“There is nothing more comforting in the life of a cancer patient than having someone who understands your suffering and gives you hope.”
Twenty-seven-years-old Yetsho (name changed), lives with one of the rarest cancers, rectal cancer.
One evening two and a half years ago, she suddenly vomited, felt dizzy and lost appetite. She was rushed to Jigme Dorji Wangchuck National Referral Hospital. She was diagnosed with cancer. From that night, Yetsho’s life changed completely. Not a day has gone without pain.
She breaks down in solitude as her body fights the pain and depression, and most often dreading treatment that has eaten in to her body. Losing hair from the chemotherapy, watching what she eats.
She has undergone a lot of transformation: physically, emotionally, and spiritually. She suffered stigma. Estranged by loved ones, she lives alone. Yet she has long forgiven them all.
“Every breath is important for me and I intend to use it to fight this disease till the last minute,” she said, her voice beaming with optimism and confidence. “I must count my blessings not troubles.”
While her own have left her, many have embraced her offering every possible support, even looking after her child. She says that she has been lucky with her friends and well wishers. The Bhutan Cancer Society pays half her rent and members come to visit her occasionally with hygiene kits.
“The support system is critical for the patient to win this battle,” she said.
Not many know about cancer in the country, she says, which is why Bhutanese generally view people living with cancer differently. “We’re no different from the normal people and given the care and support there’re people with cancer living longer than the normal ones.”
Dorji Yangzom, a 34-year-old single mother from Trashigang, was diagnosed with ovarian cancer in 2013. She thought her life was over. The year before, she had lost her husband to a liver disease. After two years of treatment, she has overcome the disease. Today she is cancer free although she has to go for regular checkups. Her family members once also thought she would die.
Most cancers can be treated if they are detected early. The most common problem in the country is that the cancer would have advanced when most patients seek medical help, which makes treatment difficult and expensive.
Cancer is becoming a major concern for the health sector and the steady increase in cancer cases in the country is fast emerging as a major burden on the national coffer. In 2015 alone, Bhutan saw 231 cancer cases out of the total of 900 plus cases reported till February 2016.
Although poor diet and alcohol, among others, have been blamed for the rise in cancer cases globally, no proper research has been conducted in Bhutan. The society is in the process of mobilising fund for a research to locate the causes of cancer in Bhutan.
The most common cancers in Bhutan are cancers of the stomach and food pipe, cervical cancer, cancers of head and neck (mouth, throat and nose). Lung, liver, breast, colorectal and prostate cancers are also common in the country.
According to health experts 25 percent of cancers are caused by preventable infections, such as HPV (cervical cancer), Hepatitis B (liver cancer) and H.pylori (stomach infection). Public health officials believe lives can be saved through affordable and timely cancer services.
Meanwhile, with support of the Bhutan Cancer Society and the health ministry, public awareness on cancer and support for patients are expected to improve. Despite human resource and fund shortages, the society conducts prevention campaigns and provides nutritional support to cancer patients. While cancer patients need a lot of protein, some cannot afford to take the required amount of protein-rich foods.
The society is the only non-profit organization established for the benefit of a cancer patient, caregiver and general population.
It provides palliative care to the patients as well as the caregivers beginning at diagnosis and continuing through treatment, follow-up care and the end of life. We also support the cancer patients financially which includes transportation allowance and basic amenities.
The society works on creating a network of cancer survivors and cancer patients to help create a sense of community and because we feel it is important for peer-support. It has also created a platform where cancer patients can visit our office and share their concerns in full confidentiality and where we try to solve their concerns when needed. As cancer treatment is provided only in Thimphu, most patients are in no position to manage accommodation while undergoing treatment in Thimphu. At present it is seeking funding to mobilise resource to operate and manage a four-room transit home for patients in Thimphu.
Health officials say most cancers are caused by behavioural factors and can be prevented by adopting healthy lifestyles like refraining from consumption of alcohol and tobacco. It can also be reduced by avoiding exposures to chemicals from the food that we eat and from environment we work or live in.
Hepatitis B virus causes liver cancer, which can be prevented by adopting healthy sexual practices like avoiding multiple sexual partners and use of condoms, among others.
As for cervical cancer, regular PAP smear examinations for women between 25 to 65 years could help in early diagnosis and treatment. To protect women from cervical cancer, Human Paplloma Virus vaccine is given to schoolgirls in class VI and at 12 years of age for those out of school.
Cancers of the head and neck, followed by hematological and cervical cancers topped the list of referral cases to India. The report states that in the past solid tumors involving gastrointestinal, hepato-biliary and the respiratory system would also comprise a substantial number. Now with the availability of specialists, including oncologists in the country, cases have reduced significantly.
“We’re fortunate that the healthcare is free,” Yetsho said. While on referal outside the country where every medical service is charged, she has witnessed how patients and escorts suffer to access simple services. She had travelled to Kolkata alone. Her next review is pending and is dependent on the condition of her health.
She recalls that her ailment had helped her realise the value of life. She prays everyday, whenever possible. Often she is sedated from morphine that she has to take to overcome the pain and have to travel between hospital and home.
“I would like to help any cancer patient if I recover,” Yetsho said. Miracles can happen, she says.
Bhutan Cancer Society (BCS) is a Public Benefit Organization registered under the Civil Society Organizations Authority. It was launched in February 2015 coinciding with World Cancer Day. It is the only non-profit organization established for the benefit of cancer patient, caregiver and general population in Bhutan. It primarily works under the three major pillars: Care and Support for cancer patient and caregivers; Advocacy and Cancer Prevention and Cancer Research.
The mission of BCS is to improve cancer care and reduce the incidence of cancer in Bhutan, through cancer control activities (education and prevention and research) and providing psychosocial support to those people affected and effected by cancer in Bhutan.
Inline with the mission the following objectives are formulated to guide the organization;
Optimizing prevention of cancer in collaboration with national and international stakeholders through education, advocacy and research.
Advocating and mobilizing resources for cancer prevention, treatment, care and support.
Enhancing quality of life for terminal cancer patients through provision of social, spiritual, psychological and financial support (where needed).
Sharing reliable and accurate information
With support from Helvetas Swiss Intercooperation and Bhutan Centre for Media and Democracy (BCMD)