18 die of cancer in Punjab everyday

18 die of cancer in Punjab everyday
33,318 deaths reported in last five years, says first state-wide survey

Tribune News Service

Punjab State Report on Cancer Awareness and Symptom based Early Detection Campaign

Chandigarh, January 28
The first ever state-wide survey of cancer victims in Punjab has revealed high incidence of cancer in the Malwa belt, even as the cancer cases in the state are only a little more than the national average.

The survey has also reported average cancer prevalence of 216 cases per lakh population and suspected cancer cases of 319 per lakh population. If these two figures are taken into account, it seems a large number of cancer cases have been going undetected till now and that cancer incidence figures in Punjab could be much more than have been reported even in this survey. This was confirmed by Secretary, Health Vini Mahajan.

According to the survey, the overall figure of 90 cases per lakh population is only slightly more than the national average of 80 cases per lakh population. The situation, however, is grim in the Malwa region. The Malwa region has reported 107 cancer cases per lakh population as compared to 88 cases per lakh in the Doaba region and 64 cases per lakh population in Majha.

The report, which was released by Health Minister Madan Mohan Mittal today, states that the Muktsar district in the Malwa region has witnessed 136 cancer cases per lakh population – the highest in the state. Mansa comes a close second with 134.8 cases per lakh population, Bathinda third with 125.8 cases and Ferozepur fourth with 114 cases per lakh population. The survey has taken into record cancer cases reported to state health department workers who carried out a door-to-door campaign.

In Doaba, the cancer incidence is highest in Kapurthala district, which has reported 99 cases per lakh population. The Majha belt has least number of cancer cases. Tarn Taran has the least number of cases (41).

The Health Minister said a total of 23,874 cancer cases had been reported in the survey. As many as 33,318 cancer deaths have occurred in the state in the last five years (the break up comes out to be 18 deaths per day.) The survey data reveals that there are 84,453 persons in the state who have cancer-like symptoms.



Keeping cancer alive: State of Punjab


Author(s): Sonal Matharu
Date: Jul 15, 2012

Punjab has been in the grip of cancer for over a decade but the government has ignored the threat. Sonal Matharu reports with photographer Sayantoni Palchoudhuri from the state

image“If you want to live go to Bikaner,” neighbours told Raj Rani, who suffers from breast cancer

It all started with a knot in her left breast. Within no time it grew to the size of a tennis ball. In pain, 40-year-old Raj Rani went to the doctor in her village in Punjab’s Ferozepur district. Finding no relief, she started doing the rounds of government hospitals in Ludhiana and Faridkot and then a private hospital in Bathinda. Shelling out money at hospitals was not easy with a non-earning husband and sons bringing home little as small-time mechanics. By this time, a year had lapsed and Raj Rani’s health started deteriorating; she had stopped eating and had no hope of surviving.

Mukhtair Kaur of Jhajjar village in Bathinda thinks she got breast cancer because she beat her chest too much when her brother died. She has been a patient for the past 15 years Mukhtair Kaur of Jhajjar village in Bathinda thinks she got breast cancer because she beat her chest too much when her brother died. She has been a patient for the past 15 years“If you want to live, go to the hospital in Bikaner,” told her neighbours. With no option, she undertook a 10-hour road journey to Bathinda to board the train to Bikaner in Rajasthan, another nine-hour journey.

Doctors at Acharya Tulsi Regional Cancer Treatment and Research Center (RCC) removed her left breast and gave her chemotherapy. Three years later, Raj Rani sits patiently at the door of the hospital’s cancer out patient department for further check-ups.

“Correct treatment has kept me alive,” she says. Every district in Punjab is brimming with cancer cases. The Malwa region of Punjab, a cotton-growing belt, has the highest incidence of cancer in India, admitted Montek Singh Ahluwalia, deputy chairperson of the Planning Commission while releasing the plan for states for 2012-13.

Malwa region comprises the southern districts of Bathinda, Faridkot, Moga, Mukhtasar, Ferozepur, Sangrur and Mansa.

72-year-old Jaswant Kaur found she has breast cancer at a screening camp in Faridkot. Treatment will cost `2 lakh, doctors told her. She has resorted to taking unani medicine72-year-old Jaswant Kaur found she has breast cancer at a screening camp in Faridkot. Treatment will cost Rs 2 lakh, doctors told her. She has resorted to taking unani medicineAbsence of reasonable and quality treatment in Punjab forces hundreds of cancer patients to travel from faraway places to make a beeline for RCC, one of the 18 regional cancer research centres in the country.

In 2005, Down To Earth had reported the inadequate and expensive treatment for cancer in Punjab (‘Cancer train’, June 1-15) when Delhi non-profit Centre for Science and Environment (CSE) tested the blood samples of people living in Bathinda and found unacceptable levels of pesticides in them (‘Residue of a revolution’, Down To Earth, June 1-15, 2005).

Seven years later, government has done little to make treatment for cancer available in the state. Patients like Raj Rani still rely on the distant Bikaner hospital.

Patients wait outside the doctor’s room at RCCPatients wait outside the doctor’s room at Acharya Tulsi Regional Cancer CentreOptions too few

Bathinda, the hub of cancer in Punjab, has no facility to treat the disease in its civil hospital.

Patients have to choose between small private hospitals and the super-specialty Max Hospital. The hospital was built in November 2011 on government land through public-private partnership after government understood the cancer threat in the state.

But the hospital is run privately. It has the latest technology and equipment and the treatment bill can shoot up to lakhs of rupees.

“One chemotherapy session costs Rs 1.25 lakh. Treatment for pancreatic cancer can cost Rs 3.5 lakh,” says Manjinder Sidhu, oncologist at the hospital.

Both Karnail Singh and his wife Balbir Kaur of Jhajjar village in Bathinda are cancer patientsBoth Karnail Singh and his wife Balbir Kaur of Jhajjar village in Bathinda are cancer patientsPatients in the state decide against the Centrally-run Postgraduate Institute of Medical Education and Research in Chandigarh because it takes months to get admission there.

Eighty-year-old Karnail Singh and his wife Balbir Kaur, both cancer patients from Jhajjar village in Bathinda, opted for RCC. “Doctors in Bathinda robbed me,” says Singh. They kept getting the same tests done.

Each time it cost Rs 1,400. A farmer, he took loans for the initial treatment of his wife’s uterus cancer and his stomach cancer. Treatment at RCC added extra years to their lives. Balbir’s surgery and Karnail’s radiotherapy were done for free.

Medicines were also free. Investigations are cheap—Rs 50 each for biopsy and x-ray and CT scan. MRI costs about Rs 1,200.

Pappu Mamman, 50, awaits his chemotherapy session. He suffers from cancer in the oesophagusPappu Mamman, 50, awaits his chemotherapy session. He suffers from cancer in the oesophagusThe state government counters people’s allegations of poor facilities with a list—a brachytherapy machine at Government Medical College and Hospital in Patiala, a radiotherapy machine at Sri Guru Gobind Singh Medical College in Faridkot and a cobalt source machine at Sri Guru Ram Das Institute of Medical Sciences and Research Centre in Amritsar. But these are not enough.

The number of new cases from Punjab remains high, says Ajay Sharma, director, RCC. There has been no decline in the number of follow-up cases either.

In 2009, the hospital received 6,138 new cases and 45,357 follow-ups. In 2010, there were 6,295 new cases and 45,189 follow-ups. In 2011, new cases reduced to 5,787 and follow-up cases to 43,189.

However, the percentage of new cases that come from Punjab remains the same—60 to 70 per cent, says Sharma.

Government’s baby steps

To generate data on the magnitude and pattern of the disease, the Indian Council of Medical Research (ICMR) set up the national cancer registry programme in 1981 with centres at Mumbai, Bengaluru and Chennai.

Mamman being taken for chemotherapyMamman being taken for chemotherapyBut the programme failed to yield results. After high incidence of cancer cases were reported in Punjab, in 2010 the Centre asked the state to maintain a separate registry.

It was only in November 2011 that Punjab started maintaining such data. The drawback in the programme was that cancer cases that came only in government hospitals were to be reported.

On October 18, 2011, the state government made it mandatory for all public and private hospitals, pathological, clinical and radiological labs and medical institutions imparting medical education and providing diagnostic or treatment facility for cancer, to report all cancer cases to the pathology department of Government Medical College in Patiala. The college sends the data to ICMR for compilation.

Now, threat from uranium

While Punjab government is still trying to reach a conclusion on the link between pesticides and cancer, in 2009 a German laboratory tested hair samples of autistic children in Bathinda and found uranium, a carcinogen, in them.

A team from Bhabha Atomic Research Centre (BARC) carried out further tests and found that of nine water samples from Faridkot and Amritsar, three exceeded the Atomic Energy Regulatory Board’s (AERB) limit for uranium in drinking water of 60 µg/l (microgram per litre). Till 2011, BARC along with Guru Nanak Dev University had analysed 996 samples for uranium. Their report says, “Uranium concentration in water in a large number of samples is above the AERB specified limit of 60 µg/l in drinking water, the highest being 644 µg/l .”

Uranium concentration in 520 water samples from Bathinda, Mansa, Faridkot and Ferozepur ranged from 2.1 µg/l to 644 µg/l. In 92 water samples from remaining 13 districts—Taran Taran, Moga, Barnala, Sangrur, Ludhiana, Fatehgarh Sahib, Mohali, Ropar, Nawanshehar, Hoshiarpur, Gurdaspur, Amritsar and Pathankot—uranium content was between 0.1 µg/l and 153 µg/l.

However, the studies could not link the presence of uranium in Punjab water to high incidence of cancer. Epidemiological studies are required for the purpose.

According to the new registry, between December 2011 and June 2012, Patiala recorded 1,131 cases—highest in the state—and 74 deaths. The highest mortality was in Bathinda with 99 patients dying within six months.

But the numbers give just a fraction of the disease burden in the state. “In Patiala the number of cases is highest because the registry is located here,” says Manjit Singh Bal, professor and head of pathology department in Government Medical College, Patiala.

He also heads the registry programme. Doctors at faraway places do not bother to send data, he says. “They find filling forms a waste of time,” he adds.

Ailing state

Taking suo motu cognizance of media reports on rising cancer cases, in August 2011 the National Human Rights Commission (NHRC) asked the Punjab government what steps it had taken to check the problem.

The state government submitted two reports—on September 20, 2011, and February 27, 2012—saying it had banned 20 pesticides in Malwa and withdrawn their registrations. But it did not mention the names of the pesticides or the crops on which they were used. Pesticide suppliers do not even know of the ban.

“There is no government ban on pesticides,” says Chaitar Singh, a pesticide supplier in Chaina Bazar, Faridkot.

In the second report to NHRC, principal secretary, health and family welfare department, accepted that use of pesticides “was on the higher side in Malwa region on account of growing of cotton crop. But in the last four to five years, its use has reduced because farmers have switched to Bt cotton which requires 20 per cent of the pesticides used for earlier cotton varieties”.

State government data contradicts the statement. Reduction in pesticide use has been negligible in the past few years—from 5,975 tonnes in 2006-07, it came down to 5,690 tonnes in 2010-11.

Jarnail Singh, a farmer since 1970 in Bathinda, says between 1992 and 2004 pesticides were extensively used on cotton crop. When Bt cotton was introduced in 2004, there were no pests in the first two years. But new pests started attacking soon and farmers resorted to extensive pesticide spraying.

Offering lip service

In July 2011, the Punjab government entitled all cancer patients to get Rs 1.5 lakh for treatment from the chief minister’s fund. Till May 2012, it has spent over Rs 30 crore to treat 3,329 patients.

imageTreatment at the super-specialty Max Hospital in Bathinda is too expensiveBut the scheme is of little help because the amount goes directly to the hospital where the patients get treated. “We have to purchase all the medicines,” says Amarjit Singh. He buys injections for his younger brother who has stomach cancer. “One injection costs Rs 25,000,” he says as he waits at the Bathinda platform to take the train to Bikaner.

Max Hospital has treated 90 patients for cancer ever since the hospital started. Of these, 40 applied for money under the scheme, but only 24 could avail the privilege. Four of them passed away during treatment.

Doctors at Punjab seem to have left treatment to godsDoctors at Punjab seem to have left treatment to godsPromises made by political parties carry little meaning. In January, the state government announced it would set up a cancer hospital in Bathinda.

The four main parties in the state—Congress, Shiromani Akali Dal, Bharatiya Janata Party and People’s Party of Punjab—for the first time included the issue of high cancer incidence in their election manifestoes.

But residents are not convinced. “These were hollow promises just to win votes,” says Amarjit Singh.

“Waiting for people to get the disease and then offering them treatment is not the answer,” says G P I Singh, dean of Adesh Institute of Medical Sciences and Research in Bathinda and convener of Environmental Health Action Group, a non-profit. “We need to map the entire state to find out why the fatal disease is occurring,” he says.

Restoring groundwater in Punjab, India’s breadbasket: finding agricultural solutions for water sustainability

Author(s): Shama Perveen, Chandra Kiran Krishnamurthy, Rajinder S. Sidhu, & et al
Source: Columbia water Center
Publication Date: July 2012

Inline image 1

For Indians, the very mention of the word “Punjab” conjures up visions of lush green fields, rich alluvial soils and water aplenty. Punjab has for years been the breadbasket of India, and since the “Green Revolution” of the 1960s, it has taken on an even greater role in feeding the nation. Comprising a mere 1.57 percent of India’s total geographical area, today the state of Punjab produces 12 percent of the India’s 234 million tons of foodgrain, and nearly 40 and 60 percent of the wheat and rice that buffer the nation’s central pool for maintaining food stocks and operating public distribution system for the poor. Today, however, Punjab’s agricultural success is threatened by unsustainable irrigation practices and a rapidly dropping water table. This white paper outlines the extent and severity of Punjab’s water crisis, and outlines the results of a field study to help farmers irrigate rice more efficiently. The paper then focuses on the application of the tensiometer, a simple device that had the most promising results in helping farmers save water. The paper concludes that in conjunction with other measures, it is possible to rapidly scale up tensiometer use by rice farmers in Punjab, thus saving millions of liters of water as well as over 80 million kilowatt hours per year of electricity for a very low cost.

Other side of farm suicides in Punjab: Book on women’ misery in Punjabi by Orissa woman activist


SANGRUR: The debt ridden farm suicides inPunjab might be projected as disturbing trend pointing towards further aggravating agrarian scene at the place more known as birth of green revolution in India but till now not much has been written about the pitfalls of farm suicides on the familial front. Now a researcher and woman activist has come up with a book about how the women had to face the wrath of agrarian crisis in Punjab. Ranjana Padhi has documented the miseries of women facing farm suicides through her book ‘Punjab de kheti sankat di kahani -auratan di aapni jubani'(The story of Punjab’ agrarian crisis and women’ agony). Interestingly despite her being of Orissa origin, she has liked the book to be translated first in Punjabi and will come out with English version later.

Many documentaries, books have been written on agrarian crisis in Punjab, some of which by showcasing the real picture has taken the outer world by surprise. Only recently human rights activist Inderjit Singh Jaijee had come up with book ‘Debt and death in rural India, The Punjab story’ but was not entirely on women.

Anti displacement activist Ranjana Padhi, who is actively working for women empowermentsince late eighties through various NGOs of Saheli, Kashipur solidarity, has projected the condition of women as precarious after male member takes the extreme step. In most of the cases women had to turn as wage labourers or in menial jobs for survival. Padhi has based her assertion on the findings after extensive interactions with 136 families mainly women in Punjab’ 8 districts of Malwa region, most affected on farmer-farm labourer count.

“During visits to Punjab in 2008-2010, I came across the condition of women belonging of farm and farm labourers families, where male members committed suicide, was very miserable. The women belonging to somewhat affluent families had to turn to wage labourers as raising children, feeding and educating them turned out to be herculean task for them in the absence of any financial support from any quarters”, said Padhi talking to Times of India over phone from Pune, where she is based.

Ranjana, who is in late forties and works as technical editor with a firm after MA English is coming up with the English title ‘Those who did not die: Impact of peasant suicides in Punjab’.

It has been pointed out that debt on farm and farm labourers had been mounting due to expenses on dowry, drug addiction, to cure depression. There are numerous instances of women facing the heat after male members committed suicide as Jasbir Kaur of Mansa is passing through lean patch after losing out the land due to debt after husband committed suicide, Charanjit Kaur of Bathinda is facing it hard to run household. Says Charanjit it all started with amrican sundi(English worm)that eat up cotton crop leading to family’ miseries.

“It is all due to lopsided policies and the trend of farm suicides and misery of women is here to stay till governments not comes up with remedial measures and finically bailing out the debt hit families”, said Buta Singh, who has translated the book in Punjabi.

62% farmers cannot meet educational needs: Survey by Punjab Farmers Commission

http://timesofindia.indiatimes.com/india/62-farmers-cannot-meet-educational-needs-Survey/articleshow/12049496.cms, TNN | Feb 27, 2012, 02.22AM IST

CHANDIGARH: A recent survey on government’s plan to shift small and marginal farmers away from unprofitable agriculture and engage them in economically viable activities, has found the government initiatives lacking in preparing the farmers undertake the transition.

The survey conducted in 50 villages by Punjab Farmers Commission has revealed that 62% of Punjab farmers holding land up to 10 acres do not earn enough to take care of their educational needs.

The survey has revealed that the dropout rate among the farmers’ children is so high that only 0.4% of students reach the post graduation level and only 5% get technical education. Also, only 73% of posts of teachers are filled in rural areas.

The rural schools are facing an economic exclusion – majority of these students being from scheduled castes. Farmers of upper strata of villages are sending their children to private schools, which however do not have qualified and sufficient staff.

The survey found that in a test conducted in 147 government and 174 private schools on the syllabus of class V and VI syllabus, only 16% students of mathematics and 31% of science in the government school could answer questions. The same ratio in private schools was 3% and 8% respectively. And 12% and 16% of mathematics and science students respectively in government schools could not offer a single answer. In private schools, 21% students just could not offer any reply about questions on mathematics.

The study has suggested that a separate cadre of rural teachers should be created and that a teacher should work for 10 years in rural areas before being transferred to urban areas. For ensuring attendance of teachers, biometric and SMS-based attendance should be introduced, it said.

Punjab: DECLINING WATER TABLE Reduce area under paddy, water board tells govt



Another wake call on Groundwater use in Punjab: CGWB says in 84% area the level is going down (in 14% it is too brackish to be useful), 103 of 137 blocks are in over exploited, five in critical and four in semi critical category, 73% of irrigation is coming from Groundwater, not canals and Punjab needs to reduce area under Paddy.


Reduce area under paddy, water board tells govt
Sarbjit Dhaliwal
Tribune News Service

Chandigarh, February 24
Expressing concern over the declining water table in the state, the Central Ground Water Board has recommended reducing area under paddy by more than 10 lakh hectares to achieve sustainable growth. In a detailed report submitted to the state government, the board has drawn a road map for the state for ground water management.

“The present state of development and management of groundwater resources in Punjab is a matter of concern for the future of agriculture in the state.There is an urgent need to evolve an optimal ground water management strategy to tackle the problem of the declining water levels,” says the report.

Dwelling on crop diversification, the board says the area under paddy (rice), which consumes six times more water than maize, 20 times more than groundnut, and 10 times more than other kharif crops, has to be reduced.

The board has urged the state to shift from flood irrigation to underground piped water, furrow irrigation and drip and sprinkle irrigation. Punjab is the largest contributor of rice to the central pool.

Educating farmers about the declining water table, regulating power supply, artificial recharge, provision of deeper aquifers and groundwater regulation are the other measures suggested by the board for ground water management.

The board says the groundwater level in Punjab has fallen in about 42,170 sq km area in the north, northeast, central and southern parts, which constitute about 84 per cent of the total area.

The worst affected districts are Nawanshahr, Jalandhar, Kapurthala, Moga, Patiala, Ropar, Fatehgarh Sahib, Sangrur, Mansa, Bathinda, Hoshiarpur, Gurdaspur and Amritsar.

There is only 14 per cent area where ground water level is rising owing to less extraction of water because of its brackish quality, which is unfit for use for both domestic and irrigation purposes. In some pockets in Mansa, Moga, Bathinda, Muktsar, Faridkot and Ferozepur, the water level has gone up. The water level in the state ranges from 0.20 metre below ground level (bgl) in Ferozepur district to 32.28 metres bgl in Fatehgarh Sahib district.

The report says that the annual average rainfall has decreased by 45-50 per cent during the past two decades.

It was recorded 755 mm in 1990, 375 mm in 2004 and 420 mm in 2009.

About 97 per cent of the net sown area is irrigated and 80 per cent of the water resources available are used for the farm sector.

Contrary to the impression that the canal system is a major source of irrigation in Punjab, only 27 per cent area is irrigated with canal waters and the remaining 73 per cent area by groundwater pumped out through tubewells. Of the 137 blocks assessed by the board, 103 fall under “over-exploited” category, five in critical and four in semi-critical categories.

The water table is declining at a faster rate in urban areas and industrial towns. “The water level is declining at the rate of 0.50 to 0.60 metre per year in some urban areas and industrial towns”, says the report. However, potable water is available in 84 per cent of state’s total area.

The board says that the main source of pollution is domestic and municipal waste, agriculture practices and industrial activities.

“Untreated effluents from industries have resulted in increased levels of heavy metals like lead, cadmium, manganese, iron, chromium and copper,” says the government report.

Alarming Facts

Area under paddy consumes six times more water than maize, 20 times more than groundnut and 10 times more than other kharif crops

The groundwater level has fallen in (42,170 sq km area) about 84 per cent of the state’s total area

The worst-hit districts are Nawanshahr, Jalandhar, Kapurthala, Moga, Patiala, Ropar, Fatehgarh Sahib, Sangrur, Mansa, Bathinda, Hoshiarpur, Gurdaspur and Amritsar

The remedy

State told to shift from flood irrigation to underground piped water, furrow irrigation and drip and sprinkle irrigation

Regulate power supply, opt for artificial recharge and deeper aquifers

Damage Control: Committees under DCs set up in 12 blocks

The Central Ground Water Authority has notified 12 blocks, Nakodar, Shahkot, Lohian, Phagwara, Khanna, Nihalsinghwala, Patran, Sunam, Barnala, Sherpur, Dhuri and Malerkotla. It has authorised the Deputy Commissioners concerned to impose restrictions on the construction/installation of any structure for the extraction of groundwater. Committees headed by the DCs have been empowered to regulate and manage the groundwater. Without the permission of the committees, no tubewell or any other source for extracting groundwater can be set up in the notified areas.

Farmer suicides: NGO points to Punjab reporting fewer numbers

SANGRUR: The number of farmer suicides in Punjab seems to vary according to the source providing information about that. An NGO,Movement Against State Repression (MASR), has stated that Punjab is a glaring example of neglecting the factor of farmer suicides when it comes to determining the amount of funds that should be spent on assisting agriculturists.

MASR’s convener Inderjit Singh Jaijee said, “As per information we collected, a Punjab policereport says that only seven farmers committed suicide from the period of 2002 to 2006.”

In 2008, state revenue department had mentioned in a report compiled on the basis of details provided by deputy commissioners that 132 farmers committed suicide during five years starting with 2002. Jaijee said Punjab Agricultural University’s economics department team came up with a figure of 2,890 suicides from 2000 to 2008 in just two districts. It stated that in Sangrur and Bathinda, 1,643 and 1,247 farmers had committed suicide, respectively.

MASR claimed about 1,700 farmers committed suicide from 1988 to 2008 in just two subdivisions of Sangrur district. “Going by that, the suicide figure across Punjab could be an estimated 20,000 in all these years,” said Jaijee. A Punjab Farmers’ Commission study had said that about 2,000 committed suicide in the state every year.

Bharatiya Kisan Union (Ugrahan) has claimed more than 40,000 farmers committed suicide in these years. Jaijee added, “Punjab has outclassed even Maharashtra and Andhra Pradesh as data collected by MASR bares the truth on these suicides. In Maharashtra, 34,659 farmers committed suicide from 2000 to 2008 out of rural population of 5.58 crore. That comes to 62 farmer suicides per lakh population. Likewise, 18,396 farmers committed suicide in Andhra Pradesh which has a rural population of 5.54 crore. The figure of suicides per lakh there comes up to 33. As compared to highly farmer suicide-prone states, Punjab recorded 24,732 in eight years (as per NGO and farmer union figures, which have not been authenticated by state) in a rural population of mere 1.61 crore. That works out to 154 farmer suicides per lakh.”

Farmer organization BKU’s (Ugrahan) general secretary Sukhdev Singh Kokri said, “Till now, Union government has meted out gross injustice to Punjab. That was proven when Punjab got just Rs 1,000 crore as assistance, when nationally, the figure was Rs 71,000 crore. That means a bit more than 1% of total assistance came the way of the state. Even if a parliamentary panel is formed, it will ignore Punjab.”