Unravelling Excellence in Cancer Care across India

the earliest description of cancer can

be found in the edwin smith papyrus way

back

in 1600 bc when it describes a case of

breast cancer

with an attempt to remove it by surgery

unfortunately

it also mentions that there was no cure

for cancer

medicine and oncology since then has

made outstanding progress

the progress has been astonishing having

said that we continue to grapple

with very many problems cancer has now

become the second leading cause

of death worldwide in a span of less

than a decade and in 2018

there were an estimated 9.6 million

deaths

due to cancer is there an economic loss

due to lack of cancer surgery investment

there is

we need to understand that all solid

tumors especially if they are localized

are best treated with the help of

radical oncologic surgery

but most of the lmics suffer from lack

of investment

uh in cancer surgery and you can see in

this particular picture

that there is an alarming increase in

the graph which shows that by 2030

the cumulative gdp loss would be

estimated to be around

6 trillion us dollars look at this

situation we have 42 000 patients of

cancer at tata memorial which are

treated by 188 staff members

compare that with the md anderson cancer

center where 41 000 patients

are treated by 1 700 staff

at houston in texas i’ve had the

opportunity

to work with a global group to try and

look at the problems

that are associated with low and

middle-income countries

and we want to try and see how we can

change

wherein we have islands of excellence

but we need to have more standardized

care

across these nations in other words we

want to develop from dedicated cancer

units

to comprehensive cancer centers across

a country like india for example let’s

look at tata memorial center in mumbai

in this particular slide you see the

light blue bars they indicate

the number of new registrations of

cancer

that we have seen over the years last

year we recorded 75

000 new patients of cancer

the blue bars reflect the admissions

that we have in our hospital

the blue bars haven’t gone up as much as

the light blue bars

and the reason is simple to create a

dedicated manpower

in terms of nursing paramedical staff

doctors and specialists

is one major challenge and the other

challenge is

creation of hospital beds we have a

ratio

which is again very typical for any lmic

the picture that you see over here also

shows a busy outpatient clinic

at the tata memorial for a person in a

country like india this is not a shock

for anyone else especially in any of the

g8 countries this would be a

shock as to how can one manage this

remarkably we obviously develop our own

systems

wherein we are able to offer high

quality care to a large number of

patients

which is a usual problem with the

populist country like india

in tata memorial every year we see about

0.5

million patients who visit us

and the footfall over the next one

decade is expected to double

and we think that we will be seeing 1

million patients a year

by 2030. this is a picture

which shares with you what i consider as

one of the most

complex operations in the body indeed

the world acknowledges

that pancreatic cancer surgery is

dangerous

challenging complex in the face of an

aggressive cancer

which is located in an anatomically

complex part of the body

we have evolved over a period of time i

am a pancreatic cancer surgeon by

specialization and over a period of 20

years

it’s been a gratifying journey but we

have now started to produce results

which are not only a benchmark for low

and middle-income countries

but are comparable with the best in the

world

does this happen overnight not at all

it’s taken us

a decade and a half as we complete two

decades of complex pancreatic surgery

it requires patience passion and

consistency

look at this gentleman with the thai

cave rescue

no one knew about him and what did he

say after the thai cave rescue

i died for passion and always wondered

if it would have a purpose

last two weeks was what i prepared for

for the whole of my life

the next picture is about a spot which

is very dear to me

cricket there’s one gentleman whose name

is synonymous with being a world famous

sportsman

an iconic cricketer perhaps the best

cricketer

in the last hundred years sachin

tendulkar

the other name is of yours truly this

was the time when i used to play cricket

at a junior level

in mumbai and i’ve enjoyed playing my

cricket then

and even now i do try to find time to

play cricket and enjoy this great sport

i’ve done reasonably well in surgery and

continue to enjoy my journey

thanks to the passion that i have and

thanks to the consistency that we have

established in surgery

unfortunately i did not become a

cricketer but what made sachin special

what makes him unique the thing that

separated him from rest of the boys

was the fact that he had remarkable

almost unbelievable consistency

33 years ago but even when he retired

after an international career of 24

years

he still had the same consistency and

the same passion

clearly consistency is what transforms

average into excellence

while we are doing this we are also

bombarded with constant evolution

and development of modern technology

and technology is a wonderful tool for

example

you can see robotic surgery being

performed by me

it’s superb technology easy on the

ergonomics

it’s a wonderful toy if i may say in the

hands of skilled

and experienced and capable surgeons it

can also be dangerous

technology is like a wild horse

we are the ones who need to master it

and we should never be

slaves of technology while we continue

to master it

we also need to be aware that the basics

don’t change

you need to invest in time you need to

have

patience you need to have passion and

you need to negotiate

your learning curves before you can

master robotic surgery

more than technology there are other

important drivers which continue to

inspire me

making impossible possible is something

which is

the way forward in my opinion

to do that i need to challenge myself

again and again

and i also need to mentor generations

ahead this is a picture of a complex

pancreatic cancer operation

that has been undertaken and done

successfully

a few years ago this operation was

impossible

but now we are able to do this fairly

routinely

is this because i have improved yes to

an extent i have partly improved

but i think it’s no more about me it’s

about a

team i’m truly blessed to have a

fabulous team

all of them who are dedicated to the art

and science of gastrointestinal cancers

talent can win matches but teams

win championships so my journey

of excellence in pancreatic cancer

surgery began

in switzerland and in germany in the

year 2000

and continued for a few years thereafter

i enjoyed learning and making attempts

to master pancreatic surgery then

came back to india implemented and

standardized this kind of surgeries

and then of course had the opportunity

to train a large number of young

surgeons and students

and when they remember me on teachers

days

and other days when they express words

of gratitude

it’s extremely satisfying but you know

what is more satisfying

i want you to focus on the picture which

shows the india map

today we have surgeons who are doing

high quality surgery

in parts of india where it was never

done before

so complex pancreatic surgery is no more

just in the metros

but it’s also in the smaller cities and

towns

across the length and breadth of india

but these young highly specialized and

motivated surgeons and doctors

need excellent institutions so that they

can stay motivated and enjoy what they

are doing

it’s also important that patients get

access to high quality care

close to their homes rather than

traveling vast distances

to reach our hospital in mumbai

and this has been our effort for example

you can see this beautiful hospital

in varanasi which was inaugurated by the

honourable prime minister of india

mr modi we’ve also developed hospitals

not just in varanasi

but also in punjab in guwahati and in

wiseac

but the biggest pleasure that i get is

to visit these hospitals

be a part of their ecosystem spend time

with the young

doctors and the surgical teams over

there operate with them

transfer our skills with them exchange

ideas with them

learn from them and keep moving ahead

and taking the art and science of cancer

care across india

i leave you with what is clearly a dream

that is expected to become a reality

in the next three to five years a state

of the art cancer center

which would be catering to each and

every individual in this country

across socioeconomic strata and serve

the needs of the nation for the next 50

years to come

of course in life what you really want

never comes easy

but as vincent van gogh the famous dutch

artist said

great things are done by a series of

small things

brought together thank you