Radiation therapy as an essential form of cancer treatment can now be done in the country with the first radiation therapy machine arriving in Thimphu last month.
The equipment was procured as a package deal from CARE Australia and includes oncology education for Bhutanese doctors and staff on operating the machine. The government is paying in installments of Nu 1 million a month to CARE Australia for the package deal.
The health ministry has been sending cancer patients to Calcutta, India, for oncology care spending Nu 170 to 180 million a year. Between 2013 to 2017, a total of 2,013 cancer patients were treated outside the country.
The medical superintendent of JDWNRH, Doctor Gosar Pemba said that, they will train the staff of the hospital and as of today, two staff was trained as radio technicians. “The package also says that, they will put their own people to run the machine and do the maintenance by themselves”, he said.
After 10 to 11 years, the machine will be handed over to Bhutan and everything will be done by staff of JDWNRH.
Bhutan does not have an oncologist. However, there is no need of an oncologist to diagnose a patient with cancer according to Dr Gosar Pemba. “Any specialist can diagnose any type of cancers but we need oncologist for drug prescription or for treatment of cancer,” he said.
Since the machine comes as a whole package, he said that an oncologist has come in the country who will discuss the modality through Skype with the doctors in Calcutta and Bangalore and start the treatment here in the country.
“With no oncologist in the country, we are sending the cancer patients to India for chemotherapy as the best treatment for the patient,” Dr Gosar Pemba said adding that there are many machines needed to treat cancer apart from chemo and radiation.
“For example a PET Scan is a machine used to detect if there is any reminisce of cancer and this scan is done after Chemo and Radiation”, he said. But he pointed out that cost analysis needs to be done before buying such expensive machines because it might be more cost effective to do PET scan outside the country because of the small number of patients.
Dr Gosar Pemba said the types of cancer referred to India are head and neck cancer, various blood cancers including leukemia in children, cervical cancer, thyroid cancer or Gastrointestinal (GI) cancer and brain cancer, which is common in the country.
After diagnosis, he said that they have to stage the cancer and according to staging, they decide if the cancer is operable or not operable and accordingly they post for the surgery. “After the cancer is removed, the cancer is sent to histopathology to see what type of cancer it is and as per the report the cancer board will decide if the patient should be given radiotherapy, chemotherapy or both (chemo-radiation) together at the time,” he said.
He also said that chemo has its own regime, depending upon the types of cancer it can be 3 cycle, 4 cycle and respectively and it will be all decided by the hospital in Calcutta. Thereafter, they will give the first chemo in Calcutta and refer the patient back to Bhutan for continuation.
Whereas for radiation, he said that they do it every day, which finishes in one week to 10 days. Depending on how many cycles, they complete the chemotherapy in they then send the patient back to Calcutta for review whereby they will decide if the patient has to further undergo chemo and radiation or not.
“According they will give the radiation and second dose of chemo and give us the protocol on how to continue here in JDWNRH and it goes on until the patient does not need further chemo,” he said.