Last days of patients with least hope to survive
Patients at a ward of national cancer institute at Mohakhali.Photo: STAR
Mukta, a 22-year-old woman, was lying on a bed at the National Institute of Cancer Research & Hospital (NICRH). A veneer of bandage covered the two gaping wounds on her chest.
"I have pain," she said twice in a faint voice with a blank look on her face.
Sent from the Khulna Medical College where the doctors amputated her cancerous breasts, the young woman and her rickshaw-puller father from Satkhira now do not know where to go and what to do.
"I will tell you the medicines she needs. But will you be able to buy those?" said a doctor to the rickshaw-puller who has lost all his scant savings to provide his daughter with treatment.
"I have no money left to buy medicines. I don't know where will I go," said the father lamenting at his daughter's bedside.
Mukta is one of the hundreds of cancer patients coming to the NICRH from across the country who cannot afford expensive drugs.
"We are gathering whatever free samples we have to help out Mukta. But at the end of the day we will not be able to give medicines to all the patients unless the hospital has adequate supply," said the doctor.
In spite of the fact that this is the lone government specialised cancer hospital in the country most of the time the hospital has to face a shortage of drugs used in treatment of this killer disease.
Sources said the hospital gets insufficient supply of the required drugs from the government and the patients have to buy the rest from outside. But often the drugs are not available in medicine shops.
"For chemotherapy I will have to buy at least two drugs from outside which cost around Tk 10,000. My husband has spent all he saved in the last one year. If it really takes this much then I will go home and wait for the inevitable," said Shahnaz, suffering from uterus cancer.
Cancer patients from other hospitals in the city and around the country are mostly referred to this institute because of its specialised set-up.
"First I took my wife to Dhaka Medical College Hospital where the doctors fixed the schedule for her radiotherapy after 25 days which seemed too late for me. Then I brought her to this hospital and got a date within 10 days," said a garment worker who took his wife there.
In spite of the lack of drugs and many other problems, for the patients of low and fixed income brackets this is the only place where they can come for treatment of this deadly disease.
"Here one radiotherapy costs Tk 100. Sometimes I have to pay bribes to hospital staff. But if I take the therapy from private clinics then it would cost at least Tk 700. Treatment is, no doubt, cheaper at this hospital," said a patient.
A strong pungent smell greets one visiting the 50-bed ward of the institute. According to nurses there is only one bathroom for the 50 patients plus their attendants meaning at least another 50 people.
"There will be smell where there are patients. Besides, it is mixed with the smell of drugs," said a nurse.
Emergency service or emergency patient management is often impossible at the institute due to lack of a blood bank and 24-hour blood test facility.
"We don't have a blood bank. When a patient needs blood transfusion he has to collect it from outside. Sometimes we collect blood from DMCH. Often we don't have the time to collect the required blood," said a duty doctor.
"It is not possible to do emergency blood tests in the evening or at night at this institute as the blood test lab is closed after office hours," he added.
He pointed out that due to a lack of manpower they are missing the emergency services needed to save critical patients.
The institute is facing some other problems including absence of intensive care unit and unavailability of emergency drugs.
"Emergency drugs needed to treat high blood pressure and for blood reaction management are not available here. If the patient does not buy those beforehand then it is difficult to handle an emergency patient," said a doctor.
The institute needs 20 to 25 saline bags for inpatients and another 100 bags for outpatients every day. Each chemo patient needs 4 to 7 bags of saline a day. At the outdoor section, 60 patients takes chemotherapy every day.
On average 200 patients are given radiotherapy every day.
Institute sources said the government's annual supply of saline bags lasts for a few months. Most patients have to buy it from outside.
Shortage of beds is another problem. Many patients have to go back home as it is hard for them to get a bed at the institute. However, flooring is not permitted at this institute unlike many other government hospitals.
Cancer patients need nutritious food, which the institute is not able to provide. "I have started giving my patients rice starch and boiled potatoes to maintain the level of nutrition," said a doctor.
The institute is also facing a shortage of duty doctors, nurses and fourth-class employees. Only one doctor remains on duty at the afternoon shift (2:30 to 9:00pm) and night shift (9:00pm to 8:00am).
Seven nurses work in the morning shift where at least 12 are needed. Three or four nurses work in the evening where at least six are needed. These nurses have to do OT and postoperative duties too, said a nurse.
Many posts of fourth-class employees, like wards boys, aya and cleaners, remain vacant, said sources at the institute.
At present there is no ENT (ear, nose, throat) doctor at the institute. The ENT patients, numbering 30 a day on average, are being attended by surgical oncologists, said sources.
Occupational hazard is part of the job of nurses as they are exposed to the rays while delivering chemotherapy.
"We need to do some extra jobs like delivering chemotherapy. But we do not have training on that. Besides, we are exposed to rays. In developed countries they put on special garbs but here we try to protect ourselves by wearing masks and gloves only," said a senior nurse.
Asked, Prof AMM Shariful Alam, director, NICRH, said new posts have been created for a blood bank, which will be in the 150-bed new building of the institute now under construction.
He admitted the shortage in saline and drug supply.
"When the supply is finished the doctors contribute, Zakat money is utilised and the Department of Social Welfare also helps up," he said.
Asked about the shortage of duty doctors, he said "When we will shift to the new building we will have at least five duty doctors in a shift."
On the vacant posts he said, "We have written to the Ministry of Establishment to fill the vacant posts of fourth-class employees."
Volunteers at pain and palliative care clinic
At the initiative of the Department of Medical Oncology of NICRH, a pain and palliative care clinic was set up at the institute in November 2006 without any government funds, where terminally-ill patients are given pain management drugs and counselling.
On average, 8 to 10 terminally-ill patients come here every day.
Dr Parveen Shahida Akhtar, professor, Medical Oncology and initiator of the clinic, said most patients coming to this institute are poor and they come at an advanced stage of cancer due to lack of awareness.
A unique feature of the clinic is that relatives of cancer patients and cancer survivors work here as volunteers.
"While working here one day it came to my mind that young relatives of the patients can work for us for one or two hours as volunteers instead of just sitting here and attending the patients. When I proposed, they happily agreed. Besides, there are cancer survivors," said Dr Parveen.
Every day some five volunteers work at the clinic. "Most of them are from the working class but they do not take any remuneration from the authorities for their service," she said.
"I work here because I know the pains of a cancer patient," said a volunteer cancer survivor wishing not to be named.
"More volunteer service is needed to help poor patients coming from outside Dhaka. Due to lack of publicity most people do not know that here we have a palliative care clinic," said Dr Parveen.
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