The numbers in all probability do not reflect the actual magnitude of the problem due to either non reporting or gaps in data collection but even the available numbers show that Bhutan cannot afford to ignore Cancer any more.
For a country with a population well under 700,000 Bhutan saw 3,301 reported cancer cases in a five year period from 2008-2012. The numbers meanwhile are only increasing as this deadly diseases sinks its roots into Bhutan.
In the same period around 382 people have died of cancer. The actual death cases are estimated to be higher as not all cancer deaths are reported to the hospital.
Of all the cancers the highest type of cancer by far in Bhutan is stomach cancer followed by cervical cancer and cancers of the head (mouth, tongue) and neck.
Other cancers prevalent in Bhutan are those of the lung, blood, tumors in different parts of the body, brain tumors, intestinal cancers, and cancers of the bone.
On an average, 4-5 cancers patients are being admitted in JDWNR hospital which includes both old and new cases. In a year, Thimphu hospital sees over 2000-3000 such patients.
Cancer is one of the major Non Communicable Diseases (NCDs) afflicting Bhutan. The other major NCDs includes diabetes, hypertension, chronic respiratory diseases (COPD¬Chronic Obstructive Pulmonary Diseases).
The Medical Specialist of JDWNRH Dr. Tashi Wangdi said, “The prevalence of cancer is definitely on the rise. The top three cancers are public health challenges, which have to be faced and dealt with.”
Cancer not only causes a lot of suffering for the individual patients and their family members but at the same time it costs a lot for the government to fund the treatment of these cases especially when patients are referred out for treatment.
In many cases the patients are put on many medications which are not curative but only prolongs life for one or two years.
The specialist said that around 50% of the cancers can be treated and cured if detected at an early stage.
A rapid change in life style, rural-urban migration, change in dietary habits, and sedentary life styles are leading to a huge burden of NCDs like cancer all over the world and Bhutan is not being spared according to experts.
“In Bhutan, stomach cancer is the number one cancer because I think it is due to our dietary habits. We Bhutanese take a lot of spicy foods, beetle nuts, alcohol, and also old preserved meat especially in Haa and Paro and especially the highlanders who keep very old meat for a long period of time which is actually kind of delicacy and they have a habit of eating it consistently,” he said.
He also said that wild fern (na-kay) used as a delicacy in Bhutan be it in a parties or at home is carcinogenic. “If you go in the jungle, animals don’t eat wild ferns as animals know what to eat and what not to eat, but human beings go and cut the wild ferns and eat it as a delicacy. Wild ferns have been found to have certain carcinogens which may be the cause of stomach cancer,” he said.
In Japan, a study showed that certain community had more stomach cancer compared to others as they were eating lot of wild ferns. Then the study found that wild ferns contained carcinogens that caused stomach cancer.
Dr. Tashi Wangdi said that recent scientific finding has shown that salt not only causes blood pressure but it can also cause stomach cancer.
He said salt intake in Bhutan is very high because Bhutanese on an average consume at least 10-12 grams of salt per day though internationally it is recommended that people should not take more than 5gm which is the maximum limit.
“So any country where salt intake is high, like in Bhutan, we will have high prevalence of stomach cancer,” he said.
“If there are definite carcinogens (chemicals that are present in certain foods which are known to lead to cancer if taken in certain quantities over a period of time) in the diet, in the water, in the food people eat it leads to cancer,” Dr. Tashi Wangdi said.
Carcinogens could be industrial chemicals like mercury etc which on polluting a drinking source over a period of time can lead to cancer.
Likewise in the case of mouth cancer, the doctors said that in India ‘Panparag’, Indian pan and many of them are known to cause cancer. India, Bangladesh and Pakistan have high prevalence of such cancers. He said that Doma (betel-chewing), also contain some carcinogens which can cause cancers in the mouth cavity and tongue.
The doctor said that Coke and Pepsi including many junk foods contain so much of sugar and fats but children at even the age of 2-3 are given such food which means sugar and fat consumption is very high. So eventually kids become obese and once kids become obese they are more prone to get cancer, diabetes and hypertension.
Other well known causes of cancer in Bhutan are alcohol and tobacco which also cause a host of other medical problems.
The doctors shared that cancer is usually caused by multiple factors and not a single factor as multiple factors have to go together to cause cancer including a genetic propensity to develop cancer. However, he said that even if a person has a genetic tendency to develop a certain diseases, it is not necessary that they will develop the disease but if their life style is inappropriate then it will lead to the manifestation of the disease.
He said people should be aware but being aware is not good enough, as one has to implement in their day to day life.
The Challenge and solution
The Health system was designed to combat that problem of infectious diseases and even the human resource pattern in terms of doctors and medical staff was trained to deal with such diseases. However, in the last 10-15 years, Bhutan is faced with the new challenges of NCDs like cancers, heart attacks, strokes, diabetes, and smoker’s lung (COPD).
“We have to do a radical change in our health system and approach because these conditions have to be dealt in a very different way” he said.
The doctor said that health resources have to be deployed in a different way, in terms of medicines and technologies, so as to address the diseases and also make a people aware.
The doctor pointed out that Bhutan in the field of health has made modern developments in terms of life style and longevity.
“But it is sad to say that Bhutanese people are becoming unhealthier day by day because now they are being struck down by these diseases and these diseases are life-long diseases and are very expensive,” he said.
He said for a simple condition like Blood Pressure if they don’t take the medicines regularly, they could land up getting a stroke or heart attack and it would cost the government at least Nu 300,000 to treat a single patient.
He said, as far as cancer is concerned, the first primary step that is being advocated by the Ministry of Health on the recommendation of WHO and other international bodies is awareness programs, prevention programs and promotion programs which is especially important for a resource constrained country.
The doctor pointed out that prevention of cancer is not just the MoH’s business, but other sectors all have to play a part like Ministry of Agriculture and Forest (MoAF) and Ministry of Economic Affairs (MoEA) who make rules and regulation on import of food, which are very important.
“We just allow the import of any sorts of food from outside which is not good for health are given to children,” he said.
Medical experts and the latest research show that people can dramatically reduce their chances of getting cancer by cutting down or giving up animal protein and products, exercising and avoiding all kinds of processed food.