Community-based cancer treatment at the grassroots level

Community-based cancer treatment at the grassroots level

By Rita A. Widiadana

The government has just launched a five-year program to
develop a national cancer control strategy which actively
involves the community. A number of non-government organizations,
however, have been applying a community-based cancer treatment
program at the grassroots level since l980s. The Kusuma Buana
Foundation in Jakarta is one example. The Jakarta Post recently
visited the foundation's family clinics to look at its activities
in the early detection and prevention of cervical cancer. The
endeavor involves thousands of women from middle and low-income
groups in Jakarta.

JAKARTA (JP): Better late than never, a doctor at a health
foundation commented on the implementation of the government's
five-year cancer control program.

"The rapid growth of various cardiovascular and non-infective
diseases, including cancer, can actually be halted by
implementing a series of preventive actions rather than resorting
to curative treatment," explained Adi Sasongko, chairman of the
Kusuma Buana Foundation, a non-profit organization dealing with
mother-and-child health care.

Cancer can inflict the rich and the poor as well as the young
and the old, he said, but "so far, the government seems to focus
more on hospital-based programs, which turn out to be too costly
and ineffective in controlling the diseases."

Efforts directed towards cancer control in all parts of the
world encompass a wide range of areas, from fundamental research
to preventive epidemiology, from public education to the
development of professional expertise, and from skills for early
diagnosis to creation of infrastructure for sophisticated
therapeutic technology. The problems in developing nations are
compounded by over population, poor education and socio-economic
constraints.

The development of sophisticated hospitals or cancer treatment
centers, Sasongko said, is indeed very important in curing
cancer.

"But, there are only a small number of cancer patients who can
afford such costly medical treatment while at the same time the
number of cancer sufferers is increasing very rapidly," Sasongko
said.

In l989, one in every 1,000 Indonesians had cancer. The number
is rapidly increasing because of changing patterns in diet and
lifestyle. Official data from the Ministry of Health reveals that
each year Indonesia sees an additional 190,000 cancer sufferers.
At least a fifth of them are terminal.

Soejoga, the Director General of Medical Services at the
Ministry of Health, said earlier that more than 80 percent of
cancer patients in Indonesia are incurable because they seek
medical treatment too late.

Sasongko explained that the number of Indonesians suffering
from cancer can be reduced by actively educating the public about
its dangers.

"Indonesia can learn from other developing nations, including
India, to deal with cancer," he said.

India's experience in applying the rural model developed by
the Tata Memorial hospital in New Delhi indicates the benefit of
such efforts when dealing with cancer.

The problem of cancer in India is mainly solved at the grass-
roots level, in the rural areas where the majority of the
country's population reside. Educating the public about the
symptoms and augmenting professional education helps in earlier
diagnosis and promotes simple treatment methods that can be
applied on the national level rather than at large-scale
metropolitan cancer centers. The establishment of simpler cancer
centers can effectively serve the needs of low-income patients
who will be spared the cost and time of traveling to major
cities.

"We can encourage people, for instance, to change their diets
and their lifestyles. We can also ask them to undergo medical
check-ups for early detection of any related cancer disease,"
Sasongko added.

Impressive program

Cervical cancer is the biggest killer of Indonesian women.

Poor education, excessive menstrual bleeding, early sexual
intercourse, repeated pregnancies and two or more marital
partners allow the disease to develop in Indonesia. Smoking and
the low educational level of husbands are also crucial risk
factors.

To increase the public's awareness of the cervical cancer, the
foundation set up an community-based program in 1987.

The foundation has been very active in promoting pap-smears
among adult and married women in Jakarta's most densely-
populated areas, including in Pisangan, Jatinegara (East
Jakarta), Pal Batu (South Jakarta), and Kebon Jeruk (West
Jakarta).

"Pap-smears have long been known as a very simple medical
method to detect any cervical or uterine cancer symptoms," he
maintained.

Sasongko went on to say that the main targets of the program
are housewives, female teachers, workers and traders living
nearby the foundation's clinics.

"However, most targeted women come from low-income families,
they have little spare time to join the counseling program in the
clinics as they spend most of their time earning a living or
taking care of their children," midwife Murdiati, a team member,
added.

Every married woman is advised to have a Pap smear at least
once in a year.

To have such a test, Murdiati said, a woman should go to a
large clinics or a gynecologist. Each examination will cost
between Rp 50,000 (US$25) and Rp 100,000 ($50). The foundation
sets a lower rate of Rp 15,000 per examination.

Misleading information on pap-smears has also prevented people
from taking this important test.

"Many women are afraid to have such an examination because
they receive the wrong information from friends and relatives.
They often associate Pap smear examinations with other serious
uterine observations which use hi-tech medical equipment," she
explained.

Murdiati added that many women are also reluctant to have male
doctors or health workers carry out pap-smears for them. "Most
women prefer to go to midwives or female doctors to have the pap-
smears," she added.

Volunteers

To make the program more effective, the foundation established
a special team involving three doctors, midwives, trained
paramedics and volunteers to work in its six family clinics.

The team provides counseling and education on the importance
of pap-smears, medical treatment and laboratory tests.

Midwife Murdiati, said the foundation has trained prominent
members of the community family welfare organization as
volunteers.

"These volunteers play significant roles in disseminating
information. They include the program in their daily activities
to reach a wider audience. Their efforts have been quite
successful," Murdiati explained.

The program also involves other community groups including
elementary school teachers and members of Koran reciting
societies in the targeted areas.

Since the program started eight years ago, the foundation has
drawn 6,666 women to have pap-smears. About 140 women were found
to have pre-cervical cancer.

"We have to send these patients to hospitals for further
treatment as we don't have adequate medical facilities to cure
them," said Sasongko.

He admitted that the foundation's program still has many
shortcomings. Lack of funds and medical staff have hampered the
foundation from expanding the program to other slum areas in the
capital.

"I only expect that the government pays serious attention to
this grassroots cancer treatment program," he said.

Nigel Gray, the president of the International Union Against
Cancer, warned on the eve of the International Cancer Conference
last week, that a screening program to treat cancer, now
available through developments in medical science, would not be
successful unless a simultaneous effort was made at making
treatment accessible to everyone.