The cost of radiation treatment and palliative intent is around US$ 200-250. The expense of chemotherapy is separate and has to be borne by the patient and that depends on the regimen and the molecule used. Also, the patient has to pay for all the diagnostic facilities including the expensive CT scan and MRI, which adds another US$100-200. This also does not include the expenses of surgical treatment if required by the patient, which is much more expensive than radiation treatment. Recently, the Government of Nepal has taken a very encouraging step to help people suffering from cancer by providing a fund of US$ 440 (NRs 50,000) to support each individual having cancer. This amount is not provided to the individual but is provided to the institution for covering the expenses of the radiation treatment, chemotherapy, and investigations. With a view of serving the poor people, I have recently joined a government hospital where the cost of treatment is low compared to private institutions. Here I get to do lots of cases (Oncological including reconstruction, Trauma, Salivary gland diseases, Infections, TMJ pathology, Pre-prosthetic, Aesthetic surgery) which have helped me to develop my clinical skills and practice. Besides being Central Government Hospitals, with quite a good number of patients and infrastructure, an Oral and Maxillofacial Unit is still not BER OF MAJOR THE TABLE SHOWING THE NUM YEAR OCTOBER THE ING DUR CASES PERFORMED 2014 TO SEPTEMBER 2019
Maxillofacial trauma 666 Oral and maxillofacial tumours and cysts 120 Infections 50 Salivary gland diseases 20 Reconstructive surgeries 20 TMJ pathology 14 Pre-prosthetic and aesthetic surgery 12 TOTAL 902 24 iaoms.org
well set-up and it’s running under a dental department. There is still a lack of manpower for team-work and many difficult surgeries have to be performed in limited resources. This is a totally different scenario than what I saw in during my fellowship. Travelling through this journey what I have felt is that it is very important to train our other colleagues for better teamwork. There are lots of cases but efficient teamwork is lacking. So, I just have a vision that if this hospital itself could be developed as a training centre, patients, surgeons and the entire OMFS unit could be benefitted. For that, trainers visit is important and if this is feasible, our dream of teamwork will be fulfilled as one trainer in one unit will be training so many young surgeons. The major challenge observed in oncology service in Nepal is the high cost of the treatment and because of the lack of insurance, and proper health policy, people have to bear all burden by themselves. Another major challenge is the lack of awareness about the prognosis of disease as most of the patients, their family, and even a lot of physicians and health care professionals consider cancer an incurable at any stage. This leads to delay in presentation of patients to hospital and thus increasing the number of advanced stages cancers and thus the morbidity and mortality. As oncology is a specialized field, lack of human resources is another problem in a developing country. Since oncology requires a wide variety of health care professionals including a radiation oncologist, physician, physicist, oncology nurses, therapy radiographer, palliative care experts, counsellors etc., it’s very difficult to have all of them available in one center, which makes the work environment more challenging for all. To conclude, though the patients have benefitted to a certain extent while performing surgery at a low cost or even free of cost for very poor patients in the government hospital, lack of proper instruments and teamwork is still an insure which needs to be addressed by the concerned. If every field in the cancer treatment is developed, the morbidity and mortality due to oral cancer can be decreased and it will not be seen as 2nd most common cancer in Nepal in the coming years. ■December 2019