In December 2006, Dr. Ravi Kannan, a surgical oncologist, who had just left the Adyar Cancer Institute after 15 years of practice, got a call from Dr. Chinmoy Choudhury, then director and current chairperson of the governing body at the Cachar Cancer Hospital and Research Centre in Silchar, Assam. He’d called to talk about a patient, but he also invited Dr. Kannan to head the centre. So Dr. Kannan and his wife, Seetha, went over for a weekend to explore the possibility.
“When we saw the conditions there, I knew I had received my calling,” he says, adding that it was Seetha who really took the decision, resigning from her job at the U.S. Consulate, “because she felt Silchar needed us more than Chennai. She volunteered at the community [and continues to] and we found help coming from various quarters to help us adapt,” he says. And so in 2007 began a journey of cancer treatment in Silchar. Here, the doctor, recently honoured with the Padma Shri, tells us more about his experiences.
What was the scenario when you reached Silchar?
For various reasons, mainly lifestyle, the maximum number of patients come from Assam. We did not have a roadmap to our problems, so we began fire-fighting as each issue cropped up, tackling it one at a time.
How did you fire-fight your way through?
Most of what I learnt comes from my mentors from school, medical college, post grad, and later the Institute, where we had been trained to deal with all issues, not just my area of specialization (head and neck). All those held me in good stead. I had no idea of administration, pharmacy, and so on, but we dealt it one day at a time.
What was the most important problem that you faced?
When I first came here, I followed the Institute policy: treat people for free, at low cost, or no cost. But, that didn’t seem to work. We tried out several options, but after several trials, meetings, and especially after a presentation at Kolkata, we began to look deeper into our problems trying to understand the why of it all. We found that out of every 100 patients who came into OPD, 58% never came for visit two, mainly because they worked for daily wages -- they were the sole bread-winners, with large families.
How did you addressthis?
We realised at that moment that if we did not pay attention to socio-economic dimensions, we could never deliver. Our treatment depended on solving the root of the crisis. We took two decisions: one, every patient would go back with a follow-up date and secondly, we began to provide ad-hoc jobs, like cleaning, cooking, gardening, which did not require skilled labour. Seeing the abject poverty that they lived in, we provided free accommodation and nutritious food too.
Did the situation improve drastically?
Not quite. When we did the audit, we found that 55% had completed prescribed treatment. But even as we began to feel cheerful, the situation sank in. Let me explain: Say in a city like Mumbai, when they say they are treating 50% of patients where they see 30,000 odd patients and most of them come from other states, they seek only diagnosis, or an opinion and usually go back to their home states for continuation of treatment. But, for me, in Silchar, I am the last stop, and so 55%, it is a failure.
What did you do to tackle this?
I heard Ms. Harmala Gupta in Delhi speak about home-care. Though we had been providing home-care facilities, it had not quite achieved momentum. Ms. Gupta was offering quality home-care for free and they were well-organised. That inspired us to adopt free home-care at Silchar too. We not only visited homes of patients who couldn’t come, but also those of patients who never came for a follow-up. So, that year, the medical compliance went to 70%. When we found that our patients had fear of treatment charges, we devised a plan: one-time payment of ₹500 that would include multiple visits for a life-time. This in turn reassured our patients. It was a confidence-building-measure that we aimed at, and it is that which defines us today.
Do you have separate slabs for those who can and those who can’t afford treatment?
If we were to hike up prices for the rich, then, instead of focussing on what the patient needs, we would then begin to focus on what the patient is capable of giving. The rich would slowly elbow out the poor. In order to avoid this, we decided to have uniformity that would facilitate equitable and accessible healthcare.
What does the award mean to you?
I think The recognition is not about me; it is about all my colleagues, the hospital, everyone who has helped us in big and small ways. If the recognition can help awareness of cancer in the region, where more people can access treatment, that will be great. From 23 members, we are a team of 350 members, each a hero in their own right, who own the hospital, making it what it is today.
