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