A different treatment for cancer
Dr Ravi Kannan, winner of this year's Magsaysay award, has been recognized for his work in providing holistic healthcare and cancer care to the underserved in India. He left a lucrative position in a metro city to work in a small town where he believed he was most needed. His efforts have resulted in increased patient compliance and access to treatment for thousands of people. This highlights the issue of poverty and lack of access to healthcare in South Asia.
Sanjay Nagral
Sep 4, 2023, Hindustan Times
In this undated handout photo provided by the Ramon Magsaysay Awards Foundation, 2023 Ramon Magsaysay Awardee Ravi Kannan R. from india checks an x-ray. A Philippine university professor who became a peace negotiator and helped ease decades of Muslim insurgency violence in her country and an Indian doctor, who left a major hospital career to treat desperate cancer patients in a far-flung region were among those who won this year's Ramon Magsaysay Awards, regarded as Asia's version of the Nobel Prize. (Ramon Magsaysay Awards Foundation via AP) (AP)
I don’t know Dr Ravi Kannan. I had read about him and his work for a few years. Now everyone knows about him. As the deserving winner of this year’s Magsaysay award. Not many surgeons win this award. This is not a prize for performing large volumes of surgery or discovering a new treatment. Ravi has won the award for holistic healthcare and taking cancer care to the underserved. For the world of Indian surgery, a Magsaysay award is very rare. So are individuals like Ravi.
Ravi Kannan trained as a cancer surgeon from the Adyar Cancer Institute in Chennai. Most surgeons with this background migrate abroad or work in the burgeoning private sector and earn a handsome income. But Ravi decided to do something else. In 2007, he quit his job as the director of surgical oncology at Adyar and moved to Silchar in Assam to take the position of director of the Cachar Cancer Hospital and Research Centre. Silchar is not exactly the kind of place which is lucrative financially or career-wise. It surprised many that Ravi left his position in a metro for a hospital in a small town in India. His answer. ‘It is where I am most needed’. Maybe he saw the plight of patients who travel all the way from far-flung areas especially the North East for cancer treatment. Many of us have experienced this. Lamented about it, sympathised . Ravi decided to act.
To quote from the awards citation “Under Kannan’s leadership, CCHRC became a comprehensive cancer hospital and research centre. From a hospital with limited facilities, it now has 28 departments covering oncology, pathology, radiology, microbiology, epidemiology, tumour registry and palliative care. Kannan saw from the beginning that it was not just a matter of having ‘state-of-the-art’ facilities. Patient compliance rate to treatment was 28%. Patients came but did not continue treatment due to the difficulties of traveling long distances, the cost (including the loss of income of family caregivers), and resignation to the belief that the patient would never be cured. Clearly, the underlying reason was poverty. Thus, the hospital introduced pro-poor initiatives such as free treatment, food and lodging, ad hoc employment for caregivers, and a homecare program. Hospital teams travel long distances to train family members in pain management and palliative care, as well as provide free medicines. As a result, patient compliance rose to 70%. CCHRC now provides free or subsidized cancer treatments to around 5,000 new patients annually, catering to approximately 20,000 patients. Kannan says, “No one should be denied access to treatment due to want of money.”
Another surgeon who won the Magsaysay award back in 1998 is Adibul Rizvi from Karachi. Adib-saab, as he is called, set up the Sindh Institute of Urology and Transplantation in 1971. It is now a state-of-the-art Urology and Kidney Transplant Centre catering to thousands from across Pakistan. But that’s not why Adib-saab has been much feted and admired. It’s because SIUT works on the premise that no patient will ever be sent back for the lack of money. All treatment is free, including kidney transplants. In 2016, I visited SIUT and actually witnessed this in practice. Dr Rizvi says “ The ordinary people of Pakistan are disenfranchised from healthcare. I am just trying my bit to change that”. In Bangladesh, a British-trained vascular surgeon Zafarullah Chowdhury, who passed away recently, won the award in 1985. Zafarullah returned to participate in the liberation war and established Gana Swasthya Kendra, a huge primary health care project for the poor in rural Bangladesh. He recruited local women with no medical background to serve as paramedics. He said these women need to have the skills the population can’t do without.
It doesn’t take much for any doctor working in South Asia to understand how poverty and poor access results in denial of basic healthcare to a large number of our people. Why do some take it seriously and act? What motivates them? We often hear about them when they are well known. But the early years of their work is not easy. The harsh realities of working with the underserved and the feeling of being left out of the mainstream creates a lot of self-doubt. Also while the driven individual may be willing to make the sacrifices, the family may not. I know several committed activists who finally couldn’t stand the isolation of being in a very small place when it came to their children’s education.
Decades ago, several doctors spurned the comforts, income and lifestyle to set up rural health projects and practices in underserved areas of India. Many of them were inspired by idealism which emanated from influence of Gandhian, socialist or religious ideals. They rejected mainstream careers and plunged themselves to work with communities. In 1996 a group of specialist doctors from AIIMS set up a hospital and rural health project Jan Swasthya Sahayog in a tribal area near Bilaspur. Some even had to face the wrath of the state. Binayak Sen, a paediatrician from CMC Vellore, spent his life in Chhattisgarh working among tribals. What he got in return was imprisonment.
Individuals like Ravi are a reminder. Of how some rise above others. Of an alternative role model that is successful in its own way. But they could also be the cause of uneasiness to some. To those of us who from our comfortable perches abroad or in India pontificate about the needs of our undeserved people. To those who in spite of a comfortable and affluent life strive for more money by any means. And to a system which depends on individual heroism to provide healthcare to the underserved.