From Little Things, Big Things Grow

Most of us are touched by cancer in some way. A partner, a relative, a friend, a co-worker may be living with cancer or have lost their battle. The bond between a patient, their immediate relatives and a physician is very close, and patients inevitably place their hopes for a good outcome on a physician. Being a physician is a role of considerable responsibility and empathy – we celebrate with their victories and grieve with their losses.   

Sheikh Zayed Hospital is a tertiary care hospital, in city of Rahim Yar Khan. Although it is a small hospital in South Punjab, it treats a large geographic foot print i.e. the population of South Punjab, Interior Sindh and Baluchistan—areas with comparatively higher poverty and fewer resources. Sheikh Zayed Hospital’s Oncology Department was established in 2009.  We have outdoor clinic, where we provide consultation for diagnosis  treatment, follow up and have chemotherapy bay consisting of 9 beds for chemotherapy administration .Due to lack of ward (building, doctor, paramedical staff and necessary equipment) we cant admit patient for management of chemotherapy complications oncological emergencies and for administration of long chemotherapy protocol Current, patients are required to purchase their chemotherapy drugs themselves.

Medical oncology care in second and third tier cities in Punjab is challenging. Distance, poverty, illiteracy, lack of trained doctors, inadequate basic testing facilities (like ct scans and mri ), social taboos and spiritual beliefs are all factors leading to late diagnosis and high rate of morbidity and mortality. Two challenges are extremely notable: 1) the scarcity and distance to surgical skills and ration facilities; and, 2) the treatment of female patients due to cultural and social norms.

I joined Sheikh Zayed Hospital seven months ago. My mission is to ensure that all people affected by cancer are empowered by knowledge, strengthened by action and sustained by the community. In my humble capacity, I have made trivial contributions to oncology department here. One of the successes that I am extremely happy about is a successful negotiation with Fauji Fertilizer Company (a large profitable organization), they have agreed to sponsor two breast or colon cancer patient, every 6 months. I have also helped create a patient support fund. Friends and family make donations in form of zakat and sadqa (charity). Overtime, I hope this fund will grow and enable us to provide free cancer care to those that need it thereby improving access.

To make things easy for female patient, male and female beds has been separated by wooden partition. Oxygen cylinders, nebulizers, pulse oximeters, glucometers, medicine trolleys,  red , yellow and green dustbins have been added to the  ward – this is basic equipment that was previously unavailable. A formal request has been sent to the principal Sheikh Zayed Hospital, ( he is principal to sheikh zayed hospital)to convert the oncology outdoor clinic to full fledged indoor department.

In conclusion, I will like to say one size does not fit all, when it comes to cancer prevention, treatment and after treatment. We must adapt our approaches specifically for patients and the contexts we are treating them in. Success depends on effective and respectful mutual communication based on empathy and social circumstances. We know are patients may have limited resources and have to allocate those to various priorities. As physicians, all we can do is advise them to the best of our abilities on the best information we have.  

Dr Shanzah Shahbaz
Senior Registrar, Sheikh Zayed Hospital