SHAL­IZA HAS­SANALI

Can­cer, this coun­try’s sec­ond lead­ing cause of death, is on the rise and the chair­man of the T&T Can­cer So­ci­ety (TTSC) Dr As­ante Le Blanc is con­cerned.

Her or­gan­i­sa­tion op­er­ates on funds re­ceived from cor­po­rate spon­sors and the Gov­ern­ment to pro­vide screen­ing at a re­duced cost and pro­motes aware­ness to cit­i­zens. Three years ago, their “sub­ven­tion was al­most tak­en away” but they were able to show the Gov­ern­ment the work they have been do­ing and “got their sub­ven­tion,” she re­vealed.

How­ev­er, the State’s fund­ing is a drop in the buck­et to the work the TTSC has been un­der­tak­ing. Every month the TTCS screens be­tween 300 to 500 pa­tients for breast, cer­vi­cal, prostate and col­orec­tal can­cers.

Com­ment­ing on re­cent can­cer sta­tis­tics, Le Blanc said based on the TTCS’s lat­est da­ta “we did not see what we want­ed to see which is a de­crease.” She is wor­ried be­cause if cor­po­rate T&T pulls its fund­ing, it would put the so­ci­ety on shaky ground.

“You can’t be­moan the Gov­ern­ment has a lot on their plate,” she said.

Since the clo­sure of T&T’s bor­ders last March, the TTCS has seen an up­take of pa­tients. Le Blanc said the TTCS wants to un­der­take stud­ies with PSA test­ing and prostate can­cer and are cur­rent­ly do­ing re­search on the preva­lence of child­hood can­cers in a cer­tain part of Trinidad to see if en­vi­ron­men­tal fac­tors have been con­tribut­ing to the dis­ease.

Le Blanc is of the view that T&T does not have suf­fi­cient pub­lic health care fa­cil­i­ties to treat can­cer pa­tients.

“We have to do more when it comes to on­col­o­gy in T&T,” she said.

There is a need for a cen­tralised on­col­o­gy unit that can pro­vide co­or­di­na­tion of all treat­ments and post-treat­ments, coun­selling, nu­tri­tion, acupunc­ture and in­sti­tu­tion­al­i­sa­tion.

In 2002, then prime min­is­ter Patrick Man­ning promised a Na­tion­al On­col­o­gy Cen­tre as the main treat­ment fa­cil­i­ty for can­cer. The cost of con­struc­tion, ini­tial­ly es­ti­mat­ed at $144 mil­lion, was put at $800 mil­lion in 2012. Af­ter spend­ing $300 mil­lion on a foun­da­tion, Health Min­is­ter Ter­rence Deyals­ingh an­nounced in 2018 the ter­mi­na­tion of the cen­tre’s con­tract.

Last June, Prime Min­is­ter Dr Kei­th Row­ley said at the launch of an $84 mil­lion Lin­ear Ac­cel­er­a­tor Wing at the St James Med­ical Com­plex that his Gov­ern­ment could have spent more mon­ey on equip­ment to treat can­cer had it not been for past cor­rup­tion.

“There is a lot more work to be done. When you think of how much it costs to treat one can­cer pa­tient, just one, the mil­lions of dol­lars for just one pa­tient, this is why the so­ci­ety is pro­mot­ing pre­ven­tion, ed­u­ca­tion and screen­ing be­cause if we get ear­ly de­tec­tion we will spend much less mon­ey and we will save lives,” Le Blanc said.

Ad­mit­ting the health sys­tem has faced short­ages of drugs, ma­chines mal­func­tion­ing while doc­tors are over­worked and over­whelmed, Le Blanc said no sys­tem is per­fect.

“But I can tell you hon­est­ly they have im­proved and they are try­ing,” she said.

Last month, Health Min­is­ter Ter­rence Deyals­ingh said it costs the State $500,000 to treat one lung can­cer case. Be­tween 2013-2017, there were 641 lung can­cer deaths.

As to how many new can­cer cas­es are de­tect­ed an­nu­al­ly, one of the coun­try’s lead­ing on­col­o­gist Dr Kavi Capildeo puts the fig­ure at 4,000. Capildeo, who is based at the St James Med­ical Com­plex, treats 1,500 of these pa­tients and at­tends to six to sev­en of them every week.

A year sup­ply of the drug Trastuzum­ab to treat a pa­tient with breast can­cer said can cost the State $100,000,” he said.

“There are treat­ments that are dif­fi­cult to get in the pub­lic ser­vice and there are some pro­ce­dures that we can’t get lo­cal­ly at all, for ex­am­ple, bone mar­row trans­plan­ta­tion, stem cell trans­plan­ta­tions, stereo­tac­tic ra­dio­ther­a­py.”

If some­one has re­lapsed lym­phoma and the treat­ment re­quires bone mar­row trans­plan­ta­tion, “you would have to look at whether you are able to fund that in Cu­ba or the US or Colom­bia, and then, the cost can be­come very much an is­sue.”

What is the cost of a bone mar­row trans­plan­ta­tion over­seas?

“In the States that can hit US$200,000 and more. In Colom­bia, it is prob­a­bly half that,” Capildeo said.

He said if T&T were to con­sid­er do­ing such a pro­ce­dure “it wouldn’t be about do­ing one as a demon­stra­tion and pulling to­geth­er re­sources that aren’t nor­mal­ly avail­able be­cause that will take us back to the is­sue of deal­ing with blood can­cers . . . haema­to­log­i­cal can­cers and to up­grade that as­pect of treat­ment de­liv­ery.”

To start with, we need to strength­en the blood trans­fu­sion ser­vices and that would then bring us to the is­sue of build­ing up a bet­ter donor base and donor sup­ply be­cause for a long time we have been deal­ing with re­place­ment do­na­tions, rather than vol­un­tary do­na­tions, Capildeo ex­plained.

Even as the Health Min­istry con­tin­ues to foot the bill for treat­ment, some pa­tients have to pur­chase their med­ica­tion and pay pri­vate labs for blood tests and scans.

Ac­cord­ing to Capildeo, fi­nances are the biggest ob­sta­cle in health care, not on­ly in T&T but glob­al­ly.

While it was im­pos­si­ble to move ahead with the na­tion­al on­col­o­gy cen­tre, Capildeo said hav­ing a hub for treat­ment, re­search, train­ing and strate­gic plan­ning—each feed­ing in­to one an­oth­er could have been help­ful.

When Bhat­too was di­ag­nosed with leukaemia in 2015, she re­flect­ed on the agony her 37-year-old broth­er en­dured be­fore dy­ing of lym­phoma can­cer.

“When I got the news that I have can­cer I could not swal­low my own sali­va. I went im­me­di­ate­ly back to my broth­er,” she re­called.

Bhat­too de­cid­ed to hide the dev­as­tat­ing news from her fam­i­ly.

“I start­ed to think about my hus­band and fam­i­ly. They are the world to me and I couldn’t put them through that pain . . . .to look at me every day in the hos­pi­tal . . just liv­ing to die be­cause that was the end re­sult of my broth­er,” she said.

As she lay on the hos­pi­tal bed, Bhat­too con­tem­plat­ed her next move.

“I had med­ica­tion with me to keep me calm af­ter los­ing my daugh­ter in a hor­ri­ble ac­ci­dent and I did the most ter­ri­ble thing to my­self. I took out the med­ica­tion and I am cer­tain there were more than 30 pills in the bot­tle. I prayed and I asked God to make a place for me with him be­cause I thought I was go­ing to die. I want­ed the easy way out. I am go­ing to save my fam­i­ly the trou­ble of see­ing me suf­fer,” Bhat­too said, wip­ing away tears.

She dis­solved the tablets in wa­ter and drank them. When she awoke in the In­ten­sive Care Unit at the San­gre Grande Hos­pi­tal, Bhat­too cried like a ba­by.

To this day, she con­stant­ly asks God for for­give­ness.

While she un­der­went four months of treat­ment, the med­ica­tion she re­quired was un­avail­able at the hos­pi­tal. Bhat­too had to take 13 tablets which cost her $1,066 dai­ly. That med­ica­tion, which she took for two and a half months, crip­pled her fi­nan­cial­ly. She al­so had to pay for scans and blood tests pri­vate­ly.

This left her to draw one con­clu­sion: “If you don’t have the fi­nan­cial sup­port you might as well be dead.”

In three months, Bhat­too de­te­ri­o­rat­ed from a ro­bust 140-pound woman to skin and bones. Her hair fell off, fin­ger­nails turned black and her eyes in­to their sock­ets, mak­ing her un­recog­nis­able to her grand­chil­dren. Now in re­mis­sion, Bhat­too has lived to tell her touch­ing sto­ry.

Denyse Per­sad cringes every time she hears the word can­cer. Last Jan­u­ary, she had to rush her 29-year-old son Stephan to the den­tist af­ter he com­plained about a toothache. The med­ica­tion pre­scribed bare­ly eased hiss pain which prompt­ed Per­sad to have a se­ries of med­ical tests done that showed he had leukaemia.

Per­sad vivid­ly re­mem­bered her son’s ini­tial re­ac­tion to the shock­ing news.

“He al­ways said to me, mom I could han­dle any­thing once it is not can­cer,” Per­sad said.

Stephan was ad­mit­ted to the San Fer­nan­do Gen­er­al Hos­pi­tal. How­ev­er, lit­tle could have been done for him med­ical­ly.

“They did not have the blood prod­ucts to sup­port the chemo. They did not have med­ica­tion to sup­port his type of leukaemia, so there was noth­ing here for him,” she said.

Doc­tors ad­vised Per­sad to take her son to Cu­ba for treat­ment which she did. Af­ter five months of treat­ment, Stephan re­turned home in good health but need­ed to be read­mit­ted at the San Fer­nan­do Hos­pi­tal for fol­low up care.

That turned out to be a dis­as­ter.

“The doc­tors called. There is no room at the hos­pi­tal. Some­one is still oc­cu­py­ing the room so he can’t come,” Per­sad re­called.

Stephan had to be put in one of three ster­ile rooms. The wait seemed like an eter­ni­ty as Stephan’s health de­te­ri­o­rat­ed. When he was fi­nal­ly ad­mit­ted, the un­ex­pect­ed hap­pened.

“He got a re­lapse while await­ing fol­low up chemother­a­py treat­ment. It was a night­mare. It was dif­fi­cult to see your child in that po­si­tion and he is feel­ing help­less be­cause that is what the sit­u­a­tion seemed to be. You can’t leave the coun­try it is COVID and the bor­ders are closed,” Per­sad said.

Per­sad turned to pri­vate health care for treat­ment. But doc­tors gave Stephen a few weeks to live

She said: “I was in a mess. I looked at the doc­tors telling them this can’t be for re­al.”

Doc­tors sug­gest­ed that Stephan be put in a hos­pice, but Per­sad want­ed her son to spend his last days home with his fam­i­ly.

Af­ter spend­ing $500,000 to save her son’s life, Per­sad said “he didn’t last too long af­ter. He died… me hold­ing him. That is how he passed. He died with me. He died in my arms.”

Can­cer sur­vivor Shiv­ana Boodoo is still reel­ing in shock af­ter fork­ing out over $100,000 at a pri­vate hos­pi­tal to re­move her thy­roid when she was di­ag­nosed with can­cer last No­vem­ber.

“The hor­ror sto­ries I hear in pub­lic hos­pi­tals... I just didn’t want to take the risk of hav­ing to wait longer than nec­es­sary in a pub­lic hos­pi­tal to get the surgery done. With can­cer, time is of the essence,” Boodoo said.

How­ev­er, that de­ci­sion came with a heavy price for Boodoo’s fam­i­ly. The cost to re­move part of her thy­roid was $45,000 which had to be paid up­front. How­ev­er, up­on com­ple­tion of the op­er­a­tion, the cost jumped to $75,000 as Boodoo’s thy­roid had to be com­plete­ly re­moved.

She spent an ad­di­tion­al $30,000 in hos­pi­tal­i­sa­tion, med­ica­tion, blood tests and scans.

“Me and my hus­band . . . our per­son­al sav­ings we had to dip in­to that. There are set­backs as far as the fu­ture goals that we had,” Boodoo said.

Can­cer sur­vivor Joy­clyn Han­iff is the em­bod­i­ment of true grit and de­ter­mi­na­tion. In the last 11 years, she has bat­tled bone and breast can­cers. Last Wednes­day, doc­tors dis­cov­ered a mass on her ovary.

The news was yet an­oth­er blow to 82-year-old Han­iff who kept it from her chil­dren. She had to muster enough courage to break the news.

“I want to tell you this, I nev­er be­lieved there is a God in my younger days,” she said with con­vic­tion.

Ad­mit­ting that life has been no bed of ros­es, Han­iff now seems to be los­ing hope.

“As I say right now I feel I should go. I had enough,” Han­iff said.