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Table of Contents
MUSINGS
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 208-210

Bathinda to Bikaner: My experience of the “cancer train”


Cl Spl Med and Medical Oncologist, Department of Medicine, Oncology Centre, INHS, Asvini, Mumbai, Maharashtra, India

Date of Submission06-May-2021
Date of Decision16-May-2021
Date of Acceptance19-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Amol Patel
Cl Spl Med and Medical Oncologist, Department of Medicine, Oncology Centre, INHS, Asvini, Mumbai, 400005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_95_21

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How to cite this article:
Patel A. Bathinda to Bikaner: My experience of the “cancer train”. Cancer Res Stat Treat 2021;4:208-10

How to cite this URL:
Patel A. Bathinda to Bikaner: My experience of the “cancer train”. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Oct 22];4:208-10. Available from: https://www.crstonline.com/text.asp?2021/4/2/208/320128



Cancer is on the rise in India. If you are from North India, you might have heard about the “cancer train” in Punjab.[1] As an oncology professional, there were several questions that came to my mind when I first read about it and watched the news on television. Why is this train known as the “cancer train?” Why does it run between Bathinda and Bikaner only? Are these patients different from those in the rest of India? Is there any particular risk factor for increased cancer cases in that region? To get answer to these questions, I embarked on a journey on this train.

A train holds sentimental value for each one of us. It is a lifeline for many lives. From the day of its inception in 1880 to this date, we have seen a phenomenal transformation of trains in India. India has the largest network of rail transport in the world. As a medical oncologist, when I first discovered the “cancer train” on YouTube, I was unable to comprehend why there was a train exclusively for patients with cancer that runs in a specific region of northern India. After the ugly partition of India, trains loaded with dead bodies crossed the new borders, and now, we had a train carrying patients with cancer! Nobody in this world would like to associate such a name with a train unless there was a valid rationale for such a nomenclature.

Curiosity paves the way, and this time, it led me to Bathinda to board this train on May 24, 2018. It was the peak of summer, and I left home at 11:30 am. My wife booked me an Uber taxi and packed me lunch and some dry fruits in a bag. My older daughter wished me goodbye remarking, “I hope you find whatever you are looking for.” My family was a little confused and concerned about what I was doing. Nonetheless, I took a train from Old Delhi railway station to Bathinda; it was an hour late. I boarded the train but had to change my seat twice at my co-passengers' request as they wanted to sit with their relatives. Switching seats can be annoying, especially when helping someone against your will.

I met a very interesting person on my way to Bathinda, a middle-aged lady, who was a doctor and had migrated to Canada for her children's education. She was visiting India after 3 years. Before moving to Canada, she had worked as a general practitioner and gynecologist in Abor, Punjab for 15 years. She briefed me about the cancer pattern in Punjab and expressed her concern over the rapid rise in cancer cases in this region. She blamed pesticides and fertilizers for the rising incidence of cancer. With this background, I said goodbye to my fellow passengers and deboarded the train at Bathinda after a 5-hour journey.

As I alighted, I noticed the remarkable cleanliness on the platform. People were rushing, either to board a train or to leave the station. For the first time in my 16 years of rail journeys, I did not have to rush toward the destination. I was already at my destination – Bathinda railway station [Figure 1]. I felt good. I had some tea, and enquired about the cancer train with two food vendors. I realized that they were not too interested in providing me with answers. One vendor told me that the train was scheduled for departure at 09:30 pm. I had a wait time of almost 2 hours. After getting some rest in a hotel and regaining my energy, I went back to the station and bought a ticket to travel in this special train. A very clever and helpful clerk was sitting at the ticket counter. I enquired with him about the cancer train. I asked, “Why is this train called the cancer train?” To this he said, “Many patients from Punjab travel to Bikaner for cancer treatment. There is a charitable hospital in Bikaner, which is very popular across Punjab, Rajasthan, and Haryana. Hence, over a period of time, the passengers who traveled to Bikaner for cancer treatment by this train started calling it the “cancer train.” I then asked, “Why only this train, why not the others?” To which he replied, “This is the only train that goes up to Bikaner which leaves the station at 9:30 pm.”
Figure 1: Bathinda railway station

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I was thankful to the railway clerk for all the information he gave me about this special train.

I waited on the platform, and at last, the moment that I was waiting for arrived. The train was on time. I had observed a few passengers with their relatives on the platform. They appeared sad, and the reasons were clear. They were at war with the Emperor of All Maladies – cancer. I interacted with the patients and their relatives, and it made me realize that people could be nice despite going through grief. They shared their emotions and experiences of cancer treatment with me as if I were a member of their own family. The “Atithi Devo Bhava*” culture is still alive in our country. Indeed, I managed to get the answers to all my questions. The train halted at the station for almost 40 minutes as if it were awaiting its favorite passengers. During this time, I managed to do a complete recce of the train from the engine to the last bogie marked with an “X.”

“Were the patients who traveled by this train different from those in the rest of India?” The answer was, “No.” Some patients had breast cancer, some had head-and-neck cancers. They reminded me of my residency days when we would see a lot of patients with cancers of the head-and-neck region. Head-and-neck cancers are common in India primarily because of tobacco use and alcohol consumption. Regardless of where you travel in India, you will see the omnipresent gutkha and mobile phone repair shops. One person had cancer of the food pipe, and there was a 5-year-old boy with cancer, but his father told me that he was suffering from a disease other than cancer. Every coach had two to three passengers who were going to Bikaner for treatment, and there were reserved seats for cancer patients [Figure 2] in some of the coaches.
Figure 2: Reserved seats for cancer patients in rail coach
*in Sanskrit, “Atithi” means guest and “Devo” means god. In Indian culture, a guest is considered a god.


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“Is there any particular risk factor for the high incidence of cancer among these people?” The answer to this question required a deeper understanding of the science and was open to debate. There once was a great debate on the television program, “Satyamev Jayate” on the use of pesticides and the rising incidence of cancer in our country. There are some well-established risk factors for cancer such as smoking and chewing tobacco, alcohol consumption, and lack of physical activity. However, to prove the causal association between cancer and other potential risk factors such as pesticides and fertilizers, large case–control studies are required.[2] Excessive use of pesticides is a matter of concern, and various studies on pesticides and herbicides such as parathion, malathion, diazinon, tetrachlorvinphos, and glyphosate have revealed an association with cancer.[3] However, this is still a matter of debate and controversy. A famous Marathi saying by the great Saint Gyaneshwar goes, “Ati tethe mati.” Roughly translated, this means, “Excessive use of these chemicals is bad.” According to some, farmers in our country use a lot of pesticides when they grow crops for sale but use no pesticides or very limited quantity when cultivating crops, fruits, and vegetables for themselves.

I wondered why the patients were traveling to Bikaner. One of the passengers whose wife had recurrent breast cancer gave me the logical answer. In the charitable hospital in Bikaner, the cost of treatment is relatively low. For example, the cost of breast cancer surgery is ₹16,000–18,000, which is ten times less than the cost of this surgery in other hospitals. The patients have complete faith in the doctors and really admire the quality of treatment. Another passenger mentioned that the cost of each cycle of chemotherapy for breast cancer in this charitable hospital is around ₹5000–6000. One passenger argued that it is difficult for villagers to go to metropolitan cities for treatment as the cost of treatment in these cities is very high.

Considering the fact that the green revolution started in this region of country, there is much to be done in the future to understand the risk factors for cancers and strengthen the cancer prevention strategies.

I wished my co-passengers the best of luck and went back to my hotel. I had an uncomfortable and restless sleep that night.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The Shocking Tale of India's “Cancer Train.” Business Insider India. Available from: https://www.businessinsider.in/the-shocking-tale-of-indias-cancer-train/articleshow/52690219.cms. [Last accessed on 2021 May 05].  Back to cited text no. 1
    
2.
Burns CJ, Juberg DR. Cancer and occupational exposure to pesticides: an umbrella review. Int Arch Occup Environ Health 2021. doi: 10.1007/s00420-020-01638-y. Epub ahead of print.   Back to cited text no. 2
    
3.
Position Statement – Pesticide and Cancer – National Cancer Control Policy. Available from: https://wiki.cancer.org.au/policy/Position_statement_-_Pesticides_and_cancer. [Last accessed on 2019 Dec 01].  Back to cited text no. 3
    


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