Jovia, who died on Apr. 29, 2016, suffered from both HIV/AIDS and cervical cancer, a deadly combination affecting thousands of women in Uganda. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Uganda, Jul 25 2016 (IPS)

Lying on a dirty bed in a crowded, squalid hostel in Kampala, emaciated Jovia, 29, managed a weak smile as a doctor delivered her a small green bottle containing a liquid.

“I’m so happy they’ve brought the morphine,” the mother told IPS, just about the only words she could get out during what would be the last weeks of her life. “It controls my pain and makes my life more bearable.”“As long as radiotherapy is not available in Uganda many more patients will die.” -- Dr. Anne Merriman

Jovia was suffering from both HIV/AIDS and cervical cancer, a deadly combination affecting thousands of women in Uganda. While the east African country had huge success in the battle against the HIV virus in the 1990s, cervical and other cancers are the new health crises gripping the developing nation. One in 500 Ugandans suffers from cancer. But only five per cent of patients will get any form of treatment, facing an often tortuous death.

Thanks to Hospice Africa Uganda (HAU), founded 23 years ago by the 2014 Nobel Peace Prize Nominee, British-born Dr. Anne Merriman, patients like Jovia are given not only affordable pain-controlling oral liquid morphine, but comfort, hope and dignity in their last days.

At 81, Dr. Merriman is credited with introducing palliative care to Africa. HAU has cared for a total of 27,000 seriously ill and dying people since 1993, the vast majority with the morphine made at its Kampala headquarters for just two dollars a bottle, with government funding.

In Uganda, cancer is usually diagnosed quite late, due to poor screening and lack of health services. According to the country’s Uganda Cancer Institute (UCI), 80 per cent of sufferers die because of late diagnosis.

For patients like Jovia, who passed away peacefully on Apr. 29, leaving a daughter, 14, radiotherapy can cure or extend life when treated in early stages.

A tray of morphine at Hospice Africa Uganda. Credit: Amy Fallon/IPS

But in early April, Uganda’s only radiotherapy machine broke beyond repair. It was used by about 30,000 cancer patients annually. Since then, thousands in need of radiotherapy to cure their cancer, or extend their lives, have been left without vital treatment.

The Ugandan government had purchased a new machine, worth a reported 500,000 dollars, three years ago, but it could not be delivered as special bunkers needed to house the machine had to be built.

Facing an uproar from within Uganda at the lack of radiotherapy services, the government promised a new bunker would be built within six months. Aga Khan University Hospital in Nairobi, Kenya, offered free treatment for 400 Ugandan cancer patients. The plan was that they would be sent there by the Ugandan government through the UCI.

But more than three months later there is still huge confusion and contradictory reports and statements about the delivery of this promise, and controversy over the delay in getting desperate patients. Despite repeated requests for clarification the UCI nor Uganda’s ministry of health are able to state exactly how many patients – if indeed any – have yet been sent to Kenya for treatment.

Christine Namulindwa, UCI’s public relations officer, pointed out patients going to Nairobi have to go through an “evaluation”, and be approved by a board.

“So far we’ve submitted 15 names to the ministry of health and more are yet to be submitted,” she said last month. The pledge for free treatment from Aga Khan did not cover the cost of transporting patients and upkeep while in Nairobi, she said.

She said there were “patients who are still waiting” and referred IPS to the health ministry for further questions.

On July 1, Professor Anthony Mbonye, Acting Director General of Health services, told IPS via email the ministry of health had “received a budget for supporting patients to Aga Khan and will provide transport and funds for maintenance”.

A lawyer had “cleared a memorandum of understanding between Aga Khan and UCI,” he said.

“The radiotherapy machine was bought, but the bunker is yet to be rehabilitated. In two months’ time the machine will be installed and services will resume.”

Stories in East African papers in early July reported that the “long wait” was “over” for patients, after Aga Khan signed an MOU with UCI, allowing 400 out of 17,000 patients to “receive treatment”. But they did not give a date for when they would go to Kenya.

Another report said only tumour patients with chances of survival, but including those suffering breast and cervical cancer, would be transported to Kenya using government vans. It said accommodation and other support services were being organised by Uganda’s High Commission in Nairobi, and 20 patients have been approved to go. But again it gave no specific date for their transportation.

Two of seven patients have been treated at Aga Khan not through the UCI and the Ugandan government, but through a partnership with HAU and Road to Care, a programme developed by Canadian doctor Joda Kuk. He set up scheme in 2011 after he witnessed women with cervical cancer in rural areas of Uganda needing desperate assistance to get to Kampala for radiotherapy.

Mary Birungi and Mary Gahoire, a mother of three, both from western Uganda, returned home the week of July 21 after travelling to Kenya by road, being housed by Road to Care and completing radiotherapy treatment there. They are now back with their families.

Two more patients are in the middle of treatment this week and and two more will travel to Kenya. The seventh patient is due to go there in the first week of August.

Dr. Anne Merriman pleaded with the Ugandan government to do all in its power to complete the building of the new bunkers so the new radiotherapy machine can be commissioned as soon as possible.

“We are so happy that under Road to Care seven of our patients will be treated in Kenya, but this is just a drop in the ocean,” she said. “The need is huge. There has been so much confusion since the machine broke down, causing huge stress to patients and families. “

“As long as radiotherapy is not available in Uganda many more patients will die.”

On July 23, Professor Mbyonye told IPS that “some” patients have gone to Kenya and had already come back through the agreement between the health ministry and Aga Khan, but couldn’t give more details.

For many though, it’s too late.

Vesta Kefeza, 49, a mother of seven, has advanced cervical cancer. Lying on a mattress on the ground of her one-room home in Namugongo slum, Kampala, she is immobile, as her leg has ballooned due to a complication from the cancer.

She has been on HAU’s programme since 2011 and is administered morphine by their nurses. Uganda became the first country in the world to allow nurses to prescribe the drug in 2004. The hospice team also provides food and spiritual support.

In June, thanks to a donation from Ireland, Kefeza received a wheelchair, allowing her to get out into the fresh air and go to church.

“Until then I lay in bed all day,” she said. “I thank God for my blessings. I am lucky to have HAU caring for me.”

A hospital in Srinagar, Kashmir. Credit: Umer Asif/IPS

By Umar Shah
SRINAGAR, India, Dec 18 2015 (IPS)

In an isolated ward of one of Kashmir’s largest government-run hospitals, 54-year-old Ashraf Ali Khan is finding it hard to sleep properly. His 15-year-old son, Asif, is sitting on a bench near the bed staring at his ailing father.

Asif has not been told by his family that his father is suffering from a potentially terminal disease cancer. He knows his father is suffering from a consistent fever which sent him to the hospital, but doesn’t know his father is in the last stage of the crippling disease.

Ashraf Ali, a carpenter, went to the doctor eight months ago after persistent coughing. He had a chest X-ray which then led to further examinations. After series of tests, it was finally he was diagnosed with lung cancer. He has two months to live at best.

Ashraf is among thousands of people who have ben struck down with the disease. In a war-torn Kashmir, about 4000 cases are found every year in this Himalayan region.

Apart from the political uncertainty, which so far has claimed thousands of lives, experts says there is a 20 per cent rise in cancer cases in Kashmir with figures never decreasing. The latest data published by the state’s health department has Kashmir topping the list of cancer cases in India.

The data reveals in the past three years, more than 1,700 people have died due to cancer in Kashmir. It says that since January 2014 there were 12,091 patients who were detected with cancer in various state hospitals. In 2013, 6,300 patients were detected with the killer disease.

The top 10 cancers taking a toll in Kashmir are lung cancer, stomach, colon (large intestine cancers), breast, brain, esophagus (cancer of food pipe), non-Hodgkin’s lymphoma, gastroesophageal, junction cancer (cancer between the stomach and food pipe), ovarian and skin cancers.

Experts say the cancer mortality rate among the people in Kashmir witnessed a sharp increase due to some leading behavioural and dietary risks, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and lack of regular check-ups. Changing lifestyle, environmental degradation and differing food habits are reasons attributed to the surge in all the cancers especially in esophagus, colon and breast cancers.

Kashmir’s leading oncologist Mohammad Maqbool Lone says the situation in Kashmir is becoming more grim every day a with the highest number of lung cancers In the country found in the people of Kashmir.

“The situation is indeed alarming in Kashmir. There are patients hailing from every part of Kashmir including the far flung areas which are diagnosed with such a terminal disease,” says Lone.

Until now no single factor has been identified as the main cause of the rising cancers as compared to other regions of India. As health experts in Kashmir are not certain about the major causes for the rise of the deadly disease, they suspect three main components can trigger the rise of cancer in this Himalayan region.

One is a societal component with poor rural lifestyles and general deprivation, in particular a lack of vitamins and dietary nutrients.

The second reason for rising cancers in Kashmir is the use of copper utensils in cooking, the consumption of spicy, deep fried foodstuffs, and the drinking of hot salty tea which is largely being consumed in every home in Kashmir.

The third factor in rising cancer cases is an environmental issue with exposure to high levels of dietary nitrosamines from diverse sources. Overall, these three components are the general pattern that has led to esophageal and other cancers.

Oncologist Abdul Rashid Lone says that rising numbers of smokers has led to a rise in lung cancers here. He also claims that the detection rate also has increased besides the advancement in medical technologies.

“Earlier, most of the cancer cases in Kashmir used to go unnoticed. At present, the technology has advanced so much that a patient can be diagnosed with the disease. This is the main reason that today we say cancer cases rise in Kashmir,” Dr Lone said.

Oncologist Riyaz Ahmad Shah says that apart from the lung cancer, there are cases of stomach cancer on the rise in Kashmir. He says certain types of cancers are found in children including blood cancers and tumours.

“In case of females, there are cancers related to the reproductive system like cervical cancer, ovarian tumours and breast cancer. In males there are stomach, lung, and esophagus cancers found,” said Dr Shah.

Renowned gastroenterologist, Dr Showkat Ahmad Zargar, says any delay in the detection of cancer could prove fatal for the patient. He says due to the massive adulteration in food items, gastric diseases are on rise in Kashmir.

“Such diseases are killing people slowly. The people here are not very much health conscious which leads to the delay in detecting whether a person is suffering from a cancer or not,” Dr Showkat said.

“There are high chances that a person suffering from cancer can be cured if detected at early,” said Dr Sana-ul-lah who heads the oncology department in one of Kashmir’s leading government run hospitals.

Tobacco use in Kashmir has increased along with unhealthy diets. “If the key risk factors are avoided, Kashmir could be saved from this fatal disease which continues to claim thousands of precious lives every year in the region,” Dr Sana-ul-lah said.

Insha Usman, a research scholar says there are no major steps being taken by the state government to ensure that people are informed and are aware of cancer. She says early symptoms and preventive measures should be made public in far flung areas of Kashmir so that people are conscious of the cancer threat.

“Ironically, there is no comprehensive policy available with the government at the present time that could have made people aware of such a fatal disease. Mass awareness campaigns in villages and towns and people are informed about the symptoms of cancer and early treatment,” she said.

According to the latest study, colorectal cancer (CRC) is the major cause of mortality and morbidity worldwide and in Kashmir, CRC has been found to be the third most common gastrointestinal cancer after esophageal and gastric.

The study says there are certain factors which increase person’s risk of developing CRC. “The most important of these are the age, diet, obesity, diabetes and smoking, personal cancer history, alcohol consumption, large intestinal polyps, family history of colon cancer, race and ethnic background, genetic or family predisposition,” said the finding.

It adds that another major cause of cancer deaths was a late visit to the doctor. “The involvement of quacks, inexperienced medical practitioners and post-referral delays make the situation difficult to handle,” the study concluded.

The steady rise in cancer patients began several decades ago leading to the establishment of an NGO. The Cancer Society of Kashmir, formed in 1999, provides medical and financial help to poor patients suffering from the dreadful disease here.

Masood Ahmad Mir from Cancer Society of Kashmir says that they have started a one-day care centre which runs twice a week. “During this time, doctors from different fields like medical oncology, radio oncology, and gastroenterology sit together and treat patients. We do not charge anything from the people who visit us for the treatment,” he said.

(End)

Many specialist doctors and nurses in Africa are migrating to greener pastures, leaving cancer patients with few options. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Feb 13 2015 (IPS)

Hidden by the struggles to defeat Ebola, malaria and drug-resistant tuberculosis, a silent killer has been moving across the African continent, superseding infections of HIV and AIDS.

World Cancer Day commemorated on Feb. 4 may have come and gone, but the spread of cancer in Africa has been worrying global health organisations and experts year round. The continent, they fear, is ill-prepared for another health crisis of enormous proportions.

By 2020, according to the World Health Organisation (WHO), approximately 16 million new cases of cancer are anticipated worldwide, with 70 percent of them in developing countries. Africa and Asia are not spared.“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, private oncologist in South Africa’s Eastern Cape Province

“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, a private oncologist in South Africa’s Eastern Cape Province, told IPS.

“Africa and its leaders have failed to recognise cancer as a high-priority health problem despite millions of people succumbing to the disease,” added Thabane.

Most of Africa’s 2,000 plus languages have no word for cancer. The common perception in both developing and developed countries is that it is a disease of the wealthy world, where high-fat, processed-food diets, alcohol, smoking and sedentary lifestyles fuel tumour growth.

While many cancers are linked to unhealthy diets and smoking, a large number – particularly in Africa – are caused by infections like hepatitis B and C which can lead to liver cancer and the human papillomavirus (HPV) that causes almost all cervical cancers.

An HPV vaccine treatment costs 350 dollars for three doses over six months in most sub-Saharan African countries, whereas in Zimbabwe radiotherapy costs between 3,000 and 4,000 dollars for a whole session.

A study published in 2011 found that since 1980 new cervical cancer case numbers and deaths dropped substantially in rich countries, but increased dramatically in Africa and other poor regions. Overall, 76 percent of new cervical cancer cases are in developing regions, and sub-Saharan Africa already has 22 percent of all cervical cancer cases worldwide.

According to Zimbabwe’s Ministry of Health and Child Care, the country only has four oncologists catering to over 7,000 cancer patients nationwide. “The shortage of cancer doctors stands as an impediment to comprehensive treatment and care for cancer patients here,” Dr Prosper Chonzi, director of Health Services in the Zimbabwean capital, Harare, told IPS.

The shortage of cancer specialists is also seen in West Africa.

Last year, The Vanguard, a Nigerian newspaper, reported that there were an estimated 60 oncologists serving over 300 million people in the West African sub-region with fewer than 20 oncologists serving 160 million Nigerians. Ghana has only seven for 24 million people, Burkina Faso two and Cote D’Ivoire just one. Sierra Leone has more than six million people and no cancer doctors.

Across the continent in Kenya, cancer accounts for approximately 18,000 deaths annually, with up to 60 percent of fatalities occurring among people who are in the most productive years of their life. Men are most commonly diagnosed with prostate or oesophageal cancer, and women are most frequently affected by breast and cervical cancer.

Zimbabwe’s health activists blame the absence of cancer education for the upsurge of fatal cases in the African nation. “Very few people, including government, consider cancer a real threat to the health delivery system,” Agnes Matutu, director of the Zimbabwe Cancer Alliance, an anti-cancer lobby group here, told IPS.

Melody Hamandishe, a retired government nutritionist, told IPS she blamed imported genetically modified foods. This contributes to cancer, she said, as does the abuse of alcohol, often causing liver cancer.

In Zambia, anti-cancer activists accuse the government of not prioritising the fight against the disease. “People are perishing in huge numbers because of cancer here in Zambia while government is seized with fighting HIV/AIDS,” Kitana Phiri, a cervical cancer survivor, now a devoted anti-cancer activist based in the Zambian capital, Lusaka, told IPS.

In Tanzania, cancer is also wreaking havoc. A January 2014 report by the Ocean Road Cancer Institute (ORCI), the only specialised facility for cancer treatment in this east African nation, said there are 100 new patients in every 100,000 population out of the country’s population of 45 million.

Finally, in Namibia, uranium workers were reported to have elevated rates of cancers and other illnesses after working in one of Africa’s largest mines.

Rio Tinto’s Rössing uranium mine extracts millions of tonnes of rock a year for the mineral. “Most workers stated that they are not informed about their health conditions and do not know if they have been exposed to radiation or not. Some workers said they consulted a private doctor to get a second opinion,” say researchers at Earthlife Namibia and the Labour Resource and Research Institute who collaborated in a study.

“The older workers all said they know miners dying of cancers and other illnesses. Many of these are now retired and many have already died of cancers,” says the study report.

Cancer is not beyond us in terms of cancer control and reducing the impact of the disease, declared the Cancer Association of South Africa (CANSA) on World Cancer Day this year.

“The global cancer epidemic is huge and set to rise,” said Elize Jourbert, head of CANSA. “In South Africa, more than 100 000 are diagnosed annually. This day helps us spread the word and raise the profile of cancer”.

Under the tagline ‘Not beyond us’, World Cancer Day in South Africa focused on taking a positive and proactive approach to the fight against cancer, highlighting that solutions do exist regarding cancer care and early detection and that they are within reach.

Meanwhile, Ellen Awuah-Darko, the 75-year-old founder of the Accra-based Jead Foundation for breast cancer, says it was her personal experience of finding a breast lump and ending up paying tens of thousands of dollars to be treated in the United States that made her start to push for change.

“In America I had to put down 70,000 dollars before they’d even talk to me,” she said in an interview with Reuters. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women a simple breast examination and show them how to check themselves.

“Early detection can save your life,” she said. “I want everybody to know that. It’s not something people should be ashamed of or embarrassed about.”

Edited by Lisa Vives/Phil Harris    

Local women's NGO, Vois Blong Mere, campaigns for women's rights in Honiara, capital of the Solomon Islands. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Jan 28 2015 (IPS)

Women now face a better chance of surviving breast cancer in the Solomon Islands, a developing island state in the southwest Pacific Ocean, following the recent acquisition of the country’s first mammogram machine.

But just a week ahead of World Cancer Day, celebrated globally on Feb. 4, many say that the benefit of having advanced medical technology, in a country where mortality occurs in 59 percent of women diagnosed with cancer, depends on improving the serious knowledge deficit of the disease in the country.

"While cancer is included on the NCD [non-communicable diseases] list, very little attention and resources are specifically addressing women and breast cancer awareness." -- Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji
“Breast cancer is a health issue that women are concerned about in the Solomon Islands, but adequate awareness of it among women is not really prioritised,” Bernadette Usua, who works for the local non-governmental organisation, Vois Blong Mere (Voice of Women), in the capital, Honiara, told IPS.

Rachel, a young 24-year-old woman living with her two children, aged three and five years, in one of the country’s many rural villages, did not know what breast cancer was when she detected a lump in her breast in August 2013.

But the lump grew larger prompting her to travel to Honiara several months later to see a doctor.

“She went to the central hospital and was advised to have her left breast removed, but due to the little knowledge that she and her husband had about what it would be like, both were afraid of the surgery,” Bernadette Usua, who is Rachel’s cousin, recounted.

“So they just left the hospital without any medication or other assistance, and went home,” she continued.

Rachel tried traditional medicine available in her village, but the cancer and pain became more aggressive. Usua remembers next seeing her cousin in July of last year.

“She was sitting on her bed night and day with extreme pain, unable to lie down and sleep. But she was still brave as she nursed herself, washed herself and cooked for her children. She cried and prayed until she passed away in September,” Usua recalled.

Breast cancer is the most common cancer in women worldwide and in the Solomon Islands, where it accounted for 92 of more than 200 diagnosed cases in 2012. But its incidence in the developing world, where 50 percent of cases and 58 percent of fatalities occur, is rapidly rising.

Low survival rates of around 40 percent in low-income countries, compared to more than 80 percent in North America, are due mainly to late discovery of the disease in patients and limited diagnosis and treatment offered by under-resourced health centres.

Last year Annals of Global Health revealed that of 281 cancer cases identified in women in the Solomon Islands in 2012, 165 did not survive, while in Papua New Guinea and Fiji fatalities occurred in 2,889 of 4,457, and 418 of 795 diagnosed cases, respectively.

Insufficient public knowledge about the disease is an issue across the region.

“Currently public health education and promotion is focussing heavily on the control of NCDs [non-communicable diseases] as a whole. While cancer is included on the NCD list, very little attention and resources are specifically addressing women and breast cancer awareness,” said Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji, a Pacific Island state home to over 880,000 people.

In the Solomon Islands, mammograms, or x-rays of the breast, will now be free to all female citizens who comprise about 49 percent of the population of more than 550,000. This is after installation of digital mammography equipment, funded by the national First Lady’s Charity, in Honiara’s National Referral Hospital.

Dr. Douglas Pikacha, general surgeon at the hospital, explained that mammograms were vital to early detection of breast disease and the saving of women’s lives through early treatment, such as surgery and chemotherapy.

Mammography is considered the most effective form of breast cancer screening by the World Health Organisation (WHO), with some evidence that it can reduce subsequent loss of life by an estimated 20 percent, especially in women aged 50-70 years.

But with more than 80 percent of the population residing in rural areas and spread over more than 900 different islands, Josephine Teakeni, president of Vois Blong Mere, is deeply concerned about the fate of many women who are located far from the main health facilities in the capital. An estimated 73 percent of doctors and all medical specialists in the country are based at the National Referral Hospital.

She says that reliable breast cancer screening and diagnosis is urgently needed in provincial hospitals if the mortality rate is to be reduced. Most patients must travel an average of 240 kilometres to reach the National Referral Hospital, commonly by ferry or motorised canoe, given the prohibitive expense of internal air services.

There is also a critical shortage of health care workers in the country with 0.21 doctors per 1,000 people and Teakeni claims that “while waiting for an operation the delay can result in full advancement of the cancer and death.”

However, there is a further challenge with almost half of all women diagnosed with breast cancer refusing a mastectomy, which involves the partial or entire surgical removal of affected breasts, even though it may result in the patient’s recovery, the Ministry of Health reports.

“Many prefer traditional treatment to mastectomy because they believe it is more womanly to have their breast than to live without it,” Pikacha said.

The high risk of cancer mortality is another factor impacting gender inequality in the Pacific Island state where entrenched cultural attitudes and widespread gender violence, experienced by 64 percent of women and girls, hinders improvement of their social and economic status.

Teakeni believes that an urgent priority is dramatically improving “awareness among women about the signs and symptoms of breast cancer, and even simple tests that women can do themselves, such as checking the breast for lumps while having a shower,” as well as the importance and impact of medical treatment.

Still, the installation of the new mammogram machine gives women on this island something, however small, to celebrate.

Edited by Kanya D’Almeida

Distribution of Cancer Cases in Jordan

By IPS Correspondents
AMMAN, Apr 11 2014 (IPS)

Infographic- Global Cancer Incidence vs. Mortality by Region

By IPS Correspondents
UNITED NATIONS, Apr 10 2014 (IPS)

Infographic- Highest Cancer Rates vs. Highest Cancer Mortality

By IPS Correspondents
UNITED NATIONS, Apr 10 2014 (IPS)

Top 10 Cancer Diagnoses in Peru

By IPS Correspondents
LIMA, Apr 10 2014 (IPS)

Claudia Alvarado, with her parents and her nail polish, who along with Peru’s Plan Esperanza have helped her to bravely face the treatment for leukaemia. Credit: Milagros Salazar/IPS

By Milagros Salazar
LIMA, Apr 10 2014 (IPS)

Her tiny fingers and toes have been painted with different shades of nail polish, the bright colours contrasting sharply with the bleak road she has been on for half her young life.

Since she was three years old, Claudia, who has not yet turned seven, has been fighting leukaemia, with the help of a public health cancer treatment programme in Peru: Plan Esperanza or Plan Hope."When you are diagnosed with breast cancer, you immediately think your life is over. But if you find out there is a programme that can help you, you carry on and fight." -- Susana Wong

As in the rest of the Americas, cancer is the second cause of death here, following cardiovascular disease. In this country of 30.5 million people, the annual death toll from cancer is 107 per 100,000 population, and each year 45,000 new cases are diagnosed, according to the Health Ministry.

The ministry estimates that 157 people per 100,000 population suffer from cancer in this South American country.

To bring down these statistics and the high costs of cancer treatment, the Peruvian government launched Plan Esperanza in November 2012. The programme is aimed at improving comprehensive treatment for cancer patients and providing guaranteed oncology services, especially for the poor.

Claudia Alvarado was diagnosed with leukaemia in June 2010. Since then, she has undergone constant lab tests and often painful treatments.

Attending school and having friends have been replaced by long, exhausting trips between hospitals in Lima, the capital, and La Libertad, the northern department where she used to live.

Her hometown is Santa Rosa, a community of rice farmers. Her mother, Ivon Sánchez, told IPS that the one-hour bus ride to the public hospital in the city of Chepén took them through “three ghost towns.”

From Chepén, Claudia was referred to a public hospital in Chiclayo, the capital of another northern department, Lambayeque. And from there she was sent to the National Institute of Neoplastic Disease (INEN) in Lima, another public health institution.

At the institute, she underwent an aggressive treatment programme, which was fully covered by the Intangible Solidarity Fund for Health (FISSAL), which finances care in cases of high-cost health problems like cancer for those affiliated with the national Seguro Integral de Salud (SIS – Comprehensive Health Insurance).

The SIS also provides free healthcare for people in the fourth or fifth income quintiles, such as Claudia’s family.

In January 2012, Claudia suffered a relapse. Her mother remembers that she broke down in grief and anger because she knew the term “relapse” might be a euphemism for a journey with no return.

The only option was a bone marrow transplant. But the tests showed that Claudia’s brother, 12-year-old Renzo, was not compatible as a donor. “We thought it was all over,” Claudia’s mother said.

But in November 2012, the government launched Plan Esperanza, and that year the SIS and FISSAL signed international agreements with two hospitals in the United States to perform bone marrow transplants on children who had not responded well to chemotherapy or who had suffered relapses.

Claudia received the transplant on Sep. 6, 2013 in the Miami Children’s Hospital in the U.S.

The operation took eight hours, followed by 28 days of fever as high as 40 degrees C.

She pulled through and flew back to Lima with her mother in December. Since then she has continued to fight her illness, in the house the family has rented in a poor district in the south of Lima, where IPS visited her.

Her family moved to the capital in order to be together, and her father, Fortunato Alvarado, left his job as a farm labourer and now works as a taxi driver.

As Claudia waits for the 200 critical post-operation days to pass, she has to rest and avoid active play, while staying away from other children to keep from getting sick. Her skinny body weighs just 18 kilos.

She is disciplined about taking her medicine, and eats lemon drops after swallowing the most bitter-tasting pills.

Up to late 2013, Plan Esperanza, whose services are completely free of charge, had benefited 57,531 people, with a total public spending of over 6.4 million dollars. The Plan also includes nationwide campaigns for cancer prevention and diagnosis.

So far 600,000 people have participated in mass screenings for early cancer detection, and three million people nationwide have received counselling and advice, oncologist Diego Venegas, the coordinator of Plan Esperanza, told IPS.

“The important thing is to provide patients with complete treatment, in order to save their lives,” he said.

Of those diagnosed, 75 percent had advanced stage cancer, so the plan began to include home treatments.

Venegas explained that treatment under the Plan is initially reserved for the nearly 13 million affiliates of the SIS.

The most common forms of cancer covered by FISSAL funds are cancer of the cervix, breast, colon, stomach, prostate, leukaemia and lymphoma.

Forms of cancer that are not included in the Plan are still treated free of charge for SIS affiliates.

Treatment in each case costs an average of 260,000 dollars.

In the case of Claudia, the costs of the transplant in Miami, the plane tickets for the patient and her mother, and the six-month stay in the U.S. amounted to more than 300,000 dollars. Added to that are the costs of the chemotherapy and medicines she received in Peru before and after the transplant.

Susana Wong, president of the Club de la Mama (Breast Club) at the National Institute of Neoplastic Diseases, has seen hundreds of breast cancer patients who have benefited from Plan Esperanza.

“People now have a chance to live, because treatment is very expensive. When you are diagnosed with breast cancer, you immediately think your life is over. But if you find out there is a programme that can help you, you carry on and fight,” Wong, who was diagnosed with breast cancer in 2006, told IPS.

Dr. Miguel Garavito, the head of FISSAL, said the state funding is compensated by the large number of patients – mainly from poor families – and the success of the transplants.

“Peru is one of the few countries in the world that have this kind of free coverage for cancer treatment,” he told IPS.

A more precise register of cancer cases is being drawn up, because currently statistics are only available from the three largest cities: Lima, Arequipa and Trujillo.

Venegas said more staff is needed, as well as training in advances made in cancer treatment, and greater decentralisation so that treatment reaches patients in more remote regions.

A multisectoral commission is being set up to fight cancer on all fronts, including better access to clean water and sanitation.

The link between poor sanitation and cancer is exemplified by the central department of Huánuco, where 70 percent of the people lack potable piped water. Deaths from gastric cancer total 150 per 100,000 population, significantly higher than the national average.

This type of cancer, according to Venegas, is associated with drinking water quality.

As a public health problem, cancer merits a strong response from the state – at least as strong as Claudia has proven herself to be, after spending over half of her life fighting leukaemia, and cheering herself up with her favourite colours of nail polish.

Excerpt:

The King Hussein Cancer Centre, Jordan's premier cancer treatment facility located in Amman, is being expanded to double its capacity as national and regional cancer rates continue to rise. Credit: Elizabeth Whitman/IPS

By Elizabeth Whitman
AMMAN, Apr 10 2014 (IPS)

The concrete skeleton of a twin 13-storey complex towers over surrounding buildings on one of Amman’s busiest streets. The ongoing expansion of the King Hussein Cancer Centre symbolises progress as much as it portends a crisis.

After its completion, expected in 2015, the new buildings will more than double the KHCC‘s current capacity, increasing space for new cancer cases from 3,500 per year to 9,000. Yet even this 186-million-dollar project may be insufficient to shoulder Jordan’s growing cancer burden."We don't have a single medical oncologist or radio oncologist in the south." -- Dr. Jamal Khader

In Jordan, cancer is the leading cause of death after heart disease. Over 5,000 Jordanians annually are diagnosed with cancer, a figure projected to reach 7,281 by 2020, statistics that reflect global trends.

Cancer was once viewed as a first-world scourge. But in 2008, 56 percent of new cancer cases were in the developing world. And by 2030, the proportion will have climbed to 70 percent.

If Jordan fails to actively prepare for a continuing wave of cancer cases, “we won’t be able to cope with the increased number of patients and the increased cost of treatment,” leading to “less treatment and more mortalities,” Dr. Sami Khatib, a clinical oncologist who is president of the Arab Medical Association Against Cancer and former president of the Jordan Oncology Society, told IPS.

Jordan is fortunate to have the KHCC, a non-governmental organisation run by the King Hussein Cancer Foundation that is the country’s only comprehensive cancer treatment centre and the only cancer treatment facility in the Arab world to receive Joint Commission accreditation.

The KHCC has been a pioneer in cancer treatment in Jordan, transforming the process from disjointed visits with various specialists to comprehensive care with a treatment protocol.

But it is merely one centre. About 60 percent of Jordan’s cancer cases are in Amman, according to the latest national statistics in cancer incidence, which are from 2010. Yet according to Khatib, around 80 percent of cancer treatment facilities in Jordan are in Amman.

For the half of Jordan’s population residing in Amman or its outskirts, this location is ideal. For residents of remote areas, reaching these facilities can be a major problem.

“Inequality of access is the major obstacle” in providing cancer treatment in a country where “the whole spectrum of cancer treatment is available,” concluded Dr. Omar Nimri, director of the Jordanian Cancer Registry at the Ministry of Health, in the 2014 World Cancer Report.

An island of care

Sitting on a plain bench in a waiting room at the KHCC one morning were Nisreen Harabi and Sana’ Iskafee, two wives of the same husband. Harabi rocked back and forth as if to distract herself from pain while Iskafee spoke.

To reach Amman from their home in the village of Luban one hour away, Iskafee said, the women had to take one or two affordable public buses or spend 15 dinars (21 dollars) on a taxi ride.

Nisreen has cancer in her lymph nodes, according to Sana’, and must go to the KHCC four times a week for radiation therapy.

“We started coming two months ago,” Sana said. “The hardest part for us is the transportation. We live so far away.”

That morning, they had left their home at 6:30 am for a noon appointment, as a variety of factors can often cause delays on public transportation in Jordan.

“The distribution [of cancer treatment facilities] is not fair, as a whole, for Jordan,” Dr. Jamal Khader, a radiation oncologist at the KHCC and president of the Jordan Oncology Society, told IPS.

Like Nisreen, about 60 percent of cancer patients will at some point go through radiology treatment, he pointed out. But they have to be in Amman daily for a 10 to 15-minute session, making for a lot of extra suffering for those living outside the capital.

“We don’t have a single medical oncologist or radio oncologist in the south” or other remote areas, Khader added. “The ideal scenario for a cancer patient is to be treated in a comprehensive centre,” of which the KHCC is the only one. And specialised doctors and technology are primarily available in Amman.

Although all patients across Jordan receive “almost” the same quality treatment, no matter the health care facility they visit, Nimri told IPS in an interview, poorer patients or those who live far from Amman face extra difficulties.

“They have to rent a place, or stay in a hotel, or stay with relatives if they have any,” he said.

In that sense, Harabi is lucky to live one hour away.

Travel and accommodations require time and money, the latter of which is in especially short supply in a country where average annual per capita income is 5,980 dollars. Although societies and charities may help to cover costs, the system that remains in place is a centralised one that does not cater to impoverished patients living far from the capital.

“We need to build facilities…in the north and in the south of Jordan to better cover all the population,” Khatib said. He said the government had “a plan to start building facilities for the treatment of cancer in the different governorates of Jordan” and that “maybe they will start implementing it… soon.”

The situation is changing, albeit gradually. King Abdullah University Hospital in the northern city of Irbid has plans to get radio therapy machines, so that cancer patients residing in northern Jordan would not have to go to Amman for radiation therapy.

A national control plan for cancer is currently being developed as well, with the goal of outlining guidelines for prevention, diagnosis, treatment, and beyond. Khader, the KHCC oncologist, hoped the plan would be finalised within a year and that it could help identify “what facilities are missing here and there.”

Cancer treatment is divided into several sectors, besides the KHCC. Members of the military and security services, and their families, are treated at military facilities; private hospitals are available for those who can afford them; and those who do not qualify or cannot afford to go elsewhere have public facilities run by the Ministry of Health.

Yet their capacity does not match that of the KHCC, with “variable cancer care across facilities,” a 2011 report by the Harvard Global Equity Initiative noted. Of 29 public hospitals, only one offers chemotherapy, it said.

Furthermore, a difference in quality in treatment does exist between public and private facilities, Khatib allowed. As is generally true in most countries, “I think it’s much better in the NGO and private sectors than in the public sector,” he said.

Most cancer patients have their treatment covered by the Ministry of Health or the royal court, Khader noted, since by law, every Jordanian can apply for free treatment. While this policy eases individual suffering, for the government, it will become a financial “crisis to cope with all the commitments,” he added.

Nimri calculated roughly that with 25,000 – 30,000 cancer patients and the average cost of cancer treatment at 20,000 dollars per patient per year, Jordan is spending annually at least half a billion dollars on cancer treatment.

A multi-factor disease

Forty-eight percent of men over the age of 15 in Jordan smoked cigarettes (compared to 5.7 percent of women), according to WHO statistics from 2009, while 63.3 and 70.4 percent of men and women, respectively, had a body mass index (BMI) over 25, or in other words were overweight.

Tobacco is the biggest risk factor for cancer, and the WHO estimates that its use causes 22 percent of cancer deaths and 71 percent of lung cancer deaths globally.

Another 30 percent of cancer deaths are due to behavioural and dietary risks overall, such as having a high body mass index, poor diet, or lack of exercise.

“Our population is growing and aging… without having embraced healthy lifestyles that may help prevent many non-communicable diseases such as cancer,” wrote Dr. Abdallatif Woriekat, then minister of health, in Jordan’s 2010 national report on cancer incidence.

“The unhealthy diet and potentially lethal habit of tobacco use in particular, unfortunately, remains highly common and acceptable among Jordanians, and will undoubtedly leave a large unwanted print with its strong contribution to the increasing incidence of cancer,” he concluded.

Excerpt:

A patient being treated at the Regional Cancer Centre in Thiruvananthapuram, India. Credit: K.S. Harikrishnan/IPS

By Kanya D'Almeida
UNITED NATIONS, Apr 9 2014 (IPS)

Few people in the world can claim to be untouched by cancer. If not personally battling it in one form or another, millions are at this very moment sitting beside loved ones fighting for their lives, visiting friends recovering from chemo, or researching the latest treatments for their relatives.

The forecast by the world’s leading cancer research organisation predicts that things will only get worse. The World Cancer Report 2014 says we can expect a 70 percent increase in new cancer cases over the next 20 years, hitting 25 million by the year 2025.

Produced every five years by the International Agency for Research on Cancer (IARC), a specialised agency of the Geneva-based World Health Organisation (WHO), the 632-page report noted that new cancer cases rose from 12.7 million in 2008 to 14.1 million in 2012. The same year recorded 8.2 million cancer-related deaths globally.

Increasingly, the disease is gaining a foothold in low- and middle-income countries that have neither the experience nor the financial resources to deal with it.

A full 60 percent of cancer cases now occur in Asia, Africa and Central and South America, the same regions that account for 70 percent of cancer-related deaths.

Gauging the ‘Cancer Divide’

Experts from around the world say that, when it comes to cancer, developing countries are caught between the devil and the deep blue sea.

On the one hand, they continue to experience high rates of infection-related cancers like cervical, stomach and liver cancer, all of which are associated with poverty: lack of access to vaccines, an absence of screening facilities, and inadequate treatment options.

On the other hand, cancer associated with a wealthier lifestyle – such as cancers of the lung, breast and large bowel, which are linked to increased consumption of alcohol, tobacco and processed foods – are also on the rise in the ranks of these countries’ burgeoning middle classes.

For instance, the American Cancer Society reported just a few months ago that Africa is witnessing an “alarming rise” in tobacco use, with the number of adult smokers expected to skyrocket “from 77 million to 572 million by 2100 if new policies are not implemented and enforced.”

Evan Blecher, director of the international tobacco control research programme at the American Cancer Society and author of the report ‘Tobacco Use in Africa’, attributes the rise to multiple factors, economic growth being a primary one.

“African economies are growing faster and more consistently now than any time in the last 50 years,” Blecher told IPS from his native Cape Town. “Economic growth and development increases tobacco use because of higher disposable incomes.

“Some of the countries where we have seen the biggest increases include Angola, the Democratic Republic of the Congo, Ethiopia, Madagascar, Mozambique, Senegal, and Nigeria – these countries are amongst the most rapidly growing countries in Africa and the world,” he added.

This ‘double burden’ – of cancers associated with both growth and poverty – threatens to cripple healthcare systems already stretched too thin.

The International Atomic Energy Agency found that low- and middle-income countries account for 85 percent of the world’s population but possess just 4,400 megavoltage machines, less than 35 percent of global radiotherapy capacity.

Keeping in mind that roughly 50 to 65 percent of all cancer patients eventually require some type of radiotherapy, the huge dearth spells bad news for developing countries. According to the IAEA, some 23 countries – most of them in Africa – with populations of over one million people do not have a single radiotherapy machine.

Assessing inequality

R. Sankaranarayanan, special advisor on cancer control at the IARC, told IPS that the cancer divide does not only separate nations at various levels of development, but also affects different populations within countries.

“The wide disparities in survival outcomes from breast and large bowel cancer between rural and urban areas in countries such as China, India, Thailand, etc. and… breast cancer survival disparities between the black and white populations in the United States… are good examples,” he said.

The latter has been widely reported in the U.S., with researchers and medical professionals lamenting the 8.8 percent gap between breast cancer-related mortality rates for black and white women.

Data released last month by the American Cancer Society suggests that poverty fuels disparities in cancer diagnoses and mortality rates.

Given that obesity is a huge problem in African American communities, affecting roughly 50 percent of all adults compared to 35 percent of white adults, it is unsurprising that African Americans experience a higher incidence of colorectal cancer, which is associated with overconsumption of unhealthy, processed foods.

In India, where over a million new cancer cases were reported in 2012 and nearly a million people died from some form of the disease, a huge diversity of lifestyles seems to account for the gaping cancer divide.

For instance, the highest incidence of cancer was recorded in the northeastern state of Mizoram, one of the fastest growing economies in India, while the lowest incidence was reported in Barshi, a rural registry in the western state of Maharashtra, where much of the population is engaged in agricultural activity.

Silvana Luciani, advisor on cancer prevention and control in the department of non-communicable diseases and mental health at the Pan American Health Organisation (PAHO), says interregional disparities in health services also result in lopsided mortality rates.

“In Central America you see cervical cancer mortality rates of about 15 or 18 per 100,000 whereas in North America the cervical cancer mortality rate will be around two, which is significantly lower,” she told IPS.

“This has a lot to do with better pap smear screening programmes in North America that have been in existence for a long time and are of a much higher quality than in Central America, where healthcare systems are much more fragmented,” she said.

Sankaranarayanan says countries such as South Korea, Turkey, Malaysia, India, Ghana, Morocco, Brazil, Chile, Colombia, Costa Rica and Mexico are “increasingly introducing universal health care coverage or national insurance schemes that target the most socio-economically downtrodden populations… although the rapidly ageing populations and continued introduction of high cost technologies for cancer care are increasing pressures on these systems.”

Excerpt:

By Martin Khor
GENEVA, Mar 9 2014 (IPS)

If you or some family members or friends suffer from cancer, hepatitis, AIDS, asthma or other serious ailments, it’s worth your while to follow the negotiations on the Trans Pacific Partnership Agreement and other similar bilateral trade agreements.

It’s really a matter of life and death. For the TPPA can cut off the potential supply of cheaper generic medicines that can save lives, especially when the original branded products are priced so sky-high that very few can afford them.

Recently, a cancer specialist in New Zealand (one of the TPPA counties) warned that the TPPA would prolong the high cost of treating breast cancer because of new rules to protect biotechnology-based cancer drugs from competition from generics. And this will affect the lives of cancer patients.

Some cancer medicines can cost a patient over 100,000 dollars for a year’s treatment. But generic versions could be produced for a fraction, making it possible for patients to hope for a cure and a reprieve from death.

In India, local companies are leading the fight to make medicines more affordable to thousands of patients suffering from breast, kidney, liver and

gastrointestinal cancer and chronic leukemia.

For example, an Indian company produced a generic drug for kidney and liver cancer 30 times cheaper than the branded product (140 dollars versus 4,580 dollars for a month’s treatment) after it was given a compulsory license.

India has a law that disallows patents for a newer form of drugs or known substances unless it improves the medicine’s efficacy or effectiveness. Under the World Trade Organisation (WTO) rules, countries are free to set their own standards for novelty, or whether a product is novel enough to be eligible for a patent.

Also, in many countries, the patent law allows for companies to obtain compulsory licenses to import or make generic versions of original medicines. Governments grant such licenses if the branded products are too expensive and the original companies do not offer attractive terms for a voluntary license to other firms.

Multinational companies have strongly opposed compulsory licenses or the Indian-type laws that allow for patents only for genuine innovations.

This is where the TPPA comes in. Mainly at the insistence of the United States, countries are being asked to accept standards of intellectual property, that go beyond the rules of the WTO’s.

Especially noteworthy is the U.S. insistence that the TPPA countries agree to give a type of intellectual property known as “data exclusivity” for five years to companies producing original medicines.

This is extended to eight or 12 years for “biologics”, or medicines made with biotechnology. Many of the new medicines for treating cancers are biologics.

This will cause immense problems for patients waiting for cheaper medicines because “data exclusivity” prevents generic companies from relying on the safety and clinical trial data of the original company to get safety clearance for their generic products.

Thus, even if a generic company can prove that its medicine is bio-equivalent to the original medicine that has already passed the safety standard required by the health regulatory authorities, it will not be allowed to sell its medicine unless it comes up with its own safety and clinical trial data.

This goes against the current practice of generic medicines and safety standards. But the U.S. is insisting on this in the TPPA.

Few generic companies have the funds or technical ability to do their own clinical trials, and thus generic medicines could well be prevented from being used in TPPA countries for five to 12 years – even if the medicines are not patented.

That is the most significant aspect of the TPPA, and this is why so many groups of patients, health organisations and independent medical experts have been outraged and outspoken in their opposition to the agreement.

According to Jamie Love of Knowledge Ecology International, an expert on drugs and patents, the average cost of eight biologic cancer drugs registered with the U.S. drug authorities in 2011-2013 is 128,000 dollars (for a year’s treatment), with the most expensive being over 390,000 dollars. At such prices, hardly anyone in developing countries can afford these medicines.

In mid-February, eight prominent organisations including Medicins Sans Frontieres, Oxfam, Public Citizen, Health Gap and Knowledge Ecology International, issued a strong statement on their deep concern about the public health implications that the TPPA’s measures will have for millions of patients in need of access to affordable medicines around the whole Asia-Pacific region.

Said the groups: “The negotiations must take into account the health needs of all patients living in TPPA countries, and the U.S. must halt its efforts to limit countries’ freedom and flexibilities, otherwise the TPPA will jeopardize many, if not millions, of lives.”

Developments in India, which is not a TPPA country, show the patient-friendly policies that can emerge when public health concerns are given priority.

For instance, an Indian company is producing a generic version of the drug Gleevac, which is used to treat a chronic form of leukemia as well as gastrointestinal cancer, bringing the cost of treatment down from 70,000 dollars a year (in the U.S.) to 2,500 dollars a year in India.

This was possible because the Indian government denied the original company a patent on Gleevac because it was not judged to be novel enough, and an objection to that decision was rejected by the Indian Supreme Court.

Countries that join the TPPA will find it very difficult or impossible to undertake policies and practices similar to India’s, should the U.S. proposals in the intellectual property chapter be accepted.

Moreover, countries that don’t produce the generic drugs have the option to import them from India and other generics-producing countries. But if the TPPA imposes data exclusivity rules of the type desired by the U.S., it would be difficult to import and sell them.

Some countries are opposed to some of the U.S. proposals. The views and positions that defend public health must prevail, for after all, it is a matter of life and death.

Excerpt:

A patient being treated at the Regional Cancer Centre in Thiruvananthapuram in India. Traditional Ayurvedic treatment is being used increasingly to back regular cancer care. Credit: K.S. Harikrishnan/IPS.

By K. S. Harikrishnan
THIRUVANANTHAPURAM, India , Feb 24 2014 (IPS)

Balakrishnan, a labourer from Kochi in the southern Indian state of Kerala, was suffering from oral cancer. He was admitted to the Regional Cancer Centre (RCC) in Thiruvananthapuram. After the first course of radiation therapy, the 60-year-old could not eat or drink because of severe pain and infection in the mouth.

An Ayurvedic mouth wash developed from the Neem plant was administered to Balakrishnan for three weeks during the second course of radiation. Ayurveda is a  herb and plant-based traditional Indian system of medicine. The result was excellent. He could consume soft drinks and eat without any difficulty.“It was found that the side effects were much less in patients who took the Ayurveda drug compared to others who did not use the medicine."

“I did not use any antibiotics for the pain and inflammation that occurred after the radiation. The Ayurvedic mouthwash was enough to contain the side effects,” he said.

Balakrishnan was not the only one. Apart from him, 148 patients diagnosed with oral cancer were administered the Neem-based medicine at the RCC for treating inflammation.

“It was found that the side effects were much less in patients who took the Ayurveda drug compared to others who did not use the medicine,” Dr. Divya Raveendran, who was the lead researcher involved in the integration of modern and traditional medicines, told IPS before her sudden death.

Senior oncologist at the RCC Dr. K. Ramadas said many herbal components have been found to be more effective in their natural forms than as isolated molecules in managing the side effects of chemotherapy and radiation.

“Ayurveda may not have a big role in the main treatment modalities for cancer. But it has a complementary role. Many drugs in the Indian Systems of Medicine (ISM) have proven anti-inflammatory properties,” he told IPS.

A clinical trial at the RCC showed that use of an Ayurveda drug, Varanadi Ghritha, was good for preventing recurrence in treated head and neck cancer patients.

The RCC is one of the first major governmental health organisations in the country to have started the integration of modern medicine with ISM for curing cancer on the basis of scientific validation of traditional drugs.

Reports citing World Health Organisation statistics published in 2013 reveal that nearly 700,000 Indians die of cancer every year, while over a million are newly diagnosed with some form of the disease. “As against 477,000 men, 537,000 women were diagnosed with cancer in India in 2012,” a WHO report says.

Medical experts point out that despite differences between modern and traditional medicine in the approach to treatment, both systems have much to offer for cancer treatment. They say integration would enable the the public to obtain a wider range of treatment under one roof, leading to better healthcare delivery.

Dr. Stanly John, vice-president of the New Delhi-based Central Council for Indian Medicine of the Government of India, told IPS that the cost of cancer treatment with newer therapies was very high and was becoming out of reach for common people.

“If an integrated approach is adopted, it will help reduce the cost of treatment and improve the quality of life of all patients. Many institutions in the country are now integrating modern cancer treatment with traditional medicine for curing the killer disease,” he said.

In India, the practice of combining traditional and modern medicine started in the early 1980s. Navajyothisree Karunakara Guru, a practitioner of traditional medicine at the Santhigiri Ashram in Thiruvananthapuram district of the southern Indian state Kerala used it to contribute to treatment of several diseases, including cancer. Governmen initiatives to integrate ISM with mainstream healthcare began only in 2007.

According to the U.S.-based National Centre for Complementary and Alternative Medicine, a substantial amount of scientific evidence suggests that some complementary health approaches may help manage some symptoms of cancer and the side effects of treatment.

“Scientific evaluation that is used to assess conventional therapies should be used to evaluate complementary approaches,” the centre says. “Some complementary approaches are beginning to find a place in cancer treatment – not as cures, but as additions to treatment plans that may help patients cope with disease symptoms and side effects of treatment and improve their quality of life.”

“Many drugs in Ayurveda have proven anti-inflammatory properties that should be explored for the common good of cancer patients,” said Dr. Rveendran. “Therefore, there is no need for modern medicine to turn its face away from ISM. Curcumin, the yellow pigment in turmeric which is known for anti-cancerous and anti-oxidant properties, is a good chemo-preventive agent.”

A research study conducted at Kerala Agricultural University in Thrissur by Shareesh Nalpadi in 2007 revealed that a traditional rice variety called Njavara has some anti-carcinogenic properties, especially in preventing breast cancer.

According to the American Cancer Society (ACS), laboratory and clinical studies suggest that some Ayurvedic herbal preparations may contain substances that have the potential to help in prevention and treatment of certain types of cancer.

“Although Ayurveda has been largely untested by Western researchers, there is a growing interest in integrating some parts of the system into modern medical practice. A few of the herbs and substances have been purified into drugs that are used along with other medicines to treat cancer.

“The National Cancer Institute funded a series of laboratory studies to evaluate two Ayurvedic herbal remedies, called MAK-4 and MAK-5. The studies so far have shown some promise against tumours in rats and cancer cells in lab dishes,” the ACS says on its website cancer.org.

Doctors practising ISM explain that Ayurveda immunotherapy called “Rasayana chikitsa” can play a crucial role in cancer preventive management as it revives the body’s support systems. They say that “Rasayana chikitsa” can help cancer patients tolerate radiation and chemotherapy better and mitigate toxic side effects.

Dr. G.R. Sunitha, professor at the Government Ayurveda College in Thiruvananthapuram, told IPS that many patients are coming forward to try Ayurveda treatment for curing terminal illnesses.

Many herbs used in Ayurveda are anti-oxidant, and may prevent the onset of cancer. Early detection of the illness, the age of the patient and location of illness in the body are decisive factors in curing cancer, she said.

The Siddha system of medicine, considered one of the most ancient medicine systems in the world, offers some therapy for diseases like cancer, and for recurrence of tumours and leukaemia, Siddha doctors say.

Dr. M. R. Dhanesh, a Siddha physician in Thrissur, said Siddha medicines are quick in helping treat diseases if patients can observe strict rules of diet.

“Allegations against the side effects of metallic contents in Siddha medicine are baseless. If one prepares the medicines scientifically as per the doctrines prescribed by ancient Siddha sages, no side effect will occur.”

Patients at a chemotherapy session in the Civil Hospital in the province of Cienfuegos, Cuba. Credit: Jorge Luis Baños/IPS

By Ivet González
HAVANA, Nov 12 2013 (IPS)

The meagre budgets of Cuban families are put to the test when one of the members is diagnosed with cancer. Although treatment is free of cost, only extended networks of support help alleviate the economic impact of the disease, which is now the number one cause of death.

“The most expensive thing is the diet. We have to buy fruit, vegetables, chicken and fish, which are costly and hard to get,” said Adolfo (not his real name), who changed jobs four times in his efforts to help his wife through her 11-year battle with cancer, which she finally lost in September.

“One day I spent my entire two-week salary on fruit and vegetables. When I reached into my pocket for money to buy meat, it was empty,” the 61-year-old Adolfo told IPS.

In Cuba, health care is free, and surgery, visits to specialists and treatments such as chemotherapy are universally available. However, following a healthy diet while under treatment, paying for transport to healthcare centres and other aspects become a heavy burden for families.

That problem is one of the hidden sides of this disease, which in 2012 caused one out of every four deaths in this country of 11.2 million, surpassing heart disease as the number one cause of death.

The Public Health Ministry reports that some 30,000 new cases are now diagnosed annually, 2,000 more than in 2004, and it anticipates that the figure will rise to 35,000 in 2015.

Adolfo left his job as a manager at a state company to become a driver at a foreign company with better pay and a more flexible schedule.

He says he was lucky to have that opportunity, an exceptional one for Cubans, who earn the equivalent of 19 dollars on average. Food is expensive, consuming 70 to 90 percent of family income, according to local economists.

“The ration book monthly quota [of food guaranteed at subsidised prices] and the special diet [by prescription] that every patient receives is just a support,” Adolfo explained. “And hiring a carer is almost impossible,” he added.

His family is small, which is common in Cuban society, where the fertility rate is low: 1.69 children per woman.

A study published in April by the British journal The Lancet Oncology, “Planning Cancer Control in Latin America and the Caribbean”, estimated that in 2009 the financial burden of this disease in the region was four billion dollars and rising.

In addition to the direct costs of medical care, the report added indirect costs, such as loss of work days and productivity, among others.

Cancer and other non-transmissible diseases are surpassing infectious diseases in the region as the greatest threat to health, the study reported. However, the general incidence of cancer in Latin America is 163 cases per 100,000 inhabitants – much lower than in the European Union, where it is 264 per 100,000, or the United States, with 400 per 100,000.

Nevertheless, Latin America’s mortality/incidence ratio is 0.59 for all types of cancer, much higher than in the European Union, where it is 0.43, or the United States, with 0.35. In addition, it is estimated that between 2008 and 2020, the number of malignant tumour cases will rise by 42 percent throughout the region.

According to The Lancet, Cuba has the seventh highest incidence of cancer in the region, and a mortality/incidence ratio that is higher than the Latin American average, with 0.63, despite the fact that it is one of the Latin American nations that invests the greatest proportion of its GDP in public health: 9.7 percent.

In this country, which has been in an economic crisis for more than 20 years, solidarity during difficult times is a collective weapon of survival.

“Non-nuclear family members help out financially, because the closest family members have to take care of the patient,” said Odania Hernández, who supports her sister, who underwent surgery for cervical cancer. She lives in a rural town 268 kilometres from Havana, where “the neighbours help out a lot, too,” she told IPS.

People like Hernández who live in more remote areas must travel to Havana to receive specialised care. “We go there every three months and we’re constantly spending money,” said this homemaker, who praised the “excellent quality of medical services” received.

Even friends who live abroad send remittances to help out with her sister’s struggle with cancer, which began in 2011.

“We Cubans have not lost our sensitivity to other people’s pain,” said biologist María Elena Herrera, posting on the Café 108 interactive section of the IPS Cuba website. The Cuban diaspora mobilises immediately when things like this crop up, she added. The United States alone is home to more than 1.8 million people of Cuban origin.

Herrera also emphasised the very traditional local custom of collections, known as “poninas.” Friends and neighbours gather food, money, and hard-to-find items such as syringes and cotton balls to deliver to the patient’s family.

“The pharmaceutical industry contributes to the dietary aspect with natural products that improve the quality of life” of patients, Dr. Niudis Cruz, with the state-run Grupo Empresarial Labiofam, told IPS.

“Avoiding stress and following a healthy lifestyle help prevent malignant tumours,” said Cruz. Labiofam specialises in natural products, including new anti-tumour treatments, in a country that has put a strong emphasis on the biopharmaceutical sector.

One of the principal risk factors found in Cuba is the shift from a traditional diet to “junk food,” and a consequent increase in obesity, which, according to the National Office of Statistics and Information (ONEI), affected 47.6 percent of the population in 2011, compared to 32 percent in 1995.

Tobacco consumption has dropped off in recent years, but its prevalence in 2010 was still at 23.7 percent. In addition, according to ONEI, people are starting to smoke at an earlier age, and last year 9.7 percent of active smokers were adolescents.

Another determining factor is the accelerated aging of the Cuban population. Currently, 18.3 percent of the country’s people are over 60.

When the United Nations commemorates the International Day Against Nuclear Tests later this week, the lingering question in the minds of most anti-nuclear activists is whether or not the existing moratorium on testing will continue to be honoured – or occasionally violated with impunity.

John Loretz, programme director at International Physicians for the Prevention of Nuclear War, told IPS that since the 1990s the moratorium has been honoured by most states with nuclear weapons.

The exceptions, he pointed out, have been India and Pakistan, both of which tested nuclear weapons in 1998, but have not done so since then, and North Korea, which has conducted three very small tests since 2006.

When Pyongyang conducted its third test last February, the 15-member U.N. Security Council condemned the test as “a grave violation” of its previous resolutions and described North Korea as a country which is “a clear threat to international peace and security.”

And when the council adopted its third resolution, immediately following the third test, it expressed a determination to take “significant action” in the event of a “further” nuclear test by North Korea.

The annual International Day Against Nuclear Tests – observed on Aug. 29 but being commemorated at the U.N., with a seminar and an exhibition, on Sep. 5 – is an important way to raise awareness about nuclear weapons, said Loretz, and specifically “the continuing threat they pose to our health and survival and the imperative that we rid the world of them”.

Asked if the growing new rift between the United States and Russia will have a negative impact, Loretz admitted, “The rift is problematic, but I have no reason to think either country would resume nuclear testing as a result of a presumably temporary souring of the relationship.”

He said both countries are modernising their arsenals, however, and current problems could increase political pressure to do so further.

Currently, there are five declared nuclear weapon states – the United States, Britain, Russia, France and China, which are the five permanent members (P-5) of the Security Council – along with three undeclared nuclear weapon states – India, Pakistan and Israel.

But it has still not been determined whether North Korea should be designated a nuclear power.At least 430,000 people died of cancer by the year 2000 because of radioactive fallout.

Dale Dewar, former executive director of Physicians for Global Survival, told IPS the world has somewhat successfully eliminated atmospheric and deep underground testing of nuclear weapons, although North Korea did the latter just a year ago.

The United States has embarked upon a plan for “subcritical nuclear testing” where no self-sustaining nuclear chain reaction can occur, she said. The behaviour of plutonium, an important component of nuclear weapons, can be observed during these tests.

The costs of the tests and testing facility are exorbitant. A single test costs around 20 million dollars, according to the U.S. Department of Energy (DOE), and preparation for the test costs upwards of 100 million dollars.

Dewar said Physicians for Global Survival sees these costs as monies removed from health care, education and social services – taxpayer money that has been diverted for military and in this case theoretical science fictional future use.

“Were the bombs for which these tests are conducted ever used, the lives and health of hundreds of thousands, maybe millions, would be affected. There is no justification for continuing to possess such weapons, much less test them,” she asserted.

Tilman A. Ruff, associate professor at the Nossal Institute for Global Health at the University of Melbourne, told IPS an estimated 2,061 nuclear test explosions, conducted by eight or nine nations since 1945, have been used to develop nuclear weapons, fuelling the greatest immediate threat to global survival and health.

Test explosions themselves also exact a substantial and persisting environmental and human toll, he said.

“Every person and living thing contains strontium-90 in their teeth and bones, cesium-137 inside their cells, carbon-14, plutonium-239 and other radioactive materials dispersed worldwide,” said Ruff, who is also co-chair of the International Steering Group and Australian Board member of the International Campaign to Abolish Nuclear Weapons.

He said a study by International Physicians for the Prevention of Nuclear War (IPPNW) found that at least 430,000 people died of cancer by the year 2000 because of this radioactive fallout, and over time, more than 2.4 million people will die of cancer caused by nuclear test explosions.

“In almost every case, nuclear test sites have been forced upon indigenous, minority and colonised peoples, and downwind communities and test site workers have suffered most,” he noted.

At every nuclear test site, he pointed out, a long-term radioactive and toxic legacy remains along with yet unmet needs for clean-up and remediation, long-term environmental monitoring, and care and compensation for those affected.

These responsibilities rest with the governments that undertook the tests.

While underground nuclear tests disperse much less radioactive fallout into the atmosphere than above-ground tests, they shatter the surrounding rock and pose a long-term hazard for future generations of radioactive leakage into the environment and groundwater, Ruff declared.

Loretz told IPS the Comprehensive Test Ban Treaty (CTBT) was adopted in 1996 but has not yet been ratified by enough states to enter into force.

The United States has signed but not ratified it, and a commonly shared opinion is that U.S. ratification, which is a necessity, would tip the balance and lead to the other ratifications required for entry into force, he said. “That’s one big thing that remains to be done.”

“Many of us have come to believe that CTBT ratification, while important and useful, is now secondary to the comprehensive treaty for which the International Campaign to Abolish Nuclear Weapons (ICAN) is campaigning.”

A global ban as the opening act to eliminating actual nuclear weapons would include a prohibition against testing, he added.

A child at a lead-contaminated site. Credit: Blacksmith Institute

By Stephen Leahy
UXBRIDGE, Canada, May 9 2013 (IPS)

Toxic waste sites in 31 countries are damaging the brains of nearly 800,000 children and impairing the health of millions of people in the developing world, two new studies have found.

Toxins and pollutants in the environment are major sources of illness and reduced lifespans globally. The impacts on health in some countries are on par with malaria, said Kevin Chatham-Stephens, a pediatric environmental health fellow at the Icahn School of Medicine at Mount Sinai."We have found lots of nasty sites out there but we don't have the money to clean them up." -- Bret Ericson of the Blacksmith Institute

“We were surprised that health impacts of living near toxic sites were on par with other well-known threats to public health such as malaria,” Chatham-Stephens told IPS.

In one study researchers found elevated levels of lead, chromium and other chemicals in soil and water samples near 373 toxic waste sites located in India, the Philippines and Indonesia. Nearly nine million people live near these sites and researchers calculated that the likely impact from diseases caused by exposure to these chemicals amounted to 828,722 lost years due to ill-health, disability or early death.

Malaria in the same countries caused 725,000 lost years of full health.

The “lost year” metric is known as disability-adjusted life years (DALY), a measure of overall disease burden used by the World Health Organisation. One DALY represents the loss of one year of equivalent full health.

“Lead and hexavalent chromium proved to be the most toxic chemicals and caused the majority of disease, disability and mortality among the individuals living near the sites,” said Chatham-Stephens, co-author of the study published this week in Environmental Health Perspectives.

The study was done in partnership with the Blacksmith Institute, a small international NGO based in New York City investigating the health risks of toxic sites in low and middle income countries. Blacksmith publishes the annual “World’s Worst Pollution Problems Report” to raise awareness and funding to help clean-up the worst sites.

Toxic sites “fly under the radar” in terms of public health awareness and action. Little research has been done on the health impacts of chemical pollutants in developing countries.

“This is the first estimate of the burden of disease resulting from living near toxic waste sites,” said Chatham-Stephens.

Previous studies have shown that lead can cause neurological, gastrointestinal and cardiovascular damage. Exposure to high levels of chromium has been shown to increase chances of developing lung cancer.

“This study highlights a major and previously under-recognised global health problem in lower and middle income countries,” said Philip Landrigan, MD, MSc, dean for Global Health at the Icahn School of Medicine and a co-author.

“The next step is targeting interventions such as cleaning up the sites and minimising the exposure of humans in each of these countries where toxic chemicals are greatly present,” said Landrigan.

In a second study, researchers measured lead levels in soil and drinking water at 200 toxic waste sites in 31 countries, then estimated the blood lead levels in 779,989 children who were potentially exposed to lead from those sites. They found that their blood lead levels were likely very high, 15 to 20 times higher on average than children in the U.S.

“Lead has serious, long-term health consequences such as the potential to impair cognitive development in children and cause mental retardation,” said Chatham-Stephens.

Based on these findings, Chatham-Stephens estimates a loss of five to eight IQ points per child and an incidence of mild mental retardation in six out of every 1,000 children.

Increased cardiovascular disease is another impact from lead exposure but wasn’t part of the study. “We couldn’t account for every health impact,” he said. “We hope these studies raise awareness and result in on-site disease surveillance, including measurements of blood lead levels in children.”

Given the very high levels of toxins at some sites, targeted clean-up is also an urgent issue, he said.

“(Toxic sites) are a major public health problem that is hiding in plain sight,” Bret Ericson of the Blacksmith Institute previously told IPS.

“We have found lots of nasty sites out there but we don’t have the money to clean them up,” Ericson said.

A large portion of cigarette packages must be devoted to warnings on the health risks of smoking. Credit: Kara Santos/IPS

By Fabíola Ortiz
RIO DE JANEIRO, Apr 4 2013 (IPS)

Brazil has taken another step to combat the harmful habit of smoking with the creation of the Centre for Studies on Tobacco and Health (CETAB).

But the new centre, established by the state-run Oswaldo Cruz Foundation (FIOCRUZ) as part of the Sergio Arouca National School of Public Health, has set its sights even further. CETAB will also undertake research on three other risk factors for non-communicable chronic diseases, in addition to smoking: excessive alcohol consumption, lack of physical activity, and poor eating habits.

In 2011, Brazil adopted the Strategic Action Plan to Combat Non-Communicable Diseases, such as cancer, diabetes, heart disease and respiratory ailments.

“We are going to focus on these and conduct research on the risk factors. Cigarette smoking stands out as one of the worst villains. It offers no benefits whatsoever. There is no such thing as a reasonable level of cigarette smoking that could be considered harmless. It has only negative effects,” the coordinator of the new centre, Vera da Costa e Silva, told Tierramérica.*

The Ministry of Health will devote 6.2 million dollars to the plan adopted in 2011, which establishes actions to be undertaken up until 2022.

Among other targets, the plan is aimed at reducing premature death from these causes among people under 70 by two percent annually, to eventually reach 196 deaths per 100,000 inhabitants by 2022, as compared to 255 per 100,000 in 2011.

The World Health Organization (WHO) considers tobacco to be the leading preventable cause of death in the world, and estimates that about a third of the global population aged 15 and older, or one in three adults, are smokers.

The more than 4,700 toxic substances found in tobacco smoke make it a cause of roughly 50 different diseases.

In Brazil, lung cancer is the most lethal type of cancer and also one of the leading causes of death.

Reducing exposure to the risk factors associated with diseases will make it possible to reduce the incidence of the diseases as well, stressed Costa e Silva.

CETAB will focus on teaching, research and technical cooperation, both within Brazil and abroad.

“We want to work with information, education, regulation and public policies for prevention. We are going to provide health care professionals in the public health system with training and treatment options for the risk factors. The courses we offer can be taken long-distance,” said the CETAB coordinator.

In terms of international cooperation, the centre plans to work with other countries in Latin American as well as Portuguese-speaking African countries. This will mean sending Brazilian specialists to the offices that FIOCRUZ operates abroad, such as in Mozambique, and attracting specialists from these other countries to Brazil.

CETAB also plans to support the efforts of WHO and the Pan American Health Organization (PAHO).

“We have already had good returns with them as international partners, and we see a number of possibilities on the horizon,” said Costa e Silva.

The centre is starting out with a team of nine researchers from fields such as economics, engineering, pharmaceuticals, medicine and biology.

Tobacco use is an epidemic and the biggest known risk factor, according to the president of Brazil’s National Academy of Medicine, Marcos Moraes.

In the late 1980s, almost 40 percent of Brazilians were smokers. In 25 years, this percentage fell to around 15 percent. Brazil currently has a population of 192 million.

“We achieved these results thanks to the control measures we have adopted,” Moraes told Tierramérica. “The tobacco industry is always very active, even though they are fully aware that they are selling a disease, and our goal is for the country to safeguard its health and prohibit the sale of harmful products,” he added.

Moraes reported that a marked decline in smoking has been observed in middle-class youth, although there has been a “slow but steady increase” in young smokers from poorer segments of the population.

“One of the most important strategies for combating tobacco use is raising the price of cigarettes. In 2012, Brazil increased taxes on cigarettes substantially, but they are still among the lowest in the world. Where there is poverty, there is smoking,” said Moraes.

According to WHO, he added, for every dollar collected through these taxes, 4.5 dollars are spent on health care for tobacco-related diseases.

Around 10 billion dollars of public health care spending in Brazil goes towards the treatment of problems caused by smoking, while the revenues earned through taxes on the tobacco industry amount to only three billion dollars, he noted.

Statistics on the evolution of the number of smokers in Brazil serve as a measure of the efficacy of the country’s prevention policy, but “this policy is always under threat,” he warned.

Although it is recognised as an example for the rest of the world, Brazil cannot celebrate or “set off fireworks, because this is an ongoing battle,” Moraes commented.

The creation of this new study centre will serve as another tool to contribute to the work of the network of institutions already active in this area.

Brazil is frequently called upon to provide international cooperation and share its experiences in the fulfilment of the WHO Framework Convention on Tobacco Control, which sets out specific steps for governments to combat tobacco use.

* This story was originally published by Latin American newspapers that are part of the Tierramérica network.

A tsunami is looming on the horizon and the world is unprepared for it. This one won’t be a massive wall of water but a tidal wave of disease – and experts say the international community needs to act fast to keep it from crashing.

“Non-communicable diseases (NCDs) – cancer, heart disease, diabetes and chronic respiratory diseases, among others – have become the leading cause of death worldwide,” Jeffrey Sturchio, senior partner at the U.S.-based consulting firm Rabin Martin, told a conference organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on World Cancer Day in Geneva.

“Some 36 million people die from (NCDs) every year, 80 percent of them in low and middle income countries – a figure that will increase by 17 percent in the coming years and by 25 percent in Africa,” he added.

Tuberculosis and malaria, in comparison, kill one to two million people around the world every year.

“The disease burden is shifting to NCDs, but since developing countries still have to fight infectious diseases, they face a double burden,” Sturchio warned.

However, developing countries do not appear to be paying adequate attention to the impending crisis.

“In 2010 HIV/AIDS was responsible for 3.5 percent of deaths worldwide, malaria for 1.5 percent, cancer for 12.6 percent and heart diseases for 14 percent,” Cary Adams, chief executive officer of the Union for International Cancer Control, told IPS on the sidelines of the conference on Feb. 4.

These statistics alone should be sufficient for governments to put NCDs high on their list of national priorities. “But in sub-Saharan Africa, HIV/AIDS caused 13.3 percent of deaths, malaria 6.7 percent and cancer 4.5 percent”, he said, which explains why African health ministers keep putting cancer on the back burner.

“But the (reality) is, the problem will double in the next 15 years. There is a tsunami of NCDs approaching and we need to tackle it today,” Adams stressed.

To tackle this “tsunami”, four health federations – the International Diabetes Federation, the Union for International Cancer Control, the World Heart Federation and the Union against Lung Disease and Tuberculosis – came together to form the Non-communicable Diseases Alliance. With a network of over 2,000 non-governmental organisations based in over 170 countries, it seeks to amplify the voice of civil society in the global debate on NCDs.

The Alliance was also instrumental in pushing the United Nations General Assembly to organise, in September 2011, a high-level meeting that officially declared NCDs a “challenge of epidemic proportions”, which, if it is to be addressed, requires the cooperation of governments, civil society and the private sector.

“This is not an easy thing to do,” Adams, who chairs the NCD Alliance, conceded to IPS. “We have tried to work on a common agenda and find consensus, but some NGOs would not talk to us because we engage with the private sector. We try to embrace the private sector without compromising on integrity and independence and everything we do is based on science.”

Still, the mobilisation has borne some fruits. Five years ago, non-communicable diseases were barely on the agenda. The U.N.’s political declaration and a series of follow-up activities built tremendous momentum, resulting in a plan of action that stretches to 2025, with clear targets such as reducing NCD-related deaths by 25 percent in that time frame.

But financial resources are stretched thin, and it is unlikely that the funds needed to launch a massive global campaign will be readily available.

“The reality is that in the last 20 years, tens of billions of dollars in official development assistance have gone to developing countries, mainly (to fight) HIV/AIDS, and it is unrealistic to think that the same will happen again,” Sturchio admitted.

It will therefore be necessary to capitalise on existing investments and reallocate some of the resources already in circulation, he said.

“Hundreds of HIV clinics were created across sub-Saharan Africa that can also be used for NCDs. When patients come to these clinics, they can also be tested for other infections or provided with vaccines,” he suggested.

For Margaret Kruk, a professor at Columbia University’s school of public health, primary care must be reconceptualised to tackle NCDs in low and middle-income countries.

“In theory, many NCD services can be provided in primary care, like primary prevention of hepatitis B, immunisation, smoking cessation, cholesterol and glucose testing, mammography and opportunistic screening for depression,” she said.

“But primary care in (developing) countries is not able to meet NCD challenges. The patient is not seen in a holistic way.”

She added that the challenge is most severe in sub-Saharan Africa, where, for the last half a century, national health plans have been oriented towards the “traditional killers” like infectious diseases, and have also focused heavily on maternal and child health.

This is partly due to the fact that the eight Millennium Development Goals (MDGs) laid out by the United Nations Millennium Summit in 2000 placed a great deal of emphasis on these “preventable causes of death”.

But as the 2015 deadline for achieving these targets draws closer, priorities will have to be re-examined.

Adams believes that one of the Alliance’s most important tasks over the next two years will be to make non-communicable diseases central in the post-2015 international development process.

Indeed, relatively simple public policy measures can go a long way in reducing NCDs – such as pushing people to consume less sugar and salt, eat less fatty foods, give up smoking and exercise more.

Already developing countries are becoming conscious that they don’t need additional funding for those measures. But when it comes to drugs, costs are much higher in developing countries than in the United States, for example.

From the manufacturer to the wholesale distributor, to the intermediaries and the clinics, monopolies, taxes, regulations and administrative hurdles push the price of medicines up to prohibitive rates in the global South.

The Southern African Development Community and the East African Community have undertaken initiatives to harmonise regulations at the regional level, but for Sturchio these are not enough: “Countries must be able to make sovereign decisions on the medicines they use, but today a lot of duplications make the supply chain inefficient.”

He does not believe intellectual property issues constitute an obstacle to stemming the wave of NCDs.

“Most of the medicines needed to treat NCDs are off patent,” he told IPS. “The challenge is to find ways to bring them to the people. Hundreds of medicines (to treat cancer) are very inexpensive and yet unavailable.”

A recent World Health Organisation (WHO) survey revealed that poor people in India were twice as likely to smoke as the rich. Credit: K. S. Harikrishnan/IPS

By Mauro Teodori
THIRUVANANTHAPURAM, India , Nov 30 2012 (IPS)

Mujeeb Rahuman (39), a mason in the Venjaramoodu village in Thiruvananthapuram, the southernmost district in India’s coastal Kerala state, has been a chain smoker for the past twenty years.

Rahuman told IPS he spends “about 1,500 rupees (27 dollars) per month on cigarettes”, representing a large chunk out of his modest monthly income of 8,000 rupees (144 dollars). “I use them as a way to pass the time.”

But this habit is not as leisurely as it sounds. In fact, Rahuman embodies a growing addiction to tobacco among the poor in India, who are now developing higher rates of cancer and experiencing increased mortality rates.

A recent World Health Organisation (WHO) survey revealed that poor people in India were twice as likely to smoke as the rich.

According to the Planning Commission of India, as many as 354 million people – or 29 percent of the population – currently live below the poverty line, which is defined by a monthly income of anything below 672 rupees (roughly 12 dollars) for rural India and 859 rupees (about 15 dollars) for urban labourers.

The WHO survey, entitled ‘Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries’, reported that over a quarter of the country’s population of 1.2 billion people is addicted to tobacco, a habit influenced to a great extent by income.

For instance, the survey found that 46.7 percent of men in lower socioeconomic strata are smokers, compared to 21.8 percent of rich men.

Only 7.6 percent of Indian women smoke, but here, too, the discrepancy is stark: women in lower socioeconomic strata are four times more likely to smoke than their more affluent counterparts – 12.4 percent of women from a lower income bracket have taken up the habit, as opposed to just 3.1 percent of wealthy women.

This disparity does not merely represent a difference in lifestyle choices – it highlights the stress of poverty that leads to addiction and points to a growing health gap between the rich and poor in India.

The survey was initiated in response to reports that poorer people actually faced a greater risk of dying from smoking than more affluent people.

According to the WHO, the ‘smoking divide’ also deepens the gulf of income inequality, since the poor divert their limited wages away from housing, better food or healthcare towards the purchase of tobacco products.

The Mumbai-based Advocacy Forum for Tobacco Control listed various forms of tobacco products popular with the Indian masses including beedis, which account for 34 percent of tobacco products in the country; chuttas and cheroots, small rolls of tobacco leaves; Dhumtis, conical cigarettes created by rolling tobacco leaf in the leaf of another plant; and cigars.

Data from the National Sample Survey Office of India, under the ministry of statistics and programme implementation, shows that the price of beedis makes them a much more popular option – the cost of smoking cigarettes is 399 rupees (about seven dollars) per month, while beedi consumption costs as little as 93 rupees (close to two dollars), according to the Global Adult Tobacco Survey (GATS) for 2009-10.

In fact, 37 percent of rural households and 20 percent of urban households consume beedis, compared to just 3.7 and 9.6 percent respectively for cigarettes.

And meanwhile, the health impacts of tobacco consumption are growing increasingly more severe.

According to a book entitled ‘Kerala, Fifty Years and Beyond’, which documents Kerala’s impressive development record over the last five decades, tobacco has been identified as the leading cause of cancer in India, responsible for 40 to 50 percent of cancers in men and 20 percent of cancers in women.

“Tobacco chewing has resulted in a huge (medical) burden of oral cancer and oral precancerous conditions,” the book said.

Dr. R. Jayakrishnan, assistant professor at the community oncology division of the Regional Cancer Centre in Thiruvananthapuram, told IPS the leading cause of oral cancer was tobacco-related chewing, adding that most patients visiting the centre hail from low-income households.

“Today, 80 percent of lung cancer cases appear to be a result of smoking. The need of the hour is to develop prevention strategies that specifically focus on poor people,” he told IPS.

M. A. Oommen, a prominent Indian economist, told the media in Thiruvananthapuram recently, “While linking a high incidence of smoking with poverty is a simplistic correlation, the issue has to be tackled in a multi-pronged manner, such as giving incentives to the poor to get out of the habit, moral persuasion, a higher excise duty on tobacco products and structural reforms through better employment opportunities.”

A 2012 Asian Development Bank study predicted that increasing cigarette prices, by imposing higher taxes on manufacturers, would save more than 27 million lives in five Asian countries including India.

The Times of India recently reported that a 50 percent increase in cigarette prices in India will save 4.1 million people from the ravages of tobacco consumption, while a 100 percent increase in prices could prevent eight million deaths annually.

(END)