After two days of flying halfway across the globe, we arrived in Kathmandu, Nepal. As we landed at the airport, Justin, a 29 year-old brain cancer survivor cranked up his I-pod and we all sang along with Bob Seger, “We’re going to Kathmandu!”
The sights, sounds, and smells of the city immediately reminded us that we are not in Iowa anymore. As we left the terminal building we found ourselves immersed in a sea of people, who were all jostling for our attention. We boarded a bus and headed into the heart of the city. The roads were jam-packed with various types of vehicles – some of which appeared familiar (cars, buses, motorcycles), and some of which didn’t (rickshaws, tuk-tuks, carts)!
On our first day in Kathmandu we immersed ourselves in the global aspect of the mission of Above +Beyond Cancer. We wanted to make a connection to the cancer care community in Nepal and learn about the magnitude of the cancer problem here in Nepal. We were invited to visit the Bhaktapur Cancer Hospital, a public hospital that takes care of many of the underserved of Nepal. The hospital is a collection of small buildings located near one another in a seemingly haphazard pattern. We were greeted in an outdoor area between several of the buildings. The group of doctors, nurses and administrators that meet us were very excited about our arrival. It was a flurry of introductions that were so fast with names so unfamiliar to me that I immediately lost track of one name before the next introduction began. I tried to focus so as to be able to honor the next physician by remembering his name but quickly realized that it was going to be an ongoing struggle for me.
We were given a tour of the hospital. Each building houses approximately ten patients. It was unclear which of the patients are “inpatients” and which patients are receiving outpatient treatment. We visited the chemotherapy area. The most notable characteristic of the patients was the quiet peaceful nobility they seemed to possess. There were approximately eight patients in beds on either side of a central hallway. They appeared to be suffering advanced stages of cancer based on their malnourished appearance. I made eye contact with each one of them and quietly offered a bow of my head and a greeting of “Namaste”.
We then walked through the Palliative Care section of the hospital. The patients looked similar to the chemotherapy patients except that they do not have I.V. lines. I was again struck by the quiet and noble demeanor of the patients. I knew that they must be suffering from advanced cancer, but they weren’t expressing any outwardly emotional signs of pain.
Since I’m a radiation oncologist, I was given the opportunity to visit the radiation therapy area. It was a small building with very thick cement interior walls to shield the gamma rays that are emitted from the Cobalt unit. I meet with the radiation therapist, a bright young man who spoke perfect English. He received his training at the University of Wisconsin. The department was quite small, but they treat 70 patients a day on one machine. That’s incredibly busy. Most of the patients they treat are lung cancer and head & neck cancer patients – both are cancers that are caused by smoking. They also treat many women with cervix cancer, likely a result of a high incidence of HPV virus infection.
After touring the facilities, our hosts took us to a conference room where we were treated with great honor. The chief administrator of the hospital, the chief of surgical oncology, the chief of medical oncology and the head of the Nepal Cancer Relief Society were all present. There were a series of formal introductions followed by speeches. We were told of the magnitude of the cancer problem in Nepal and the inadequacy of funding and facilities to begin to take care of the needs of the people. Lung cancer, head & neck cancer, lymphoma, and cervix cancer appeared to be the most common cancers.
They invited me to give a presentation to the assembled group that included all our 19 cancer survivors and 17 caregivers, along with the doctors, nurses and administrators of the cancer hospital. I took the opportunity to introduce our group and speak about the issues that we share with our Nepal friends. I told them that in the U.S. there will be 600,000 people who will die of cancer this year. Smoking causes one-third of these deaths. Nepal and the U.S. both experience incredible death and suffering due to tobacco use. Although we’ve made some great progress, both of our countries need to do more. I shared with them the fact that in the U.S., one-third of all cancer are caused by obesity and lack of exercise. This is not an issue Nepal. I acknowledge that we in the U.S. could learn something about diet and exercise from our Nepalese friends.
Finally, three of our cancer survivors got up to tell their stories. Justin, a 28 year-old brain cancer survivor, spoke about his surgery, radiation and chemotherapy and then told the group about the incredible blessing he has experienced as a result of his involvement with Above + Beyond Cancer. Ruth, a 64-year old sarcoma patient who has undergone amputation of her right arm, told of her treatment and the amazing recovery she has made. She spoke with candor, intelligence and humor, and she inspired all of us with her can-do spirit in the face of obvious adversity. Michael, a 45-year old colon cancer survivor told his story of the discovery and treatment of colon cancer. He attributes his successful outcome to a colonoscopy that led to the discovery of his cancer.
Our hosts were incredibly moved and inspired by the survivors’ stories. In Nepal, the death rate from cancer is much higher than in the U.S. Cancer is not often found early in Nepal and most people equate cancer with death. Because of that, cancer is a huge negative stigma and patients are often embarrassed by their diagnosis. The fact that Above + Beyond Cancer brought 19 cancer survivor to Nepal to climb a mountain blew them away! They want every doctor and patient in Nepal to hear the survivors’ stories so that they can understand that cancer does not have to be death sentence. These 19 survivors have allowed the entire staff of the cancer hospital to see a vision for the future.
We completed our visit with a group photo of our team and theirs. We learned the next day that the photo, along with a story about our visit, appeared in the Kathmandu newspaper. We vowed to remain connected with our new Nepalese friends that are engaged with us in the fight against cancer. We are working together, with our friends at the Nepal Cancer Relief Society and the American Cancer Society, to create a world with less cancer.