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Institute for Sustainable Livelihood and Entrepreneurship Development An initiative of Durgapur Institute for Sustainable Livelihood

CHETANA Awareness Campaign for Cancer – a Lifestyle Disease

Acknowledgements CHETANA – 2013, the maiden advocacy program of DISL has been launched on 17th March, 2013. We wish to thank and acknowledge the contributions of various people who made this program and this report presentation possible. We heartily appreciate the contribution of Dr. Runu Mukherjee for her moral and technical support about the domain of cancer control. We thank Mr. Rupak Das and the members of The Lions Club, Durgapur Steel City Chapter for their motivation and support all the way. We pay our special thanks and gratitude to the sponsors who extended their generous help and assistance without which the project could not be materialized. Finally we appreciate all the participants of CHETANA whose presence and involvement has been instrumental in enriching the program.

Prologue… The need for statistics sometimes comes from the daily lives, incidences and surroundings. A few years back, may be when we were in our college days, we hardly came to know about someone dying of cancer. The reason may be two – the disease itself was not that common or the facilities of treatment were such that it could not be detected. Compare that with today’s scenario. In many families, among their relatives or in known circles we get to know about the prevalence of cancer. It is almost everywhere and increasing. The very next day after our first interaction with Dr. Runu Mulkherjee at Breast Cancer Awareness Clinic of DSP, one of our students applied for leave in college as her mother was to be taken for a treatment of breast cancer. We preferred not to waste time and looked into the data, facts and tried to get the big picture about the problem. The questions were basic. Can we prevent it? Can an early detection save lives? CHETANA has been launched on the affirmative answers of these questions. This report presents everything about the journey called CHETANA. The goal can only be reached with your support and good wishes.

Let us Pledge to Hold Hands and Fight Cancer Together

Background Note… Cancer is a leading cause of death worldwide. The World Health Organization estimates that 7.6 million people died of cancer in 2005 and 84 million people will die in the next 10 years if proper action is not taken. In India the situation is grave. In 2010 around 555,000 people died of cancer in India. Out of this tobacco-related cancers represented around 42% of male and 18% of female cancer deaths. Cervical, stomach and breast cancers accounted for 41% of cancer deaths in women in urban and rural areas. So, it is high time to combine our voices to deliver the powerful

“Cancer should not be a death sentence anywhere in the world as there are proven ways to prevent and cure many cancers” – Dr Oleg Chestnov, Asst. DirectorGeneral, Noncommunicable Diseases and Mental Health, WHO.

message for comprehensive and integrated cancer control.

Detecting Cancer Early Can Save your Life! Cancer is to a large extent avoidable. Many cancers can be prevented. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope. More than 70% of all cancer deaths occur in developing countries, where the preparedness for prevention, diagnosis and treatment of cancer is limited or nonexistent. So the primary step should be early detection and for that extensive awareness about the disease is a must.

“One in Two Countries Unprepared to Prevent and Manage Cancers” - WHO


Cancer Prevention: Cancer prevention is an essential component to fight against cancer because about 40% of all cancer deaths can be prevented. Many of the important cancer risk factors arise due to lifestyle problems such as tobacco use, alcohol use, unhealthy diet including low fruit and vegetable intake, physical inactivity, overweight and obesity.





carcinogens like ultra violate and ionizing radiation, chemical carcinogens that may come from contaminated food and biological carcinogens such as infectious virus, bacteria and parasites (WHO report on Cancer Control: Module – 2; 2007). The following graph clarifies it all by showing the contribution of selected risk factors to all cancer deaths:

Contribution of Selected Risk Factors to all Cancer Deaths

Source: WHO report on Cancer Control: Module – 2 (Prevention)

The prevention of cancer should be

reduction of these risk factors in the

considered in the context of actions to

population that will not only reduce the

prevent other chronic lifestyle diseases such

incidence of cancer but also prevent other

as diabetes, cardiovascular diseases, chronic

lifestyle diseases. The relation between these



lifestyle problems and cancer is evident. For

dependence. This is because cancer shares

an example we have put forward the graph

common risk factors with these lifestyle

showing the


consumption and death rate of lung cancer

The interventions should be aimed at the

using US data from 1900 – 2006.




between tobacco

Tobacco Use in the US, 1900 – 2006 and Lung Cancer Death Rate

Source: Cigarette Consumption – US Department of Agriculture, 1900 – 2007. *Age-adjusted to 2000 US standard population

Prevention and Early Detection is the Key to Effective Cancer Control WHO has set a goal of reducing

cancer deaths over the next decade.

death rate of chronic diseases by 2%

The control of major cancer risk

per annum, over and above projected

factors and early detection will have

trends from 2006 – 2015. Achieving

a major role in achieving this goal.

this goal means avoiding 8 million

“My mother died after having been detected of Cancer Breast within one month. I don‟t want to die the same way. Please help” Source: Outdoor of Breast Cancer Awareness Clinic, Durgapur Steel Plant Hospital

Project CHETANA – 2013 Purpose and Goal “Health is an area of great promise but also great frustration.

Components of

CHETANA Plan and implement in controlled environment

There seems to be plenty of „low-hanging fruits‟ available, from vaccines to bed nets, that could save lives at a minimal costs, but all too few people make use of such preventive technologies” – A V Banerjee & E Duflo, Poor Economics.





undertaken as a year-long activity for 2013, focusing on the issues of chronic lifestyle problems that lead to cancer

Gathering knowledge about the area of intervention (Cancer & Lifestyle diseases)

Advocacy to share the problem with key resources and decision makers

Intended results in uncontrolled environment




overweight, obesity along with physical inactivity can reduce as much as 15% cancer deaths worldwide. the primary thrust of CHETANA

and other lifestyle diseases.


The treatment or cure of cancer is often

has been to understand the gravity of the

expensive. Preventive measures by

problem, to formulate policy through

following healthy lifestyle means a lot


to the control of cancer and other

implementation strategy for the outreach

lifestyle diseases. Controlling tobacco


use means reducing 1.5 million cancer

CHETANA is to reach out to the target

deaths per year, 60% of which accounts

population as much as possible and

for people from low and middle income

aware them about lifestyle problems,

countries. Leaving harmful alcohol

preventive measures and early detection

completely, increasing fruit and

to combat cancer.

Output: Implementing outreach programs as the outcome of advocacy

Purpose: Reaching out to the people at different pockets of the society








Goal: Creating awareness, Helping early detection, reducing cancer deaths


CHETANA – 2013 Our Maiden Advocacy Action… With

“Advocacy is the effort to influence people, primarily decision-makers, to create change”


the thematic priority of cancer the strategic

advocacy of






action control

for and

CHETANA is synchronized with non-

become the catalyst for the effective

communicable lifestyle diseases and

outreach programs to reach out to the

other related problems. The basic

maximum number of beneficiaries in a

objective of the maiden campaign has

cost effective manner.

been to share the problem with the

So for the very nature of advocacy, we

people from different sectors like

have done this program in a controlled

healthcare professionals, academicians,

environment. First ‘Why CHETANA’

corporate and NGOs. The success of

and what is expected from the event is

the program greatly depends on how






Broadly the program was devided in two segments – one for doctors elaborating on the issue technically and the other segment belongs to the trainers as well as motivational speakers to see the other facets of different lifestyle issues. The technical keynote lecture is given by Dr. Runu Mukherjee followed by Dr. Alok Sanyal and Dr. Sudipto Ghoshal. With great clarity the speakers




diseases, lifestyle problems of younger generation, and increasing concern for cancer. Several vital statistics on cancer

Topic of the Event: CHETANA Awareness Campaign for Cancer – a Lifestyle Disease Venue: Bonolata, City Centre, Durgapur Date: 17th March, 2013; Time: 10:30 AM Goal of the Event: Advocating for Creating awareness about lifestyle diseases, taking preventive measures and helping early detection to combat cancer. Target Population of the Event: Healthcare profs, Corporate, academicians, NGOs Technique of Interaction: Participative management Technique Communication Method: Barrier free two way communication method Total no of Participants: 54

Reflection of the Event Schedule Sequencing of the Sessions Events Registration/Networking I Inauguration of the Event II

III (Keynote Speech)







Focus of the Sessions

 Purpose of the event explained  A brief background note on DISL

Presentation by Dr. Runu  Thoroughly explained about lifestyle Mukherjee, Dy Director, diseases. DSP Hospital,  Shared statistics on cancer and other In charge Breast Cancer lifestyle diseases Awareness Clinic, DSP  Special focus on breast cancer with cases Hospital and examples Feedback slips on the events are distributed to the participants which is to be collected after next two sessions and will be distributed to the presenters. Presentation by Dr. Alok  Lifestyle problems of the younger Sanyal, a renowned generation is emphasized Gynecologist at Durgapur  Focused on increasing concern for cancer Presentation by Dr.  Cancer awareness in general Sudipto Ghoshal,  Lifestyle diseases and remedies Paramedical College, Dgp Feedback slips are collected from the participants and given to Dr. Runu Mekherjee to check participants’ suggestions and takeaway. Art papers titled “Janchetana: the most desired action area” are given to participants for putting down pictorial/schematic presentation of problems and action area. These to be collected after next 2 presentations Purpose: Thematic Apperception Test Presentation by Mrs  Mostly focused on urban lifestyle Manisha Hati, problems International Trainer  Do’s and Don’ts of living  Focused on addictions and diseases Presentation by Mr. Jiban  Motivational speech to reinvent the way Banerjee, Faculty of Stats, of life by healthy living Bidhan Institution Open discussion Forum Brief open discussion about future roadmap Concluding speech by Mr Pravat Chatterjee, Hon. Mayor in Council, DMC Vote of Thanks

and other lifestyle diseases has also been shared. Dr. Mukherjee specially emphasized on the breast cancer problem and expressed her concern that the cases are increasing rapidly. All the healthcare experts emphasized that it is better to go for cheaper prevention

Take Away: “A very good learning platform, an awareness campaign, about the hazards of modernized lifestyle and what preventive measures we can adopt” – Dr. Arindam Modak

than expensive cure and at the same time for many types of cancer, early detection can save lives. After first presentation gets over feedback slips were distributed to the participants and collected after third presentation and shared

Suggestions: “It requires more people of every walks of life to associate with the whole venture. Thanks to CHETANA” –Mr. D. D. Sen

with the presenters. A few glimpses of participants’ take-away and suggestion are shared here.

Take Away: “1. Knowledge about cancer 2. Present scenario of cancer 3. Preventive measures” – Dr Debdas Karmakar

Suggestions: “More initiatives should be taken to communicate the views and suggestions through the media/NPO/NGO/Govt. institutions…..” – Mr. Soumen Routh Suggestions: “Vulnerable group like students, how can be stopped from such risks can be elaborated” –Dr. Srikanta Banerjee Take Away: “Dr. Sanyal‟s warning that industrial emissions have become more dangerous than personal habits like smoking” – Shankha Guha

The two final presentations by Mrs Hati and

art paper with a heading ‘JanCHETANA;

Mr. Banerjee were a change of taste and

Lifestyle Problems: The Most Desired



Action Area’. The papers were given

deliberations. Mrs Hati on the capacity of an

before the final two presentations and

international trainer interestingly focused on

collected it back after the deliberations of



speakers Mrs Manisha Hati and Mr Jiban

elaborated ‘Do’s and Don’ts’ of living. She

Banerjee. The outcome of TAT was quite

also focused on addictions and related diseases.

interesting. With pictorial and schematic

The speech of Mr Banerjee has been truly

presentations participants has raised several

motivational. The core of his entire discussion

actionable issues of lifestyle, such as long

was actually reinventing the way of life by

working hours, fast lifestyle, smoking habits

healthy living. His presentation was backed by

etc. One sectoral or macro view was also

examples and full of enthusiasm all through.

presented in the way that low back pain, eye








disorders, vascular diseases for people from

Thematic Apperception Test:

IT sector; chest or lung diseases for people

A Thematic Apperception Test has been tried

in construction fields; stress for healthcare

in one of its form to get inputs from participants about the most critical points of concern. The seating arrangements were in groups according to tables. Each table/groups were provided with sketch pens and a colored

providers. The fast-food habits of young generation is also considered by the participants as the immediate actionable area, as comes out from TAT. .

Open Discussion Forum: The final


very important

part of

CHETANA as an advocacy program was a brief but effective Open Discussion Forum. The idea central to this discussion was how to take the campaign to the maximum number of people in an efficient and cost effective way. The contribution in this open discussion by the participants was rich and practical in terms of efficient and cost effective implementation of the outreach programs for CHETANA. Participants or rather stakeholders of our maiden advocacy initiative have expressed

their willingness to take this campaign to their own field of operations, may it be academic




shop-floor executives

of and

panchayats. The program finally concluded with the concluding





Chatterjee, Mayor-in-Council, Durgapur Municipal Corporation. The organizers expressed their sincere thanks and gratitude to all the participants for their inclusive cooperation and enthusiasm for effectively carrying campaign.





CHETANA – 2013 Implementation Modules for Outreach

Focal Point

CHETANA Planning for Outreach (Bottom-up Approach)

Facilitating Outreach Advocacy Action

“Save Yourself by Yourself” Swami Vivekananda





Civil Servants


Implementing Outreach for CHETANA

Reach out to maximum number of beneficiaries Purpose: Prevention and Early Detection

Interventions for Prevention: The comprehensive prevention of cancer requires a range of interventions at individual as well as population level in a stepwise manner – core activities, expanded activities and finally to include all other desirable

CHETANA for Cancer Control (CCC) Priorities CCC Outreach  Lifestyle diseases in General  Unhealthy diet, physical inactivity, overweight and obesity  Tobacco and alcohol use  Environmental and occupational exposure to carcinogen

activities. Interventions those are immediately feasible and at the same time areas of highest

Decide the form of intervention: Meeting, Seminar, Media campaign, survey, workshop, others

concerns are to be implemented first as the immediate core activities. The expansion of activities comes in the next step. The campaign CHETANA – 2013 desires to focus

Decide target population: Estimate number of beneficiaries to be addressed

on some core risk factors for cancer control as its immediate priorities. The schematic flowchart shown here presents a systematic implementation module for a campaign focusing cancer prevention. All the outreach programs






CHATANA and the implementing agency. The outreach model of CHETANA is based on the intensity of communication of the partner organization with their immediate


 Program Design  Exploring sources of funding  Budget allocation  Admin Support  Media Relations and communications

beneficiaries. For example if a college becomes a partner organization for outreach then students become the beneficiaries. As the epidemic of cancer is prevalent among the all sections of the people irrespective of their

Implementation of Outreach Campaign

culture, education and economic strata, so wider the scope of partnership, better will be

Short Term Outcome:

the outcome in the sense that larger number of

Public awareness, Engagement, Strategic communication of the message, Media coverage, increased capacity, trust, cooperation, new partnerships (including govts.)

people can be reached. The campaign for prevention is less resource intensive and advocacy and planning is the prerequisite for the successful implementation. The chart beside is only an indicative one and feedbacks will be taken to make it more meticulous.

Long Term Outcome: Achieving Cancer Control




screening is to be taken up for breast and cervical cancers initially as the core/feasible



activity under early detection campaign.


The high mortality of the breast and cervical

detection program that makes it really complex

cancer can be attributable to the fact that



more than 80% of the patients are diagnosed


in very late stages due to late referral from

environment. The early detection program of

primary health centers and late healthcare

CHETANA intends to intervene at the


community level and the primary level only

CHETANA ideally promotes to focus on

looking at the feasibility which depends on the

the activities of early diagnosis and

resources, skills and infrastructure available.

screening of breast cancer and cervical

Given the present constrained resource setup,

cancer in 2013 and to expand the campaign

low cost approaches to early diagnosis and

in 2014 onwards.









This a


complexity resource

CHETANA Focus for Early Detection Campaign





Breast Cancer Awareness and Early Detection Cervical Cancer Awareness and Early Detection

Scope of Intervention for CHETANA Example: Cervical Cancer

Intervention for CHETANA in Early Detection Programs

Source: Cancer Control (Early Detection), WHO Report

The Journey Begins‌ The problem may be huge but a systematic approach towards the problem is always helpful. Knowledge is the key to success. The campaign CHETANA is all about transforming this knowledge into action. The ideation of CHATANA has been materialized following a bottom up approach which, we believe, is going to be helpful throughout the lifecycle of the comprehensive cancer control, may it be planning, implementation, monitoring or evaluation. The critical success factor of CHETANA solely depends on the partnership with different stakeholders. We value our partners as the primary change agents and key stakeholders of CHETANA. We believe that, regardless of the resource level, by joining hands together, we can take actions to curb cancer epidemic, save lives and prevent necessary sufferings.

References: Planning; Cancer control: knowledge into action: WHO guide for effective programmes (module 1) Prevention; Cancer control: knowledge into action: WHO guide for effective programmes (module 2) Early Detection; Cancer control: knowledge into action: WHO guide for effective programmes (module 3) Policy and Advocacy; Cancer control: knowledge into action: WHO guide for effective programmes (module 6) Selig W et al. (2005). Advocacy and comprehensive cancer control. Cancer Causes and Control,16(Suppl.1):S61–S68 ‘Indian cancer statistics, a model to be followed‟, Press Release by International Agency for Research on Cancer. Date: 28th March, 2012 American Cancer Society, Be Clear on Cancer:





ANNEXTURE – 1.1: Campaign for Prevention: Template for Deciding on the Possible Areas of Concern to be taken up by Partner Agency for the Outreach of CHETANA -2013 Concern areas to be covered

Target Population

Your strengths in this issue


Required resources

Cancer in General Lifestyle Diseases in General Breast Cancer Cervical Cancer Colon and Rectum Oral Cavity Larynx Other related areas ANNEXTURE – 1.2: Campaign for Prevention: Template for Post-Decision Administration of the Outreach Program by Partner Agency for CHETANA - 2013 Area finalized for the outreach program

Cancer in General Lifestyle Diseases in General Breast Cancer Cervical Cancer Colon and Rectum Oral Cavity Larynx Other related areas

Total estimated cost of the program

Possible sources of fund

Means to make it cost effective

Risk factors

ANNEXTURE – 2: Format for Post-program Report or Documentation for the outreach of CHETANA - 2013 The Event:

CHETANA Awareness Campaign for Cancer – a Lifestyle Disease Venue:


Time (from – to):

The Areas of Concerns Addressed: eg. General, Breast cancer etc……… Goal of the Event: Nature of the Event: eg. summit/workshop/camp/campaign etc. Technique of Interaction: Communication Method: Target Population: Total Number of Participants: Physical Resources used (for early detection campaign):

Key Resource Persons: 1. 2. 3. Non-technical Resource Persons:

Reflection of Event Schedule Sequencing of the Event


Short Term Outcome of the Event: Expected Long Term Outcome: Future Prospect of the Event:

Focus of the Activity

At the Back Stage Author of the report: Abhijit Roy Event Ideation and Coordination: Bhaswati Roy Abhijit Roy Technical Consultation about the Domain: Dr. Runu Mukherjee Special Thanks to: Arnab Kumar Mondal Swastika Banerjee Mohana Majumdar Prasenjit Sahoo

An Initiative of

Durgapur Institute for Sustainable Livelihood Durgapur, West Bengal Registration No: 99167 under West Bengal Societies Registration Act, 1961 Contact: + 91 9434250582 + 91 9614588301 Email:

CHETANA; Awareness Campaign for Cancer - a Lifestyle Disease