrated by all the families.  There is no question of forgetting anybody’s birthdays or wedding anniversary or any other occasion which deserves a celebration.  I have been a great believer in the concept of  “Celebrate life”.  We practice this by having family get-togethers, at the  drop of a hat in which besides the families in our compound, other relatives often join in.

I know of a few friends who practice this concept in the flats they own along with their siblings in the apartment complex built at the site of their ancestral property.  If all the family members live in the same city it makes  sense for them to live under one roof with different kitchens than live far away from each other.

For those nuclear families who live in apartment complexes on their own without any siblings and relatives living nearby, I have a word of advice.  Cultivate your neighbours and other friends in the apartment complex to develop a support system of your own consisting of a few good  friends. Remember you have to be good to them first before you expect them to return the favour.  It will greatly  help in countering  the  negative aspects of living as a nuclear family. 

That is what many  NRI children, who do not have the advantage of getting International Ayah Service (IAS) from  their old parents do when they are living abroad! They  form their support group of friends who help each other in times of crisis or even when they need someone to look after their kids when they are busy otherwise!

Every problem has a solution.  Since the concept of nuclear families has come to stay. it is upto each family to find a solution to the problems  created by being in a nuclear family.  The joint and several family is one such solution.