Nepal’s other pandemic: cancer

It started with persistent skin allergy for 15-year-old Uma Kumari Sah. She got a checkup at a leprosy hospital in Dhanusa, and later in India. Doctors detected a growth in her lungs. The very next day she flew to Kathmandu where she was given six cycles of chemotherapy, twice a week.

Sah is from Hariban municipality of Sarlahi district where 30 people have died in the past three years, seven others are undergoing treatment for various types of cancer.  

The three neighbourhoods of the village have a population of 1,500. Extrapolating this figure nationwide would mean a death toll from cancer of a staggering 650,000 people all over Nepal in three years.

Hariban village is at the lap of the Chure Range adjoining the Tarai. There is well water, and the fertile fields are perfect for vegetables which are taken to Kathmandu to be sold. But what brings the farmers prosperity could also be one of the reasons for the epidemic of cancer here.

Farmers are using herbicides and insecticides, some of them banned in Nepal. The water table is receding due to over-extraction and what comes out of the pumps is arsenic-laced.

Cancer used to be so rare in Nepal that there is no word for it in the Nepali language. But Hariban could be a microcosm of the cancer sweeping the country. Cancer is now the fifth leading cause of death in Nepal, with lung, breast, cervix, stomach and colorectal cancers being the most common.

Approximately 28,000 new carcinoma cases are diagnosed every year in Nepal with mortality at 20,000, both at an increasing rate as per the Global Cancer Observatory estimates. But many more cases go undiagnosed due to lack of resources and insufficient screening.

The ongoing Covid-19 pandemic has added to the crisis. There were five times more funerals at the Pashupati cremation site in December 2020 compared the previous year. While some could be people who died from the coronavirus, many others are thought to be patients with cancer or other chronic disease who could not get timely treatment.   

Lockdowns and restrictions as well as fear of contracting SARS-CoV-2 had affected patients of many chronic illnesses such as cancer due to reduced treatment and screening facilities. This in turn has likely resulted in more fatalities, say health experts.

Back in Hariban, Sah is now doing well after treatment. She says: “I’m lucky because my family could afford the treatment. I now plan to study science, be a nurse and care for patients like me. I want to help the poor and provide them treatment without cost.”

Rafi Miya also lives in the neighbourhood and can barely survive on income from farm. Now, in addition to poverty, the family is burdened with cost of cancer treatment for himself and his son.

Miya was diagnosed with throat cancer after a biopsy in Bharatpur Cancer Hospital. “They operated on me and took the growth out, but my voice is hoarse now. We cannot get the medication here, and it is expensive.”

His son Lipla Miya’s cancer has affected his bowel and bladder functions. His treatment has already cost Rs200,000.  

Phekini Devi Mahato Sundi also lives nearby, and started getting skin rashes, and suspects the lump in her breast is cancer. She cannot even afford to travel to get a checkup. Her husband Sinai has asthma, and is despondent that he does not have the money for her treatment. 

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“We have no money, without it there is no treatment. Doctors only treat those with money,” he says, pointing to his damaged spectacles, which he cannot afford to replace.   

At Hariban’s Namuna Community Hospital, physician Anil Kumar Chaudhari conforms that there has been a steep rise in malignancies, and patients are referred to hospitals in Kathmandu or Bharatpur.

“There is a steady stream of cancer patients from the surrounding villages, most have skin, liver, lungs and throat cancer,” says Chaudhary. “Those who can afford it go to India.”

The Nepal government provides Rs100,000 for cancer patients who cannot afford treatment, but this is negligible compared to the total bill. Most patients here seek treatment when the cancer is at an advanced stage, so they end up losing all their money as well as their lives.

Another neighbor, Jaggilal Sah suffered minor illnesses for a few years, but when he got sick during the pandemic, the doctors diagnosed him with third stage brain tumour. Surya Bahadur Sangtang’s father was also diagnosed with last stage cancer and died within few months.

Says Sangtang: “He was admitted to hospital for 2-3 months, we lost all our money, and we also lost our father.”

The dramatic rise in cancer made Harban’s local government investigate possible contributing factors. Many residents depend on commercial vegetable farming, and there is rampant pesticide spraying.  

With the depletion of groundwater, villagers have turned to shallow tubewells increasing the risk of arsenic contamination. A sample survey from community tubewells here showed the amount of arsenic at 0.63mg/l , several times higher than the safe limit of 0.05mg/l.

Near the village is the Indushankar Sugar Mill that buys sugarcane from local farmers and turns it into sugar and alcohol, letting out toxic effluent into surrounding waterways. There are also 125 brick kilns in Sarlahi district, 16 of them in Hariban alone. Soot particles from the stacks can also be carcinogenic.

Says a local Dhanbahadur Ghising: “Farmers use pesticides elsewhere too, but why aren’t other villages also getting cancer? This probably means it has something to do with polluted water and arsenic here.”

Hariban Municipality has been forced to act. It is installing deep tubewells from up to 30m so that there is less chance of arsenic contamination of drinking water. The Indushankar Sugar Mill also dug a deep well and installed three tanks to store drinking water for villagers.

Progress on the alternative sources of water is slow, and it will take time to have an impact. In the meantime, young and old in Hariban face daily exposure to whatever is causing the cancer epidemic here. This Sarlahi village also has lessons for other parts of Nepal, which may also be exposed to the same risk factors.

Based on Episode 2 of Saglo Samaj, a tv magazine program produced by Himalmedia which is broadcast every Monday, at 8:30 pm on Dish Home Channel 130.