Keywords
Cancer care - Homi Bhabha Cancer Hospital and Research Centre Vizag - residency bond
Introduction
On the eve of 2019, my destiny landed me at Vizag, the City of Destiny. As part of
the 1-year bond that every medical oncology resident at Tata Memorial Centre (TMC),
Mumbai has to complete after 3 years of DM course, I was at Vizag. From the shores
of the Arabian Sea to the beaches of Bay of Bengal, the shift I thought will be just
of the rooms. However, something much deeper awaited me at the Homi Bhabha Cancer
Hospital and Research Centre (HBCHRC), the Vizag unit of TMC, Mumbai, under the Department
of Atomic Energy, Government of India.
The Soil
In 2009, the Indian Government decided to establish new cancer centers in different
nooks of the country in collaboration with TMC, Mumbai. Dr. Y. S, Rajasekhara Reddy,
then chief minister of Andhra Pradesh accepted this opportunity. The first official
team visited the site at Aganampudi, a village on the outskirts of Vizag, inhabited
by the employees in Steel Plant and people working in the unorganized sector. About
a hundred acres of barren land under the government was identified in the valley on
the sides of the National Highway, NH 16. As it happens often, the official proceedings
dragged on till 2013, when the land was finally registered under the hospital. There
was no way that the hospital could offer any services in the near future as even the
building tenders were not opened at that time.
The Buds and Saplings
In 2013, being a barren land, the hospital administration decided to plant saplings
around. The initiative resulted in 4000 plants, which included mainly the Indian trees
such as neem, peepul, mango, jamun, and banyan. Thus, even before the hospital started,
the life energy expressed itself in full bloom here. The same energy infuses strength
to scores of cancer patients who visit this place today. The area around the hospital
today has one of the best green pastures among the oncology hospitals in the country.
Garden and the Gardener
“A Project Site under construction” would have been the obvious fate for years. However,
in 2014, it was proposed that clinical services would begin inside a shipping container!
Two shipping containers were painted blue and converted into outpatient units. Subsequently,
few smaller buildings were built around the container to accommodate the increase
in the patient numbers. The turning point for the institution happened when Dr. Raghunadharao
Digumarti took over the post of director. As the Professor of Medical Oncology at
Nizam’s Institute of Medical Sciences, Hyderabad, he was well settled in the city
with a busy clinical and administration schedule and numerous research projects. Armed
only with zeal for human service and openness to face challenges, he solely started
the medical oncology OPD on June 2, 2014, inside the shipping container. His years
of clinical and administrative experience has since then reflected in the dynamic
and decisive future course of the institution. Even today, the OPD runs inside a modified
shipping container!
The Blooming Flowers
Apart from medical oncology services, the onus was first laid on the preventive and
palliative care aspects, very essential for the rural population. From the beginning,
the department of gyneconcology pioneered cervical cancer screening measures along
with HPV vaccination efforts and currently coverage of services has steadily grown
along with expertise in doing liquid-based cytology and HPV testing in the molecular
oncology department inside the hospital. The HBCHRC conducted the annual meeting of
Indian Society of Colposcopy and Cancer Pathology at Vizag in April 2019. It has also
been selected by the ICMR recently as the nodal center for training all government
health personnel and nongovernmental organizations in cervical cancer screening as
per its ECHO programme.
Palliative care at the HBCHRC also began in a shipping container and now has expanded
into all aspects of palliative care, including childhood cancer services, home visits,
hospice, training, and education of the community. It conducts an IAPC certificate
course in palliative care twice in a year. The onus is on early integration of palliative
care in pediatric cancer patients at the HBCHRC, and the department work in this aspect
won the first prize for poster in the annual Pediatric Solid Tumor Conference conducted
by the TMC, Mumbai, in April 2019. Huddles for quick interdisciplinary meetings and
collaborative alliances are unique to the palliative care practice here.
The daycare in the hospital provides chemotherapy to 30–40 patients per day every
day and has been selected by the Tata Trusts as the model daycare center in the country
for the training of oncology nurses. The medical oncology department successfully
conducted the DNB Medical Oncology Practical examinations in May 2019. HBCHRC is the
only cancer center in Vizag, which has a qualified pediatric oncologist for childhood
cancer care. With the lack of facilities such as operation theater and intensive care
unit (ICU) in the Aganampudi temporary hospital, the surgery unit was made possible
by collaborating with the Visakhapatnam Port Hospital. The third floor of Port Hospital
was renovated with the help of sponsors and handed over to the HBCHRC for oncosurgery,
ICU, and inpatient services.
Equipped with basic imaging like X-rays, ultrasound apart from mammogram, the radiologists
manage to do 5–10 interventions per day including biopsies, fine-needle aspiration
cytology, cell block, pleural taps, etc., Recently, computed tomography (CT) has become
functional since August 2019. Oncopathology department has grown to become the referral
center for the examination of biopsies done from different hospitals in the district
of Vizag and is also an accredited center for liquid-based cytology. Almost all immunohistochemistry
tests are done in the unit. Molecular oncology unit is equipped with real-time polymerase
chain reaction facility and routinely does molecular tests for CML, HPV, etc., For
a resident who trained in the best facilities of TMC, Mumbai, this is a wonder that
all of this exists in makeshift buildings.
The Deep Roots
For HBCHRC, the roots derive nutrition from two sources: the hearts of benevolent
sponsors and the support from TMC, Mumbai. The patient facilities such as the air-conditioned
waiting hall, canteen hall, and water purifier are sponsored by different trusts and
individuals. The transparency and sincerity in such transactions have motivated many
to come forward to help. The HBCHRC is a unit of TMC, Mumbai, which supports the financial,
academic, and administrative working of the institution. Resident doctors from TMC
are posted in the departments of medical and surgical oncology, anesthesia, and radiology
as a part of the bond and get an unparalleled chance to learn that limited infrastructure
is not an impediment to quality cancer care. The infrastructure of the actual proposed
hospital is being built up currently, and by the end of 2019, it is supposed to be
fully functional with advanced imaging and radiation therapy facilities.
A Resident’s Awe
From the midst of the complexity of CTs and magnetic resonance imaging at the TMC,
radiology residents come to the simplicity of HBCHRC, Vizag. These words from one
of them beautifully capture the experience. “How monotonous will be a place which
has only radiography, ultrasonography, and mammography units functioning since 3 years?
That was the question everyone in my department back in Mumbai had. But I came here
for a 3month term and realized this was everything opposite of monotonous. The variety
of cases and the proportion of undiagnosed cases were ample here and that was a challenge
which pushes one’s intellect to the limits enriching the knowledge database. The faith
that the seniors have in you and genuine encouragement and freedom to put forward
your thoughts is humbling as well as boosts the confidence and puts a positive pressure
to be worthy of it. The working environment here is admirable. Everyone’s behavior
here, including the nonteaching staff, is so cordial and welcoming that one never
feels like an outsider, and is so beautifully accepted into the family.”
Homi Bhabha Cancer Hospital and Research Centre: Miracle in Cancer Care
Homi Bhabha Cancer Hospital and Research Centre: Miracle in Cancer Care
HBCHRC is a miracle because, in any other instance or in any other part of our country,
it would have been a paper entity from 2009 for the next 10 years. The proposed hospital
building still is not complete or suitable for any clinical services. The authorities
led by the Director himself took the initiative to start the oncology services to
the needy patients in Vizag in 2014. Since then, more than 23,000 patients have been
treated at this small temporary facility. Making a start inside a shipping container
(where outpatient services still continue), it blissfully offers hope, cure and care
to thousands of patient from Andhra Pradesh, Orissa, and Jharkhand with the best treatment
that can be received in any tier-one city or top oncology center in the country. This
is a saga of magnificent vision, unwavering passion and impeccable service in oncology
care in our country with limited resources. For a bonded resident, there is no better
way to become transformed than this experience.
