Humanitarian Efforts: Case Histories

Head and Neck Cancer in India - An American Perspective

The Indian Atomic Energy Commission, during the infancy of a new-formed nation, established Tata Memorial Hospital in 1951 to become a center of excellence for the treatment of the oncology patient. Over the years, international attention has come due to the vast volume of head and neck cancer patients treated there. It was not until this trip to India that I realized the widespread use of betel nut, betel leaf, and sundry tobacco products had created a true national health crisis.

Tata Memorial Hospital is situated in the heart of the Bombay peninsula and is surrounded by a population of approximately15,000,000 Indians. But this hospital's reputation, as the flagship of the Indian medical system, reaches not only the surrounding 200 miles of Bombay, but also the entire subcontinent. Of special note is the role that this hospital plays in the overall care of the indigent patient. Approximately 70 percent of the patient population are considered to have no ability to pay for their care. The average cancer patient's annual income ranged from 1000-4000 rupees per year ($25-100).

Every year, the hospital sees approximately 5,000 new head and neck cancer patients. Not all of these are subsequently treated by surgery, but are given a combination of treatment modalities to best accommodate the patient and the limited operating room availability. The head and neck service (three teams) performed 60-80 major head and neck procedures per week and saw 300-400 outpatients per week. The facilities were very accommodating, most notably their radiation oncology department, which treated approximately 400 patients daily. Due to the daily influx of new cancers, the average patient's wait for surgery or radiation may be as long as five to six weeks.

Under the auspices of Dr. Ashok Mehta, I became an integral part of the treatment team. My firsthand role in patient care came in the clinic setting where patients came from near and far. Due to the sheer number of patients, encounters were very brief, at times less than 10 minutes. However, in that period of time, the doctors were able to obtain a history and perform a very focused exam. At no point did I feel that the patients were being given inferior care, and the patients seemed most grateful for the attention given. In the operating room the sterility and equipment were equal to, if not better than, that in the United States. As for overall patient care, techniques as well as treatment algorithms were very similar to those that are followed in the United States.

The social habits of the population lie at the core of this national health problem. As is well known, the betel leaf, betel nut, and various forms of tobacco are completely unregulated in India and used (inhaled or chewed) by almost 250,000,000 people. Although lung cancer remains the major cause of tobacco-related deaths, head and neck cancer is a close second for men, and third for women of the subcontinent. A significant portion of the population is illiterate. Slowly, however, the media infrastructure of television, radio, and newspapers is reaching the distant corners of India, and the message of the ill effects of tobacco will ultimately help in raising public awareness.

The overall experience and the volume of patients, both surgical and in an outpatient setting, were simply amazing. In my three and a half months at the hospital I was involved with approximately 800 outpatients and 300 surgical cases. My experience has given me a better understanding of head and neck cancer and those who suffer from this devastating disease. I am grateful to the University of Louisville and the AAO-HNSF for their support in promoting this very unique and educational opportunity. I hope to return again and again to give back in some small way to the country of my family's heritage.

Tapan A. Padhya, MD
Cincinnati, OH

Editor's Note: Dr. Padhya received the Humanitarian Efforts Committee's 1998 Post-Residency Humanitarian Service Award for his service to the underprivileged of India. The award, which includes $2,500, is offered to members who have completed their residency within the past five years and are planning a medical mission in an underserved area for a minimum of three months. For further information and an application, contact the committee's staff liaison Catherine R. Lincoln, CAE at 703-519-1556.