Death comes by appointment in Bargarh district of Odisha. Every other day, it declares its arrival with cancer striking one amongst them. The family of Japa Pradhan, a 55-year-old resident of Bhoipali village in this western Odisha district, has seen more deaths due to cancer than because of old age.
Japa lost his father, two uncles and an aunt to blood cancer within just a few decades. Now, cancer has struck his own generation. Balram Pradhan, his cousin, has been suffering from liver cancer since July 2015. “I have no clue why cancer is wreaking havoc in my family,” says Japa.
It’s not just this family in Bhoipali that has been afflicted by cancer. Krishna Chandra Barik, a retired schoolteacher, was inconsolable when his daughter, still in her 20s, passed away in 2012 due to skin cancer. His neighbour, Rukmini Padhaan, 45, considers herself a miraculous survivor of breast cancer.
Death knocked the house of Basanti Bhui, an accredited social health activist, in 2011 — she lost her brother to brain cancer. Barely had she recovered from the tragedy, her mother succumbed to liver cancer. “At least 15 families in the 200-household village are currently fighting cancer,” she says. Bhoipali lies in Bheden, one of the two blocks in Bargarh worst hit by cancer; the other being Attabira.
When Down To Earth (DTE) reached Bhoipali, residents, even from nearby villages, crowded around the reporter, each narrating their own tale of distress and misery. It was all too evident that the emperor of all maladies reigns supreme in the entire Bargarh district.
In the barely 72-hour travel to this bucolic district’s six villages, the reporter counted at least 15 cancer-related deaths. Many more were desperately fighting the killer disease. Cancer has swept through this 1,249-village district taking into its fold 1.4 million residents.
The disease ranges from cervical, the most common here, to breast cancer, head and neck, stomach, lungs, blood, colorectal and ovary, says Ashok Panigrahi, a doctor in the department of pharmacology at the Veer Surendra Sai Institute of Medical Sciences and Research (VSS Hospital) located in Sambalpur district nearby.
“I can say with a fair degree of responsibility that cancer has entered our life cycle, and every family here is directly or indirectly affected by it,” Ram K Purohit, a doctor practising in Bargarh since early 1990s told DTE.
Balram Pradhan of Bhoipali village has been suffering from liver cancer since July 2015. Photo: Vikas Choudhary
Rajesh Tripathy, a general physician in Bargarh, backs Purohit’s claim. His 50-bed Sai Kripa Nursing Home, which he started in 2005, gets 10-15 cancer cases every month. Of the total surgeries performed in the hospital every month, at least five are cancer related, he estimates.
To understand how cancer is spreading its tentacles in Odisha, Panigrahi conducted a study in 23 districts of the state. He found that Bargarh is the worst hit by cancer, with 26.3 per cent of the cases reported from here. His data shows a steady rise in the number of cancer patients in western Odisha.
A total of 1,017 cases were reported in 2014-15. The number rose to 1,066 in 2015-16, and to 1,098 in 2016-17. His paper was published in October, 2018 in IOSR Journal of Dental and Medical Sciences.
Traversing the rickety lanes between the lush green paddy fields to Jamurda village, an overwhelming smell of pesticides fills the air. Here, Sudhanshu Barik’s mother sits teary eyed. “I fumble each time my 11-year-old asks me why he can no longer go to school,” she says. “I don’t have the courage to tell him he has blood cancer,” she says.
In just six months, the boy has lost weight, and turned too low-spirited and weak to take the stress of school. Sudhanshu’s father, Mahesh, is an agriculture labourer. So is Ganesh, just a few kilometres away in Kutpali village.
The unfortunate thread of cancer links Sudhanshu to Ganesh’s 40-year-old sister Hara Pradhan. Frail, she lies motionless on a tiny charpoi (bed) in a dingy one-room house. For the past two years, she has been bleeding almost continuously from the vagina. “Her saree often gets drenched with blood,” says her brother Ganesh.
Hara is a widow living with metal illness. She can barely do her own chores. “She has uterus cancer, but was unable to take blood transfusion the first time we took her to hospital. Now we have no money to go to the hospital again,” says her frustrated brother. “It would be better that she died than suffer so much,” he cries as Hara writhes in pain. Neither Ganesh nor Mahesh can fathom what has brought devastation to their families.
The link lies in paddy farming, says Snehangini Chhuria, MLA of Attabira constituency. Bargarh gets abundant water from the Hirakud dam in Sambalpur. All the farmers here grow paddy, which requires a lot of water. Bargarh gets so much water that farmers sow paddy twice a year, instead of the usual one. In the 2018 kharif season, of the total 0.34 million hectares (ha) cultivable land, paddy was grown in 0.24 million ha. Small wonder, Bargarh is also called the rice bowl of Odisha.
Some 15 years ago, says Chhuria, farmers from the neighbouring and water-starved state of Andhra Pradesh shifted to Bargarh. They habitually sprayed pesticides. The native farmers imitated the practice. This is the root of all problems, she asserts.
Farmers here use pesticides such as pyrethroid, organophosphate, thiocarbamate and neonicotenide. The World Health Organization places these in Class II hazardous category, Class I being the most hazardous. But even Class II pesticides “have severe negative effects on human health and environment,” writes BR Mahananda, professor, environment science, Sambalpur University, in his 2016 research paper Impact of Pesticides on Farmer’s Health of Western Odisha.
Scientific literature attributes the cancers prevalent in Bargarh to these pesticides, says Panigrahi. The mean age of the cancer-affected patients here is above 50 years. “Pesticides take years to show their impacts,” he told DTE. “The government has not conducted any test for groundwater contamination. But we are clear that pesticides are the reason for the high number of cancer cases in Bargarh,” he asserts.
Farmers come in constant contact with pesticides for prolonged periods. They have no knowledge or training on how to use it safely. In his research, Mahananda found that 11 per cent of the paddy farmers he studied did not know that pesticides are harmful; 35 per cent did not follow the instructions provided on pesticide containers; and, 18 per cent didn’t even know that containers have instructions for pesticide use. About 64 per cent did not use a protective cover such as gloves, boots, towels, full pants and full shirts while spraying pesticides.
Mohan Kampa, 60, of Mehena village, has no money to get treated for his auditory canal cancer. Photo: Vikas Choudhary
“Pesticides are carcinogenic, but the poor farmers are compelled to use it to tackle pest attacks,” says Anil Kumar Swain, head of Krishi Vigyan Kendra in Bargarh. In 2017, for instance, farmers sprayed pesticides aggressively as the pest Brown Leaf Hopper, locally called Chakda, attacked their paddy fields. Yet, the stubborn pest destroyed 95 per cent of the crop.
Pesticides can kill 80 per cent of the pests, but Chakda multiplies fast. A female Chakda gives birth to 250 offspring within just 20 days. The year 2017 had a prolonged summer and delayed winter, which created favourable weather conditions for the pest to multiply.
This was a time for prosperity for pesticide dealers as well. Use of pesticides jumped from 440.702 tonnes in 2016 to 713.867 tonnes in 2017. Promoting pesticides as saviour of crops, the dealers even conducted free on-field demonstrations. The promotion continues and in case a pesticide fails one year, the company markets it afresh with a new name.
“Our message to use the harmless bio-pesticides gets lost to these dealers’ aggressive promotions,” says Swain. But bio-pesticides are also expensive and take a long period of time to show results. All farmers here cannot afford it.
Odisha falls among the seven low-income states in India, as per the World Bank. The assault of cancer in such a poor state has thrown residents’ budget out of gear. Mahesh, for instance, has taken a Rs 1.5 lakh loan for the monthly chemotherapy sessions for Sudhanshu. Half the sessions are still not over and he is left with only Rs 20,000. He also needs to take antibiotic tablets daily. One strip of four tablets costs Rs 700. Mahesh has now applied for financial aid from the Chief Minister’s Relief Fund, like many others in the village.
Similarly, in Mehna village, Mohan Kampa, 60, has no money to get his treatment for the auditory canal cancer in his right ear. Doctors referred him to Acharya Harihar Regional Cancer Centre, 300 km away in Cuttack. He was prescribed medicines in May and told to return two months later. “I have run out of cash. My sons, a transporter and a labourer, used to send me cash. But they, too, have little money. What’s the point of going to the hospital?”
Getting cancer treatment in Bargarh is not easy. The district has only one government hospital and three 50-bed private hospitals. The government hospital almost always has a serpentine queue of patients since the state government provides free chemotherapy in all its hospitals. But the hospital does not have facilities to conduct even the basic MRI test, endoscopy or CT Scan.
In private hospitals, an endoscopy can cost Rs 2,000, while a CT Scan can cost between Rs 2,000 and Rs 5,000. Doctors refer patients to the better equipped VSS Hospital located nearby. The rush of patients here forces the 30-bed cancer unit to accommodate 260 patients. The hospital has only three oncologists and 13 nurses.
In the rush, a few patients become victims of misdiagnosis. Sanjukta Satapathy of Remunda village has a swollen stomach, and has been making rounds of several hospitals since August 2017. She was operated for stomach cancer and went through chemotherapy sessions. When the problem relapsed in June 2018, doctors declared she may just have ulcer.
The government refuses to acknowledge the crisis and does not deem it fit to conduct even a preliminary survey, says Purohit. Odisha is not even a part of the National Cancer Registry, which systematically collects cancer data. Though Chief Minister Naveen Patnaik recently announced that work on this will begin soon, nothing has happened in this direction as yet.
DTE sent a detailed questionnaire to state health minister Naba Kishore Das and to state health commissioner Pramod Kumar Meherda asking why despite concrete evidence, the government had not initiated any step to minimise incidences of cancer in Bargarh. Their replies are still awaited. Repeated telephone calls to Meherda went unanswered.
Doctors in Bargarh unanimously agree that early detection is the only way to reduce mortality, and a cancer hospital in Bargarh can help. But the government wants to open a branch of the Tata Memorial Hospital (TMH) in Cuttack, a city that already has a cancer hospital. Demanding setting up of TMH in Bargarh, non-profit United Forum for Cancer, in 2018, wrote to Union Minister for Petroleum and Natural Gas Dharmendra Pradhan who belongs to western Odisha. The non-profit also wrote to the state health minister in January 2019.
Sanjukta Satapathy. 40, of Remunda village was treated for stomach cancer in 2017, Now, doctors say she might just haev ulcer. Photo: Vikas Choudhary
With no government help in sight, Saroj Kumar Sahoo, a farmer in Tejagola village, decided to take corrective measures. He has learnt his lesson the hard way. Having lost his father and uncle to cancer, he switched to organic farming.
“I used to take my uncle for treatment to a cancer hospital in Cuttack. There I would see many of my acquaintances getting treatment. It was heart-breaking. I realised that pesticides are a slow poison. I have a wife and son. I cannot risk their lives,” he says. Sahoo now uses the expensive bio-pesticides. Also, farmers in the adjacent fields use pesticides indiscriminately, so the pests travel to his field. “It will be difficult, but I am ready to wait,” he says.
Amidst the dark clouds, the silver lining is a group of IT professionals. They live in Bhubaneswar but have made Bargarh their second home. The group, called Ummeedein (‘hope’ in English), organises camps and visits homes in Bargarh to generate awareness on early cancer detection. It distributes pocket-size booklets called Cancer Chalisa. It is written in Odiya and provides information on early cancer detection.
DTE attended one such camp organised for anganwadi workers. “We have identified many patients from this campaign,” says Nitai Panigrahi, one of the founders of Ummeedein.
“That Bargarh is facing a crisis is very clear,” says Panigrahi. “The government must now acknowledge it and begin work on a cancer registry as the first step towards tackling it,” he adds.