A Dual Battle

Female cancer patients in Kashmir are fighting a dual battle for survival. While the killer disease has made their existence uncertain, the attitude of Kashmir’s conservative society hasn’t brought any solace to them, Saima Bhat reports.

Sana, 28, was diagnosed with cancer when she was eighteen years old. “At that time, I was not aware what I have to go through. I didn’t even really know why I was undergoing a surgery as my family had not informed me that I was suffering from cancer. Some of my relatives spread the news like fire that I had cancer.”

After undergoing multiple medical treatments in the last decade, Sana got cured. Till then, she was studying and did her post graduation as well. But now, her only concern is her marriage. “I know I have to face hurdles in getting married. I am ready for all consequences as it was not me who created this problem. I have already decided that I will tell the person before marriage that I had this problem. I don’t want to start a relation with a lie. I will leave the decision to him,” she says.

Sana’s parents are worried about her future too. They have rested all their hopes with God with a belief that since Sana was well educated, she would get a perfect match.

In a conservative society like Kashmir’s, people with such health ailments don’t share their problems with others and when the victims are unmarried youth, the issue gets more complicated due to fears that such patients might die early and face fertility problems. “Medically, it is not true. I have treated many such patients who later got married, had children and are now living a healthy life,” Dr Abdul Rasheed Lone, an oncologist at Sher-i-Kashmir Institute of Medical Sciences, Soura, where most of the cancer patients of Kashmir valley are treated, says.

There are some types of cancers which are found in young, unmarried females like germ cell cancer but they are fully curable and 80 percent of such patients don’t face any problem in fertility, Dr Lone says. Another such type of cancer, Lymphomas, which is common among kids, is also curable up to 80 percent but nowadays, as the technology has improved, such patients are given chemotherapy in a way which doesn’t interfere with their fertility process, says Dr Lone.

Sayeda doesn’t regret the step she took three years back for her lone daughter, Nazima. Sayeda had informed her daughter’s prospective in-law’s that Nazima has been diagnosed with cancer. For some time, Nazima was shocked. But as days passed, her priorities changed. Her health became her only concern. For mother-daughter duo, the year 2010 changed everything.

“When blood tests confirmed Nazima was having leukemia, I lost all hopes,” recalls Sayeda. Somewhere, she regrets that she couldn’t afford to take her daughter outside the state for better treatment. Doctors treating Nazima say she will live a normal life but she has to be on medication and go through regular follow-ups throughout her life.

Nazima’s marriage was scheduled to take place within six months and Sayeda decided to inform the boy and his parents about her ailment. “I didn’t want to hide anything from them, even though doctors had advised me that Nazima won’t be facing any hurdles in her married life,” Sayeda says.

In Kashmir, a disease like cancer always brings up two issues; one is, of course, related to health, and the other is living in a conservative society. “Kashmiris can accept daughters with some health problems but they will never allow a cancer patient getting married to their dear ones,” says father of Nazima.

“Detection of cancer does not mean that the patient will die. There are types of cancers and the disease is like any other disease,” says Dr Lone of SKIMS.

Dr Lone also believes that there is a social taboo associated with the disease, “And in case of unmarried youth – both males and females, it becomes a hurdle in getting married. Recently I was working on a presentation on germ cell tumors in young females, where I presented three patients as index cases who were treated 10 years back. But when I informed those patients that I have presented their case history, they were so frightened. I had to assure them that we didn’t disclose their names,” he said.

A total of 2097 patients were registered in SKIMS in 2007, 2465 patients [1467 males, 922 females, 44 MCH, 32 FCH] in 2008, 2968 patients [1705 males, 1168 females, 60 MCH, 35 FCH] in 2009, 2623 patients [1544 males, 1007 females, 36 MCH, 36 FCH] in 2010, 3057 patients [1744 males, 1220 females, 59 MCH, 34 FCH] in 2011 and 2737 up to October 31, 2012. While the number of such cases in SMHS was 6169 in 2007, 6138 in 2008, 7836 in 2009, 11708 in 2010 and 19973 patients in 2011.

Among various types of cancers, Esophagus, Lung, Stomach and Breast cancers are most common among Kashmiris and these numbers exclude the ones who go outside the state for treatment or who don’t come for follow-ups. According to oncologists, there are such malignancies also which have recurrence rate and in those cases, they ask patients to wait for some time before getting married or having another child.

Dr Lone says the married patients, who are registered at SKIMS, come along with their life partners. But when it comes to unmarried youth of rural areas, their parents abandon them. “In rural areas, a couple usually have four or five children and if any one among them gets diagnosed with cancer, mostly female ones, the family abandons them or don’t come for follow-ups,” says Dr. Rashid.

But the situations is different among the patients who are registered with Cancer Society of Kashmir (CSK), an NGO, where out of 10 female married patients, six are abandoned by their life partners. “We give 100 percent free treatment. That is why we keep on getting such patients who cannot afford proper medication. Among them are mostly female married patients who are abandoned by their life partners as well,” says an official in CSK. Presently, CSK provides free medical aid to its 450 registered cases of cancer patients.

Shugufta, 32, a mother of one child, was diagnosed with GIST (Gastro Intestinal Stromal Tumor) four years back. Her husband, a driver, gave it a thought for a week and finally asked Shugufta to leave, despite knowing that her father was an old man and doesn’t have any support. “He asked me to leave along with my five-year-old son. When I asked him for reason, he said he doesn’t have money for my treatment.”

Shugufta is on a regular follow ups in CSK and the doctors who are treating her say she is responding well to treatment. “I know cancer treatment costs much but how is it justified that we will leave those patients to suffer. Presently there are round about three NGO’s who specifically treat cancer patients free of cost. There are two main government hospitals as well, where such patients can benefit. So abandoning is not an option. And most importantly, such patients respond more positively to medicines only if they don’t have any other stress in life,” says a doctor.

Dr Lone says when a person comes to know that he/she is suffering from cancer, it definitely causes stress, “But then proper counseling is needed which is lacking in Kashmir. When we tell any patient that you are having cancer, they leave all hopes of living. It is when a counselor can play a big role. As doctors we treat patients and when time allows, we do counseling also, but that is not the way. Awareness is very important,” he says.

“When we tell our patients to come for follow-up after five or six months, they get surprised saying, ‘We have cancer and you are asking us to come after six months’, Then we counsel them that there is a need for regular follow ups but that doesn’t mean they have to remain present round the clock in hospital,” Dr Sanaullah Kuchay, an oncologist at SHMS hospital in Srinagar, said.

Some names of the victims have been changed.