The normally bustling, outpatient unit of the Adyar Cancer Institute, is deafeningly quiet. And so it has been over the last two months, confirms Chairperson of the Institute, Chennai, Dr V Shanta, as she shares her concerns in the background of the devastating COVID pandemic.

“Over the years, we have evolved standardized protocols integrating all the advances in oncologic science and technology into our treatment. But this never-before situation has raised multiple concerns,” said Dr Shanta, “With the lockdown adding to the panic, many patients were unable to reach the cancer centre. Outpatients numbered about 400 before lockdown times and bed occupancy was about 550-600. There were no occupants or outpatients during lockdown.”

“Many institutions would not accept patients due to fear and lack of facilities for staff protection. Which means thousands of patients across the country would have been in various kinds of distress,” she called out.

The Ministry of Health & Department of Public Health guidelines for medical and nursing staff, technicians, sanitary workers and others are extensive. The high prevalence of the infection makes it mandatory to provide accepted Personal Protective Equipment (PPE) to staff .

“Our regular monthly running costs have gone up by about Rs 30 lakh** due to the pandemic! Besides, COVID testing of all patients who need treatment will add to costs,” Dr Shanta said. (ACI is not a designated COVID hospital, testing is only mandatory for patients and their relatives/attenders)

Currently, the Institute has been advised to ensure careful division of the patient population. “Besides COVID testing kits needed for initial screening, we need to organise separate entries for outpatients, inpatients and patients coming for treatment on a daily basis. Then there is a need for life saving facilities like oxygen, water, milk etc… and these are just the major ones,” Dr Shanta shared.

“Already, easing of lockdown this week has meant that about 150 outpatients turn up each day, and about 20 -30 occupants are in our wards. We are getting organised to begin work but my doctors and nurses are nervous and unsure of the numbers we will need to be ready to handle!”

For a charitable hospital (NGO) committed to free service for a large number of underprivileged patients,  how challenging is the situation? As most  donations get diverted to GOI and GOTN, contributions to NGOs are limited.

“Individual donors might be available – but for how long? Maintaining staff salaries without disturbance will definitely be a challenge,”

Dr V Shanta, Chairperson, Adyar Cancer Institute

Given India’s large size and population,  accessible, affordable and equitable treatment is definitely inadequate, with severe constraints in delivery of treatment to rural patients.  “The need for health insurance has always existed, but how effectively it can reach those who really need it, remains to be seen,” said Dr Shanta, “ Political will is imperative to transform primary health care into an organised system.” 

Dr Shanta hopes that post pandemic, regular habits — in terms of cleanliness and hygiene — such as spitting on the road, easing oneself in public places, overcrowding in buses and places of worship, keeping social distance etc may improve  for the better, post pandemic.

“Ensuring better treatment for marginalized cancer patients in a pandemic situation depends on how the public and corporate organisations rise to the occasion.  Not only in Chennai, but across India and all across the world, cancer patients will face major challenges and concerns in the kind of care they can expect in the days to come. In the current year, cancer morbidity globally will be significantly higher than earlier. We are committed to the care of the underprivileged, and we shall do our best!” she signs off.

** Errata: The regular monthly running cost of the Adyar Cancer Institute had been mistakenly pegged at Rs 30 lakh in the original version of the article.