‘Bringing in expert trainers instead of sending doctors abroad will be more effective’

Cancer has been here in Bangladesh for long but its recorded treatment started after the emergence of a cancer centre in 1989. But the centre suffered doctor crisis as promising students would pursue surgery, gynaecology instead of oncology. 

However, the scenario changed when the National Institute of Cancer Research and Hospital had been founded. From then on, the top students started entering the field. However, around three decades have passed since the inception of the cancer institute but Bangladesh is still struggling with cancer treatment. 

Dr Habibullah Talukder Ruskin, an associate professor and head of cancer epidemiology at the National Institute of Cancer Research, made some observations on cancer treatment in an interview with The Business Standard. 

The veteran cancer prevention specialist finds a gap in cancer treatment.

 "The first batch of senior experts have retired and the next batches arrived. But many fresh graduate doctors have been promoted to associate professor or professor in a very short time, say in five to seven years, under political influence. So, they lack proper guideline and efficiency in the practical field," said a frustrated Dr Habibullah. 

To bring a change in oncology treatment, guided practical training is inevitable. And skill development is a must for that. The veteran oncologist wants the development of a multi-disciplinary curriculum model to be the first and foremost priority.

"Engaging doctors, providing clinical treatment, in prevention is crucial. The course on epidemiology or its prevention has been dropped from the curriculum. But restoring it is critical," he said. 

Bangladesh still lacks data on the number of cancer patients. But prevention and awareness-raising programmes can save patients. 

Among many gloomy pictures, Dr Habibullah has also found some hopes. The government, he said, has already taken an initiative to empower doctors in divisional, district and upazila levels. 

At least, screening and limited curative services can be introduced in rural areas across the country. "If Bangladesh wants to spread the service, it needs to train up new graduates. There are 30 medical colleges in the country. If one doctor can be trained on early screening, detection and prevention of cancer for three months as his or her mandatory course requirements in cancer institute, we can create a skilled force." 

"Each medical college covers three to four districts. So, if at least one doctor from each medical college can be trained, in three years, we will get 90 trained oncologists."   

"In the next stage, three fresh graduates can be trained from 30 colleges, enabling us to cover 64 districts," he elaborated. 

"If we undertake a five-year-long project, we will be able to disseminate the service all over the country. If we train each doctor of 50 to 60 upazilas for 15 days in the first phase, then for a month in the next phase, they can at least learn how to detect cancer. Later, if they find any serious case, they can refer them to specialists."

International Agency for Research on Cancer estimated "there are 1,21,000 new cancer patients in Bangladesh". But only 30,000 come under the health net, according to a 2006 government survey on cancer registration, Dr Habibullah said. 

"If we undertake a five-year project, prioritising doctors giving treatment to villagers for promotion, we may create a trained force." 

"Overseas training costs crores of taka. Instead of sending our doctors abroad for training, we can bring trainers from countries such as Thailand and India. One trainer will train 20 participants. It will save the cost and will be more effective," he explained. 

Using technology, we can also train the doctors of community clinics as well. The government has a plan to introduce full-fledged cancer hospitals in eight divisional cities. If a specialist counsels the doctors through teleconferencing, their efficiency can be increased. Every day every centre will get an expert opinion.

About the private sector, he said, "We would encourage the private sector to specialise in cancer treatment. A waiver can be introduced on the machinery import. And in exchange, the hospitals can be asked to give at least a 10 percent discount on treating poor patients.  

The cancer expert also stressed the need for making private hospitals self-reliant. 

"One thing the private hospitals need to stop doing is depending on public doctors. Government doctors give Ninety percent of treatment at private hospitals. The doctors of public hospitals serve private hospitals as they pay well. But by this, these hospitals never get self-sufficient." 

Institutional practice needs to be introduced where the government can be a major player. Say, it can double the wages and make it mandatory for the employed doctors to do their institutional practice. 

Half of the payment from the practice will go to the government exchequer and the doctor will receive the rest. It can increase the income of the public hospital.
 
"The hospitals also need to invest in the diagnosis system. If the patients get their diagnosis done in the hospital, the government may generate more income. The medical tests can also be a source of income. Government management can bring change," said Habibullah.