The phrase ‘to take care’ has different meanings in different settings

By Dr Ulhas Ganu

I recall the statement made by my professor of Management Practices more than 30 years ago: whether we like it or not, finance inevitably touches every possible sphere of our life. Its impact on cancer patients and their families is more evident than anywhere else in life. Modern therapy is focused and inevitably more expensive, and affordability makes an enormous difference. Yet there is an inertia in getting adequate medical insurance. There is an overall attitude to neglect health-related problems as most of them are transient and self-limiting, with recovery almost assured with a little help from supportive medication. Only the nagging problem leads one to a doctor followed by proper investigation and proper diagnosis, which in turn leads to curative therapy to ensure a better prognosis. The delay defines the outcome of therapy. Affordability is yet another factor that comes in to play at this stage and not having medical insurance puts a lot of pressure on the family resources.

During the past couple of months, I came across three different shades of human behavior, all pertaining to healthcare worries, responses and experiences, each having profound implications for the future of the persons involved and their families. A friend’s neighbor came with a request to know which hospital and oncosurgeon to approach his 60-year-old mother’s surgery for colon cancer. They were worried as it was Stage IV cancer and wanted to know what the likely expenses and chances of a positive response post-therapy would be. The obvious worry was whether medical insurance of around Rs 3 lakh only could be enough to get optimum therapy.

The second case was that of a 42-year-old man with oesophageal cancer. Talking to his young wife was extremely embarrassing, to say the least. She said that while he could swallow rice with some difficulty, eating chapati was impossible for him and vomiting was the result. They were lucky to approach their physician quickly and diagnostic tests with PET-Scan confirmed the presence of a small tumor in the esophagus. A quick successful surgery followed by radiation therapy improved the chances of an excellent outcome. Yet a modest income and no insurance made them scramble for collecting Rs 5 lakh for the surgery from relatives and friends. The cause for such early onset of oesophageal cancer was the habit of eating pan with tobacco several times a day for years. The reason: a boring job in the automobile industry with long hours and peer pressure from colleagues. No animal consumes such substances without food value for them except water, which has been rightly considered as one of the nutritional factors. What a pity that for temporary pleasure, the intelligent man risks not only his life but that of his dependents. The fellow may escape somewhat lightly because of reasonably early detection, and quicker surgery options followed by adjuvant radiation therapy.

On the contrary, I also came across a case where the lady developed ascitic fluid in her abdominal cavity. Instead of taking sound medical advice, the family approached a naturopath and homeopath who assured that he could reduce the fluid development with natural remedies. Headache, backache, fever, or any pain, including abdominal pain, is not a disease by itself but a symptom. The generation of ascitic fluid is also a symptom and not a disease. Logical thinking, looking at the potential cause-effect relationship and reaching the right consultant is a priority. One does not treat symptoms but the disease, which, in this case, was ovarian cancer and a delay in treatment resulted in the loss of a precious life. Forewarned is forearmed; yet these cases show that though ill-health is a reality, people believe that it will not touch them. Inadequate finances should not result in less than optimum therapy. Another misconception is about the need for an insurance policy. The young feel that it is too early to spend on insurance, forgetting that this an investment. The more the people opting for medical insurance, the better will be the facilities provided by insurance companies, and the better the treatment options available for the patients for better outcomes.