Heavy rolls the cancer train, still

Sanjeev Singh Bariana

Squinting to catch the blurred image of the 54704 Jodhpur-Bathinda passenger train entering Bathinda railway station at 9 pm in the chilling foggy January night, a frail 68-year-old Madan Lal of Mallan village in Faridkot district struggles to move. He grabs his small soiled bag and drags himself to stand straight as the cancer train arrives at Platform Number 2 to leave for Bikaner.

Accompanied by his sister Usha Rani, he boards the Sleeper coach, the only compartment with reserved seats, allowing him to lie down on his seat while his sister chooses to sit near his feet. The remaining coaches on the train are of the general category. Packed to near capacity, passengers jostle for space. They try to wrap themselves in blankets, which sometimes fall short of covering their feet, and at times their head, as they guard themselves against the biting cold.

We board the compartment with reserved seats. The Travelling Ticket Examiner (TTE) obliges by giving us two berths. Most of the passengers are cancer patients, who would disembark at Bikaner. Many of them are visiting the Acharya Tulsi Regional Cancer Hospital and Research Centre in the coveted Prince Bijay Singh Memorial Hospital in Bikaner, which like many hospitals in Punjab is covered for benefits under the Mukh Mantri Punjab Cancer Raahat Kosh Scheme (MMPCRKS).

Flashing a faint smile, cancer patient Madan Lal says: “Kambal lai lao (Take a blanket). The journey has just begun and it will get even colder during the night.” Madan Lal has been undergoing treatment for cancer in his food pipe. He told us that he has visited the Bikaner hospital more than 30 times since March last year after he suffered from a bout of typhoid.

When asked why he was travelling to a far-off place in Rajasthan when Punjab had state-of-the-art facilities for cancer treatment, his sister Usha Rani interrupts: “My brother was detected with typhoid in March last year and his condition deteriorated. We went to the Faridkot Government Hospital at least four times but never got a chance to see any doctor, so we came here”.

On the adjoining seat, Balwant Singh, sarpanch of Kothe Sangat village, joins in the conversation: “Faridkot hasptal te neelian paggan te bhegve chole waalian dian sifarishan challdian ne” alluding to the influence of the ruling Shiromani Akali Dal and BJP leaders in getting an appointment with the doctors. He says: “It is also not easy to get cash incentives under the Mukh Mantri Punjab Cancer Raahat Kosh Scheme (MMPCRKS).”

Reflecting on the large number of patients from Punjab travelling on the train, Krishan Lal from Ladhokan village near Fazilka says: “There are very good doctors at Faridkot hospital. Only, a poor man is never able to reach them in their office. My son took me there five times but we did not get even a brief appointment.”

He adds: “We, then, went to a private doctor in Bathinda who recommended several tests in different laboratories. The entire exercise cost me more than Rs 80,000 but still my treatment did not begin. It was then that someone advised us to go to the Bikaner hospital. Bathinda, Ludhiana, Jalandhar and Amritsar have numerous facilities for conducting tests, but all these centres are merely minting money in the name of treatment.”

Biting cold and tales of cold treatment do not let us sleep and we move further in the train. Here we find Daljit Singh from Moga switching off the lights for the night. He is accompanying his ailing mother Harbhajan Kaur. “Everyone will be rushing to the residences of doctors in the morning before they reach the hospital,” he says.

Puzzled, my photographer colleague raises his head when Daljit Singh says: “The doctors charge us Rs 200 for visiting them at their residence early in the morning. They recommend tests, which we get done before we visit them in the hospital later during the day. This saves our time”.

The train is late by about two hours when it reaches Bikaner at 7.30 am. Everyone leaves, with majority scurrying to the residences of doctors. Lost in the melee, we walk to the pan shop in front of the station and ask the way to the hospital. Chewing betel, Sita Ram smiles: “Get an autorickshaw. He will charge only Rs 20 for both of you”. “Punjab se ho?” he adds. I reply with “Yes but why?” He smiles “Roj ek train bhar ke aati hai aur sham ko phir bhar ke jaati hai (A train comes full in the morning and leaves full in the evening)”.

In the hospital

Sturdy countenances with turbans mark the sizeable majority of Punjabis in long queues at the registration counter. They outnumber other patients in room no 1 where three doctors are attending to a huge rush of patients.

According to the head of the Department of Radio Oncology, Dr Harvinder Singh Kumar, “More than one-third of visitors here are from Punjab. Our doctors examine nearly 10 new and about 75 follow up cases from Punjab every day. A majority of these patients are very poor.”

Smiling gently at the public comment that they were bribing “gentleman” doctors by giving Rs 200 for consultation at their residences, Dr Harvinder says: “Our hospital has permitted doctors to see patients, only for consultation, at their residence since this saves their time in getting the tests done till they come in for a formal appointment. They are happy coming here because our staff does not recommend unnecessary and expensive tests”.

Here we find Madan Lal, whom we had met in the train, sitting on a bench. “They have asked me to get fresh endoscopy done,” he says.

The increasing number of patients has led to the mushrooming of many medical stores and testing centres in the city. Those near the hospital charge a premium. Grurbhaj Singh, who’s standing in the queue, says: “We get due attention here, although the travel part is tiresome”.

Soon a number of patients come and sit under the sun in the hospital compound. Dayawanti, a patient of throat cancer from Dhurkot, near Barnala, is moaning on the side of the pavement while her daughter Babli keeps her company. A family member has gone to collect her reports.

Consoling her, Bakshish Singh from Taalan village in Patiala, says: “Rovo na bibi (Don't cry mother). I have been bringing my wife, Charanjit Kaur, here for the past several months. My elder son has died. His wife left our home leaving behind their three daughters with us. The Almighty will show us some way”.

Camping here for the past 21 days, Dayawanti’s nephew, Pawan Kumar, says: “A large number of poor patients coming from Malwa indicates that the government has miserably failed to address the problem in Punjab”.

Janakraj from Abohar has a similar woe to share. “Back home, I had spent more than Rs 2.5 lakh on tests alone, and still the treatment didn’t begin, while here the entire process cost me only Rs 30,000. I have been told that I have nearly recovered.”

Malian Singh from Makha village in Bathinda says, “One of the major reasons why we come here is because of the availability of inexpensive accommodation and food. You can have quality food for merely Rs 5 per thali on the hospital premises. This is nowhere in Punjab”.

The hospital mess serves meals to 3,000-3,500 persons everyday.

Bakshish Singh leads us to a tent on the campus. “This is our bedding and there are no charges for staying under this tent.” There are, however, some unfortunate ones like Dayawanti, who sleep on the pavement.

As the day draws to a close, we proceed to leave for Punjab, thinking about the people we met on the train, and many, many others who struggle to cope with the debilitating disease and the inexplicable failure to provide adequate facilities back home.

FACTFILE

• It takes around eight hours for the 325-km-long journey between Bathinda and Bikaner on the 54704 Jodhpur-Bathinda passenger train.
• On an average, 100 cancer patients, besides 200-odd co-travellers travel on the train everyday.
• On the ticket priced at Rs 210, a cancer patient goes free and one accompanying attendant gets a concession of 75 per cent.
• A room at a dharmshala in Bikaner costs Rs 50 while a thali in the hospital canteen costs a mere Rs 5.
• The last survey report in 2013 found that there had been 33,318 cancer deaths during the five preceding years.
• There were at least 18 deaths due to cancer each day.
• The survey revealed 23,874 cases of active cancer while 84,453 showed symptoms.
• Relief worth Rs 347 crore under the Mukh Mantri Punjab Cancer Raahat Kosh Scheme has been distributed to 28,000 patients since 2011.
• Contaminated water, uranium and excessive use of chemical fertilisers are said to be the major causes for the rise of cancer in Punjab.
• Government-approved list of registered hospitals includes Oswal (Ludhiana), DMC (Ludhiana), Ivy (Mohali), PGIMER (Chandigarh), Government Medical College and Hospital, Sector 32 (Chandigarh), Rajendra Medical College and Hospital (Patiala), Guru Ram Das Hospital and Government Hospital, both in Amritsar.