But as more and more people in Kerala live longer, they become increasingly likely to succumb to diseases, like cancer, that plague the elderly everywhere. “With aging, you get more occurrences of cancer,” said Dr. K. Somarajan, an oncologist who joined Green Gardens in 2000. Each year, between 40,000 to 50,000 cancer patients are treated in Kerala. Among males, about 50 percent of cancers are attributed to tobacco and alcohol, while breast cancer is the most common cancer among women, according to the state government’s Regional Cancer Center in Trivandrum.
By law, any citizen is entitled to free health care at Kerala’s state-funded hospitals. But the six government medical college hospitals that treat most cancer patients are underfunded. Only 3 percent of India’s gross domestic product goes to health care, and states are hampered by their responsibilities to meet payrolls. In Kerala, about 50 percent of state expenditures go toward salaries.
“The net result is that few patients get modern treatment,” Dr. Cherian said. “These hospitals are operating by the Western standards of the 1950’s.”
Moreover, given their hefty caseloads, doctors are reluctant to spend long hours performing surgery on patients whose survival prospects are dim, Dr. Cherian said. There is also the reality of corruption. “Some doctors at these hospitals will tell the patients they only have so much time to treat them, but if they see them outside their office hours they can provide better care, for a fee of course,” Dr. Cherian continued. Another problem is that many specialists tend to take it upon themselves to address a patient’s problem, even if he or she would be better off referred to someone else. “If you go to one of the state hospitals and see a surgeon for your cancer, then he is likely to operate, even if you might be better served by chemotherapy,” Dr. Somarajan said. “And if you see a radiologist, he’ll treat you even if you’re better off getting surgery.”
Those who can afford it seek treatment at one of Kerala’s two large private hospitals. Others go abroad. “Look at our MPs [members of Parliament]; whenever they need a major operation they go abroad,” Dr. Cherian said. “What kind of message does that send?”
For patients like Pappachan, a 65-year-old with few resources, Green Gardens is their final hope. Pappachan lives in Trivandrum – a four-hour train ride from Green Gardens. He received chemotherapy at the regional center in Trivandrum – the state’s best public hospital – but the treatment was unsuccessful. Then he made the trip to Green Gardens.
“We’re the place of last resort,” Dr. Cherian said. “Seventy percent of the patients come to us in a very advanced stage.” Consequently, the hospital cures less than half of the cancer patients it treats. “But if not for us, these people would go untreated,” he continued.
It is not uncommon for patients, like Pappachan, to come from many miles away. Theresa, a 62-year-old retired schoolteacher, made the 16-hour train ride from Goa. Dr. Cherian had treated her for throat cancer before he joined Green Gardens. Now, six years later, Theresa was concerned about a small growth on her tongue.
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