Why India's Punjab State Has the
 Country's Highest Cancer Rates
BY ANKITA RAO, GLOBALPOST AND BIBEK BHANDARI, GLOBALPOST
PUNJAB, India — Three days after her mother died, Rajinder Kaur 
sat quietly on the edge of a rope cot, staring at her sandaled 
feet as the buzz of her friends and family filled the courtyard 
of her village home in Sher Singh Wala in rural Punjab.
The 20-year-old nursing student, with a girlish frame and long black braid,
listlessly recounted the details of her mother’s last 40 days — from a
sudden diagnosis of blood cancer to the unaffordable treatment that left
 Kaur with few options but to watch the pillar of the family suffer in the
 hospital until she passed away.
Kaur’s mother, who died in May, is among the latest casualties in India’s
 northern state of Punjab, home to the highest rate of cancer in India.
 Here, in the country’s breadbasket, 18 people succumb to the disease every
 day, according to a recent report published by the state government.
 There are ninety cancer patients per 100,000 people compared to the 
national average of eighty. And the Malwa region, where Kaur’s family lives,
 has been dubbed "the cancer belt" of the state because of its particularly 
high incidence of the disease.
In villages like Sher Singh Wala, working class, agricultural communities are
bearing the heaviest burden of this complex crisis — one that involves limited
 resources, lack of political will and a toxic environmental problem that 
could foreshadow what many other Indian communities will experience as they 
follow the state’s economic model.
“We need to strike at the root,” said J.S. Thakur, professor and researcher
at the Postgraduate Institute of Medical Education and Research, who has 
conducted extensive studies on cancer in Punjab.
MINDER PAL SINGH / EPA
An Indian farmer walks near agricultural fields on the outskirts of Amritsar,
 India.
In this region, there are ninety cancer patients per 100,000 people compared
 to the national average of eighty.
While the causes of cancer are complicated and still unknown, Thakur and his 
team found that contaminated water from rapid industrialization and excessive 
use of chemical fertilizers for high-yielding crops are contributing to the
steep rates in the state. Just miles away from the Kaur family’s home are 
colossal industrial plants that have polluted the irrigation system in the area.
“The overall responsibility goes to the government, and the people are also
responsible because they have not made an issue of it”
Malkit Singh, a member of the panchayat, or village council, in Sher Singh Wala,
 said cancer deaths affect almost every other home in his 2,000-person village.
Including his: Singh lost his brother and two cousins to cancer in the past decade.
But Singh, a broad man who wears a traditional turban, said that the 
government’s inability to regulate toxic chemicals is not their only downfall.
 There is also public outcry that the state has done little to expand the 
limited healthcare resources available for families who can’t pay to travel 
to a private, specialized clinic.
“The overall responsibility goes to the government, and the people are also
responsible because they have not made an issue of it,” he said.
VERMA / REUTERS
A laborer carries saplings at a paddy field at Mullanpur village in the northern
 Indian state of Punjab, home to the highest rate of cancer in India. Here, 
in the country’s breadbasket, 18 people succumb to the disease every day, 
according to a recent report published by the state government.
The region’s only government cancer ward was established just six years ago 
in the town of Faridkot, an hour’s drive from Sher Singh Wala. On a morning 
in May, frail women and men slept along the hallways and on the floor of 
the waiting room as they anticipated the next available doctor, or further
 tests.
Every day the hospital — staffed with just four oncologists and nine 
residents in training — receives about 20 new cases and 150 regular cancer
 patients, said Dr. H.P. Yadav, head of department at the Guru Gobind Singh
 Medical College and Hospital. Since the service started in 2008, there has
 been an influx of patients from the region, who previously traveled to nearby
 states like Rajasthan or New Delhi for treatment.
“There is a scheme for people from Punjab: They’ll get a financial assistance
 of 1.5 lakh rupees [about $2,500],” Yadav said. “We are trying to give more
 assistance from our side but the treatment cost is high.”
Meanwhile, a senior official at the hospital who asked that his name not be 
used said the state has done little to support the center. Most of the 
initial funding, instead, came from the national government, universities
 and donors.
“We focus on poor patients...We started this NGO because people were being
overcharged and we were fed up with the politics.”
Costly treatment is an undeniable burden for most people in this 
agriculturally rich but poverty stricken region. For them, the government 
assistance under the Chief Minister’s Cancer Relief Fund scheme is only a 
temporary solution. When medicines cost almost 20,000 rupees ($400) per month,
 families are often left to make difficult decisions.
Part of that price tag comes from lack of regulation and oversight. Some 
pharmacies in the region were charging more than ten times the original price
 for certain cancer-related drugs, according to a private investigation by the
 Bhai Ghaniya Cancer Roko Sewa Society, a local nongovernmental organization.
“We focus on poor patients,” said Kultar Singh, vice president of the group. 
“We started this NGO because people were being overcharged and we were fed up
 with the politics.”
Their efforts have proven fruitful. Last year the team wrote a letter to the
 chief justice of Punjab’s high court, prompting them to hold the National
 Pharmaceutical Pricing Authority accountable for 46 anti-cancer drugs that
are supposed to be affordable. In May, the Punjab government rolled out a plan
 to provide subsidized medicines to cancer patients at public hospitals.
Without that support, money can prove a harsh limitation.
INDER PAL SINGH / EPA
The sun rises behind a newly planted paddy field on the outskirts of Amritsar, 
India. In May, the local government here in Punjab rolled out a plan to provide
 subsidized medicines to cancer patients at public hospitals.
Heeding a relative’s suggestion, Kaur said her family first visited a private
hospital in Ludhiana, where they were quoted approximately $20,000 for her 
mother’s blood cancer treatment — a large amount for the middle class farming
 family.
“My mom said she didn’t want such an expensive treatment,” Kaur said of her
 mother’s decision. “They told us there was a 35 percent chance she would 
stay alive.”
The family then consulted a homeopathic doctor, who prescribed a range of 
natural medicines. But Kaur said her mother’s health quickly deteriorated 
and they were forced to admit her to a government-subsidized local hospital
 without regular cancer specialists. Within a matter of days she caught an
 infection and passed away before she could receive further treatment —
 leaving Kaur and her younger brother, 15-year-old Manjinder, without one 
parent.
“They told us there was a 35 percent chance she would stay alive.”
Kultar Singh said many families who are fighting cancer also lack the
 education and awareness they need to protect themselves. His NGO is 
trying to educate communities at the grassroots level.
“People fear the word cancer and it’s like a taboo,” he said. “There’s a
 myth in the village that with this disease you’re bound to die. At first,
 instead of going to doctors, they go to shamans and traditional healers.”
Meanwhile, Thakur, the lead researcher, said any real solution to the problem
 with require accessible clean water and a change in industrial practices,
 rather than simply treating the symptoms of what has become a toxic 
environment.
Until then, families like Kaur’s will be left to wonder if there was any 
way to prevent what happened to a loving wife and mother.
“She was really good. She sewed her own clothes, she was always thinking 
about her children,” Kaur said, remembering her mother as tears escaped from
 her eyes. “She never got tired.”