Kandy, Sri Lanka -- The ancient Sinhalese kings built their capital in the tropical forests of Ceylon´s central mountains, later renowned for their fine Orange Pekoe teas. Today, Kandy is Sri Lanka´s second largest city with a bustling marketplace and tourist trade, and a general hospital that provides free medical services to five of the country´s nine provinces, or roughly 7 million people. On clinic days, when doctors see outpatients, the hallways are swamped - over 2,000 patients may line up to see the doctors on any given day.
The three basement-level wards devoted to cancer are as cramped as the rest of the hospital. "Across Sri Lanka, we are witnessing a rapid rise in adult cancers of all types," explains Dr. Sarath Wattegama, the hospital´s chief radiation oncologist. "People are simply living longer, and the incidence of adult cancers and the demand for radiotherapy services is accelerating."
Pressed by growing demand, Dr. Wattegama and his assistants can only afford a few minutes with each patient for diagnosis, treatment and follow-up. The inpatient ward for cancer has just 70 beds, but at any given time the number of patients is twice as large. Some do not get a bed and must pass the time sitting on a bench, or share a bed with another patient. Child patients must share a bed with their mother.
"The pattern of childhood cancers here is similar to the rest of the world," explains Doctor Wattegama, "50 percent are leukemia and 50 per cent are solid tumours. Unfortunately, we still lack the state-of-the art treatment equipment of the West."
In 2002 alone, almost 25,000 new and treated cases of cancer were recorded in Sri Lanka, representing over a 100 percent increase from figures for 1992. "We treat about 120 to 150 patients a day with the two cobalt therapy units in this facility," explains Mr. H.M.S. Herath, the principal medical physicist at Kandy. "That´s roughly twice as many patients per machine as they would treat in Australia or Singapore."
With support from the IAEA, Mr. Herath has received specialised training in operating treatment planning software, which helps more accurately calculate the dose of gamma radiation on cancerous tumours.
Mr M.S. Chandrapala, a 45 year-old former fish vendor, is a recent beneficiary of Kandy´s radiation therapy. He was selling fish door-to-door until nine months ago when he was diagnosed with a brain tumour. In fact, when he arrived semi-conscious for an examination it appeared that he had lung cancer and that the malignant cells had already gone into his brain. Had it not been for radiotherapy, he probably would not be alive today.
Following radiation treatments, Mr. Chandrapala is now in a stable condition, but too weak to work. Sitting on the porch of his house in a village outside Kandy, Mr Chandrapala knows, although belatedly, that cigarette smoking was the cause of his lung cancer. In a wooden shed next to his simple house, his wife and two children earn extra income by selling groceries and homemade pastries to neighbours.
Mrs. W.G. Malkanthi, a slender 42-year-old woman with three children, is another beneficiary of Kandy´s treatment facilities. Almost a year ago, she decided to go for a second time to Dubai to earn money as a housemaid. A medical check-up, however, revealed that she had rectal cancer. She was immediately operated on at Kandy Hospital and the tumour was removed.
Mrs. Malkanthi has a good chance for full recovery, but her treatment is not yet finished. She must undergo extensive chemotherapy followed by a course of radiation treatment.
"One third of all cancer cases are curable, another third are recurrent cases, and the rest are a case of life extension – the challenge is to catch the cancer in the early stages," explains Dr. Wattegama.
Every week she travels from her village to see Dr. Wattegama at his clinic. Her home is not too far away from the city, but the journey is an ordeal for a post-cancer surgery patient. Mrs. Malkanthi's ongoing medical expenses could cost her up to 1000 Rupees every week – about 10 US dollars. Her husband, a manual day labourer is lucky to earn 50 to 200 Rupees a day crushing stones. Their proximity to Kandy hospital, with its free medical service for the poor, is their best hope for a return to normal life.
Overall upgrading of Kandy General´s cancer treatment facilities began in 1998, with $260,00 in project assistance from IAEA´s Technical Co-operation Programme. The cancer unit received a low-dose brachytherapy system to treat cervical cancers, a fully equipped radiation laboratory, and a workshop to produce immobilization devices. The hospital computerized tomography (CT) and magnetic resonance imaging (MRI) scanners were linked to the newly acquired Theraplan 1000 Treatment Planning System, operated by an IAEA-trained specialist.
"Thanks to the Agency´s assistance we made a very big step ahead," says Dr. Wattegama. "We are now in a position to treat patients more effectively, and to control cancer more aggressively."