“Rural India needs trained centres to combat urology ailments”
“It is very important that a person should have a healthy lifestyle, which includes daily exercise, eating healthy food. Healthy food includes fresh food, not frozen or junk food. So by following these two steps and through awareness, a person can avoid urological problems to a large extent,” said Dr Anup Kumar, HOD, Urology & Renal Transplant, Safdarjang Hospital, New Delhi, in an exclusive interview to Deepak Kumar Rath, Editor, Uday India. A gold-medalist from AIIMS and in Robotics from USA, Dr. Anup candidly admits that he treats patients with a motto to help the poor patients. “I believe if you work for a good cause, people do support you and they come and join you.” Excerpts:
What is the scenario of urology ailments in India in general?
In India, if you talk about general urology ailments, it depends upon the age category of the population. So I would start with the elderly population, i.e. 50 years plus. For that population in India, there are four categories: (1) Stone diseases, (2) Cancers, (3) Benign conditions like prostate enlargement, and (4) Infections. And finally I would talk about kidney failures. So these are the broad categories the 50 plus people in India get afflicted with. The commonest is the prostate enlargement, then come stones and infections followed by cancers and kidney failures and transplant of kidney. If I talk about the whole of India, the scenario is dismal, as 80 per cent of the population lives in the rural areas, who do not have access to a trained urologist. So they ignore their problem till it reaches a late stage complicated problem. Then they go to a metro city like Delhi or Mumbai. If we can educate the people about these diseases, they would come to a trained urologist at a very early stage. This would lessen the overburden on medical infrastructure in government hospitals in metro cities. Hence, there are two point, one, we would have to create trained centres in rural areas so the people there do not need to go to a metro city. Second, we have to educate them that they come early for treatment. This would reduce the burden of disease on our society.
What is the percentage of patients from the rural areas in your hospital?
It is a mixed percentage. We get 70 per cent patients from the rural area and 30 per cent from urban and sub- urban areas. They come from all over India–Bihar, UP, Haryana, Punjab, Himachal, J&K, north-eastern states etc–as people think hospitals in their states don’t have as much modernized and advanced facilities as we have in our hospital.
These patients come from the rural areas, which don’t even have primary or secondary-level centres. How can we combat this situation?
The problem is, for any trained urologist centre, we require a trained urologist. In rural areas and in sub urban areas, urologists’ number is very less. Most of the trained urologists are working in the urban areas or metro cities. So what we can do is, create a nodal centre, which would cater to a certain number of rural areas, as it is not possible to have a single trained centre in every rural area.
What are the basic precautions a person should take to avoid urological problems?
It is very important that a person should have a healthy lifestyle, which includes daily exercise, eating healthy food. Healthy food includes fresh food, not frozen food or junk food. So by following these two steps and through awareness, a person can avoid urological problems to a large extent. By awareness, I mean that if a person is having urine-related problem above 50 years of age like you get up in mid-night to pass urine, which is the earliest reason for prostate enlargement and, at the same time, cancer can also occur like this. Again I say if a person is finding it difficult to pass urine, pass urine frequently, blood in urine, burning sensation in urine, pain in abdomen, he should immediately contact a trained urologist. I suggest to all males above 50, to have mandatorily done a yearly check-up of your urinary system and this check-up is free of cost in all government hospitals and through this check-up, a disease can be picked at an early stage. If a disease is diagnosed at an early stage, we can cure it early and complication could be lessened. Furthermore, if a disease is diagnosed at an early stage, it incurs cost far less than that on a disease picked up at the last stage. Take the example of prostate cancer, if I get a patient at an early stage, I can cure the patient and remove cancer. At the same time, if a patient comes in the last stage, then the treatment happens to be very costly, as drugs for the last stage are very costly and the government provides those drugs free of cost. So this burden of finances is on the government, which could be curtailed if people are made aware. Hence, I emphasize that prevention is better than cure.
In the present -day world, people are more accustomed with modern lifestyle, i.e. lesser sleep, late-night sleep, consumption of alcohol, etc. Does this lifestyle not contribute to urological problems?
Consumption of alcohol and tobacco is the root cause of many types of cancer including kidney cancer and bladder cancer besides causing many other problems in body such as lever problem, pancreas problem and such people are more prone to heart diseases and heart attack. So, a healthy lifestyle means, a person should avoid all these habits and should have a good sleep of eight hours, which is very helpful for overall condition of the body. A good sleep and happiness lessen anxiety, pressure and stress, which are very common in the modern lifestyle. Here it is worth mentioning that a large number of women above thirty-five years in India, owing to pressure of work at home and office, are afflicted with frequent urine passing. Hence it is of paramount importance that a person should have a good sleep, contented life, good food habits and keep refrain from consumption of alcohol and tobacco so as to live a good healthy life.
Do you think non-vegetarianism also contribute to urological problems?
There have been a lot of studies, which suggest that a vegetarian has advantage over those who eat unhealthy, non-vegetarian food. I am not saying that eating non-vegetarian food is unhealthy, but there are a lot of people who eat canned or preserved meat, which can contain a lot of toxins that may cause cancer, obesity and heart diseases. Studies also say that eating green leafy fresh vegetables is far better than eating canned, preserved meat. I would add whether a person is vegetarian or non-vegetarian is the matter of one’s choice, but one should keep one thing in mind that there should not be excess of fat and carbohydrate in one’s food.
To what extent research is done in the field of urology in India?
Indians are doing a lot of research in this field, which is appreciated by the whole world. For instance, our institute has done a lot of basic research on bladder cancer, prostate cancer etc, i.e. how to detect cancer. We are trying to ascertain genes that cause cancer. Once we detect those genes, we can modify those genes and prevent cancer. So, this is the field of gene therapy. This research is going on but there is still need for more research. However, it is noteworthy that we have a lot of talented people in the country but owing to lack of adequate infrastructure we cannot tap their potential.
What is the role of ICMR?
ICMR is a very good institute, which is in basic research and our department has done a lot of research in collaboration with ICMR. ICMR is one institute that always promotes research and those who are interested in research they can contact ICMR and they can get funds also to do research.
What is the role of robotics in urology?
Robotics was first used in USA in 2000 to facilitate the prostate cancer treatment. It has now become standard care system for cancer treatment. There is a gamut of operations which can be done through it and there are a lot of advantages of this technique. It saves operating time, lessens pain, reduces blood loss, early recovery, etc.
In India, how many patients are taking advantage of robotics?
Robotics in government hospitals was first started in AIIMS and later it was started in PGIMER. It is also available in major private hospitals. However, government hospitals are still lacking in this facility. In this regard, our institute started this initiative four years back and we will get it in next two months. But endeavours should be made to bring this technology to maximum number of government hospitals so as to provide robotics to the poor free of cost.
What is the number of patients in India afflicted with kidney cancer and prostate cancer?
About prostate cancer, we published a study with ICMR, in which we have compiled data from all cancer institutes in India. According to these data, prostate cancer is the second most common among Indian males. In next 20 years, the number of patients will double. Talking about kidney cancer, as compare to last 10 years, the incidence is increasing as we are detecting them at early stage in metro cities.
Why do the majority of people prefer private sector hospitals to government hospitals?
It is true that government hospitals have more talented and experienced doctors than those in private sector hospitals, but infrastructure lack in government hospitals. If two shortcomings are done away with then everyone would like to come to government hospitals. These shortcomings are sanitation and security. Sanitation has to be implemented in government hospitals from the first go. And adequate number of security personnel should be provided in government hospitals so that chaotic condition, owing to increased number of patients, could be averted. If these two things are improved, then government hospitals would become a better place.
You want to say that PM’s Swachh Bharat campaign should be started from hospitals.
Yes, it should start from government hospitals in Delhi, which become example for others to follow. Government hospitals are the mirror of the society because 80 per cent of patients come to these hospitals.
What is the reason of brain drain from the government hospitals to private hospitals?
It is obvious that if you do not provide doctors good environment to work, they would leave for private hospitals. Doctors want to work in government hospitals; they do not run after money. But, at least, they should be provided with healthy and secure atmosphere so that they can work with full zeal, tenacity and resolve in serving the poor.
What has been your experience and expectations?
We are working under very difficult conditions. We have to face a lot of administrative issues and conditions are not very favourable for those who want to work due to different reasons. But I work here on my own will and no one forced me to work here and I will keep on working here till my heart says you have to help the poor. I believe if you work for a good cause, people do support you and they come and join you.