An incomplete healing

Inadequate facilities for reconstructive surgery and limited staff are affecting cancer treatment in government hospitals
Eight-year-old Syed Farhan from Warangal, Telangana was diagnosed earlier this year with Ewing’s sarcoma, a rare type of cancer that occurs in bones or in the soft tissue around the bones. He then underwent six cycles of chemotherapy, to have an aggressive tumour in his right tibia shrunk just enough for surgical resection.
Prohibitive costs
More than a month after his chemotherapy concluded at a private health institution, the boy has not undergone surgery to remove the residual growth, which may fuel the disease’s spread. His family is deterred by the cost which is not covered under Telangana’s health-care insurance meant for below poverty line families. Reconstruction with an expandable implant, to suit the growing limbs of a child, followed by tumour resection, can cost over Rs. 6 lakh. The family plans to get further treatment at the State-run Regional Cancer Centre (RRC), while attempting to raise funds only for the implant, but it may have to wait long for surgery. Farhan’s plight is shared by many cancer patients who cannot avail of appropriate timely reconstruction surgeries in private health care due to the cost and in turn have to look to public institutions. However, the absence of dedicated plastic surgery departments or limited staff where they do exist, results in an inordinate delay at RRCs.
“We have one dedicated specialist now but the wait [for] to avail complex reconstruction surgery due to a large patient load at the hospital can get long. The demand for plastic surgeons specialising in onco-reconstruction is only set to rise given the burden of head and neck cancers on the country’s healthcare,” says Dr. Arvind Krishnamurthy, Professor and Head of Surgical Oncology at Cancer Institute, Adayar, Chennai. Head and neck cancers constitute over a third of all cancers in India.
“Major reconstructive surgeries are expensive procedures in private health care. Governments should take responsibility and set up reconstructive oncology departments, besides surgical oncology, in all institutes. That apart, under state health schemes such as Aarogyasri and Ayushman Bharat, the importance of these procedures is not adequately recognised,” says Dr. B. Mani Kumari, former head of the Plastic and Reconstructive Surgery Department at MNJIO. Marathon reconstruction procedures such as micro-vascular reconstruction earn private hospitals at the most Rs. 45,000 under health insurance schemes. Doctors in the private sector view this as inadequate compensation for such surgeries. Dr. Krishnamurthy adds that private institutions see only a fraction of patient numbers that regional centres see. However, medical tourism and patients who can pay make up for the lack of big numbers. He feels there is a need for greater recognition by governments of the skills of surgeons performing complex oncology reconstructions especially in the context of increasing cases of cancers being diagnosed in the country. He also emphasises the point that rigorous training of surgeons is more important than hiring or setting up more institutions.

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