Central Asia

INCTR in Nepal

INCTR staff visited Nepal in January to discuss with oncologists in Kathmandu and the mayor of Banepa the possibility of working with the Cancer Relief Society of Nepal (CRSN) to improve cancer control. The CRSN has volunteers working in 25 districts.

The IARC estimates that in this country of 23.9 million people, there are at least 17,000 new cases of cancer per year, a high fraction of which are either cancers of the uterine, cervix, or breast. The next most frequently observed neoplasms, oral cancers and other neoplasms of the upper aero-digestive tract, are more frequently seen than lung cancer, although the incidence of the latter is rising. Oral cancers are associated with chewing habits. Indoor pollution from use of open fires remains a problem. Cancer services in Nepal are limited, with only two cancer centers and three radiotherapy units (all cobalt-60 machines), one of which is in need of a new cobalt source and renovation. Although a few physicians and surgeons have specialized knowledge of cancer treatment, the vast majority practice general medicine or surgery, and cancer patients are largely treated in general wards.

Banepa is developing rapidly, and according to its mayor, Dr Shrestha, the city is destined to become the gateway to Kathmandu. Within five kilometers of Banepa are two well-established hospitals, a traditional medicine health center (Ayurvedic) and a new university (Kathmandu University), which will soon open a medical school and an information technology center. The new medical school— the seventh in Nepal—will contribute to the graduation of some 700 doctors per year in Nepal. This compares to just 30 per year only a few years ago. One of the hospitals in Banepa, Scheer Hospital, is supported by the Seventh Day Adventists, and has considerable undeveloped space. A major new road is to be built between Banepa and the eastern part of Nepal, so that this region could become a major element in the socioeconomic development of Nepal. In this respect, Banepa would seem an ideal site for an INCTR Collaborating Unit to work closely with the CRSN and local physicians to improve cancer registration, early detection (particularly for cervical cancer and oral cancer), and cancer treatment in Nepal.

Nepal is a relatively small country with a total expenditure on health of some 41 international dollars per capita, only 11 dollars of which are provided by the government. Hospitals are overcrowded in Kathmandu, and many populations are under-served with respect to family health care. Clearly, early detection of cancer could do much to ease the present burden on medical services, and because of the importance of women's cancers, programs of this kind could be integrated with other aspects of health care. Although it will take a number of years to extend services to the outlying communities, screening camps and educational programs are high on the list of potential collaborative activities between the INCTR and the devoted members of the CRSN, working in close conjunction with Nepalese health care professionals and regional and governmental health authorities.