Here's the bad news: More people die of cancer in India than those in the West. And the mortality rate is about the same in both rural and urban India, and therefore unaltered by access to healthcare.
According to the Times of India, the results of the Million Death Study reveals a uniquely Indian cause for this anomaly:
An Indian peculiarity crops up here. As MDS says that cancer deaths were two times higher in the least educated than in the most educated adults, it would follow that educated Indians living in cities and enjoying better access to cancer care should be able to beat the disease. But this is clearly not the case. "Women won't come to hospitals to show a lump in their breast because it's not painful. Men won't get themselves checked despite losing weight drastically . This is true in both urban and rural India," says a senior doctor.
The problem, analyses Dr Shastri, is that greater awareness in urban areas hasn't really translated into attitudinal changes. "People in urban areas, too, visit doctors only when their cancer is advanced . Therefore, the death rate is high in cities despite the availability of world-class treatment."
In other words, Indians are scaredy cats who prefer to live in denial. This is certainly one important reason. A friend's mother hid the lump in her breast for years out of fear of the disease. Cancer is still ingrained in the Indian mind as a fatal disease, hence the reasoning: Why endure brutal chemo sessions only to die after months of additional suffering. According to Yuvraj Singh's friends, one reason he preferred to seek treatment in Boston is that “it isn’t like India where cancer is treated virtually like a death warrant.” (See my previous article for more on why Indians are specifically scared of cancer)
But the doctors interviewed by TOI offer at best a partial truth. The reasons why Indians rarely go to a doctor – whether for cancer or a viral fever – are far more complex. More importantly, we also don't receive proper attention when we do indeed seek medical attention. Here are three other reasons why I as a layperson think we fail to get adequate medical care despite "the availability of world-class treatment."
One, the disappearing family doctor. When I was a kid, everything from my father's fever to my chicken pox to my sister-in-law's near miscarriage to my grandfather's stroke medication was supervised by Dr Valvade, a matronly doctor who was almost a part of the family. When things looked a bit serious, she referred us personally to a specialist who kept her in the loop. She would come home, see us after-hours, take phone calls early in the morning or late at night.
Today, any visit to a doctor requires hours in a crowded waiting room, which is nigh impossible for most busy urban professionals. And unless you've remained in the same city for decades, the chances are the attention you receive will be prefunctory and minimal. She's extremely busy and so are you. The result: the family doctor has been replaced by a trusted pharmacist. Unless the symptoms look serious, he's the go-to guy for most medical ailments.
Where the family doctor was once a family's unofficial "life guard" – the one tasked with keeping an eye out for potentially life-threatening symptoms — that responsibility now lies with us. And with the important exception of our children, we are poor "life guards" when it comes to our own health. There's a "jab tak chalta hai" attitude toward our own bodies, exacerbated by our hectic work-family schedules and the time commitment now required to seek medical care.
Two, class matters. My maid goes to the doctor far more often than I do. Any fever that goes unabated in her family for more than two days requires a visit to the neighbourhood doc. He inevitably administers an unnamed injection, and sends her off with a couple of pills. She's never informed of the diagnosis, except in the vaguest terms.
And when she or any of her family members fail to respond to this one-size-fits-all treatment, she comes to me, as when her son's "viral fever" escalated to bronchitis. I took him to my doctor who took one look at his prescription and declared, "This is junk."
It is absurd, Dr Shastri, to pretend that all Indians have equal access to our world class medical community. Most working class Indians rely on a poorly qualified doctor who can barely diagnose a run-of-the-mill disease, leave alone cancer.
Continues on the next page
Also this: even when there is a correct diagnosis, most urban Indians cannot afford the care. Take for instance, our building's 75-year old security guard who went to the government hospital to get his swollen and painful knees checked. When they sent him off with just a packet of pills – without taking an X-ray – we sent him to a specialist orthopedic hospital, where they dutifully performed all the expensive tests. Then they informed him that he needed surgery which would cost Rs 2 lakhs – failing which his knees would give out entirely in a couple of years.
No one was willing to pay for the surgery, and now he's more depressed than ever. He knows what's wrong with him, but he can't do anything about it. So maybe there is indeed a good reason why poor Indians, be it rural or urban, prefer not to know what ails them. And in many cases, it doesn't matter if they do.
Three, a good doctor is hard to find. Yes, we have world class doctors but it doesn't mean we receive world class treatment. There are countless cases where the best doctors fail to make the right diagnosis because they are too busy or just not interested, and more so when they're big-name specialists. Bigger the reputation, the less likely you are to get his full attention, unless you come with the right references (either from a medical colleague or a "connection").
My mother's case offers an instructive example. She was being treated by the city's leading neurologist when she suffered her second stroke. Now, she had not been referred to this man by anyone of importance, but chose him because of his reputation. Five years ago, when she forgot to take her blood thinners for a couple of days – in the excitement of a family celebration – she started to slur. My uncle, a heart surgeon from the UK, insisted she go see her doctor. After a ten-minute consultation spent detailing her symptoms, he sent her packing without once asking her about her medication. She suffered a full-on stroke later that evening.
We all know of such cases – the uncle who was never diagnosed with kidney cancer until it was too late, the aunt whose rare lung disease remained undiscovered almost till the very end, a friend's mother who died of a heart attack in the hospital because the doctors didn't act with due urgency. So how can we get the right care? The ugly truth about Indian medical care is that A-list treatment requires A-list connections. There are no exceptions to our corrosive sifarish culture, be it in life or death. Unlike the West, there are no consequences for medical negligence or incompetence.
Now I know that the "evidence" offered is anecdotal and personal, but these stories – I'd wager – are far too familiar to most of us. Getting medical care remains a profoundly anxiety-producing experience for most of us: from finding the right doctor to getting the right diagnosis, and therefore the right care. For all our fabulous 21st century medical facilities, for most us, medical care in India is like playing a life-and-death version of Russian roulette.