A rural Indian oncologist

Pankaj Chowdhary is a consultant in Padhar, a tribal area of India, Sarah Maidment finds out more

Name—Pankaj Chowdhary
Position—Consultant oncologist at Padhar Hospital, Madhya Pradesh, India
Biography—Chowdhary runs the busy oncology department at Padhar Hospital. Motivated by a desire to help the poor and his Christian faith, he chose to work in the relatively tough environment of a rural mission hospital rather than the comfort and luxury of a well established regional cancer centre. He is passionate about disease prevention and is an active member of the Action Council against Tobacco

Why did you go into oncology?

I originally planned to go into psychiatry, but competition for postgraduate training was fierce. I spent six months in oncology when I did my house jobs and decided that this was the job for me. Oncology is a fascinating specialty, requiring a broad knowledge base of anatomy, biochemistry, physics, and pathology. Your aptitude and skills are tested daily, and there is no room for getting bored.

I have the opportunity to practise preventive, curative, and supportive medicine. In a single morning I might make a new diagnosis of cancer, biopsy a suspicious lesion, administer a dose of chemotherapy, plan the most effective course of radiotherapy, and educate a family on the harmful effects of tobacco use.

Why are you working at a rural hospital?

I wanted to be able to make a difference. If you’re working in a regional cancer centre where there are 40 oncologists what difference is one more doctor going to make? Here I have more of a free hand. The hospital management is good, and I can clearly see the fruits of my work.

What facilities are available at Padhar?

For diagnosis, we have x ray, ultrasound, and computed tomography. We have a pathology laboratory for histology, haematology, and fine needle aspiration cytology. For treatment, we offer surgery, radiotherapy, and chemotherapy.

What types of cancer do you see most often?

In men, head and neck cancers are by far the most common, followed by oesophageal and lung cancers. Cervical cancers are the most common in women, closely followed by breast and head and neck cancers.

What are the barriers to effective treatment?

Many patients present with advanced disease, by which time it is too late for curative treatment. Padhar is a tribal area, where people are largely uneducated and poorly informed—only 46% attend school. Even after initial treatment, they don’t understand the need for follow-up and future prevention. They have misconceptions about Western medicine, making them reluctant to consent to treatment.

The medical fraternity outside the hospital are also poorly informed. The local quack doctors often misdiagnose patients and treat them inappropriately. They make money out of the patients and fail to do anything to treat the cancer. Even qualified doctors mismanage patients with cancer. A common belief is that “cancer equals death” and that there is no hope for the patient, which is why doctors fail to investigate further and patients present with advanced disease.

We’re always short of funds. Most of my patients cannot afford treatment but they know that they can get financial help here. We can apply for aid from the central and state governments. We also receive support from charities and drug companies. One success story is of a young man with metastatic seminoma of the testis who was treated with chemotherapy samples from a drug company while we were waiting to receive funding for his treatment.

What are your biggest challenges?

On a personal level I face challenges every day. Will this patient benefit from treatment? What about the cost? Is this a fair way of using resources? On a hospital level it is a challenge to run a high quality department. We lack funds and staff, and this makes it difficult to audit our practice. On a national level, the big challenge is one of prevention. Tobacco is the biggest culprit in most cancers in India.

I am a member of the Action Council against Tobacco, which has branches all over India. We seek to make changes to local legislation, public policy, and the law. We want to change young peoples’ attitudes towards tobacco and work with users who want to quit. We have recently set up a tobacco cessation clinic here at Padhar.

What motivates you?

I love making a difference in people’s lives: seeing the smiles on my patients’ faces and the relatives looking relieved and relaxed. I am also motivated by my colleagues, who are like minded in seeking to work for the best interests of the patients rather than to make money.

In a specialty such as oncology, it would be unrealistic to expect to cure every patient. I love the satisfaction of knowing that I have treated my patients to the best of my ability and made a positive impact at such a difficult time in their lives.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Sarah Maidment foundation year 1 doctor Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust
sarah.maidment@gmail.com
Student BMJ 2009;17:001-036-ISSN 0966-6494 | January 2009